Conservative Treatment for Metatarsus Adductus, A Systematic Review of Literature

There are various treatment approaches for the subjects with metatarsus adductus, including nonsurgical and surgical treatment. Nonsurgical treatments such as serial casting, modified shoes (Bebax shoe, Ipos antiadductus shoe) and orthoses (Wheaton brace, counter rotation system splint, Denis Brown bar, and Fillauer bar) are widely used in this regard. The main question posted here is which orthoses are more effective in correcting metatarsus adductus. Therefore, the aim of this review was to determine the efficiency of various nonsurgical treatments used for metatarsus adductus. MEDLINE/PubMed, EMBASE, Cochrane Central Register of Controlled Trial, Cochrane Data base of systematic review (CDSR), Scopus and ISI Web of knowledge (from 1960 to 2021) were searched by predefined search strategies to screen eligible randomized controlled studies meeting established criteria. The quality of the studies was assessed based on Down and Black tool. 200 studies on this topic were reviewed and finally 11 studies which met the inclusion criteria were selected for final analysis. These studies evaluated the efficiency of nonsurgical treatment options on foot angle and deformity correction in the subjects with metatarsus adductus. Quality of the papers based on Downs and Black tool varied between 13 and 23. Some treatments such as Wheaton brace, rigid strap, exercise (manipulation), reverse last shoe and plaster cast are used for these subjects. Although good correction can be achieved with use of these treatment methods, some of them have complications which should be considered in this regard. It seems that Wheaton brace and Bebax shoe have fewer complications compared to other methods.

The effect of action observation training on gait and balance of patients with neurological and musculoskeletal disorders: A systematic review

Background

Various treatment approaches are being applied for recovery of gait after different medical conditions. Action observation is a new motor learning approach, which is considered as a complementary training to the conventional rehabilitation programs such as occupational therapy for this purpose.

Objective

To find out which patients benefit more from action observation training.

Methods

Electronic databases, including Scopus, PubMed, Web of Science, Science Direct, and PEDro were searched. Prospective studies published in peer-reviewed journals with full text available in English, which investigated the effect of action observation on gait and balance of patients with neurologic or musculoskeletal disorders, were included. The methodological quality of the studies was assessed by the Downs and Black checklist, and the information was presented based on the PICO style.

Results

Nineteen studies recruiting post-orthopedic patients (4 studies), patients with stroke (11 studies), and Parkinson’s disease (4 studies) fulfilled the eligibility criteria. Quality scores ranged from 51.85% to 81.48%. Balance and walking ability were the most reported primary outcomes.

Conclusion

Patients in the chronic phase of stroke might benefit more from action observation training plus occupational therapy in different aspects of gait than orthopedic patients and those with Parkinson’s disease.

Comparison of the knee joint reaction force between individuals with and without acute anterior cruciate ligament rupture during walking

Background

Anterior cruciate ligament plays a significant role in knee joint stability. It is claimed that the incidence of knee osteoarthritis increases in individuals with anterior cruciate ligament (ACL) rupture. The aim of this study was to evaluate the knee joints reaction force in ACL rupture group compared to normal subjects.

Method

Fifteen patients with acute ACL rupture and 15 healthy subjects participated in this study. The ground reaction force (GRF) and kinematic data were collected at a sampling rate of 120 Hz during level-ground walking. Spatiotemporal parameters, joint angles, muscle forces and moments, and joint reaction force (JRF) of lower extremity were analyzed by OpenSIM software.

Results

The hip, knee and ankle joints reaction force at loading response and push-off intervals of the stance phase during walking was significantly higher in individuals with ACL rupture compared to healthy controls (p value < 0.05). Walking velocity (p value < 0.001), knee (p value = 0.065) and ankle (p value = 0.001) range of motion in the sagittal plane were significantly lower in the patients with ACL rupture compared to healthy subjects. The mean value of vertical GRF in the mid-stance, the peak of the hip adduction moment in loading response and push-off phases, the hip abductor, knee flexor and vastus intermedius part of quadriceps muscle forces were significantly higher compared to healthy subjects (p < 0.05) while vastus medialis and vastus lateralis produced significantly lower force (p < 0.001).

Conclusions

Based on results of this study, lower limb JRF was higher in those with ACL rupture compared to healthy subjects may be due to the compensatory mechanisms used by this group of subjects. An increase in knee JRF in patients with ACL rupture may be the reason for the high incidence of knee OA.

Evaluation of the Stability of the Subjects with Anterior Cruciate Injuries Reconstruction

Anterior cruciate ligament (ACL) is the most frequently injured ligament in the knee and is often injured during sport-related activities. ACL injuries influence the abilities of the subjects during standing and walking. Although early surgical intervention is preferred treatment for the majority of knee surgeons, the effect of this approach on postural stability of patients is not fully understood. Therefore, the aim of this study was to determine the difference between stability of ACL-reconstructed subjects before and after surgery. A group of 15 consecutive ACL injured patients participated in this study. Postural stability of the patients was evaluated 1 week before and 6 months after surgery (ACL reconstruction with hamstring autograft). A Kistler force plate was used to evaluate center of pressure (COP) sway during quiet standing. The mean values of the COP parameters were obtained in pre and postsurgery conditions. Paired sample t-test was used to evaluate the difference between the stability parameters of the two conditions. The significant point was set at 0.05. The mean value of path length of COP velocity in mediolateral (ML) direction was 1,485.57 ± 479.42 mm and 2,641.33 ± 996.26 mm before and after surgery, respectively (p-value = 0.01). Although the mean value of COP velocity in anteroposterior and ML directions increased after surgery, the difference was only significant for velocity in ML direction (p-value = 0.049). The results of this study showed that the standing stability of those with ACL reconstruction decreased significantly after ACL reconstruction, which may be due to the effects of the surgery on sensory mechanism of ACL and inability of patients to return to their previous deep sense perception and knee proprioception.

