A Rare Case of Transepiphyseal Distal Femur Fracture Dislocation With Delayed Recovery of a Common Peroneal Nerve Injury.

The aim of this study is to bring attention to a unique case and our approach to treatment in this context. We describe a case of an 11-year-old male who presented to us with an injury to his left knee following trauma with pain, swelling, shortening and deformity for one day. An X-ray revealed a transepiphyseal fracture dislocation of the left distal femur (Salter-Harris type 1 injury) and neurovascular examination was conclusive of foot drop which pointed towards injury to common peroneal nerve (CPN). The patient was taken up for closed reduction with percutaneous pinning under mobile C-arm guidance. The fracture was reduced and fixed with two cross K-wires and immobilized with the above knee anterior-posterior slab for six weeks. The wires were removed after six weeks but there was no improvement in the dorsiflexion of the left ankle. An electromyography (EMG) and nerve conduction velocity (NCV) study test was performed after 12 weeks which showed decreased amplitude and prolonged latency in the left CPN with early denervation of the muscles supplied by the left CPN. Fifteen weeks of follow-up showed complete recovery in the dorsiflexion of the left ankle with a slight lag in the extension of the left great toe making this an unusually delayed recovery of CPN palsy following a distal femur transepiphyseal fracture.

Unilateral peroneal neuropathy in a patient following laparoscopic sleeve gastrectomy.

Peroneal neuropathy, characterized by the occurrence of a foot drop, can develop due to a variety of factors, such as tumors, trauma, or metabolic conditions, making it one of the most prevalent peripheral neuropathies of the lower limbs. This condition is becoming more identifiable among patients who have undergone substantial weight reduction through bariatric surgery. The condition may present with symptoms like pain, sporadic paresthesia, and functional restrictions, primarily linked to foot drop. This case study explores an episode of acute foot drop in a patient who underwent a sleeve gastrectomy, leading to substantial weight loss.The patient, a middle-aged woman with a history of obesity, underwent sleeve gastrectomy and achieved normal body mass index (BMI) within a year. Eleven months post-surgery, she experienced a right-sided foot drop following a minor knee injury. Detailed history taking revealed noncompliance with vitamin supplementation, recurrent vomiting episodes, and a recent diagnosis of pancreatic insufficiency. Peripheral neuropathy, particularly peroneal nerve involvement, was confirmed through nerve conduction studies and radiological imaging. The mechanism of injury was attributed to rapid weight loss, potential nutrient deficiencies, and possible traction to the nerve.This case underscores the importance of early identification, comprehensive nutritional assessment, and timely intervention in managing neurological complications of post-bariatric surgery. Increased awareness among healthcare providers, particularly musculoskeletal specialists, is crucial as the prevalence of bariatric surgery continues to grow, ensuring optimal care for patients in this vulnerable population.

Isolated left foot drop post aortobifemoral bypass surgery: A case report.

INTRODUCTION: Foot drop is a disorder characterized by weakness in the dorsiflexor muscles of the foot, caused by various pathologies, including neurological, muscular, spinal, and autoimmune conditions. Sometimes, it can be iatrogenic due to direct nerve compression, traction, or ischemia. The occurrence and underlying mechanism of foot drop following aortobifemoral bypass surgery are not well-documented in literature. CASE PRESENTATION: A 40-year-old male, with short distance claudication secondary to multi-level lower limb arterial occlusions, mainly, external iliac arteries and superficial femoral arteries. The patient underwent an uneventful aortobifemoral bypass. Post-operatively, the patient developed left sided foot drop with no clear etiology. With intensive physiotherapy, the patient improved and eventually recovered. DISCUSSION: After excluding other causes of the manifestation, this case could potentially give an insight to a rare postoperative complication following aortobifemoral bypass surgery. Despite a smooth intraoperative course, the patient developed foot drop, a rarely reported complication, suggesting a potential link between the procedure and foot drop. CONCLUSION: This case report highlights a rare postoperative complication after aortobifemoral bypass surgery, emphasizing the need for further research to elucidate the direct mechanisms behind this rare occurrence.

Sensing and Control Strategies Used in FES Systems Aimed at Assistance and Rehabilitation of Foot Drop: A Systematic Literature Review.

