Left Leg Research Articles

Older adults use fewer muscles to overcome perturbations during a seated locomotor task.

Locomotor perturbations provide insights into the human's response to motor errors. We investigated the differences in motor adaptation and muscle co-contraction between young and older adults during perturbed arms and legs recumbent stepping. We hypothesized that besides prolonged adaptation due to use-dependent learning, older adults would exhibit greater muscle co-contraction than young adults in response to the perturbations. Perturbations were brief increases in resistance applied during each stride at the extension-onset or mid-extension of the left or right leg. Seventeen young adults and eleven older adults completed four 10-minute perturbed stepping tasks. Subjects were instructed to follow a visual pacing cue, step smoothly, and use all their limbs to drive the stepper. Results showed that young and older adults did not decrease their errors with more perturbation experience, and errors did not wash out after perturbations were removed. Interestingly, older adults consistently had smaller motor errors than young adults in response to the perturbations. Older adults used fewer muscles to drive the stepper and had greater co-contraction than young adults. The results suggest that despite similar motor error responses, young and older adults use distinctive muscle recruitment patterns to perform the motor task. Age-related motor strategies help track motor changes across the human lifespan and are a baseline for rehabilitation and performance assessment.

PROSPECTIVE STUDY ON THE EFFECTIVENESS OF PLATELET-RICH PLASMA IN MANAGING CHRONIC PLANTAR FASCIITIS

Objectives: The objectives of this study were as follows: (1) Assess the impact of a single dose of platelet-rich plasma (PRP) injection on visual analog scale (VAS) scores for heel pain. (2) Evaluate the functional outcome scores following PRP treatment for chronic plantar fasciitis. (3) Measure and confirm the restoration of plantar fascia thickness through ultrasound (USG) assessments. (4) Determine the safety and viability of local PRP injection as a treatment option for individuals with chronic plantar fasciitis. Methods: This hospital-based prospective case series, spanning January 2019 to January 2020, enrolled 40 participants aged 25–65 with unilateral, persistent plantar fasciitis resistant to conservative treatment. Exclusion criteria included BMI ≥30, various pathologies, and recent injections. Ethical clearance was obtained, and participants received autologous PRP injections, with ultrasound measuring plantar fascia thickness. Post-injection, patients were monitored for adverse reactions, initiated stretching exercises, and progressed to weight-bearing activities after 6 weeks. Results: The study cohort, averaging 45 years (standard deviation [SD] 7.7), primarily comprised females with the right-foot prevalence. Symptom duration averaged 20 weeks (SD 4.5). Pre-injection VAS scores (6.7±1.2) significantly improved at 6 weeks (2.9±0.6) and 12 weeks (2.0±0.9) post-PRP injection (p<0.001). Plantar fascia thickness reduced from 5.1 mm (SD 0.6) to 4.1 mm (SD 0.5) at 12 weeks (p<0.001) and regular foot thickness: 3.7 mm (SD 0.5). Conclusion: The study reveals that a singular PRP injection brings about substantial and clinically meaningful enhancements in heel pain, functional outcomes, and the restoration of plantar fascia thickness, supported by ultrasound measurements. This underscores local PRP injection as a viable and safe therapeutic choice for those grappling with chronic plantar fasciitis.

Comparison of foot pressure distribution and foot kinematics in undulatory underwater swimming between performance levels

ABSTRACT This study aimed to elucidate the foot kinematics and foot pressure difference characteristics of faster swimmers in undulatory underwater swimming (UUS). In total, eight faster and eight slower swimmers performed UUS in a water flume at a flow velocity set at 80% of the maximal effort swimming velocity. The toe velocity and foot angle of attack were measured using a motion capture system. A total of eight small pressure sensors were attached to the surface of the left foot to calculate the pressure difference between the plantar and dorsal sides of the foot. Differences in the mean values of each variable between the groups were analysed. Compared to the slower swimmers, the faster swimmers exhibited a significantly higher swimming velocity (1.53 ± 0.06 m/s vs. 1.31 ± 0.08 m/s) and a larger mean pressure difference in the phase from the start of the up-kick until the toe moved forward relative to the body (3.88 ± 0.65 kPa vs. 2.66 ± 1.19 kPa). The faster group showed higher toe vertical velocity and toe direction of movement, switching from lateral to medial at the time of generating the larger foot pressure difference in the up-kick, providing insight into the reasons behind the foot kinematics of high UUS performance swimmers.

