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An Aggressively Recurrent Squamous Cell Carcinoma of the Foot. 侵袭性复发性足部鳞状细胞癌
IF 0.5 4区 医学 Q4 ORTHOPEDICS Pub Date : 2024-07-01 DOI: 10.7547/21-044A
Arthur Tarricone, Allen Gee, Karla De La Mata, Wayne Axman, Cristina Buricea, Michael Trepal, Prakash Krishnan

Squamous cell carcinoma is a malignant tumor that is most commonly found on the head and neck. The current global incidence of squamous cell carcinoma at any site is estimated to be more than 1 million cases per year, with a reported 3-year mortality rate of 30%. Recurrence of squamous cell carcinoma at any site is estimated to be 15% to 50% and has been associated with greater rates of infiltration, perineural invasion, and mortality. Recent studies have shown lower-extremity squamous cell carcinoma to be distinct from squamous cell carcinoma at any site with histologic and clinical differences. Lower-extremity squamous cell carcinoma is suggestively less aggressive and carries less risk of metastasis. However, lower-extremity squamous cell carcinoma prevalence, mortality, and recurrence rates have not been extensively studied. The present report depicts a case of recurrent squamous cell carcinoma originating in 2006 in the dorsal forefoot and provides the clinical management of subsequent recurrence episodes, with excisions from 2015 and 2020.

鳞状细胞癌是一种恶性肿瘤,最常见于头颈部。据估计,目前全球每年任何部位的鳞状细胞癌发病率超过 100 万例,3 年死亡率为 30%。据估计,任何部位的鳞状细胞癌复发率为 15%至 50%,并且与浸润、神经周围侵犯和死亡率较高有关。最近的研究表明,下肢鳞状细胞癌与任何部位的鳞状细胞癌在组织学和临床上都有所不同。下肢鳞状细胞癌的侵袭性较低,转移风险也较小。然而,下肢鳞状细胞癌的发病率、死亡率和复发率尚未得到广泛研究。本报告描述了一例2006年起源于前足背侧的复发性鳞状细胞癌,并提供了2015年和2020年切除的后续复发病例的临床治疗方法。
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引用次数: 0
Clinical and Medical Imaging Findings of the Forefoot Following a COVID-19 Infection: A Case Report. COVID-19 感染后前足的临床和医学影像检查结果:病例报告。
IF 0.5 4区 医学 Q4 ORTHOPEDICS Pub Date : 2024-07-01 DOI: 10.7547/22-104
Dominick Casciato, Randall Thomas, Joshua Houser

Since the beginning of the SARS-CoV-2 pandemic, manifestations of the COVID-19 virus have been reported throughout the body, visible both clinically and radiographically. In the foot and ankle, one such phenomenon presents as cutaneous changes associated with neuralgia to the digits. Although rare, emerging reports described similar manifestations of COVID-19 in the foot, though limited to superficial structures. In this case report, we present a 52-year-old male experiencing burning pain and hyperpigmented lesions to the digits of his left foot 2 weeks prior to a formal diagnosis with COVID-19. Advanced imaging showed a third interspace neuroma as well as distal-to-proximal bone marrow edema in the distal phalanx of all digits, a pattern seen in vasculopathies, 4 weeks after diagnosis. In the absence of diabetes mellitus or peripheral vascular disease, the patient underwent a simple neurectomy. At the follow-up appointment 12 weeks after the initial encounter, his symptoms resolved. Our study reports a case describing osseous along with cutaneous manifestations in the foot of a patient with COVID-19.

自 SARS-CoV-2 大流行开始以来,COVID-19 病毒的表现已遍布全身,在临床和影像学上均可见。在足部和踝部,其中一种表现为与手指神经痛相关的皮肤变化。尽管罕见,但新出现的报告也描述了 COVID-19 在足部的类似表现,不过仅限于浅表结构。在本病例报告中,我们介绍了一名 52 岁的男性,在被正式诊断为 COVID-19 前两周,他的左脚手指出现灼痛和色素沉着病变。诊断 4 周后,高级影像学检查显示其所有指骨远端均出现第三间隙神经瘤和从远端到近端的骨髓水肿,这在血管性疾病中很常见。在没有糖尿病或外周血管疾病的情况下,患者接受了简单的神经切除术。在初次就诊 12 周后的复诊中,他的症状得到了缓解。我们的研究报告了一个病例,该病例描述了 COVID-19 患者足部的骨性表现和皮肤表现。
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引用次数: 0
Joint Preserving Limb Salvage Secondary to Septic Nonunion Following Placement of a Fibular Intramedullary Nail: A Case Report. 腓骨髓内钉置入后继发化脓性骨不连的关节保留肢体抢救:病例报告。
IF 0.5 4区 医学 Q4 ORTHOPEDICS Pub Date : 2024-07-01 DOI: 10.7547/22-079
Kenny Luong, Christopher Bergen, Michael Huchital, Michael Subik

