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The increasing incidence of calcaneal tendon ruptures has substantially impacted orthopedic care and costs related to its treatment and prevention. Primarily motivated by the increasing of life expectancy, the growing use of tenotoxic drugs and erratic access to physical activity, this injury accounts for considerable morbidity regardless of its outcome. In recent years, the evolution of surgical and rehabilitation techniques gave orthopedists better conditions to decide the most appropriate conduct in acute tendon rupture. Although still frequent due to their high neglect rate, Achilles chronic ruptures currently find simpler and more biological surgical options, being supported by a new specialty-focused paradigm. Resumo A crescente incidência de rupturas do tendão calcâneo tem impactado substancialmente o cuidado ortopédico e os custos relacionados ao seu tratamento e prevenção. Motivada principalmente pelo aumento da expectativa de vida, o crescimento do uso de drogas tenotóxicas e o acesso errático à atividade física, essa lesão gera morbidade considerável aos pacientes qualquer seja o desfecho a ser considerado. A evolução das técnicas cirúrgicas e de reabilitação permitiu que ortopedistas, nos últimos anos, tivessem melhores condições para decidir a conduta mais apropriada nas roturas agudas do tendão calcâneo. Por mais que ainda frequentes pela sua alta taxa de negligência, as rupturas crônicas do Aquiles hoje encontram opções operatórias biológicas mais simples e são amparadas por um novo paradigma que se debruça sobre a especialidade.

ResumoA crescente incidência de rupturas do tendão calcâneo tem impactado substancialmente o cuidado ortopédico e os custos relacionados ao seu tratamento e prevenção. Motivada principalmente pelo aumento da expectativa de vida, o crescimento do uso de drogas tenotóxicas e o acesso errático à atividade física, essa lesão gera morbidade considerável aos pacientes qualquer seja o desfecho a ser considerado. A evolução das técnicas cirúrgicas e de reabilitação permitiu que ortopedistas, nos últimos anos, tivessem melhores condições para decidir a conduta mais apropriada nas roturas agudas do tendão calcâneo. Por mais que ainda frequentes pela sua alta taxa de negligência, as rupturas crônicas do Aquiles hoje encontram opções operatórias biológicas mais simples e são amparadas por um novo paradigma que se debruça sobre a especialidade.

Made available in DSpace on 2021-06-25T11:00:45Z (GMT). No. of bitstreams: 0 Previous issue date: 2021-01-01 The present study aimed to evaluate the new heterologous fibrin biopolymer associated, or not, with photobiomodulation therapy for application in tendon injuries, considered a serious and common orthopedic problem. Thus, 84 Rattus norvegicus had partial transection of the calcaneus tendon (PTCT) and were randomly divided into: control (CG); heterologous fibrin biopolymer (HFB); photobiomodulation (PBM); heterologous fibrin biopolymer + photobiomodulation (HFB + PBM). The animals received HFB immediately after PTCT, while PBM (660 nm, 40 mW, 0.23 J) started 24 h post injury and followed every 24 h for 7, 14, and 21 days. The results of the edema volume showed that after 24 h of PTCT, there was no statistical difference among the groups. After 7, 14, and 21 days, it was observed that the treatment groups were effective in reducing edema when compared to the control. The HFB had the highest edema volume reduction after 21 days of treatment. The treatment groups did not induce tissue necrosis or infections on the histopathological analysis. Tenocyte proliferation, granulation tissue, and collagen formation were observed in the PTCT area in the HFB and HFB + PBM groups, which culminated a better repair process when compared to the CG in the 3 experimental periods. Interestingly, the PBM group revealed, in histological analysis, major tendon injury after 7 days; however, in the periods of 14 and 21 days, the PBM had a better repair process compared to the CG. In the quantification of collagen, there was no statistical difference between the groups in the 3 experimental periods. The findings suggest that the HFB and PBM treatments, isolated or associated, were effective in reducing the volume of the edema, stimulating the repair process. However, the use of HFB alone was more effective in promoting the tendon repair process. Thus, the present study consolidates previous studies of tendon repair with this new HFB. Future clinical trials will be needed to validate this proposal. Department of Biomedical Engineering Instituto Científico E Tecnológico University Brazil Biotechnology and Biodiversity Research Center UESPI Center for the Study of Venoms and Venomous Animals (CEVAP) São Paulo State University (UNESP – Univ Estadual Paulista) Department of Physiotherapy Federal University of São Carlos Department of Health Sciences Piauí State University (UESPI) Department of Physiotherapy, Faculdade Uninovafapi Center for the Study of Venoms and Venomous Animals (CEVAP) São Paulo State University (UNESP – Univ Estadual Paulista)

