Plantar Flexion Range Of Motion Research Articles

High-heeled shoes increase motion of the talocrural joint while limiting the subtalar joint.

Foot issues caused by High-heeled shoes (HHS) may be related to changed kinematics. This study aimed to use novel dynamic biplane radiography (DBR) to investigate the effect of HHS on the in vivo six degrees of freedom (6DOF) kinematics of the talocrural and subtalar joints. Fourteen healthy female participants were recruited. Magnetic Resonance Imaging (MRI) scan images of each participant's ankle were used to create three-dimensional (3D) bone models. Two-dimensional (2D) motion perspective views of the foot were captured by DBR while walking with and without HHS. The 2D perspective views and 3D bone models are imported into a customized program for alignment. 6DOF kinematic data were extracted for the talocrural and subtalar joints during the stance phase of gait. Compared to barefoot, the maximum plantarflexion angle of the talocrural joint increased (6.5 ± 2.4° vs. 28.8 ± 6.0°, P < 0.001) when walking with HHS; minimum inversion angle increased (-1.8 ± 1.7° vs. -4.9 ± 2.3°, P < 0.001). The range of motion (ROM) of the talocrural joint was increased in plantarflexion (13.8 ± 3.2° vs. 20.3 ± 7.4°, P = 0.002). The maximum internal rotation angle of the subtalar joint increased during HHS (-0.4 ± 1.8° vs. -3.2 ± 2.7°, P = 0.02). The ROM of external rotation (7.6 ± 2.5° vs. -5.9 ± 2.3°, P = 0.03) and eversion (10.4 ± 3.5° vs. 8.2 ± 2.6°, P = 0.041) decreased. During the stance phase, HHS increased peak plantarflexion, inversion angle, and plantarflexion ROM of the talocrural joint. HHS decreased external rotation and eversion ROM of the subtalar joint. These results may provide a basis for developing prevention and treatment strategies for HHS injuries.

Investigating the Effects of Shockwave and Percussion Massage Gun on Subacute Myofascial Pain in Gasterocenemious Muscle

Introduction: Myofascial pain syndrome is a common musculoskeletal injury, especially among athletes, typically treated with symptomatic invasive and non-invasive methods. This study compares the effects of massage guns and radial extracorporeal shock wave therapies on myofascial pain syndrome symptoms in amateur athletes. Materials and Methods: In this clinical trial, 45 amateur athletes (18-30 years old) were recruited, who were randomly assigned to 15-member groups of shock wave, massage gun, and control (routine treatment included electrotherapy and stretching, which was applied on three groups). After initial evaluations of the pain intensity, pain pressure threshold (PPT), isometric muscle strength, and range of motion (ROM), the patients received single-session treatment and were immediately reassessed. Results: The results showed pain relief and improved PPT following shock wave plus routine treatment (P=0.03). The control group had less pain, while pain intensity and PPT did not change. The variables were not significantly different between the groups (P=0.12). Shock wave along with routine treatment increased plantar flexion ROM (P=0.00), unlike the massage gun. Additionally, dorsiflexion ROM (P=0.63) and maximal isometric gastrocnemius muscle strength (P=0.95) remained unchanged in all groups. Conclusion: One session of massage gun therapy immediately reduced gastrocnemius muscle pain, while it failed to change PPT, maximal isometric gastrocnemius muscle strength, or dorsiflexion and plantar flexion ROM. However, shock wave therapy immediately increased plantar flexion ROM and PPT, and reduced pain intensity. These modalities led to limited changes, suggesting the need for repeated sessions and supplementary treatments.

Improved Postoperative Radiographic Alignment Associated with Patient-Specific Instrumentation in Total Ankle Arthroplasty

