Relationship Between Weightbearing Ankle Dorsiflexion Passive Range of Motion and Ankle Kinematics During Gait

Clinical and biomechanical characteristics of responders and non-responders to insoles in individuals with excessive foot pronation during walking

This study aimed to identify the clinical and biomechanical factors of subjects with excessive foot pronation who are not responsive (i.e., "non-responders") to medially wedged insoles to increase knee adduction external moment. Ankle dorsiflexion range of motion, forefoot-shank alignment, passive hip stiffness, and midfoot passive resistance of 25 adults with excessive bilateral pronation were measured. Also, lower-limb angles and external moments were computed during walking with the participants using control (flat surface) and intervention insoles (arch support and 6° medial heel wedge). A comparison between "responders" (n = 34) and "non-responders" (n = 11) was conducted using discrete and continuous analyses. Compared with the responders, the non-responders had smaller forefoot varus (p = 0.014), larger midfoot passive internal torque peak (p = 0.005), and stiffness measured by the torsimeter (p = 0.022). During walking, non-responders had lower angle peaks for forefoot eversion (p = 0.001), external forefoot rotation (p = 0.037), rearfoot eversion (p = 0.022), knee adduction (p = 0.045), and external hip rotation (p = 0.022) and higher hip internal rotation angle peak (p = 0.026). Participants with small forefoot varus alignment, large midfoot passive internal torque, stiffness, small knee valgus, hip rotated internally, and foot-toed-in during walking did not modify the external knee adduction moment ("non-responders"). Clinicians are advised to interpret these findings with caution when considering the prescription of insoles. Further investigation is warranted to fully comprehend the response to insole interventions among individuals with specific pathologies, such as patellofemoral pain and knee osteoarthritis (OA).

Osteochondral autograft transplantation in the treatment of AO/OTA type C3 tibial plafond fractures with irreducibly comminuted area and/or cartilage delamination in the distal tibial facet

INTRODUCTION

Tibial plafond fractures, especially the AO/OTA type C3 ones that take place in young patients with excessive facet fragmentation and cartilage loss that preclude anatomical reduction and effective internal fixation, are devastating situations that often subject to primary arthrodesis. The aim of the current study is to introduce a joint preserving technique by using osteochondral autograft to treat such difficult cases and to evaluate its short-term outcome.

METHODS

A total of 11 patients suffering AO-OTA type C3 tibial plafond fractures with irreparable area treated with osteochondral autograft and ORIF, with an average follow-up period of 34 months, were analyzed. Visual analogue scale (VAS), short-form 36 (SF-36), American Orthopaedic Foot and Ankle Society (AOFAS) ankle-hindfoot score, and ankle range of motion (ROM) were assessed for functional outcome evaluation. The weight-bearing AP and lateral radiograph, as well as CT reconstructive images were examined to evaluate bony union and the occurrence of post-traumatic arthritis.

RESULTS

At the final follow-up, the mean VAS scale was 2.2. The mean AOFAS and SF-36 scores were 86.3 and 84.5 respectively. Among all the included patients, 8 achieved both AOFAS and SF-36 scores above 80. The average ankle range of motion was 29.9°. No infection, compartment syndrome, post-traumatic arthrosis or donor site pain was noted in the current study. No patient received secondary ankle arthrodesis at the end of the follow-up.

CONCLUSIONS

Although primary ankle arthrodesis is an effective method, routine ankle arthrodesis should be carried out with second thoughts in patients, especially patients with relatively young age, suffering AO-OTA type C3 tibial plafond fractures with irreducible area. On the other hand, osteochondral autograft transplantation may provide a chance to relieve pain without sacrificing the joint.

Exercise as Medicine for Older Women

Exercise is associated with protective effects, yet most adult women in this country do not meet the physical activity recommendations set forth in the Physical Activity Guidelines for Americans. This article discusses how exercise affects disease and prevents functional decline. It also clarifies why exercise is not a generic cure-all but is instead a tool physicians can use with precision to affect a myriad of health issues. Specifics will be provided regarding physical fitness assessments and comprehensive treatments and how physicians can be more involved in using physical fitness to keep their older female patients healthy.

Peroneus Brevis flap in Achilles tendon reconstruction. Clinical, radiological and functional analysis

BACKGROUND

We would like to describe our experience with Peroneus Brevis flap in complicated Achilles tendon re-ruptures with fringed stumps.

METHODS

Eight patients with monolateral re-rupture of Achilles tendon were selected as eligible for surgical repair with Peroneus Brevis flap. Patients' outcome was evaluated clinically (ATRS and ROM), functionally (Gait analysis) and MRI was performed before and after surgery.

RESULTS

Effective coverage of tissue defect was reached in all patients. Functional assessment evaluation results were registered in a follow-up time that ranged from 12 to 18 months. ATRS and ROM tests' results showed good functional recovery without functional limitations or subjective reports pain. Post-operative MRI showed no signs of inflammation or tissue gaps. Gait analysis showed a partial reduction of performance in the affected side that did not affect patients' quality of life.

