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Surgery for Haglunds / Retrocalcaneal Bursitis
Discussion in 'Foot Surgery' started by NewsBot, May 10, 2008.
haglund deformity
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Surgery for Retrocalcaneal Bursitis: A Tendon-splitting versus a Lateral Approach.
Anderson JA, Suero E, O'Loughlin PF, Kennedy JG.
Clin Orthop Relat Res. 2008 May 9 [Epub ahead of print]
For patients with refractory retrocalcaneal bursitis (Haglund's syndrome), the most effective surgical approach has not been defined. We asked whether patients undergoing the tendon-splitting approach and the lateral approach would have comparably effective relief of pain for both types of calcaneal ostectomies. We retrospectively reviewed 30 patients (31 feet) who underwent the tendon-splitting approach and compared their results with 32 previous patients (35 feet) who had a lateral incision. Minimum followup was 12 months (mean, 16 months; range, 12-23 months) for the tendon-splitting group and 15 months (mean, 51 months; range, 15-109 months) for the lateral group. The mean American Orthopaedic Foot and Ankle Society score improved from 43 points preoperatively to 81 points (range, 8-100 points) postoperatively in the tendon-splitting group and from 54 points to 86 points (range, 55-100 points) in the lateral group. The mean physical component score of the Short Form-36, version 2, at followup was 52 (range, 22-61) in the tendon-splitting group and 49 (range, 34-63) in the lateral group. The median return to normal function was 4.1 months (range, 3-13 months) in the tendon-splitting group and 6.4 months (range, 4-20 months) in the lateral group. Both approaches to calcaneal ostectomy provided symptomatic pain relief. However, patients in the tendon-splitting group returned to normal function quicker than patients in the lateral group. Level of Evidence: Level III, retrospective comparative study.
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NewsBot, May 10, 2008
Admin2 Administrator Staff Member
Re: Surgery for Retrocalcaneal Bursitis: A Tendon-splitting versus a Lateral Approach
Haglunds in an elite marathon runner
Reduction of retrocalcaneal bursitis?
Posterior Calcaneal Exostosis
Retro-calcaneal bursae
Admin2, May 10, 2008
drsarbes Well-Known Member
I don't consider a retrocalcaneal exostosis the same as a Haglunds.
The Haglunds is associated with a rear foot cavus and occurs on the lateral/posterior surface of the os calcis. These are pressure related. These can frequently be removed with little or no involvement of the achilles.
Retrocalcaneal exostoses with bursitis is a different animal all together. Normally occurring in adults with or without a pes cavus, these are enthesopathies of varying degrees and conformation.
Surgery includes removal of the spurs, along with tendon debridement and usually removal of the superior angle of the posterior Os Calcis.
In simple terms......if it's posteriolateral and the patient is young - HAGLUNDS.
if the pain is medial/lateral and central with a large exostosis visualized on
X-ray - RETROCALCANEAL EXOSTOSIS.
Apples and oranges.
DrSArbes
Fellow American College of Foot & Ankle Surgeons
Board Certified Foot & Ankle Surgery, ABPS
Adjunct Professor OCPM
Green Bay, Wisconsin, USA
drsarbes, May 11, 2008
Tendon-splitting approach for the surgical treatment of Haglund's deformity and associated condition. Evaluation and results
Fridrich F.
Acta Chir Orthop Traumatol Cech. 2009 Jun;76(3):212-7.
PURPOSE OF THE STUDY: To evaluate the results of the dorsal longitudinal tendon-splitting approach for surgical treatment of Haglund's deformity and associated conditions. MATERIAL: The group comprised patients who underwent surgery for Haglund's deformity and related conditions between January 2003 and June 2007. There were 15 patients, six women and nine men, with 17 treated heels (one man and one woman had bilateral surgery).
METHODS: Using the tendon-splitting approach, a prominence of the posteriosuperior border of the calcaneus was resected and the associated conditions were treated. The evaluation was based on a 1-to-5-degree scale and included the patient's clinical state before and after surgery (pain, shoe-wearing and load tolerance), and pre-operative radiography (presence of Haglund's deformity, ossification of the Achilles tendon and/or adjacent tissues). The study was retrospective.
RESULTS: The average age of the patients at the time of surgery was 44.5 years (range, 16 to 60). The minimum follow-up was 6 months (range, 6 to 65 months). X-ray and intra-operative findings showed Haglund's deformity in 13 cases, calcaneal bursitis in six, ossified mass at the insertion of the Achilles tendon in six, intratendinous ossification in two, and partial tendon degeneration and subcutaneous bursitis in one case each. Post-operative relief was recorded in 16 treated heels. The condition in one patient deteriorated, as manifested by heel swelling after exercise and a feeling of tension at the insertion site of the Achilles tendon in forced dorsiflexion of the ankle. An average preoperative score of 4.1 improved to 2.1 post-operatively. No serious complications either overall or at the site of surgery (Achilles tendon rupture, poor wound healing) were found. Three heels retained a slight restriction of motion (up to 10 degrees). One heel showed impaired sensitivity in the region treated.
DISCUSSION: The tendon-splitting approach provides a good view of and easy access to the structures to be operated on. The risk of incomplete resection of the prominence or of leaving sharp edges because of an insufficient view is small. Compared with other methods, this approach allows for concurrent treatment of other conditions that may be present at the insertion site of the Achilles tendon. The tendon-splitting approach does not result in any structural changes of the Achilles tendon.
CONCLUSIONS: The dorsal longitudinal tendon-splitting approach for surgical treatment of Haglund's deformity is an efficient, undemanding and safe method alternative to lateral or medial approaches used more often. It allows for concurrent treatment of several pathological conditions at the insertion site of the Achilles tendon, such as subcutaneous bursitis, ossified mass at the tendon insertion, tendon degeneration, intratendinous ossification, calcaneal bursitis and Haglund's deformity.
NewsBot, Sep 18, 2009
Surgical correction of Haglund's triad using complete detachment and reattachment of the Achilles tendon.
DeVries JG, Summerhays B, Guehlstorf DW.
J Foot Ankle Surg. 2009 Jul-Aug;48(4):447-51.
Haglund's triad consists of the simultaneous presentation of the following clinical entities: Achilles tendinosis, Haglund's deformity, and retrocalcaneal bursitis. In this retrospective study, we review outcomes following the surgical treatment of Haglund's triad by means of complete detachment and reattachment of the Achilles tendon, removal of the retrocalcaneal exostosis, and excision of the retrocalcaneal bursa through a medial J-shaped approach. Patients were identified via chart review, and sent consent forms and a questionnaire consisting of a visual analog scale (VAS), a satisfaction survey, and the Maryland Foot Score. Seventeen patients (22 feet) met the inclusion criteria and returned the consent and questionnaires. Their mean age was 51.6 +/- 11.6 years, and the mean duration of postoperative follow-up was 40.1 +/- 27.0 months. The mean preoperative VAS was 7.9 +/- 2.3, and the postoperative VAS was 1.6 +/- 1.3 (P < .001). The mean postoperative Maryland Foot Score was 91.5 +/- 9.1, with 16 good to excellent results. Of the 17 patients, 16 were satisfied and only 1 was somewhat unsatisfied. Four complications were observed, and 1 of these required further surgical intervention. The outcome of this study demonstrated that surgical correction of Haglund's triad using a medial "J" approach, complete detachment and reattachment of the Achilles tendon, exostectomy, and retrocalcaneal bursectomy provided patient satisfaction with limited complication
NewsBot, Oct 15, 2009
I don't agree with their definition of Haglund's.
drsarbes, Oct 16, 2009
Endoscopic Calcaneoplasty (ECP) in Haglund's Syndrome. Indication, Surgical Technique, Surgical Findings and Results.
Jerosch J, Sokkar S, Dücker M, Donner A.
Z Orthop Unfall. 2011 Dec 16. [Epub ahead of print]
Posterior calcaneal exostosis treatment modalities have given rise to many controversial opinions. After failure of the conservative treatment, surgical bursectomy and resection of the calcaneal exostosis are indicated by many authors. But clinical studies also show a high rate of unsatisfactory results with a relative high incidence of complications. The minimally invasive surgical technique by an endoscopic calcaneoplasty (ECP) could be an option to overcome some of these problems.
MATERIAL AND METHOD:
Between 1999 und 2010 we operated 164 patients with an age range between 16 and 67 years, 81 males and 83 females. The radiological examination prior to surgery documented in all cases a posterior superior calcaneal exostosis that showed friction to the Achilles tendon. All patients included in the study had no clinical varus of the hind foot, nor cavus deformities. All patients had undergone a trial of conservative treatment for at least 6 months and did not show a positive response. The average follow-up was 46.3 (range: 8-120) months.
According to the Ogilvie-Harris score 71 patients presented good and 84 patients excellent results, while 5 patients showed fair results, and 4 patients only poor results. All the post-operative radiographs showed sufficient resection of the calcaneal spur. In 61 patients the preoperative MRI showed a partial rupture of the Achilles tendon close to the insertion side. In no case could we observe a complete tear at the time of follow-up. Only minor postoperative complications were observed. In many patients we could observe a chondral layer at the posterior aspect of the calcaneus. Close to the intersion the Achilles tendon showed also in many patients a chondroide metaplasia.
ECP is an effective and minimally invasive procedure for the treatment of patients with calcaneal exostosis. After a short learning curve the endoscopic exposure is superior to the open technique, has less morbidity, less operating time, and nearly no complications. Moreover, the pathology can be better differentiated.
NewsBot, Dec 20, 2011
"Endoscopic Calcaneoplasty (ECP)...."
Can't seem to get this study in it's entirety, or in English.
If anyone has the description of this procedure and the post operative care, please post.
drsarbes, Dec 21, 2011
Endoscopic treatment of Haglund's syndrome with a three portal technique.
Wu Z, Hua Y, Li Y, Chen S.
Int Orthop. 2012 Mar 14
The purpose of our study is to make a retrospective evaluation of endoscopic treatment of Haglund's syndrome using a new three portal technique.
All 23 patients (25 heels) with a mean age of 27.7 years were evaluated pre-operatively and postoperatively with parallel pitch lines, the American Orthopaedic Foot and Ankle Society (AOFAS) score and the Ogilvie Harris score.
The mean follow-up was 41 months (range, 30-59 months). There were no obvious complications in our study. In 22 heels, postoperative lateral radiographs showed the achievement of negative parallel pitch lines. The average AOFAS score improved from 63.3 ± 11.9 points pre-operatively to 86.8 ± 10.1 points at final follow-up. There were 14 excellent results, seven good results, two fair results and two poor results. For the Ogilvie Harris score, there were 15 excellent, seven good, one fair, and two poor results.
An endoscopic procedure using the three portal technique seemed to be a safe and efficacious option for surgical treatment of Haglund's syndrome.
NewsBot, Mar 15, 2012
The Keck and Kelly Wedge Calcaneal Osteotomy for Haglund's Deformity: A Technique for Reproducible Results
Troy J. Boffeli, Matthew C. Peterson
Journal of Foot and Ankle Surgery (in press)
Surgical treatment of Haglund's deformity typically involves either bump removal or a closing wedge calcaneal osteotomy. Although bump removal may initially seem easier to perform and quicker to heal, there are advantages to avoiding bone resection adjacent to the Achilles tendon. Healing of the wedge osteotomy can be faster and more predicable than tendon healing at the Achilles insertion, which is beneficial to the young and active population that tends to have this condition. This article describes a reproducible Keck and Kelly closing wedge osteotomy technique that effectively decompresses the posterior/superior aspect of the calcaneus without need for dissection around the Achilles insertion. Our technique allows for consistent correction of Haglund's deformity, reliable symptom relief, and minimal opportunity for intraoperative or postoperative complications. Technique pearls include patient selection criteria for bump removal versus wedge osteotomy and a preoperative template protocol.
Surgical treatment of chronic retrocalcaneal bursitis.
Wiegerinck JI, Kok AC, van Dijk CN.
Arthroscopy. 2012 Feb;28(2):283-93.
The purpose of this systematic review was to analyze the results of surgical treatments for chronic retrocalcaneal bursitis (RB).
Medline, CINAHL (Cumulative Index to Nursing and Allied Health Literature), Embase, and the Cochrane Library (1945 to December 2010) were systematically searched for the following terms: calcaneal AND (prominence OR exostosis) OR ((retrocalcaneal OR calcan(*)) AND (burs(*) OR exosto(*) OR prominence)) OR Haglund[tw] OR Haglund's[tw] OR ((retrocalcaneal OR calcan(*)) AND (ostectom(*) OR osteotom(*) OR resect(*))). Therapeutic studies on 10 or more subjects with RB were eligible. Quality was assessed by use of the GRADE scale and Downs and Black scale.
Of 876 reviewed abstracts, 15 trials met our inclusion criteria evaluating 547 procedures in 461 patients. Twelve trials reported an open surgical technique; three studies evaluated endoscopic techniques. Differences in patient satisfaction favored the endoscopic technique. The complication rate differed substantially, favoring endoscopic surgery over open surgery.
There are many different surgical techniques to treat RB. Regardless of technique, resecting sufficient bone is essential for a good outcome. Even though the level of evidence of included studies is relatively low, it can be concluded that endoscopic surgery is superior to open intervention for RB. More evidence is a necessity to be more conclusive regarding the best surgical treatment.
NewsBot, May 9, 2012
Outcome of endoscopic decompression of retrocalcaneal bursitis
Vamsi Kondreddi, R Krishna Gopal, Ranjith K Yalamanchili
Indian J Orthop 2012;46:659-63
Background: Posterior heel pain due to retrocalcaneal bursitis, is a disabling condition that responds well to the conventional methods of treatment. Patients who do not respond to conservative treatment may require surgical intervention. This study evaluates the outcome of endoscopic decompression of retrocalcaneal bursitis, with resection of posterosuperior eminence of the calcaneum.
Materials and Methods: This present study included 25 heels from 23 consecutive patients with posterior heel pain, who did not respond to conservative treatment and underwent endoscopic decompression of the retrocalcaneal bursae and excision of bony spurs. The functional outcome was evaluated by comparing the pre and postoperative American Orthopedic Foot and Ankle Society (AOFAS) scores. The Maryland ankle and foot score was used postoperatively to assess the patient's satisfaction at the one-year followup.
Results: The University of Maryland scores of 25 heels were categorized as the nonparametric categories, and it was observed that 16 patients had an excellent outcome, six good, three fair and there were no poor results. The AOFAS scores averaged 57.92 ± 6.224 points preoperatively and 89.08 ± 5.267 points postoperatively (P < 0.001), at an average followup of 16.4 months. The 12 heels having noninsertional tendinosis on ultrasound had low AOFAS scores compared to 13 heels having retrocalcaneal bursitis alone. At one year followup, correlation for preoperative ultrasound assessment of tendoachilles degeneration versus postoperative Maryland score (Spearman correlation) had shown a strong negative correlation.
Conclusion: Endoscopic calcaneal resection is highly effective in patients with mild or no degeneration and yields cosmetically better results with fewer complications. Patients with degenerative changes in Achilles tendon had poorer outcomes in terms of subjective satisfaction.
NewsBot, Dec 8, 2012
Outcome of endoscopic decompression of retrocalcaneal bursitis.
Kondreddi V, Gopal RK, Yalamanchili RK.
Indian J Orthop. 2012 Nov;46(6):659-63.
Posterior heel pain due to retrocalcaneal bursitis, is a disabling condition that responds well to the conventional methods of treatment. Patients who do not respond to conservative treatment may require surgical intervention. This study evaluates the outcome of endoscopic decompression of retrocalcaneal bursitis, with resection of posterosuperior eminence of the calcaneum.
This present study included 25 heels from 23 consecutive patients with posterior heel pain, who did not respond to conservative treatment and underwent endoscopic decompression of the retrocalcaneal bursae and excision of bony spurs. The functional outcome was evaluated by comparing the pre and postoperative American Orthopedic Foot and Ankle Society (AOFAS) scores. The Maryland ankle and foot score was used postoperatively to assess the patient's satisfaction at the one-year followup.
The University of Maryland scores of 25 heels were categorized as the nonparametric categories, and it was observed that 16 patients had an excellent outcome, six good, three fair and there were no poor results. The AOFAS scores averaged 57.92 ± 6.224 points preoperatively and 89.08 ± 5.267 points postoperatively (P < 0.001), at an average followup of 16.4 months. The 12 heels having noninsertional tendinosis on ultrasound had low AOFAS scores compared to 13 heels having retrocalcaneal bursitis alone. At one year followup, correlation for preoperative ultrasound assessment of tendoachilles degeneration versus postoperative Maryland score (Spearman correlation) had shown a strong negative correlation.
Endoscopic calcaneal resection is highly effective in patients with mild or no degeneration and yields cosmetically better results with fewer complications. Patients with degenerative changes in Achilles tendon had poorer outcomes in terms of subjective satisfaction.
NewsBot, Jan 18, 2013
Endoscopic calcaneoplasty: five-year results
Gökhan KAYNAK, Tahir Ö⁄ÜT, Necip S. YONTAR, Hüseyin BOTANLIO⁄LU,
Ata CAN, Mehmet Can ÜNLÜ
Acta Orthop Traumatol Turc 2013;47(4):261-265
Objective: The aim of this study was to evaluate the results of the endoscopic calcaneoplasty technique
for the treatment of retrocalcaneal bursitis and Haglund's disease.
Methods: This study included 30 feet of 28 patients who underwent endoscopic surgery for Haglund's
disease between 2003 and 2011. The inflamed bursa and posterosuperior surface of the calcaneus were
removed with a shaver and bone resection performed until there was no friction on the Achilles tendon
with the ankle in dorsiflexion. All patients were discharged on the same day and allowed full weight-bearing
at the second postoperative week. American Orthopedic Foot and Ankle Society (AOFAS) scores and
patient satisfaction were recorded.
Results: Average follow-up was 58.4 months. AOFAS scores significantly improved from a postoperative
average of 52.6 points to 98.6 points at the final evaluation (p<0.005). All patients were satisfied
with the result of the operation.
Conclusion: Endoscopic calcaneoplasty with the patient in the prone or supine position appears to be
a safe and effective surgical procedure for the treatment of retrocalcaneal bursitis and Haglund's disease.
Results of operative treatment for recalcitrant retrocalcaneal bursitis and midportion Achilles tendinopathy in athletes
Heinz Lohrer, Tanja Nauck
Archives of Orthopaedic and Trauma Surgery; June 2014
The results of operative treatment for recalcitrant midportion Achilles tendinopathy and recalcitrant retrocalcaneal bursitis were evaluated using the patient administered, disease specific, and validated VISA-A-G questionnaire.
A cohort of 89 patients was prospectively followed. These patients underwent operations for sport induced midportion Achilles tendinopathy (39 procedures) or retrocalcaneal bursitis (55 procedures). Depending on the individual intraoperative findings the patients of either disease were treated with two respective operative modifications (tendon repair or no tendon repair). Preoperative and follow-up status (3, 6, and 12 months) were investigated using the VISA-A-G questionnaire.
Preoperatively, the four groups scored from 37.0 ± 17.6 to 45.9 ± 15.2 (p = 0.376–0.993) on the VISA-A-G questionnaire. Six and 12 months postoperatively, the VISA-A-G scores improved significantly (p < 0.001). Twelve months postoperatively, the groups' scores were not different (p = 0.100–0.952) and ranged from 80.8 ± 17.9 to 90.3 ± 10.6.
Retrocalcaneal bursitis and midportion Achilles tendinopathy responded equally well to operative treatment. When repaired, additional tendon lesions did not influence this result. We demand to differentiate not only between midportion Achilles tendinopathy and retrocalcaneal bursitis but also to identify additional Achilles tendon lesions to specifically address these lesions during operative procedures.
NewsBot, Jun 19, 2014
Can We Measure the Heel Bump? Radiographic Evaluation of Haglund's Deformity
Gythe H. Bulstra, MD et al
The Journal of Foot and Ankle Surgery;Articles in Press
Haglund's deformity is a symptomatic posterosuperior deformity of the heel. The lateral radiograph of the ankle will show a prominent, large, posterosuperior part of the calcaneus, which can be measured using the Fowler and Philips angle (FPA, the angle between the posterior and plantar surface of the calcaneus) and the calcaneal pitch angle (CPA, the angle between the sole of the foot and the plantar part of the calcaneus). Although these angles are commonly used, these radiographic angle measurements have never shown a relationship with Haglund's deformity. In 78 patients (51% male) with symptomatic Haglund's deformity and a control group of 100 patients (41% male) with no heel complaints, we measured the FPA and CPA on weightbearing lateral radiographs of the foot. Using an unpaired t tests, no significant difference was found between the 2 groups in the FPA (p = .40). We measured a significant difference in the CPA between the Haglund group and the control group (p = .014). Subgroup analysis showed that this difference was mainly found in females (p < .00), with no significant difference seen in the males (p < .48). Females with Haglund's deformity will have a greater CPA than will females without Haglund's deformity. The CPA showed a difference between the Haglund and non-Haglund groups, although mainly in females. Although the evidence from our study is limited, it would be interesting to study the CPA further, because it implicates the verticalization of the calcaneus. This change in position results in extra traction on the Achilles tendon and can eventually cause tendinitis and bursitis. Radiographic measurement should be used as an auxiliary tool. If the calcaneus tends to change position, it would be interesting to understand this process, which could eventually lead to improvement in the treatment of Haglund's deformity.
NewsBot, Aug 30, 2014
Endoscopic Calcaneoplasty for Haglund's deformity
S.Appala Raju, M Vijay Bhushanam, G Rajasekhar Rao, M Venkateswara Rao
INTERNATIONAL JOURNAL OF HEALTH RESEARCH IN MODERN INTEGRATED MEDICAL SCIENCES (IJHRMIMS), ISSN XXXX (P), ISSN XXXX (O), Oct-Dec 2014 (full text pdf)
Endoscopic calcaneoplasty is a minimally invasive technique for resection of inflamed retrocalcaneal bursa
and resection of abnormal prominence over the postero superior part of calcaneum.In this report, we describe the treatment
of Haglund's deformity by minimally invasive method to overcome wound healing problems.It also offers an advantage
of shorter recovery time and proved cosmesis
Safety of Achilles Detachment and Reattachment Using a Standard Midline Approach to Insertional Enthesophytes
Jeffrey E. McAlister, DPM, Christopher F. Hyer, DPM, MS, FACFA
Jnl Foot Ank Surg January 22, 2015
Detachment with reattachment of the Achilles tendon is a common surgery for debridement of retrocalcaneal exostosis, bursitis, and other insertional pathologic entities. The technique involves a midline skin incision on the posterior Achilles to the tendon. The distal Achilles attachment is removed in a U-shaped manner, leaving the medial and lateral flares, but exposing the posterior spur. This midline approach provides excellent exposure and allows for rapid and efficient surgical debridement. The tendon is reapproximated and repaired with a suture anchor to facilitate fixation to the posterior calcaneus. Some surgeons have expressed concerned that the rupture risk could be increased in the postoperative period using this technique. The present study was a retrospective medical record review of 98 patients (100 feet) who had undergone a midline approach with Achilles reattachment after insertional Achilles debridement during a 3-year period. The demographic and comorbidity data were collected and analyzed. The outcome measures were postoperative rupture and the need for revision surgery. The mean age was 51.9 years, and the patients included 59 females (60.2%) and 39 males (39.8%). The complications included 4 rupture or avulsion revisions (4.0%) and 2 recurrent pain and tendinitis revisions (2.0%). The most common repeat repair procedure included hardware removal and a flexor hallucis longus transfer or augmentation. Nine patients (9.0%) had wound complications, 7 (77.8%) of which necessitated incision and drainage. The midline approach with Achilles detachment and reattachment is a safe and effective method of surgical treatment of insertional Achilles pathologic entities. The low reoperation rate of 4.0% will allow foot and ankle surgeons to safely rely on this approach.
Comparision of open versus endoscopic calcaneoplasty for haglunds deformity: A short term analysis
Appala Raju S, Rajasekhara Rao G, Vijayabhushanam M, Venkateswara Rao M, Anil B.
Journal of Evolution of Medical and Dental Sciences 2015; Vol. 4, Issue 12, February 09; Page: 1930-1934,
Endoscopic calcaneoplasty is a minimally invasive technique for resection of inflamed
retrocalcaneal bursa and resection of abnormal prominence over the postero superior part of
calcaneum.In this article we would like to compare the results of open versus endoscopic
calcaneoplasty after a minimun followup of one year. AIMS: To evaluate the functional outcome of
patients with Haglunds deformity and compare open technique versus endoscopic method using
AOFAS {American orthopaedic foot and ankle society hind foot} Scoring system after one year
Our study favored an endoscopic technique over open procedures like:
1. Decreased operative period.
2. Decreased surgical site infection and wound healing.
3. Early return to normalcy.
4. Significant AOFAS ankle-hind foot scores (p=0.019).
NewsBot, Feb 10, 2015
Comparision of open versus endoscopic calcaneoplasty for haglunds deformity: A short term analysis.
Journal of Evolution of Medical and Dental Sciences 2015; Vol. 4, Issue 12, February 09; Page: 1950-1954, DOI: 10.14260/jemds/2015/283
Endoscopic calcaneoplasty is a minimally invasive technique for resection of inflamed retrocalcaneal bursa and resection of abnormal prominence over the postero superior part of calcaneum.In this article we would like to compare the results of open versus endoscopic calcaneoplasty after a minimun followup of one year. AIMS: To evaluate the functional outcome of patients with Haglunds deformity and compare open technique versus endoscopic method using AOFAS {American orthopaedic foot and ankle society hind foot} Scoring system after one year
NewsBot, Mar 1, 2015
Haglund Deformity – Surgical Resection by the Lateral
S Natarajan, MS Orth, VL Narayanan,
Malaysian Orthopaedic Journal 2015 Vol 9 No 1
The aim of this study was to analyse the outcome of surgical
Haglund deformity is a prominence in the postero
superolateral aspect of the calcaneum. Haglund deformity is
a prominence in the postero superolateral aspect of the
calcaneum, causing a painful bursitis, which may be difficult
to treat by non-operative measures alone. Various surgical
methods are available for effective treatment of refractory
Haglund's deformity. This study is to evaluate whether
adequate resection of Haglund deformity by a lateral
approach provides good to excellent results. During the
period from 2009 to 2012, 40 patients with 46 feet had
undergone resection of Haglund deformity using lateral
approach and the outcome was analysed using AOFAS
Ankle-Hind Foot Scale. The mean AOFAS score at the
follow up was 86/100, with the majority of patients
reporting alleviation of pain at one year follow up. The
lateral approach to calcaneal ostectomy can be an effective
treatment for those suffering from refractory Haglund
deformity. However, the patient must be made aware of the
duration of recovery being long.