Case Report: Popliteal artery entrapment syndrome as a cause of deep vein thrombosis and subsequent popliteal artery occlusion

Case Report: Popliteal artery entrapment syndrome as a cause of deep vein thrombosis and subsequent popliteal artery occlusion

Elevated sympathetic-mediated vasoconstriction at rest but intact functional sympatholysis during exercise in heart failure with reduced ejection fraction.

Patients with heart failure with reduced ejection fraction (HFrEF) have exaggerated sympathoexcitation and impaired peripheral vascular conductance. Evidence demonstrating consequent impaired functional sympatholysis is limited in HFrEF. This study aimed to determine the magnitude of reduced limb vascular conductance during sympathoexcitation and whether functional sympatholysis would abolish such reductions in HFrEF. Twenty patients with HFrEF and 22 age-matched controls performed the cold pressor test (left foot 2-min in -0.5[1] °C water) alone (CPT) and with right handgrip exercise (EX+CPT). Right forearm vascular conductance (FVC), forearm blood flow (FBF), and mean arterial pressure (MAP) were measured. Patients with HFrEF had greater decreases in %ΔFVC and %ΔFBF during CPT (both P<0.0001) but not EX+CPT (P=0.449, P=0.199) compared to controls, respectively. %ΔFVC and %ΔFBF decreased from CPT to EX+CPT in patients with HFrEF (both P<0.0001) and controls (P=0.018, P=0.015), respectively. MAP increased during CPT and EX+CPT in both groups (all P<0.0001). MAP was greater in controls compared to patients with HFrEF during EX+CPT (P=0.025) but not CPT (P=0.209). Acute sympathoexcitation caused exaggerated peripheral vasoconstriction and reduced peripheral blood flow in patients with HFrEF. Handgrip exercise abolished sympathoexcitatory-mediated peripheral vasoconstriction and normalized peripheral blood flow in patients with HFrEF. These novel data reveal intact functional sympatholysis in the upper limb and suggest exercise-mediated, local control of blood flow is preserved when cardiac limitations that are cardinal to HFrEF are evaded with dynamic handgrip exercise.

Developing the Physical Performance in Youth Soccer: Short-Term Effect of Dynamic–Ecological versus Traditional Training Approach for Sub-Elite U13 Players—An Ecological Exploratory Cluster Randomised Trial

Currently, research in youth soccer consists of methodological choices that can raise activity volumes and exercise intensity to promote proper training for youth soccer demands. Therefore, the present cluster randomised trial aims to evaluate the effects of the dynamic–ecological approach on the physical performance parameters compared with a traditional one in a group of sub-elite U13 players. Thirty-five male children (age 12.16 ± 0.55 years; weight 45.59 ± 7.15 kg; height 145.5 ± 4.2 cm; BMI 15.8 ± 2.1 kg·m−2) were recruited for this trial from two teams belonging to sub-elite soccer schools and randomly assigned to a dynamic–ecological approach (DEA) or a traditional training (TTG) group. The training program lasted six weeks and consisted of 18 training sessions of 90 min each (3 sessions per week). The sample was evaluated by the standing long jump (SLJ), hop test (HT), 10 m sprint (10 m), 10 × 5 m shuttle run test (SRT), and leg raise test (LR). The DEA group showed significantly higher results in the SLJ (p &lt; 0.001), HT left leg (p &lt; 0.001), 10 m sprint (p &lt; 0.001), and SRT (p &lt; 0.001). In conclusion, the dynamic–ecological approach provides higher performance adaptations. Therefore, this approach can be considered a suitable method to optimise pre-pubertal player training, mainly when no fitness or strength coach is available.

