.------ . a -.--.----.-....___--__.._ - Semantic Scholar

BRIEF

REPORTS

HEEL-PAD

COMPRESSIBILITY

ULTRASOUND

CALCANEAL

FRACTURES:

ASSESSMENT

P. 5. KERR,

D. A. SILVER,

It has

suggested

been

AFTER

K. TELFORD.

that

H. S. ANDREWS,

fracture

of the

R. M. ATKINS

calcaneum

pro-

disruption

of the heel

ardise the normally satisfactory results of open reduction, internal fixation and early mobilisation seen in other intraarticular fractures (Heckman 1991 ; Kenwright 1993; Parmar, Triffitt and Gregg 1993).

pad

pad

previously

using

studied

ultrasound

the thickness

(Silver

of the unloaded

et al 1994).

We compared

the thickness on the injured side with that on the normal side in patients who had suffered unilateral fractures of the calcaneum, but were unable to show any thinning. The heel pad on normal.

the injured Prichasuk

side was actually (1994) has shown

plaining of idiopathic in the ‘compressibility’ with normal volunteers. In view

of the

slightly thicker that subjects

than com-

that

has

been

attributed

and

and

present

under

our

com-

results.

Patients and methods. We studied ten patients who had had unilateral displaced intra-articular fractures of the calcaneum, at a mean time of 35 months from injury ( 16 to 55). Four had been treated by operation and six conservatively. Ultrasound

measurements

obtained using Laboratories,

an ATL Redmond,

of

heel-pad

thickness

machine (Advanced Washington) and

were

Technology a 5 MHz

mechanical sector array transducer by a method described previously (Silver et al 1994). A commercial compressionextension device was clamped to the ultrasound transducer to determine the change in heel-pad thickness with an applied load. One observer applied a tieasured load, while

heel pain have significant differences of their heel pads when compared

significance

compression

state.

we have

load such as occurs during standing or walking. describe a method for measuring changes in heel-

We have

resting

fracture,

pressive We now

under

the

calcaneal

the

thickness

during

after

assessed

heel

area

pad

duces considerable damage to the heel pad with subsequent atrophy and symptoms related to loss of its protective effect (Kuhns 1949). These may be sufficiently severe to jeop-

to

a second

recorded

the ultrasound

measurements.

20 18 a

--

16

. 14

.

.....

.-

. .

-

E

Ia

12

.2

10

.

Fractured

side

.

.--.

C a

Normal side

...

.

.------- .

a

9. I

Fig. I 64

4.

2L 0

.

---

---

----.

0.5

0

-.--.----.. ...___--__.._

.

1

1.5 ApplIed

of

Orthopaedic

Senior

to Mr

504

forces

Lecturer

Surgery

Radiologist BS2

R. M. Atkins.

©1995 British Editorial Society of Bone 030l-620X195/3R33 $2.00 J Bone Joint Surg [Br] 1995:77-B:504-5. Received 11 Apri/ 1994; Accepted 6 July

3

load (kgIcm)

D. A. Silver. BSc, MRCP, FRCR, Senior Registrar H. S. Andrews, DMRD, MRCP, FRCR, Consultant Department of Radiology Bristol Royal Infirmary, Marlborough Street. Bristol Correspondence

-.-.

2.5

Readings

P. 5. Kerr, FRCS, Research Registrar K. Telford, MB ChB, Senior House Officer R. M. Atkins, MA. DM, FRCS. Consultant Department

2

and

1994

Joint

Surgery

8HW.

UK.

were

of 0, 3 and

taken 6kg.

in a random The

contact

order surface

transducer was 2 cm giving loads of respectively. The mean pressure passing ing foot in adults has been shown to be 1.8) (Betts et al 1980), increasing to 5

with area

OF BONE

of the

1 .5 and 3 kg/cm, through the stand0.9 kg/cm (0.6 to kg/cm at impact

during walking (Perry 1983). Our experimental recreates forces of a similar magnitude. Results. Before loading, our findings were similar previously reported (Silver et al 1994). The mean THE JOURNAL

applied

ANt)

JOINT

model to those heel-pad SURGERY

BRIEF

Table I. Heel-pad niaxiiiial loading

thickness

(miii)

Loadin

and

percentage

compression

g (kg/cm2)

0

1.5

REPORTS

belief

under

internal No

Normal

side

I 7.9

1 1.0

9.8

45.3

Injured

side

19.4

12.5

10.7

44.8

NS

NS