Operative Treatment of Haglund Syndrome With Central Achilles Tendon-Splitting Approach
Jae Hoon Ahn, MD, Chi-Young Ahn, MD, Chu-Hwan Byun, MD, Yoon-Chung Kim, MD
Jnl Foot and Ankle Surgery; Article in Press
Haglund syndrome is characterized by chronic posterior heel pain associated with a posterosuperior calcaneal prominence. We assessed the clinical and radiologic outcomes after operative treatment of Haglund syndrome using the central tendon-splitting approach. Fifteen feet in 15 patients were investigated retrospectively after surgery. Of the 15 patients, 14 were males (93.3%) and 1 was female (6.7%). Their mean age was 33.1 ? 8.2 (range 20 to 50) years. The mean follow-up duration was 3.5 ? 1.5 years (range 24 to 90 months). The American Orthopaedic Foot and Ankle Society ankle-hindfoot Scale and Victorian Institute of Sport Assessment-Achilles scores were investigated to assess the clinical outcomes. Patient satisfaction was assessed at the latest follow-up visit. The lateral talo-first metatarsal angle, calcaneal pitch angle, Fowler-Philip angle, and parallel pitch line were measured to assess the foot shape and radiographic outcomes. Clinically, the mean American Orthopaedic Foot and Ankle Society ankle-hindfoot scale score increased from 62.1 ? 7.5 preoperatively to 92.5 ? 3.5 at the latest follow-up visit. The mean Victorian Institute of Sport Assessment-Achilles score increased from 53.2 ? 7.4 to 89.6 ? 3.4. All patients were satisfied with the operative results. Radiographically, all patients had cavus feet with an increased lateral talo-first metatarsal angle (mean +5.9? ? 5.0?) and calcaneal pitch angle (mean 26.0? ? 3.8?). The mean Fowler-Philip angle decreased from 58.9? ? 15.0? to 32.5? ? 7.2? postoperatively, and the positive parallel pitch line had changed to a negative value in all cases. Operative treatment with the central tendon-splitting approach appears to be safe and satisfactory for intractable Haglund syndrome.
NewsBot, Jul 29, 2015
Haglund's disease: surgical outcome of calcaneal osteotomy
Veerabhadra Javali, Virupaksha N. Reddy
Int J Res Orthop. 2017 Mar;3(2):278-281
Background: The aim of the present study was to assess the surgical outcome of Haglund's disease by calcaneal
osteotomy.
Methods: 23 cases of Haglund's disease who failed to respond to conservative treatment were considered for surgery.
Parallel pitch lines were drawn in the lateral view radiograph of the calcaneum and the bursal projection to be resected
was assessed. All cases were surgically treated with calcaneal osteotomy through lateral approach and followed.
Results: 23 cases of Haglund's disease were treated with this procedure and 21 were available for follow up. The
mean follow-up was 15 months. The mean preoperative AOFAS score of 60.57 points (SD= 3.23) and postoperative
score of 88.71 points (SD= 3.92) was obtained. Three minor complications were noted.
Conclusions: The results of the current study suggest that calcaneal ostectomy produces outcomes that justify
surgical intervention in cases of Haglund's disease.
A Proposed Staging Classification for Minimally Invasive Management of Haglund's Syndrome with Percutaneous and Endoscopic Surgery.
Syed TA, Perera A
Foot Ankle Clin. 2016 Sep;21(3):641-64. doi: 10.1016/j.fcl.2016.04.004.
Haglund's syndrome encompasses several different pathologies, including Haglund's deformity, insertional Achilles tendonopathy, retrocalcaneal bursitis, and superficial bursitis. Traditionally treated with open surgery, there is increasing interest in a more minimally invasive approach to this difficult region to reduce complications and improve the rate and ease of recovery. We review the evidence available for 2 of these techniques: the endoscopic calcaneoplasty and percutaneous Zadek's calcaneal osteotomy (also known as Keck and Kelly's osteotomy). The senior author's classification for management of the condition is presented as well as describing his operative technique for these procedures.
NewsBot, Apr 30, 2017
Calcaneus Exostectomy and Achilles Tendon Reattachment for the Treatment of Haglund Deformity
Phisitkul, Phinit MD; Rungprai, Chamnanni MD
Techniques in Foot & Ankle Surgery: June 2017 - Volume 16 - Issue 2 - p 74–80
Insertional Achilles tendinosis with Haglund deformity is a common cause of posterior heel pain and the diagnosis can be established by history, physical examination, and imaging. Operative treatment may be required if the conservative treatment has failed. A common surgical procedure usually includes open debridement of Achilles tendon and retrocalcaneal bursa, exostectomy of posterior superior aspect of the calcaneus, and reattachment of the Achilles tendon using a double-row suture anchors. The results of these procedures demonstrated significant improvement of functional outcomes and pain relief with minimal complications.
Surgical Correction of Haglund's Triad Using a Central Tendon-Splitting Approach: A Retrospective Outcomes Study
Zhan Xia et al
Foot and Ankle Surgery; Article in Press
We evaluated the surgical outcomes of Haglund's triad using a central tendon-splitting approach, with Achilles tendon partial detachment and debridement, excision of the retrocalcaneal bursa, resection of Haglund's prominence, and reattachment of the Achilles tendon. The medical records of 22 patients (22 heels) who had undergone surgical correction of Haglund's triad from January 2010 to December 2015 were reviewed retrospectively. The visual analog scale pain score, American Orthopaedic Foot and Ankle Society (AOFAS) Ankle-Hindfoot scale score, and 36-item Short-Form Health Survey physical and mental component scores were prospectively collected preoperatively, 6 months postoperatively, and at the last visit. The scores of a subjective question involving satisfaction were prospectively collected at the last visit. Possible risk factors were also evaluated. We reviewed the data from 12 females and 10 males, with the mean age of 59.2 ± 7.3 years and a mean follow-up duration of 15.1 ± 4.6 months. Significant improvement was found in the mean visual analog scale pain score, average American Orthopaedic Foot and Ankle Society Ankle-Hindfoot scale score, and 36-item Short-Form Health Survey physical component scale score. The overall satisfaction rate was 77.3% (17 of 22). Postoperative complications included 2 cases of delayed wound healing and 1 case of sensation loss over the heel wound. No Achilles tendon rupture or wound infection developed. Gender and body mass index did not affect the surgical outcomes. The surgical technique we used for Haglund's triad provided effective pain relief, function improvement, and overall enhancement of patients' health condition. More research is required to further evaluate the outcomes of our surgical approach to treat Haglund's triad and the possible risk factors.
Surgical treatment for Haglund's deformity
A comparative study of the calcaneal closing-wedge calcaneal osteotomy versus posterior-superior prominence removal in both sides with Haglund syndrome
Lin C et al
Zhonghua Yi Xue Za Zhi. 2017 Sep 19;97(35):2733-2736. doi: 10.3760/cma.j.issn.0376-2491.2017.35.004.
Objective: To compare the clinical outcome of removal of calcaneal posterior-superior prominence and that of calcaneal closing-wedge osteotomy for Haglund syndrome. Methods: From February 2009 to July 2014, 36 patients with Haglund syndrome were included.They were divided into two groups, and each group included 18 patients and underwent removal of calcaneal posterior-superior prominence and calcaneal closing-wedge osteotomy respectively.They were evaluated preoperatively and after 6 , 12 months and 24 months postoperatively by American Orthopedic Foot & Ankle Society (AOFAS) score, VAS score, VISA-A questionnaire and Maryland Foot Score.Fowler-Philip angle and calcaneal posterior slope of the two groups were compared preoperatively and after 6 months.All data were analysis utilizing SPSS 18.0. Results: At six months of follow-up, the weight-bearing lateral X-rays reveals that removal of calcaneal posterior-superior prominence did not change Fowler-Philip angle and calcaneal posterior slope and calcaneal closing-wedge osteotomy decreased Fowler-Philip angle and calcaneal posterior slope significantly[from preoperation (56.5±5.4)°, (120.0±1.3)°to postoperation (48.4±4.6)°, (109.0±5.3)°]. At six months of follow-up, the AOFAS score, VAS score, VISA-A questionnaire and Maryland Foot Score were worse in the wedge calcaneal osteotomy group.At twelve months of follow-up, no significant difference (P>0.05)was found between the two groups in terms of VAS score, and Maryland Foot Score, while the AOFAS score, and VISA-A questionnaire in the wedge calcaneal osteotomy group were better than those of posterior-superior prominence removal group.At twenty-four months of follow-up, the AOFAS score, VAS score, VISA-A questionnaire and Maryland Foot Score were better in the wedge calcaneal osteotomy group (P<0.05). Conclusions: Both the two surgical methods are effective for Haglund syndrome.Calcaneal closing-wedge osteotomy decreased Fowler-Philip angle and calcaneal posterior slope of calcaneus and its clinical outcome appears better than that removal of calcaneal posterior-superior prominence.
Early Results of Arthroscopic Treatment
of Haglunds Deformity in A Latin
American Cohort
Samuel Rosas et al
SM Musculoskelet Disord. 2017; 2(1): 1021.
Arthroscopic treatment for ankle diseases has proven to be successful as multiple articles describe
favorable outcomes, low complication rates and cost-effectiveness [1]. Nonetheless, these articles are most
often from North America, Europe and Pacific nations, thus there is a lack of literature supporting these outcomes
in the Latin American patient population. The purpose of this study was to describe the early outcomes of a
commonly performed procedure focusing in the Latin patient population. We conducted the study on a case
series of patients who underwent arthroscopic treatment of Hagelund lesions at a tertiary care center in Medellin,
Colombia Outcomes were measured by previously trained personnel decrease bias.
The goal of this study was to report the short-term outcomes of these patients and thus our focus was on the
first 12 months after surgery. A total of 6 patients had available data for the follow up.
The mean age was 43.1 (SD 21.6), 66.7% of patients were males and all cases had unilateral surgeries.
Mean follow up was 10.9 months (range 3- 24.3). 100%of patients stated they would undergo the operation
again, with the mean satisfaction on the 10-point scale being 9 (range 7-10). No patient had undergone a second
procedure for the same indication. One patient had instability symptoms, but this was not reproducible during
the examination. In summary, arthroscopic treatment of Haglund deformity in a Latin patient population yielded
satisfactory results.
Achilles Pullout Strength After Open Calcaneoplasty for Haglund Syndrome
Glenn Pfeffer, MD, Tyler Gonzalez, MD, MBA, Matthew Zapf, MD, MSc, ...
Foot & Ankle International April 13, 2018
Haglund syndrome involves a prominent posterior superior prominence of the calcaneus. If nonoperative management fails, operative management with calcaneoplasty is often needed. No study has assessed Achilles tendon pullout strength after an open calcaneoplasty for Haglund syndrome. The purpose of this study was to investigate those changes in a cadaveric model and provide objective data upon which to base postoperative recovery.
Seven matched pairs of cadaveric specimens (mid-tibia to toes) were divided into 2 cohorts: (1) intact/untreated and (2) open resection. The open resection group was treated with an open calcaneoplasty through a posterior approach using a microsagittal saw. We compared Achilles pullout strength between the 2 groups through the use of a mechanical testing system. Specimens were then loaded to failure. Lateral radiographs were obtained before and after surgery to quantify bone removal. Outcome measures included height of bony resection, angle of bone resection, and load to failure.
The mean maximum pullout strength was significantly higher in the intact specimens (1300 ± 500 N) compared to the open resection group (740 ± 180 N) (P < .01), representing a 45% reduction in pullout force in the open resection group. Pullout force was significantly correlated to bone mineral density (BMD) (P < .05). Pullout force was negatively correlated to both radiographic measures of resection level, angle, and height, but neither of these were significant.
Open calcaneoplasty demonstrated a significant weakness of the Achilles tendon insertion. Pullout strength of the Achilles was also positively correlated with BMD.
Clinical Relevance:
Biomechanical evidence presented above supports the practice of protected weightbearing and cautious return to activity after open calcaneoplasty for Haglund syndrome.
Surgical resection of Haglund deformity by lateral approach: our
institutional experience on 29 heels
Naseer A. Mir et al
Mir NA et al. Int J Res Orthop. 2018 Jul;4(4):595-600
Background: Haglund deformity is a common cause of posterior heel pain and consists of a constellation of soft
tissue and osseous abnormalities. The treatment starts with conservative approach and ends with surgical treatment in
case conservative treatment fails and the symptoms are bothersome. Different surgical procedures and approaches
have been used for this deformity. But in the literature, the results have been inconsistent. In this study we evaluated
the clinical and functional outcome of osteotomy of the calcaneal tuberosity with debridement of the retrocalcaneal
bursa and the Achilles tendon using a lateral approach at our institute.
Methods: A total of 29 feet in 25 patients that underwent surgical procedure from August 2013 to March 2017 at our
institute were included in this study. The clinical and functional outcome was evaluated using AOFAS ankle-hind
foot scale.
Results: The mean AOFAS ankle-hind foot score had improved by 32 points from the pre-operative mean score, with
a mean score of 86 at the final follow up of one year. Five out of 29 operated feet had superficial surgical site
infection in the postoperative period that responded to antibiotic therapy and regular antiseptic dressings. One patient
had local betadine allergy.
Conclusions: We conclude lateral approach to debridement and calcaneal tuberosity resection is an effective method
with good clinical and functional outcome in patients with refractory Haglund deformity.
Treating Haglund's Deformity with percutaneous
Achilles tendon decompression: a case series
Fabrizio Sergio et al
Muscles, Ligaments and Tendons Journal 2018;8 (4):488-494
Introduction: Haglund's syndrome is a deformity
of the postero-superior and lateral heel-shaped
profile commonly associated with inflammation of
the retro-calcaneal bursa and characterized by
pain and swelling. Aim of the study was to evaluate
the reliability and effectiveness of minimally
invasive percutaneous surgical procedure for
Achilles tendon decompression.
Methods: From January 2014 to April 2016, a total
of 21 continuous patients with Haglund's deformity
(15 men, 6 women, mean age of 40 years) were
enrolled. The regularization of calcaneous profile
and borsectomy were performed in all cases. The
results were evaluated both clinically with American
Orthopaedic Foot and Ankle Society hindfoot
score (AOFAS-hindfoot), Visual Analog Scale
(VAS) before surgery and at 6 months' follow-up.
Radiographic results were also collected using
Fowler-Philip before the surgery and one-month
follow-up.
Results: The average AOFAS-hindfoot score increased
from 50.57 to 97.42 (p<.00001). VAS score
decreased from 6.85 to 0.19 (p<.00001) and the
mean Fowler-Philip angle decreased from 79,57°
to 53.76°(p<.00001). In our series, no complications
were observed and all patients were satisfied
at last follow-up.
Conclusions: Our results suggest that Achilles
decompression by percutaneous approach for
painful Haglund's deformity is a reliable and effective
surgical procedure.
Biomechanical Comparison of Achilles Tendon Pullout Strength Following Midline Tendon-Splitting and Endoscopic Approaches for Calcaneoplasty
Max P. Michalski, MD, MSc, Tyler A. Gonzalez, MD, MBA, Melodie F. Metzger, PhD, ...
Foot & Ankle International June 17, 2019
Calcaneoplasty is a common procedure performed for the management of Haglund's syndrome when nonoperative management fails. Midline tendon-splitting and endoscopy are 2 common approaches to calcaneoplasty. Studies have suggested that an endoscopic approach may allow earlier return to activity and superior outcomes, but there are no biomechanical or clinical studies to validate these claims. The goal of this study was to quantify and compare Achilles tendon pullout strength following midline tendon-splitting and endoscopic calcaneoplasty in cadaveric specimens.
Twelve match-paired cadaveric specimens were randomly divided into 2 groups: endoscopic and midline tendon-split. Following calcaneoplasty, fluoroscopy was used to match bone resection and the Achilles was loaded to failure in a mechanical testing system. A paired-samples t test was conducted to compare bone resection height, bone resection angle, load to failure, and mode of failure.
The endoscopic approach yielded a 204% greater postsurgical pullout strength for the Achilles tendon than the midline tendon-split (1368 ± 370 N vs 450 ± 192 N, respectively) (P < .05). There were no differences in resection angle or resection height. All specimens failed due to bone or tendon avulsion.
Endoscopic calcaneoplasty had more than 3 times greater pullout strength than the midline tendon-splitting approach.
This may allow earlier return to functional rehabilitation following endoscopic calcaneoplasty, but further studies are needed to determine if these differences are clinically significant. Further understanding of the time-zero biomechanics following calcaneoplasty may provide guidance regarding postoperative management with respect to surgical approach.
Dr Rich Blake Active Member
NewsBot said: ↑
Thank you for this article on this very stubborn disease! Rich
Dr Rich Blake, Dec 8, 2019
Effectiveness of shockwave therapy along with contrast
bath and static Achilles stretch in patients with
Dr. Sonia Chahar and Dr. Mukesh Sharma
International Journal of Physical Education, Sports and Health 2019; 6(4): 92-96
Background: Several studies have studied the effect of TENS, contrast bath, Ultrasound and Achilles
tendon stretching on retrocalcaneal bursitis (RCB). However combined effect of extracorporeal
shockwave therapy (ESWT) with contrast bath and Achilles stretch has not been reported so far.
Objective: To study the effectiveness of ESWT along with contrast bath and static Achilles stretch in
patients with RB.
Study Design: Experimental study.
Methodology: 30 patients having retrocalcaneal bursitis (female, male) fulfilling the inclusion and
exclusion criteria were recruited and were randomly allocated in two groups. Group A subjects were
given with contrast bath & Achilles stretch exercises and group B subjects were given ESWT along with
contrast bath & Achilles stretch exercises. Pain, AROM of ankle dorsiflexion (DF) & plantarflexion (PF)
and functional ability were depicted by using VAS scale, goniometer and Roles and Maudsley's (RM)
score respectively.
Data Analysis: Data Analysis was done by using SPSS version 15.0.
Result: Significant changes were seen between & within both groups for VAS, Ankle ROM and
functional ability.
Conclusion: Study proves that ESWT has an additional effect in the management of RCB
NewsBot, Jan 6, 2020
Great to hear!!
Dr Rich Blake, Jan 7, 2020
Use of Ultrasonically Interdigitated Anchors in Haglund's Deformity Correction Surgery.
Warren B et al
Foot Ankle Spec. 2020 Mar 4
Haglund's deformity is a common cause of foot pain, with high success rates of surgical intervention. Because early weightbearing rehabilitation correlates with better surgical results, the integrity of anchors employed in these surgeries needs to be evaluated for proper fixation strength, leading to improved postoperative outcomes. The ultrasonically interdigitated anchor is a biodegradable suture anchor that is melted into bony trabeculae using ultrasound, leaving a small biological footprint and less interference on computed tomography and magnetic resonance imaging scans, without loss of fixation strength. We performed a review of 44 patients aged 26 to 84 years treated with either ultrasonically interdigitated anchors or fully threaded titanium anchors during Haglund's deformity excision. Overall, 7 of 14 patients who received an ultrasonically interdigitated anchor reported raw PROMIS (Patient-Reported Outcomes Measurement Information System) scores averaging 14.3, with an average return to ambulation time of 4.2 weeks. Fifteen of 30 patients receiving a fully threaded titanium anchor reported raw PROMIS scores averaging 9.7, with an average return to ambulation time of 3.5 weeks. We found little difference between the outcomes between the 2 anchors and no massive failures or infections in either group, implying that ultrasonically interdigitated anchors are a viable option for Achilles tendon reattachment during Haglund's deformity repair surgery.
The Central-Splitting Approach for Achilles Insertional Tendinopathy and Haglund Deformity.
Ricci AG et al
JBJS Essent Surg Tech. 2020 Feb 21;10(1)
Insertional Achilles tendinopathy causes posterior heel pain at the insertion of the Achilles tendon, often in combination with a calcaneal exostosis, or Haglund deformity. Insertional Achilles tendinopathy often presents with a posterior osseous prominence and leads to calcification of the Achilles tendon1. Nonoperative treatment of these conditions includes activity modification, nonsteroidal anti-inflammatory agents, heel lifts, shoe modification, physical therapy focused on eccentric strengthening exercises, iontophoresis, and shock wave therapy. Nonoperative treatment will fail in approximately 50% of these cases, and such patients become candidates for surgical intervention2,3. Multiple surgical approaches have been described, including the medial J-shaped, lateral, Cincinnati transverse, double incision, and central-splitting approaches4. Currently, there is no consensus regarding the ideal approach. Recent literature has suggested that the central-splitting approach allows for adequate exposure of both the most commonly diseased area of the tendon and the calcaneal exostosis, with excellent postoperative pain and functional results5-13.
Place the patient in the prone position with the feet at the edge of the operating table. Make a full-thickness, 5 to 7-cm longitudinal incision centered over the Achilles tendon and the posterior aspect of the calcaneus. Make a central incision through the Achilles tendon. Sharply mobilize the medial and lateral slips and excise the diseased portion of the Achilles tendon. Expose the calcaneal exostosis and perform the calcaneal exostectomy with a microsagittal saw. Repair the remaining healthy-appearing Achilles tendon to the calcaneus with 2 suture anchors. An additional suture anchor or, alternatively, the double-row technique for the Achilles tendon repair may be used. Repair the central split in the Achilles tendon with absorbable suture. Close the soft tissue and skin in layers.
Alternative approaches include the medial, lateral, or Cincinnati transverse incisions. The central-splitting approach is favored because of the excellent exposure of both the diseased tendon and the calcaneal exostosis. Additional augmentations to this procedure include a flexor hallucis longus transfer and a gastrocnemius recession.
This technique provides adequate exposure to the diseased Achilles tendon, calcific deposits, and calcaneal exostosis. Recent studies have demonstrated it to be a safe and effective technique with high patient-satisfaction scores
Comparison of dorsal closing wedge calcaneal osteotomy versus posterosuperior prominence resection for the treatment of Haglund syndrome.
Ge Z et al
J Orthop Surg Res. 2020 May 7;15(1):168
Haglund syndrome is a common disease that causes posterior heel pain. This study compared the clinical outcomes of dorsal closing wedge calcaneal osteotomy (DCWCO) and posterosuperior prominence resection (PPR) for the treatment of Haglund syndrome.
This retrospective study included 12 patients who underwent DCWCO and 32 patients who underwent PPR from January 2010 to August 2016. Patients were evaluated using the American Orthopedic Foot Ankle Society ankle-hindfoot scale (AOFAS), Victorian Institute of Sport Assessment Scale for Achilles tendinopathy (VISA-A), Fowler-Philip angle, Bohler's angle, and calcaneal pitch angle preoperatively and postoperatively (at 3 months, 6 months, 1 year, and the latest follow-up).
Both groups exhibited a significant increase in their AOFAS and VISA-A scores after surgery. The DCWCO group had lower AOFAS scores than the PPR group at 6 months (77.6 ± 5.1 vs. 82.8 ± 7.8; P = 0.037) but had higher scores at the latest follow-up (98.2 ± 2.3 vs. 93.4 ± 6.1; P = 0.030). The DCWCO group had lower VISA-A scores at 3 months (56.9 ± 13.9 vs. 65.2 ± 11.0; P = 0.044) but higher scores at the latest follow-up (98.2 ± 2.6 vs. 94.3 ± 5.0; P = 0.010) than the PPR group. Both groups exhibited significant changes in the Fowler-Philip angle and Bohler's angle after surgery. The postoperative Fowler-Philip angle of the DCWCO group was greater than that of the PPR group (35.9° ± 4.9° vs. 31.4° ± 6.2°; P = 0.026). However, there was no statistically significant difference in any other angle of the two groups postoperatively.
Compared to the PPR group, the DCWCO group had poorer short-term clinical outcomes but provide better long-term function and symptom remission. This method can be a good option for those patients with higher functional expectations.
Evaluation of Results of Minimally Invasive Endoscopic
Management of Haglund Syndrome
N. Srinivas Reddy et al
J Cont Med A Dent Jan-Apr 2020 Volume 8 Issue 1
Background: The purpose of our study is to evaluate endoscopic treatment of Haglund's syndrome in which all
patients showed a Haglund projection on radiography and none had a cavo-varus deformity. Methods: Our
study included n=24 patients (30 heels) with a mean age of 32 years (range 26-44 years). They presented with
posterior ankle impingement syndrome with Haglund's deformity on radiography and were resistant to
conservative therapy for more than 6 months. They underwent two portal endoscopic surgeries in Prathima
Institute 1 of Medical Sciences, Nagunur, Karimnagar between May 2016 and October 2019. Results: The mean
follow-up was 24 months (range 6–41 months). In 27 heels, postoperatively we achieved negative parallel pitch
lines on lateral radiographs. The average AOFAS score improved from 59.3±9.9 points preoperatively to
94.8±9.1 points at final evaluation (p<0.01). There were sixteen excellent results, ten good results, two fair
results, and two poor results. For the Ogilvie Harris score, there were seventeen excellent, ten good, one fair,
and two poor results. The VAS for pain decreased from 6.8 ± 1.4 (range 5-10) preoperatively to 1.8±0.8 (range
0-4) (p< 0.01) at final evaluation. There were no obvious intra or post-operative complications. All patients
were satisfied with the result of the operation. Conclusion: Endoscopic calcaneoplasty is a safe and effective
minimally invasive treatment option for Haglund disease after failure of conservative treatment for 6 months.
NewsBot, Jun 8, 2020
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I was inspired to write this particular post about the use of sensation and color after re-reading Janine K. Spendlove's 2nd book in the War of the Seasons series. The novels are about a human girl who falls into an alternate world full of fairies, elves, sprites, etc. Each of the seasons: Fall, Spring, Summer, Winter are at war, and each of at the four books focuses on a particular one. It's like Alice in Wonderland meeting Harry Potter – a festival of creativity and a delight for the senses.
I absolutely love the way Janine uses color in her narration. It causes the pages to seem alive, dripping with oranges, purples, pinks, and blues. The elves' eyes swirl with color to match their emotions. The outfits and hair each character wears is described in neon brilliance. It's a delight for the imagination and makes each sentence yummy, like eating a decadent chocolate cake.
Another book that delights with its use of color in the narration is The Night Circus by Erin Morgenstern. There too, the author uses colors to vividly paint a picture in the readers' minds. It doesn't take away from a reader's own imagination, it just builds out the scene.
I was once given excellent advice about a short story I'd written. My editors said that the action of the story was good, but that I'd effectively only described a blank box with blank people inside. I needed to describe the scenery/make it vivid. The advice was perfect, and I know as a reader I like it when an author paints me a stunning picture that I can then revolve and keep dreaming about in my own imagination.
In Janine's WotS series the world is a dessert for the senses, almost like looking at a rainbow as I read. It was quite entertaining to re-read book 2 of her series, The Half-blood. Even look at the gorgeous covers filled with color!


