Bilateral Ankle Research Articles

Does ipsilateral chronic ankle instability alter kinematics of the other joints of the lower extremities: a biomechanical study.

We evaluated and compared kinematics of bilateral ankle, knee, and hip joints in patients with chronic unilateral ankle instability (CAI) with healthy controls. Fifteen individuals diagnosed with CAI and a control group of 16 individuals were matched. Different peaks within the gait cycle (at different intervals) for the dorsiplantar, inversion/eversion, and abduction/adduction axis were compared between injured and uninjured sides of patients with CAI with a control group. Comparison of the uninjured ankle in CAI with the control group showed higher dorsiflexion in one peak of the stance phase (p = 0.003), higher inversion in one peak of the stance phase (p = 0.022), and the swing phase (p = 0.004). The hip joint of the uninjured side showed higher extension in one peak of the stance phase (p < 0.001), and two peaks of the swing phase (p < 0.05). Furthermore, it showed higher adduction in one peak of the foot flat to mid-stance phase (p = 0.001), higher abduction in one peak of the late swing phase (p = 0.047), and the swing phase (p = 0.032). The knee joint of the uninjured side showed higher flexion in all measured peaks of the gait cycle (p < 0.05) (except for one peak in the late swing phase) compared to the control group. Chronic ankle instability results in altered biomechanics of the ipsilateral knee as well as the contralateral ankle, knee, and hip joints. The alterations caused by CAI may predispose patients to overuse and/or acute injuries of other joints of lower extremities during routine and sporting activity.

Voluntary Forelimbs Exercise Reduces Immobilization-Induced Mechanical Hyperalgesia in the Rat Hind Paw.

Voluntary exercise is sufficient to protect against neuropathic pain. However, it is unclear whether voluntary exercise reduces immobilization-induced hyperalgesia. We examined the effect of voluntary forelimb exercise on immobilized-induced hyperalgesia in hind paws of rats. Wistar rats were randomly divided into the (1) both hind limbs immobilized group (IM group), (2) immobilization and exercise with nonimmobilized fore limbs group (EX group), and (3) control group. In the IM and EX groups, the bilateral ankle joints of each rat were immobilized in full plantar flexion with a plaster cast for eight weeks. In the EX group, voluntary exercise using nonimmobilized forelimbs in the running wheel was administered during the immobilization period, while hind limbs were kept immobilized (60 min/day, 5 days/week). Mechanical hyperalgesia in the hind paw was measured using a digital von Frey device every week. To investigate the abnormality of primary sensory neurons and central sensitization, the number of calcitonin gene-related peptide-positive cells in the dorsal root ganglion and the expression level of calcitonin gene-related peptide in the spinal dorsal horn were analyzed by immunohistochemical staining. Immobilization-induced mechanical hyperalgesia was inhibited in the EX group compared to the IM group at three weeks after immobilization. In the EX group, the number of calcitonin gene-related peptide-positive cells in the dorsal root ganglion and the expression level of calcitonin gene-related peptide were significantly decreased compared to those in the IM group. Our results therefore suggest that voluntary forelimb exercise during hind limb immobilization partially reduces immobilization-induced hyperalgesia by suppressing that the plastic changes of the primary sensory nerves that excessively transmit pain and increased responsiveness of nociceptive neurons in the spinal dorsal horn.

Neuromechanical model-based control of bi-lateral ankle exoskeletons: biological joint torque and electromyogram reduction across walking conditions

To enable the broad adoption of wearable robotic exoskeletons in medical and industrial settings, it is crucial they can effectively support large repertoires of movements. We propose a new human-machine interface to drive bilateral ankle exoskeletons during a range of 'unseen' walking conditions that were not used for establishing the control interface. The proposed approach uses person-specific neuromechanical models of the human body to estimate biological ankle torques in real-time from electromyograms (EMGS) and joint angles. A low-level controller based on a disturbance observer translates biological torque estimates into exoskeleton commands. We call this 'neuromechanical model-based control' (NMBC). NMBC enabled five individuals to voluntarily control exoskeletons across two walking speeds performed at three ground elevations with no need for predefined torque profiles, nor a prior chosen neuromuscular reflex rules, or state machines as common in literature. Furthermore, a single subject case study was carried out on a dexterous moonwalk task, showing reduction in muscular effort. NMBC enabled reducing biological ankle torques as well as eight ankle muscle EMGs both within (22% for the torque; 13% for the EMG) and between walking conditions (22% for the torque; 13% for the EMG) when compared to non-assisted conditions. Torque and EMG reduction in novel walking conditions indicated the exoskeleton operated symbiotically as an exomuscle controlled by the operator's neuromuscular system. This will open new avenues for systematic adoption of wearable robots in out-of-the-lab medical and occupational settings.

