Lateral Heel Research Articles

Gait Training Interventions for Individuals with Chronic Ankle Instability: A Systematic Review & Meta-Analysis.

This review aimed to determine if gait training interventions influence lower extremity biomechanics during walking in individuals with chronic ankle instability (CAI). A literature search was conducted in PubMed, CINAHL, SPORTDiscus, and MEDLINE to identify English-language studies from inception through September 2022. Eligible studies included randomized control trials, repeated measures design, and descriptive laboratory studies measuring the effects during or following a gait training intervention on biomechanical outcomes (kinematics, kinetics, electromyography) during walking in individuals with CAI. Gait training interventions were broadly categorized into devices (destabilization devices, novel gait training device) and biofeedback (visual, auditory, and haptic delivery modes). Meta-analyses were conducted when appropriate using random-effects to compare pre-and post- gait training intervention mean differences and standard deviations. Thirteen studies were included. Meta-analyses were conducted for single session gait training studies only. Eleven studies reported kinetic outcomes. Our meta-analyses showed location of center of pressure (COP) was shifted medially from 0-90% (Effect Size [ES] range=0.35-0.82) of stance, contact time was decreased in medial forefoot (ES=0.43), peak pressure was decreased for lateral midfoot (ES=1.18) and increased for hallux (ES=0.59), pressure time integral was decreased for lateral heel (ES=0.33) and lateral midfoot (ES=1.22) and increased for hallux (ES=0.63). Three studies reported kinematic outcomes. Seven studies reported electromyography outcomes. Our meta-analyses revealed increased activity following initial contact (IC) for fibularis longus (ES=0.83). Gait training protocols improved some lower extremity biomechanical outcomes in individuals with CAI. Plantar pressure outcome measures seem to be most impacted by gait training programs with improvements in decreasing lateral pressure associated with increased risk for lateral ankle sprains. Gait training increased EMG activity post-IC for the fibularis longus. Few studies have assessed the impact of multi-session gait training on biomechanical outcome measures. Targeted gait trainning should be considered when treating patients with CAI.

Body Mass and Foot-dominance Disparities in the Foot Plantar Pressure Parameters of Older Women.

To examine the effects of foot dominance and body mass on foot plantar pressures in older women of regular, overweight, and obese weights. 96 female adults were divided into regular-weight group (68.30 ± 4.19 yr), overweight group (69.88 ± 3.76 yr), and obesity group (68.47 ± 3.67 yr) based on their body mass index scores. Footscan® plantar pressure test system was used to assess the dynamic plantar pressures, and parameters were collected from risk analysis, foot axis analysis, single foot timing analysis, and pressure analysis. (1) The local risks of lateral forefoot and midfoot, the minimum and maximum subtalar joint angles, the flexibility of subtalar joint, foot flat phase, as well as the average pressures on toes, metatarsals,, midfoot, and lateral heel, with the peak pressures on toe 2-5, metatarsal 2, metatarsal 5, midfoot, and lateral heel had significant within-subject differences. (2) The phases of initial contact and foot flat, the average pressures on toe 2-5, metatarsals, midfoot, and heels, with the peak pressures on metatarsal 1-4, midfoot, and heels exhibited significant between-subjects differences. (3) There was an interaction effect of foot dominance and body mass index on the flexibility of subtalar joint. The non-dominant foot works better for stability, especially when touching on and off the ground. The dominant foot works better for propulsion but is more susceptible to pain, injury, and falls. For obese older women, the forefoot and midfoot are primarily responsible for maintaining stability, but the lateral midfoot and hindfoot are more prone to pain and discomfort.

