PAIN FROM PLANTAR FASCIITIS

Introduction: Fasciitis of the foot is an inflammatory condition characterized by pain in the medial, central and lateral sectors of the sole accompanied by stiffness. The aim of this study was to examine and interpret the features of the pain focus in this condition from a clinical and esthesiological point of view and in relation to the objective findings of a biomechanical evaluation. Material and Method: Twenty-two subjects (17males, 5 females), aged 19-51 years were examined who practised sport regularly; all presented pain in the sole of the foot. Each subject underwent a clinical and esthesiological examination with measurement of pain thresholds to electrical stimulation of the skin, subcutaneous tissue and muscle in the trigger point zone and unaffected controlateral area and also an evaluation of biomechanical parameters related to function by means of an analysis of the foot-ground reaction and peak force revealed by isokinetic dynamometer. The patient were then fitted with a corrective insole and re-subjected to the above examinations after 30 and 60 days. Results: The subjects were divided into 3 groups on the basis of the TrP site and area of referred pain, as follows:Group A (12 cases) had fascial pain in the calcaneum attachment. The objective examination showed an active TrP determining referred pain in the median part of the sole of the foot. Group B ( 8 cases) had pain localized in the middle third of the medial part of the fascia. The objective examination showed an active TrP causing pain radiating disto-proxiamlly to the attachment of the peroneus muscle at the base of the V metatarsus. The esthesiological evaluation of these groups showed lowered pain thresholds in the skin and muscle compared with the controlateral areas. The isokinetic examination revealed a significant decrease in the peak force in concentric contraction and peak force in eccentric contraction. The foot-ground reaction were abnormal for same spatial and temporal components. A significant reduction of the painful symptoms was observed in these subjects after 30 days with corrective insole, together with a normalization of locomotion. After 60 days, the pain had disappeared and there was an objective reduction of the irritability of the TrPs and absence of the target zone. The esthesiological examination of the pain threshold to electrical stimulation of the skin and muscle showed a further increase with respect to the previous control. All components of the foot-ground reaction were improved. Conclusion: These results show that pain from fasciitis of the sole of the foot is due to an abnormality of movement which gives rise to an imbalance of the force and flexibility of the flexor muscle in this area. The improvement of the ground-foot reaction brings about a gradual disappearance of the painful symptoms

PLANTAR FASCIITIS: AN UPDATE ON CLINICAL AND BIOMECHANICAL FEATURES

Plantar fasciitis is an inflammatory condition, characterized by pain in the medial, central and lateral plantar compartments, accompanied by stiffness. The purpose of this study is to compared 30 runner affected by plantar fasciitis to a. control group and to point out 1) the different areas of pain and referred pain, 2) the isokinetic muscular performance of the plantar flexor muscle, by means of a Cibex 6000 isokinetic dynamometer and tests performed concentrically and eccentrically at 30, 60, 90, 180 deg/sec. 3) the data of the foot-ground reaction got by means of a. dynamometric platform. Results: In all the three sectors of plantar fascia there are different areas of pain and referred pain. An high incidence of plantar flexor muscle strength deficits has been showed both during concentric and eccentric contraction, and in addition the ankle range of motion is reduced. The gait analysis has shown a persistent alteration of the foot-ground reaction's parameters. The Aa. present the results of the treatment based on the correction of biomechanical deficits with follow-up of three years

Highlights from "Italian Standards of care for Diabetes Mellitus 2009-2010".

The Italian Standards for the Treatment of Diabetes Mellitus represent a consensus document of the two Italian scientific diabetes societies (AMD and SID), providing specific recommendations for the diagnosis and treatment of diabetes and its complications. The level of scientific evidence behind every recommendation has been classified in accordance with the National Guidelines Plan. An original processing system was employed: the document prepared by the Editorial Team was published online for 20 days, and the suggestions and criticisms of about 30 persons were evaluated and integrated to those provided by a panel of diabetologists and members of other healthcare professions dedicated to diabetes care, as well as lay members. Lastly, the document was approved by AMD and SID National Steering Committees. In this version, some highlights of the full document (www.siditalia.it; www.aemmedi.it) concerning the main and most representative recommendations on diagnosis and treatment of diabetes and its complications as well as on diabetes care in some specific contexts, are reported

AMD Annals: a model of continuous monitoring and improvement of the quality of diabetes care

