The effect of botulinum toxin injection into the deep digital flexor muscle on foot biomechanics in healthy horses.

To develop and test an experimental model for in vivo short-term recording of peak isometric forces of the digital flexor muscles in the forelimb of adult horses. In vivo experimental study. Four healthy, anesthetized, adult Thoroughbred horses (3 to 7 years old; 527 +/- 87 kg) In dorsal recumbency, ulnar and median nerves were exposed and instrumented with insulated bipolar cuff stimulation electrodes for later connection to an electrical stimulator. In left lateral recumbency, a biplanar fixator was applied to the right humerus and a custom-made, rigid, aluminum frame connected to it, to allow loading of muscles distal to the fixator. Threaded transfixation pins through the radial and metacarpal condyles were clamped to the rigid frame so that the humerus, radius, ulna, and metacarpus were fixed in position. Each digital flexor muscle insertion tendon was transected just above the metacarpophalangeal joint, extracted from the carpal canal, and secured in a metal clamp positioned at the distal myotendinous (MT) junction. Distally, the clamp was connected in series to a load cell and a pneumatic actuator to record force and to maintain muscle length during nerve stimulation. A linear potentiometer was connected in parallel to the actuator to record MT junction position. Initial trials were conducted to identify median and ulnar nerve stimulation variables to achieve maximal muscle contraction. Isometric contractions were performed at different muscle lengths and peak forces registered during 3 seconds of supramaximal dual (ulnar and median) nerve stimulation. A stimulation voltage of 2.5 to 5.0 V at 50 Hz usually produced maximal force for both the superficial digital flexor (SDF) and deep digital flexor (DDF) muscles. Single ulnar and median nerve stimulation elicited force development not only in the DDF muscle but also in the SDF muscle. At voltages higher than 1 V, normalized force was greatest with combined median and ulnar nerve stimulation for both the DDF and SDF muscles; however, normalized force was greater for median nerve stimulation than ulnar nerve stimulation in the DDF muscle, and the opposite relationship was observed for the SDF muscle. Final recording of dual supramaximal nerve stimulation of SDF and DDF muscles resulted in peak isometric forces of 716 +/- 192 N and 1,577 +/- 203 N, respectively. The instrumentation technique and experimental protocol enabled recording of peak isometric forces in the SDF and DDF muscles of anesthetized adult horses. Studies using this model will improve knowledge of SDF and DDF muscle mechanics with insight to functional implications of the complex architecture of these muscles. Knowledge of the dynamic performance of the SDF and DDF muscles would also be useful for the development of new treatment strategies for flexor deformities and tendon injuries in horses.

ObjectivesTo determine the stance duration and ground reaction forces (GRF) of horses with deep digital flexor (DDF) tendinopathy at the level of the foot and compare the stance duration and GRF to those of clinically sound horses.DesignProspective clinical study.AnimalsSixteen horses (seven horses with bilateral forelimb lameness, four horses with unilateral forelimb lameness, and five horses with no lameness).ProceduresAnalyses of kinetic variables were performed on both forelimbs from sound horses and horses diagnosed with chronic DDF tendinopathy. Stance duration and longitudinal and vertical components of the GRF were determined for the limbs of clinically sound horses and limbs of horses with DDF tendinopathy. Separate Spearman correlation analyses were used to assess potential association within groups (combined left and right forelimbs of clinically sound horses, lamest limbs of horses with DDF tendinopathy, and contralateral limbs of horses with DDF tendinopathy) and with the set of kinetic variables. Analysis of variance on mean ranks of tied values was used to determine differences in kinetic variables between groups (PROC GLIMMIX) using the kinetic values of the clinically sound horses as the reference group.ResultsThere were a total of 11 lame horses. Seven horses had bilateral forelimb lameness and four had unilateral lameness. Of the 11 horses, there were 15 DDF tendinopathies. There were eight dorsal border DDF tendinopathies, five core DDF tendinopathies, and two sagittal/parasagittal splits DDF tendinopathies. The most lame limbs of horses with DDF tendinopathy had significantly smaller values for peak vertical force and time of peak braking force than did forelimbs of clinically sound horses. Also, the most lame limbs of horses with DDF tendinopathy had significantly larger values for the time of peak vertical force than did forelimbs of clinically sound horses.Conclusions and Clinical RelevanceHorses with chronic DDF tendinopathies develop certain alterations of GRF parameters. This information can be used in future studies to determine if particular kinetic variable changes in horses with DDF tendinopathies differ from those of horses with other pathologies within the foot and therefore could be diagnostic.