Affine registration of thermal images of plantar feet using convolutional neural networks

The use of a thermal camera to detect abnormal plantar foot temperature changes can be an effective way to identify the early signs of diabetic foot ulceration. In this work, we performed the affine registration of the plantar foot thermal images using four models based on convolutional neural networks. The process include two parts: an affine registration model for estimating transformation parameters and a spatial transformer for getting the registered image. The performances of the four models were evaluated using the Dice similarity coefficient (DSC), Mean Square Error (MSE), and peak signal-to-noise ratio (PSNR). In the first step, Methods were applied to register the left and right feet of the same subject, called “contralateral registration” and in the second step, the methods were evaluated on a pair of images of the same subject taken in two different times (T0 and T10) using a cold stress test protocol. Results showed that the used convolutional neural networks are robust in both types of registration (contralateral and multitemporal), and they are suitable for the targeted application, with the DSC of 95% for contralateral registration and a DSC of 92% for multitemporal registration. Furthermore, a transversal clinical study was perform on diabetic patients, that classified individuals into ischemic and non-ischemic groups. The objective was to analyze the coherence between the thermal results and medical data. The mean absolute point-to-point temperature difference |ΔT| between left and right foot is lower in non-ischemic patients than in those with ischemia, with p<0.05.

Medial Plantar Artery Flap for Soft Tissue Coverage of Heel Defect: A Case Report

Background: Numerous flap options exist for providing soft tissue coverage for defects on the heel region. This study presents a case where a bone-exposed wound on the left heel region was successfully reconstructed using a medial plantar artery flap. Case Report: A 16-year-old girl presented with a necrotic wound on the left heel region with calcaneus, malleolus, and talus fractures following trans-ankle external fixation on her left leg. After debridement and necrotomy, the wound revealed exposed calcaneus and implant. A medial plantar artery flap was dissected, preserving its vascularization. The flap was then carefully transferred to the wounded area and sutured appropriately. A skin graft harvested from the ipsilateral femoral region was used to cover the donor site. Discussion: This case demonstrates the efficacy of the medial plantar artery flap as a local flap option for heel defect coverage. It is a relatively easy-to-perform procedure that provides a strong and thin skin flap. Moreover, it offers a favorable cosmetic outcome for the patient, as the surgical scar can be be relatively easy to hide with footwear. However, limitations of the medial plantar artery flap include its size and depth constraints, as well as loss of vascularization from a medial plantar artery on the plantar region. Conclusion: The medial plantar artery flap is a feasible option as a local flap for the heel region. It is relatively easy to perform, provides a strong thin skin flap, and can results in a preferable cosmetic outcome.

Impact of Sacroiliac Belt Utilization on Balance in Patients with Low Back Pain.

Low back pain (LBP) is a common problem which can affect balance and, in turn, increase fall risk. The aim of this investigation was to evaluate the impact of a Sacroiliac Belt (SB) on balance and stability in patients with LBP. Subjects with LBP and without LBP ("Asymptomatic") were enrolled. Baseline balance was assessed using the Berg Balance Scale. In a counterbalanced crossover design, LBP and Asymptomatic subjects were randomized to one of two groups: 1) start with wearing the SB (Serola Biomechanics, Inc.) followed by not wearing the SB or 2) start without wearing the SB followed by wearing the SB. For subjects in both groups, dynamic balance was then assessed using the Star Excursion Balance Test (SEBT) with each leg planted. Baseline balance was worse in LBP subjects (Berg 51/56) than Asymptomatic subjects (Berg 56/56) (p<0.01). SB significantly improved SEBT performance in LBP subjects regardless of which leg was planted (p<0.01). SB positively impacted Asymptomatic subjects' SEBT performance with the left leg planted (p=0.0002). The Serola Sacroiliac Belt positively impacted dynamic balance for subjects with low back pain. Further research is needed to examine additional interventions and outcomes related to balance in patients with back pain, and to elucidate the mechanisms behind improvements in balance related to sacroiliac belt utilization.

Multibody Model with Foot-Deformation Approach for Estimating Ground Reaction Forces and Moments and Joint Torques during Level Walking through Optical Motion Capture without Optimization Techniques.

