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Necrotizing fasciitis (NF) is a rare and life threating soft-tissue infection specific to the skin’s fascia layer. It is most often encountered in the peripheries, abdominal wall, and perineum and has numerous etiologies and associated pathogens. Early diagnosis and rapid surgical debridement are essential in treating NF as the infection progresses rapidly and mortality rate increases significantly with time. The current difficulty in initial diagnosis is due to the lack of obvious skin findings early on in the infection. Laboratory tests, including the laboratory risk indicator for necrotizing fasciitis (LRINEC) score, gas on imaging tests, and physical exam findings are the current clues to an early diagnosis but official diagnosis can only be confirmed by surgical exploration and discovery of a lack of resistance to dissection in the fascia layer. The LRINEC score analyzes one variable, specifically C-reactive protein (CRP), which is often not included in routine laboratory tests skin infections at the emergency department (ED). Furthermore, no specific set of physical exam findings has been distinctly associated with diagnosis of NF over other soft-tissue infections and the most specific imaging tests are too expensive for routine use. A new and modified LRINEC score based only on routine ED laboratory tests as well as an additional objective scoring system for physical exam findings are the next steps toward rapid diagnosis. This approach requires large-scale retrospective statistical analyses of NF cases across the country for identification of the most prevalent physical exam findings and abnormal laboratory values.

Estimates show that roughly 2 million people around the world present with chronic plantar heel pain each year, of which the number one cause is plantar fasciitis. The degree of this pain ranges from obnoxious to debilitating and often features a progressive worsening of symptoms. If mistreated or simply left untreated, it can leave athletes sidelined from their respective sports indefinitely, and anyone whose occupation requires extended weight bearing activity fighting through enormous levels of pain to perform their duties. Plantar fasciitis arises more often in certain populations than others, and the reasons behind these correlations are highlighted and explored here. This condition causes a significant amount of frustration from both patients and physicians alike, because it is difficult to diagnose as a variety of differential diagnoses cause a similar type of pain. This paper discusses the most critical signs in determining whether or not a patient is dealing with plantar fasciitis, as well as reviewing the treatment options recommended, which depend on the extent to which microtear damage has occurred. A hindrance to appropriate care for patients exists, perhaps due to inconsistencies in the understanding of plantar fasciitis and the language used to describe it. Here the ability of physicians to eliminate almost entirely the use of painful, costly procedures and help patients return to weight bearing activities pain-free is discussed.

Purpose: Due to the vital role that blood flow plays in maintaining tissue health, compromised blood flow can prevent effective tissue healing. An adducted hallux, as often seen inside a narrow shoe, may put passive tension on the abductor hallucis, consequently compressing the lateral plantar artery (LPA) into the calcaneus and thus restricting blood flow. The purpose of this study was to compare blood flow within the LPA before and after passive hallux adduction (PHA). Methods: Forty-five healthy volunteers (20 female, 25 male; age = 24.8 ± 6.8 yr; height = 1.7 ± 0.1 m; weight = 73.4 ± 13.5 kg) participated in this study. Blood velocity and vessel diameter measurements were obtained using ultrasound imaging (L8-18i transducer, GE Logiq S8). The LPA was imaged deep to abductor hallucis for 120 seconds: 60 seconds at rest followed by 60 seconds of PHA. Maximal PHA was performed by applying pressure to the medial side of the proximal phalanx of the hallux. Blood flow was then calculated in mL/min, and pre-PHA blood flow was compared to blood flow during PHA. Results: Log transformed data was used to run a paired t-test between the preadduction and postadduction blood flow. The volume of blood flow was 22.2% lower after PHA compared to before (–0.250 ± 0.063, p < 0.001). Conclusion: Although PHA is only a simulation of what would happen to the hallux inside of a narrow shoe, our preliminary findings of decreased blood flow through PHA suggest blood flow in narrow footwear and its effects on tissues within the foot are worth investigating.

Thesis (Ph.D.)--University of Wollongong, 2005. / Typescript. Includes bibliographical references: leaf 140-179.

The aim of this thesis is to evaluate the short and long term effectiveness of foot orthoses in the treatment of plantar fasciitis.Three studies were undertaken, the first two informing the third. The aim of the first study was to establish prescription habits of Australian and New Zealand podiatrists in order to ascertain the most commonly prescribed foot orthoses. The second study was conducted to establish the most appropriate outcome measure to assess the effectiveness of foot orthoses in the treatment of plantar faciitis. The main study, a pragmatic single-blind randomised control trial, was conducted to evaluate the effectiveness of three types of foot orthoses in the treatment of plantar fasciitis. The research concluded that provision of appropriate foot orthoses produces small short-term benefits in function for people with plantar fasciitis, but no effect is apparent at twelve months. / Doctor of Philosophy (PhD)

Thesis (Ph.D.)--University of Wollongong, 2006. / Typescript. Includes bibliographical references: leaf 148-160.

