Plantar Flexion Movements Research Articles

Curved carbon plates inside running shoes modified foot and shank angular velocity improving mechanical efficiency at the ankle joint

Recent technologically advanced running shoes have been designed with higher stack height and curved carbon plate-reinforced toe springs to enhance running performance. The purpose of this study was to examine how curved carbon-plate reinforcement modulated mechanical efficiency at the ankle joint during the running stance phase. We prepared two footwear conditions: Non and Carbon, both had a 3D-printed midsole (40-mm heel thickness). A full-length curved carbon plate was inserted along the toe spring in Carbon. The participants included 14 non-rearfoot long-distance athletes. They were required to run at a speed of 12 km/h on a 20-m runway with both shoes. Mechanical-energy expenditure (MEE, indicating mechanical work) and compensation (MEC, indicating mechanical efficiency) were calculated in the following mechanical-energy transfer phases: concentric, eccentric, and no-transfer. Running with Carbon exhibited improved MEC and reduced MEE at the ankle joint during the concentric transfer phase than with Non. The improvement in the concentric MEC at the ankle joint indicates that a larger amount of mechanical energy is transferred from the shank into the foot segment that compensates for the force exerted by the plantar flexor muscles, which implies more mechanically efficient plantarflexion movement. As the ankle joint is the largest energetic contributor in the running stance phase, greater MEC and lower MEE and torque at the ankle joint could improve running performance. Hence, the curved carbon plate may be a key feature of advanced footwear technology.

Evaluation of distal tibia slope in pilon fractures after surgical fixation

IntroductionAlteration of sagittal alignment during fracture fixation directly impacts ankle motion in dorsiflexion and plantarflexion. Previously research measured the anterior distal tibia angle (ADTA) in a normal healthy population. The null hypothesis for this study is that ADTA is restored to normal range following unstable pilon fractures. The aim of this study is to identify the range of the ADTA in distal tibia fractures after surgical fixation, compared to a previously published normal population. Material and MethodsA retrospective review of operative distal tibia fractures (AO/OTA classification 43A and 43C – 43B were excluded due to lower likelihood of fracture changing the ADTA) was performed. ADTA on lateral radiograph was measured as the angle relative to the tibia shaft. Results100 patients with post-operative radiographs that met inclusion criteria were analyzed. The average ADTA was 6.9° (⌠=4.62°) with a maximum slope of 19.2° (i.e. anterior orientation) and a minimum of -3.3° (i.e. posterior orientation). The uninjured population had an average ADTA of 6.0° (range -2.0°-14°, ⌠=3.0°). ConclusionThis analysis shows the average distal tibia sagittal alignment in the post-surgical group is similar to a normal, uninjured population. Large alterations in ADTA would directly impact the ankle in the plane of motion (i.e. negative ADTA would decrease ankle dorsiflexion). Considering ADTA as an objective intra-operative parameter optimizes sagittal plane alignment.

Subacute Influence of Body Cooling on the Perception of Delayed Onset Muscle Pain

Objective: To investigate the subacute influence of the use of body cooling by immersion in cold water on the perception of Delayed Muscle Pain (DOMS), in the posterior leg muscles, 24, 48 and 72 hours after carrying out a three-course muscle fatigue protocol. series of repetitions until concentric failure of the bilateral plantar flexion and dorsiflexion movement. Methods: 22 untrained participants (age: 20.4±1.7 years; body mass: 65.91±15.38kg; height: 166.86±8.47cm) participated in an effort protocol that consisted of three sets of repetitions until concentric failure of the leg muscles, of plantar flexion and bilateral dorsiflexion movement, with one's own body weight. After one minute, through a draw, one of the legs was designated for immersion, up to the height of the popliteal fold, in a vat of ice water (between 12 and 14º C), during three stages of 5 minutes with a 1 minute break between each stage, totaling 15 minutes of immersion. At the same time, the other leg remained in passive recovery, serving as control. After 24, 48 and 72 hours, the individuals were evaluated regarding the perception of DOMS, in both legs, with an analog pressure algometer (pressure of 6kgf/cm²). The perception of pain was signaled by the participants using the Pain Visual Analogue Scale (VAS). Results and conclusions: No statistically significant differences (p<0.05) were found between body cooling and passive recovery, in both groups, in the assessment of perception of DOMS 24, 48 and 72 hours after the exercise protocol.

