Improved Ankle Dorsiflexion Research Articles

Effects of ankle isokinetic training on muscle strength and balance amongst older women with mild Parkinson's disease: A randomised trial.

Patients with Parkinson's disease frequently experience problems with balance and gait. This study examined the influences of regular ankle isokinetic muscle strength training on muscle strength and balance ability amongst elderly women with mild Parkinson's disease. A total of 55elderly women with mild Parkinson's disease were randomly divided into the experimental group (n= 28) and the control group (n= 27) for 16weeks. The experimental group was trained for 16weeks by using isokinetic muscle strength training. After 16weeks of training in the experimental group, the peak torque (PT) of ankle (average of the left and right sides) dorsiflexion, plantarflexion, eversion and inversion, and the standing balance index revealed that the left and right stability and overall stability indexes significantly increased by 25.9%, 43.5%, 62.7%, 82.8%, 37.1% and 32.2%, respectively (p< 0.05). The experimental group exhibited significantly increased PT of ankle dorsiflexion, plantarflexion, eversion and inversion. Moreover, the left and right stability and overall stability indexes were significantly improved compared with those of the control group (p< 0.05). This study found a linear regression relationship between the PT of ankle inversion and overall stability index. This study determined that ankle isokinetic muscle strength training improved ankle dorsiflexion, plantarflexion, eversion and inversion muscle strength, and balance ability amongst elderly women with mild Parkinson's disease. However, it did not improve stability in the anterior and posterior directions. Ankle inversion muscle strength is more likely to affect overall balance.

Treatment of acute ankle distortion in footballers : Are we doing it particularly right or particularly wrong?

Despite the high incidence of ankle sprains, the ideal treatment is controversial and asignificant percentage of patients who have suffered an ankle sprain never fully recover. Even professional athletes are affected by this post-traumatic complication. There is strong evidence that permanent impairment after an ankle injury is often due to an inadequate rehabilitation and training program and too early return to sport. Therefore, athletes should start acriteria-based rehabilitation after ankle sprain and gradually progress through the programmed activities, including e.g. cryotherapy, edema reduction, optimal load management, range of motion exercises to improve ankle dorsiflexion and digital guidance, stretching of the triceps surae with isometric exercises and strengthening of the peroneus muscles, balance and proprioception training, and bracing/taping. The fact that this is professional sport does not exempt it from consistent, stage-appropriate treatment and acautious increase in load. However, there are anumber of measures and tools that can be used in the intensive care of athletes to improve treatment and results.

Articulated ankle-foot-orthosis improves inter-limb propulsion symmetry during walking adaptability task post-stroke

BackgroundCommunity ambulation involves complex walking adaptability tasks such as stepping over obstacles or taking long steps, which require adequate propulsion generation by the trailing leg. Individuals post-stroke often have an increased reliance on their trailing nonparetic leg and favor leading with their paretic leg, which can limit mobility. Ankle-foot-orthoses are prescribed to address common deficits post-stroke such as foot drop and ankle instability. However, it is not clear if walking with an ankle-foot-orthosis improves inter-limb propulsion symmetry during adaptability tasks. This study sought to examine this hypothesis. MethodsIndividuals post-stroke (n = 9) that were previously prescribed a custom fabricated plantarflexion-stop articulated ankle-foot-orthosis participated. Participants performed steady-state walking and adaptability tasks overground with and without their orthosis. The adaptability tasks included obstacle crossing and long-step tasks, leading with both their paretic and nonparetic leg. Inter-limb propulsion symmetry was calculated using trailing limb ground-reaction-forces. FindingsDuring the obstacle crossing task, ankle-foot-orthosis use resulted in a significant improvement in inter-limb propulsion symmetry. The orthosis also improved ankle dorsiflexion during stance, reduced knee hyperextension, increased gastrocnemius muscle activity, and increased peak paretic leg ankle plantarflexor moment. In contrast, there were no differences in propulsion symmetry during steady-state walking and taking a long-step when using the orthosis. InterpretationPlantarflexion-stop articulated ankle-foot-orthoses can improve propulsion symmetry during obstacle crossing tasks in individuals post-stroke, promoting paretic leg use and reduced reliance on the nonparetic leg.

