Ankle Foot Research Articles

Design and analysis of solid ankle foot orthosis by employing mechanical characterization and a low-cost scanning approach for additive manufacturing

PurposeThis study aims to investigate the fabrication of solid ankle foot orthoses (SAFOs) using fused deposition modeling (FDM) printing technology. It emphasizes cost-effective 3D scanning with the Kinect sensor and conducts a comparative analysis of SAFO durability with varying thicknesses and materials, including polylactic acid (PLA) and carbon fiber-reinforced (PLA-C), to address research gaps from prior studies.Design/methodology/approachIn this study, the methodology comprises key components: data capture using a cost-effective Microsoft Kinect® Xbox 360 scanner to obtain precise leg dimensions for SAFOs. SAFOs are designed using CAD tools with varying thicknesses (3, 4, and 5 mm) while maintaining consistent geometry, allowing controlled thickness impact investigation. Fabrication uses PLA and PLA-C materials via FDM 3D printing, providing insights into material suitability. Mechanical analysis uses dual finite element analysis to assess force–displacement curves and fracture behavior, which were validated through experimental testing.FindingsThe results indicate that the precision of the scanned leg dimensions, compared to actual anthropometric data, exhibits a deviation of less than 5%, confirming the accuracy of the cost-effective scanning approach. Additionally, the research identifies optimal thicknesses for SAFOs, recommending a 4 and 5 mm thickness for PLA-C-based SAFOs and an only 5 mm thickness for PLA-based SAFOs. This optimization enhances the overall performance and effectiveness of these orthotic solutions.Originality/valueThis study’s innovation lies in its holistic approach, combining low-cost 3D scanning, 3D printing and computational simulations to optimize SAFO materials and thickness. These findings advance the creation of cost-effective and efficient orthotic solutions.

Controlling flat-foot limit cycle walkers with compliant joints based on local stability variation.

This study investigates local stability of a four-link limit cycle walking biped with flat feet and compliant ankle joints. Local stability represents the behavior along the solution trajectory between Poincare sections, which can provide detailed information about the evolution of disturbances. The effects of ankle stiffness and foot structure on local stability are studied. In addition, we apply a control strategy based on local stability analysis to the limit cycle walker. Control is applied only in the phases with poor local stability. Simulation results show that the energy consumption is reduced without sacrificing disturbance rejection ability. This study may be helpful in motion control of limit cycle bipedal walking robots with flat feet and ankle stiffness and understanding of human walking principles.

Deep learning based ankle–foot movement classification for prosthetic foot

The primary motivation behind this study is the aspiration to design a prosthetic foot that demonstrates enhanced functionality, enabling more active and prompt responses, particularly tailored for individuals with below-knee amputations. This goal underscores the intention to create a prosthetic foot with the capability to execute foot movements in a more natural and effective manner. A new 1D-ResCNN model has been proposed for the rapid and accurate classification of foot movements based on user intent in the context of a prosthetic limb. This research introduces an innovative approach by integrating inertial measurement units with deep learning algorithms to advance the development of more functional prosthetic feet, specifically tailored for below-knee amputees. Leveraging wearable technologies, this method allows for the prolonged monitoring of foot movements within the users’ natural environments. The dual benefits of cost reduction and enhanced user experience are achieved through this combination of advanced technologies, providing a promising avenue for the evolution of prosthetic foot design and usage. The results obtained with this model are satisfying both in terms of speed and accuracy with 99.8% compared to other methods in the literature.

