Plantar fasciitis is one of the most common painful foot con ditions. It affects both active and sedentary adults, with a peak incidence in those between 40 and 60 years of age. 8,20 Impaired vascularity with subsequent metabolic disturbance has been proposed as one of its causes.11,31 A moderate to marked increase in vascularity in the proximal plantar fascia has been observed in patients with plantar fasciitis. 7,31 This increase is typical in those who have had plantar fasciitis for less than 12 months, and has been associated with greater intensity of pain.31 Similar vascularization has been observed in patients with Achilles, 23,36 patellar, 9 and rotator cuff tendinopathy. 18 The intensity of pain with chronic tendinopathy has also been found to be greater in patients with tendon vascularization compared to those without. 9,10,38 Alfredson 2 proposed that vascularization in diseased tendons is one of the potential mediators of pain in tendinopathy, nerve ingrowth associated with new vessels being the cause of pain reported by patients.Higher tendon vascularity has also been reported to be associated with greater dysfunction in patients with patellar 9 and Achilles tendinopathy. T T METHODS:Thirty-eight patients with chronic unilateral plantar fasciitis and 21 controls participated in this study. Proximal plantar fascia vascularization and thickness were assessed using ultrasound imaging, and pain and foot dysfunction were quantified with a visual analog scale and the Chinese version of the Foot Function Index, respectively. Paired t tests were used to assess the side-to-side differences in fascia thickness and vascularity index (VI) in the control and patient groups, and an unpaired t test was used to make comparisons with the patient group. Multiple regression analysis was performed to identify whether the VI and fascia thickness were associated with pain and foot dysfunction. T T RESULTS:There were significantly higher VI (mean  SD, 2.4%  1.4%) and fascia thickness (5.0  1.3 mm) values in the affected feet when compared with the unaffected feet in the patient group (VI, 1.4%  0.5%; fascia thickness, 3.3  0.7 mm) and with the dominant side of the controls (VI, 1.6%  0.4%; fascia thickness, 2.9  0.6 mm). After accounting for age, gender, body mass index, and duration of symptoms, the VI explained 13% and 33% of the variance in pain scores measured with a visual analog scale and the pain subscale of the Foot Function Index, respectively; the VI and fascia thickness explained 42% of the variance in the Foot Function Index. T T CONCLUSION: Individuals with unilateralchronic plantar fasciitis demonstrated significantly greater vascularity and thickened fascia on the affected side compared to the unaffected side and also to healthy controls. Fascia vascularity was associated independently with self-perceived pain, and both fascia vascularity and thickness were associated with foot dysfunction in patients with chronic plantar fasciitis. Public trials registry: Current Controlled Trials, ISRCTN49594569. J...

A 37-year-old healthy Chinese man with traumatic bilateral concurrent patellar tendon rupture is presented. This is the 19th case reported in the literature. Sports-related activities are the most common cause of injury. The mechanism of rupture is forceful contraction of quadriceps muscle on a partially flexed knee. Previous surgical treatments have potential problems. Soft tissue anchors were used for restoration of the patellar continuity. Improved surgical techniques and excellent functional results are expected.

Introduction: Deficit in the first metatarsophalangeal joint (MTPJ) extension range is suggested as one of the intrinsic risk factors for Plantar fasciitis. However, the relationship between MTPJ range and intensity of pain and dysfunction has not been explored. The purpose of this study was to determine if a difference exists in extension Range of Motion (ROM) of the first MTPJ between PF sufferers and healthy controls; and to explore its association with intensity of pain and dysfunction.Methods: Thirty-six patients (22 female) with unilateral plantar fasciitis (19 on the dominant foot) and 21 healthy controls were recruited. Active and passive ROM of first MTPJ extension were assessed. In the healthy control, side-to-side difference on the joint range was compared using repeated measure analysis of variates with gender as a factor. Multivariate analysis of variates was used to compare MTPJ extension range between patients and healthy control matched with leg dominance, and with gender and body mass index as covariates. Partial correlation coefficient tests were conducted to assess relationships between MTPJ extension range and intensity of pain and dysfunction controlled with BMI, activity level and affected side. Results:The active and passive MTPJ range was significantly greater in the dominant than non-dominant feet (all p < 0.05) in the healthy controls. Female patients had significantly larger passive MTPJ extension range (p = 0.034 and 0.006) for patients with the dominant and non-dominant feet being affected, respectively). Significant correlation was detected between the passive MTPJ extension range and intensity of pain (r = -0.54, p = 0.017) and pain score of foot functional index (r = -0.47, p = 0.042) in the female patients. Conclusions:In female patients with plantar fasciitis, increased passive metatarsal phalangeal joint extension range is detected, and a larger extension range is associated with less pain.