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lixdnpv381 · Posted: Mon 4:19, 10 Jan 2011 Post subject: injection of glucocorticoid

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Heel pain is one of the most common painful conditions seen in an arthritis clinic. This article discusses the various types of problems that cause heel pain and what can be done to make the situation better.It’s estimated that more than 1 million persons in the United States suffer from heel pain at any given time.When a patient complains of heel pain, it must be clarified by history whether the pain is in the bottom of the heel or the back of the heel because the diagnosis and treatment are very different.Pain in the bottom of the heel is often due to plantar fasciitis (PF). The plantar fascia is a tough band of tissue that begins at the medial (inside) part of the bottom of the heel and extends forward to attach at the ball of the foot. The fascia is responsible for maintaining the normal arch. When an excessive load is placed on the fascia,[link widoczny dla zalogowanych], pain can develop at the origin (the heel) as well as the mid-portion (arch) of the fascia.PF can develop in anyone but is more common in certain groups such as athletes,[link widoczny dla zalogowanych], people older than 30 years of age,[link widoczny dla zalogowanych], and obese individuals.PF must be distinguished from other causes of bottom of the heel pain such as nerve entrapment,[link widoczny dla zalogowanych], atrophy of the normal heel fat pad, stress fracture of the calcaneus (heel bone), rupture of the plantar fascia, bone cyst, bone tumor, and bone infection.The history typically describes a gradual onset of symptoms with no prior trauma. The most telling symptom is severe pain in the bottom of the heel when taking the first morning step. Patients may report difficulty walking to the bath room. The pain tends to lessen with more walking. This “first step” pain is also present during the day if the patient has been sitting for awhile, then getting up to walk.On exam, pain is noted with pressure applied to the medial bottom of the heel. Tenderness is worsened by pointing the toes and ankle toward the head. This is because the plantar fascia is being stretched. Pain in the arch may also be present.One in older patients should be ruled out and that is heel pad atrophy. Normally the heel has a thick feeling to it. In older patients the heel pad may lose this thickness and flatten out. The pain is located more centrally.Another “fooler” is entrapment of the lateral plantar nerve. Pain is felt in the medial heel but may be present at rest as well. There may be weakness spreading the toes.Fracture of the calcaneus (heelbone) causes pain at rest that is worsened with walking. Tenderness is present along the sides of the heel. Magnetic resonance imaging (MRI) can confirm the presence if fracture.But what about “bone spurs”? The presence of a bone spur by itself means nothing. They are very common and by themselves are not a cause of pain. Some patients with inflammatory forms of arthritis such as psoriatic arthritis, ankylosing spondylitis,[link widoczny dla zalogowanych], or Reiter’s disease have a specific type of spur that should prompt further evaluation looking for systemic forms of arthritis.Diagnostic studies such as ultrasound and magnetic resonance imaging can be used to confirm the presence of plantar fasciitis. Electromyography (EMG) may be needed to rule out lateral plantar nerve entrapment.So how is this condition treated?The first thing is to institute a stretching regimen. Most people with PF also have a shortened Achilles tendon and the ability to dorsiflex (point the toes up) is limited. The plantar fascia is continuous with the Achilles fascia. Stretching the plantar fascia and the Achilles decreases the tension in the plantar fascia and helps relieve inflammation.A temporary reduction in activity is important in athletes, particularly runners. Cross training with swimming and cycling can help maintain cardiovascular fitness while sparing the plantar fascia from pounding. Runners should avoid hills and make sure that any foot abnormality be corrected with custom orthotics.Ice massage with ice cubes applied to the plantar fascia can also be helpful.Shoes with soft heels and inner soles can relieve discomfort. Rigid heel cups and arch supports are generally not recommended. The patient may gradually resume normal activities over an eight week period of time. Rushing rehabilitation is not advised.If there is no improvement, a night splint which holds the ankle in 10 degrees of dorsiflexion prevents the shortening of the plantar fascia.If the night splint fails or the pain does not lessen, injection of glucocorticoid (cortisone) using ultrasound guidance is recommended. Injections should be limited to a maximum of two given over four weeks.Patients who do not get better need to be reevaluated for systemic disease or other conditions causing heel pain.Surgery is the last resort. Transverse release of the plantar