Ankle Plantar Flexion Research Articles

Walking with unilateral ankle-foot unloading: a comparative biomechanical analysis of three assistive devices

BackgroundFoot and ankle unloading is essential in various clinical contexts, including ulcers, tendon ruptures, and fractures. Choosing the right assistive device is crucial for functionality and recovery. Yet, research on the impact of devices beyond crutches, particularly ankle-foot orthoses (AFOs) designed to unload the ankle and foot, is limited. This study investigates the effects of three types of devices—forearm crutches, knee crutch, and AFO—on biomechanical, metabolic, and subjective parameters during walking with unilateral ankle-foot unloading.MethodsTwenty healthy participants walked at a self-selected speed in four conditions: unassisted able-bodied gait, and using three unloading devices, namely forearm crutches, iWalk knee crutch, and ZeroG AFO. Comprehensive measurements, including motion capture, force plates, and metabolic system, were used to assess various spatiotemporal, kinematic, kinetic, and metabolic parameters. Additionally, participants provided subjective feedback through questionnaires. The conditions were compared using a within-subject crossover study design with repeated measures ANOVA.ResultsSignificant differences were found between the three devices and able-bodied gait. Among the devices, ZeroG exhibited significantly faster walking speed and lower metabolic cost. For the weight-bearing leg, ZeroG exhibited the shortest stance phase, lowest braking forces, and hip and knee angles most similar to normal gait. However, ankle plantarflexion after push-off using ZeroG was most different from normal gait. IWalk and crutches caused significantly larger center-of-mass mediolateral and vertical fluctuations, respectively. Participants rated the ZeroG as the most stable, but more participants complained it caused excessive pressure and pain. Crutches were rated with the highest perceived exertion and lowest comfort, whereas no significant differences between ZeroG and iWalk were found for these parameters.ConclusionsSignificant differences among the devices were identified across all measurements, aligning with previous studies for crutches and iWalk. ZeroG demonstrated favorable performance in most aspects, highlighting the potential of AFOs in enhancing gait rehabilitation when unloading is necessary. However, poor comfort and atypical sound-side ankle kinematics were evident with ZeroG. These findings can assist clinicians in making educated decisions about prescribing ankle-foot unloading devices and guide the design of improved devices that overcome the limitations of existing solutions.

GAIT DISORDERS IN THE ELDERLY AND THE RISK OF FALLS

Falls are the leading cause of injury in people over 65 in the United States. In 2018, 27.5% of seniors over age 65 reported at least one fall in the past year and 10.2% had injuries after a fall in the past year. One feature of walking that has been used to identify people who are at risk for falling is gait unsteadiness. An unsteady gait pattern will be characterized with greater kinematics variability. Decreasing variability of walking patterns may help to prevent falls by achieving a more stable gait pattern, thus improving the control of the whole-body position and by reducing the mediolateral momentum of the centre of mass. Walking more slowly, with a higher STF and shorter STL, may help to stabilize the gait pattern and allow greater adjustment and flexibility to changes in walking conditions (increasing or decreasing walking speed), especially in patients with history of falls. Compared with the elderly with no history of falls, elderly people who are at risk for falls will have the following characteristics of gait: decreased ankle plantar flexion and hip extension during push-off, increased hip flexion during the swing phase, reduced mediolateral sway and decreased reaction time. Key words: elderly falls, gait analysis.

Beyond Contractures in Spinal Muscular Atrophy: Identifying Lower-Limb Joint Hypermobility.

