Hallux Extension Research Articles

Retrospective analysis of peripheral neuropathy in blood cancer survivors evaluated for cellular therapy.

12087 Background: Blood cancer survivors (BCS) sustain peripheral neuromotor decline from toxic therapies but also aging, diabetes and cancer. Peripheral neuropathy (PN) threatens balance and quality of life, and pre-existing nerve deficits raise future PN risk. The evaluation for cellular therapies is an opportunity to identify functional deficits and optimize their management before additional toxic exposures or disease progression. PN is often diagnosed by paresthesias, but toe strength and sensory deficits also impact balance. We aim to quantify the prevalence of these 3 PN manifestations and walking difficulty in BCS evaluated at our center for possible cellular therapies and compare BCS with and without paresthesias. Methods: We retrospectively analyzed clinical data from 5 years of physical therapy (PT) evaluations during the medical assessment for cellular therapy. As count (%) or mean ± SD we described foot paresthesias [Functional Assessment of Cancer Therapy (FACT) Item NTX2], hallux extension weakness (Medical Research Council Grade ≤4 either side), hallux vibration deficit (biothesiometer ≥24.7 V), and reported trouble walking (FACT An6). We then dichotomized the cohort by NTX2 and compared groups with Chi-square, Fisher’s exact or Wilcoxon rank sum tests. Results: 598 (87.6%) of 683 BCS evaluated by PT had FACT data (79.1% White, 5.5% Latinos); 1 in 2 BCS reported paresthesias, 71.2% as moderate-severe. See table for group comparisons. Race (p=.654) & ethnicity (p=.608) were n.s. 506 BCS with FACT (84.6%) had both strength and sensory data; we found ≥ 1 hallux deficit in 396 (78.3%), more commonly with paresthesias (86.3% vs. 69.5%, p<.001). Conclusions: At cellular therapy evaluation, 1 in 2 BCS reported foot paresthesias, and 3 in 4 had strength or sensory hallux deficit. Regardless of the cause, these deficits could contribute to the trouble walking reported by 44%. BCS with paresthesias were older and had more myeloma, diabetes, chemotherapy, hallux deficits, and trouble walking. But trouble walking and hallux deficits were also common without paresthesias. Research is needed to quantify hallux-gait relationships in BCS, and to establish the highest-value rehabilitative approaches to improve strength and walking before further toxic exposures. [Table: see text]

Development and Earliest Validation of a Portable Device for Quantification of Hallux Extension Strength (QuHalEx).

Hallux strength is associated with sports performance and balance across the lifespan, and independently predicts falls in older adults. In rehabilitation, Medical Research Council (MRC) Manual Muscle Testing (MMT) is the clinical standard for hallux strength assessment, but subtle weakness and longitudinal changes in strength may go undetected. To address the need for research-grade yet clinically feasible options, we designed a new load cell device and testing protocol to Quantify Hallux Extension strength (QuHalEx). We aim to describe the device, protocol and initial validation. In benchtop testing, we used eight precision weights to apply known loads from 9.81 to 78.5 N. In healthy adults, we performed three maximal isometric tests for hallux extension and flexion on the right and left sides. We calculated the Intraclass Correlation Coefficient (ICC) with 95% confidence interval and descriptively compared our isometric force-time output to published parameters. QuHalEx benchtop absolute error ranged from 0.02 to 0.41 (mean 0.14) N. Benchtop and human intrasession output was repeatable (ICC 0.90-1.00, p < 0.001). Hallux strength in our sample (n = 38, age 33.5 ± 9.6 years, 53% female, 55% white) ranged from 23.1 to 82.0 N peak extension force and 32.0 to 142.4 N peak flexion, and differences of ~10 N (15%) between toes of the same MRC grade (5) suggest that QuHalEx is able to detect subtle weakness and interlimb asymmetries that are missed by MMT. Our results support ongoing QuHalEx validation and device refinement with a longer-term goal of widespread clinical and research application.

