Ankle Dorsiflexion Strength Research Articles

Subjective memory complaints predict poorer functional recovery during the first year following hip-fracture surgery among elderly adults.

Subjective memory complaints (SMCs) in the elderly are associated with poor recovery in performing activities of daily living. This study was designed to examine SMCs and their association with recovery and health outcomes of older persons within 1 year following hospital discharge after hip-fracture surgery. Data were collected between 2012 and 2015 from 194 hip-fractured elders in northern Taiwan. SMCs were assessed by the Prospective and Retrospective Memory Questionnaire. Recovery outcomes included self-care ability (activities of daily living [ADLs] and instrumental activities of daily living [IADLs]), physical function (range of motion and maximal muscle strength), cognitive function, delirium, depressive symptoms, and health-related quality of life (HRQoL). Outcomes were assessed before discharge and 1, 3, 6, and 12 months afterwards. Associations of SMCs with participants' recovery outcomes were examined by the generalized estimating equation approach. Participants with SMCs had significantly poorer recovery outcomes than those without SMCs. Additionally, the interaction term for time-by-SMC was significant on ADLs, IADLs, maximal strength of quadriceps muscles, maximal strength of hip abductor muscles, ankle dorsiflexion, and HRQoL, suggesting that negative associations with SMCs increased over time. Participants with SMCs were at significantly higher risk for cognitive impairment and delirium than those without SMCs. Participants with SMCs not only had worse recovery than those without SMCs, but their rate of recovery was also slower during the first year following hip-fracture surgery. Therefore, SMCs need to be assessed to identify patients at high risk for worse recovery outcomes following hip fracture.

The effects of military style ruck marching on lower extremity loading and muscular, physiological and perceived exertion in ROTC cadets

Military ruck marching with load carriage increases ground reaction forces, which are related to bone stress injuries (BSI). This study’s purpose was to examine whether a ruck march increases impact loading and to describe muscular, physiological and perceived exertion in Army Reserve Officer Training Corps (ROTC) cadets. Secondary purposes examined relationships among loading changes after the ruck march and baseline characteristics. Fifteen Army ROTC cadets performed a 4-mile march. Lower extremity loading and muscular, physiological and perceived exertion were measured pre- and post-march. Results indicated significant increases in peak impact force and loading rate and decreases in ankle dorsiflexion and plantarflexion strength. Factors that might have been related to changes seen in lower extremity loading did not yield any compelling relationships to explain those changes. In conclusion, the ruck march led to increased peak impact force and loading rate, which have been shown to be related to the risk of BSI. Practitioner summary: This study examined ROTC cadets ankle strength and lower extremity loading before and after a ruck march. We found that lower extremity loading increased after the march, and ankle dorsiflexion (DF) strength decreased, despite the cadets not feeling fatigued. These changes are consistent with risk factors for bone stress injuries. Abbreviations: BSI: bone stress injury; ROTC: Reserve Officer Training Corps; PIF: peak impact force; LR: loading rate; RPE: rate of perceived exertion; APFT: Army physical fitness test; DF: dorsiflexors; PF: plantar-flexors; INV: invertors; EV: evertors; HHD: handheld dynamometer; %HRmax: percentage of maximum heart rate

P72 Muscle weakness affects function differently in males and females in inclusion body myositis: providing results for focused clinical care and clinical trial design

