fracture, we have assessed the area during the resting state. and under com- pressive .... scapular notch may develop. sometimes bridged by bone. (Fig. 1). Fig. I.
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