John Kingsley RSW PAI (b.1956) is a Scottish artist born in Glasgow. Working in both representational and more abstract formats, the landscapes of Scotland and Provence in particular have been long-standing sources of inspiration for him.
He studied drawing and painting at Glasgow School of Art from 1973-77 under the tutorship of Geoffrey Squire, and other prominent Scottish artists such as James D. Robertson and David Donaldson.
Continuing his work in Scottish art, in 1979 John Kingsley was elected an artist member of the Glasgow Art Club. From 1980-86 he exhibited solo shows at the annual S.N.O. promenade concerts at the Kelvin Hall, Glasgow and in 1986 he was elected a member of Group 81 Artists, who exhibited regularly at the McLellan Galleries, Glasgow.
A finalist in the Hunting Art prizes competition in London in 1989, 1993, and 1998, and highly commended in the same competition in 1996, John Kingsley has firmly established his reputation as a leading Scottish contemporary artist. He won the William Bowie Landscape Prize in 1991 and the Mary Armour Award at the Paisley Art Institute in 1992. Other awards include the Paisley Art Institute prize in 2003, the Reid Kerr College Award for painting in 2006, the Watermark Award in 2013, and the May Marshall Brown Award in 2017 (both at the RSW). John Kingsley also served as a member of the council of the Paisley Art Institute for fifteen years and was recently made an RSW after being elected a member of the Royal Scottish Society of Painters in Watercolour.
Today, John Kingsley lives and works in Glasgow, and has an international reputation with art works in many private and public collections across Europe, Australia, Canada, and the USA. His paintings can be found in the art collections of HRH the Duke of Edinburgh, the Argyle and Bute District Council, and the Royal College of Physicians and Surgeons in Glasgow.
In addition to Red Rag Art Gallery John Kingsley has exhibited at a number of other Scottish Art Galleries including the Royal Glasgow Institute, Royal Scottish Academy, and the Paisley Institute. Each painting at Red Rag is sourced from the John Kingsley artist studio and like all Red Rag Contemporary art it can be shipped worldwide.
Artist John KINGSLEY PAI RSW is one of a growing number of artists whose modern art works feature at Red Rag Gallery in Bath. Modern art work from John KINGSLEY PAI RSW is regularly exhibited at the Bath art gallery which also offers an extensive choice of modern art, contemporary sculptures and collectible art prints from other present day artists.
Should you wish to buy or require further information about modern art from John KINGSLEY PAI RSW please contact/email Red Rag Modern Art Gallery or alternatively contact Red Rag on the number below.