Category: Ankle Arthritis; Ankle Introduction/Purpose: The rate of total ankle arthroplasty (TAA) is projected to continue to increase globally over the next several decades. While the most significant predictor of complications after total ankle arthroplasty is implant malalignment, intra-operative evaluation of alignment can be technically challenging to achieve. Patient-specific instrumentation (PSI) was designed to improve the accuracy of implant positioning in TAA. Therefore, we sought to compare radiographic alignment and postoperative function in patients who underwent TAA with PSI guides versus standard instrumentation. Methods: We retrospectively reviewed 75 ankles who underwent TAA using PSI compared to 80 ankles who underwent TAA without PSI. Demographics, radiographic alignment, range of motion (ROM), complications, and postoperative American Orthopaedic Foot and Ankle Society (AOFAS) scores were compared. All patients had minimum 1-year follow-up. Demographics were similar between cohorts, including gender (p=0.176), body mass index (p=0.914), laterality (p=0.847), preoperative diagnosis (p=0.126), and history of diabetes mellitus (p=0.665), although patients in the PSI group were older (mean=68.56 versus 64.75, p=0.014) and had a higher American Society of Anesthesiologists score (mean=2.37 versus 2.15, p=0.003). Preoperative dorsiflexion (mean=9.09° versus 8.79°, p=0.762), plantarflexion (mean=29.59° versus 27.50°, p=0.152), and total ROM (mean=38.68° versus 36.29°, p=0.260) were similar between cohorts. The PSI cohort had more preoperative talar tilt (mean=7.48° versus 4.38°, p=0.004), but similar coronal angle (mean=-2.39° versus -0.09°, p=0.242) and sagittal translation (mean=3.14° versus 1.30°, p=0.085). Results: Postoperative coronal angle (mean=0.27° (range=-8.16°-5.42°) versus 1.38° (range=-4.19°-9.14°), p=0.006) and sagittal angle (mean=-1.99° (range=-9.01°-3.94°) versus -4.51° (range=-13.0°-2.0°), p&lt; 0.001) were more accurate and had a narrower range with the PSI guides compared to the manual guides. Postoperative ROM was similar between the PSI and manual groups, including dorsiflexion (mean=10.27° versus 10.83°, p=0.549), plantarflexion (mean=29.27° versus 29.83°, p=0.607), and total ROM (mean=39.54° versus 40.67°, p=0.496). Patients with PSI had improved AOFAS alignment scores (mean=9.73 versus 8.89, p=0.005), but there were similar AOFAS pain (mean=29.32 versus 31.51, p=0.125), function (mean=40.48 versus 38.79, p=0.281), and total scores (mean=79.52 versus 79.19, p=0.897) between cohorts. There were similar numbers of patients who required revision (1.33% versus 7.50%, p=0.144) or irrigation and debridement (4.00% versus 5.00%, p=1.000) between cohorts. Conclusion: PSI is associated with more accurate postoperative coronal and sagittal alignment compared to manual instrumentation TAA. While patients with PSI had decreased AOFAS alignment scores, both cohorts had similar postoperative range of motion and overall AOFAS scores. While there were a similar number of revisions and irrigation and debridement procedures in each cohort, this retrospective review was limited to shorter term follow-up. Further research is needed to determine if the improved alignment with the use of PSI implants is associated with better survivability long term.

Dorsal Calcaneal Wedge Removal in Zadek Osteotomy: A Cadaveric Study

Category: Hindfoot; Ankle Introduction/Purpose: Insertional Achilles tendinopathy (IAT) is a common pathology with multiple surgical interventions available for treatment. The Zadek, dorsal closing wedge calcaneal osteotomy (ZO) has been demonstrated to be effective treatment of IAT. There have been various recommendations in the literature as to what measurement of wedge removal should be considered ideal to produce greatest postoperative range of motion (ROM), thus postoperative biomechanical potential. Accordingly, the purpose of this cadaveric study was to assess the range of motion achieved after various measurements of wedge removal by ZO. Methods: The ZO was performed on six cadaveric specimens. A 7.5mm and 15mm osteotomy was marked and sequentially completed on each specimen. Lateral fluoroscopic imaging was utilized to take preoperative and postoperative ROM measurements for each osteotomy. Dorsiflexion (DF) and plantarflexion (PF) ROM arcs were measured for each wedge size and compared by t-test. Effect sizes were calculated by Cohen’s d analysis. Results: Maximal DF was 110.87±12.97 deg in the pre-osteotomy state. Removal of a 7.5mm wedge improved DF by 8 deg to a mean 102.93±13.81 deg (p=0.08). Removal of a 15mm wedge improved DF by 16 deg to a mean 95.96±11.41 deg (p=0.003). Cohen’s d and effect size calculation demonstrated a 7.5mm wedge to have a small effect on DF, while a 15mm wedge had a medium effect (0.29, 0.52 respectively). Maximal PF did not change significantly amongst the pre-osteotomy, 7.5mm wedge, or 15mm wedge positions. ICC was 0.96. Conclusion: Based on the results presented in this study, removal of a 15mm wedge with ZO yields significant and greater improvement in ROM than a 7.5mm wedge. We hope the current study will better inform preoperative planning for ZO.

Effects of running-induced fatigue on joint kinematics and kinetics during overground running: a systematic review and meta-analysis.

