Surface EMG analysis of tibialis anterior and gastrocnemius activity under different loading positions.

The utility of needle arthroscopy in the ankle joint: A cadaveric study evaluating visualization, surgical feasibility, and learning curve considerations.

Lights, Cameras, Action - The influence of lighting and camera position on walking and running kinematic measurements using Theia3D markerless motion capture.

Shaoyao Gancao Decoction ameliorates rheumatoid arthritis via inhibition of TNF-α/NF-κB signaling pathway.

Ankle cartilage is prone to degeneration due to overuse. Developing a non-invasive MRI technique to detect early running-induced lesions enables timely intervention. To evaluate the value of the ultrashort echo time magnetization transfer (UTE-MT) sequence in monitoring tibiotalar cartilage changes in amateur marathon runners before and after a marathon. Prospective. Thirty amateur marathon runners (25 males, 5 females; range: 24-50 years). 3D UTE-MT (gradient-echo), 3D UTE-T2* (gradient-echo). MRI scans at three time points: 1 week pre-marathon, 2 days post-marathon, and 4 weeks post-marathon. Medial and lateral tibiotalar cartilage was subdivided into 12 subregions, consisting of anterior, middle, and posterior segments for the tibial and talus parts on each side. The UTE-MTR and UTE-T2* values were measured per subregion at each time point. Repeated measures one-way ANOVA and the Tukey test. p < 0.05 was considered statistically significant. Most cartilage subregions showed decreased UTE-MTR values 2 days post-marathon and increased after 4 weeks. Significant differences in UTE-MTR over time were observed in 9 subregions, including the medial and lateral anterior, middle, and posterior tibial cartilage (MTiA, MTiM, MTiP, LTiA, LTiM, LTiP), the medial and lateral posterior talus regions (MTaP, LTaP), and the medial middle talus cartilage (MTaM). Post hoc tests revealed significant UTE-MTR decreases 2 days post-marathon in all 9 regions (Rate: MTiA: -3.9%; MTiM: -2.8%; MTiP: -3.0%; MTaP: -4.5%; MTaM: -4.2%; LTiA: -3.5%; LTiM: -4.7%; LTiP: -5.8%; LTaP: -6.8%), with significant increases in MTiA (3.7%) and MTaM (4.4%) at 4 weeks. UTE-T2* values rose in most cartilage regions at 2 days post-marathon and continued increasing at 4 weeks. Only MTiP, LTiM, and LTaM showed significant changes. This study demonstrates that the UTE-MT sequence enables the quantitative assessment of dynamic changes in tibiotalar joint cartilage after a marathon. Stage 1.

Gait analysis of children with neurodevelopmental disorders using gait profile score.

The impact of custom-made rocker sole shoes on biomechanical parameters of the lower limb during gait and running: A systematic review.

A longer Achilles tendon (AT) moment arm (MA) relative to the foot length requires less muscle force for a given plantarflexion moment, thereby lowering mechanical load on the tendon. We examined whether the AT and foot MA lengths in healthy (N=28) differ from height and body mass matched individuals with AT tendinopathy (N=28) and rupture (N=29). We hypothesized that a longer AT MA has a protective effect on tendon loading with the patient groups having smaller MA compared to asymptomatic individuals. MAs were assessed using 2-D image-based method. AT MA was defined as the shortest distance from the centre line of action of the AT to the line between malleoli. Ratio of ankle lever was calculated by dividing AT by Foot MAs. AT MA was longer in healthy than either the tendinopathy (mean difference 3.86mm, p=0.02) or rupture group (5.41mm, p<0.001). Foot MA was not statistically different between the groups (p=0.06). Ratio of ankle lever differed between groups with the healthy group showing higher ratio compared to both the tendinopathy group (0.04, p=0.001), and the rupture group (0.06, p<0.001). AT and Foot MAs correlated with body mass and height, whereas the ratio of ankle lever did not. A longer AT relative to foot MA length may improve the tendon's safety factor by reducing mechanical stress. This ratio may serve as an accessible intrinsic risk factor for AT injuries, even when assessed only using simple 2-D anatomical measures.