Functional electrical stimulation (FES) is a rehabilitation and assistive technique used for stroke survivors. FES systems mainly consist of sensors, a control algorithm, and a stimulation unit. However, there is a critical need to reassess sensing and control techniques in FES systems to enhance their efficiency. This SLR was carried out following the PRISMA 2020 statement. Four databases (PubMed, Scopus, Web of Science, Wiley Online Library) from 2010 to 2024 were searched using terms related to sensing and control strategies in FES systems. A total of 322 articles were chosen in the first stage, while only 60 of them remained after the final filtering stage. This systematic review mainly focused on sensor techniques and control strategies to deliver FES. The most commonly used sensors reported were inertial measurement units (IMUs), 45% (27); biopotential electrodes, 36.7% (22); vision-based systems, 18.3% (11); and switches, 18.3% (11). The control strategy most reported is closed-loop; however, most of the current commercial FES systems employ open-loop strategies due to their simplicity. Three main factors were identified that should be considered when choosing a sensor for gait-oriented FES systems: wearability, accuracy, and affordability. We believe that the combination of computer vision systems with artificial intelligence-based control algorithms can contribute to the development of minimally invasive and personalized FES systems for the gait rehabilitation of patients with FDS.

Ipsilateral Foot Drop and Erectile Dysfunction After the Use of a Traction Table in Intramedullary Femur Fixation: A Case Report and Review of the Literature.

This report presents a case of ipsilateral foot drop and erectile dysfunction following the use of a traction table during intramedullary femur fixation. The patient, a 39-year-old male, underwent surgery for a femur fracture using an intramedullary nail and was positioned on a traction table during the procedure. Post-operatively, he developed foot drop and erectile dysfunction. Neurological examination revealed peroneal nerve injury as the likely cause of the foot drop. The erectile dysfunction was attributed to pudendal nerve injury. Various treatment options were considered, including physical therapy for foot drop and phosphodiesterase inhibitors for erectile dysfunction. In conclusion, this case underscores the importance of recognizing and addressing potential complications associated with traction table use in orthopedic procedures, particularly concerning neurological sequelae and sexual dysfunction.

Dorsiflexion Specific Ankle Robotics to Enhance Motor Learning After Stroke: A Preliminary Report.

Background: Robotics has emerged as a promising avenue for gait retraining of persons with chronic hemiparetic gait and footdrop, yet there is a gap regarding the biomechanical adaptations that occur with locomotor learning. We developed an ankle exoskeleton (AMBLE) enabling dorsiflexion assist-as-needed across gait cycle sub-events to train and study the biomechanics of motor learning stroke. This single-armed, non-controlled study investigates effects of nine hours (9 weeks × 2 sessions/week) locomotor task-specific ankle robotics training on gait biomechanics and functional mobility in persons with chronic hemiparetic gait and foot drop. Subjects include N = 16 participants (8 male, 8 female) age 53 ± 12 years with mean 11 ± 8 years since stroke. All baseline and post-training outcomes including optical motion capture for 3-D gait biomechanics are conducted during unassisted (no robot) over-ground walking conditions. Findings: Robotics training with AMBLE produced significant kinematic improvements in ankle peak dorsiflexion angular velocity (°/s, + 44 [49%], p < 0.05), heel-first foot strikes (%steps, + 14 [15%], p < 0.01) toe-off angle (°, + 83[162%], p < 0.05), and paretic knee flexion (°, + 20 [30%], p < 0.05). Improvements in gait temporal-spatial parameters include increased paretic step length (cm, + 12 [20%], p< 0.05), reduced paretic swing duration (%GC, -3[6%], p < 0.05), and trend toward improved step length symmetry (-16 [11%], p = 0.08). Functional improvements include 10-meter comfortable (m/s, + 13 [16%], p < 0.01) and fastest (m/s, + 13 [15%], p<0.01) walking velocities, 6-minute timed walk distance (m, + 16 [19%], p < 0.01) and Dynamic Gait Index scores (+15 [15%], p < 0.01). Subjects' perceived improvements surpassed the minimal clinically important difference on the Stroke Impact Scale (SIS) mobility subscale (+11 [19%], p < 0.05). Conclusions: AMBLE training improves paretic ankle neuromotor control, paretic knee flexion, and gait temporal-distance parameters during unassisted over-ground walking in persons with chronic stroke and foot drop. This locomotor learning indexed by an increase in volitional autonomous (non-robotic) control of paretic ankle across training translated to improvements in functional mobility outcomes. Larger randomized clinical trials are needed to investigate the effectiveness of task-specific ankle robotics, and precise training characteristics to durably improve gait, balance, and home and community-based functional mobility for persons with hemiparetic gait and foot drop. Clinical trial identifier: NCT04594837.