Background: The natural history of spinal muscular atrophy (SMA) is well understood, with progressive muscle weakness resulting in declines in function. The development of contractures is common and negatively impacts function. Clinically, joint hypermobility (JH) is observed but is poorly described, and its relationship with function is unknown. Methods: Lower-limb ROM (range of motion) assessments of extension and flexion at the hip, knee, and ankle were performed. ROMs exceeding the published norms were included in the analysis. The functional assessments performed included the six-minute walk test (6 MWT) and the Hammersmith Functional Motor Scale-Expanded (HFMSE). Results: Of the 143 participants, 86% (n = 123) had at least one ROM measure that was hypermobile, and 22% (n = 32) had three or more. The HFMSE scores were inversely correlated with hip extension JH (r = -0.60, p = 0.21; n = 6) and positively correlated with knee flexion JH (r = 0.24, p = 0.02, n = 89). There was a moderate, inverse relationship between the 6 MWT distance and ankle plantar flexion JH (r = -0.73, p = 0.002; n = 15). Conclusions: JH was identified in nearly all participants in at least one joint in this study. Hip extension, knee flexion and ankle plantar flexion JH was associated with function. A further understanding of the trajectory of lower-limb joint ROM is needed to improve future rehabilitation strategies.

No sign of weakness: a systematic review and meta-analysis of hip and calf muscle strength after anterior cruciate ligament injury

ObjectiveWe aimed to determine hip and lower-leg muscle strength in people after ACL injury compared with an uninjured control group (between people) and the uninjured contralateral limb (between limbs).DesignSystematic review...

Biomechanics of sit-to-stand with dual tasks in older adults with and without mild cognitive impairment

BackgroundThe decline in cognitive function in older adults with mild cognitive impairment (MCI) may contribute to a change in movement pattern during sit-to-stand transitions (STS). However, when comparing older adults with MCI to older adults without MCI, there is a lack of evidence of kinematic and kinetic data during STS. Furthermore, while significant cognitive dual-task interference has been demonstrated in older adults with MCI, studies on the effects of dual motor tasks in MCI, particularly during STS, have not been reported. Research questionAre there any differences in the movement time, joint angles, and maximum joint moments while performing STS under single- and dual-task conditions in older adults with and without MCI? MethodsIn a cross-sectional study, 70 participants were divided into two groups: older adults with MCI and without MCI. Motion analysis and a force plate system were used to collect and analyze the STS movement. All participants were asked to do the STS movement alone and the STS with a dual motor task with the self-selected pattern on an adjustable bench. ResultsOlder adults with MCI had greater maximum trunk flexion during STS with a dual task than older adults without MCI and greater than STS alone. Furthermore, older adults with MCI had a greater ankle plantar flexion moment during STS with a dual task than during STS alone. SignificanceEven though the STS task is one of the simplest functional activities, different strategies to achieve the STS action with dual tasks were found among older adults with and without MCI in terms of joint angle and joint moments.

The association of range of motion, lower limb strength, and load during jump landings in professional ballet dancers

This study aimed to investigate the associations between peak plantarflexion ankle joint moments and vertical ground reaction forces (vGRF) during jump landings, and static ankle dorsiflexion range of motion (ROM), three-dimensional ankle excursions, and lower extremity strength in professional ballet dancers. Twenty-seven professional ballet dancers volunteered to participate (men = 14, women = 13). Participants attended one data collection session to measure dorsiflexion ROM and isometric lower extremity strength. Two further sessions were used to establish ankle mechanics and vGRFs during countermovement jump landings in seven foot positions, via a seven-camera motion capture system and piezoelectric force platform. Two linear mixed-effects models were used to investigate associations between the target variables and strength, dorsiflexion ROM, and ankle excursions. Dancer identification, sex, and foot position were entered as random effects. Model fit, when considered independent of random effects, was generally poor with the predictor variables explaining little of the variance of peak plantarflexion ankle joint moments (R2 = 0.02) or vGRF (R2 = 0.01). Model fit improved when random effects were considered (R2 = 0.65 & 0.34). Frontal plane ankle excursion was the only predictor variable with a significant negative association with peak plantarflexion ankle joint moments (p = .016), although coefficient estimates were small. Strength, static ankle dorsiflexion ROM, and three-dimensional ankle excursions are poor predictors of load experienced at a joint and system level in professional ballet dancers. Differences between individuals, sex, and foot position may be better indicators of the load experienced during jump landings.