Effects of flossing technique on ankle mobility and vertical jump performance

ContextFlossing may report benefits on range of motion. However, it's unknown whether flossing using pneumatic tourniquets may influence performance in bilateral countermovement jumping tests. ObjectiveTo analyze the acute effects induced by a flossing protocol with a pneumatic tourniquet placed at the intermalleolar level on jumping ability in basketball players.Study design: cross-sectional study. Methods54 basketball players (mean (SD) 17.16 (1.27) years; 22.23 (1.99) kg/m2) from a professional club were recruited. After a familiarization phase, a pressurized cuff (continuous pressure at 180 mmHg) was placed at the intermalleolar level for 2 min performing plantar and dorsal flexion movements without load. The Leg Motion test and the Countermovement jump were used to measure ankle dorsiflexion and vertical jump height. ResultsAfter the intervention, a significant ankle dorsiflexion improvement was observed in the left leg in males (12.48 (5.08) vs. 13.44 (5.23) cm, p < 0.05) and in both ankles in females (right: 9.59 (3.29) vs. 10.74 (3.34) cm, p < 0.05; left: 9.91 (2.77) vs. 10.96 (2.57) cm, p < 0.05). However, the intervention showed no significant difference in bilateral jumping ability in neither group (p > 0.05). ConclusionsThe application of intermalleolar flossing using pneumatic tourniquet in elite basketball players did not interfere in jumping ability, and it may improve ankle range of motion. These findings may help clinicians make decisions in practice.

A Comparative Study on Gender Differences in the Effects of Self-myofascial Release Using a Foam Roller on Soft Tissue Stiffness and Joint Range of Motion

OBJECTIVES The purpose of this study was to conduct a comparative analysis of gender differences in the acute effects of self-myofascial release (SMFR) using a foam roller on soft tissue stiffness and range of motion (ROM).METHODS Twenty-four participants, comprising 12 men and 12 women, were recruited from the M Exercise Center in Seoul. Soft tissue stiffness and ROM were measured before and after SMFR treatment to assess its acute effects.RESULTS Following SMFR application, no significant differences were observed in soft tissue stiffness or joint ROM among female participants. However, significant differences were observed in the male group regarding the range of motion (ROM) of plantar flexion in the prone position (&lt;i&gt;p&lt;/i&gt;=.023) and dorsiflexion in the supine position (&lt;i&gt;p&lt;/i&gt;=.001), as well as plantar flexion (&lt;i&gt;p&lt;/i&gt;=.023). Covariance analysis comparing gender differences revealed significant variations between groups in the achilles tendon (&lt;i&gt;p&lt;/i&gt;=.033) and medial side of the gastrocnemius muscle (&lt;i&gt;p&lt;/i&gt;=.032). Apart from these findings, no significant differences were observed between genders in soft tissue stiffness and joint ROM.CONCLUSIONS Thus, two sets of 30-second SMFR sessions can be deemed sufficiently effective for increasing ankle joint ROM in males. However, further research is warranted to extend these findings to females. Given the inconclusive results regarding soft tissue stiffness across genders, future studies should explore this phenomenon with larger sample sizes.

Effectiveness comparison of a new hook-shaped anatomical locking plate and conventional anatomical locking plate in treatment of Danis-Weber type A lateral malleolus fractures