This study evaluated the acute fatigue-inducing effect of distance running on kinematics and kinetics during overground running. Standardised mean differences (SMD) with 95% confidence intervals (95% CI) were used to pool data across 16 studies. Effects during consistent (pre- and post-fatigue running speed within ± 5%) versus varied speed running (difference of >5% between running speeds) were analysed separately. There was strong evidence that running-induced fatigue significantly increases ground contact times at consistent running speeds (SMD 0.52 [95% CI 0.22, 0.82]) and moderate evidence that step length shortens at varied running speeds (SMD -1.27 [95% CI -1.79, -0.75]). There was strong evidence that fatigue does not change peak: hip and knee flexion angles, hip adduction angle, hip and knee internal rotation angles, hip and knee extension moments, hip and knee abduction moments, knee abduction angle, knee flexion and extension moments, knee adduction moment, rearfoot eversion angle, and plantarflexion moments, or knee flexion and plantarflexion range of motion during stance. Running-induced fatigue increases contact times and reduces step length, whereas lower-body joint angles and moments are unchanged. Minimising changes in stride parameters could provide a mechanism for reducing the effects of fatigue on running performance.

Dorsal calcaneal wedge removal in zadek osteotomy: A cadaveric study

BackgroundInsertional Achilles tendinopathy (IAT) is a common pathology with multiple surgical interventions available for treatment. The Zadek, dorsal closing wedge calcaneal osteotomy (ZO) has been demonstrated to be effective treatment of IAT. There have been various recommendations in the literature as to what measurement of wedge removal should be considered ideal to produce greatest postoperative range of motion (ROM), thus postoperative biomechanical potential. Accordingly, the purpose of this cadaveric study was to assess the range of motion achieved after various measurements of wedge removal by ZO. MethodsThe ZO was performed on six cadaveric specimens. A 7.5 mm and 15 mm wedge osteotomy was marked and sequentially completed on each specimen. Lateral fluoroscopic imaging was utilized to take preoperative and postoperative ROM measurements for each osteotomy. Dorsiflexion (DF) and plantarflexion (PF) ROM arcs were measured for each wedge size and compared by t-test. Effect sizes were calculated by Cohen’s d analysis. ResultsMaximal DF was 110.87 ± 12.97 deg in the pre-osteotomy state. Removal of a 7.5 mm wedge improved DF by 8 deg to a mean 102.93 ± 13.81 deg (p = 0.08). Removal of a 15 mm wedge improved DF by 16 deg to a mean 95.96 ± 11.41 deg (p = 0.003). Cohen’s d and effect size calculation demonstrated a 7.5 mm wedge to have a small effect on DF, while a 15 mm wedge had a medium effect (0.29, 0.52 respectively). Maximal PF did not change significantly amongst the pre-osteotomy, 7.5 mm wedge, or 15 mm wedge positions. ICC was 0.96. ConclusionBased on the results presented in this study, removal of a 15 mm wedge with ZO yields significant and greater improvement in ROM than a 7.5 mm wedge. We hope the current study will better inform preoperative planning for ZO. Study typeProspective Cadaver Study. Level of evidenceV.

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.

Hexaxial external fixator versus intramedullary nail in treating segmental tibial fractures: a retrospective study

BackgroundIt’s difficult to treat segmental tibial fractures (STFs), which are intricate injuries associated with significant soft tissue damage. The aim of this study was to compare the clinical effect of hexaxial external fixator (HEF) and intramedullary nail (IMN) in treatment of STFs.MethodsA total of 42 patients with STFs were finally recruited between January 2018 and June 2022. There were 25 males and 17 females with age range of 20 to 60 years. All fractures were classified as type 42C2 using the Arbeitsgemeinschaftfür Osteosythese/Orthopaedic Trauma Association (AO/OTA) classification. 22 patients were treated with HEF and 20 patients were treated with IMN. The condition of vascular and neural injuries, time of full weight bearing, bone union time and infection rate were documented and analyzed between the two groups. The mechanical medial proximal tibial angle (mMPTA), mechanical posterior proximal tibial angle (mPPTA), mechanical lateral distal tibial angle (mLDTA), mechanical anterior distal tibial angle (mADTA), hospital for special surgery (HSS) knee joint score, American Orthopaedic Foot and Ankle Society (AOFAS) ankle joint score, range of motion (ROM) of flexion of keen joint and ROM of plantar flexion and dorsal flexion of ankle joint were compared between the two groups at the last clinical visit.ResultsThere were no vascular and neural injuries or other severe complications in both groups. All 22 patients in HEF group underwent closed reduction but 3 patients in IMN group were treated by open reduction. The time of full weight bearing was (11.3 ± 3.2) days in HEF group and (67.8 ± 5.8) days in IMN group(P < 0.05), with bone union time for (6.9 ± 0.8) months and (7.7 ± 1.4) months, respectively(P < 0.05). There was no deep infection in both groups. In the HEF group and IMN group, mMPTA was (86.9 ± 1.5)° and (89.7 ± 1.8)°(P < 0.05), mPPTA was (80.8 ± 1.9)° and (78.6 ± 2.0)°(P < 0.05), mLDTA was (88.5 ± 1.7)° and (90.3 ± 1.7)°(P < 0.05), while mADTA was (80.8 ± 1.5)° and (78.4 ± 1.3)°(P < 0.05). No significant differences were found between the two groups at the last clinical visit concerning HSS knee joint score and AOFAS ankle joint score, ROM of flexion of keen joint and ROM of plantar flexion of ankle joint (P > 0.05). The ROM of dorsal flexion of ankle joint in IMN group was (30.4 ± 3.5)°, better than (21.6 ± 2.8)° in HEF group (P < 0.05).ConclusionIn terms of final clinical outcomes, the use of either HEF or IMN for STFs can achieve good therapeutic effects. While HEF is superior to IMN in terms of completely closed reduction, early full weight bearing, early bone union and alignment. Nevertheless, HEF has a greater impact on the ROM of dorsal flexion of the ankle joint, and much more care and adjustment are needed for the patients than IMN.

