Introduction: With aging and in disease, the changes in bone microstructure and geometry influence the mechanical properties of cortical bone. We examine the cross-section geometrical properties of cortical bone, area and second moment of inertia, and microstructural parameters in an ovine model of osteoporosis.

Methods: Twenty seven skeletally mature sheep were randomly divided into two groups: ovariectomy (OVX; n=11) and control (CON; n=16). Animals were sacrificed at 31 months following surgery. Compact bone samples were harvested from mid-diaphysis of the left and right metatarsal,4cm proximal to the metatarsal-phalangeal joint using a low speed diamond saw (Accutom 50, Struers, Ballerup, Denmark). For histological analysis, thin sections (150–200μm) were prepared. Each section was initially examined using brightfield microscopy (Olympus 1X51, Hamburg, Germany). Cortical area was measured using an image analysis system by measuring area enclosed by the perisoteal surface and subtracting the area of the medullary canal (analySIS, Soft Imaging systems, Munster, Germany). Sections were then examined using polarised light microscopy, cortical thickness was measured in four regions: anterior, posterior, medial and lateral. These regions were defined by finding the widest diameter of the medullary cavity of the section and drawing a line perpendicular through the midpoint. At each point total cortical thickness, periosteal thickness and endosteal thickness was measured. All measurements were scaled according to animal weight.

Results: The outer cortical area was significantly greater in the OVX group compared to CON (p=0.006), the inner medullary area was also greater in the OVX group, but not significant. The actual cortical area (outer cortical area – medullary area) was significantly greater in OVX (129.27mm2 vs 119.24 mm2, p=0.005). Second moment of inertia (I), was significantly greater in OVX (2.53 m4 v 2.21m4, p=0.002).

In all four cortical regions OVX was thicker than CON, however this never achieved significance. Similarly, in all four regions endosteal bone was thicker in OVX, but this was not significant. Periosteal bone was thicker in CON in the medial and lateral regions, whereas OVX periosteal bone was thicker in anterior and posterior regions (NS).

Conclusion: Our results demonstrate structural adaptation of cortical bone in a model of ovine osteoporosis. In theory these changes result in improved biomechanical properties of that bone; resistance to bending (second moment of inertia) and compressive strength (cross-sectional area). However in osteoporosis this biomechanical advantage is offset by diminution of bone quality.

Purpose of study: Study and prove the benefits and efficacy of the use of extracorporeal shockwave therapy (ESWT)for the treatment of planter fasciitis.

Introduction: Planter fasciitis is the second most common cause of heel pain. Conservative treatment modalities for the treatment of planter fasciitis includes NSAIDS, heel cushions, ultrasound, physiotherapy, injections, etc and these often do not offer satisfactory results. We present the results of the use of ESWT in the treatment of planter fasciitis with good results.

Methodology: 129 patients, 77 males and 52 females with a 152 heels were treated with ESWT from July 2002 until August 2004 and were included in the study. The average age was 53.2 years (Range 28 to 83 years). All patients had previously undergone other conservative forms of treatment with poor results. Inclusion criteria included age greater than 18 years, male or female, no previous history of surgery on the heel or foot, visual analogue score of over 5 for pain. Treatment was done on an outpatients basis. Each patient received between minimum of one and maximum of three sessions of ESWT at two weeks interval.

Results: 116 patients, 69 males and 47 females with 136 heels were reviewed with 13 patients with 16 heels lost to followup. 52 patients (44.8%) with 60 heels (44.1%) had excellent results. 45 patients (38.8%) with 53 heels (38.0%) had good results. 13 patients (11.2%) with 16 heels (11.8%) had fair results. 6 patients (5.2%) with 7 heels (5.1%) had poor results. Overall 104 patients (89.7%) with a 121 heels (89.0%) considered the outcome to be successful.

Conclusion: Based on our results, we recommend ESWT fot the treatment of planter fasciitis especially in patients with failed other forms of conservative treatment and as an alternative to surgery with good results.

The aim of this study is to explore the effect of extracorporeal shock wave therapy (ESWT) in patients with chronic planter faciitis. In this prospective study 70 heels in 62 patients with chronic planter faciitis in whom conventional conservative treatment consisting of nonsteroidal anti-inflammatory drugs, heel cup, orthoses and/or shoe modifications, local steroid injections have failed, were treated with low energy ESWT. Patients were reviewed at 6, 12 and 24 weeks post treatment. At follow-up there was significant decrease in pain on the visual analog scale (VAS) (p=0.27), with significant improvement in pain score (p=0.009) and in functional score (p< 0.001). The comfortable walking distance has increased significantly. There were no reported side effects. This study indicates that in patients with chronic plantar fasciitis, the ESWT provide a good pain relief and a satisfactory clinical outcome.

Introduction: Although the application of low-energy Extracorporeal shock waves application (ESWA) to treat musculoskeletal disorders is controversial, there has been some limited, short-term evidence of its effectiveness for the treatment of chronic plantar fasciitis. Objective: The aim of this prospective study is to explore the effect of Extracorporal shock waves in patients with chronic planter faciitis. Methodology & results: In this prospective study 70 heels in 62 patients with chronic planter faciitis in whom conventional conservative treatment consisting of nonsteroidal anti-inßammatory drugs, heel cup, orthoses and/or shoe modiþcations, local steroid injections have failed, were treated with low energy ESWA. Standard radiographs of the affected heels were obtained before ESWA to document the existence of a calcaneal heel spur. Pre and post therapy subjective and objective scoring systems are being used to know the functional outcome (SF36 Health Survey score, Short Form McGill Pain Questionaire, American Orthopaedic foot and ankle society Hindfoot Scale, Visual analogue Pain score). Patients were reviewed at 6 and 12 weeks post treatment. At followup pain was decreased by 70% to 90% on the visual analog scale (VAS) and the comfortable walking time had increased signiþcantly. There were no reported side effects. Conclusion: This study indicates that in patients with chronic plantar fasciitis, the ESWA.provide a good pain relief and a satisfactory clinical outcome