Chronic pelvic pain (CPP) is a disabling disease that causes distress as the quality of life of CPP patients is vastly diminished. In addition, CPP is a public health crisis and is a burden on healthcare expenditure. In the United States, the annual costs for the diagnosis and treatment of CPP are 2.8 billion US $. Moreover, to the indirect cost resulting from the absence from work and CPP associated family problems add 550 million US $ more making the economic burden more than 3.4 billion US $ (Mathias et al., 1996). Yet, the diagnosis of CPP is usually complicated as there are no gold standard guidelines that clearly define this syndrome. Although we have a limited understanding of its etiology, CPP has been found to be correlated with central sensitization, painful bladder syndrome, irritable bowel syndrome, endometriosis and adhesions. As such, in the evaluation of patients, it is imperative to take a comprehensive patient history. Performing physical examinations and ultrasound imaging is of particular value to elucidate the etiology of pain. As CPP patients are at risk for psychological disorders, psychological assessments are critical to diagnose associated psychological disorders and to take these into account in planning a holistic treatment plan for patients. By such evaluation techniques, we can provide better diagnostic service and patient care to people with CPP

BACKGROUND: Chronic pelvic pain affects ~15% of women, and is associated with 52 significant societal cost and impact on women’s health. Identifying factors involved in 53 chronic pelvic pain is challenging due to its multifactorial nature and confounding between 54 potential factors. For example, while some women with endometriosis have chronic pelvic 55 pain, there may be comorbid conditions that are implicated in the chronic pelvic pain rather 56 than the endometriosis itself. 57 OBJECTIVE: To explore multifactorial variables independently associated with the severity 58 of chronic pelvic pain in women. 59 STUDY DESIGN: Baseline cross-sectional data from an ongoing prospective cohort, 60 collected from patient online questionnaires, physical examination, and physician review of 61 medical records. Participants were recruited from a tertiary referral center for endometriosis 62 and chronic pelvic pain in Vancouver, Canada between December 2013 and April 2015. 63 Exclusion criteria included menopausal status or age > 50 years. Primary outcome was self- 64 reported severity of chronic pelvic pain in the last 3 months (0-10 numeric rating scale). 65 Potential associated factors ranged from known pain conditions assessed by standard 66 diagnostic criteria, validated psychological questionnaires, musculoskeletal physical exam 67 findings, as well as pain-related, reproductive, medical/surgical, familial, demographic and 68 behavioral characteristics. Mann-Whitney, Kruskal-Wallis, or Spearman test were used to 69 identify variables with an association with the primary outcome (p 0.05), followed by 70 multivariable linear regression to control for confounding and to identify independent 71 associations with the primary outcome (p 0.05). 4 Severity of chronic pelvic pain 72 RESULTS: Overall, 656 women were included (87% consent rate), of which 55% were 73 diagnosed with endometriosis. The following factors were independently associated with 74 higher severity of chronic pelvic pain: abdominal wall pain (p = 0.005), pelvic floor 75 tenderness (p = 0.004), painful bladder syndrome (p = 0.019), higher score on pain 76 catastrophizing scale (p 0.001), adult sexual assault (p = 0.043), higher body mass index (p 77 = 0.023), current smoking (p = 0.049), and family history of chronic pain (p = 0.038). 78 Severity of chronic pelvic pain was similar between women with and without endometriosis. 79 CONCLUSIONS: Multifactorial variables independently associated with severity of chronic 80 pelvic pain were identified, ranging from myofascial/musculoskeletal, urological, family 81 history, and psycho-social factors. Continued research is required to validate these factors 82 and to determine whether any are potentially modifiable for the management of chronic 83 pelvic pain.

