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Stellar D, Lyons SR, Ramdass R, Meyr AJ. The Role of Equinus in Flatfoot Deformity. Clin Podiatr Med Surg 2023; 40:247-260. [PMID: 36841577 DOI: 10.1016/j.cpm.2022.11.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
Equinus plays an important role in flatfoot deformity. Proper evaluation and surgical management are critical to comprehensively treat and successfully resolved patients' symptoms. We have discussed the cause, evaluation, and some of the common surgical options. Each procedure has its inherent benefits and risks. It is imperative that the foot and ankle surgeon identify and include these procedures as part of the complete reconstructive surgery.
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Affiliation(s)
- Devrie Stellar
- Inova Fairfax Medical Campus, 3300 Gallows Road, Fairfax, VA 22031, USA.
| | - Sean R Lyons
- Inova Fairfax Medical Campus, 3300 Gallows Road, Fairfax, VA 22031, USA
| | - Roland Ramdass
- Foot & Ankle Center, P.C., 912 South Pleasant Valley Road, Winchester, VA 22601, USA; Residency Training Committee Inova Fairfax Medical Campus
| | - Andrew J Meyr
- Department of Podiatric Surgery, Temple University School of Podiatric Medicine, 2nd Floor, 148 North 8th Street, Philadelphia, PA 19107, USA
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2
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Gupta U, Sharma A, Rizvi MR, Alqahtani MM, Ahmad F, Kashoo FZ, Miraj M, Asad MR, Uddin S, Ahamed WM, Nanjan S, Hussain SA, Ahmad I. Instrument-Assisted Soft Tissue Mobilization Technique versus Static Stretching in Patients with Pronated Dominant Foot: A Comparison in Effectiveness on Flexibility, Foot Posture, Foot Function Index, and Dynamic Balance. Healthcare (Basel) 2023; 11:healthcare11060785. [PMID: 36981441 PMCID: PMC10048685 DOI: 10.3390/healthcare11060785] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2023] [Revised: 02/28/2023] [Accepted: 03/03/2023] [Indexed: 03/10/2023] Open
Abstract
Background: Pronated foot is a deformity with various degrees of physical impact. Patients with a pronated foot experience issues such as foot pain, ankle pain, heel pain, shin splints, impaired balance, plantar fasciitis, etc. Objective: The study intended to compare the effectiveness of IASTM (instrument-assisted soft tissue mobilization) and static stretching on ankle flexibility, foot posture, foot function, and balance in patients with a flexible pronated foot. Methods: Seventy-two participants between the ages of 18–25 years with a flexible pronated foot were included and allocated into three groups: Control, stretching, and IASTM group using single-blinded randomization. Range of motion (ROM) measuring ankle flexibility, foot posture index (FPI), foot function index (FFI), and dynamic balance was measured at baseline and after 4 weeks of intervention. Soft tissue mobilization was applied on to the IASTM group, while the stretching group was directed in static stretching of the gastrocnemius-soleus complex, tibialis anterior, and Achilles tendon in addition to the foot exercises. The control group received only foot exercises for 4 weeks. Results: The result shows the significant improvement of the right dominant foot in ROM plantar flexion, (F = 3.94, p = 0.03), dorsiflexion (F = 3.15, p = 0.05), inversion (F = 8.54, p = 0.001) and eversion (F = 5.93, p = 0.005), FFI (control vs. IASTM, mean difference (MD) = 5.9, p < 0.001), FPI (right foot, control vs. IASTM MD = 0.88, p = 0.004), and in dynamic balance of the right-leg stance (anterior, pre vs. post = 88.55 ± 2.28 vs. 94.65 ± 2.28; anteromedial, pre vs. post = 80.65 ± 2.3 vs. 85.55 ± 2.93; posterior, pre vs. post = 83 ± 3.52 vs. 87 ± 2.99 and lateral, pre vs. post = 73.2 ± 5.02 vs. 78.05 ± 4.29) in the IASTM group. The FFI was increased remarkably in the stretching group as compared to the control group. Conclusions: Myofascial release technique, i.e., IASTM with foot exercises, significantly improves flexibility, foot posture, foot function, and dynamic balance as compared to stretching, making it a choice of treatment for patients with a flexible pronated foot.
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Affiliation(s)
- Ujjwal Gupta
- Department of Physiotherapy, Faculty of Allied Health Sciences, Manav Rachna International Institute and Studies (MRIIRS), Faridabad 121001, India
| | - Ankita Sharma
- Department of Physiotherapy, Faculty of Allied Health Sciences, Manav Rachna International Institute and Studies (MRIIRS), Faridabad 121001, India
| | - Moattar R. Rizvi
- Faculty of Allied Health Sciences, Manav Rachna International Institute and Studies (MRIIRS), Faridabad 121001, India
| | - Mazen M. Alqahtani
- College of Applied Sciences, Almaarefa University, Riyadh 13713, Saudi Arabia
- Department of Physical Therapy & Health Rehabilitation, College of Applied Medical Sciences, Majmaah University, Almajmaah 15431, Saudi Arabia
- Correspondence: (M.M.A.); (F.A.); (I.A.)
| | - Fuzail Ahmad
- College of Applied Sciences, Almaarefa University, Riyadh 13713, Saudi Arabia
- Correspondence: (M.M.A.); (F.A.); (I.A.)
| | - Faizan Z. Kashoo
- Department of Physical Therapy & Health Rehabilitation, College of Applied Medical Sciences, Majmaah University, Almajmaah 15431, Saudi Arabia
| | - Mohammad Miraj
- Department of Physical Therapy & Health Rehabilitation, College of Applied Medical Sciences, Majmaah University, Almajmaah 15431, Saudi Arabia
| | - Mohammad R. Asad
- Department of Basic Medical Sciences, College of Medicine, Majmaah University, Almajmaah 15431, Saudi Arabia
| | - Shadab Uddin
- Department of Physical Therapy, Faculty of Applied Medical Sciences, Jazan University, Jazan 45142, Saudi Arabia
| | - Waseem M. Ahamed
- Department of Physical Therapy, Faculty of Applied Medical Sciences, Jazan University, Jazan 45142, Saudi Arabia
| | - Saravanakumar Nanjan
- Department of Physical Therapy, Faculty of Applied Medical Sciences, Jazan University, Jazan 45142, Saudi Arabia
| | - Sayed A. Hussain
- College of Applied Sciences, Almaarefa University, Riyadh 13713, Saudi Arabia
| | - Irshad Ahmad
- Department of Medical Rehabilitation Sciences, College of Applied Medical Sciences, King Khalid University, Abha 61413, Saudi Arabia
- Correspondence: (M.M.A.); (F.A.); (I.A.)