Could the anterior cruciate ligament reconstruction and pronated feet affect the plantar pressure variables and muscular activity during running? A comparative study

The unilateral anterior cruciate ligament reconstruction can create asymmetry in vertical ground reaction force and muscle activities, which could be amplified by pronated feet. The study compared plantar pressure variables, amplitude, and muscular frequency in individuals with pronated feet and anterior cruciate ligament reconstruction (PF/ACLR) versus control during running. As part of a cross-sectional study, 15 individuals with PF/ACLR (aged 23.2 ± 4.5 years) and 15 healthy control participants (aged 22.9 ± 4.1 years) ran barefoot at a speed of 3.3 m/s±5% on an 18-m runway. During running, a foot scan and electromyography systems were used to record the peak plantar pressure variables and electromyography activity of the main lower limb muscles, respectively. Results demonstrated lower peak plantar pressure values at the Toe 1 region (p < 0.001, d = 1.83) for the PF/ACLR group. The PF/ACLR group had larger peak plantar pressure values at toes second to fifth (p = 0.013, d = 1.15), fourth (p = 0.026, d = 0.97), fifth (p < 0.001, d = 1.74) metatarsal, and medial (p = 0.002, d = 1.41), and lateral (p = 0.001, d = 1.51) heel regions. The PF/ACLR group presented larger tibialis anterior (p = 0.003, d = 1.15), vastus lateralis (p = 0.001, d = 1.27), and gluteus medius (p = 0.009, d = 0.60) amplitude at the loading phase. At the mid-stance phase, larger tibialis anterior (p = 0.039, d = 0.99) and vastus lateralis (p = 0.00.024, d = 1.52) amplitudes were observed. For the push-off phase, the PF/ACLR group presented larger vastus medialis (p = 0.037, d = 0.82), biceps femoris (p = 0.004, d = 1.14), and semitendinosus (p = 0.001, d = 0.96) amplitudes. Our results demonstrated that pronated feet and anterior cruciate ligament reconstruction significantly impact plantar pressure variables and muscular amplitude in the lower limb during running.

MedCapsNet: A modified Densenet201 model integrated with capsule network for heel disease detection and classification

Conditions affecting the heel bone, such as heel spurs and sever's disease, pose significant challenges to patients' daily activities. While orthopedic and traumatology doctors rely on foot X-rays for diagnosis, there is a need for more AI-based detection and classification of these conditions. Therefore, this study addresses this need by proposing MedcapsNet, a novel hybrid capsule model combining modified DenseNet201 with a capsule network, designed to accurately detect and classify heel bone diseases utilizing lateral heel x-ray foot images. We conducted a comprehensive series of experiments on the proposed hybrid architecture with several datasets, including the Heel dataset, Breast BreaKHis v1, HAM10000 skin cancer dataset, and Jun Cheng Brain MRI dataset. The first experiment evaluates the proposed model for heel diseases, while the other experiments evaluate the model on a range of medical datasets to demonstrate its performance over existing studies. On the heel dataset, MedCapsNet achieves an accuracy of 96.38%, AUC of 98.35% without data augmentation, cross-validation accuracy of 95.69%, and AUC of 98.87%. The proposed model, despite employing a fixed architecture and hyperparameters, outperformed other models across four distinct datasets, including MRI, X-ray, and microscopic images with various diseases. This is notable because different types of medical image datasets typically require different architectures and hyperparameters to achieve optimal performance.

Impact of foot progression angle on spatiotemporal and plantar loading pattern in intoeing children during gait

Intoeing in children is a common parental concern, but our understanding of the impact of foot progression angle (FPA) in these children leaves remains limited. This study examines the relationship between FPA and plantar loading pattern, as well as gait symmetry in children with intoeing. The sample included 30 children with intoeing caused by internal tibial torsion, uniformly divided into three groups: unilateral intoeing, bilateral mild intoeing, and bilateral mild-moderate intoeing. The relationship between FPA and plantar loading pattern, and gait symmetry within and among groups were assessed using dynamic pedobarographic and spatiotemporal data. Results indicated a significant correlation between FPA and peak pressure, maximum force, and plantar impulse in the medial and central forefoot, and also the medial and lateral heel zones for both bilateral intoeing groups. Significant differences were observed only in subdivided stance phase, including loading response, single support, and pre-swing phases, between the unilateral intoeing and bilateral mild intoeing groups. These findings suggest that FPA significantly affects the forefoot and heel zones, potentially increasing the load on the support structures and leading to transverse arch deformation. While children with intoeing demonstrate a dynamic self-adjustment capability to maintain gait symmetry, this ability begins to falter as intoeing becomes more pronounced.

