Gait analysis of leprosy patients with foot drop using principal component analysis.

BACKGROUND: Peripheral nerve injury caused by leprosy can lead to foot drop, resulting in an altered gait pattern that has not been previously described using 3D gait analysis. METHODS: Gait kinematics and dynamics were analyzed in 12 patients with unilateral foot drop caused by leprosy and in 15 healthy controls. Biomechanical data from patients' affected and unaffected limbs were compared with controls using inferential statistics and a standard distance, based on principal components analysis (PCA). FINDINGS: Patients walked slower than controls (0.8 ± 0.2 vs. 1.1 ± 0.2 m/s, p = 0.003), with a reduced stance and increased swing percentage. The affected limb increased (p < 0.05) plantar flexion at the initial contact (-16.8o ± 8.3), terminal stance (-29.1o ± 11.5), and swing (-12.4o ± 6.2) in the affected limb compared to unaffected (-6.6o ± 10.3; -14.6o ± 11.6; 2.4o ± 7.6) and controls (-5.4o ± 2.5; -18.8o ± 5.8; -1.4o ± 3.9). Increased pelvic tilt and knee adduction/abduction range, with lower hip adduction, were observed. The second peak of ground reaction force (98.6 ± 5.2 %BW), ankle torque (0.99 ± 0.33 Nm/kg), and net ankle work in stance (-0.03 ± 5.4 J/Kg) decreased in the affected limb compared to controls (104.1 ± 5.5 %BW; 1.24 ± 0.4 Nm/kg; -4.58 ± 5.19 J/kg; p < 0.05). There were decreasing multivariate standard distances in the affected limb compared with the unaffected and controls. PCA loading factors highlighted the major differences between groups. INTERPRETATION: Leprosy patients with foot drop presented altered gait patterns in affected and unaffected limbs. There were remarkable differences in ankle kinematics and dynamics. Rehabilitation devices, such as ankle foot orthosis or tendon transfer surgeries to increase ankle dorsiflexion, could benefit these patients and reduce deviations from normal gait.

Changes in plantar load distribution and gait pattern following foot drop correction in leprosy affected patients.

This study was done to compare the changes in plantar load (weight distribution) and gait patterns before and after tibialis posterior transfer surgery in people affected by leprosy. Changes in gait patterns were observed and proportionate changes in plantar load were quantified using data captured by a baropodometer. All the eight patients who underwent tibialis posterior transfer surgery in 2013 in our hospital were included in the study. In addition to the regular pre-operative and post-operative assessments, the patients also underwent baropodometric evaluation. There was a significant change in plantar load at the heel, lateral border and forefoot. Using the foot pressure scan, it was noted that the progression of the centre of mass (displayed graphically as 'the gait line') was also affected by the altered pattern of weight distribution. This study reiterates the importance of tibialis posterior transfer because: it restores the normal gait pattern of 1, 2, 3 (where 1 is heel strike, 2 is mid foot contact and 3 is forefoot contact) and provides a more uniform distribution of planter load.

Long term results of tibilalis posterior tendon transfer for foot drop in leprosy.

Seventy four patients, who underwent tibialis posterior transfer between 1960 and 1970 at the Schieffelin Leprosy Research & Training Centre, were reviewed more than 10 years follow up. Sixty four patients (86.5%) improved from a high stepping gait to a heel toe gait. The foot at rest position and the range of movement which were seen after surgery were retained. Postoperative complications were minimal. Interosseous method was better than the circumtibial. Tibilais posterior tendon transfer has served the gait and foot function in the long term.

Tibialis posterior transfer by interosseous route for the correction of foot drop in leprosy.

This article summarises a prospective study to evaluate the long-term results produced by interosseous transfer of the tibialis posterior tendon for the correction of foot drop due to leprosy neuritis. The study was carried out in 120 feet in 69 patients. All patients had closed elongation of the tendo Achillis (ETA) before transfer of the bifurcated tibialis posterior tendon through the interosseous route to the tendons of tibialis anterior and peroneous tertius or brevis over the dorsum of feet. At final follow-up of average 24 months, all the patients with ETA had a significantly greater range of active dorsiflexion of more than 10 degrees above 90 degrees, which was not merely from the tenodesing effect. The results, in terms of improvement in gait and prevention of trophic changes, remained satisfactory. An interosseous route is preferred with split attachment to the tibialis anterior and to the peroneus brevis or tertius tendons.

The ANK device: a new approach in the treatment of the fractures of the lateral malleolus associated with the rupture of the syndesmosis.

The ANK device was developed for the treatment of fractures of the lateral malleolus occurring with rupture of the syndesmosis. While it provides the anatomic reduction of the fracture and the syndesmosis, it allows the physiologic movements of the fibula. It is not used for comminuted fractures of the lateral malleolus and in cases where fibular medullary canal is narrow. We included forty-nine patients who had the ANK device applied and at least 2 years follow-up. The mean follow-up was 41 months (range 24-124). The fractures were evaluated according to the Lauge-Hansen classification; 25 cases were evaluated as supination-external rotation, 11 cases were pronation-abduction, and 13 cases were pronation-external rotation type fractures. There were also 46 fractures of the medial malleolus and three ruptures of the deltoid ligament. Twenty-nine (59,2%) patients were evaluated as excellent, 12 (24,5%) as good, 5 (10.2%) as fair and 3 (6.1%) as poor. Arthrosis was observed in 3 (6.1%) of the patients.

