Anterior Leg Research Articles

Morphofunctional evaluation of great saphenous vein's tributaries after thermoablation: A case series

ObjectiveThis study evaluates hemodynamic and anatomic changes in great saphenous vein (GSV) tributaries after endovenous laser ablation (EVLA). MethodsThis case series analyzed 112 areas in 28 lower limbs of 25 patients who underwent EVLA from April 2022 to June 2023 at the Hospital das Clínicas de Pernambuco/UFPE. All patients were evaluated by Doppler ultrasound preoperatively and 3 months after the surgical treatment. The parameters studied were GSV diameter and patency, GSV tributary diameter, patency and flow direction, and the Venous Clinical Severity Score after EVLA. The GSV characteristics were evaluated in four regions: saphenous-femoral junction, medium thigh, knee, and medium leg. The tributary veins were grouped in four areas: anterior thigh, posterior thigh, anterior leg, and posterior leg. ResultsThe results included 28 lower limbs from 23 patients; 18 patients (67.9%) were women, and the average age was 49 years; 2 patients were lost to follow-up. Ninety days after EVLA, all treated GSVs were occluded. The average diameter of GSV decreased in all four regions studied: saphenous-femoral junction, medium thigh, knee, and medium leg (P ≤ .001). We analyzed 101 GSV tributaries. In the analysis of GSV tributaries by area, we identified a mean diameter decrease in all groups of tributaries (P < .001). Considering the tributaries with reflux, we also identified a reduction in the number of tributaries with reflux in all four groups (P ≤ .001). All tributaries were patent preoperatively; at 3 months after the surgical treatment, GSV tributaries occlusion was infrequent, except for the anterior thigh group. There was a decrease from 9 to 5 points in Venous Clinical Severity Score after EVLA (P < .001). ConclusionsThis study demonstrated that, after GSV laser ablation, there was a statistically significant decrease in the diameters of all tributary groups, and the number of tributaries with decreased reflux; however, the occlusion of tributaries was not a frequent finding.

Extensor Retinaculum Syndrome of the Ankle: An Adult Case Series.

Extensor retinaculum syndrome (ERS) is a relatively rarely diagnosed compartment syndrome-like entity caused by elevated pressures in the tissues deep to the superior extensor retinaculum (SER). ERS is identified as out-of-proportion anterior ankle pain, pain with passive toe plantarflexion, elevated SER pressures (>40 mm Hg), and ultimately toe extension weakness and first web space numbness. Although previously described in a pediatric population, this case series is the first to our knowledge in an adult population. Seven nonconsecutive cases over 18 years from 2 surgeons are reported who underwent complete SER release for ERS either through the direct lateral approach to the fibula or the anterolateral approach to the distal tibia. All were associated with traumatic injuries including 3 bimalleolar ankle fractures, 3 tibial pilon fractures, and 1 distal tibial/fibular shaft fracture. All patients developed writhing anterior ankle pain worsened with passive toe plantarflexion. SER compartment pressures ranged from 50 to >135 mm Hg. Five cases displayed decreased first web space sensation. The diminished or absent first web space sensation uniformly improved post-release. Complications included 1 patient with complex regional pain syndrome type 1, 1 patient required hardware removal, and 2 had persistent but improved first web space sensation changes. Clinical suspicion for possible ERS should arise after distal tibial/fibular fractures when the excruciating pain localizes to the ankle instead of the classic anterior leg muscle bellies. If pain is worsened with passive toe plantarflexion, this diagnosis should be considered. Recommended treatment involves complete release of the SER anywhere on the anterior surface between the tibia and fibula depending on the approach needed for fixation of the associated fracture. Level IV, case series.

Effects of transcutaneous auricular vagus nerve stimulation (tVNS) on balance in patient with chronic lower back pain