Necrotizing fasciitis (NF) is a critical and rapidly progressive infection of the skin and soft tissue, and it is associated with a high mortality rate. NF of the cervicofacial region is uncommon due to the rich vascular supply of the head and neck, which promotes an efficient immune response to infection. Patients who are immunocompromised or have comorbidities affecting the vasculature, such as diabetes mellitus or peripheral vascular disease, are at an increased risk of more severe disease and outcome. Cervicofacial necrotizing fasciitis (CNF) is most frequently attributed to mucosal damage, such as those related to dental infections or local trauma including medical procedures. Due to its ability to quickly spread to the neck and mediastinum, CNF must be diagnosed and treated expeditiously. In this report, we present a case of a 28-year-old female with a past medical history significant for obesity and tobacco abuse who presented to the emergency department (ED) with fever, left-sided facial pain, cervical pain, and swelling. She had worsening symptoms despite current treatment with clindamycin for a dental abscess. A CT scan of the head and neck revealed an odontogenic abscess complicated by CNF. Intravenous antibiotics were initiated and she underwent prompt surgical intervention. She remained nasally intubated following her surgery due to concern for postoperative edema leading to airway compromise. Following extubation, she experienced an uncomplicated recovery. This case demonstrates that NF is a complication of dental infection that may occur even in young and relatively healthy patients. Additionally, due to the swiftly destructive nature and high mortality rate of CNF, early diagnosis and aggressive medical and surgical therapy are essential to reduce morbidity and mortality.

Purpose: The purpose of this dissertation was to determine the effects of chronic plantar fasciitis on intrinsic foot structures with respect to biomechanics, muscle atrophy and muscle energetics. This was accomplished in three parts. Methods: In Part I, a three-dimensional motion capture system with a synchronized force platform quantified multi-segment foot model kinematics and ground reaction forces associated with walking. Healthy individuals were compared to individuals with chronic plantar fasciitis feet. Typical kinematic variables, measures of coupling, phase and variability were examined in rearfoot, forefoot and hallux segments. In Part II, foot and leg magnetic resonance images were taken in subjects with unilateral plantar fasciitis so that within each subject, the healthy limb could be compared to the plantar fasciitis limb. Cross sectional areas (CSA) of the plantar intrinsic foot muscles (PIFM) and tibialis posterior muscle were computed from user-digitized images. In Part III, the metabolic demands of the PIFM were evaluated using phosphorous magnetic resonance spectroscopy at rest and after barefoot walking. Muscle pH and the ratio of inorganic phosphate to phosphocreatine (Pi/PCr) were compared in healthy and plantar fasciitis feet. Results: In comparison to healthy feet, plantar fasciitis feet exhibited significantly (p < 0.05): 1) greater rearfoot motion, 2) greater sagittal plane forefoot motion, 3) fewer rearfoot-forefoot frontal anti-phase movements, 4) reduced rearfoot-forefoot transverse coordinative variability, 5) greater first metatarsophalangeal (FMPJ) joint dorsiflexion, 6) greater FMPJ-medial longitudinal arch (MLA) coupling variability, and 7) decreased vertical ground reaction forces at propulsion. Also, plantar fasciitis feet had 5.2% smaller PIFM CSA at the forefoot compared to contralateral healthy feet. No CSA differences were seen in the rearfoot PIFM or at the tibialis posterior muscle. The PIFM of healthy and PF feet were not significantly different in resting intracellular levels of pH or Pi/PCr, and there were no significant differences in the increase of Pi/PCr from rest to postwalking. Conclusions: In Part I, it was concluded that plantar fasciitis feet exhibit kinematics which are consistent with theoretical causation of the plantar fasciitis injury, that is, the plantar fasciitis foot exhibits excessive motion. Fewer number of anti-phase movements exhibited by plantar fasciitis feet may be an indication of pathology. The ground reaction force results suggested a compensatory pain response. In Part II, it was concluded that atrophy of the forefoot PIFM may destabilize the medial longitudinal arch and prolong the healing process. Lastly in Part III, it was concluded that resting energetics were consistent with muscle free of systemic disease or neuromuscular pathology. The presence of plantar fasciitis did not elicit systematic asymmetries in the metabolic response in comparison to healthy feet. Clinical Relevance: These kinematic results provided some evidence to support the clinical assertion that excessive motion is related to plantar fasciitis. These results also support treatment modalities which clinicians currently use to reduce rearfoot eversion, flattening of the medial longitudinal arch and dorsiflexion of the FMPJ (e.g. foot orthoses, insoles, taping, rocker soles). When treating plantar fasciitis patients, clinicians should assess for PIFM and tibialis posterior muscle atrophy and prescribe targeted exercises when appropriate.

Author: Bc. Kateřina Průchová Title: The effectiveness of shock wave therapy for plantar fasciitis Objectives: The main goal of this work is to assess the effect of the radial and focused shock wave therapy for plantar fasciitis compared with therapeutic ultrasound. Methods: The study included 55 patients with diagnose of heel spur syndrome. Patients were divided into three groups according to undergoing therapy. Group A (n = 20) received 6 applications of radial shock wave, group B (n = 20) obtained 3 applications of focused shock wave and group C received 8 applications of therapeutic ultrasound. Intensity and character of the pain were assessed before and after therapeutic intervention using non-standardized questionnaire. For the assessment and description of the results were used standard statistical indicators and methods. Results: Radial and focused shockwave therapy had according to the obtained results in the selected treatment protocol positive effect on the clinical course of the disease and was markedly more effective than therapeutic ultrasound. Almost all parameters reached the highest percentage improvement in the group treated with 6 applications of radial shock waves. There were no complications and side effects during the experiment. Keywords: heel spur, plantar fasciitis,...