***TASK*** the task is to summarize an input biomedical literature in six sentences 
    ***INPUT*** the input is a biomedical literature 
    ***OUTPUT*** the output is the summary of an input biomedical literature in six sentences 
    ***DOCUMENTATION*** 
    ***EXAMPLES*** 
    Input: The present study analyzed the impact of the running style and the morphologic and functional characteristics of the foot on the incidence of non-traumatic foot and lower limb disorders in runners . From January 2004 to December 2008 , we prospect ively examined 166 runners , both recreational and competitive , involved in various running specialities , from three athletics clubs in Northern Italy . They were 86 males and 80 females , with a mean age of 31.1 ± 12.2 years . We considered non-traumatic foot and lower limb diseases reported during the follow-up period , which result ed in a minimum sport rest of two weeks . The incidence of these diseases was examined with respect to general characteristics , type of activity , foot morphology , running style . 59 % of athletes reported one or more diseases . The most common were plantar fasciitis ( 31 % of athletes ) and Achilles tendinopathies ( 24 % ) . Overall , the more prone to injuries were males ( 60.9 % of cases ) , competitive runners ( 70.9 % ) , middle-distance runners ( 51.7 % ) , and those using spike shoes ( 80.3 % ) . Age , body weight and height were not important predictors of running injuries in general . Considering the morphological characteristics of the foot , the most prone to injury were the varus hindfoot ( 87.5 % of cases ) and the cavus arch ( 71.4 % ) . In conclusion , a deep knowledge of the factors predisposing runners to specific diseases , often chronic and highly debilitating for the athlete , may allow implementing effective therapeutic measures . Key pointsExamination of 166 runners during a period of five years of activity . The incidence of these diseases was examined with respect to general characteristics , type of activity , foot morphology , running style.59 % of athletes reported one or more diseases . The most common were plantar fascitis ( 31 % of athletes ) and Achilles tendinopathies (24%).Overall , the more prone to injuries were males ( 60.9 % of cases ) , competitive runners ( 70.9 % ) , middle-distance runners ( 51.7 % ) , and those using spike shoes (80.3%).Age , body weight and height were not important predictors of running injuries in general . The most prone to injury were the varus hindfoot ( 87.5 % of cases ) and the cavus arch ( 71.4 % ) A prospect i ve , descriptive study was performed at Oakwood Healthcare medical clinics to determine the body mass index ( BMI ) of patients with heel pain and of a control group of patients presenting for other reasons . A question naire was used to obtain information in each of the patient groups and to determine characteristics of patients with plantar fascial heel pain .  St and ard weightbearing lateral radiographs were taken to determine overall foot structure . The typical patient was female , had heel pain for just over 1 year , with a sedentary to moderate activity level . Although height was comparable , patients with heel pain had a higher BMI ( 30.4 + /- 0.7 ) than those without heel pain ( 28.2 + /- 0.7 , p = .04 ) . The BMI appears to play a greater role in heel pain than does foot structure , as the authors found no structural commonalities that would explain these patients ' pain . Control patients also reported a higher level of activity . Fifty-one percent exercised three or more times per week for more than 20 minutes each time , while less than half that ( 25.4 % ) of heel pain patients did so . While half of the heel pain patients had been treated by other providers prior to visiting our clinic , fewer than 25 % of these patients had been instructed to lose weight by a physician . The authors feel that a BMI of 25 ( the target for decreased cardiovascular risk ) represents a reasonable goal for weight loss that may reduce heel pain The aim of this study was to investigate the effectiveness of shoe inserts and plantar fascia-specific stretching vs shoe inserts and high-load strength training in patients with plantar fasciitis . Forty-eight patients with ultrasonography-verified plantar fasciitis were r and omized to shoe inserts and daily plantar-specific stretching ( the stretch group ) or shoe inserts and high-load progressive strength training ( the strength group ) performed every second day . High-load strength training consisted of unilateral heel raises with a towel inserted under the toes . Primary outcome was the foot function index ( FFI ) at 3 months . Additional