Background. tVNS is a technique of electrical stimulation of vagus nerve afferents that is used as a therapy for chronic pain. This study aims to analyze the effect of adding tVNS to exercise therapy on dynamic balance in chronic LBP patients measured by Maximized Reach Distance (%MAXD) and composite score of Modified Star Excursion Balance Test (MSEBT). Method. The method is an experimental study with a pretest-posttest randomized control group study. 22 people with mechanical chronic LBP aged 16-55 years who were randomly allocated into an exercise group (control group) and an exercise plus tVNS group (intervention group). MSEBT dynamic balance was measured before and after intervention. Results. In the intervention group the average MSEBT anterior right and left leg before (74.57±14.72;73.53±15.0) after (86.45±15.98; 86.98±15.9), posteromedial right and left before (88.23±16.76; 75.15±15.04) after (99.65±14.56, 92.19±11.91), right and left posterolateral before (76.66±13.89, 78.02±13.44) after (84.00±17.25, 84.30±13.90) there was a significant difference (p &lt;0.05). Comparing anterior ΔMSEBT, right composite score and left posteromedial posterolateral ΔMSEBT between groups, there was a significant difference (p &lt;0.05), not significant in right posteromedial posterolateral ΔMSEBT. Conclusion. The addition of tVNS to exercise therapy after 2 weeks on dynamic balance with MSEBT assessment showed a significant improvement in the intervention group. The results were better in the intervention group than in the control group. Further research is still needed to investigate the potential of adding tVNS to chronic LBP.

Changes in the mechanical properties of the thigh and lower leg muscle-tendon units during the early follicular and early luteal phases.

This study aimed to determine changes in the muscle and tendon stiffness of the thigh and lower leg muscle-tendon units during the early follicular and early luteal phases, and check for possible relations between muscle and tendon stiffness in each phase. The sample consisted of 15 female university students with regular menstrual cycles. The basal body temperature method, ovulation kit, and salivary estradiol concentration measurement were used to estimate the early follicular and early luteal phases. A portable digital palpation device measured muscle-tendon stiffness in the early follicular and early luteal phases. The measurement sites were the rectus femoris (RF), vastus medialis (VM), patellar tendon (PT), medial head of gastrocnemius muscle, soleus muscle, and Achilles tendon. No statistically significant differences in the thigh and lower leg muscle-tendon unit stiffness were seen between the early follicular and early luteal phases. Significant positive correlations were found between the stiffness of the RF and PT (r = 0.608, p = 0.016) and between the VM and PT (r = 0.737, p = 0.002) during the early luteal phase. The present results suggest that the stiffness of leg muscle-tendon units of the anterior thigh and posterior lower leg do not change between the early follicular and early luteal phases and that tendons may be stiffer in those women who have stiffer anterior thigh muscles during the early luteal phase.

The effect of general osteopathic treatment on muscle tone according to electromyography data

Introduction. Clinical research in osteopathy is criticized for the lack of standardization of treatment and insufficient use of instrumental methods to assess its effectiveness. Therefore, in order to increase evidence in osteopathy, it is relevant to search for instrumental methods that allow recording and measuring objective indicators and their changes after standardized osteopathic correction. The aim of the study is to research the effect of general osteopathic treatment on muscle tone using electromyography in practically healthy people. Materials and methods. A study was conducted on the basis of the Department of Osteopathy of the Mechnikov NWSMU. 30 practically healthy volunteers without any active complaints, aged 20 to 42 years (median 25 years), took part in the study. The criteria for non-inclusion were the presence of diseases and/or conditions that are an absolute contraindication to osteopathic correction, taking muscle relaxants or acetylcholinesterase inhibitors, diseases belonging to the G00-G83 group according to ICD-10, the presence of a trauma history for less than 1 year. All volunteers underwent general osteopathic treatment (GOT) as a standardized variant of osteopathic correction. Before and immediately after the GOT, muscle tone was studied using surface electromyography (sEMG), which was performed on the complex of wireless monitoring of electrophysiological signals «Kolibri» (manufacturer LLC «Neurotech», Russia). At rest, the average amplitude of the electrical activity of the muscles of the upper arms, the interscapular region, the anterior and posterior muscle groups of the thigh and lower legwere measured. The recording was made simultaneously from several muscle groups, synchronously from the right and left sides of the body. Results. After the GOT, a statistically significant decrease in the average amplitude of the thigh anterior surface muscles electrical activity from the median of 8 MV to 4 MV (p = 0,00001), the lower leg anterior surface from the median of 9 MV to 7 mv (p = 0,008) was detected, which indicates their relaxation. The tone of the other muscle groups did not change statistically significantly. The asymmetry of the average amplitude of electrical activity was observed in the studied muscles, which shows an imbalance of tone between symmetrical muscles. In most of the studied muscle groups, this indicator did not change statistically significantly after the GOT. And only in the anterior thigh muscle group, the asymmetry of the average amplitude of electrical activity decreased statistically significantly from the median of 7 MV to 2 MV (p = 0,0046). Conclusion. With the help of the sEMG, it was found that one session of GOT leads to a decrease in the tone of the anterior thigh and lower leg muscle groups, as well as a decrease in the asymmetry of the tone of the anterior thigh muscle group. These results can be explained from the standpoint of the GOT effect on skeletal muscles by means of improving the characteristics of the muscle tissue itself and the surrounding fascia, as well as by inhibitory and harmonizing effects on the nervous system, which ensures the maintenance and regulation of muscle tone. Surface EMG can be used to objectively record and measure the results of osteopathic correction to increase the evidence of clinical trials in osteopathy.