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Lucena-Anton D, Luque-Moreno C, Valencia-Medero J, Garcia-Munoz C, Moral-Munoz JA. Effectiveness of Dry Needling of Myofascial Trigger Points in the Triceps Surae Muscles: Systematic Review. Healthcare (Basel) 2022; 10:healthcare10101862. [PMID: 36292308 PMCID: PMC9602116 DOI: 10.3390/healthcare10101862] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2022] [Revised: 09/13/2022] [Accepted: 09/20/2022] [Indexed: 11/16/2022] Open
Abstract
This study aims to analyze the effects of Dry Needling (DN) for the release of myofascial trigger points (MTrPs) in the triceps surae muscles (TSM). A systematic review was performed up to February 2022 in PubMed, PEDro, Scopus, CENTRAL, and Web of Science. Selection criteria were studies involving subjects older than 18 years presenting MTrPs in the TSM, without any concomitant acute or chronic musculoskeletal conditions; DN interventions applied to the MTrPs of the TSM; and results on pain, range of motion (ROM), muscle strength, muscle stiffness, and functional outcomes. The PEDro scale was used to assess the methodological quality of the studies, and the Risk of Bias Tool 2.0 to assess risk of bias. A total of 12 studies were included in the systematic review, involving 426 participants. These results suggest that DN of MTrPs in TSM could have a positive impact on muscle stiffness and functional outcomes. There are inconclusive findings on musculoskeletal pain, ROM, and muscle strength. Significant results were obtained in favor of the control groups on pressure pain thresholds. Despite the benefits obtained on muscle stiffness and functional performance, the evidence for the use of DN of MTrPs in the TSM remains inconclusive.
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Affiliation(s)
- David Lucena-Anton
- Department of Nursing and Physiotherapy, Faculty of Nursing and Physiotherapy, University of Cadiz, 11009 Cadiz, Spain
| | - Carlos Luque-Moreno
- Department of Physiotherapy, Faculty of Nursing, Physiotherapy and Podiatry, University of Seville, 41009 Seville, Spain
- Correspondence:
| | - Jesus Valencia-Medero
- Department of Nursing and Physiotherapy, Faculty of Nursing and Physiotherapy, University of Cadiz, 11009 Cadiz, Spain
| | - Cristina Garcia-Munoz
- Department of Nursing and Physiotherapy, Faculty of Nursing and Physiotherapy, University of Cadiz, 11009 Cadiz, Spain
| | - Jose A. Moral-Munoz
- Department of Nursing and Physiotherapy, Faculty of Nursing and Physiotherapy, University of Cadiz, 11009 Cadiz, Spain
- Institute of Research and Innovation in Biomedical Sciences of the Province of Cadiz (INiBICA), University of Cadiz, 11009 Cadiz, Spain
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Lee J, Park C, Cha Y, You JSH. Comparative effects of different manual techniques on electromyography activity, kinematics, and muscle force in limited ankle dorsiflexion syndrome. J Back Musculoskelet Rehabil 2021; 34:1105-1112. [PMID: 34057133 DOI: 10.3233/bmr-200257] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
BACKGROUND Although the instrument-assisted manual (IM) technique has been widely utilised to improve soft tissue and joint mobility, its therapeutic benefits and underlying neuromechanical mechanisms remain unknown compared to those of conventional static stretching (SS) and hold-relax (HR) manual techniques. OBJECTIVE This study aimed to compare the effects of the SS, HR, and IM techniques on muscle activity, kinematics, and strength during deep squatting in limited ankle dorsiflexion (DF) syndrome. METHODS This was a cross-sectional randomised controlled study including 39 adults divided into three groups: SS group: 13, HR group: 13, IM group: 13. Outcome measures were the tibialis anterior (TA): gastrocnemius (GCM) balance ratio and ankle, knee, hip and thoracolumbar junction angles. TA muscle strength was analysed to evaluate the limited ankle DF. Analysis of variance was performed, with P< 0.05. RESULTS The TA:GCM balance ratio, ranges of motion of ankle DF and knee flexion, and TA muscle strength in the IM group improved significantly compared to that in either the SS group or HR group (P< 0.05). CONCLUSIONS Our novel results demonstrated that IM was most effective in normalising TA:GCM balance, ankle DF range of motion, and TA muscle strength during deep squatting in adults with limited ankle DF.
