Achilles Tendon Rupture
Kauranen K, Kangas J, Leppilahti J. Recovering motor performance of
the foot after Achilles rupture repair: a randomized clinical study about
early functional treatment vs. early immobilization of Achilles tendon in
tension. Foot Ankle Int. 2002;23:600-5.
The authors evaluated thirty patients in whom an acute, complete, closed
Achilles tendon rupture was repaired with Kessler sutures with an aponeurosis
flap. The patients were randomized to treatment with immobilization in a
plaster cast or an active brace. Measurements were made at twelve and
twenty-four weeks postoperatively. There were no significant differences
between the involved extremity and the contralateral, uninvolved lower
extremity, regardless of immobilization technique, with regard to reaction
time, speed of movement, tapping speed, anterior-posterior coordination, or
lateral coordination at twenty-four weeks. Lateral coordination in the
plaster-cast group was better than that in the active-brace group at twelve
weeks, but this difference was not present at twenty-four weeks.
Ankle Injuries
Kerkhoffs GM, Handoll HH, de Bie R, Rowe BH, Struijs PA. Surgical
versus conservative treatment for acute injuries of the lateral ligament
complex of the ankle in adults. Cochrane Database Syst Rev.
2002;3:CD000380.
The authors reviewed seventeen studies involving a total of 1950 mostly
young, active, adult males. Outcome measures were variously defined, and data
for pooling for individual outcomes were only available for a maximum of
eleven studies. The authors concluded that there were no significant
differences between conservative and surgical treatment with regard to three
primary outcome measures (nonreturn to preinjury level of sports, undefined
pain or pain with activity, and subjective or functional instability) after
modification of the analyses with use of the random effects model. There also
was no significant difference with regard to ankle sprain recurrence, the
other primary outcome measure.
Van Der Windt DA, Van Der Heijden GJ, Van Den Berg SG, Ter Riet G, De
Winter AF, Bouter LM. Ultrasound therapy for acute ankle sprains.
Cochrane Database Syst Rev. 2002;1:CD001250.
None of the four placebo-controlled trials that were reviewed by the
authors demonstrated a significant difference between true and sham ultrasound
therapy for any outcome measure after seven to fourteen days of follow-up. The
authors concluded that the extent and quality of the available evidence
regarding the effects of ultrasound therapy for acute ankle sprains is
limited.
Kerkhoffs GM, Struijs PA, Marti RK, Assendelft WJ, Blankevoort L, van
Dijk CN. Different functional treatment strategies for acute lateral ankle
ligament injuries in adults. Cochrane Database Syst Rev.
2002;3:CD002938.
The authors reviewed nine trials involving 892 participants with regard to
the results of different functional treatment methods for acute lateral ankle
ligament injuries. Use of a semirigid ankle support resulted in a shorter time
to return to work compared with use of an elastic bandage. Participants who
wore a lace-up ankle support had less persistent swelling at short-term
follow-up when compared with participants who wore a semi-rigid ankle support,
elastic bandage support, or tape support. Tape treatment resulted in
significantly more complications, usually skin irritation, when compared with
treatment with an elastic bandage.
Pijnenburg AC, Glas AS, De Roos MA, Bogaard K, Lijmer JG, Bossuyt PM,
Butzelaar RM, Keeman JN. Radiography in acute ankle injuries: the Ottawa
Ankle Rules versus local diagnostic decision rules. Ann Emerg Med.
2002;39:599-604.
The authors evaluated 647 patients with a painful ankle after trauma. They
diagnosed seventy-four ankle fractures (forty-one of which were clinically
important) with the Ottawa Ankle Rules and with two local Dutch ankle rules in
an effort to validate each set of diagnostic criteria. The Ottawa Ankle Rules
had a sensitivity of 98% for the identification of clinically important
fractures, whereas the local rules had sensitivities of 88% and 59%. Use of
the Ottawa Ankle Rules also resulted in fewer radiographs being ordered
compared with the other two sets of rules. The authors concluded that the
Ottawa Ankle Rules are the most suitable for implementation in The
Netherlands.
Plantar Fasciitis
Porter D, Barrill E, Oneacre K, May BD. The effects of duration and
frequency of Achilles tendon stretching on dorsiflexion and outcome in painful
heel syndrome: a randomized, blinded, control study. Foot Ankle Int.
2002;23:619-24.
A prospective, randomized, blinded study of ninety-four patients (122
affected heels) was performed in an effort to determine the optimal duration
and frequency of Achilles tendon stretching exercises to reduce the pain
associated with painful heel syndrome. The patients were randomized into two
groups. One group performed sustained stretches (three minutes, three times
daily). The second group performed intermittent stretches (five sets, twenty
seconds each, two times daily). The outcome measures were increased Achilles
tendon flexibility and decreased pain. Both types of stretching increased
flexibility and decreased pain. There was no significant difference in outcome
between the two groups. Both types of stretching were effective nonsurgical
treatments for painful heel syndrome.