Tibio-Fibular Fusion by Posterolateral Approach to Treat Nonunion of Tibia

A 30- year- old male has sustained open fracture of left leg and undergone 4 surgeries for four years (1. debridement and external fixator, 2. removal of external fixator, 3. vascularized contrafibular autograft plus change new plate/screws of ipsifibula, 4. flap surgery to cover the wound). At the time of examination: unability to walk, abnormal movements of leg, tibial bone loss 8 cm, especially the soft tissue of almost total anterior leg was so bad: no more subcutaneous tissue, skin very next to bone decouraging any attempt anterior approach. Diagnosis: pseudarthrosis of left leg with tibial large bone loss in the status of seriously damaged soft tissue of anterior leg surface. Technique operation chosen: Posterolateral. Appoach, Tibiofibular Fusion with massive autocancellous bone graft harvested from posterior iliac pelvis. Casting 4 months (from midthigh to metatarsal head). Postoperative walking with two crutches, Full Weight Bearing allowed after 14 weeks. Removal of cast after 16 weeks. Full knee flexion obtained 8 weeks after cast removal. Review at tenth month: normal walk, slight running, complete knee Range of Motion, 5. degree loss of dorsiflexion of ankle. X-rays: good fusion proximal and distal tibiofibular spaces and partly fusion the tibio-tibial gap. By this case,we can resumably conclude Tibiofibular Fusion through Posterolateral Approach should be strongly indicated for the leg nonunion in which the soft tissue of anterior surface is not favorable for nearby approach.

Assessing the effectiveness of Compare Assistant for improving intra-rater reliability of ultrasound-measured muscle thickness.

Muscle thickness measured via ultrasound is commonly used to assess muscle size. The purpose of this study was to determine if the reliability of this measurement will improve if using the Compare Assistant tool, and whether this depends on technician experience and the muscle being assessed. Individuals came to the laboratory for two visits each separated by 24h. On day 1, two ultrasound images were taken on the individual's anterior upper arm (elbow flexors) and anterior lower leg (tibialis anterior) by two inexperienced and one experienced ultrasound technician. On day 2, three images were taken: (1) without looking at the previous images taken on day 1; (2) after re-examining the images taken on day 1, and (3) side-by-side with the images taken on day 1 via Compare Assistant. Bayes Factors (BF10) were used to provide evidence for the null (< 0.33) or alternative (> 3) hypotheses. There was no rater by measurement technique interaction (upper body: BF10 = 0.04, lower body: BF10 = 0.138), nor was there a main effect of measurement technique (upper body: BF10 = 0.052, lower body: BF10 = 0.331), indicating that reliability measures were not improved for either the upper body (CV%, no look: 2.92 vs. Compare Assistant: 2.87) or lower body (CV%, no look: 1.81 vs. Compare Assistant: 1.34) as a result of using Compare Assistant. The results of this study suggest that day-to-day reliability of muscle thickness measurement may be limited by random biological variability as opposed to technician error.

Associations of Morphological Changes in Skeletal Muscles of Preschool Children in China Following Physical Activity.

Physical activity (PA) is likely to be the most important modifiable factor in skeletal muscle development. However, the influence of PA on the skeletal muscle of preschool children has not been thoroughly investigated. The main objective of this study was to quantitatively measure PA, and then, to assess whether associations exist between site-specific muscle changes and PA in relation to sex and weight statuses in preschool children aged 3 to 4 years. A total of 86 healthy preschool children, aged 3-4 years, were instructed to wear an accelerometer for seven consecutive days. The number of steps taken daily, and minutes spent in moderate-vigorous PA (MVPA) and total PA (TPA) were recorded. Muscle thickness was measured by B-mode ultrasonography using a 5-18 MHz scanning head. Muscle thickness was measured at seven sites: the lateral forearm, upper arm, abdomen, anterior and posterior thigh, and anterior and posterior lower leg. There was no significant difference between boys and girls in terms of MVPA and TPA on weekdays and weekends. According to the linear regression models, after adjusting for daylight duration, the muscle of the posterior thigh was significantly positively associated (p < 0.05) with daily steps and MVPA on weekdays for boys and girls, respectively. We found that the muscle thickness of the posterior thigh in preschool children was significantly positively associated with PA, as measured by daily steps and MVPA. We suggest that for the overall health and well-being of preschool children, the levels of PA should be maintained and/or increased, and preferably transformed into a regular part of daily living.

