OBJECTIVE: This study was designed to evaluate the compressibility of heel pads in patients with diabetes mellitus. METHOD: The subject were twenty control subjects and 20 patients with diabetes mellitus diagnosed at least 5 years previously, over the age of 40. The thickness of heel pads was measured by ultrasonography without pressure and with pressure of 1 kg, 2 kg and 3 kg at the line connecting the second toe and the mid-heel point. The ratio of the thickness of the heel pad with pressure of 1 kg, 2 kg, 3 kg and without pressure, R1 (ratio of the thickness of heel pad with 1 kg and without pressure), R2 (2 kg) and R3 (3 kg), was compared between controls and diabetics. RESULTS: There was no significant difference of heel pad thickness between controls and diabetics without pressure in sole. The diabetics had greater ratio, less compressibility than controls (p<0.05). The ratio of the control group was R1; 0.67+/- 0.07, R2; 0.53+/-0.07 and R3; 0.45+/-0.07, whereas that ratio of the diabetic group was R1; 0.80+/-0.09, R2; 0.68+/-0.09 and R3; 0.58+/-0.09. CONCLUSION: The evaluation of compressibility of heel pad of the patients with diabetes mellitus compared with the control group will help to make a treatment of heel pain or discomfort.
Diabetes Mellitus* ; Heel* ; Humans ; Toes ; Ultrasonography

PURPOSE: To evaluate the sonographic findings of plantar fasciitis. MATERIALS AND METHODS: Both feet of 30patients(mean age, 44years) in whom plantar fasciitis had been clinically diagnosed, and those of healthyvolunteers(mean age, 34years) were evaluated with ultrasound(US) using a 7.0MHz linear array transducer. Heel painwas unilateral in 26 patients and bilateral in four. Sagittal sonograms were obtained in the prone position, andthe thickness of the plantar fascia was measured at its proximal end near its insertion into the calcaneus. Wealso evaluated hypoechoic fascia, perifascial fluid collection, fiber rupture, calcaneal spur and calcifications. RESULTS: Plantar fascia thickness was significantly greater in the heels of patients with plantarfasciitis(3.2-8mm; mean, 5.1 +/-1.12) than in their asymptomatic heels(1.3-5mm; mean, 3.5 +/-0.78)(p<0.0001), inwhich it was similar to that of heels of patients in the control group(1.8-5mm; mean, 3.0 +/-0.71)(p<0.0001). Theproximal plantar fascia was hypoechoic in 31 symptomatic heels(91.2%), in four asymptomatic heels(15.4%), and innone of the patients in the control group. Calcaneal spurs were identified in sixteen symptomatic heels(47.1%),and in two which were asymptomatic(7.7%). Perifascial fluid collection was identified in only two symptomaticheels(5.9%). CONCLUSION: In plantar fasciitis, sonography demonstrates that the fascia is thicker as well ashypoechic. For the clinical diagnosis of planter fasciitis, US can therefore be used as an adjunct to clinicaldiagnosis.
Calcaneus ; Diagnosis ; Fascia ; Fasciitis ; Fasciitis, Plantar* ; Foot ; Heel ; Heel Spur ; Humans ; Prone Position ; Rupture ; Transducers ; Ultrasonography*

OBJECTIVE: To investigate and compare the effect of low-dye taping (LDT) and figure-8 modification of LDT (MLDT) on peak plantar pressure and heel pain in patients with heel pad atrophy. METHODS: There were reviewed 32 feet of 19 patients who have been diagnosed with heel pad atrophy who were enrolled in this study. The patients were diagnosed with heel pad atrophy with clinical findings, and loaded heel pad thickness measured by ultrasonography. At the first visit, patients were taught how to do LDT and MLDT. They were instructed to do daily living with barefoot, LDT and MLDT at least one time per day. Patients performed pedobarography with barefoot, LDT and MLDT within 2 weeks. The severity of heel pain was also checked with the visual analogue scale (VAS) during daily living with barefoot, LDT and MLDT. RESULTS: VAS of hindfoot were significantly decreased after LDT and MLDT (p < 0.01). Peak plantar pressure under hindfoot were also decreased after LDT and MLDT (p < 0.01). The effect of MLDT in decreasing peak plantar pressure of hindfoot (p < 0.01) and pain relief (p=0.001) was better than the effect of LDT. CONCLUSION: The LDT technique is clinically useful for pain management and reducing peak plantar pressure of hindfoot in patients with heel pad atrophy. MLDT is more effective than LDT in reducing peak plantar pressure and heel pain in patients with heel pad atrophy.
Atrophy* ; Foot ; Gait ; Heel* ; Humans ; Pain Management ; Ultrasonography