Abstract Background Sporadic inclusion body myositis (IBM) is a muscle wasting disorder usually affecting those aged over 50 years, characterised by slowly progressive weakness of the distal upper limbs and proximal lower limbs. Particular weakness of pinch, knee extension and ankle dorsiflexion result in functional decline and disability. Weakness-associated functional decline differences between genders has not previously been investigated. This study aimed to investigate for differences of functional decline in men and women with IBM. Methods A cohort of verified adult IBM patients were followed at a single specialist neuromuscular clinic (Royal Victoria Infirmary, Newcastle-upon-Tyne, UK) between 2004-15, with data collected at each clinic visit. Strength of 11 movements was measured via dynamometry at each clinic visit. Patient-reported function was measured via the Neuromuscular Symptom Score (NSS). Generalised linear modelling, adjusted for disease duration, was carried out to identify associations between strength and function (NSS). Pinch, knee extension and ankle dorsiflexion strength measurements were analysed. Modelling was carried out separately for male and female cohorts. Results Data of 75 participants (47% female) was analysed. A total of 591 measurements were taken. Median age at time of IBM diagnosis was 68.8 years. Median baseline NSS score was 45 (IQR 37, 54) for the male cohort and 40 (IQR 29, 45) for the female cohort. The median disease duration of the study cohort was 2.6 years. Reduced function (NSS) was significantly associated with reduced pinch, knee extension and ankle dorsiflexion strength in the male cohort only (Table 1). No significant associations were observed in the female cohort. Conclusion This is the first study to demonstrate that the progression of weakness, in the characteristic muscle groups affected in IBM, impacts on function differently in men and women. These results illustrate the importance of functional assessment in patients with IBM and the importance of focused physiotherapy upon function-dependent muscle groups. Further, potential gender-based differences of weakness-related function in IBM should be considered when designing clinical trials. Disclosures J. Williams None. A. Oldroyd None. J. Lilleker None. H. Chinoy None. J. Miller None.

The Relationship Between Muscle Strength and Range of Motion in Lower Extremity With Balance and Risk of Falling in Elderl

Purpose: The present study examined the relationship between muscle strength and range of motion in lower extremity with balance and risk of falling in the elderly. Methods: This was a cross-sectional study. The statistical population included healthy elderly (Mean±SD age: 65.64±4.95 y) in Rasht City, Iran. The study was conducted on 65 healthy elderly males who met the study inclusion criteria and were selected by convenience sampling method. In this study, to measure static and dynamic balance, Sharpened Romberg test and Get Up and Go test were conducted, respectively. Additionally, the falling risk was measured by the Berg Balance Scale. Moreover, the maximum isometric force of the muscle groups in the lower extremities was measured using a hand-held dynamometer, and the range of motion was measured by a goniometer. The obtained data were analyzed using descriptive and analytical statistics by SPSS. Results: The present study results demonstrated that the muscle strength of hip extension, hip abduction, hamstring, quadriceps, and ankle plantarflexion had a significant relationship with static balance; while being negatively related to dynamic balance (P≤0.05). Furthermore, we observed a significant and negative relationship between the muscle strength of ankle dorsiflexion and dynamic balance and risk of falling (P≤0.05). There was also a positive and significant relationship between the range of motion hip extension, knee flexion, plantar flexion, and ankle dorsiflexion and static balance, while indicating a negative and significant relationship between these variables and dynamic balance and risk of falling (P≤0.05). Conclusion: The muscle strength hip abduction, hip extensions, hamstring, quadriceps, plantar flexion, ankle dorsiflexion and range of motion hip extension, knee flexion, ankle plantar flexion, and dorsiflexion seem to affect balance maintenance and fall risk in the elderly.

Lomber Disk Hernisi Nedeniyle Düşük Ayak Gelişen Hastalarda Semptomların Başlangıcından Ameliyata Kadar Geçen Sürenin Prognoza Etkisi

