Sever’s disease—also known as calcaneal apophysitis—is a common cause of heel pain in pediatric patients typically aged 7 - 14 years old. Sever’s disease can be painful and limit a child’s function as well as par...Sever’s disease—also known as calcaneal apophysitis—is a common cause of heel pain in pediatric patients typically aged 7 - 14 years old. Sever’s disease can be painful and limit a child’s function as well as participation in physical activity. Herein, we described a case of delayed presentation of chronic Sever’s disease in a child who had been experiencing heel pain for over one year which worsened substantially when the child began to participate in sports. This is important for the emergency medicine physician because Sever’s disease represents an underdiagnosed cause of foot and heel pain in the pediatric patient and may be often missed. We describe the diagnosis and treatment options of Sever’s disease as well as associated controversies, e.g., whether activity is indeed the cause of Sever’s disease and whether imaging is needed for a diagnosis.展开更多
In spite of ill-effects of high heel shoes, they are widely used for women. Hence, it is essential to understand the load transfer biomechanics in order to design better fit and comfortable shoes. In this study, both ...In spite of ill-effects of high heel shoes, they are widely used for women. Hence, it is essential to understand the load transfer biomechanics in order to design better fit and comfortable shoes. In this study, both experimental measurement and finite element analysis were used to evaluate the biomechanical effects of heel height on foot load transfer. A controlled experiment was conducted using custom-designed platforms. Under different weight-bearing conditions, peak plantar pressure, contact area and center of pressure were analyzed. A three-dimensional finite element foot model was used to simulate the high-heel support and to predict the internal stress distributions and deformations for different heel heights. Results from both experiment and model indicated that heel elevations had significant effects on all variables. When heel elevation increased, the center of pressure shifted from the midfoot region to the forefoot region, the contact area was reduced by 26% from 0 to 10.2 cm heel and the internal stress of foot bones increased. Prediction results also showed that the strain and total tension force of plantar fascia was minimum at 5.1 cm heel condition. This study helps to better understand the biomechanical behavior of foot, and to provide better suggestions for design parameters of high heeled shoes.展开更多
Forefoot pain is common in high-heeled shoe wearers due to the high pressure caused by the center of body mass moving forward and the increased arch height with heel elevation.Sufficient arch support could reduce the ...Forefoot pain is common in high-heeled shoe wearers due to the high pressure caused by the center of body mass moving forward and the increased arch height with heel elevation.Sufficient arch support could reduce the high pressure over forefoot.However,too much arch support could lead to abnormal foot alignment and pain over midfoot.Little information is reported on the relationship among plantar arch height,shank curve design and plantar pressure.This study aimed at quantifying the plantar arch height changes at different heel heights and investigating the effect of shank curve on plantar pressure distribution.The plantar arch height increased to（7.6±1.3） mm at heel height of 75 mm.The Chinese standard suggests the depth of last should be 8.5 mm for heel height of 75 mm.When a shank curve with higher depth of last（11 mm） was used,the peak pressure over forefoot further decreased in midstance phase,which might ease the forefoot problems,while the peak pressure over midfoot increased but not exceeded the discomfort pressure thresholds.To achieve a more ideal pressure distribution in high-heeled shoes,a higher than expected depth of last would be suggested that would not cause discomfort over midfoot.展开更多
Background: Lack of an observable vertical impact peak in fore/mid-foot running has been suggested as a means of reducing lower extremity impact forces, although it is unclear if impact characteristics exist in other ...Background: Lack of an observable vertical impact peak in fore/mid-foot running has been suggested as a means of reducing lower extremity impact forces, although it is unclear if impact characteristics exist in other axes. The purpose of the investigation was to compare three-dimensional(3 D) impact kinetics among foot-strike conditions in over-ground running using instantaneous loading rate–time profiles.Methods: Impact characteristics were assessed by identifying peak loading rates in each direction(medial–lateral(ML), anterior–posterior(AP),vertical, and 3 D resultant) following foot-strike