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Affiliation(s)
- Jihoon Lee
- Sports Movement Artificial-Intelligence Robotics Technology (SMART) Institute, Department of Physical Therapy, Yonsei University, Wonju, Korea.,Department of Physical Therapy, Yonsei University, Wonju, Korea
| | - Chanhee Park
- Sports Movement Artificial-Intelligence Robotics Technology (SMART) Institute, Department of Physical Therapy, Yonsei University, Wonju, Korea.,Department of Physical Therapy, Yonsei University, Wonju, Korea
| | - Youngjoo Cha
- Department of Physical Therapy, Cheju Halla University, Jeju, Korea
| | - Joshua Sung H You
- Sports Movement Artificial-Intelligence Robotics Technology (SMART) Institute, Department of Physical Therapy, Yonsei University, Wonju, Korea.,Department of Physical Therapy, Yonsei University, Wonju, Korea
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5
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Janowski JA, Phelan-Smith DML, Kroat Brady MN, Michels KL, Timm AH, Boucher NM, Casteen KD, Village D, Sleeper MD. Acute Effects of Dry Needling on Myofascial Trigger Points in the Triceps Surae of Ballet Dancers: A Pilot Randomized Controlled Trial. Int J Sports Phys Ther 2021; 16:418-430. [PMID: 33842037 PMCID: PMC8016472 DOI: 10.26603/001c.21475] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2020] [Accepted: 11/08/2020] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND There is convincing evidence that dancers suffer injuries to the triceps surae musculature. Research on the immediate effects of dry needling (DN) is limited, and it is important to understand the acute effects of this treatment prior to performance. PURPOSE The purpose of this pilot study was to assess the immediate effects of DN on myofascial trigger points in terms of skin surface temperature, pain, active and passive range of motion, and torque production in the triceps surae of ballet dancers. STUDY DESIGN Randomized, double-blinded pilot study. METHODS Professional ballet dancers that fit inclusion and exclusion criteria (n=11) were randomly assigned to an experimental or control group. The dancers had three pre-determined standard point (SP) measurement spots that were used as a baseline for surface temperature comparisons. The dancers were also palpated for trigger point (TP) spots. Both SP and TP spots were marked for future measurements. The experimental group received DN, while the control group received sham DN (SHAM) to their bilateral calves at the TP spots. Immediately prior to and following treatment, both DN and SHAM groups were tested for skin surface temperature, pain, range of motion, and plantar flexion torque by blinded assessors. Paired t-tests and independent t-tests were performed to examine for differences between groups. RESULTS The surface temperature for the TP was higher than the SP measurements prior to intervention (Right calf p= .014; Left calf p= .031). There were no significant changes in VAS scale reported pain and ROM. The plantar flexion torque measurements showed an increase in the DN group of the left calf at the angular velocity of 60 degrees/sec. CONCLUSION This was a unique pilot study examining the acute effects of DN on professional ballet dancers. The results were limited due to low sample size. However, the methodology for this study and surface temperature results invites future research. LEVEL OF EVIDENCE Level 1b.
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Yamada N, Okamoto S, Shiraishi Y, Hashimoto S, Akiyama Y, Yamada Y. Machine-assisted foot stretching in the elderly: a comparison with self-stretching. J Phys Ther Sci 2021; 33:179-186. [PMID: 33814701 PMCID: PMC8012194 DOI: 10.1589/jpts.33.179] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2020] [Accepted: 12/01/2020] [Indexed: 11/24/2022] Open
Abstract
[Purpose] Self-stretching is the traditional at-home stretching method of choice. We developed an automatic foot-stretching machine to perform effective dorsiflexion stretching safely and easily at home. The effects of automatic stretching using our machine and self-stretching were investigated and compared. [Participants and Methods] Twelve healthy elderly people participated in the study. Automatic dorsiflexion static stretching was performed with the right foot, and self-stretching using a towel was performed with the left foot. Before and after each stretching, passive range of motion in dorsiflexion, maximal voluntary contraction strength in plantarflexion, passive resistive torque during passive dorsiflexion, and displacement of the muscle-tendon junction of the medial gastrocnemius muscle were measured. [Results] The range of motion in dorsiflexion had a significantly greater increase after automatic stretching than after self-stretching. The maximum strength in plantarflexion tended to decrease after automatic stretching but did not decrease after self-stretching. The passive resistive torque in both types of stretches decreased in some of the participants but increased in others. The displacement of the muscle-tendon junction of the medial gastrocnemius tended to shorten during automatic stretching as compared with self-stretching. [Conclusion] Foot stretching using a machine is as effective as self-stretching and tends to affect the tendon rather than the muscle.
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Affiliation(s)
- Naomi Yamada
- Department of Rehabilitation, Aichi Medical College: 519 Ichiba, Kiyosu-city, Aichi 452-0931, Japan.,Department of Mechanical Systems Engineering, Nagoya University, Japan
| | - Shogo Okamoto
- Department of Mechanical Systems Engineering, Nagoya University, Japan
| | - Yuma Shiraishi
- Department of Mechanical Systems Engineering, Nagoya University, Japan
| | - Senri Hashimoto
- Department of Rehabilitation, Aichi Medical College: 519 Ichiba, Kiyosu-city, Aichi 452-0931, Japan.,Department of Rehabilitation, Fujita Health University Hospital, Japan
| | - Yasuhiro Akiyama
- Department of Mechanical Systems Engineering, Nagoya University, Japan
| | - Yoji Yamada
- Department of Mechanical Systems Engineering, Nagoya University, Japan
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Yamada N, Okamoto S, Akiyama Y, Yamada Y. Principal motion analysis of manual stretching techniques for the ankle joints. J Phys Ther Sci 2020; 32:584-590. [PMID: 32982055 PMCID: PMC7509160 DOI: 10.1589/jpts.32.584] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2020] [Accepted: 06/22/2020] [Indexed: 11/25/2022] Open
Abstract
[Purpose] Physical therapists frequently perform manual stretching of the ankle joints.
Manual stretching procedures are challenging to define because they involve
multidirectional joint motions and external forces. Therefore, in this paper, we propose a
method for quantitatively and statistically analyzing the manual foot stretching
techniques used by physical therapists. [Participants and Methods] The participants were
four physical therapists, and three patients who have a spastic foot. We investigated the
manual foot stretching techniques employed by the physical therapists using a
three-dimensional analysis system and an instrumented brace with force sensors. Principal
motion analysis was applied to the obtained data, and principal motions were determined.
[Results] The first principal motion was the application of force for the dorsiflexion of
the foot; second, the pushing/pulling of the heel; third, the eversion/inversion of the
entire foot; and fourth, the eversion/inversion of the forefoot. Furthermore, the manual
stretching techniques varied among the physical therapists, even for the same patient, and
some techniques occurred only between particular pairs. [Conclusion] This study
demonstrated the effectiveness of the principal motion analysis for the statistical
assessment of manual stretching techniques and clarifying differences in stretching
technique among physical therapists.
