Tarsal tunnel syndrome: A narrative literature review

Background Tarsal tunnel syndrome is classified as a focal compressive neuropathy of the posterior tibial nerve or one of its associated branches individually or collectively. The tunnel courses deep to fascia, the flexor retinaculum and within the abductor hallucis muscle of the foot/ankle. The condition is rare and regularly under-diagnosed leading to a range of symptoms affecting the plantar margins of the foot. There are many intervention strategies for treating tarsal tunnel syndrome with limited robust evidence to guide the clinical management of this condition. The role of conservative versus surgical interventions at various stages of the disease process remains unclear, and there is a need for a structured, step-wise approach in treating patients with this syndrome based on derived empirical evidence. This narrative review attempts to scrutinize the literature to date by clarifying initial presentation, investigations and definitive treatment for the purpose of assisting future informed clinical decision and prospective research endeavours. Process The literature searches that have been incorporated in compiling a rigorous review of this condition have included: the Cochrane Neuromuscular Group's Specialized Register (Cochrane Library 2013), the databases of EMBASE, AMED, MEDLINE, CINAHL, Physiotherapy evidence database (PEDRO), Biomed Central, Science Direct and Trip Database (1972 to the present). Reference listings of located articles were also searched and scrutinized. Authors and experts within the field of lower-limb orthopaedics were contacted to discuss applicable data. Subject-specific criteria searches utilizing the following key terms were performed across all databases: tarsal tunnel syndrome, tibial neuralgia, compression neuropathy syndromes, tibial nerve impingement, tarsal tunnel neuropathy, entrapment tibial nerve, posterior tibial neuropathy. These search strategies were modified with differing databases, adopting specific sensitivity-searching tools and functions unique to each. This search strategy identified 88 journal articles of relevance for this narrative literature review. Findings This literature review has appraised the clinical significance of tarsal tunnel syndrome, whilst assessing varied management interventions (non-surgical and surgical) for the treatment of this condition in both adults and children. According to our review, there is limited high-level robust evidence to guide and refine the clinical management of tarsal tunnel syndrome. Requirements for small-scaled randomized controlled trials in groups with homogenous aetiology are needed to analyse the effectiveness of specific treatment modalities. Conclusions It is necessary that further research endeavours be pursued for the clinical understanding, assessment and treatment of tarsal tunnel syndrome. Accordingly, a structured approach to managing patients who have been correctly diagnosed with this condition should be formulated on the basis of empirical evidence where possible.

GRDB: A general purpose relational database system

This article discusses the design and development of GRDB (General Purpose Relational Data Base System) which has been implemented on a DEC-1090 system in Pascal. GRDB is a general purpose database system designed to be completely independent of the nature of data to be handled, since it is not tailored to the specific requirements of any particular enterprise. It can handle different types of data such as variable length records and textual data. Apart from the usual database facilities such as data definition and data manipulation, GRDB supports User Definition Language (UDL) and Security definition language. These facilities are provided through a SEQUEL-like General Purpose Query Language (GQL). GRDB provides adequate protection facilities up to the relation level. The concept of “security matrix” has been made use of to provide database protection. The concept of Unique IDentification number (UID) and Password is made use of to ensure user identification and authentication. The concept of static integrity constraints has been used to ensure data integrity. Considerable efforts have been made to improve the response time through indexing on the data files and query optimisation. GRDB is designed for an interactive use but alternate provision has been made for its use through batch mode also. A typical Air Force application (consisting of data about personnel, inventory control, and maintenance planning) has been used to test GRDB and it has been found to perform satisfactorily.

Elizabeth Gottschalk with unidentified classmates on a field trip from Sophienschule; Hannover, Germany. Institutions; Educational; Schools; Portraits; Groups

Elizabeth Gottschalk is probably the student far left on the horse wagon

Cover of the book "Reise durch die Provence 1928" that celebrates the trip through Provence taken by Ellen Catzenstein, Mara Matthiesen and Gerda Rotermund.

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Liederkranz trip to Hundseck Portraits Groups

Liederkranzausflug nach Hundseck; Standing l-r; Sidi Ullmann, Ehepaar, Alfred und Toni Hirschland, Willi Ullmann, Lisel Suess, Lene Hesse-Sinzheimer, Julius Suess, ?, Hermann Boehm, Eugen Hirsch, Dr. Carl Kahn, Frau von Michael Rothschild (Ella?), Max Sinzheimer, Grete Hirschland and Alfred Liebmann ; Seated l-r: Adele Boehm, Michael Rothschild, rosel Suess, Louis Kahn (Junior), Ehepaar Dr. Gustav Hecht, Paula Hirsch and Marianne Kahn

Fritz Gottschalk and Therese Gottschalk nee Molling on a ski trip; Berchtesgaden, Germany.

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Desiderius Herlinger, Annie Unger, Fritz Unger and Leopold Giustina (chauffeur) on driving trip to England.

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Reiss family on skiing trip; Arosa Portraits Family

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Class portrait to remember the trip to Kablau(?).

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Elizabeth Gottschalk with unidentified classmates on a field trip from Sophienschule; Hannover, Germany. Institutions; Educational; Schools; Portraits; Groups

Elizabeth Gottschalk is probably the student far left on the horse wagon

Cover of the book "Reise durch die Provence 1928" that celebrates the trip through Provence taken by Ellen Catzenstein, Mara Matthiesen and Gerda Rotermund.

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Fritz Gottschalk and Therese Gottschalk nee Molling on a ski trip; Berchtesgaden, Germany.

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Reiss family on skiing trip; Arosa Portraits Family

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Class portrait to remember the trip to Kablau(?).

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Development and preliminary validation of the Drinking Expectancy Sexual Vulnerabilities Questionnaire (DESV-Q): A purpose-specific instrument for rape-perception research

Background Alcohol expectancies likely play a role in people’s perceptions of alcohol-involved sexual violence. However, no appropriate measure exists to examine this link comprehensively. Objective The aim of this research was to develop an alcohol expectancy measure which captures young adults’ beliefs about alcohol’s role in sexual aggression and victimization. Method Two cross-sectional samples of young Australian adults (18–25 years) were recruited for scale development (Phase 1) and scale validation (Phase 2). In Phase 1, participants (N = 201; 38.3% males) completed an online survey with an initial pool of alcohol expectancy items stated in terms of three targets (self, men, women) to identify the scale’s factor structure and most effective items. A revised alcohol expectancy scale was then administered online to 322 young adults (39.6% males) in Phase 2. To assess the predictive, convergent, and discriminant validity of the scale, participants also completed established measures of personality, social desirability, alcohol use, general and context-specific alcohol expectancies, and impulsiveness. Results Principal axis factoring (Phase 1) and confirmatory factor analysis (Phase 2) resulted in a target-equivalent five-factor structure for the final 66-item Drinking Expectancy Sexual Vulnerabilities Questionnaire (DESV-Q). The factors were labeled: - (1) Sexual Coercion - (2) Sexual Vulnerability - (3) Confidence - (4) Self-Centeredness - (5) Negative Cognitive and Behavioral Changes The measure demonstrated effective items, high internal consistency, and satisfactory predictive, convergent, and discriminant validity. Conclusions The DESV-Q is a purpose-specific instrument that could be used in future research to elucidate people’s attributions for alcohol-involved sexual aggression and victimization.