The purpose of this prospective cohort study was to determine if hamstring tightness was an increased risk in plantar fasciitis. It was thought that there is an increased risk of plantar fasciitis when hamstring tightness is present. A total of 105 patients (68 women, 37 men) were included in the study, 79 of whom were diagnosed with plantar fasciitis. Body mass index (BMI) was calculated and the presence of plantar fasciitis, equinus, and calcaneal spurs were assessed. The popliteal angle was measured using standard diagnostic techniques. Without controlling for covariates, BMI, the presence of a calcaneal spur, tightness in the gastrocnemius, gastrocnemius-soleus, and hamstring all had statistically significant association with plantar fasciitis. After controlling for covariates, patients with hamstring tightness were about 8.7 times as likely to experience plantar fasciitis (P < .0001). Patients with BMI >35 were approximately 2.4 times as likely to experience plantar fasciitis compared with those with BMI <35 (P = .04). This study demonstrates that hamstring tightness plays a significant role in the presence of plantar fasciitis and should be addressed along with equinus and obesity when providing treatment to patients with this diagnosis.

T he anatomy of the mortise of the Lisfranc joint between the medial and lateral cuneiforms was studied in detail, with particular reference to features which may predispose to injury. In 33 consecutive patients with Lisfranc injuries we measured, from conventional radiographs, the medial depth of the mortise (A), the lateral depth (B) and the length of the second metatarsal (C). MRI was used to confirm the diagnosis. We calculated the mean depth of the mortise (A+B)/2, and the variables of the lever arm as follows: C/A, C/B and C/mean depth. The data were compared with those obtained in 84 cadaver feet with no previous injury of the Lisfranc joint complex. Statistical analysis used Student's two-sample t-test at the 5% error level and forward stepwise logistic regression. The mean medial depth of the mortise was found to be significantly less in patients with Lisfranc injuries than in the control group. Stepwise logistic regression identified only this depth as a significant risk factor for Lisfranc injuries. The odds of being in the injury group is 0.52 (approximately half) that of being a control if the medial depth of the mortise is increased by 1 mm, after adjusting for the other variables in the model. Our findings show that the mortise in patients with injuries to the Lisfranc joint is shallower than in the control group and the shallower it is the greater is the risk of injury. J Bone Joint Surg [Br] 2002;84-B:981-5. The tarsometatarsal joint of the foot (Lisfranc joint) consists of the distal row of tarsal bones, the medial, intermediate , and lateral cuneiforms and the cuboid, which articulate with the bases of the five metatarsals. It is S-shaped and is divided into three columns, with three distinct arches. 1,2 Of the three arches, the horizontal arch is anchored by the base of the second metatarsal, which is recessed into a 'mortise' between the medial and lateral cuneiforms (Fig. 1), and stabilises the joint. 2,3 Intermetatarsal and thin dorsal ligaments connect the second, third, fourth and fifth metatarsals, and the tarso-metatarsal joint is further stabilised by the strongest of the ligamentous structures, the plantar tarsometatarsal ligaments. There is no intermetatarsal ligament between the bases of the first and second metatarsals. The main stabilis-ing structure of the tarsometatarsal joint is a Y-shaped interosseous ligament (Lisfranc's ligament). This extends on the plantar surface from the lateral aspect of the medial cuneiform to the medial aspect of the base of the second Fig. 1 Anatomical specimen of a left foot. It was dissected in an oblique axial plane showing the position of the second metatarsal base in the mortise between the medial and lateral cuneiform.