A Unique Cause Of Sciatica In A Masters Martial Arts Athlete

HX 71-year-old male masters martial arts athlete referred for suspected “sciatica.” He had around one month of right buttocks pain with radiation to his posterior thigh. He endorsed a recent increase in his Krav Maga martial arts activity. He had pain localized over the ischial tuberosity, rated an 8/10, and described as sharp and burning. Symptoms provoked with hip movement and weight activities. He endorsed hamstring weakness and had developed a limp while walking. Denied any lower extremity numbness or low back pain. On further questioning of his personal musculoskeletal history, he did admit to a prior right proximal hamstring injury around 1 year, and a remote history of low back pain requiring a L4-L5 decompression surgery. PHYSICAL EXAM: On inspection, he had a soft tissue defect over his ischial tuberosity, but no swelling or ecchymosis. He had an antalgic gait on his right hip, extreme tenderness along his ischial tuberosity and proximal hamstring. Hip range of motion was difficult to assess due to pain. He had 5/5 strength and intact sensation throughout his bilateral lower extremities except for right knee flexion which was 4/5 and painful. Reflexes were 1+ and symmetric at the bilateral knee and ankle. Special testing was negative for a seated slump test bilateral. DIFFERENTIAL: 1. Sciatica 2. Herniated disc 3. Piriformis syndrome TEST/RESULTS: Diagnostic ultrasound of his right posterior hip region was performed in clinic. This demonstrated a high grade retracted and avulsed partial tear of the proximal hamstring tendon, involving both the conjoint and semimembranosus tendons. DIAGNOSIS: Avulsed Proximal Hamstring tear TREATMENT/ OUTCOMES: A right hip MRI was performed for surgical planning purposes. This further demonstrated a high-grade, greater than 75%, partial thickness tear involving the conjoint and semimembranosus tendon origin with 4.4 cm of retraction. He underwent an open proximal primary repair of the hamstring tendon with neuroplasty of the sciatic nerve. The patient began post-operative physical therapy around 1 month after surgery which he successfully completed. 8 months post-operative he has had near resolution of his right buttocks pain at the ischial tuberosity and his posterior thigh pain had resolved. For activity, he has been able to resume cardiovascular exercise with walking and biking.

Bilateral Ankle Pain In An Adolescent Male Football Player

Bilateral Ankle Pain In An Adolescent Male Football Player

Effects of ankle continuous passive motion on soleus hypertonia in individuals with cerebral palsy: A case series

BackgroundContinuous passive motion device (CPM) provides repetitive movement over extended periods of time for those who have low functional ability. The purpose of this research was to evaluate the effects of a four-week program of continuous passive motion of the ankle joint on the changes in soleus hypertonia in individuals with cerebral palsy who suffered from life-long hypertonia. MethodsA single group, repeated-measures study was conducted. Eight individuals (7 males and 1 female with a mean age of 21.8 ± 8.5 years) with spastic cerebral palsy underwent bilateral ankle CPM for 1 h a day, 5 days a week, for 4 weeks. The outcome measures included the Modified Ashworth Scale (MAS) score, passive range of motion (PROM) of the ankle, the ratio of maximum H reflex to maximum soleus M-response (H/M ratio), and post-activation depression (PAD). All outcomes were measured before and after the intervention. A paired t-test was used to examine treatment effects pre-versus post-intervention. ResultsPaired t-tests showed that the CPM program significantly decreased the MAS score (p = 0.006), decreased the maximum H/M ratio (p=0.001), improved PAD (p = 0.003, p = 0.040, and p = 0.032 at 0.2 Hz, 1 Hz, and 2 Hz, respectively), and increased the passive ankle range of motion (p = 0.049). ConclusionAnkle CPM not only reduced soleus hypertonia but also improved the PROM in individuals with cerebral palsy. The results of this study show ankle CPM to be an effective intervention for individuals with cerebral palsy.