ObjectiveThis study aims to investigate the incidence, risk factors, and clinical characteristics of deep vein thrombosis (DVT) following radiofrequency ablation (RFA) combined with sclerotherapy for varicose veins.MethodsA retrospective analysis was conducted on patients who underwent combined RFA and sclerotherapy between June 2018 and June 2024. The incidence of postoperative DVT and its clinical characteristics were evaluated, with 13 potential risk factors assessed through univariate and multivariate logistic regression. Patients with distal DVT were divided into two groups: Group A (treatment with prophylactic-dose anticoagulation) and Group B (no anticoagulation), with thrombus resolution outcomes compared between the groups.ResultsAmong 567 patients with varicose veins, including 226 males and 341 females (male-to-female ratio 1:1.51), with a mean age of 57.79 ± 11.38years (range: 28-77years), postoperative DVT occurred in 46 patients (8.11%), 36 of whom (78.26%) were diagnosed within 3days. Thrombosis predominantly affected the muscular veins and posterior tibial veins (91.30%). Multivariate analysis identified a history of thrombosis, injection volume >10mL of foam, and injection sites distal to the ankle joint as independent risk factors for DVT. Furthermore, Group A demonstrated a significantly lower prevalence of thrombosis at each time point compared to Group B (p < .05).ConclusionThe incidence of postoperative DVT following combined RFA and foam sclerotherapy for varicose veins is relatively high, with the majority occurring in the early postoperative period. Thrombosis primarily affects the muscular and posterior tibial veins. A history of thrombosis, injection volume >10mL of foam, and injection sites distal to the ankle joint are independent risk factors. Prophylactic-dose anticoagulation therapy may facilitate thrombus resolution in patients with distal DVT.

Validity and reliability of IMUs-based system in assessing lower extremity inter-joint coupling angles and variability during gait in older adults.

Rheumatoid arthritis (RA) is a complex autoimmune joint disease characterized by persistent synovial inflammation and hyperplasia. The TNF-α/NF-κB signaling pathway is one of the most important inflammatory pathways involved in the onset and progression of RA. In addition, impaired lymphatic drainage plays a critical role in disease exacerbation. Iguratimod (IGU), a novel disease-modifying antirheumatic drug, has been shown to exert immunomodulatory effects. However, the precise mechanisms underlying its anti-inflammatory function remain unclear. Furthermore, whether IGU could restore lymphatic reflux function in inflammatory arthritis has yet to be determined. Therefore, the study aimed to elucidate the mechanisms underlying the therapeutic effects of IGU in RA. The therapeutic efficacy of IGU was evaluated in a collagen-induced arthritis (CIA) mouse model, with methotrexate used as a positive control. Histopathological analyses of footpad and ankle tissues were performed to asses of disease onset and progression. Levels of inflammatory cytokines (e.g., TNF-α, IFN-γ, IL-4, and IL-6) and IgG autoantibody (such as anti-CCP antibody) were determined using ELISA. Lymphangiogenic markers, including VEGF-C, VEGFR-3, and LYVE-1, were assessed in ankle joint tissues. The protein and mRNA expression levels of TNF-α and NF-κB in joint tissues were also evaluated. In addition, an in vitro tube formation assay was performed to examine the direct effects of IGU on lymphangiogenesis. IGU treatment significantly alleviated arthritis severity in CIA mice by reducing joint inflammation, minimizing tissue damage, and preserving bone integrity. Beyond its established anti-inflammatory properties, IGU could enhance lymphangiogenesis in inflamed joints. Mechanistically, IGU suppressed the TNF-α/NF-κB signaling pathway, thereby attenuating immune responses and inflammatory cytokine production. Furthermore, IGU directly promoted lymphatic vessel formation by upregulating LYVE-1, Prox-1, VEGF-C, and VEGFR-3 in lymphatic endothelial cells. The effect might contribute to the restoration of lymphatic drainage function. The study suggests that IGU exerts a dual therapeutic action by modulating inflammation and promoting lymphatic vessel formation, which might facilitate the restoration of lymphatic drainage and contribute to improved outcomes in RA.

