Ankle Dorsiflexion Strength Research Articles

Gastrocnemius electrical stimulation increases ankle dorsiflexion strength in patients with post-acute sequelae of SARS-COV-2 (PASC): a double-blind randomized controlled trial

Post-Acute sequelae of SARS-CoV-2 (PASC) is a multisystem disorder causing persistent musculoskeletal deconditioning and reduced lower extremity strength. Electrical stimulation (E-Stim) to the gastrocnemius muscle can enhance strength outcomes by increasing the frequency of muscle fiber activation. We investigated its effect on individuals with PASC. Participants were randomized into intervention (IG) or control (CG) groups. The IG self-administered daily one-hour E-Stim to both their gastrocnemius muscles using a functional device over 4-week, while the CG used a sham device. Primary outcomes were ankle dorsiflexion strength assessed via dynamometry during maximum voluntary contractions, and gastrocnemius voluntary activation (GVA) via surface electromyography. The secondary outcome assessed activities of daily living (ADL), instrumental ADL, and mobility queries. Percentage improvement was calculated. Eighteen patients were analyzed (IG = 10; CG = 8). After 4 week, the IG showed a significantly higher improvement in ankle dorsiflexion strength (222.64%) compared to the CG (51.27%, p = 0.002). Additionally, the IG’s ankle dorsiflexion strength improvement significantly correlated with GVA improvement (rho = 0.782) at 4 week. The secondary outcomes did not reveal significant changes in neither group. Self-administered gastrocnemius E-Stim improves ankle dorsiflexion strength in individuals with PASC. However, larger sample sizes and longer interventions are needed to validate these findings.

Effects of ankle isokinetic training on muscle strength and balance amongst older women with mild Parkinson's disease: A randomised trial.

Patients with Parkinson's disease frequently experience problems with balance and gait. This study examined the influences of regular ankle isokinetic muscle strength training on muscle strength and balance ability amongst elderly women with mild Parkinson's disease. A total of 55elderly women with mild Parkinson's disease were randomly divided into the experimental group (n= 28) and the control group (n= 27) for 16weeks. The experimental group was trained for 16weeks by using isokinetic muscle strength training. After 16weeks of training in the experimental group, the peak torque (PT) of ankle (average of the left and right sides) dorsiflexion, plantarflexion, eversion and inversion, and the standing balance index revealed that the left and right stability and overall stability indexes significantly increased by 25.9%, 43.5%, 62.7%, 82.8%, 37.1% and 32.2%, respectively (p< 0.05). The experimental group exhibited significantly increased PT of ankle dorsiflexion, plantarflexion, eversion and inversion. Moreover, the left and right stability and overall stability indexes were significantly improved compared with those of the control group (p< 0.05). This study found a linear regression relationship between the PT of ankle inversion and overall stability index. This study determined that ankle isokinetic muscle strength training improved ankle dorsiflexion, plantarflexion, eversion and inversion muscle strength, and balance ability amongst elderly women with mild Parkinson's disease. However, it did not improve stability in the anterior and posterior directions. Ankle inversion muscle strength is more likely to affect overall balance.

Effect of strength training with additional acupuncture on balance, ankle sensation, and isokinetic muscle strength in chronic ankle instability among college students.