follow-ups were performed at 1 , 6 , and 12 months . At the primary endpoint , at 3 months , the strength group had a FFI that was 29 points lower [ 95 % confidence interval ( CI ) : 6 - 52 , P = 0.016 ] compared with the stretch group . At 1 , 6 , and 12 months , there were no differences between groups ( P > 0.34 ) . At 12 months , the FFI was 22 points ( 95 % CI : 9 - 36 ) in the strength group and 16 points ( 95 % CI : 0 - 32 ) in the stretch group . There were no differences in any of the secondary outcomes . A simple progressive exercise protocol , performed every second day , result ed in superior self-reported outcome after 3 months compared with plantar-specific stretching . High-load strength training may aid in a quicker reduction in pain and improvements in function OBJECTIVE To evaluate the long-term efficacy of steroid injection for plantar fasciitis using clinical parameters and high-resolution ultrasonography . MATERIAL AND METHODS Thirty patients ( 27 female and three male ) with plantar fasciitis and 30 healthy controls matched by age , gender and body mass index ( BMI ) , were enrolled in this study . Seventeen of the patients had bilateral and 13 had unilateral ( six right , seven left ) plantar fasciitis .  Palpation-guided steroid injection was applied to the 47 heels of 30 plantar fasciitis patients .  Ultrasound examination and pain intensity with visual analog scale ( VAS ) were assessed three times in each plantar fasciitis patients ; before injection and at 1 and 6 months after steroid injection . Ultrasonography was performed to the controls at initial assessment . RESULTS The plantar fascia was remarkably thicker in the plantar fasciitis group than in controls ( P < 0.001 ) . The thickness of the plantar fascia and mean VAS values in the plantar fasciitis group decreased significantly 1 month after steroid injection ( P < 0.001 , P < 0.001 , respectively ) and a further decrease was noted 6 months postinjection ( P < 0.001 , P < 0.001 , respectively ) . Strong correlation was found between the changes of plantar fascia thickness and VAS values 1 month after ( P < 0.001 , r : 0.61 ) and 6 months after ( P < 0.001 , r : 0.49 ) steroid injection . The incidence of hypoechoic fascia was 73 % in the plantar fasciitis group before steroid injection . It decreased significantly at 1 and 6 months postinjection ( 33 % and 7 % , respectively , P < 0.001 ) . Gross fascia disruption or other side effects were not observed after steroid injection . CONCLUSION Steroid injection could be used in plantar fasciitis treatment for its positive long-term effects The prevalence of foot and ankle disorders was determined in a community-based , multiethnic ( non-Hispanic White , African American , and Puerto Rican ) r and om sample of 784 community-dwelling adults aged 65 or more years in 2001 - 2002 in Springfield , Massachusetts . Overall , the five most common conditions were toenail disorders ( 74.9 % ) , lesser toe deformities ( 60.0 % ) , corns and calluses ( 58.2 % ) , bunions ( 37.1 % ) , and signs of fungal infection , cracks/fissures , or maceration between toes ( 36.3 % ) ; 30.9 % had some tenderness to palpation of the foot or ankle , and 14.9 % had ankle joint pain on most days in the past 4 weeks . Toenail conditions , fungal symptoms , and ulcers or lacerations were more common in men , while bunions and corns and calluses were more common in women ( p < 0.001 ) . Significant racial/ethnic differences , independent of education or gender , were found for the prevalence of most toe deformities and flat feet , as well as for corns and calluses , fungal signs , edema , ankle joint pain , tenderness to palpation , and sensory loss . Foot and ankle disorders are common in these older adults . Examination of their prevalence in different segments of the community may inform future studies to determine etiology and means of prevention Loss of heel pad elasticity has been suggested as one of the possible explanations of plantar heel pain . This hypothesis is evaluated by this blinded observer prospect i ve study , using an age and weight matched control population .  Hindfoot lateral radiographs of 73 patients with plantar heel pain , 29 of whom had bilateral involvement ( 102 feet ) , and who ranged in age from 20 to 60 years , were studied and compared with 120 healthy subjects ( 240 feet ) .  