Evidence-based medicine is a new paradigm for medical practice in situations that generate uncertainties regarding disease diagnosis, prognosis, and therapeutic management, requiring professionals to develop expertise in the critical evaluation and validation of scientific publications. Thus, this study aimed to evaluate the articles published in Brazil between 2010 and 2019 on foot and ankle medicine. Three researchers independently searched for articles on foot and ankle medicine in three renowned Brazilian orthopedic journals, as follows: Revista Brasileira de Ortopedia, Acta Ortopedica Brasileira, and Revista Abtpe. In total, 296 articles were identified and complied with the inclusion criteria, being thus analyzed. Applying the Oxford hierarchy of evidence classification, we found that, across the three journals, most articles were at levels 4 and 5 of evidence and originated in the state of Sao Paulo. The most discussed topics were trauma, hallux valgus, pathologies of the calcaneus tendon, and ligament injuries. Given that the predominance of articles with a lower level of evidence has also been reported in the literature for international journals, initiatives that encourage an increase in the number, in the popularization, and the improvement of the level of evidence for foot and ankle medicine research in Brazil are warranted.

RESUMO A deformidade em equino leva a diversos transtornos da marcha, ao causar alterações no apoio do pé e afetar regiões anatômicas mais distantes, como o joelho, quadril e tronco. Geralmente é secundária à retração, encurtamento ou espasticidade do tríceps sural, de modo que algumas intervenções cirúrgicas podem ser necessárias para corrigi-la. Trata-se de um dos procedimentos mais antigos da Ortopedia, antes realizado apenas no tendão calcâneo e que, ao longo do tempo, evoluiu com técnicas diferentes de acordo com o grau de deformidade, doença de base e perfil do paciente. Busca-se corrigir a deformidade, com a menor interferência possível na força muscular e, com isso, diminuir a incidência de complicações, como marcha agachada, arrastada e pé calcâneo. Do ponto de vista anatômico, o tríceps sural apresenta cinco regiões que podem ser abordadas cirurgicamente para correção do equino. Em virtude da complexidade do paciente com equino, os ortopedistas devem ter experiência com ao menos uma técnica em cada zona. Neste texto são abordadas e analisadas criticamente as técnicas mais importantes para correção do equino, principalmente de modo a evitar complicações. Foi realizada uma busca sobre técnicas cirúrgicas mais comuns de correção do equino em livros clássicos e identificação e consulta aos artigos originais. Em seguida, fez-se uma busca em bases de dados nos últimos dez anos. ABSTRACT The equinus deformity causes changes in the foot contact and may affect more proximal anatomical regions, such as the knee, hip and trunk, potentially leading to gait disorders. The equinus is usually secondary to retraction, shortening and/or spasticity of the triceps surae, and it may require surgical correction. Surgery for the correction of equinus is one of the oldest procedures in Orthopedics, and it was initially performed only at the calcaneus tendon. The technique has evolved, so that it could be customized for each patient, depending on the degree of deformity, the underlying disease, and patient´s profile. The aim is to correct the deformity, with minimal interference in muscle strength, thus reducing the incidence of disabling complications such as crouch gait and calcaneus foot. We conducted a literature search for the most common surgical techniques to correct the equinus deformity using classic books and original articles. Further, we performed a database search for articles published in the last ten years. From the anatomical perspective, the triceps surae presents five anatomical regions that can be approached surgically for the equinus correction. Due to the complexity of the equinus, orthopedic surgeons should be experienced with at least one procedure at each region. In this text, we critically approach and analyze the most important techniques for correction of the equinus, mainly to avoid complications.