BACKGROUND: Chronic pelvic pain affects ~15% of women, and is associated with 52 significant societal cost and impact on women’s health. Identifying factors involved in 53 chronic pelvic pain is challenging due to its multifactorial nature and confounding between 54 potential factors. For example, while some women with endometriosis have chronic pelvic 55 pain, there may be comorbid conditions that are implicated in the chronic pelvic pain rather 56 than the endometriosis itself. 57 OBJECTIVE: To explore multifactorial variables independently associated with the severity 58 of chronic pelvic pain in women. 59 STUDY DESIGN: Baseline cross-sectional data from an ongoing prospective cohort, 60 collected from patient online questionnaires, physical examination, and physician review of 61 medical records. Participants were recruited from a tertiary referral center for endometriosis 62 and chronic pelvic pain in Vancouver, Canada between December 2013 and April 2015. 63 Exclusion criteria included menopausal status or age > 50 years. Primary outcome was self- 64 reported severity of chronic pelvic pain in the last 3 months (0-10 numeric rating scale). 65 Potential associated factors ranged from known pain conditions assessed by standard 66 diagnostic criteria, validated psychological questionnaires, musculoskeletal physical exam 67 findings, as well as pain-related, reproductive, medical/surgical, familial, demographic and 68 behavioral characteristics. Mann-Whitney, Kruskal-Wallis, or Spearman test were used to 69 identify variables with an association with the primary outcome (p 0.05), followed by 70 multivariable linear regression to control for confounding and to identify independent 71 associations with the primary outcome (p 0.05). 4 Severity of chronic pelvic pain 72 RESULTS: Overall, 656 women were included (87% consent rate), of which 55% were 73 diagnosed with endometriosis. The following factors were independently associated with 74 higher severity of chronic pelvic pain: abdominal wall pain (p = 0.005), pelvic floor 75 tenderness (p = 0.004), painful bladder syndrome (p = 0.019), higher score on pain 76 catastrophizing scale (p 0.001), adult sexual assault (p = 0.043), higher body mass index (p 77 = 0.023), current smoking (p = 0.049), and family history of chronic pain (p = 0.038). 78 Severity of chronic pelvic pain was similar between women with and without endometriosis. 79 CONCLUSIONS: Multifactorial variables independently associated with severity of chronic 80 pelvic pain were identified, ranging from myofascial/musculoskeletal, urological, family 81 history, and psycho-social factors. Continued research is required to validate these factors 82 and to determine whether any are potentially modifiable for the management of chronic 83 pelvic pain.

BACKGROUND: Chronic pelvic pain affects ~15% of women, and is associated with 52 significant societal cost and impact on women’s health. Identifying factors involved in 53 chronic pelvic pain is challenging due to its multifactorial nature and confounding between 54 potential factors. For example, while some women with endometriosis have chronic pelvic 55 pain, there may be comorbid conditions that are implicated in the chronic pelvic pain rather 56 than the endometriosis itself. 57 OBJECTIVE: To explore multifactorial variables independently associated with the severity 58 of chronic pelvic pain in women. 59 STUDY DESIGN: Baseline cross-sectional data from an ongoing prospective cohort, 60 collected from patient online questionnaires, physical examination, and physician review of 61 medical records. Participants were recruited from a tertiary referral center for endometriosis 62 and chronic pelvic pain in Vancouver, Canada between December 2013 and April 2015. 63 Exclusion criteria included menopausal status or age > 50 years. Primary outcome was self- 64 reported severity of chronic pelvic pain in the last 3 months (0-10 numeric rating scale). 65 Potential associated factors ranged from known pain conditions assessed by standard 66 diagnostic criteria, validated psychological questionnaires, musculoskeletal physical exam 67 findings, as well as pain-related, reproductive, medical/surgical, familial, demographic and 68 behavioral characteristics. Mann-Whitney, Kruskal-Wallis, or Spearman test were used to 69 identify variables with an association with the primary outcome (p 0.05), followed by 70 multivariable linear regression to control for confounding and to identify independent 71 associations with the primary outcome (p 0.05). 4 Severity of chronic pelvic pain 72 RESULTS: Overall, 656 women were included (87% consent rate), of which 55% were 73 diagnosed with endometriosis. The following factors were independently associated with 74 higher severity of chronic pelvic pain: abdominal wall pain (p = 0.005), pelvic floor 75 tenderness (p = 0.004), painful bladder syndrome (p = 0.019), higher score on pain 76 catastrophizing scale (p 0.001), adult sexual assault (p = 0.043), higher body mass index (p 77 = 0.023), current smoking (p = 0.049), and family history of chronic pain (p = 0.038). 78 Severity of chronic pelvic pain was similar between women with and without endometriosis. 79 CONCLUSIONS: Multifactorial variables independently associated with severity of chronic 80 pelvic pain were identified, ranging from myofascial/musculoskeletal, urological, family 81 history, and psycho-social factors. Continued research is required to validate these factors 82 and to determine whether any are potentially modifiable for the management of chronic 83 pelvic pain.

