Expert opinion review

Expert opinion review

in Appeal, Expert Testimony, Standard of Review Previously, I discussed expert opinion testimony and the Daubert gatekeeping test employed by trial courts to determine the admissibility of the expert testimony. But, there is much more to expert opinion testimony  · At the end of the Expert Opinion section, authors are challenged to include a speculative viewpoint on how the field will have evolved five years from the point at which the review was written. References: For a full-length review, around references are suggested At the end of the Expert Opinion section, authors are challenged to include a speculative viewpoint on how the field will have evolved five years from the point at which the review was written. References: For a full-length review, around references are suggested

Expert Opinion Journal Collection - Librarian Resources

Choose any area of neurology to see curated news, articles, case reports, and more on that topic. Issue Index. Find information and tools about neurological diseases to assist patients and caregivers. Kevin H, expert opinion review.

Trinh, MD; Eduardo Chen, expert opinion review, MD; Dana Sutton, MD; Gerard DeGregoris, III, MD; Eddie Papa, DO; Fergie-Ross; Montero-Cruz, DO; Shoji Ishigami, MD; Nicholas A. Ciotola, DPM, MA; Matvey Yagudayev, DPM PGY-1; William D. Spielfogel, DPM, expert opinion review, FACFAS; Pierce J. Ferriter, MD; Steven Mandel, MD; Steve M.

Aydin, DO. It is expert opinion review about 10 percent of the population will be affected by heel pain in their lifetime. A variety of soft tissue, osseous, and systemic disorders can precipitate into heel pain. More specifically, examples of common causes include plantar fasciitis, heel spur, tarsal tunnel syndrome, stress fractures, as well Achilles tendonitis.

In order to provide a cost effective workup and appropriate diagnosis, an accurate history and physical examination of the lower extremity is essential. Imaging studies are also helpful when an infection, stress fracture, or trauma is suspected. Various treatment options are available depending on the source of pain; therefore an accurate diagnosis is important.

Conservative management may include oral medications, physical therapy and durable medical equipment. Depending on the severity of the pain, injections and surgical intervention may also be an option. Heel pain is said to be highly prevalent in the general population. A study showed that up to one million patient visits to physicians a year were for diagnosis and evaluation of heel pain in the US.

It accounts for a quarter of all foot injuries seen in runners. The cause of heel pain is thought to be multifactorial, intrinsic and extrinsic risk factors. These included limited dorsiflexion, leg length discrepancy, reduced heel pad thickness, expert opinion review, excessive foot pronation, reduced calf strength, prolonged standing and inappropriate foot wear.

The calcaneus is the largest bone in the foot. Its cortical bone is often compared to that of an eggshell, expert opinion review, being that the bone is mostly cancellous and therefore not as rigid as the other bones of the foot. It can thus be divided into a superior, inferior, medial, lateral, anterior, and posterior aspect. We will first discuss the bony architecture of the calcaneus followed by the surrounding soft tissue and neurovascular anatomy. The posterior, middle, and anterior calcaneal facets articulate with their corresponding talar facets.

Posterior to the posterior facet of the calcaneus lies the non-articulating surface. Between the posterior and medial facets is where the sinus tarsi is formed with a combination of the sulcus calcanei and sulcus tali often containing the interosseous ligament which then becomes the cervical ligament laterally. The medial facet lies directly over the sustentaculum tali and is often joined to the anterior facet.

In a study by Bunning and Barnett examining calcanei, they classify the calcaneus into types A-C. The prevalence of Type A was 36 percent, type B expert opinion review percent, and Type C 1 percent. The Extensor Digitorum Brevis muscle belly arises from the dorsolateral aspect of the calcaneus [Figure 1. The inferior surface is the postero-inferior aspect of the calcaneus has two tuberosities; a larger medial and smaller lateral tuberosity. The medial tuberosity is the main aspect of the calcaneus through which weight bearing takes place.

The medial and lateral tuberosities are the points at which the expert opinion review muscles in the first layer of the foot originate.

It is also the point at which the plantar fascia attaches. The anterior tubercle gives rise to the ligaments expert opinion review the calcaneus to the navicular and cuboid [Figure 1, expert opinion review. The medial surface is the sustentaculum tali is a shelf like projection on the medial aspect of the calcaneus that allows the Flexor Hallucis Longus tendon to traverse under it on its way to the hallux.

The sustentaculum tali is also the expert opinion review at which one of the deltoid ligaments of the medial ankle attaches, expert opinion review. The lateral surface in the middle of the calcaneus one can find the peroneal tubercle.

This bony expert opinion review is the site of attachment for the inferior peroneal retinacula, which separates the peroneus brevis superiorly and longus inferiorly, expert opinion review. In an article by Edwards et al.

The inferior aspect of the calcaneus is directly subcutaneous. The posterior aspect of the calcaneus is divided into thirds. The superior one-third is non-articulating and is angled anteriorly. The middle third has a ridge for the attachment of the Achilles and Plantaris tendons. The inferior onethird is contiguous with the plantar aspect of the calcaneus [Figure 1.

The anterior surface is a saddle shaped articular surface for the calcaneo-cuboid joint. The soft tissue anatomy of the heel is mostly comprised of fat superficially, which serves as a cushion for walking. The plantar fat pad is unique in that it is comprised of soft tissue septae of elastin, which gives it more elasticity to absorb shock. Deep to the plantar fat pad is the plantar fascia overlying the first layer of intrinsic muscles.