Acute effects of self-myofascial release compared to dry needling on myofascial pain syndrome related outcomes: Range of motion, muscle soreness and performance. A randomized controlled trial

Objectivesmyofascial pain syndrome (MPS) is associated with reductions in range of movement (ROM), decrease in physical function and performance and increase in pain in different populations. Elucidating the best prevention and treatment strategies for MPS has been one of the main goals in the last decade. The objective of the present study was to compare the acute effects of self-myofascial foam rolling release (SFR) and dry-needling (DN) techniques on ankle dorsiflexion ROM, soreness post-needling and performance through countermovement jump (CMJ) height. Methodsa prospective crossover design composed by 12 active adults, aged 23.41 ± 1.68 years (weight: 78.33 ± 9.02 Kg; height: 1.79 ± 0.088 m) with active ankle dorsiflexion restriction was performed. Participants were randomized into the SFR and DN techniques to analyze its effects on ankle dorsiflexion ROM, muscle soreness and jump height at pre, post and 24 h post-intervention. Resultssignificant improvements were found by DN on ankle dorsiflexion at 24 h post intervention and muscle soreness by SFR at the same time point. No significant differences were found between conditions. ConclusionsBoth SFR and DN are effective in improving ankle dorsiflexion and performance in young adults without producing an acute effect in muscle soreness.

Comparison between prefabricated ankle-foot orthoses, Dyna Ankle and UD Flex, in patients with hemiplegia.

To compare the kinematic effects of two widely-used prefabricated ankle-foot orthoses (AFOs), the Dyna Ankle (DA) and UD Flex (UD), on the gait cycle of patients with hemiplegia due to cerebral palsy or acquired brain injury. This was a retrospective cohort study involving 29 patients. Gait analysis results were assessed under three conditions: barefoot, with the DA, and with the UD. Friedman tests and post hoc analysis with Bonferroni correction were performed to assess differences between the three conditions. The DA significantly improved ankle dorsiflexion during the mid-swing phase, making it more effective in correcting foot drop compared with the UD (DA: 2.28°, UD: 0.44°). Conversely, the UD was more effective in preventing knee flexion during the loading response (DA: 28.11°, UD: 26.72°). The DA improved ankle dorsiflexion during the swing phase significantly more than that with the UD in patients with hemiplegia. Compared with the DA, the UD more effectively prevented increased knee flexion during the loading response. The choice to prescribe these orthoses should consider individual patient characteristics.

Clinical Feasibility of a Markerless Gait Analysis System.

The gait analysis method that has been used in clinical practice to date is an optical tracking system (OTS) using a marker, but a markerless gait analysis (MGA) system is being developed because of the expensive cost and complicated examination of the OTS. To apply this MGA clinically, a comparative study of the MGA and OTS methods is necessary. The purpose of this study was to evaluate the compatibility between the OTS and the MGA methods and to evaluate the usefulness of the MGA system in actual clinical settings. From March 2021 to August 2021, 14 patients underwent gait analysis using the OTS and MGA system, and the spatiotemporal parameters and kinematic results obtained by the 2 methods were compared. To evaluate the practicality of the MGA system in an actual clinical setting, MGA was performed on 14 symptomatic children with idiopathic toe walking, who had been treated with a corrective cast, and the pre-cast and post-cast results were compared. For the OTS, the Motion Analysis Eagle system was used, and for MGA, DH Walk was used. The spatiotemporal parameters showed no significant difference between the OTS and MGA system. The joint angle graphs of the kinematics along the sagittal plane showed similar shapes as a whole, with particularly high correlations in the hip and knee (pelvis: 29.4%, hip joint: 96.7%, knee joint: 94.9%, and ankle joint: 68.5%). A quantified comparison using the CORrelation and Analysis (CORA) score also showed high similarity between the 2 methods. The MGA results of pre-cast application and post-cast removal for children with idiopathic toe walking showed a statistically significant improvement in ankle dorsiflexion after treatment (p < 0.001). MGA showed a good correlation with the conventional OTS in terms of spatiotemporal parameters and kinematics. We demonstrated that ankle sagittal kinematics improved after treatment by corrective cast in children with idiopathic toe walking using the MGA method. Thus, after the improvement of a few limitations, the MGA system may soon be able to be clinically applied.