text:
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Betty Davis60s & 70s Soul & FunkLight In The Attic
Betty Davis was a musical maverick with vision. Image, substance, sex, and grit combined with a badass band that could deliver the funk bed backbone to the sultry music between the sheets. After cutting two notorious discs for the Just Sunshine label (Betty Davis and They Say I'm Different), and Nasty Gal for Island Records, Davis went to work on her most personal and expressive record yet. After capturing 10 hard-hitting tracks in 1976 at the remote Studio In The Country (Louisiana), a creative difference with her then label caused the platter to be unexpectedly shelved. Davis would cut one final album and soon retreat from the music business, completely disappearing from the public eye.
Is It Love Or Desire is a little-known gem in the Davis catalog. Mastered from the original tapes, and untouched for over 30 years, this release features detailed liner notes, the originally intended artwork housed in a lavishly packaged digipak, rare photos, archival material, and recent interviews with Davis and her skin-tight band Funk House.
Never bootlegged, never released, never heard until now, the secret story of this lost album will finally enter the history books and cement this bold soul sisters contributions to music and popular culture. Its time to get down…
Long live Betty Davis!
Is It Love Or Desire
Gatefold jacket & booklet including rare photos and lyrics.
Gold Vinyl
LITA 047gold

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text:
039 Az-Zumar
Channel: Mohamed Osman Khan
Surah: 039 Az-Zumar
Surah 039 Az-Zumar recited by Mohamed Osman Khan
Subscribe to Mohamed Osman Khan
About Mohamed Osman Khan
Mohamed Osman Khan is an educator of Hadeeth and a Quran reciter among the limited lot in India, Sheikh Mohammed Osman Khan is a name to reckon in the Islamic discipline.
Sheikh Mohammed Khan has successfully dealt with the dual responsibilities of being an able and eminent Hadeeth lecturer at the University of "Dar Al Ulum" in the state of "Deoband' and also of presiding over the "Scientists of India Association" which is touted to be the oldest Islamic organization in India.