instructions(fore-foot, mid-foot, subtle heel, and obvious heel strike). Kinematic and kinetic data were analyzed among 9 male participants in each foot-strike condition.Results: Loading rate peaks were observed in each direction and foot-strike condition, differing in magnitude by direction(3 D resultant and vertical > AP > ML, p ≤ 0.031) and foot-strike: ML(fore-foot and mid-foot strike > obvious heel strike, p ≤ 0.032), AP(fore-foot and mid-foot strikes > subtle-heel and obvious heel strikes, p ≤ 0.023). In each direction, the first loading rate peak occurred later during heel strike running relative to fore-foot(p ≤ 0.019), with vertical and 3 D resultant impact durations exceeding shear(ML and AP, p ≤ 0.007) in each condition.Conclusion: Loading rate–time assessment identified contrasting impact characteristics in each direction and the 3 D resultant following foot-strike manipulations, with potential implications for lower extremity structures in running.展开更多
BACKGROUND Diabetic foot ulcers(DFUs)are common in patients with diabetes,especially those undergoing hemodialysis.In severe cases,these ulcers can cause damage to the lower extremities and lead to amputation.Traditio...BACKGROUND Diabetic foot ulcers(DFUs)are common in patients with diabetes,especially those undergoing hemodialysis.In severe cases,these ulcers can cause damage to the lower extremities and lead to amputation.Traditional treatments such as flap transposition and transfemoral amputation are not always applicable in all cases.Therefore,there is a need for alternative treatment methods.CASE SUMMARY This report describes a 62-year-old female patient who was admitted to the hospital with plantar and heel ulcers on her left foot.The patient had a history of renal failure and was undergoing regular hemodialysis.Digital subtraction angiography showed extensive stenosis and occlusion in the left superficial femoral artery,left peroneal artery and left posterior tibial artery.Following evaluation by a multidisciplinary team,the patient was diagnosed with type 2 DFUs(TEXAS 4D).Traditional treatments were deemed unsuitable,and the patient was treated with endovascular surgery in the affected area,in addition to supportive medical treatment,local debridement,and sequential repair using split-thickness skin and tissue-engineered skin grafts combined with negative pressure treatment.After four months,the wound had completely healed,and the patient was able to walk with a walking aid.CONCLUSION This study demonstrates a new treatment method for DFUs was successful,using angioplasty,skin grafts,and negative pressure.展开更多
文摘Sever’s disease—also known as calcaneal apophysitis—is a common cause of heel pain in pediatric patients typically aged 7 - 14 years old. Sever’s disease can be painful and limit a child’s function as well as participation in physical activity. Herein, we described a case of delayed presentation of chronic Sever’s disease in a child who had been experiencing heel pain for over one year which worsened substantially when the child began to participate in sports. This is important for the emergency medicine physician because Sever’s disease represents an underdiagnosed cause of foot and heel pain in the pediatric patient and may be often missed. We describe the diagnosis and treatment options of Sever’s disease as well as associated controversies, e.g., whether activity is indeed the cause of Sever’s disease and whether imaging is needed for a diagnosis.
基金supported by the Research Grant Council of Hong Kong (PolyU5317/05E, PolyU5331/07E, PolyU5352/08E)
文摘In spite of ill-effects of high heel shoes, they are widely used for women. Hence, it is essential to understand the load transfer biomechanics in order to design better fit and comfortable shoes. In this study, both experimental measurement and finite element analysis were used to evaluate the biomechanical effects of heel height on foot load transfer. A controlled experiment was conducted using custom-designed platforms. Under different weight-bearing conditions, peak plantar pressure, contact area and center of pressure were analyzed. A three-dimensional finite element foot model was used to simulate the high-heel support and to predict the internal stress distributions and deformations for different heel heights. Results from both experiment and model indicated that heel elevations had significant effects on all variables. When heel elevation increased, the center of pressure shifted from the midfoot region to the forefoot region, the contact area was reduced by 26% from 0 to 10.2 cm heel and the internal stress of foot bones increased. Prediction results also showed that the strain and total tension force of plantar fascia was minimum at 5.1 cm heel condition. This study helps to better understand the biomechanical behavior of foot, and to provide better suggestions for design parameters of high heeled shoes.