Effectiveness of instrument assisted soft tissue mobilization versus foam rolling on trigger point release in calf muscles

BackgroundInstrument assisted soft tissue mobilization and foam rolling are two techniques that have been proven effective in treating Myofascial Trigger Points, irrespective of the type of trigger point. However, little is known about the comparative effectiveness of Instrument assisted soft tissue mobilization and foam rolling. This study proposed to evaluate the effectiveness of either technique on plantar flexors trigger points, ankle dorsiflexion, and lower limb power present in the calf muscles in non-symptomatic patients. MethodForty-two subjects with bilateral calf muscle tightness, at least one trigger point in the calf muscle, and fulfilling the inclusion criteria were randomly assigned to either of the groups. Group A was treated for gastrocnemius and soleus trigger points using Instrument assisted soft tissue mobilization and Group B was treated using the Foam Rolling method. Treatment was given every alternate day, a total of 3 sessions. Subjects were evaluated on 1st and 3rd sessions for pre-post differences of ankle dorsiflexion Range of motion in weight bearing and non-weight bearing position, pressure pain threshold for gastrocnemius trigger point 1(G1), 2(G2), and soleus point 1(S1) on both sides, and lower limb power. ResultWithin group analyses, both groups had shown statistically significant results for all parameters except gastrocnemius trigger point 2 of foam rolling. For between group comparison foam rolling had a statistically significant result in non-weight bearing ankle dorsiflexion range of motion. ConclusionBoth Instrument assisted soft tissue mobilization and Foam rolling were equally effective for treating calf trigger points. But foam rolling was more effective in improving ankle dorsiflexion range of motion.

Functional Repetitive Neuromuscular Magnetic Stimulation (frNMS) Targeting the Tibialis Anterior Muscle in Children with Upper Motor Neuron Syndrome: A Feasibility Study.

Non-invasive neurostimulation as an adjunctive intervention to task-specific motor training is an approach to foster motor performance in patients affected by upper motor neuron syndrome (UMNS). Here, we present first-line data of repetitive neuromuscular magnetic stimulation (rNMS) in combination with personalized task-specific physical exercises targeting the tibialis anterior muscle to improve ankle dorsiflexion (functional rNMS (frNMS)). The main objective of this pilot study was to assess the feasibility in terms of adherence to frNMS, safety and practicability of frNMS, and satisfaction with frNMS. First, during 10 training sessions, only physical exercises were performed (study period (SP) A). After a 1 week break, frNMS was delivered during 10 sessions (SPC). Twelve children affected by UMNS (mean age 8.9 ± 1.6 years) adhered to 93% (SPA) and 94% (SPC) of the sessions, and omittance was not related to the intervention itself in any case. frNMS was safe (no AEs reported in 88% of sessions, no AE-related discontinuation). The practicability of and satisfaction with frNMS were high. Patient/caregiver-reported outcomes revealed meaningful benefits on the individual level. The strength of the ankle dorsiflexors (MRC score) clinically meaningfully increased in four participants as spasticity of ankle plantar flexors (Tardieu scores) decreased in four participants after SPC. frNMS was experienced as a feasible intervention for children affected by UMNS. Together with the beneficial effects achieved on the individual level in some participants, this first study supports further real-world, large-scale, sham-controlled investigations to investigate the specific effects and distinct mechanisms of action of frNMS.

