Acute Effects of Local High-Frequency Percussive Massage on Deep Fascial and Muscular Stiffness and Joint Range of Motion in Young Adult Men.

BACKGROUND: Local high-frequency percussive (HFP) massage has recently found widespread application in physical therapy. Although HFP massage reportedly improves range of motion (ROM), the mechanism underlying its action has not yet been proven. This study aimed to clarify whether a 5-minute percussive massage regimen affects muscular or connective tissues, such as the deep fascia and deep intermuscular fascia and the change in joint ROM. METHOD: The study sample was calculated using G*Power analysis program, and this study enrolled 15 healthy men who underwent 5-minute HFP massage to the medial gastrocnemius muscle. Shear-wave elastography was used to measure tissue stiffness in the deep fascia, muscle, and deep intermuscular fascia through shear-wave velocity as well as the ROM of the volunteers' ankle joint dorsiflexion before and after the HFP massage. A value of P < .05 was used to declare statistical significance, and post hoc was used to calculate the effect size using G*Power. RESULTS: Shear-wave velocity revealed a significant change in the deep fascia (P = .003; shear-wave velocity: -0.7 m/s) and significant increase in ROM of ankle dorsiflexion (P = .002; increase in ROM: 3.0°) after 5 minutes of HFP massage. However, the muscle and deep intermuscular fascia did not exhibit any significant changes. CONCLUSIONS: HFP massage for 5 minutes modified the stiffness of the deep fascia and concurrently improved the ankle joint-dorsiflexion ROM. This method can be used as an intervention to decrease stiffness of the deep fascia and increase the ROM efficiently.

Disabled throwing shoulder/elbow players have high rates of impaired foot function.

The prevalence of impaired foot function and floating toes of 91 baseball players with disabled throwing shoulder or elbow were retrospectively investigated. Foot function was evaluated by foot "rock paper scissors" and floating toes were confirmed if none of the toes made contact with the mat in standing posture. The prevalence of impaired foot function and floating toes and the relationship between between them were determined. Abnormal foot function was observed in 83 players (91%); of those, 73 players (88%) also had floating toes, and the prevalence was statistically significant compared to those without it (12%) (P < 0.001). Floating toes were observed in 74 players (81%); of those, 73 players (99%) had impaired foot function, and the prevalence was also statistically significant compared to those without them (59%) (P < 0.001). Baseball players with disabled throwing shoulder or elbow have high rates of impaired foot function and floating toes.

Comparison of foot posture and foot muscle morphology between lifesaver athletes and healthy adults.

This study aimed to compare the foot muscle morphology and foot posture between healthy adults and lifesavers in sandy beach sports. The participants included 15 lifesaver athletes and 15 healthy adults. Using a non-contact three-dimensional foot measurement device, the foot length, width, and arch height of the right foot were measured while standing and sitting without back support, and the transverse arch length ratio and arch height index were subsequently calculated. Muscle cross-sectional area was measured using an ultrasound imaging device. Muscle cross-sectional areas, arch height, foot width, arch height index, and transverse arch length ratio were larger in the lifesaver than in the healthy adult group. Lifesavers had higher arches and more developed intrinsic and extrinsic muscles than healthy adults. Performing physical activity while barefoot on sandy beaches may effectively develop the foot intrinsic and extrinsic muscles and raise the arch.

Change in the sub-sesamoid soft tissue thickness under different loading conditions.

[Purpose] To measure the sub-sesamoid soft tissue thickness change from non-loading to self-weight loading conditions. [Participants and Methods] The study included 17 female participants for the study. A questionnaire was used to collect the demographic data and participant anamnesis, such as the presence of foot injuries and diabetes. The measured height and weight were used to calculate the body mass index. Participants were required to stand on an evaluation device from non-loading to 100% loading conditions to measure the sub-sesamoid soft tissue thickness. [Results] Significant differences were observed between the tibial and fibular sub-sesamoid soft tissue thicknesses under non-loading and all loading conditions. Significant soft tissue thinning was observed with a change from non-loading to 25% loading condition. However, no significant differences in the rate of change were observed between the tibial and fibular sub-sesamoid soft tissue thicknesses at 100% loading. [Conclusion] The sub-fibular sesamoid soft tissue was thicker than the sub-tibial sesamoid soft tissue in all loading conditions. The sub-sesamoid soft tissue thickness change was larger during initial loading stage than during the late loading stage, which may be normal in healthy females in their 20s.