Purpose: The effects of the combination of strength training and acupuncture on chronic ankle instability have not been studied. This study examined effects of strength training combined with acupuncture on balance ability, ankle motion perception, and muscle strength in chronic ankle instability among college students. Methods: Forty-six chronic ankle instability college students were randomly categorized into the experimental group (n = 24, strength training + acupuncture) and the control group (n = 22, strength training) for an 8-week intervention. Results: For the results at 8weeks, compared with the baseline, in the experimental group, the chronic Ankle Instability Tool (CAIT) score, ankle dorsiflexion, plantar flex, eversion peak torque (60°/s), and plantar flex peak torque (180°/s) increased by 13.7%, 39.4%, 13.7%, 14.2%, and 12.3%, respectively. Dorsiflexion, plantar flexion, inversion, and eversion kinesthetic sensation test angles decreased by 17.4%, 20.6%, 15.0%, and 17.2%, respectively. Anterior-posterior and medial-lateral displacement, and anterior-posterior and medial-lateral velocity decreased by 28.9%, 31.6%, 33.3%, and 12.4%, respectively. Anterior-posterior and medial-lateral displacement, and anterior-posterior and medial-lateral mean velocity decreased by 28.9%, 31.6%, 33.3%, and 12.4%, respectively. In the control group, the Cumberland Ankle Instability Tool score and the ankle dorsiflexion peak torque (60°/s) increased by 13.8% and 17.9%, respectively. The inversion kinesthetic sensation test angle decreased by 15.2%, whereas anterior-posterior and medial-lateral displacement, and anterior-posterior and medial-lateral mean velocity decreased by 17.1%, 29.4%, 12.3%, and 16.8%, respectively. 2) For the comparison between the groups after 8weeks, the values of ankle dorsiflexion and plantar flex peak torque (60°/s) in the experimental group were greater than those in the control group. The values of ankle plantar flex kinesthetic sensation test angle, the anterior-posterior displacement, and anterior-posterior mean velocity in the experimental group were lower than those in the control group. Conclusion: Acupuncture treatment in conjunction with muscle strength training can further improve the balance ability of anterior-posterior, ankle dorsiflexion, and plantar flex strength and plantar flex motion perception in chronic ankle instability participants.

Efeito agudo da cinesioterapia e da eletroestimulação neuromotora sobre a variação térmica de indivíduos com insuficiência venosa crônica

Abstract Introduction: Chronic venous insufficiency (CVI) is a change in the venous system that can be caused by dysfunction in the triceps surae muscles. Objective: To evaluate the acute effect of neuromuscular electrical stimulation and kinesio-therapy on ankle joint flexibility, infrared radiation and triceps surae strength in individuals with CVI. Methods: We conducted a comparative study, in which ankle flexibility, dorsiflexion and plantar flexion strength and thermal variations of the calf were evaluated. An electrical stimulation session (1 kHz Aussie current with burst = 2 ms) was performed on the right lower limb (EG - electrostimulation group) and kinesio-therapy on the lower limb left (KG - kinesiotherapy group), with stretching and metabolic exercises involving the ankle. Results: Nineteen female patients were evaluated. Analysis of ankle flexibility did not demonstrate significant changes. In the assessment of muscle strength, there was no difference between groups, and in the intragroup assessment, only KG showed an increase for dorsiflexion (before treatment: 11.6 ± 3.5; 24 h after: 13.5 ± 3.0; p = 0.02), and for plantar flexion (before: 11.8 ± 6.3; 24 h later: 14.4 ± 5.06; p = 0.04). Regarding thermography, there was no intragroup difference, while in the intergroup assessment, KG showed an increase in temperature immediately and 24 h later (0.44 ± 0.68, p = 0.01 and 0.25 ± 0.83, p = 0.07, respectively). When analyzing the correlation between dorsiflexion and plantar flexion strength of both lower limbs with total range of motion of the right and left ankle, a positive correlation was observed only between the plantar flexion strength immediately after and 24 h later with range of motion and ankle in KG (r = 0.49, p = 0.03 and r = 0.51, p = 0.03, respectively). Conclusion: There were no significant differences between kinesiotherapy and electrotherapy when analyzing joint flexibility and muscle strength, but kinesiotherapy was superior in increasing calf temperature before and after 24 h of intervention.

A portable articulated dynamometer for ankle dorsiflexion and plantar flexion strength measurement: a design, validation, and user experience study

Monitoring ankle strength is crucial for assessing daily activities, functional ability, and preventing lower extremity injuries. However, the current methods for measuring ankle strength are often unreliable or not easily portable to be used in clinical settings. Therefore, this study proposes a portable dynamometer with high reliability capable of measuring ankle dorsiflexion and plantar flexion. The proposed portable dynamometer comprised plates made of aluminum alloy 6061 and a miniature tension–compression load cell. A total of 41 healthy adult participants applied maximal isometric dorsiflexor and plantar flexor forces on a Lafayette Handheld Dynamometer (HHD) and the portable dynamometer. The results were cross-validated, using change in mean, and two independent examiners evaluated the inter-rater and test–retest reliabilities in separate sessions using intraclass correlation coefficients, standard error of measurement, and minimal detectable change. Both dorsiflexion and plantar flexion measurements demonstrated a strong correlation with the HHD (r = 0.827; r = 0.973) and showed high inter-rater and test–retest reliabilities. Additionally, the participant responses to the user experience questionnaire survey indicated vastly superior positive experiences with the portable dynamometer. The study findings suggest that the designed portable dynamometer can provide accurate and reliable measurements of ankle strengths, making it a potential alternative to current methods in clinical settings.

