This document discusses heel pain and plantar fasciitis. It covers the anatomy of the plantar fascia and its connections. Differential diagnosis is discussed. Non-operative treatments include stretching, night splints, orthotics and steroid injections. Surgery is reserved as a last resort and involves plantar fascia release. Gastrocnemius contracture is associated with plantar fasciitis and Achilles tendinopathy. Positive early results are shown for gastrocnemius lengthening (gastroc recession/posterior medial gastrocnemius recession (PMGR)) in recalcitrant cases.
Tendoachilles rupture and its managementRohan Vakta
Achilles tendon is the strongest tendon of body. There are many causes of its rupture. It can be acute or chronic rupture. Management of chronic rupture by semitendinosus tendon is mentioned here.
Tendoachilles rupture and its managementRohan Vakta
Achilles tendon is the strongest tendon of body. There are many causes of its rupture. It can be acute or chronic rupture. Management of chronic rupture by semitendinosus tendon is mentioned here.
LCPD or Perthes disease - idiopathic avascular necrosis of femoral head, characterized mainly in child age 4-7 years - with a feature of limping and pain in the hip or groin
The majority of elderly patients who receive a hip replacement retain the prosthesis for 15 to 20 years, and sometimes for life. However, some patients may need one or more revisions of a hip replacement, particularly if the initial hip replacement surgery is performed at a young age and the patient chooses to have a very active physical lifestyle.
LCPD or Perthes disease - idiopathic avascular necrosis of femoral head, characterized mainly in child age 4-7 years - with a feature of limping and pain in the hip or groin
The majority of elderly patients who receive a hip replacement retain the prosthesis for 15 to 20 years, and sometimes for life. However, some patients may need one or more revisions of a hip replacement, particularly if the initial hip replacement surgery is performed at a young age and the patient chooses to have a very active physical lifestyle.
congenital pseudoarthrosis of tibia or anterolateral bowing of tibia is cause of major morbidity in children with no definitive or curative management.
Proximal Fibular Osteotomy for Knee Osteoarthritis - What is the evidence?Dr Saseendar MD
Proximal Fibular Osteotomy for Knee Osteoarthritis - What is the evidence?
knee osteoarthritis, knee surgery, total knee replacement, osteoarthritis, knee pain, elderly,
https://kneesurgrelatres.biomedcentral.com/articles/10.1186/s43019-019-0016-0
Brief discussion regarding management of physiotherapy, pharmacotherapy, orthosis, principles of orthopedic surgical managements, addressing problems at hip, knee and ankle, soft tissue release procedures, osteotomies, timing of surgery, complications, prognosis, hip at risk signs, birthday syndrome, role of botulinum toxin, upper extremity involvement, contracture release.
Proximal fibular osteotomy - What is the evidence?Dr Saseendar MD
Proximal fibular osteotomy has been proposed as a simple and inexpensive alternative to high-tibial osteotomy and unicondylar knee arthroplasty and may be useful for low-income populations that cannot afford expensive treatment methods. However, there is no consensus existing regarding the mechanism by which it acts nor the outcome of this procedure. This study was performed to analyze the available evidence on the benefits of proximal fibular osteotomy and to understand the possible mechanisms in play. There are various mechanisms that are proposed to individually or collectively contribute to the outcomes of this procedure, and include the theory of non-uniform settlement, the too-many cortices theory, slippage phenomenon, the concept of competition of muscles, dynamic fibular distalization theory and ground reaction vector readjustment theory. The mechanisms have been discussed and future directions in research have been proposed. The current literature, which mostly consists of case series, suggests the usefulness of the procedure in decreasing varus deformity as well as improving symptoms in medial osteoarthritis. However, large randomised controlled trials with long-term follow-up are required to establish the benefits of this procedure over other established treatment methods.
