Ankle Region Research Articles

Clear cell sarcoma in pelvic region - case report

Clear cell sarcoma is a rare tumor with a predilection to involve tendon and aponeuroses, predominantly around the foot and ankle region. It is clinically, genetically as well as biologically distinct from malignant melanoma, however share some histological and immunohistochemical similarities with it. Clear cell sarcoma usually arise from the deep soft tissue of lower extremities and carries a balanced translocation t(12;22) (q13;q12). The fusion protein activates MiTF, a melanocytic transcription factor which leads to tumor growth and melanin production. The head & neck and trunk are distinctly unusual sites for occurrence of CCS. We herewith describe a CCS in the pelvis of the 26 years-old male patient presented with the chief complaints of paraesthesia, weakness, muscle wasting in right lower limb with foot drop since one year with review of literature.

Osteopathic Manipulative Treatment Versus Exercise Program in Runners With Patellofemoral Pain Syndrome: A Randomized Controlled Trial.

The effects of an exercise program (EP) for the treatment of patellofemoral pain syndrome (PFPS) are well known. However, the effects of osteopathic manipulative treatment (OMT) are unclear. To evaluate the effects of OMT versus EP on knee pain, functionality, plantar pressure in middle foot (PPMF), posterior thigh flexibility (PTF), and range of motion of hip extension in runners with PFPS. This is a randomized controlled trial. Human performance laboratory. A total of 82 runners with PFPS participated in this study. The participants were randomized into 3 groups: OMT, EP, and control group. The OMT group received joint manipulation and myofascial release in the lumbar spine, hip, sacroiliac joint, knee, and ankle regions. The EP group performed specific exercises for lower limbs. The control group received no intervention. The main evaluations were pain through the visual analog scale, functionality through the Lysholm Knee Scoring Scale, dynamic knee valgus through the step-down test, PPMF through static baropodometry, PTF through the sit and reach test, and range of motion through fleximetry. The evaluations were performed before the interventions, after the 6 interventions, and at 30-day follow-up. There was a significant pain decrease in the OMT and EP groups when compared with the control group. OMT group showed increased functionality, decreased PPMF, and increased PTF. The range of motion for hip extension increased only in the EP group. Both OMT and EP are effective in treating runners with PFPS.

3D optical scanning as an objective and reliable tool for volumetry of the foot and ankle region

BackgroundEdema development of the foot and ankle region should be evaluated by an objective measurement. We hypothesized, that 3D optical scanning of this region can serve as an alternative to clinically established measurement techniques. MethodsTwo investigators determined the volume by 3D optical scanning and the figure-of-eight method in a random order at 2 separate time points. Plots were created and ICCs were calculated for determination of reliability. The Pearson correlation coefficient served as a measure of the association between both measures. Results40 healthy volunteers with mean age of 28.3±9.9 years underwent four sequences of measurements. The inter- and intraobserver reliability of both methods was excellent with high intraclass correlation coefficients (ICC 3,1). A strong correlation (r=0.96, P<0.001) between measured ankle volumes was noted. Conclusion3D optical scanning turned out to be more reliable than the figure-of-eight method in a preclinical set-up. A clinical use should be aimed at.

Guild burials or family graves? Intrapopulation relationship analysis of 18th century La Concepción church cemetery in Santa Cruz de Tenerife, Canary Islands

La Concepción church is the oldest church in Santa Cruz de Tenerife and it was used as a cemetery for over 200 years, during the 16th century and up to the 18th century. Those who were buried there were from multiple ethnic backgrounds and with different lifestyles. During an emergency archaeological excavation, comingled, poorly preserved bone remains of about 300 individuals were excavated. We here analyze a total of 198 tali, looking for the presence of non-metric traits. The results show that the frequencies of non-metric traits were greater than the majority of previous studies, indicating that a large proportion of the sample had an increased activity in the ankle region. Some traits appeared in the same bone and, more importantly, several tali with uncommon combinations belonged to individuals buried in the same tomb. These results were tested for randomness with binomial distribution tests that resulted in a P < 0.0001. Moreover, tombs containing tali with uncommon trait combinations showed a tendency to cluster in certain areas of the church. The results of this study therefore show that either people who performed similar activities that led to the development of certain patterns of trait combinations were interred together or in neighboring tombs, or these combinations of traits indicate a genetic relationship that explains why the individuals were buried in the same tombs. This study highlights the importance of analysing trait combinations in talar bones, since, together with other bioanthropological research tools – including genetics, and/or historical data – they may provide useful information for the reconstruction of important aspects of the daily lives of past populations. The study of trait combinations in talar bones may also aid in the detection and understanding of relationships within a cemetery, where kinship analysis is unable to be applied.