Conservative versus surgical treatment of foot drop in peroneal nerve entrapment: rationale and design of a prospective, multi-centre, randomized parallel-group controlled trial

BackgroundHigh-quality evidence is lacking to support one treatment strategy over another in patients with foot drop due to peroneal nerve entrapment. This leads to strong variation in daily practice.Methods/designThe FOOTDROP (Follow-up and Outcome of Operative Treatment with Decompressive Release Of The Peroneal nerve) trial is a randomized, multi-centre study in which patients with peroneal nerve entrapment and persistent foot drop, despite initial conservative treatment, will be randomized 10 (± 4) weeks after onset between non-invasive treatment and surgical decompression. The primary endpoint is the difference in distance covered during the 6-min walk test between randomization and 9 months later. Time to recovery is the key secondary endpoint. Other secondary outcome measures encompass ankle dorsiflexion strength (MRC score and isometric dynamometry), gait assessment (10-m walk test, functional ambulation categories, Stanmore questionnaire), patient-reported outcome measures (EQ5D-5L), surgical complications, neurological deficits (sensory changes, motor scores for ankle eversion and hallux extension), health economic assessment (WPAI) and electrodiagnostic assessment.DiscussionThe results of this randomized trial may elucidate the role of surgical decompression of the peroneal nerve and aid in clinical decision-making.Trial registrationClinicalTrials.gov NCT04695834. Registered on 4 January 2021.

Reconstruction of the extensor hallucis longus with a hamstring tendon autograft: a systematic review

Objective: The purpose of this study was to systematically review the literature regarding the use of hamstring tendon (HT) autograft for extensor hallucis longus (EHL) reconstruction. Methods: A systematic search for studies addressing the use of HT autograft for reconstruction of nonrepairable EHL tendon injuries was performed in December 2021. The databases searched include Embase, Medline, Europe PMC, Cochrane, and Scopus. Predetermined inclusion and exclusion criteria were implemented, and appropriate studies were selected for review. Results: The database search resulted in one study that met the inclusion and exclusion criteria. Three additional studies met inclusion and exclusion criteria after screening the references of the selected study. A total of four studies were included in the final review. Clinical presentation, surgical technique, postoperative rehabilitation, clinical follow-up, and outcomes were recorded. All four studies reported single cases of EHL tendon reconstruction using a semitendinosus autograft with satisfactory clinical results and no complications. Patients may experience a five degrees decrease in range of motion or minimal decrease in hallux extension strength; however, all patients were asymptomatic and reported no limitations. Conclusion: Four case reports regarding EHL tendon reconstruction were reviewed and demonstrated using a semitendinosus autograft as a viable option with favorable outcomes and no complications. Level of Evidence IV; Systematic Review

Effects of Weight-bearing Exercise on a Mini-trampoline, and Foot-ankle Therapeutic Exercise Program on Foot-ankle Functionality in People With Diabetic Peripheral Neuropathy

Purpose: This study aims to investigate and compare the efficacy of two training programs of weight-bearing on a mini-trampoline, and ankle exercise therapy on foot-ankle functionality in people with peripheral neuropathy. Methods: The present research is a clinical trial study that has been conducted using two intervention groups and one control group. The statistical population of this study includes 48 women living in Tehran City, Iran with type 2 diabetes and moderate or severe neuropathy. The Michigan neuropathy screening instrument (MNSI) and foot health status questionnaire (FHSQ-BR) were used to collect data. The first experimental group performed mini-trampoline exercises, while the second group performed ankle therapeutic exercises at home for eight weeks. Data were analyzed using analysis of covariance (ANOVA) and correlated t-test. Results: The findings showed that mini-trampoline exercise and ankle exercise therapy had a significant effect on relieving foot pain (P&lt;0.05), as well as improving foot functionality (P&lt;0.05) and overall foot health (P&lt;0.05) in both intervention groups compared to the control group. Also, the results showed that ankle exercise therapy was more effective than mini-trampoline exercise in two variables of foot pain and foot functionality (P&lt;0.05). Both training programs showed significant effects on the ankle range of motion (P&lt;0.05), while, no significant difference was observed between the two intervention groups for the range of motion of the ankle (P&lt;0.05). Moreover, mini-trampoline exercise and ankle exercise therapy revealed a significant effect on the range of motion of the metatarsophalangeal joints compared to the control group (P&lt;0.05). In the range of motion of dorsiflexion of the right foot, mini-trampoline exercises were more effective than therapeutic exercises, while regarding the variable of dorsiflexion of the left foot, the effectiveness of ankle training intervention was more than trampoline (P&lt;0.05). Both trampoline exercise and ankle therapeutic exercise interventions had a significant effect on ankle strength, but no difference was observed in plantar flexion strength of the right foot between the two intervention groups. However, the mini-trampoline intervention was more effective than the ankle exercise therapy intervention for the three variables of the hallux dorsiflexion strength of the hallux and plantar flexion strength of the left foot (P&lt;0.05). Both training interventions were effective on the variable of right and left hallux flexion strength (P&lt;0.05). The efficacy of none of the two interventions on the right and left hallux extension strength was confirmed; the effectiveness of both interventions on the right and left hallux flexion strength was similar and no significant difference was observed (P&gt;0.05). No significant difference was found in the control group after 8 weeks for the relevant variables (P&gt;0.05). Conclusion: Exercises on the mini-trampoline and ankle therapeutic exercises at home can be effective in improving patients’ quality of life as a simple, affordable, low-risk, and quick-improvement treatment program that focuses on the use of segmental exercises for foot functionality.

