Gastrocnemius Length Research Articles

A Study of Orthopedic Patient Leaflets and Readability of AI-Generated Text in Foot and Ankle Surgery (SOLE-AI).

Introduction The internet age has broadened the horizons of modern medicine, and the ever-increasing scope of artificial intelligence (AI) has made information about healthcare, common pathologies, and available treatment options much more accessible to the wider population. Patient autonomy relies on clear, accurate, and user-friendly information to give informed consent to an intervention. Our paper aims to outline the quality, readability, and accuracy of readily available information produced by AI relating to common foot and ankle procedures. Materials and methods A retrospective qualitative analysis of procedure-specific information relating to three common foot and ankle orthopedic procedures: ankle arthroscopy, ankle arthrodesis/fusion, and a gastrocnemius lengthening procedure was undertaken. Patient information leaflets (PILs) created by The British Orthopaedic Foot and Ankle Society (BOFAS) were compared to ChatGPT responses for readability, quality, and accuracy of information. Four language tools were used to assess readability: the Flesch-Kincaid reading ease (FKRE) score, the Flesch-Kincaid grade level (FKGL), the Gunning fog score (GFS), and the simple measure of gobbledygook (SMOG) index. Quality and accuracy were determined by using the DISCERN tool by five independent assessors. Results PILs produced by AI had significantly lower FKRE scores when compared to BOFAS -40.4 (SD: ±7.69) compared to 91.9 (SD: ±2.24) (p ≤ 0.0001), indicating poor readability of AI-generated text. DISCERN scoring highlighted a statistically significant improvement in accuracy and quality of human-generated information across two PILs with a mean score of 55.06 compared to 46.8. FKGL scoring indicated that the required grade of students to understand AI responses was consistently higher than compared to information leaflets at 11.7 versus 1.1 (p ≤ 0.0001). The number of years spent in education required to understand the ChatGPT-produced PILs was significantly higher in both GFS (14.46 vs. 2.0 years) (p < 0.0001) and SMOG (11.0 vs. 3.06 years) (p < 0.0001). Conclusion Despite significant advances in the implementation of AI in surgery, AI-generated PILs for common foot and ankle surgical procedures currently lack sufficient quality, depth, and readability - this risks leaving patients misinformed regarding upcoming procedures. We conclude that information from trusted professional bodies should be used to complement a clinical consultation, as there currently lacks sufficient evidence to support the routine implementation of AI-generated information into the consent process.

Longitudinal changes in Achilles tendon and triceps surae muscle architecture during a 156-km mountain ultramarathon.

This study aimed to assess the longitudinal changes in triceps surae muscle-tendon architecture during a mountain ultramarathon. Experienced trail runners [n = 55, 78% men, age: 45.2 (13.5) yr] participated in a 156-km trail run (6,000 m climbing) consisting of six 26-km laps. The resting architectural properties of triceps surae muscle-tendon were measured using ultrasound imaging for Achilles tendon cross-sectional area (AT CSA), medial gastrocnemius muscle pennation angle, thickness, length, and fiber length. Measurements were performed the day before the race (baseline), at 52 km (T1), at 104 km (T2), at 156 km (T3), and 12 h after the race (H12). Among finishers (n = 41), there was a significant biphasic change in AT CSA during the race (P = 0.001). First, a significant decrease in AT CSA occurred between baseline and T1 (P = 0.006), with a greater decrease for participants averaging speed >8 km/h (P = 0.014). Second, there was a significant increase in AT CSA especially between T2 and T3 (P = 0.006) that was correlated with a decrease in average speed (P = 0.001) and alteration of spaciotemporal running parameters (P < 0.05). Changes in muscle-tendon architecture were not significantly different between finishers (n = 41) and nonfinishers (n = 14). In 47 participants (85.5%) who completed the follow-up, AT CSA at H12 was greater compared with baseline (P = 0.010). The main finding is the significant and biphasic modification of the AT CSA during a 156-km mountain ultramarathon with an initial decrease corresponding to mechanical stress followed by a secondary increase suggesting adaptive mechanotransduction persisting after 12 h.NEW & NOTEWORTHY Achilles tendon cross-sectional area (AT CSA) demonstrated significant adaptive modifications during a 156 km mountain ultramarathon in trained athletes. Initially, a decrease in AT CSA, especially at higher running speeds, is consecutive to the biomechanical stress on the plantar flexor muscle-tendon unit (MTU). Subsequently, there is a significant increase in AT CSA persisting up to 12 h after the race, which likely corresponds to an adaptive process to limit the compressive and tensile load on the tendon.