Feasibility of an early progressive resistance exercise program for acute Achilles tendon rupture

BackgroundLong-term strength deficits are common after Achilles tendon ruptures. Early use of progressive resistance exercises may help reduce strength deficits, but the feasibility of this approach is unknown. The aim was to investigate the feasibility of early progressive resistance exercises regarding patient acceptability and compliance with the intervention.MethodsWe recruited patients with an acute Achilles tendon rupture treated non-surgically. During 9 weeks of immobilisation with a walking boot, participants attended weekly supervised physiotherapy sessions of progressive resistance exercises and performed home exercises, consisting of isometric ankle plantarflexion, seated heel-rise, and elastic band exercises. Acceptability was evaluated using a 7-point Likert scale (1 = very unacceptable and 7 = very acceptable) with feasibility threshold at 80% of the participants rating ≥ 4. Adherence to the exercises was defined as 80% of the participants performing at least 50% of the home exercises. During the intervention, tendon healing and adverse events were monitored.ResultsSixteen participants (mean age 46 (range 28–61), male/female = 13/3) completed the intervention. Pre-injury Achilles tendon total rupture score was 98 (SD 8). All participants rated the acceptability of the exercises ≥ 5 (moderate acceptable to very acceptable) at 9- and 13-week follow-up and 9/16 rated 7 points (very acceptable). Participants performed 74% (range 4–117) of the total prescribed home exercises and 15/16 performed > 50%. One participant was not compliant with the home exercises due to feeling uncomfortable performing these independently. There were no re-ruptures, but one case of deep venous thrombosis.ConclusionsThe early progressive resistance exercise program for treatment of non-surgically treated Achilles tendon rupture was feasible. Future studies should investigate the efficacy of the progressive intervention.Trial registrationThe study was registered at Clinical Trials (NCT04121377) on 29 September 2019. ClinicalTrials: NCT04121377.

Medial Gastrocnemius Strain: Clinical Aspects and Algorithmic Approach.

Medial gastrocnemius strain (MGS), is the most common cause of mid-calf pain in athletes due to the stretch of the gastrocnemius muscle when the knee is in extension and the ankle is in dorsiflexion. Chronological age and previous calf injury are the most substantial risk factors for MGS, including high body mass index, previous lower limb injuries, L5 radiculopathy, and inadequate warm-up. The dominant presentation of MGS is a pain that can be diverse from acute to latent, which is felt in the posteromedial aspect of the calf and is often preceded by a feeling of a pop. The signs of MGS include antalgic gait, ecchymosis, swelling, local tenderness, and sometimes a palpable gap felt along the muscle. Passive dorsiflexion of the ankle or resistive ankle plantarflexion with knee extension can indicate a more severe injury, while functional tests can illicit milder injuries of calf muscles-including gastrocnemius. The diagnosis of MGS is usually made by clinical evaluation. However, imaging modalities-including magnetic resonance imaging and ultrasound-can be helpful in case of suspicion. In most cases of MGS, the cornerstone of treatment is nonoperative rehabilitation, which can be performed as a 4-phase program and should be tailored individually. Some instances of MGS are referred for early or later surgical treatment if indicated. In this article, we review the literature about various aspects of MGS, from diagnosis to treatment and rehabilitation, and propose a structured approach to this injury.

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.

Lower Limb Joint Mechanics during Maximal Accelerative and Decelerative Running.

Maximal acceleration and deceleration tasks are frequently required in team sports, often occurring rapidly in response to external stimuli. Accelerating and decelerating can be associated with lower limb injuries; thus, knowledge of joint mechanics during these tasks can improve the understanding of both human high performance and injury mechanisms. The current study investigated the fundamental differences in lower limb joint mechanics when accelerating and decelerating by directly comparing the hip, knee, and ankle joint moments and work done between the two tasks. Twenty participants performed maximal effort acceleration and deceleration trials, with three-dimensional marker trajectories and ground reaction forces collected simultaneously. Experimental data were combined with inverse dynamics analysis to compute joint moments and work. Net joint work for all lower limb joints was positive during acceleration and negative during deceleration. This occurred because of significantly greater positive work production from the ankle and hip during acceleration and significantly greater negative work production from all joints during deceleration. The largest contributions to positive work during acceleration came from the ankle, followed by the hip and knee joints, whereas the largest contributions to negative work during deceleration came from the knee and hip joints, followed by the ankle. Peak joint moments were significantly greater when decelerating compared with accelerating, except for the peak ankle plantarflexion and hip flexion moments, which were significantly greater when accelerating. Our findings may help to guide training interventions, which aim to enhance the performance of acceleration and deceleration tasks, while also mitigating the associated injury risk.