Effects of ankle–foot orthoses on gait parameters in post-stroke patients with different Brunnstrom stages of the lower limb: a single-center crossover trial

BackgroundAnkle-foot orthoses (AFO) can improve gait posture and walking ability in post-stroke patients. However, the effect of AFO on gait parameters in post-stroke patients according to the Brunnstrom stage of stroke recovery of the lower limbs remains unclear. The study aimed to investigate whether stroke patients with different Brunnstrom stages benefit from wearing AFO.MethodsTwenty-five post-stroke participants included 18 men (50 ± 13 years) and 7 women (60 ± 15 years). The patients were divided based on Brunnstrom stage III or IV of the lower limbs. All patients underwent the gait and timed up and go (TUG) test using a gait analysis system while walking barefoot or with an AFO. The spatiotemporal and asymmetric parameters were analyzed.ResultsAll 25 patients completed the study. Significant differences were observed between barefoot and AFO use in TUG time (P < 0.001) but not walking velocity (P > 0.05). The main effect of the swing time ratio was significant in both groups (P < 0.05); however, the main effects of stride length, stance time, and gait asymmetry ratio were nonsignificant (P > 0.05). For barefoot versus AFO, the main effects of stride length (P < 0.05) and swing time (P < 0.01) ratios were significant, whereas those of stance time and gait asymmetry ratio were nonsignificant (P > 0.05).ConclusionsPost-stroke patients with lower Brunnstrom stages benefitted more from AFO, particularly in gait asymmetry.

Study on the effect of blood flow restriction training combined with IASTAM on ankle strength and function intervention in athletes with chronic ankle instability in sport dance events

BackgroundAthletes engaged in sports dance frequently encounter the potential for ankle injuries and instability, factors that may contribute to diminished training efficacy, compromised athletic performance, prolonged recuperation, and heightened susceptibility to recurring injuries.ObjectiveThe objective of this study was to investigate the impact of an exercise intervention (comprising blood flow restriction training combined with low-load ankle muscle strength training and balance training) as well as instrument-assisted soft tissue mobilization (IASTM) on the foot and ankle function, strength, and range of motion in sports dance athletes exhibiting ankle instability (CAI).MethodsThirty participants exhibiting ankle instability, restriction, or discomfort were recruited and randomly assigned to two groups: the Test group (comprising blood flow restriction training combined with IASTM, n = 15) and the traditional ankle strength training group (n = 15). The intervention spanned 4 weeks, with one session per week. Assessment of the Cumberland Ankle Instability Tool (CAIT), Foot and Ankle Ability Measure (FAAM), and ankle range of motion occurred at three time points: pre-intervention, immediately following the initial intervention, and after 4 weeks of intervention. Ankle strength testing was conducted solely before and after the intervention for comparative analysis.ResultsThere were no significant variances in baseline characteristics between the two intervention groups. In terms of CAIT scores, both groups exhibited notably higher scores following the initial intervention and after 4 weeks of intervention compared to pre-intervention (P < 0.05). The Test group displayed higher CAIT scores than the control group, signifying a more pronounced enhancement in ankle stability among patients in the Test group. Concerning FAAM scores, both groups significantly enhanced ankle function in CAI patients (P < 0.05), with the Test group demonstrating notably higher FAAM-SPORT scores than the control group (P < 0.05), indicating superior restoration of athletic capability in the Test group. As for improvements in ankle range of motion, both groups demonstrated significant enhancements compared to pre-intervention (P < 0.05). The Test group exhibited significantly superior improvements in dorsiflexion, eversion, and inversion range of motion compared to the control group (P < 0.05), while the control group did not exhibit significant enhancements in plantarflexion and eversion range of motion (P > 0.05). Both groups displayed enhanced ankle strength in CAI patients following the intervention (P < 0.05), with the Test group manifesting notably higher dorsiflexion and inversion strength than the control group (P < 0.05).ConclusionBoth blood flow restriction training combined with IASTM and traditional ankle strength and stability training have shown significant improvements in stability, function, strength, and range of motion in CAI patients. Furthermore, the Test group exhibits superior efficacy in ankle stability, daily functional movement, dorsiflexion, and eversion range of motion compared to the control group.Clinical trial registration9 February 2024, ClinicalTrials.gov, ID; NCT06251414.