Investigating the Combined Effects of Fascial Distortion Model Manual Therapy and Balance-Strength Training in Individuals with Chronic Ankle Instability.

The Fascial Distortion Model (FDM) is a relatively new manual therapy approach in the field of musculoskeletal physical therapy, and its potential effectiveness in treating chronic ankle instability (CAI) remains unexplored. A randomized controlled trial with 23 participants was conducted. Patients were randomly assigned to either the FDM + balance-strength training (BST) group (n = 8), receiving extra FDM sessions weekly in addition to two sessions of BST, or the BST group (n = 7). Healthy controls (n = 8) did not receive any treatment and participated only in pre- and post-test measurements. Objective measurements including Y-Balance Test Lower Quarter (YBT-LQ), Flamingo Balance Test (FBT), Weight-Bearing Lunge Test (WBLT), ankle joint range of motion (ROM), and Cumberland Ankle Instability Tool (CAIT) were recorded at baseline and the end of the intervention. The results demonstrated significant differences between the FDM + BST and BST groups for supination ROM (p = 0.008) and similarly for WBLT (p = 0.041), FBT (p = 0.40), YBT-LQ (p = 0.023), and CAIT score (p = 0.008). Moreover, while both groups demonstrated significant improvement at the post-test compared with their pre-test for plantarflexion and pronation ROM, WBLT, and CAIT score, the FDM + BST group demonstrated significant improvements in supination ROM, FBT, and YBT-LQ. Our study suggests that the addition of FDM concepts to a BST may lead to enhanced improvements in ankle ROM, static and dynamic balance, and self-reported outcomes in individuals with CAI compared to BST.

Influence of Joint Line Level on Clinical Outcomes and Range of Motion in Total Ankle Arthroplasty.

Ankle arthritis leads to an elevated joint line compared to the nonarthritic ankle, as measured by the "joint line height ratio" (JLHR). Previous work has shown that the JLHR may remain elevated after total ankle arthroplasty (TAA). However, the clinical impact of this has yet to be determined. This study assessed the correlation between postoperative JLHR, post-TAA range of motion (ROM), and 1-year Patient-Reported Outcome Measurement Information System (PROMIS) scores. A retrospective review of 150 patients who underwent primary TAA was performed. Preoperative and postoperative JLHR, as well as postoperative dorsiflexion, plantarflexion, and total ROM, was calculated on weightbearing radiographs at a minimum of 1-year follow-up. Correlation between JLHR, post-TAA ROM, and 1-year PROMIS scores was investigated using Pearson correlation and multiple linear regression models. Interobserver reliability for the JLHR was also calculated. Interobserver reliability for the JLHR was excellent (r = 0.98). Mean (SD) JLHR changed from 1.66 (0.45) to 1.55 (0.26) after TAA (P < .001), indicating that the joint line was lowered after TAA. An elevated joint line was correlated with decreased post-TAA dorsiflexion (r = -0.26, P < .001), total ROM (r = -0.18, P = .025), and worse 1-year PROMIS physical function (r = -0.22, P = .046), pain intensity (r = 0.22, P = .042), and pain interference (r = 0.29, P = .007). There was no correlation between the JLHR and post-TAA plantarflexion (r = -0.025, P = .76). Regression analysis identified a 0.5-degree reduction in post-TAA dorsiflexion with each 0.1-unit increase in JLHR (Coeff. = -5.13, P = .005). In this patient cohort, we found that an elevated joint line modestly correlated with decreased postoperative dorsiflexion, total ROM, and worse 1-year PROMIS scores. These data suggest that effort likely should be made toward restoring the native joint line at the time of TAA. In addition, future studies investigating the clinical outcomes after TAA may consider including a measure of joint line height, such as the JLHR, because we found it was associated with patient-reported outcomes. Level III, retrospective review of prospectively collected data.