To investigate the effectiveness of a new hook-shaped anatomical locking plate in the treatment of Danis-Weber type A lateral malleolus fractures. A retrospective analysis was performed on the clinical data of 45 patients with Danis-Weber type A lateral malleolus fractures who met the selection criteria between November 2020 and November 2022. According to the surgical methods, they were divided into the observation group (treated with the new hook-shaped anatomical locking plate, 23 cases) and the control group (treated with the conventional lateral malleolus anatomical locking plate, 22 cases). There was no significant difference in baseline data such as gender, age, cause of injury, Danis-Weber type of fracture, time from injury to operation, and combined ligament injury between the two groups ( P>0.05). The operation time, partial weight-bearing time, return to work time, and postoperative complications were recorded and compared between the two groups. The function and pain of ankle joint were evaluated by the range of motion of ankle dorsiflexion, plantarflexion, varus, valgus, and visual analogue scale (VAS) score at 1 and 3 months after operation, and at last follow-up, and the American Orthopaedic Foot and Ankle Society (AOFAS) score at 3 months after operation and at last follow-up. All patients were followed up 10-18 months (mean, 15.1 months). There was no significant difference in operation time between the two groups ( P>0.05); the postoperative partial weight-bearing time and return to work time of the observation group were significantly earlier than those of the control group ( P<0.05). During the follow-up, there was 1 case of joint stiffness in the observation group, and 1 case of joint surface displacement, 1 case of joint stiffness, and 1 case of traumatic arthritis in the control group. There was no significant difference in the incidences of complications between the two groups ( P>0.05). With the extension of time after operation, the range of motion of ankle dorsiflexion, plantarflexion, varus, valgus, and VAS score of the two groups gradually improved, and there were significant differences between different time points ( P<0.05); At 1 and 3 months after operation, the above indexes in the observation group were significantly better than those in the control group ( P<0.05), and there was no significant difference between the two groups at last follow-up ( P>0.05). The difference of AOFAS score between the last follow-up and 3 months after operation in the observation group was significantly better than that in the control group ( P<0.05). Compared with the conventional lateral malleolus anatomical locking plate, the new hook-shaped anatomical locking plate has a more reliable fixation effect in the treatment of Danis-Weber type A lateral malleolus fracture, which is conducive to early functional exercise of the ankle joint, so that patients can bear weight earlier and return to work earlier, and the operation time is not significantly prolonged, and the effectiveness is satisfactory.

Development of Physiotherapy Standard Operating Procedures Case of Ankle Sprain in Basketball Players

Physiotherapy is a form of health service aimed at individuals and groups as maintaining and restoring body movement functions throughout life. Ankle Sprain is a stretching or tearing that occurs due to (overstretch) trauma to the lateral ligament complex, due to inversion and plantar flexion movements that occur excessively when the foot is unable to provide perfect support on the floor/ground. A common injury to the ankle is Ankle Sprain, a sports injury that often occurs in volleyball and basketball players. To develop Standard Operating Procedures in performing physiotherapy treatment in chronic Ankle Sprain cases. This study was conducted using the research method of developing physiotherapy operational standards with this ankle sprain injury handling model starting with preliminary studies, history taking, assessment, diagnosis, intervention, and evaluation. The type of research conducted is Quantitative research using quasi experimental methods with pretest-posttest control group design. Experimental and control groups conducted an initial test. Both groups received different treatments, where the experimental group received thrust manipulation intervention and the control group received non thrust intervention in the form of myofascial release. There was a significant reduction in pain after manipulation therapy with the thrust and nonthrust methods on two groups were measured using the Numeric Rating Scale and after being evaluated for two weeks the pain did not increase. The provision of thrust and nonthrust manipulation therapy measures is highly recommended for the treatment of ankle pain. However, between the two methods there has not been. However, there is no significant difference between the two methods given the limited time of the study.

Discrepancies Between Intraoperative and Postoperative Ankle Motion Measured for Anterior-Approach Total Ankle Arthroplasty.

