Ankle Foot Research Articles

Assessing the Impact of Posterior Leaf Spring Ankle Foot Orthosis on Knee Joint of Hemiplegic Stroke Patients Through Software Gait Analysis

Background: Ankle Foot Orthoses (AFO) is mostly advised for a stroke patient who is complicated with plantarflexion deformity, to support and improve the alignments of the feet for reducing knee joint extension and promoting hip joint extension through stance-phase.
 Objective: To provide deeper knowledge using software gait analysis for the biomechanical effects of PLS AFO for stroke patients.
 Patients and Methods: We divided 42 participants into 3 groups (the first and second groups were 28 stroke participants that used AFO and with OUT-AFO and the third group was 14 normal participants without deformity. All participants walk 10 meters in a straight line for the same time their gait was captured at Comfortable Walking Speed (CWS). Temporal-spatial and kinematic parameters of the knee joint were compared in the study.
 Results: The PLS AFO showed improvement in knee ROM in the AFO condition that has better knee flexion in the early stance (from 8.16 to 16.24 degrees in the AFO condition), a huge increase in the late stance of knee extension (from 0.16 to 3.82 degrees) and better knee flexion than the barefoot condition in the swing flexion (from 26.1 to 39.78 degrees). Also, the mean Time Up and Go (TUG) identically decreased in stroke participants (from 36.04 s in OUT-AFO to 22.6 s in AFO condition).
 Conclusion: In this study, we showed that using a PLS AFO can be beneficial for improving knee ROM and progress walking speed, gait symmetry, balance, and reducing the risk of falls.

An Overview of Mathematical Methods Applied in the Biomechanics of Foot and Ankle–Foot Orthosis Models

Ankle–foot orthoses (AFOs) constitute medical instruments designed for patients exhibiting pathological gait patterns, notably stemming from conditions such as stroke, with the primary objective of providing support and facilitating rehabilitation. The present research endeavors to conduct a comprehensive review of extant scholarly literature focusing on mathematical techniques employed for the examination of AFO models. The overarching aim is to gain deeper insights into the biomechanical intricacies underlying these ankle–foot orthosis models from a mathematical perspective, while concurrently aiming to advance novel models within the domain. Utilizing a specified set of keywords and their configurations, a systematic search was conducted across notable academic databases, including ISI Web of Knowledge, Google Scholar, Scopus, and PubMed. Subsequently, a total of 23 articles were meticulously selected for in-depth review. These scholarly contributions collectively shed light on the utilization of nonlinear optimization techniques within the context of ankle–foot orthoses (AFOs), specifically within the framework of fully Cartesian coordinates, encompassing both kinematic and dynamic dimensions. Furthermore, an exploration of a two-degree-of-freedom AFO design tailored for robotic rehabilitation, which takes into account the interplay between foot and orthosis models, is delineated. Notably, the review article underscores the incorporation of shape memory alloy (SMA) elements in AFOs and overviews the constitutive elastic, viscoelastic, and hyperelastic models. This comprehensive synthesis of research findings stands to provide valuable insights for orthotists and engineers, enabling them to gain a mathematical understanding of the biomechanical principles underpinning AFO models and fostering the development of innovative AFO designs.

Relationship between ankle–foot-complex mobility during static loading and frontal moment impulses of knee and hip joints during the stance phase