Diagnostic accuracy of ultrasound and MR imaging in peroneal neuropathy: A prospective, single-center study.

INTRODUCTION/AIMS: Magnetic resonance imaging (MRI) findings in peroneal neuropathy are not well documented and the prognostic value of imaging remains uncertain. Upper limits of cross-sectional area (CSA) on ultrasound (US) have been established, but uncertainty regarding generalizability remains. We aimed to describe MRI findings of the peroneal nerve in patients and healthy controls and to compare these results to US findings and clinical characteristics. METHODS: We prospectively included patients with foot drop and electrodiagnostically confirmed peroneal neuropathy, and performed clinical follow-up, US and MRI of both peroneal nerves. We compared MRI findings to healthy controls. Two radiologists evaluated MRI features in an exploratory analysis after images were anonymized and randomized. RESULTS: Twenty-two patients and 38 healthy controls were included. Whereas significant increased MRI CSA values were documented in patients (mean CSA 20 mm2 vs. 13 mm2 in healthy controls), intra- and interobserver variability was substantial (variability of, respectively, 7 and 9 mm2 around the mean in 95% of repeated measurements). A pathological T2 hyperintense signal of the nerve was found in 52.6% of patients (50% interobserver agreement). Increased CSA measurements (MRI/US), pathological T2 hyperintensity of the nerve and muscle edema were not predictive for recovery. DISCUSSION: Imaging is recommended in all patients with peroneal neuropathy to exclude compressive intrinsic and extrinsic masses but we do not advise routine MRI for diagnosis or prediction of outcome in patients with peroneal neuropathy due to high observer variability. Further studies should aim at reducing MRI observer variability potentially by semi-automation.

Crushing Muscles: A Case Study on Rhabdomyolysis, Renal Failure, and Compartment Syndrome Triggered by Pre-Workout Supplement Abuse.

The use of steroids and protein-based dietary supplements for muscle enhancement is prevalent in contemporary society. While these products promise increased muscle mass and strength, they carry significant risks, including severe medical complications. The consumption of these supplements has been linked to adverse symptoms, including dehydration, gastrointestinal distress, dizziness, and alterations in heart rate and blood pressure, primarily due to ingredients like creatine, arginine, and caffeine. Following the proper dosage, ensuring adequate hydration, and consulting a healthcare provider to verify if the supplement's components could affect any pre-existing conditions is recommended. Indiscriminate use of these products, including taurine, can lead to serious side effects. We present a 36-year-old patient with severe rhabdomyolysis, life-threatening acid-base imbalance, renal and liver injury, and peripheral neuropathy associated with the use of performance-enhanced unregulated supplements and exercise. This case highlights the importance of recognizing and managing complications related to exercise-aid supplements, emphasizing early identification and management. Increasing social awareness and research on those products is highly needed to avoid supplement-associated complications and potential long-term disabilities.

Rapidly Progressive, Symmetrical, Acute Cutaneous Necrosis of Bilateral Lower Limbs: A Rare Presentation of Polyarteritis Nodosa.

Acute cutaneous necrosis is a rare presentation of polyarteritis nodosa (PAN). In this study, we report a presentation with symmetrical cutaneous necrosis of the lower limbs, which ascended upward at a rapid rate. A 47-year-old man presented with a fever of one day and pain in the feet for six days. He had no history of claudication. Upon examination, he was febrile, and subtle bluish discoloration was observed on the sole of his foot. There was a bilateral stocking-type paresthesia up to the ankle joint. His blood pressure on admission was 210/120 mmHg. Eight hours later, the pain subsided, but a left-sided foot drop was noted along with the paresthesia extending up both feet to approximately 10 cm above the medial malleolus. The feet turned black, and dark discoloration spread rapidly upward over the next 16 hours, and the skin became necrosed. A clinical diagnosis of vasculitis was established, and the patient received IV methylprednisolone at a daily dosage of 1 g for three days, effectively stopping the advancement of necrosis. This was followed by treatment with IV cyclophosphamide. A conclusive diagnosis of PAN was made, and the patient underwent wound debridement. After three months of physiotherapy, a successful skin graft was performed. Prompt identification of the underlying etiology is crucial to prevent the advancement of necrosis and save the limbs. When vasculitis is suspected, ruling out infectious causes is essential before starting early immunosuppressive treatment.

A Comprehensive Physiotherapeutic Intervention for Complex Proximal Tibia Fracture With Ilizarov Fixator and Foot Drop in 18-Year-Old Adult: A Case Report.

