Panagiotis Baltopoulos

Treatment of plantar fasciitis in recreational athletes: two different therapeutic protocols.

Plantar fasciitis (PF) commonly causes inferior heel pain and occurs in up to 10% of the US population. Treatment protocols in most studies include the use of ice therapy, nonsteroidal anti-inflammatory drugs (NSAIDs), and stretching and strengthening protocols. The aim of the current study was to examine the effectiveness of 2 different therapeutic approaches on the treatment of PF in recreational athletes using the Pain and Disability Scale for the evaluation. A total of 38 participants with PF were randomly allocated to 2 different groups of 19 male participants in each group. Group 1 was treated with ice, non-steroidal anti-inflammatory medication, and a stretching and a strengthening program. Group 2 received the same therapeutic procedures as group 1, reinforced by acupuncture treatment. The primary outcomes, nominated a priori, were pain description and mobility-function at 1 and 2 months. Outcomes were measured with the pain scale for PF. The mean total score of the acupuncture group at the third measurement was statistically minor compared with the mean total score of the first group. Acupuncture should be considered as a major therapeutic instrument for the decrease of heel pain, combined with traditional medical approaches.

The Effect of Q Angle on Ankle Sprain Occurrence

The intersegmental joint forces and the structures that must resist them (articular surfaces, ligaments, and musculature) are related through anatomical alignment of the joints and skeletal system. Ankle joint structure can affect or be affected by bony malformations of the surrounding areas, including the knee and hip. The aim of the current study is to examine the possible relationship between the quadriceps (Q) angle and other factors (anthropometric characteristics, medical history, and age) on the occurrence of ankle sprains, because its value, when assessed correctly, provides useful information for the anatomical alignment of the lower extremity. The study sample consisted of 45 high-level athletes, evenly distributed among 3 sports (basketball, soccer, and volleyball). Q angle measurements were made on radiographs. The study lasted for 2 years. A logistic regression was used to determine the importance of each factor on the probability in question. A significance level of P = .1 was used. The factors contributing more to an ankle sprain were a previous injury of the same type ( P < .01) followed by body mass index (BMI; P < .10) and age (P < .10). On the contrary, Q angle was proven to be statistically nonsignificant (P > .10). The results were valid even when the BMI variable was substituted by body inertia propensity, a derived variable. The Q angle remained statistically nonsignificant ( P > .10). The Q angle magnitude does not seem to be a decisive factor that could increase the probability of spraining an ankle. The most important factors that could affect the probability of sustaining an ankle sprain are the athletes age, anthropometric characteristics, and prior injuries.

Involvement of the p38 MAPK-NF-κB Signal Transduction Pathway and COX-2 in the Pathobiology of Meniscus Degeneration in Humans

Meniscal tears are attributed to either trauma or degeneration processes. Clinical data suggest that meniscal degeneration (MD) is associated with knee osteoarthritis; however, the molecular events underpinning the pathogenesis of MD in humans remain elusive. Here we immunohistochemically examined the expression of p38 MAPK, its phosphorylated/activated form (p-p38), its target NF-κB (p50–p65 dimer), and COX-2 in ruptured menisci and investigated their involvement in MD development. Our findings demonstrate increased expression of the p38-NF-κB axis elements and COX-2 in disintegrated fibrocartilage, suggesting a role of these molecules in the pathobiochemistry of MD and consequential rupture.

Exercise-Induced Scalenus Syndrome

Background Thoracic outlet syndrome is described as a group of distinct disorders producing signs and symptoms attributed to compression of nerves and blood vessels in the thoracic outlet region. Purpose To describe the exercise-induced scalenus anticus syndrome attributed to the anterior scalenus hypertrophy as a thoracic outlet syndrome underlying mechanism and to give recommendations for a safe and effective surgical treatment. Study Design Case series; Level of evidence, 4. Methods Twelve young professional athletes admitted for thoracic outlet syndrome (8 cases of neurologic thoracic outlet syndrome, 4 cases of mixed neurologic and vascular thoracic outlet syndrome) who reported numbness, tingling, early fatigue, muscle weakness, and pain were enrolled in the study. Scalenus hypertrophy was suspected to be the causative factor. Scalenectomy was performed in all cases. Results All patients had moderate to severe hypertrophy of the anterior scalenus muscle. Scalenectomy was performed, and there were no intraoperative or postoperative complications. Full activity was quickly achieved, and no recurrence of symptoms was documented. Conclusion Surgical intervention for scalenus anticus syndrome can allow an athlete to return to full activity and improve quality of life. Surgical intervention seems to be the treatment of choice in terms of restoring quality of life and physical activity.

