Left Leg Research Articles

Isolated Cleft Foot: A Case Report and Review of Literature

AbstractCleft foot is a rare congenital anomaly (syndromic/isolated). Although there have been published reports about this anomaly, none has so far described standardized treatment guidelines. In this case report, we describe the details of operative management of an isolated cleft foot in an 8-year-old girl with a brief review of literature, keeping in mind the aims of the treatment, governed by the local culture and preferred footwear design in the Indian scenario.

Arthroscopic-assisted uni-portal ligament flavum sparing bone anchoring annular suture technique for lumbar disc herniation: A case report and literature review.

Lumbar disc herniation (LDH) manifests in diverse forms. If the nucleus pulposus or endplate tissues protrudes, the location of annular tears also varies, which poses various challenges for the annular suture technique. Tears at the annular attachment area at the edge of the vertebral body (cephalad or caudad) are considered a prohibitively challenging area for annular suturing. A 37-year-old woman presented with a gradual onset of symptoms, experiencing leg pain and numbness over the left leg for 1 year before presentation. The pain radiated to the left S1 dermatome. Despite undergoing continuous medical therapy for more than 6 months, her symptoms showed no improvement. The strength of the left plantar flexion in the ankle and great toe was rated at 4 out of 5. The straight leg-raising and strengthening tests were positive for the left sides. Lumbar computed tomography and magnetic resonance imaging revealed left-sided disc herniation at the L5-S1 level, and nerve root compression, confirming the diagnosis of LDH. The preoperative impression was LDH, intraoperative confirmation of a tear in the annular attachment area at the vertebral body edge. This patient was treated with an arthroscopic-assisted uniportal spinal surgery (AUSS) technique focusing on ligament flavum (LF) preservation, protruding nucleus pulposus removal, nerve root decompression, and vertebral edge tear was then sutured using a bone anchoring annular suture with the Smile suture device. This technique was performed successfully in a patient with LDH. Significant improvements were observed in postoperative pain and numbness, Visual Analog Scale, and Japanese Orthopaedic Association scores. No postoperative instability or complications were observed, with computed tomography and magnetic resonance imaging confirming complete decompression. To the best of our knowledge, this is the first used AUSS with LF preservation and bone anchoring annular suture technique for LDH. This case study demonstrates the AUSS combined with LF preservation and the bone anchoring annular suture technique provides favorable clinical and imaging outcomes and is a safe and effective technique for the treatment of LDH.

Complex trauma sequelae: Mycobacterium goodii and Priestia endophytica Hardware infection in a patient with Ehlers-Danlos syndrome

A 26-year-old man with Ehlers-Danlos syndrome, recurrent otitis externa, and chronic otitis media sustained a left lower extremity amputation and open femur fracture with internal hardware fixation after a motor vehicle collision in Arizona. He presented to the emergency department at our institution with severe left leg pain and purulent discharge despite receiving two unidentified antibiotics upon discharge. Evaluations revealed an abscess and malunion of the femur. Initial cultures yielded scant Priestia endophytica, leading to daptomycin treatment. His condition worsened until Gram-positive bacilli identified as Mycobacterium goodii, a rare nosocomial mycobacterial species, were found. Significant improvement occurred with appropriate antibiotics. This case highlights the challenges in diagnosing and managing M. goodii infections in immunocompromised patients with orthopedic complications and notes P. endophytica as a previously unreported, possibly opportunistic human pathogen.

A two-headed accessory muscle on the sole of the foot

Anatomical variations include the absence of a muscle or tendon or its presence as an accessory muscle or tendon. Clinically, anatomic variations play an important role in diagnosis and theraphy. In anatomy dissection laboratory, during routine dissection for educational purposes, a 83 -year- old male cadaver was dissected and a two-headed accessory muscle was observed on the plantar surface of the left foot. The medial and lateral heads of the muscle were observed close to the medial and lateral plantar neurovascular bundles. The accessory muscle was pierced by the tendon of the flexor digitorum longus muscle and both muscles were inserted to the distal phalanx of the fifth toe. The variations of the accessory muscles should be taken into consideration in surgical interventions, since, they may change the course of the intervention or as in the case of abductor hallucis muscle, they may be used in reconstructive procedures as grafts. Therefore, it is crucial for surgeons, orthopedic physicians, and anatomists to have a detailed knowledge of the intrinsic muscles of the foot.22-07-2024