BACKGROUND: Chronic pelvic pain affects ~15% of women, and is associated with 52 significant societal cost and impact on women’s health. Identifying factors involved in 53 chronic pelvic pain is challenging due to its multifactorial nature and confounding between 54 potential factors. For example, while some women with endometriosis have chronic pelvic 55 pain, there may be comorbid conditions that are implicated in the chronic pelvic pain rather 56 than the endometriosis itself. 57 OBJECTIVE: To explore multifactorial variables independently associated with the severity 58 of chronic pelvic pain in women. 59 STUDY DESIGN: Baseline cross-sectional data from an ongoing prospective cohort, 60 collected from patient online questionnaires, physical examination, and physician review of 61 medical records. Participants were recruited from a tertiary referral center for endometriosis 62 and chronic pelvic pain in Vancouver, Canada between December 2013 and April 2015. 63 Exclusion criteria included menopausal status or age > 50 years. Primary outcome was self- 64 reported severity of chronic pelvic pain in the last 3 months (0-10 numeric rating scale). 65 Potential associated factors ranged from known pain conditions assessed by standard 66 diagnostic criteria, validated psychological questionnaires, musculoskeletal physical exam 67 findings, as well as pain-related, reproductive, medical/surgical, familial, demographic and 68 behavioral characteristics. Mann-Whitney, Kruskal-Wallis, or Spearman test were used to 69 identify variables with an association with the primary outcome (p 0.05), followed by 70 multivariable linear regression to control for confounding and to identify independent 71 associations with the primary outcome (p 0.05). 4 Severity of chronic pelvic pain 72 RESULTS: Overall, 656 women were included (87% consent rate), of which 55% were 73 diagnosed with endometriosis. The following factors were independently associated with 74 higher severity of chronic pelvic pain: abdominal wall pain (p = 0.005), pelvic floor 75 tenderness (p = 0.004), painful bladder syndrome (p = 0.019), higher score on pain 76 catastrophizing scale (p 0.001), adult sexual assault (p = 0.043), higher body mass index (p 77 = 0.023), current smoking (p = 0.049), and family history of chronic pain (p = 0.038). 78 Severity of chronic pelvic pain was similar between women with and without endometriosis. 79 CONCLUSIONS: Multifactorial variables independently associated with severity of chronic 80 pelvic pain were identified, ranging from myofascial/musculoskeletal, urological, family 81 history, and psycho-social factors. Continued research is required to validate these factors 82 and to determine whether any are potentially modifiable for the management of chronic 83 pelvic pain.

Type of study: prospective study. Objective: Demonstration the role of combined bony procedures using triple arthrodesis and soft tissue procedures in correction of cavus foot deformity in adults. Background: Rigid cavus deformity is a complex foot deformity which has different forms and results from different aetiologies. Triple arthrodesis is considered as a golden standard for treatment of such deformities. Combined bony and soft tissue procedures are needed for correction of deformity. Tendon transfer is important to restore the muscle balance around the foot. Patients and Methods: Between 2013 – 2015 fifteen feet with rigid cavus deformity were corrected surgically with Ryerson's triple arthrodesis (five feet) or Lambrinudi triple arthrodesis (10 feet) combined with tibialis posterior tendon or long toes flexor tendons transfer to the dorsum of the foot. Follow up period ranged from 20 to 47 months (mean 32.17 ± 7.62). All patients were assessed clinically and radiologically for determination of the amount of correction. The outcome was graded according to criteria of Angus and Cowell. Results: the outcome was good in two feet, fair in eleven feet and poor in two feet. The correction in the hindfoot alignment and in the range of ankle joint motion was significant. The correction in the radiological parameter was statistically insignificant. Conclusions: Successful treatment of rigid cavus foot deformity requires comprehensive understanding of the nature of the deformity and its pathology. Adding tendon transfer to the corrective bony procedure is mandatory to restore the muscle balance around the foot and to prevent the recurrence.

Type of study: prospective study. Objective: Demonstration the role of combined bony procedures using triple arthrodesis and soft tissue procedures in correction of cavus foot deformity in adults. Background: Rigid cavus deformity is a complex foot deformity which has different forms and results from different aetiologies. Triple arthrodesis is considered as a golden standard for treatment of such deformities. Combined bony and soft tissue procedures are needed for correction of deformity. Tendon transfer is important to restore the muscle balance around the foot. Patients and Methods: Between 2013 – 2015 fifteen feet with rigid cavus deformity were corrected surgically with Ryerson's triple arthrodesis (five feet) or Lambrinudi triple arthrodesis (10 feet) combined with tibialis posterior tendon or long toes flexor tendons transfer to the dorsum of the foot. Follow up period ranged from 20 to 47 months (mean 32.17 ± 7.62). All patients were assessed clinically and radiologically for determination of the amount of correction. The outcome was graded according to criteria of Angus and Cowell. Results: the outcome was good in two feet, fair in eleven feet and poor in two feet. The correction in the hindfoot alignment and in the range of ankle joint motion was significant. The correction in the radiological parameter was statistically insignificant. Conclusions: Successful treatment of rigid cavus foot deformity requires comprehensive understanding of the nature of the deformity and its pathology. Adding tendon transfer to the corrective bony procedure is mandatory to restore the muscle balance around the foot and to prevent the recurrence.