Application of Human Acellular Dermal Matrix with Skin Graft for Lacunar Soft-Tissue Defect of Lateral Heel after Calcaneal Fracture.

To investigate the clinical effect of human acellular dermal matrix (HADM) combined with split-thickness skin graft in repairing lacunar soft tissue defects of the lateral heel after calcaneal fracture. From June 2018 to October 2020, providers repaired 11 cases of lacunar soft tissue defects at the lateral part of the heel using HADM combined with split-thickness skin graft. After thorough debridement, the HADM was trimmed and filled into the lacunar defect area. Once the wound was covered, a split-thickness skin graft and negative-pressure wound therapy were applied. Providers evaluated the appearance, scar, ductility of the skin graft site, appearance of the donor site, healing time, and any reoperation at follow-up. Of the 11 cases, 8 patients achieved successful wound healing by primary intention. Three patients showed partial necrosis in the edge of the skin graft, but the wound healed after standard wound care. Evaluation at 6 and 12 months after surgery showed that all patients had wound healing and mild local scarring; there was no obvious pigmentation or scar formation in the donor skin area. The average healing time was 37.5 days (range, 24-43 days). The HADM combined with split-thickness skin graft is a simple and effective reconstruction method for lacunar soft tissue defect of the lateral heel after calcaneal fracture. In this small sample, the combination demonstrated few infections, minor scar formation, few donor site complications, and relatively short hospital stays.

Comparing Frequency Spectrum of Ground Reaction Forces in Blind and Healthy Participants With Open and Closed Eyes During Walking

Background and Aims This study aimed to compare the frequency spectrum of ground reaction forces in blind and healthy participants with open and closed eyes during walking. Methods This study was quasi-experimental. The statistic samples comprised 15 blind men with a mean age of 25.22±6.33 years and 15 healthy men with a mean age of 27.22±5.31 years. They were selected by available sampling. A foot scan (RS Scan International, Belgium) device was used to measure the foot pressure values while walking. Variables of foot pressure were recorded at a sampling frequency of 300 Hz. For data analysis, we used the paired t test to compare the within-group means and the independent t test to compare the between-group means in SPSS software, version 24. Results The results showed that the frequency content with 99.5% power was greater in the blind group than in the healthy group with open eyes in the vertical direction, first metatarsal, and lateral and medial heel parts (P&lt;0.05). Also, the frequency content with 99.5% power was greater in the healthy group with closed eyes than those healthy ones with open eyes (P&lt;0.05). The frequency content with 99.5% power (P=0.004) and numbers of essential harmonics (P=0.003) in the vertical direction in the blind group were respectively 9.84% and 13.51% less than the healthy group with closed eyes. The number of essential harmonics (P=0.002) in the vertical direction in the healthy group with closed eyes was 20.61% greater than those healthy ones with open eyes. The frequency content with 99.5% power in the vertical direction in the blind group was less than that of the healthy group with closed eyes (P=0.023). Conclusion Considering the increase in frequency with 99.5% power and the number of essential harmonics in different areas of the soles of the foot in the blind group and healthy group with closed eye, it is recommended that physiotherapists, motion analysts, and rehabilitation specialists design a special rehabilitation protocol for blind people and those who lost their vision due to an accident.

The effect of personalized orthopedic insoles on plantar pressure during running in subtle cavus foot.