The effects of hallux extension on plantar pressure behavior and foot posture

The minimal clinically important difference (MCID) of modified Dynamic Gait Index (mDGI) has not yet been determined for People with Neurological Disorders (PwND).To establish the MCID of the mDGI to determine clinically meaningful improvement in balance and gait in PwND.In this longitudinal study from a randomised clinical trial, 55 participants both in and outpatients with neurological disorders, received fifteen 40-minute rehabilitation sessions. Inpatients received daily treatments over a period of three weeks while outpatients received three treatments/week over a period of five weeks. An anchor-based method using percentage rating of improvement in balance (Activities Balance Confidence scale, ABC) was used to determine the MCID of mDGI. The MCID was defined as the minimum change in mDGI total score (post – pre intervention) that was needed to perceive at least a 10 % improvement on the ABC scale. A Receiver Operating Characteristic curve was used to define the cut-off for the optimal MCID of the mDGI discriminating between improved and not improved participants.The MCID of the mDGI total score was 6 points and Area under the Curve was 0.64. For the mDGI time sub-scores the MCID was 2 points and Area under the Curve was 0.6.The MCID of balance and gait improvement measured by mDGI was prudently establish at ≥7 points, meaning that this is the minimum improvement score PwND need to get to perceive a clinically relevant change in their balance and gait confidence. These reference values can be a tool incorporated into clinicians daily practice to interpret mDGI change scores helping to determine whether the intervention is effective; to develop clinical tailored intervention goals and to establish meaningful perceived change in PwND.

The Babinski sign in Renaissance paintings—a reappraisal of the toe phenomenon in representations of the Christ Child: observational analysis

ObjectiveTo investigate systematically the presence of the Babinski sign in paintings of the Christ Child by the greatest painters of the Renaissance.DesignObservational analysis.SettingLarge collection of paintings depicting the Christ Child...

PO 18068 - Treatment of chronic extensor hallucis longus tendon injury using plantaris tendon graft

Introduction: Foot extensor tendon injuries account for 1% of all tendon injuries. Extensor hallucis longus (EHL) tendon lacerations are even less common, and studies on the subject are limited to a small number of case reports and series. Objective: The objective of this report is to show the possibility of using the plantaris muscle as a graft option for the reconstruction of the extensor hallucis longus tendon in cases of damage due to chronic injury. Methods: The subject was a 30-year-old male factory worker who had had a laceration in the dorsal region of the right foot for approximately 2 months. He showed a deficit in hallux extension. Given the indication for surgical treatment and due to the distances between the stumps, we chose to use the plantaris muscle as a graft. Results: The patient was evaluated 6 months after surgery, and we observed a satisfactory outcome with improvements in hallux extension and functional gait. Conclusion: We chose the plantaris tendon as a graft because we believe it is easily harvested, has low morbidity at the donor site, has no or minimal loss of function and meets the needs for the desired reconstruction. Because this is a large graft, we solved the problem of the smaller diameter by performing double-band reconstruction. We concluded that the plantaris is a viable option for neglected EHL injuries or rerupture that offers low morbidity with no significant loss of function in the donor region.