Several challenges exist for the foot and ankle surgeon when addressing the complications associated with ankle fracture repair. The risk of joint destruction, debilitation, and even limb loss may be amplified by the noncompliant patient. There is an abundance of literature documenting the management of fracture nonunions in the setting of infection with a variety of techniques proven successful in managing large osseous defects and eradicating infection. We present a particularly challenging case in which we modified an existing method of treatment to preserve the ankle joint of a failed reduction complicated by septic nonunion following placement of a fibular intramedullary nail.

足踝外科医生在处理与踝关节骨折修复相关的并发症时面临着一些挑战。患者不服从治疗可能会增加关节破坏、衰弱甚至肢体缺失的风险。有大量文献记录了在感染情况下处理骨折不愈合的方法,其中有多种技术被证明能成功处理大面积骨缺损并根除感染。我们介绍了一个特别具有挑战性的病例,在该病例中,我们对现有的治疗方法进行了修改,以保留腓骨髓内钉置入后因化脓性骨不连而并发的骨折复位失败的踝关节。
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引用次数: 0
Walking Bike as an Effective Tool to Reduce Plantar Peak Pressure in Diabetes Mellitus. 步行自行车是降低糖尿病患者足底峰压的有效工具
IF 0.5 4区 医学 Q4 ORTHOPEDICS Pub Date : 2024-07-01 DOI: 10.7547/22-127
Ulrich Illgner, Alexander Mehlhorn, Nani Osada, Veit Krenn, Franz Landauer

Background: Foot ulcers and infections are a major and costly problem in patients with diabetes and a major cause of amputations. Plantar peak pressure plays an essential role in plantar ulceration. Off-loading is a common tool to reduce plantar peak pressure and risk of ulceration. The goal of this study was to determine whether reduction of plantar peak pressure can be achieved using a walking bike (a bike without pedals) compared with walking.

Methods: The study starts with a PubMed literature review. In a blinded prospective protocol, 14 healthy individuals (seven men, seven women; mean ± SD age, 39.5 ± 11.3 years) are included. In-shoe pedobarography sensors were attached between the skin and the standardized shoes, then participants walked 10 m three times and then moved over the same distance using a walking bike without removal of the sensor (three times) in a gait laboratory (84 measurements).

Results: In this single-blinded prospective study, mean ± SD plantar peak pressure was significantly reduced from 49.4 ± 12.9 N/cm2 with walking to 35.2 ± 14.6 N/cm2 using a walking bike (P = .003). Mean ± SD step length increased significantly from 0.68 ± 0.13 m to 0.91 ± 0.19 m (P < .001) due to a significantly reduced number of steps (from 7.7 ± 1.4 steps per 10 m of walking to 5.7 ± 1.1 steps per 10 m of using a walking bike; P < .001).

Conclusions: Plantar peak pressure is a risk factor for ulceration in diabetes. Herein, a significant reduction of plantar peak pressure was seen using a walking bike compared with walking (P = .003). Walking bikes may be a tool for off-loading for diabetic patients, especially if both feet are ulcerated. Additional studies to validate these findings in patient care are planned.