Although intraoperative ankle motion serves as a foundational reference for anticipated motion after surgery and guides the addition of procedures to enhance ankle motion in total ankle arthroplasty (TAA), the relationship between intraoperative and postoperative ankle motion remains unclear. This study aimed to investigate the discrepancy between intraoperative and postoperative ankle range of motion (ROM) following TAAs using the anterior-approach, fixed-bearing systems. This study retrospectively reviewed 67 patients (67 ankles) who underwent primary TAA at a single institution. Three different types of anterior-approach, fixed-bearing TAA systems were included. Intraoperative fluoroscopy was used to document the maximal dorsiflexion and plantar flexion at the end of the case. Standardized weightbearing maximum dorsiflexion and plantar flexion sagittal radiographs were obtained pre- and postoperatively, following a previously described method. The motion between 3 different time points (preoperative, intraoperative, and postoperative [mean 11.4 months]) was compared using pairwise t tests, and their differences were quantified. The mean total tibiotalar ROM was 38.1 degrees (SD 7.8) intraoperatively, and the postoperative total tibiotalar ROM was 24.2 degrees (SD 9.7) (P < .001), indicating that a mean of 65.3% (SD 26.7) of the intraoperative motion was maintained postoperatively. Intraoperative dorsiflexion (mean 11.6 [SD 4.5] degrees) showed no evidence of difference from postoperative dorsiflexion (mean 11.4 [SD 5.8] degrees, P > .99), indicating that a median of 95.6% (interquartile range: 66.2-112) of the intraoperative maximum dorsiflexion was maintained postoperatively. However, there was a significant difference between intraoperative plantarflexion (mean 26.4 [SD 6.3]) and postoperative plantarflexion (12.8 [SD 6.9] degrees, P < .001), indicating a mean 50.6% (SD 29.6) of intraoperative motion maintained in the postoperative assessment. There was an improvement of 2.5 degrees in the total tibiotalar ROM following TAA with statistical significance (P < .043). This study revealed a significant difference between intraoperative ankle ROM and ankle ROM approximately 1 year after anterior-approach, fixed-bearing TAA, mainly due to plantarflexion motion restriction. Minimal difference in dorsiflexion suggests the importance of achieving the desired postoperative dorsiflexion motion during the surgery using the best possible adjunct procedures. Level IV, case series.

Comparison of Knot-Tying Techniques During the Arthroscopic Broström-Gould Procedure: Semiconstrained Freehand Versus Knot Pusher Techniques.

The arthroscopic Broström technique with or without Gould modification has been used to treat patients with anterior talofibular ligament injury who failed nonoperative management and progressed to chronic lateral ankle instability. However, some patients develop limited range of motion over the ankle joint postoperatively. To compare the clinical outcomes and midterm functional performance of knot-tying techniques between using a knot pusher and a semiconstrained freehand tie during arthroscopic Broström-Gould procedure with inferior extensor retinaculum (IER) augmentation. It was hypothesized that the semiconstrained freehand tie would provide better plantarflexion of the ankle joint compared with the knot pusher. Cohort study; Level of evidence, 3. Included were 135 consecutive patients with mild-to-moderate lateral ankle instability (mean age, 42.7 years; range, 16-78 years) who underwent an arthroscopic Broström-Gould procedure from March 1, 2016, to April 30, 2022. The patients were divided into 2 groups according to the tying technique used in the Gould modification: surgical tie using a knot pusher (KP group; n = 30) or a semiconstrained freehand tie (FT group; n = 105). Radiographic parameters and ultrasound dynamic testing were examined during the preoperative assessment. Preoperative and 2-year postoperative assessments comprised American Orthopaedic Foot and Ankle Society Ankle-Hindfoot Scale, visual analog scale for pain, and 12-Item Short Form Survey (SF-12) scores. The 2 groups had no differences in age, sex, or severity distribution in the preoperative assessment. American Orthopaedic Foot and Ankle Society Ankle-Hindfoot Scale, visual analog scale pain, and SF-12 scores were significantly better at the postoperative evaluation (all P < .05) in both groups. No significant difference was noted between groups in outcome scores. In the KP group, however, 7 out of 30 patients (23.3%) developed ankle stiffness with tightness when performing plantarflexion movement. No patients in the FT group reported similar symptoms. For mild-to-moderate chronic lateral ankle instability, we propose an arthroscopic Broström procedure with the addition of IER augmentation using a semiconstrained freehand tie to avoid overtightening the IER. This ensures favorable patient satisfaction and clinical outcomes without limitation of plantarflexion of the ankle joint and avoids the possible complication of stiffness with plantarflexion.

The NewGait Rehabilitative Device Corrects Gait Deviations in Individuals With Foot Drop.

