Limb Injuries Research Articles

Bilateral ankle syndesmosis injury: a rare case report

This report describes a case of bilateral acute ankle syndesmosis injuries in a 15-year-old male basketball player. The patient had a background of previous inversion injuries but no symptoms of chronic pain or instability. The case report illustrates the importance of clinical suspicion when evaluating acute syndesmosis injuries in conjunction with radiographic assessments in primary care. This is the first reported case of such injury in bilateral limbs.

Discovering Key Topics in Emergency Medical Dispatch from Free Text Dispatcher Observations.

The objective of this work was to discover key topics latent in free text dispatcher observations registered during emergency medical calls. We used a total of 1374931 independent retrospective cases from the Valencian emergency medical dispatch service in Spain, from 2014 to 2019. Text fields were preprocessed to reduce vocabulary size and filter noise, removing accent and punctuation marks, along with uninformative and infrequent words. Key topics were inferred from the multinomial probabilities over words conditioned on each topic from a Latent Dirichlet Allocation model, trained following an online mini-batch variational approach. The optimal number of topics was set analyzing the values of a topic coherence measure, based on the normalized pointwise mutual information, across multiple validation K-folds. Our results support the presence of 15 key topics latent in free text dispatcher observations, related with: ambulance request; chest pain and heart attack; respiratory distress; head falls and blows; fever, chills, vomiting and diarrhea; heart failure; syncope; limb injuries; public service body request; thoracic and abdominal pain; stroke and blood pressure abnormalities; pill intake; diabetes; bleeding; consciousness. The discovery of these topics implies the automatic characterization of a huge volume of complex unstructured data containing relevant information linked to emergency medical call incidents. Hence, results from this work could lead to the update of structured emergency triage algorithms to directly include this latent information in the triage process, resulting in a positive impact in patient wellbeing and health services sustainability.

Comparison of Lower Limb Muscle Activation Patterns in Different Foot Structures using Voluntary Response Index: A Study Protocol

Background: Structural foot disorders can widely contribute to lower limb musculoskeletal conditions. Some researchers consider them the origin of overuse injuries in lower limbs. Although their effects on electrical activities of intrinsic and extrinsic foot muscles are well-established, their impact on other lower limb muscle groups are yet to be clarified.
 Objectives: This study aims to identify the activation patterns of lower limb muscle groups in various foot structures.
 Materials and Methods: In this case control study, 45 asymptomatic male and female subjects with different foot structures (pronated, supinated, and normal) will be selected using non-random sampling. The electrical activities of the gluteus medius, vastus lateralis and medialis, biceps femoris, semitendinosus, and lateral and medial gastrocnemius muscles will be examined during a jump-landing task. Voluntary response index, including magnitude and similarity index, will be subsequently calculated.
 Discussion: While several studies have evaluated the activation of lower limb muscles in different foot structures, they have solely focused on foot muscles. In contrast, the present study will assess activation patterns of the global lower limb muscles using the voluntary response index.

Limb specific training magnitude and asymmetry measurement to discriminate between athletes with and without unilateral or bilateral lower limb injury history

ObjectivesThis study investigates the use of tibia-mounted inertial measurement units (IMUs) as an alternative to upper trunk-mounted IMUs for assessing lower limb training magnitudes and asymmetries in Badminton players. DesignCross-Sectional Study. SettingYouth athlete training environment. ParticipantsThirty-three adolescent Badminton players, grouped based on injury history (non-injured = 19, bilateral = 6, unilateral = 8). Main outcome measuresPlayers wore 1 upper trunk-mounted and 2 tibia-mounted IMUs during simulated match-play. Modified vector magnitudes were assessed to identify if the IMUs can discriminate between injury history groups to assess the device location sensitivity, determine to what extent players exhibit movement asymmetry within the sport, and explore if asymmetries exist within groups with injury history. ResultsUpper trunk-mounted IMUs could not distinguish between injury history groups. Statistically significant asymmetries were observed in the non-injured group, however these were below the 10% threshold for clinical asymmetry. No significant asymmetries were observed in the bilaterally injured group, while statistically significant asymmetries were observed in the unilaterally injured group, which were above the 10% threshold for clinical asymmetry. ConclusionThese results suggest that direct limb specific IMU measurement offers a method to suitably assess training magnitudes and asymmetry within a sporting performance, rather than isolated non-sport specific testing.