BackgroundAnkle–foot-complex mobility impairments, which can be assessed by the difference between the sitting and standing positions, are related to an increase in the load on the knee and hip joints during the stance phase of the gait. Research questionWhat is the relationship between the ankle–foot-complex mobility during static weight bearing and the mechanical stresses on the knee and hip joints throughout the stance phase? MethodsAnkle–foot-complex mobility and gait data were collected from 26 healthy adults. The complex mobility was established by comparing the foot indices, measured using a three-dimensional foot scanner, in sitting and standing positions. The gait data were acquired using eight cameras (recording at 100 Hz) and three force plates (recording at 1000 Hz). Stance phase data were collected via ground reaction forces. The stance phase was dissected into shock absorption and propulsion phases, during which the external knee and hip adduction moment impulses (KAMi, HAMi) were recorded. The correlation between the ankle–foot-complex mobility during static weight bearing and KAMi and HAMi during the stance phase was examined using Pearson's product–moment correlation coefficients. ResultsThis study revealed that KAMi correlated with medial malleolus mobility (r = −0.44) throughout the stance phase. Furthermore, in the propulsive phase, KAMi correlated with calcaneus (r = 0.51) and navicular (r = −0.50) mobilities, whereas HAMi correlated with calcaneus mobility (r = −0.40). SignificanceThe study provides insights into the relationship between the static mobility of the ankle–foot complex in healthy individuals and mechanical stress during the stance phase. Calcaneus and navicular mobilities were related to efficient push-off in the propulsive phase. Medial malleolus mobility was related to the control of the lateral tilt of the lower limb and ankle dorsiflexion motion throughout the stance phase.

Effect of Kinesio Taping on Posture, Balance and Gait in Spastic Cerebral Palsy – A Systematic Review

ABSTRACT Background: Cerebral palsy (CP) is a nonprogressive developmental disorder characterized by motor deficits, such as abnormal posture, balance, and gait impairments leading to deformities, affecting activities daily and, therefore, the quality of life. The application of Kinesio taping (KT) in patients with CP has emerged as a choice of adjunct treatment. Therefore the objective of this review was to evaluate the effectiveness of KT as an addition to conventional physiotherapy (CPT) interventions on posture, balance, and gait in spastic cerebral palsy. Materials and Methods: A bibliographic search was done in various databases. Only randomized controlled trials on KT in CP were included. The risk of bias in included studies was evaluated by using the RoB 2.0 tool. Downs and Black checklist was used to determine the overall quality of studies. Results: A total of five studies were eligible, out of which two studies reported a low risk of bias and three studies reported some concerns on RoB 2.0. The overall methodological quality of the studies ranged from fair to good. Out of five studies in three studies, KT was more effective as adjunct CPT than CPT alone on sitting posture, balance, and standing balance. In one study, KT was equally effective as ankle foot orthosis on gait. Lastly, one study showed a significant improvement with KT application over CPT alone, but the effects of neuromuscular electrical stimulation were more significant than KT on postural control and sitting. Conclusion: KT is a noninvasive, inexpensive, and compliant adjunct to physiotherapy in patients with spastic CP for better outcomes regarding posture, balance, and gait.

Functional outcome of routine versus on-demand removal of the syndesmotic screw.

The primary aim of this study was to present the mid-term follow-up of a multicentre randomized controlled trial (RCT) which compared the functional outcome following routine removal (RR) to the outcome following on-demand removal (ODR) of the syndesmotic screw (SS). All patients included in the 'ROutine vs on DEmand removal Of the syndesmotic screw' (RODEO) trial received the Olerud-Molander Ankle Score (OMAS), American Orthopaedic Foot and Ankle Hindfoot Score (AOFAS), Foot and Ankle Outcome Score (FAOS), and EuroQol five-dimension questionnaire (EQ-5D). Out of the 152 patients, 109 (71.7%) completed the mid-term follow-up questionnaire and were included in this study (53 treated with RR and 56 with ODR). Median follow-up was 50 months (interquartile range 43.0 to 56.0) since the initial surgical treatment of the acute syndesmotic injury. The primary outcome of this study consisted of the OMAS scores of the two groups. The median OMAS score was 85.0 for patients treated with RR, and 90.0 for patients treated with ODR (p = 0.384), indicating no significant difference between ODR and RR. The secondary outcome measures included the AOFAS (88.0 in the RR group and 90.0 for ODR; p = 0.722), FAOS (87.5 in the RR group and 92.9 for ODR; p = 0.399), and EQ-5D (0.87 in the RR group and 0.96 for ODR; p = 0.092). This study demonstrated no functional difference comparing ODR to RR in syndesmotic injuries at a four year follow-up period, which supports the results of the primary RODEO trial. ODR should be the standard practice after syndesmotic screw fixation.