The Expression of the Force-Length Properties of the Gastrocnemius in Ice Hockey Players.

Leonard, C and Challis, JH. The expression of the force-length properties of the gastrocnemius in ice hockey players. J Strength Cond Res 38(9): 1635-1639, 2024-Although the force-length properties of muscles have an approximately parabolic shape, in vivo not all the force-length curve is necessarily used, only a portion of the curve is expressed (i.e., ascending, plateau, or descending regions of the force-length curve). The number of sarcomeres in series in a muscle fiber affects the expressed section of the force-length curve; this number can be influenced by the nature of activity the muscle experiences. It was hypothesized that the reduced range of motion ice skaters experience, because of the constraints imposed by the ice skates, that the gastrocnemii of a group of ice skaters will adapt and will more frequently express in vivo the plateau of the force-length curve compared with a nonspecifically trained population. Twelve NCAA Division I female ice hockey players volunteered for the study. Their maximum isometric ankle plantarflexion moments were recorded for 6 ankle angles and 3 knee angles. Exploiting the biarticularity of the gastrocnemius, the expressed sections of the subject's force-length curves were determined. Six subjects operated over the ascending limb, 5 operated over the plateau region, and 1 over the descending limb. This frequency of distribution for ice hockey players was statistically different to the distribution measured for 28 nonspecifically trained subjects from a previous study ( p < 0.0001). These results likely reflect morphological differences between the 2 groups for their gastrocnemii, potentially arising from the limited range of gastrocnemius length feasible in ice-skates. These results have implications for the specificity of their off-ice training for ice hockey players.

Needle‑based gastrocnemius lengthening: a novel ultrasound‑guided noninvasive technique: part II—clinical results

BackgroundIsolated gastrocnemius contracture has been associated with more than 30 lower limb disorders, including plantar heel pain/plantar fasciitis, Achilles tendinosis, equinus foot, adult flatfoot, and metatarsalgia. Although many techniques are available for gastrocnemius recession, potential anesthetic, cosmetic, and wound-related complications can lead to patient dissatisfaction. Open and endoscopic recession techniques usually require epidural or general anesthesia, exsanguination of the lower extremities and stitches and can damage the sural nerve, which is not under the complete control of the surgeon at all stages of the procedure. The purpose of this study is to evaluate the clinical results of a surgical technique for gastrocnemius lengthening with a needle, as previously described in cadaver specimens.Methods and resultsWe performed a prospective study of ultrasound-guided gastrocnemius tendon lengthening in level II using a needle in 24 cases (19 patients) of gastrocnemius contracture. The study population comprised 12 males and 7 females. Mean age was 41 years (18–64). All but 5 recessions were bilateral and occurred simultaneously. The indication for the procedure was gastrocnemius contracture; although the patients also presented other conditions such as non-insertional Achilles tendinopathy in 6 patients (2 were bilateral), insertional Achilles calcifying enthesitis in 4 (1 was bilateral), metatarsalgia in 4, flexible flat foot in 1 and plantar fasciitis in 5 (2 were bilateral). The inclusion criteria were the failure of a previous conservative protocol, that the Silfverskiöld test was positive, and that the pathology suffered by the patient was within the indications for surgical lengthening of the patients and were described in the scientific literature. The exclusion criteria were that the inclusion criteria were not met, and patients with surgical risk ASA 3 or more and children. In these patients, although possible, it is preferable to perform the procedure in the operating room with monitoring, as well as in children since they could be agitated during the procedure at the office. We used the beveled tip of an Abbocath needle as a surgical scalpel. All patients underwent recession of the gastrocnemius tendon, as in an incomplete Strayer release. We evaluated pre- and postoperative dorsiflexion, outcomes, and procedural pain (based on a visual analog scale and the American Orthopedic Foot and Ankle Society scores), as well as potential complications. No damage was done to the sural bundle.ResultsAnkle dorsiflexion increased on average by 17.89°. The average postoperative visual analog score for pain before surgery was 5.78, 5.53 in the first week, 1.89 at 1 month, and 0.26 at 3 months, decreasing to 0.11 at 9 months. The mean postoperative American Orthopedic Foot and Ankle Society Ankle-Hindfoot score the average was 50.52 before surgery, 43.42 at 1 week, 72.37 at 1 month, 87.37 at 3 months, and 90.79 at 9 months.ConclusionUltrasound-guided needle lengthening of the gastrocnemius tendon is a novel, safe, and effective technique that enables the surgeon to check all the structures clearly, thus minimizing the risk of neurovascular damage. The results are encouraging, and the advantages of this approach include absence of a wound and no need for stitches. Recovery is fast and relatively painless. A specific advantage of ultrasound-guided needle lengthening of the gastrocnemius tendon is the fact that it can be performed in a specialist's office, with a very basic instrument set and local anesthesia, thus reducing expenses.