Aim: The aim of this study was to evaluate the effect of the duration from foot drop development to nerve decompression on the rate and degree of recovery in foot drop clinic.Material and Methods: We retrospectively reviewed 30 consecutive patients who had undergone microdiscectomy for foot drop clinic (ankle dorsiflexion 0/5 paresis) between April 2014 and February 2019. Patients were divided into three groups according to the time from foot drop development to surgery, as <72 hours, 72 hours to 1 week, and >1 week. Kruskal-Wallis and Bonferroni corrected Mann Whitney U test were used to evaluate the rate and degree of recovery of ankle dorsiflexion muscle strength between groups.Results: In this study, 30 patients (18 females and 12 males) who underwent surgery for foot drop were evaluated. Mean age at the time of surgery was 46.5±13.5 (range, 18-72) years. Postoperative ankle dorsiflexion strength was 4.2±1.6 (range, 0-5) in <72 hours group, 1.7±1.6 (range, 0-5) in 72 hours - 1 week group and 1.0±1.3 (range, 0-3) in >1 week group. Postoperative muscle strength improvement level of <72 hours group was significantly different both from 72 hours - 1 week group (p=0.003) and from >1 week group (p=0.002). There was no statistically significant difference between 72 hours - 1 week group and >1 week group (p=0.427).Conclusion: In foot drop clinic, the duration from onset of symptoms to surgical decompression was a statistically significant predictor of postoperative recovery rates.

Postural balance, muscle strength, and history of falls in end-stage renal disease patients living with a kidney transplant: A cross-sectional study

BackgroundEnd-stage renal disease patients living with a kidney transplant (KT) often present with frailty, functional disability, and mobility impairments that may result in a high risk of falls. Postural balance and muscle strength are implicated in the etiology of falls in the geriatric population, and both may be impaired in KT patients. Research questionWe conducted a cross-sectional investigation to estimate the prevalence of falls, as well as to explore the association between postural balance, muscle strength and history of falls in end-stage renal disease patients living with a KT. MethodsFifty-nine prevalent KT patients (age = 53.2 ± 11 years) were enrolled in this cross-sectional study. Participants were classified as fallers/non-fallers and underwent an objectively-measured assessment of postural balance on a stabilometric platform in eyes open (EO), eyes closed (EC), and dual-task (DT) conditions. Center of pressure (CoP) variables were taken for the analysis. In addition, participants underwent isometric (IM) and isokinetic (IK) assessments of lower limb muscle strength on a multi-joint evaluation system. ResultsThirty-four percent of the study participants reported at least one fall in the previous 12 months. In logistic regression analysis, CoP velocity in EO (OR: 1.23, 95 % CI: 1.06–1.43, p = .007), and IK ankle dorsiflexion strength (OR: 0.87, 95 % CI: 0.77-0.99, p = .034) were independently associated with increased odds of falling. SignificanceThis cross-sectional study indicates that patients living with a KT presented with a prevalence of falls indicative of a high risk of falling. Postural balance and muscle strength are exercise-modifiable factors and further research is warranted to establish to what extent these measures may be implicated in the etiology of falling in this patient group.

Predictors of Walking Activity in Children and Adolescents With Myelomeningocele

ObjectiveTo assess the relationship between real-world walking activity in children and adolescents with myelomeningocele (MMC) and gross measures of lower extremity strength, range of motion, demographics, and medical history. DesignProspective study. SettingParticipants recruited in outpatient clinics; data collected in a hospital-based motion analysis laboratory and in the community. ParticipantsChildren and adolescents (N=52) with daily step count data available from a larger study of ambulatory children and adolescents with MMC. InterventionsNot applicable. Main Outcome MeasureUnivariate and multivariate regression was used to assess which participant characteristics and clinical factors were related to average number of steps per day. ResultsUnivariate analysis showed a lower number of steps per day correlated with older age, male sex, higher body mass index, higher lesion level, use of assistive devices for ambulation, history of shunt placement, more television (TV) watched per week, lower hip extension and abduction strength, knee flexion strength, and ankle dorsiflexion and plantarflexion strength, and decreased knee and hip range of motion. Only assistive device usage and hours of TV watched per week remained in the final multivariate model predicting number of steps per day. ConclusionsWalking activity in children and adolescents with MMC was best predicted by assistive device use and amount of sedentary activity. Other predictors of walking activity from univariate analysis were related to assistive device use. This information can help tailor rehabilitation efforts and educate patients and families. Interventions targeting early prevention of strength loss and contractures may be important to retain or increase walking activity in children and adolescents with MMC.