OBJECTIVE: in recent years, several initiatives have been launched by the Associazione medici diabetologi (AMD) in the context of a national quality improvement program.These activities include: identification of specific indicators of quality of diabetes care, development of a software to calculate such indicators by using routine clinical data, creation of a network of diabetes clinics and analysis and publication of the results in ad hoc reports (AMD Annals). Through the best performer approach, each centre could compare its own performance not only with the theoretical targets suggested by existing guidelines, but also with the results achieved by the best centres operating within the same healthcare system.We evaluated whether the involvement of diabetes clinics into the AMD Annals initiative improved the quality of care over 4 years. DESIGN: a controlled before and after study was performed to compare data collected from 2004 to 2007 by two groups of centres: group A included centres that had been involved in the project since the first edition of AMD Annals; group B included centres only involved in the last edition. SETTING AND PARTICIPANTS: overall, 124 diabetes clinics provided data on over 100,000 type 2 diabetes patients/year seen from 2004 to 2007. MAIN OUTCOME MEASURES: process indicators included the proportion of patients with at least one measurement of HbA1c, blood pressure and lipid profile during the previous 12 months. Intermediate outcomes included percentages of patients with levels of HbA1c ≤ 7%, blood pressure ≤ 130/85 mmHg and LDL-cholesterol <100 mg/dl (favourable indicators), and the percentages of patients with levels of HbA1c ≥ 9%, blood pressure ≥ 140/90 mmHg and LDL-cholesterol ≥ 130 mg/dl (unfavourable indicators). Percentages of patients treated with insulin, two or more antihypertensive agents, and statins were also evaluated. A multilevel analysis adjusted for age, gender, diabetes duration, and clustering effect was applied to investigate the changes in the indicators between the two groups of centres during 4 years. RESULTS: lipid profile monitoring increased more in group A (+6.2% from 2004 to 2007) than in group B (+2.4%), while HbA1c and blood pressure monitoring did not change over time in both groups. As for the outcomes considered, the percentage of patients with HbA1c ≤ 7% increased by 6% in group A and by 1.3%in group B, while the proportion of patients achieving the blood pressure target increased in group A (+6.4%), but not in group B (-1.4%). A reduction in the percentage of patients with blood pressure ≥ 140/90 mmHg was found in group A (-7.3%) but not in group B (-0.9%). Marked improvements in the proportion of patients with LDL-cholesterol at target were documented in both groups (group A: +10.5%; group B: +12.2%.) The proportion of patients treated with insulin increased in group A only (+5.8%), while the use of statins grew by 20%in both groups.The proportion of individuals treated with two or more antihypertensive drugs increased by 3.6% in group A and by 1.6% in group B. CONCLUSION: the AMD Annals approach can be considered as a case model for quality improvement activities in chronic diseases and a tool to evaluate the level of adoption/acceptance of guidelines in clinical practice. The considerable success documented was obtained without allocation of extra resources or financial incentives but simply through a physician-led effort made possible by the commitment of the specialists involved

[AMD Annals: a model of continuous monitoring and improvement of the quality of diabetes care].

OBJECTIVE: in recent years, several initiatives have been launched by the Associazione medici diabetologi (AMD) in the context of a national quality improvement program.These activities include: identification of specific indicators of quality of diabetes care, development of a software to calculate such indicators by using routine clinical data, creation of a network of diabetes clinics and analysis and publication of the results in ad hoc reports (AMD Annals). Through the best performer approach, each centre could compare its own performance not only with the theoretical targets suggested by existing guidelines, but also with the results achieved by the best centres operating within the same healthcare system.We evaluated whether the involvement of diabetes clinics into the AMD Annals initiative improved the quality of care over 4 years. DESIGN: a controlled before and after study was performed to compare data collected from 2004 to 2007 by two groups of centres: group A included centres that had been involved in the project since the first edition of AMD Annals; group B included centres only involved in the last edition. SETTING AND PARTICIPANTS: overall, 124 diabetes clinics provided data on over 100,000 type 2 diabetes patients/year seen from 2004 to 2007. MAIN OUTCOME MEASURES: process indicators included the proportion of patients with at least one measurement of HbA1c, blood pressure and lipid profile during the previous 12 months. Intermediate outcomes included percentages of patients with levels of HbA1c ≤ 7%, blood pressure ≤ 130/85 mmHg and LDL-cholesterol <100 mg/dl (favourable indicators), and the percentages of patients with levels of HbA1c ≥ 9%, blood pressure ≥ 140/90 mmHg and LDL-cholesterol ≥ 130 mg/dl (unfavourable indicators). Percentages of patients treated with insulin, two or more antihypertensive agents, and statins were also evaluated. A multilevel analysis adjusted for age, gender, diabetes duration, and clustering effect was applied to investigate the changes in the indicators between the two groups of centres during 4 years. RESULTS: lipid profile monitoring increased more in group A (+6.2% from 2004 to 2007) than in group B (+2.4%), while HbA1c and blood pressure monitoring did not change over time in both groups. As for the outcomes considered, the percentage of patients with HbA1c ≤ 7% increased by 6% in group A and by 1.3%in group B, while the proportion of patients achieving the blood pressure target increased in group A (+6.4%), but not in group B (-1.4%). A reduction in the percentage of patients with blood pressure ≥ 140/90 mmHg was found in group A (-7.3%) but not in group B (-0.9%). Marked improvements in the proportion of patients with LDL-cholesterol at target were documented in both groups (group A: +10.5%; group B: +12.2%.) The proportion of patients treated with insulin increased in group A only (+5.8%), while the use of statins grew by 20%in both groups.The proportion of individuals treated with two or more antihypertensive drugs increased by 3.6% in group A and by 1.6% in group B. CONCLUSION: the AMD Annals approach can be considered as a case model for quality improvement activities in chronic diseases and a tool to evaluate the level of adoption/acceptance of guidelines in clinical practice. The considerable success documented was obtained without allocation of extra resources or financial incentives but simply through a physician-led effort made possible by the commitment of the specialists involved