Investigation of the effects of hallux extension on lower extremity biomechanics during walking

Investigation of the effects of hallux extension on lower extremity biomechanics during walking

Idiopathic generalized dystonia

Idiopathic generalized dystonia is a group of neurodegenerative diseases primarily charecterized by dystonic hyperkinetic disorder (irregular slow involuntary movements of different body parts accompanied by specific muscle tone changes and pathological poses). A 54-year-old female was admitted with various complaints. The leading syndrome was extrapyramidal due to which the differential diagnosis included Parkinson’s disease, multiple system atrophy, corticobasal degeneration, etc. The diagnosis of idiopathic generalized dystonia, in the form of lower extremity hyperkinesia with dystonic equinus of the left foot and hallux extension and cheirospasm, was made by a method of exclusion. The clinical case described in the article illustrates variety of clinical manifestations of the disease imitating clinical presentation of various neurological and psychiatric disorders, complexity of diagnostic search and importance of timely diagnosis of this disease.

Technique tip: EDL-to-EHL double loop transfer for extensor hallucis longus reconstruction

BackgroundExtensor hallucis longus (EHL) tendon injuries often occur in the setting of lacerations to the dorsum of the foot. End-to-end repair is advocated in acute lacerations, or in chronic cases when the tendon edges are suitable for tension free repair. Reconstruction with allograft or autograft is advocated for cases not amenable to a primary direct repair. This is often seen in cases with tendon retraction and more commonly in the chronic setting. In many countries the use of allograft is very limited or unavailable making reconstruction with autograft and tendon transfers the primary choice of treatment. Tendon diameter mismatch and diminished resistance are common issues in other previously described tendon transfers. MethodsWe present the results of a new technique for reconstruction of non-reparable EHL lacerations in three patients using a dynamic double loop transfer of the extensor digitorum longus (EDL) of the second toe that addresses these issues. ResultsAt one-year follow up, all patients recovered active/passive hallux extension with good functional (AOFAS Score) and satisfaction results. No reruptures or other complications were reported in this group of patients. No second toe deformities or dysfunction were reported. ConclusionsSecond EDL-to-EHL Double Loop Transfer for Extensor Hallucis Longus reconstruction is a safe, reproducible and low-cost technique to address EHL ruptures when primary repair is not possible. Level of evidenceIV (Case Series).

Prophylactic stretching does not reduce cramp susceptibility.

Some clinicians advocate stretching to prevent muscle cramps. It is unknown whether static or proprioceptive neuromuscular facilitation (PNF) stretching increases cramp threshold frequency (TFc ), a quantitative measure of cramp susceptibility. Fifteen individuals completed this randomized, counterbalanced, cross-over study. We measured passive hallux range of motion (ROM) and then performed 3 minutes of either static stretching, PNF stretching (hold-relax-with agonist contraction), or no stretching. ROM was reassessed and TFc was measured. PNF stretching increased hallux extension (pre-PNF 81 ± 11°, post-PNF 90 ± 10°; P < 0.05) but not hallux flexion (pre-PNF 40 ± 7°, post-PNF 40 ± 7°; P > 0.05). Static stretching increased hallux extension (pre-static 80 ± 11°, post-static 88 ± 9°; P < 0.05) but not hallux flexion (pre-static 38 ± 9°, post-static 39 ± 8°; P > 0.05). No ROM changes occurred with no stretching (P > 0.05). TFc was unaffected by stretching (no stretching 18 ± 7 Hz, PNF 16 ± 4 Hz, static 16 ± 5 Hz; P = 0.37). Static and PNF stretching increased hallux extension, but neither increased TFc . Acute stretching may not prevent muscle cramping. Muscle Nerve 57: 473-477, 2018.