TL 18168 - Effect of obesity on the functional outcome of flexor hallucis longus tendon transfer surgery in patients with Achilles tendinopathy

Introduction: Several factors, including diabetes and smoking, increase the risk of and predisposition for complications of foot and ankle surgeries; however, studies assessing the effects of obesity remain scarce. The objective of this study is to assess the effects of obesity on functional outcomes of flexor hallucis longus (FLH) tendon transfer surgery in patients with chronic Achilles tendinopathy. Methods: A retrospective study was performed with patients aged 18 years or older who underwent FHL tendon transfer between March 2010 and May 2015. The characteristics recorded were sex, age, body mass index (BMI), American Orthopedic Foot and Ankle Society (AOFAS) score, Foot and Ankle Outcome Score (FAOS) and ankle plantar flexion and dorsiflexion strength, assessed using an isokinetic dynamometer. Results: The sample had 24 participants (13 women and 11 men) with a mean age of 55.7 years; among them, 13 were obese (BMI>=30), and 11 were nonobese (BMI<30). After a mean follow-up time of 66 months, the FAOS of the sample increased from 28 to 91 points (p=0.000). No significant difference in the postoperative AOFAS score or FAOS was found between the subgroups (p>0.05), with values of 83 and 86.7 points (AOFAS) and 92.72 and 90 points (FAOS) for obese and nonobese patients, respectively. The comparison of the strength of each motion revealed no significant difference (p>0.05) between subgroups. There was no association between BMI and postoperative functional outcomes (AOFAS score and FAOS) (p>0.05) or correlation between BMI and the strength of the operated ankles. Conclusion: Our findings indicate that flexor hallucis longus tendon transfer surgery in Achilles tendinopathy is effective for obese and nonobese patients based on the AOFAS and FAOS scores and dynamometry results.

Postural Stability in Children with High Sacral Level Spina Bifida: Deviations from a Control Group

Objective: To assess static and dynamic postural stability changes in children with high sacral level spina bifida.Methods: Thirty-five children with high sacral level spina bifida and 35 age-matched healthy controls were enrolled. Their lower extremity muscle strengths and static and dynamic postural stability parameters were measured with the use of a dynamometer and the NeuroCom Balance Master® device, respectively. Functional gait and balance were evaluated using the five times sit-to-stand test (5STS) and the 6-minute walk test (6MWT). Spinal, hip, and ankle deformities of the patient group were measured by radiologic evaluation.Results: In comparison with controls, patients were found to have lower ankle dorsiflexion and plantar-flexion strength, increased 5STS duration, and decreased 6MWT distance while both static and dynamic postural stability parameters were significantly different. Bilateral ankle muscle strengths were found to be negatively correlated with postural stability parameters. The presence of hydrocephalus or meningomyelocele in the patient group was found to have negative effects on static postural stability.Conclusion: Static and dynamic postural stability is affected even in children with high sacral level spina bifida who are expected to have best condition in this patient population. The ankle muscle strength is the main factor influencing these changes.

Muscle Function and Muscle Size Differences in People With and Without Plantar Heel Pain: A Systematic Review.

