Vibration perception among children and adolescents with Charcot-Marie-tooth disease and implications for foot posture

BACKGROUND

Alterations in vibration perception among children and adolescents with Charcot-Marie-Tooth disease might explain observed changes in foot posture. Therefore, this cross-sectional study compared the vibration perception of the lower limbs in youths with and without Charcot-Marie-Tooth disease and verified the cut-off value of the distal vibration perception for the Charcot-Marie-Tooth group. In addition, associations between dynamic plantar pressure, vibration perception and isometric muscle strength were investigated.

METHODS

Participants aged 9-18 (Charcot-Marie-Tooth group n = 32; Typical group n = 32) had vibration perception measured by a 128-Hz graduated tuning fork. The static and dynamic foot posture were evaluated by the Foot Posture Index and pressure distribution measuring system, respectively. For the Charcot-Marie-Tooth group, a hand-held dynamometer evaluated the isometric muscle strength of the lower limbs.

FINDINGS

Children with Charcot-Marie-Tooth disease presented impaired vibration perception at the distal phalanx of the hallux and head of the first metatarsal compared to their typically developing peers, while adolescents with Charcot-Marie-Tooth disease showed impairment in all the tested regions compared to their typically developing peers. The cut-off value for vibration perception for participants with Charcot-Marie-Tooth disease was 5.7, considering the original grade of the tuning-fork 128 Hz. Among the associations established for the Charcot-Marie-Tooth group, a greater vibration perception at the distal phalanx of the hallux was associated with a longer rearfoot contact time (β = 31.02, p = 0.04).

INTERPRETATION

These new findings may guide the clinical evaluation and rehabilitation treatment for children and adolescents with Charcot-Marie-Tooth disease.

Footwear and Foam Surface Alter Gait Initiation of Typical Subjects

Gait initiation is the task commonly used to investigate the anticipatory postural adjustments necessary to begin a new gait cycle from the standing position. In this study, we analyzed whether and how foot-floor interface characteristics influence the gait initiation process. For this purpose, 25 undergraduate students were evaluated while performing a gait initiation task in three experimental conditions: barefoot on a hard surface (barefoot condition), barefoot on a soft surface (foam condition), and shod on a hard surface (shod condition). Two force plates were used to acquire ground reaction forces and moments for each foot separately. A statistical parametric mapping (SPM) analysis was performed in COP time series. We compared the anterior-posterior (AP) and medial-lateral (ML) resultant center of pressure (COP) paths and average velocities, the force peaks under the right and left foot, and the COP integral x force impulse for three different phases: the anticipatory postural adjustment (APA) phase (Phase 1), the swing-foot unloading phase (Phase 2), and the support-foot unloading phase (Phase 3). In Phase 1, significantly smaller ML COP paths and velocities were found for the shod condition compared to the barefoot and foam conditions. Significantly smaller ML COP paths were also found in Phase 2 for the shod condition compared to the barefoot and foam conditions. In Phase 3, increased AP COP velocities were found for the shod condition compared to the barefoot and foam conditions. SPM analysis revealed significant differences for vector COP time series in the shod condition compared to the barefoot and foam conditions. The foam condition limited the impulse-generating capacity of COP shift and produced smaller ML force peaks, resulting in limitations to body-weight transfer from the swing to the support foot. The results suggest that footwear and a soft surface affect COP and impose certain features of gait initiation, especially in the ML direction of Phase 1.

Clinical rearfoot and knee static alignment measurements are not associated with patellofemoral pain syndrome

The aim of the present study was to investigate the association between the patellofemoral pain syndrome and the clinical static measurements: the rearfoot and the Q angles. The design was a cross-sectional, observational, case-control study. We evaluated 77 adults (both genders), 30 participants with patellofemoral pain syndrome, and 47 controls. We measured the rearfoot and Q angles by photogrammetry. Independent t-tests were used to compare outcome continuous measures between groups. Outcome continuous data were also transformed into categorical clinical classifications, in order to verify their statistical association with the dysfunction, and χ2 tests for multiple responses were used. There were no differences between groups for rearfoot angle [mean differences: 0.2º (95%CI -1.4-1.8)] and Q angle [mean differences: -0.3º (95%CI -3.0-2.4). No associations were found between increased rearfoot valgus [Odds Ratio: 1.29 (95%CI 0.51-3.25)], as well as increased Q angle [Odds Ratio: 0.77 (95%CI 0.31-1.93)] and the patellofemoral pain syndrome occurrence. Although widely used in clinical practice and theoretically thought, it cannot be affirmed that increased rearfoot valgus and increased Q angle, when statically measured in relaxed stance, are associated with patellofemoral pain syndrome (PFPS). These measures may have limited applicability in screening of the PFPS development.