Реабилитация комбатантов: этический и медицинский подходы

Background:The need for early and effective medical rehabilitation of combatants is determined by a number of social, ethical and demographic factors.The ethical context of the rehabilitation of combatants is associated with the mental reflection of participants in local wars, considered on the model of the Afghan and Chechen wars. At the same time, the researchersnote that the phenomenon is most fully represented in American and European literature on the example of Vietnam War veterans, known in publications as "trauma and memory studies" and requires the development of similar research practices in domestic science. The purpose of the work is to show the possibilities of medical rehabilitation of NWO combatants using exoprostheses in the context of the ethics of care. Materials and methods: To demonstrate the medical and social prospects for the rehabilitation of pathology and injuries of the upper limbs, a review of domestic and foreign sources of open databases was carried out. The calculation of the needs for orthotics of the upper limbs was carried out on the model of Tatarstan and the Volgograd region. The research materials of the Federal Centerfor Support of the Development and Production of Exoprostheses of the Federal State Budgetary Educational Institution of Higher Education VolgGMU of the Ministry of Health of Russia were used in the work.Results:Specialists of the Center for Exoprosthetics of the Volg State Medical University developed a passive exoskeleton of the upper limb "EKZAR-34" for habilitation and rehabilitation of patients with symptoms of upper flaccid paresis. The advantages of the development are complemented by affordability, technical feasibility and wide application possibilities. Currently, on the basis of the Center for Exoprostheses of the VolgGMU, participants in combat operations and non-combatants of the Northern Military District are undergoing rehabilitation using the EXAR-34. The need for orthotics, calculated on the model of Tatarstan and the Volgograd region, demonstrates the continuity of rehabilitation of wartime and peacetime, as a general trend in personalized medicine aimed at the needs of a particular patient.Conclusion:Attention to the problem of rehabilitation should be permanent, reflecting the position of society towards vulnerable groups, based on the ethics of respect and care.

Management of conflict injuries to the upper limb. Part 1: assessment and early surgical care.

Upper limb injuries are common in conflict zones. The functions of the upper limb are impossible to replicate with prosthetic replacement and wherever possible attempts should be made to preserve the limb with further secondary reconstruction aimed at restoration of function. Casualty assessment, haemorrhage control and resuscitation are simultaneously undertaken at the receiving medical facility. Primary surgical management involves decontamination and debridement, skeletal stabilization, restoration of vascularity, compartment fasciotomy where indicated and wound temporization with dressings. Operative findings and interventions should be documented and if evacuation of the casualty is possible, copies should be provided in the medical records to facilitate communication in the chain of care. Secondary procedures are required for further assessment and debridement prior to planning reconstruction and definitive fracture stabilization, nerve repair, wound cover or closure.

Injuries related to taekwondo training - short report based on experiences from Primary School No. 31 with sports championship classes in Bydgoszcz (Poland)

Taekwondo has become a very popular sport in Poland and around the world, and training in this martial art begins with young children. Taekwondo trainings are organized in kindergartens and schools, clubs and master classes are organized in sports schools, and children take part in competitions. Taekwondo, like any martial art, carries a potential risk of injury. According to the literature, lower limb injuries are the most common, as in taekwondo the lower limbs are mainly used. Head and spine injuries as a result of falls are also described. The author emphasizes that despite the injuries described in the literature and the frequency of occurrence defined as about 2.5 - 8%, injuries in the sports school in Bydgoszcz are significantly less frequent. The author also points out that there are also injuries (fractures) of the upper limbs, which are ignored by numerous international publications. Despite this, it should be emphasized that taekwondo is a safe sport discipline. Its prevalence among school children is a favorable phenomenon.

A cranio-encephalic trauma due to electric-scooter accident: could the wearing of a helmet reduce this risk?

Nowadays, one of the most important health and social policy issues concerning all countries is the problem of road accident rates. Traffic is one of the most important risk factors. For this reason, ridesharing companies have been launching electric scooters in Rome since June 2019 with the aim of reducing car traffic. In the absence of relevant legislations, the risk is that of facing an increase in deaths due to electric scooter crashes. We report the case of an electric scooter accident victim with cranio-encephalic trauma associated with limb injuries that caused immediate death. This case report emphasizes how the obligation of using helmets must be extended to all ages, in order to reduce the risk of increasing the number of deaths. Compulsory helmet use can reduce fatalities in all cases where high-speed crashes are not involved.