Plantar heel pain is a common condition, but little is known about the relationship between muscle strength and plantar heel pain. To review the evidence relating to muscle strength in those with and without plantar heel pain. We systematically reviewed the literature by searching key databases. Included studies assessed muscle strength (or endurance or size as proxies) in those with and without plantar heel pain. A modified Downs-Black quality index was used to assess study quality and the Grading of Recommendations Assessment, Development and Evaluation (GRADE) tool was used to evaluate the strength of the evidence. Meta-analysis was performed where possible. Seven studies met the eligibility criteria. Hallux plantar flexion, lesser toe plantar flexion, ankle dorsiflexion, ankle inversion, and ankle eversion strength values were reduced in those with heel pain compared to those without; however, there was inconsistency in the findings between studies. No difference was found in calf muscle endurance between those with and without plantar heel pain (standardized mean difference, 0.01; 95% confidence interval: -0.56, 0.59). Generally, foot muscle volume was smaller in people with plantar heel pain compared to those without. The quality of individual studies was generally high (score range, 11-16/17 on the modified Downs-Black quality index); however, the GRADE ratings suggest the strength of this evidence to be very low. People with plantar heel pain have reduced strength and volume of the foot muscles, but there is no discernible difference in calf muscle endurance. These findings should be interpreted with respect to the very low GRADE ratings and are likely to change with further research. Accordingly, the role of muscle strength in plantar heel pain is worthy of further investigation. J Orthop Sports Phys Ther 2019;49(12):925-933. Epub 9 Oct 2019. doi:10.2519/jospt.2019.8588.

Ankle Dorsiflexion Strength Monitoring by Combining Sonomyography and Electromyography.

Ankle dorsiflexion produced by Tibialis Anterior (TA) muscle contraction plays a significant role during human walking and standing balance. The weakened function or dysfunction of the TA muscle often impedes activities of daily living (ADL). Powered ankle exoskeleton is a prevalent technique to treat this pathology, and its intelligent and effective behaviors depend on human intention detection. A TA muscle contraction strength monitor is proposed to evaluate the weakness of the ankle dorsiflexion. The new method combines surface electromyography (sEMG) signals and sonomyography signals to estimate ankle torque during a voluntary isometric ankle dorsiflexion. Changes in the pennation angle (PA) are derived from the sonomyography signals. The results demonstrate strong correlations among the sonomyography-derived PA, the sEMG signal, and the measured TA muscle contraction force. Especially, the TA muscle strength monitor approximates the TA muscle strength measurement via a weighted summation of the sEMG signal and the PA signal. The new method shows an improved linear correlation with the muscle strength, compared to the correlations between the muscle strength and sole sEMG signal or sole PA signal, where the R-squared values are improved by 4.21 % and 1.99 %, respectively.

Balance impairment in pediatric charcot-marie-tooth disease.

Balance impairment contributes to gait dysfunction, falls, and reduced quality of life in adults with Charcot-Marie-Tooth disease (CMT) but has been minimally examined in pediatric CMT. The CMT Pediatric Scale (CMTPedS) was administered to 520 children with CMT. Associations between balance function (Bruininks-Oseretsky Test of Motor Proficiency [BOT-2]) and sensorimotor and gait impairments were investigated. Daily trips/falls were reported by 42.3% of participants. Balance (BOT-2) varied by CMT subtype, was impaired in 42% of 4-year-olds, and declined with age (P < 0.001). Vibration (P < 0.001), pinprick (P < 0.004), ankle dorsiflexion strength (P < 0.001), and foot alignment (P < 0.004) were associated with BOT-2 balance (adjusted R2 = 0.28). The visual dependence of balance increased with age. Balance impairment occurs from a young age in children with CMT. Balance intervention studies are required in pediatric CMT and should consider the degree of sensorimotor impairment, foot malalignment, and visual dependence. Muscle Nerve, 2019.

Effects of a falls exercise intervention on strength, power, functional ability and bone in older frequent fallers: FaME (Falls Management Exercise) RCT secondary analysis.