Analysis of the uninjured tibiofibular syndesmosis using conventional CT-imaging and axial force in different foot positions

BackgroundSyndesmosis measurments and indices have been controversial and showed interindividual variability. The purpose of this study was to analyze, by conventional axial computed tomography images and a simulated load device, the uninjured tibiofibular syndesmosis under axial force and forced foot positions. MethodsA total of 15 healthy patients (30 ankles) were studied using adjustable simulated load device (ASLD). This device allowed to perform bilateral ankle CT scans in two forced foot and ankle positions (30° of plantar flexion, 15° of inversion, 20° of internal rotation and 15° of dorsal flexion, 15° of eversion, 30° of external rotation). Axial load was applied simultaneously in a controlled manner (70% body weight). Measurements on the axial image of computed tomography were: syndesmotic area (SA), fibular rotation (FR), position of the fibula in the sagittal plane (FPS), depth of the incisura (ID) and direct anterior difference (ADD), direct middle difference (MDD) and direct posterior difference (PDD). ResultsIn patients without injury to the tibiofibular syndesmosis, the application of axial load and forced foot and ankle positions showed statistically significant differences on the distal tibiofibular measurements between the stressed and the relaxed position, it also showed interindividual variability : SA (median = 4.12 [IQR = 2.42, 6.63]) (p < 0.001), ADD (0.67 [0.14, 0.67]) (p < 0.001), MDD(0.45, [0.05, 0.9]) (p < 0.001), PDD (0.73 [−0.05, 0.73]) (p < 0.002). However, it did not detect statistically significant differences when the tibiofibular differences between the stressed and the relaxed position in one ankle were compared with the contralateral side: SA (−0.14, SD = 4.33 [95% CI = −2.53, 2.26]), ADD (−0.42, 1.08 [−1.02, 0.18]), MDD (0.29, 0.54 [−0.01, 0.59]), PDD (−0.1, 1.42 [−0.89, 0.68]). Interobserver reliability showed an Intraclass correlation coefficient of 0.990 [95% CI = 0.972, 0.997]. ConclusionsWide interindividual variability was observed in all syndesmotic measurements, but no statistically significant differences were found when comparing one ankle to the contralateral side. Measuring syndesmosis alignment parameters, may only be of value, if those are compared to the contralateral ankle.

Two-year reduction of dual-energy CT urate depositions during a treat-to-target strategy in gout in the NOR-Gout longitudinal study.

ObjectivesThere is a lack of large longitudinal studies of urate deposition measured by dual-energy CT (DECT) during urate lowering therapy (ULT) in people with gout. We explored longitudinal changes in DECT urate depositions during a treat-to-target strategy with ULT in gout.MethodsPatients with a recent gout flare and serum-urate (sUA) >360 µmol/l attended tight-control visits during escalating ULT. The treatment target was sUA <360 µmol/l, and <300 µmol/l if presence of tophi. A DECT scanner (General Electric Discovery CT750 HD) acquired data from bilateral forefeet and ankles at baseline and after one and two years. Images were scored in known order, using the semi-quantitative Bayat method, by one experienced radiologist who was blinded to serum urate and clinical data. Four regions were scored: the first metatarsophalangeal (MTP1) joint, the other joints of the toes, the ankles and midfeet, and all tendons in the feet and ankles.ResultsDECT was measured at baseline in 187 of 211 patients. The mean (s.d.) serum urate level (μmol/l) decreased from 501 (80) at baseline to 311 (48) at 12 months, and 322 (67) at 24 months. DECT scores at all locations decreased during both the first and the second year (P <0.001 for all comparisons vs baseline), both for patients achieving and not achieving the sUA treatment target.ConclusionsIn patients with gout, urate depositions in ankles and feet as measured by DECT decreased both in the first and the second year, when patients were treated using a treat-to-target ULT strategy.