Tensor fascia lata[tfl] muscle pedicle grafting for avn hip dr mohamed ashraf...drashraf369
slide presentation of a very promising surgical technic for a very elusive condition called avascular necrosis of femoral head.good clinical and surgical demo by dr mohamed ashraf,HOD, govt TD medical college ,alleppey,kerala, india
Couples presenting to the infertility clinic- Do they really have infertility...Sujoy Dasgupta
Dr Sujoy Dasgupta presented the study on "Couples presenting to the infertility clinic- Do they really have infertility? – The unexplored stories of non-consummation" in the 13th Congress of the Asia Pacific Initiative on Reproduction (ASPIRE 2024) at Manila on 24 May, 2024.
New Directions in Targeted Therapeutic Approaches for Older Adults With Mantl...i3 Health
i3 Health is pleased to make the speaker slides from this activity available for use as a non-accredited self-study or teaching resource.
This slide deck presented by Dr. Kami Maddocks, Professor-Clinical in the Division of Hematology and
Associate Division Director for Ambulatory Operations
The Ohio State University Comprehensive Cancer Center, will provide insight into new directions in targeted therapeutic approaches for older adults with mantle cell lymphoma.
STATEMENT OF NEED
Mantle cell lymphoma (MCL) is a rare, aggressive B-cell non-Hodgkin lymphoma (NHL) accounting for 5% to 7% of all lymphomas. Its prognosis ranges from indolent disease that does not require treatment for years to very aggressive disease, which is associated with poor survival (Silkenstedt et al, 2021). Typically, MCL is diagnosed at advanced stage and in older patients who cannot tolerate intensive therapy (NCCN, 2022). Although recent advances have slightly increased remission rates, recurrence and relapse remain very common, leading to a median overall survival between 3 and 6 years (LLS, 2021). Though there are several effective options, progress is still needed towards establishing an accepted frontline approach for MCL (Castellino et al, 2022). Treatment selection and management of MCL are complicated by the heterogeneity of prognosis, advanced age and comorbidities of patients, and lack of an established standard approach for treatment, making it vital that clinicians be familiar with the latest research and advances in this area. In this activity chaired by Michael Wang, MD, Professor in the Department of Lymphoma & Myeloma at MD Anderson Cancer Center, expert faculty will discuss prognostic factors informing treatment, the promising results of recent trials in new therapeutic approaches, and the implications of treatment resistance in therapeutic selection for MCL.
Target Audience
Hematology/oncology fellows, attending faculty, and other health care professionals involved in the treatment of patients with mantle cell lymphoma (MCL).
Learning Objectives
1.) Identify clinical and biological prognostic factors that can guide treatment decision making for older adults with MCL
2.) Evaluate emerging data on targeted therapeutic approaches for treatment-naive and relapsed/refractory MCL and their applicability to older adults
3.) Assess mechanisms of resistance to targeted therapies for MCL and their implications for treatment selection
Report Back from SGO 2024: What’s the Latest in Cervical Cancer?bkling
Are you curious about what’s new in cervical cancer research or unsure what the findings mean? Join Dr. Emily Ko, a gynecologic oncologist at Penn Medicine, to learn about the latest updates from the Society of Gynecologic Oncology (SGO) 2024 Annual Meeting on Women’s Cancer. Dr. Ko will discuss what the research presented at the conference means for you and answer your questions about the new developments.
Tom Selleck Health: A Comprehensive Look at the Iconic Actor’s Wellness Journeygreendigital
Tom Selleck, an enduring figure in Hollywood. has captivated audiences for decades with his rugged charm, iconic moustache. and memorable roles in television and film. From his breakout role as Thomas Magnum in Magnum P.I. to his current portrayal of Frank Reagan in Blue Bloods. Selleck's career has spanned over 50 years. But beyond his professional achievements. fans have often been curious about Tom Selleck Health. especially as he has aged in the public eye.
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Introduction
Many have been interested in Tom Selleck health. not only because of his enduring presence on screen but also because of the challenges. and lifestyle choices he has faced and made over the years. This article delves into the various aspects of Tom Selleck health. exploring his fitness regimen, diet, mental health. and the challenges he has encountered as he ages. We'll look at how he maintains his well-being. the health issues he has faced, and his approach to ageing .
