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

Foot pain, particularly caused by heel spurs and Sever's disease, significantly impacts mobility and daily activities for many people. These diseases are traditionally diagnosed by orthopedic specialists using X‐ray images of the lateral foot. In certain situations, the absence of specialists requires the adoption of AI‐based methods; however, the lack of a dataset hinders the use of AI for the preliminary diagnosis of these diseases. Therefore, this study first presents a novel dataset consisting of 3956 annotated lateral foot X‐ray images and uses the original capsule network (CapsNet) to automatically detect and classify heel bone diseases. The low accuracy of 73.99% of CapsNet due to the low extraction feature layers led us to search for a new model. For this reason, this paper also proposes a new enhanced capsule network (HeCapsNet) by adjusting the features extraction layers, adding extra convolutional layers, using "he normal" kernel initializer instead of "normal" and utilizing the "same" padding scheme to perform better with medical images. Evaluating the performance of the proposed model, higher accuracy rates are achieved, including 97.29% for balanced data, 94.19% for imbalanced data, area under the curve (AUC) of 98.69%, and a fivefold cross‐validation accuracy of 95.77%. We then compared our proposed model with state‐of‐the‐art modified CapsNet models using various datasets (MNIST, Fashion‐MNIST, CIFAR10, and brain tumor). HeCapsNet performed similarly to modified CapsNets on relatively simple non‐medical datasets such as MNIST and Fashion‐MNIST, but performed better on more complex medical datasets. [ABSTRACT FROM AUTHOR]

Knochen ist elastisch und verformbar. Kehrt aber ein Knochen nach Trauma, chronischem Zug, Druck oder Torsion nicht in die alte Position zurück, verbleiben Schmerzen im Knochen und in den beteiligten, nicht dehnbaren Faszien, Sehnen, Kapsel- und Bandstrukturen. Nachdem mit dem Strain-Relief-Konzept im vorigen Heft die theoretischen Grundlagen eines neuen manuellen Verfahrens zur Behandlung chronischer Schmerzen im Bewegungsapparat vorgestellt wurden [4] , widmet sich dieser Beitrag der praktischen Anwendung. Am Beispiel der unteren Extremität wird gezeigt, wie man manuell das ossäre Gewebe vom Strain befreien kann und damit erfolgreich Schmerzen mindert oder sogar beseitigt. Bone is elastic and deformable. However, if a bone does not return to its former position after trauma, chronic traction, pressure or torsion, pain will remain in the bone and in the non-stretchable fascia, tendons, capsule and ligament structures involved. Following the introduction of the theoretical basis of a new manual method for the treatment of chronic pain in the musculoskeletal system in the previous issue with the strain relief concept [4] , this article is dedicated to the practical application. Using the lower extremity as an example, it demonstrates how the osseous tissue can manually be freed from the strain, thus successfully reducing or even eliminating pain. [ABSTRACT FROM AUTHOR]

Objectives: Identify the effectiveness of neurokinetic therapy on pain and plantar fascia thickness in patients with plantar fasciitis. Method: An experimental study was performed on 80 patients with plantar fasciitis after screening based on selection criteria. The patients were randomly allocated into two groups: the neurokinetic therapy group (n = 40) and the foot core exercises group (n = 40). In both groups, the treatments were given for two weeks, five days each week. The pre-and post-test results were assessed. A statistical analysis was performed on the gathered data. Result: A significant statistical difference was observed between the groups; the post-test mean value of the Foot Function Index scale in the neurokinetic therapy group was 129.12, while in the foot core exercises group was 141.42. Additionally, the post-test mean value of the therapeutic ultrasound in the neurokinetic therapy group was 3, whereas in the foot core exercises group was 3.38. These values yielded a p-value of less than 0.001. Conclusion: This study demonstrated an improvement in both groups. However, the neurokinetic therapy group showed a significant improvement in pain, functionality, and plantar fascia thickness compared to the foot core exercises group. Level of evidence IV; Experimental study.

Conditions affecting the heel bone, such as heel spurs and sever's disease, pose significant challenges to patients' daily activities. While orthopedic and traumatology doctors rely on foot X-rays for diagnosis, there is a need for more AI-based detection and classification of these conditions. Therefore, this study addresses this need by proposing MedcapsNet, a novel hybrid capsule model combining modified DenseNet201 with a capsule network, designed to accurately detect and classify heel bone diseases utilizing lateral heel x-ray foot images. We conducted a comprehensive series of experiments on the proposed hybrid architecture with several datasets, including the Heel dataset, Breast BreaKHis v1, HAM10000 skin cancer dataset, and Jun Cheng Brain MRI dataset. The first experiment evaluates the proposed model for heel diseases, while the other experiments evaluate the model on a range of medical datasets to demonstrate its performance over existing studies. On the heel dataset, MedCapsNet achieves an accuracy of 96.38%, AUC of 98.35% without data augmentation, cross-validation accuracy of 95.69%, and AUC of 98.87%. The proposed model, despite employing a fixed architecture and hyperparameters, outperformed other models across four distinct datasets, including MRI, X-ray, and microscopic images with various diseases. This is notable because different types of medical image datasets typically require different architectures and hyperparameters to achieve optimal performance.