Comparative Effects of Active Release Technique and Positional Release Therapy in Female Students with Tightened Calf Muscles

Background: Prior research has established that regular use of high-heeled shoes significantly alters the gait pattern, impacts ankle joint motion, increases joint forces and moments in the lower extremities, modifies foot pressure distribution, and affects posture and balance. These biomechanical changes can lead to tightened calf muscles and associated discomfort in frequent high heel wearers. Objective: The main objective of this study is to compare the effect of Active Release Technique and Positional Release Therapy in female students with tightened calf muscles. Methods: A randomized clinical trial including 26 subjects by using convenient sampling technique, with subject age ranging from 20-30 years wearing high heels with minimum duration (5 hours a day, 5 times a week and for more than 1 year) with heel height minimum of 2''. The outcome measures were ankle dorsiflexion plantar flexion range of motion measured by goniometer, and pain measured by Numerical Pain Rating Scale. Data was collected for 4 months (Feb-May 2023) from The University of Faisalabad and Government College University Faisalabad. Over four weeks &amp; 3 times per week both groups received ultrasound and traditional Physiotherapy of conventional calf muscle stretching as baseline treatment. Group 1 received Positional Release Therapy, while Group 2 received Active Release Technique. Results: Friedman test showed within-group improvements in NPRS, Dorsiflexion, Plantar flexion, and Cadence (p&lt;0.05) for both groups. Mann Whitney U test revealed significant improvements in NPRS, Dorsiflexion, Plantar flexion, and Cadence at post-treatment (p&lt;0.05) for Positional Release Therapy group more than Active Release Therapy.. Conclusion: Positional Release Therapy (PRT) has more significant effects for calf muscle tightness, exhibiting increased cadence, ankle dorsiflexion, and plantar flexion range of motion, along with significant pain reduction than Active Release Therapy (ART)

The Relationship of Obesity with Range Of Motion (ROM) On The Ankle

Introduction. Obesity is weight gain beyond the limits of physical and skeletal needs due to excessive accumulation of body fat that may increase risk factors for musculoskeletal disorders. A musculoskeletal disorder that can occur is a limited range of motion of a joint. This study aimed to identify the relationship between obesity and ankle range of motion (ROM). Methods. This study was conducted using an analytical observational study with an overall sample of 311 students who met the inclusion criteria. The sample for this study was students’ class of the Muhammadiyah Palembang's School of Medicine from 2018 to 2020 and was extracted using the total extraction method. The population of this study is Palembang students. Results. The study found that 238 students (76.5%) were not obese and 65 students (20.9%) were obese. Among obese college students, 51 college students (69.9%) had normal dorsiflexion ROM and 22 college students (30.1%) had abnormal dorsiflexion ROM. Obese students had normal plantarflexion ROM in her 20 students (27.4%) and students with abnormal plantarflexion ROM in her 53 students (72.6%). 195 students (81.9%) had normal dorsiflexion ROM and 43 students (49.7%) had abnormal dorsiflexion ROM. 185 students (77.7%) had normal plantarflexion ROM and 53 students (22.3%) had abnormal plantarflexion ROM. Conclusion. Suggesting an association between obesity and the Range of Motion (ROM) in the ankle joint.

Passive Movements Do not Appear to Prevent or Reduce Joint Stiffness in Medium to Long-Stay ICU Patients: A Randomized, Controlled, Within-Participant Trial.