Functional and clinical outcome of arthroscopic primary single bundle anterior cruciate ligament reconstruction using peroneus longus autograft

Background: Peroneus longus tendon (PLT) autograft has emerged as one of the primary graft options for arthroscopic anterior cruciate ligament reconstruction (ACLR). We aimed to study whether PLT autograft could be used as primary graft for arthroscopic single bundle ACLR, without compromising stability of donor ankle. Materials and Methods: A prospective observational study of 120 patients, who underwent single bundle arthroscopic ACLR with ipsilateral PLT autograft was done. Functional outcome of patients were evaluated with international knee documentation (IKDC) and Lysholm knee scores after one year. The donor ankle morbidity was assessed using American orthopedic foot and ankle score (AOFAS) and foot and ankle disability index (FADI) scores. Results: The mean IKDC pre-op subjective score was 55.3 ± 10.7 and after one year follow-up was 91.4 ± 5.86. The mean difference of IKDC score between pre-op and post-op evaluation was 33.1 ± 11.4, with a p-value of &lt;0.001. The pre-operative mean Lysholm score was 67.6 ± 10.8 and on follow-up after 1 year was 93.6 ± 6.3. The mean difference of Lysholm score was 25.1± 10.4, and p-value &lt;0.001. The mean AOFAS score was 98.14 ± 3.16 and the mean FADI score was 98.37 ± 2.71 on one year follow-up. Conclusion: The significant improvements in IKDC and Lysholm knee scores after using PLT autograft, makes it one of the graft choices for ACLR. The apprehension of donor ankle instability is mitigated by excellent AOFAS and FADI scores reported in the study. PLT is an ideal graft choice for arthroscopic primary single bundle ACLR. Keywords: anterior cruciate ligament; peroneus longus tendon; autograft; arthroscopy; ACL reconstruction

Ankle Foot Orthosis Alters Gait Characteristics in Patients with Peripheral Artery Disease

Ankle Foot Orthosis Alters Gait Characteristics in Patients with Peripheral Artery Disease

Functional knee and ankle outcomes of a peroneus longus tendon autograft for primary reconstruction of the anterior cruciate ligament

Background Peroneus longus tendon (PLT) autograft is commonly used for anterior cruciate ligament (ACL) reconstruction because it is easily harvested and has the same size and strength as the ACL. There are few studies in the literature that discussed donor site complications after ACL reconstruction by PLT. PLT was used as an autograft for reconstructions of the medial patellofemoral ligament and deltoid ligament. We evaluated clinical and functional outcomes for knee, foot, and ankle joints after the use of PLT as an autograft in primary isolated ACL reconstruction. Patients and methods We retrospectively reviewed all patients who were operated for primary ACL reconstruction by PLT autograft from May 2020 to May 2021. Preoperatively and postoperatively, all patients were examined clinically for knee stability by anterior drawer, Lachman, and pivot shift tests, applying the International Knee Documentation Committee as well as the Lysholm score. American Orthopedic Foot and Ankle Score, Foot and Ankle Ability Measure, and ankle range of motion were used for the evaluation of postoperative foot and ankle functions. Return time to the sport was also evaluated. Results Sixty-five patients with ACL-injured knees were included. Their mean age was 29.81 ± 8.33 years and ranged from 20 to 45 years, and males were 54 (83%) and females were 11 (17%). The mean postoperative follow-up period was 32.5 ± 3.1 months. Mean of American Orthopedic Foot and Ankle Score was 99.33 and Foot and Ankle Ability Measure was 99.7 after 12 months. Postoperative Lysholm score mean±SD was 95.30 ± 4.65, and the International Knee Documentation Committee mean±SD was 93.47 ± 9.82 with P value less than 0.001. Return to sport ranged from 4 to 8 months with mean±SD of 5.67 ± 0.75. Conclusion PLT autograft for primary reconstruction of isolated ACL injury did not affect foot and ankle functions with good knee stability and restoration of knee functions postoperatively, which facilitated the return to preoperative sports activity level.