Resume Les ruptures du tendon calcaneen sont en incidence croissante. Leur siege est habituellement situe en zone medio-tendineuse. La rupture distale est rare et s’observe classiquement chez des patients plus âges ; l’avulsion du calcaneum en est une forme exceptionnelle. Un homme de 48 ans pratiquant tres regulierement le football, en loisir veteran, a ete pris en charge pour une rupture distale du tendon calcaneen gauche dans un contexte de tendinopathie degenerative connue et suivie depuis 6 mois. Une echographie avant la rupture, ainsi qu’une IRM, objectivaient une enthesopathie micro-fissuraire en regard de l’angle postero-superieur du calcaneum avec une bursite pretendineuse. Le patient a ete initialement traite par une infiltration de corticoides permettant temporairement la reprise du sport. Il a ensuite consulte, dans un delai de 15 jours, pour une symptomatologie typique de rupture du tendon calcaneen. Lors de la chirurgie, il a ete constate une avulsion osseuse de l’insertion calcaneenne du tendon avec un aspect inflammatoire et degeneratif. Deux ancres ont permis la reinsertion distale du tendon calcaneen, suivie d’une immobilisation pour une duree de 2 mois, puis d’un protocole de reeducation. Le resultat fonctionnel a ete evalue par la mesure de la force musculaire du triceps sural avec un dynamometre. Le patient a pu reprendre le football et le footing au meme niveau au 8e mois. La plupart des techniques chirurgicales ne sont pas realisables en cas d’avulsion calcaneenne. La reinsertion transcalcaneenne par ancres est une solution simple, apportant une resistance indeniable et un bon resultat fonctionnel.

Background: Surgery is frequently considered an option for refractory, symptomatic noninsertional Achilles tendinopathy. Gastrocnemius equinus can result in mechanical overload of the Achilles tendon and may be a factor in its etiology. Our hypothesis was that reducing load transmission to the Achilles tendon by gastrocnemius lengthening (Strayer procedure) may be an effective treatment. Materials and Methods: A prospective case series of all patients with a minimum 1-year symptomatic nonin-sertional Achilles tendinopathy who underwent gastrocnemius lengthening was evaluated before surgery, and at 1 and 2 years after surgery. There were 14 patients (17 tendons). Results: One year after surgery, the median American Orthopaedic Foot and Ankle Society (AOFAS) Ankle-Hindfoot score was 100 points, as compared to 71 points preoperatively ( p< 0.001). The median total Foot Function Index (FFI) decreased significantly from 39 to 12 points at 1 year ( p< 0.001) and remained stable (12 points) at 2 years. An electronic goniometer recorded a mean gain in ankle dorsiflexion of 13 degrees. At 1 year after surgery the MRI in all eight patients (ten tendons) with a preoperative MRI demonstrated a decrease in signal hyperintensity and tendon size, signifying an improvement of the tendinopathy. At 2 years after surgery, patient satisfaction assessment revealed that all but one patient was satisfied with the result and 11 of the 14 (79%) patients were able to resume their previous sporting activities. There were no complications. Conclusion: Gastrocne-mius lengthening was an effective treatment for chronic Achilles noninsertional tendinopathy. Two-year results show good to excellent clinical outcome. Level of Evidence: Level IV, Prospective Case Series

O tendão calcâneo é uma das estruturas tendíneas que sofrem lesões com maior frequência em cães, e a não realização do tratamento implica comprometimento da função locomotora. Este trabalho objetivou relatar um caso atendido no Hospital de Clínicas Veterinárias da Universidade Federal do Rio Grande do Sul (HCV – UFRGS) de estiramento crônico do tendão calcâneo comum em um cão da raça Rottweiler, com sete anos de idade, apresentando histórico de claudicação. Ao exame físico, o animal apresentava-se com hiperflexao da articulação tíbiotarsal esquerda, à palpação, o tendão encontrava-se íntegro e edemaciado. O diagnóstico de estiramento crônico do tendão foi baseado no histórico, sinais clínicos e exames complementares, sendo o animal submetido à cirurgia reparadora. Realizou-se tenectomia parcial e posterior tenorrafia utilizando-se sutura em laço de travamento com fio nylon monofilamentar. A articulação tibiotarsal esquerda foi imobilizada com fixação esquelética externa. Após duas semanas do procedimento cirúrgico, o animal apresentava apoio do membro afetado. A técnica cirúrgica utilizada foi satisfatória para o tratamento desta lesão, pois promoveu cicatrização do tendão e o retorno da deambulação normal.