Intrinsic ankle stiffness is associated with paradoxical calf muscle movement but not postural sway or age.

Due to Achilles tendon compliance, passive ankle stiffness is insufficient to stabilise the body when standing. This results in 'paradoxical' muscle movement, whereby calf muscles tend to shorten during forward body sway. Natural variation in stiffness may affect this movement. This may have consequences for postural control, with compliant ankles placing greater reliance upon active neural control rather than stretch reflexes. Previous research also suggests ageing reduces ankle stiffness, possibly contributing to reduced postural stability. Here we determine the relationship between ankle stiffness and calf muscle movement during standing, and whether this is associated with postural stability or age. Passive ankle stiffness was measured during quiet stance in 40 healthy volunteers ranging from 18 to 88years of age. Medial gastrocnemius muscle length was also recorded using ultrasound. We found a significant inverse relationship between ankle stiffness and paradoxical muscle movement, that is, more compliant ankles were associated with greater muscle shortening during forward sway (r≥0.33). This was seen during both quiet stance as well as voluntary sway. However, we found no significant effects of age upon stiffness, paradoxical motion or postural sway. Furthermore, neither paradoxical muscle motion nor ankle stiffness was associated with postural sway. These results show that natural variation in ankle stiffness alters the extent of paradoxical calf muscle movement during stance. However, the absence of a clear relationship to postural sway suggests that neural control mechanisms are more than capable of compensating for a lack of inherent joint stiffness.

Does spastic myopathy determine active movement and ambulation speed in chronic spastic paresis?-A cross-sectional study on plantar flexors.

Functional correlates of spastic myopathy, the muscle disorder of spastic paresis, are unknown. To explore reciprocal relationships between clinical and structural parameters of plantar flexors with i) ambulation speed, ii) dorsiflexion and plantarflexion torques in chronic hemiparesis. Cross-sectional trial in chronic stroke-induced hemiparesis (>6 months). Plantar flexors were quantified through i) the Five Step Assessment: maximal extensibility (XV1), active range of dorsiflexion (XA); ii) ultrasonography: fascicle length (Lf) and thickness (Th) of medial gastrocnemius (GAS) and soleus (SOL), knee extended in an isokinetic ergometer, ankle at 80% XV1-GAS. Maximal isometric torques in plantar flexion (PF) and dorsiflexion (DF) and maximal barefoot 10-meter ambulation speed were collected. Relationships between structural, biomechanical, clinical and functional parameters were explored using non-parametric testing (Spearman). Twenty-one subjects (age 58.0±8.4, mean±SD, time since lesion 7.8±5.7 years) were recruited, with the following characteristics: ambulation speed, 0.77±0.37m/sec; XV1-SOL 92.7±10.3°; XV1-GAS 91.3±9.6°; XA-SOL 86.9±10.0°; XA-GAS 7676±14.2°; LfGAS, 58.2±18.3mm; ThGAS, 17.1±3.6 mm; LfSOL, 36.0±9.6 mm; ThSOL, 13.8±3.3mm; PF peak-torque 46.5±34.1Nm, DF peak-torque, 20.1±19.1Nm. XA-SOL and XA-GAS strongly correlated with XV1-SOL and XV1-GAS respectively (ρ = 0.74, p = 4E-04; resp ρ = 0.60, p = 0.0052). Ambulation speed moderately correlated with LfGAS (ρ = 0.51, p = 0.054), ThGAS (ρ = 0.58, p = 0.02) and LfSOL (ρ = 0.63, p = 0.009). DF and PF peak-torques both correlated with LfGAS (ρ = 0.53, p = 0.04) a; resp. ρ = 0.71, p = 0.0015). In chronic hemiparesis, active dorsiflexion is mostly determined by plantar flexor extensibility. Plantar flexor fascicle shortening is associated with reduced ambulation speed and ankle torques. Attempts to restore plantar flexor extensibility might be important objectives for gait rehabilitation in chronic hemiparesis.

Flexor Hallucis Longus Transfer And V-Y Plasty: An Effective Treatment Modality for Chronic Achilles Rupture - A Case Series.