ICU patients have an increased risk of joint stiffness because of their critical illness and reduced mobility. There is a paucity of evidence evaluating the efficacy of passive movements (PMs). We investigated whether PMs prevent or reduce joint stiffness in ICU patients. A randomized, controlled, within-participant, assessor-blinded study. A 48-bed tertiary care adult ICU. Intubated patients who were expected to be invasively mechanically ventilated for greater than 48 hours with an ICU length of stay greater than or equal to 5 days, and unable to voluntarily move their limbs through full range of motion (ROM). The ankle and elbow on one side of each participant's body received PMs (10 min each joint, morning and afternoon, 5 d/wk). The other side acted as the control. The PMs intervention continued for as long as clinically indicated to a maximum of 4 weeks. The primary outcome was ankle dorsiflexion ROM at cessation of PMs. Plantarflexion, elbow flexion and extension ROM, and participant-reported joint pain and stiffness (verbal analog scale [VAS]) were also measured. Outcomes were recorded at baseline and cessation of PMs. For participants whose PMs intervention ceased early due to recovery, additional post-early-cessation of PMs review measurements were undertaken as near as possible to 4 weeks. We analyzed data from 25 participants with a median (interquartile range) ICU stay of 15.6 days (11.3-25.4). The mean (95% CI) between-side difference for dorsiflexion ROM (with knee extension) at cessation of PMs was 0.4 degrees (-4.4 to 5.2; p = 0.882), favoring the intervention side, indicating there was not a clinically meaningful effect of 5 degrees. No statistically significant differences were found between the intervention and control sides for any ROM or VAS data. PMs, as provided to this sample of medium to long-stay ICU patients, did not prevent or reduce joint stiffness.

Efficacy of supramalleolar osteotomy in the treatment of traumatic ankle joint varus deformity in adolescents

BackgroundSupramalleolar osteotomy (SMOT) has emerged as a valuable treatment for ankle varus deformity; however, there are fewer reports of treatment outcomes in adolescents. The purpose of this study was to investigate the radiologic and clinical outcomes of SMOT for the treatment of traumatic ankle joint varus deformity (TAVD) in adolescents.MethodsWe reviewed 32 adolescent cases who underwent SMOT between February 2017 and February 2022 for TAVD. Radiologic assessment included tibial anterior surface angle (TAS), talar tilt angle (TT), and tibial lateral surface angle (TLS) preoperatively and at 3 months and 12 months postoperatively, and clinical assessment was performed using American Orthopaedic Foot and Ankle Society (AOFAS) scores, Visual Analogue Scale (VAS) scores, and ankle dorsiflexion–plantarflexion ROM including preoperative and 6 months postoperative and 12 months postoperative.ResultsAll 32 patients were followed up completely with a mean follow-up of (20.3 ± 3.2) months. From the radiologic outcomes, the mean preoperative TAS improved from 61.53 ± 3.74 to 88 ± 1.72 at 12 months postoperatively, the mean preoperative TT decreased from 2.25 ± 1.32 to 0.5 ± 0.57 at 12 months postoperatively, the mean preoperative TLS improved from 76.72 ± 0.21 to 79.34 ± 1.52 at 12 months postoperatively, the differences between the above preoperative and 12 months postoperative radiologic outcomes were statistically significant (p < 0.05), the mean preoperative AOFAS score improved from 65.5 ± 9.40 to 92.34 ± 4.00 at 12 months postoperatively, the mean preoperative VAS score decreased from 2.44 ± 1.24 to 0.78 ± 0.75 at 12 months postoperatively, and the mean preoperative range of motion (ROM) of ankle improved from 50.16 ± 7.46 to 55.78 ± 4.77 at 12 months postoperatively. The differences between the above preoperative and 12 months postoperative clinical results were statistically significant (p < 0.05).ConclusionOur study demonstrated that SMOT was effective in correcting TAVD and significantly improving ankle function in adolescents, and that it is an efficient and successful method for restoring ankle joint congruence and normal hindfoot alignment.

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.

Short-term effectiveness of INBONE TM Ⅱ total ankle prosthesis arthroplasty in the treatment of moderate to severe varus-type ankle arthritis