Transcutaneous spinal cord stimulation (tSCS) is an emerging treatment for motor recovery following spinal cord injury (SCI). However, the extent of motor recovery with tSCS and the reasons why some individuals with motor-complete SCI respond less effectively, despite having the same injury classification, remain unclear. Here, we demonstrate that lumbosacral tSCS can enable anti-gravity voluntary movement following motor-complete SCI, and identify markers that distinguish responders from non-responders. Ten individuals with chronic cervical and upper thoracic motor-complete SCI received 30Hz lumbosacral tSCS with a 10kHz carrier frequency for 60min, 2-5 times per week, for a minimum of 6 weeks (12-36 sessions). Post-intervention, volitional movement was measured using surface electromyography (EMG) over the quadriceps and tibialis anterior (TA), and knee and ankle joint range of motion. To identify markers of responsiveness, we assessed the integrity of the corticospinal tract (motor evoked potentials; MEPs), ascending sensory pathways (somatosensory evoked potentials; SEPs), spinal cord reflexes (H-reflex), and motor neurons (compound muscle action potential, CMAP), along with muscle morphology using ultrasound echo-intensity. This observational cohort study was reported in accordance with STROBE guidelines. Five of 10 individuals demonstrated voluntary anti-gravity knee extension and ankle dorsiflexion strength in the presence of tSCS. TA MEPs were observed in one responder only and tibial nerve SEPs were not observed in any participants. All participants showed poor TA muscle morphology. Four responders had a soleus H-reflex (compared to 2/5 non-responders) and a normal amplitude fibular CMAPs (compared to 2/5 non-responders). These results show that tSCS can enable volitional motor activity against gravity in people with motor-complete SCI, but there is variability in responsiveness. Using conventional neurophysiological techniques, we were unable to consistently demonstrate the pathways facilitating voluntary control or the factors differentiating responders versus non-responders, but trends were observed. Spinal cord reflex and peripheral motor nerve integrity may be important for responding to tSCS but may not distinguish responders from non-responders. Additional assessments are needed to develop biomarkers for stratifying motor responders to tSCS. Trial Registration on ClinicalTrials.gov NCT04726059 (registered: 2021-Jan-22), NCT04604951 (registered: 2020-Oct-25), NCT05369520 (registered: 2022-May-05).

Children with psoriasis can develop juvenile psoriatic arthritis. Musculoskeletal ultrasound is a helpful imaging modality in the early recognition of joint inflammation. This pilot study aims to describe clinical and subclinical joint and nail abnormalities in children with psoriasis. Children with psoriasis and healthy controls underwent ultrasound examination of various joints, entheses, and nails. Using a standard acquisition protocol, images were obtained in both B-mode and PD-mode. Differences between psoriasis and control groups were examined. Fifteen psoriasis patients who were not on systemic therapy and did not have clinical signs of arthritis and thirteen age- and sex-matched healthy controls were enrolled. While patients with psoriasis demonstrated subclinical synovitis in the finger, knee, and ankle joints more frequently than the control group (p = 0.047), no statistically significant difference was observed in the comparison of each specific joint. PD positivity was detected at the entheses in two patients with psoriasis and at three entheseal sites of two healthy children. Nail ultrasound examination demonstrated significantly thicker nail beds (1.6 vs. 1.4mm, p < 0.001) and more frequent abnormal nail structure (70% vs. 21.2%, p < 0.001) in the psoriasis group compared to control group while the thickness of the nail plate and nail matrix were similar. Type II nail morphology changes were the most frequently detected type according to the Wortsman classification. Positive PD-mode findings in the nail bed and nail matrix were more common in the control group (both p < 0.001). Among the psoriasis cohort, nails with abnormal exam findings had significantly thicker nail plate (0.4 vs. 0.35mm, p = 0.003) and nail bed (1.8 vs. 1.6mm, p = 0.006) measurements compared to nails with normal examination. Ultrasound is a useful tool for evaluating inflammatory joint and nail findings that may help delineate subclinical joint inflammation in children with psoriasis.