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Affiliation(s)
- Naomi Yamada
- Department of Rehabilitation, Aichi Medical College: 519 Ichiba, Kiyosu City, Aichi 452-0931, Japan.,Department of Mechanical Systems Engineering, Nagoya University, Japan
| | - Shogo Okamoto
- Department of Mechanical Systems Engineering, Nagoya University, Japan
| | - Yasuhiro Akiyama
- Department of Mechanical Systems Engineering, Nagoya University, Japan
| | - Yoji Yamada
- Department of Mechanical Systems Engineering, Nagoya University, Japan
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Kim TH, Lim OK, Park KD, Lee JK. Comparison of Two Static Stretching Techniques for the Triceps Surae in Healthy Individuals: Wall and Inclined Board Stretchings. Ann Rehabil Med 2020; 44:125-130. [PMID: 32392651 PMCID: PMC7214133 DOI: 10.5535/arm.2020.44.2.125] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2019] [Accepted: 09/10/2019] [Indexed: 11/10/2022] Open
Abstract
Objective To compare the effectiveness of static stretching techniques for correcting the tightness of the triceps surae. Methods In this observational, cross-sectional study, participants (30 healthy volunteers) completed 10 repetitions of each stretching exercise, holding each stretch for 10 seconds, with a 1-minute rest period between repetitionsand a 1-hour rest period between the two stretching techniques, namely, wall and inclined board stretchings. The length of the triceps surae and range of ankle dorsiflexion were measured on lateral view radiographs. The muscle activity during the stretch was measured using quantified surface electromyography of the lateral gastrocnemius. The subjective stretching sensation was evaluated using the visual analog scale. Results Both stretching techniques showed statistical differences in all the parameters. Stretching on an inclined board yielded a greater increase in the triceps surae length than did wall stretching (mean difference, 0.72; p=0.02). The range of ankle dorsiflexion was higher with inclined board stretching than with wall stretching (mean difference, 2.57; p=0.03). The mean muscle activity was significantly lower withinclined board stretching than with wall stretching (mean difference, 53.72; p<0.01). The visual analog scale score was higher with inclined board stretching than with wall stretching (mean difference, 2.07; p<0.01). Conclusion In this study, inclined board stretching was more effective than wall stretching for correcting tightness of the triceps surae. Therefore, inclined board stretching should be encouraged for the triceps surae.
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Affiliation(s)
- Tae Hee Kim
- Department of Rehabilitation Medicine, Konkuk University Chungju Hospital, Chungju, Korea
| | - Oh Kyung Lim
- Department of Rehabilitation Medicine, Gil Medical Center, Gachon University College of Medicine, Incheon, Korea
| | - Ki Deok Park
- Department of Rehabilitation Medicine, Gil Medical Center, Gachon University College of Medicine, Incheon, Korea
| | - Ju Kang Lee
- Department of Rehabilitation Medicine, Gil Medical Center, Gachon University College of Medicine, Incheon, Korea
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Immediate Effects of Intermittent Bilateral Ankle Plantar Flexors Static Stretching on Balance and Plantar Pressures. J Manipulative Physiol Ther 2020; 43:24-31. [PMID: 32061419 DOI: 10.1016/j.jmpt.2019.02.012] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2018] [Revised: 02/20/2019] [Accepted: 02/20/2019] [Indexed: 11/21/2022]
Abstract
OBJECTIVE The purpose of this study was to analyze the immediate effects of an intermittent plantar flexion static-stretching protocol on balance and plantar pressures. METHODS The study included a sample size of 24 healthy participants (21 female and 3 male). Participants were 32.20 ± 8.08 years, 166.20 ± 8.43 cm, and 62.77 ± 9.52 kg. All participants performed an intermittent plantar flexion static-stretching protocol. Five sets (60 seconds intermittent stretch; 15 seconds for the rest time) of a passive plantar flexor stretching (70% to 90% of the point of discomfort) were performed. Static footprint analysis and a stabilometry analysis were performed before and after stretching. A P value < .05 with a CI of 95% was considered statistically significant for all tests. RESULTS Intermittent ankle plantar static stretching resulted in a significantly greater forefoot surface contact area and lower rear foot medium and maximum plantar pressures. In addition, static stretching caused a lower displacement of the center of pressure for both eyes open and eyes closed conditions. CONCLUSION An intermittent plantar flexor static-stretching protocol improved balance and reduced rear foot plantar pressures (maximum and medium pressures).
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Arslan İ, Yücel I, Öztürk TB, Karahan N, Orak MM, Midi A. The Effects of Corticosteroid Injection in the Healthy and Damaged Achilles Tendon Model: Histopathological and Biomechanical Experimental Study in Rats. Turk Patoloji Derg 2020; 36:39-47. [PMID: 31538652 PMCID: PMC10512677 DOI: 10.5146/tjpath.2019.01468] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2019] [Accepted: 09/01/2019] [Indexed: 11/18/2022] Open
Abstract
OBJECTIVE To show the effects of corticosteroids on inflammatory reactions in the injured Achilles tendon in rats. MATERIAL AND METHOD Thirty-two adult Wistar Albino rats were used in the study. The rats were divided into 4 groups. In the first group (Intact Saline), saline solution was injected to the intact Achilles tendon. In the second group (Intact Corticosteroid), corticosteroid was injected to the intact tendon. In the third group (Injured Saline), saline solution was injected to the injured Achilles tendon. In the fourth group (Injured Corticosteroid), corticosteroid was injected to the injured tendon. All groups were sacrificed on day 30 and Achilles tendons were taken and prepared for histological and biomechanical evaluation. RESULTS According to the biomechanical test; mean load-to-failure of the Intact Saline group was significantly lower than the Intact Corticosteroid (p=0.016), Injured Saline (p=0.001) and Injured Corticosteroid) (p=0.012) groups. According to the histopathological evaluation, tenocyte mean of the Intact Saline group was statistically lower than the Injured Saline and Injured Corticosteroid groups. Tenocyte mean of the Intact Corticosteroid group was statistically significantly lower than the Injured Saline and Injured Corticosteroid groups. The ground substance mean of the Intact Saline group was significantly lower than the Injured Saline and Injured Corticosteroid groups. The ground substance mean of the Intact Corticosteroid group was significantly lower than the Injured Saline and Injured Corticosteroid groups. There was no statistically significant difference between the groups in terms of calcification. CONCLUSION It has been found that there is biomechanical and histopathological significant benefit of intra-tendon corticosteroid administration in the experimentally generated Achilles tendon injury model.
