mitigating pain associated with plantar fibro-fatty pad dysfunction

Mart · Dec 6, 2010

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Hi
Does anyone have any ideas for mitigating pain associated with plantar fibro-fatty pad dysfunction causing plantar heel pain? I am trying to help a 45 YO lady with longstanding plantar heel pain, denied recollection of a traumatic event, diagnostic ultrasound exam normal for chronic plantar fasciosis but suggestive for overly compliant plantar fibro-fatty pad (visibly thin and overly compliant with probe pressure), normal radiographic exam. She has tolerance for pain of approximately1 hour weight-bearing wearing running shoes, this is increased to 2 hrs using foot orthoses with 10mm neoprene compliant heel ramp.
My thoughts are; foot-wear with proven damping heel characteristics, possibly use of MBT which might reduce peak pressures at heel contact or other foot-wear modification which increases 1st rocker duration?
Ideas/experiences or citations welcomed

Cheers

Martin
The St. James Foot Clinic
1749 Portage Ave.
Winnipeg
Manitoba
R3J 0E6
phone [204] 837 FOOT (3668)
fax [204] 774 9918
www.winnipegfootclinic.com

nigelroberts · Dec 8, 2010

Hi Martin
May be worth checking out with MR as well. ?? problem with the calcaneum.

Regards

Nigel

mike weber · Dec 8, 2010

Hi Martin

I´ve looked but did not find much

but .... not sure it helps ??

Heel pad stiffness in runners with plantar heel pain

Keith Romea, Paul Webbb, Anthony Unsworthc, Ian Haslockd
Received 20 October 2000; accepted 22 August 2001.

Abstract
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.
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http://www.asbweb.org/conferences/2005/pdf/0780.pdf

The effect of heel-pad thickness and loading protocol on measured heel-pad stiffness and a standardized protocol for inter-subject comparability

Iain R. Spearsab, Janice E. Miller-Youngc
Received 20 September 2004; accepted 28 September 2005. published online 15 November 2005.

Abstract
Background

Heel-pad stiffness is an important parameter in clinical assessments of the lower limb and is usually quantified by the slope of the force–deformation curve. However, the data produced is affected by the geometry of the heel, thus making inferences about tissue behaviour difficult.

Method

With the use of finite element analysis the aim of this study is to explore the possibility of expressing heel-pad stiffness in terms of stress–strain data. An axisymmetric, non-linear and time-dependent representation of the heel was created. The material model, incorporating non-linearity and viscoelasticity, was based on a series of experiments involving healthy, cadaveric specimens and loading at different loading rates (0, 175 and 350mm/s). The conditions of an in vivo study were then replicated and stress–strain data of the model were compared. Good agreement was achieved (error <5%) at higher strains (>0.2). Probe diameter, loading rate and heel-pad thickness were then varied and heel-pad stiffness, expressed in terms of both force–deformation and stress–strain characteristics, reported.

Findings

In terms of the force–deformation characteristics, thin heels are consistently stiffer than thick heels. In terms of stress–strain characteristics, thicker heels are stiffer than thin heels using small probes whereas thinner heels are stiffer than thick heels using large probes. It was possible to predict stress–strain data of the heel-pad that are least-dependent of heel-pad thickness using large probes and slow-rising loads.

Interpretation

It is suggested that stress–strain curves derived from large probes under slow loads would provide the most robust and standardized measure of heel-pad stiffness.
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mike weber · Dec 8, 2010

and check this one out again not sure if it helps.

Volume 32, Issue 5, Pages 516-522 (June 2010)

Constitutive formulation and analysis of heel pad tissues mechanics

A.N. Natali, C.G. Fontanella, E.L. Carniel
Received 28 May 2009; received in revised form 11 February 2010; accepted 18 February 2010. published online 22 March 2010.

Abstract
This paper presents a visco-hyperelastic constitutive model developed to describe the biomechanical response of heel pad tissues. The model takes into account the typical features of the mechanical response such as large displacement, strain phenomena, and non-linear elasticity together with time-dependent effects. The constitutive model was formulated, starting from the analysis of the complex structural and micro-structural configuration of the tissues, to evaluate the relationship between tissue histology and mechanical properties. To define the constitutive model, experimental data from mechanical tests were analyzed. To obtain information about the mechanical response of the tissue so that the constitutive parameters could be established, data from both in vitro and in vivo tests were investigated. Specifically, the first evaluation of the constitutive parameters was performed by a coupled deterministic and stochastic optimization method, accounting for data from in vitro tests. The comparison of constitutive model results and experimental data confirmed the model's capability to describe the compression behaviour of the heel pad tissues, regarding both constant strain rate and stress relaxation tests. Based on the data from additional experimental tests, some of the constitutive parameters were modified in order to interpret the in vivo mechanical response of the heel pad tissues. This approach made it possible to interpret the actual mechanical function of the tissues.

Keywords: Heel pad, Tissue mechanics, Constitutive model, Visco-elasticity, Mechanical tests
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Mart · Dec 8, 2010

nigelroberts said: ↑

Hi Martin
May be worth checking out with MR as well. ?? problem with the calcaneum.

Regards

Nigel
Click to expand...

Thanks Nigel; I have bone edema in my ddx - pain not severe enough to warrant cost of MR right now given that it is unlikley to change treatment plan. radiographic exam has ruled out bone cyst, stress # also less likely thiough not certain.

cheers

Martin

The St. James Foot Clinic
1749 Portage Ave.
Winnipeg
Manitoba
R3J 0E6
phone [204] 837 FOOT (3668)
fax [204] 774 9918
www.winnipegfootclinic.com

Mart · Dec 8, 2010

m weber said: ↑

and check this one out again not sure if it helps.
Click to expand...

Thanks Michael

I wonder how useful measuring this kind of data would be if we had clinical tools for that purpose. In the end the diagnosis would be based on history and PE aided by imaging and irrespective of biomechanically measured properties; irrespective the treatment plan would involve same ideas; stress reduction.

I think that there would be some merit though in testing treatment modalities such as mechanical properties/ efficacy of foot-wear etc but am not aware of any studies specific to this issue other than generalised studies for plantar heel pain which seem to lack specfic differentiation for underlying injury (ie is chronic plantar fasciosis present or not?)

cheers

Martin

The St. James Foot Clinic
1749 Portage Ave.
Winnipeg
Manitoba
R3J 0E6
phone [204] 837 FOOT (3668)
fax [204] 774 9918
www.winnipegfootclinic.com

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