The effect of spinal bracing on stability in patients with adolescent idiopathic scoliosis

BACKGROUND

Adolescent idiopathic scoliosis (AIS) may change the physical orientation of body segments and affect balance in individuals. Spinal/trunk brace is commonly used for the management of idiopathic scoliosis. The aim of this study was to compare the standing stability of AIS patients with and without a brace, and to compare them with healthy subjects.

METHOD

Twenty subjects (10 healthy subjects and 10 AIS with thoracolumbar/lumbar curve) were recruited for the study. Stability of the scoliotic subjects was evaluated while standing with and without orthosis. A Kistler force plate was employed to estimate the mediolateral and anteroposterior displacements of center of pressure.

RESULTS

The results of this study indicated that there was no significant difference between center of pressure variables in healthy subjects and scoliotic patients. Moreover, trunk bracing only influenced the center of pressure (CoP) excursion in mediolateral direction (p< 0.05).

CONCLUSION

Although further research studies are needed, results showed that there was no difference between stability of scoliotic and normal subjects. Moreover, the use of orthosis did not improve their standing stability.

Evaluation of the efficiency of the Chêneau brace on scoliosis deformity : A systematic review of the literature

BACKGROUND

Scoliosis is a three-dimensional deformity of the spine and rib cage. Depending on the severity of this disease, various kinds of treatment methods have been used and bracing is among the most common. One of the braces which has been used for subjects with scoliosis is the Chêneau brace. The aim of this review was to evaluate the efficiency of the Chêneau brace on the scoliosis curve progression and control based on the available literature.

METHOD

We conducted a Medline search via PubMed, Google Scholar, ISI Web of Sciences, Ebsco and Scopus. Keywords such as Chêneau brace, Chêneau light and CAD/CAM spinal brace were used in combination with scoliosis. The quality of the studies was evaluated by the Down and Black tool.

RESULTS

Based on the aforementioned keywords, 55 papers were found. Finally based on the mentioned criteria 14 papers were selected for final analysis. The quality of the studies varied between scores of 13 and 25 using the Down and Black tool. The results of the selected studies confirmed that a good scoliotic curve correction can be achieved with the Chêneau brace.

CONCLUSION

The Chêneau brace provides a 3-dimensional correction of the spinal deformity which not only influences the progression of scoliotic curve but also influences its natural history. It cannot be concluded that the Chêneau brace is superior to other available braces; however, it has been shown that this brace is effective to control the scoliotic curve progression especially in the lumbar and thoracolumbar regions.

Balance and gait performance of scoliotic subjects: A review of the literature

INTRODUCTION

Scoliosis is one of the common spinal deformities and considered as lateral curvature of the spine. Scoliosis lead to changes in the synergy between body segments, spinal anatomy, left-right trunk symmetry and cause pathological gait pattern [1,4,5-7]. Scoliosis is a structural deformity, so it can alter center of mass (COM) position and weight distribution on lower limbs. This suggests that scoliotic patients show the poorer stability rather aged match normal group. It was controversial that scoliosis influences the balance and gait performances, and also the effects of brace on these parameters. Therefore, it was aimed to evaluate the available literatures on balance and gait of scoliotic subjects.

MATERIALS AND METHODS

We conducted a search via PubMed, Google scholar and ISI web of knowledge to identify studies on scoliosis field and the effect of this deformity on kinetic and kinematic parameters as well as the influence of bracing on mentioned parameters. Some key words such as kinetic, kinematic, gait, stability, and walking were used in combination with scoliosis. The publication dates of the full-length articles were between 1998 and 2014. Down and Black tool was used to evaluate the quality of the articles.

RESULTS

Our multiple Medline searches led to the find out 54 papers that 26 of which were relevant based on title and abstract. Based on their references, we retrieved 6 more articles. We ultimately included 31 articles in this literature review. The number of studies regarding the influence of brace on kinetic and kinematic parameters in scoliotic subject was small. Based on the results of various studies, there is no correlation between gait pathology and scoliotic curve direction, no difference between stability of scoliotic and normal subjects and no difference between range of motions of lower limb joints in scoliotic subjects while walking with and without orthosis.

CONCLUSION

There was a not sufficient robust evidence to judge about the influence of scoliosis deformity on kinetic and kinematic parameters. However, it should be emphasized that use of orthosis may influence the symmetry of gait and improve standing stability in adult with idiopathic scoliosis.

Scoliosis curve analysis with Milwaukee orthosis based on Open SIMM modeling

BACKGROUND

Scoliosis is a three-dimensional spinal deformity characterized by lateral curvature and rotational deformity of the spine. Various methods have been used to investigate the performance of the subjects during walking with an orthosis, but nobody study the biomechanics of orthotic use by understanding the length of the muscles and the force produced by them. Therefore, the aim of this research is to test the effect of the orthosis on the muscular force, tendon length during walking with and without orthosis.

MATERIALS AND METHODS

A 12-year-old scoliosis subject was recruited in this study. The forces produced by trunk musculature, joint reaction force, length of trunk musculature were some parameters selected in this study. Open SIMM and Visual 3D software were used to model the subject.

RESULTS

The results of this research showed that the length of erector spine muscles increased follow the use of orthosis. Moreover, the force produced by trunk muscles differed during walking with and without orthosis and also between right and left sides.

DISCUSSION

It seems that Open SIMM software can be used to predict the length of muscles, active-passive forces produced by muscles in scoliotic subjects. Therefore, it is recommended this research be done on more number of subjects.