The effect of foot somatosensory loss in postural control during Functional reach test in patients with diabetic polyneuropathy: A controlled study

BackgroundIn patients with diabetic polyneuropathy (DPN), differences in postural control due to losing the lower limb somatosensory information were reported. However, it is still unclear by which mechanisms the dynamic postural instability is caused. ObjectivesThis study aimed to investigate postural control differences and neuromuscular adaptations resulting from foot somatosensory loss due to DPN. MethodsIn this controlled cross-sectional study, fourteen DPN patients and fourteen healthy controls performed the Functional Reach Test (FRT) as a dynamic task. The postural control metrics were simultaneously measured using force plate, motion capture system, and surface electromyography (sEMG). The main metrics including reach length (FR), FR to height ratio (FR/H), displacement of CoM and CoP, moment arm (MA), and arch height ratio. Also, kinematic (range of motion of ankle, knee, and hip joints), and sEMG metrics (latencies and root mean square amplitudes of ankle and hallux muscles) were measured. To compare variables between groups, the independent sample T-test for (normally distributed) and the Mann-Whitney U test (non-normally distributed) were used. ResultsThe subjects' reach length (FR), FR to height ratio, absolute MA, and displacement of CoM were significantly shorter than controls, while displacement of CoP was not significant. Arch height ratio was found significantly lower in DPN patients. We observed that CoM was lagging CoP in patients (MA = + 0.89) while leading in controls (MA = -1.60). Although, the muscles of patients showed significantly earlier activation, root mean square sEMG amplitudes were found similar. Also, DPN patients showed significantly less hip flexion, knee extension, and ankle plantar flexion. ConclusionsThis study presented that decreasing range of motion at lower limbs’ joints and deterioration in foot function caused poor performance at motor execution during FRT in DPN patients.

Reliability of Percutaneous Achilles Tenotomy in the Treatment of Idiopathic Clubfoot.

Talipesequinovarus is a congenital ankle/foot malformation that commonly affects newborns. In its treatment using the Ponseti method, an Achilles tenotomy is frequently needed to correct residual equinus deformity. Percutaneous (PC) tenotomy is the most commonly used technique and needs to be thoroughly evaluated. The question we needed to answer was: "Does PC Achilles tenotomy result in complete tendon sectioning"? This clinical study included 56 idiopathic clubfeet in 36 patients who presented during the first 6 months of life and were treated with Ponseti manipulation and casting followed by PC Achilles tenotomy. PC tenotomy was done under general anesthesia, and Thompson's calf squeeze test was performed intraoperatively just after tenotomy. In case of a negative test (ie, ankle plantar flexion with calf squeeze), the percutaneous incision was extended to assess the cause of the negative test. Forty-nine feet (87.5%) had a complete tenotomy, as evidenced by a positive Thompson's calf squeeze test. While 7 feet (12.5%) showed a negative test, and therefore the percutaneous incision was extended and all were found to have an incompletely divided Achilles tendon. The tendons were then completely divided, after which Thompson's test became positive in all. Percutaneous Achilles tenotomy is a reliable procedure, but was found to result in incomplete tendon sectioning in 12.5% of cases, affecting the range of ankle dorsiflexion. Thompson's squeeze test is reliable in picking up cases of incomplete tenotomy after the PC technique, and in these cases the incision should be extended for complete sectioning. Level I.

Efficacy of hinged and carbon fiber ankle-foot orthoses in children with unilateral spastic cerebral palsy and drop-foot gait pattern.

