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At least 19 recordsLinked to original sources
PubMed2002

[Heel pressure ulcers. Comparative study between heel protective bandage and hydrocellular dressing with special form for the heel].

INTRODUCTION: The heels, together with the sacra area, are one of the most frequent spots where pressure sores appear here in Spain. Any preventive measure against pressure sores on heels needs be oriented towards two main objectives: effective relief of pressure and its compatibility with localized care and skin inspection in order to detect lesions early on at least once a day. PATIENTS, MATERIALS AND METHODS: The authors planned a comparative, multi-centered, open, labeled and controlled study in which patients were assigned to two groups receiving these treatments: one received traditional preventive pressure sore treatment and a protective bandage on their heels while the other used a special Allevyn Heel hydrocellular dressing to protect their heels. The patients took part in this study over an eight week period. The response variable used to determine the effectiveness of the preventive measure in this study was the appearance of pressure sores. RESULTS: At the beginning, 130 patients were included in this study, 65 in each one of the treatment groups. In the bandage group, 50 patients finished this study while 61 in the dressing group finished this study. The appearance of pressure sores in the protective bandage group occurred in 44% of the patients, 22 out of 50, while in the dressing group, the occurrence rate was 3.3%, 2 out of 61 patients with a value of "ji" squared p < 0.001. The risk factor to develop a pressure sore brought us a value of relative risk of 13.42 (IC 95%: 3.31-54.3) in the group wearing the protective bandage compared to the group wearing the dressing. COMMENTS: The results of this study allow us to accept as valid the alternate hypothesis that there exist significant statistical differences between both treatment methods in favor of the Allevyn Heel dressing instead of the protective heel bandage. The use of this dressing, even though it is more expensive a priori than the protective bandage, in terms of unit cost for the product, has proven to be more effective in preventing pressure sores, and cheaper than the protective bandage if we bear in mind these combination of variables: time of usage, application and removal.

Bandages↗
PubMed2000

Venepuncture versus heel lance for blood sampling in term neonates.

BACKGROUND: Heel lance has been the conventional method of blood sampling in neonates for screening tests. Neonates undergoing this procedure experience pain. Despite various studies evaluating the role of pharmacological and non-pharmacological interventions to date, there are no effective and practical methods to alleviate pain from heel lance. OBJECTIVES: To determine whether venepuncture or heel lance is less painful and more effective for blood sampling in term neonates. SEARCH STRATEGY: Systematic search in accordance with Cochrane Neonatal Collaborative Review Group. All randomized controlled trials which compared pain response to venepuncture vs. heel lance were searched using MEDLINE, Embase, CINAHL, the Cochrane Library, reference lists of identified trials and personal files. No language restrictions were applied. SELECTION CRITERIA: Randomized controlled trials which compared pain response to venepuncture vs. heel lance were selected for this review. DATA COLLECTION AND ANALYSIS: Data regarding the primary outcome of pain response to venepuncture vs. heel lance as assessed by validated pain measures were abstracted. Secondary outcomes including the need of repeat blood sampling, bruising/hematoma at local site, and parental perception of their own anxiety and infant's pain were also abstracted. All data were analysed using Revman 3.1. When possible, meta-analysis was done using relative risk (RR) and event rate difference (ERD), along with their 95% confidence intervals (CI). If ERD was significant, number needed to treat (NNT) was calculated. MAIN RESULTS: Two trials were eligible for inclusion in the review. One study using Neonatal Infant Pain Scale (NIPS) and one study using Neonatal Facial Action Coding System (NFCS) and cry duration showed statistically significantly lower pain scores for venepuncture as compared to heel lance. In one study, maternal anxiety was noted to be higher in the venepuncture group as compared to heel lance group prior to the procedure; however, after observing the procedure, mothers rated their infant's pain to be lower in the venepuncture group. A meta-analysis was performed on the need for at least one additional skin puncture to obtain the required amount of blood using venepuncture as compared to heel lance. The relative risk for requiring more than one skin puncture for venepuncture versus heel lance was 0.19 [95% confidence interval (CI) 0.10, 0.38]. The risk difference was -53% (95% CI -66%, -40%). The number needed to treat (NNT) to avoid one repeat skin puncture was 1.9 (95% CI 1.5, 2.5). REVIEWER'S CONCLUSIONS: Venepuncture, when performed by a trained phlebotomist, appears to be the method of choice for blood sampling in term neonates. For each two venepunctures instead of heel lance, the need for one additional skin puncture can be avoided. In view of the promising results derived from small studies with some methodological limitations, further well designed randomized controlled trials need to be conducted. The interventions should be compared in settings where several individuals perform the venepuncture and/or the heel lance.