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Affiliation(s)
- İlyas Arslan
- Department of Orthopedics and Traumatology, Fatih Sultan Mehmet Training and Research Hospital, İstanbul, Turkey
| | - Istemi Yücel
- Department of Orthopedics and Traumatology, Fatih Sultan Mehmet Training and Research Hospital, İstanbul, Turkey
| | - Turhan Beyza Öztürk
- Department of 2nd Grade Student, İstanbul Bahçeşehir University Faculty of Medicine, İstanbul, Turkey
| | - Nazım Karahan
- Department of Orthopedics and Traumatology, Fatih Sultan Mehmet Training and Research Hospital, İstanbul, Turkey
| | - M. Müfit Orak
- Department of Orthopedics and Traumatology, İstanbul Bahçeşehir University Faculty of Medicine, İstanbul, Turkey
| | - Ahmet Midi
- Department of Pathology, İstanbul Bahçeşehir University Faculty of Medicine, İstanbul, Turkey
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Koo S, Chun S, Lee KM, Cho BC, Koo YJ, Kang DW, Park MS. Sex Differences in Pedobarographic Findings and Relationship between Radiographic and Pedobarographic Measurements in Young Healthy Adults. Clin Orthop Surg 2018; 10:216-224. [PMID: 29854346 PMCID: PMC5964271 DOI: 10.4055/cios.2018.10.2.216] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/02/2017] [Accepted: 11/17/2017] [Indexed: 11/25/2022] Open
Abstract
Background Although pedobarographic measurement is increasingly used for clinical and research purposes, relatively few published studies have investigated normative data. This study examined pedobarographic findings in young healthy adults with regard to sex-related differences and correlations among measurement indices. Methods Twenty young healthy adults (mean age, 22.4 years; standard deviation, 1.2 years; and 10 males and 10 females) were included. Weight bearing anteroposterior (AP) and lateral foot radiographs were taken, and dynamic pedobarographic data during treadmill walking and maximum ankle dorsiflexion were obtained. AP talo-first metatarsal angle, naviculocuboid overlap, lateral talo-first metatarsal angle, and plantar soft tissue thickness were measured on foot radiographs. Pedobarographic data including peak pressure and pressure-time integral were measured on five plantar segments: medial forefoot (MFF), lateral forefoot (LFF), medial midfoot (MMF), lateral midfoot (LMF), and heel. Results Male and female subjects significantly differed in body mass index (BMI, p < 0.001), AP talo-first metatarsal angle (p = 0.018), soft tissue thickness under the metatarsal head (p = 0.040) and calcaneal tuberosity (p < 0.001), maximum dorsiflexion during stance phase (p = 0.041), peak pressure on the MFF (p = 0.005) and LFF (p = 0.004), and pressure-time integral on the MFF (p = 0.018) and heel (p = 0.001). BMI was significantly correlated with soft tissue thickness under the metatarsal head (r = 0.521, p = 0.018) and calcaneal tuberosity (r = 0.585, p = 0.007), peak pressure on the MFF (r = 0.601, p = 0.005) and LFF (r = 0.487, p = 0.029), pressure-time integral on the heel (r = 0.552, p = 0.012), and total pressure-time integral (r = 0.755, p < 0.001). Maximum dorsiflexion demonstrated significant negative correlations with pressure-time integral on the MFF (r = −0.595, p = 0.007) and total pressure-time integral (r = −0.492, p = 0.032). Pressure-time integral varus/valgus index was significantly correlated with pressuretime integral forefoot/heel index (r = 0.472, p = 0.036). Conclusions Sex-related differences in pedobarographic examination were observed, which could provide useful information in setting appropriate treatment goals and obtaining appropriate control data. The effects of subtalar motion in distributing plantar pressure should be investigated in a future study.
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Affiliation(s)
- Seungbum Koo
- Department of Mechanical Engineering, Chung-Ang University, Seoul, Korea
| | - Sangho Chun
- Department of Mechanical Engineering, Chung-Ang University, Seoul, Korea
| | - Kyoung Min Lee
- Department of Orthopedic Surgery, Seoul National University Bundang Hospital, Seongnam, Korea
| | - Byung Chae Cho
- Department of Orthopedic Surgery, Seoul National University Bundang Hospital, Seongnam, Korea
| | - Young-Jun Koo
- Department of Mechanical Engineering, Chung-Ang University, Seoul, Korea
| | - Dong-Wan Kang
- Department of Orthopedic Surgery, Seoul National University Bundang Hospital, Seongnam, Korea
| | - Moon Seok Park
- Department of Orthopedic Surgery, Seoul National University Bundang Hospital, Seongnam, Korea
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Holtmann JA, Südkamp NP, Schmal H, Mehlhorn AT. Gastrocnemius Recession Leads to Increased Ankle Motion and Improved Patient Satisfaction After 2 Years of Follow-Up. J Foot Ankle Surg 2017; 56:589-593. [PMID: 28476392 DOI: 10.1053/j.jfas.2017.01.037] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/21/2015] [Indexed: 02/03/2023]
Abstract
The isolated gastrocnemius contracture present in neurologic healthy patients results in a significant limitation of ankle dorsiflexion causing pathologic gait patterns and a greater risk of further foot disorders. Gastrocnemius recession is an established procedure to increase ankle dorsiflexion. However, little evidence is available of the use of gastrocnemius recession in these patients. Complication rates, recurrence of gastrocnemius contracture, and the prevalence of additional foot disorders needs further evaluation. A study group of 64 operated limbs undergoing gastrocnemius recession was evaluated to determine the prevalence of foot disorders, pre- and postoperative ankle dorsiflexion, and incidence of complications. A subgroup of 15 (23.4%) patients without additional operative procedures was examined regarding ankle dorsiflexion, strength (Janda method), sensitivity in the operated limb, and the pre- and postoperative Foot Function Index scores. The prevalence of foot disorders showed pes planus (41%), hallux valgus (38%), metatarsalgia (19%), hammertoe deformity (13%), and symptomatic Haglund exostosis (11%). At 31 months of follow-up, the patients had significantly benefited from increased ankle dorsiflexion of 13.3° ± 7.9° (p < .001). Postoperatively, 16% patients experienced complications. In the subgroup of 15 patients, the follow-up examination after 44 months showed ankle dorsiflexion of 14° ± 7.1°. The plantarflexion strength was 4 of 5 (Janda method). The Foot Function Index score had improved significantly from 65.4 ± 26.5 points to 33.4 ± 19.5 points (p < .001). Patients with isolated gastrocnemius contracture seem to have a high prevalence of symptomatic foot disorders. At a mid-term follow-up examination, gastrocnemius recession (Strayer) was shown to be an effective procedure to significantly improve ankle dorsiflexion, functionality, and pain symptoms. More attention should be given to the development of postoperative complications.