Diclofenac-hyaluronate conjugate (diclofenac etalhyaluronate) intra-articular injection for hip, ankle, shoulder, and elbow osteoarthritis: a randomized controlled trial.

BACKGROUND: To evaluate the efficacy and safety of intra-articular injection of diclofenac etalhyaluronate (DF-HA) in patients with osteoarthritis (OA) of the hip, ankle, shoulder, or elbow. METHODS: In this randomized, placebo-controlled, double-blind study in Japan, Japanese patients aged ≥20 years diagnosed with OA of the hip, ankle, shoulder, or elbow were randomly assigned 1:1 to DF-HA 30 mg or placebo (citric acid-sodium citrate buffered solution). Subjects received three injections of the study drug in each joint cavity every 4 weeks and were assessed for 12 weeks after the first injection. The primary endpoint was the mean change from baseline in a diary-based 11-point numerical rating scale (NRS) for pain over 12 weeks, analyzed for each joint. Treatment-emergent adverse events were recorded, and morphological changes in each joint were evaluated radiographically. RESULTS: The study drug (DF-HA vs placebo) was injected into 90, 60, 90, or 50 subjects with OA of the hip, ankle, shoulder, or elbow (46 vs 44, 30 vs 30, 45 vs 45, and 25 vs 25, respectively). The group differences in the mean change from baseline in the pain NRS over 12 weeks were - 0.81 (95% confidence interval: - 1.48 to - 0.13), - 0.07 (- 1.03 to 0.89), 0.15 (- 0.48 to 0.78), and 0.61 (- 0.41 to 1.62) for the hip, ankle, shoulder, and elbow joints, respectively, with statistically significant differences observed only in the hip joint. The change from baseline in the hip joint was greater with DF-HA than placebo at all time points from Weeks 1-12. No clinically significant adverse events or radiographic changes were observed. CONCLUSIONS: Intra-articularly administered DF-HA for hip OA produced a rapid response and was safe, with analgesia maintained for 12 weeks when administered every 4 weeks. TRIAL REGISTRATION: JapicCTI-173,678 (First registered date: 21 August 2017).

Effect of Ankle Motion and Tensile Stress at the Achilles Tendon on the Contact Pressure Between the Achilles Tendon and the Calcaneus.

Impingement between the Achilles tendon and the posterosuperior prominence of the calcaneus is considered to be a cause of insertional Achilles tendinopathy. The corresponding treatment intends to reduce tensile stress from calf muscles and avoid hyper-dorsiflexion of the ankle joint for decreasing the contact pressure; however, no study has reported on whether these treatments can decrease impingement. Thus, this study investigated the hypothesis that the tensile stress of the Achilles tendon and ankle motion affect the contact pressure between the Achilles tendon and the posterosuperior prominence of the calcaneus. Six fresh-frozen cadaveric lower leg specimens were procured. Each specimen was set to a custom foot-loading frame and loaded with a ground reaction force of 40 N and a tensile load of 70 N along the Achilles tendon. The contact pressure between the Achilles tendon and the posterosuperior prominence of the calcaneus was measured using a miniature pressure sensor under different tensile loadings of the Achilles tendon at the neutral ankle position. Similarly, the contact pressures during the ankle motion from a neutral position to maximum dorsiflexion were measured. The tensile load of the Achilles tendon and ankle motion affected the contact pressure between the Achilles tendon and the posterosuperior prominence of the calcaneus. The contact pressure increased with tensile load or ankle dorsiflexion. Conditions with increasing the tensile load of the Achilles tendon or under ankle dorsiflexion increase the contact pressure between the Achilles tendon and the posterosuperior prominence of the calcaneus.

Immediate effects of plantar vibration stimuli during static upright posture following total hip arthroplasty in females.