A painful massive cyanotic edema of the left leg

A painful massive cyanotic edema of the left leg

A Unique Positioning of Saphenofemoral Junction: A Case Report and Literature Review

Introduction The saphenofemoral junction (SFJ) serves as a proximal link joining the superficial and deep veins in the lower limbs. Its anatomical position is typically 2.5 cm inferior and 4 cm lateral to the pubic tubercle. This study reports an exceptional case wherein the SFJ was found in the lower thigh. Case presentation A 24-year-old male presented with left leg pain and swelling for five years duration. Clinically, the left lower limb showed noticeable varicose veins. The duplex ultrasound showed several enlarged varicose veins, primarily around the knee. However, the SFJ was observed roughly 15 cm below the pubic tubercle, with a reflux lasting more than four seconds. The patient declined all therapy modalities, and regrettably, he was lost to further follow-up. Literature review No prior reports were found in the literature describing such an abnormal positioning of the SFJ approximately 15 cm below the pubic tubercle. Conclusion In conclusion, while the lower limb veins have various anatomical variations, locating the SFJ in the mid-third of the thigh is rare and has not been documented in the literature.

Early onset primary torsion dystonia with DYT1 positive in an 8-Year-old child: a case report

Apart from tremor, primary clinical symptom of primary torsion dystonia (PTD) is dystonia. No history or evidence of neuronal degeneration or acquired origin are present. Out of the seven different loci reported for PTD, only two genes have been identified. This case is being presented with a diagnosis of PTD. The patient, an 8-year-old boy from non-consanguineous parents, had problem in walking for one year, mostly in his left leg and had trouble using his left hand to pick up objects. He had dystonia in the left upper and lower limbs, had intact sensory function with intact cranial nerve function. All his laboratory tests were normal including brain imaging; nevertheless, genetic testing revealed DYT1 was positive. BIRDEM Med J 2024; 14(3): 158-160

Correlation between common iliac vein geometry and the risk of deep vein thrombosis in patients with May-Thurner syndrome.

May-Thurner syndrome (MTS) is a continuous pathological change of the left common iliac vein intraluminal wall due to compression between the right common iliac artery and a lumbar vertebra, with clinical signs of compromised venous drainage of the left leg, which eventually leads to development of left-sided deep vein thrombosis (DVT). To analyze the correlation between iliac vessel geometry and probability of DVT in patients with MTS. This study consists of two age-matched female groups: DVT (n = 21) and control (n = 28). Iliac vein geometry, including left common iliac vein (LCIV) diameter, percentage of stenosis, angle between LCIV and right common iliac vein (RCIV), tilt angle of each CIV with horizontal line, and crossing angle between right common iliac artery (RCIA) and LCIV, were measured on computed tomography venography (CTV) images. The probability of DVT development was assessed using logistic regression. Comparing the DVT and control groups, the mean LCIV diameter was 2.4 mm and 3.7 mm (P = 0.001), and mean LCIV stenosis was 77.7% and 68.3% (P = 0.001), respectively. After age-adjustment, the odds of left DVT in patients with MTS correlated with LCIV diameter (odds ratio [OR]=0.25, P < 0.001, 95% confidence interval [CI]=0.11-0.54), LCIV stenosis (%) (OR=1.12, P = 0.003, 95% CI=1.04-1.21), LCIV tilt angle (OR=0.95, P < 0.038, 95% CI=0.91-0.99), and angle between two CIVs (OR=1.04, P < 0.039, 95% CI=1.00-1.09). LCIV diameter and percentage of stenosis, LCIV tilt angle, and CIV angle were independent risk factors for the development of DVT in patients with MTS.

Diagnosis of Shin Splint: A Case Report

A 28-year-old woman presented with left leg pain, persisting for five months. The pain, localized to the anterior compartment of the leg, is exacerbated with activity. Examination revealed tenderness over the muscle bulk adjacent to the anterior tibial crest. Lower limb radiography was unremarkable, but a bone scan confirmed the diagnosis of shin splint (medial tibial stress syndrome). Despite various treatment modalities, including conservative measures and surgical fasciotomy, no treatment has shown clear superiority over others. Extracorporeal shock wave therapy (ESWT) demonstrated promising results; however, the quality of supporting studies was limited. This case highlights the challenges in managing shin splints and underscores the need for further research to determine the most effective treatment options.

