OBJECTIVES: This study compared foot arch height, plantar fascia thickness, a range of motion assessments of the ankle joint, strength of the ankle joint, plantar pressure, and balance between obese and normal weight young adults. METHODS: Fifty-two participants were required for the present study design to achieve 80% power, 0.8 effect size (η2), and an alpha level of 0.05. The participants were categorized to normal weight or obese groups based on BMI (≤ 24 kg/m2 and ≥ 25 kg/m2, respectively). The foot and ankle disability index and Sport survey were completed by the participants before the measurements. Foot arch height was measured using the navicular drop test, and plantar fascia thickness was measured using ultrasound. Plantar pressure and balance tests were also conducted, followed by ankle joint range of motion and strength tests. RESULTS: Foot arch height and plantar fascia thickness was significantly higher in the obese group compared with the normal weight group (p < 0.01). There were significant differences in eversion of ankle strength, plantar pressure in the big toe and heel and anterior-posterior balance between normal and obese weight groups (p < 0.05). CONCLUSION: Obese young adults had more abnormalities in the medial longitudinal arch, plantar fascia, and plantar pressure as well as weakened ankle eversion strength and balance problems compared with the normal weight group.
Ankle ; Ankle Joint ; Body Mass Index ; Fascia ; Foot ; Hallux ; Heel ; Humans ; Obesity ; Range of Motion, Articular ; Sports ; Ultrasonography ; Young Adult

PURPOSE: To analyze the correlation between a rupture of the hypovascular zone and early single heel raising after Achilles tendon repair. MATERIALS AND METHODS: From January 2012 to August 2015, 68 patients, who underwent surgical treatment for a Achilles tendon rupture using Krackow method, were analyzed retrospectively. The patients were divided into two groups according to possibility of single heel raises within 3 months postoperatively. During the periodic outpatient observations, the visual analogue scale, Achilles tendon total rupture score (ATRS), and timing capable single heel raises were evaluated. In addition, the preoperative defect size and distance between the calcaneal osteotendinous junction and the rupture site were measured by ultrasound in all cases. RESULTS: Twenty-three patients could perform a single heel raise within 3 months after surgery (early single heel raise group), and forty-five patients could perform a single heel raise after 3 month postoperatively. The age, gender, body mass index, smoking, and operation delay were similar in the two groups. In addition, the defect size and distance between the calcaneal osteotendinous junction and rupture site as measured by preoperative ultrasound were similar (p=0.379 and p=0.631, respectively). On the other hand, when the rupture site was divided into the hypovascular zone (4~7 cm from calcaneal osteotendinous junction) and non-hypovascular zone, the hypovascular zone rupture rate was significantly lower in the early single heel raise group (60.9%, 14/23; 91.1%, 41/45; p=0.003). In logistic regression analysis, the odds of the hypovascular zone rupture group being capable of early single heel raise were 0.189 (p=0.017). The ATRS score at 3 months and 1 year after surgery were significantly higher in the early single heel raise group (p < 0.001). CONCLUSION: Achilles tendon rupture at the hypovascular zone is a poor prognostic factor for early single heel raise and might affect the prognosis significantly after an Achilles tendon rupture operation.
Achilles Tendon* ; Body Mass Index ; Hand ; Heel* ; Humans ; Logistic Models ; Methods ; Outpatients ; Prognosis ; Retrospective Studies ; Rupture* ; Smoke ; Smoking ; 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

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

Plantar fasciitis is a common cause of heel pain in adults. Although it is usually a self-limiting condition, the pain may become prolonged and severe enough to cause significant distress and disruption to the patient's daily activities and work. PubMed and Cochrane Central Register of Controlled Trials databases were searched for randomised controlled trials (RCTs) and a total of ten RCTs were selected for evaluation. These RCTs involved the use of either palpation- or ultrasonography-guided corticosteroid injections in patients diagnosed with plantar fasciitis. All placebo-controlled RCTs showed a significant reduction in pain with the use of corticosteroid injections. Some studies also showed that corticosteroid injections yielded better results than other treatment modalities. However, it is evident from these studies that the effects of corticosteroid injections are usually short-term, lasting 4-12 weeks in duration. Complications such as plantar fascia rupture are uncommon, but physicians need to weigh the treatment benefits against such risks.
Adrenal Cortex Hormones ; administration & dosage ; therapeutic use ; Adult ; Evidence-Based Medicine ; Fasciitis, Plantar ; drug therapy ; Heel ; injuries ; Humans ; Middle Aged ; Pain ; drug therapy ; Pain Measurement ; Palpation ; Patient Satisfaction ; Randomized Controlled Trials as Topic ; Rupture ; Treatment Outcome ; 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

PURPOSE: The purpose of the study was to investigate five cases with chronic Achilles tendon rupture that occurred after steroid injections. MATERIALS AND METHODS: In our hospital, we experienced five cases of chronic Achilles tendon rupture from September 2010 to March 2012. All patients had got steroid injection for Achilles tendinitis at the other hospitals, and their heel pain was aggravated when they visited our outpatient department. After treatment, signs and symptoms of Achilles tendon rupture were developed and the diagnosis was confirmed by ultrasonography or magnetic resonance imaging (MRI). Surgical treatment was done for Achilles tendon rupture. RESULTS: There was difference between intra-operative findings of Achilles tendon rupture and usual chronic Achilles tendon rupture. Unlike usual findings of chronic Achilles tendon rupture whose scar tissue or tissue attenuation are found around the defect area of Achilles tendon, there were partial necrosis of tendon severe adhesion with surrounding tissue, extensive defect and longitudinal rupture on ruptured area. Also, severe inflammation of paratenon, granulation and fibrinoid deposit were found on biopsy findings in four cases. CONCLUSION: Based on review of data about relative risk and benefit of local corticosteroid injection to inflammatory lesion in Achilles tendon, it requires more attention to Achilles tendon rupture following local corticosteroid injection.
Achilles Tendon* ; Biopsy ; Cicatrix ; Diagnosis ; Heel ; Humans ; Inflammation ; Magnetic Resonance Imaging ; Necrosis ; Outpatients ; Rupture* ; Tendinopathy* ; Tendons ; Ultrasonography

To identify a proper T-score threshold for the diagnosis of osteoporosis in Koreans using quantitative ultrasonography (QUS), normative data from 240 females and 238 males (ages 20-29 yr) were newly generated. Then, the osteoporosis prevalence estimate for men and women over 50 yr of age was analyzed using previous World Health Organization (WHO) methods and heel QUS. T-scores were calculated from the normative data. There were definite negative correlations between age and all of the QUS parameters, such as speed of sound (SOS), broadband ultrasound attenuation (BUA), and estimated heel bone mineral density (BMD) (p<0.0001). After applying the recently determined prevalence of incident vertebral fracture in Koreans over 50 yr of age (11.6% and 9.1%, female vs male, respectively) to the diagnosis of osteoporosis by T-scores from heel BMD as measured by QUS, it was revealed that applicable T-scores for women and men were -2.25 and -1.85, respectively. These data suggest that simply using a T-score of -2.5, the classical WHO threshold for osteoporosis, underestimates the true prevalence when using peripheral QUS. Further prospective study of the power of QUS in predicting the absolute risk of fracture is needed.
Absorptiometry, Photon ; Adult ; Aged ; Aged, 80 and over ; Bone Density/physiology ; Female ; Fractures, Bone/diagnosis/epidemiology ; Heel/ultrasonography ; Humans ; Korea ; Male ; Middle Aged ; Osteoporosis/diagnosis/*ultrasonography ; Reference Values ; Risk ; Severity of Illness Index ; Young Adult

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*

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