PURPOSE: Proprioceptive function of the lower limbs deteriorates in patients following total hip arthroplasty. Patients show poor balance and rely more on visual information than proprioceptive information. Plantar vibration stimuli can mechanically enhance somatosensory input from the plantar cutaneous mechanoreceptors, thereby improving static balance. Plantar vibration stimuli may improve static balance in patients after total hip arthroplasty. This is the first study to investigate whether plantar vibration stimuli affects static balance during the early phase following total hip arthroplasty. MATERIALS AND METHODS: In this cross-over design study, 16 female patients (aged 65.1 ± 11.0 years) received plantar vibration stimuli for 2 minutes or the sham interventions after total hip arthroplasty in a randomized order on different days. The foot centre of pressure was measured for the total path length, mediolateral path length, and anteroposterior path length directions before and immediately after the interventions in the static standing position both with eyes open and closed. Patients were instructed to minimize body sway when standing. RESULTS: A significant increase was observed in the centre of pressure parameters in the eyes closed condition than in the eyes open condition. The centre of pressure parameters for the eyes closed condition was significantly decreased after vibration interventions than that before intervention. CONCLUSIONS: This study supports the view that plantar vibration stimuli can change static balance in patients in the early phase after total hip arthroplasty temporarily by up-weighting sensory information. These stimuli may serve as a treatment option for influencing balance following total hip arthroplasty.

Is metatarsus primus elevatus truly observed in hallux rigidus? Radiographic study using mapping methods.

BACKGROUND: Hallux rigidus and metatarsus primus elevatus (MPE) are associated, but their causal relationship remains unknown. Several surgical approaches for treating hallux rigidus are available. We evaluated morphological characteristics of hallux rigidus with different grades to determine the optimal surgical approach. The amount of degenerative change in the metatarsophalangeal joint on the preoperative roentgenograms was graded on a scale of 1-3. We analyzed the morphology of hallux rigidus using X-ray image mapping developed by our team. METHODS: This study involved weight-bearing, dorsoplantar, and lateral foot X-rays of 36 feet from 26 patients underwent surgery for hallux rigidus (Group R) at our institution, and 26 normal feet (Group N). A two-dimensional coordinate system was used to analyze the sharps of these feet by converting each dot on the radiographs into X and Y coordinates. Diagrams of the feet from each group were drawn for comparison. Feet with grades 2 (Group R2) and 3 (Group R3) hallux rigidus and normal feet were compared by Kruskal-Wallis test. RESULTS: Mapping revealed that the tip of distal phalanges of the second, and third toes in Group R medially shifted (P < 0.05) in dorsoplantar image of the feet, and that the medial point, a part of the talus, navicular, cuneiform, and first metatarsal bone in Group R, shifted lower (P < 0.05) in lateral feet images of the feet. Multiple comparisons revealed a significant navicular bone depression in grade 3 hallux rigidus compared with normal feet. A significant difference was observed between Group N and R3 but not between Group R2 and N or R3. CONCLUSIONS: X-ray morphological analysis of the foot revealed MPE in Group R. Elevation gradually increased as hallux rigidus grade worsened. Therefore, osteotomy combined with cheilectomy, whereby the first metatarsal bone can be tilted toward the plantar side, are useful for treating a higher-grade hallux rigidus. LEVEL OF EVIDENCE: Level III, comparative study.

Short-term efficacy and safety of hyaluronic acid injection for plantar fasciopathy.

PURPOSE: Plantar fasciopathy is the most common cause of plantar heel pain and is considered to be a type of enthesopathy. The short-term efficacy, safety, and dose-response relationship of high-molecular-weight hyaluronic acid (HA) was investigated in patients with plantar fasciopathy. METHODS: In this multicenter, prospective, randomized, double-blind, placebo-controlled trial, 168 patients with persistent pain from plantar fasciopathy for more than 12 weeks were randomly assigned to receive 2.5 mL of 1% HA (H-HA), 0.8 mL of 1% HA (L-HA), or 2.5 mL of 0.01% HA (control group) once a week for 5 weeks. The primary endpoint was improvement in visual analogue scale (VAS) score for pain from baseline to week 5. RESULTS: The VAS scores (least squares mean ± standard error) in each group decreased gradually after the start of treatment, a change of -3.3 ± 0.3 cm for the H-HA group, -2.6 ± 0.3 cm for the L-HA group, and -2.4 ± 0.3 cm for the control group, with the H-HA group improving significantly more than the control group (P = 0.029). No serious adverse events were reported. There was no difference between the groups in the incidence rates of adverse drug reactions. CONCLUSION: The administration of five injections of high-molecular-weight HA is an effective treatment with no serious adverse drug reactions and is a conservative treatment option for plantar fasciopathy. This treatment contributed to alleviation of pain in patients with plantar fasciopathy and improvement in their activities of daily living. LEVEL OF EVIDENCE: I.