The purpose of this quasiexperimental study was to test the effects of wearing the NewGait rehabilitative device on walking abilities in individuals with foot drop. The study involved 16 participants with foot drops caused by stroke (11 participants), multiple sclerosis (one participant), and peripheral neuropathies (four individuals). During a single testing session, participants walked 12 m at their self-selected speed in four experimental conditions: walking without any orthotic device; walking while wearing a regular plastic posterior leaf ankle foot orthosis (AFO); walking with the NewGait device assisting ankle dorsiflexion only; and walking with the NewGait device assisting the hip, knee, and ankle joint motions. Body motions during walking were recorded using a 3D system for motion analysis and analyzed with a set of spatiotemporal and kinematic parameters and a gait decomposition index. The gait decomposition index indicated sagittal interjoint coordination in the three joint pairs (hip-knee, knee-ankle, and hip-ankle) of the paretic (foot drop) leg during walking and was validated in a previous study. Overall, wearing all three orthotic devices improved the gait velocity, ankle dorsiflexion, and foot clearance compared to gait trials in which no assistive devices were used. However, wearing the AFO significantly restricted the plantarflexion range of motion and decreased interjoint coordination as measured by joint decomposition. In contrast, the NewGait device altered the ankle plantarflexion motions but also increased coordinated movement (reduced the decomposition) in most lower-extremity joint pairs and conditions. Therefore, the NewGait rehabilitative device can be considered superior to a regular AFO in correcting gait deviations caused by foot drop.

Muscle fiber strain rates in the lower leg during ankle dorsi-/plantarflexion exercise.

Static quantitative magnetic resonance imaging (MRI) provides readouts of structural changes in diseased muscle, but current approaches lack the ability to fully explain the loss of contractile function. Muscle contractile function can be assessed using various techniques including phase-contrast MRI (PC-MRI), where strain rates are quantified. However, current two-dimensional implementations are limited in capturing the complex motion of contracting muscle in the context of its three-dimensional (3D) fiber architecture. The MR acquisitions (chemical shift-encoded water-fat separation scan, spin echo-echoplanar imaging with diffusion weighting, and two time-resolved 3D PC-MRI) wereperformed at 3 T. PC-MRI acquisitions and performed with and without load at 7.5% of the maximum voluntary dorsiflexion contraction force. Acquisitions (3 T, chemical shift-encoded water-fat separation scan, spin echo-echo planar imaging with diffusion weighting, and two time-resolved 3D PC-MRI) were performed with and without load at 7.5% of the maximum voluntary dorsiflexion contraction force. Strain rates and diffusion tensors were calculated and combined to obtain strain rates along and perpendicular to the muscle fibers in seven lower leg muscles during the dynamic dorsi-/plantarflexion movement cycle. To evaluate strain rates along the proximodistal muscle axis, muscles were divided into five equal segments. t-tests were used to test if cyclic strain rate patterns (amplitude > 0) were present along and perpendicular to the muscle fibers. The effects of proximal-distal location and load were evaluated using repeated measures ANOVAs. Cyclic temporal strain rate patterns along and perpendicular to the fiber were found in all muscles involved in dorsi-/plantarflexion movement (p < 0.0017). Strain rates along and perpendicular to the fiber were heterogeneously distributed over the length of most muscles (p < 0.003). Additional loading reduced strain rates of the extensor digitorum longus and gastrocnemius lateralis muscle (p < 0.001). In conclusion, the lower leg muscles involved in cyclic dorsi-/plantarflexion exercise showed cyclic fiber strain rate patterns with amplitudes that varied between muscles and between the proximodistal segments within the majority of muscles.

Acute effect of open and closed kinetic chain training on lower limb muscle strength in young adults

Among training prescription variations for improving muscle strength, we can highlight open kinetic chain (OKC) and closed kinetic chain (CKC) exercises. The aim of this study was to investigate the acute effect of OKC and CKC exercises on lower limb muscle strength in young adults. Subjects were invited to participate in an acute training consisting of three OKC exercises and three CKC exercises and performed three sets of ten repetitions. To evaluate the torque and muscle power, an isokinetic dynamometer and a force platform were used. The analyzed variables were: peak of torque, time to peak torque, mean power and average power. Univariate analyses were used to compare the performance of participants in OKC and CKC exercises in torque and power tests. Peak torque was higher in the extensor and plantar flexion movements than knee and ankle joints, respectively. When comparing OKC and CKC exercises, OKC exercises produced a higher peak of torque and mean power in all the joints than CKC. We concluded that OKC exercises can be used for improving strength in young adults.