Objective: To evaluate large propensity-matched cohorts to assess outcomes in patients receiving advanced treatment (AT) with skin substitutes for lower extremity diabetic ulcers (LEDUs) versus no AT (NAT) for the management of LEDUs. Method: The Medicare Limited Dataset (1 October 2015 through 2 October 2018) were used to retrospectively analyse people receiving care for a LEDU treated with AT or NAT (propensity-matched Group 1). Analysis included major and minor amputations, emergency department (ED) visits and hospital readmissions. In addition, AT following parameters for use (FPFU) was compared with AT not FPFU (propensity-matched Group 2). A paired t-test was used for comparisons of the two groups. For comparisons of three groups, the Kruskal–Wallis test was used. A Bonferroni correction was performed when multiple comparisons were calculated. Results: There were 9,738,760 patients with a diagnosis of diabetes, of whom 909,813 had a LEDU. In propensity-matched Group 1 (12,676 episodes per cohort), AT patients had statistically fewer minor amputations (p=0.0367), major amputations (p<0.0001), ED visits (p<0.0001), and readmissions (p<0.0001) compared with NAT patients. In propensity-matched Group 2 (1131 episodes per cohort), AT FPFU patients had fewer minor amputations (p=0.002) than those in the AT not FPFU group. Conclusion: AT for the management of LEDUs was associated with significant reductions in major and minor amputation, ED use, and hospital readmission compared with LEDUs managed with NAT. Clinics should implement AT in accordance with the highlighted parameters for use to improve outcomes and reduce costs.

We retrospectively evaluated 109 magnetic resonance studies in patients with prior ankle sprains to investigate the frequency and pattern of bone bruises. Patterns of bone bruises were then correlated with the ligaments injured. In addition, the age of the injury was determined from medical records to correlate the presence of bone bruises with the temporal period from injury. Bone bruises occurred in 39% of ankle sprains. Multiple bone bruises were seen in 40% of those with bone bruises; they occurred more frequently in patients with multiple ligaments injured. The marrow changes may be secondary to impaction, rotary instability of the ankle, and microavulsion vectors. Bone bruise-like lesions were seen at an average of 8.4 weeks in age but were seen more than a year after the injury. We conclude that bone bruises frequently occur in patients with ankle sprains, and the marrow changes may be caused by one of the three proposed mechanisms.

Objective: To evaluate the cost-effectiveness and budget impact of using standard care (no advanced treatment, NAT) compared with an advanced treatment (AT), dehydrated human amnion/chorion membrane (DHACM), when following parameters for use (FPFU) in treating lower extremity diabetic ulcers (LEDUs). Method: We analysed a retrospective cohort of Medicare patients (2015–2019) to generate four propensity-matched cohorts of LEDU episodes. Outcomes for DHACM and NAT, such as amputations, and healthcare utilisation were tracked from claims codes, analysed and used to build a hybrid economic model, combining a one-year decision tree and a four-year Markov model. The budget impact was evaluated in the difference in per member per month spending following completion of the decision tree. Likewise, the cost-effectiveness was analysed before and after the Markov model at a willingness to pay (WTP) threshold of $100,000 per quality adjusted life year (QALY). The analysis was conducted from the healthcare sector perspective. Results: There were 10,900,127 patients with a diagnosis of diabetes, of whom 1,213,614 had an LEDU. Propensity-matched Group 1 was generated from the 19,910 episodes that received AT. Only 9.2% of episodes were FPFU and DHACM was identified as the most widely used AT product among Medicare episodes. Propensity-matched Group 4 was limited by the 590 episodes that used DHACM FPFU. Episodes treated with DHACM FPFU had statistically fewer amputations and healthcare utilisation. In year one, DHACM FPFU provided an additional 0.013 QALYs, while saving $3,670 per patient. At a WTP of $100,000 per QALY, the five-year net monetary benefit was $5003. Conclusion: The findings of this study showed that DHACM FPFU reduced costs and improved clinical benefits compared with NAT for LEDU Medicare patients. DHACM FPFU provided better clinical outcomes than NAT by reducing major amputations, ED visits, inpatient admissions and readmissions. These clinical gains were achieved at a lower cost, in years 1–5, and were likely to be cost-effective at any WTP threshold. Adoption of best practices identified in this retrospective analysis is expected to generate clinically significant decreases in amputations and hospital utilisation while saving money.

No abstract

No abstract

No abstract