Effects of a 4-Week Intrinsic Foot Muscle Exercise Program on Motor Function

PURPOSE: The purpose of this single-blinded randomized control trial was to study the effects of a 4-week intrinsic foot muscle (IFM) exercise program on motor function, perceived difficulty, and IFM motor activation measured using ultrasound imaging (USI) during three IFM exercises. METHODS: 24 healthy, recreationally active young adults with no history of ankle or foot injury who have never performed IFM exercises participated (12 males, 12 females; mean age=21.5±4.8 years; BMI = 23.5±2.9 kg/m2). Following randomization, participants allocated to the intervention group received a progressive home IFM exercise program performed daily. Participants in the control group did not receive any intervention and were asked not to alter their physical activity during the trial. Clinician-assessed motor performance (4-point scale: 0=does not initiate movement, 3=performs exercise in standard pattern), patient perceived difficulty (5 point Likert scale: 1=very easy, 5=very difficult), and USI motor activation measures (active thickness/resting) of the abductor hallucis (AbdH), flexor digitorum brevis (FDB), quadratus plantae (QP), and flexor hallucis brevis (FHB) were assessed during a toe spread out, hallux extension, and lesser toe extension exercise. The Wilcoxon signed rank test was used to assess the pre to post intervention motor performance and perceived difficulty measures. Repeated measures ANOVAs were used to analyze the USI measures. RESULTS: The intervention group demonstrated significant improvement in motor performance in the toe spread out exercise (pre=1.9±0.5, post=2.6±0.5, p=.008) and less perceived difficulty in the toe spread out (pre=3.1±1.3, post=2.3±1.2, p=.01), isolated hallux extension (pre=3.2±1.5, post=2.0±1.2, p=.005), and lesser toe extension (pre=1.9±0.7, post=1.2±0.4, p=.03) exercises. Both groups demonstrated increased USI motor activation in the AbdH during the toe spread out exercise (intervention: pre=1.07±.06, post=1.11 ± .08; control: pre=1.08±.06, post=1.11±.06, p=.05). No other significant main effects or group by time interactions were observed. CONCLUSION: A 4-week IFM exercise intervention resulted in improved motor performance and decreased perceived difficulty when performing the exercises, but not changes in USI measures of IFM activation.

Effect of walking speed on foot kinematics determined by the Oxford Foot Model

Introduction: The motion occurring at the joints of the foot are related to the functional demands during walking. Subtalar joint pronation during loading response might be essential to dampen impact forces, whereas supination during push-off might provide a rigid lever for thrust [1]. To verify the function it is important to determine adaptive movements at increasing walking speeds. The Oxford Foot Model (OFM) provides information about 3D foot motion. For the clinical interpretationof thedata itwouldbehelpful to knowwhich parameters might give the foot flexibility for shock absorption and a rigid lever for thrust. Therefore the aim was to investigate the effect of walking speed on foot kinematics. Patients/materials and methods: 11 typically developed children 10 (SD=2) years participated in the study. They walked at slow, preferred and fast speeds. Motion was captured with the Vicon camera system using the OFM. In total 16 parameters were derived. To separate between shock damping and thrust, gait was subdivided into pronation phase (0–30% gait cycle) and supination phase (30–70%). In pronation phase tibia to hindfoot peak plantarflexion, peak eversion and peak external rotation, forefoot to midfoot peak plantarflexion, peak pronation and peak abduction, peak hallux flexion and min. medial arch height were determined. In the supination phase it were tibia to hindfoot peak plantarflexion, peak supination and peak adduction, forefoot to midfoot peak plantarflexion, peak supination and peak adduction, peak hallux extension andmax.medial arch height. Only parameterswere considered for statistical analysis that showed a continuous increase or decrease with speed. ANOVA on the factor speedwas performed following post-hoc tests. Results:21 legswere analysed. Significant differences inparameters between all three walking speeds were observed in the pronation phase for increasing peak hindfoot to tibia external rotation (p< .001). For the supination phase it were increasing peak plantarflexion of hindfoot to tibia (p= .002), increasing peak plantarflexion of the midfoot (p< .001) and increasing peak hallux dorsiflexion (p< .001). Discussion and conclusions: In the pronation phase only hindfoot to tibia external rotation was significantly increased with speed. This allows the tibia to internally rotate with respect to the knee, which is a prerequisite for knee flexion [1]. Therefore hindfoot rotation indirectly allows for shock absorption, since it enabled the knee to flex and thus allowed the quadriceps musculature more time to dampen impact forces. Concerning thrust during the supination phase, the ankle joint plantar flexes more with increasing speed. This might result in greater ankle pushoff power. In addition the midfoot was significantly more plantar flexed. Thatmeans that the longitudinal arch betweenhindfoot and midfoot was increased. The reason might be the windlass effect caused by the increased hallux flexion observed. In conclusion none of the selected parameters during pronation phase could be directly associated with dampening impact forces. However, hindfoot to tibia external rotation was indirectly allowing the knee to flex and thereby dampening impact forces. A rigid lever for thrust was obtained by the windlass effect, which was shown to increase midfoot plantarflexion with speed.