Do lower limb motor-evoked potentials predict walking outcomes post-stroke?

BackgroundThis observational study examined whether lower limb (LL) motor-evoked potentials (MEPs) 1 week post-stroke predict recovery of independent walking, use of ankle-foot orthosis (AFO) or walking aid, at 3 and...

Conservative versus surgical treatment of foot drop in peroneal nerve entrapment: rationale and design of a prospective, multi-centre, randomized parallel-group controlled trial

BackgroundHigh-quality evidence is lacking to support one treatment strategy over another in patients with foot drop due to peroneal nerve entrapment. This leads to strong variation in daily practice.Methods/designThe FOOTDROP (Follow-up and Outcome of Operative Treatment with Decompressive Release Of The Peroneal nerve) trial is a randomized, multi-centre study in which patients with peroneal nerve entrapment and persistent foot drop, despite initial conservative treatment, will be randomized 10 (± 4) weeks after onset between non-invasive treatment and surgical decompression. The primary endpoint is the difference in distance covered during the 6-min walk test between randomization and 9 months later. Time to recovery is the key secondary endpoint. Other secondary outcome measures encompass ankle dorsiflexion strength (MRC score and isometric dynamometry), gait assessment (10-m walk test, functional ambulation categories, Stanmore questionnaire), patient-reported outcome measures (EQ5D-5L), surgical complications, neurological deficits (sensory changes, motor scores for ankle eversion and hallux extension), health economic assessment (WPAI) and electrodiagnostic assessment.DiscussionThe results of this randomized trial may elucidate the role of surgical decompression of the peroneal nerve and aid in clinical decision-making.Trial registrationClinicalTrials.gov NCT04695834. Registered on 4 January 2021.

Relationship between proprioception and balance control among Chinese senior older adults.

Background: Balance impairment is the most common risk factor for falls among older adults, with three potential factors (tactile sensation, proprioception, and muscle strength) being responsible for their balance control. However, controversies remain on whether or not balance control is related to the three contributors among older adults. Therefore, clarifying the above questions helps explain the mechanisms of increased falls among senior older adults. This study compares the balance control and the three factors and investigates their relationships among older adults of different ages. Methods: 166 participants ultimately passed the qualification assessment and were categorized into younger (YG, 60-69years, n = 56), middle (MG, 70-79years, n = 57), or older (OG, ≥80years, n = 53) aged groups. Berg Balance Scale (BBS) performance, tactile sensation, proprioception, and muscle strength were tested. One-way ANOVA and partial correlation were performed to explore the differences between groups in BBS and its three potential contributors, along with the correlations between them within each age group. Results: Significant differences among the three groups were detected in BBS scores (p < 0.001), tactile sensation at the great toe (p = 0.015) and heel (p = 0.025), proprioception of knee flexion (p < 0.001) and extension (p < 0.001), and ankle plantarflexion (p < 0.001) and dorsiflexion (p < 0.001), and muscle strength of ankle plantarflexion (p < 0.001) and dorsiflexion (p < 0.001), and hip abduction (p < 0.001). Proprioception of knee flexion (r = -0.351, p = 0.009) and extension (r = -0.276, p = 0.041), and ankle plantarflexion (r = -0.283, p = 0.036), and muscle strength of ankle plantarflexion (r = 0.326, p = 0.015) and hip abduction (r = 0.415, p = 0.002) were correlated with BBS among the YG. Proprioception of ankle plantarflexion (r = -0.291, p = 0.030) and muscle strength of ankle plantarflexion (r = 0.448, p = 0.001) and dorsiflexion (r = 0.356, p = 0.007) were correlated with BBS among the MG. Muscle strength of ankle plantarflexion (r = 0.276, p = 0.039) and hip abduction (r = 0.324, p = 0.015) were correlated with BBS among the OG. Conclusion: YG and MG had better balance control, tactile sensation, proprioception, and muscle strength compared to OG. Proprioception correlated with balance control in YG and MG, but not in the OG. The worsen proprioception among the OG could be the key for increased falls. Exercise should be recommended to improve proprioception among senior older adults.