Blood Specimen Collection↗
PubMed2001

Heel pad stiffness in runners with plantar heel pain.

OBJECTIVE: To evaluate significant differences in heel pad stiffness within a cohort of runners with diagnosed plantar heel pain and to explore the clinical importance of maximum heel pad stiffness values. DESIGN: A cross-sectional design was used to quantify the heel pad stiffness of 166 runners with 33 diagnosed with plantar heel pain. BACKGROUND: Palpation is still widely used to evaluate heel pad stiffness subjectively in everyday clinical practice. However, there is limited quantifiable data pertaining to heel pad stiffness measurements in runners and those with heel pain. METHODS: A portable hand-held device measured force applied by a metal probe, and its displacement into the plantar surface of the heel pad. Non-linear modelling allowed curve coefficients b0 and b1 to be evaluated and was described by an exponential function using a non-linear regression equation. Exploratory analysis was used to describe a single-point approximation for clinical use. RESULTS: An independent t-test demonstrated a statistically significant difference between the curve coefficient b1 (p<0.05). No significant difference was found for coefficient b0 between the plantar heel pain group and the non-plantar heel pain group (p>0.05). Exploratory analysis demonstrated maximum mean stiffness of 3.22 N/mm for the non-plantar heel pain group and 2.87 N/mm for the plantar heel pain-group, an 11% mean difference. CONCLUSION: The results suggested that heel pad stiffness may be associated with plantar heel pain subjects. RELEVANCE: Heel pad stiffness measurements may give a better insight into the mechanical properties of the heel pad in subjects with plantar heel pain.

Adolescent↗
PubMed2000

Interventions for treating plantar heel pain.

BACKGROUND: Ten percent of people may experience pain under the heel (plantar heel pain) at some time. Injections, insoles, heel pads, strapping and surgery have been common forms of treatment offered. The absolute and relative effectiveness of these interventions are poorly understood. OBJECTIVES: The objective of this review was to identify and evaluate the evidence for effectiveness of treatment in treating plantar heel pain. SEARCH STRATEGY: MEDLINE (from 1966 to December 1997), EMBASE and the Cochrane Library were searched. Three podiatry journals (The Foot, The Chiropodist (later The Journal of British Podiatric Medicine), and The British Journal of Podiatric Medicine) were handsearched. We contacted known investigators in the field to identify unpublished data or research in progress. Non English language reports were excluded from the review. SELECTION CRITERIA: Randomised and quasi randomised trials of interventions for plantar heel pain in adults. DATA COLLECTION AND ANALYSIS: Two reviewers independently evaluated studies for inclusion, extracted data and assessed study quality. Additional information was obtained by direct contact with investigators. No poolable data were identified. Where measures of variance were available we have calculated the weighted mean differences based on visual analogue scale (VAS) scores. MAIN RESULTS: Eleven randomised trials involving 465 participants were included. Study quality was generally poor, and pooling of data was not possible. All studies measured a reduction in heel pain as the primary outcome. Seven trials evaluated interventions against placebo/dummy or no treatment. There was limited evidence for the effectiveness of topical corticosteroid, administered by iontophoresis in reducing pain. There was no evidence for the effectiveness of injected corticosteroid. There was limited evidence for the effectiveness of low energy extracorporeal shock wave therapy in reducing night pain, resting pain and pressure pain in the short term (12 weeks). In individuals with chronic pain (longer than six months), there was limited evidence for the effectiveness of dorsiflexion night splints in reducing pain. There was no evidence to support the effectiveness of therapeutic ultrasound, low-intensity laser therapy, exposure to an electron generating device or insoles with magnetic foil. No randomised trials evaluating orthotic devices, surgery, or radiotherapy against a control population were identified. There was limited evidence for the superiority of corticosteroid injections over orthotic devices. REVIEWER'S CONCLUSIONS: Although there is limited evidence for the effectiveness of local corticosteroid therapy, the effectiveness of other frequently employed treatments in altering the clinical course of plantar heel pain has not been established in comparative studies. Well designed and conducted randomised studies are required.