Mechanism of reducing knee adduction moment by shortening of the knee lever arm via medio-lateral manipulation of foot center of pressure: A pilot study

During steady-state walking, mediolateral gait stability can be maintained by controlling the center of pressure (CoP). The CoP modulates the moment of the ground reaction force, which brakes and reverses movement of the center of mass (CoM) towards the lateral border of the base of support. In addition to foot placement, ankle moments serve to control the CoP. We hypothesized that, during steady-state walking, single stance ankle moments establish a CoP shift to correct for errors in foot placement. We expected ankle muscle activity to be associated with this complementary CoP shift. During treadmill walking, full-body kinematics, ground reaction forces and electromyography were recorded in thirty healthy participants. We found a negative relationship between preceding foot placement error and CoP displacement during single stance; steps that were too medial were compensated for by a lateral CoP shift and vice versa, steps that were too lateral were compensated for by a medial CoP shift. Peroneus longus, soleus and tibialis anterior activity correlated with these CoP shifts. As such, we identified an (active) ankle strategy during steady-state walking. As expected, absolute explained CoP variance by foot placement error decreased when walking with shoes constraining ankle moments. Yet, contrary to our expectations that ankle moment control would compensate for constrained foot placement, the absolute explained CoP variance by foot placement error did not increase when foot placement was constrained. We argue that this lack of compensation reflects the interdependent nature of ankle moment and foot placement control. We suggest that single stance ankle moments do not only compensate for preceding foot placement errors, but also assist control of the subsequent foot placement. Foot placement and ankle moment control are ‘caught’ in a circular relationship, in which constraints imposed on one will also influence the other.

Researchers and clinicians have suggested that overuse injuries to the lower back and lower extremities of figure skaters may be associated with the repeated high impact forces sustained during jump landings. Our primary aim was to compare the vertical ground reaction forces (GRFs) in freestyle figure skaters (n = 26) and non-skaters (n = 18) for the same barefoot single leg landing on a force plate from a 20 cm platform. Compared with non-skaters, skaters exhibited a significantly greater normalised peak GRF (3.50 ± 0.47 × body weight for skaters vs. 3.13 ± 0.45 × body weight for non-skaters), significantly shorter time to peak GRF (81.21 ± 14.01 ms for skaters vs. 93.81 ± 16.49 ms for non-skaters), and significantly longer time to stabilisation (TTS) of the GRF (2.38 ± 0.07 s for skaters vs. 2.22 ± 0.07 s for non-skaters). Skaters also confined their centre of pressure (CoP) to a significantly smaller mediolateral (M–L) (25%) and anterior–posterior (A–P) (40%) range during the landing phase, with the position of the CoP located in the mid to forefoot region. The narrower and more forward position of the CoP in skaters may at least partially explain the greater peak GRF, shorter time to peak, and longer TTS. Training and/or equipment modification serve as potential targets to decrease peak GRF by distributing it over a longer time period. More comprehensive studies including electromyography and motion capture are needed to fully characterise the unique figure skater landing strategy.