OBJECTIVE: To know the clinically meaningful findings of ultrasonography in plantar fasciitis. METHOD: Thirty one feet of 24 patients who had clinical diagnosis of plantar fasciitis and 70 feet of 35 healthy volunteers were evaluated with ultrasound. Sagittal sonograms were obtained in the prone position, and the plantar fascia thickness (PFT) was measured at proximal end near its insertion into the calcaneus. Hypoechogenecity, perifascial fluid collection, tendon rupture, calcaneal spur and calcification were also evaluated. RESULTS: The plantar fascia thickness (PFT) of the symptomatic heels (SH) of patients group (4.83+/-0.86 mm) was significantly greater than that of their asymtomatic heels (ASH) (2.95+/-0.57 mm)(p<0.05) and it was also greater than that of control group (2.63+/-0.41 mm)(p<0.05). The range of difference of both PFT was 0.7~3.2 mm in patients group and 0~0.8 mm in control group. Hypoechogenecity was found in 22 SH (71%), perifascial fluid collection in 5 SH (16%) and calcification in 2 SH (6%). Calcaneal bony spur was identified in 7 SH (26%) on simple radiography. CONCLUSION: Increased thickness (>3.8 mm), difference of thickness between SH and ASH (>1.0 mm) and hypoecho genecity of plantar fascia were clinically meaningful ultrasonographic findings of plantar fasciitis, and ultrasonogrphy can be used as the inital imaging modality for the diagnosis.
Calcaneus ; Diagnosis ; Fascia ; Fasciitis, Plantar* ; Foot ; Healthy Volunteers ; Heel ; Heel Spur ; Humans ; Prone Position ; Radiography ; Rupture ; Tendons ; Ultrasonography

PURPOSE: This retrospective study was designed to evaluate the appearances of plantar fasciitis by ultrasonography. MATERIALS AND METHODS: 48 cases of unilateral plantar fasciitis were enrolled in this study. Plain radiograph and real- time sonography of both feet were perfomred and the results were compared between the affected feet and controlateral symptomless feet. Calcaneal spur were observed on plain radiograph and thickness of plantar fascia, hypoechogenecity, blurring of border of plantar fascia, perifascial effusion, wavy plantar fascia were observed on sonography. RESULTS: Women (35 cases) and left feet (30 cases) were more frequent than men and right feet. Thickness of plantar fascia in affected site was thicker than normal site (p<0.01). Hypoechogenecity was observed only in 39 cases (81%) affected site, blurring of border of plantar fascia in affected site was 30 cases (62%) and 7 cases (15%) in normal site, perifascial effusion was observed only in 38 cases (79%) affected site, wavy plantar fascia in affected site was 43 cases (90%) and 2 cases (4%) in normal site. Calcaneal spur in affected site was 36 cases (75%) and 33 cases (69%) in normal site. CONCLUSION: Sonography is a useful diagnostic procedure for the plantar fasciitis especially in the unilateral plantar fasciitis.
Fascia ; Fasciitis, Plantar* ; Female ; Foot ; Heel Spur ; Humans ; Male ; Retrospective Studies ; Ultrasonography