Purpose: This retrospective study aimed to investigate whether the standard radiographic indicators for Haglund's syndrome are applicable to insertional Achilles tendinopathy. Methods: Patients who underwent surgery for insertional Achilles tendinopathy in one heel and experienced no pain in the other heel were enrolled in this study. Preoperative calibrated radiographs of the lateral view of the calcaneus were assessed using (1) calcaneal pitch angle, (2) Fowler-Phillip angle, (3) posterior calcaneal angle, (4) Chauveau-Liet angle, (5) X/Y ratio, (6) Haglund’s deformity height, (7) Haglund’s deformity peak angle, (8) calcification length, (9) calcification width, (10) parallel pitch test, and (11) presence of free body. The Wilcoxon signed rank test and McNemar’s test were used for statistical analyses. Results: Seventy-one patients (52 males; mean age, 57.2; mean body mass index, 27.1) were included. Mean values for each index in the symptomatic and asymptomatic heels were as follows, respectively: (1) 23.5, 23.0 (p = 0.30); (2) 58.9, 57.8 (p

Führt eine Dauerbelastung und -beanspruchung oder ein Trauma zur Überschreitung der Elastizitätsgrenze des Knochens, kann es zu einer leichten plastisch-elastischen Verformung der ossären Strukturen kommen. Kehrt der Knochen nicht in seine ursprüngliche neutrale Form zurück, entsteht bzw. verbleibt eine chronische Spannung in der trabekulären Matrix. Das wiederum führt zu einem dauerhaften Zug/Druck auf die beteiligten, nachweislich nicht dehnbaren Faszien-, Kapsel-, Band- und Sehnenstrukturen mit einer zwangsläufigen Aktivierung der darin verwobenen Schmerzrezeptoren. Chronische, mitunter therapieresistente Beschwerden im Knochen selbst und in den mit ihm verankerten Strukturen sind die Folge. In diesem Artikel wird mit dem (Knochen-)Strain Relief ein neues konservatives Behandlungskonzept vorgestellt, mit dessen Hilfe manuell pathologische, nicht sichtbare Knochen„verformungen" in die anatomische Ausgangslage zurückgebogen/-gedreht/-gedrückt werden können, um die permanenten Spannungen, Scherungen oder Zug auf Faszien und Sehnen zu minimieren und damit chronische Schmerzen sehr erfolgreich zu mindern oder sogar zu beseitigen. If a permanent load and stress exceeds the elastic limit of the bone, a slight plastic-elastic deformation of the osseous structures may occur. If the bone does not return to its original neutral shape a chronic tension in the trabecular matrix develops or remains. This in turn leads to permanent traction/pressure on the involved fascia, capsule, ligament and tendon structures, which have been shown to be non-extensible, with inevitable activation of the pain receptors interwoven within them. Chronic, sometimes therapy-resistant complaints in the bone area are the result. This article introduces (Bone) Strain Relief, a new conservative treatment concept that can be used to manually bend/rotate/push pathological, invisible bone "deformities" back into their original anatomical position in order to minimize the permanent tension/shear/pull on fascia and tendons and thus very successfully reduce or even eliminate chronic pain. [ABSTRACT FROM AUTHOR]

Aim: to evaluate the effect of using a medical vibration platform on the severity of pain, quality of life, functional and anatomical characteristics of the foot and ankle in patients with plantar fasciitis.Materials and methods: the study involved 91 patients with plantar fasciitis, among them 73 (80.2 %) women, 18 (19.8 %) men. The patients were divided into two groups: the main group consisted of 43 patients, the control group — 48 patients. In the main group, standard treatment was performed, including shock wave therapy, kinesio taping, standard exercises in the first week and exercises on a medical vibration platform in the second and third weeks, in the control group, exercises in the second and third weeks were performed with the patient standing on the floor. To assess the dynamics of treatment, a questionnaire was conducted using the VAS, the AOFAS scale, and the SF-36 questionnaire. Instrumental methods of examination included the evaluation of Friedland’s podological index, Y-balance test. All parameters were assessed before treatment, after treatment, and 3 months after treatment.Results: the use of exercise therapy on a medical vibration platform in the complex treatment of patients with plantar fasciitis, compared with exercise therapy on the floor, made it possible to statistically significantly reduce the level of pain after treatment (p < 0.05), increase the stability of the feet and ankle joint (p < 0.05 ), and in the long-term period allowed to significantly reduce the level of pain (p