To assess outcomes of FHL transfer and V-Y plasty for chronic Achilles rupture due to insertional Achilles tendinopathy. A case series of 12 patients was conducted between 1st January 2017 and 31st December 2018. The patients had short flexor hallucis longus tendon transfer with gastrocnemius lengthening by V-Y plasty for Achilles tendon rupture. Patients were allowed full weight bearing at six weeks post-operatively, and were followed up at three months and six months post-operatively, when the range of motion of the ankle was examined, and the outcome was assessed using the EFAS score. Of the 12 patients in the study, the majority were males; the mean age was 50.6±8.96 years. A significant improvement in dorsiflexion and plantarflexion was noted at the six-month follow-up compared to the three-month follow-up (P=<0.001 for both). When compared to the normal side, dorsiflexion and plantarflexion of the affected ankle were significantly less at three months but were comparable at six months post-operatively. A significant improvement was noted in the mean EFAS score at the six-month follow-up (25.5±5.71) compared to three months (18.6±0.90) post-surgery (P=0.001). Males were also noted to have significantly higher EFAS scores at their six-month follow-up than females (P=0.022). In contrast, a negative correlation was noted between the European Foot and Ankle Society (EFAS) score at the final follow-up and age (P=0.011). FHL tendon transfer with V-Y plasty in chronic Achilles rupture due to insertional Achilles tendinopathy is an effective procedure resulting in the restoration of the ankle range of motion and improvement in functional scores.

Human in vivo medial gastrocnemius gear during active and passive muscle lengthening: effect of inconsistent methods and nomenclature on data interpretation.

'Muscle gear' is calculated as the ratio of fascicle-to-muscle length change, strain, or velocity. Inconsistencies in nomenclature and definitions of gear exist across disciplines partly due to differences in fascicle [curved (Lf) versus linear (Lf,straight)] and muscle [whole-muscle belly (Lb) versus belly segment (Lb,segment)] length calculation methods. We tested whether these differences affect gear magnitude during passive and active muscle lengthening of human medial gastrocnemius of young men (n=13, 26.3±5.0 years) using an isokinetic dynamometer. Lb, Lb,segment, Lf and Lf,straight were measured from motion analysis and ultrasound imaging data. Downshifts in belly gear but not belly segment gear occurred with muscle lengthening only during active lengthening. Muscle gear was unaffected by fascicle length measurement method (P=0.18) but differed when calculated as changes in Lb or Lb,segment (P<0.01) in a length-dependent manner. Caution is therefore advised for the use and interpretation of different muscle gear calculation methods and nomenclatures in animal and human comparative physiology.

Myoelectric activity and improvements in strength and hypertrophy are unaffected by the ankle position during prone leg curl exercise – a within person randomized trial

ABSTRACT To examine the effect of ankle position (i.e. gastrocnemius muscle length) on training outcomes during leg curl exercise, we recruited untrained and trained healthy adults to participate in two separate experiments. In Experiment 1, we studied the acute influence of ankle position on knee flexor myoelectric (EMG) activity during leg curl exercise in a group of trained and a separate group of untrained adults. In Experiment 2, we studied the effects of ankle position on knee flexors muscle thickness and torque across a 10-week training protocol in trained adults. We hypothesized that leg curl exercise with the ankle in a plantarflexed position would enhance EMG activity, muscular strength, and hamstrings muscle thickness. We randomized the legs within a person to perform leg curl exercise with one in a plantarflexed position and the other in a dorsiflexed position. Experiment 1 revealed no significant differences between ankle positions in the EMG activity of hamstring muscle in either group (all p > 0.05). Experiment 2 revealed a significant pre- to post-intervention increase in biceps femoris long head (BFLH) muscle thickness (p = 0.026) and isometric torque (p = 0.03), but there were no significant effects of the ankle position (p = 0.596) or interaction between ankle position and timepoint for these variables (p = 0.420). In sum, the ankle position did not have acute effects on hamstrings EMG activity, nor did it affect strength and hypertrophy adaptations after 10-weeks of leg curl exercise training. Interestingly, however, the limb which performed leg curl exercise in a dorsiflexed position performed a higher total training volume. Highlights Different ankle positions (i.e. dorsiflexion or plantarflexion) do not affect hamstrings EMG activity during prone leg curl exercise. Different ankle positions show similar adaptation in strength and hypertrophy of biceps femoris long head after 10 weeks of training. Training in the plantarflexed position may be useful for time-constrained individuals, allowing similar training adaptations with smaller training volume.

Medial Gastrocnemius Muscle Properties of Children With Cerebral Palsy After Different Tone Treatments: A Pilot Study.