The Management of Congenital Idiopathic Clubfoot Deformity: An Observational Study

Background: Club feet are a frequent birth defect, and congenital club foot is one of the most prevalent. Patients with this condition are often treated with surgery. A congenital club foot is a complicated joint malformation that may take many different forms. Objective: To observe the management of congenital idiopathic clubfoot deformity. Methodology: This research was conducted between January 2007 and December 2008 at the orthopaedic department of Bangabanghu Sheikh Mujib Medical University in Shahbag, Dhaka. Group-I included 13 patients with 19 feet who had surgery using Mckay's process, and Group-II included 12 patients with 17 feet who underwent surgery using Turco's technique, for a total of 25 patients with 36 feet. There was complete observance of all ethical norms. Medical history, physical exams, and specific tests all pointed to a positive diagnosis. Two groups then had surgery, one through the Turco incision and the other via the Cincinnati one. SPSS (Statistical Package for the Social Science) was used for the statistical analysis. Results: The next most common age range was between 12 and 17 years old. McKay's method had a success rate of 23.07%, whereas Turco's method achieved a success rate of 25.0%. There were around 75% males and 25% females in the Turco group. There were more men than women in McKay's group (61.53% vs. 38.46%). Four patients included their right foot (21.05%), three their left foot (15.80%), and six their both feet (63.15%) during McKay surgery. Of McKay's patients who had the treatment, just 10.54 percent had negative results, while the remaining 89.46 percent performed well. Conclusion: Everyone agrees that a congenital clubfoot abnormality should be surgically corrected. Bias was not a possibility. It may be advantageous for our people if this prospective research evaluating the results of the Turco and McKay surgical procedures for treating congenital clubfoot is completed.

Calcific Myonecrosis of the Leg: A Clinical and Diagnostic Dilemma

Background: Calcific myonecrosis (CMN) is a rare condition, often considered to be a late sequela of antecedent trauma. Case Report: We describe here our experience in managing a 56-year-old male referred with a painless swelling on the lateral aspect of the left lower leg with a suspicion of a tumour. Results: Clinical and imaging features were classic of CMN. Conclusion: Clinical assessment, role of ultrasound scan in reaching a diagnosis and the management are highlighted.

Interlimb coordination is not strictly controlled during walking

In human walking, the left and right legs move alternately, half a stride out of phase with each other. Although various parameters, such as stride frequency and length, vary with walking speed, the antiphase relationship remains unchanged. In contrast, during walking in left-right asymmetric situations, the relative phase shifts from the antiphase condition to compensate for the asymmetry. Interlimb coordination is important for adaptive walking and we expect that interlimb coordination is strictly controlled during walking. However, the control mechanism remains unclear. In the present study, we derived a quantity that models the control of interlimb coordination during walking using two coupled oscillators based on the phase reduction theory and Bayesian inference method. The results were not what we expected. Specifically, we found that the relative phase is not actively controlled until the deviation from the antiphase condition exceeds a certain threshold. In other words, the control of interlimb coordination has a dead zone like that in the case of the steering wheel of an automobile. It is conjectured that such forgoing of control enhances energy efficiency and maneuverability. Our discovery of the dead zone in the control of interlimb coordination provides useful insight for understanding gait control in humans.

Utilizing Additive Manufacturing for Economical Prosthetic Limb Prototyping: A Guide from Regression Modelling

This study investigated the development of a low-cost prosthetic limb using additive manufacturing techniques, guided by anthropometric data and regression modeling. Anthropometric measurements were collected from 250 healthy young adults to characterize limb dimensions. Statistical analysis revealed the mean, standard deviation, and range for right and left leg and elbow lengths. A regression model was formulated to estimate limb lengths based on these measurements. A robust regression model demonstrated a significant correlation (r = 0.993, r² = 0.986) between right limb measurements and corresponding left limb measurements, indicating that right leg and elbow lengths could accurately predict left side measurements. The derived regression equation (RLL = 2.253 + 0.959 LLL + 0.054 LEL) provides a practical tool for designing customized prosthetics. Utilizing 3D printing technology, these findings can enhance the production of tailored prosthetic limbs, improving comfort and functionality for users. The study recommends further validation across diverse populations, integration into clinical practices, and continued research and development supported by policy and funding initiatives. These steps will advance the accessibility and effectiveness of personalized prosthetic solutions.

