The Foot
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The use of orthotic heel lifts is proposed in many cases of Achilles tendon disorders as a first-line or conservative treatment. The use of heeled shoes induces a plantar flexion of the ankle joint with a consequent decrease in the tension forces acting onto the triceps surae. The question to address is how high must the heel be? Gait cycle using 1 cm- and 2 cm-high heel lifts was examined. ⋯ A very significant decrease (p=0.0001) was found in the amplitude of the curve expressing the force produced by the whole limb in response to ground reaction forces. This is expressed by a decrease in minimum values, suggesting a lower degree of energy absorption at heel strike, as well as maximum values reflecting the amount of energy generated at push off. This might suggest that by reducing energy absorption by the whole limb a 2-cm heel lift would have a protective effect for those muscles that are most significantly involved in this function, such as the tibiotarsal complex (triceps surae) and the knee complex (rectus femoris).
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Randomized Controlled Trial
Audiovisual distraction as an adjunct to pain and anxiety relief during minor surgery.
Minor surgery for ingrown toenails can provoke anxiety and the anaesthetic injection can be acutely painful. Distraction techniques may reduce the associated pain and anxiety. ⋯ Pain of injected anaesthesia correlates closely with pre-operative anxiety. Formal audiovisual distraction has no added benefit over interpersonal interaction in the alleviation of pain and anxiety in patients undergoing nail surgery.