In children with unilateral spastic cerebral palsy (USCP), ankle-foot orthoses (AFOs) are widely used to correct common gait deviations such as a drop-foot pattern. Most studies on this topic have investigated specific time points while omitting other parts of the gait cycle. This study investigated the separate effects of prefabricated carbon fiber AFOs and custom-made hinged AFOs compared with barefoot walking in children with USCP with a drop-foot gait pattern using statistical parametric mapping. Retrospective, cross-sectional, repeated measures study. Twenty ambulatory children (9.9 ± 2.5 years) with USCP and a drop-foot gait pattern were included. Kinematics, kinetics, and spatiotemporal parameters assessed during 3-dimensional gait analysis were compared between barefoot and AFO walking. Statistical parametric mapping was used to compare joint angles and moment waveforms. Kinematics, kinetics and spatiotemporal parameters assessed during 3-dimensional gait analysis were compared between barefoot and AFO walking for each AFO type but not between the 2 AFO types. Compared with barefoot walking, there was a steeper sole angle at initial contact, corresponding to a heel strike pattern, and an increased ankle dorsiflexion in swing with the use of both AFOs. The ankle plantar flexion moment during loading response increased. Ankle power generation during pre-swing decreased in the carbon fiber AFO group when walking with AFOs. Both AFOs were beneficial for improving a drop-foot gait pattern in these small patient groups and can, therefore, be recommended to treat this gait deviation in patients with unilateral cerebral palsy. However, the reduction in ankle power generation during push-off and additional goals targeted by AFOs, such as correction of structural or flexible foot deformities, should be considered for prescription.

A Quality Improvement Project to Measure and Improve the Quality of Below-Knee Ankle Cast Application in Emergency Departments.

Background Ankle fractures are very common injuries seen in an emergency setting. Initial management involves the application of below-knee plaster casts. At our local trauma meetings, we have observed that below-knee casts are often applied incorrectly which can result in suboptimal outcomes for patients and increase the burden on plaster room services if re-application is required. This quality improvement project aimed to assess the quality of below-knee cast applications for ankle fractures in two local district general hospitals (DGHs). Methodology We performed a closed-loop audit utilising a retrospective analysis of patients who underwent casting for unstable ankle fractures. Two audit cycles were completed over a 90-day period across two DGHs. Working within our local orthopaedic unit, we created a targeted, multi-disciplinary educational programme led by experienced plaster technicians. Between audit cycles, we organised a single interactive session with specialist nurses in the urgent treatment centre (UTC) of our DGH while a second DGH did the same with junior doctors working in the emergency department. Both sessions demonstrated correct casting techniques and discussed the importance of a neutral ankle position for optimal patient recovery. Our audit criteria were based on AO Foundation guidance, which states that the ankle should be immobilised in a neutral plantigrade position. All patients with an unstable ankle fracture requiring immobilisation in a below-knee cast were included in the audit. We measured the angle of plantarflexion from neutral, with 90° representing a neutral angle. The angle between the axis of the tibia and the sole of the foot was measured and judged to be within an acceptable range if it was between 80° and 100°, representing a stable ankle position. The audit findings were presented in our local audit meeting. Results In our first audit cycle, we collected data from 65 patients across both sites (N = 32 for DGH 1 and N = 33 for DGH 2). The mean angle was 108.5° and 18 of the 65 (27.7%)patients had angles of ankle plantarflexion that were in the acceptable range (80°-100°). Following the intervention, we again collected data from 61 patients across both sites (N = 28 for DGH 1 and N = 33 for DGH 2). The mean angle was 106.2° and 23 of the 61 (37.7%)patients had an acceptable angle of ankle plantarflexion (80°-100°). Both of our outcome measures showed an improvement but were not statistically significant. The hospital that provided an educational session for the doctors showed an improvement in acceptable ankle casts of 3% while the hospital which provided an educational session for the UTC team improved by 22%. Conclusions We demonstrated a quantifiable approach to assess and improve the quality of below-knee cast application for ankle fractures via a single intervention that would be easily reproducible in other hospitals. We suggest further studies to investigate below-knee cast application quality and its association with patient outcomes as our data and other preliminary sources suggest that current standards are unsatisfactory.