Adrenal Cortex Hormones↗
PubMed1988

Significance of heel pad confinement for the shock absorption at heel strike.

Shock absorption (SA) is a simple way to reduce the body load and can be used in the prevention and treatment of injuries. The heel pad is the most important shock absorber in the shoe heel complex. The purpose of this study was to investigate whether the SA at heel strike can be increased by heel support in people and shoes with high or low SA. The impact forces at heel strike were measured on an AMTI (R) force platform. Fourteen legs were tested in seven persons (nine with normal and five with low heel pad SA) in gait analysis and in human drop tests. The tests were performed barefooted, and in a soccer and a running shoe (selected by shoe drop test), with and without the distal 2 cm of the heel counter. The heel pad confinement produced by the heel counter (the heel counter effect) increased the SA in both shoe types significantly in both impact situations. The mean increase in SA was 8.8% (range 5.8%-15.5%). The heel counter effect was in all situations significantly higher in persons with low heel pad shock absorbency (LHPSA) than in those with normal heel pads. The barefoot impact peak force per kg body weight was significantly higher (6% mean) on the side with LHPSA. The running shoe provided the significantly greatest SA compared with the soccer shoe. It is concluded that the shock absorbency at heel strike can be increased significantly by heel support, with highest effect in persons with LHPSA, both in shoes with high and low SA.(ABSTRACT TRUNCATED AT 250 WORDS)

Adolescent↗
PubMed1999

The mechanical properties of the heel pad in unilateral plantar heel pain syndrome.

Plantar heel pain syndrome has been attributed to entrapment neuropathy, plantar fasciitis, calcaneal spurs, and stress fractures of the calcaneus. Although deteriorated mechanical properties of the heel pads may play an important role in the pathogenesis of heel pain syndrome, this has received little notice. In this study, a specially designed compression relaxation device with a push-pull scale and a 10-MHz linear array transducer was used to determine thickness of the heel pad under different loading conditions. Twenty consecutive patients aged 29 to 77 years with unilateral plantar heel pain syndrome were enrolled. Thickness of heel pad bilaterally was measured when the heel pad was compressed by serial increments of 0.5 kg to a maximum of 3 kg and then relaxed sequentially. The load-displacement curve during a loading-unloading cycle was plotted, and the compressibility index and energy dissipation ratio of the heel pad were calculated accordingly. Phase I displacement of the heel pad (from 0 to 1 kg load) on the painless side was greater than that on the painful side (P < 0.01), but there was no statistically significant difference between painless and painful sides in thickness of unloaded heel pads, compressibility index, or energy dissipation ratio (P > 0.05). In conclusion, the affected heel pad in plantar heel pain syndrome was stiffer under light pressure than the heel pad on the painless side. The changed nature of chambered adipose tissue in a painful heel pad may be responsible for its increased stiffness under light pressure.

Adipose Tissue↗
PubMedDate not supplied

Effects of changes in heel fat pad thickness and elasticity on heel pain.