To describe the tenoscopic anatomy of the carpal sheath of the flexor tendons (carpal sheath) viewed from a lateral approach. Tenoscopic observation of structures within the carpal sheath subsequently confirmed by dissection. 12 equine cadaveric forelimbs. The limbs were positioned lateral side up with the carpus slightly flexed. After distention of the carpal sheath, a portal for the arthroscope was made approximately 3 cm proximal to the distal radial physis and 2.5 cm caudal to the radius between the tendons of the ulnaris lateralis and lateral digital extensor muscles. A lateral tenoscopic approach was adequate to identify all structures within the carpal sheath. From proximal to distal, structures identified using this approach were the radial head of the deep digital flexor muscle, accessory ligament of the tendon of the superficial digital flexor muscle, distal radial physis, tendons of the superficial and deep digital flexor muscles, accessory carpal bone, antebrachiocarpal and middle carpal joints, and vincula of the tendon of the deep digital flexor muscle. A lateral tenoscopic approach offered an easy, repeatable entry into the carpal sheath and allowed good observation of all structures within the sheath except for the medial borders of the tendons of the deep and superficial digital flexor muscles. Applications of a lateral tenoscopic approach to the carpal sheath include diagnostic procedures, lavage and synovial resection for septic tenosynovitis, desmotomy of the accessory ligament of the tendon of the superficial digital flexor muscle for flexural deformity or tendinitis, and removal of osteochondromas from the distal radial metaphysis.

A Novel Approach to the Treatment and Prevention of Laminitis: Botulinum Toxin Type A for the Treatment of Laminitis

Background and Aims Several treatments have been recommended to enhance the running mechanics of individuals with flat feet. Less emphasis has been paid to the impact of these treatments on the ground reaction forces (GRF) and the center of pressure (COP), while these kinetic effects are essential in identifying possible injuries and the body’s compensatory mechanisms in response to any therapeutic approach. The present study aimed to compare the effects of foot orthoses and antipronation taping on COP and GRF on the running of people with flat feet. Methods The present study was quasi-experimental with a randomized cross-over design. The kinematic and kinetic data of 20 young people with flexible flat feet were measured while running under three conditions: athletic shoes, athletic shoes with foot orthoses (FO), and athletic shoes with low-Dye (LD) tape. A one-way repeated measure analysis of variance from the SPM1d package was used to compare differences in GRF and COP time series under different conditions. Results The results showed that foot orthoses reduced the anteroposterior GRF compared to low-Dye tape and increased the lateral GRF compared to athletic shoes alone. However, the conditions did not significantly affect the vertical GRF (P<0.05). Moreover, FO-shoes and LD-shoes caused medial and lateral shifts in COP, respectively (P<0.05). Conclusion This research showed that foot orthoses cause inefficient force transmission in the anterior direction. Furthermore, running with FO-shoes and LD-shoes substantially influences COP displacements towards the end of the stance phase; however, it does not appear to increase running-related injuries since minimal load and forces are applied to the joint at that time.

IntroductionOne of the causes of injury to the superficial digital flexor tendon (SDFT) is assumed to be repeated high intensity loading of the tendon. Earlier fatigue of the deep digital flexor muscle (DDFM) in comparison to the time of fatigue of the superficial digital flexor muscle (SDFM) is also assumed to increase load on the SDFT during long distance running. This study evaluated the fatigue of SDFM and DDFM with maximal exercise.MethodsTwo wire electrodes were inserted into the SDFM and DDFM of 6 Thoroughbred horses (461–557 kg). Electromyogram (EMG) and hoof strain gauge signals were recorded at 2,500 Hz with horses on an inclined treadmill (6%), and filter processing was applied (high‐pass 10 Hz for EMG and low‐pass 200 Hz for strain gauge). Integrated EMG (iEMG), the median frequency (MF) of EMG, and the stride frequency (SF) were compared using paired t‐test during 100–105% heart rate max exercise and trotting before and after maximal exercise.ResultsThe SF significantly decreased and iEMG of SDFM tended to decrease during maximal exercise (P = 0.055), while MF of EMG in SDFM and DDFM did not change. The iEMG of SDFM and DDFM significantly decreased and MF of EMG in DDFM tended to decrease at a trot after maximal exercise (P = 0.063).ConclusionsThe DDFM may fatigue earlier than SDFM during long distance running. Further study is needed to evaluate the relationship between the decrease in iEMG of SDFM and DDFM during maximal exercise and the injury to SDFT.Ethical Animal ResearchThe study was approved by the Animal Welfare and Ethics Committee of the Japan Racing Association Equine Research Institute. Sources of funding: Japan Racing Association. Competing interests: none.