Electromyostimulation Application on Peroneus Longus Muscle Improves Balance and Strength in American Football Players

The aim of this study was to evaluate the effect of 5weeks of electromyostimulation (EMS) of the peroneus longus muscle on balance and muscle strength in American Football (AmF) players. Thirty-two healthy male athletes (4 American Football team training sessions per week, college level) were randomly divided into the EMS and control groups. The EMS applications were conducted on the dominant peroneus longus muscle 3 times per week for 5weeks, with each application lasting 25minutes. Before and after the interventions, the strength of ankle dorsiflexion-plantar flexion and foot eversion-inversion wasmeasured with isometric dynamometer and anterior-posterior sway, mediolateral sway, perimeter, and ellipse area were measured with the Technobody Balance System in unilateral stance positions, while eyes were open. Changes between initial and final tests for dorsiflexion and eversion strength, and mediolateral sway for dynamic balance in the groups were significantly different (P = .039, P = .027, P = .030, respectively). The EMS application had positive effects on muscle strength and dynamic balance of AmF players. The EMS can be used to improve isometric strength and dynamic balance in AmF players.

Randomized Phase 2 Study of ACE-083 in Patients With Charcot-Marie-Tooth Disease.

The goal of this work was to determine whether locally acting ACE-083 is safe and well tolerated and increases muscle volume, motor function, and quality of life (QoL) in adults with Charcot-Marie-Tooth disease (CMT) type 1. This phase 2 study enrolled adults with CMT1 or CMTX (N = 63). Part 1 was open label and evaluated the safety and tolerability of different dose levels of ACE-083 for use in part 2. Part 2 was a randomized, placebo-controlled, 6-month study of 240 mg/muscle ACE-083 injected bilaterally into the tibialis anterior muscle, followed by a 6-month, open-label extension in which all patients received ACE-083. Pharmacodynamic endpoints included total muscle volume (TMV; primary endpoint), contractile muscle volume (CMV), and fat fraction. Additional secondary endpoints included 6-minute walk test, 10-m walk/run, muscle strength, and QoL. Safety was assessed with treatment-emergent adverse events (TEAEs) and clinical laboratory tests. In part 1 (n = 18), ACE-083 was generally safe and well tolerated at all dose levels, with no serious adverse events, TEAEs of grade 3 or greater, or death reported. In part 2 (n = 45 enrolled, n = 44 treated), there was significantly greater change in TMV with ACE-083 compared with placebo (least-squares mean difference 13.5%; p = 0.0096). There was significant difference between ACE-083 and placebo for CMV and change in ankle dorsiflexion strength. Fat fraction and all other functional outcomes were not significantly improved by ACE-083. Moderate to mild injection-site reactions were the most common TEAEs. Despite significantly increased TMV and CMV, patients with CMT receiving ACE-083 in tibialis anterior muscles did not demonstrate greater functional improvement compared with those receiving placebo. Clinical Trials Registration: NCT03124459. This study provides Class II evidence that intramuscular ACE-083 is safe and well tolerated and increases total muscle volume after 6 months of treatment in adults with CMT1 or CMTX.

Spinal cord gray matter atrophy is associated with functional decline in post-polio syndrome.