A Randomized Comparison Between Anterior Talofibular Ligament Repair Using Broström Operation with and without an Internal Brace

The aim of the study was to compare the intermediate-term (>24 months) clinical outcomes between anterior talofibular ligament repair using Broström operation with and without an internal brace. Nineteen patients underwent surgery using an arthroscopic traditional Broström repair with an internal brace technique (IB) and Eighteen patients underwent surgery using an arthroscopic traditional Broström repair without an internal brace technique (TB) . All patients were evaluated clinically using the Foot and Ankle Outcome Score (FAOS) and Foot and Ankle Ability Measure (FAAM). According to FAAM, sports activity scores of TB and IB groups were 83.33 ± 5.66 and 90.63 ± 6.21 at the final follow-up (p = .02). There were no significant differences in preoperative and postoperative stress radiographs between the two groups. Total medical expense was more in the IB group (p < .001). It also has a significant superiority in the terms of FAAM scores at sports activity. However, there was no difference during daily life.

Impact of Midfoot Charcot Arthropathy (Brodsky Type 1) on Patient Reported Outcome Scores

Introduction/Purpose: Charcot arthropathy is a debilitating and challenging clinical problem for patients and providers. Patient reported outcome measures (PROMs) are an effective tool for gauging a patient’s quality of life and daily functioning, but they have not been reported in the setting of Charcot arthropathy. Our goal is to assess PROMs severity in midfoot Charcot arthropathy (Brodsky Type 1), alongside linked demographics and comorbidities. We will compare these values with PROMs from conditions like ESRD, knee and hip arthritis, highlighting Charcot arthropathy's comparable debilitation. Methods: A retrospective chart review identified 67 patients with Brodsky Type 1 Charcot arthropathy by one of two fellowship- trained foot and ankle surgeons at a single academic medical center between years 2015 and 2023. ICD-10 CM codes E11.610, M14.671, and M14.672 were used to identify diagnosis of Charcot arthropathy and radiological interpretation determined Brodsky type. Data collected from patient charts included demographics, medical history, presence of ulcers, and preoperative Visual Analog Scale (VAS), 12-Item Short Form Health Survey (SF-12), Pain Catastrophizing Scale (PCS), Pain Disability Index (PDI), SSS- 8, Foot and Ankle Outcome Score (FAOS), and Foot and Ankle Ability Measure (FAAM) scores and postoperative FAOS and FAAM scores. A One-Way ANOVA was performed to evaluate statistical significance. Averages of preoperative PROM scores were compared to literature values for other diseases. Results: Our cohort was mostly male (58.2%), with mean age 61.73 years, BMI 32.9, and A1C 6.9. Initial presentation revealed 50.7% had ulcers. Brodsky type 1 (midfoot) had notably the lowest pre-op PROM scores when compared to other Brodsky types: PDI Recreation (p=.033), FAOS Symptoms and Stiffness (p=.044), and FAOS Recreation (p=.027). Ulcer presence yielded significantly lower FAAM-ADL scores (p=.038), while other PROMs showed no statistical difference. Our mean VAS score was 53.34 which was higher than hip arthritis VAS (43.0) but lower than ESRD VAS (60.0) and knee arthritis VAS (64.2). Our SF-12 PCS scores (29.4) exceeded prior reports (hip 28.5, knee 28.6), while SF-12 MCS scores were higher in earlier studies (hip 49.6, knee 51.5) than our 43.8. Conclusion: Patients with Charcot arthropathy struggle in daily tasks, reflected in lowered FAOS ADL scores. Brodsky type 1 patients also face challenges in higher-level activities, evident in reduced PDI recreation and FAOS recreation scores. Those with ulcers similarly encounter issues in daily tasks, seen in lower FAAM ADL scores. Brodsky type 1 patients also experience debilitating pain as noted by higher VAS scores when compared to known debilitating conditions such as hip and knee arthritis. Comparatively minor differences in knee and hip arthritis SF-12 PCS scores indicate significant physical limitations for these patients.