Hammer DS, Rupp S, Kreutz A, Pape D, Kohn D, Seil R. Extracorporeal
shockwave therapy (ESWT) in patients with chronic proximal plantar fasciitis.
Foot Ankle Int. 2002;23:309-13.
In this study, extracorporeal shock-wave therapy was compared with a
conservative regimen (consisting of nonsteroidal anti-inflammatory
medications, use of a heel cup, use of an orthosis, local steroid injections,
and electrotherapy) for the treatment of chronically painful proximal plantar
fasciitis. Forty-seven patients (forty-nine feet) who had had a failure of at
least six months of conservative treatment were randomized into two groups.
The first group (twenty-five heels) underwent immediate extracorporeal
shock-wave therapy with three sessions performed at weekly intervals, and the
other group (twenty-four heels) continued to be treated conservatively for
another twelve weeks. No significant differences in pain or walking time were
seen after twelve weeks of conservative treatment in the second group. The
patients in the second group then were managed with the extracorporeal
shock-wave therapy protocol. Both groups had improved visual analog scale
scores and increased comfortable walking time after extracorporeal shock-wave
therapy.
Rompe JD, Schoellner C, Nafe B. Evaluation of low-energy
extracorporeal shock-wave application for treatment of chronic plantar
fasciitis. J Bone Joint Surg Am. 2002;84:335-41.
The authors compared two methods of administering low-energy shock-wave
therapy. Group I (forty-nine patients) underwent three applications of 1000
impulses of low-energy shock waves, and Group II (forty-eight patients)
underwent three applications of ten impulses of low-energy shock waves. At six
months, the visual analog scale scores for Group I were significantly better
than those for Group II. In addition, twenty-five of the forty-nine patients
in Group I were able to walk without pain at six months, compared with zero of
the forty-eight patients in Group II. By five years, many of the patients in
Group II had had surgery, thus improving the overall outcomes in Group II and
decreasing the differences between the groups. The authors concluded that
treatment with three applications of 1000 impulses of low-energy shock waves
appears to be effective therapy for plantar fasciitis and may help patients
avoid surgery for heel pain.
Diabetes
Smith J. Débridement of diabetic foot ulcers. Cochrane
Database Syst Rev. 2002;4:CD003556.
This author evaluated five randomized, controlled trials on methods of
débridement of diabetic foot ulcers. Three trials involved the use of a
hydrogel débridement technique, and the pooled data suggested that
hydrogels are significantly more effective than gauze or standard care for the
treatment of diabetic foot ulcers. The other trials that were evaluated were
small and did not have significant results.
Reiber GE, Smith DG, Wallace C, Sullivan K, Hayes S, Vath C, Maciejewski
ML, Yu O, Heagerty PJ, LeMaster J. Effect of therapeutic footwear on foot
reulceration in patients with diabetes: a randomized controlled trial.
JAMA. 2002;287:2552-8.
The authors evaluated 400 diabetes patients with history of foot ulcers
randomized into three groups. One group (121 patients) received three pairs of
therapeutic shoes and three pairs of custom cork inserts with a neoprene
closed-cell cover. The second group (119 patients) received three pairs of
therapeutic shoes and three pairs of prefabricated, tapered polyurethane
inserts with a brushed nylon cover. The control group (160 patients) wore
their usual footwear. The main outcome measure was foot reulceration. The
two-year cumulative rates of reulceration were low in all three groups (15%,
14%, and 17%, respectively). Therapeutic shoes and custom cork or preformed
polyurethane inserts conferred no significant reduction in the rate of ulcer
recurrence compared with the rate in the control group.
van Schie CH, Whalley A, Armstrong DG, Vileikyte L, Boulton AJ. The
effect of silicone injections in the diabetic foot on peak plantar pressure
and plantar tissue thickness: a 2-year follow-up. Arch Phys Med
Rehabil. 2002;83:919-23. Twenty-eight patients with diabetic neuropathy
were randomized into an active treatment group (fourteen patients), in which
six injections of 0.2 mL of liquid silicone were given under the metatarsal
head sites with callus, and a placebo group (fourteen patients), in which
equal volumes of saline solution were injected. Plantar tissue thickness and
plantar pressures were measured at three, six, twelve, and twenty-four months.
Plantar tissue thickness remained increased in the silicone group at twelve
and twenty-four months. Plantar pressure was reduced in the silicone group at
twelve months but not at twenty-four months. However, when considered along
with the measured increase in plantar pressure in the placebo group at
twenty-four months, the baseline plantar pressure in the silicone group at
twenty-four months showed that the silicone may still retain some
pressure-reducing properties.