Aim: to study the clinical and radiological parameters of patients with plantar fasciitis.Materials and methods: the study involved 91 patients with plantar fasciitis, 73 (80.2%) women, 18 (19.8%) men. The mean age of the patients was 53.42 ± 9.16 years, disease duration was 30.32 ± 8.06 days, BMI was 24.75 ± 4.55 kg/m2. Patients underwent history taking, pain level and quality of life were assessed using the visual analogue scale, the SF-36 questionnaire and the AOFAS scale. The functional state of the feet was assessed using plantoscopy, Y-balance test, Friedland index. X-ray parameters were assessed using magnetic resonance imaging.Results: the disease is common among women aged 51 to 60 years. In 100% of cases, there is no traumatic etiological factor, 42.9% of the subjects note an increase in body weight as the cause, 35.2% – the relationship of the onset of pain with wearing flat shoes; men are more likely to associate the onset of symptoms with an increase in physical activity (83.3%). Subjective sensation of pain on the VAS does not depend on gender (p = 0.280), age (p = 0.509), disease duration (p = 0.371), BMI (p = 0.974). X-ray parameters of patients are characterized in 49.5% by the absence of heel exostosis, in other cases, the development of a heel spur is more typical for women (p = 0.019), its length does not depend on the duration of the disease (p = 0.845), age (p = 0.054), BMI (p = 0.196), lifestyle (p = 0.324) and does not correlate with the severity of pain (p = 0.691). The level of pain is directly proportional to the thickness of the plantar fascia (p < 0.001, ρ = 0.459). Calcaneal edema is observed in 14.3 % of patients, soft tissue edema — in 18.7 %; there was no relationship between calcaneal edema (p = 0.604) and soft tissue edema (p = 0.541) with the severity of pain, and calcaneal edema directly correlates with BMI (p = 0.029).Conclusion: These studies suggest that among the predictors of the development of plantar fasciitis, the most significant are female gender, overweight, wearing flat shoes, and the disease itself is not always a consequence of the development of a heel spur.

Background and Objectives: We aimed to compare the effectiveness of ESWT (Extracorporeal Shock Wave Therapy) and RFA (Radiofrequency Thermal Ablation) on pain, disability, and activity limitation in the treatment of plantar fasciitis in patients with calcaneal spurs. Materials and Methods: Patients who apply to Orthopedics and Traumatology and Physical Medicine and Rehabilitation departments with a complaint of heel pain are included in this retrospective study. We included patients diagnosed with calcaneal spurs who received treatment with ESWT (n = 80) and RFA (n = 79) between 1 August 2021 and 1 September 2022. All patients were evaluated using the Visual Analog Scale (VAS), Foot Function Index (FFI), and the Roles and Maudsley score (RM) before and after treatment. An evaluation was performed on average 6 months after treatment. Results: This study included 79 RFA patients (34 females and 45 males) with a mean age of 55.8 ± 9.6 years and 80 ESWT patients (20 females and 60 males) with a mean age of 49.1 ± 9.5 years. There was a significant decrease in VAS scores after treatment in both the RFA and ESWT groups (z: −4.98, z: −5.18, respectively, p < 0.001). The reductions in FFI pain, FFI activity restriction, FFI disability, and RM scores were significant in both groups, although the scores after treatment were lower in the RFA group. Conclusions: This study demonstrates that ESWT and RFA significantly reduced pain, disability, and activity restriction in the treatment of plantar fasciitis in patients with calcaneal spurs. ESWT proved particularly effective in alleviating pain, whereas RFA had more pronounced effects on reducing disability and activity limitations. The choice of treatment should be based on the patient's specific complaints. [ABSTRACT FROM AUTHOR]

There is growing interest in adopting validated and reliable patient-reported outcome measures following surgery. While the Foot and Ankle Outcome Score (FAOS) has previously been validated for use in multiple foot/ankle conditions, it has not yet been validated in patients with infracalcaneal heel pain. In this study we aimed to validate the FAOS by looking at 4 psychometric properties of the survey: construct validity, content validity, reliability, and responsiveness, using patients in our practice with a clinical diagnosis of plantar fasciitis. A total of 150 patients (mean age 49.7 ± 12.1 years [36 men and 114 women]) were included in one or more of the 4 components of this study. All FAOS subscales demonstrated adequate construct validity when compared with the physical health component of the 12-Item Short Form Health Survey (SF-12), and 2 out of 5 subscales demonstrated moderate correlation with the mental health component of SF-12 (all Spearman rho >0.3, and p values <0.05). Most FAOS subscales demonstrated content validity and were found to contain relevant questions from the patient's perspective. All 5 subscales demonstrated good test-retest reliability with intraclass correlation coefficients ≥ 0.827. Finally, 4 out of the 5 subscales (all but other symptoms) were responsive to change at a mean follow up of 12.2 months after surgery (p <.05). We conclude that the FAOS is a responsive, reliable, and valid instrument for use in infracalcaneal heel pain. We believe that due to its ease of use and broad applicability, the FAOS could be more widely adopted in foot/ankle practices as patient-centered healthcare delivery and research becomes increasingly prioritized in the US and abroad. [ABSTRACT FROM AUTHOR]