Effects of Articulated &amp; Static Ankle Foot Orthotics on Gait Kinematics: Foot Drop Patients Perspective

Foot drop is a common occurrence following stroke. Ankle foot orthotics (AFO) are used to correct drop foot deformity with several AFOs available to choose from. Literature suggests research on the impact of articulated AFO on gait. Objective: To determine the impact of static/ rigid and articulated AFO on gait kinematics in foot drop cases. Methods: This cross-sectional study involved 100 unilateral drop foot cases from the PIPOS Rehabilitation Services Program from September 2019 to February 2020. The sample included both genders aged 2-15 years. Gait Lab data were used to compare the results while wearing static AFO and articulated AFO and analyzed using SPSS version 21. T-test was used to see difference between groups with p-value &lt;0.05 considered significant. Results: Articulated AFO is significantly (p&lt;0.001) better than rigid AFO in terms of step length, stride time, and cadence. Articulated AFO is significantly better at initial contact (p&lt;0.001), mid stance (Hip p=0.006, Knee &amp; ankle p&lt;0.001) and terminal stance (p&lt;0.001) than rigid AFO. For Initial Swing, there was a significant (p&lt;0001) difference between AFOs for extension at knee and ankle joint. At mid-swing articulated AFO provided significantly (p&lt;0.001) better flexion at hip and knee joint. At terminal swing articulated AFO provided significantly (p&lt;0.001) better flexion at the hip and required extension at the knee. Conclusions: This study identified Articulated AFO was superior to rigid AFO in improving functional mobility and gait consistency &amp; lowering the risk of falling. Articulated AFOs were significantly better in terms of step length, stride time, and cadence.

Active Ankle–Foot Orthosis Design and Computer Simulation with Multi-Objective Parameter Optimization

There are many current active orthosis designs to assist with disabilities related to foot-drop, with most of them intervening during the whole gait cycle. We propose that, for the treatment of foot-drop, it is possible to design an ankle–foot device that will assist a walking user only during the dorsiflexion stages of the gait, avoiding interference with other stages, by using a single actuator with a simple transmission and a suspension block. This design can be improved by the use of multi-objective optimization to obtain a static set of parameters that are applicable to varying initial conditions. We present a computer simulation study of an active ankle–foot orthosis design, based on the interaction of a cam and lever with a suspension block, with the objective of assisting only with dorsiflexion during the gait cycle, leaving the rest of the movements unimpeded while reducing the complexity and weight of the device. This design is validated using a full simulation environment that includes the movements of the lower leg and foot, as they interact with our device and a ground element. As part of the design and validation, we found sets of mechanical and control parameters that provoke adequate output behavior of the orthosis to help the wearer perform a moderate-speed, normal gait. To optimize the design, we proposed three objectives to warrant ankle angle accuracy, minimal oscillations, and low energy consumption. A set of solutions was obtained with multi-objective optimization algorithms NSGA-II and RVEA to tune the parameters of the active orthosis. The solutions set from RVEA resulted in lower mean and standard deviation values for the oscillations and energy objectives in comparison to the solutions from NSGA-II, while for the MSE objective, NSGA-II obtained lower mean and standard deviation; for the energy consumption objective, the mean score using RVEA is 17% less than with NSGA-II. The orthosis is shown to be robust to differences in initial ankle angles. We observed that it is possible to obtain a broad set of solutions with a good performance during the gait cycle in controlled spaces and that in this application, the RVEA algorithm results in a better option for optimization to balance the objectives.