Changes in the plantar pressure distribution during gait throughout gestation

BACKGROUND

The intention of this investigation was to longitudinally describe and compare the plantar pressure distribution in orthostatic posture and gait throughout pregnancy.

METHODS

A prospective longitudinal observational study was conducted with six pregnant women (mean ± SD age, 32 ± 3 years) with a mean ± SD weight gain of 10.0 ± 1.4 kg. Peak pressure, contact time, contact area, and maximum force in five plantar areas were evaluated using capacitive insoles during gait and orthostatic posture. For 1 year, the plantar pressures of pregnant women were evaluated the last month of each trimester. Comparisons among plantar areas and trimesters were made by analysis of variance.

RESULTS

For orthostatic posture, no differences in contact time, contact area, peak pressure, and maximum force throughout the trimesters were found. During gait, peak pressure and maximum force of the medial rearfoot were reduced from the first to third and second to third trimesters. Maximum force increased at the medial forefoot from the first to second trimester. Contact area increased at the lateral rearfoot from the second to third trimester and at the midfoot from the first to third trimester. Contact time increased at the midfoot and medial and lateral forefoot from the first to third trimester.

CONCLUSIONS

Pregnant women do not alter plantar pressure during orthostatic posture, but, during gait, the plantar loads were redistributed from the rearfoot (decrease) to the midfoot and forefoot (increase) throughout pregnancy. These adjustments help maintain the dynamic stability of the pregnant woman during locomotion.

Rearfoot alignment and medial longitudinal arch configurations of runners with symptoms and histories of plantar fasciitis

OBJECTIVE

To evaluate and compare rearfoot alignment and medial longitudinal arch index during static postures in runners, with and without symptoms and histories of plantar fasciitis (PF).

INTRODUCTION

PF is the third most common injury in runners but, so far, its etiology remains unclear. In the literature, rearfoot misalignment and conformations of the longitudinal plantar arch have been described as risk factors for the development of PF. However, in most of the investigated literature, the results are still controversial, mainly regarding athletic individuals and the effects of pain associated with these injuries.

METHODS

Forty-five runners with plantar fasciitis (30 symptomatic and 15 with previous histories of injuries) and 60 controls were evaluated. Pain was assessed by a visual analogue scale. The assessment of rearfoot alignment and the calculations of the arch index were performed by digital photographic images.

RESULTS

There were observed similarities between the three groups regarding the misalignments of the rearfoot valgus. The medial longitudinal arches were more elevated in the group with symptoms and histories of PF, compared to the control runners.

CONCLUSIONS

Runners with symptoms or histories of PF did not differ in rearfoot valgus misalignments, but showed increases in the longitudinal plantar arch during bipedal static stance, regardless of the presence of pain symptoms.

Alteração do arco longitudinal medial na neuropatia periférica diabética

OBJETIVO: Descrever e comparar as características antropométricas dos pés de sujeitos saudáveis e diabéticos neuropatas por meio de índices classificatórios do Arco Longitudinal Medial (ALM): Índice do Arco (IA), Índice de Chippaux-Cmirak (CSI) e Ângulo  (Â) e comparar a classificação destes métodos nestes grupos. MATERIAIS E MÉTODO: Grupo controle (GC) composto por 21 sujeitos saudáveis, e grupo diabético (GD), formado por 46 diabéticos portadores de neuropatia diabética. Pela impressão plantar foram calculados os índices. RESULTADOS: Houve maior proporção de pés planos no GD para os três índices (IA: 32,2%, CSI: 59,7%, A: 17,5%), enquanto os pés cavos comportaram-se de forma contrária. Os grupos foram estatisticamente diferentes em relação à proporção de pés planos no IA (p=0,0080) e no CSI (p=0,0000) e de pés cavos no  (p=0,0036). Houve diferença significativa quando comparados GC e GD para os três índices: IA (p=0,0027), CSI (p=0,0064),  (p=0,0296). CONCLUSÃO: Os dados demonstram alterações motoras e ortopédicas decorrentes da neuropatia periférica, responsável pela desestruturação do pé, levando ao desabamento do ALM. Observou-se que o ângulo A destoou fortemente da classificação do arco feita pelos outros dois índices, e com isso destacamos que sua utilização merece cuidado.