Introduction: One of the more common foot dysfunctions is a heel spur, which is a bony growth on the base of the heel bone. It is accompanied by pain. Extracorporeal shock wave therapy becomes an increasingly common, effective and non-invasive method of the heel spur treatment. The objective of this study is to assess the effect of shock wave therapy on pain and daily functioning in patients with the heel spurs. Material and method: The study group consisted of 73 people with diagnosed the heel spurs and suffering from pain associated with this condition. Each participant underwent a series of 5 shock wave treatments with 7-day intervals. The treatments were conducted using an apparatus: BTL-5000 SWT POWER + HIGH INTENSITY LASER 12. This author’s questionnaire and a Numeric Rating Scale (NRS) for pain were also used in this research. Results: After applying the therapy, it was observed that there is a statistically significant decrease in the intensity of pain experienced by patients during the day (from 5.28±1.46 to 1.1±1.03) and at night (from 1.65±1.84 to 0.17±0.58). The statistical analysis also showed a significant decrease in the frequency of pain during the day and at night after applying shock wave. Before the therapy, the majority of patients indicated, that pain affected their professional activity rarely, often or very often. However, after the therapy, the majority of participants felt that pain does not affect their work. Similar results were obtained in relation to the question regarding the influence of pain on the performance of daily activities. Conclusions: Shock wave treatments had the effect of reducing both the frequency and severity of pain. The treatments also reduced the negative impact of pain on professional and daily activities in the participants.

Background: Shock wave therapy is one of the modern methods of treatment used to treat diseases of muscles, tendons, and entheses in orthopedics, as well as in sports medicine. The therapy is increasingly used in the treatment of plantar fasciitis—a disease that is very difficult and burdensome to treat. Where basic conservative treatment for heel spurs fails, the only alternative consists of excision of the bone outgrowth, and shock wave therapy: a modern, minimally invasive, and relatively safe method. The aim of the study was to determine the long-term effectiveness of extracorporeal shock wave therapy in the treatment of painful ailments occurring in the course of plantar fasciitis in amateur runners. Materials and methods: The study includes a group of 39 men and women, aged 34–64 (mean age 54.05 ± 8.16), suffering from chronic pain in one or both feet, occurring in the course of plantar fasciitis. The patients had to meet five criteria to qualify for the study. The group was divided into two subgroups: those who had not undergone other physiotherapeutic procedures prior to the extracorporeal shock wave therapy (ESWT-alone; 23 people), and those who had received other procedures (ESWT-plus; 16 people). The therapy was performed using extracorporeal shock wave (ESWT). No local anesthesia was used. The effectiveness of the extracorporeal shock wave therapy was evaluated using the visual analogue scale of pain (VAS), Modified Laitinen Pain Index Questionnaire, the AOFAS scale (American Orthopedic Foot and Ankle Society), and a survey questionnaire consisting of 10 questions concerning metrics and subjective assessment of the effects of therapy. The interview was conducted before ESWT, and again five years later. Results: The use of extracorporeal shock wave therapy reduced the intensity and frequency of pain, and improved daily and recreational activity. Moreover, a reduction in the level of pain sensation on the VAS scale and pain symptoms during walking was demonstrated. More favorable results were obtained in the ESWT-plus group; however, the first effects were observed later than in the ESWT-alone group. Conclusions: Extracorporeal shock wave therapy is an effective form of therapy for amateur runners. It reduces pain associated with plantar fasciitis that amateur runners may experience at rest, while walking, and during daily and recreational activity. [ABSTRACT FROM AUTHOR]

Copyright of Operative Orthopädie und Traumatologie is the property of Springer Nature 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.)

Abstract Aim Plantar enthesophyte is a common degenerative disorder. Surgical and medical treatment options are associated with either poor outcome or high percentage of relapse. Observations have indicated a beneficial effect of radiation therapy. We therefore wanted to evaluate pain reduction using orthovolt or cobalt-based radiation treatment for painful plantar enthesophyte and determine long-term response as well as prognostic parameters in this condition. Methods We identified a total of 102 consecutive patients treated for a total of 117 symptomatic heel spurs. 59 patients were treated with cobalt radiation, 31 patients with orthovolt therapy and 12 patients with both radiation systems. Primary outcome measure was pain reduction being scored using the modified Rowe Score prior therapy, at the end of each treatment series as well as after 6 weeks. Secondary outcome measure was long-term outcome, evaluated in patients with a follow-up period of longer than 3 years. Results Before radiation therapy, 61 patients (60.4%) had a score of 0, significant strong pain. At the time of completion of radiation treatment, 3 patients (2.7%) were pain-free (score of 30), whereas 8 patients (7.9%) had still severe pain (score 0). 6 weeks after radiation therapy, 33 patients (32.7%) were pain-free and 8 patients (7.9%) had severe pain (score 0), while at the time data of collection, 74 patients (73%) were free of pain and 1 patient (1%) had strong pain (score 0). Duration of pain before the start of radiation treatment was a significant prognostic factor (p = 0.012) for response to treatment. Conclusion Radiotherapy of painful plantar enthesophyte is a highly effective therapy with little side effects providing long-term therapeutic response. The only significant prognostic parameter for response to treatment is the duration of pre-radiation therapy pain. Early integration of radiation therapy in the treatment seems to result in superior pain reduction.