To investigate the short-term effectiveness of INBONE TM Ⅱ total ankle prosthesis arthroplasty in the treatment of moderate to severe varus-type ankle arthritis. The clinical and radiographic data of patients with moderate to severe varus-type ankle arthritis, who were admitted between May 2017 and November 2021 and treated with total ankle arthroplasty (TAA) using INBONE TM Ⅱ prosthesis, was retrospectively analyzed. A total of 58 patients (58 ankles) met the selection criteria and were included in the study. Among them, there were 24 males and 34 females, with an average age of 62.6 years (range, 41-85 years). According to the preoperative tibiotalar angle (TTA), the patients were divided into a moderate varus group (group A, TTA 5°-15°, n=34) and a severe varus group (group B, TTA>15°, n=24). There was no significant difference in gender, side, etiology, preoperative American Orthopaedic Foot and Ankle Society (AOFAS) score, ankle dorsiflexion, plantarflexion, and total range of motion, and tibial lateral surface angle (TLS) between the two groups ( P>0.05). Yet the patients in group A were younger than group B, the degrees of oesteoarthritis (Takakura stage) and ankle pain [visual analogue scale (VAS) score] were milder, and the TTA, talar tilt angle (TT), hindfoot alignment angle (HAA) were smaller while the tibial articular surface angle (TAS) was larger, showing significant differences ( P<0.05). The pre- and post-operative VAS score, AOFAS score, the occurrence of early and late complications, the radiographic parameters of the ankle (TTA, TAS, TT, HAA, TLS), ankle dorsiflexion, plantarflexion, and total range of motion were recorded and compared. All patients were followed up 19-72 months, with an average of 38.9 months. Compared with the preoperative data, the VAS score of all patients significantly decreased ( P<0.05); the AOFAS score, ankle dorsiflexion range of motion, and total range of motion significantly increased ( P<0.05); and the TTA, TAS, TT, HAA, and TLS significantly improved at last follow-up ( P<0.05); but there was no significant difference in plantarflexion range of motion ( P>0.05). Early complications occurred in 13 patients, and only 1 patient underwent revision surgery due to a larger size of the talar component. At last follow-up, there was no significant difference in the difference of clinical parameters before and after operation between the two groups ( P>0.05); there was a significant difference in the difference of other radiographic parameters ( P<0.05) except TLS. No significant difference in the incidence of complications between the two groups was found ( P>0.05). TAA using the INBONE TM Ⅱtotal ankle prosthesis is an effective treatment for moderate or severe varus-type ankle arthritis, and good clinical and radiographic results can be obtained. Correcting bony deformities and balancing soft tissue are the keys to successful surgery.

Effect of a Neuromuscular Training on Knee Valgus, Range of Motion and Muscle Strength of Soccer Players With Dynamic Knee Valgus

Background and Aims The present study aims to investigate the effect of a neuromuscular training program on knee valgus angle, and range of motion (ROM) and muscle strength of hip and ankle in male adolescent football players with dynamic knee valgus (DKV). Valgus knee is one of the most common neuromuscular abnormalities that is involved in causing non-contact damage to the anterior cruciate ligament (ACL). Methods This is a quasi-experimental study. Participants were 25 adolescent male football players with DKV who were purposefully selected from Shahin Football Academy in Amol, Iran and randomly divided into two groups of control and training. The existence of DKV was assessed by Squats test and the valgus angle were assessed by jump-landing test and Kinovea software. The abduction and external rotation strength and ROM of hip and the dorsiflexion and plantarflexion strength and ROM of ankle were evaluated with Manual Muscle Testing and a goniometer, respectively. After performing the pre-test assessments, the subjects in the training group performed neuromuscular training for 8 weeks, while the control group also participated in the physical fitness program of Shahin Football Academy. At the end, assessments were performed again in two groups. To examine the differences, repeated measures analysis of variance and Bonferroni post hoc test were used in SPSS software, version 24. The significance level was set at 0.05. Results The results showed a significant difference in knee valgus angle (P=0.001), abduction ROM of hip (P=0.01), external rotation ROM of hip (P=0.01), dorsiflexion ROM of ankle with knee extension (P=0.001), dorsiflexion ROM of ankle with knee flexion (P=0.001), hip abduction strength (P=0.002), hip external rotation strength (P=0.01), and plantarflexion strength of ankle (P=0.03) between the control and training groups. However, the results showed no significant difference in plantarflexion ROM of ankle and dorsiflexion strength of ankle (P&gt;0.05). After one month, the results showed the sustainability of the effect of training on abduction and external rotation ROM of hip, dorsiflexion ROM of ankle with knee extension and flexion, and dorsiflexion and plantarflexion strength of ankle. Conclusion The neuromuscular training can reduce the risk of non-contact ACL injury in male football players with DKV by improving strength and ROM of hip and ankle.

Effects of exercise treatment on functional outcome parameters in mid-portion achilles tendinopathy: a systematic review.