Stress analysis in three-dimensional foot models of normal and diabetic neuropathy.

In this paper, a three-dimensional two-arch model of the foot is developed, taking foot geometry from X-rays of normal and diabetic subjects, which considered bones, cartilages, ligaments, important muscle forces and foot-sole soft-tissue. The stress analysis is carried out by a finite element technique using NISA software for the foot models simulating quasi-static walking phases of heel-strike, mid-stance and push-off. The analysis shows that the highest stresses occur during the push-off phase in the dorsal central part of the lateral and medial metatarsals and the dorsal junction of the calcaneus and cuboid. The vertical stresses, in the foot-sole soft-tissue at the foot-ground interface, for normal and diabetic neuropathic subjects, are the highest in the push-off phase and were in good agreement with the experimentally measured foot pressures. It is found that the foot-sole vertical stresses (at the foot-ground interface), in diabetic neuropathy, increase considerably in the heel region in the heel-strike phase and in the fore-foot regions in the push-off phase. The high stress concentration areas, in the plantar surfaces indicated above, are of great importance since it is found from clinical reports that in diabetic neuropathic patients these areas of the foot-sole are prone to ulcers. Thus, this investigation could possibly provide information on the areas of high stress concentration of the foot bones in the normal foot giving rise to arthritis when the mechanical strength decreases and possible high stress regions of foot bone giving rise to disintegration of tarsal bones in leprosy, as well as an insight into the factors contributing to plantar ulcers in diabetic neuropathy.

Avaliacao funcional do amputado de membro inferior ao final do processo de reeducacao da marcha com protese / Functional evaluation of the amputated one of inferior member to the end of the process of re-education of the march with prosthesis

O tratamento fisioterapico do amputado de membro inferior tem como objetivo levar o paciente a recuperar o maximo de sua capacidade funcional. Neste trabalho propomos um protocolo de avaliacao funcional do paciente, ao final do processo de reeducacao da marcha, segundo as habilidades, dificuldades, limitacoes e expectativas do paciente

A new DSP-based multichannel EMG acquisition and analysis system.

This paper describes the design of a digital signal processor based system for a personal computer for EMG data acquisition to monitor muscle activity during gait and to estimate the power spectrum of the acquired data under normal and pathological conditions. It also gives the hardware details of the velocity meter which is used to monitor the muscle activity with speed of walking. Software has been developed for system initialization, data acquisition, processing of acquired data, and data display for five channels. The developed equipment will be useful to clinicians for enhancing the understanding of a patient's dynamic performance.

Surgery of foot drop in leprosy by tibialis posterior transfer.

In the surgery of foot drop the common method of correction is by transfer of tibialis posterior muscle, either to the joint capsule in the middle of the foot (Selvapandian's method) or a double transfer to the toe extensor tendons (Srinivason's method). A retrospective study was done to compare the results of surgery done by those two methods at the Sacred Heart Leprosy Centre, Kumbakonam with a follow-up ranging from one to nine years where 78 feet had tibialis posterior transfer by Srinivasan's method and 20 by Selvapandian-Brand method. Restoration of the normal heel-toe gait was the criteria taken to evaluate the results. Good results were obtained by either method in nearly 70% of cases. The post operative findings and the causes of failure are analysed in detail. The pre and post-operative physiotherapy methods which mainly contribute a successful result are described and stressed.

Therapeutic footwear for the insensitive foot.

The patient with insensitive feet may be injured by poorly fitted or inappropriate footwear. The risk of soft-tissue injury from friction or pressure can be reduced by careful selection and fitting of footwear and frequent evaluation of both footwear and the patient's feet. Concepts, methods, and materials utilized in treating patients with Hansen's disease can be applied to the prevention and treatment of injuries secondary to sensory deficit caused by other conditions. The microcapsule sock test has been used to assess shear forces and pressures that occur while shoes are worn. Test method and interpretation of test results are described.

Gait study in evaluation of results in intramedullary nailing for femoral shaft fractures.

The present preliminary investigation conducted on six adult males whose femur shaft fractures had been fixed internally by means of Hansen-Street intermedullary nails indicated that our gait study technic helps confirm the clinical findings in such cases. Five patients, although their fractures had united and they had resumed their usual activities, were not deemed quite normal as yet and the causes for their gait abnormality were identified in the clinical examination. The gait study technic thus provided fairly accurate quantitative support of the clinical findings.

Problems in footwear for the leprosy patient

This paper deals with footwear for partially amputated feet of patients in tows and cities who require either surgical footwear made to measure or normal footwear which can be adapted surgically. It includes a problems associated with amputation of the great toe including balance, relief of pressure and satiffeling to prevent deformity. Unilateral amputation of all toes and associated complications, bilateral amputation of al toes, with similar complications, but with the added possibility of rocker soles to correct the gait, and amputatiuons through the midtarsalarea where major protheses are necessary.Descriptions are given of the use of sponge rubber cork and plastazote for weight distribution and relief and of the manufacture of suitable footwear by the vacuum forming method.