A 73-Year-Old Man with Bilateral Posterior Ankle Pain.

A 73-Year-Old Man with Bilateral Posterior Ankle Pain.

Relationship Between Gastrocnemius Muscle Length and Overhead Squat Movement Compensations Among Active-Duty Firefighters

Restricted gastrocnemius length may impair movement efficiency during functional movements. However, this is yet to be examined among tactical athletes. This study examined the relationship between gastrocnemius muscle length and movement compensations during a two-leg overhead squat among career firefighters. Bilateral ankle dorsiflexion passive range of motion data were collected from 50 firefighters, and movement compensations observed during a two-leg overhead squat were recorded. Firefighters with reduced average ankle dorsiflexion passive range of motion were more likely to demonstrate movement compensations during the overhead squat. Clinicians should utilize interventions that lengthen gastrocnemius musculature to improve the squat movement efficiency of firefighters.

Effects of wedge-shaped heel pad in the treatment of extremely severe burn patients with foot drop deformity

Objective: To explore the effects of wedge-shaped heel pad in the treatment of foot drop deformity in extremely severe burn patients. Methods: A retrospective cohort study method was conducted. From March 2015 to July 2016, 33 patients with foot drop deformity caused by extremely severe burn scar who met the inclusion criteria were admitted to the Department of Burn Rehabilitation of Kunshan Rehabilitation Hospital, including 18 males and 15 females, aged (38±9) years. Patients received comprehensive post-burn rehabilitation treatment after admission, and the wedge-shaped heel pad with appropriate height was placed under the patients' insole, according to the degree of the foot drop deformity in patients. Standing, squatting, and walking exercises were performed after putting on shoes with wedge-shaped heel pad. Before and immediately after the first treatment (hereinafter referred to as before and immediately after treatment), and in 1 month after treatment with wedge-shaped heel pad, the Simple Balance Scale was used to evaluate the standing balance ability of patients. In 1, 3, and 12 months after treatment, active ranges of motion (AROMs) of bilateral ankle joint dorsiflexion and knee joint flexion were measured with joint motion range measuring ruler, the shortest distance between buttocks of patients and the ground when squatting and walking distance in 1 min of patients were measured with measuring tape, and the independent ability of transferring between beds and chairs, walking, and walking up and down stairs in the movement items of activity of daily living (ADL) in patients were evaluated with modified Barthel index. Data were statistically analyzed with Friedman test, Wilcoxon rank sum test, unequal interval analysis of variance for repeated measurement, and Bonferroni correction. Results: Immediately after treatment, the standing balance ability of patients was 2.0 (1.0, 2.0) levels, which was significantly higher than 1.0 (0, 1.0) level before treatment (Z=-5.568, P<0.01); in 1 month after treatment, the standing balance ability of patients was 3.0 (2.5, 3.0) levels, which was significantly higher than that immediately after treatment (Z=-5.303, P<0.01). In 3 and 12 months after treatment, AROMs of the left and right ankle joint dorsiflexion and the left and right knee joint flexion in patients were significantly increased compared with those in 1 month after treatment (Z=-4.860, -4.836, -4.965, -4.909, -5.037, -5.025, -5.020, -4.942, P<0.01); in 12 months after treatment, AROMs of the left and right ankle joint dorsiflexion and knee joint flexion in patients were significantly increased compared with those in 3 months after treatment (Z=-5.062, -4.962, -5.017, -4.944, P<0.01). In 3 and 12 months after treatment, the shortest distances between buttocks of patients and the ground were (67±11) and (57±11) cm, which were significantly shorter than (72±11) cm in 1 month after treatment (P<0.01), respectively; in 12 months after treatment, the shortest distance between buttocks of patients and the ground was significantly shorter than that in 3 months after treatment (P<0.01). In 3 and 12 months after treatment, the walking distances within 1 min of patients were significantly longer than that in 1 month after treatment (Z=-5.043, -5.016, P<0.01); in 12 months after treatment, the walking distance within 1 min of patients was significantly longer than that in 3 months after treatment (Z=-5.025, P<0.01). In 3 and 12 months after treatment, the independent ability of transferring between beds and chairs, walking, and walking up and down stairs in the movement items of ADL in patients were significantly increased compared with those in 1 month after treatment (Z=-4.472, -4.025, -4.707, -4.565, -3.994, -4.777, P<0.01); in 12 months after treatment, the independent ability of transferring between beds and chairs, walking, and walking up and down stairs in the movement items of ADL in patients were significantly increased compared with those in 1 month after treatment (Z=-3.827, -3.358, -3.557, P<0.01). Conclusions: After using the wedge-shaped heel pad, the standing balance ability, ankle joint dorsiflexion range of motion, walking ability are significantly improved, and the independent levels of movement items in ADL are significantly increased in extremely severe burn patients with foot drop deformity.