Exercise interventions are evident in the treatment of mid-portion Achilles tendinopathy (AT). However, there is still a lack of knowledge concerning the effect of different exercise treatments on improving a specific function (e.g., strength) in this population. Thus, this study aimed to systematically review the effect of exercise treatments on different functional outcomes in mid-portion AT. An electronic database of Pubmed, Web of Science, and Cochrane Central Register of Controlled Trials were searched from inception to 21 February 2023. Studies that investigated changes in plantar flexor function with exercise treatments were considered in mid-portion AT. Only randomized controlled trials (RCTs) and clinical controlled trials (CCTs) were included. Functional outcomes were classified by kinetic (e.g., strength), kinematic [e.g., ankle range of motion (ROM)], and sensorimotor (e.g., balance index) parameters. The types of exercise treatments were classified into eccentric, concentric, and combined (eccentric plus concentric) training modes. Quality assessment was appraised using the Physiotherapy Evidence Database scale for RCTs, and the Joanna Briggs Institute scale for CCTs. The search yielded 2,260 records, and a total of ten studies were included. Due to the heterogeneity of the included studies, a qualitative synthesis was performed. Eccentric training led to improvements in power outcomes (e.g., height of countermovement jump), and in strength outcomes (e.g., peak torque). Concentric training regimens showed moderate enhanced power outcomes. Moreover, one high-quality study showed an improvement in the balance index by eccentric training, whereas the application of concentric training did not. Combined training modalities did not lead to improvements in strength and power outcomes. Plantarflexion and dorsiflexion ROM measures did not show relevant changes by the exercise treatments. In conclusion, eccentric training is evident in improving strength outcomes in AT patients. Moreover, it shows moderate evidence improvements in power and the sensorimotor parameter "balance index". Concentric training presents moderate evidence in the power outcomes and can therefore be considered as an alternative to improve this function. Kinematic analysis of plantarflexion and dorsiflexion ROM might not be useful in AT people. This study expands the knowledge what types of exercise regimes should be considered to improve the functional outcomes in AT.

A Minimal Sensor Inertial Measurement Unit System Is Replicable and Capable of Estimating Bilateral Lower-Limb Kinematics in a Stationary Bodyweight Squat and a Countermovement Jump.

This study aimed to validate a 7-sensor inertial measurement unit system against optical motion capture to estimate bilateral lower-limb kinematics. Hip, knee, and ankle sagittal plane peak angles and range of motion (ROM) were compared during bodyweight squats and countermovement jumps in 18 participants. In the bodyweight squats, left peak hip flexion (intraclass correlation coefficient [ICC] = .51), knee extension (ICC = .68) and ankle plantar flexion (ICC = .55), and hip (ICC = .63) and knee (ICC = .52) ROM had moderate agreement, and right knee ROM had good agreement (ICC = .77). Relatively higher agreement was observed in the countermovement jumps compared to the bodyweight squats, moderate to good agreement in right peak knee flexion (ICC = .73), and right (ICC = .75) and left (ICC = .83) knee ROM. Moderate agreement was observed for right ankle plantar flexion (ICC = .63) and ROM (ICC = .51). Moderate agreement (ICC > .50) was observed in all variables in the left limb except hip extension, knee flexion, and dorsiflexion. In general, there was poor agreement for peak flexion angles, and at least moderate agreement for joint ROM. Future work will aim to optimize methodologies to increase usability and confidence in data interpretation by minimizing variance in system-based differences and may also benefit from expanding planes of movement.

The Assessment of Ankle Range-of-Motion and Its Relationship with Overall Muscle Strength in a Cross-Section of Soccer Players.

Soccer (football) practice can induce a limitation of ankle range of motion (ROM) that is a possible risk factor for injury and other negative consequences over time. The main objective of this research was to investigate the effects of soccer practice on ankle ROM throughout the entire period of a sports career of soccer players (SP). Furthermore, the relationship between ankle ROM and muscle strength in SP of different ages was studied. A total of 204 SP (range 6.7−45.1 years) and 87 controls (range: 7.5−45.2 years) matched for age, body mass index (BMI), and gender, were assessed. Ankle ROM in both plantar flexion (APF) and dorsiflexion (ADF) in addition to handgrip strength (HGS) were evaluated using an inclinometer and the Jamar hydraulic hand dynamometer, respectively. The comparison between SP and control groups showed a significant reduction in ankle ROM of both APF (26.3 ± 7.2° vs. 32.6 ± 7.4°; d = −0.90; p < 0.001) and ADF (95.5 ± 15.6° vs. 105.5 ± 15.8°; d = −0.66; p < 0.001). In SP, the results of the ANOVAs test indicate that age had a significant effect on ADF (F = 4.352, p = 0.038, partial eta-squared (ηp2) = 0.015) but not on APF (F = 0.430, p = 0.746, ηp2 = 0.001). Moreover, considering only the SP, a weak inverse correlation between ADF and HGS group ADF was found (rs = −0.27; p < 0.001). Factors such as the non-linear trend of growth in young SP could hinder the definition of the relationship between ankle ROM, age, and muscle strength. However, the appropriate consideration of age and muscle strength could facilitate the management of ankle ROM in PF of different ages.