Validity and Reliability of the Oslo Sports Trauma Research Center (OSTRC) Questionnaire on Overuse Injury and Health Problem in Thai Version

Background: The Oslo Sports Trauma Research Center (OSTRC) questionnaires on overuse injury and health problem were developed to register overuse injury and health problems. However, this questionnaire has not been translated or validated in Thai. Objective: To develop the original edition of the OSTRC Questionnaire on overuse injuries and health problems into Thai language and to examine the validity and reliability of the adapted scale. Materials and Methods: The development of the questionnaire followed the steps of translation, which included forward translation, translation merging, backward translation, and critique by the researcher, health professionals, speech professionals, athletes, and the translators for semantic and conceptual equivalence. A cohort of 65 Thai athletes were recruited. Cross-sectional surveillance data were used to record overuse injury and health problem. Throughout the 12-week surveillance period, all participants were assigned to complete the questionnaire within three days after receiving a questionnaire by e-mail. Robustness and reliability process was seen in the 57 athletes who completed their 12 weeks of surveillance period. Results: The OSTRC on overuse injuries and health problems Thai version (OSTRC-OT and HT) showed a high internal consistency. Cronbach’s α of the OSTRC-OT for ankle, knee, and hip regions was 0.919, 0.973, and 0.976, respectively, and the OSTRC-HT was 0.959 and an excellent test-retest reliability with intraclass correlation coefficient of the OSTRC-OT for ankle, knee, and hip regions at 0.994, 0.970, and 0.991, respectively, and the OSTRC-HT at 0.970; all p-values&lt;0.001. Known-groups validity, the severity scores of the OSTRC-OT for ankle, knee, and hip regions, and the OSTRC-HT scores were statistically significant different between injury and non-injury groups. Conclusion: The validity and reliability of both questionnaires, the OSTRC-OT and the OSTRC-HT were at an excellent level. Moreover, the OSTRC-OT and OSTRC HT have an excellent ability to separate athletes who have an injury and health problem for those who do not. Keywords: Questionnaire, Sport, Overuse injury, Health problem

Response to Comment on "Li et al, Distally Based Sural Adipofascial Turnover Flap for Coverage of Complicated Wound in the Foot and Ankle Region".

Response to Comment on "Li et al, Distally Based Sural Adipofascial Turnover Flap for Coverage of Complicated Wound in the Foot and Ankle Region".

Osteitis Fibrosis Cystica: Classical Case Report of an Uncommon Presentation in a Young Female.

Osteitis fibrosa cystica (OFC) is a skeletal disease related to long standing, end-stage hyperparathyroidism. However, nowadays hypercalcemia due to primary or secondary hyperparathyroidism can often be detected early by laboratory screening and imaging modalities; consequentially the frequency of osteitis fibrosa cystica has drastically declined. OFC, also termed as Brown tumor, can mimic primary bone tumors clinically, which often leads to misdiagnosis and inappropriate management. Moreover due to its rarity, it is usually not considered initially in the differential diagnosis of bony tumors. Case presentation: This is the case of a 19-year-old female, who presented with pain over the left ankle region for 3months. The biochemical screening revealed a picture consistent with primary hyperparathyroidism and the radiologically proven to be left inferior parathyroid adenoma. She underwent excision of the primary parathyroid adenoma, and gradual regression of symptoms was noted postoperatively. Osteitis fibrosa cystica is a rare manifestation of hyperparathtyroidism, which has become a forgotten entity lately due to early identification of hypercalcaemia by modern techniques. A delay in the diagnosis of parathyroid adenoma results in manifestations that can be avoided. The diagnosis of OFC requires a high degree of clinical suspicion. When hypersecretion of PTH is corrected, spontaneous regression of the lesion is expected.