Gait pathology presented with developmental dysplasia of the hip: a control case study

A well-known and long-term complication of developmental dysplasia of the hip (DDH) is improper gait pattern, early regressive joint disorder, and permanent pain. It can affect the family's psychological, social, and functional parts. This study planned to resolve foot posture and gait analysis across patients with developmental hip dysplasia and correlate it with the control group. Case-control studies determine the main results. We correlated the gait analysis results on the Zebris FDM platform. The case included candidates with DDH under conservative treatment with an abduction brace and a control group with healthy participants. This study was conducted at King Abdullah Specialized Children Hospital, Riyadh, in the Kingdom of Saudi Arabia. This research enclosed 445 outcomes with DDH and 168 for the control category. The Sign test presented a significant diversity in Zebris FDM outcomes between DDH and the control group, especially in left foot external rotation with a p-value of 0.01 (left hip mean of 4.53, n=445, SD 8.78). A significant variation was present in step width, stance phase on both legs, single support, load response, swing phase, pre-swing, and a double support p-value of 0.00 (p&lt;0.05). W-sitting was preferred in 256 (n=445, 58%) of the DDH results and by 61 (n=168, 36%) from the control group. This study's outcomes presented a greater risk of pronation on the left foot and gait alteration on the right lower limb. The gait investigation presented a clear description of its patterns in paediatrics with DDH. Analyzing the gait among the DDH and the control group demonstrated a variation in each gait outcome from Zebris FDM platform software. DDH has a negative response on the gait pattern and foot posture, this is a great consequence presented in connection with Saudi applicants. Keywords: FDM, DDH, gait, control group, Kingdom of Saudi Arabia

Case Report: Soft tissue infection with Burkholderia thailandensis capsular variant: case report from the Lao PDR

Background Burkholderia thailandensis is an environmental bacteria closely related to Burkholderia pseudomallei that rarely causes infection in humans. Some environmental isolates have shown to express a capsular polysaccharide known as B. thailandensis capsular variant (BTCV), but human infection has not previously been reported. Although B. thailandednisis has been identified in environmental samples in Laos before, there have not been any human cases reported. Case A 44-year-old man presented to a district hospital in Laos with a short history of fever and pain in his left foot. Physical examination identified a deep soft-tissue abscess in his left foot and an elevated white blood count. A deep pus sample was taken and melioidosis was suspected from preliminary laboratory tests. The patient was initially started on cloxacillin, ceftriaxone and metronidazole, and was then changed to ceftazidime treatment following local melioidosis treatment guidelines. Laboratory methods A deep pus sample was sent to Mahosot Hospital microbiology laboratory where a mixed infection was identified including Burkholderia sp. Conventional identification tests and API 20NE were inconclusive, and the B. pseudomallei-specific latex agglutination was positive. The isolate then underwent a Burkholderia species specific PCR which identified the isolate as B. thailandensis. The isolate was sent for sequencing on the Illumina NovaSeq 6000 system and multi-locus sequence typing analysis identified the isolate had the same sequence type (ST696) as B. thailandensis E555, a strain which expresses a B. pseudomallei-like capsular polysaccharide. Conclusion This is the first report of human infection with B. thailandensis in Laos, and the first report of any human infection with the B. thailandensis capsular variant. Due to the potential for laboratory tests to incorrectly identify this bacteria, staff in endemic areas for B. thailandensis and B. pseudomallei should be aware and ensure that appropriate confirmatory methods are used to differentiate between the species.

PSXIII-5 Behavior and blood urea nitrogen in cattle grazing meadow bromegrass and supplemented with condensed and hydrolizable tannins