Objectives:Falls Management Exercise (FaME) has been shown to reduce falls in frequent fallers and in lower risk sedentary older people. The effects of FaME on the strength, power, physical function and bone health of frequently falling older women are yet to be established.Methods:This paper reports secondary analysis of data from the original randomised controlled trial of FaME in 100 community dwelling women aged ≥65 years with a history of ≥3 falls in the previous year. Intervention was group delivered, weekly one hour tailored dynamic balance and strength exercise classes and home exercise for nine months.Outcome measures included:strength (handgrip, quadriceps, hamstrings, hip abductors, ankles), lower limb explosive power and functional tests (timed up and go, functional reach, timed floor rise and balance), analysed using Linear Mixed Model analysis. Bone Mineral Density (BMD) at hip and spine was measured in a smaller sub-group and analysed using t-tests.Results:Significant time*group interactions in all measures of strength, except isometric ankle dorsiflexion, concentric hamstring and eccentric quadriceps strength. These improvements in strength equated to average improvements of 7-45%. There were also significant improvements in explosive power (W/kg) (18%, p=0.000), timed up and go (16%, p=0.000), functional reach (17%, p=0.000), floor rise (10%, p=0.002) and eyes closed static balance (56%, p=0.000). There was a significant loss of hip BMD in the control group (neck of femur p<0.05; ward’s triangle p<0.02).Conclusion:The FaME intervention improves lower limb strength, power and clinically relevant functional outcomes in frequently falling older women.

Limited Walking Abilities and Impaired Ankle Dorsiflexion Function in Children After Intense Cancer Treatment.

With improved survival rates in pediatric oncology, the detection of adverse side- and late-effects is gaining increased interest. This cross-sectional study investigated walking abilities and ankle dorsiflexion function in children with cancer. Study participants included 16 children with various cancers (4-20 years, patient group) after completion of the intense treatment and 16 age- and gender-matched healthy peers (comparison group). Walking speed (10-meter-walking-test, treadmill test assessing preferred transition speed), walking capacity (2-minute-walk-test), walking balance (Timed-Up-And-Go-Test), active/passive ankle dorsiflexion range of motion (ROM) (goniometer) and ankle dorsiflexion strength (hand-held dynamometer) were comprehensively assessed. Significant lower values in the patient group were found for walking capacity, maximum walking speed, ankle dorsiflexion ROM and strength. No significant differences between the groups were found for preferred walking speed and walking balance. Limited walking abilities and ankle dorsiflexion dysfunctions are prominent in children with cancer; having the potential to impact children's community mobility and physical activity. To provide holistic care, the development of specific supportive strategies such as exercise interventions and its translation into clinical practice needs to be accelerated.

Evaluation of the results of flexor hallucis longus tendon transfer for chronic Achilles tendinopathy

Objective: To demonstrate that transfer of the flexor hallucis longus (FHL) through a single access site for Achilles tendinosis provides good results and can allow satisfactory recovery of ankle flexion strength. Methods: This is a case-control study with 28 consecutive patients who underwent surgery for Achilles tendon debridement and FHL transfer between January 2009 and July 2015. The patients’ body mass index (BMI), plantar flexion strength and ankle dorsiflexion strength were assessed using an isokinetic dynamometer (Humac Norm model, CSMi) and the American Orthopaedic Foot and Ankle Society (AOFAS) ankle-hindfoot scale. Results: Of the 28 patients, 53.8% were women, and the mean age was 55 years. After a median follow-up of 3.1 years, the plantar flexion strength of the operated ankles was 26.42 Nm (± 2.18), and the dorsiflexion strength was 16 Nm (± 1.99). The final AOFAS score was 85.3 points, with 82.1%of patients achieving good and excellent results. The results showed a significant difference in plantar flexion strength (p=0.0001) between the operated foot and the contralateral foot. No significant difference was found when comparing patients with different BMIs in relation to muscle strength and AOFAS score.Conclusion: FHL transfer surgery using a single posteromedial route for chronic Achilles tendinopathy presents good functional results and is a safe technique with a low complication rate. Level of Evidence III; Therapeutic Studies; Case Control Study.

Reductions in muscle quality and quantity in chronic inflammatory demyelinating polyneuropathy patients assessed by magnetic resonance imaging.