ObjectiveTo determine if patients with post‐polio syndrome (PPS) show spinal cord gray matter (SCGM) atrophy and to assess associations between SCGM atrophy, muscle strength and patient‐reported functional decline.MethodsTwenty patients diagnosed with PPS (March of Dimes criteria) and 20 age‐ and sex‐matched healthy controls (HC) underwent 3T axial 2D‐rAMIRA magnetic resonance imaging at the intervertebral disc levels C2/C3–C6/C7, T9/T10 and the lumbar enlargement level (T max) (0.5 × 0.5 mm2 in‐plane resolution). SCGM areas were segmented manually by two independent raters. Muscle strength, self‐reported fatigue, depression and pain measures were assessed.ResultsPost‐polio syndrome patients showed significantly and preferentially reduced SCGM areas at C2/C3 (p = 0.048), C3/C4 (p = 0.001), C4/C5 (p < 0.001), C5/C6 (p = 0.004) and T max (p = 0.041) compared to HC. SCGM areas were significantly associated with muscle strength in corresponding myotomes even after adjustment for fatigue, pain and depression. SCGM areaTmax together with age and sex explained 68% of ankle dorsiflexion strength variance. No associations were found with age at or time since infection. Patients reporting PPS‐related decline in arm function showed significant cervical SCGM atrophy compared to stable patients adjusted for initial disease severity.ConclusionsPatients with PPS show significant SCGM atrophy that correlates with muscle strength and is associated with PPS‐related functional decline. Our findings suggest a secondary neurodegenerative process underlying SCGM atrophy in PPS that is not explained by aging or residua of the initial infection alone. Confirmation by longitudinal studies is needed. The described imaging methodology is promising for developing novel imaging surrogates for SCGM diseases.

Transfer of Soleus Muscular Branch of Tibial Nerve to Deep Fibular Nerve to Repair Foot Drop After Common Peroneal Nerve Injury: A Retrospective Study.

ObjectiveCommon peroneal nerve (CPN) injury that leads to foot drop is difficult to manage and treat. We present a new strategy for management of foot drop after CPN injury. The soleus muscular branch of the tibial nerve is directly transferred to the deep fibular nerve, providing partial restoration of motor function.MethodsWe retrospectively reviewed eight patients treated for CPN injury between 2017 and 2019. The soleus muscular branch of the tibial nerve was transferred to the deep fibular nerve to repair foot drop. Electrophysiology was conducted, and motor function was assessed. Motor function was evaluated by measuring leg muscle strength during ankle dorsiflexion using the British Medical Research Council (BMRC) grading system and electromyography (EMG).ResultsIn 10–15 months postoperatively, EMG revealed newly appearing electrical potentials in the tibialis anterior, extensor hallucis longus, and extensor toe longus muscle (N = 7). Two patients achieved BMRC grade of M4 for ankle dorsiflexion, 2 patients achieved M3, 1 patient achieved M2, and 2 patients achieved M1. Four patients showed good functional recovery after surgery and could walk and participate in activities without ankle-foot orthotics.ConclusionSurgical transfer of the soleus muscular branch of the tibial nerve to the deep fibular nerve after CPN injury provides variable improvements in ankle dorsiflexion strength. Despite variable strength gains, 50% of patients achieved BMRC M3 or greater motor recovery, which enabled them to walk without assistive devices.

The prevention of injuries among youth basketballers according to the "Sequence of Prevention": a systematic review.

Basketball is played by the youth worldwide, and various injuries occur in youth basketball. There is currently no overview of the incidence, the risk factors and preventive measures of musculoskeletal injuries among youth basketball players. This systematic review describes the most common injuries among youth basketball players. The most common risk factors and various preventive measures and interventions have also been reported and discussed. Search strategies were built based on groups of keywords, namely 'injury', 'youth basketball', and 'cohort'. Search strategies were entered into Medline and SPORTDiscus. Titles, abstracts and full text articles were screened by two researchers. Data from the included articles were extracted by one researcher and checked by another researcher. Twenty-seven studies showed that the overall injury rate ranged from 2.64 to 3.83 per 1 000 hours of exposure. Ankle-(22%-37%) and knee injuries (5%-41%) were the most common injuries. Risk factors for knee injuries included ankle dorsiflexion with a range less than 36.5 degrees and female athletes with greater hip abduction strength. High variations of postural sway corresponded to occurrences of ankle injuries (p=0.01, OR =1.22; p<0.001, OR =1.22). A core intervention (rate = 4.99/1 000 athlete exposure (AEs)) focused on the trunk and lower extremity led to a reduction in injuries compared to a sham intervention (rate =7.72/1 000 AEs) (p=0.02). Wearing a McDavid Ultralight 195 brace reduced ankle injuries compared to the controls (HR 0.30; 95 % CI 0.17 0.90; p=0.03). Ankle and knee injuries are the most common injuries among youth basketball players. Poor postural control, reduced ankle dorsiflexion and high hip abduction strength are the main risk factors. A neuromuscular warm-up, in combination with strength and stability exercises, seems to be the best training method to prevent injuries. Ankle injuries can be reduced by wearing a lace-up ankle brace.