Peroneus Brevis Muscle Flap as a Tissue Cover for Defect over Lower Mid Leg and Ankle Defects: A Case Series

Mid leg and ankle area are more vulnerable for post-traumatic full thickness soft tissue loss. Implants used in osteosynthesis in this region are also at risk of exposure as its placement is in subcutaneous plane as well as precarious blood supply in shin region. Various options like local flap to free flap are described for reconstruction of small and medium size defects in this region. Peroneus brevis is also well described in literatures. In this case series which was done over the period of six years that includes 10 patients with post-traumatic as well as post orthopaedics surgical intervention defects in lower mid leg and ankle region. Patients were selected for proximally and distally based peroneus brevis muscle flap according to the location of defects. Data regarding age, sex, aetiological factor, size of defect, type of flap, survival of flap, donor site complications were recorded. Out of 10 patients, eight were males and two were females. Major aetiological factor was two wheeler road traffic accident. Majority of the patient had orthopaedic surgical intervention for fracture fixation prior to or along with flap surgery. Only one patient, in this series had marginal flap necrosis. Rest of flaps survived well without any donor site complications. In authors experience peroneus brevis muscle flap is dependable for medium size defects over lower leg and ankle.

On-Body UWB Channel Classification and Characterization for Various Physical Exercises

This paper presents classification, characterization and modelling of ultra-wideband (UWB) on-body channel links while performing various physical exercises. The physical exercises mainly focus on range-of-motion exercises in which the upper and lower limb movement is dominant. Such exercises are suitable for various applications in medical domain such as rehabilitation, physiotherapy, in sports for training and general-well-being. Wrist and ankle regions have been chosen for the wearable antenna placement and three different antenna orientations have been considered with respect to the location on the limb, inner, outer, and front region. The channel for various activities has been classified into line of sight (LOS) and non-line of sight (NLOS) links based on computation of Kurtosis. On-body statistical analysis and distance-dependent study is performed on two important channel parameters, path loss magnitude and rms delay spread considering the LOS and NLOS links. The channel variation is attributed to the location/orientation of the antenna, Tx-Rx distance, obstruction caused by the human body and different categories of activities.

Arthroscopically assisted resection of overlooked fracture of posterior talar procesus

Introduction. The fractures of the posterior process of the talus are relatively rare injuries of the ankle. They most frequently occur via the mechanism of the forced hyper plantar flexion and inversion. Sometimes they are not initially diagnosed, since over 40% of cases of the fractures of the posterior process of the talus are not seen in the initial radiography. The objective of this work is the review of the case study of the arthroscopically treated unhealed fracture of the posterior process of the talus. Case outline. In our case report we present a 30-year-old male, professional soccer player, with a threemonth-long history of chronic pain in the region of the left ankle and heel and the fracture of the posterior process of the talus. Conclusion. The work shows all the advantages of minimally invasive surgery ? arthroscopic excision of the fragment, quick recovery and returning to physical activities.

Prevalence of Accessory Deep Peroneal Nerve in Sample of Bosnia and Herzegovina Subjects: an Electrophysiological Study.

Background:The accessory deep peroneal nerve (ADPN) is as an anomalous nerve derived from the superficial peroneal nerve or its branch and supplies motor innervations for extensor digitorum brevis (EDB) and sensory innervations for the lateral part of the ankle and foot regions. It is the most common anomalous innervation present in the lower limb.Objective:The aim of this study was to determine the prevalence of ADPN electrophysiologically in a sample of Bosnia and Herzegovina subjects who referred to an electromyography lab.Methods:This cross-sectional descriptive study included 316 lower limbs from 171 subjects referred for electrodiagnostic studies to Electromyography Lab, Department of Neurology, University Clinical Center Tuzla (Bosnia and Herzegovina) (102 females/60% and 69/40%) males). Motor nerve conduction studies for the peroneal nerve and ADPN were done. Compound muscle action potential (CMAP) and nerve conduction velocity (NCV) of deep peroneal nerve (DPN) were measured by using EMG machine by stimulating DPN at knee, ankle and lateral malleolus areas accordingly, with recording from extensor digitorum brevis (EDB) muscle.Results:ADPN was found in 46 (14.5%) of 316 legs. ADPN was found in 18 (39.1%) right lower limbs and 28 (60.9%) left lower limbs. Ten subjects (5.8%) had bilateral ADPN. There was no statistically significant difference between the occurrence of ADPN in women versus men (p=0.757), as well as in right versus left legs (p=0.237).Conclusion:This study demonstrated that ADPN prevalence, in a sample of Bosnia and Herzegovina subjects who referred to an electromyography lab is 14.5%. Recognition of ADPN is very important for proper interpretation of lower limbs electrophysiological data.