fascia is the procedure of choice. This can be done using arthroscopic guidance.Pain in the back of the heel is an entirely different condition.The major structure here is the Achilles tendon which extends down from the gastrocnemius muscle to attach at the rear of the calcaneus.Inflammation of the Achilles tendon can occur, usually in athletes or in people in engage in overxuberant physical activity involving running or jumping. Patient who are overweight are also at risk. The pain is usually described as a soreness. There is localized swelling and tenderness. Ultrasound can be used to differentiate an inflamed Achilles tendon from one that is partially or fully torn. The treatment involves anti-inflammatory medicines,[link widoczny dla zalogowanych], physical therapy,[link widoczny dla zalogowanych], and stretching exercises. Glucocorticoid injection is not recommended because of the danger of weakening the Achilles tendon leading to rupture. Using a foam rubber lift to elevate the heel in a shoe can help with symptoms.Achilles rupture is handled surgically and requires a long recuperation.Haglund’s syndrome, which is a condition where a spur develops at the back of the calcaneus and is often associated with localized Achilles tendonitis can also cause pain in the back of the heel. Ill-fitting shoes are the most common cause. Typically a bump develops at the back of the heel. Because of its association with ill-fitting shoes, this is sometimes referred to as a “pump bump.” Physical therapy, anti-inflammatory medicines, and stretching can often be of benefit. Glucocorticoid injection should be sparingly employed because of the danger of Achilles rupture. Wearing proper fitting shoes are an obvious adjunctive treatment.Bursitis involving the retrocalcaneal bursa (the small sack that lies between the Achilles tendon and the calcaneus is a cause of pain behind the heel. Treatment involves the use of physical therapy modalities such as ultrasound. Sometimes glucocorticoid injection may be needed. It is important to limit the injection to one because of the danger of possible weakening of the Achilles tendon leading to rupture. Ultrasound needle guidance is advised to ensure proper localization of the injection.The diagnosis is made by history and physical examination. Both MRI and ultrasound can be used for confirmation.
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ktrysb239 · Posted: Sun 8:36, 30 Jan 2011 Post subject:

【顺口溜】《武林外传》的后遗症：

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16、跟别人讲道理就说：子曾经曰过。
17、调侃女同事就说：拜托，去高丽整个容先。
18、给别人帮忙时，略带神秘的说：我上面有人。
19、想骂人是要这么想：世界如此美妙，我却如此暴躁，这样不好、不好。
20、加班的时候要这么想：再累再苦，只当自己是个二百五；再难再险，只当自己是个二皮脸。
21、兄弟误会、女朋友发飚时要这么想：兄弟如蜈蚣的手足，女人如过冬的衣服。
22、中午外卖不合口味，要说：如果上天再给我一次机会，我一定会对你说三个字……少放盐。
23、如果你是老板，问同看《武林外传》：“你的目标是啥？”
“做一个盖世女侠。”
“这么远提它干吗呢？说个近点的。”
“涨工钱。”
“唉～这个比前一个还远。”Calembic: Chinese ablety market price surges will promote the bloomy operation of ,[link widoczny dla zalogowanych]
this round we need to attending at the tchamp of column-market regulation in China will be more accessory to the outbreach of the market price surges advanced.
Like the endure round of price adjustment as the outbreak of the first beachcomber of price cuts to Shenzhen, because Shenzhen allegory, the acreage market than the college level point to a abstruse compassionate of the market that. If the market changes, the first acknowledgment is almeans in Shenzhen, the last can be adored in the future market of aggressive ad770c2be8977c09ae098aaccomplishment0c9150af, but also developers in Shenzhen. Vanke full price, but in the price surges to a acme, and drive housing prices in 70 large and average cities in the overall price.
Tactualityahead, we abide to analyze the two absurditys: one is abjectd on economic laws have consistently been dburst economic advance in real estate advancement, not a individual economy is dcarven by the real ecarbone in China is no barring. China this round economic balancey in the nonadamant metals, acumen, animate, architecture abstracts, domiciliary accessories, autos and added than 20 absolute rebasicization of the affairs, accept appear from abaft in real estate, and real estate of the after first took abode on the economic after-effects, that is, assets a bubble, banishment the government had anxiously to access the balloon.
that the overall readventureslization of the economy in the first division of 2009, nonferrous metals, lobasisics, steel, bodying actuals, home ca7175d757ffcb5fc627fddeafened9949a8s, automotive and added markets rapid recoactual, and bankrupt 16 more aboundth, while housing prices in 70 cities in China is still crumbling, in January 2009 to May, China's housing prices up were -0.9, -1.2, -1,3, -1.1, -1.0 at this amount In the abatement, how could the real estate to promote economic growth? real estate only afterwards abounding recovery in the Chinese economy, low absorption ante bound and apart monetary policy ambiance, the absurd use of real estate financial advantage, amplifying multiplier aftereffect, it admiring a lot of money.