Motor and functional outcome of selective dorsal rhizotomy in children with spastic diplegia at 12 and 24\xa0months of follow-up

BackgroundSelective dorsal rhizotomy (SDR) in ambulatory children affected by cerebral palsy (CP) is a surgical treatment option to lower spasticity and thereby improve gait and ambulation. The aim of the current study is to investigate the outcome of children with respect to spasticity, muscle strength, and overall function after SDR.MethodsAll children who underwent SDR via a single-level laminotomy in the time period from January 2007 to April 2015 at our center were enrolled in this study. Within a standardized evaluation process, the following was assessed routinely pre-operatively and 12 and 24 months following surgery: extent of spasticity at hip adductors and hamstrings as characterized by the Modified Ashworth Scale (MAS), maximal muscle strength as characterized by the Medical Council Research Scale (MRC), overall function regarding ambulation as characterized by the Gross Motors Function Classification System (GFMCS), and overall function as characterized by the Gross Motor Function Measure (GMFM-88).ResultsMatching sets of pre- and post-operative assessments of the chosen outcome parameters were available for 109 of the 150 children who underwent SDR within the observation period. After 24 months, the MAS scores of hip adductors (n = 59) improved in 71% and 76% of children on the right and left side, respectively. In 20% and 19%, it remained unchanged and worsened in 9% and 5% of children on the right and left side, respectively (p < 0.00625). For hamstrings, the rates for the right and left sides were 81% and 79% improvement, 16% and 16% unchanged, and 4% and 5% worsened, respectively (p < 0.00625). Muscle strength of ankle dorsiflexion and knee extension significantly improved after 24 months. Overall function assessed by GMFM-88 improved significantly by 4% after 12 months (n = 77) and by 7% after 24 months (n = 56, p < 0.0001).ConclusionsThe presented data underlines the benefit of SDR in a pediatric patient collective with bilateral spastic CP. The procedure resulted in an effective and permanent reduction of spasticity and improved overall function without causing relevant weakness of the lower extremities.

Relationship of proprioception, cutaneous sensitivity, and muscle strength with the balance control among older adults

BackgroundBalance impairment is one of the strongest risk factors for falls. Proprioception, cutaneous sensitivity, and muscle strength are 3 important contributors to balance control in older adults. The relationship that dynamic and static balance control has to proprioception, cutaneous sensitivity, and muscle strength is still unclear. This study was performed to investigate the relationship these contributors have to dynamic and static balance control. MethodsA total of 164 older adults (female = 89, left dominant = 15, age: 73.5 ± 7.8 years, height: 161.6 ± 7.1 cm, weight: 63.7 ± 8.9 kg, mean ± SD) participated in this study. It tested the proprioception of their knee flexion/extension and ankle dorsi/plantarflexion, along with cutaneous sensitivity at the great toe, first and fifth metatarsals, arch, and heel, and the muscle strength of their ankle dorsi/plantarflexion and hip abduction. The Berg Balance Scale (BBS) and the root mean square (RMS) of the center of pressure (CoP) were collected as indications of dynamic and static balance control. A partial correlation was used to determine the relationship between the measured outcomes variables (BBS and CoP-RMS) and the proprioception, cutaneous sensitivity, and muscle strength variables. ResultsProprioception of ankle plantarflexion (r = –0.306, p = 0.002) and dorsiflexion (r = –0.217, p = 0.030), and muscle strength of ankle plantarflexion (r = 0.275, p = 0.004), dorsiflexion (r = 0.369, p < 0.001), and hip abduction (r = 0.342, p < 0.001) were weakly to moderately correlated with BBS. Proprioception of ankle dorsiflexion (r = 0.218, p = 0.020) and cutaneous sensitivity at the great toe (r = 0.231, p = 0.041) and arch (r = 0.285, p = 0.002) were weakly correlated with CoP-RMS in the anteroposterior direction. Proprioception of ankle dorsiflexion (r = 0.220, p = 0.035), knee flexion (r = 0.308, p = 0.001) and extension (r = 0.193, p = 0.040), and cutaneous sensitivity at the arch (r = 0.206, p = 0.028) were weakly to moderately correlated with CoP-RMS in the mediolateral direction. ConclusionThere is a weak-to-moderate relationship between proprioception and dynamic and static balance control, a weak relationship between cutaneous sensitivity and static balance control, and a weak-to-moderate relationship between muscle strength and dynamic balance control.