Spasticity in children with cerebral palsy can be managed by a spectrum of approaches, from conservative therapy, to temporary botulinum toxin A injections, to permanent transection of sensory nerves with a selective dorsal rhizotomy. This pilot study investigated whether these three tone management approaches are associated with histological and biochemical properties of the medial gastrocnemius. A convenience sample of children with cerebral palsy undergoing gastrocnemius lengthening surgery was enrolled. Intraoperative biopsies were obtained from three individuals (one each: minimal tone treatment; frequent gastrocnemius botulinum toxin A injections; previous selective dorsal rhizotomy). All individuals had plantarflexor contractures, weakness, and impaired motor control before the biopsy. Differences between participants were observed for muscle fiber cross-sectional area, fiber type, lipid content, satellite cell density, and centrally located nuclei. The most pronounced difference was the abundance of centrally located nuclei in the botulinum toxin A participants (52%) compared with the others (3-5%). Capillary density, collagen area and content, and muscle protein content were similar across participants. Several muscle properties seemed to deviate from reported norms, although age- and muscle-specific references are sparse. Prospective studies are necessary to distinguish cause and effect and to refine the risks and benefits of these treatment options.

Knee movements cause changes in the firing behaviour of muscle spindles located within the mono-articular ankle extensor soleus in the rat.

We recently showed that within an intact muscle compartment, changing the length of one muscle affects the firing behaviour of muscle spindles located within a neighbouring muscle. The conditions tested, however, involved muscle lengths and relative positions that were beyond physiological ranges. The aim of the present study was to investigate the effects of simulated knee movements on the firing behaviour of muscle spindles located within rat soleus (SO) muscle. Firing from single muscle spindle afferents in SO was measured intra-axonally for different lengths (static) and during lengthening (dynamic) of the lateral gastrocnemius and plantaris muscles. Also, the location of the spindle within the muscle was assessed. Changing the length of synergistic ankle plantar flexors (simulating different static knee positions, between 45 and 130°) affected the force threshold, but not the length threshold, of SO muscle spindles. The effects on type II afferents were substantially (four times) higher than those on type IA afferents. Triangular stretch-shortening of synergistic muscles (simulating dynamic knee joint rotations of 15°) caused sudden changes in the firing rate of SO type IA and II afferents. Lengthening decreased and shortening increased the firing rate, independent of spindle location. This supports our prediction that the major point of application of forces exerted by connections between adjacent muscles is at the distal end of SO. We conclude that muscle spindles provide the CNS with information about the condition of adjacent joints that the muscle does not span.

A cross sectional study investigating dynamic balance when stepping to targets in children with cerebral palsy compared to typically developing children

BackgroundChildren with Cerebral Palsy (CP) have altered anticipatory postural adjustments (APAs) during gait initiation. These APAs may affect dynamic balance in tasks such as stepping. Research questionsHow are APAs in children with CP affected during stepping to precise targets? How do children with CP modulate APAs when stepping to medial and lateral targets? What is the association between APAs and symptom severity, movement quality and impairment profile? MethodChildren undertook a stepping task to laterally and medially placed targets with either leg, in a randomised order. Movement of the centre of pressure (COP) and markers at the pelvis and foot were measured via a force plate and 3D motion analysis. Motion of the centre of mass (COM) was estimated via pelvic markers. APAs were assessed prior to leading leg lift-off in medio-lateral and antero-posterior directions. Stepping error was calculated. Baseline characteristics of children with CP included Gross Motor Function Measure (GMFM), Quality Function Measure (QFM), leg muscle hypertonia (Tardieu test) and strength (manual dynamometry). ResultsSixteen ambulant children with CP (12.2 years ± 2.2) and 14 typically developing (TD) children (11.6 years ± 2.9) were assessed. In children with CP, APAs in the medio-lateral direction were 20–30% smaller. Children with CP were less able to modulate their APAs with steps to medial and laterally placed targets, than TD children. Medio-lateral COP motion was associated with movement quality assessed by QFM subsections, GMFM (correlation coefficient r = 0.66–0.80) and hip abductor strength (r = 0.75). Antero-posterior APAs were significantly smaller when stepping with the non-paretic leg in children with CP. APA size was positively related to the length of the contralateral, paretic gastrocnemius (r = 0.77). Stepping error was higher in children with CP and inversely correlated to the size of the medio-lateral APA. DiscussionChildren with CP show smaller medio-lateral APAs especially when stepping to medially placed targets. APA size may be limited by proximal muscle strength and gastrocnemius length.