Enhancing walking performance in patients with peripheral arterial disease: An intervention with ankle-foot orthosis

Lower extremity peripheral artery disease (PAD) is a cardiovascular condition manifesting from narrowed or blocked arteries supplying the legs. Gait is impaired in patients with PAD. Recent evidence suggests that walking with carbon fiber ankle foot orthoses (AFOs) can improve patient mobility and delay claudication time. This study aimed to employ advanced biomechanical gait analysis to evaluate the impact of AFO intervention on gait performance among patients with PAD. Patients with claudication had hip, knee, and ankle joint kinetics and kinematics assessed using a cross-over intervention design. Participants walked over the force platforms with and without AFOs while kinematic data was recorded with motion analysis cameras. Kinetics and kinematics were combined to quantify torques and powers during the stance period of the gait cycle. The AFOs effectively reduced the excessive ankle plantar flexion and knee extension angles, bringing the patients' joint motions closer to those observed in healthy individuals. After 3 months of the AFO intervention, the hip range of motion decreased, likely due to changes occurring within the ankle chain. With the assistance of the AFOs, the biological power generation required from the ankle and hip during the push-off phase of walking decreased. Wearing AFOs resulted in increased knee flexor torque during the loading response phase of the gait. Based on this study, AFOs may allow patients with PAD to maintain or improve gait performance. More investigation is needed to fully understand and improve the potential benefits of ankle assistive devices.

Ankle-foot orthosis in stroke survivors: status of the issue

This paper presents an analysis of information regarding the peculiarity of ankle joint orthosis in cerebral stroke survivors. Gait research methods used to assess gait changes in patients who had suffered a cerebral stroke were briefly reviewed. The three most common patterns of gait impairment after a stroke, namely, stiff-knee gait, “dropped foot,” and gait with knee joint hyperextension, were described. A brief review of the main functional types of ankle joint orthoses, namely, static and dynamic, considering their strengths and weaknesses, was presented. Changes in temporal, spatial, and kinematic parameters of gait in cerebral stroke survivors using orthoses were reported. Changes in gait parameters when using ankle joint orthoses depending on the initial pattern of gait disturbance were assessed. The effect of orthotics on the angles of flexion in the ankle, knee, and hip joints at various gait phases as well as their effect on the speed, rhythm, and length of the step were described. Data on the effect of ankle orthosis on patient’s ability to maintain balance were also presented. The effects of orthosis on gait biomechanics and balance function in stroke survivors are debatable. Thus, our findings in this study allow us to raise the question regarding the optimal timing of the use of ankle joint orthoses during the recovery period of a stroke. Possible reasons for these ambiguous results were considered. The necessity for further research into the effectiveness of ankle–foot orthoses regarding various pathological gait patterns in stroke survivors is justified.

The Effect of a New Generation of Ankle Foot Orthoses on Sloped Walking in Children with Hemiplegia Using the Gait Real Time Analysis Interactive Lab (GRAIL).

Cerebral palsy poses challenges in walking, necessitating ankle foot orthoses (AFOs) for stability. Gait analysis, particularly on slopes, is crucial for effective AFO assessment. The study aimed to compare the performance of commercially available AFOs with a new sports-specific AFO in children with hemiplegic cerebral palsy and to assess the effects of varying slopes on gait. Eighteen participants, aged 6-11, with hemiplegia, underwent gait analysis using GRAIL technology. Two AFO types were tested on slopes (uphill +10 deg, downhill -5 deg, level-ground). Kinematic, kinetic, and spatiotemporal parameters were analyzed. The new AFO contributed to significant changes in ankle dorsi-plantar-flexion, foot progression, and trunk and hip rotation during downhill walking. Additionally, the new AFO had varied effects on spatiotemporal gait parameters, with an increased stride length during downhill walking. Slope variations significantly influenced the kinematics and kinetics. This study provides valuable insights into AFO effectiveness and the impact of slopes on gait in hemiplegic cerebral palsy. The findings underscore the need for personalized interventions, considering environmental factors, and enhancing clinical and research approaches for improving mobility in cerebral palsy.