Ergonomic assessment in metal-based small industries in Bogor Regency, Indonesia, 2019

ObjectiveSmall and medium-sized enterprises (SMEs) play a major role in economic growth and employment, and they come with a greater risk of work-related illnesses for workers. Metal-based SMEs are recognised as the sector with the most demanding physical work activities and awkward postures, which are considered risk factors of musculoskeletal disorders (MSDs). This study analysed the risk factors of MSDs associated with different work postures during production. MethodsBody postures were examined using the Rapid Entire Body Assessment (REBA) method, and the data on musculoskeletal symptoms were collected using the Nordic Musculoskeletal Questionnaire (NMQ). ResultsThe results were calculated using the REBA method to determine the level of risk of various postures, namely, low risk (3.6%), medium risk (25.0%), high risk (60.7%), and very high risk (10.7%). The NMQ results indicated that most of the symptoms and discomfort were in the lower back (65%), wrist (45%), shoulder (35%), and ankle (35%) regions. ConclusionsThe physical factors contributed more to the musculoskeletal symptoms in the body regions affected. The use of tools in lifting activities could decrease the level of risk.

Use of Adipofascial Reverse Sural Artery Flap for Distal Leg and Ankle Region Reconstruction- A Prospective Cohort Study

Introduction: Though distally based sural artery fasciocutaneous flap is a good choice for distal leg and ankle reconstruction, shortcomings like venous congestion and flap bulkiness are matters of concern. Aim: To assess the utility of adipofascial flap for distal leg and ankle reconstruction, complications, and long-term functional results with range of motion at ankle joint. Materials and Methods: A prospective cohort study (January 2018 to December 2019) was conducted at Safdarjung Hospital, New Delhi, India on patients having distal leg defect and ankle defects reconstructed with Distally Based Sural Artery Adipofascial Flap (DBSAAF). Participants of any age and aetiology were included in the study while polytrauma patients, life-threatening injuries, mangled extremity patients were excluded. Postoperatively flap survival, complications and functional outcome were assessed. Results: Total 21 patients with above defects had undergone DBSAAF reconstruction. Fifteen (71.4%) patients were males and 6 (28.6%) were females, with mean age of 34.85 years. Causes of defect were road traffic injury in 6 (28.6%) patients, additional Tendoachilles tear was repaired in 5 (23.8%) patients. Four (19%) patients had avulsion injury, 3 (14.3%) patients had postburn unstable scar, and chronic ulcer was found in 3 (14.3%) patients. The maximum defect size was 8.5×7 cm (mean of 5.24×4.34 cm). The width of flap pedicle was kept at 4 cm maximum (mean=3.04 cm). All flaps were transported to the defect site by incising the intervening bridge, tunneling was not done. Fourteen patients did not have any co-morbidity, whereas four patients were chronic smokers, and three were diabetics. Flap survived completely in all patients. Three patients had partial graft loss and one patient had chronic discharge. Follow-up for maximum of six months (mean=4.04 months) were done. Conclusion: DBSAAF is a reliable flap for defects of distal leg and ankle region. Advantages are aesthetically better donor area, normal contour, and minimal scarring. It does not require a secondary debulking making it a one stage procedure and allowing patients to use their normal footwear.

Arterial Parameters in Type-2 Diabetes and Healthy Subjects by using Impedance Plethysmography: A Case-control Study