The heel fat pad has a unique structure that is important for its shock-absorbing function. Loss of elasticity and changes in the thickness of the heel pad have been suggested as causes of heel pain. The present study of a population with heel pain shows the relationship between the thickness and elasticity of the heel fat pad and age, sex, obesity, duration of symptoms, subcalcaneal spurs, and noninvasive conservative treatment. Of 182 patients with heel pain who visited an outpatient clinic during a 3-year period, 50 (67 heels) fulfilling specific criteria were treated with a combination of nonsteroidal anti-inflammatory drugs, contrast baths, stretching exercises, and change of footwear habits. Patients were followed up for 1 year. Delayed healing, increased thickness, and decreased elasticity of the heel fat pad were found in patients who were older than 40 years, who had symptoms for longer than 12 months before treatment, and who had a large subcalcaneal spur. An increase in heel fat pad thickness with aging and increased body weight reduce the elasticity of the heel fat pad. In addition, subcalcaneal spurs diminish the elasticity of the heel fat pad and play a role in the formation of heel pain.

Adipose Tissue↗
PubMed1999

The relationship of heel pad elasticity and plantar heel pain.

Loss of heel pad elasticity has been suggested as one of the possible explanations of plantar heel pain. This hypothesis is evaluated by this blinded observer prospective study, using an age and weight matched control population. Hindfoot lateral radiographs of 73 patients with plantar heel pain, 29 of whom had bilateral involvement (102 feet), and who ranged in age from 20 to 60 years, were studied and compared with 120 healthy subjects (240 feet). Heel pad thickness and heel pad compressibility index were not significantly different in patients with plantar heel pain than in healthy subjects matched for age and weight. In patients with unilateral heel pain, heel pad thickness and heel pad compressibility index on the painful side were not significantly different from the opposite painless side. The contribution of the heel pad elasticity measured as a visual compressibility index for plantar heel pain is a matter of debate.

Adult↗
PubMed2002

[The relationship between the thickness and elasticity of the heel pad and heel pain].

OBJECTIVES: We investigated the factors affecting the thickness and elasticity of the heel pad and sought relationship between the heel pad thickness and elasticity and heel pain. METHODS: Of 182 patients who presented with a complaint of heel pain over a three year period, 50 patients (38 females, 12 males; mean age 46 years; range 23 to 73 years) met specific criteria for the study. A combined treatment modality was conducted throughout a year which consisted of non-steroidal anti-inflammatory drugs, contrast baths, stretching exercises, and changes in footwear design. At the end of a year, the results were assessed according to the criteria proposed by Wolgin et al. Measurements of heel pad thickness were performed according to the technique described by Jorgensen: compressibility index of the heel pad was calculated on anteroposterior and lateral radiographs of the heel, loaded and unloaded by body weight. RESULTS: The results were good in 35 patients (70%), fair in 12 patients (35%), and poor in three patients (6%). Four patients (8%) developed recurrences. Increased heel pad thickness, decreased elasticity, and delayed healing were observed in males, in patients above 40 years of age, in obese patients, in those with a pretreatment symptom duration exceeding 12 months, and in those with a greater subcalcaneal spur. CONCLUSION: The thickness of heel pad increases in relation to age and weight, resulting in decreased elasticity. In addition, subcalcaneal spur may be involved in heel pain induction through decreasing heel pad elasticity.

Adult↗
PubMedDate not supplied

Correlation of heel pain with body mass index and other characteristics of heel pain.

A prospective, descriptive study was performed at Oakwood Healthcare medical clinics to determine the body mass index (BMI) of patients with heel pain and of a control group of patients presenting for other reasons. A questionnaire was used to obtain information in each of the patient groups and to determine characteristics of patients with plantar fascial heel pain. Standard weightbearing lateral radiographs were taken to determine overall foot structure. The typical patient was female, had heel pain for just over 1 year, with a sedentary to moderate activity level. Although height was comparable, patients with heel pain had a higher BMI (30.4 +/- 0.7) than those without heel pain (28.2 +/- 0.7, p = .04). The BMI appears to play a greater role in heel pain than does foot structure, as the authors found no structural commonalities that would explain these patients' pain. Control patients also reported a higher level of activity. Fifty-one percent exercised three or more times per week for more than 20 minutes each time, while less than half that (25.4%) of heel pain patients did so. While half of the heel pain patients had been treated by other providers prior to visiting our clinic, fewer than 25% of these patients had been instructed to lose weight by a physician. The authors feel that a BMI of 25 (the target for decreased cardiovascular risk) represents a reasonable goal for weight loss that may reduce heel pain.