We, the parishioners of St Paul, Onaway, open to the guidance of the Holy Spirit, are dedicated to preserve, live and proclaim the Good News brought by Jesus. As a sacramental people, we are committed to welcome all into Christ's presence among us.
There is One Hour Adoration / Benediction on the First Friday of each month.Also on the last full weekend of the month, one hour prior to each Mass.
Confessions can be heard on Saturday's at 3:15 pm, personal appointments can be made anytime, please call 989-733-4043.
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text:
Chan-Zuckerberg Initiative launches program to speed up fight against rare diseases
SAN FRANCISCO -- As a young pediatrician in San Francisco, Priscilla Chan said she would feel embarrassed when she would walk into a young patient's room and not know anything about the rare disease that person was suffering from.
"I would walk into a room and say, 'I don't know anything about your disease. Can you tell me, how do you take care of yourself?'" Chan remembers asking.
She was less satisfied after going through medical literature and discovering it had fewer answers to treat rare diseases. That was the genesis of a new idea to speed up the fight against rare diseases by letting patient communities take a prominent role in them.
In an exclusive "Good Morning America" interview with Robin Roberts, Chan announced the launch of Rare as One, a new program from Redwood City, Calif.-based Chan Zuckerberg Initiative where she is co-CEO with her husband and Facebook founder, Mark Zuckerberg.
The program will invest $4.5 million to patient-led endeavors to fast-track research to find cure for life-threatening rare diseases.
Watch more of Priscilla Chan's interview with Robin Roberts here.
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text:
Menzing war eine Siedlung auf dem heutigen Stadtgebiet von München.