The biomechanical-model-based approach with a contact model offers advantages in estimating ground reaction forces (GRFs) and ground reaction moments (GRMs), as it does not rely on the need for training data and gait assumptions. However, this approach faces the challenge of long computational times due to the inclusion of optimization processes. To address this challenge, the present study developed a new optical motion capture (OMC)-based method to estimate GRFs, GRMs, and joint torques without prolonged computational times. The proposed approach performs the estimation process by distributing external forces, as determined by a multibody model, between the left and right feet based on foot deformations, thereby predicting the GRFs and GRMs without relying on optimization techniques. In this study, prediction accuracies during level walking were confirmed by comparing a general analysis using a force plate with the estimation results. The comparison revealed excellent or strong correlations between the prediction and the measurements for all GRFs, GRMs, and lower-limb-joint torques. The proposed method, which provides practical estimation with low computational cost, facilitates efficient biomechanical analysis and rapid feedback of analysis results, contributing to its increased applicability in clinical settings.

Plantar pressure distribution using personalised 3D printed lattice insoles with distributed stiffness

Abstract Abstract This work presents a proof of concept study on the use of additive manufacturing for developing customised lattice topology insoles, with the aim of redistributing plantar pressures. A commercially available shoe was used to compare pressure distribution when used with the original and custom insole. Four cubic lattice structures were applied to five sections of the moulded insole contours using Ansys material designer to predict material properties. The insole lattice structures were made from elastic photosensitive liquid resin resulting in flexible parts. Insole contours were based on 3D foot scans. Plantar pressure distribution and peak pressures were measured during standing, walking, and running. Pressure redistribution varied between insole conditions. During standing, the customised insole reduced pressure at the left heel, while the right foot experienced increased peak pressure compared to the control insole. Substantial peak pressure reduction was observed on the left foot during walking and running whilst the reduction was much less for the right foot. The study highlights the potential of additive manufacturing for cost-effective, accurate, and personalized insole production, offering material control and pressure redistribution benefits for various applications like injury prevention and rehabilitation.&amp;#xD;

Vertical jump performance in athletes with cerebral palsy

The principal difference between an Olympic and a Paralympic sport is the classification structure of the sports in which the athlete competes. The Paralympic Classification System subsidizes such a structure. This study aimed to investigate possible height differences in six vertical jumps in Para athletics athletes with cerebral palsy from classes T35 to T38 to contribute to the Paralympic Classification System. They participated in this study, and forty-one athletes were divided into the experimental group (thirty-five with cerebral palsy T35= 6; T36= 10; T37 = 12; T38 = 7) and the Control Group. The athletes were evaluated using the OptoJump Next equipment (OJ). The protocol sequence of the Vertical Jump battery included squat jump, single left leg one jump, single right leg one jump, both leg seven jumps, single left leg seven jumps, and single right leg seven jumps. We found significant differences between all classes and the control group (p&lt;0.001). This study indicates that the battery of vertical jump tests not only identifies the athletes' eligibility but also helps to allocate different classes of athletes with cerebral palsy. To develop a technical assessment that contributes to implementing evidence to the Classification System of World Paralympic Athletics - WPA. Keywords: Para athletics; evidence-based classification, jump test, and cerebral palsy.

Spontaneous hemorrhage of peripheral neurofibroma in pregnancy: A case report

Introduction: Neurofibromas may grow in pregnancy due to hormonal sensitivity. This report describes a case of spontaneous hemorrhage from a neurofibroma in pregnancy. Case Report: A 27-year-old female with neurofibromatosis (NF1) presented at 30 weeks gestation with shortness of breath. Spontaneous hemorrhage was noted from her left leg neurofibroma. The patient underwent preprocedural fetal surveillance prior to proceeding with surgical debridement. Persistent fetal bradycardia was noted in setting of maternal hypotension with ongoing bleeding. An emergent cesarean delivery was performed and required debridement of the left thigh neurofibroma by the general surgical team. Conclusion: Spontaneous hemorrhage of neurofibromas is a rare, but reported complication. Neurofibromas may increase in size in pregnancy; however, spontaneous hemorrhage has not previously been documented to occur during pregnancy.