Weakness in patients with chronic inflammatory demyelinating polyneuropathy (CIDP) may be caused by decreases in muscle quantity and quality, but this has not been explored. Twelve patients with CIDP (mean age 61 years) and 10 age-matched (mean age 59 years) control subjects were assessed for ankle dorsiflexion strength, and two different MRI scans (T1 and T2) of leg musculature. Isometric strength was 36% lower in CIDP patients compared with controls. Tibialis anterior muscle volumes of CIDP patients were smaller by ∼17% compared with controls, and non-contractile tissue volume was ∼58% greater in CIDP patients. When normalized to total muscle or corrected contractile volume, strength was ∼29% and ∼18% lower, respectively, in CIDP patients. These results provide insight into the structural integrity of muscle contractile proteins and pathologic changes to whole-muscle tissue composition that contribute to impaired muscle function in CIDP. Muscle Nerve 58: 396-401, 2018.

Clinical Outcomes of Nerve Transfers in Peroneal Nerve Palsy: A Systematic Review and Meta-Analysis.

Given the unsatisfactory outcomes with traditional treatments, there is growing interest in nerve transfers to reestablish ankle dorsiflexion in peroneal nerve palsy. The objective of this work was to perform a systematic review and meta-analysis of the primary literature to assess the effectiveness of nerve transfer surgery in restoring ankle dorsiflexion in patients with peroneal nerve palsy. Methodology was registered with PROSPERO, and PRISMA guidelines were followed. MEDLINE, EMBASE, and the Cochrane Library were systematically searched. English studies investigating outcomes of nerve transfers in peroneal nerve palsy were included. Two reviewers completed screening and extraction. Methodological quality was evaluated with Newcastle-Ottawa Scale. Literature search identified 108 unique articles. Following screening, 14 full-text articles were reviewed. Four retrospective case series met inclusion criteria for meta-analysis. Overall, 41 patients underwent nerve transfer for peroneal nerve palsy. The mean age of the patients was 36.1 years, mean time to surgery was 6.3 months, and the mean follow-up period was 19.0 months. Donor nerve was either tibial (n = 36) or superficial peroneal branches/fascicles (n = 5). Recipient nerve was either deep peroneal (n = 24) or tibialis anterior branch (n = 17). Postoperative ankle dorsiflexion strength demonstrated a bimodal distribution with a mean Medical Research Council of 2.1. There were no significant differences in dorsiflexion strength between injury sites (p = 0.491), injury mechanisms (p = 0.125), donor (p = 0.066), or recipient nerves (p = 0.496). There were no significant correlations between dorsiflexion strength and patient age (p = 0.094) or time to surgery (p = 0.493). There is variability in dorsiflexion strength following nerve transfer in peroneal nerve palsy, whereby there appear to be responders and non-responders. Further studies are needed to better define appropriate patient selection and the role of nerve transfers in the management of peroneal nerve palsy.

Hip motor control training did not improve muscle performance during jump landing in young dancers with recent ankle-foot injury

Dance is a unique combination of athleticism and artistry which exposes dancers to extreme physical demands and risks of injuries. Previous studies showed that hip muscle training improved lower extremity neuromuscular control in patients with ankle instability. However, few studies investigated the effectiveness of hip control training in dancers with ankle-foot injury. Therefore, aim of this study was to determine whether hip control training could improve muscle performance in dancers with ankle-foot injury. Thirty-three young dancers with ankle-foot injury within 6 months were recruited. Participants were randomized to the hip motor control training group (3 males and 13 females, 19.24 ± 3.03 years old, n = 16) or the control group (4 males and 13 females, 19.45 ± 1.41 years old, n = 17) and received hip motor control training or regular training for 4 weeks. The outcome measurement included compensated turnout, muscle activation (gluteus maximus, gluteus medius, biceps femoris, femoris rectus, tibialis anterior, peroneal longus and soleus) during jump landing, and lower extremity muscle length and muscle strength. Two-way repeated measures ANOVA was used to examine the intervention effect. A statistical significance was set at P < 0.05. After four weeks of training, the hip motor control training group did not show significant improvement in the compensated turnout angle or muscle activation during jump landing except the affected side rectus femoris (50.13 ± 14.88 vs. 51.52 ± 10.16, P = 0.026) as compared to the control group. The 4-week hip training program however improved lower extremity muscle strength including both affected and non-affected side hip muscle strength and ankle dorsiflexion strength, and non-affected side knee flexion and ankle eversion and inversion strength. Hip motor control training improved lower extremity muscle strength, but its effect on lower extremity muscle activation or turnout angle requires further research to clarify.