Characterization of Motor Performance in 200 Normal Ankles Through Isokinetic Evaluation

Category: Ankle; Sports Introduction/Purpose: The isokinetic test has been used diffusely as a way to evaluate the functional results after the rehabilitation of musculoskeletal injuries. In the ankle, in particular, most studies are related to lateral ligament injuries and Achilles tendon’s injuries. However, different protocols are used and a lack of normative values is observed in the literature. The aim of this work is to perform a global isokinetic evaluation on healthy ankles in order to propose reference values for future patients. Methods: We evaluated 100 participants (200 ankles) using the Biodex 3 System for the eversion, inversion, dorsiflexion and plantar flexion movements of the ankle. The sample consisted of individuals aged 20-60 years, with an active life and practice of recreational physical activity (non-athlete) and without previous injuries. Five repetitions for strength (N / m) and work (J) at a speed of 30º / sec and 10 repetitions for power (W) at a speed of 120º / sec were performed in our protocol. Agonist / antagonist ratio and the Muscle Deficiency Index, which globally assesses the balance between the sides for each movement, were also evaluated, as well as the demographic variables. Different statistical analyzes were performed for each parameter. Results: The mean age was 38.5 years and BMI 25.8 in 69 men and 31 women. In 78 participants, the dominant ankle was the right one. The non-dominant side was consistently stronger in all movements (p &lt; 0.001). The mean values obtained for force in each movement were 29.9N/m for eversion, 34.8N/m for inversion, 48.6N/m for dorsiflexion and 140.2 N/m for plantar flexion. Such parameters for men and women were also obtained (p &lt; 0.001) and there was no correlation between age or BMI with the maximum torque through Spearman's Correlation. The ratio of eversors/inverters was 88.8% and that of dorsiflexors/plantar flexors was 36.1%. The Muscle Deficiency Index showed a balance between the sides for each movement, with an average global difference of less than 10% between them. Conclusion: As far as we know, this is the largest isokinetic assessment of normal ankles ever performed. The sample, although not stratified, was considered homogeneous (coefficient of variation &lt; 50%), which allows to propose several normative values for a non-athlete population in the isokinetic evaluation. It would be interesting to compare these data in the future with the functional results in patients after the treatment of certain injuries.

Kinematic Gait Analysis in People with Mild-Disability Multiple Sclerosis Using Statistical Parametric Mapping: A Cross-Sectional Study.

Multiple sclerosis (MS) is a chronic autoimmune disease that affects the central nervous system. Gait abnormalities, such as altered joint kinematics, are common in people with MS (pwMS). Traditional clinical gait assessments may not detect subtle kinematic alterations, but advances in motion capture technology and analysis methods, such as statistical parametric mapping (SPM), offer more detailed assessments. The aim of this study was to compare the lower-limb joint kinematics during gait between pwMS and healthy controls using SPM analysis. Methods: A cross-sectional study was conducted involving pwMS and healthy controls. A three-dimensional motion capture system was used to obtain the kinematic parameters of the more affected lower limb (MALL) and less affected lower limb (LALL), which were compared using the SPM analysis. Results: The study included 10 pwMS with mild disability (EDSS ≤ 3) and 10 healthy controls. The results showed no differences in spatiotemporal parameters. However, significant differences were observed in the kinematics of the lower-limb joints using SPM. In pwMS, compared to healthy controls, there was a higher anterior pelvis tilt (MALL, p = 0.047), reduced pelvis elevation (MALL, p = 0.024; LALL, p = 0.044), reduced pelvis descent (MALL, p = 0.033; LALL, p = 0.022), reduced hip extension during pre-swing (MALL, p = 0.049), increased hip flexion during terminal swing (MALL, p = 0.046), reduced knee flexion (MALL, p = 0.04; LALL, p < 0.001), and reduced range of motion in ankle plantarflexion (MALL, p = 0.048). Conclusions: pwMS with mild disability exhibit specific kinematic abnormalities during gait. SPM analysis can detect alterations in the kinematic parameters of gait in pwMS with mild disability.

Midterm Results of AAA Ankle Arthroplasty.