Plantar fasciitis and calcaneal spur are common causes of heel pain in the community. People use the Internet to obtain medical information about diseases. We reviewed Internet information sources on plantar fasciitis and calcaneal spur for quality and readability. The first 50 websites for each search term ("calcaneal spur", "heel spur", and "plantar fasciitis") were scanned on www.google.com. Six different valid tools were used for information quality and readability assessment. We searched for HONCode (Health On the Net Foundation Code) stamps on included websites. The total mean points for DISCERN were 50.52 ± 14.62, and the total mean points for JAMA (Journal of the American Medical Association) were 2.42 ± 1.26. In total, 25.72% of 97 websites had HONCode stamps. The average scores for the readability indicators were calculated to be Flesch–Kincaid Grade Level (FKGL): 7.27 ± 1.71, Gunning Fog: 8.46 ± 2.17, Simple Measure of Gobbledygook (SMOG): 6.89 ± 1.24, and Coleman Liau Index: 15.56 ± 1.85. In our study, when the website resources were examined, there were profit websites the most and website quality and readability were moderate level. A significant proportion of the websites have a financial bias and provide low-quality information. A mechanism for monitoring the quality and readability of online information must be established and managed systematically. [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]

Introduction and objective: Plantar fasciitis affects both young active patients and older people leading a sedentary lifestyle. It is result from chronic overload of the plantar fascia. About 80% of patients with plantar fasciitis improve within 12 months with non-surgical treatment. Nonsurgical management includes e.g. activity modification, cooling, non-steroidal anti-inflammatory drugs, stretching and strengthening exercises and manual therapy. Materials and methods: PubMed database was searched. The criteria for qualifying the articles for the review were the following keywords: plantar fasciitis, muscle stretching, exercise, manual therapy, heel spur. 11 articles from 2017 to 2022 were analyzed. Description of the state of knowledge: Calf stretching is one of the treatments for plantar fasciitis with the best results in the long run. In turn, strengthening exercises turn out to be more effective in a short time. One should also not forget about influence other methods of conservative treatment, such as cooling, orthoses or physical therapy, that support and accelerate the treatment process. Summary: Strengthening exercises of the plantar fascia are more effective than stretching in terms of reducing pain and improving function in the short term, while stretching exercises show better results in the long term. The best results are obtained by combining stretching of the triceps calf muscle with other methods of conservative treatment. There are no studies supporting the hypothesis that stretching alone is more effective in the treatment process than other methods and placebo.

Background: The differential diagnosis of heel and foot pain is extensive, but the most common is mechanical etiology. The anatomic location of the pain can aid in diagnosis. Plantar fasciitis is the most common diagnosis, resulting in medial plantar heel pain, particularly with the first weight-bearing steps after rest. Objective: We tried to describe most common causes of non-traumatic heel pain in our locality. Patients and methods: The current study was prospectively conducted between May 2019 and May 2020. The study enrolled 100 patients who were complaining of heel pain. Full history evaluation and clinical assessment were done in all patients Results: Mean age of enrolled patients was 39.92 ± 14.49 years with range between 18 and 68 years. The majority (52%) of enrolled patients were females and 48 (48%) patients were males. Based on clinical, laboratory and radiological findings of enrolled patients; 45 (45%) had planter fasciitis, 32 (32%) had heel spur and 23 (23%) had Achilles tendinitis. Conclusion: Non-traumatic heel pain is a common issue in the clinical practice. Planter fasciitis is considered the most frequent etiology of such pain in our setting. Comparative studies between different available modalities for management of heel pain are warranted. [ABSTRACT FROM AUTHOR]

Treatment of subacute and chronic heel pain often presents a unique challenge to the physician. Regenerative therapies, such as injectable amnion and connective tissue matrix, may represent a promising new approach in these patients, and have become increasingly popular in the United States. However, little literature exists evaluating these injections compared to conventional nonoperative means. As such, we designed a retrospective comparative study evaluating patients in our practice who received a standardized plantar fascial treatment protocol only (standard therapy), and those who received regenerative plantar fascial injections in addition to standard therapy. A total of 54 patients were followed over a 3-month observation period (91.7 ± 73.9 days), with numeric pain rating (NPR) serving as the primary outcome. Both groups saw an improvement in NPR at the end of the observation period, but patients in the regenerative therapy group demonstrated lower pain scores than those receiving standard therapy alone (mean NPR 2.1 ± 2.3 vs 4.4 ± 2.8, p =.004). Additionally, those in the standard therapy group were significantly more likely to proceed onto surgical intervention compared to the regenerative therapy group (unadjusted odds ratio 15.6, 95% CI 3.0-27.9). The use of regenerative injections for subacute and chronic plantar fasciitis showed promise in our study, and may help mitigate against the need for invasive surgical intervention. [ABSTRACT FROM AUTHOR]

Copyright of Agri: Journal of the Turkish Society of Algology / Türk Algoloji (Ağrı) Derneği'nin Yayın Organıdır is the property of KARE Publishing 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.)