Global body posture evaluation in patients with temporomandibular joint disorder

AIM

To identify the relationship between anterior disc displacement and global posture (plantar arches, lower limbs, shoulder and pelvic girdle, vertebral spine, head and mandibles). Common signs and symptoms of anterior disc displacement were also identified.

INTRODUCTION

Global posture deviations cause body adaptation and realignment, which may interfere with the organization and function of the temporomandibular joint.

METHODS

Global posture evaluation was performed in a group of 10 female patients (20 to 30 years of age) with temporomandibular joint disc displacement and in a control group of 16 healthy female volunteers matched for age, weight and height. Anterior disc displacement signs, symptoms and the presence of parafunctional habits were also identified through interview.

RESULTS

Patients with disc displacement showed a higher incidence of pain in the temporomandibular joint area, but there were no differences in parafunctional habits between the groups. In the disc displacement group, postural deviations were found in the pelvis (posterior rotation), lumbar spine (hyperlordosis), thoracic spine (rectification), head (deviation to the right) and mandibles (deviation to the left with open mouth). There were no differences in the longitudinal plantar arches between the groups.

CONCLUSION

Our results suggest a close relationship between body posture and temporomandibular disorder, though it is not possible to determine whether postural deviations are the cause or the result of the disorder. Hence, postural evaluation could be an important component in the overall approach to providing accurate prevention and treatment in the management of patients with temporomandibular disorder.

Mudanças no padrão temporal da EMG de músculos do tornozelo e pé pré e pós-aterrissagem em jogadores de voleibol com instabilidade funcional

INTRODUÇÃO: A instabilidade funcional (IF) é a complicação mais comum após o entorse de tornozelo; acomete até 52% dos atletas com história de entorse. O entorse de tornozelo é uma das lesões esportivas mais comuns, inclusive no voleibol, em que 90% dos entorses de tornozelo ocorrem durante a aterrissagem, após o movimento de bloqueio. A IF é definida por queixas de falseios e entorses recorrentes, sem que haja evidências clínicas de lesão ligamentar, sendo extremamente prejudicial para a prática do voleibol, pois interfere na realização dos fundamentos envolvidos na modalidade. OBJETIVOS: Comparar os padrões temporais e de magnitude da atividade eletromiográfica dos músculos tibial anterior (TA), fibular longo (FL) e gastrocnêmio lateral (GL) durante a aterrissagem do salto vertical após a execução da habilidade do bloqueio do voleibol entre jogadores com e sem IF de tornozelo. MÉTODOS: Foi adquirida a atividade EMG do tibial anterior, do fibular longo e do gastrocnêmio lateral em 21 atletas com IF (GI) e em 19 atletas controle (GC) - idade média de 20 ± 4 anos. Os envoltórios lineares foram calculados para cada um dos grupos no período de tempo entre 200ms antes e 200ms após o instante do impacto, determinados por meio da componente vertical da FRS. A magnitude e o instante do pico máximo de cada um dos músculos também foram determinados matematicamente. Os grupos foram comparados por meio do teste t (α = 0,05). RESULTADOS: O grupo com instabilidade apresentou instante de pico do TA mais tardio ± (GC = -107,4 ± 29,6ms; GI = -134,0 ± 26,0ms) e FL (GC = -11,0 ± 55,9ms; GI = -41,7 ± 49,8ms) e menor pico de TA (GC = 68,5 ± 17,2%; GI = 81,2 ± 28,8%) e FL (GC = 72,9 ± 27,3%; GI = 59,1 ± 16,0%), CONCLUSÕES: Os resultados mostram um padrão de alteração mais tardio e com menor magnitude nos músculos de atletas com IF que podem predispô-los à condição de instabilidade, mesmo na ausência de lesão anatômica.