Outcome reports for Alpha Ankle Arthroplasty (AAA), a third-generation implant relying on a mobile bearing design for total ankle replacement, are sparse. This retrospective study evaluated the midterm survivorship, clinical, and radiologic outcomes after implantation of this implant. For 64 patients who received 65 Triple A ankle implants between 2009 and 2020, implant survival was calculated using the Kaplan-Meier curve. Clinical outcomes were evaluated by measuring the range of motion, stability, Western Ontario and McMaster Universities Osteoarthritis Questionnaire score (WOMAC), and American Orthopaedic Foot & Ankle Society ankle-hindfoot score (AOFAS). The average pain level and satisfaction with the postoperative result were rated on a numeric rating scale (0-10). Additionally, radiologic analysis was performed using anteroposterior and lateral radiographs and tibiotalar alignment was assessed. The implant-survival rate was 61.5% at a mean follow-up of 8.2 years. Twenty-five patients (38.5%) required revision surgery (average time to revision, 3.1 years, 95% CI 2.1-4.1 years). For patients without revisions, the average range of motion in dorsiflexion and plantarflexion were 3.6 ± 4.2 degrees and 21.9 ± 7.8 degrees, respectively. The mean WOMAC and AOFAS scores were 44.7 ± 47.5 and 75.1 ± 14.0, respectively. The average pain and subjective satisfaction scores were 2.0 ± 1.7 and 8.5 ± 1.9, respectively. Mean alignment values did not differ significantly for patients who required revision surgery. We found a high revision rate with use of the AAA. However, patients who did not require revision surgery had, on average, high satisfaction and good functional outcomes. Level IV, case series.

Time-to-Surgery and Short-Term Outcomes of Trimalleolar Ankle Fracture During the COVID-19 Pandemic.

Introduction During the coronavirus disease 2019 (COVID-19) pandemic, a rapid and significant transformation in patient management occurred across the healthcare system in order to mitigate the spread of the disease and address resource constraints. Numerous surgical cases were either postponed or canceled, permitting only the most critical and emergent cases to proceed. The impact of these modifications on patient outcomes remains uncertain.The purpose of this study was to compare time-to-surgery and outcomes of open reduction and internal fixation for trimalleolar ankle fractures during the pandemic to a pre-pandemic group.We hypothesized that the pandemic group would have a prolonged time-to-surgery and worse outcomes compared to the pre-pandemic cohort. Materials and methods This retrospective cohort study was conducted within a single healthcare system, examining the treatment of trimalleolar ankle fractures during two distinct periods: April to July 2020 (COVID-19 group) and January to December 2018 (2018 group). Cases were identified usingCurrent Procedural Terminologycode 27822. Information on demographics, fracture characteristics, and outcomes was obtained through chart review. Outcomes analyzed included time-to-surgery, mean visual analog scale scores, ankle strength and range of motion, and complications. Results COVID-19 and 2018 groups consisted of 32 and 100 patients, respectively. No significant difference was observed in group demographics and comorbidities (p > 0.05). Fracture characteristics were similar between groups apart from tibiofibular syndesmosis injury, 62.5% (20/32) in COVID-19 vs 42.0% (42/100) in 2018 (p = 0.03). Time-to-surgery was not significantly different between the two groups (8.84 ± 6.78 days in COVID-19 vs 8.61 ± 6.02 days in 2018, p = 0.85). Mean visual analog scale scores, ankle strength, and ankle range of motion in plantarflexion were not significantly different between the two groups at three and six months postoperatively (p > 0.05). Dorsiflexion was significantly higher in the COVID-19 group at three months (p = 0.03), but not six months (p = 0.94) postoperatively.No significant difference in postoperative complication was seen between groups, 25.0% (8/32) COVID-19 group compared to 15.0% (15/100) 2018 group (p = 0.11). Conclusions Patients who underwent surgery during the early months of the COVID-19 pandemic did not experience prolonged time-to-surgery and had similar outcomes compared to patients treated prior to the pandemic.

Evaluation of Robotic Ankle-Foot Orthosis with Different Actuators Using Simscape Multibody for Foot-Drop Patients