A trajectory tracking method based on robust model predictive control for a bionic ankle–foot aided by a tensegrity mechanism

In this article, a robust model predictive control method is investigated for settling the trajectory tracking problem of a bionic ankle–foot aided by a tensegrity mechanism. In order to achieve adaptive movement of the ankle–foot mechanism, a three-degrees-of-freedom spatial ankle–foot mechanism is designed by tensegrity, which is a spatial grid structure composed of springs and struts. Dynamic analysis is the basis of control algorithm research, and the dynamic model of the mechanism can be established by a Lagrangian equation. Then, a controller is proposed for tracking the trajectory of the ankle–foot mechanism under external disturbances. Combining rolling optimization and feedback correction, the controller can be defined as an optimization problem, by solving which the ankle–foot mechanism can be controlled to track the desired trajectory quickly. Furthermore, stability analysis is an essential part of predictive controller design, which can help to understand the operational mechanism of the control strategy. Numerical results demonstrate that the proposed approach improves trajectory tracking accuracy and avoids mechanism movement problems caused by disturbances.

Restoration of Over-Ground Walking via Non-Invasive Neuromodulation Therapy: A Single-Case Study

Spinal cord injuries (SCI) can result in sensory and motor dysfunctions, which were long considered permanent. Recent advancement in electrical neuromodulation has been proven to restore sensorimotor function in people with SCI. These stimulation protocols, however, were mostly invasive, expensive, and difficult to implement. In this study, transcutaneous electrical stimulation (tES) was used to restore over-ground walking of an individual with 21 years of chronic paralysis from a cervical SCI. After a total of 66 weeks of rehabilitation training with tES, which included standing, functional reaching, reclined sit-up, treadmill walking, and active biking, significant improvement in lower-limb volitional movements and overall light touch sensation were shown as measured by the International Standards for Neurological Classification of Spinal Cord Injury (ISNCSCI) score. By the end of the study, the participant could walk in a 4-m walking test with the aid of a walking frame and ankle–foot orthoses. The successful sensorimotor recovery of our study participant sheds light on the future of non-invasive neuromodulation treatment for SCI paralysis.

Effect of Chronic Ankle Instability on the Biomechanical Organization of Gait Initiation: A Systematic Review.

This systematic review was conducted to provide an overview of the effects of chronic ankle instability (CAI) on the biomechanical organization of gait initiation. Gait initiation is a classical model used in the literature to investigate postural control in healthy and pathological individuals. PubMed, ScienceDirect, Scopus, Web of Science, and Google Scholar were searched for relevant articles. Eligible studies were screened and data extracted by two independent reviewers. An evaluation of the quality of the studies was performed using the Downs and Black checklist. A total of 878 articles were found in the initial search, but only six studies met the inclusion criteria. The findings from the literature suggest that CAI affects the characteristics of gait initiation. Specifically, individuals with CAI exhibit notable differences in reaction time, the spatiotemporal parameters of anticipatory postural adjustments (APAs) and step execution, ankle-foot kinematics, and muscle activation compared to healthy controls. In particular, the observed differences in APA patterns associated with gait initiation suggest the presence of supraspinal motor control alterations in individuals with CAI. These findings may provide valuable information for the rehabilitation of these patients. However, the limited evidence available calls for caution in interpreting the results and underscores the need for further research.