背景:足部溃疡和感染是糖尿病患者的主要问题,代价高昂,也是截肢的主要原因。足底峰值压力在足底溃疡中起着至关重要的作用。负重是降低足底峰值压力和溃疡风险的常用工具。本研究的目的是确定与步行相比,步行自行车(无踏板的自行车)能否降低足底峰值压力:研究首先对 PubMed 上的文献进行了回顾。在盲法前瞻性方案中,14 名健康人(7 名男性,7 名女性;平均 ± SD 年龄,39.5 ± 11.3 岁)参与了研究。在皮肤和标准鞋之间安装了鞋内足底照相传感器,然后参与者步行 10 米三次,然后在步态实验室使用步行自行车移动相同距离(三次),不移除传感器(84 次测量):在这项单盲前瞻性研究中,平均±标准值足底峰值压力从步行时的 49.4 ± 12.9 牛顿/平方厘米显著降低到使用步行自行车时的 35.2 ± 14.6 牛顿/平方厘米(P = .003)。平均±标准步长从 0.68 ± 0.13 米显著增加到 0.91 ± 0.19 米(P < .001),原因是步数显著减少(从步行每 10 米 7.7 ± 1.4 步减少到使用步行自行车每 10 米 5.7 ± 1.1 步;P < .001):结论:足底峰值压力是糖尿病患者溃疡的风险因素。结论:足底峰值压力是糖尿病患者溃疡的危险因素。在这里,与步行相比,使用步行自行车可明显降低足底峰值压力(P = .003)。健步自行车可能是糖尿病患者减轻负重的一种工具,尤其是在双脚溃疡的情况下。我们还计划进行更多的研究,以在患者护理中验证这些发现。
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引用次数: 0
Orthoses Effect on Radiographic Measurements of Hallux Abducto Valgus: A Systematic Review. 矫形器对拇指内收外翻放射学测量的影响:系统回顾
IF 0.5 4区 医学 Q4 ORTHOPEDICS Pub Date : 2024-07-01 DOI: 10.7547/23-171
Patrick A DeHeer, Niral A Patel, William Wolfe, Bethany Badell, Mallory Kirkland, Blake Wallace

Background: Hallux abducto valgus (HAV), commonly referred to as a bunion, is a prevalent foot deformity with multifactorial etiology, including genetic predisposition, biomechanical abnormalities, and footwear choices. HAV is often managed conservatively with orthotic devices aimed at reducing deformity progression and alleviating associated pain. However, the effectiveness of orthotics in altering radiographic measurements of HAV remains debated. This systematic review aims to evaluate the impact of orthotic interventions on radiographic parameters.

Methods: A comprehensive search of five electronic databases-PubMed, Cochrane Library, CINAHL, Medline, and EMBASE-was conducted, covering the period from inception to March 2021. The search included terms related to HAV and orthotic interventions. Studies were included if they provided pre- and post-treatment radiographic measurements of halux abductus angle (HAA), hallux valgus angle (HVA), or intermetatarsal angle (IMA) and involved the use of orthotics. A total of 523 references were initially identified, with five studies meeting the inclusion criteria for review. Data extraction focused on study characteristics, orthotic type, radiographic measurements, and follow-up duration.

Results: The systematic review found insufficient high-quality evidence to support the effectiveness of orthotics in slowing the progression of HAV deformity. Of the five studies included, results were mixed: two studies reported changes in radiographic measurements following orthotic use, though one of these involved toe spacers rather than traditional orthotics. The remaining studies found no significant impact of orthotics on HAA, HVA, or IMA. The heterogeneity in study design, population, and orthotic types limited the ability to draw robust conclusions.

Conclusions: Current evidence does not conclusively support the use of orthotics for altering the radiographic progression of HAV. The reviewed studies highlight significant variability in outcomes and suggest that while orthotics may provide symptomatic relief, their role in deformity correction remains unclear. Whether and to what extent orthotics affect common radiographic measures of HAV deformity should be proven with further studies and investigation.

