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Yeungnam University Journal of Medicine May 2019Forefoot disorders are often seen in clinical practice. Forefoot deformity and pain can deteriorate gait function and decrease quality of life. This review presents... (Review)
Review
Forefoot disorders are often seen in clinical practice. Forefoot deformity and pain can deteriorate gait function and decrease quality of life. This review presents common forefoot disorders and conservative treatment using an insole or orthosis. Metatarsalgia is a painful foot condition affecting the metatarsal (MT) region of the foot. A MT pad, MT bar, or forefoot cushion can be used to alleviate MT pain. Hallux valgus is a deformity characterized by medial deviation of the first MT and lateral deviation of the hallux. A toe spreader, valgus splint, and bunion shield are commonly applied to patients with hallux valgus. Hallux limitus and hallux rigidus refer to painful limitations of dorsiflexion of the first metatarsophalangeal joint. A kinetic wedge foot orthosis or rocker sole can help relieve symptoms from hallux limitus or rigidus. Hammer, claw, and mallet toes are sagittal plane deformities of the lesser toes. Toe sleeve or padding can be applied over high-pressure areas in the proximal or distal interphalangeal joints or under the MT heads. An MT off-loading insole can also be used to alleviate symptoms following lesser toe deformities. Morton's neuroma is a benign neuroma of an intermetatarsal plantar nerve that leads to a painful condition affecting the MT area. The MT bar, the plantar pad, or a more cushioned insole would be useful. In addition, patients with any of the above various forefoot disorders should avoid tight-fitting or high-heeled shoes. Applying an insole or orthosis and wearing proper shoes can be beneficial for managing forefoot disorders.
PubMed: 31620619
DOI: 10.12701/yujm.2019.00185 -
Brazilian Journal of Physical Therapy 2021Low back pain is the leading cause of disability worldwide. The therapeutic management of patients with chronic LBP is challenging. (Randomized Controlled Trial)
Randomized Controlled Trial
BACKGROUND
Low back pain is the leading cause of disability worldwide. The therapeutic management of patients with chronic LBP is challenging.
OBJECTIVES
The aim of this study is to evaluate the effects of heat and transcutaneous electrical nerve stimulation combined on pain relief in participants with chronic low back pain.
METHODS
Fifty participants with chronic (≥3 months) low back pain were randomly assigned to two groups: HeatTens (n=25) and control group (n=25). Primary outcome was pain. Secondary outcomes were pressure pain thresholds, temporal summation, conditioned pain modulation, fear-avoidance and beliefs questionnaire, central sensitization inventory, quality of life, and medication use. The control group received no treatment and continued usual care. After four weeks of treatment, all measurements were repeated.
RESULTS
Fifty individuals participated in this study. Significant higher pressure pain threshold measures after both 30min and 4 weeks for the lower back region and the second plantar toe were found only in the experimental group.
CONCLUSION
The combination of heat and transcutaneous electrical nerve stimulation does not reduce pain scores in patients with chronic low back pain. Pressure pain threshold values significantly improved, showing beneficial effects of the experimental treatment. ClinicalTrials.gov: NCT03643731 (https://clinicaltrials.gov/ct2/show/NCT03643731).
Topics: Central Nervous System Sensitization; Chronic Pain; Disabled Persons; Hot Temperature; Humans; Low Back Pain; Pain Management; Pain Threshold; Quality of Life; Transcutaneous Electric Nerve Stimulation
PubMed: 32434666
DOI: 10.1016/j.bjpt.2020.04.001 -
Orthopedic Reviews 2022Posterior tarsal tunnel syndrome (PTTS) is an entrapment neuropathy due to compression of the tibial nerve or one of its terminal branches within the tarsal tunnel in... (Review)
Review
Posterior tarsal tunnel syndrome (PTTS) is an entrapment neuropathy due to compression of the tibial nerve or one of its terminal branches within the tarsal tunnel in the medial ankle. The tarsal tunnel is formed by the flexor retinaculum, while the floor is composed of the distal tibia, talus, and calcaneal bones. The tarsal tunnel contains a number of significant structures, including the tendons of 3 muscles as well as the posterior tibial artery, vein, and nerve. Focal compressive neuropathy of PTTS can originate from anything that physically restricts the volume of the tarsal tunnel. The variety of etiologies includes distinct movements of the foot, trauma, vascular disorders, soft tissue inflammation, diabetes mellitus, compression lesions, bony lesions, masses, lower extremity edema, and postoperative injury. Generally, compression of the posterior tibial nerve results in clinical findings consisting of numbness, burning, and painful paresthesia in the heel, medial ankle, and plantar surface of the foot. Diagnosis of PTTS can be made with the presence of a positive Tinel sign in combination with the physical symptoms of pain and numbness along the plantar and medial surfaces of the foot. Initially, patients are treated conservatively unless there are signs of muscle atrophy or motor nerve involvement. Conservative treatment includes activity modification, heat, cryotherapy, non-steroidal anti-inflammatory drugs, corticosteroid injections, opioids, GABA analog medications, tricyclic antidepressants, vitamin B-complex supplements, physical therapy, and custom orthotics. If PTTS is recalcitrant to conservative treatment, standard open surgical decompression of the flexor retinaculum is indicated. In recent years, a number of alternative minimally invasive treatment options have been investigated, but these studies have small sample sizes or were conducted on cadaveric models.