THE EFFICACY OF DISTAL TIBIAL GROWTH MODULATION IN THE TREATMENT OF PAEDIATRIC FOOT AND ANKLE DISORDERS: A RETROSPECTIVE STUDY OF CASES FROM 2003 TO 2022

AbstractObjectivesEpiphysiodesis is a commonly used treatment for lower limb angular deformities. However, in recent years, distal tibial growth modulation using ‘eight plates’ or screws has emerged as an alternative treatment for paediatric foot and ankle disorders, such as CTEV. Our objective was to assess the efficacy of distal tibial modulation in correcting various paediatric foot and ankle disorders.MethodsThis retrospective study analysed 205 cases of paediatric foot and ankle disorders treated between 2003 and 2022, including only cases where the eight plate or screw was fixed on the anterior surface of the distal tibia. Our aim was to measure post-operative changes in dorsiflexion, the distal tibial angle, and the tibiocalcaneal angle by examining clinical records and radiology reports.ResultsWe identified nine cases (nine feet) meeting the full inclusion criteria, comprising seven cases of CTEV, one case of arthrogryposis, and one case of cavovarus foot. The cohort consisted of five male and four female patients, with a mean age of 10 years and 9 months at the time of surgery. Seven cases involved the left tibia, and two cases involved the right tibia. The mean time between pre-operative X-ray to surgery was 168 days, and the mean turnaround time between surgery and post-operative X-ray was 588 days. A mean change in the distal tibial angle of 4.33 degrees was noted. However, changes in dorsiflexion were documented in only one case, which showed a change of 13 degrees. Notably, our average distal tibial angle was significantly lower than reported in the literature, at 4.33 degrees. Additionally, some studies in the literature used the Oxford Ankle Foot Questionnaire for Children to assess pre- and post-operative outcomes, but it is important to note that it is validated only for children aged 5 to 16. Furthermore, most cases reported an improved tibiocalcaneal angle except for an anomaly of 105 degrees. We assessed satisfactory patient outcomes using patient notes. Out of the 6 procured notes, one has been discharged. The rest are still under yearly or 6-monthly review and are at various stages, such as physiotherapy, removing the eight plate, or requiring further surgery. The most common presentations at review are plantaris deformity and pain.ConclusionsOur study suggests that distal tibial growth modulation can be an effective treatment option for selected paediatric foot and ankle disorders. However, due to the limited number of cases in our study, the lack of documentation of changes in dorsiflexion, and a lack of pre- and post-operative outcomes using a standardised method, further research is needed to investigate this procedure's long-term outcomes and potential complications.Declaration of Interest(b) declare that there is no conflict of interest that could be perceived as prejudicing the impartiality of the research reported:I declare that there is no conflict of interest that could be perceived as prejudicing the impartiality of the research project.

Avulsion fracture is associated with more pain after anatomic repair procedure for ATFL injury at the talar side

AbstractPurposeTo evaluate the clinical outcomes of anatomic repair procedure for chronic anterior talofibular ligament (ATFL) injury at the talar side, and to compare the outcomes between patients with and without concomitant avulsion fractures. It was hypothesized that anatomic repair procedure could produce similarly satisfactory outcomes for those two groups.MethodsThirty‐nine consecutive patients with chronic ATFL injuries at the talar side who underwent anatomic repair procedure at the department of sports medicine at Peking University Third Hospital between 2013 and 2018, were retrospectively evaluated. The pain visual analogue scale (VAS), American Orthopaedic Foot & Ankle Society (AOFAS) score, Tegner score, and Foot & Ankle Outcome Score (FAOS) were recorded as the primary outcomes. Time to return to sports (RTS), surgical satisfaction, deficiency of ankle range of motion (ROM), recurrent sprain, and postoperative complications were recorded as the secondary outcomes. Outcomes were compared between patients with (Group A, 16 cases) and without (Group B, 23 cases) concomitant avulsion fractures.ResultsThe mean follow‐up time was 79.4 ± 17.0 and 76.6 ± 18.5 months for Group A and B, respectively. VAS, AOFAS, Tegner, FAOS, and all subscale scores of FAOS were significantly improved in both groups at the final follow up. Patients in group A had inferior postoperative VAS, AOFAS, FAOS, and pain score of FAOS compared to group B (1.1 ± 1.1 vs. 0.4 ± 0.5, 89.1 ± 10.1 vs. 95.2 ± 5.2, 87.2 ± 7.2 vs. 91.5 ± 4.1, and 88.4 ± 11.3 vs. 96.7 ± 3.5, respectively).The mean time to RTS, rate of satisfaction and recurrent sprain had no significant differences between group A and B (6.1 ± 2.8, 93.8%, and 18.8% vs. 5.2 ± 2.2, 100.0%, and 13.0%, respectively), and the rate of ROM deficiency was significantly higher in group A (37.5 vs. 8.7%). Avulsion fracture was identified as an independent risk factor for inferior pain score of FAOS.ConclusionAnatomic repair procedure for chronic ATFL injuries at the talar side produces favourable results for patients with and without avulsion fractures at 5 to 10 years follow‐up, however, avulsion fracture is associated with more pain.Level of evidenceIII.