Early Life and Career
Childhood and Athletic Beginnings
Tom Selleck was born on January 29, 1945, in Detroit, Michigan, and grew up in Sherman Oaks, California. From an early age, he was involved in sports, particularly basketball. which played a significant role in his physical development. His athletic pursuits continued into college. where he attended the University of Southern California (USC) on a basketball scholarship. This early involvement in sports laid a strong foundation for his physical health and disciplined lifestyle.
Transition to Acting
Selleck's transition from an athlete to an actor came with its physical demands. His first significant role in "Magnum P.I." required him to perform various stunts and maintain a fit appearance. This role, which he played from 1980 to 1988. necessitated a rigorous fitness routine to meet the show's demands. setting the stage for his long-term commitment to health and wellness.
Fitness Regimen
Workout Routine
Tom Selleck health and fitness regimen has evolved. adapting to his changing roles and age. During his "Magnum, P.I." days. Selleck's workouts were intense and focused on building and maintaining muscle mass. His routine included weightlifting, cardiovascular exercises. and specific training for the stunts he performed on the show.
Selleck adjusted his fitness routine as he aged to suit his body's needs. Today, his workouts focus on maintaining flexibility, strength, and cardiovascular health. He incorporates low-impact exercises such as swimming, walking, and light weightlifting. This balanced approach helps him stay fit without putting undue strain on his joints and muscles.
Importance of Flexibility and Mobility
In recent years, Selleck has emphasized the importance of flexibility and mobility in his fitness regimen. Understanding the natural decline in muscle mass and joint flexibility with age. he includes stretching and yoga in his routine. These practices help prevent injuries, improve posture, and maintain mobilit
- Video recording of this lecture in English language: https://youtu.be/lK81BzxMqdo
- Video recording of this lecture in Arabic language: https://youtu.be/Ve4P0COk9OI
- Link to download the book free: https://nephrotube.blogspot.com/p/nephrotube-nephrology-books.html
- Link to NephroTube website: www.NephroTube.com
- Link to NephroTube social media accounts: https://nephrotube.blogspot.com/p/join-nephrotube-on-social-media.html
The prostate is an exocrine gland of the male mammalian reproductive system
It is a walnut-sized gland that forms part of the male reproductive system and is located in front of the rectum and just below the urinary bladder
Function is to store and secrete a clear, slightly alkaline fluid that constitutes 10-30% of the volume of the seminal fluid that along with the spermatozoa, constitutes semen
A healthy human prostate measures (4cm-vertical, by 3cm-horizontal, 2cm ant-post ).
It surrounds the urethra just below the urinary bladder. It has anterior, median, posterior and two lateral lobes
It’s work is regulated by androgens which are responsible for male sex characteristics
Generalised disease of the prostate due to hormonal derangement which leads to non malignant enlargement of the gland (increase in the number of epithelial cells and stromal tissue)to cause compression of the urethra leading to symptoms (LUTS
These simplified slides by Dr. Sidra Arshad present an overview of the non-respiratory functions of the respiratory tract.