Isolated Talonavicular Arthrodesis as Treatment for Flexible Progressive Collapsing Foot Deformity: A Case Series

Category: Hindfoot; Other Introduction/Purpose: Progressive collapsing foot deformity (PCFD) remains a challenging condition for foot and ankle surgeons to treat. While there exists more clarity on the treatment for end-stage rigid deformities involving PCFD, there is still significant debate over different surgical treatment options for the flexible collapsing foot. Common surgical corrections for flexible PCFD include the 'All-American Procedure' popularized by Manoli in the 1990s. Isolated talonavicular (TN) arthrodesis has also been described for the treatment of flexible PCFD. The primary objective of this study was to evaluate clinical and radiographic outcomes in patients with AAFD treated with isolated tri-planar corrective TN arthrodesis. A secondary objective was to establish whether there is a correlation between radiographic outcomes and clinical outcomes. Methods: Fifty-four patients (59 feet) from July 2013 to October 2020 with flexible PCFD underwent surgical treatment with isolated TN arthrodesis. Patients with other arthrodesis or hindfoot osteotomies were excluded. Concomitant gastrocnemius lengthening and toe deformity correction procedures were not an exclusion criterion. Weight-bearing radiographs were performed pre- and postoperatively, with Meary angle (or lateral talo-first metatarsal angle) and calcaneal pitch measured on lateral view. The degree of TN coverage on antero-posterior (AP) radiographs were measured with the TN coverage angle and the degree of first ray angular deformity was measured using Simmon angle (or AP talo-first metatarsal angle). Angles were measured by a foot and ankle fellow. The Foot &amp; Ankle Ability Measure (FAAM) and Veterans-Rand 12 Item Health Survey (VR- 12) were used to clinically evaluate the patient. Results: Thirty-seven females and seventeen males were evaluated with a mean age 61 years at the time of surgery and an average length of follow up of 19 months. There were significant improvements in deformity correction found in this study. Radiographically, the lateral radiographs demonstrated Meary angle correction from 27 degrees pre-operatively to 9 degrees post- operatively (p&lt;0.001) and calcaneal pitch improving from 15 degrees pre-operatively to 18 degrees post operatively (p&lt;.001). AP radiographic analysis demonstrated TN coverage angle improving from 35 degrees pre-operatively to 5 degrees post-operatively (p&lt;0.001) and Simmon angle improving from 20 degrees pre-operatively to 6 degrees, post-operatively (p&lt;.001). The only statistically significant improvement in clinical outcomes was in the FAAM score (pre-operative score 48.48, post-operative score 58.45 (p&lt;.001)). Conclusion: Isolated TN arthrodesis is a viable option for multi-planar deformity correction in patients with flexible PCFD. Not only did it provide significant improvements in radiographic alignment, it also provided improved functional outcomes as demonstrated on FAAM scores. Comparative studies with other surgical treatment techniques such as the 'All-American Procedure' should be performed to determine which is the best technique for patients with flexible PCFD.

Needle-based gastrocnemius lengthening: a novel ultrasound-guided noninvasive technique

BackgroundGastrocnemius tendon lengthening is performed to treat numerous conditions of the foot and ankle. Gastrocnemius shortening has been associated with more than 30 lower limb disorders, including plantar heel pain/plantar fasciitis, Achilles tendinosis, equinus foot, adult flat foot deformity, and metatarsalgia. Ultrasound-guided ultraminimally invasive lengthening of the gastrocnemius is a step forward in this type of surgery. It can be performed in both legs simultaneously without ischemia using only local anesthesia plus sedation and without the need for a cast or immobilization. The truly novel advantage of the procedure is that it can be performed in the office, without specific surgical instruments. The aim of our research was to prove the effectiveness and safety of a new closed needle-based ultrasound-guided surgical procedure for lengthening the gastrocnemius tendon.Methods and resultsWe performed ultrasound-guided gastrocnemius tendon lengthening using a needle in eight fresh frozen specimens (3 left and 5 right). None of the specimens had been affected by disease or undergone previous surgery that could have affected the surgical technique. We used a linear transducer with an 8- to 17-MHz linear transducer and the beveled tip of an Abbocath as a surgical blade to perform the lengthening procedure. The gastrocnemius Achilles tendon recession was entirely transected in all eight specimens, with no damage to the sural nerve or vessels. The improvement in dorsal flexion was 15°.ConclusionNeedle-based ultrasound-guided gastrocnemius tendon lengthening is safe, since the surgeon can see all structures clearly, thus minimizing the risk of damage. The absence of a wound obviates the need for stitches, and recovery seems to be faster. The procedure can be performed in a specialist's office, as no specific surgical instruments are required. This technique could be a valid option for gastrocnemius lengthening and may even be less traumatic than using a hook-knife, as in our previous description.