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Affiliation(s)
- Julia Alessandra Holtmann
- Orthopaedic Resident, Department of Orthopedic and Trauma Surgery, Inselgruppe Spital Tiefenau, Bern, Switzerland.
| | - Norbert P Südkamp
- Professor, Department of Orthopedic and Trauma Surgery, University Medical Center, Freiburg, Germany
| | - Hagen Schmal
- Professor, Department of Orthopedic and Trauma Surgery, University Medical Center, Freiburg, Germany; Orthopaedic Surgeon, Department of Orthopedics and Traumatology, Odense University Hospital, Odense, Denmark; Orthopaedic Surgeon, Department of Clinical Research, University of Southern Denmark, Odense, Denmark
| | - Alexander T Mehlhorn
- Assistant Professor, Department of Orthopedic and Trauma Surgery, University Medical Center, Freiburg, Germany; Orthopaedic Surgeon, Center of Foot and Ankle Surgery, Schön Klinik München Harlaching, Munich, Germany
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Abstract
Equinus is linked to most lower extremity biomechanically related disorders. Defining equinus as ankle joint dorsiflexion less than 5° of dorsiflexion with the knee extended is the basis for evaluation and management of the deformity. Consistent evaluation methodology using a goniometer with the subtalar joint in neutral position and midtarsal joint supinated while dorsiflexing the ankle with knee extended provides a consistent clinical examination. For equinus deformity with an associated disorder, comprehensive treatment mandates treatment of the equinus deformity. Surgical treatment of equinus offers multiple procedures but the Baumann gastrocnemius recession is preferred based on deformity correction without weakness.
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Affiliation(s)
- Patrick A DeHeer
- Surgery Department, Indiana University Health North Hospital, Carmel, IN, USA; Surgery Department, Johnson Memorial Hospital, Franklin, IN, USA; Department of Podiatric Medicine and Radiology, Rosalind Franklin University of Medicine and Science, North Chicago, IL, USA.
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Capobianco CM. Surgical Equinus Correction for the Diabetic Charcot Foot: What the Evidence Reveals. Clin Podiatr Med Surg 2017; 34:33-41. [PMID: 27865313 DOI: 10.1016/j.cpm.2016.07.005] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
Triceps surae contracture, or equinus, is a known deforming force in the foot and ankle. Biomechanical studies have shown that ankle equinus significantly alters gait and plantar pressures, and in the diabetic neuropathic patient population, this can propagate plantar ulceration and/or Charcot neuroarthropathy (CN). Surgical correction of equinus is globally and frequently used to aid in plantar wound healing in the neuropathic diabetic patient, with and without CN. Treatment guidelines for equinus correction in this medically complex population are undefined and lack evidence from high-quality published peer-reviewed studies.
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Affiliation(s)
- Claire M Capobianco
- Orthopaedic Associates of Southern Delaware, 1539 Savannah Road, Suite 203, Lewes, DE 19958, USA.
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15
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Tang Qian Ying C, Lai Wei Hong S, Lee BH, Thevendran G. Return to physical activity after gastrocnemius recession. World J Orthop 2016; 7:746-751. [PMID: 27900272 PMCID: PMC5112344 DOI: 10.5312/wjo.v7.i11.746] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/18/2016] [Revised: 08/10/2016] [Accepted: 09/08/2016] [Indexed: 02/06/2023] Open
Abstract
AIM To prospectively investigate the time taken and patients’ ability to resume preoperative level of physical activity after gastrocnemius recession.
METHODS Endoscopic gastrocnemius recession (EGR) was performed on 48 feet in 46 consecutive sportspersons, with a minimum follow-up of 24 mo. The Halasi Ankle Activity Score was used to quantify the level of physical activity. Time taken to return to work and physical activity was recorded. Functional outcomes were evaluated using the short form 36 (SF-36), American Orthopedic Foot and Ankle Society (AOFAS) Hindfoot score and modified Olerud and Molander (O and M) scores respectively. Patient’s satisfaction and pain experienced were assessed using a modified Likert scale and visual analogue scales. P-value < 0.05 was considered statistically significant.
RESULTS Ninety-one percent (n = 42) of all patients returned to their preoperative level of physical activity after EGR. The mean time for return to physical activity was 7.5 (2-24) mo. Ninety-eight percent (n = 45) of all patients were able to return to their preoperative employment status, with a mean time of 3.6 (1-12) mo. Ninety-six percent (n = 23) of all patients with an activity score > 2 were able to resume their preoperative level of physical activity in mean time of 8.8 mo, as compared to 86% (n = 19) of patients whose activity score was ≤ 2, with mean time of 6.1 mo. Significant improvements were noted in SF-36, AOFAS hindfoot and modified O and M scores. Ninety percent of all patients rated good or very good outcomes on the Likert scale.
CONCLUSION The majority of patients were able to return to their pre-operative level of sporting activity after EGR.