Effects of a Targeted Exercise Program on Inter-Leg Asymmetries in Patients with Patellofemoral Pain

Patellofemoral pain (PFP) is often associated with impaired muscle strength, flexibility, and stability. It has been suggested that inter-leg asymmetries have an important role in increasing the risk of musculoskeletal injuries, including PFP. Thus, the aim of this study was to identify significant asymmetries and determine the effects of a symmetry targeted exercise program in patients with PFP. Eighteen patients aged 13 to 54 years (24.17 ± 12.52 years) with PFP participated in this study. Strength, flexibility and stability outcomes of the trunk, hip, knee and ankle muscles were assessed. A single-group pretest–posttest design was used to assess changes in inter-leg and agonist–antagonist asymmetries resulting from the 8-week period of the supervised exercise program. Results indicated a significant improvement in inter-leg symmetry regarding bilateral stance in a semi-squat position (p = 0.020, d = 0.61, df = 17) and ankle plantarflexion (p = 0.003, d = 0.32, df = 17) and ankle dorsiflexion strength (p &lt; 0.001, d = 0.46, df = 17). In addition, the ratio of ankle dorsiflexion/plantarflexion (p = 0.036, d = 1.14, df = 17) and hip extension/flexion (p = 0.031, d = 0.94, df = 16) changed significantly during the intervention period. To our knowledge, this was the first study to evaluate inter-leg asymmetries resulting from a period of a supervised exercise program. The results indicate that an exercise program focusing on individual asymmetries may influence specific deficits and contribute to better rehabilitation outcomes.

Clinical Outcomes After Neurolysis for the Treatment of Peroneal Nerve Palsy: A Systematic Review and Meta-Analysis.

Neurolysis techniques have been adapted for decompression of peripheral nerves in multiple locations, including the common peroneal nerve (CPN) at the fibular neck. The aim of this study was to conduct a systematic review and meta-analysis to summarize the clinical outcomes of neurolysis for the management of peroneal nerve palsy (PNP). Preferred Reporting Systems for Systematic Reviews and Meta-Analyses guidelines were followed for this meta-analysis. Four databases were queried, and randomized clinical trials, cohort studies, case-control studies, and case series with n > 10 published in English that evaluated clinical outcomes of neurolysis for the treatment of PNP and foot drop were included. Two reviewers completed screening and data extraction. Methodological quality was evaluated using the Newcastle-Ottawa Scale. A total of 493 articles were identified through literature search. Title and abstract screening identified 39 studies for full-text screening. Ten articles met the inclusion criteria for qualitative analysis, and 8 had complete data for meta-analysis.Overall, there were 368 patients (370 nerves) who had neurolysis of the CPN for PNP, of which 59.2% (n = 218) were men and 40.8% (n = 150) were women. The mean age of the patients was 47.1 years (SD, 10.0 years), mean time to surgery was 9.65 months (SD, 6.3 months), and mean follow-up time was 28 months (SD, 14.0 months). The median preoperative Medical Research Council (MRC) score was 1 (IQR 0, 3), with 42.2% (n = 156) having MRC score of 0. The median postoperative MRC score was 5 (IQR 4, 5), with 53.9% (n = 199) having MRC score of 5. Complications of neurolysis of the peroneal nerve for treatment of PNP included postoperative infection (0.54%, n = 2), wound dehiscence (0.27%, n = 1), hematoma (0.54%, n = 2), bleeding (0.27%, n = 1), relapse of PNP (0.27%, n = 1), and 1 case of mortality due to sepsis. Our meta-analysis shows that neurolysis of the CPN is safe and improves ankle dorsiflexion strength in patients with PNP. Future studies should use a standardized method of measuring sensory outcomes, and studies of higher levels of evidence are needed to better assess the clinical outcomes of neurolysis for treatment of PNP.

Recovery of foot drop in chronic inflammatory demyelinating polyneuropathy (CIDP).