Modified donor blood flow-preserved cross-leg anterolateral thigh flap procedure for complex lower extremity reconstruction

BackgroundComplex lower limb reconstruction due to severe trauma remains a challenge for reconstructive surgeons. Here, we introduce a modified donor blood flow-preserved cross-leg anterolateral thigh flap procedure and evaluate its clinical efficacy.MethodsBetween January 2013 and December 2019, 22 patients (range 10 to 64 years old) with unilateral lower limb injury underwent modified donor blood flow-preserved cross-leg anterolateral thigh flap procedures. Among them, 16 cases were traffic accidents, 5 cases were persistent ulcers, and 1 case was a degloving injury. The arterial pedicle of the flap was prepared in a Y-shaped fashion and microanastomosed to the posterior tibial artery of intact leg in a flow-through style. A split-thickness skin graft was applied to wrap the vascular pedicle after anastomosis. The flap was designed in a single or bilobed fashion according to the shape of the tissue defect. The operation time, the intraoperative blood loss and the length of hospital stays were recorded. The vascular pedicle was divided 4 weeks after anastomosis. Doppler ultrasound was performed to evaluate the blood flow of the donor posterior tibial artery during postoperative follow-up.ResultsAll 22 flaps survived. The tissue defects ranged from 12 × 6 to 21 × 18 cm2. The flap sizes ranged from 14 × 7.5 to 24 × 21 cm2. The average operation time, intraoperative blood loss and length of hospital stays were 6.73 ± 1.49 h, 280.95 ± 59.25 ml and 30.55 ± 2.52 days, respectively. Eighteen flaps were designed in a single fashion, while four were in bilobed fashion. Twenty patients underwent fasciocutaneous flap transplantations, while two underwent musculocutaneous flap transplantations. Two cases developed local lysis of the flap which healed after further debridement. Direct suture of the incision after flap harvest was performed in 16 cases, while additional full-thickness skin grafting was performed in the remaining 6 cases. Further bone transport procedures were performed in 15 patients who had severe tibia bone defects. The blood flow of donor posterior tibial artery was confirmed in all patients during follow-ups. All patients recovered flap sensation at the final follow-up. The postoperative follow-ups ranged from 18 to 84 months, and no long-term complications were observed.ConclusionsThe modified donor blood flow-preserved cross-leg anterolateral thigh flap procedure is an ideal method to repair severe lower limb trauma with tibial artery occlusion which avoids sacrificing the major artery of the uninjured lower limb.

Traumatic arterial injuries in upper and lower limbs: what every radiologist should know.

Traumatic arterial injuries of the extremities are a rare but potentially fatal event. Computed tomography (CT) angiography of the extremities has become the technique of choice and can provide rapid accurate detection and characterization of vascular lesions. Vascular injuries can be classified in active hemorrhage, vasospasm, occlusion, post-traumatic arteriovenous fistula, pseudoaneurysm, and patterns of intimal injuries. The learning objectives of this pictorial essay are to review the normal arterial anatomy of the upper and lower limbs, describe the technique of CT angiography in vascular trauma of the extremities, describe and illustrate the CT-angiography findings of traumatic arterial injuries, and know the potential pitfalls when interpreting a CT-angiography of the extremities.

Sprained Knee Prophylaxy Using the Star Excursion Balance Test (SEBT)

"Introduction. To control the movement, the brain must process proprioceptive information provided by mechanoreceptors. The role of proprioception in daily activities, physical exercises, were presented, using the SEBT technique and the proprioceptive mechanisms that represent the base of dynamic postural control. Objective. The aim was to highlight the effects of proprioceptive training on lower limb balance in subjects with lower limb injuries but also in healthy subjects, and to evaluate the effectiveness of proprioceptive programs based on postural instability to reduce knee sprains by developing proprioceptive control. These findings indicate the improvement of proprioceptive control which may be a key factor in reducing knee sprain. Methods. The research was performed on 30 subjects, male and female, employees of the Ministry of National Defense, distributed in two experimental groups: G1 and G2. Results. SEBT has become a dynamic test used in clinical trials and research. The results of the research showed validity for SEBT. Conclusions. Knee sprain is a trauma that occurs frequently among athletes. Like athletes, the Ministry of National Defense employees represent a population at high risk of injury or recurrence. Keywords: knee sprain, postural control, neuromuscular control, dynamic balance test. "

Effects of lead leg selection on bilateral landing force-time characteristics: Return to sport testing implications.