Introduction: A reduced blood supply to lower limb, due to arterial disease, is a common cause of foot ulceration in patients with Diabetes Mellitus (DM). Impedance Plethysmography (IPG) is based on the measurement of changes in the electrical resistance (impedance) caused by blood volume changes. Aim: To compare parameters of type-2 diabetic subjects with those of healthy subjects along with different age group and to associate with Blood Flow Index (BFI), Fasting Blood Sugar (FBS), Post-Prandial Blood Sugar (PP2BS) and Body Mass Index (BMI). Materials and Methods: This case-control study was conducted at Government Medical College and in UHTC, Bhavnagar, Gujarat, India, from May 2012 to August 2013 on 100 healthy subjects and 100 type-2 diabetic subjects. IPG arterial parameters like BFI, Pulse Arrival Time (PAT), Pulse Termination Time (PTT), Differential Pulse Arrival Time (DPAT), Z0 (Basal impedance) recorded. The data were analysed by unpaired t-test and ANOVA test. Results: This study had 200 subjects of age more than 30 years. The diabetic subjects included 56 males and 44 females whereas the healthy subjects included 67 males and 33 females. There was bilateral significant reduction of BFI, PAT at knee, ankle and calf segment among diabetics group in males and females; and a bilateral significant reduction of PTT at ankle segment among diabetic males and females. DPAT value increased at knee, calf and ankle segment on both sides in male and female; except right ankle segment in diabetic group in females as compared to healthy subjects. Z0 increased at knee, ankle and calf segment in diabetic group on both side in males and females. BFI decreased with an increase in the duration of diabetes. The effect of FBS, PP2BS and BMI in diabetic subjects suggested a negative association with BFI. Conclusion: There was decrease in BFI, PAT, PTT and increase in DPAT in the knee, calf and ankle region of diabetic subjects. BFI negatively correlated with FBS, PP2BS and BMI among diabetics and decreased with increased duration of DM

Musculoskeletal complaints in military recruits during their basic training

IntroductionOveruse injuries often start with a musculoskeletal complaint, which can progress over time to an injury. Little or no information is known about the development and severity of overuse injuries...

Reverse sural artery fasciocutaneous flap in soft tissue reconstruction in lower extremity

Background: Soft tissue defect around distal leg, ankle and heel region is a challenging task for an orthopaedic surgeon. Sural artery reverse fasciocutaenous flap has been widely used and is a successful method for soft tissue reconstruction in such situation. This study aimed to find out the result of sural artery distal based pedicle flap in managing soft tissue recon­struction around the ankle and distal leg.&#x0D; Methods: This was a retrospective study of 12 cases of sural artery based fasciocutaenous flap done between January 2015 to December 2019. Medical records were used to find the details of demographic data, operative details and post-operative status of the patients. Patients were contacted for the final follow up at minimum of 6 months after operation for assessment of the outcome. Demographic and clinical data were entered in excel chart and the clinical result was analyzed using SPSS software version 20.0.&#x0D; Results: There were total of 12 patients who underwent sural artery flap procedure. Among them, 10 were male and 2 females with mean age of 39 (range, 25-52) years. Eleven flaps survived with satisfactory functional outcome. One had complete flap necrosis, two had patchy margin necrosis and two had superficial infection which healed well with minor debridement and antibiotics.&#x0D; Conclusions: Sural artery based reverse fasciocutaenous flap is good and technically easier option for an orthopaedic surgeons for the soft tissue reconstruction around ankle, heel and distal leg in traumatic, infective or other etiology with satisfactory outcome in most of the patients.

Non-invasive sorptive extraction for the separation of human skin surface chemicals using comprehensive gas chromatography coupled to time-of-flight mass spectrometry: A mosquito-host biting site investigation.

Variation in inter-human attractiveness to mosquitoes, and the preference of mosquitoes to bite certain regions on the human host, are possible avenues for identifying lead compounds as potential mosquito attractants or repellents. We report a practical, non-invasive method for the separation and detection of skin surface chemical compounds and comparison of skin chemical profiles between the ankle and wrist skin surface area sampled over a 5-day period of a human volunteer using comprehensive gas chromatography coupled to time-of-flight mass spectrometry. An in-house made polydimethylsiloxane passive mini-sampler, worn as an anklet or a bracelet, was used to concentrate skin volatiles and semi-volatiles prior to thermal desorption directly in the gas chromatography. A novel method for the addition of an internal standard to sorptive samplers was introduced through solvent modification. This approach enabled a more reliable comparison of human skin surface chemical profiles. Compounds that were closely associated with the wrist included 6-methyl-1-heptanol, 3-(4-isopropylphenyl)-2-methylpropionaldehyde, 2-phenoxyethyl isobutyrate, and 2,4,6-trimethyl-pyridine. Conversely, compounds only detected on the ankle region included 2-butoxyethanol phosphate, 2-heptanone, and p-menthan-8-ol. In addition to known human skin compounds we report two compounds, carvone and (E)-2-decenal, not previously reported. Limits of detection ranged from 1 pg (carvone) to 362 pg (indole).