Isolated Gastrocnemius Contraction and Gastroc Recession Surgery in Case of Planter Fasciitis: A Systemic Review and Meta-Analysis.

The current systematic and meta-static review aimed to analyze the correlation between isolated gastrocnemius contracture and plantar fasciitis and the effectiveness of gastroc recession surgery in the treatment of plantar fasciitis. The Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines were followed to conduct this meta-analysis. A literature search was carried out on the following databases, including Google Scholar, PubMed, EMBASE, and the Cochrane databases with the appropriate medical subject headings (MeSH) to identify the eligible articles. A total of 13 studies were included in this meta-analysis. In this study, there is a significant difference in chronic plantar fasciitis outcome when comparing experimental and control (RR: 0.02; 95% CI: 0.01 to 0.05; P < 0.001; I2 = 29%). There is a significant difference in pain scale outcome when comparing pre-treatment and post-treatment (RR: 3.25; 95% CI 1.44 to 7.32; P = 0.004 < 0.01; I2 = 0%). A significant difference in VAS scale outcome when comparing pre-treatment and post-treatment (RR: 2.58; 95% CI 1.52 to 4.38; P = 0.0004 < 0.01; I2 = 0%). In conclusion, the current systematic review and meta-analysis of gastrocnemius recession and proximal medial gastrocnemius release and other treatment measures for plantar fasciitis suggests that the improvement of ankle dorsiflexion, reduction in pain, and patient satisfaction are almost similar in all the treatment measures. Among the five treatment measures, gastrocnemius recession remains the best, followed by proximal medial gastrocnemius release.

Assessment of Dorsiflexion Ability across Tasks in Persons with Subacute SCI after Combined Locomotor Training and Transcutaneous Spinal Stimulation.

In people with spinal cord injury (SCI), transcutaneous spinal stimulation (TSS) has an immediate effect on the ability to dorsiflex the ankle, but persistent effects are not known. Furthermore, TSS has been associated with improved walking, increased volitional muscle activation, and decreased spasticity when combined with locomotor training (LT). In this study, the persistent impact of combined LT and TSS on dorsiflexion during the swing phase of walking and a volitional task in participants with SCI is determined. Ten participants with subacute motor-incomplete SCI received 2 weeks of LT alone (wash-in phase), followed by 2 weeks of either LT + TSS (TSS at 50 Hz) or LT + TSSSham (intervention phase). There was no persistent effect of TSS on dorsiflexion during walking and inconsistent effects on the volitional task. There was a strong positive correlation between the dorsiflexor ability for both tasks. There was a moderate effect of 4 weeks of LT on increased dorsiflexion during the task (d = 0.33) and walking (d = 0.34) and a small effect on spasticity (d = -0.2). Combined LT + TSS did not show persistent effects on dorsiflexion ability in people with SCI. Four weeks of locomotor training was associated with increased dorsiflexion across tasks. Improvements in walking observed with TSS may be due to factors other than improved ankle dorsiflexion.

"Kinesio Taping Along with PNF Stretching Improved Ankle Dorsiflexion in Children with Spastic Diplegic Cerebral Palsy"

"Kinesio Taping Along with PNF Stretching Improved Ankle Dorsiflexion in Children with Spastic Diplegic Cerebral Palsy"

"Kinesio Taping Along with PNF Stretching Improved Ankle Dorsiflexion in Children with Spastic Diplegic Cerebral Palsy"

"Kinesio Taping Along with PNF Stretching Improved Ankle Dorsiflexion in Children with Spastic Diplegic Cerebral Palsy"

The Effectiveness of Serial Casting in the Treatment of Recurrent Equinovarus in Children With Arthrogryposis.