Learning objectives:
1. Enlist the non-respiratory functions of the respiratory tract
2. Briefly explain how these functions are carried out
3. Discuss the significance of dead space
4. Differentiate between minute ventilation and alveolar ventilation
5. Describe the cough and sneeze reflexes
Study Resources:
1. Chapter 39, Guyton and Hall Textbook of Medical Physiology, 14th edition
2. Chapter 34, Ganong’s Review of Medical Physiology, 26th edition
3. Chapter 17, Human Physiology by Lauralee Sherwood, 9th edition
4. Non-respiratory functions of the lungs https://academic.oup.com/bjaed/article/13/3/98/278874
Lung Cancer: Artificial Intelligence, Synergetics, Complex System Analysis, S...Oleg Kshivets
RESULTS: Overall life span (LS) was 2252.1±1742.5 days and cumulative 5-year survival (5YS) reached 73.2%, 10 years – 64.8%, 20 years – 42.5%. 513 LCP lived more than 5 years (LS=3124.6±1525.6 days), 148 LCP – more than 10 years (LS=5054.4±1504.1 days).199 LCP died because of LC (LS=562.7±374.5 days). 5YS of LCP after bi/lobectomies was significantly superior in comparison with LCP after pneumonectomies (78.1% vs.63.7%, P=0.00001 by log-rank test). AT significantly improved 5YS (66.3% vs. 34.8%) (P=0.00000 by log-rank test) only for LCP with N1-2. Cox modeling displayed that 5YS of LCP significantly depended on: phase transition (PT) early-invasive LC in terms of synergetics, PT N0—N12, cell ratio factors (ratio between cancer cells- CC and blood cells subpopulations), G1-3, histology, glucose, AT, blood cell circuit, prothrombin index, heparin tolerance, recalcification time (P=0.000-0.038). Neural networks, genetic algorithm selection and bootstrap simulation revealed relationships between 5YS and PT early-invasive LC (rank=1), PT N0—N12 (rank=2), thrombocytes/CC (3), erythrocytes/CC (4), eosinophils/CC (5), healthy cells/CC (6), lymphocytes/CC (7), segmented neutrophils/CC (8), stick neutrophils/CC (9), monocytes/CC (10); leucocytes/CC (11). Correct prediction of 5YS was 100% by neural networks computing (area under ROC curve=1.0; error=0.0).
CONCLUSIONS: 5YS of LCP after radical procedures significantly depended on: 1) PT early-invasive cancer; 2) PT N0--N12; 3) cell ratio factors; 4) blood cell circuit; 5) biochemical factors; 6) hemostasis system; 7) AT; 8) LC characteristics; 9) LC cell dynamics; 10) surgery type: lobectomy/pneumonectomy; 11) anthropometric data. Optimal diagnosis and treatment strategies for LC are: 1) screening and early detection of LC; 2) availability of experienced thoracic surgeons because of complexity of radical procedures; 3) aggressive en block surgery and adequate lymph node dissection for completeness; 4) precise prediction; 5) adjuvant chemoimmunoradiotherapy for LCP with unfavorable prognosis.
Explore natural remedies for syphilis treatment in Singapore. Discover alternative therapies, herbal remedies, and lifestyle changes that may complement conventional treatments. Learn about holistic approaches to managing syphilis symptoms and supporting overall health.
Are There Any Natural Remedies To Treat Syphilis.pdf
Heel pain - Derek Park
1. Heel pain
Derek Park
Barnet & Chase Farm Hospital
Acknowledgement: Mr Matthew Solan
Royal Surrey County Hospital
2. Insertional TA tendinopathy
• Can be associated with a
prominent posterosuperior
calcaneal tuberosity (Haglund’s
deformity)
• Retrocalcaneal bursitis
3. Insertional TA tendinopathy
• Focal tenderness at the site of
TA insertion
• Lateral XRs may reveal
calcification
• Non-operative: same as mid
substance tendinosis = shoes
with soft heel or open back;
ESWT
• Surgery: debridement in mild
cases; severe cases tendon
can be removed and reattached
6. Plantar heel pain
• Common condition
• Affects 1:10 adults
• Often self-limiting
• Recalcitrant cases can be
challenging
7. Anatomy
PF is closely connected to the paratenon of
Achilles tendon, through the periosteum of the
heel. Hence it is functionally & structurally
continuous with TA
8. Anatomy
• Type I collagen
• Supports medial longitudinal