Heel spur is an osteophytic protrusion larger than 2 mm that lies just anterior to the tuberosity of the calcaneus. Heel spur can be of two types: plantar heel spur and dorsal heel spur. The aim of this study was to evaluate the relationship between the heel spurs incidence with age, sex and side. A total of 2000 bilateral radiographs of 1000 patients (518 men and 482 women) aged 20-93 years who applied to Terme state hospital, Samsun, Turkey due to trauma were examined. Patients were grouped into 10 year age ranges (20-29 years; 30-39 years; 40-49 years; 50-59 years; 60-69 years and over 70 years). The incidences of plantar heel spur, dorsal heel spur, and both were evaluated according to age, sex and side relations. Plantar or dorsal heel spurs were detected in 32.6 % (326 patients) of the patients. The incidences of plantar heel spur, dorsal heel spur, plantar and dorsal heel spur were 26.0 %, 16.9 %, and 10.3 % respectively. According to sex, the incidence of plantar heel spur was higher in women in all age groups. Although the incidence of dorsal heel spur was higher in men in the 6th decade, it was more common in women in other age groups. The incidence of plantar heel spur was 2.615 times higher in the right foot and 2.810 times higher in the left foot in women. As the age increased, the risk of plantar heel spur increased 1.060 times in the right foot and 1.061 times in the left foot. The incidence of dorsal heel spur was 1.510 times higher in the right foot and 1.715 times higher in the left foot in women. As the age increased, the incidence of dorsal heel spur increased in both feet and this increase was 1.055 times in both feet. [ABSTRACT FROM AUTHOR]

Introduction: Calcaneal spur is the bony protrusion especially seen on the dorsal and plantar surface of the calcaneus bone. It was aimed to obtain the data about the incidence of calcaneal spur and few other observations. Method: A total 50 (right side 22 and left side 28) dry adult human calcanei of unknown sex from Department of Anatomy, BGS GIMS were used. Naked eye examination of all the banes was performed and incidence of spurs was recorded. Aim: The aim of the present study was to observe the calcaneal spur and lipping and vascular foramen in dry bones. Results: The incidence of spur observed was 32%. The findings were been compared with other researchers. Following the classification of types of bone, type I is common. The medial tubercle was observed as the largest tubercle. An incidence of lipping of facets was observed in 34% and prominence of vascular foramina in 64%. Conclusion: The study is helpful in understanding a possible clinical correlation with heel pain. [ABSTRACT FROM AUTHOR]

Aim: Plantar enthesophyte is a common degenerative disorder. Surgical and medical treatment options are associated with either poor outcome or high percentage of relapse. Observations have indicated a beneficial effect of radiation therapy. We therefore wanted to evaluate pain reduction using orthovolt or cobalt-based radiation treatment for painful plantar enthesophyte and determine long-term response as well as prognostic parameters in this condition. Methods: We identified a total of 102 consecutive patients treated for a total of 117 symptomatic heel spurs. 59 patients were treated with cobalt radiation, 31 patients with orthovolt therapy and 12 patients with both radiation systems. Primary outcome measure was pain reduction being scored using the modified Rowe Score prior therapy, at the end of each treatment series as well as after 6 weeks. Secondary outcome measure was long-term outcome, evaluated in patients with a follow-up period of longer than 3 years. Results: Before radiation therapy, 61 patients (60.4%) had a score of 0, significant strong pain. At the time of completion of radiation treatment, 3 patients (2.7%) were pain-free (score of 30), whereas 8 patients (7.9%) had still severe pain (score 0). 6 weeks after radiation therapy, 33 patients (32.7%) were pain-free and 8 patients (7.9%) had severe pain (score 0), while at the time data of collection, 74 patients (73%) were free of pain and 1 patient (1%) had strong pain (score 0). Duration of pain before the start of radiation treatment was a significant prognostic factor (p = 0.012) for response to treatment. Conclusion: Radiotherapy of painful plantar enthesophyte is a highly effective therapy with little side effects providing long-term therapeutic response. The only significant prognostic parameter for response to treatment is the duration of pre-radiation therapy pain. Early integration of radiation therapy in the treatment seems to result in superior pain reduction. [ABSTRACT FROM AUTHOR]