The susceptibility of the tibia to fractures arises from its exposed position, making it a commonly affected area. The proximal tibia exhibits a wide metaphyseal region that gradually narrows distally, forming a triangular shape. The extended tibia shaft articulates with the fibula, talus, and distal femur. We have discussed the case of an 18-year-old male who experienced a road traffic accident on January 7, 2023, involving a collision between his bike and four-wheeler, resulting in high-energy forces impacting his left lower limb. As a consequence, he lost mobility in the left lower limb. Upon examination, he was diagnosed with a compound grade 3C proximal tibia fracture treated with Ilizarov fixators, accompanied by a neurovascular deficit leading to a foot drop on the left side. Additionally, he had a previous operative case involving a femur shaft fracture on the left side, which was managed with in situ implants. It concluded that the rehabilitation approach was effective in pain reduction, improving range of motion, muscle strength, and reducing sensory impairment. Improved results on the lower extremity functional scale and the foot and ankle ability measures showed that the physiotherapy method had been successful in helping the patient regain independence in everyday activities. The success of rehabilitation and the recovery of patients are greatly influenced by post-operative physical therapy.

Fibular (peroneal) neuropathy.

Fibular neuropathy has variable presenting features depending on the site of the lesion. Anatomical features make it susceptible to injury from extrinsic factors, particularly the superficial location of the nerve at the head of the fibula. There are many mechanisms of compression or other traumatic injury of the fibular nerve, as well as entrapment and intrinsic nerve lesions. Intraneural ganglion cysts are increasingly recognized when the mechanism of neuropathy is not clear from the medical history. Electrodiagnostic testing can contribute to the localization as well as the characterization of the pathologic process affecting the nerve. When the mechanism of injury is unclear from the analysis of the presentation, imaging with MRI and ultrasound may identify nerve lesions that warrant surgical intervention. The differential diagnosis of foot drop includes fibular neuropathy and other neurologic conditions, which can be distinguished through clinical and electrodiagnostic assessment. Rehabilitation measures, including ankle splinting, are important to improve function and safety when foot drop is present. Fibular neuropathy is less frequently painful than many other nerve lesions, but when it is painful, neuropathic medication may be required. Failure to spontaneously recover or the detection of a mass lesion may require surgical management.

The effect of electromyographic feedback functional electrical stimulation on the plantar pressure in stroke patients with foot drop.

Purpose: The purpose of this study was to observe, using Footscan analysis, the effect of electromyographic feedback functional electrical stimulation (FES) on the changes in the plantar pressure of drop foot patients. Methods: This case-control study enrolled 34 stroke patients with foot drop. There were 17 cases received FES for 20 min per day, 5 days per week for 4 weeks (the FES group) and the other 17 cases only received basic rehabilitations (the control group). Before and after 4 weeks, the walking speed, spatiotemporal parameters and plantar pressure were measured. Results: After 4 weeks treatments, Both the FES and control groups had increased walking speed and single stance phase percentage, decreased step length symmetry index (SI), double stance phase percentage and start time of the heel after 4 weeks (p < 0.05). The increase in walking speed and decrease in step length SI in the FES group were more significant than the control group after 4 weeks (p < 0.05). The FES group had an increased initial contact phase, decreased SI of the maximal force (Max F) and impulse in the medial heel after 4 weeks (p < 0.05). Conclusion: The advantages of FES were: the improvement of gait speed, step length SI, and the enhancement of propulsion force were more significant. The initial contact phase was closer to the normal range, which implies that the control of ankle dorsiflexion was improved. The plantar dynamic parameters between the two sides of the foot were more balanced than the control group. FES is more effective than basic rehabilitations for stroke patients with foot drop based on current spatiotemporal parameters and plantar pressure results.

One-stage Neurorrhaphy and Posterior Transposition with Gastrocnemius Fascial Flap for Common Peroneal Nerve Injury: Preliminary Results.