Recurrent Dislocation of the Tibialis Posterior Tendon Treated With Suture Tape: A Case Report of an Innovative Operative Procedure.

Dislocation of the tibialis posterior tendon (PTT) is a rare traumatic injury, and treatment is often delayed. Conservative treatment is ineffective for recurrent dislocation of the PTT; however, a reference standard procedure has not yet been established. In the present case report, we describe an innovative pseudo-pouch closing procedure with suture tape and a suture anchor for recurrent PTT dislocation. The patient returned to preoperative levels of activity at 21 weeks postoperatively and was asymptomatic at the 1-year follow-up examination.

Arthroscopic Resection of Symptomatic Ossicle of the Medial Malleolus: A Case Report.

An ossicle around the medial malleolus is difficult to differentiate from an unfused ossification center, an avulsion fracture, and os subtibiale. Misdiagnosis can lead to inappropriate or unnecessary treatments. We describe a patient with a symptomatic ossicle of the medial malleolus in the left ankle that prevented participation in sports activities because of medial ankle pain. Plain radiography and computed tomography revealed a small ossicle associated with the anterior colliculus of the medial malleolus. Conservative treatment failed, and the patient underwent ankle arthroscopy. Instability of the ossicle was identified after the hypertrophic inflammatory synovium had been debrided. The ossicle was resected in a step-by-step manner with an arthroscopic shaver and grasper through the anteromedial accessary portal. The deltoid ligament sustained minimal damage after resection. The patient fully recovered and was able to return to sports activities 3 months after surgery. Arthroscopic resection of the ossicle at the medial malleolus requires no additional treatments of the deltoid ligament, effectively relieves symptoms, and enables the patient to return to full preinjury activities.

Superficial blood flow of the superior labrum associated with rotator cuff tear using laser Doppler flowmeter.

INTRODUCTION: Superior labrum anterior and posterior (SLAP) lesions due to overuse by repeated pitching motion and trauma are often noted and usually. However, shoulder disorders with a chronic course are often accompanied by SLAP lesions. SLAP lesions are frequently observed during arthroscopic surgery of the shoulder joint for rotator cuff tear in middle-aged and elderly individuals, suggesting the involvement of factors other than pitching motion and traumatic events in the pathogenesis. We considered that blood flow in the labrum is altered. The purpose of this study was to clarify the superficial blood flow in the superior labrum during arthroscopic surgery of the rotator cuff tear and investigate whether it is altered with labrum injury. MATERIALS AND METHODS: We evaluated 33 subjects with a mean age of 55.1 years who underwent arthroscopic surgery for partial or complete rotator cuff tears. The blood flow measurement site for the superior labrum was set at the supraglenoid tubercle attachment site, and blood flow was measured twice using laser Doppler flowmeter. The mean was calculated and compared among the normal labrum and type 1 SLAP lesions. RESULTS: The morphology of the labrum was normal in 16 subjects, and 17 subjects had type 1 SLAP lesions. The mean blood flow was 1.75 ml/min/100 g in subjects with a normal labrum; however, in subjects with type 1 SLAP lesions, blood flow was 1.32 ml/min/100 g, showing significant differences (P < 0.01). CONCLUSION: Superficial blood flow in the superior labrum of the shoulder with rotator cuff tear was measured using laser Doppler flowmetry. The blood flow in type 1 SLAP lesions was lower than that in the normal labrum.

The short-term effect after a single injection of high-molecular-weight hyaluronic acid in patients with enthesopathies (lateral epicondylitis, patellar tendinopathy, insertional Achilles tendinopathy, and plantar fasciitis): a preliminary study.