432 A Rare Case of Ipsilateral Foot Drop Due to Common Peroneal Nerve Palsy at the Level of Fibular Head Following Total Hip Arthroplasty

Abstract Background Common peroneal nerve (CPN) palsy after primary total hip arthroplasty (THA) is a rare complication with poor functional outcome and has a prevalence of 0.3-2.1%. Case Presentation A 77-year-old gentleman was diagnosed with severe osteoarthritis of the left hip and underwent a hybrid left total hip replacement via posterior approach in right-lateral position. There was no usage of spinal anaesthesia, leakage from the wound, intra-operative nerve injury or any localised haematoma. Post-operatively on day 3, he was noted to have foot drop with loss of foot eversion and dorsiflexion with sensory loss along the distribution of the superficial peroneal and tibial nerve. Clinical Outcomes Nerve conduction study of left lower limb showed absent left superficial peroneal sensory response, absent left peroneal to extensor digitorum brevis and tibialis anterior motor responses with denervation across the anterior and lateral left lower leg muscles suggestive of a severe partial lesion of the left common peroneal nerve at the level of fibular head. Patient was placed in a foot drop splint with follow-up neurological evaluation. Discussion Post-operative CPN palsy are mostly neuropraxias caused due to direct compression, either by surgical instruments or anatomical structures, or from tension or ischemia to the nerve during intra-operative limb manipulation or limb lengthening. Additionally, usage of cement less components combined with Enoxaparin or due to any haematoma may compress the nerve. Age, BMI and initial severity of sensory and motor neurological deficits are prognostic factors indicating recovery. Full recovery is between 16-56% of cases at an average of 15 months.

222 Pediatric Pulse Oximetry to Monitor the Post-Operative Integrity of Free Flaps

Abstract Introduction The post-operative monitoring of free-flaps can be a challenge, particularly for junior staff on-call and in patients with darker or mottled skin. We present a case employing paediatric pulse oximetry to monitor a free flap where clinical assessment was challenging, illustrating its value as an adjunct to existing techniques such as doppler. Case A 23-year-old patient underwent tenolysis to his anterior right leg compartment due to a painful, tethered scar following injury. He subsequently had a superficial circumflex iliac perforator (SCIP) flap anastomosed end-to-side to his posterior tibial artery. The operation was technically challenging, but the flap had a strong doppler and remained clinically well until day 4 post-op, where it became mottled but remained warm and soft. Clinical assessment was equivocal, and a paediatric pulse oximeter was taped to the flap, consistently showing saturations &amp;gt;95%, providing reassurance out-of-hours and facilitating the decision to delay haematoma evacuation for the following day. The flap survived and the patient did well. Conclusions The use of paediatric pulse oximetry to assess free flaps is a useful technique for clinically ambiguous cases where re-exploration could compromise survival. It is cheap, widely accessible and can be easily employed by junior clinicians and nurses who may be relatively inexperienced in their assessment of flaps’ clinical condition.

Cycle exercise training and muscle mass: A preliminary investigation of 17 lower limb muscles in older men.