Arthrogryposis multiplex congenita (AMC) is characterized by joint contractures in 2 or more body areas, often resulting in clubfoot deformities that are typically stiffer than those seen in idiopathic clubfoot deformities. While surgery is routinely used to treat clubfoot in AMC, it has a high rate of recurrence and complications. Current literature suggests serial casting (SC) could be useful in treating clubfoot in AMC, though evidence of its effectiveness is limited. Passive range of motion (PROM), dynamic foot pressure, parent-reported Pediatric Outcomes Data Collection Instrument, brace tolerance, and the need for post-casting surgery were evaluated retrospectively in children with AMC treated with SC to address clubfoot deformities. Analysis of variance or paired t tests were used as appropriate on pre-casting, short-term (within 6mo after SC) and/or longer-term (6 to 18mo after SC) parameters to determine the effectiveness of SC. Brace tolerance before and after SC was analyzed using the Global Test for Symmetry, and medical records were reviewed to determine the need for surgery post-SC. Forty-six children (6.1±3.1y old) were cast an average of 2.5±1.9 times, resulting in 206 SC episodes. PROM showed improvement in ankle dorsiflexion and forefoot abduction in the short term (P<0.05), returning to baseline measurements in the long term (P=0.09). Brace tolerance improved after casting (P<0.05). Only 15% of feet required surgery at follow-up at 10.3±5.5 years. There were no significant changes in dynamic foot pressure or Pediatric Outcomes Data Collection Instrument results after SC, except for an increase in the pain subtest (P<0.05). Serial casting in children with AMC can be effective in temporarily improving PROM and improving brace tolerance, but it does not impact dynamic barefoot position. Positive impact of conservative management in children with AMC can potentially delay or reduce the need for invasive surgical intervention by improving PROM and brace tolerance. Level III, Retrospective Comparative Study.

Tibiopedal Motion Following Tendo-Achilles Lengthening or Gastrocnemius Recession in Total Ankle Replacement: A Comparative Cohort Study.

End-stage ankle arthritis is a debilitating condition often necessitating total ankle replacement (TAR). Tendo-Achilles lengthening (TAL) and gastrocnemius recession (GR) are commonly performed with TAR to improve ankle dorsiflexion (DF). No studies to date have radiographically analyzed tibiopedal motion to guide surgical management. The purpose of this study is to determine the effect of a TAL or GR during TAR on radiographic tibiopedal range of motion (ROM). A retrospective review of a prospectively maintained database was conducted followed by a propensity score-matched analysis of 110 patients who underwent TAL (n = 26), GR (n = 29), or no lengthening procedure (n = 55) with TAR. Minimum of 1-year ROM radiographic follow-up was required. Exclusion criteria included (1) calcaneal osteotomies, (2) simultaneous or previous hindfoot or midfoot arthrodesis, (3) prior ankle arthrodesis, or (4) revision TAR. Demographic data were extracted from the TAR database. Radiographic assessment included tibiopedal dorsiflexion (DF) and plantarflexion (PF). DF improved by 2.8 degrees (P = .0286) and by 6.0 degrees (P < .0001) in the TAL and GR cohorts, respectively, with no difference in the control group (+0.7 degrees, P = .3764). PF was decreased by 4.5 degrees (P = .0152) and by 7.2 degrees (P = .0002) in the TAL and GR cohorts, respectively, with no difference in the control group (-0.2 degrees, P = .8546). Minimal differences were observed for total arc of motion for all 3 groups (control 0.5 degrees, GR -1.2 degrees, TAL -1.7 degrees), all of which were nonsignificant (all P > .05). There was no between-group difference in the change in overall arc of motion between the groups (P = .3599). GR resulted in a greater increase in DF (6.0 vs 2.8 degrees; P = .1074), with a reciprocal greater decrease in PF (7.2 vs 4.5 degrees; P = .2416) compared with the TAL cohort. Both TAL and GR increased postoperative DF; however, this was accompanied by a reciprocal loss in PF. Minimal differences were observed for total arc of motion. Patients should be counseled that concomitant procedures performed to increase DF will do so at the expense of PF. Level III, retrospective review of prospectively collected data.