This study investigated the ankle-to-knee and knee-to-ankle joint energy transfer via the biarticular gastrocnemii muscles during unpredictable and adapted drop-like gait perturbations to understand how biarticular mechanisms of the gastrocnemii contribute to the mechanical work performed by the Achilles tendon (AT) force at the ankle joint. This was done by measuring AT elongation and quantifying AT force as an indicator of triceps surae muscle forces, as well as the body kinematics and electromyographic activity of the soleus, gastrocnemius medialis and gastrocnemius lateralis muscles, in 17 participants. Biarticular mechanisms contributed significantly to both the negative and positive mechanical work performed by the AT force at the ankle joint during both types of drop-like perturbations, constituting 17% to 26% of this mechanical work. In particular, during the initial stance phase of unpredictable, drop-like perturbations, a significant proportion of energy (26% of the negative mechanical work done at the ankle joint) was transferred from the ankle to the knee joint via the biarticular gastrocnemii muscles. More importantly, the rate of this energy transfer was elevated during the unpredictable perturbations, when beneficial stability control mechanisms based on prediction are unavailable, compared with adapted ones. Finally, our findings imply that elastic tissues contribute significantly to managing drop-like perturbations, including energy storage and recoil in the AT and potential for elastic energy exchange in the vasti tendons during the energy transfer phases. These findings could inform the design of prevention treatments and bioengineering approaches, especially for improving stability control in uneven terrain.

Although boots are commonly used for many occupational and daily activities, their effects on joint mechanics and injury risk are not well understood. This study aimed to evaluate the influence of boots on lower limb joint contact forces during walking. To achieve this, experimental markers and ground reaction force data were collected from 20 healthy individuals during walking in boots and casual footwear. Musculoskeletal modelling was used to compute the three-dimensional lower limb joint contact forces, as well as the total contribution of muscles to joint compressive load. The continuous and discrete results were compared between the conditions using statistical parametric mapping and paired t-test, respectively. Walking in boots significantly increased hip joint compressive forces during mid-stance (p = 0.002, d = 0.85) and push-off (p = 0.03, d = 0.44) phases, as well as the knee joint compressive forces during the push-off phase (p = 0.007, d = 0.53), while it reduced the ankle compressive force during the mid-stance phase (p = 0.016, d = 0.75). The intersegmental compressive impulse was greater significantly in the hip (p = 0.003, d = 0.48), knee (p = 0.003, d = 0.52), and ankle (p = 0.007, d = 0.46) joints. The contributions to joint compressive impulse were significantly greater for the hip abductors (p < 0.001, d = 0.99), iliopsoas (p = 0.001, d = 0.47), and hamstrings (p < 0.001, d = 0.94) in the boot condition. Overall, hip and knee compressive impulses were increased by 10.5% and 7%, respectively, whereas ankle compressive impulse was decreased by 1.5% when walking in boots compared with casual footwear. Our findings suggest that walking in boots is associated with compensatory mechanisms at the hip and knee joints in response to the potential ankle restrictions imposed by boots. This might have implications for joint health, injury prevention and footwear design.