背景:拇外翻(HAV)通常被称为拇囊炎,是一种常见的足部畸形,其病因是多因素的,包括遗传倾向、生物力学异常和鞋袜选择。拇外翻通常采用保守疗法,使用矫形器来减少畸形发展和减轻相关疼痛。然而,矫形器在改变 HAV 影像学测量结果方面的有效性仍存在争议。本系统综述旨在评估矫形器干预对放射学参数的影响:方法:对五个电子数据库(PubMed、Cochrane Library、CINAHL、Medline 和 EMBASE)进行了全面检索,检索期从开始到 2021 年 3 月。检索包括与 HAV 和矫形干预相关的术语。如果研究提供了治疗前后半外翻角 (HAA)、半外翻角 (HVA) 或跖间角 (IMA) 的影像学测量结果,并涉及矫形器的使用,则被纳入研究范围。最初共确定了 523 篇参考文献,其中有 5 项研究符合纳入审查的标准。数据提取的重点是研究特点、矫形器类型、放射学测量和随访时间:系统性综述发现,没有足够的高质量证据支持矫形器在延缓HAV畸形进展方面的有效性。在纳入的五项研究中,结果参差不齐:两项研究报告了使用矫形器后放射学测量结果的变化,但其中一项研究涉及的是脚趾垫片而非传统矫形器。其余研究发现矫形器对 HAA、HVA 或 IMA 没有明显影响。研究设计、研究人群和矫形器类型的异质性限制了得出可靠结论的能力:结论:目前的证据并不完全支持使用矫形器来改变 HAV 的放射学进展。所回顾的研究强调了结果的显著差异性,并表明尽管矫形器可缓解症状,但其在畸形矫正中的作用仍不明确。矫形器是否以及在多大程度上影响了常见的 HAV 畸形放射学测量,还需要进一步的研究和调查来证明。
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引用次数: 0
Congenital Posteromedial Bowing of the Tibia: A Conservative Casting and Bracing Approach. 先天性胫骨后内侧弯曲:保守铸造和支撑方法。
IF 0.5 4区 医学 Q4 ORTHOPEDICS Pub Date : 2024-07-01 DOI: 10.7547/21-159
Patrick DeHeer, Tyler Sten

Congenital posteromedial bowing of the tibia is a rare structural deformity of the lower extremity. This severe deformity may be discovered on ultrasound prenatally but is more commonly evident immediately after birth. Prognostically, congenital posteromedial bowing of the tibia ranges from a self-resolving condition to the development of a significant limb-length discrepancy with functional deficits. This condition can be treated conservatively but may require surgical correction in adolescence or at skeletal maturity. This case study presents a pediatric patient who underwent early conservative treatment with casting and bracing in a podiatric medical clinic setting.

先天性胫骨后内侧弯曲是一种罕见的下肢结构性畸形。这种严重的畸形可在产前通过超声波检查发现,但更常见的是在出生后立即显现。从预后角度看,先天性胫骨后内侧弯曲可以自行缓解,也可以发展成明显的肢体长度差异,并伴有功能障碍。这种情况可以保守治疗,但可能需要在青春期或骨骼发育成熟时进行手术矫正。本病例研究介绍了一名在足科诊所接受早期石膏和支具保守治疗的儿童患者。
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引用次数: 0
Atypical Presentation of Tenosynovial Giant Cell Tumor on the Hallucal Flexor Tendon Sheath: A Case Report. 非典型表现的腱鞘巨细胞瘤位于舌侧屈肌腱鞘上:病例报告。
IF 0.5 4区 医学 Q4 ORTHOPEDICS Pub Date : 2024-07-01 DOI: 10.7547/23-073
Khurram H Khan, Laine Angstadt, WooYoung Chun, Aileen Grace P Arriola

Tenosynovial giant cell tumor (TGCT) is a rare type of neoplasm that may be locally aggressive but is most often benign and can be divided into two subtypes: localized and diffuse. It tends to develop in the joints, bursae, and tendon sheaths primarily in the digits of the hand and less commonly in the forefoot. This soft-tissue mass has many possible differential diagnoses, including lipoma, ganglion cyst, plantar fibroma, and various sarcomas; surgical excision is usually indicated to reach a definitive diagnosis and rule out malignancy. We report a rare case of a 30-year-old woman with atypical plantar hallucal pain and a palpable mass on the plantar lateral aspect of the left hallux. Surgical excision and histopathologic evaluation confirmed a TGCT of the left hallucal flexor tendon sheath. Although it bears clinical resemblance to several other soft-tissue masses, TGCT has numerous pathognomonic features evident with advanced imaging and histologic analysis that help the physician obtain an accurate diagnosis and proceed with appropriate treatment.