Ultrasonographic assessment of lower limb muscle architecture in children with early-stage Duchenne muscular dystrophy.

Muscle imaging methods such as ultrasound and magnetic resonance imaging have been used for many years to determine the dystrophic process in muscular dystrophies. However, the knowledge regarding muscle architecture in children at early-stage Duchenne muscular dystrophy (DMD) with different functional levels is limited. To explore the effect of functional level on muscle architectural properties in children with early stage DMD and the difference between DMD and typically developing (TD) peers. Thirty children with DMD (15 Grade 1 and 15 Grade 2 according to the Vignos Scale) and 5 TD peers were included. Ultrasound imaging was used to measure muscle thickness (MT), fascicle length (FL), and pennation angle (PA) of vastus lateralis (VL) and medial gastrocnemius (MG) muscles bilaterally. The MT and FL values for VL, and MT, FL and PA values for MG muscles were higher in children with DMD compared with those of TD peers (p<0.05). The FL of VL, and MT and FL of GM muscles of children with DMD Grade 2 were higher than those of children with DMD Grade 1 (p<0.05). MT and FL are increased in children with DMD compared with TD peers. Additionally, muscle architecture seems to be affected even at the early stages of the disease.

Management of Insertional Achilles Tendinopathy.

Insertional Achilles tendinopathy is a common condition that can lead to chronic, debilitating heel pain in athletes and nonathletes alike. Conservative treatment options include activity and shoe wear modification, physical therapy, injections, and extracorporeal shock wave therapy. When nonsurgical treatment fails, surgical treatment is recommended. Although there are options aimed at preserving the tendon and débriding the retrocalcaneal bursa and excess bone formation, others are aimed at detaching the Achilles tendon to perform a thorough débridement and subsequent reattachment. Additional or alternate procedures may include a calcaneal closing wedge osteotomy, gastrocnemius lengthening, and flexor hallucis longus tendon transfer. Recent advances in suture anchor techniques further add to the complexity of available options. This review discusses the relevant anatomy, biomechanics, and pathophysiology as well as the recent available evidence for nonsurgical and surgical management of this condition to guide surgeons in selecting the most appropriate treatment for their patients.

Continuous Wear of Night and Day Orthosis Is a Key Factor for Improvement of Fixed Equinus Deformity after the Transverse Vulpius Procedure.

Background: Equinus foot deformity is secondary to either spasticity or contracture of the gastrocnemius–soleus complex. The plantar flexion is basically treated conservatively; several different surgical methods have been discussed. This paper focuses on the improvement of passive ankle dorsiflexion after a transverse Vulpius procedure in equinus foot deformity. Additionally, the influence of consequent postoperative wear of orthosis on the improvement of ankle range of motion was investigated. Methods: In total, 41 patients with neuromuscular impairment and 59 equinus feet deformities were surgically treated by using a transverse Vulpius procedure. A total of 19 female patients and 22 male patients with a mean age at surgery of 10.18 years (2 to 31) were included. Mean follow-up took place 12.26 ± 7.95 months after surgery. Passive ankle dorsiflexion was measured and subjective patients’ satisfaction was assessed. Results: Range of motion, measured as the maximum of passive ankle joint dorsiflexion, improved significantly from −8° ± 5.9° to 11.1° ± 6.7° directly after surgery to 16.2° ± 10.7° at follow-up. The improvement of passive ankle dorsiflexion was significantly associated with the continuous wearing of night and day orthosis (p = 0.0045). Patient subjective satisfaction was very high. Conclusion: A transverse Vulpius procedure for aponeurotic gastrocnemius and soleus muscle lengthening of equinus foot deformity resulted in a significant improvement of passive ankle dorsiflexion. Positive surgical results correlated to a continuous use of orthotic devices.