Intrinsic factors associated with medial tibial stress syndrome in athletes: A large case-control study

Background. Medial tibial stress syndrome (MTSS) is the most common lower-leg injury in athletes, and is thought to be caused by bony overload. To prevent MTSS, both pathophysiological and aetiological factors specific to MTSS need to be identified. The intrinsic risk factors that contribute to the development of MTSS are still uncertain.Objective. To determine the intrinsic risk factors of MTSS by sampling a large population of athletic MTSS patients and controls.Methods. Athletes with MTSS and control subjects were medically examined in terms of range of motion of the leg joints (hip abduction, adduction, internal and external range of motion; ankle plantar and dorsal flexion; hallux extension and flexion; subtalar inversion and eversion), measures of over-pronation and maximal calf girth.Results. Ninety-seven subjects agreed to participate in the study: 48 MTSS patients and 49 active controls. The following variables were considered: gender, age, body mass index (BMI), hip abduction, hip adduction, internal and external hip range of rotation, ankle plantar and dorsal flexion, hallux flexion and extension, subtalar inversion and eversion, maximal calf girth, standing foot angle and navicular drop test. In multivariate logistic regression analysis, hip abduction (odds ratio (OR) 0.82; 95% confidence interval (CI) 0.72 - 0.94), ankle plantar flexion (OR 0.73; 95% CI 0.61 - 0.87) and subtalar inversion (OR 1.24; 95% CI 1.10 - 1.41) were significantly associated with MTSS. The Nagelkerke R2 for this model was 0.76, indicating that 76% of the variance in the presence of MTSS could be explained by these variables.Conclusion. Decreased hip abduction, decreased ankle plantar flexion and an increased subtalar inversion could be considered risk factors for MTSS.

Intrinsic factors associated with medial tibial stress syndrome in athletes: A large case-control study

Background. Medial tibial stress syndrome (MTSS) is the most common lower-leg injury in athletes, and is thought to be caused by bony overload. To prevent MTSS, both pathophysiological and aetiological factors specific to MTSS need to be identified. The intrinsic risk factors that contribute to the development of MTSS are still uncertain.Objective. To determine the intrinsic risk factors of MTSS by sampling a large population of athletic MTSS patients and controls.Methods. Athletes with MTSS and control subjects were medically examined in terms of range of motion of the leg joints (hip abduction, adduction, internal and external range of motion; ankle plantar and dorsal flexion; hallux extension and flexion; subtalar inversion and eversion), measures of over-pronation and maximal calf girth.Results. Ninety-seven subjects agreed to participate in the study: 48 MTSS patients and 49 active controls. The following variables were considered: gender, age, body mass index (BMI), hip abduction, hip adduction, internal and external hip range of rotation, ankle plantar and dorsal flexion, hallux flexion and extension, subtalar inversion and eversion, maximal calf girth, standing foot angle and navicular drop test. In multivariate logistic regression analysis, hip abduction (odds ratio (OR) 0.82; 95% confidence interval (CI) 0.72 - 0.94), ankle plantar flexion (OR 0.73; 95% CI 0.61 - 0.87) and subtalar inversion (OR 1.24; 95% CI 1.10 - 1.41) were significantly associated with MTSS. The Nagelkerke R2 for this model was 0.76, indicating that 76% of the variance in the presence of MTSS could be explained by these variables.Conclusion. Decreased hip abduction, decreased ankle plantar flexion and an increased subtalar inversion could be considered risk factors for MTSS.

Intrinsic factors associated with medial tibial stress syndrome in athletes: A large case-control study

Background. Medial tibial stress syndrome (MTSS) is the most common lower-leg injury in athletes, and is thought to be caused by bony overload. To prevent MTSS, both pathophysiological and aetiological factors specific to MTSS need to be identified. The intrinsic risk factors that contribute to the development of MTSS are still uncertain. Objective. To determine the intrinsic risk factors of MTSS by sampling a large population of athletic MTSS patients and controls. Methods. Athletes with MTSS and control subjects were medically examined in terms of range of motion of the leg joints (hip abduction, adduction, internal and external range of motion; ankle plantar and dorsal flexion; hallux extension and flexion; subtalar inversion and eversion), measures of over-pronation and maximal calf girth. Results. Ninety-seven subjects agreed to participate in the study: 48 MTSS patients and 49 active controls. The following variables were considered: gender, age, body mass index (BMI), hip abduction, hip adduction, internal and external hip range of rotation, ankle plantar and dorsal flexion, hallux flexion and extension, subtalar inversion and eversion, maximal calf girth, standing foot angle and navicular drop test. In multivariate logistic regression analysis, hip abduction (odds ratio (OR) 0.82; 95% confidence interval (CI) 0.72 - 0.94), ankle plantar flexion (OR 0.73; 95% CI 0.61 - 0.87) and subtalar inversion (OR 1.24; 95% CI 1.10 - 1.41) were significantly associated with MTSS. The Nagelkerke R 2 for this model was 0.76, indicating that 76% of the variance in the presence of MTSS could be explained by these variables. Conclusion. Decreased hip abduction, decreased ankle plantar flexion and an increased subtalar inversion could be considered risk factors for MTSS.