Correlates and predictors of paediatric leg pain: a case–control study

Paediatric leg pains, long described as 'growing pains', frequently present to clinicians, are prevalent in early childhood, disrupt sleep, and distress affected children and parents. There are many cited associations, but no defined leg pain sub-types, nor revealed predictive factors. We explored the implicated factors (viz. foot arches, foot strength, joint mobility, vitamin D, iron) in children with leg pain versus a control group. Leg pain sub-groups-growing pains (GP), restless legs (RLS), both (mixed)-are defined for the first time. A case controlled study design, in a primary care setting, Mumbai, India. A total of 77 children with leg pains (n = 64) and controls (n = 13), aged 3-12years, identified by paediatricians, completed data collection. Blood assays for iron and vitamin D, pain, Beighton score, foot arch, foot strength and anthropometrical data were collected. All outcome measures were validated, with standardised protocols. Leg pain (all groups) was predicted by increased joint mobility and increased ankle dorsiflexion strength (β = 0.56, P < 0.05). GP sub-group was predicted by increased ankle dorsiflexion strength (β = - 0.06, P < 0.05). Mixed (GP/RLS) and RLS sub-groups were predicted by increased ankle dorsiflexion strength (β = 0.66, P < 0.05) and pain questionnaire (β = 0.11, P < 0.05). Hypovitaminosis D was detected in 87% of the sample, and anaemia in 13%. Increased strength of ankle dorsiflexors and joint flexibility were each found predictive for leg pain. Increased body weight, waist girth, and BMI were all associated with leg pain.

Changes in Lower Extremity Musculoskeletal Characteristics Associated with Ankle Sprain History in Intercollegiate Soccer Athletes

Ankle sprains (AS) result in persistent neuromuscular deficits and increased risk of re-injury. Examining the effect of AS on lower extremity (LE) flexibility, strength, static balance (SB), and dynamic postural stability (DPS) may aid in the development of injury prevention and rehabilitation programs. PURPOSE: Determine side-to-side differences in LE flexibility, strength, SB, and DPS in intercollegiate soccer athletes with a history of ankle sprain (HAS). METHODS: Fifteen intercollegiate male and female soccer athletes with a HAS participated (Age:20.2±1.3years, Height:175.3±9.9cm, Weight:68.7±10.2kg). LE flexibility tests included weight-bearing and active ankle dorsiflexion, active knee extension, and straight leg raise. LE strength tests included ankle dorsiflexion/plantarflexion, ankle inversion/eversion, hip abduction/adduction, hip internal/external rotation, and knee flexion/extension. LE SB and DPS were assessed with a force plate collecting ground reaction forces (GRF). Single-leg SB was assessed under eyes-open and eyes-closed conditions. DPS was assessed during a single-leg landing task. Side-to-side differences were assessed using T-tests, Wilcoxon Signed-Ranks or Mann-Whitney U tests, as appropriate. Significance for all tests was set at p<0.05, a priori. RESULTS: Athletes with a HAS demonstrated significant side-to-side differences for weight-bearing ankle dorsiflexion (p=0.044), ankle dorsiflexion strength (p=0.006), and knee flexion strength (p=0.023). No other significant differences were observed. CONCLUSION: Athletes with a HAS demonstrated persistent side-to-side differences despite returning to competition. These differences, including weight-bearing ankle dorsiflexion flexibility, ankle dorsiflexion strength, and knee flexion strength may predispose these athletes to re-injury. The results of this study should guide AS rehabilitation programs in an effort to mitigate these persistent changes in an attempt to prevent re-injury.