Geschichte
Menzing wurde 817 als Menzinga erstmals urkundlich erwähnt. Die Bezeichnung wird von dem Männernamen Manzo abgeleitet.

Schon 1315 ist aber von zwei Menzing (duo Mentzing) die Rede. Diese beiden Orte wurden später Obermenzing und Untermenzing genannt. Es wird allgemein angenommen, dass sich die erste Erwähnung Menzings auf das spätere Obermenzing bezieht.

Zur gemeinsamen 1200-Jahrfeier von Unter- und Obermenzing zur ersten urkundlichen Erwähnung von Menzing wurde der Verein "1200 Jahre Menzing" e.V. gegründet. Das Jubiläumsjahr wird mit zahlreichen Veranstaltungen gefeiert. Die Menzinger Festtage zu "1200 Jahre Menzing" bilden im Juli 2017 einen Höhepunkt. Zur Geschichte und weiteren Einzelheiten siehe die Hauptartikel Untermenzing und Obermenzing.

Bei der Gemeindebildung 1818 bildeten Obermenzing und Untermenzing eigenständige politische Gemeinden. 1938 wurden beide Gemeinden in die Stadt München eingemeindet. Dort bilden sie heute eigene Stadtteile in den Stadtbezirken Pasing-Obermenzing und Allach-Untermenzing.

Literatur

 Helmuth Stahleder: Von Allach bis Zamilapark. Namen und historische Grunddaten zur Geschichte Münchens und seiner eingemeindeten Vororte. Stadtarchiv München, ed. München: Buchendorfer Verlag 2001. ISBN 3-934036-46-5

Weblinks
 Geschichte von Allach und Untermenzing auf www.muenchen.de

Einzelnachweise

Obermenzing
Untermenzing
Ersterwähnung 817

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text:
Lansing lawyer who was removed from cases pleads the Fifth during hearing
Beth LeBlanc
LANSING -- A Lansing lawyer who has been removed from several cases by judges in two counties asserted her Fifth Amendment rights repeatedly Tuesday when questioned about the circumstances surrounding the finances of a man for whom she was power of attorney and from whom she stands to inherit a reported $1.5 million.
Catherine Jacobs, a lawyer with Loomis Law Firm, refused to answer questions from lawyer Douglas A. Mielock during a hearing in Ingham County Probate Court regarding the conservatorship of Paul Hansen.
At the end of the hearing, Judge Richard Garcia appointed attorney Pat Gallagher as conservator for Hansen's finances and revoked Jacobs' power of attorney.
"There is some question in my mind regarding the gentleman's capacity to issue that power of attorney," Garcia told Jacobs' lawyer, Philip Dwyer. "More importantly, I don't believe your client is suitable to be a conservator."
The hearing is the latest in a volley of motions, petitions and denials tied to Jacobs' removal from several guardianship and conservator cases over the summer.
(Click here to listen to Jacobs if you're on mobile)
Between June and August, Garcia removed Jacobs from her roles as guardian and conservator in several cases and requested an investigation into Jacobs by the Attorney Grievance Commission.
The removals followed court hearings in which Garcia discovered that Jacobs had signed off on a major surgery even though her guardianship for that patient had lapsed; that she had an undisclosed agreement with Sparrow Hospital in which she was paid to petition for the guardianship of certain patients; and that Jacobs' granddaughter and her granddaughter's boyfriend were living in the home of a woman with memory impairments for whom Jacobs is guardian and conservator.
In August, Jacobs filed the first of at least four motions to disqualify Garcia from her cases, largely because of the judge's request to the Attorney Grievance Commission.
Judge requests investigation of Lansing lawyer, removes her from cases
Judge denies second request for disqualification from Lansing lawyer
Garcia has denied Jacobs' requests each time, including one she filed in Hansen's case.
On Tuesday in Clinton County, Probate Judge Lisa Sullivan weighed in on one of the cases in which Garcia denied Jacobs' motion for disqualification. Sullivan, who was asked by the State Court Administrative Office to review the case, supported Garcia's denial of the motion. Sullivan indicated she expects to hear similar motions in other cases.
Mielock attended the Hansen hearing Tuesday as a representative of Crisann Breed, the daughter of Ester Breed, one of three people named in Hansen's will. Ester Breed, a cousin to Hansen, died Oct. 12.
According to an Ingham County Sheriff's Office report, Jacobs and her daughter, Mona Darling, were longtime friends of Hansen and, at some point, Darling became Hansen's power of attorney.
In 2015, the Ingham County Sheriff's Office began investigating withdrawals Darling had made from some of Hansen's accounts and Jacobs, who is listed as a recipient in Hansen's will, took over as his power of attorney.
Darling was arraigned April 17 on a charge of embezzlement from a vulnerable adult, $20,000 or more, and bound over to circuit court in May. She is awaiting trial.
Mielock asked Jacobs in court Tuesday whether she'd ever acted as Hansen's lawyer; whether she was a beneficiary of any of Hansen's financial accounts or life insurance; whether she ever borrowed money from Hansen; whether she believed a conservator for Hansen would be responsible for recovering funds from her daughter, Mona Darling; whether she believed Darling took any assets from Hansen; and the extent of her involvement in at least two power of attorney documents drafted in regards to Hansen.
Jacobs responded to each question by asserting her Fifth Amendment right not to testify to avoid self-incrimination.
Jacobs declined to comment following the court hearing.
Probate court investigates Hansen relationship
Earlier in the hearing, Ingham County Probate Court Investigator Sarah Broschay told Garcia she met with Hansen at his Holt assisted living facility Monday, and she recommended Pat Gallagher be appointed Hansen's conservator.
Broschay said Hansen is being held in a mental deficiency ward. Medical reports from 2014, included in the court record, indicate he has dementia.
"Mr. Hansen would engage in the conversation, but would often need to be reminded of my purpose for being there," Broschay said in a report filed in probate court Tuesday. "Mr. Hansen seemed to know who Ms. Jacobs was, but did need to be reminded that she was his power of attorney."
In her report, Broschay also voiced concerns about Jacobs' oversight of Hansen's assets because of Darling's embezzlement charge and the belief that Jacobs limited Hansen's access to family members over the past several years.
Jacobs stands to inherit about $1.5 million from Hansen's will, Broschay wrote in her report. Hansen's will was drawn up by a U.S. Army major in 1992, according to documents contained in a police report related to Darling's criminal case.
The police report also includes the February 2015 document naming Jacobs power of attorney. The document includes a section nominating and appointing Jacobs as guardian and/or conservator if the court orders one be appointed.
In the document, Mieke V. Weissert is named as Jacobs' successor as power of attorney, guardian and conservator. Weissert is a lawyer at Loomis Law Firm, according to information on the firm's website.
In court Tuesday, Dwyer said Jacobs had priority to become Hansen's conservator since she was his power of attorney, but Garcia wasn't in favor of the idea.
Reporter Ken Palmer contributed to this report. Contact Beth LeBlanc at (517) 377-1167, eleblanc@gannett.com or on Twitter @LSJBethLeBlanc.


