Dr. Sridhar Musthyala

A case report is presented of a patient found at surgery to have an anomalous neural loop of the ulnar nerve at the wrist. The literature is reviewed. Although previous cases have been reported with compressive symptoms or as a coincidental finding we believe that this is the first case reported where symptoms were directly related to the presence of the loop without evidence of a compressive lesion.

Background Ever since the original historical description of postero-superior heel pain by Haglund in 1927, it has been attributed to footwear and variations in shape and axis of the calcaneus. Radiological indices used in literature to correlate heel pain with calcaneal abnormalities are inconsistent and prone to high intra and inter-observer variability. Methods We used two new parameters for assessing the correlation between postero-superior heel pain and the calcaneus. Calcaneal body index assesses the shape of the calcaneus and the calcaneal inclination angle assesses the orientation of the calcaneus. We reviewed 117 cases and 72 controls. We measured calcaneal inclination angle, calcaneal body index along with the conventional angles in use in all cases and controls. Results We have found these measurements to correlate well with symptoms. Both these parameters are not interdependent. The entire calcaneus is taken into consideration, instead of taking a few fixed and inconsistent bony landmarks. The parameters previously described were also used in this study and it was found that these were not statistically associated with postero-superior heel pain. Conclusions The two new parameters we have proposed in this study although a tedious method, give a holistic and objective assessment of calcaneal shape and inclination.