Joint-Preserving Osteotomy of the Lateral Tibial Plafond for Posttraumatic Osteonecrosis: A Prospective Cohort Study.

Posttraumatic osteonecrosis (ON) of the lateral distal tibia is a rare but severe complication of malleolar fractures. Treatment options include ankle fusion, arthroplasty, osteotomy, and drilling but clinical data on outcomes are limited to single case reports. The aim of this study was to prospectively evaluate the outcome following joint-preserving reconstruction. Over a 10-year period, 10 patients (8 females and 2 males, average age 36 years; range, 27-68 years) with posttraumatic ON were treated with intra-articular osteotomy of the distal tibia and bone grafting. All patients initially sustained a closed pronation injury, 7 with initial tibiotalar subluxation. Chronic syndesmotic instability following initial treatment was present in 4 patients and 5 were smokers. All patients were followed for a median of 68 (range, 12-103) months, 7 returned in person for clinical and radiographic follow-up. No immediate postoperative complications were seen. Secondary ankle fusion was necessary in 1 case (10%) because of progressive osteoarthritis. At the time of follow-up, anterior ankle arthritis leading to impingement and requiring cheilectomy was noted in 4 cases, partial graft necrosis, and secondary syndesmotic instability requiring revision surgery was seen in 1 case each. Compared with the preoperative values, significant improvement in the Olerud-Molander Ankle Score (P = .012), EuroQuol-5 Score (P = .008), and Foot Function Index (FFI-D pain, P = .028; FFI-D restriction, P = .038) was seen. Average range of motion at the ankle was 45 degrees. In our limited series of patients with posttraumatic ON of the lateral distal tibia, we found that joint-preserving reconstruction using an intra-articular distal tibial osteotomy with autologous bone grafting usually provided significant functional improvement and pain relief. In our cohort secondary fusions by a median 5.5-year follow-up were rare, but secondary, joint-sparing surgeries were common. Level III, prospective study.

The Effect of Progressive Muscle Relaxation on the Value of Ankle Brachial Index and Foot Sensitivity in Patients with Diabetes Mellitus

Diabetes mellitus (DM) is a global health threat due to many other health risks such as kidney failure, heart disease, stroke and even serious injuries that can cause complications. One of the complications is peripheral neuropathy nerve damage that causes diabetic ulcers so that there is a risk of decreased foot sensitivity and changes in ankle brachial index values in diabetics. Progressive muscle relaxation technique is one of the actions that can affect the hypothalamus to regulate and reduce the activity of the sympathetic nervous system to provide direction by moving the feet slowly and regularly. Objective: to determine the effect of progressive relaxation techniques on the value of ankle brachial index and foot sensitivity in patients with diabetes mellitus. Methods: This study used quasi experiment method with pre test and post test design approach with control group. The population of DM patients was 120 respondents, then the sample was taken using non-probability sampling and based on inclusion and exclusion criteria. Sampling using total sampling with the number of respondents 15 intervention groups and 15 control groups. Analysis using the t-test. Results: The results of the study on the ABI value obtained a p-value of 0.02 in the intervention group and a p-value of 0.414 in the control group while the foot sensitivity value obtained a p-value of 0.01 in the intervention group and 0.07 in the control group. Conclusion: This shows that there is an increase in ABI values and foot sensitivity in patients with diabetes mellitus. The progressive relaxation technique can be used as an intervention to prevent diabetic foot ulcers.

The Ankle Ligament Reconstruction-Return to Sport after Injury (ALR-RSI) is a valid and reliable measure to assess psychological readiness before returning to sport following peroneal tendon pathology surgery.