BACKGROUND: Hyaluronic acid (HA) with a high molecular weight of 2700 kDa is approved in Japan to treat osteoarthritis of the knee, periarthritis scapulohumeralis, and knee pain associated with rheumatoid arthritis. The purpose of this preliminary study was to investigate the short-term efficacy, safety, and injectable volume of HA in the treatment of enthesopathies. METHODS: A total of 61 patients (16 with lateral epicondylitis, 14 with patellar tendinopathy, 15 with insertional Achilles tendinopathy, and 16 with plantar fasciitis) were each administered a single injection of HA (up to 2.5 ml). Efficacy and safety were assessed by comparing the visual analog scale (VAS) for pain and local symptoms before injection (baseline) and at 1 week after injection. We also investigated the injectable volume by means of the difference in syringe weight before and after injection and by the judgment of the administering investigator. RESULTS: The injection of HA resulted in a change in VAS (mean ± SD) of -2.20 ± 2.26 cm for the four sites overall and -2.55 ± 2.43 cm for lateral epicondylitis, -2.01 ± 2.16 cm for patellar tendinopathy, -1.80 ± 1.91 cm for insertional Achilles tendinopathy, and -2.38 ± 2.61 cm for plantar fasciitis. The injection of HA also improved local symptoms in each site. It was also determined that 2.5 ml of HA can be injected in each of the four sites. CONCLUSION: A single injection of HA resulted in similar improvements of pain in each of the four enthesopathies (lateral epicondylitis, patellar tendinopathy, insertional Achilles tendinopathy, and plantar fasciitis). These results suggest that HA could be clinically effective in the treatment of enthesopathies.

Changes in functional characteristics of heel fat pad with age.

BACKGROUND: This study aimed to investigate age-related changes in the heel fat pad's microchamber and macrochamber layers, particularly focusing on load-induced alterations. Understanding these changes is crucial for elucidating age-related differences in foot mechanics and their potential implications for mobility and comfort. METHODS: Fifty-five healthy individuals were divided into three age groups: young adults (≤29 years), middle-aged adults (30-44 years), and elderly individuals (≥45 years). Ultrasonic imaging was utilized to measure the thickness of the heel fat pad's microchamber and macrochamber layers under varying load conditions. Thickness, percentage changes, and ratios of load-induced thickness changes were calculated to assess age-related differences. FINDINGS: Under no-load conditions, both microchamber and macrochamber layers of the heel fat pad were significantly thicker in middle-aged and elderly individuals than in young adults. When load was applied middle-aged and elderly participants exhibited smaller changes in the macrochamber layer and larger changes in the microchamber layer compared to young adults. INTERPRETATION: Our findings suggest that age influences the structural characteristics and response of the heel fat pad to mechanical loading. Thicker heel fat pad layers in middle-aged and elderly individuals under no-load conditions may reflect age-related changes in fat distribution or composition. Moreover, differences in load-induced thickness changes indicate altered mechanical properties with age, potentially affecting shock absorption and overall foot function. Understanding these age-related variations can help develop interventions aimed at preserving foot health and mobility across the lifespan.

Arthroscopic Resection of Symptomatic Ossicles of the Medial Malleolus Combined With Deltoid Ligament Repairs in Athletes: A Report of Three Cases.

We report three cases of young athletes with symptomatic ossicles of the medial malleolus who underwent arthroscopic resections of the ossicle combined with deltoid ligament repair. A differential diagnosis of the ossicles beneath the medial malleolus, accessory ossification center, avulsion fracture resulting in pseudoarthrosis, and accessory bone such as os subtibiale has been proposed. However, it is difficult to differentiate them clearly. Most of these ossicles are asymptomatic, although they can cause chronic medial ankle pain, especially in young athletes who require surgical treatment. All three patients had pain in the distal part of the medial malleolus, which restricted their sports activities. Plain radiographs of all three cases revealed a well-defined, round-shaped bony lesion beneath the medial malleolus. Ultrasonographic imaging, magnetic resonance imaging, and arthroscopic findings revealed that ligament attachment to the ossicle varies in volume and type according to the cases. In other words, the mechanisms through which the existence of the ossicles affects the stability of the ankle joint and foot alignment are different in each case, indicating that deltoid ligament repair is necessary according to the cases. In all three cases, we performed arthroscopic resections of ossicles combined with deltoid ligament repairs, achieving favorable short-term clinical outcomes.