Objective: This study aims to investigate the patterns of plantar pressure distribution during running for patients with subtle cavus foot (SCF) and determine the impact of personalized orthopedic insoles with forefoot wedge on plantar pressure distribution in patients with SCF. Methods: Sixteen undergraduate participants (8 with SCF and 8 with normal arches) were recruited based on arch height index measurements. Two full-length insoles were personalized for each SCF based on plantar pressures during running, an arch support insole (ASI) and an arch support with forefoot wedge insole (AFI). Foot pressure data collected during different insole conditions in running, analyzing ten regions of footprints for peak pressure and pressure-time integral. Results: Higher peak pressures were observed in patients with SCF at the medial forefoot (p = 0.021), medial heel (p = 0.013), and lateral heel (p = 0.025), with a higher pressure-time integral also noted at the medial forefoot (p = 0.025), medial heel (p = 0.015), and lateral heel (p = 0.047) when compared to normal arches. Compared with without-insole, both the AFI and the ASI reduced peak pressure at the medial (AFI p = 0.011; ASI p = 0.024) and lateral heel (AFI p = 0.028; ASI p = 0.032). The AFI reduced peak pressure at the medial heel (p = 0.013) compared with the ASI. Both the AFI and the ASI reduced pressure-time integral at the medial forefoot (AFI p = 0.003; ASI p = 0.026), central forefoot (AFI p = 0.005; ASI p = 0.011), medial heel (AFI p = 0.017; ASI p = 0.005), and lateral heel (AFI p = 0.017; ASI p = 0.019). Additionally, the ASI reduced pressure-time integral at the big toe (p = 0.015) compared with the without-insole. Conclusion: These findings demonstrate that during running in patients with SCF, plantar pressures are concentrated in the forefoot and heel compared to the normal arch. The personalized orthotic insoles can be used to effectively redistribute plantar pressure in patients with SCF running. Incorporating a forefoot wedge to specifically address the biomechanical abnormalities associated with SCF may enhance the effectiveness of orthopedic insoles.

Dynamic Foot Pressure During Walking: A Potential Indicator of Bone Mineral Density.

Physical skeletal loading can affect the bone mineral density (BMD). This study investigated the association between BMD and dynamic foot pressure during gait. A total of 104 patients (mean age, 62.6 ± 12.4 years; 23 male and 81 female) who underwent dual x-ray absorptiometry and pedobarography were included. BMD values of the lumbar spine, femoral neck, and total femur were assessed. The mean and maximum pressures were measured at the hallux, lesser toes, 1st metatarsal head, 2nd and 3rd metatarsal heads, 4th and 5th metatarsal heads, midfoot, medial heel, and lateral heel. Multivariable regression analysis was performed to identify factors significantly associated with BMD. The lumbar spine BMD was significantly associated with the mean pressure at the 4th and 5th metatarsal heads (p = 0.041, adjusted R 2 of model = 0.081). The femoral neck BMD was significantly associated with the maximum pressure at the 2nd and 3rd metatarsal heads (p = 0.002, adjusted R 2 = 0.213). The total femoral BMD also showed a significant association with the maximum pressure at the 2nd and 3rd metatarsal heads (p = 0.003, adjusted R 2 = 0.360). Foot plantar pressure during gait was significantly associated with BMD, and could potentially be used to predict the presence of osteoporosis. Prognostic Level III . See Instructions for Authors for a complete description of levels of evidence.

Evaluation of therapeutic benefits of botulinum toxin for foot dystonia associated with Parkinson's disease