Type of study: prospective study. Objective: Demonstration the role of combined bony procedures using triple arthrodesis and soft tissue procedures in correction of cavus foot deformity in adults. Background: Rigid cavus deformity is a complex foot deformity which has different forms and results from different aetiologies. Triple arthrodesis is considered as a golden standard for treatment of such deformities. Combined bony and soft tissue procedures are needed for correction of deformity. Tendon transfer is important to restore the muscle balance around the foot. Patients and Methods: Between 2013 – 2015 fifteen feet with rigid cavus deformity were corrected surgically with Ryerson's triple arthrodesis (five feet) or Lambrinudi triple arthrodesis (10 feet) combined with tibialis posterior tendon or long toes flexor tendons transfer to the dorsum of the foot. Follow up period ranged from 20 to 47 months (mean 32.17 ± 7.62). All patients were assessed clinically and radiologically for determination of the amount of correction. The outcome was graded according to criteria of Angus and Cowell. Results: the outcome was good in two feet, fair in eleven feet and poor in two feet. The correction in the hindfoot alignment and in the range of ankle joint motion was significant. The correction in the radiological parameter was statistically insignificant. Conclusions: Successful treatment of rigid cavus foot deformity requires comprehensive understanding of the nature of the deformity and its pathology. Adding tendon transfer to the corrective bony procedure is mandatory to restore the muscle balance around the foot and to prevent the recurrence.

Type of study: prospective study. Objective: Demonstration the role of combined bony procedures using triple arthrodesis and soft tissue procedures in correction of cavus foot deformity in adults. Background: Rigid cavus deformity is a complex foot deformity which has different forms and results from different aetiologies. Triple arthrodesis is considered as a golden standard for treatment of such deformities. Combined bony and soft tissue procedures are needed for correction of deformity. Tendon transfer is important to restore the muscle balance around the foot. Patients and Methods: Between 2013 – 2015 fifteen feet with rigid cavus deformity were corrected surgically with Ryerson's triple arthrodesis (five feet) or Lambrinudi triple arthrodesis (10 feet) combined with tibialis posterior tendon or long toes flexor tendons transfer to the dorsum of the foot. Follow up period ranged from 20 to 47 months (mean 32.17 ± 7.62). All patients were assessed clinically and radiologically for determination of the amount of correction. The outcome was graded according to criteria of Angus and Cowell. Results: the outcome was good in two feet, fair in eleven feet and poor in two feet. The correction in the hindfoot alignment and in the range of ankle joint motion was significant. The correction in the radiological parameter was statistically insignificant. Conclusions: Successful treatment of rigid cavus foot deformity requires comprehensive understanding of the nature of the deformity and its pathology. Adding tendon transfer to the corrective bony procedure is mandatory to restore the muscle balance around the foot and to prevent the recurrence.

Background: Cavus foot is one of complex foot deformity. The hindfoot may be in neutral, valgus or varus position. In sagittal plane it may in equinus, neutral or calcaneal position. The forefoot may be pronated or supinated. It has wide variety of etiology. Type of Study: retrospective study. Patient and methods: 20 feet in 15 patients were operated in 2008, in Heidelberg University hospital, Germany. The pre- and post- operative radiographs were reviewed. The patients were called backed for clinical evaluation. AOFAS of the ankle and hindfoot scale and the function index were used for post –operative evaluation. Results : In lateral pre-operative radiographs, the mean values of talo-1st metatarsal angle was 13.12°, calcaneal pitch was 21.75°, tibial-calcaneal angle was 69.14°, talo-calcaneal angle was 51.70° and the calcaneo-1st metatarsal angle was 58.72°. In dorso-plantar pre-operative radiographs, the mean values of talo-1st metatarsal angle was 32.51°, forefoot adductus angle was 41.73° and talo-calcaneal angle was 13.67°. In lateral post-operative radiographs, the mean values of talo-1st metatarsal angle was -7,92°, calcaneal pitch was 12.35°, tibial-calcaneal angle was 73.78°, talo-calcaneal angle was 40° and the calcaneo-1st metatarsal angle was 29.67°. In dorso-plantar post-operative radiographs, the mean values of talo-1st metatarsal angle was 5.67°, forefoot adductus angle was 16.01° and talo-calcaneal angle was 17.60°. The average of AOFAS was 77.67, while the average foot function index was 20.62. Conclusion: The correction of foot deformity is not only correction of foot form but also restoration of foot function. Restoration of soft tissue balance, which is achieved with planned tendon transfer, is essential for patient satisfaction.