Design and Manufacturing Ankle Foot Prosthetics for Patients with Transtibial Amputation

Rapid Prototyping (RP) is a technology used to incrementally shape products or add material using 3D printing equipment. 3D printing is extensively utilized throughout several industries, particularly in the medical sector. This study aims to make a valuable contribution to the field by specifically focusing on the manufacturing of foot prosthetics for patients who have undergone below-knee amputations. The design step on Solidwork software is initiated, followed by the realization of the chosen design utilizing a 3D printing machine, which utilizes PLA as the preferred material. The main focus of this study is to optimize the manufacturing process in order to determine the parameters that result in the most effective production of foot prosthesis, while minimizing the time required for machining. Optimization analysis revealed that the most effective parameters for producing PLA foot prosthesis using a 3D printing machine are a layer height of 0.1 mm, infill density of 100%, print speed of 100 mm/s, and nozzle temperature of 210°C. These adjusted parameters are essential benchmarks for the production sector of foot prostheses.

A pelvic kinematic approach for calculating hip angles for active hip disarticulation prosthesis control

BackgroundControl system design for a microprocessor-controlled hip–knee–ankle–foot (HKAF) prosthesis is a challenge since hip disarticulation amputees lack the entire leg and, therefore, only have pelvis movement as user-guided input. This research proposes a method for determining hip joint angles from pelvis movement in a control system for the next generation of powered prostheses.MethodThree-dimensional pelvic motion and stance time of 10 transfemoral (TF) prosthetic users were used to identify important features and to develop an algorithm to calculate hip angles from pelvis movement based on correlation and linear regression results. The algorithm was then applied to a separate (independent) TF group to validate algorithm performance.ResultsThe proposed algorithm calculated viable hip angles during walking by utilizing pelvic rotation, pelvic tilt, and stance time. Small angular differences were found between the algorithm results and motion capture data. The greatest difference was for hip maximum extension angle (2.5 ± 2.0°).ConclusionsSince differences between algorithm output and motion data were within participant standard deviations, the developed algorithm could be used to determine the desired hip angle from pelvis movements. This study will aid the future development of gait control systems for new active HKAF prostheses.

Medical simulator for the training of radiologists: experimental work

BACKGROUND: Ankle injuries of various nature bruises, sprains, tears, dislocations and subluxations, and fractures account for 2030% of all musculoskeletal system injuries. The most common ankle injuries are a tear and sprain. The difficulty in treating fractures in this location is due to the need for accurate repositioning of the articular surface and stable fixation of fragments. The actual task is to train roentgenologists in the field. The inclusion of medical personnel in the educational process at all levels of training simulation courses aids in the reduction of errors, reduction of problems, and the improvement of the quality of medical treatment provided to the public.
 OBJECTIVE: This study aims to develop and create a simulator that simulates human bone structure and soft tissues and allows roentgenologists to get through training and instruction radiological examinations of an ankle joint and a foot.
 MATERIALS AND METHODS: The following stages of the simulators development have been completed: acquiring ankle bone samples, creating a mold for casting, and constructing the simulator. The results of computer and magnetic resonance imaging were used to construct bone samples, from which a computerized 3D model of the bones of the foot and ankle joint was obtained. Using additive technologies, anatomically correct reproductions of human foot and ankle bones were made. At the next stage, a three-dimensional digital model was developed, and a mold for casting the finished product was made. Bone samples collected in a single structure were placed inside the mold. Next, a step-by-step filling of the form with a soft gel-like material was performed. In this case, a self-vulcanizing silicone rubber composition is selected, which, after solidification, imitates human soft tissues.
 RESULTS: During the course of the study, a prototype medical simulator was created that models human bone structure and soft tissues and allows roentgenologists to practice performing ankle joint and foot roentgenography.
 CONCLUSION: Because of its high anatomical accuracy, ease of use, and mass production potential, the developed simulator can be widely employed in the teaching of roentgenologists.