CONCLUSIONS

In the presence of fringed stumps in Achilles tendon re-rupture, tendon flaps have the benefits of autologous tissues transfers and present less risks of failure than free flaps. Among them, Peroneus Brevis flap is easy to perform and leads to donor site's low morbidity. Our preliminary experience provides support for this technique to be potentially validated in larger more controlled trial.

The iPhone Measure app level function as a measuring device for the weight bearing lunge test in adults: a reliability study

Background

Ankle joint range of motion is a frequently assessed measure used by health care clinicians who manage lower limb pathologies to identify ankle equinus and/or other joint motion concerns that may negatively impact on function. The purpose of this study was to assess a new iPhone application (the level function of the 'Measure application'), for measuring the weightbearing ankle lunge test in a healthy adult population (reliability) and measuring known angles (validity) when compared to a digital inclinometer.

Methods

To determine intra-rater reliability, inter-rater reliability and concurrent validity, 168 measures were conducted on 21 participants. Participants were preconditioned prior to assessment, and two experienced raters measured ankle dorsiflexion range of motion in the knee extended and knee flexed positions of the weight bearing lunge test, using an iPhone level function (of the Measure application) and a digital inclinometer in a randomised order, over two timepoints. Concurrent validity was also determined by comparison of measures of the two devices at known surface angles (0 and 15 degrees) in multiple planes. Reliability and validity were determined with intraclass correlation coefficients, concurrent validity was explored with the Bland Altman plot and an intraclass correlation coefficient. The Standard Error of the Mean and the minimal detectable change were also explored.

Results

The intra-rater reliability using the iPhone and inter-rater reliability using the digital inclinometer, in the knee extended position, were ICC 0.85 respectively, indicating good reliability. All other intra-rater reliability and inter-rater reliability for both devices and both leg positions were over ICC 0.90, indicating excellent reliability. Concurrent validity between the two devices on a flat and known angle surface were ICC 1.0 (Limits of Agreement - 1.0 to 0.61), indicating excellent validity, with good validity demonstrated by a Bland Altman plot of all measures in all positions (ICC of 0.84 (Limits of agreement = - 4.51 to 6.49)).

Conclusion

The use of the iPhone level measure, within the Measurement App has demonstrated to be an easy and reliable measurement tool to determine ankle joint dorsiflexion during the weightbearing lunge test in healthy adults.

Efficacy of instrument-assisted soft tissue mobilization in comparison to gastrocnemius-soleus stretching for dorsiflexion range of motion: A randomized controlled trial

OBJECTIVES

To determine the efficacy of IASTM of the gastrocnemius-soleus complex in comparison to a traditional stretching intervention on dorsiflexion ROM.

METHODS

Sixty healthy participants were randomly allocated to one of 3 groups: IASTM (n = 20), stretching (n = 20), or control group (n = 20). The dependent variables for this study was dorsiflexion range of motion (ROM) via three measurement methods which included Modified root position 1- knee extended (MRP1), Modified root position 2- knee flexed (MRP2), and weight bearing lunge test (WBLT). A multivariate analysis of variance (MANOVA) was utilized to analyze the ROM differences between the groups (IASTM, stretching, and control groups), with a post-hoc Tukey and pairwise least significant difference tests to assess individual pairwise differences between the groups.

RESULTS

The MANOVA found significant ROM differences between the three intervention groups (F_6,110 = 2.40, p = .032). Statistically significant differences were identified between both the IASTM and control as well as the stretching and control group through the WBLT and MRP2 assessments, but not in the MRP1 assessment. Further, there was no statistically significant difference between the IASTM and stretching groups using any of the three methods.

CONCLUSION

A single session of IASTM or stretching increased ankle dorsiflexion ROM in WBLT and MRP2. No significant difference was noted in the MRP1. Both IASTM and stretching appear to have a greater effect on soleus muscle flexibility as evidenced by ROM gains measured with the knee in a flexed position. No clinically significant difference was identified between the intervention groups in weight-bearing conditions; thus empowering patients with the use of self-stretching would seemingly be reasonable and efficient. Combined effects of stretching and IASTM warrant further investigation for increasing dorsiflexion range of motion as a summative effect is unknown.

Influence of ankle dorsiflexion range of motion on heel-rise time during gait

[Purpose] The purpose of this study was to examine the correlation between weight-bearing (WB) and non-WB ankle dorsiflexion (DF) range of motion (ROM) and ankle movement during gait, including heel-rise time and ankle DF at heel-rise. [Subjects and Methods] Thirty healthy male subjects were recruited for this study. Ankle DF ROM of both feet was measured under the WB and non-WB conditions. Heel-rise time and ankle DF at heel-rise in both feet during gait were measured using a motion analysis system. Pearson product moment correlations were used to identify correlation ankle DF ROM and ankle movement during gait. [Results] Heel-rise time and ankle DF at heel rise were significantly correlated with WB ankle DF ROM. However, no correlations were found between ankle movement during gait and non-WB ankle DF ROM. [Conclusion] These findings demonstrate that WB ankle DF ROM measurements can be used to predict heel-rise time and ankle DF at heel-rise.