Objective: The aim of this study was to compare the effect of the low level laser therapy in the organization of the collagen fibers with 3 J/cm² of dose in two wavelengths (670nm and 904nm) and in the combination of both on the tissue repair of the calcaneus tendon. Methods: We used 37 female Wistar rats divided in 5 groups which had been submitted to the total tenotomy. Group GA (n= 8) was submitted to the laser irradiation in λ= 904nm, GaAS, pulsated emission, peak power 15W and dose of 3J/ cm², group GB (n= 8) was submitted to laser irradiation λ= 670nm AlGaInP diode, continuous emission, power 30 mW and dose 3J/cm², group GAB (n= 8) was submitted to association of both of lasers and group GCL (n= 7) which the calcaneum tendon was submitted to placebo treatment. The group GP (n= 6) was a standard group without lesion and treatment. The animals received 12 sessions of lasertherapy and submitted to euthanasia on 14 th day after surgery. The tendons were submitted to histological procedure and were analyzed to evaluate the optic retardation (in nm) for the birefringence measurement. Results: The statistic analysis showed that the irradiated groups have higher values of optic retardation statistically significant than placebo group (p= 0,00001). It indicates that all the treated groups show better organization of collagen fibers in the longitudinal axis of the tendon, evidencing better quality in the tissue repair. The group GAB was that shown best results (p= 0,00001) when compared to another groups.

Controlled laboratory study.To evaluate the effect of low-intensity therapeutic ultrasound on the murine calcaneus tendon healing process.Therapeutic ultrasound promotes formation and maturation of scar tissue.Calcaneus tendon tenotomy and tenorrhaphy was performed on 28 Wistar rats. After the procedure, the animals were randomly divided into 2 groups. The animals in the experimental group received a 5-minute ultrasound application, once a day, at a frequency of 1 MHz, a spatial average temporal average intensity of 0.1 W/cm2, and a spatial average intensity of 0.52 W/cm2 at a 16-Hz frequency pulse mode (duty cycle, 20%). Data for the injured side were normalized in relation to the data from the contralateral healthy calcaneus tendon (relative values). The animals in the control group received sham treatment. After a 28-day treatment period, the animals were sacrificed and their tendons surgically removed and subjected to mechanical stress testing. The parameters analyzed were cross-sectional area (mm2), ultimate load (N), tensile strength (MPa), and energy absorption (mJ).A significant difference between groups was found for the relative values of ultimate load and tensile strength. The mean ± SD ultimate load of the control group was -3.5% ± 32.2% compared to 33.3% ± 26.8% for the experimental group (P = .005). The mean tensile strength of the control group was -47.7% ± 19.5% compared to -28.1% ± 24.1% for the experimental group (P = .019). No significant difference was found in cross-sectional area and energy absorption.Low-intensity pulsed ultrasound produced by a conventional therapeutic ultrasound unit can positively influence the calcaneus tendon healing process in rats.

Made available in DSpace on 2022-04-29T02:56:40Z (GMT). No. of bitstreams: 0 Previous issue date: 2011-01-01 Objective: The aim of this study was to evaluate the effects on the mechanical properties of rats' calcaneus tendons, of repair arrangements using suture material in the absence of any healing process. Method: Twelve male Wistar rats were used. They were subjected to placement of a modified Kessler suture stitch in the calcaneus tendon. The sacrifices were performed immediately after and six weeks after the operation. The mechanical properties studied were maximum load, tension in the maximum load and module of elasticity. The contralateral tendon was used as a control. Results: The statistical analysis showed that for the times studied, the values for mechanicalproperties did not present any significant differences. In relation to the control, i.e. the contralateral tendon without a suture, the results demonstrated that, six weeks after the operation, the values for the modulus of elasticity were lower, whereas there were no significant variations in maximum load or tension at maximum load. Conclusion: Placement of suture material on an extrasynovial tendon without lesions decreased the modulus of elasticity, but it did not interferewith the maximum load or tension at maximum load, six weeks after the operation. Doutor da Faculdade de Medicina de Botucatu UNESP, São Paulo, SP Médica Ortopedia e Traumatologia da Faculdade de Medicina de Botucatu UNESP, São Paulo, SP Doutor da Faculdade de Medicina de Botucatu UNESP, São Paulo, SP Médica Ortopedia e Traumatologia da Faculdade de Medicina de Botucatu UNESP, São Paulo, SP