Background:In this study, we evaluated the effects of a combined exercise program incorporating a postural balance apparatus on the fall-related physical fitness and blood vessel elasticity of older women.Methods:The participants were 36 women aged 65 years or older who did not engage in regular exercise. They were randomly divided into an exercise group (n = 18) and a control group (n = 18). The exercise group underwent a combined exercise program for 12 weeks (60 minutes a day for 5 days a week), whereas the control group engaged in no physical activity or exercise during the 12 weeks. The combined exercise program consisted of aerobic exercise (such as step-ups and the short foot exercise), resistance exercises (such as heel raises, semi-squats, and weight-bearing closed-chain exercises), and joint mobility exercises (such as step-ups with pelvic floor muscle engagement, lower body stretching, and back stretching) to be performed on a postural balance apparatus, which provided an inclined and elastic surface to facilitate ankle dorsiflexion, joint mobility, and proprioceptive stimulation. The exercises were performed at a moderate intensity, maintaining a perceived exertion rating between 11 and 14, for 12 weeks. The outcome variables were measured through experimental procedures. The collected data were analyzed using means, standard deviations, and 2-way repeated measures analysis of variance.Results:We found a significant improvement in the range of motion for left ankle dorsiflexion in the lying and seated positions, as well as right ankle dorsiflexion in the lying, seated, and prone positions, in the exercise group compared to the control group (P < .05). Furthermore, the atherosclerosis left brachial–ankle pulse wave velocity, atherosclerosis right brachial–ankle pulse wave velocity, diastolic blood pressure, and heart rate significantly decreased in the exercise group compared to the control group (P < .05).Conclusions:These results confirmed that the 12-week apparatus-assisted combined exercise program, unlike conventional programs, effectively improves ankle dorsiflexion, vascular elasticity, and cardiovascular health in older women.

To evaluate the effectiveness of arthroscopic anterior talofibular ligament (ATFL) repair with retaining of avulsion fragments at the fibular insertion site in treatment of ATFL injury. A retrospective case series was conducted on 135 patients who underwent arthroscopic ATFL repair with retaining of avulsion fragments at the fibular insertion site between September 2019 and December 2024. The analysis included 72 males and 63 females, with a mean age of 29 years (range, 12-61 years). Concomitant pathologies included osteochondral lesions of the talus in 21 cases, calcaneofibular ligament injury in 41 cases, and tarsal sinus syndrome in 43 cases. The mean duration of symptoms was 10 months (range, 8-60 months). The talus tilt test was positive or suspected positive in 41 patients before operation. Pre- and post-operative evaluations of pain relief and functional recovery of ankle joint were performed using pain visual analogue scale (VAS) score, American Orthopedic Foot & Ankle Society (AOFAS) score, and Foot & Ankle Outcome Score (FAOS) (including 5 subscales: symptoms, pain, activities of daily living, sport, and quality of life). Ankle stability was evaluated using anterior drawer test [measuring anterior talar translation (ATT)] and talus tilt test. Additionally, time to return to sports, recurrent ankle sprain, and complications were recorded as well. The mean operation time was 40 minutes (range, 30-50 minutes), and the mean intraoperative blood loss was 2 mL (range, 1-3 mL). All patients were followed up 12-75 months (mean, 44 months). All incisions achieved primary healing, and no complication such as infection, neurovascular or tendon injury, or thrombosis was observed. At last follow-up, VAS score significantly decreased when compared with preoperative value, AOFAS score and all FAOS subscale scores significantly increased, ATT measured on anterior drawer test significantly reduced (all graded as 0). All differences were significant ( P<0.05). Patients who tested positive or suspected positive in preoperative talus tilt test were all negative at last follow-up. Patients returned to sports at a mean of 9 months (range, 3-18 months) postoperatively. Twelve patients (8.9%) experienced recurrent ankle sprain due to sports-related injury after returning to sports and all recovered with conservative management without revision surgery. Arthroscopic ATFL repair with retaining of avulsion fragments at the fibular insertion site can restore ankle stability, significantly relieve pain, restore motor ability, have an enhanced recovery and achieve satisfactory activity recovery.