The objective of this study is to determine the effectiveness of 16-month milk consumption as a part of the health promotion community program for women in Asan. Subjects included 313 women belonging to the milk group (mean age = 69.1, range 47~89 y) and 66 women to the control (mean age = 43.6, range 20~69 y) group. For those in the milk group, one cup (200ml) of partially lactose-digested low-fat milk was provided everyday for 16 months. Each subject was interviewed to assess calcium intake by a 24-h recall after fasting blood was obtained for analyzing bone turnover markers, and calcaneus broadband ultrasound attenuation (BUA) was measured by quantitative ultrasound (QUS) on the left heel before and after the milk supplementation. After 16 months, the calcium intake levels changed from 55% of recommended dietary allowance (RDA) to 85% RDA in the milk group and from 73% RDA to 84% RDA in the control group. BUA were reduced from 67.9+/-8.1 to 64.7+/-17.5 dB/MHz for milk and from 90.4+/-13.0 to 87.2+/-15.2 dB/MHz for control groups. Paired ttest showed the changes of BUA for both groups (-3.24 and -3.15 dB/MHz for milk and control groups, respectively) were significant, but the two groups did not show any differences in absolute changes. When post-BUA was analyzed after age, initial BUA and menopausal status were controlled as covariates in ANCOVA model, the milk group showed significantly (p < 0.05) smaller changes than the control group (-3.50 vs -6.71 dB/MHz, respectively). According to a multiple regression analysis, milk consumption and initial BUA showed significant interaction meaning that those with lower initial BUA showed higher milk effects. We conclude that one-cup a day milk consumption for 16 month can prevent further bone loss and significantly improve calcium intake.
Calcaneus ; Calcium ; Chungcheongnam-do* ; Fasting ; Female ; Health Promotion ; Heel ; Humans ; Milk* ; Osteocalcin ; Recommended Dietary Allowances ; Ultrasonography*

The authors have used a B-mode real-time sector scanner and a 10-MHz probe for measurement of the skin thickness at 21 different sites in healthy Koreans. Subjects consisted of 35 adults(17 males, 18 females) who were divided into three age groups .' young(20 39 years, 12 subjects), middle-aged(40 59 years, 13 subjects), and old(over 60 years, 10 subjects). The results were as follows. 1, The measurements of the skin thickness in examined sites varied from 1.99 to 4.59 milimeters . flexor aspect of the upper arm, dorsum of the hand, extensor aspect of the forearm and flexor aspect of the forearm were thinner, and heel, upper back, metatarsus were thicker than other sites. 2, The skin thickness in males was generally thicker than that in females '. cheek, extensor aspect of the thigh were highly significantly thicker (p<0.01), and chest, upper back, lower back, flexor aspect of the upper arm and extensor aspect of the lower leg were significantly thicker(p< 0.05) in males than in females, 3. The skin was thickest in the old age groups.
Arm ; Cheek ; Female ; Forearm ; Hand ; Heel ; Humans ; Leg ; Male ; Metatarsus ; Skin* ; Thigh ; Thorax ; Ultrasonography*

PURPOSE: To compare the clinical outcomes of ultrasound-guided percutaneous repair (USPR) and open repair in a ruptured Achilles tendon. MATERIALS AND METHODS: The outcomes of 12 patients with USPR (group A) and 18 patients with open repair (group B) from January 2015 to February 2017 were analyzed retrospectively. The postoperative clinical evaluations were performed using the Arner-Lindholm scale, American Orthopedic Foot and Ankle Society (AOFAS) ankle-hindfoot score, Achilles tendon total rupture score (ATRS), and visual analogue scale for the overall satisfaction and cosmetic satisfaction with the scar, and the starting time of single heel raises. The complications were also evaluated. RESULTS: The Arner-Lindholm scale, AOFAS ankle-hindfoot score, ATRS, starting time of single heel raises were similar in both groups (all p>0.05). Group A showed a significantly higher overall patient's satisfaction and cosmetic satisfaction in than group B (all p < 0.05). Two cases of Achilles tendon elongation were encountered in group A, and 1 case of re-rupture with deep infection and 1 case of superficial infection were experienced in group B. CONCLUSION: USPR showed good clinical outcomes and high satisfaction as well as a low rate of complications, such as sural nerve injury. Therefore, USPR can be considered as an effective surgical treatment option for Achilles tendon ruptures.
Achilles Tendon* ; Ankle ; Cicatrix ; Foot ; Heel ; Humans ; Orthopedics ; Retrospective Studies ; Rupture ; Sural Nerve ; Ultrasonography