Effectiveness of FRIRAGE massage in the management of ankle injury in child

The aim of this study was to determine the effectiveness of frirage massage in the management of ankle injuries in children of Kurusumange Village, Tanralili District, Maros Regency. This research is a type of preexperiment research with the one group pretes-posttes design method, the sample in this study amounted to 35 children obtained through nonprobability sampling techniques with a purposive sampling approach. Data collection was carried out using the Pre Post Questionnaire sheet with ankle injury questionnaire adapted from the Oxford ankle foot questionnaire which has been declared valid and reliable with the results of the reliability coefficient = 0.956. Then, the data were analysed using the Wilcoxon Test with a significant level of 5%. This study showed that the average value of ankle degree before and after frirage massage was 69.43% and 50.71%. This study showed a decrease in the degree of ankle disorders in children after frirage massage treatment by 18.72%, the Wilcoxon signed rank test showed a significant value of ρ Value of 0.000. This study can be concluded that frirage massage is effective as an ankle injury management in reducing the degree of ankle disorders in children of Kurusumange Village, Tanralili District, Maros Regency.

Alternatif Design of Compliant Mechanism Based Ankle Foot Prosthesis

People with permanent disabilities such as transtibial amputees can be independent and lead normal lives through prosthetics. Foot prosthetics is currently a custom product that is adapted to the features of the amputated leg, so it is more expensive and time consuming. Artificial foot products in Indonesia are still dominated by imported products, so they have high prices and are difficult to reach for lower-middle class amputees. The purpose of this study was to create an alternative design of the ankle foot for users of below-knee prosthetics. The design was made using Solidwork software. Two types of alternative ankle foot designs were produced in this study. Both designs apply a compliant mechanism system to make it more flexible when used. The design is made to meet one of the specified criteria, namely light weight with a mass of less than 2.3883 kg. Three alternative materials are offered in both design alternatives, namely Acrylonitrile Butadiene Styrene (ABS), Poly Oxy Methylene (POM), and AISI 304. Based on the design, it is found that the lightest design is owned by an alternative ankle foot design 1 with ABS material that is equal to 62.69 gram.

A new method of anterior talofibular ligament reconstruction: Arthroscopically artificial ligament reconstruction with tensional remnant-repair