We quantified the effect of lead leg selection on landing force-time characteristics during a vertical drop landing (VDL) initiated with a step-off. Plyometric-trained subjects (male: n=8; female: n=5; age =23±3.3years; body mass =74.4±11.2kg) performed 6step-off-initiated VDLs from a 45-cm box (n=3/lead leg). Pooled and lead leg stratified between-limb comparisons of limb-specific initial ground contact timing, peak vertical ground reaction force (Fzpeak ), and early landing-phase impulse (Impulse100ms ) were assessed by a two-factor, within-subject ANOVA, and limb symmetry indexes were calculated (α=0.05). Pooled data showed that the lead leg made contact prior to the trail leg and contributed a greater fraction to Fzpeak compared with the trail leg. Stratifying trials by lead leg selection led to significant between-limb differences in Fzpeak (p<0.05) and Impulse100ms (p<0.01) with the right leg leading but not with the left leg leading. Lead leg selection in step-off-initiated VDLs influenced landing performance and limb symmetry indexes of variables associated with lower limb injury risk, suggesting the need to control for lead leg selection in these tasks. A step-off may not be a suitable technique to initiate landing tasks when assessing limb symmetry.

Sex-disaggregated analysis of the injury patterns, outcome data and trapped status of major trauma patients injured in motor vehicle collisions: a prespecified analysis of the UK trauma registry (TARN)

ObjectivesTo identify the differences between women and men in the probability of entrapment, frequency of injury and outcomes following a motor vehicle collision. Publishing sex-disaggregated data, understanding differential patterns and...

Pulse oximetry for the diagnosis of vascular injury following limb trauma

Prompt diagnosis and intervention are essential for acute limb ischaemia after trauma. Guidelines for diagnosis are changing with new evidence. Pulse oximetry may be a useful adjunct. We aim to assess the value of pulse oximetry and other common tests for diagnosing vascular injury.Electronic medical records of patients with limb injuries were identified. Patient demographics, the mechanism of injury, comorbidities, the results of diagnostic tests or examinations, and the end outcome were extracted. Receiver Operator Characteristics (ROC) curves were used to calculate cut-offs with optimum sensitivity and specificity for pulse oximetry. Performance characteristics to predict vascular injury for all documented tests were calculated and compared.SpO2 values were significantly different in the group with and without vascular disruption (p = 0.034). Using a cut-off of 96% calculated from ROC curve analysis, SpO2 had a sensitivity of 78% and a specificity of 90%. For the other techniques, abnormal pulse oximetry waveform, absent distal pulses, and capillary refill over 2 s were significantly different between the two groups. Abnormal pulse oximetry waveform had the highest specificity (100%) while SpO2 was the most sensitive (78%).We suggest that pulse oximetry is a useful adjunct for patients with limb trauma, an abnormal waveform or SpO2 value below 96% suggests vascular disruption is present. Capillary refill over 2 s and absent distal pulses can also be used; if either are positive, this suggests vascular disruption. No test or examination was shown to be able to exclude vascular injury.

Traumatic Dislocation of the Proximal Tibiofibular Joint: A Systematic Review and 10-year Experience From a Level 1 Trauma Center.

Introduction:Traumatic proximal tibiofibular joint dislocations occur infrequently and are typically the result of high-energy trauma. These injuries can be a marker of limb injury severity because patients often sustain vascular injury and are at high risk of amputation. The purpose of this study was to present a systematic review of traumatic proximal tibiofibular joint dislocations and compare rates of associated injuries with a retrospective series of patients at a level 1 trauma center. The secondary objective was to report rates and clinical predictors of limb amputation.Methods:A systematic review was conducted, identifying three studies meeting eligibility criteria. A retrospective chart review was conducted identifying 17 skeletally mature patients with proximal tibiofibular dislocation treated from January 2010 to February 2021. A chart review extracted patient demographics, fracture patterns, open fracture, preoprative and postoperative peroneal nerve injury, vascular injury, and amputation. Binary logistic regression analysis was used to identify clinical predictors of outcomes.Results:Sixteen of 17 proximal tibiofibular injuries (94.1%) were associated with fracture, most commonly tibial shaft (n = 11, 68.75%). Twelve of 17 fractures (76.5%) were open. Five vascular injuries (29.4%) occurred requiring surgical intervention. Seven (41.2%) preoperative peroneal nerve deficits were noted; six had persistent deficits postoperatively or underwent amputation (average follow-up 31.3 ± 32.6 months). Two patients in the sample without preoperative peroneal nerve deficits were noted to exhibit them after fixation. Eight patients (47%) underwent an amputation, 7 (87.5%) of whom had an open fracture and 4 (50%) of whom had documented vascular injury.Discussion:Traumatic proximal tibiofibular fractures indicate severe injury to the lower extremity with high risk for nerve injury and possible amputation. Patients who present with vascular injury and open fracture in association with proximal tibiofibular joint disruption may be at elevated risk of amputation.