Functional Morphologic Changes of the Heel Fat Pad and Plantar Fascia in Patients With Heel Pain During Weightbearing and Nonweightbearing.

Background: This study aimed to investigate the thickness changes of the heel fat pad and the plantar fascia associated with loading and unloading in healthy individuals and patients with heel pain and reveal the differences between them. Methods: The study included adult male participants with (n = 9) and without (n = 26) heel pain. The participants placed their right foot on an evaluation apparatus with a polymethylpentene resin board (PMP), while their left foot was positioned on a weighing scale used to adjust the loading weight. The heel fat pad was differentiated into superficial Microchamber and deep Macrochamber layers. These layers and plantar fascia thickness were measured using an ultrasonographic imaging device at loading phase ranging from 0% to 100% of their body weight and unloading phase from 100% to 0%. Additionally, the study examined the thickness change ratios of the superficial and deep heel fat pad layers when the load increased from 0% (unload) to 100% (full load). Results: In healthy individuals and patients with heel pain, no significant thickness changes were observed in the Microchamber layer of the heel fat pad or the plantar fascia during loading and unloading evaluations. However, significant thickness changes were observed in the Macrochamber layer of the heel fat pad, and the pattern of change differed between the loading and unloading phases. Additionally, patients with heel pain showed differences in the thickness change and thickness change ratios of the microchamber and macrochamber layers of the heel fat pad during both loading and unloading phases. The thickness of the plantar fascia did not show significant differences between both groups. Conclusion: Compared with healthy individuals, in our relatively small study, patients with heel pain had greater deep fat pad compression in loading and less recovery after load removal. This finding suggests that these patients have different intrinsic fat pad function and related morphology than those without heel pain. Level of Evidence: Level III, retrospective cohort study.

Differences in muscle activity of extrinsic and intrinsic foot muscles in toe grip and push-down movements of the great toe.

Toe flexor strength is generated primarily by the flexor hallucis longus (FHL) of the extrinsic foot muscles (EFMs) and the plantar intrinsic foot muscles (PIFMs) of the great toe. Toe flexion methods can be broadly classified into toe grip (TG) and toe push-down (TP). Additionally, TP's interphalangeal joint (IPJ) position may influence the FHL and PIFMs activity ratios. This study aimed to elucidate the differences in the muscle activity and muscle activity ratios of the FHL and AbdH during TG, TP with IPJ flexion (TPIF), and TP with IPJ extension (TPIE). Surface electromyography and a custom-made instrument were used to measure the FHL and AbdH muscle activity during TG, TPIF, and TPIE of the great toe in 28 healthy men. The muscle activity and AbdH/FHL muscle activity ratio in the three conditions were statistically compared. The FHL activity was significantly higher during TG and TPIF than during TPIE. The AbdH muscle activity was significantly higher during TPIF and TPIE than that during TG. The AbdH/FHL muscle activity ratio was significantly higher for TPIE, TPIF, and TG in that order. This study showed that the FHL and AbdH muscle activity differed depending on the TG and TP of the great toe, and that the AbdH/FHL muscle activity ratio was different in the IPJ position. These results suggest that selecting a toe flexion method according to the target muscle when measuring and training the great toe flexor strength is important.

Effect of Height and Weight on Heel Fat Pad Movements Between Microchamber and Macrochamber Layers in Loading and Unloading.