To assess the exposure range of the talar dome during open surgery for osteochondral lesions of the talus (OLT) by simulating the maximum flexion and extension of the ankle joint and anterior half medial malleolar osteotomy using digital methods and cadaver experiments. Sixty sets of CT scan data from normal ankle joints of Chinese adults were randomly selected. Digital methods were used to simulate maximum dorsiflexion, maximum plantarflexion, and anterior half medial malleolar osteotomy. The exposure ratios for the talar dome at the 1/6, 1/4, 1/2, 3/4, and 5/6 longitudinal lines (A‒P line) were measured under direct visualization and verified through cadaveric experiments. A total of 58 ankle joint CT datasets and 8 cadaveric ankle joint specimens were included in the study. Under direct visualization, maximum plantarflexion exposed the anterior portion of the talar dome, with the following exposure ratios for the 1/6, 1/4, 1/2, 3/4, and 5/6 A‒P lines: 51.11%, 54.35%; 49.51%, 52.88%; 47.5%, 50.49%; 51.53%, 50.49%; and 52.68%, 51.26%, respectively. In maximum plantarflexion combined with an anterior half medial malleolar osteotomy, the exposure at the 1/6 A‒P line was 81.15% and 80.91%, respectively. During maximum dorsiflexion, the exposure ratios for the 1/6, 1/4, 1/2, 3/4, and 5/6 A‒P lines of the posterior talar dome were: 31.8%, 31.04%; 30.84%, 30.44%; 25.85%, 27.98%; 19.59%, 23.63%; and 17.96%, 20.17%, respectively. Digital simulation and cadaveric experiments provide useful references for selecting the surgical approach for open surgery for OLT. When the OLT lesion is located in the anterior half of the talar dome, exposure can be achieved without osteotomy in maximum plantarflexion. When the lesion is located in the posterior 30% of the medial region, maximum dorsiflexion can provide exposure. For lesions in the medial-mid to posterior region (50‒80%) of the talar dome, anterior half medial malleolar osteotomy can be applied to avoid a full medial malleolar osteotomy, but this approach is not suitable for posteromedial lesions located in the central-lateral region of the talar dome.

Despite returning to sport (RTS), individuals after anterior cruciate ligament reconstruction (ACLR) may exhibit residual biomechanical alterations that are not fully captured by conventional RTS assessments. This study investigated 3D lower-limb kinematics during the critical early landing phase (0-100 ms) in individuals who had already returned to sport after ACLR, with the aim of examining how task-specific demands and localized acute fatigue influence early landing movement patterns. In this secondary analysis of a publicly available 3D motion capture dataset, 19 participants post ACLR (involved limb) and 22 healthy controls (dominant limb) were assessed. Knee, ankle, and pelvic joint angles were extracted at initial contact (IC, 0 ms) and at 25, 50, 75, and 100 ms intervals. Tasks included the unilateral counter movement jump (uCMJ) and single leg forward hop (SLH) under fatigued and non-fatigued conditions. Linear mixed-effects models compared kinematics across groups and conditions. The ACLR group demonstrated a consistent transverse plane kinematic pattern suggestive of greater knee internal rotation during the early landing phase across all tasks (p < 0.05). Sagittal plane strategies showed marked task dependency. During the SLH task, the ACLR group showed a stiffer landing pattern, characterized by reduced knee flexion by 2°-4° and concurrent ankle dorsiflexion restriction around 50 ms after IC. Conversely, no significant between-group differences in knee flexion were observed during the uCMJ task. Furthermore, the localized acute fatigue protocol did not significantly alter these observed inter-group discrepancies. Individuals who had returned to sport after ACLR may retain residual early landing kinematic patterns, including a consistent transverse plane movement pattern and task specific stiff landing strategies. Future RTS assessment and post-RTS monitoring may benefit from placing greater emphasis on tasks with substantial horizontal braking demands, such as the SLH, as these tasks may provide additional information on residual early landing movement control patterns beyond conventional performance based outcomes. Rehabilitation may benefit from targeting landing quality, rotational control, and distal ankle buffering capacity.

Ankle joint contact forces and muscle contributions during walking differentiate chronic ankle instability from copers and uninjured controls.