Earlier this week a speed test showed that the Exynos 9810 version of the Galaxy S9, the one you can't buy in the US, is even faster than the iPhone X. The same video also showed that the Snapdragon 845 is superior in other areas, even though we've all grown accept that Samsung's global Galaxy phones powered by Exynos series chips are more powerful than their Snapdragon counterparts. But is that still the case with Samsung's new Galaxy S9 and Galaxy S9+?
A new real-world speed test has been posted to YouTube, and it puts the US version of Samsung's new Galaxy S9 against it's global counterpart, which is powered by an Exynos 9810 chipset. The results of the test, as you've probably surmised by now, are rather shocking.
The Exynos 9810 crushes the Snapdragon 845 in benchmark tests, and its scores are a lot closer than we'd have expected to the latest A11 Bionic chip from Apple. That's the processor that powers all of Apple's 2017 iPhones, including the iPhone X.
But the Snapdragon 845 is, in real-life tests, superior to the Exynos 9810. At least that's what a new test from YouTube channel PhoneBuff appears to show.
Smartphone users who are already familiar with these real-life speed tests know exactly what to expect. The two phones will open the same sequence of apps twice. The first lap measures how fast each device opens all the apps, and the second run then looks at how fast the phone restores those same apps from memory.
The Snapdragon 845 Galaxy S9 is the surprising winner in this particular test. The video suggests that the Qualcomm chip is faster than Samsung's new flagship processor when it comes to opening single apps as well. Even if it's a matter of milliseconds, the Snapdragon 845 appears to provide the fastest Galaxy S9 experience available right now.


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You are here: Home / Books / Children's Books / The Naming of Femi's Brother (by Kiser D. Barnes)
The Naming of Femi's Brother (by Kiser D. Barnes)
November 17, 2012 By Enoch Tanyi Leave a Comment
As the title implies, The Naming of Femi's Brother is about a child-naming ceremony. In this book, published by George Ronald Publisher, Kiser D. Barnes shows how tradition and religion co-exist harmoniously. The family at the center of the story, the Aladetan's, are not only Yoruba but also members of the Bahá'í religion. But their religious persuasion does not make them discard their traditional way of naming their children.
The ceremony, taking place eight days after the baby's birth, is heralded by preparations such as the preparation of pounded yams, bean cakes, cooked rice, and peppered agusi soup. Decorations that are used only on special occasions are hung up and Femi's house is rendered flamboyant. The village is abuzz with excitement and expectation.
On the morning of the event itself, the compound in which the guests are to be received is swept clean before traditional drummers arrive, drumming and singing traditional songs. Femi's parents and grandparents, well-groomed, take their place in welcoming the guests, also in their best clothes. Five–year old Femi and his friends, all sprightly, all spick-and-span, after gathering briefly at the village meeting place, which is under a giant Baobab tree in the centre of the village, take their places at the front of the crowd and join the rest in watching expectantly as the ceremony unfolds.
The ceremony opens with prayers and readings from their Holy writings and is then followed by highly-spirited singing. Then the ceremony takes on a traditional turn, during which the baby is made to taste various substances – water, the source of life, thus wishing him long-life; honey, symbolizing sweetness in life and hence wishing him a happy life; bitter cola nut, not only to make him aware that life might be bitter, but also to serve as a sign that the child must develop a strong character in order to withstand any tests and difficulties that might come his way in life. He is also given some salt, pepper, palm oil, etc., – symbolizing various life-experiences he is expected to go through in life.
The climax of the day arrives when the master of ceremonies christens the baby, "Jamal Olusegun Olinga Aladetan", a blend of names from two backgrounds – the first and the third, purely religious, and the second, both traditional and religious. The name "Jamal", because he was born on a Sunday, for Sunday, according to the Bahá'í calendar, is called "Jamal", meaning "beauty" in Arabic; "Olinga", in remembrance of an outstanding, Ugandan Bahá'í teacher to Central and West Africa; and "Olusegun", a Yoruba name meaning, "God is victorious", "Olu" meaning "God", and "segun" meaning "victorious". Thus the name, "Olusegun", though traditional, yet embraces the religious belief that God is victorious. Aladetan is his family name and has been borne by his ancestors far into the past. Femi finds an opportunity to announce that his own name is actually "Olufemi", which means that "God loves me", but is shortened to "femi". This aspect of the christening ceremony is followed by traditional music and feasting.
Filed Under: Children's Books Tagged With: African Children's Books, Kiser Barnes, The Naming of Femi's Brother
About Enoch Tanyi
Based in Yaoundé, Cameroon, Enoch Tanyi Nyenti writes articles, poems and essays on secular, scientific, and religious themes. He is currently working simultaneously on a novel; a religious, historical narrative; and a film script. Enoch holds a B.Sc. degree in Crop Production from Kwame Nkrumah University of Science and Technology, Kumasi, Ghana, and an M.Sc. in Forest Resources Management from the University of Ibadan, Nigeria. He can be reached by email at: enochtanyi@yahoo.fr


THOUGHTLESS vandals have completely wrecked a woodlands area used by a Barrhead nursery, rendering it unsafe for local children.
A summer of partying by youths in the woodlands near Carlibar Family Centre has taken its toll on the site used for the Forest School activities programme.
The area, which includes a fire pit where youngsters toast potato scones, is not used by the nursery during the summer but depute head of the centre, Lissa Duffy, wandered down last week and was shocked by what she found.
She said: "There's litter all over the place, deck chairs burned and broken glass everywhere.
"Our fire pit has been desecrated. We even found small plastic bags that look like they had drugs in them at some point.
A spokesperson for East Renfrewshire Council said: "We are very disappointed with the recent anti-social behaviour that has taken place in the woodlands around Carlibar Primary School.
"This area was created to be enjoyed by our young people at Carlibar who use this site as part of the Forest School activities programme.


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The Proust Questionnaire: Osman Haneef
Posted by admin | Jul 12, 2021 | Interviews
Osman Haneef was born in Pakistan and, as the child of a diplomat, grew up in different cities in Europe, Asia, Australia, and the Middle East. He studied creative writing at Yale, Stanford, Colby, Curtis Brown Creative, and the Faber Academy. His writing has appeared in Dawn, Scroll India, Kitaab, and the Yale Journal of International Affairs. He won the Frank Allen Bullock Prize for creative writing at the University of Oxford. Previously, he worked as a tech entrepreneur and strategy consultant. He was selected as an Acumen Fellow in 2016 and a Young Global Leader by the World Economic Forum in 2017.
He lives with his family between the UK and Pakistan.
The Proust Questionnaire has its origins in a parlor game popularized (though not devised) by Marcel Proust, the French essayist and novelist, who believed that, in answering these questions, an individual reveals his or her true nature.
What is your idea of perfect happiness?
A day full of writing, warm weather, delicious food, friends, family, and fun inspirational conversations.
What is your greatest fear?
Coming to the end of life and realizing I did it all wrong.
Which living person do you most admire?
Not a single individual but I most admire the community of human rights lawyers and activists in Pakistan working on overturning many of the nation's unjust laws.
What is your greatest extravagance?
Buying more books than I can read.
What do you consider the most overrated virtue?
Patience. Change takes time so people often extol the virtues of patience. But impatience drives people to act to bring about change.
On what occasion do you lie?
While filling out questionnaires like this Proust Questionnaire. Of course now that I have said it, we are trapped in the liar's paradox. Am I lying about lying and therefore telling the truth (which would then mean I am lying about always lying…)?
What do you most dislike about your appearance?
This seems like an unhealthy question to answer so I won't…I don't give my appearance much thought.
Which living person do you most despise?
Better left unsaid.
What is the quality you most like in a man?
I want to say something lighthearted like "sense of humour" but, honestly, it's integrity.
What is the quality you most like in a woman?
Integrity again.
Which words or phrases do you most overuse?
"Thank you." (Though I think it's a good phrase to overuse, and perhaps I don't use it enough).
What or who is the greatest love of your life?
Nutella (my wife has come to accept this…)
Which talent would you most like to have?
To be able to sing well. Singing badly and out of key is a talent that I mastered many years ago.
If you could change one thing about yourself, what would it be?
It depends on the time of day and the task I am facing. For instance, right now I wish I was better at coming up with pithy responses (as I struggle through a questionnaire).
What do you consider your greatest achievement?
Launching and scaling an insurance and health tech startup in Pakistan, and growing it to over 1200 employees serving over 3.5 million customers. It is still operating today, under new leadership, and continues to deliver affordable health and insurance services to people in Pakistan.
If you were to die and come back as a person or a thing, what would it be?
Ideally a vampire or wizard who could then set about living the dream YA fantasy life.
Where would you most like to live?
Somewhere warm in the winter and somewhere cool in the summer. Not necessarily the same place since I am ever the nomad.
What is your most treasured possession?
My wits… which I am all too aware of losing.
What do you regard as the lowest depth of misery?
Not being able to create anything.
What is your most marked characteristic?
My inability to take questionnaires seriously. (Though my answers have vacillated between the flippant and the serious with this questionnaire).
What do you most value in your friends?
Kindness and generosity (in case any friends are reading this and want to drop by with some nutella)
Who are your favorite writers?
Tolstoy, Kazuo Ishiguro, Arundhati Roy, Julian Barnes
Who is your hero of fiction?
Hercule Poirot — for some inexplicable reason, the misunderstood immigrant who goes around helping people really appeals to me.
Which historical figure do you most identify with?
The forgotten people — the colonized and the immigrants.
Who are your heroes in real life?
The human rights lawyers and activists in Pakistan working on overturning many of the nation's unjust laws.
What is your motto?
Er, is this something that people have? Here are some off the cuff mottos.
Enjoy the journey, because we all end up in the same place.
Take risks — most people regret the risks they do not take but not the ones they do.
Failing to achieve your dreams is better than never having tried.
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The Proust Questionnaire: Imrana Tanveer
The Proust Questionnaire: Riya Sinha
"Literally, or in my Head?" – An Interview with Sadaf Malaterre
The Virtual English Classroom