腱鞘巨细胞瘤(TGCT)是一种罕见的肿瘤,可能具有局部侵袭性,但多为良性,可分为两种亚型:局部型和弥漫型。它往往发生在关节、滑囊和腱鞘中,主要发生在手的指端,前足较少见。这种软组织肿块有许多可能的鉴别诊断,包括脂肪瘤、神经节囊肿、足底纤维瘤和各种肉瘤;通常需要进行手术切除以明确诊断并排除恶性肿瘤。我们报告了一例罕见病例,患者是一名 30 岁女性,患有非典型足底幻觉痛,左脚脚掌外侧可触及肿块。手术切除和组织病理学评估证实了左侧拇指屈肌腱鞘的 TGCT。虽然 TGCT 在临床上与其他几种软组织肿块相似,但通过先进的影像学和组织学分析,TGCT 有许多明显的病理特征,有助于医生获得准确的诊断并进行适当的治疗。
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引用次数: 0
Evaluation of Ankle Joint Position Sense in Patients with Type 2 Diabetes Mellitus with Peripheral Neuropathy by Isokinetic Dynamometer. 用等速测力计评估伴有周围神经病变的 2 型糖尿病患者的踝关节位置感。
IF 0.5 4区 医学 Q4 ORTHOPEDICS Pub Date : 2024-07-01 DOI: 10.7547/22-035
Özlem Kılıç, Elem İnal, Hüseyin Demirci, Gülümser Aydın

Background: Proprioceptive disorders may occur when thick fibers are affected in diabetic neuropathy. This can lead to impaired joint stabilization and increased risk of falls and fractures. We evaluated joint position sense (JPS) in diabetic patients to detect those at risk for neuropathy earlier.

Methods: Sixty diabetic patients and 30 healthy individuals aged 30 to 60 years were included in the study and divided into three groups: 30 diabetic patients with peripheral neuropathy, 30 diabetic patients without peripheral neuropathy, and 30 nondiabetic control patients. Presence of neuropathy was determined electrophysiologically. Passive ankle JPS was evaluated by an isokinetic system in all three groups. Both 10° and 30° plantarflexion and 10° dorsiflexion were determined as target angles. The mean absolute angular error (MAAE) values for three trials with each angle were assessed by Kruskal-Wallis and Mann-Whitney U tests.

Results: The MAAEs with all of the angles were significantly higher in diabetic patients with peripheral neuropathy compared with diabetic patients without peripheral neuropathy and the control group (P < .001 for all of the comparisons). The MAAEs with right ankle 10° plantarflexion (P = .004) and 10° dorsiflexion (P = .007) and left ankle 10° plantarflexion (P = .008) were significantly higher in diabetic patients without peripheral neuropathy than in the control group.

Conclusions: According to these results, ankle JPS may be deteriorated before determination of neuropathy electrophysiologically.Therefore, we believe that prophylactic programs in terms of the risk of falls and fractures by evaluating JPS need to be developed in the early stages of diabetes.

背景:当糖尿病神经病变中的粗纤维受到影响时,可能会出现肢体感觉障碍。这会导致关节稳定性受损,增加跌倒和骨折的风险。我们对糖尿病患者的关节位置感(JPS)进行了评估,以便及早发现有神经病变风险的患者:研究纳入了 60 名糖尿病患者和 30 名 30 至 60 岁的健康人,并将他们分为三组:30 名有周围神经病变的糖尿病患者、30 名无周围神经病变的糖尿病患者和 30 名非糖尿病对照组患者。是否存在神经病变通过电生理学方法确定。所有三组患者的被动踝关节JPS均通过等速系统进行评估。10°和30°跖屈和10°背屈均被确定为目标角度。通过 Kruskal-Wallis 和 Mann-Whitney U 检验评估了每个角度三次试验的平均绝对角度误差(MAAE)值:结果:与无周围神经病变的糖尿病患者和对照组相比,患有周围神经病变的糖尿病患者所有角度的平均绝对角度误差都明显增大(所有比较中的 P < .001)。无周围神经病变的糖尿病患者右踝10°跖屈(P = .004)和10°背屈(P = .007)以及左踝10°跖屈(P = .008)的MAAEs明显高于对照组:因此,我们认为需要在糖尿病的早期阶段就通过评估 JPS 来制定预防跌倒和骨折风险的方案。
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引用次数: 0
Investigation of Spatiotemporal Gait Characteristics, Balance, and Pain in Forefoot and Rearfoot Problems: Preliminary Results. 前足和后足问题的时空步态特征、平衡和疼痛调查:初步结果
IF 0.5 4区 医学 Q4 ORTHOPEDICS Pub Date : 2024-07-01 DOI: 10.7547/22-139
Sulenur Yıldız, Elif Kirdi, Semra Topuz, Nilgun Bek

Background: Foot problems are common in the general adult population. Whereas older people experience foot problems because of multiple chronic diseases, younger people often have musculoskeletal foot problems related to overuse. Symptoms and severity may differ depending on the anatomical location of the problem, such as forefoot and rearfoot problems. We aimed to compare the differences in spatiotemporal gait characteristics, balance, and pain in musculoskeletal forefoot and rearfoot problems.