BackgroundFoot dystonia occurs in patients with Parkinson's disease (PD) and leads to pain, malformation, and difficulty with walking. Botulinum toxin injections may be effective for foot dystonia, but the extent of improvement and effects on motor function are unclear. MethodsIn this study, we performed botulinum toxin injections for foot dystonia in 25 patients with PD. At 3 weeks and 3 months post-infection, we assessed changes in plantar pressure distribution utilizing the Pressure Plate system; dystonia using the Modified Ashworth Spasm score; pain using the visual analog scale (VAS) score; and lower extremity function using the Calf-raise Senior (CRS) test, Timed Up and Go (TUG) test, and gait parameters (eg, stride length, step length). ResultsWe found improved Modified Ashworth Spasm score (p < 0.01) and VAS score (p < 0.01) post-injection. CRS test score (3 weeks, p = 0.006; 3 months, p = 0.068), stride length (3 weeks, p = 0.012; 3 months, p = 0.715), and step length (3 weeks, p = 0.011; 3 months, p = 0.803) also improved. Plantar pressure distribution improved after botulinum toxin injection (metatarsal 1, 3 weeks, p = 0.031; 3 months, p = 0.144; metatarsal 2, 3 weeks, p = 0.049; 3 months, p = 0.065; metatarsal 3, 3 weeks, p = 0.002; 3 months, p = 0.017; metatarsal 4, 3 weeks, p = 0.017; 3 months, p = 0.144; medial heel, 3 weeks, p = 0.01; 3 months, p = 0.395; lateral heel, 3 weeks, p = 0.035; 3 months, p = 0.109). ConclusionBotulinum toxin injection for foot dystonia in patients with PD can reduce spasms and pain and normalize plantar pressure distribution, which improves balance and lower extremity function.

Combined effect of myofascial release and passive stretching on plantar pressure in individual with hamstring tightness- an experimental study

IntroductionThe lower kinetic chain is known to be affected by hamstring tightness which causes biomechanical alterations. As per the literature, short hamstring might cause prolonged forefoot loading, which can cause higher repeated stress on the plantar fascia. There is evidence supporting the use of various stretching and myofascial release techniques for hamstring tightness, further research is needed to investigate their impact on plantar pressure. Hence the study aims to determine combined effect of myofascial release and passive stretching on plantar pressure in individual with hamstring tightness. MethodsThis was an experimental pre-post study design with 67 randomised screenings from asymptomatic health care science students aged 18 to 25. From this scientific survey, a sample size of 47 students having HMS tightness based on the popliteal angle were recruited using a universal goniometer. An intervention was proposed that included MFR and passive stretching in 3 sessions on alternate days. Plantar pressure of these individuals was noted by using the “Harris and Beath foot printing mat” before and after the intervention. ResultSignificant pressure changes were observed after intervention: great toe of right side (p = 0.001), toes 2 to 5 of right side (p = 0.010) and left side (p = 0.008), first metatarsal of left side (p = 0.010), lateral forefoot of right side (p = 0.019) and left (p = 0.018), medial heel (p = 0.044), and lateral heel of right side (p = 0.025). These values substantiate the enhancement in plantar pressure. ConclusionThe combined effect of Myofascial release and passive stretching in an individual with hamstring tightness resulted in a significant increase in popliteal angle and plantar pressure.

Effects of biofeedback on biomechanical factors associated with chronic ankle instability: a systematic review with meta-analysis

BackgroundBiofeedback may alter the biomechanics of lower extremities in patients with chronic ankle instability (CAI). We aimed to systematically review the literature on the effect of gait-training and biofeedback on biomechanical parameters in individuals with CAI and conduct a meta-analysis.MethodsWe searched four databases including PubMed, Web of Science, Scopus and Embase from their inception through 30th June 2022. The Downs and Black appraisal scale was applied to assess quality of included studies. Two reviewers screened studies to identify those reporting the effect of biofeedback on biomechanical factors associated with CAI. Outcomes of interest were kinetics and kinematics. Two authors separately extracted data from included studies. Data of interest were study design, number of sessions, intervention, tools, outcomes, number, sex, age, height, and body mass of participants.ResultsThirteen studies with a total of 226 participants were included. Biofeedback was capable of shifting center of pressure (COP) and lateral plantar pressure medially and reducing foot inversion, adduction, propulsive vertical ground reaction force (vGRF), ankle joint contact force, peak pressure and pressure time integral in the lateral mid-foot and forefoot. Auditory biofeedback had agreater impact on modifying plantar pressure in individuals with CAI. The meta-analyses revealed that visual biofeedback reduces peak pressure in lateral mid-foot and pressure time integral at lateral and medial heel and pressure increases under the hallux.ConclusionBiofeedback can alter pressure, vGRF, and foot inversion associated with CAI. Auditory biofeedback had greater impact on modifying plantar pressure in individuals with CAI. Further studies are required to assess the prolonged effect and clinical consequences of biofeedback or a combination of feedback on CAI in different age groups. Moreover, developing a low-cost and user-friendly device that can be evaluated in high quality RCTs is important prior to implementing the intervention in the clinical setting to reduce symptoms of CAI.

