Plantar fascia rupture is an occasional complication in patients with chronic plantar fasciitis or in patients with plantar fasciitis treated with steroid injection. Very few cases of spontaneous plantar fascia rupture have been reported in the literature (Herrick and Herrick, Am J Sports Med 1983;11:95; Lun et al, Clin J Sports Med 1999;9:48-9; Rolf et al, J Foot Ankle Surg 1997;36:112-4; Saxena and Fullem, Am J Sports Med 2004;32:662-5). Spontaneous medial plantar fascia rupture in a 37-yr-old man with no preceding symptoms or steroid injections was confirmed with diagnostic ultrasound, which revealed severe fasciitis at the calcaneal insertion with partial tearing. After conservative treatment, the patient returned to full activities. We discuss the anatomy, risk factors, examination findings, and treatment for this condition, as well as the unique benefits that ultrasound offers over magnetic resonance imaging. It is important to consider plantar fascia rupture in patients with hindfoot pain and medioplantar ecchymosis, particularly if an injury occurred during acceleration maneuvers. Ultrasound in these cases can be used to diagnose a plantar fascia tear quickly, accurately, and cost-effectively.
To determine if lumbosacral transforaminal epidural steroid injection (LTFESI) is as effective in treating lumbosacral radicular pain in obese (body mass index [BMI] Ͼ30) and overweight (25ϽBMIϽ30) population compared with the nonoverweight (18.5ϽBMIϽ25) population, because BMI has not been described as a prognostic indicator with regard to LTFESI outcomes. Design: Retrospective, case control pilot study. Setting: Major metropolitan urban academic spine and sports clinic. Participants: Patients who were not overweight (nϭ9), overweight (nϭ9), and obese (nϭ6) presented with lumbosacral radicular pain and received a LTFESI. Interventions: Fluoroscopically guided contrast-enhanced LTFESI. Main Outcome Measures: 11-point pain intensity numeric rating scale scores were recorded before LTFESI and at an average follow-up interval of 4 weeks. We determined the mean percentage reduction in pain and the proportion of individuals with a 50% or greater reduction in pain in the 3 BMI groups. Results: No significant differences were found between the normal BMI group and higher BMI groups with regard to percentage improvement in pain (Pϭ.7154, Pϭ.4566) or in the proportion of each group with a 50% or greater reduction in pain (Pϭ.4566, Pϭ.1520). Conclusions: This preliminary data does not show that LTFESI is less effective for the higher BMI groups compared with normal BMI cohorts for the treatment of lumbosacral radicular pain. However, our sample size was not large enough to find a significant difference at a power of 80%. A larger study is needed to confirm whether BMI is a prognostic indicator for outcomes of LTFESI for lumbosacral radicular pain.
Conclusions: FAD is a diagnostic test that has the potential to accurately diagnose diskogenic LBP without the inherently painful need of a PLD.
The aim of this study was to compare the rehabilitative outcomes of 2 common approaches in total hip arthroplasties, in the subacute setting. Design: We obtained a comprehensive list of patients admitted for subacute rehabilitation of total hip arthroplasties between July 2009 and February 2011. Based on the surgical approach documented in electronic medical records, we then separated the patients into the anterior approach group and the posterior approach group, and then compared averages: length of stay, admission Functional Independence Measure (FIM) scores, discharge FIM scores, and FIM gain and dispositions. Setting: A subacute rehabilitation unit. Participants: Admissions to subacute rehabilitation from July 2009 to February 2011 after total hip arthroplasties. Interventions: Not applicable. Main Outcome Measures: Length of stay, admission FIM score, discharge FIM score, and FIM gain and disposition after rehabilitation. Results: During our time frame, 60 patients were admitted to the subacute rehabilitation unit after total hip arthroplasties. Of the 60, only 10 underwent anterior approaches (16.6%). Admission FIM scores were found to be significantly higher in the anterior approach group (Pϭ.028) than in the posterior approach group. Comparison of the two groups' length-of-stays shows the anterior approach group tended to be shorter than the posterior approach group (Pϭ.106). However, no significant difference was found between the 2 groups in discharge FIM scores (Pϭ.164) and FIM gains (Pϭ.364). Discharge FIM scores tended to be higher in the anterior approach group, whereas FIM gains tended to be higher in the posterior approach group. Conclusions: Patients undergoing postoperative subacute rehabilitation for anterior total hip arthroplasties have significantly higher admission FIM scores compared with patients with posterior approach total hip arthroplasties. Anterior approach total hip arthroplasties also tend to have shorter lengths-of-stay and higher discharge FIM scores then posterior total hip arthroplasties. Significantly higher admission FIM scores support the idea that anterior hip precautions are less restrictive of many activities of daily living, when compared with posterior precautions.
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