Study of Gait and Posture Kinematic Indices for the Evaluation of Ankle-Foot Orthoses *

Motor disabilities resulting from pathologies such as brain injuries, strokes, spinal cord injuries and other neurological diseases usually lead to deficits in locomotion. One such problem is Drop Foot (DF), which can severely impair walking function. To cope with this pathology, ankle-foot orthoses (AFOs) can be used, which allow the patient to improve ankle dorsiflexion during the swing phase of the foot. The aim of this research work is to evaluate the impact of the use of a passive AFO orthosis on gait by studying the kinematic indices of gait in patients with DF. The study was conducted on a population of 19 patients at the IRCCS Istituti Clinici Maugeri in Bari. Ninteen subjects (12 males, 7 females), with unilateral DF syndrome, were involved in this research. The experimental data collection procedures consisted of gait analysis sessions performed with the Mobility Lab system by APDM (APDM Inc, Portland, OR, USA, http://apdm.com). In this test subjects wore 3 IMUs (low back and dorsal surface of the feet) and are instructed to stand quietly for 30 s and then asked to walk over a 7 meters walkway, turn around a pivot and walk back to the starting point. Each subject performed two sessions in two different gait conditions: (i) unconstrained gait (without any AFO); (ii) gait with an AFO attached to the participant’s affected limb. The median value of each parameter among the three selected trials was extracted and considered for the analysis. We focused on the following set of spatio-temporal parameters, which have clinical relevance in patients with DF: Elevation at Midswing ( cm ) (EMS), Gait Cycle Time ( s ) (GCT), Stride Length ( m ) (SL). These metrics were statistically analysed with two-way ANOVA test to explore the effects produced by the variables ‘Condition’ (With/Without AFO), ‘Limb’ (Affected/Contralateral) and the interaction between these two factors. Statistical analyses were performed using R version 4.0.3 (R Foundation, Vienna, Austria). Table 1 presents the results of the statistical test, reporting p-values when a significant difference was obtained (p−value < 0.05). Otherwise the absence of statistical significance is reported (ns). The level of statistical significance is specified by a different number of stars (∗): the higher number of stars, the lower α value threshold for the p − value. Fig. 1 shows the boxplots representing the distribution of the analysed data. This paper presented a clinical study regarding the impact of using a solid plastic AFO on spatio-temporal gait metrics of 19 patients with DF syndrome. Our analysis pointed out that EMS is generally higher in affected limb than in contralateral limb, as the patient compensates for difficulties in lifting the front part of the foot by increasing foot elevation during swing. However the use of the AFO has no significant effects on either foot. On the contrary, the GCT is reduced when the AFO is worn by the patient demonstrating higher confidence in step execution. The use of the AFO also tends to improve the stride length of both feet, however this difference is not statistically significant. In future studies, it would be better to evaluate changes in gait metrics on a longer walking trial, to carry out the assessment on a larger number of steps.

Effects of inclined treadmill training on inadequate ankle control during walking in individuals after stroke: A pilot randomized controlled trial.

Inadequate ankle control influences walking ability in people after stroke. Walking on inclined surface activates ankle muscles and movements. However, the effect of inclined treadmill training on ankle control is not clear. To investigate the effects of inclined treadmill training on ankle control in individuals with inadequate ankle control after chronic stroke. This was a randomized single-blinded study. Eighteen participants were randomly assigned to receive 12 sessions of 30 min inclined (n = 9) or regular (n = 9) treadmill training and 5 min over-ground walking training. The outcomes included ankle control during walking, muscle strength of affected leg, walking performance, and stair climbing performance. Inclined treadmill training significantly improved ankle dorsiflexion at initial contact (p = 0.002), increased tibialis anterior activities (p = 0.003 at initial contact, p = 0.006 in swing phase), and decreased dynamic plantarflexors spasticity (p = 0.027) as compared with regular treadmill training. Greater improvements were also shown in stair climbing with affected leg leading (p = 0.006) and affected knee extensors strength (p = 0.002) after inclined treadmill training. Inclined treadmill training was proposed to improve inadequate ankle control after chronic stroke. Inclined treadmill training also improved the stair climbing ability accompanied with increased muscle strength of the affected lower extremity.