arch & aids propulsion,
dissipates forces + stresses
during gait and loading
• Visco-elastic property
• Ruffini & Pacinian corpuscles =
mechanoreceptors
• Hyaluronan (HA) = proximally
24. Treatment
• AOFAS position statement:
• Don’t perform surgery for PF
before trying 6 months of
nonoperative Rx (97% will
resolve with 6 months of
consistent, nonoperative Rx)
• Surgery is reserved as a last
resort:
• Open or endoscopic plantar
fascia release + release
FBLPN +/- tarsal tunnel
release
25. Evidence
• Marginal gains only
• steroid injection - short term & small degree
• orthoses - prolonged standing
• limited evidence that stretching & heel pads are
better than custom-made orthoses
• ESWT +ve but small effect
1. Crawford & Thomson Cochrane 2000, 2003
2. Thomson & Crawford BMC 2005
33. The role of gastrocnemius
contracture
• Association between isolated
gastrocnemius contracture and
forefoot/hindfoot problems -
DiGiovanni JBJS 2002, Patel &
DiGiovanni FAI 2011
• Spectrum midfoot/arch collapse
- J Anderson, D Bohay et al
34. Tibial nerve
Semimembranosus
Short saphenous vein
Midline
Medial Sural Cutaneous nerve
Common
Peroneal
nerve
Lateral Sural
Cutaneous
nerve
Anatomy
Hamilton et al. FAI 2009
Medial approach is free from nervous structures
36. PMGR
• Heel pain clinic
• Gastrocnemius contracture and its role
in plantar fasciitis and Achilles
tendinopathy
• Specific indications
• Stress ongoing management with
eccentric stretching +/- ESWT
51. • Prospective consecutive series of 21 heels (17
patients) with recalcitrant plantar fasciitis
• Symptom duration 12 months to 6 years
• Positive Silfverskiöld’s test
• Confirmed with imaging (MRI, USS or bone
scan)
• Average 24 months follow up (8-36 months)
• Outcome measure: 5 pt Likert scale, calf
weakness, satisfaction
Results - PMGR in
recalcitrant plantar
fasciitis
Abbassian et al. FAI Jan
2012
52. 0
2
5
7
9
11
Worse No change Some improvement Significant
improvement
Pain Free
5 point Likert scale
88% recommend surgery
No weakness
1 minor wound complication
Abbassian et al. FAI Jan
2012
53. Results - PMGR in
Achilles Tendinopathy
• 10 PMGRs (9 patients) over 2 years
• Duration symptoms 6-15 months
• Min follow up 18 months (20-40 months)
• Outcome measures: VAS, VISA-A,
AOFAS ankle-hindfoot score & overall
satisfaction score Gurdezi et al. FAI May 2013
55. PMGR
• Surrey - Mx plantar fasciitis &
Achilles tendinopathy
• Satisfactory correction not
significantly increased with
lateral head release
• Early results encouraging
• Day surgery, LA +/-
sedation,rapid rehabilitation,
low rate of complications
56. Personal approach
• Clinical assessment - include XRs,
USS to define pathology and PF
thickness, r/o other pathology
• 6 months physio (lower limb team)
• If gastroc tight - stretch - PMGR
• If not - ESWT
• Consider steroid, PRP, ABT, HA,
dry needling, acupuncture, topaz
• Defer surgery indefinitely
57. Summary
• Aim for logical approach, step-
wise management, and one-
stop model
• Think of tight calves
• Consider non-operative
measures always
• Evidence
58. References
1.Hicks JH. The mechanics of the foot. II. The plantar aponeurosis and the arch. J
Anat. 1954 Jan;88(1):25-30.
2. Bolgla LA, Malone TR. Plantar fasciitis and the windlass mechanism: a
biomechanical link to clinical practice. J Athl Train. 2004 Jan;39(1):77-82.
3.Shaw HM, Vázquez OT, McGonagle D, Bydder G, Santer RM, Benjamin M.
Development of the human Achilles tendon enthesis organ. J Anat. 2008
Dec;213(6):718-24.
4.Pavan PG, Stecco C, Darwish S, Natali AN, De Caro R. Investigation of the
mechanical properties of the plantar aponeurosis. Surg Radiol Anat. 2011
Dec;33(10):905-11.
5.Stecco C, Corradin M, Macchi V, Morra A, Porzionato A, Biz C, De Caro R. Plantar
fascia anatomy and its relationship with Achilles tendon and paratenon. J Anat.
2013 Dec;223(6):665-76.
6.Martin RL, Davenport TE, Reischl SF, McPoil TG, Matheson JW, Wukich DK,
McDonough CM. Heel pain-plantar fasciitis: revision 2014. J Orthop Sports Phys
Ther. 2014 Nov;44(11):A1-33.