Study protocol for a prospective cohort study describing the injury characteristics in elite gymnasts in TeamGym: the Swedish TeamGym Injury Cohort – STIC

IntroductionGymnastics consists of several different disciplines, whereof TeamGym is one. TeamGym is a young discipline with sparse research. The aim of the study is to investigate the injury characteristics in...

Lower Extremity Kinematic and Kinetic Characteristics as Effects on Running Economy of Recreational Runners.

This study aimed to determine associations between running economy (RE) and running sagittal plane kinematic and kinetic parameters. A total of 30 male recreational runners (age: 21.21 ± 1.22 yr, V̇O 2max : 54.61 ± 5.42 mL·kg -1 ·min -1 ) participated in two separate test sessions. In the first session, the participant's body composition and RE at 10 and 12 km·h -1 were measured. In the second session, measurements were taken for the sagittal plane of hip, knee, and ankle angles and range of motion (ROM), as well as ground reaction force. Moderate correlations were found between lower energy costs at 12 km·h -1 and smaller hip flexion at toe-off ( r = 0.373) as well as smaller peak hip flexion during stance ( r = 0.397). During the swing phase, lower energy costs at 10 km·h -1 were moderately correlated with smaller peak knee flexion and smaller knee flexion and extension ROM ( r = 0.366-0.443). Lower energy costs at 12 km·h -1 were moderately correlated with smaller peak hip and knee flexion as well as knee extension ROM ( r = 0.369-0.427). In terms of kinetics, there was a moderate correlation between higher energy costs at 10 km·h -1 and larger peak active force, as well as larger peak braking and propulsion force ( r = -0.470-0.488). Lower energy costs at 12 km·h -1 were moderately to largely correlated with smaller peak impact and braking force ( r = 0.486 and -0.500, respectively). Regarding the statistical parametric mapping analysis, most outcomes showed associations with RE at 10 km·h -1 , including knee flexion (42.5%-65.5% of the gait cycle), ankle plantarflexion (32.5%-36% of the gait cycle), active force (30.5%-35% of the stance phase), and propulsion force (68%-72.5% of the stance phase). Lower energy costs at 12 km·h -1 were correlated with smaller hip flexion (5.5%-12% and 66.5%-74%) and smaller knee flexion (57%-57.5%) during the running gait cycle. This study indicates that biomechanical factors are associated with RE in recreational runners. To design effective training methods to improve RE, coaches and runners should focus on the sagittal plane kinematics of the hip, knee, and ankle, as well as lower vertical and horizontal kinetic parameters.

First tarsometatarsal joint mobility in hallux valgus during gait: A synchronized ultrasound and three-dimensional motion capture analysis

PurposeTo quantify the vertical translation between the first metatarsal and medial cuneiform during the stance phase of gait in young individuals with and without hallux valgus.DesignThis cross-sectional observational study included 34 young adults (male, n = 4; female, n = 30) who were divided into three groups according to the hallux valgus angle: control (< 20°, n = 13), mild hallux valgus (≥ 20° to < 30°, n = 12), and moderate hallux valgus (≥ 30°, n = 9). The mobility of the first tarsometatarsal joint was evaluated during the stance phase using B-mode ultrasound synchronized with a motion analysis system.ResultsThe medial cuneiform shifted more plantar during the early phase in mild hallux valgus and during the middle and terminal phases in moderate hallux valgus than in control. The severity of the hallux valgus was correlated with a trend toward plantar shift of the medial cuneiform. The first metatarsal was located more dorsal than the medial cuneiform; however, there was no significant variation. No significant differences in the peak ankle plantarflexion angle and moment were noted between the groups.ConclusionThe hypermobility of the first tarsometatarsal joint, especially plantar displacement of the medial cuneiform in the sagittal plane, was found in young individuals with hallux valgus during the stance phase of gait, and the mobility increased with the severity of hallux valgus. Our findings suggest the significance of preventing hallux valgus deformity early in life.