PurposeTo investigate the clinical effects of arthroscopically artificial ligament reconstruction with tensional remnant-repair in patients who are obese, and/or with demand for highly intensive sports, and/or with poor-quality ligament remnants. MethodsA retrospective case series study was performed on patients treated by arthroscopically anterior talofibular ligament (ATFL) reconstruction with tensional remnant repair technique from January 2019 to August 2021. General data, including demographics, surgical time, and postoperative adverse events, were recorded. The American Orthopaedic Foot and Ankle Society score (AOFAS), foot and ankle ability measure (FAAM), visual analog scale (VAS), and anterior talar translation were measured preoperatively and at 6 weeks, 3 months, and 2 years postoperatively. Ultrasonography examination was performed preoperatively and 2 years postoperatively to evaluate the ATFL. Data were analyzed using SPSS 19.0. F test was used to analyze the pre- and postoperative VAS, FAAM, and AOFAS scores. The significance was set at p < 0.05. ResultsThere were 20 males and 10 females among the patients with a mean age of (30.71 ± 5.81) years. The average surgical time was (40.21 ± 8.59) min. No adverse events were observed after surgery. At 2 years postoperatively, the anterior talar translation test showed grade 0 laxity in all patients. VAS score significantly decreased from preoperatively to 6 weeks, 3 months, and 2 years postoperatively (p < 0.001). Improvement of FAAM score and the AOFAS score from preoperatively to 6 weeks, 3 months, and 2 years postoperatively was statistically significant (p < 0.001). At 3 months postoperatively, most patients (23/30) could return to their pre-injured activities of daily living status. At 2 years postoperatively, all patients were able to return to their pre-injured activities of daily living status, and almost every patient (18/19) who expected highly intensive sports returned to sports with only 1 obese patient failing to achieve the goal. The ultrasonography examination at 2 years postoperatively showed that there was a linear band structure of soft tissue on the tension-rich fiber tape image from the fibular to the talar attachment sits of ATFL. ConclusionThe novel arthroscopically artificial ligament reconstruction with tensional remnant-repair technique for ATFL achieved satisfactory clinical outcomes in the short and medium term after operation, and allowed early return to pre-injured activities, which could be a reliable option for patients with chronic lateral ankle instability.

Clinical outcomes following tibiotalocalcaneal arthrodesis with intramedullary nailing combined with partial fibulectomy and onlay bone graft.

Although intramedullary nailing is a popular method for tibiotalocalcaneal arthrodesis, nonunion is one of the most commonly reported complications. This study aimed to evaluate the fusion rate, improvement in functional outcomes, and occurrence of complications in tibiotalocalcaneal arthrodesis using retrograde intramedullary nailing with partial fibulectomy and onlay bone graft technique. Twenty-six consecutive patients using the proposed technique were retrospectively reviewed. For radiographic outcomes, the union rate, alignment, and any related complications were assessed. Functional outcomes were evaluated using the American Orthopedic Foot and Ankle Society hindfoot scale, Foot and Ankle Outcome Score, and visual analog scale, preoperatively and at the final follow-up. The mean follow-up period was 38.2months. The tibiotalar joint achieved complete union in 80.8% at six months postoperatively, while all the cases achieved complete union at 12months postoperatively. However, the subtalar joint achieved complete union in 26.9% at six months postoperatively, which gradually increased to 73.1% at 12months postoperatively, and 80.8% at the final follow-up without revision surgery. A subgroup analysis showed there was a trend of higher subtalar fusion rate when an additional screw for the subtalar joint fixation was placed (86.7% vs. 54.5%). The functional outcomes significantly improved at the final follow-up. A few minor complications occurred, including surgical site infection, irritational symptoms, and metal failure; however, they eventually resolved. Our technique of tibiotalocalcaneal arthrodesis with partial fibulectomy and onlay bone grafting could be a good option where both the tibiotalar and subtalar joints need to be fused.

THE PATTERN OF WHEEL SPOKE INJURY TREATED AT COMBINED MILITARY HOSPITAL RAWALPINDI

This research investigated the characteristics and patterns of wheel spoke injuries treated at Combined Military Hospital Rawalpindi. The study was conducted at Combined Military Hospital Rawalpindi, a prominent healthcare facility in Rawalpindi, Pakistan, providing medical services to military personnel and civilians. The research analyzed data gathered over a year regarding wheel spoke injuries. A random sample of eighty-two patients was selected, and data was collected on demographic information, injury specifics, clinical presentations, treatments, and outcome measures to provide a quantitative analysis. The study's results showed that the average time elapsed from injury to presentation was 6 hours. Most injuries occurred on the right foot (37 patients) and were associated with the rear wheel (34 patients). Injuries to the lateral aspect of the ankle were common (73%), with the posterior ankle being the most frequent site (n=30). Soft-tissue injuries were classified into grades 0, 1, 2, and 3, with changes in grading noted in some cases. Patients with grade 0 or 1 injuries healed faster (mean 28 days) than those with grade 2 or 3 (mean 40 days). Eight patients had associated fractures, all healed without complications with a mean healing time of 18 days. The study concluded that wheel spoke injuries are common and are often found near the Achilles tendon. Injury classification is critical for treatment decisions and predicting prognosis. Monitoring for infection and necrosis within 48 hours is vital due to poor vascularity. Customized treatment approaches, including below-knee back splints, ankle foot orthoses, and debridement, are recommended based on injury characteristics.