Adult↗
PubMed2003

Use of Allevyn heel in the management of heel ulcers.

OBJECTIVE: This small uncontrolled study examined the effectiveness of Allevyn Heel. METHOD: Twenty-two patients were recruited: 13 with heel pressure ulcers, four with diabetic heel ulcers, four with arterial heel ulcers and one 'other'. Ulcers were assessed before treatment and after the start of the dressing regimen at weeks two and four and at the end of the study. RESULTS: Patients were treated with Allevyn Heel for a mean of 47.2 days, and dressings were left in place for an average of 2.2 days before being changed. By the end of treatment, 32% of the ulcers had completely or almost healed, and a further 27% were showing evidence of granulation. Application was considered easy in 98% of instances, and 91% of the patients reported that Allevyn Heel was comfortable to wear. CONCLUSION: Allevyn Heel was found to be effective and easy to use. This extends the range of wounds that are suitable for management with Allevyn, although a larger-scale study is needed to confirm the utility of Allevyn Heel for these type of heel wounds. DECLARATION OF INTEREST: This study was supported by Smith and Nephew, Germany.

Aged↗
PubMed2003

Customized heel pads and soft orthotics to treat heel pain and plantar fasciitis.

We describe the design of a new cost-effective, comfortable orthotic designed to treat heel pain associated with plantar fasciitis. The heel pad is fabricated from a 4 degrees Sorbothane medial wedge with a customized insertion of low-density Plastazote. The orthotic is medium-density Plastazote reinforced with cork in the medial longitudinal arch. One pair of orthotics takes less than 1 hour to make. Pilot data were collected retrospectively to evaluate the efficacy of the orthotic for reducing pain. Ten clients at a hand and foot orthotic clinic with a mean age of 71+/-9.1 years and with unilateral or bilateral heel pain associated with plantar fasciitis were provided with customized heel pads and soft, molded orthotics at their initial visit. Pain levels were recorded with verbal and Likert-type scales. After 5 weeks of heel pad and orthotic use, all patients showed a reduction in pain, with the overall reduction being highly significant (P</=.0001). Customized heel pads and soft molded orthotics are an effective first-line treatment for the heel pain and loss of function associated with plantar fasciitis.

Aged↗
PubMed2003

Calcified nodule on the heel of a child following a single heel stick in the neonatal period.

Dystrophic cutaneous calcification may arise at sites of local trauma or in association with various disorders. Calcified nodules of the heel have been reported in high-risk neonates following repeated heel sticks to draw blood. We present a healthy 2-year-old boy with a calcified nodule on the heel secondary to a single heel stick in the neonatal period. The patient was born full-term at 38 weeks' gestation, with a birth weight appropriate for gestational age. A firm nodule was noticed at the age of 8 months; this became tender. Histology revealed epidermal and subepidermal deposition of calcium. Serum calcium and phosphate levels were normal. Although calcified heel nodules occur mostly in high-risk neonates, this case suggests that this condition also can occur in healthy children after only a single heel stick. Dermatologists should include this entity in the differential diagnosis of warty papules on the heels of children.

Calcinosis↗
PubMed1994

Preventing heel pressure sores: a comparison of heel pressure relieving devices.

It has been widely recognized that elderly patients with an orthopaedic problem are predisposed to developing heel pressure sores. In this study four pressure-reducing devices, commonly used in the prevention of heel ulcers, were objectively compared for their ability to decrease or remove pressure on the heels of patients with fractured necks of femurs and fractured femurs. Forty-one patients were randomly allocated a pressure relieving device. The efficacy of the device was evaluated by continuously assessing the skin integrity of both heels on a daily basis over a period of 12 days. Data were collected over a 30 month period. The four devices were foam splints, eggshell foam, duoderm and heel protector boots. Foam splints and eggshell foam proved to be more effective devices in relieving pressure exerted on the heel. This study recognizes that meticulous nursing care remains the critical element in prevention of heel ulcers; however, the use of eggshell foam and foam splints in conjuction with this enhances the maintenance of skin integrity.