Foot drop is common in chronic inflammatory demyelinating polyneuropathy (CIDP), but its prognosis is uncertain. CIDP patients with less than anti-gravity strength (<3/5 power) of ankle dorsiflexion (ADF) on Medical Research Council manual muscle testing on presentation at our center were identified by retrospective review. After initiation of standard treatment, ADF power was serially tabulated, and predictors of recovery were determined. Of the 27 identified patients, ADF power at presentation was <3/5 in 48/54 legs. At 1 y after treatment, ADF power improved to >/= 3/5 in 17/27 patients in one (N=6) or both (N=11) legs. On multi-variate analysis, predictors of recovery of ADF power were tibialis anterior compound muscle action potential amplitude at presentation, shorter disease duration, and female gender. Foot drop improves to anti-gravity power in most treated CIDP patients depending in part on the severity of fibular motor axon loss at onset of treatment.

Factors contributing to racial differences in gait mechanics differ by sex

BackgroundRacial differences in gait mechanics have been recently reported, but we don’t know what factors may drive differences in gait and whether these factors are innate or modifiable. The answers to those questions will inform both basic research and clinical interventions and outcomes. Research questionDo anthropometric, strength, and health status measures explain racial differences in gait between African Americans (AA) and white Americans (WA)? MethodsVenous blood samples, anthropometric measures, lower extremity strength, and an assessment of health status were collected from 92 participants (18–30 years old) as part of an Institutional Review Board-approved study. 3D motion capture and force plate data were recorded during 7 walking trials at set regular (1.35 m/s) and fast (1.6 m/s) speeds. Racial differences in gait were identified at both speeds. Correlations between anthropometric, strength, and health status independent variables and outcome measures were computed after stratifying data by sex. Stepwise linear regression models evaluated whether the inclusion of anthropometric, strength, and health status independent variables explained racial effects. ResultsIn males, no racial differences in gait were explained by independent variables. Q-angle and ankle dorsiflexion strength accounted for racial differences in self-selected walking speed in females. Racial differences in ankle plantarflexion angle were explained by ankle plantarflexion strength differences. SignificanceFactors that explain racial differences in gait in females were both innate and modifiable. These data make clear that it is important to include racially diverse normative gait databases in research studies. These results also identify potential intervention targets aimed at reducing racial health disparities.

Long-Term Patient Reported Outcomes after Correction of Traumatic Foot Drop

Category:Trauma; AnkleIntroduction/Purpose:There is limited literature on patient reported outcomes after tendon transfer for traumatic foot drop. The purpose of this study was to determine long-term patient reported functional outcomes after posterior tibialis tendon (PTT) transfer in patients with foot drop resulting from a traumatic common peroneal nerve injury.Methods:Between August 2006 to January 2019, 31 patients underwent PTT transfer for foot drop secondary to a traumatic injury to their common peroneal nerve at our institution. The average follow-up was 14 months. A retrospective chart review was performed to document physical exam measures and to review postoperative radiographs for changes in foot alignment. There were 17 out of the initial 31 patients available at a mean follow-up of 5.9 years who responded to a phone questionnaire, including the Foot and Ankle Ability Measure (FAAM) questionnaire, and questions on brace and assistive device use, activity level, and satisfaction with surgery.Results:Preoperatively, all patients had an equinus contracture with no dorsiflexion strength, abnormal gait, and used an ankle- foot orthosis (AFO) or pneumatic boot for ambulation. Postoperatively, the average ankle dorsiflexion strength was 4/5 with 28/31 patients reporting a normal gait and 26/31 not using a brace for ambulation. Postoperative radiographs did not show changes in alignment or progression to flatfoot deformity. For the subset of 17 patients who responded to the phone questionnaire, the mean FAAM ADL subscale score was 68.1 and the Sport subscale score was 52.1 at an average of 5.9 years after surgery. The majority of patients (76%) were very or quite satisfied with the outcome of surgery and 15/17 (88%) patients reported they would undergo the PTT transfer procedure again.Conclusion:Posterior tibialis tendon transfer for patients with foot drop secondary to a traumatic injury to their common peroneal nerve showed a high satisfaction rate and improvement in function after surgery without the need for brace or assistive device use at long-term follow-up at an average of 6 years. Additionally, there was no progression to flatfoot deformity after posterior tibialis tendon transfer at 1 year postoperatively.