“Antero-medial load shift” in unilateral plantar heel pain – A cross-sectional exploratory study

Background and purposePlantar foot pressure provides an insightful data in the ankle and foot complex which may aid in the detection of underlying pathology. Since individuals with unilateral plantar heel pain (PHP) tend to develop compensatory loading strategies, this study aimed to observe the foot loading pattern compared to the asymptomatic side and its relationship with the morphological variations in individuals with unilateral PHP. MethodsIt was a prospective cross-sectional study done on 17 participants with unilateral PHP. The calcaneal inclination and calcaneal first metatarsal angles were measured using lateral weight-bearing radiographs for both symptomatic and asymptomatic feet. Static and dynamic plantar foot pressures for both sides were obtained using a “Portable baropodometry platform 0, 5 m Entry Level footscan®. ResultsOn the symptomatic side, the pressure in the lateral heel was reduced by 65% in static and 67% in dynamic measurements, while in the medial heel, it was reduced by 16 % in static and 47 % in dynamic measurements compared to that of the asymptomatic side. There was a transfer of pressure from the hind foot to the forefoot by 44 % in static and 46 % in dynamic measurements resulting in anterior load shift. It was also observed that the prevalence of PHP was higher in the normal arched foot (59%). ConclusionBased on the observations, compared to the asymptomatic side, patients with unilateral plantar heel pain exhibited an anteromedial load shift (AMLS) in their plantar pressures. PHP was reported higher in the foot with normal morphology. Level of evidenceLevel 4.

Effect of orthopedic insoles on spinal deformity and walking in adolescents with idiopathic scoliosis summary.

To observe the effects of scoliosis-specific exercise therapy combined with braces and orthopedic insoles on improved spinal deformity and walking ability in adolescents with idiopathic scoliosis (AIS). From September 2019 to September 2020, 60 outpatient AIS patients were distributed into brace group (n = 30) at random and brace combined orthopedic insole group (n = 30). Both groups underwent brace dryness, and the observation group used scoliosis-specific exercise therapy combined with brace therapy, and on this basis, orthopedic insole intervention was added for 8 h per day for 2 months. At the same time, 20 adolescents of the same age with normal spinal development were recruited as a healthy group. GaitScan instruments were used to collect gait and plantar pressure measurements from study subjects. First, the gait and plantar pressure data of AIS patients and healthy groups were compared horizontally to ascertain the abnormal indicators, and then the spinal deformity and the above abnormal indicators were compared between the brace group and the brace combined orthopedic insole group. The plantar pressure center drift index (CPEI) in the AIS group was higher than that in the healthy group (F = 3.120, P < 0.05), and there were significant differences in the ratio of medial and lateral heel pressure (M/l) and total foot pressure (P < 0.05) between the AIS group and the healthy group, and no noticeable variations were found in the support phase period, walking speed, and proportion of each phase (P > 0.05). After treatment, the Cobb angle was significantly reduced in both the brace group and the brace combined with orthopedic insole group (P < 0.05), and there was no significant difference between the groups (P > 0.05). There were no significant changes in the pressure ratio of CPEI, M/l and bilateral full foot in the brace group (P > 0.05). The CPEI decreased in the brace combined with orthopedic insole group (P < 0.05), and the pressure ratio of M/l and bilateral full foot tended to 1 (P < 0.05), and was better than that in the brace group (P < 0.05). Patients with AIS may have local and worldwide asymmetric changes in plantar pressure distribution. The addition of orthopedic insoles has limited effect on improving scoliosis deformity in patients with AIS, but it can effectively improve the abnormal biomechanics of patients with AIS, so that the patient's force tends to be balanced.