Arch supports commonly used to alleviate foot pain can impede the normal drop of medial longitudinal arch (MLA) thereby altering its function. The purpose of the study was to examine the effect of using arch supports on vertical ground reaction force (GRF) and center of pressure (COP) during simulated midstance while the foot was statically loaded. Ten healthy young subjects were recruited. Two dimensional (2D) analysis of the MLA was captured for both barefoot (BF) and arch support conditions before and after loading via a custom made weight loading apparatus. The foot was loaded and positioned to simulate the midstance phase of walking. Two-dimensional reflective markers demarcated the MLA and captured with the loaded foot on a force platform. The impeded MLA drop was compared between the unloaded BF, loaded BF and loaded arch support conditions. The vertical GRF, the anterior-posterior and the medial-lateral COP displacements were also measured in response to the impeded MLA by the arch supports. The arch supports impeded the MLA drop (p<0.05) and shifted the COP toward the medial side (p<0.05), specifically for the rearfoot (calcaneal segment region), but no changes were determined for the vertical GRF (p>0.05). The impedance of MLA drop by the arch support altered the pattern of the ML COP shift in the rearfoot region. The use of arch supports may not relieve painful foot conditions that are associated with excessive calcaneal eversion indicated by altering COP shifts in localized foot regions.

We investigated co-varied changes in muscle activity during voluntary sway tasks that required a quick shift of the center of pressure (COP). We hypothesized that multi-muscle synergies (defined as task-specific covariation of elemental variables, muscle modes) stabilize a COP location in the anterior-posterior direction prior to a voluntary COP shift and that during the shift the synergies would weaken. Standing subjects performed two tasks, a cyclic COP shift over a range corresponding to 80% of the maximal amplitude of voluntary COP shift at 1 Hz and a unidirectional quick COP shift over the same nominal amplitude. The cyclic sway task was used to define muscle modes (M-modes, leg and trunk muscle groups with parallel scaling of muscle activation level within a group) and the relations between small changes in the magnitudes of M-modes [in the principal component analysis (PCA), the M-mode magnitudes are equivalent to PC scores] and COP shifts. A novel approach was used involving PCA applied to indices of muscle integrated activity measured both within a trial and across trials. The unidirectional sway task was performed in a self-paced (SP) manner and under a typical simple reaction time (RT) instruction. M-modes were also defined along trials at those tasks; they have been shown to be similar across tasks. Integrated indices of muscle activity in the SP-sway and RT-sway tasks were transformed into the M-modes. Variance in the M-mode space was partitioned into two components, one that did not affect the average value of COP shift (V (UCM)) and the other that did (V (ORT)). An index (DeltaV) corresponding to the normalized difference between V (UCM) and V (ORT) was computed. During steady-state posture, DeltaV was positive corresponding to most M-mode variance lying in a sub-space corresponding to a stable COP location across trials. Positive DeltaV values have been interpreted as reflecting a multi-M-mode synergy stabilizing the COP location. The magnitude of DeltaV was larger in SP trials than in RT trials. During voluntary COP shifts, the DeltaV magnitude dropped to zero or even became negative. We conclude that M-mode synergies stabilize COP location during quiet standing, while these synergies weaken or disappear during fast voluntary COP shifts. Under RT conditions, the COP stabilizing synergies were weaker supposedly to facilitate a quick COP shift without time for preparation. The suggested method of M-mode identification may potentially be applied to analysis of postural synergies in persons with impaired postural control such as elderly persons, persons with atypical development, or in the course of rehabilitation after an injury.