Iatrogenic nerve injury and foot drop: Surgical results in 28 patients

Background: Most peroneal nerve injuries resulting in foot drop are secondary to trauma or iatrogenic. Foot drop can occur due to potential complications from the hip, lumbosacral spine, and knee surgeries, which are critical to diagnose and manage.Methods: We reviewed our foot drop patients’ data to determine the incidence and iatrogenic causes of the injury and managed surgically by neurolysis of the peroneal nerve and transfer of functional fascicles of either the superficial peroneal or the tibial nerve to the deep peroneal nerve.Results: We found 28 iatrogenic foot drop patients who have had surgery and postoperative follow-up evaluations with us. Before the onset of foot drop, all except one (27 of 28) patient have had surgeries in other clinics before presenting to our institution. Foot drop in one patient was due to infection and hip wound after he was intubated and stayed in ICU for 4 weeks. Thirteen of the 28 patients have had lumbosacral (L3-4, L4-L5, and L5-S1) fusion or laminectomy, eight have had hip surgery, and five have had knee surgery. One patient had a fasciotomy due to compartment syndrome and another patient had two previous surgeries for posterior tibial entrapment and tarsal tunnel syndrome at other institutions. NCS and EMG reports showed that these patients had injuries to the peroneal or tibial nerve after their prior surgeries. One patient had a femoral nerve injury. Preoperatively, 10 patients had severe foot drop with muscle weakness and a functional grade of 0/5; 16 patients had grades ranging from 1 to 2/5; and two patients had 3/5. Overall, 23 of the 28 patients (83%) had improvement in their ankle dorsiflexion with anti-gravity and regained a healthier gait after the decompression, neurolysis, and nerve transfer at our clinic.Conclusion: Twenty-three of the 28 (83%) iatrogenic foot drop patients in this report regained a healthier gait with improved ankle dorsiflexion and anti-gravity after the neurolysis, and nerve transfer of the peroneal or tibial nerve and transfer of functional fascicles of either the superficial peroneal or the tibial nerve to the deep peroneal nerve at our clinic.

Multidimensional Outcomes of Selective Dorsal Rhizotomy for Children With Spastic Cerebral Palsy: Single-Level Laminectomy vs Multiple-Level Laminotomy Techniques.

Selective dorsal rhizotomy (SDR) reduces lower limb spasticity, improves gait patterns, and restores normal physical and social activity in children with spastic cerebral palsy. Single-level laminectomy (SLL) and multiple-level laminotomy (MLL) are 2 surgical approaches for SDR with limited clinical data comparing their postoperative outcomes. To compare the differences in multidimensional outcomes after SDR between SLL and MLL for children with spastic cerebral palsy. We retrospectively reviewed children who underwent SDR in our hospital from 1997 to 2016. The multidimensional outcomes in spasticity, joint range of motions, gait kinetics, gross motor activities, functional outcomes, and urological outcomes were assessed 1 year postoperatively. Hip dysplasia and scoliosis rate were compared as long-term outcomes. Sixty children underwent SDR, including 34 SLL patients and 26 MLL patients. Most improvements in multidimensional outcomes were comparable between SLL and MLL. Patients in the SLL group had larger improvements in ankle dorsiflexion in the midstance phase (SLL 7.59° ± 11.48° vs MLL 0.29° ± 11.30°, P = .027). The rate of scoliosis was similar between the 2 surgical approaches (SLL 12.1% vs MLL 15.4%, P = .722). SDR for children with spastic cerebral palsy could provide physical, functional, and urological improvements. SLL achieved a higher degree of improvement in ankle dorsiflexion in the midstance phase. The rate of scoliosis was not significantly increased by multiple-level laminotomy.

Respective Contributions of Instrumented 3D Gait Analysis Data and Tibial Motor Nerve Block on Presurgical Spastic Equinus Foot Assessment: A Retrospective Study of 40 Adults.

