The aim of this study is to search if there is any proprioceptive difference between auto and allograft anterior cruciate ligament (ACL) reconstructions, and also to determine if there is any relationship between instrumented anterior knee laxity and proprioception after an ACL reconstruction. The following four groups were constituted for this purpose: group I, control group; group II, autograft reconstructions; group III, allograft reconstructions and group IV, people with injured ACLs. Each group consisted of 20 patients/volunteers. Two subgroups were constituted according to the findings of KT-1,000 laxity testing in group II and III; patients/volunteers found to have a laxity of 3 mm or less were enrolled in the normal subgroup and those with a laxity of more than 3 mm were enrolled in the lax subgroup. Two proprioceptive tests were used: threshold to detect passive motion (TDPM) and joint position sense (JPS) by using Cybex Norm dynamometer. Patients underwent ten tests and the discrepancy in degrees was averaged for ten trials. Comparisons were made to evaluate the proprioceptive differences between groups/subgroups; ANOVA and t test was used for comparisons where appropriate, and the significance was set at P < 0.05. There was a significant difference in degrees between patients with injured ACLs and the other three groups in TDPM evaluations (injured: 1.93 degrees vs. control: 1.03 degrees , autograft: 1.01 degrees , allograft: 0.96 degrees ; P < 0.001). Auto and allograft reconstructions were not different from each other and controls. Allo and autograft ACL reconstructions are not different from each other according to proprioceptive measurements. Also, proprioception is not correlated to postoperative anterior knee laxity; many variables involve joint proprioception and mostly the anterior knee laxity may not be the sole determining element, and a lax ACL still may fulfill some of its afferent arc functions as long as it bridges the femur and tibia.

The heel fat pad has a unique structure that is important for its shock-absorbing function. Loss of elasticity and changes in the thickness of the heel pad have been suggested as causes of heel pain. The present study of a population with heel pain shows the relationship between the thickness and elasticity of the heel fat pad and age, sex, obesity, duration of symptoms, subcalcaneal spurs, and noninvasive conservative treatment. Of 182 patients with heel pain who visited an outpatient clinic during a 3-year period, 50 (67 heels) fulfilling specific criteria were treated with a combination of nonsteroidal anti-inflammatory drugs, contrast baths, stretching exercises, and change of footwear habits. Patients were followed up for 1 year. Delayed healing, increased thickness, and decreased elasticity of the heel fat pad were found in patients who were older than 40 years, who had symptoms for longer than 12 months before treatment, and who had a large subcalcaneal spur. An increase in heel fat pad thickness with aging and increased body weight reduce the elasticity of the heel fat pad. In addition, subcalcaneal spurs diminish the elasticity of the heel fat pad and play a role in the formation of heel pain.

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Between 1989 and 2000, 16 patients underwent surgery for tarsal tunnel syndrome; 12 patients (13 feet) were available for follow-up at a mean of 83 (12-143) months. The symptoms had resolved in six feet, were improved in four, were unchanged in two and recurred after five years in one. Better results are obtained in patients who have space occupying lesions than in those in whom the aetiology is idiopathic or post-traumatic or those with foot deformities.Résumé Entre 1989 et 2000 nous avons traité chirurgicalement 16 malades présentant un syndrome du tunnel tarsien. Chez 12 malades (13 pieds) les résultats ont été évalués après une moyenne de 83 (12-143) mois. Pour six pieds les symptômes avaient complètement disparus, pour quatre pieds les symptômes ont été améliorés, deux pieds ont été inchangés et dans un cas les symptômes sont revenus après 60 mois. Le résultat du traitement chirurgical est meilleur chez les patients avec des lésions l'espace occupante. IntroductionTarsal tunnel syndrome (TTS) is an entrapment neuropathy of the posterior tibial nerve and its branches within the tunnel formed by the flexor retinaculum. It was first described by Kopell and Thompson [11] in 1960. The term "Tarsal Tunnel Syndrome" was first used independently by Keck [10] and Lam [12] in 1962. The syndrome may be idiopathic or secondary to direct pressure from space-occupying lesions, adhesions following trauma, inflammatory causes or deformities of the foot [1,2,21,24,26,28,30].Onset of symptoms is usually insidious. Patients usually complain of burning pain and numbness, especially on the medial plantar aspect of the foot, in the area served by the affected nerve [18,30]. Tinel's sign is usually positive [3,20,27]. There may be night pain and cramps in the longitudinal arch. Symptoms are related to exercise and maximal at the end of the day [14,21,30]. Diagnosis is made from the history, physical examination and nerve conduction studies. Normal nerve conduction studies, however, may not exclude an entrapment neuropathy [5,7,9,19,22]. In this study, we aimed to assess the factors that affect the outcomes of surgically treated TTS patients, such as different aetiologies, duration of symptoms etc.. Patients and methodsOf 16 patients with TTS who underwent surgery, 12, (13 feet) were available for review at a mean follow-up of 83 (12-143) months. There were nine women and three men, with a mean age of 39.5 (25-57) years and a mean duration of symptoms of 31.9 (2-240) months. In six patients the right foot was involved, five the left and both in one. Tinel's sign was positive pre-operatively in 12 feet and doubtful in one. All pre-operative EMGs, except for one, were consistent with a diagnosis of TTS. The findings were positive for the medial plantar nerve in four feet and for both plantar nerves in eight. There were significant foot deformities in five cases, three of which had pes planus, one splayfoot and one calcaneal fracture. Atrophy and weakness of the plantar muscles was found in one case, whose symptoms were c...

In this study we aimed to determine the role of bone scintigraphy as an objective diagnostic method in patients with heel pain. 67 heels of 50 of 182 patients with defined features who attended the orthopedics outpatient clinic with heel pain over a 3-year period, were treated with combined methods such as nonsteroidal anti-inflammatory drugs (NSAID) and contrast baths, stretching exercises and changing of footwear habits. A one year follow-up was established. The criteria identified by Wolgin et al. were used in assessing the results of the treatment. Subcalcaneal spur was demonstrated by radiography in 44 of the 67 heels. There were two different imaging patterns observed on three phase bone scintigraphy. Type I imaging pattern: Focal increased activity in the heel region or normal activity on dynamic and the blood pool phases and focal increased activity at the inferior calcaneal surface in the late static phase. Type II imaging pattern: Diffuse increased activity along the plantar fascia in the dynamic and the blood pool phase, and focal increased activity at the inferior calcaneal surface in the late static phase. There were 34 (50.7%) type I and 18 (26.8%) type II imaging patterns on the scans. Type I and type II imaging patterns were described as osseous and fascial respectively. At the final examination, the results for pattern type I were good in 16 patients (66.7%), fair in 6 patients (25%) and poor in 2 patients (8.3%), whereas in pattern type II results were good in 12 patients (80%) and fair in 3 patients (20%). The recurrence frequency was 4.1% and 6.6%, respectively. Subcalcaneal spur was determined in 70.5% of the patients with osseous pathology and 55.5% of the patients with fascial pathology. Based on this result, it can be ascertained that calcaneal spurs develop during the pathological process causing heel pain. Other findings supporting this claim were the differences in symptom periods of the patients with type I and type II imaging patterns and scintigraphies were normaly in 10 of 44 heels indicating subcalcaneal spurs on radiographies. These findings suggested that metabolic changes contributing to subcalcaneal spur were complete. Three phase bone scintigraphy is an objective method which can be used to diagnose heel pain, especially when determining the etiological factors and prognosis.

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