REVERSE SURAL ARTERY FASCIOCUTANEOUS FLAP IN SOFT TISSUE RECONSTRUCTION IN LOWER EXTREMITY

Background: Soft tissue defect around distal leg, ankle and heel region is a challenging task for an orthopaedic surgeon. Sural artery reverse fasciocutaenous flap has been widely used and is a successful method for soft tissue reconstruction in such situation. This study aimed to find out the result of sural artery distal based pedicle flap in managing soft tissue recon­struction around the ankle and distal leg. Methods: This was a retrospective study of 12 cases of sural artery based fasciocutaenous flap done between January 2015 to December 2019. Medical records were used to find the details of demographic data, operative details and post-operative status of the patients. Patients were contacted for the final follow up at minimum of 6 months after operation for assessment of the outcome. Demographic and clinical data were entered in excel chart and the clinical result was analyzed using SPSS software version 20.0. Results: There were total of 12 patients who underwent sural artery flap procedure. Among them, 10 were male and 2 females with mean age of 39 (range, 25-52) years. Eleven flaps survived with satisfactory functional outcome. One had complete flap necrosis, two had patchy margin necrosis and two had superficial infection which healed well with minor debridement and antibiotics. Conclusions: Sural artery based reverse fasciocutaenous flap is good and technically easier option for an orthopaedic surgeons for the soft tissue reconstruction around ankle, heel and distal leg in traumatic, infective or other etiology with satisfactory outcome in most of the patients.

Enhancement of ergonomic wearable chair with voice controlled using Raspberry pi

Ergonomics is the designing of products and systems that suit a range of people who use them. The Ergonomically designed wearable chair ensures the ability of the user to sit and stand anywhere. It provides the convenience and required posture for their workplace thereby overcoming disabilities caused due to long hours of standing and sitting. This device increases the efficiency of the user by reducing tiredness, pain in the lower back, leg and ankle region. Enhancing the wearable device with voice control will facile the operation of the system and provide automatic control over the device. The chair is wearable due to its exoskeleton-like design and portable due to its lightweight arrangement. This paper elaborately explains the design, mechanism, and application of the wearable ergonomic chair with voice automation. Future developments and challenges are also discussed in this paper.

Comparative analysis of propeller flaps vs. modified perforator-based flaps in foot and ankle reconstruction

Lower leg, ankle, and foot defects pose a challenge for the surgeon due to the thin soft tissue cover and presence of important structures like bone, tendons, ligaments, and neurovascular bundles superficially. Since this region is prone to trauma and infection, the need arises to select an ideal flap to give a stable soft tissue cover. Propeller and perforator-based flaps are the most commonly used local flaps which can offer a durable soft tissue cover. However, they have disadvantages. Propeller flaps are more prone to venous congestion which can lead to partial or complete flap failure. Perforator-based flaps do not enjoy the freedom of rotation like propeller flaps. In this study we present a simple modification in perforator-based flaps by retaining a thin continuity of subcutaneous tissue to the minor blade of the perforator flap, which can be rotated up to 180° like propeller flaps, thus avoiding the complications of venous congestion. All patients in whom perforator-based flaps were used in the reconstruction of the lower leg, foot, and ankle region from November 2015 to January 2019 were incuded in this study. Degree of rotation, venous congestion grade, and success rate between modified-perforator flaps (MPF) and propeller flaps were compared. A total of 47 patients were included in the study. In 27 cases, traditional propeller flap technique was used. Eight cases presented with complications. In the 20 cases where a MPF was performed, one partial flap loss was observed. The mean degree of rotation was significantly higher in the MPF group (155°) if compared with the propeller flap group (137.6°) (p = 0.003).There was a statistically significant reduction in incidence of venous congestion in the MPF group (p = 0.019). The MFP herein presented seems a simpler solution to reconstruct foot and lower leg defects as it has a lesser complication rate in comparison with traditional propeller flaps. Level of evidence: Level III, therapeutic study.