Fisioterapia em pacientes com síndrome fêmoro-patelar: comparação de exercícios em cadeia cinética aberta e fechada

Este estudo teve como objetivo comparar a eficácia do fortalecimento muscular na recuperação funcional da síndrome fêmoro-patelar (SFP). Foram selecionadas 20 mulheres com SFP divididas em dois grupos: o Grupo 1 (G1) realizou fortalecimento do músculo quadríceps femoral em cadeia cinética aberta (CCA) e o Grupo 2 (G2) em cadeia cinética fechada (CCF), durante oito semanas com freqüência de duas vezes semanais. Foi avaliada a dor, capacidade funcional, flexibilidade, encurtamento dos músculos isquiotibiais, ângulo Q e eletromiografia (EMG) dos músculos vasto medial (VM) e vasto lateral (VL) durante extensão isométrica da perna. Antes e após o tratamento, as variáveis foram analisadas pelo teste de Wilcoxon, e entre os grupos pelo teste t para amostras independentes ou Anova de Friedman ou Manova (a<0,05). Após o tratamento, os resultados mostram que houve melhora da capacidade funcional, encurtamento dos músculos isquiotibiais e flexibilidade. Porém, somente o G1 apresentou diminuição da intensidade da dor e aumento da atividade EMG do músculo VL, enquanto ambos não modificaram o ângulo Q. Os dados sugerem que os tratamentos baseados no fortalecimento do músculo quadríceps femoral possibilitaram melhoras importantes nos principais sinais e sintomas apresentados pelas pacientes, não havendo diferenças evidentes entre os realizados em CCA e CCF.

Desigualdade estrutural discreta de membros inferiores é suficiente para causar alteração cinética na marcha de corredores?

Desigualdade de membros inferiores (DMI) está presente em cerca de 70% da população geral, podendo ser do tipo estrutural onde existe diferença no comprimento de estruturas ósseas, ou funcional, como resultado de alterações mecânicas dos membros inferiores. A desigualdade pode ainda ser classificada quanto a sua magnitude, sendo discreta, moderada, ou grave. As desigualdades discretas têm sido associadas especificamente à fratura por estresse, dor lombar e osteoartrite, e quando uma desigualdade está presente em indivíduos cuja sobrecarga mecânica é acentuada pela sua prática profissional, diária ou recreativa, estas alterações ortopédicas podem se manifestar precoce e gravemente. O objetivo deste estudo foi analisar e comparar a força reação do solo (FRS) durante a marcha de corredores com e sem DMI discreta. Os resultados mostraram que os sujeitos com desigualdades de 0,5 a 2,0 cm apresentaram no membro menor maiores valores da força vertical mínima (0,57 ± 0,07 PC) em relação ao membro maior (0,56 ± 0,08 PC). Logo, sujeitos com DMI discreta adotam mecanismos compensatórios capazes de gerar sobrecarga adicional ao sistema musculoesquelético para promover uma marcha simétrica como demonstrado pelos valores do Índice de Simetria Absoluto das variáveis da FRS vertical e horizontal.

Mecanismos de ativação agonista e antagonista no joelho de indivíduos com reconstrução de ligamento cruzado anterior: estudo cinético e eletromiográfico