Tuberculosis of bilateral ankles: Misdiagnosed as rheumatoid arthritis

The osteoarticular tuberculosis is a uncommon diease, which is accout for 0.1%-0.3% of Tuberculosis (TB). The involoment of foot and ankle is only 0.01%-0.03% of TB, particularly the bilateral feet and ankles are affected is extremely rare. Futhermore, its clinical manifestation is atypical and similar with autoimmune disorder, subacute or chronic pyogenic arthritis, osteochondrosis, benign bone tumors and so on, which conduce to the delay of its diagnose and therapy along with unfavourable prognosis. Here we present a case of a 52-year-old man with bilateral feet and ankles tuberculous arthritis, misdiagnosed successively Rheumatoid Arthritis (RA) and Poncet’s diease. It is hope that can enhance the alertness about osteoarticular tuberculosis. Keywords: Osteoarticular tuberculosis; ankle; foot; misdignose.

Four-Dimensional CT Analysis of Normal Syndesmotic Motion.

Background:The syndesmosis ligament complex stabilizes the distal tibiofibular joint while allowing for small amounts of physiologic motion. When injured, malreduction of the syndesmosis is the most important factor that contributes to inferior functional outcomes. Syndesmotic reduction is a dynamic measure, which is not adequately captured by conventional computed tomography (CT). Four-dimensional CT (4DCT) can image joints as they move through range of motion (ROM). The aim of this study was to employ 4DCT to determine in vivo syndesmotic motion with ankle ROM in uninjured ankles.Methods:Uninjured ankles were analyzed in patients who had contralateral syndesmotic injuries, as well as a cohort of healthy volunteers with bilateral uninjured ankles. Bilateral ankle 4DCT scans were performed as participants moved their ankles between maximal dorsiflexion and plantarflexion. Multiple measures of syndesmotic width, as well as sagittal translation and fibular rotation, were automatically extracted from 4DCT using a custom program to determine the change in syndesmotic position with ankle ROM.Results:Fifty-eight ankles were analyzed. Measures of syndesmotic width decreased by 0.7 to 1.1 mm as the ankle moved from dorsiflexion to plantarflexion (P < .001 for each measure). The fibula externally rotated by 1.2 degrees with ankle ROM (P < .001), but there was no significant motion in the sagittal plane (P = .43). No participants with bilateral uninjured ankles had a side-to-side difference in syndesmotic width of 2 mm or greater.Conclusion:4DCT allows accurate, in vivo syndesmotic measurements, which change with ankle ROM, confirming prior work that was limited to biomechanical studies. Side-to-side syndesmotic measurements are consistent within subjects, validating the method of templating syndesmotic reduction off the contralateral ankle, in a consistent ankle position, to achieve anatomic reduction of syndesmotic injury.Level of Evidence:Level II, prospective cohort study.

A rare case of Polyarteritis Nodosa associated with autoimmune hepatitis: a case report