To provide a quantitative description of the architecture of superficial digital flexor (SDF) and deep digital flexor (DDF) muscles in adult horses to predict muscle-tendon behavior and estimate muscle forces. 7 forelimb specimens from 7 adult Thoroughbreds. Muscle and tendon lengths and volumes were measured from 6 fixed forelimbs. After processing, fiber bundle and sarcomere lengths were measured. Optimal fascicle lengths and muscle length-to-fascicle length, muscle length-to-free tendon length, and fascicle length-to-tendon length ratios were calculated, as were tendon and muscle physiologic cross-sectional areas (PCSAs). Pennation angles were measured in 1 embalmed specimen. The SDF optimal fascicle lengths were uniformly short (mean +/- SD, 0.8 +/- 0.1 cm), whereas DDF lengths ranged from 0.9 +/- 0.2 cm to 10.8 +/- 1.6 cm. The DDF humeral head had 3 architectural subunits, each receiving a separate median nerve branch, suggestive of neuromuscular compartmentalization. Pennation angles were small (10 degrees to 25 degrees). The PCSAs of the SDF and DDF muscle were 234 +/- 51 cm2 and 259 +/- 30 cm2, with estimated forces of 4,982 +/- 1148 N and 5,520 +/- 544 N, respectively. The SDF muscle appears to provide strong tendinous support with little muscle fascicular shortening and fatigue-resistance properties. The DDF muscle combines passive and dynamic functions with larger tension development and higher shortening velocities during digital motion. Architectural parameters are useful for estimation of forces and have implications for analysis of muscle-tendon function, surgical procedures involving muscle-tendon lengthening, and biomechanical modeling.

Passive and active mechanical properties of the superficial and deep digital flexor muscles in the forelimbs of anesthetized Thoroughbred horses

Modulation of anticipatory postural adjustments using a powered ankle orthosis in people with Parkinson’s disease and freezing of gait

Movements by a standing person are commonly associated with adjustments in the activity of postural muscles to cause a desired shift of the center of pressure (COP) and keep balance. We hypothesize that such COP shifts are controlled (stabilized) using a small set of central variables (muscle modes, M-modes), while each M-mode induces changes in the activity of a subgroup of postural muscles. The main purpose of this study has been to explore the possibility of identification of muscle synergies in a postural task using the framework of the uncontrolled manifold (UCM) hypothesis employing the following three steps in data analysis: (i) Identification of M-modes: Subjects were asked to release a load from extended arms through a pulley system, resulting in a COP shift forward prior to load release. Electromyographic (EMG) activity of eleven postural muscles on one side of the body was integrated over a 100 ms interval corresponding to the early stage of the COP shift, and subjected to a principal component (PC) analysis across multiple repetitions of each task. Three PCs were identified and associated with a 'push-back M-mode', a 'push-forward M-mode' and a 'mixed M-mode'. (ii) Calculation of the Jacobian of the system, which relates changes in the magnitude of M-modes to COP shifts using regression techniques: Subjects performed three different tasks (releasing different loads at the back, voluntarily shifting body weight forward and backward, at different speeds) to verify if the relationship between magnitudes of M-modes and COP shifts is task or direction specific. (iii) UCM analysis: Three tasks were chosen (load release in the front, arm movement forward and backward) which were associated with an early shift in COP. A manifold was identified in the M-mode space corresponding to a certain average (across trials) shift of the COP and variance per degree of freedom within the UCM (V(UCM)) and orthogonal (V(ORT)) to the UCM was computed. Across subjects, V(UCM) was significantly higher than V(ORT) when analysis at the third step was performed using a Jacobian computed based on a set of tasks associated with a COP shift in the same direction but not in the opposite direction. This result confirms our hypothesis that the M-modes work together as a synergy to stabilize a desired shift of the COP. Forward and backward COP shifts are associated with different synergies based on the same three M-modes.