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16
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Musculoskeletal modeling of human lower limb during normal walking, one-legged forward hopping and side jumping: Comparison of measured EMG and predicted muscle activity patterns. J Biomech 2016; 49:3660-3666. [DOI: 10.1016/j.jbiomech.2016.09.041] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2015] [Revised: 09/22/2016] [Accepted: 09/30/2016] [Indexed: 11/23/2022]
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Amis J. The Split Second Effect: The Mechanism of How Equinus Can Damage the Human Foot and Ankle. Front Surg 2016; 3:38. [PMID: 27512692 PMCID: PMC4961717 DOI: 10.3389/fsurg.2016.00038] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2016] [Accepted: 06/14/2016] [Indexed: 01/03/2023] Open
Abstract
We are currently in the process of discovering that many, if not the majority, of the non-traumatic acquired adult foot and ankle problems are caused by a singular etiology: non-neuromuscular equinus or the isolated gastrocnemius contracture. There is no question that this biomechanical association exists and in time much more will be uncovered. There are three basic questions that must be answered: why would our calves tighten as we normally age, how does a tight calf, or equinus, actually cause problems remotely in the foot and ankle, and how do the forces produced by equinus cause so many seemingly unrelated pathologies in the foot and ankle? The purpose of this paper is to address the second question: how does a tight calf mechanically cause problems remotely in the foot and ankle? There has been little evidence in the literature addressing the biomechanical mechanisms by which equinus creates damaging forces upon the foot and ankle, and as a result, a precise, convincing mechanism is still lacking. Thus, the mere concept that equinus has anything to do with foot pathology is generally unknown or disregarded. The split second effect, described here, defines exactly how the silent equinus contracture creates incremental and significant damage and injury to the human foot and ankle resulting in a wide variety of pathological conditions. The split second effect is a dissenting theory based on 30 years of clinical and academic orthopedic foot and ankle experience, keen clinical observation along the way, and review of the developing literature, culminating in examination of many hours of slow motion video of normal and abnormal human gait. To my knowledge, no one has ever described the mechanism in detail this precise.
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Affiliation(s)
- James Amis
- Department of Orthopaedic Surgery, University of Cincinnati , Cincinnati, OH , USA
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18
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Ho SWL, Thevendran G. Sports Medicine and Arthroscopic Treatment of the Foot and Ankle: What Is New and Current in Singapore. Foot Ankle Clin 2016; 21:283-95. [PMID: 27261807 DOI: 10.1016/j.fcl.2016.01.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
Foot and ankle abnormalities are common in Singapore because of the compulsory conscription, the slipper-wearing culture, and the promotion of healthy living through exercise. The rapidly aging population, lack of elite sportsmen, and social and cultural norms pose unique challenges to foot and ankle surgery. Orthopedic surgery in Singapore has progressed because of the good infrastructure and modern practices executed by fellowship-trained surgeons. Evolving local practices are polarized by practice trends emulated from North America and Europe. The small community of foot and ankle surgeons currently practicing in Singapore allows for easier communication, corroborative educational events, and research initiatives.
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Affiliation(s)
- Sean Wei Loong Ho
- Department of Orthopaedic Surgery, 11 Jalan Tan Tock Seng, Tan Tock Seng Hospital, Singapore 308433, Singapore.
| | - Gowreeson Thevendran
- Department of Orthopaedic Surgery, 11 Jalan Tan Tock Seng, Tan Tock Seng Hospital, Singapore 308433, Singapore
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Endoscopic gastrocnemius recession procedure using a single portal technique: a prospective study of fifty four consecutive patients. INTERNATIONAL ORTHOPAEDICS 2015; 39:1099-107. [DOI: 10.1007/s00264-015-2723-9] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/20/2015] [Accepted: 02/22/2015] [Indexed: 10/23/2022]
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Chimera NJ, Smith CA, Warren M. Injury history, sex, and performance on the functional movement screen and Y balance test. J Athl Train 2015; 50:475-85. [PMID: 25761134 DOI: 10.4085/1062-6050-49.6.02] [Citation(s) in RCA: 91] [Impact Index Per Article: 10.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
CONTEXT Research is limited regarding the effects of injury or surgery history and sex on the Functional Movement Screen (FMS) and Y Balance Test (YBT). OBJECTIVE To determine if injury or surgery history or sex affected results on the FMS and YBT. DESIGN Cross-sectional study. SETTING Athletic training facilities. PATIENTS OR OTHER PARTICIPANTS A total of 200 National Collegiate Athletic Association Division I female (n = 92; age = 20.0 ± 1.4 years, body mass index = 22.8 ± 3.1 kg/m(2)) and male (n = 108; age = 20.0 ± 1.5 years, body mass index = 27.0 ± 4.6 kg/m(2)) athletes were screened; 170 completed the FMS, and 190 completed the YBT. INTERVENTION(S) A self-reported questionnaire identified injury or surgery history and sex. The FMS assessed movement during the patterns of deep squat, hurdle step, in-line lunge, shoulder mobility, impingement-clearing test, straight-leg raise, trunk stability push-up, press-up clearing test, rotary stability, and posterior-rocking clearing test. The YBT assessed balance while participants reached in anterior, posteromedial, and posterolateral directions. MAIN OUTCOME MEASURE(S) The FMS composite score (CS; range, 0-21) and movement pattern score (range, 0-3), the YBT CS (% lower extremity length), and YBT anterior, posteromedial, and posterolateral asymmetry (difference between limbs in centimeters). Independent-samples t tests established differences in mean FMS CS, YBT CS, and YBT asymmetry. The Mann-Whitney U test identified differences in FMS movement patterns. RESULTS We found lower overall FMS CSs for the following injuries or surgeries: hip (injured = 12.7 ± 3.1, uninjured = 14.4 ± 2.3; P = .005), elbow (injured = 12.1 ± 2.8, uninjured = 14.3 ± 2.4; P = .02), and hand (injured = 12.3 ± 2.9, uninjured = 14.3 ± 2.3; P = .006) injuries and shoulder surgery (surgery = 12.0 ± 1.0, no surgery = 14.3 ± 2.4; P < .001). We observed worse FMS movement pattern performance for knee surgery (rotary stability: P = .03), hip injury (deep squat and hurdle: P < .042 for both), hip surgery (hurdle and lunge: P < .01 for both), shoulder injury (shoulder and hand injury: P < .02 for both), and shoulder surgery (shoulder: P < .02). We found better FMS movement pattern performance for trunk/back injury (deep squat: P = .02) and ankle injury (lunge: P = .01). Female athletes performed worse in FMS movement patterns for trunk (P < .001) and rotary (P = .01) stability but better in the lunge (P = .008), shoulder mobility (P < .001), and straight-leg raise (P < .001). Anterior asymmetry was greater for male athletes (P = .02). CONCLUSIONS Injury history and sex affected FMS and YBT performance. Researchers should consider adjusting for confounders.