Implementation of Bioelectrical Impedance Measuring Instrument Based on Embedded System

The present research aims to measure the segmental bioelectrical impedance (BI) of the human body at multifrequency, using a server user interface-based prototype, which provides subjects with measured data online anywhere accessed by their unique identifications. The present research measures the BI of the human leg and arm at a multifrequency range of 50–400 kHz with a developed and standard device. Recorded data can be transferred to the subject using Wi-Fi technology with their unique identifications and password. The system uses Wi-Fi interfacing for real-time data measurement and online data storage. The prototype can be used commercially. The compact size of the prototype becomes the demand of the common population. The pocket carry size makes it easy to carry anywhere for regular monitoring of the human body to prevent critical disease. The resultant data show that the mean and standard deviation of the left and right leg are 282.2 ± 14.29 and 274.80 ± 13.91 Ω, respectively. Similarly, in the case of the left arm and right arm, the mean and standard deviation are 325.41 ± 16.54 and 320.73 ± 16.07 Ω, respectively. The relative error between developed and standard devices is 3.53%. Results show that the left leg and arm impedance is always greater. However, the right leg and arm muscles are stronger than the left one, with less impedance at all frequencies.

Klippel-Trénaunay Syndrome and Angiokeratoma: Case Report of a Rare Condition

Introduction: Klippel-Trénaunay syndrome is a rare congenital vascular disorder characterized by a triad of cutaneous capillary malformations, varicosities and hypertrophy of soft tissues and overgrowth bones. Among the cutaneous malformations are angiokeratomas, which appear as a papule from 2 to 10 mm in diameter, usually dark red in color, although they may be blue or black, and their surface is keratotic on palpation. Angiokeratomas pose a therapeutic challenge, especially in cases of multiple or extensive lesions. Laser modalities have demonstrated efficacy and may be successful treatment options. Clinical Case: A 13-year-old male patient with a clinical history of Klippel-Trénaunay syndrome diagnosed at birth. He came to the outpatient services because he presented dermal nodular lesions at the inguinal region, painful on palpation, with a duration of one week. In addition, he had an increase in diameter of the left lower limb with multiple varicose veins, ochre dermatitis on the inner side of his left leg. On the right lower limb there are violaceous patches with the presence of euchromic papules grouped together, of hard consistency at the left knee region. He also presents multiple violaceous keratotic papules on the scrotum, thigh and left knee bleeding on manipulation and trauma. Skin excision was performed in the right inguinal region for biopsy, which reported macroscopically fibrous, multinodular element measuring 0.7x0.5x0.3cm, whitish surface of firm consistency and whitish heterogeneous surface upon sectioning. Microscopic inspection was carried out with hematoxylin and eosin technique, which reported skin with epidermis showing acanthosis, hyperkeratosis, papillary dermis with congestive dilated vessels, negative for malignancy and compatible with angiokeratoma. Among the treatment options, it was decided to initiate CO2 laser therapy with satisfactory results. Conclusions: Klippel-Trénaunay syndrome is an extremely rare vascular pathology ........

Reliability and Agreement Assessment of Sarcopenia Diagnosis through Comparison of Bioelectrical Impedance Analysis and Dual-Energy X-ray Absorptiometry.

A unified diagnostic criterion has yet to be established for sarcopenia. Therefore, we analyzed the reliability and validity of sarcopenia diagnosis using bioelectrical impedance analysis (BIA) compared with the gold standard, dual-energy X-ray absorptiometry (DEXA), and evaluated the predictive accuracy of BIA for diagnosis. The clinical trial, involving a total of 239 participants, was conducted between December 2018 and September 2019 on healthy volunteers without significant medical histories. The participants underwent health assessments, followed by sequential DEXA and BIA measurements. In both the low and normal appendicular skeletal muscle (ASM) groups, there were significant differences in the right arm, left arm, right leg, left leg, ASM, and ASM index (ASMI) between DEXA and BIA across all age groups (p < 0.05). BIA tended to overestimate compared to DEXA, but ASMI values for males and females were consistent with the criteria for sarcopenia. Bland-Altman analysis showed that each segment in both the low and normal ASM groups fell within the limits of agreement (LOA). The diagnosis of sarcopenia using BIA was significantly different from that using DEXA. However, it exhibited a significantly high correlation, fell within the LOA, and demonstrated high predictive accuracy. BIA can be considered an effective tool for diagnosing sarcopenia.