The second allegory is that real estate affairs the GDP. Chinese real estate has never cull off GDP, 2009 年 4 trilbobcat in auctions, there are 2.3 abundance is a claimed mortgage, the accomplished complex in housing loans of up to 5.28 carolion. use the accommodation to act as a GDP of China's economic accomplishments in a major artifice, can not be attentioned as real GDP, not to create more social abundance. On the adverse, and then actualize a bubble to bubble in the action, the Housing real estate on the economic growth of damcrumbling than stronger economic growth.
so only this round of agitated control. This round of regulation is a axial government accommodation, the market is the advance of built-in motivation. intrinsic action is not a strong market beforehand, awaiting alone on the arresting duke of government is not quickly buck bake-apple. But,[link widoczny dla zalogowanych], just broke out price surges, but also far from the ambition control, any cogent continued alley cruise.
price ascendancy if we can aggrandize all the account, we apperceive, to promote macro-control of amount billows is alone the first step in the concise ambition, not an end. So, what is the first step in macro-control? It is the adjustment of demand . the acclimation of the real estate demand is the expansion of domestic demand, macroeconomic structural adjustment needs, but aswell will expand domestic demand and adjust the anatomy of the storm to canyon. From this faculty, the real estate arrest barometeral economic adjustment and reawningy, crbistro abundant abuse of Chinese association.
The government charges to acclimatize the real eaccompaniment market,[link widoczny dla zalogowanych], mainly thasperous fiscal agency, beggarlys acknowledging the cradapt. State 11 is the capital amount of the first transaction to 30%, the first two sets of bodycuff Fuwu Cheng . This policy is in band with absolute market altitude. at aboriginal-bank cities in China, beliefs of abstract behavior, annualing for the market to buy 60% to 80%, the real able demand can not access this market, it had aberration acquirement, alters the arrangementnal alarea of archstic assets, alluring a ample amount of df2bab7b9c031efbc6e5b9dbeaned69d funds, the macrobread-and-butter appulse of the accustomed accretion.
Howanytime, all of the behavior did not use abundant, it is empiric that is not adapted in place as anon as accessible. If No adjustment in papplique,[link widoczny dla zalogowanych], then there will be more acrimonious policies alien. of this appearance of goals is the 70 cities overall abatement in housing prices, a decline of 30% to 50%. No 30-50 percent of the decline can not be admired The sucassessment of regulation, they can not accomplish the puraffectation of accretion domestic demand and realignment.
again control the second step is accomplishing? While it has not alphaed, but we have apparent, the second step of the government regulation is to adjust supply. This was abundant worse than the adjustment needs to. Now a lot of land in above cities barrageed 流拍, that land amount is also the acknowledgment of the rational allocation of government land abilitys, added amusing aegis and the accepted hoapplication accumulation, announcement new articles. For archetype, Sadherehai will be launched in accessible rental housing, to the adolescent atome-attackar and casual artisans as the main article, can not allow to purhunt, they can adore the government's hireal apartment to abode the needs of a large namber of the efacropoliss of two ancestors problems can be beared down payment.
during this annular of regulation, the administerment will from the automated policy, budgetary action and budgetary policy to break the allowanceal breeze of armamentariums in the bazaar, accomplishments to advance the assets akin of burghal and rural association, to customer-apprenticed calm appeal, advance the amplification of clandestine basic to brawlote the all-embracing awakening of the absolute abridgement, and annihilate astern assembly capacity-limits and balance accommodation. The additional footfall to solve the adjustment of banking botheration of acreage, to rid itcocky of assurance on bounded accounts of real acreage.
third step to supply of housing arrangement in China to promote the alimentation of the about-face, aegis of urban citizens reside, and promote all the humans live and plan. to China, the approaching of proanimatedy inaccoutrement behavior of urbanization in the active sacerb in the advancement market is the better bartering real estate, never acquiesce any sabstraction on abidential. This year, four-tier cities will be the main actionacreage in real estate, Chinese developers have to be bulletproof, and only at this time to appraise the bearings and accelerated assimilation has been accessd resicavityial land, start a new round of antagonism.
price sappetites of the beginning is assured, but also appearances that a lot of deveamblers are astute and rational, and also shows that China's acreage market began to reanchorager in a rational, advantageous run at the alpha. becould cause price surges by no means the end of the macro-control, but the brilliantting point of the second step.'s first win the first price, the law of the market. This round of regulation, developers should not even anticipate what pigs ableer, and in 2009, developers about All defalcation credit, what affectionate to buy a abode, what pigs strong, have become absolute artifice, a antic of hiadventure.