Gait cycle plays a major role in human locomotion. Patients with neuromuscular problems are unable to walk normally. Foot drop causes difficulty in lifting the front part of the foot and affects the dorsiflexion (DF) and plantar flexion (PF) motion of the foot. Patient with foot drop must use ankle braces to achieve a normal gait. The existing ankle-foot orthosis (AFO) has its own limitations, as it does not produce adequate PF motion. To overcome this scenario, a study was conducted to analyse the two-degrees-of-freedom (DOF) motion of a robotic ankle foot orthosis (RAFO) with a spring-based series elastic actuator (SEA) and scissor actuator. The objective of this paper is to evaluate the two DOF of RAFO with two different actuators using simscape multibody. The RAFO with actuators were designed using Solidworks, and simulation was carried out using simscape multibody, to analyse the 2-DOF motion. The dynamic motion analysis was carried out using block libraries, bodies, joints, constraints, revolute joints, sensors and a proportional integral (PI) controller. From the simulation results, the total range of motion (ROM) 40° (PF angle of –25° and DF angle of 15°) is achieved by the proposed RAFO with different actuators. Further, based on the results, the input power consumption of spring-based SEA was found to be less than the scissor actuator. Similarly, torque and output power generation of the scissor actuator was found to be greater than spring-based SEA to achieve the normal human ROM. Hence, the designer can choose a hybrid actuator for foot-drop-disorder applications.

Analysis of Biomechanical Variables Based on the Imbalance of Ankle Muscle Strength in Ballet Dancers

PURPOSE The purpose of this study is to analyze the biomechanical variables involved in ballet dancers’ ankle muscle imbalance when performing relevé movements.METHODS The subjects of this study (n=14, age: 22.29±1.73 years old, height: 161.4±5.06cm, weight: 51.88±7.51kg) were 14 ballet dancers with 9 years of experience. Based on the reciprocal muscle strength ratio, the dancers were divided into the following groups: Close to the normal value (RMIS) and far from the normal value (RMIB) using the maximum values o f plantar flexion and dorsiflexion of the ankle joint using an isokinetic measurement equipment (60°/sec). RMIB). The biomechanical variables, namely the ankle joint movement and ground reaction force, were subsequently measured. SPSS 26.0 was used for data analysis and independent t-test was used for statistical verification. RESULTS The ground reaction force in the Z (vertical) direction based on the ankle joint muscle strength imbalance of ballet dancers was significantly lower in the RMIB group. In addition, although it was not a statistically significant difference, the plantar flexion movement was lower in the RMIB group, and there was a significant difference in the generation of ankle joint movement in the Z direction.CONCLUSIONS In conclusion, in order for a ballet dancer to efficiently utilize the force generated from the supporting leg when performing a movement, ankle imbalance must be taken into consideration when training.

A User-Friendly Nonmotorized Device for Ankle Rehabilitation

The ankle is formed by several joints, and it is the union of the lower leg with the foot. Its main function is to perform dorsiflexion and plantar flexion movements. Many people are affected by ankle problems. These problems can be due to simple factors, but they can also be a sign of a more serious impairment that can lead to the need for ankle rehabilitation. Thus, this paper presents a novel, fairly simple nonmotorized device for ankle rehabilitation. The design of the novel device is based on the crank–rocker mechanism, activated by the patient’s upper limb, allowing the execution of the ankle flexion range. The dimensions of the device were found using a differential evolution algorithm considering the ankle movement limits, the link stress, and singularity configurations. Graphic simulations were performed to validate the mathematical model. A prototype was constructed, and the angular ankle movement was verified. The device is easy to operate and low-cost, and in the future, it may be a tool for ankle rehabilitation.

AVALIAÇÃO DOS MOVIMENTOS DO TORNOZELO NA PLATAFORMA DE INVERSÃO SÚBITA

ABSTRACT Introduction: Ankle sprains are frequent in sports activities and can lead to joint instability with clinical and performance consequences. Sudden ankle inversion platforms have been used to study the mechanism of ankle sprain. Objectives: To test a static platform that simulates the movement of ankle sprain (sudden inversion) in soccer players. Methods: A platform was developed to perform the sudden movement of an ankle sprain dissociated in three axes: inversion, plantar flexion, and medial rotation. A computer program was also created to read the angular velocity and the time to reach the maximum amplitude of the three axes of movement, synchronized with the platform movements. Thirty soccer players without ankle sprains were evaluated on the sudden inversion platform. Each athlete performed 10 randomly initiated tests, with five per leg. Results: There was no statistical difference in angular velocity or time to reach maximum range of motion of plantar flexion and medial rotation between the tests. During the tests, the angular velocity of the inversion increased. Conclusion: The sudden static platform evaluated the movements performed by the ankle during the sprain reliably in the 10 tests with no difference in the mechanical behavior. Level of evidence I; Therapeutic studies - Investigation of treatment outcomes.