Cycling exercise in older individuals is beneficial for the cardiovascular system and quadriceps muscles, including partially reversing the age-related loss of quadriceps muscle mass. However, the effect of cycling exercise on the numerous other lower limb muscles is unknown. Six older men (74 ± 8 years) underwent MRI before and after 12-weeks of progressive aerobic cycle exercise training (3-4 days/week, 60-180 min/week, 60%-80% heart rate reserve, VO2 max: +13%) for upper (rectus femoris, vastii, adductor longus, adductor magnus, gracilis, sartorius, biceps femoris long head, biceps femoris short head, semimembranosus, semitendinosus) and lower (anterior tibial, posterior tibialis, peroneals, flexor digitorum longus, lateral gastrocnemius, medial gastrocnemius, soleus) leg muscle volumes. In the upper leg, cycle exercise training induced hypertrophy (p ≤ 0.05) in the vastii (+7%) and sartorius (+6%), with a trend to increase biceps femoris short head (+5%, p = 0.1). Additionally, there was a trend to decrease muscle volume in the adductor longus (-6%, p = 0.1) and biceps femoris long head (-5%, p = 0.09). In the lower leg, all 7 muscle volumes assessed were unaltered pre- to post-training (-2% to -3%, p > 0.05). This new evidence related to cycle exercise training in older individuals clarifies the specific upper leg muscles that are highly impacted, while revealing all the lower leg muscles do not appear responsive, in the context of muscle mass and sarcopenia. This study provides information for exercise program development in older individuals, suggesting other specific exercises are needed for the rectus femoris and adductors, certain hamstrings, and the anterior and posterior lower leg muscles to augment the beneficial effects of cycling exercise for older adults.

Ultrasound versus videos: A comparative study on the effectiveness of musculoskeletal anatomy education and student cognition.

Ultrasound imaging is a dynamic imaging technique that uses high-frequency sound waves to capture live images of the structures beneath the skin. In addition to its growing use in diagnosis and interventions, ultrasound imaging has the potential to reinforce concepts in the undergraduate medical curriculum. However, research assessing the impact of ultrasound on anatomy learning and student cognition is scarce. The purpose of this study was to compare the impact of ultrasound-based instruction versus narrated videos on students' understanding of anatomical relationships, as well as the role of intrinsic motivation, self-efficacy beliefs, and students' attitudes in this process. A booster course on anterior leg and wrist anatomy was offered to second-year medical students. A randomized controlled trial with a cross-over design allocated students to either an ultrasound-based teaching condition (cohort A) or a narrated anatomy video condition (cohort B). Next, participants were crossed to the alternative intervention. At the start of the study (T0), baseline anatomy knowledge, intrinsic motivation, self-efficacy beliefs, and spatial ability were measured. After the first intervention (T1) and at the end of the study (T2), both cohorts were administered an anatomy test, an intrinsic motivation scale, and a self-efficacy scale. In addition, each student was asked to fill out a perception survey after the ultrasound intervention. Finally, building on the cross-over design, the most optimal sequence of interventions was examined. A total of 181 students participated (cohort A: n = 82, cohort B: n = 99). Both cohorts performed comparably on the baseline anatomy knowledge test, spatial ability test, intrinsic motivation, and self-efficacy scale. At T1, cohort B outperformed cohort A on the anatomy test (p = 0.019), although only a small effect size could be detected (Cohen's d = 0.34). Intrinsic motivation and self-efficacy of both cohorts were similar at T1. At T2, the anatomy test, intrinsic motivation, and self-efficacy scale did not reflect an effect after studying either sequence of the interventions. Students reported favorably about the ultrasound experience, but also mentioned a steep learning curve. Medical students found the hands-on ultrasound sessions to be valuable, increasing their interest in musculoskeletal anatomy and ultrasound imaging. However, the addition of ultrasound did not result in superior spatial anatomy understanding compared to watching anatomy videos. In addition, ultrasound teaching did not have a major effect on student cognition. Ultrasound-based teaching of musculoskeletal anatomy is regarded as difficult to learn, and therefore it is hypothesized that too high levels of cognitive load might explain the presented results.