Submitted by Guilherme Lemeszenski (guilherme@nead.unesp.br) on 2013-08-22T18:57:30Z No. of bitstreams: 1 S0102-36162011000300013.pdf: 443904 bytes, checksum: dcca57fd66940d13574a19ffdfaf8571 (MD5) Made available in DSpace on 2013-08-22T18:57:31Z (GMT). No. of bitstreams: 1 S0102-36162011000300013.pdf: 443904 bytes, checksum: dcca57fd66940d13574a19ffdfaf8571 (MD5) Previous issue date: 2011-01-01 Made available in DSpace on 2013-09-30T19:52:15Z (GMT). No. of bitstreams: 2 S0102-36162011000300013.pdf: 443904 bytes, checksum: dcca57fd66940d13574a19ffdfaf8571 (MD5) S0102-36162011000300013.pdf.txt: 15147 bytes, checksum: baa51a86943e779fc08a2c574361984e (MD5) Previous issue date: 2011-01-01 Submitted by Vitor Silverio Rodrigues (vitorsrodrigues@reitoria.unesp.br) on 2014-05-20T13:32:31Z No. of bitstreams: 2 S0102-36162011000300013.pdf: 443904 bytes, checksum: dcca57fd66940d13574a19ffdfaf8571 (MD5) S0102-36162011000300013.pdf.txt: 15147 bytes, checksum: baa51a86943e779fc08a2c574361984e (MD5) Made available in DSpace on 2014-05-20T13:32:31Z (GMT). No. of bitstreams: 2 S0102-36162011000300013.pdf: 443904 bytes, checksum: dcca57fd66940d13574a19ffdfaf8571 (MD5) S0102-36162011000300013.pdf.txt: 15147 bytes, checksum: baa51a86943e779fc08a2c574361984e (MD5) Previous issue date: 2011-01-01 OBJETIVO: O objetivo do estudo foi avaliar o efeito, nas propriedades mecânicas, do arranjo de reparo com material de sutura, no tendão calcâneo de rato, na ausência de processo de cicatrização. MÉTODO: Foram utilizados 12 ratos machos da linhagem Wistar. Os animais foram submetidos à colocação de ponto de sutura tipo Kessler modificado no tendão calcâneo. Os sacrifícios foram realizados nos períodos imediato e com seis semanas de pós-operatório. As propriedades mecânicas estudadas foram: carga máxima, tensão na carga máxima e módulo de elasticidade. O tendão contralateral foi usado como controle. RESULTADOS: A análise estatística indicou que, em relação aos períodos estudados, os valores das propriedades mecânicas não apresentaram diferenças significativas. em relação ao controle, isto é, tendão contralateral sem sutura, os resultados demonstram que, com seis semanas de pós-operatório, houve queda dos valores do módulo de elasticidade, enquanto a carga máxima e a tensão na carga máxima não apresentaram variações significativas. CONCLUSÃO: A colocação de material de sutura em tendão extrassinovial não lesado provocou queda do módulo de elasticidade, porém não interferiu na carga máxima e na tensão na carga máxima após seis semanas de pós-operatório. OBJECTIVE: The aim of this study was to evaluate the effects on the mechanical properties of rats' calcaneus tendons, of repair arrangements using suture material in the absence of any healing process. METHOD: Twelve male Wistar rats were used. They were subjected to placement of a modified Kessler suture stitch in the calcaneus tendon. The sacrifices were performed immediately after and six weeks after the operation. The mechanical properties studied were maximum load, tension in the maximum load and module of elasticity. The contralateral tendon was used as a control. RESULTS: The statistical analysis showed that for the times studied, the values for mechanical properties did not present any significant differences. In relation to the control, i.e. the contralateral tendon without a suture, the results demonstrated that, six weeks after the operation, the values for the modulus of elasticity were lower, whereas there were no significant variations in maximum load or tension at maximum load. CONCLUSION: Placement of suture material on an extrasynovial tendon without lesions decreased the modulus of elasticity, but it did not interfere with the maximum load or tension at maximum load, six weeks after the operation. UNESP UNESP