Aged↗
PubMed2001

Force patterns of heel strike and toe off on different heel heights in normal walking.

This study investigated the changes of force patterns of the heel strike and toe off phases at different heel heights during normal walking. Ten healthy female college students wore running shoes, flat leather shoes and high heeled shoes while walking on a Kistler force platform at their self-comfortable paces. It was found that the high heeled shoes and the leather shoes generated significantly greater vertical impact forces and anterior-posterior forces in the toe off phase than those in the heel strike phase. Accumulated impulses did not show significant increase while the heel heights increased and total support time while wearing the high heeled shoes was significantly longer than while wearing the running shoes.

Adult↗
PubMed1994

Poor results after resection for Haglund's heel. Analysis of 35 heels in 23 patients after 3 years.

We reviewed 23 patients 3 (1-6) years after resection of the calcaneus for 35 Haglund's heels. 19 heels had been treated with a small resection and 16 with a large resection. The effect on the heel pain was independent of the size of the resection, but stiffness and ankle pain were more frequently associated with large than small resections. At follow-up persistent heel pain was found in 12 heels and additional various late complaints in 22. The overall clinical outcome was good in 20 heels, satisfactory in 10 and poor in 5 heels.

Achilles Tendon↗
PubMed1993

Deformation characteristics of the heel region of the shod foot during a simulated heel strike: the effect of varying midsole hardness.

Impact tests using a pendulum were performed on the shod heel region of nine subjects. Both soft- and hard-soled shoes were used. The deformations involved were calculated from the registered decelerations during impact. Thus, load-deformation cycles were recorded for various impact velocities. In contrast to in vivo force-platform recordings, peak loadings for the soft- and hard-soled conditions differed significantly (614 +/- 29 N vs 864 +/- 49 N, respectively), thus challenging the evidence for compensation at the level of the heel pad. Moreover, computation of the compression of the heel pad in the shoe showed an unexpected inverse relationship between shoe midsole hardness and degree of heel pad compression: the harder the midsole, the smaller the compression (soft shoe 7.6 +/- 0.9 mm; hard shoe 6.7 +/- 0.9 mm). This can be explained by assuming a loading rate dependent stiffness of the heel pad in the shod condition (stiffness in N.m-1 = 51.25x (loading rate in N.s-1)0.76; R2 = 0.90), determined by the visco-elastic nature of the heel pad and the spatial confinement of the heel counter of the shoe.

Adult↗
PubMed2004

Attenuation of spinal transients at heel strike using viscoelastic heel insoles: an in vivo study.

BACKGROUND: The transients introduced at heel strikes were linked with increased risk for low back pain. The present study was designed to monitor the transients acting on the spinal column at gait, and to find out whether said transients are attenuated by interposition of a viscoelastic heel insoles. METHODS: A lightweight (2 g) accelerometer was held against the forehead with an elastic strap. The subject was instructed to walk naturally along an 8-m rigid walkway with a built-in, high-frequency (<500 Hz) response Kistler force plate. Seven subjects, shod in leather-soled shoes, were studied sequentially without and with viscoelastic heel insoles (Viscoheel, Bauerfeind). Ground reaction force and vertical acceleration were simultaneously recorded. The data were analog-stored and analyzed with respect to time and frequency domains. RESULTS: Under the aforementioned conditions, the heel strike introduced a transient that averaged 60% of body weight and lasted for up to 5 ms. Maximal deceleration was recorded in the order of 5G, with a frequency spectrum of 100 Hz. Interposition of silicone heel insoles attenuated the ground reaction force by one third and deceleration by two thirds, the highest frequency components having been eliminated. CONCLUSION: Viscoelastic heel insoles significantly attenuate the strain on the spinal column that is caused by walking.

Adult↗