BackgroundPolyarteritis nodosa is a type of vasculitis affecting medium- and small-sized arteries that has been associated with hepatitis B but does not have an established relationship with autoimmune hepatitis. Here we report the case of an adult patient with autoimmune hepatitis who, shortly after diagnosis, developed life-threatening polyarteritis nodosa.Case presentationA 45-year-old woman was diagnosed with autoimmune hepatitis after initially presenting with a two-month history of fatigue, nausea, and anorexia and a three-week history of scleral icterus. Her liver biopsy showed mild portal fibrosis and her liver chemistries improved with prednisone and azathioprine. Three months later, she presented to the emergency department with fever, bilateral ankle pain, rash, oral ulcers, and poor vision. Physical examination was notable for erythema nodosum, anterior uveitis, retinal vasculitis, and frosted branch angiitis (frosted branch angiitis (a widespread florid translucent perivascular exudate). She subsequently developed repeated episodes of ischemic acute bowel necrosis that required multiple surgeries and extensive small bowel resections. Surgical pathology of the small bowel resection revealed ischemic necrosis, medium and small vessel vasculitis with microvascular thrombi consistent with polyarteritis nodosa. Azathioprine was discontinued and she was treated with pulse steroids followed by a prednisone taper, cyclophosphamide, and intravenous immune globulin with overall improvement in her symptomatology. Since her hospitalization, she has been maintained on low-dose prednisone and mycophenolate mofetil.ConclusionsIn patients with recent diagnosis of autoimmune hepatitis, there should be a modest suspicion for concomitant polyarteritis nodosa if symptoms and signs of multisystem vasculitis develop.

The clinical effects of mobilization with passive ankle dorsiflexion using a passive ankle dorsiflexion apparatus on older patients with knee osteoarthritis: A randomized trial.

Active exercise is the only proven effective intervention for knee osteoarthritis (OA). The addition of manual therapy has shown to improve outcome of exercises. Passive mobilization with submaximal bilateral passive ankle dorsiflexion was examined in a double-blinded randomized controlled clinical trial. A passive ankle dorsiflexion apparatus was used to standardize the frequency, range of motion, and duration parameters. The purpose of the study was to determine whether a simple standardised mobilization technique could be incorporated as a safe and unsupervised conservative treatment for knee OA. In total, 73 participants were randomly assigned to the experimental (n= 37) or control group (n= 36). All participants performed active exercises and received six sessions of 10-minute dorsiflexion intervention, either real or sham, for two weeks. Pre- and post-experimental assessments for the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC), visual analog scale (VAS) for pain, and range of motion of the knee were conducted. Results were analyzed using two-way repeated measures analysis of variance and Independent-Samples Mann-Whitney U Test. The mean score of WOMAC for the experimental and control groups changed from 31.84 to 18.19 and 34.74 to 21.06, respectively, after the intervention. The VAS also showed significant improvements. Significant improvements were observed in WOMAC in both groups after the intervention; however, differences between the groups were not statistically significant. Exercise with either 30∘ or 5∘ of passive dorsiflexion yielded favorable clinical effects. Although submaximal bilateral ankle dorsiflexion was proven to be safe for elderly participants with osteoarthritis of the knee, whether it provided extra benefits to exercises alone was unclear. Further research is required to determine the effectiveness of dorsiflexion and optimal range of mobilization.

Neuromechanical Model-Based Adaptive Control of Bilateral Ankle Exoskeletons: Biological Joint Torque and Electromyogram Reduction Across Walking Conditions

Neuromechanical Model-Based Adaptive Control of Bilateral Ankle Exoskeletons: Biological Joint Torque and Electromyogram Reduction Across Walking Conditions

Arthritis-Dermatitis Syndrome: a Case of Disseminated Gonococcal Infection with Petechial Skin Rash

A previously healthy 36-year-old woman was admitted to the hospital with vaginal discharge, bilateral ankle pain, and a lower extremity skin rash, all of which developed after unprotected vaginal intercourse with a new male partner. On examination, there was a petechial and purpuric rash involving the lower extremities and bilateral tenosynovitis of the ankle dorsiflexor tendons. Urine NAAT was positive for Neisseria gonorrhea, confirming disseminated gonococcal infection (DGI). The patient was initially treated with oral azithromycin and intravenous ceftriaxone, but as a result of psychosocial circumstances, she was prematurely discharged on an oral cephalosporin agent. She represented with treatment-failure DGI and was treated with a 7-day course of intramuscular ceftriaxone. Repeat urine NAAT was negative for gonorrhea and the patient remained asymptomatic. This case features an atypical cutaneous manifestation of DGI, characterized by a painless petechial and purpuric skin rash rather than the tender papulo-pustular lesions that are typically seen. Additionally, it highlights the importance of DGI treatment with a 7-day parenteral cephalosporin therapy when antibiotic susceptibility is not available.