Objectives: The aim of this study was to investigate the 25-hydroxyvitamin D (25(OH)D), parathyroid hormone (PTH), and calcitonin levels and lipid profiles in patients with calcaneal spurs. Patients and methods: Between March 2018 and June 2019, a total of 50 patients (30 males, 20 females; mean age: 39.8±8.1 years; range, 24 to 54 years) admitted to our clinic with heel pain and diagnosed with heel spurs based on radiographic images were included. The control group consisted of 50 age- and sex-matched healthy volunteers (32 males, 18 females; mean age: 35.7±9.6 years; range, 20 to 56 years). Blood samples were collected from all participants. Total cholesterol, high-density lipoprotein cholesterol (HDL-C), low-density lipoprotein cholesterol (LDL-C), triglyceride, phosphate, and calcium levels were measured using the colorimetric method. The PTH and 25(OH)D levels were measured using the chemiluminescent microparticle immunoassay. Calcitonin levels were detected using the chemiluminescent immunometric assay. Results: In the patients with calcaneal spurs, 25(OH)D and HDL-C levels were significantly lower (p<0.001), while LDL-C, triglyceride, and PTH levels were significantly higher (p<0.05, p<0.002 and p<0.001, respectively). There was no significant difference in the calcium, phosphate, body mass index, and calcitonin levels between the groups. Conclusion: Our study results suggest that calcaneal spur formation is associated not only with weight-related pressure, but also with lipid levels and hormonal alterations involved in calcium metabolism. Based on these findings, hormonal alterations and lipids should be considered in patients with calcaneal spurs. [ABSTRACT FROM AUTHOR]

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Conditions affecting the heel bone, such as heel spurs and sever's disease, pose significant challenges to patients' daily activities. While orthopedic and traumatology doctors rely on foot X-rays for diagnosis, there is a need for more AI-based detection and classification of these conditions. Therefore, this study addresses this need by proposing MedcapsNet, a novel hybrid capsule model combining modified DenseNet201 with a capsule network, designed to accurately detect and classify heel bone diseases utilizing lateral heel x-ray foot images. We conducted a comprehensive series of experiments on the proposed hybrid architecture with several datasets, including the Heel dataset, Breast BreaKHis v1, HAM10000 skin cancer dataset, and Jun Cheng Brain MRI dataset. The first experiment evaluates the proposed model for heel diseases, while the other experiments evaluate the model on a range of medical datasets to demonstrate its performance over existing studies. On the heel dataset, MedCapsNet achieves an accuracy of 96.38%, AUC of 98.35% without data augmentation, cross-validation accuracy of 95.69%, and AUC of 98.87%. The proposed model, despite employing a fixed architecture and hyperparameters, outperformed other models across four distinct datasets, including MRI, X-ray, and microscopic images with various diseases. This is notable because different types of medical image datasets typically require different architectures and hyperparameters to achieve optimal performance., Competing Interests: The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (© 2024 The Author(s).)

Background The present study was undertaken to evaluate the relationship between location of the rotator cuff tear and shape of the subacromial spur. Methods Totally, 80 consecutive patients who underwent arthroscopic repair for partial thickness rotator cuff tear were enrolled for the study. Bigliani’s type of the acromion, type of subacromial spur, and location of partial thickness tear of the rotator cuff were evaluated using plain X-ray and magnetic resonance imaging. We then compared the groups of no spur with spur, and heel with traction spur. Results Of the 80 cases, 25 cases comprised the no spur group, and 55 cases comprised the spur group. There was a significant difference in type of tear (p=0.0004) between these two groups. Bursal side tears were significantly greater (odds ratio=6.000, p=0.0007) in the spur group. Subjects belonging to the spur group were further divided into heel (38 cases) and traction spur (17 cases). Comparing these two groups revealed significant differences only in the type of tear (p=0.0001). Furthermore, the heel spur had significantly greater bursal side tear (odds ratio=29.521, p=0.0005) as compared to traction spur. Conclusions The heel spur is more associated to bursal side tear than the traction spur, whereas the traction spur associates greater to the articular side tear.

Purpose: This retrospective study aimed to investigate whether the standard radiographic indicators for Haglund's syndrome are applicable to insertional Achilles tendinopathy., Methods: Patients who underwent surgery for insertional Achilles tendinopathy in one heel and experienced no pain in the other heel were enrolled in this study. Preoperative calibrated radiographs of the lateral view of the calcaneus were assessed using (1) calcaneal pitch angle, (2) Fowler-Phillip angle, (3) posterior calcaneal angle, (4) Chauveau-Liet angle, (5) X/Y ratio, (6) Haglund's deformity height, (7) Haglund's deformity peak angle, (8) calcification length, (9) calcification width, (10) parallel pitch test, and (11) presence of free body. The Wilcoxon signed rank test and McNemar's test were used for statistical analyses., Results: Seventy-one patients (52 males; mean age, 57.2; mean body mass index, 27.1) were included. Mean values for each index in the symptomatic and asymptomatic heels were as follows, respectively: (1) 23.5, 23.0 ( p  = 0.30); (2) 58.9, 57.8 ( p  < 0.05); (3) 7.6, 9.2 ( p  < 0.05); (4) 15.8, 13.9 ( p  < 0.05); (5) 2.8, 2.8 ( p  = 0.87); (6) 5.4, 5.0 ( p  < 0.05); (7) 99.6, 99.0 ( p  = 0.44); (8) 10.5, 7.6 ( p  < 0.001); and (9) 5.1, 4.4 ( p  < 0.05). The sensitivity, specificity, and area under curve of significant indicators were as follows, respectively: (2) 0.78, 0.37, 0.55; (3) 0.45, 0.72, 0.58; (4) 0.63, 0.54, 0.57; (6) 0.45, 0.69, 0.59; (8) 0.48, 0.80, 0.66; and (9) 0.63, 0.54, 0.59. The presence of free body also showed a significant difference between both heels ( p  < 0.05)., Conclusion: Some radiographic indicators for Haglund's syndrome are applicable to the diagnosis of insertional Achilles tendinopathy. A comparison of the parameters of Haglund's syndrome with those of insertional Achilles tendinopathy may illuminate the etiology and pathology of insertional Achilles tendinopathy and lead to novel treatments., Competing Interests: The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (© 2024 The Authors.)