PubMed: 35769658
DOI: 10.52965/001c.35444 -
American Family Physician Jan 2018The differential diagnosis of heel pain is extensive, but a mechanical etiology is the most common. The specific anatomic location of the pain can help guide diagnosis....
The differential diagnosis of heel pain is extensive, but a mechanical etiology is the most common. The specific anatomic location of the pain can help guide diagnosis. The most common diagnosis is plantar fasciitis, which leads to medial plantar heel pain, especially with the first weight-bearing steps after rest. Other causes of plantar heel pain include calcaneal stress fractures (progressively worsening pain after an increase in activity or change to a harder walking surface), nerve entrapment or neuroma (pain accompanied by burning, tingling, or numbness), heel pad syndrome (deep, bruise-like pain in the middle of the heel), and plantar warts. Achilles tendinopathy is a common cause of posterior heel pain; other tendinopathies result in pain localized to the insertion site of the affected tendon. Posterior heel pain can also be attributed to Haglund deformity (a prominence of the calcaneus that may lead to retrocalcaneal bursa inflammation) or Sever disease (calcaneal apophysitis common in children and adolescents). Medial midfoot heel pain, particularly with prolonged weight bearing, may be due to tarsal tunnel syndrome, which is caused by compression of the posterior tibial nerve. Sinus tarsi syndrome manifests as lateral midfoot heel pain and a feeling of instability, particularly with increased activity or walking on uneven surfaces.
Topics: Diagnosis, Differential; Foot Diseases; Heel; Humans; Pain; Pain Management
PubMed: 29365222
DOI: No ID Found -
EFORT Open Reviews Aug 2018Plantar fasciopathy is very prevalent, affecting one in ten people in their lifetime.Around 90% of cases will resolve within 12 months with conservative...
Plantar fasciopathy is very prevalent, affecting one in ten people in their lifetime.Around 90% of cases will resolve within 12 months with conservative treatment.Gastrocnemius tightness has been associated with dorsiflexion stiffness of the ankle and plantar fascia injury.The use of eccentric calf stretching with additional stretches for the fascia is possibly the non-operative treatment of choice for chronic plantar fasciopathy.Medial open release of approximately the medial third of the fascia and release of the first branch of the lateral plantar nerve has been the most accepted surgical treatment for years.Isolated proximal medial gastrocnemius release has been reported for refractory plantar fasciopathy with excellent results and none of the complications of plantar fasciotomy. Cite this article: 2018;3:485-493. DOI: 10.1302/2058-5241.3.170080.
PubMed: 30237906
DOI: 10.1302/2058-5241.3.170080 -
Annals of Palliative Medicine Sep 2020Rearfoot disorders are frequently encountered in clinical practice. We reviewed common rearfoot disorders and present conservative treatments, focusing on shoe... (Review)
Review
Rearfoot disorders are frequently encountered in clinical practice. We reviewed common rearfoot disorders and present conservative treatments, focusing on shoe modification and the application of insoles or orthoses. Achilles tendinopathy is caused by excessive mechanical loads on the gastrocnemius and soleus muscles. Heel lifts, rocker shoes, and the AirHeel Brace can be used to reduce symptoms. Haglund's deformity is an osseous prominence of the posterosuperior part of the calcaneus bone, the pain from which can be alleviated by reducing pressure on the affected area by appropriately modifying the back of the shoe to prevent contact with the lesion. The pain from retrocalcaneal bursitis can be controlled by lifting the heel and loosening the shoe counter. Plantar fasciitis causes plantar heel pain, and its orthotic treatments include the application of a heel cup, heel pad, heel wedge, Thomas heel, and night splint. Calcaneal stress fractures are generally caused by repetitive loads and occur mainly in sporting activities. Patellar tendon-bearing (PTB) orthoses are helpful in reducing the load on the calcaneal bone. Heel fat pad atrophy refers to the loss of the fat pad that absorbs shock in the heel. To reduce pain caused by heel fat pad atrophy, rocker soles, heel pads, and solid ankle cushion heels (SACHs) may be used. Tarsal tunnel syndrome is caused by compression of the tibial nerve within the tarsal tunnel and its symptoms can be managed by rocker soles, supporting medial arches, Thomas heels, and SACHs. Shoe modification or application of orthoses can be helpful for managing rearfoot pain. However, for the active and wide application of these conservative treatment methods, more clinical studies should be conducted.
Topics: Achilles Tendon; Foot Diseases; Heel; Humans; Pain; Tendinopathy
PubMed: 32787369
DOI: 10.21037/apm-20-446