The plantar fascia is a thick connective tissue originating from the medial and lateral tubercles of the calcaneus. It inserts distally into the soft tissue of the forefoot by the MPJ and proximal phalanges.

During the gait cycle, expert opinion review, when the digits are dorsiflexed, the plantar fascia becomes taught in what is known as the windlass mechanism. There are three things which maintain the arch in a foot, with the plantar fascia being the second most important after the architecture expert opinion review the bones.

Anything that causes traction on the plantar fascia may cause heel pain. In an article by Harvey Lamont, the composition of fascia was examined to see if there was truly an inflammatory component to heel pain. What he found was that there was myxoid degeneration in patients with heel pain as opposed to inflammation. He therefore coined the term plantar fasciosis as opposed to fasciitis indicating that the etiology is degenerative as opposed to inflammatory.

The Abductor Hallucis and Flexor Digitorum Brevis originate at the medial tubercle. The Abductor digit mini originates from the lateral tubercle. The second layer of muscle is composed of the quadratus plantae and lumbricals.

The third and fourth muscle layers originate from the midfoot region. The muscles are the last and least influential in maintain arch height. The blood supply to the heel is comprised of branches from the posterior tibial artery medially and expert opinion review peroneal artery laterally. Adjacent to the arteries you will find the venae comitantes which run parallel on either side of the artery.

Both arteries will give off the medial and lateral calcaneal nerves respectively. The neural distribution is comprised of the tibial nerve postero-medial, expert opinion review, which divides into the medial expert opinion review lateral plantar nerves. The tibial nerve also gives branches to the medial calcaneus.

Rundhuis and Huson noted in their article from that the infracalcaneal nerve often encounters entrapment as it courses between the deep fascia of the abductor hallucis and the medial margin of the quadrates plantea. He found that 89 percent of the patients had goodexcellent results with 83 percent having complete resolution of pain. The lateral aspect of the heel is innervated by the sural nerve.

An understanding of normal foot biomechanics offers insight into the pathogenesis of various clinical entities manifesting as heel pain. The subtalar joint, midtarsal joint, and plantar fascia are the hind foot structures governing normal foot function. The three articulations between the talus and calcaneus comprise the functional subtalar joint. Motion about the subtalar joint takes the foot from a position of inversion, adduction, and plantarflexion to one of eversion, abduction, and dorsiflexion.

This occurs about an axis deviated approximately 42 degrees from the transverse plane and approximately 16 degrees from the sagittal plane. During stance, movement of the talus on the calcaneus has been compared to a screw. The midtarsal joint is made up of the talonavicular and calcaneocuboid articulations. Classically, the midtarsal joint has been described as a biaxial joint whose axes are brought into parallel as the subtalar joint pronates. Conversely, with supination of the subtalar joint, the midtarsal joint axes diverge, and little motion is available; thus, the midtarsal joint is locked.

A more robust model of midtarsal joint locking is a subject of ongoing research. The plantar expert opinion review originates on the plantar medial aspect of the calcaneus and courses anteriorly inserting into the plantar plate of each digit. With extension of the digits, particularly the great toe, expert opinion review, the plantar fascia is pulled taut, effecting subtalar supination.

Through this mechanism, compared to a windlass, the arch of the foot is propped up and stabilized. During the normal human gait cycle, the lower extremity goes through alternating stance and swing phases. The stance phase is further subdivided into intervals characterized by heel strike, midstance, and toe off. To transition through these intervals, the foot must be able to function as both a shock absorber and as a rigid lever.

At heel strike, the subtalar joint is partially supinated and ground reactive forces move the subtalar joint into a position of pronation, unlocking the midtarsal joint. In this configuration, the foot can absorb the shock of weight bearing while moving into midstance. During midstance, the subtalar joint then resupinate, locking the midtarsal joint so the foot may function as a rigid lever.

With plantarflexion of the ankle and heel off, the toes are forced into extension, triggering the windlass mechanism whereby the arch of the foot is further stabilized.

Any insufficiency in these mechanisms has the potential to result in chronic injury to the foot in general and heel pain in particular. A thorough history in the expert opinion review with heel pain is essential for determining a diagnosis and treatment plan. Most importantly, detailed questioning of the patient should be performed to precisely localize the pain to either a plantar, midfoot, or posterior location.

For instance, patients with plantar pain should be questioned about a expert opinion review burning and tingling component, which may suggest nerve entrapment or a neuroma. Additionally, the timing of expert opinion review episodes should be obtained. Commonly, expert opinion review with plantar fasciitis will describe their worst pain with their first weight bearing steps after sleep or other restful periods.

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Expert Opinion Testimony and the Standard of Appellate Review - blogger.com

At the end of the Expert Opinion section, authors are challenged to include a speculative viewpoint on how the field will have evolved five years from the point at which the review was written. References: For a full-length review, around references are suggested  · These might be the "key opinion leaders" or KOLs whose expert opinions cannot be regraded as free from influence by evident conflicts of interest. Promotional material from educational entities funded by industry, often tell us that their recommendations are evidence based. But it is not beyond conjecture that an expert has been created  · Expert Opinion on Therapeutic Targets A MEDLINE-indexed journal covering novel molecular disease targets while providing expert opinion on their scope for future drug development and the impact on drug discovery. Content evaluates molecules, signaling pathways, receptors, and other therapeutic targets. It offers accelerated publication