Background: The purpose of this study was to clarify the differences in the movement of the superficial microchambers and deep macrochambers of the heel fat pad during loading and unloading movements, and to clarify the influence of height and weight on this movement. Methods: The subjects were 21 healthy adults. The right foot was placed on an evaluation instrument stand made of polymethylpentene (PMP) resin plate, and the left foot was placed on a scale stand used to adjust the amount of load. When measuring, the heel fat pad is divided into the superficial microchamber layer and the deep macrochamber layer, and the thickness due to loading from 0% to 100% of the body weight and unloading from 100% to 0% is measured. Measurement was performed every 20% using an ultrasound imaging device. We also examined the rate of change in the thickness of the superficial and deep layers of the heel fat pad when applying 100% load (end load) from 0% load (unload). Results: No changes were observed in the superficial layer of the heel fat pad during unloading, but significant changes were observed in the deeper layers. Additionally, the thickness of the microchamber and macrochamber layers tended to increase under each loading condition as the height and weight increased. On the other hand, the rate of change in the thickness of the macrochamber layer tended to decrease. Conclusion: The microchamber layer and the macrochamber layer of the heel fat pad may have different functions. As height and weight increase, the thickness of the microchamber and macrochamber layers may increase, and the rate of change in the thickness of the macrochamber layer appears to decrease. Although the thickness increases as the load increases, we found that the related elasticity decreases. Level of Evidence: Level Ⅳ, cross-sectional survey study.

Hallux valgus in preprofessional adolescent dancesport athletes: Prevalence and associated training factors.

BACKGROUND: This study aimed to determine the risk factors of hallux valgus angle among preprofessional adolescent dancesport athletes. METHODS: A total of 275 athletes, (73 males and 202 females) aged between the ages of 11 and 18 years, participated in this study. A cross-sectional questionnaire was used to survey their demographic characteristics (sex and age), training information (starting age, weekly training time, and athletic career [number of years of training at this specific dancesport school]), and measured their height and weight. The hallux valgus angle was measured based on foot photographs. The chi-square test was used to compare the difference with prevalence of hallux valgus between male and female athletes. A normal distribution test was performed, and based on the test results, unpaired t-test and multiple logistic regression were conducted to identify training factors for the hallux valgus in this cohort. RESULTS: Chi-square test showed higher prevalence of hallux valgus in female elite adolescent dancesport athletes than males. The t-test results did not show any significant differences between the hallux valgus group and non-hallux valgus groups with start age, athletic career, and weekly training time. Multiple logistic regression analysis with hallux valgus as the dependent variable revealed that the female sex was a strong predictor of a higher prevalence of hallux valgus (odds ratio [OR]: 3.954, 95% confidence interval 95% CI: 2.193-7.131, and p < 0.001). Weekly training time was also entered into the multiple logistic regression model (OR: 1.033, 95% CI: 1.001-1.067, and p = 0.041). CONCLUSIONS: Our findings revealed that the prevalence of hallux valgus in adolescent dancesport athletes was higher in females than in males. Longer weekly training time was also a risk factor for hallux valgus. Training factors should be considered in preventive programs for elite adolescent dancesport athletes, and special attention should be paid to female athletes.

Arthroscopic debridement and microfracture for bilateral osteochondral lesions on the lateral process of the talus involving the subtalar joint: A case report.

RATIONALE: Osteochondral lesions on the lateral process of the talus involving the subtalar joint are rare; the optimal surgical treatment remains to be clarified as there are few reports. Additionally, bilateral cases are extremely rare. Therefore, the clinical outcomes of the surgical treatment for bilateral osteochondral lesions on the lateral process of the talus involving the subtalar joint have not been fully elucidated. PATIENT CONCERNS: A 16-year-old boy who played soccer presented to our hospital with bilateral hindfoot pain. The symptoms persisted even after 3 months of conservative treatment. The patient and family requested surgical treatment to relieve the symptoms. DIAGNOSES: The patient was diagnosed with bilateral osteochondral lesions on the lateral process of the talus, involving the subtalar joint based on computed tomography and magnetic resonance imaging findings. INTERVENTIONS: Arthroscopic debridement and microfracture were performed bilaterally. OUTCOMES: Postoperative computed tomography and magnetic resonance imaging of both feet revealed remodeling of the subchondral bone. The patient returned to play at the pre-injury level with no pain. LESSONS: This report describes a case of bilateral osteochondral lesions on the lateral process of the talus, involving the subtalar joint. Arthroscopic debridement and microfracture were effective in relieving symptoms and the subchondral bone remodeling. To the best of our knowledge, this is the first report of arthroscopic treatment of osteochondral lesions of the lateral process of the talus involving the subtalar joint.