Prevalence of medial tibial stress syndrome [MTSS] in secondary high school sports players

Background: Medial Tibial Stress Syndrome [MTSS] is a lower limb injury related to repetitive overuse of shin muscles. Some known assessment tools for diagnosis of MTSS are manual muscle testing for strength of soleus, tibialis posterior muscle and universal goniometer for ankle – range of motion. Previous studies have also concluded association of foot pronation with MTSS. Objective: The objective of this study was to check prevalence of MTSS in group of secondary high school sports players, to compare if prevalence was more in males or females and check association between foot posture and MTSS. Materials and Method: 60 participants of age group 12- 15 years were selected according to inclusion criteria of which 30 were males and 30 were females. The purpose of study and procedure to be done was explained to participants as well as guardian and informed consent was taken from both. The outcome measures i.e ankle- range of motion, manual muscle testing for soleus and tibialis posterior and Foot posture index were assessed bilaterally. The scores were recorded and hence analyzed. Result: Out of 60 participants 31 were positively diagnosed for MTSS 24 were negative and 5 were excluded. Post assessment we found that prevalence of MTSS was more in males (59.2%) as compared to females (53.5%). Our records resulted that pronatory foot type is notably associated with MTSS. The p value for ankle ROM plantarflexion was 0.075 and for dorsiflexion was 0.58. The p value for soleus strength score was 0.0001 and we observed that strength for tibialis posterior was not significantly reduced.

Injuries in alpine summer sports - types, frequency and prevention: a systematic review

IntroductionSummer alpine sports, including mountain biking, hiking and airborne pursuits, have experienced a recent surge in popularity. Accordingly, trauma associated with these activities has increased. There is a scarcity of literature exploring clinical aspects surrounding injuries. Specifically, no single article provides a general overview, as individual studies tend to focus on one particular sport. In the present study, we performed a systematic literature review to summarize existing knowledge and explore the potential for prevention and clinical decision making in this group.MethodLiterature searches were performed using the PubMed and Scopus database for the most commonly ventured sports associated with injury: mountain biking, climbing, airborne sports, paragliding, and base jumping. From this search, studies were identified for qualitative and quantitative analyses. These searches were done according to PRISMA guidelines for systematic reviews. Studies were then analyzed regarding epidemiology of injuries, relevant anatomical considerations and prevention strategies were discussed.ResultsA broad spectrum of injury sites and mechanisms are seen in mountain biking, climbing or airborne sports. Mountain biking related injuries commonly involve the upper extremity, with fractures of the clavicle being the most common injury, followed by fractures of the hand and wrist. Scaphoid fractures remain of paramount importance in a differential diagnosis, given their often subtle clinical and radiological appearance. Paragliding, skydiving, and base jumping particularly affect transition areas of the spine, such as the thoracolumbar and the spinopelvic regions. Lower limb injuries were seen in equal frequency to spinal injuries. Regarding relative risk, mountain biking has the lowest risk for injuries, followed by climbing and airborne sports. Male alpinists are reported to be more susceptible to injuries than female alpinists. Generally, the literature surrounding hiking and water-related mountain sports is insufficient, and further work is required to elucidate injury mechanisms and effective preventative measures. A helmet seems to decrease the likelihood of face and head injuries in mountain sports and be a meaningful preventive measurement.