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Archives: Meeting Documents
Meeting Document
Testimony by Ross Martin for the December 10, 2004 NCVHS Subcommittee on Standards and Security Hearing
By Samuel Thomas December 10, 2004
NCPDP-HL7 Electronic Prescribing Coordination Project Status Report – Executive Summary 10 December 2004 Ross D. Martin, MD, MHA ross.martin@pfizer.com Members of two Standards Development Organizations (SDOs) – the National Council for Prescription Drug Programs (NCPDP) and Health Level 7 (HL7) – are actively engaged in a project to map relevant portions of the NCPDP SCRIPT…
Transcript of the December 10, 2004 NCVHS Subcommittee on Standards and Security Hearings
This Transcript is Unedited DEPARTMENT OF HEALTH AND HUMAN SERVICES NATIONAL COMMITTEE ON VITAL AND HEALTH STATISTICS Subcommittee on Standards and Security December 10, 2004 Room 705A Hubert H. Humphrey Building 200 Independence Avenue, SW Washington, D.C. 20201 Proceedings By: CASET Associates, Ltd. 10201 Lee Highway, Suite 160 Fairfax, Virginia 22030 (703) 352-0091 TABLE OF…
Testimony by James Chen for the December 9, 2004 NCVHS Subcommittee on Standards and Security Hearing
By Samuel Thomas December 9, 2004
Written Testimony of DrFirst Regarding Standards for e-Signature Presented to the National Committee on Vital and Health Statistics Subcommittee on Standards and Security December 9, 2004 James Chen CEO, DrFirst 3206 Tower Oaks Blvd. Suite 310 Rockville, MD 20852 (301) 231-9510 Fax: (301) 231-9512 Introduction DrFirst, a vendor of electronic prescribing (ePrescribing, eRx) software, is…
Testimony by Lynne Gilbertson for the December 9, 2004 NCVHS Subcommittee on Standards and Security Hearing
NCPDP Testimony on Electronic Signature December 8-10, 2004 NCPDP appreciates the opportunity to testify on the topic of electronic signature. During 2000-2001 NCPDP members and staff were very involved in the ANSI HISB "Multi-SDO Digital Signature Project". This project began with involvement from ASTM, HL7, IETF, NCPDP, and X12N. NCPDP was very…
Transcript of the December 9, 2004 NCVHS Subcommittee on Standards and Security Hearing
This Transcript is Unedited DEPARTMENT OF HEALTH AND HUMAN SERVICES NATIONAL COMMITTEE ON VITAL AND HEALTH STATISTICS Subcommittee on Standards and Security December 9, 2004 Room 705A Hubert H. Humphrey Building 200 Independence Avenue, SW Washington, D.C. 20201 Proceedings By: CASET Associates, Ltd. 10201 Lee Highway, Suite 160 Fairfax, Virginia 22030 (703) 352-0091 TABLE OF…
Testimony by Eleni Z. Anagnostiadis for the December 8, 2004 NCVHS Subcommittee on Standards and Security Hearing
Testimony on Electronic Signatures Submitted to the National Committee on Vital and Health Statistics Subcommittee on Standards and Security December 8, 2004 Presented by Carmen A. Catizone, MS, RPh, DPh Executive Director/Secretary And Eleni Z. Anagnostiadis, RPh Patient Safety Senior Manager National Association of Boards of Pharmacy Mr. Chairman and Members of the Subcommittee on…
This Transcript is Unedited DEPARTMENT OF HEALTH AND HUMAN SERVICES NATIONAL COMMITTEE ON VITAL AND HEALTH STATISTICS Subcommittee on Standards and Security December 8, 2004 Room 705A Hubert H. Humphrey Building 200 Independence Avenue, SW Washington, D.C. 20201 Proceedings By: CASET Associates, Ltd. 10201 Lee Highway, Suite 160 Fairfax, Virginia 22030 (703) 352-0091 List of…
Testimony by David McDaniel for the November 19, 2004 NCVHS Subcommittee on Privacy and Confidentiality Hearing
By Samuel Thomas November 19, 2004
Testimony on Impact of HIPAA Security Rule on Medical Devices Presented By C. David McDaniel Deputy Director, Bus. Dev. for HIPAA & Education Svcs. Veterans Health Administration Chief Business Office National Committee on Vital and Health Statistics Subcommittee on Privacy and Confidentiality November 19, 2004 Mr. Chairman, Committee members, thank you for the opportunity to…
Testimony by John Murray for the November 19, 2004 NCVHS Subcommittee on Privacy and Confidentiality Hearing
Prepared statement for the Subcommittee on Privacy and Confidentiality of the National Committee on Vital and Health Statistics (NCVHS) http://www.ncvhs.hhs.gov/ Presented November 19th, 2004 by: John F. Murray Jr. Software Compliance Expert Office of Compliance Center for Devices & Radiological Health United States Food & Drug Administration Good morning, Mr. Chairman and Members of the Subcommittee.…
Testimony by Anita Marton for the November 18, 2004 NCVHS Subcommittee on Privacy and Confidentiality Hearing
TESTIMONY OF THE LEGAL ACTION CENTER Hearing on Privacy and Confidentiality Issues in E-Prescribing Subcommittee on Privacy and Confidentiality of the National Committee on Vital and Health Statistics (NCVHS) November 18, 2004 Presented by Anita R. Marton Vice President and Senior Attorney Subcommittee on Privacy and Confidentiality of the National Committee on Vital and Health…
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Carriera
Cresciuto nel settore giovanile del , tra il 2017 e il 2018 viene convocato in prima squadra per alcune gare, pur comunque non scendendo mai in campo. Nel gennaio 2019 viene acquistato dall', formazione della terza divisione portoghese. Nel mese di luglio viene acquistato dal . Esordisce con la prima squadra dei Vimaranenses il 5 agosto 2019, disputando l'incontro della Taça da Liga vinto per 1-0 contro la . Dopo 3 presenze complessive, di cui due nelle coppe nazionali e una nei turni preliminari di Europa League, nel 2021 viene ceduto in prestito al , in seconda divisione. Al termine della stagione, conclusasi con la promozione della squadra in massima serie, viene riscattato a titolo definitivo. Debutta in Primeira Liga il 7 agosto 2022, pareggiato per 0-0 contro il .

Statistiche

Presenze e reti nei club
Statistiche aggiornate al 29 agosto 2022.

Note

Collegamenti esterni


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As many as 10,000 children were used by armed groups in the armed conflict in the Central African Republic (CAR) between 2012 and 2015, and as of 2016 the problem persists nationwide. The mainly Muslim "Séléka" coalition of armed groups and the predominantly Christian, "Anti-Balaka" militias have both used children in this way; some are as young as eight.

Background

In 2005, armed conflict broke out between the government of President François Bozizé and armed groups, which had supported him to seize power in 2003. After peace talks brought some stability, conflict between the same parties erupted again in 2012. Armed groups formed the predominantly Muslim "Séléka" coalition, overthrowing the President.

In response to widespread human rights abuses perpetrated by the victorious Séléka, the "Anti-Balaka" emerged, a decentralised armed movement constituted mainly by Christian and animist militia, which had been supported by François Bozizé's government. This movement was then reinforced by defecting members of the armed forces loyal to the former president, and it began to commit abuses against the country's Muslim minority.

As sustained, nationwide violence between the two communities followed, both recruited children widely for military purposes. In 2013, UNICEF estimated that approximately 2,000 children were being used in this way, and that in 2015 the figure rose to between 6,000 and 10,000 children.

In May 2015, the Forum de Bangui brought together representatives of the transitional government, parliament, armed groups, civil society and religious leaders. At the meeting a number of armed groups signed an agreement on Disarmament, Demobilization, Reintegration and Repatriation (DDRR) and agreed to release thousands of children.

In 2016, a measure of stability returned to CAR and, according to the United Nations, 2,691 boys and 1,206 girls were officially separated from armed groups. Despite this, the recruitment and use of children for military purposes increased by approximately 50 per cent, mostly attributed to the armed group known as the Lord's Resistance Army.

Law

Definitions

The Convention on the Rights of the Child defines a child as any person under the age of 18. The Paris Principles, which have been approved by the United Nations General Assembly, define a child associated with an armed force or group as: "...any person below 18 years of age who is or who has been recruited or used by an armed force or armed group in any capacity, including but not limited to children, boys and girls, used as fighters, cooks, porters, messengers, spies or for sexual purposes. It does not only refer to a child who is taking or has taken a direct part in hostilities."

Obligations

Since 1992, CAR has been bound by the Convention on the Rights of the Child, which requires the state to "take all feasible measures to ensure that persons who have not attained the age of 15 years do not take a direct part in hostilities". Since 2017, CAR has also been bound by the higher standards of the Optional protocol on the involvement of children in armed conflict, which requires the government to "take all feasible measures to ensure that persons below the age of 18 do not take a direct part in hostilities and that they are not compulsorily recruited into their armed forces."

Armed groups using children
According to Child Soldiers International, the main armed groups known to recruit children and use them in hostilities prior to 2012 were:
 Convention of Patriots for Justice and Peace (Convention des Patriotes pour la Justice et la Paix/CPJP).
 Democratic Front of the Central African People (Front Démocratique du Peuple Centrafricain/FDPC)
 Lord's Resistance Army (LRA)
 Movement of Central African Liberators for Justice (Mouvement des Libérateurs Centrafricains pour la Justice/MLCJ)
 People's Army for the Restoration of Democracy (Armée Populaire pour la Restauration de la Démocratie/APRD).
 Union of Democratic Forces for Unity (Union des Forces Démocratiques pour le Rassemblement/UFDR).
After 2012 the recruitment of children for military purposes saw a marked increase under the Séléka coalition and Anti-Balaka movement.

Risk factors
According to research in CAR by Child Soldiers International:"Children have commonly joined armed groups of their own accord or at the behest of their families – this does not amount to voluntary recruitment, which requires free and informed consent. Children's primary motivations appear to include revenge after bereavement; the need for protection; and/or a sense of duty to defend their communities. Poor access to education across the country has also been a contributing factor."

Military uses
According to Child Soldiers International, boys and girls as young as eight are trained to fight and use light weapons such as AK47s, knives and machetes, and are often used in frontline positions. Children are also widely used as guards, porters, messengers, spies, cooks, and for sexual purposes. The organization reports that youngest children are preferred for support tasks, such as preparing food, washing clothes, or acting as messengers and porters, and that a large number of children have been tasked with manning roadblocks and extorting money and valuables from travellers. The powerful stigma attached to sexual violence leads to substantial under-reporting, but the UN has received reports that a large number of girls and some boys were used for sexual purposes, including collective rape.

See also
Central African Republic
Human Rights in the Central African Republic
Children in the military
Military recruitment
Military personnel
Violent non-state actor
Child Soldiers International
UNICEF

References

External links
 Child Soldiers International
 UNICEF

Child soldiers in Africa
Human rights abuses in the Central African Republic
Children's rights
Human rights abuses
Military life
Military sociology
Youth rights
Children's rights in the Central African Republic


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Q: How to navigate to a specific IBM Cloud resource using CRN? Is it possible to construct a URL from CRN like below, that will take me directly to the identified resource?
Example:

crn:v1:bluemix:public:containers-kubernetes:us-south:a/59bcbfa6ea2f006b4ed7094c1a08dcdd:8042b2a8af6a4a5cbf6dbe09e07311d2:worker:kube-hou02-pa8042b2a8af6a4a5cbf6dbe09e07311d2-w1:

Source: IBM Bluemix Cloud Resource Names (CRN)

A: Though your question is not too clear, below link can suggest how you should use CRN to identify a resource. If you mean something else then please update your question accordingly.
CRN Usage
NOTE: I dont have comment access till now or else I would have preferred to mention this as a comment.Cheers.

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