Abstract The nutritional value of grasslands declines as the season progresses, negatively impacting cattle nutrition. Protein supplementation may reverse this trend, although high rates of ruminal proteolysis reduce the efficiency of N utilization. Tannins decrease protein degradability in the rumen, although they are also plant defenses with potential to influence animal behavior. The objective of this study was to determine in protein-supplemented cows grazing meadow bromegrass (MB) the influence of tannins on blood urea nitrogen (BUN), and on behavioral levels of activity. Twenty-four Black Angus cow [body weight (BW) = 614 ± 20 kg]-calf (BW = 244 ± 4 Kg) pairs were allotted to six 9-acre paddocks (4 pairs/paddock); animals in the Control (Ctrl; n = 3) and Tannin treatments (TT; n = 3) grazed meadow bromegrass (MB) and had a supplement of dried distillers grains with solubles (DDGS; (1 kgּ cow-1ּ d-1), with the addition of a mix of condensed (2/3): hydrolizable tannins(1/3; SilvaTeam) at 0.4% of the diet for TT. Grazing occurred from July to September 2023 with four experimental periods of 15 d each, the first being the adaptation period (no tannins; Baseline). Data were analyzed as a mixed-effects model with repeated measures and paddock as the experimental unit. Cows were fitted with accelerometers on their left back leg to determine activity, and blood samples were collected from all animals at the end of each period to estimate BUN. Representative samples of grass and supplement were collected from each period and paddock and analyzed for CP and fiber content. Herbage availability (DM basis) in each paddock was assessed before and post-grazing during each period using a rising plate meter and calibration curves. neutral detergent fiber (NDF) (62.9 to 65.1 ± 0.5%) and and acid detergent fiber (ADF) (38.7 to 43.9 ± 0.3%) increased, whereas CP (6.8 to 3.9 ± 0.1%) declined from Period 1 to 4 (P &amp;lt; 0.05). Initial biomass was 5,272 ± 211 Kg/ha and it declined after grazing (Period 4) to 2,319 ± 94 Kg/ha (P &amp;lt; 0.05) with no differences between treatments (P &amp;gt; 0.05). No differences between treatments were observed on motion index, number of steps taken per day, and the proportional percentage of time cows spent standing (9,379 ± 740, 2,611 ± 300, and 54.9 ± 0.02%, respectively; P &amp;gt; 0.05), suggesting that cows in TT did not invest extra time in searching activities or resting relative to Ctrl. It was only detected a greater percentage of transitions from lying to standing in TT than in Ctrl (7 to 3.4 ± 0.003%; P &amp;lt; 0.001). Values for BUN did not differ between treatments (P &amp;gt; 0.05), although they declined from Baseline to Period 4 by 28 % (8.2 to 5.9 ± 0.2mg/dL) in TT and by 2.6 % (5.75 to 5.6 ± 0.01 mg/dL) in Ctrl (P &amp;lt; 0.05). These results suggest that the addition of low levels of tannins to a protein supplement in cows grazing a low-quality grass diet reduces ruminal proteolysis without adversely influencing biomass removal or animals’ levels of activity.

Gait planning and adjustment for a hexapod walking robot with one leg failure

ABSTRACT Gait adjusting is an effective way to solve leg failure problems and is also the foundation of intelligent self-adjustment. This paper takes a hexagonal type of robot as a prototype and proposes a ‘2-2-1’ gait grouping and gait sequence for the one leg failure case based on the ‘4 + 2’ gait. The longitudinal stability margin is used to evaluate the FLF-A and FLF-B gaits with left front leg failure and FLM-A and FLM-B gait with left middle leg failure. The foothold positions are adjusted by changing the median angle of the stance phase of the body-coxa joint in each leg in order to make sure the centre of gravity is in a stable support polygon. The experiments of the robot walking show that the FLF-A gait and the FLM-B gait are more stable than the FLF-B and FLM-A after adjustment. The pitch and roll angles are maintained within − 3° to 3°, which verify the effectiveness of the stance phase leg median position adjustment strategy. This study could be used to do forward pre-adjustment in the case of one leg failure.

No effects of four weeks of combined brace and Schroth therapy in moderate adolescent idiopathic scoliosis on plantar pressure distribution