Limb salvage vs amputation in crush injury due to high energy injury: A case report

Limb injury possesses significant problems, both for the treating physician and patient. Numerous problems ranging from disability, limb amputation or even death can occur to the patient. However, the definitive therapy is still debated. A 50 years old man came to the emergency room with a chief complaint of an open wound of his right leg because of a traffic accident. Subsequently, the repair, secondary closure, and skeletal traction were done following the exploration and debridement. During the next follow up, the surrounding tissues seemed to be non-viable. Therefore, the surgeon decided to do an operation with a urologist to perform hip disarticulation and scrotum necrotomy. The patient undergoes repeated debridement in operating theatre and also using negative pressure wound therapy (NPWT). After three months from the first admission, the patient's condition started to deteriorate, and unfortunately, the patient died. There are several scoring systems that can be used to help determine the management of high energy lower extremity injuries. The most used is Mangled Extremity Severity Score (MESS), Limb Salvage Index (LSI) and Predictive Salvage Index (PSI) scores. Hospital type will surely determine the facility and personnel availability. If the facility and personnel are sufficient, limb reconstruction should be attempted first. However, in the end, the family's consent after considering the risk of the surgery will determine the chosen surgery to perform. The surgeon in charge should consider the decision with high vigilance regarding the patient's clinical condition. The decision between limb salvage and amputation should consider the long-term effect which influences the patient's quality of life.

Prevalence, frontal plane knee alignment, and lower limb joint pain and injury in generalized joint hypermobility in Thai physical therapy students.

ObjectivesThe primary aim was to study the prevalence of generalized joint hypermobility (GJH) among Thai physical therapy (PT) students. The secondary aims were to compare the lower limb alignments and lower limb joint pain and injury between GJH and non-GJH individuals. Furthermore, the association between GJH, lower limb alignment, and joint pain and injury were also evaluated.Material and methodsGeneralized joint hypermobility was assessed using the Beighton score with a cut-off of 4/9 in 255 PT students. The lower limb alignments measured in the study included pelvic tilt angle, tibiofemoral angle, quadriceps angle (QA), and navicular drop. Tibiofemoral angle and QA were measured with and without quadriceps contraction. The history of lower limb joint pain and injury was recorded with a simple questionnaire. Lastly, logistic regression analysis was used to study the association between GJH, lower limb alignment, and joint pain and injury.ResultsThe prevalence of GJH was 21.18% among the studied population. Quadriceps angle during quadriceps relaxation of the non-dominant leg of the GJH group was the only lower limb alignment found greater than those of the non-GJH group. The rate of lower limb joint pain and injury was not different between the two groups. Furthermore, no significant association between GJH, lower limb alignment, and lower limb joint pain and injury was found.ConclusionsGJH is not uncommon among Thai PT students. Only the non-dominant QA was found different between groups. Generalized joint hypermobility neither increase risk nor is it associated with lower limb joint pain and injury among Thai PT students.

Gait variability between younger and older adults: An equality of variance analysis

BackgroundTo estimate gait variability, several methods have been routinely used which provide a measure of global variability. A recent study introduced a group waveform variability method which provides a point-by-point measurement of data variance equality. This can identify where in the gait cycle the significant differences in variability exist. Research questionDo waveform differences exist in equality of variance and group means in lower limb biomechanical variables between healthy younger and older adults during a gait task? MethodsTwenty healthy younger (19–44 years old, age=29.9(7.0) years, body mass index= 24.6(3.2)kg/m2, females= 10) and 20 healthy older (55–79 years old, age=63.6(5.5) years, body mass index= 25.9(2.7)kg/m2, females= 10) adults who were free from lower limb injuries and had no musculoskeletal or neurological disorders. Temporospatial outcomes, sagittal and frontal lower limb joint angles and moments, along with joint powers were examined as participants walked at a self-selected pace. Waveform patterns were normalized to the gait cycle and compared using equality of variance and statistical parametric mapping techniques. ResultsNo difference in walking speed existed between the younger or older groups (P > .05). The older group had greater variability (P < .05) in sagittal hip angles, as well as greater frontal ankle angle and moment variability. The younger group had significantly greater mean (P < .05) ankle power generation prior to toe-off. SignificanceThis study provided a baseline of temporal differences in variance between healthy younger and older individuals. Its findings warrant the use of the equality of variance test to compare temporal differences for a variety of populations and tasks. Older adults generally had more variability than the younger adults, with many differences occurring near the transition from double- to single-limb support. The statistical parametric mapping analysis showed that the older adults could not generate as much ankle power as the younger adults prior to toe-off.