TUMOR INDUCED OSTEOMALACIA: A CASE REPORT

Background:Tumor-induced osteomalacia (TIO), which is also known as oncogenic osteomalacia, is an uncommon paraneoplastic syndrome characterized by a renal phosphate loss causing hypophosphatemia, leading to rickets in children and osteomalacia in adults. It is caused by mesenchymal tumors, which secrete FGF-23 (fibroblast growth factor-23) and rarely other phosphotonins. It can present with a wide range of symptoms and there is often a delay in its diagnosis. Early diagnosis is important and surgical excision can cure the disease in most patients, thus preventing the complications.We report a case of TIO, who was diagnosed at an early stage and underwent curative surgery. Case presentation: A 30 years old female presented with pain in both legs, more severe in the left leg since about 1 year. She also had difficulty in walking, low back ache, muscle pain, mild pain in both the knee joints as well. On examination, she had limping gait, muscle power in the left leg was grade 3-4 otherwise, there was no significant findings on examination. Blood investigations showed elevated alkaline phosphatase (ALP)- 387IU/ml, low serum phosphorus- 1.2mg/dl, normal calcium - 9.8mg/dl, 25-OH Vitamin D- 24.69ng/ml, Parathyroid hormone (PTH)- 61pg/ml.Other blood tests were unremarkable. X- rays of both the legs and pelvis showed a classicalpseudo-fracture in proximal part of both the fibulae and proximal part of the right femur. This suggested hypophosphatemicosteomalacia. TmP/GFR was found to be very low (1.4mg/dl), which confirmed renal phosphate wasting. Later we got Fibroblast growth factor – 23 (FGF-23)- 617RU/ml, which was elevated. This confirmed FGF-23 related hypophosphatemicosteomalacia. In view of the patients age, onset of symptoms, lack of family history, absence of dental and hearing abnormalities, we suspected an acquired rather than a genetic cause. The patient underwent whole body Gallium-68 DOTANOC PET scan, which revealed somatostatin receptor expressing soft tissue density lesion in subcutaneous plane in the mid- anterior right leg, suggestive of FGF-23 secreting mesenchymal tumor.The patient was initially treated with replacement dose of oral phosphorus and calcitriol, along with calcium and vitamin D supplements. Later the patient underwent surgery for excision of the tumor in the right leg. The tumor was around 2cm size and the histopathology was suggestive of gaint cell rich tumor- possibly a phosphaturic mesenchymal tumor. Post surgery, the patient had significant improvement in her symptoms, gait improved and pain reduced. The serum phosphorus level was 3.8mg/dl post-operatively. The serum phosphorus level was maintained without phosphorus replacement. The patient was advised to repeat FGF-23 levels, but the patient failed to get it done. Conclusion: The diagnosis of TIO requires high index of suspicion and should always be looked as a differential diagnosis when we are evaluating a patient with osteomalacia. A detailed history and examination followed by a step wise biochemical evaluation and imaging is important to diagnose TIO in early stages. Surgical resection of the causative tumor will lead to definitve cure of the disease in most patients and avoids the complications like osteoporosis and fractures, thus improving the quality of life of the patients.

Bilateral high-frequency noninvasive peroneal nerve stimulation evokes tonic leg muscle activation for sleep-compatible reduction of restless legs syndrome symptoms.

Restless legs syndrome (RLS) is a prevalent sleep disorder with limited treatment options. Bilateral high-frequency noninvasive peroneal nerve stimulation (NPNS) reduces RLS symptoms. Here, we sought to characterize the mechanism of action for NPNS and identify predictors of treatment response. We hypothesized that, similar to voluntary leg movements, NPNS reduces RLS symptoms by activating leg muscles. For 20 adults with moderate-severe RLS, we tested this hypothesis by recording surface electromyography (EMG) from the tibialis anterior leg muscle while administering NPNS at varying amplitudes to determine the minimum NPNS amplitude that evoked EMG activity (motor threshold) and maximal NPNS amplitude that was not distracting (therapeutic intensity level). Afterwards, participants self-administered NPNS (at the therapeutic intensity level) and sham control for 14 days, each in randomized order. Efficacy was defined as International RLS Study Group Rating Scale (IRLS) score difference for NPNS compared with sham. NPNS consistently activated leg muscles; NPNS evoked EMG activity at the therapeutic intensity level for 19 of 20 participants (mean TIL: 26.6 mA, mean MT: 18.3 mA). Evoked EMG activity was tonic (not phasic) and sustained over time. Evoked EMG activity predicted efficacy; participants with lower motor thresholds had greater IRLS improvement (r = .45, P = .046). NPNS treatment did not interfere with self-reported sleep onset (NPNS: 16% of nights; sham: 11%; P = .629) and frequently improved self-reported sleep onset (NPNS: 52% of nights; sham: 15%; P = .002). These results demonstrate that NPNS reduces RLS symptoms by activating afferent pathways, thereby generating tonic and sustained leg muscle activity without interfering with sleep. Registry: ClinicalTrials.gov; Name: Noninvasive Peripheral Nerve Stimulation for Restless Legs Syndrome; URL: https://clinicaltrials.gov/ct2/show/NCT04700683; Identifier: NCT04700683. Charlesworth JD, Adlou B, Singh H, Buchfuhrer MJ. Bilateral high-frequency noninvasive peroneal nerve stimulation evokes tonic leg muscle activation for sleep-compatible reduction of restless legs syndrome symptoms. J Clin Sleep Med. 2023;19(7):1199-1209.

