Heelys and street gliders injuries: a new type of pediatric injury.
(49/147)
OBJECTIVES: Our goals were to highlight an increasing trend in orthopedic injuries in children as a result of "heeling" or "street gliding," to describe injuries sustained by children using Heelys (HSL, Carrollton, TX) and Street Gliders (Glowgadgets Ltd, Bristol, United Kingdom), and to increase public awareness and prevent such injuries. PATIENTS AND METHODS: We prospectively recorded the data of all roller shoes injuries referred to our department during the summer school holiday. Using a data-collection sheet, we recorded demographic data, type of injury, mechanism and place of injury, heeling or street-gliding experience, use of safety equipment, methods of treatment, and intention to continue heeling or street gliding after recovery from injury. RESULTS: Over a 10-week period, 67 children suffered orthopedic injuries while using Heelys or Street Gliders. There were 56 girls and 11 boys with a mean age of 9.6 years. Upper limbs were the most common location of injury. Distal radius fractures were the most prevalent, followed by supracondylar fractures, elbow dislocations, and hand fractures. The majority of children suffered the injury while heeling or street gliding outdoors. Interestingly, 20% of the injuries happened while trying Heelys or Street Gliders for the first time, and 36% of the injuries occurred while learning (using 1-5 times) how to use them. None of the children used any sort of protective gear at the time of the injury. The majority of the injured children expressed their intention to continue heeling or street gliding after complete recovery from their injury. CONCLUSIONS: Our study shows that the majority of children with injuries from heeling or street gliding are girls. We recommend close supervision of children using Heelys or Street Gliders during the steep learning curve and usage of protective gear at all times. These new types of injuries have a serious impact on child health and constitute a burden for the pediatric orthopedic service. (+info)
Plantar fasciitis: are pain and fascial thickness associated with arch shape and loading?
(50/147)
BACKGROUND AND PURPOSE: Although plantar fascial thickening is a sonographic criterion for the diagnosis of plantar fasciitis, the effect of local loading and structural factors on fascial morphology are unknown. The purposes of this study were to compare sonographic measures of fascial thickness and radiographic measures of arch shape and regional loading of the foot during gait in individuals with and without unilateral plantar fasciitis and to investigate potential relationships between these loading and structural factors and the morphology of the plantar fascia in individuals with and without heel pain. SUBJECTS: The participants were 10 subjects with unilateral plantar fasciitis and 10 matched asymptomatic controls. METHODS: Heel pain on weight bearing was measured by a visual analog scale. Fascial thickness and static arch angle were determined from bilateral sagittal sonograms and weight-bearing lateral foot roentgenograms. Regional plantar loading was estimated from a pressure plate. RESULTS: On average, the plantar fascia of the symptomatic limb was thicker than the plantar fascia of the asymptomatic limb (6.1+/-1.4 mm versus 4.2+/-0.5 mm), which, in turn, was thicker than the fascia of the matched control limbs (3.4+/-0.5 mm and 3.5+/-0.6 mm). Pain was correlated with fascial thickness, arch angle, and midfoot loading in the symptomatic foot. Fascial thickness, in turn, was positively correlated with arch angle in symptomatic and asymptomatic feet and with peak regional loading of the midfoot in the symptomatic limb. DISCUSSION AND CONCLUSION: The findings indicate that fascial thickness and pain in plantar fasciitis are associated with the regional loading and static shape of the arch. (+info)
Calcanisation of tibia using Ilizarov fixator in crush injuries of hindfoot: a new method.
(51/147)
Crush injuries of the foot are one of the most difficult and challenging tasks for a trauma surgeon to manage in terms of limb salvage and provision of a painless functional foot. Injuries to the foot, especially the hindfoot, account for almost 24.6% of all the warfare injuries in Afghanistan, of which more than 70% end in amputation for various reasons. We devised a method using the principles of Ilizarov's distraction osteosynthesis to salvage limbs with bony defects in the hindfoot which otherwise were candidates for amputation. The procedure is done in two stages. Initially, the ring fixator is applied for the soft tissue reconstruction and infection control, and the next stage consists of percutaneous "inverted L"-shaped osteotomy in the posterior half of the lower tibia. The study included 32 patients with hindfoot crush injuries involving talus, calcaneum, a combination of both, or even involving the adjacent tarsal bones. All these crush injuries were classified using the Gustilo and Anderson classification. The postoperative functional assessment of the feet was done using the Maryland Foot Score system with a minimum follow-up of four years. We had good results in 53%, fair in 34% and failure in 13% of our cases. The complications of this procedure were the same as with the use of the ring fixator elsewhere in the body. This method provides a technique to salvage the foot and produce a painless, stable, fused foot in one of the most difficult settings of a hindfoot crush injury. (+info)
Chronic psoas syndrome caused by the inappropriate use of a heel lift.