基金supported by the Research Grant Council of Hong Kong (Project Nos. PolyU5331/07E, PolyU5352/08E)a Research Studentship from the Hong Kong Polytechnic University
文摘Forefoot pain is common in high-heeled shoe wearers due to the high pressure caused by the center of body mass moving forward and the increased arch height with heel elevation.Sufficient arch support could reduce the high pressure over forefoot.However,too much arch support could lead to abnormal foot alignment and pain over midfoot.Little information is reported on the relationship among plantar arch height,shank curve design and plantar pressure.This study aimed at quantifying the plantar arch height changes at different heel heights and investigating the effect of shank curve on plantar pressure distribution.The plantar arch height increased to（7.6±1.3） mm at heel height of 75 mm.The Chinese standard suggests the depth of last should be 8.5 mm for heel height of 75 mm.When a shank curve with higher depth of last（11 mm） was used,the peak pressure over forefoot further decreased in midstance phase,which might ease the forefoot problems,while the peak pressure over midfoot increased but not exceeded the discomfort pressure thresholds.To achieve a more ideal pressure distribution in high-heeled shoes,a higher than expected depth of last would be suggested that would not cause discomfort over midfoot.
基金funded by the Institutional Development Award Network of Biomedical Research Excellence through the National Institute of General Medical Sciences (8 20 GM103440-11)
文摘Background: Lack of an observable vertical impact peak in fore/mid-foot running has been suggested as a means of reducing lower extremity impact forces, although it is unclear if impact characteristics exist in other axes. The purpose of the investigation was to compare three-dimensional(3 D) impact kinetics among foot-strike conditions in over-ground running using instantaneous loading rate–time profiles.Methods: Impact characteristics were assessed by identifying peak loading rates in each direction(medial–lateral(ML), anterior–posterior(AP),vertical, and 3 D resultant) following foot-strike instructions(fore-foot, mid-foot, subtle heel, and obvious heel strike). Kinematic and kinetic data were analyzed among 9 male participants in each foot-strike condition.Results: Loading rate peaks were observed in each direction and foot-strike condition, differing in magnitude by direction(3 D resultant and vertical > AP > ML, p ≤ 0.031) and foot-strike: ML(fore-foot and mid-foot strike > obvious heel strike, p ≤ 0.032), AP(fore-foot and mid-foot strikes > subtle-heel and obvious heel strikes, p ≤ 0.023). In each direction, the first loading rate peak occurred later during heel strike running relative to fore-foot(p ≤ 0.019), with vertical and 3 D resultant impact durations exceeding shear(ML and AP, p ≤ 0.007) in each condition.Conclusion: Loading rate–time assessment identified contrasting impact characteristics in each direction and the 3 D resultant following foot-strike manipulations, with potential implications for lower extremity structures in running.
文摘BACKGROUND Diabetic foot ulcers(DFUs)are common in patients with diabetes,especially those undergoing hemodialysis.In severe cases,these ulcers can cause damage to the lower extremities and lead to amputation.Traditional treatments such as flap transposition and transfemoral amputation are not always applicable in all cases.Therefore,there is a need for alternative treatment methods.CASE SUMMARY This report describes a 62-year-old female patient who was admitted to the hospital with plantar and heel ulcers on her left foot.The patient had a history of renal failure and was undergoing regular hemodialysis.Digital subtraction angiography showed extensive stenosis and occlusion in the left superficial femoral artery,left peroneal artery and left posterior tibial artery.Following evaluation by a multidisciplinary team,the patient was diagnosed with type 2 DFUs(TEXAS 4D).Traditional treatments were deemed unsuitable,and the patient was treated with endovascular surgery in the affected area,in addition to supportive medical treatment,local debridement,and sequential repair using split-thickness skin and tissue-engineered skin grafts combined with negative pressure treatment.After four months,the wound had completely healed,and the patient was able to walk with a walking aid.CONCLUSION This study demonstrates a new treatment method for DFUs was successful,using angioplasty,skin grafts,and negative pressure.