PURPOSE: We report the differences of the clinical outcome of various types of plantar fasciitis patients who were treated with conservative methods, and their sonographic findings. MATERIALS AND METHODS: 37 patients, 50 cases with the diagnosis of plantar fasciitis were available for review. The average age was 47.5 years (range: 22-78) and the average follow-up period was 15.8 months (range: 4-23) . Both feet of 30 plantar fasciitis patients and those of 30 healthy volunteers were evaluated with ultrasound. We treated the patients with stretching of Achilles tendon and plantar fascia, rest, nonsteroidal anti-inflammatory drugs, inserts and night splint. RESULTS: Clinical results were classified as good (resolution of symptoms) for 59.5%, fair (continued symptoms but no limitation of activity or work) for 35.1%, and poor (continued symptoms limiting activity or changing work status) for 5.4%. Plantar fascia thickness was significantly greater in the heels of patients with plantar fasciitis (range: 3.2-8.0 mm, average: 5.1 mm, SD: 1.12) than in their asymptomatic heels (range: 1.3-5.0 mm, average: 3.5 mm, SD: 0.78) and in the control group (range: 1.8-5.0 mm, average: 3.0 mm, SD: 0.71) (p< 0.0001) . CONCLUSION: In plantar fasciitis, sonography demonstrates that the fascia is thicker as well as hypoechoic. And there is a higher risk for continued symptoms in patients with bilateral symptoms and those who have symptoms for a prolonged period before seeking medical attention. Therefore plantar fasciitis is thought that it should be vigorously treated as soon as possible before the permanent change of plantar fascia.
Achilles Tendon ; Diagnosis ; Fascia ; Fasciitis, Plantar* ; Follow-Up Studies ; Foot ; Healthy Volunteers ; Heel ; Humans ; Splints ; Ultrasonography*

OBJECTIVE: To investigate the long-term effect of low-energy extracorporeal shock wave therapy (ESWT) for plantar fasciitis (PF) according to ultrasonography (US) findings. METHODS: Thirty feet of 25 patients with clinical diagnosis of PF were enrolled and divided into two groups (Apparent-US and Uncertain-US) according to US findings, such as plantar fascia thickening or hypoechogenicity. Inclusion criteria were symptom duration >6 months and a fair or poor grade in Roles-Maudsley score (RMS). ESWT (0.10 mJ/mm2, 600 shocks) was given once a week for 6 weeks. Numeric rating scale (NRS) and RMS were evaluated prior to each ESWT session, at short-term follow-up (one week after all ESWT sessions) and long-term follow-up telephone interview (mean 24 months after ESWT). Good and excellent grade in RMS were considered as treatment success. RESULTS: Repeated measure ANOVA demonstrated that NRS significantly decreased with time after ESWT up to the long-term follow-up (time effect, p<0.001) without group-time interaction (p=0.641), indicating that ESWT equally decreased pain in both groups. Overall success rate was 63.3% (short-term follow-up) and 80.0% (long-term follow-up). In comparative analysis between groups, success rate of Apparent-US and Uncertain-US at short-term follow-up was 61.9% and 66.7%, respectively, and 85.7% and 66.7%, respectively, at long-term follow-up. CONCLUSION: If other causes of heel pain are ruled out through meticulous physical examination and ultrasonography, low-energy ESWT in PF seems to be beneficial regardless of US findings. In terms of success rate, however, long-term outcome of Apparent-US appears to be superior to Uncertain-US.
Diagnosis ; Fascia ; Fasciitis, Plantar* ; Follow-Up Studies ; Foot ; Heel ; Humans ; Interviews as Topic ; Physical Examination ; Shock* ; Treatment Outcome ; Ultrasonography