Spastic equinus foot is a common deformity in neurologic patients who compromise walking ability. It is related to the imbalance between weak dorsiflexion and overactive plantar flexor muscles. To achieve the best functional results after surgical management, the challenge is to identify the relevant components involved in the deformity using several methods, namely, examination in the supine position, motor nerve blocks allowing transient anesthesia of suspected overactive muscles, and kinematic and electromyographic data collected during an instrumented 3D gait analysis. The procedure is not standardized; its use varies from one team to another. Access to gait analysis laboratories is limited, and some teams do not perform motor nerve blocks. When both examinations are available, instrumental data from the instrumented 3D gait analysis can be used to specify muscle targets for motor blocks, but data collected from both examinations are sometimes considered redundant.This retrospective cohort analysis compared examination in the supine position, temporary motor nerve blocks, and instrumented 3D gait analysis data in 40 adults after brain or spinal cord injuries. Clinical data collected before motor nerve block was not associated with instrumental data to assess calf muscle's overactivity and tibialis anterior function. Improvement of ankle dorsiflexion in the swing phase after tibial motor nerve block was associated with soleus spastic co-contraction during this phase corroborating its involvement in ankle dorsiflexion defects. This study showed the relevance of tibial motor nerve block to remove spastic calf dystonia and facilitate the assessment of calf contracture. It also underlined the need for complementary and specific analyses of the tibialis anterior abnormal activation pattern after motor nerve block to confirm or deny their pathological nature.

Relationship Between Ankle Dorsiflexion Mobility and Functional Return to Sport Test Performance in Athletes Who Have Undergone ACL Reconstruction

Background:Limited ankle dorsiflexion (DF) range has been associated with knee injuries and altered biomechanics during functional squatting and landing tasks. Prior studies correlating weight-bearing DF with altered landing mechanics have primarily used advanced motion capture technology, with limited research using clinically validated scoring tools.Hypothesis/Purpose:To assess the relationship between decreased DF and functional testing performance in youth athletes who have undergone anterior cruciate ligament reconstruction (ACLR).Methods:A retrospective review of standardized data was conducted on patients who had undergone ACLR at a pediatric sports medicine practice that had completed functional testing between December 2017 and November 2020. Patients with testing completed at a minimum of five months post-operatively, and who planned to return-to-sport (RTS) were included. Functional testing included validated protocols for the Y-Balance Test (YBT) and the Landing Error Scoring System (LESS), as well as a modified Single-Leg Squat Endurance Test (SLSET) utilizing the VAIL sports test scoring criteria. DF was measured in a weight-bearing lunge position off the front foot. Subjects were categorized into a pass or fail group based on their YBT and LESS scores (YBT≥94%, LESS≤4), and t-tests were performed to identify significant differences in DF between groups (α=0.05). Lastly, Pearson correlations were performed to identify potential relationships between DF and SLSET total score as well as normalized anterior reach collected as a component of the YBT (α=0.05).Results:303 patients (148 (48.8%) males, 15.94±2.15 years, 7.46±2.11 months post-operative) were included for analysis. Significant correlations were identified between DF and YBT composite score (p <0.001) and LESS total score (p <0.001; Table 1). Additionally, positive relationships were found between DF and both SLSET total score (p <0.001, r = 0.296) and anterior reach (p <0.001; r =0.400). Average values for DF, YBT, and LESS can be found in Table 2.Conclusion:In this pediatric ACLR population, decreased ankle dorsiflexion is associated with high risk movement patterns during functional testing. This study adds to the literature by identifying clinically applicable DF thresholds associated with passing scores on the YBT and LESS functional tests. Clinical interventions aimed at improving ankle dorsiflexion to >36° may be an important component of ACL rehabilitation.Table 1.Ankle dorsiflexion (Mean ± SD) across patients and by functional test scoresTable 2.Average values per measure (Note: Asymm = side-to-side differences)