The Impact of the Spartathlon Ultramarathon Race on Athletes’ Plantar Pressure Patterns

More than 90% of injuries in runners are recorded in the lower extremity, equally affecting the regions of the knee, shank, and foot. Stress fractures are responsible for numerous running-related injuries. In the current study, the plantar pressure patterns of prerace, immediately postrace, and 24 hours after long-distance running in the Spartathlon were analyzed to compare foot loading in the respective conditions. Forty-six male participants of the Spartathlon ultramarathon were examined before, immediately after completion of the race, and 24 hours later with plantar pressure measurements during barefoot walking on a capacitive platform. The results revealed a significant increase in the peak pressure and impulse values in the forefoot areas and a decrease under the toes before and immediately after the race. On the contrary, no significant differences were found between the prerace and the 24-hour postrace values. The present findings indicate that the Spartathlon race leads to significant variations in foot-loading characteristics, especially in the peak pressure and impulse values under the forefoot and toe regions. Twenty-four-hour postrace data measurements reveal insignificant differences from the prerace statement, probably because of the restoration of local muscular activity.

Osteoarthritis of the Ankle and Foot Complex in Former Greek Soccer Players

Sports activities cause increased loads in elite athletes’ joints. Current scientific knowledge highlights the importance of applied mechanical loads on the physiology and pathophysiology of the articular cartilage. Thus, it is possible that sporting activity has a role in the development of osteoarthritis (OA), a painful and damaging joint disease. The aim of the present study was to investigate and record osteoarthritic alterations in the ankle and foot complex in former Greek soccer players and also compare them with those in the general population. The study sample consisted of 170 male, former elite soccer players, aged between 42 and 55 years (mean = 49.8 years, standard deviation [SD] = 7.4). A control group of 132 men, aged between 42 and 55 years (mean, 50.7 years, SD = 9.9), with no regular athletic activity were examined. The development of osteoarthritic alterations was recorded through a questionnaire and clinical and radiological examination. Radiographic analysis of the images in former athletes group showed not only more signs of cartilage degeneration in comparison with the control group (P < .05) but also similar clinical manifestations (pain and impaired mobility; P > .05). Osteophyte formation is a frequent disease among former soccer players—with variations on radiographic images—but it does not appear in their clinical picture. However, it is likely that both spurs and subchondral sclerosis (main findings) are preclinical manifestations of OA. Levels of Evidence: Prognostic, Level II

Tibiofemoral Angle and Its Relation to Ankle Sprain Occurrence

The lack of a normal joint orientation generates translational or shear forces across the joint. These forces can put abnormally high strain on the cartilage and the surrounding capsuloligamentous tissues. Ankle joint structure can affect or be affected by bony malformations of the surrounding areas, including the knee and hip. The aim of the current study is to examine the possible relationship between the tibiofemoral (TFA) angle and other factors (anthropometric characteristics, medical history, and age) on the occurrence of ankle sprains because its value provides useful information for the anatomical alignment of the lower extremity. The study sample consisted of 45 high-level athletes, evenly distributed among 3 sports (basketball, soccer, and volleyball). TFA measurements were made on radiographs. The study lasted 2 years. A logistic regression was used to determine the importance of each factor on the probability in question. A significance level of P = .1 was used. The factors contributing more to an ankle sprain were a previous injury of the same type followed by body mass index (BMI) and age. On the contrary, TFA was proven to be statistically nonsignificant. When the BMI variable was substituted with body inertia propensity, a derived variable, the TFA remained statistically nonsignificant. TFA magnitude does not seem to be a determinant factor that could increase the probability of spraining an ankle.

Intervertebral disc calcification in thalassemia intermedia

Objectives:  Intervertebral disc calcification, an age‐related phenomenon of variable clinical significance is described in hemochromatosis. As β‐thalassemia is characterized by excessive tissue iron deposition and secondary hemosiderosis, and skeletal abnormalities are often observed in these patients, this study is conducted to identify the prevalence of Intervertebral Disc Calcification (IDC) in thalassemia intermedia population.

Marketed nonsteroidal anti-inflammatory agents, antihypertensives, and human immunodeficiency virus protease inhibitors: as-yet-unused weapons of the oncologists' arsenal.

Experimental data indicate that several pharmacological agents that have long been used for the management of various diseases unrelated to cancer exhibit profound in vitro and in vivo anticancer activity. This is of major clinical importance, since it would possibly aid in reassessing the therapeutic use of currently used agents for which clinicians already have experience. Further, this would obviate the time-consuming process required for the development and the approval of novel antineoplastic drugs. Herein, both pre-clinical and clinical data concerning the antineoplastic function of distinct commercially available pharmacological agents that are not currently used in the field of oncology, ie, nonsteroidal anti-inflammatory drugs, antihypertensive agents, and anti-human immunodeficiency virus agents inhibiting viral protease, are reviewed. The aim is to provide integrated information regarding not only the molecular basis of the antitumor function of these agents but also the applicability of the reevaluation of their therapeutic range in the clinical setting.

An Isolated Dorsal Dislocation of the Lateral Cuneiform

We present a case of an isolated dorsal dislocation of the lateral cuneiform bone. This particular injury is extremely rare and quite often escapes the initial assessment of the medical examiner. Timely and accurate diagnosis of the injury is very important as the treatment is usually surgical. Level of Evidence: Therapeutic, Level IV: Case Report