(52/147)
Heel lifts are commonly recommended for patients to manage the pain and discomfort of leg length discrepancies. However, used inappropriately, orthotics can create additional pain instead of alleviating it. In the case described, a 79-year-old male physician used a recommended heel lift for a perceived leg length discrepancy after right hip arthroplasty. Six months postsurgery, chronic, intractable pain developed in his hip and groin. He underwent a battery of tests to locate the pain, but its source remained elusive. Osteopathic evaluation and radiographic examination revealed an absence of leg length discrepancy and the presence of chronic psoas syndrome. Osteopathic manipulative treatment was prescribed and heel lift therapy discontinued, and the patient reported complete remission from pain. (+info)
The effects of 10% front load carriage on the likelihood of slips and falls.
(53/147)
The objective of the present study was to evaluate if anterior load carriage would increase the likelihood of slips or falls while walking over a slippery floor surface. The study hypothesized that anterior load carriage may alter spatial-temporal characteristics, such as heel contact velocity, walking velocity (i.e., the whole body center-of-mass velocity), and step length, as well as friction demand characteristics at shoe-floor interface. Additionally, the study hypothesized that alterations in these gait parameters may influence slip initiation characteristics while ambulating over a slippery floor surface. Total of 10 subjects participated in the study: 5 younger (18-28 yr old) and 5 older adults (65 and older). A mixture was used to manipulate the coefficient of friction (COF) of the floor surface. All participants were unexpectedly introduced to a slippery surface while walking with and without a load. To evaluate slip severity, slip distance I and II were evaluated to assess whether a subject fell or not. Three-way repeated measure ANOVA (mix-factor design) was performed: Age factor: between-subject, Load and Floor factors: within-subject. Overall, older adults' heel contact velocity was slower while carrying a load. Additionally, all participants exhibited shorter SL while carrying a load. No significant friction demand characteristic differences were observed for all subjects while carrying a 10% front load. The results from the present study suggest that carrying 10% of the body weight in front should not intensify the slip propensity and severity although appears to influence spatial-temporal gait characteristics. (+info)
Barefoot-pedestrian tribometry: in vivo method of measurement of available friction between the human heel and the walkway.
(54/147)
We have developed an in vivo tribometer for characterizing the friction of a human heel against a planar test surface. The pedestrian steps down on an angled test surface and an observer determines if the person's heel slips. In the simplest variation, the subject simply steps down onto the test surface. The second variation has the standing subject's lower leg constrained to a vertically running carriage, forcing the pedestrian's leg to descend vertically. The third variation has the subject sitting, with an operator raising and lowering the carriage to which the leg is attached. The test surface was fixed at a given angle, a set of repeated tests was run, and the number of tests and slips were recorded. The test-surface angle was incremented through a range that varied from no slips to all slips. We analyzed the data using logistic regression. We found that the unconstrained test subject's logistic-regression curves varied greatly from subject to subject. The standing, constrained subjects were significantly closer to each other, but at the expense of a much higher spread of the angular range. The seated, constrained test subject's results were both extremely close and had extremely low angular spread. (+info)
Decreasing the incidence of heel pressure ulcers in long-term care by increasing awareness: results of a 1-year program.
(55/147)
Heel pressure ulcers are a major problem in healthcare today. They involve extended clinician time, patient discomfort, and increased healthcare costs. In an attempt to decrease the incidence of heel pressure ulcers in one long-term care facility, a 1-year program was implemented that involved residents of one long-term care unit. In addition to staff education and awareness interventions, residents' heels were assessed daily and heel pressure-relieving measures were implemented. Kites were used to identify pressure ulcer stage, photo posters helped staff visualize the stages of heel pressure ulcers, and pencils marked with "Float Heels" were used to remind staff of the importance of prevention. Ulcer incidence rates were calculated every month. All residents (n = 40, mean age 67 years) on the unit at the beginning of the program were followed for as long as they were in the facility. At the start of the program, 50% of residents were at risk for developing ulcers and 22.5% had a heel ulcer. While the at-risk profile of residents remained relatively unchanged, no new ulcers were documented during nine of the subsequent 13 months, with incidence rates in the other 4 months ranging from 2.6% to 9.1%. Program costs were minimal and the results seem to confirm previously published studies about the positive effects of a comprehensive approach to the pressure ulcer problem. (+info)
How well do clinical pain assessment tools reflect pain in infants?
(56/147)