Objective: The aim of this study was to evaluate the effects on the mechanical properties of rats’ calcaneus tendons, of repair arrangements using suture material in the absence of any healing process. Method: Twelve male Wistar rats were used. They were subjected to placement of a modified Kessler suture stitch in the calcaneus tendon. The sacrifices were performed immediately after and six weeks after the operation. The mechanical properties studied were maximum load, tension in the maximum load and module of elasticity. The contralateral tendon was used as a control. Results: The statistical analysis showed that for the times studied, the values for mechanical properties did not present any significant differences. In relation to the control, i.e. the contralateral tendon without a suture, the results demonstrated that, six weeks after the operation, the values for the modulus of elasticity were lower, whereas there were no significant variations in maximum load or tension at maximum load. Conclusion: Placement of suture material on an extrasynovial tendon without lesions decreased the modulus of elasticity, but it did not interfere with the maximum load or tension at maximum load, six weeks after the operation.

Malleolar fractures are rarely associated with lesions of the adjacent tendons or neurovascular structures. The association of ankle fractures with Achilles tendon rupture is even more infrequent, although both of these injuries are very common in and of themselves. To our knowledge, fracture of the lateral malleolus in association with an acute rupture of the ipsilateral calcaneus tendon has not been previously described. In this article, we describe a female patient who sustained an acute rupture of the Achilles tendon in conjunction with fracture of the ipsilateral lateral malleolus.

O tendão calcâneo é uma das estruturas tendíneas que sofrem lesões com maior frequência em cães, e a não realização do tratamento implica comprometimento da função locomotora. Este trabalho objetivou relatar um caso atendido no Hospital de Clínicas Veterinárias da Universidade Federal do Rio Grande do Sul (HCV – UFRGS) de estiramento crônico do tendão calcâneo comum em um cão da raça Rottweiler, com sete anos de idade, apresentando histórico de claudicação. Ao exame físico, o animal apresentava-se com hiperflexao da articulação tíbiotarsal esquerda, à palpação, o tendão encontrava-se íntegro e edemaciado. O diagnóstico de estiramento crônico do tendão foi baseado no histórico, sinais clínicos e exames complementares, sendo o animal submetido à cirurgia reparadora. Realizou-se tenectomia parcial e posterior tenorrafia utilizando-se sutura em laço de travamento com fio nylon monofilamentar. A articulação tibiotarsal esquerda foi imobilizada com fixação esquelética externa. Após duas semanas do procedimento cirúrgico, o animal apresentava apoio do membro afetado. A técnica cirúrgica utilizada foi satisfatória para o tratamento desta lesão, pois promoveu cicatrização do tendão e o retorno da deambulação normal. The calcaneus is one of the tendons that frequently suffer more injuries in dogs and the non-completion of treatment means compromising locomotor function. This study has for objective to report a case of chronic stretching of the common calcaneus tendon in a Rottweiler dog, with seven years old, presenting history of claudication, attended on the Hospital de Clínicas Veterinárias of the Universidade Federal do Rio Grande do Sul (HCV – UFRGS). On physical examination the tendon was intact, swollen and with hyperflexion of the tarsus of the left pelvic member. The diagnosis was based on history and clinical signs and the animal was sent to restorative surgery. The tenectomy and tenorraphy were performed using a interlocking suture with mononylon wire. The left tibiotarsal joint was immobilized with external skeletal fixation. After two weeks of post-operative the animal was supporting the affected limb. The surgical technique used was satisfactory to treat the injury, as promoted healing of the tendon and returned the function of the member.