Relationship between Skeletal Muscle Thickness and Physical Activity in 4- to 6-Year-Olds in Japan.

Physical activity (PA) is widely recognized as a key factor in promoting skeletal muscle growth, though little is known about the specific impact of PA on the skeletal muscle development of preschool children. The purpose of this study is to investigate whether there is a relationship between PA levels and skeletal muscle thickness in preschoolers. By exploring this relationship, we hope to gain a better understanding of how PA can be used to promote healthy skeletal muscle development in preschoolers. In this study, a total of 275 healthy Japanese preschoolers, aged 4-6 years, from seven nursery schools in the town of Togo were recruited. Participants were asked to wear an accelerometer for four consecutive days to record their daily steps and the amount of time spent in moderate-to-vigorous PA and t total physical activity. Muscle thickness (MTs) was measured using B-mode ultrasonography at four sites: the anterior and posterior thigh (AT and PT, respectively) and the anterior and posterior lower leg (AL and PL, respectively). On weekdays, boys were found to be more physically active and engaged in significantly higher levels of total physical activity and moderate-to-vigorous PA than girls. Both boys and girls recorded more physical activity, daily steps, and higher levels of total physical activity and MVPA on weekdays compared to weekends. After adjusting for daylight duration, multivariable regression analyses revealed that increased total physical activity and moderate-to-vigorous PA were positively associated with greater muscle thickness size in the anterior tibialis (AT) and posterior lower leg (PL) muscles (β = 1.11 and β = 1.37 for AT, β = 1.18 and β = 0.94 for PL, p < 0.05) in Japanese preschoolers. The time spent involved in most of the different categories of moderate-to-vigorous PA was significantly higher for boys than for girls on the weekdays and weekends. Additionally, there was a positive correlation between time spent in moderate-to-vigorous PA and greater development of skeletal muscle in the lower body.

The Effect of Additional Leg Supports in Control of Posture in Sitting

The objective of the study was to investigate the effect of leg supports on the anticipatory and compensatory postural adjustments of sitting subjects exposed to external perturbations in the anterior-posterior direction. Ten young participants received perturbations applied to the upper body while sitting on a stool with an anterior or posterior leg support and when using a footrest. Electromyographic activities of the trunk and leg muscles and center of pressure displacements were recorded and analyzed during the anticipatory and compensatory phases of postural control. Anticipatory activities were observed in the tibialis anterior, biceps femoris, and erector spinae muscles in the anterior leg support condition. Early onset of muscle activity was observed in the tibialis anterior, biceps femoris, rectus femoris, and erector spinae muscles in the posterior leg support condition compared to the feet support condition. Moreover, to maintain balance participants utilized co-contraction of muscles as the main mechanism of balance control in sitting regardless of the availability of the anterior or posterior leg support. There was no effect of a leg support on center of pressure displacements. The outcome of the study provides a background for future investigations of the effect of leg supports on control of balance in sitting when perturbed.

Effect of Compression Tights on Skin Temperature in Women with Lipedema

The aim was to analyze the effect of compression tights on skin temperature in women with lipedema and to assess the effect of different knitting on skin temperature. Twenty-four women with lipedema (Grade I = 25%; Grade II = 75%) were divided into three groups according to the compression tights prototype assigned: control (n = 9), Flat (n = 7) and circular (n = 8). The participants performed a gait test two times, separated by 15 days: before wearing the tights of the study and after the treatment (15 days employing compression tights). Skin temperature was measured using infrared thermography before and after the gait test on both days, and six regions of interest were determined in the anterior and posterior leg. The skin temperature decreased in the different regions of interest after exercise in all the groups (e.g., anterior thigh (IC95% (−1.1, −0.7 °C) p &lt; 0.001), but no differences were observed in skin temperature between groups before and after walking (p &gt; 0.05). The use of compressing tights for 15 days does not alter skin temperature in women with lipedema before and after walking. The absence of differences in skin temperature between tights in the different assessments allows for obtaining the benefits of wearing compression tights during exercise without negative thermal effects.

Which Areas Are Still Left in Biologics Responsive Korean Patients with Moderate to Severe Plaque Psoriasis.