The Subcalcaneal Fat Pad: An Innovative Space for Passage of the Pedicle in Free Flap Reconstruction of Lateral Heel Defects.

Soft-tissue defects of the lateral heel remain a challenge for reconstructive surgeons. Although a reliable vascular supply for free flap anastomosis is available anteriorly from the anterior tibial vessels and medially from the posterior tibial vessels, the vascular anatomy of the lateral side lacks suitable donor vessels for free flap anastomoses. Although the pedicle can be passed either ventrally beneath the skin or dorsally between the Achilles tendon and calcaneus, these passages are hardly applicable for lateral heel defects. We identified the space between the plantar surface of the calcaneus and the plantar aponeurosis as an innovative approach for reconstruction. Therefore, we propose the subcalcaneal fat pad as an alternative and reliable route for the passage of the flap pedicle to the posterior tibial vessels in free flap reconstruction of soft-tissue defects in the lateral calcaneal region. Consequently, the vascular pedicle can be safely anastomosed to the posterior tibial vessels. This approach provides a new option for recipient vessels in free flap reconstruction.

Effectiveness of Lateral Heel Wedge in Patient Suffering from Knee Osteoarthritis

Effectiveness of Lateral Heel Wedge in Patient Suffering from Knee Osteoarthritis

The Variation Between Unilateral and Bilateral Weight Bearing in Hindfoot Alignment Evaluation: Part II: A Prospective In Vivo Kinematic and Plantar Pressure Study

Category: Hindfoot; Midfoot/Forefoot Introduction/Purpose: When AP, lateral, and hindfoot views weight bearing XR's were taken, patients were frequently asked to stand on the foot being examined with the other foot lifted off the floor. However, we have found that alignments of the hind and midfoot during unilateral standing are different from those when bearing weight on both feet. This study compared the kinematics and plantar pressures between unilateral and bilateral standing positions in a group of asymptomatic volunteers. Methods: Ten participants (20 feet) without symptoms, previous trauma and surgical history in both lower limbs were included. Each participant first stood comfortably on both feet, then lifted the non-examined foot off the floor. Each person switched between the above two positions three times. Kinematic data was collected using an eight-camera Optitrack 3D motion capture system to reflect changes in alignments of the ankle, subtalar, and midtarsal joints. Plantar pressure distribution was assessed using a pressure platform. Paired t-tests were used to compare the metrics between the two standing positions, with statistical significance level set at P &lt; 0.05. Results: From bilateral to unilateral weightbearing, 14 out of 21 kinematic angular parameters showed medium to high level of statistical significance (p=0.001-0.046) reflecting differences in the relative positions of the ankle, subtalar, and midtarsal joints in the two weightbearing positions resulting from pronation of the hindfoot and midfoot; the average plantar pressure change underneath the hallux (0.1616N), toes 2-5 (0.0907N), metatarsals 2-4 (0.2481N, 0.3204N, 0.2649N), midfoot (0.1794N), medial and lateral heel (0.259N, 0.246N) all showed statistically significant increase. There was a significantly higher plantar pressure increase on the medial than the lateral side of the feet. This corresponded to both the kinematic changes, and our findings in another study investigating the alignment change between the positions radiographically. Conclusion: The hindfoot and midfoot are more pronated in unilateral weightbearing than in bilateral weightbearing which may mask the severity of the deformity in a flexible cavovarus foot but increase that in a flexible flatfoot. Modification of the traditionally used unilateral weightbearing position in obtaining clinical radiographs should be considered. Bilateral WBCT scans may be a better alternative, taking advantage of allowing both feet to bearing weight naturally without concerning about one foot blocking the other during the radiographic imaging.