Heel pad thickness and heel pad compressibility index were not significantly different in patients with plantar heel pain than in healthy subjects matched for age and weight . In patients with unilateral heel pain , heel pad thickness and heel pad compressibility index on the painful side were not significantly different from the opposite painless side . The contribution of the heel pad elasticity measured as a visual compressibility index for plantar heel pain is a matter of debate OBJECTIVE To investigate the value of ultrasonography in the diagnosis of plantar fasciitis and changes in plantar fascia following ultrasound guided local steroid injection . METHODS Twenty patients with a clinical diagnosis of plantar fasciitis and 20 healthy subjects were studied prospect ively . Ultrasound examination was performed using an ATL Apogee 800 and linear array 11 MHz transducer . The affected heel was injected with 15 mg triamcinolone hexacetonide and 2 ml of 2 % lidocaine . Ultrasound examination was performed at time of clinical evaluation , again immediately after injection , and at 1 , 6 , and 30 weeks later . The thickness , echogenicity , and marginal appearance of plantar fascia were measured . RESULTS Ultrasonographic measurement of plantar fascia showed a significant increase in symptomatic heels ( range 4.8 - 6.5 , mean 5.8 + /- 2.06 mm ) compared with healthy subjects ( range 1.8 - 3.4 , mean 2.4 + /- 0.64 mm ) ( p < 0.001 ) . A significant decrease in the thickness of plantar fascia was observed 1 week after local steroid injection ( range 2.1 - 3.5 , mean 2.3 + /- 0.91 mm ) . Complete relief of symptoms and signs was further observed at 6 and 30 weeks . CONCLUSION Ultrasonographic examination of plantar fascia is easy and quick to perform . Ultrasound procedure should be considered early in diagnosis and management of heel pain . Ultrasound guided local steroid injection proved safe and effective in the treatment of plantar fasciitis Background : Plantar fasciitis is a repetitive microtrauma overload injury of the attachment of the plantar fascia at the inferior aspect of the calcaneus . Several etiological factors have been implicated in the development of plantar fasciitis ; however , the role of hamstring tightness has not been evaluated . Methods : Fifteen volunteers ( mean age 32.6 ± 4.7 years ) were prospect ively analyzed for differences in forefoot loading using a Don-Joy brace ( dj Orthopedics , Vista , CA ) applied to each knee simultaneously . The brace was locked at varying degrees of knee flexion ( 0 degrees , 20 degrees , and 40 degrees ) . Their mean popliteal angle was 6.5 degrees . Fifteen patients ( mean age 40 ± 16.5 years ) with a diagnosis of chronic plantar fasciitis were similarly analyzed on the pedobarograph . These patients also had their hamstring tightness evaluated by measuring the popliteal angle . The mean popliteal angle was 23 degrees . Results : Increasing the angle of flexion from 0 to 20 degrees at the knee joint led to a statistically significant increase in pressure in the forefoot phase by an average of 0.08 K/cm2s ( p < 0.05 ) . An increase from 20 to 40 degrees led to increased forefoot phase pressure of 0.08 kg/cm2s ( p < 0.05 ) . The percentage of time spent in contact phase decreased from 35.37 % to 30.87 % to 26.37 % with increasing flexion ( p < 0.05 ) . However there was an inverse increase in the time spent in the forefoot phase 46.6 % to 55.6 to 61.25 % with increasing degrees of flexion ( p < 0.05 ) . Conclusion : The results indicate that an increase in hamstring tightness may induce prolonged forefoot loading and through the windlass mechanism be a factor that increases repetitive injury to the plantar fascia PURPOSE To evaluate the use of axial-strain real-time sonoelastography in patients with plantar fasciitis compared with that in healthy control subjects . MATERIAL S AND METHODS Institutional review board approval and patients ' consent were obtained . Eighty feet of 80 patients ( 43 men , 37 women ; mean age ± st and ard deviation , 46.3 years ± 8.7 ) with plantar fasciitis and 50 feet of 50 asymptomatic volunteers 
    Output:
    
Higher body mass index ( BMI ) ( BMI > 27 , OR 3.7 ( 95 % CI 2.93 to 5.62 ) ) in patients with PF was the only significant clinical association , and its effect was the strongest in the non-athletic subgroup .
In people with PF compared to controls , pooled imaging data demonstrated a significantly thicker , hypoechogenic plantar fascia with increased vascular signal and perifascial fluid collection .
In addition , people with PF were more likely to have a thicker loaded and unloaded heel fat pat , and bone findings , including a subcalcaneal spur and increased Tc-99 uptake .
No significant difference was found in the extension of the first metatarsophalangeal joint .
CONCLUSIONS We found a consistent clinical association between higher BMI and plantar fasciopathy .
This association may differ between athletic and non-athletic subgroups .