Methods: Twenty-six patients with forefoot (14 participants) and rearfoot (12 participants) problems participated in this prospective study. Spatiotemporal gait characteristics (velocity, cadence, step time, step length, step-extremity ratio, stride length, base support, percentage of swing phase, percentage of stance phase, swing time, and stance time) were evaluated using an electronic walkway, and balance assessment was made using a balance check screener and trainer. The visual analog scale foot and ankle was used to determine patient pain levels. The Mann-Whitney U test was used to determine differences between groups.

Results: There were no significant differences between groups regarding spatiotemporal gait characteristics (P > .05). The eyes closed normal stability and eyes open perturbed stability scores were lower in patients with rearfoot problems (P < .05). Pain intensity evaluated with the visual analog scale foot and ankle was higher in patients with rearfoot problems (P < .05).

Conclusions: Pain levels and balance deficits in this study were higher in patients with rearfoot problems. The balance evaluation and possible effects of pain management on balance should be considered, especially in patients with rearfoot problems, in aspects of treatment.

背景:足部问题在普通成年人中很常见。老年人的足部问题是由于多种慢性疾病引起的,而年轻人的足部肌肉骨骼问题则往往与过度使用有关。症状和严重程度可能因问题的解剖位置(如前足和后足问题)而异。我们旨在比较前足和后足肌肉骨骼问题在时空步态特征、平衡和疼痛方面的差异:26名患有前足(14人)和后足(12人)问题的患者参加了这项前瞻性研究。使用电子步道对时空步态特征(速度、步频、步幅、步长、步肢比、步长、基础支撑、摆动阶段百分比、站立阶段百分比、摆动时间和站立时间)进行评估,并使用平衡检查筛选器和训练器进行平衡评估。脚踝视觉模拟量表用于确定患者的疼痛程度。采用 Mann-Whitney U 检验确定组间差异:结果:各组在时空步态特征方面无明显差异(P > .05)。后足问题患者的闭眼正常稳定性和睁眼扰动稳定性得分较低(P < .05)。用视觉模拟量表评估足踝疼痛强度时,后足问题患者的疼痛强度更高(P < .05):结论:在本研究中,后足病患者的疼痛程度和平衡障碍程度更高。在治疗过程中应考虑平衡评估和疼痛治疗对平衡可能产生的影响,尤其是对有后足问题的患者。
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引用次数: 0
Treatment Optimization with Ultrasound for Chronic Heel Pain. 利用超声波优化慢性足跟痛的治疗。
IF 0.5 4区 医学 Q4 ORTHOPEDICS Pub Date : 2024-07-01 DOI: 10.7547/22-160
Ayşe Merve Ata, Bihter Semiha Altunay

Plantar fasciitis is the most common cause of chronic heel pain. It is characterized by localized inflammation and degeneration of the proximal part of the plantar aponeurosis. Treatment is mainly conservative. Herein, a 54-year-old woman with chronic heel pain was diagnosed as having plantar fascia rupture by ultrasound, probably after extracorporeal shock wave therapy. Corticosteroid injection was avoided after ultrasound imaging. Plantar fascia rupture after extracorporeal shock wave therapy is an unexpected complication. This case report highlights the importance of ultrasound imaging for both diagnosis and injection guidance in patients with plantar fasciitis.

足底筋膜炎是慢性足跟痛最常见的原因。其特点是足底肌腱近端局部发炎和退化。治疗以保守疗法为主。本文中,一名 54 岁的女性因慢性足跟痛而被超声波诊断为足底筋膜断裂,很可能是在体外冲击波治疗后造成的。超声波成像后,避免了皮质类固醇注射。体外冲击波治疗后足底筋膜断裂是一种意想不到的并发症。本病例报告强调了超声成像在足底筋膜炎患者诊断和注射指导方面的重要性。
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引用次数: 0
期刊
Journal of the American Podiatric Medical Association
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