The objective of this study was to validate a scale that could help surgeons evaluate patients' psychological readiness to return to sport (RTS) after peroneal tendon pathology surgery. The Ankle Ligament Reconstruction-Return to Sport after Injury (ALR-RSI) scale, which had previously been validated in ankle ligament reconstruction patients, was adapted to evaluate the psychological preparedness for RTS in athletic patients who underwent peroneal tendinopathy surgery. The Foot and Ankle Outcome Score (FAOS) and Foot Ankle Ability Measurement (FAAM) scores were employed as patient-related outcome measurement (PROM) instruments. This study included 57 patients. There was a strong correlation between ALR-RSI and both FAOS and FAAM (r = -0.68 and 0.74, respectively). ALR-RSI was considerably higher in patients who returned to sports than in those who did not. The mean score was 72.9 ± 19.0 in patients who returned to the same preinjury level, 48.5 ± 24.0 in those who returned to a lower leveland 53.6 ± 31.1 in patients who changed their athletic activity (p < 0.0001). Furthermore, ALR-RSI showed at least a similar discrimination ability when compared to FAOS and FAAM. The test-retest intraclass correlation coefficient was 0.95. The Cronbach's α statistic used to measure the internal consistency was high (0.95). A Youden index of 0.65 was observed for a cut-off score of 68 points. ALR-RSI is a valid instrument for assessing psychological readiness to RTS in an athletic population following peroneal tendon surgery. When compared to the most commonly used PROMs, it was strongly correlated and demonstrated at least similar discrimination capacity. This could assist surgeons in identifying athletes who will have poor postoperative results and advising them on their capability to RTS. Level III.

Perceptions and experiences of first mobility aid provision for young children with cerebral palsy in the United States: a mixed-methods study

Purpose The purpose of this study was to establish and understand the provision process and impacts of first mobility aids for children with cerebral palsy (CP) in the United States – specifically orthoses, walkers and gait-trainers. Methods We performed a mixed-methods study including surveys and semi-structured interviews of caregivers of young children with CP (n = 10) and clinicians who work with young children with CP (n = 29). We used content analysis for the surveys and inductive coding for the interviews. Results Four themes emerged: (1) first mobility aids have mixed impacts and use patterns, (2) there is varied caregiver education and understanding about mobility aids, (3) clinician knowledge, consistency and connection impact care and (4) numerous access barriers exist for families, and there are still opportunities for improvement across all domains. Conclusions This research provides insights into the lived experiences of clinicians and caregivers of young children with CP regarding the prescription, provision, use and impact of first mobility aids, specifically ankle foot orthoses and walkers/gait trainers. This study not only provides researchers and clinicians with an understanding of the current status of the prescription and provision process in the United States, but also offers suggestions for improvements of the process and mobility aids themselves. These results have implications for future research, mobility aid, design and the provision process of first mobility aids.

Efficacy of Lower Limb Orthoses in the Rehabilitation of Children Affected by Cerebral Palsy: A Systematic Review.

Lower limb orthoses are frequently used in children suffering from cerebral palsy (CP) alongside rehabilitation. The aim of this study was to analyze the effectiveness of ankle-foot orthosis (AFO) and knee-ankle-foot orthosis (KAFO) in walking, balance maintenance, spasticity, and quality of life improvement during rehabilitation in children affected by CP. The hypothesis was that the use of orthoses could improve the parameters compared to non-use. A systematic review was conducted in the main databases, including English language RCTs published about the use of AFO and KAFO in combination or not with rehabilitation methods in children affected by CP and studies mentioning walking, balance, muscle length, and quality of life as outcomes. From an initial number of 1484 results, a final number of 11 RCTs were included, comprising a total number of 442 participants and showing an overall high risk of bias in 10 studies and some concerns in one study. Six studies investigated the domain of walking, four studies investigated the domain of balance, and two studies investigated how KAFO and AFO orthoses could improve and prevent muscle contractures. Using highly heterogeneous study designs, different kinds of orthoses and different assessment tools were used. Further studies conducted with higher methodological quality are needed to establish whether AFO and KAFO are useful or not in combination with rehabilitation in improving the investigated domains.