Background: As the anatomical variations of the foot, enlarged peroneal tubercle (EPT) and accessory anterolateral talar facet (AALTF) have attracted the attention of foot surgeons in recent years. However, EPT and AALTF have not been examined for a relationship with calcaneus spur (CS) as a common osteophyte., Methods: The subjects were 369 individuals who died in northeastern Thailand and were preserved as skeletal specimens. The authors examined for the presence of left and right EPT, AALTF, and calcaneus spur (CS). We divided the EPT (+) group with EPT and the EPT (-) group without it and also divided the AALTF (+) group with AALTF and the AALTF (-) group without it. The age at death and the presence of CS were compared statistically between the EPT (+) and EPT (-) groups and between the AATLF (+) and AALTF (-) groups., Results: Out of the total 369 cases, EPT was found in 117 cases (31.7%), AALTF was positive in 91 cases (24.7%), and CS was found in 194 cases (52.3%). In comparison between EPT (+) and EPT (-) groups, CS was significantly higher (p < 0.0001) in the EPT (+) group, but there was no significant difference in age at death. In comparison between AALTF (+) and AALTF (-) groups, there was no significant difference in age at death or CS., Conclusion: This study showed a strong relationship between EPT and CS, and the prevalence of EPT and AALTF by age in Thailand was first reported. We believe it helps to know the pathogenesis and biomechanism of EPT and AALTF., Trial Registration: Not applicable., (© 2024. The Author(s).)

Heel spurs are the bony protrusion seen especially on the dorsal and plantar face of the calcaneus bone at the attachment site of the muscles. It was aimed herein to obtain data about the life styles, daily lives, and especially the socioeconomic structures of modern and ancient Anatolian populations by evaluating the prevalence, location, age, and gender differences of heel spurs on the calcaneus and comparing these findings between the populations. Herein, the 251 calcaneus bones of 137 skeletons, which had been previously analyzed paleodemographically and dated to the Middle Ages, and 68 calcaneus bones belonging to a modern population, whose gender was unknown but lived in Anatolia, were examined in terms of heel spurs. In the current study, the presence of dorsal, plantar, or both dorsal/plantar heel spurs on these in 251 calcaneus bones was 43.9 %, 11.1 %, and 10.3 %, respectively. The presence of dorsal, plantar, or both dorsal/plantar heel spurs was determined as 22 %, 3 %, and 1.5 %, respectively, among the 68 calcaneus bones belonging to the modern population. When a comparison was made of the current study with studies in the literature on modern and prehistoric populations, a higher prevalence of heel spurs was found in prehistoric samples than in modern populations. It is our belief that this situation may have derived from the heavy labor force, environmental, or sociocultural differences in ancient Anatolian populations, insufficiency of vital materials due to inadequate industrial conditions, and the solution of anatomical disruption. In addition, the findings determined herein will guide the development of future and industrial studies on the foot and foot structure. [ABSTRACT FROM AUTHOR]

Purpose: Biodosimetric assessment and comparison of radiation-induced deoxyribonucleic acid (DNA) double-strand breaks (DSBs) by γH2AX immunostaining in peripheral leukocytes of patients with painful heel spur after radiation therapy (RT) with orthovoltage X‑rays or a 6-MV linear accelerator (linac). The treatment response for each RT technique was monitored as a secondary endpoint. Patients and methods: 22 patients were treated either with 140-kV orthovoltage X‑rays (n = 11) or a 6-MV linac (n = 11) with two weekly fractions of 0.5 Gy for 3 weeks. In both scenarios, the dose was prescribed to the International Commission on Radiation Units and Measurements (ICRU) dose reference point. Blood samples were obtained before and 30 min after the first RT session. γH2AX foci were quantified by immunofluorescence microscopy to assess the yield of DSBs at the basal level and after radiation exposure ex vivo or in vivo. The treatment response was assessed before and 3 months after RT using a five-level functional calcaneodynia score. Results: RT for painful heel spurs induced a very mild but significant increase of γH2AX foci in patients' leukocytes. No difference between the RT techniques was observed. High and comparable therapeutic responses were documented for both treatment modalities. This trial was terminated preliminarily after an interim analysis (22 patients randomized). Conclusion: Low-dose RT for painful heel spurs with orthovoltage X‑rays or a 6-MV linac is an effective treatment option associated with a very low and comparable radiation burden to the patient, as confirmed by biodosimetric measurements. [ABSTRACT FROM AUTHOR]