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Foot and ankle radiology
Published in Maneesh Bhatia, Essentials of Foot and Ankle Surgery, 2021
Plantar fasciitis is the most common cause of inferior heel pain. Classically present as plantar heel pain, it is exacerbated by passive dorsiflexion and weight-bearing after a period of prolonged rest. The cause of the pain is multifactorial and includes degeneration, microtears and low-grade inflammation of the fascial and perifascial soft tissue (6). Commonly affected groups include obese patients and athletes who perform excessive running. Seronegative spondyloarthropathies, such as ankylosing spondylitis, Reiter syndrome and psoriatic arthritis associated enthesopathy are also known causes of plantar fasciitis (7). The calcaneal spur is best demonstrated on a lateral plain radiograph; however, it is a non-specific finding that is also seen in asymptomatic individuals. US shows hypoechoic fascia with fusiform thickening, defined as being greater than 3 mm in thickness (Figure 22.10).
Paper 1
Published in Amanda Rabone, Benedict Thomson, Nicky Dineen, Vincent Helyar, Aidan Shaw, The Final FRCR, 2020
Amanda Rabone, Benedict Thomson, Nicky Dineen, Vincent Helyar, Aidan Shaw
Which feature is NOT associated with this condition?Calcaneal spurDysphagiaFacet joint ankylosisOssification of the patella tendonPosterior longitudinal ligament calcification
The ankle and foot
Published in David Silver, Silver's Joint and Soft Tissue Injection, 2018
Plantar fasciitis. This painful heel condition is characterised by an acutely tender spot in the middle of the heel pad on standing or walking. There is often a calcaneal spur demonstrated on a radiograph of the heel. This condition may occur in the seronegative arthropathies and should be suspected if the radiograph also demonstrates erosions or a fluffy or irregular calcaneal spur.
Comparison between radial and focused types of extracorporeal shock-wave therapy in plantar calcaneal spur: A randomized sham-controlled trial
Published in The Physician and Sportsmedicine, 2023
Volkan Şah, Şeyhmus Kaplan, Sezai Özkan, Cihan Adanaş, Murat Toprak
Plantar calcaneal spur (PCS), an abnormal bony outgrowth arising from the calcaneal tuberosity, is a common disorder associated with heel pain [1,2]. Its prevalence in the young to middle-aged subjects varies between 11% and 21% across various ethnicities, but increases significantly with aging and in the presence of heel pain and osteoarthritis, up to 55–81% [1]. In addition, obesity, degraded foot biomechanics such as pes planus and foot pronation, repetitive trauma and sport activities, degenerative processes, and inflammatory disorders are risk factors for PCS formation [1,2]. Although there is no standard therapy for PCS, non-surgical treatments, such as nonsteroidal anti-inflammatory medication, local injection of corticosteroids, extracorporeal shock waves, heel pads, stretching exercises, and physical therapy are usually applied. Considering that old and obesity rates will be even higher in the future, PCS also may be a bigger problem.
Low dose ionizing radiation and the immune response: what is the role of non-targeted effects?
Published in International Journal of Radiation Biology, 2021
Annum Dawood, Carmel Mothersill, Colin Seymour
LD-RT has been reported to have an analgesic effect in treating inflammatory conditions such as heel spur pain when a cumulative dose of approximately 5 Gy is used (Schneider et al. 2004; Jansen et al. 2005; Muecke et al. 2007; McKeown et al. 2015). One randomized control trial (RCT) investigated the effect of a very low dose (0.6 Gy) with that of a standard dose (6 Gy) of radiation and found that a low dose did not relieve pain (Niewald et al. 2012). The ending of the trial due to ethical reasons and a small population size (62 patients) were some of the limitations that confounded the results of the RCT. Although the exact mechanism of pain relief action of LD-RT on calcaneal spur remains unknown, few studies have suggested that it modulates inflammatory processes by targeting such functions of endothelial cells, leucocytes, and macrophages which trigger pain inducing reactions (Heyd et al. 2007; Niewald et al. 2012). For instance, leucocytes fail to adhere to the endothelium surface increasing the apoptosis rate in these cells. Macrophages express the inducible nitric oxide synthase (iNOS) which produces NO which regulates cytotoxicity and immuno-modulatory pathways (Rödel et al. 2007). It is suggested that LD-RT may have an inhibitory effect on iNOS activity which diminishes its activity. Furthermore, LD-RT may also target the macrophage induced oxidative burst which has revealed therapeutic potential (0.5 Gy) as reactive oxygen intermediates such as nitrogen oxide production is downregulated (Schaue et al. 2002). As for side effects of LD-RT, a total dose of 3 Gy for treating heel spur induced double-strand breaks (DSBs) in the leucocytes treated patients (Zahnreich et al. 2020). Although the author did not state NTE, this seems like a damage response that occurred by way of a non-targeted mechanism as local radiation was applied.