Postural control and ankle joint functions: an investigation on collegiate female volleyball players

PurposeAnkle injuries are common in volleyball players and are linked to the athlete’s postural control. The aim of the report is to investigate the differences between ankle functions and postural control ability of volleyball players and controls, and also the relationship between the variables in order to understand the factors affecting postural control.Methods40 female participants (age: 21.18 ± 0.27, volleyball players/controls: 20/20) were included in the study. Ankle functions (joint range of motion (ROM), joint position sense (JPS), vibration and isometric muscle strength) and postural control variables (anterior-posterior and medial-lateral sway velocity, ellipse area and perimeter) were evaluated by static stability test. The differences between the groups and the correlation between variables were analysed.ResultsSignificant differences favoured the volleyball group in ankle dorsiflexion, inversion, and eversion ROM, JPS, dorsiflexor and plantar flexor isometric muscle strength, and postural control variables (p &lt; 0.05). However, the control group demonstrated superior vibration sensitivity on the 1st and 5th metatarsal heads (p &lt; 0.05). A significant correlation was observed between the anterior-posterior sway velocity and dorsiflexion ROM, medial-lateral sway velocity and sway area with inversion ROM, sway area and vibration threshold in the 1st and 5th metatarsal heads (p &lt; 0.05).ConclusionsVolleyball players showed better results in ankle ROM, JPS, muscle strength and postural control. In addition to the similarities in ankle plantar flexion ROM, invertor and evertor isometric muscle strength between the groups, the controls showed better vibration sensitivity; which reveals potential causes of ankle injuries in volleyball players. Ankle function variables are found to be linked to postural control, highlighting the need to evaluate these functions for injury prevention.

Enhancing walking performance in patients with peripheral arterial disease: An intervention with ankle-foot orthosis

Lower extremity peripheral artery disease (PAD) is a cardiovascular condition manifesting from narrowed or blocked arteries supplying the legs. Gait is impaired in patients with PAD. Recent evidence suggests that walking with carbon fiber ankle foot orthoses (AFOs) can improve patient mobility and delay claudication time. This study aimed to employ advanced biomechanical gait analysis to evaluate the impact of AFO intervention on gait performance among patients with PAD. Patients with claudication had hip, knee, and ankle joint kinetics and kinematics assessed using a cross-over intervention design. Participants walked over the force platforms with and without AFOs while kinematic data was recorded with motion analysis cameras. Kinetics and kinematics were combined to quantify torques and powers during the stance period of the gait cycle. The AFOs effectively reduced the excessive ankle plantar flexion and knee extension angles, bringing the patients' joint motions closer to those observed in healthy individuals. After 3 months of the AFO intervention, the hip range of motion decreased, likely due to changes occurring within the ankle chain. With the assistance of the AFOs, the biological power generation required from the ankle and hip during the push-off phase of walking decreased. Wearing AFOs resulted in increased knee flexor torque during the loading response phase of the gait. Based on this study, AFOs may allow patients with PAD to maintain or improve gait performance. More investigation is needed to fully understand and improve the potential benefits of ankle assistive devices.

Single-Leg Heel Raise Capacity is Lower, and Perceived Ankle Instability is Greater, in Dancers and Athletes With Posterior Ankle Impingement Syndrome.

To compare clinical assessment findings between elite athletic populations with and without a clinical diagnosis of posterior ankle impingement syndrome (PAIS). Cross-sectional case-control study. Elite ballet and sport. Ten male and female professional ballet dancers and athletes with a clinical diagnosis of PAIS and were matched for age, sex, and activity to 10 professional ballet dancers and athletes without PAIS. Posterior ankle pain on body chart and a positive ankle plantarflexion pain provocation test. Single-leg heel raise (SLHR) endurance test, range of motion testing for weight-bearing ankle dorsiflexion, passive ankle plantarflexion, and first metatarsophalangeal joint dorsiflexion, and Beighton score for generalized joint hypermobility. Participants also completed the Cumberland Ankle Instability Tool (CAIT) questionnaire. The group with PAIS achieved significantly fewer repetitions on SLHR capacity testing ( P = 0.02) and were more symptomatic for perceived ankle instability according to CAIT scores ( P = 0.004). Single-leg heel raise endurance capacity was lower, and perceived ankle instability was greater in participants with PAIS. The management of this presentation in elite dancers and athletes should include the assessment and management of functional deficits.