OBJETIVO: Avaliar e comparar o torque e a atividade eletromiográfica dos músculos vasto lateral e bíceps femoral durante a extensão e a flexão do joelho em cadeia cinética aberta. MÉTODO: 15 sujeitos do sexo masculino, distribuídos em: cinco no Grupo Teste (GT) (32,2 ± 7,1 anos) com reconstrução do ligamento cruzado anterior via artroscópica (tendão patelar), e dez no Grupo Controle (GC) sem lesão (30,1 ± 10,7 anos). Foi utilizado o Cybex 6000 a 100°.s-1 e eletrodos bipolares diferenciais ativos (Delsys-Bagnoli 8), com a freqüência de amostragem de 1000 Hz e tempo de aquisição de 10 segundos. Foram considerados os valores do Root Mean Square (RMS) e o padrão temporal de ativação dos músculos em função da fase do movimento (envoltório linear). RESULTADOS: O lado lesado apresentou maior pico de torque flexor e menor pico de torque extensor. Maior ativação agonista e menor ativação antagonista para o bíceps femoral e menor ativação agonista para o vasto lateral. Pelo envoltório linear a ativação do vasto lateral no grupo teste foi diminuindo. CONCLUSÃO: Apesar de reabilitados, o membro lesado permaneceu com déficits no torque extensor, apresentando menor, mais precoce e decrescente ativação do músculo vasto lateral e menor ativação antagonista do músculo bíceps femoral, apesar do maior torque flexor e da maior ativação de unidades motoras durante a flexão do joelho. Estes déficits podem explicar algumas queixas clínicas que permaneceram nestes indivíduos.

Ground reaction force in basketball cutting maneuvers with and without ankle bracing and taping

CONTEXT AND OBJECTIVE

In basketball, the most common injuries are ankle sprains. For this reason, players frequently use external ankle devices or taping as prophylactic and rehabilitation measures. The purpose of this study was to evaluate ground reaction force (GRF) responses in basketball players while performing typical cutting maneuvers with and without ankle bracing and ankle taping.

DESIGN AND SETTING

Comparative study with experimental design of single-group repeated measurements, at Medical Rehabilitation Division, Hospital das Clínicas, Faculdade de Medicina, Universidade de São Paulo.

METHODS

Vertical (Fy) and medial-lateral (Fz) GRF measurements were made under three conditions (taping, Aircast-type orthosis and basketball shoes alone), with analysis of peak forces at foot contact (Fymax1, Fzmax1, Fymax2 and Fzmax2), growth gradient (peak/time) (GG Fymax1, GG Fzmax1, GG Fymax2 and GG Fzmax2) and impulse after foot contact.

RESULTS

Bracing significantly reduced Fymax2 and GG Fymax2. GG Fzmax1 was significantly higher for the sport shoe condition than for the taping condition. Taping increased Fy in relation to the sport shoe at foot contact, but over a longer time interval, without increasing excessive ankle loading. Fz reached a peak in less time, which might generate greater inversion/eversion loading on a player's foot. The Aircast exerted better shock-absorbing effect than did the other two conditions, since it generated less vertical force over longer time intervals and smaller medial-lateral forces in relation to taping.

CONCLUSIONS

Ankle bracing and ankle taping action mechanisms are still unclear and therefore should be carefully prescribed. More studies are needed to clarify taping and bracing effects on sporting activities.

Implementing a clinical assessment protocol for sensory and skeletal function in diabetic neuropathy patients at a university hospital in Brazil

CONTEXT AND OBJECTIVE

Physiotherapy can contribute towards recovering or preventing physical and sensory alterations in diabetic neuropathy patients. Our objective was to create and apply a protocol for functional assessment of diabetic neuropathy patients' lower limbs, to guide future physiotherapy.

DESIGN AND SETTING

Clinical study at the University Hospital and teaching/research center of Universidade de São Paulo.

METHODS

An intentional sample of diabetic neuropathy patients was utilized. The protocol was divided into: (1) preliminary investigation with identification of relevant clinical diabetes and neuropathy characteristics; (2) thermal, tactile and proprioceptive sensitivity tests on the feet; (3) evaluations of muscle function, range of motion, lower limb function, foot anthropometry.

RESULTS

The patients' mean age was 57 years, and they had had the diagnosis for 13 years on average. Distal numbness and tingling/prickling were present in 62% and 67%, respectively. There were tactile sensitivity alterations above the heel in 50%, with thermal sensitivity in 40% to 60%. The worst muscle function test responses were at the triceps surae and foot intrinsic muscles. Longitudinal plantar arches were lowered in 50%. Decreased thermal and tactile sensitivity of the heels was found. There was a general reduction in range of motion.

CONCLUSIONS

The results provided detailed characterization of the patients. This protocol may be easily applied in healthcare services, since it requires little equipment, at low cost, and it is well understood by patients.