A New Approach for Stage 2 Adult Acquired Flatfoot Deformity

Category:HindfootIntroduction/Purpose:Adult Acquired Flatfoot Deformity (AAFD) is a common progressive pathology that mainly affects patients after their 50s. Even though it is not clear yet what causes AAFD, the great majority of patients have their talonavicular (TN) joint sub dislocated in one or more planes. According to the severity of the deformity and its flexibility, different surgical procedures can be performed to realign the foot. The deformities usually happen around the TN joint, making it the center of rotation and angulation (CORA). Corrections on the CORA realign deformities in different planes and his concept can be applied to mostly any deformity. The objective of this study is to evaluate clinically and radiographically patients with stage 2 AAFD submitted to isolated TN fusion.Methods:Fifty-four patients (59 feet) from July 2013 to December 2019 with stage 2 AAFD were submitted to isolated TN fusion. All patients had clinical deformity and arch foot collapse associated with pain along the medial hindfoot. Weight-bearing x- rays were performed pre-operatively, the Meary's and calcaneal pitch angles were measured on lateral view and the Talar coverage and Simmon's angle were measured on antero-posterior view. Angles were measured by a fully trained foot and ankle surgeon. Post-operative measurements were done with the same set of images by the same surgeon, one month after the initial measurements. FAAM and VR12 were used to compare patient's clinical status. Patients with previous surgeries on the foot or ankle and patients submitted to other fusions or hindfoot osteotomies were excluded from the study. Gastrocnemius lengthening and toes corrections were not an exclusion criterion.Results:Thirty-seven females and seventeen males were evaluated with a mean age 61 years at the time of surgery. Only the FAAM score significantly improved from pre-operative (FAAM = 48.48, VR-12 Mental = 55.73, VR-12 Physical = 37.25) to most recent mean follow-up of 16.2 months (FAAM = 58.45 (p<.001), VR-12 Mental = 57.19 (p=.179), VR-12 Physical = 37.53 (p=.832). The lateral view X-Rays showed Meary's and calcaneal pitch angles mean improving from 27 and 15 degrees pre-operatively to 9 and 18 degrees post operatively (p<.001), whereas Front view foot X-Rays showed Talo-Naviciular coverage angle and Simmon's angle going from 35 and 20 degrees to 5 and 6 degrees respectively (p<.001)Conclusion:Isolated talonavicular fusion can correct the deformity on its multiple planes providing not only significant improvement on radiographic alignment but also the FAAM clinical outcome score. Comparative studies should be performed to determine which is the best technique for patients with stage 2 AAFD.

COMPARISON OF MUSCLE LENGTH IN DOMINANT VERSUS NON-DOMINANT LOWER EXTREMITY IN YOUNG ASYMPTOMATIC INDIVIDUALS

Muscle length is the length where maximum amount of force a muscle is able to produce. This length is determined by the joint angle that corresponds to the muscle. Understanding the optimal muscle length as well as its comparison between the extremities is very important as a part of examination in physiotherapy. Ranges that are obtained of muscle length helps therapist to recognize individuals with reduced flexibility. Identification and knowledge of muscle length has several role including; evaluation of pre-competition risk for injury, decreased flexibility as an predictor of muscle injury and guides in determining interventional strategy plus training program for an individual. Objectives: To compare muscle length of rectus femoris, hamstring’s, iliopsoas, gastrocnemius in dominant as well as non-dominant side of young asymptomatic individuals in the age group of 18 to 25 years. Method: Through standard goniometer muscle length data was obtained between dominant, non-dominant lower extremity. The methods of assessment used were; active knee extension (AKE) tests the hamstrings length, Thomas and modified Thomas test had been used to evaluate iliopsoas and rectus femoris while prone, figure-four position accompanied by dorsiflexion utilized for gastrocnemius. Result: Values were calculated using goniometric measurements through the group mean values. There is statistically significant variation between the muscle length of hamstring, rectus femoris, iliopsoas and gastrocnemius between the dominant and non-dominant side (p&lt;0.05). Conclusion: Along with data about lower limb muscle length of asymptomatic individuals, we conclude notable difference in dominant to non-dominant extremities muscle length in individuals eighteen to twenty five year.

A Review on Impact of Lower Extremity Muscle Length

Muscle length is known as the length at which muscle is able to generate the maximum amount of force. This length is determined by the joint angle corresponding to that muscle. Length of muscle is an important parameter of length-tension relationship. Muscle functions and its mechanics helps in surgical decision making, to establish primary ergonomic advice recommendations and to form a structure of recovery program using the benefits of length-tension relation. Understanding the optimal muscle length as well as its comparison between the extremities is very important as a part of examination in physiotherapy, particularly in the cases of musculoskeletal disorders. Several tests are available for testing the muscle length. However standardize and reliable tests are been chosen to prevent the error while testing as such measurement of hamstring, iliopsoas, rectus femoris and gastrocnemius length is been acquired through standard goniometer. The methods used for the assessment comprised of; active knee extension (AKE) tests the hamstrings, Thomas and modified Thomas test to evaluate iliopsoas and rectus femoris while prone, figure-four position accompanied by dorsiflexion for gastrocnemius. Many studies have done and their results had shown that there was difference in the lengths of muscle of lower extremity which was assessed in different players along with that normative data about the length of muscle was established. However there is paucity of study on the muscle length testing of individuals who are completely normal who are not having previous history of trauma to their lower limbs and those who are not an athlete.