BackgroundPositive effects of brace treatments in adolescent idiopathic scoliosis patients on gait were proven.AimTherefore, this study examined whether the influence of brace therapy in combination with Schroth therapy influencing the plantar pressure distribution, pre and post intensive rehabilitative inpatient treatment.DesignProspective cohort study, longitudinal.SettingScoliosis rehabilitation clinic “Asklepios Katharina-Schroth-Klinik” (Bad Sobernheim, Germany).PopulationTwenty (14f/6m) patients (12–16 years) had a medically diagnosed moderate idiopathic scoliosis (Cobb angle 20–50°, Median 30°) and an indication for combined brace and Schroth therapy with an inpatient stay (4 weeks) at the Asklepios Katharina Schroth Clinic (Germany).MethodsAt the beginning (T1) and at the end of the stay (T2), the plantar pressure distribution with (A) and without wearing a brace (B) was recorded (walking distance 10 m).ResultsNo significant differences between the left and right foot were found at baseline (T1). The T1 - T2 comparison of one foot revealed significant differences (p ≤ 0.05 − 0.001, respectively) for (A): mean pressure right midfoot, loaded area total left foot, left midfoot, left inner ball of foot, right midfoot, impulse total right foot, right midfoot and for (B): mean pressure right midfoot, right outer ball of foot, loaded area total right foot, right heel, right midfoot, impulse right heel, right midfoot, right outer ball of foot.ConclusionsA combined brace and Schroth therapy maintains the initial symmetrical plantar pressure distribution over the duration of four weeks since the significant differences fall within the range of measurement error.Clinical rehabilitation impactThe insole measuring system can be used to objectively support therapeutic gait training as part of rehabilitation and to assess insole fitting based on foot shape. Due to its convenient handling and rapid data acquisition, it may be a suitable method for interim or follow-up diagnostics in the treatment of idiopathic scoliosis.

The Influence of Ankle Mobility and Foot Stability on Jumping Ability and Landing Mechanics: A Cross-Sectional Study.

Practicing physical activities or sports that involve frequent jumping and landing can strain the muscles and joints of the lower limbs, especially in those who do not have adequate physical preparation. The objective of this study was to (a) determine the correlation between ankle range of motion (ROM) and landing stability following jumps; (b) assess the association between the jump height in a counter-movement jump (CMJ) test and ankle ROM; and (c) examine the connection between stabilometry during specific jumps movements present in many sports and in ankle stabilization. Sixty-two healthy amateur volleyball players participated in the study (age: thirty-seven females and twenty-five males; age (years): 16.5 ± 4.25; height (cm): 166 ± 11.4; weight (Kg): 61.6 ± 13.7). Participants were recruited for the study in collaboration with student sports associations. The evaluations encompassed the measurement of ankle joint mobility for both lower limbs using an inertial sensor, a static baropodometric and stabilometric analysis using a pressure platform, and the CMJ test using the Microgate system. After the assessments, participants performed a "specific jump landing task". Significant correlations were found between foot range of motion (ROM) and counter-movement jump (CMJ) performance. Specifically, the ROM of the right foot had a strong correlation with the CMJ (r = 0.81, p < 0.001), while the left foot ROM showed a moderate correlation (r = 0.46, p < 0.001). The specific jump task revealed substantial changes in stabilometry parameters, particularly during forward hops compared to lateral jumps. Dorsiflexion ROM significantly impacts jumping ability. Evaluating landing patterns and stabilometry during targeted activities can help optimize training, improve dynamic balance, and reduce ankle injury risk.

IoT-Based Wireless System for Gait Kinetics Monitoring in Multi-Device Therapeutic Interventions.

This study presents an IoT-based gait analysis system employing insole pressure sensors to assess gait kinetics. The system integrates piezoresistive sensors within a left foot insole, with data acquisition managed using an ESP32 board that communicates via Wi-Fi through an MQTT IoT framework. In this initial protocol study, we conducted a comparative analysis using the Zeno system, supported by PKMAS as the gold standard, to explore the correlation and agreement of data obtained from the insole system. Four volunteers (two males and two females, aged 24-28, without gait disorders) participated by walking along a 10 m Zeno system path, equipped with pressure sensors, while wearing the insole system. Vertical ground reaction force (vGRF) data were collected over four gait cycles. The preliminary results indicated a strong positive correlation (r = 0.87) between the insole and the reference system measurements. A Bland-Altman analysis further demonstrated a mean difference of approximately (0.011) between the two systems, suggesting a minimal yet significant bias. These findings suggest that piezoresistive sensors may offer a promising and cost-effective solution for gait disorder assessment and monitoring. However, operational factors such as high temperatures and sensor placement within the footwear can introduce noise or unwanted signal activation. The communication framework proved functional and reliable during this protocol, with plans for future expansion to multi-device applications. It is important to note that additional validation studies with larger sample sizes are required to confirm the system's reliability and robustness for clinical and research applications.