Static and Dynamic Foot Pressure Changes Among Diabetic Patients With and Without Neuropathy: A Comparative Cross-Sectional Study.

Foot ulceration is a frequent diabetic complication with potentially fatal consequences. The pathophysiology of neuropathic ulcers in the diabetic foot is thought to be influenced by abnormal plantar pressures. This study aimed to compare the maximum peak pressures among diabetic patients with and without neuropathy. The secondary aim was to evaluate the effect of glycemic control on pressure changes in both feet. The study used 62 diabetic individuals as participants. BMI was calculated, as well as illness duration, hemoglobin A1c, and the existence of neuropathy. Plantar pressure was measured in static (standing) and dynamic (walking/taking a step on the mat) settings for all patients using the BTS P-Walk system. The plantar pressures (kPa) at the five metatarsal regions, the midfoot region, and the medial and lateral heel regions were measured. We found that the dynamic maximum pressures were significantly higher in patients with diabetic neuropathy (DN) compared to diabetics without neuropathy at the first metatarsal and mid-foot area in both feet (p<0.05). We also found significantly elevated plantar pressure in patients with poor glycemic control under the second metatarsal head in the right foot (p<0.05). Persons with DN have higher maximum plantar pressures compared to diabetics without neuropathy. Patients with poor glycemic control also have a higher maximum pressure.

Direct fixation of posterior malleolus fractures-posterolateral or posteromedial approach?

Ankle fractures involving the posterior malleolus (PM) generally have worse prognosis. There is a trend towards it's direct fixation, yet the exact indications are a subject of debate. The purpose of our study was to present our treatment protocol and to discuss the advantages and limitations of the direct posterolateral and posteromedial approaches. We present a prospective series of 35 ankle fractures involving the PM, operated for a period of 4 years (2018-2022). Direct posterolateral approach was used in 20 ankles, 15 were operated via a posteromedial approach. Clinical and functional assessment was performed according to the criteria of AOFAS. 14 patients received an excellent score, 16 had good and the rest had an average score. The overall score was 85,4 (54-100). The average range of motion was 50° (15°-55°).Eight patients had superficial skin necrosis along the surgical incision. Thirteen patients need their fibular plates removed due to local irritation. Five patients, operated through a posterolateral approach, had lateral heel numbness suggestive of a sural nerve disfunction. PM is important for normal ankle kinematics. When it's direct fixation is considered appropriate, the safest and shortest route is optimal. It is determined by the preoperative CT. The posterolateral approach is more versatile, but lead to more complications in our study.

Biomechanical analysis of running: correlation between main frontal findings and foot and ankle injuries in amateur runners

To correlate the most prevalent ankle and foot injuries in amateur runners with the biomechanical analysis of running, considering the patterns of frontal analysis evaluated in a private orthopedic and physical therapy service. Retrospective analysis of 56 medical records of amateur runners with ankle and foot complaints who underwent biomechanical assessment of running in an Orthopedics and Physical Therapy clinic in 2017 and 2018. Lesions found: Shin splints (26.78%); plantar fasciitis (21.42%); Achilles tendinopathy (21.42%); Tibial Stress Syndrome (8.92%); lower limb stress fractures (5.35%); posterior tibial tendonitis (5.35%); peroneal tendinopathy and ankle sprain (7.14%); talar chondral lesion (1.78%) and Morton’s neuroma (1.78%). The biomechanical analysis showed that the most common findings were valgus knees, with 43 cases (76.78%), followed by pelvic drop and center of mass vertical oscillation, with 40 cases each (71.42%) and hamstring retraction, with 37 cases (66.07%). Among the least prevalent, varus knees and supinated foot stand out, with two cases each (3.57%) and medial or lateral heel whip (5.35%, 3 cases). The most prevalent findings were valgus knee, pelvic drop, center of mass vertical oscillation, and hamstring retraction. Among the least present, stand out the varus knees, the supinated foot and the medial or lateral heel whip.