Bilateral symmetric ankles and feet cellulitis after fish pedicure: Case report and review of the literature

Fish pedicure (feet immersion in a tank containing fish Garra rufa or Cyprinion macrostomus) is a widely diffuse cosmetic practice, usually considered safe. However, this practice is regulated only in a few Countries, and the risk of infection related to this practice is not quantified. We report a case of bilateral symmetric ankles and feet cellulitis in a previously healthy young woman without risk factors for infections, after a fish pedicure in Greece. Three cases of foot infection after fish pedicure have been described in the English literature, two sustained by S. aureus and one by Mycobacterium marinum, but none of them was so extensive, involving not only feet but also ankles. The practice of the aesthetic fish pedicure should be regulated in all Countries to reduce the risk of complications related to this procedure. Moreover, studies targeted at investigating the risk of infection associated with this procedure are warranted. Keywords: Fish pedicure; Cosmetic procedure; Cellulitis; Risk infection.

Age, gender, height and weight in relation to joint cartilage thickness among school-aged children from ultrasonographic measurement

BackgroundAmong school-age children, the decrease of cartilage thickness (Cth) with increasing age is well known. However, the influence of body mass index (BMI), height or weight on Cth has not been revealed. Here in, we aim to establish an age- and gender-specific Cth standard reference among Asians and investigate the possible prestige of BMI, height and weight.MethodsA cross-sectional study was performed in healthy Asian children. Bilateral knees, ankles, wrists, second metacarpophalangeals (MCPs) and proximal interphalangeals (PIPs) were measured using ultrasound. The children’s height, weight and BMI were also recorded for later adjustment.ResultsA total of 200 school age Asian children (including 86 girls and 114 boys, aged between 5 to 13 years-old) were investigated. Cth differences were observed in the knees, ankles, wrists, MCPs and PIPs between sexes (p < 0.05), with girls having thinner cartilage thickness. While Cth decreases with increasing age (p < 0.0001, 0.039, 0.001, 0.023, 0.091 in girls’ knees, ankles, wrists, MCPs and PIPs and p = 0.002, 0.001, < 0.0001, 0.001, 0.045 in boys’, respectively). Our data showed that weight, height and BMI are not the main factors contributing to Cth. A formula to calculate gender-specific cartilage thickness for Asian school age children is suggested. There was no difference in Cth after adjusting for height or weight between Asian or Caucasian group.ConclusionsA formula to calculate gender-specific cartilage thickness for Asian school age children is suggested. Height, weight and BMI were not the major contributor for Cth among school age children.

Detecting Sensitive Mobility Features for Parkinson's Disease Stages Via Machine Learning.

It is not clear how specific gait measures reflect disease severity across the disease spectrum in Parkinson's disease (PD). To identify the gait and mobility measures that are most sensitive and reflective of PD motor stages and determine the optimal sensor location in each disease stage. Cross-sectional wearable-sensor records were collected in 332 patients with PD (Hoehn and Yahr scale I-III) and 100 age-matched healthy controls. Sensors were adhered to the participant's lower back, bilateral ankles, and wrists. Study participants walked in a ~15-meter corridor for 1 minute under two walking conditions: (1) preferred, usual walking speed and (2) walking while engaging in a cognitive task (dual-task). A subgroup (n=303, 67% PD) also performed the Timed Up and Go test. Multiple machine-learning feature selection and classification algorithms were applied to discriminate between controls and PD and between the different PD severity stages. High discriminatory values were found between motor disease stages with mean sensitivity in the range 72%-83%, specificity 69%-80%, and area under the curve (AUC) 0.76-0.90. Measures from upper-limb sensors best discriminated controls from early PD, turning measures obtained from the trunk sensor were prominent in mid-stage PD, and stride timing and regularity were discriminative in more advanced stages. Applying machine-learning to multiple, wearable-derived features reveals that different measures of gait and mobility are associated with and discriminate distinct stages of PD. These disparate feature sets can augment the objective monitoring of disease progression and may be useful for cohort selection and power analyses in clinical trials of PD. © 2021 International Parkinson and Movement Disorder Society.