Kinetics and kinematics after the Bridle procedure for treatment of traumatic foot drop

BackgroundThe Bridle procedure restores active ankle dorsiflexion through a tri-tendon anastomosis of the tibialis posterior, transferred to the dorsum of the foot, with the peroneus longus and tibialis anterior tendon. Inter-segmental foot motion after the Bridle procedure has not been measured. The purpose of this study is to report kinetic and kinematic variables during walking and heel rise in patients after the Bridle procedure. Methods18 Bridle and 10 control participants were studied. Walking and heel rise kinetic and kinematic variables were collected and compared using an ANOVA. FindingsDuring walking the Bridle group, compared with controls, had reduced ankle power at push-off [2.3 (SD 0.7) W/kg, 3.4 (SD 0.6) W/kg, respectively, P<.01], less hallux extension during swing [−13 (SD 7)°, 15 (SD 6)°, respectively, P<.01] and slightly less ankle dorsiflexion during swing [6 (SD 4)°, 9 (SD 2)°, respectively, P=.03]. During heel rise the Bridle group had 4 (SD 6)° of forefoot on hindfoot dorsiflexion compared to 8 (SD 3)° of plantarflexion in the controls (P<.01). InterpretationThis study provides evidence that the Bridle procedure restores the majority of dorsiflexion motion during swing. However, plantarflexor function during push-off and hallux extension during swing were reduced during walking in the Bridle group. Abnormal mid-tarsal joint motion, forefoot on hindfoot dorsiflexion instead of plantarflexion, was identified in the Bridle group during the more challenging heel rise task. Intervention after the Bridle procedure must maximize ankle plantarflexor function and midfoot motion should be examined during challenging tasks.

Metatarsal extension osteotomy without plantar aponeurosis release in cavus feet. The effect on claw toe deformity a radiographic assessment

This study reviewed patients undergoing correction of cavus foot deformity by metatarsal extension osteotomy with preservation of the plantar aponeurosis, and assessed the correction achieved of the claw deformity of the toe by radiographic assessment. 15 patients (18 feet) were reviewed clinically and radiographically. All feet required extension osteotomy of the first metatarsal and four patients (5 feet) had extension osteotomy of the first to fourth metatarsals. Hallux extension angle in relation to the 1st metatarsal and in relation to the ground was measured in all feet to estimate the degree of clawing of the hallux. 13 patients (15 feet) were satisfied with the outcome of their surgery and also the appearance of their foot. The mean radiographic change in the hallux extension angle in relation to the 1st metatarsal was 16°, and in relation to the ground was 7°. These changes were statistically significant. Our results indicate an improvement in the claw toe deformity and we recommend preservation of the plantar aponeurosis in corrective surgery for cavus foot.

Ekstremite Taraf Tercihi ile Mediyal Longitudinal Ark Kollaps Seviyesi, Ayak Bileği ve Ayak Başparmağı Hareketleri Arasındaki İlişki

Objective: The aim of this study was investigate the effect of hemisphere preference on medial longitudinal arch collapse level and range of motion of ankle and hallux extension in both lower extremities and to determine whether there was a difference between the lower extremities. Material and Methods: The study was performed on 142 university students (male 77, female 65) aged between 18-27 (20.42 ± 1.441) years who agreed to participate. Participants completed two questionnaires questioning individual characteristics, and hand and foot preferences. Dorsiflexion and plantar flexion of both ankles and extension of both halluces were measured using a universal goniometer, and navicular drop (ND) in both feet using the