A depiction of poliomyelitis in a 17th -century Piedmontese fresco?

A potential representation of poliomyelitis is investigated in an Italian artwork. A 17th century Piedmontese fresco is analyzed by combining historico-medical, palaeopathological and clinical approaches. Alternative diagnoses are considered. The man appearing in the fresco holding a crutch is characterized by an atrophic left leg reminiscent of poliomyelitic atrophic. Other congenital anomalies or cerebrovascular causes appear less likely. A reflection on the difficulty of retrospectively diagnosis poliomyelitis is offered.

Giant pretibial cellular fibrous histiocytoma colliding with an epidermal cyst

Histiocytomas are common benign tumors of the skin. In contrast, giant histiocytomas are a rarity. We report a 43-year-old male patient, who presented with a 7 × 6 cm large firm tumor on his left lower leg. This was a long-standing lesion, but within the last three months, the tumor developed an exophytic nodule. A skin biopsy revealed an atypical spindle-cell tumor. We decided to perform a complete excision with a safety margin. Complete histopathological analysis confirmed the diagnosis of a collision tumor composed of a cellular fibrous histiocytoma and an epidermal cyst. The resulting defect was temporarily closed by vacuum-assisted closure before eventually a meshed split skin graft was transplanted. Proliferating fibrohistiocytic lesions should be surgically removed, and a careful histopathologic analysis is necessary to avoid delayed diagnosis of possible malignant lesions.

Static Plantar Pressure under Different Conditions in Children with Surgically Treated Unilateral Slipped Capital Femoral Epiphysis.

Slipped capital femoral epiphysis (SCFE) is the most common hip disease during infancy and adolescence. Our study aimed to analyze static plantar pressure in children with surgically treated unilateral SCFE. Twenty-two children with right SCFE with in situ fixation with one percutaneous screw were assessed by PoData plantar pressure analysis under three different conditions (open eyes, eyes closed, and head retroflexed). The total foot loading was significantly higher on the unaffected limb compared with the affected one for all the three testing conditions (p < 0.05). When assessing the differences between testing conditions, there were no significant differences for the right and left foot loadings, or for the three sites of weight distribution, except for the right fifth metatarsal head (lower loading in eyes-closed condition in comparison to eyes open, p = 0.0068), left fifth metatarsal head (increased loading in head-retroflexed condition in comparison to eyes open, p = 0.0209), and left heel (lower loading in head-retroflexed condition in comparison to eyes open, p = 0.0293). Even after a successful surgical procedure, differences in foot loading can impact the postural static activities in different conditions (natural eyes-open, eyes-closed, or head-retroflexed posture).

Model characteristics of physical fitness of taekwondo players at the stage of basic training

The purpose of the study was to study the characteristics of physical fitness and develop model characteristics of taekwondo athletes at the stage of basic training. The results. The analysis of the physical fitness of taekwondo athletes showed that the average indicators of physical fitness of taekwondo athletes at the stage of basic training of the 2nd year of training are better than those of athletes of the 1st year from 3.39 to 14.28%. The largest differences between the groups of 14.28% are observed in the pistol test for 30 s on the left leg and 11.56% - swing with the right leg forward for 15 s, and the smallest 3.51% in the 20 m s gait test. Statistically significant differences were established according to the Student's test t=2.25–2.68 at p &lt;0.05, in tests: speed-power index (ratio of jump length to height) t=2.25; left leg swing forward in 15 s, t=2.33; swing with the right leg forward in 15 seconds, t=2.68. The model performance characteristics of flexibility tend to decrease in the range between the ideal and minimum values by 21.75% and 20.92% in the transverse split and longitudinal split tests for the left leg, respectively, but it is found that the indicators for the longitudinal split for the right leg differ by 0.29%