Exploring the rationale for prescribing ankle–foot orthoses and supramalleolar orthoses in children with cerebral palsy: A narrative synthesis of rationale statements

Background: To help improve outcomes for children with cerebral palsy (CP), ankle–foot orthoses (AFOs) and supramalleolar orthoses (SMOs) are prescribed. However, it is not clear why one intervention is prescribed over the other. Objectives: To explore the rationale for prescribing AFOs and SMOs in children with CP and its link to the choice of outcome measure used. Study design: Narrative review. Methods: Six databases were searched (eg, Medline) and data extracted from articles that met the inclusion criteria. Data describing the participant demographics, type of orthosis, and outcome measures used were summarized to provide context for the different rationale for orthotic prescription that were thematically analyzed. Discussion: Forty-seven articles were included. Participants were aged 9 ± 2 years, 59% were male, 79% had diplegia, and 38% were classified as Gross Motor Function Classification System level I. All studies included a rationale for prescribing AFOs that, in most cases, reflected the outcome measures used. These rationale statements were synthesized into 5 specific themes (e.g., reduced energy expenditure and metabolic costs). By comparison, 5 of these studies described the rationale for providing SMOs, and of those that did, most of the rationale statements were nonspecific. Conclusions: A large and contemporary body of literature describes the rationale for prescribing AFOs for children with CP. There are opportunities for future research that clearly articulates the rationale for prescribing SMOs for children living with CP and to focus the rational for orthotic intervention on the real-world challenges that are most important to children living with CP, such as the ability to participate among peers.

Surgical Treatment for Isolated Closed Multi-metatarsal Fractures: At Least 2-Year Outcomes in 79 Feet

Multimetatarsal fractures are a particular type possibly associated with worse functional outcomes. Existing studies are scarce, fragmented, and lack control for confounders. This study aimed to explore the functional prognosis of isolated closed extra-articular multimetatarsal fractures and the different outcomes between the plate-screw and K-wire fixation. This retrospective study included 79 patients who underwent surgery for isolated closed extra-articular multimetatarsal fractures from May 2017 to December 2020. We recorded baseline characteristics. The primary outcome measure was Visual Analogue Scale (VAS), American Orthopedic Foot and Ankle Society (AOFAS) score, and Foot and Ankle Outcome Score (FAOS). Exploratory correlation analysis of the variables with VAS, AOFAS score, and FAOS was performed. The differences between the plate-screw group (n = 58) and K-wire group (n = 21) were compared. Seventy-nine patients (79 feet) were included with a follow-up of (47.3 ± 12.7) months (range, 26-70). Full weight bearing time was (11.7±5.3) weeks. VAS was (1.4±1.8) points, AOFAS score was (86.4±13.3) points, and FAOS was (79.0±11.1) points. Complications were observed in 17 cases (21.5%). According to exploratory correlation analysis, VAS was weakly associated with fixation method and gender, AOFAS was weakly associated with fixation method, FAOS was weakly associated with trauma mechanism. When the plate-screw group (n = 58) was compared with the K-wire group (n = 21), we found the former was superior to the latter in terms of full weight bearing time, VAS, AOFAS score, and malunion rate (all p < .05). FAOS was nonsignificant (p = .056). Operative treatment of isolated closed extra-articular multimetatarsal fractures showed good mid-term results. Plate-screw fixation was associated with faster rehabilitation as well as a lower malunion rate. The mid-term follow-up results showed patients with plate-screw fixation had better VAS and AOFAS scores.