Calcaneus tendons and ankles of 25 practising marathon runners were investigated by sonography and MR. We applied a 7.5 MHz transducer for sonography. Axial and sagittal T1-weighted, proton density-weighted, and T2-weighted SE images were performed. MR proved superior to sonography. Degenerative alterations of the calcaneus tendon, tendovaginitis of the flexor hallucis longus muscle, joint effusions and cartilage disease were diagnosed by MR but remained undetected by sonography.

A dor e o edema são sinais, entre outros, que ocorrem durante a fase inflamatória no processo de cura de tendões lesados. A terapia antiinflamatória farmacológica recebe algumas críticas, com relação a seus efeitos deletérios para o reparo. Dessa forma, ganha corpo o uso de recursos físicos para o controle do processo. O objetivo do presente estudo foi avaliar o uso do laser de baixa potência sobre a dor e edema em tendão calcâneo de ratos submetidos a trauma experimental. Foram utilizados 28 ratos Wistar, divididos em quatro grupos: GC - submetido à lesão traumática e ao tratamento placebo; G2 - submetido à lesão e irradiado com laser 2J/cm²; G4 - submetido à lesão e irradiado com 4J/cm²; G8 - submetido à lesão e irradiado com 8J/cm². A lesão foi realizada com a queda de um peso sobre a face lateral do tendão calcâneo direito de cada animal, com energia de aproximadamente 0,40J. A dor foi avaliada pelo tempo de elevação da pata (TEP) do animal caminhando durante um minuto, sobre um cilindro metálico com 30cm de diâmetro em 3rpm; a avaliação do edema ocorreu através de paquimetria; os momentos de avaliação foram: pré-lesão, pós-lesão, pós-tratamento, duas horas, oito horas, 24 horas e 5º dia de lesão. O tratamento com laser 670nm ocorreu de forma pontual e diária. Os resultados mostraram aumentos do TEP e formação de edema em todos os grupos após a lesão; para os grupos tratados houve redução da dor e do edema, fato observado no grupo controle apenas com relação à diminuição de edema no 5º dia de placebo. Conclui-se que o tratamento com laser de baixa potência diminuiu dor e edema nos animais com trauma tendíneo, de forma dose-dependente.

Reconstruction of the foot using microvascular flaps has been widely performed in the last 15 years but the choice of flap to repair some areas in the foot remains controversial. We present a series of 128 free flaps to the foot performed during the period of 1975–1990. One hundred and seventeen had a successful outcome (91%). The etiology of the problem was traumatic in 94, congenital in 10, tumor in 9, and chronic ulcerations due to vascular problems in 15. The indications for a specific flap depended on the site and extension of the foot problem, and were divided into four groups: 1 Dorsum of the foot. Cutaneous parascapular flap was the best choice. 2 The sole-weight-bearing area. We favored the use of the latissimus dorsi muscle flap covered with a split thickness skin graft, done immediately. A proper tailoring of the flap and postoperative care by the patient are very important to maintain the result without ulceration. Tactile sensation does not seem to be essential. 3 The area over the calcaneus tendon. We have used cutaneous flaps such as the parascapular and lateral arm flap or fascial flaps covered by split thickness skin grafts (STSG). The fascia used were the serratus or the parascapular. 4 Complex trauma problems with extensive skin loss or chronic ulcerations due to vascular diseases: the latissimus dorsi musculocutaneous or muscle plus STSG was mostly used. The overall number of donor areas were 5 groins, 48 parascapular, 2 gluteal fold flaps, 4 lateral arm, 61 latissimus dorsi, and 8 fascial flaps. © 1994 Wiley-Liss, Inc.

This study describes some of the ultrastructural effects of a single topical application of 90% DMSO on the calcaneus tendon of Mus musculus , from the time immediately after the first application to five days subsequent to that time. Immediately after DMSO application the intracisternal spaces of the rough E.R. were enlarged to approximately eleven times their normal width. Other cell structures and collagen appeared normal. One hour after application slightly enlarged E.R. were observed. After five hours E.R. appeared normal, but statistical analysis indicated they were significantly larger than normal E.R. After five days E.R. appeared normal and statistical analysis showed no significant difference between the five day and the normal groups. Effects of altered tonicity, DMSO substitution for water in membrane hydration sheaths, and rapid DMSO penetration are discussed in light of these findings.