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Abstract
A silent gastrocnemius contracture can gradually do so much harm when left undetected and unattended. The calf is a common source of a majority of acquired, nontraumatic adult foot and ankle problems. When it comes to surgical lengthening procedures, whether at the Achilles, at the musculotendinous junction, or more proximal, the search must move on to find the safest, most accurate, and quickest recovery method possible. Addressing the calf contracture as definitive treatment and, better yet, as prevention will no doubt become a mainstay of the treatment of many foot and ankle problems.
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Affiliation(s)
- James Amis
- Lone Star Orthopaedics, 3219 Clifton Avenue, Suite 300, Cincinnati, OH 45220, USA.
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Yoon JY, Oh JS, An DH. Three-dimensional analysis of foot motion after uphill walking with mobilization with movement using tape applied to the talocrural joint in women with limited ankle dorsiflexion. Foot Ankle Int 2014; 35:1217-25. [PMID: 25097190 DOI: 10.1177/1071100714543797] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
BACKGROUND Previous studies that investigated mobilization with movement (MWM) treatment assessed only improvements in passive range of motion (ROM). No information is currently available regarding the efficacy of modified MWM by application of tape. Therefore, we investigated the effect of uphill walking with modified MWM using tape applied to the talocrural joint (uphill walking with MWM taping) in women with limited ankle dorsiflexion. METHODS Twelve feet of 12 women with ankle dorsiflexion < 8 degrees were studied. Passive ROM measured using a goniometer was used to select participants. Participants walked on a level walkway under 3 conditions: before exercise, after uphill walking, and after uphill walking with MWM taping. The Oxford Foot Model using 3D motion analysis system was used to examine dynamic foot kinematics, and statistical significance was determined by 1-way repeated-measures analysis of variance. RESULTS After uphill walking with MWM taping, peak hindfoot dorsiflexion relative to the tibia was significantly greater than that before exercise and after uphill walking. Furthermore, peak forefoot plantarflexion relative to the hindfoot, peak hindfoot plantarflexion relative to the tibia, and backward tilt of the tibia were greater than those before exercise. CONCLUSIONS Uphill walking with MWM taping resulted in an immediate alteration in foot motion during walking, increasing hindfoot dorsiflexion in particular. CLINICAL RELEVANCE Further studies are needed to investigate the long-term effects of uphill walking with MWM taping and its potential use in rehabilitation training.
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Affiliation(s)
- Ji-yeon Yoon
- Motion Analysis Laboratory, INJE University Haeundae Paik Hospital, Busan, Republic of Korea
| | - Jae-seop Oh
- Department of Physical Therapy, INJE University, Gimhae, Republic of Korea
| | - Duk-hyun An
- Department of Physical Therapy, INJE University, Gimhae, Republic of Korea
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Yoon JY, Hwang YI, An DH, Oh JS. Changes in Kinetic, Kinematic, and Temporal Parameters of Walking in People With Limited Ankle Dorsiflexion: Pre-Post Application of Modified Mobilization With Movement Using Talus Glide Taping. J Manipulative Physiol Ther 2014; 37:320-5. [DOI: 10.1016/j.jmpt.2014.01.007] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2012] [Revised: 01/13/2014] [Accepted: 01/17/2014] [Indexed: 11/28/2022]
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Young R, Nix S, Wholohan A, Bradhurst R, Reed L. Interventions for increasing ankle joint dorsiflexion: a systematic review and meta-analysis. J Foot Ankle Res 2013; 6:46. [PMID: 24225348 PMCID: PMC4176290 DOI: 10.1186/1757-1146-6-46] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/19/2013] [Accepted: 11/09/2013] [Indexed: 12/14/2022] Open
Abstract
BACKGROUND Ankle joint equinus, or restricted dorsiflexion range of motion (ROM), has been linked to a range of pathologies of relevance to clinical practitioners. This systematic review and meta-analysis investigated the effects of conservative interventions on ankle joint ROM in healthy individuals and athletic populations. METHODS Keyword searches of Embase, Medline, Cochrane and CINAHL databases were performed with the final search being run in August 2013. Studies were eligible for inclusion if they assessed the effect of a non-surgical intervention on ankle joint dorsiflexion in healthy populations. Studies were quality rated using a standard quality assessment scale. Standardised mean differences (SMDs) and 95% confidence intervals (CIs) were calculated and results were pooled where study methods were homogenous. RESULTS Twenty-three studies met eligibility criteria, with a total of 734 study participants. Results suggest that there is some evidence to support the efficacy of static stretching alone (SMDs: range 0.70 to 1.69) and static stretching in combination with ultrasound (SMDs: range 0.91 to 0.95), diathermy (SMD 1.12), diathermy and ice (SMD 1.16), heel raise exercises (SMDs: range 0.70 to 0.77), superficial moist heat (SMDs: range 0.65 to 0.84) and warm up (SMD 0.87) in improving ankle joint dorsiflexion ROM. CONCLUSIONS Some evidence exists to support the efficacy of stretching alone and stretching in combination with other therapies in increasing ankle joint ROM in healthy individuals. There is a paucity of quality evidence to support the efficacy of other non-surgical interventions, thus further research in this area is warranted.
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Affiliation(s)
- Rebekah Young
- School of Clinical Sciences, Queensland University of Technology, Kelvin Grove, Brisbane QLD 4059, Australia
| | - Sheree Nix
- School of Clinical Sciences, Queensland University of Technology, Kelvin Grove, Brisbane QLD 4059, Australia
- Institute of Health and Biomedical Innovation, Queensland University of Technology, Kelvin Grove QLD 4059, Australia
| | - Aaron Wholohan
- School of Clinical Sciences, Queensland University of Technology, Kelvin Grove, Brisbane QLD 4059, Australia
| | | | - Lloyd Reed
- School of Clinical Sciences, Queensland University of Technology, Kelvin Grove, Brisbane QLD 4059, Australia
- Institute of Health and Biomedical Innovation, Queensland University of Technology, Kelvin Grove QLD 4059, Australia
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