Psoriasis localized to certain body areas, such as the scalp, nails, palms, soles, intertriginous regions, and genital regions, is reportedly difficult to treat. To investigate the biologics-resistant areas in South Korean patients with psoriasis treated with biologics. The study included 50 patients with chronic moderate to severe plaque psoriasis from the Pusan National University Hospital and Chosun University Hospital between October 2019 and September 2020. The patients had at least one psoriatic lesion, were treated with biologics for more than six months, and exhibited a partial or good response (reaching a Psoriasis Area and Severity Index [PASI] score of 1~5 after biologics treatment). A total of 50 patients with psoriasis (32 male, mean±standard deviation 47.8±11 years), with a median PASI score of 1.8, were included. The most common biologics-resistant areas were the anterior lower leg (56.0%), followed by the knee (48.0%) and posterior lower leg (42.0%). The proportion of biologics-resistant areas were obtained for body regions traditionally considered as difficult-to-treat entities, including the fingernails (10.0%), toenails (14.0%), scalp (38.0%), palm (12.0%), sole (14.0%), and genital areas (10.0%). This study determined the biologics-resistant areas in South Korean patients, successfully treated with biologics, in a real-world clinical setting.

Association Between Knee Extension Strength at 3 and 6Months After Anterior Cruciate Ligament Reconstruction.

Deficits in knee extension strength after anterior cruciate ligament reconstruction have been a major problem. The inadequate recovery of the knee extension strength of surgical limb reportedly delays return to sports and increases reinjury risk. Accordingly, the early detection of knee extension strength deficits after reconstruction may help plan early interventions to manage impairment. This study aimed to clarify the association between knee extension strength at 3 and 6months after anterior cruciate ligament reconstruction. Retrospective study. Fifty patients who underwent primary anterior cruciate ligament reconstruction using hamstring grafts were included. At 3months postoperatively, the limb symmetry index (LSI) of isokinetic knee extension strength (IKE) at 60°/s, degree of swelling, passive range of motion of knee flexion and extension, and anterior leg reach distance were measured. At 6 months postoperatively, the LSI of IKE was measured at 60°/s, which was used as the main outcome. A correlation analysis was performed with the LSI of IKE at 6months postoperatively as the dependent variable and the LSI of IKE at 3months postoperatively as the independent variable. Subsequently, a multiple regression analysis was performed, with LSI of IKE at 6months postoperatively as the dependent variable; LSI of IKE at 3months postoperatively as the independent variable; and other variables, demographic information, and surgical data as covariates. The correlation analysis revealed that the LSIs of IKE at 3 and 6months postoperatively were correlated (r = .535, P < .001). In the multiple regression analysis, the LSI of IKE at 3months postoperatively was significantly associated with that at 6months postoperatively, even when other variables were included as covariates (R2 = .349, P = .004). Asymmetry of knee extension strength at 3months postoperatively could be more useful than other variables related to knee strength in predicting the asymmetry of knee extension strength at 6months postoperatively.

Low-Intensity Resistance Exercise Based on Myofascial Chains Alters the Lower-Limb Tension and Improves Health Status in Female Individuals With Knee Osteoarthritis.

Low-intensity resistance exercise therapy (LIRET) based on myofascial chains, applied to both affected and nonlocal joints, is an effective method for knee osteoarthritis (OA) rehabilitation. This study applied LIRET in a comparison of prevalues and postvalues of lower-limb tension in female patients with knee OA and asymptomatic participants. Twenty-four female participants with knee OA and 20 asymptomatic women took part in a 3-month long application of LIRET. Participants' ankle passive torque and ankle range of motion in the sagittal plane were assessed with an isokinetic dynamometer. The collected values were used to estimate the sagittal-plane lower-limb tension. Compared with the asymptomatic group, participants with knee OA presented decreased maximum ankle dorsiflexion (P < .001), decreased ankle plantar flexion range (P = .023), ankle resting position more inclined to dorsiflexion (P = .017), increased ankle dorsiflexion stiffness (P = .005), and lower ankle plantar flexion stiffness (P = .034). After exercise intervention, the knee OA group self-reported less knee pain (P < .001), improved physical function (P < .001), increased maximum dorsiflexion (P = .021), and increased plantar flexion range (P < .001). While plantar flexion stiffness increased (P = .037), dorsiflexion stiffness decreased (P = .015) and ankle resting position moved toward dorsiflexion (P = .002). Results suggest possible decreased anterior leg tension and possible increased posterior leg tension in patients with knee OA. The results supported that knee OA patients present imbalanced myofascial tension of lower limbs. LIRET based on myofascial chains appears to decrease pain, and stiffness, and improve physical function of patients with knee OA and change their lower-limb tension.