OBJECTIVE: Common peroneal nerve (CPN) injury is a frequently encountered lower extremity injury. Furthermore, several previous studies have demonstrated that patients who underwent direct suturing of the CPN following rupture experienced unfavorable postoperative prognoses. Therefore, we aimed to present a novel modified surgical approach for CPN rupture and assess the effectiveness of this technique in restoring lower limb functionality. METHODS: In this retrospective observational study, we included patients with CPN rupture who underwent one-stage neurorrhaphy and posterior transposition combined with nerve wrapping using a gastrocnemius fascial flap for CPN rupture between January 2016 and December 2020. Lower limb function was evaluated using the lower extremity functional scale (LEFS) and British Medical Research Council (BMRC) grading system. We also assessed the influence of age, sex, duration of symptoms, mechanism of injury, and surgical modality on the postoperative recovery of lower extremity function using subgroup and regression analyses. RESULTS: Thirty-seven patients (mean age = 35.76 ± 13.01 years) with at least 2 years of follow-up were included in the final analysis. The LEFS scores significantly improved after surgery at the last follow-up (p < 0.01). Moreover, 67.57% of the patients achieved good or excellent postoperative outcomes (BMRC: M3 or above). Results of the subgroup analysis and regression models suggested that patients who underwent direct suturing showed better recovery of lower extremity function than those who underwent nerve grafting. CONCLUSION: One-stage neurorrhaphy and posterior transposition combined with nerve wrapping using a gastrocnemius fascial flap exhibited encouraging outcomes in restoring lower-limb function among patients with CPN rupture. This novel surgical technique is expected to be an effective method for treating CPN ruptures in the future.

Rehabilitation of a Patient With D12 Wedge Compression Fracture and Bilateral Foot Drop With Spinal Fusion and Posterior Decompression: A Case Report.

Vertebral fracture (VF) is one of the most common injuries seen in individuals with osteoporosis, especially in post-menopausal females. There is an increase in bone resorption rate, leading to the destruction of the microarchitecture of bone. A 67-year-old female patient diagnosed with wedge compression fracture of the D12 vertebra, mild compression of the spinal cord, and bilateral foot drop came to a tertiary care hospital, where she underwent spinal fusion at the D11-L1 level and posterior decompression, after which she was referred to physiotherapy, where a patient-tailored treatment protocol was made and implemented over three weeks. Outcome measures like the visual analog scale (VAS), functional independence measure (FIM), and Oswestry's low back disability questionnaire were recorded before and after rehabilitation, and improvement in pain and activities of daily living (ADL) was found. The patient needed mild assistance. There was also improvement in the range and strength of the lower limb muscles. This case report aims to provide a comprehensive treatment protocol for a post-operative spinal fusion and bilateral foot drop patient.

Physiotherapy Rehabilitation Towards Foot Drop in a Paediatric Case of Iatrogenic Sciatic Nerve Palsy: A Case Report.

In this report, we are presenting a case of injection nerve palsy in a three-year-old child whose parents visited with the complaint of weakness of the left lower limb, inability to walk, and difficulty in performing lower limb movements after taking diphtheria-tetanus-pertussis (DPT) vaccination in the gluteal region by intramuscular route. The child exhibited a foot drop on his left leg and a high step gait when examined. Nerve conduction velocity was performed, which revealed pure motor axonal mononeuropathy involving the left sciatic nerve. She was diagnosed with a left sciatic nerve injury from a foot drop and was referred to physiotherapy. With the proper exercise protocol, physiotherapy rehabilitation began. We report that after rehabilitation, she showed improvement in the strength of the lower limb and gait pattern. As a result, physiotherapy is critical in improving a patient's gait pattern, ensuring early and rapid recovery, and treating the condition's clinical manifestations. This case study concludes that physiotherapy rehabilitation for injection palsy in a three-year-old female child with foot drop led to improved lower-limb strength, which assisted the patient in ambulation and prevented other deformities.

Feasibility of a promising pulsed electrostimulator for rapid motor recovery of foot drop.

Purpose: Foot drop still occurs in clinical practice, including in our case. Treatments for foot drop vary based on its etiology and severity of symptoms. Hence, in intractable foot drop cases, an invasive surgical intervention is needed. Here, we introduce a special noninvasive technique to treat our patient's foot drop. In this approach, we applied STIMPOD NMS460 neuromuscular stimulator device (STIMPOD NMS460), which is a low-frequency (10 Hz or less) transcutaneous electrical nerve stimulation (TENS) device with a pulsed radiofrequency (PRF) component. We are eager to know how effective the device is in treating foot drop, and we compared it with two kinds of surgical interventions. Materials and methods: The device settings are 5 Hz in frequency and 30mA in current amplitude. The device was applied on her left side at the L4 and L5 regions and at the fibular head. Each therapy session consists of individual 15-min treatments on these two body areas, and it only takes a total of 30 minutes. We recorded the change in ankle dorsiflexion degrees and muscle strength of our patient. Results and Conclusions: To our surprise, our patient's actual treatment status through STIMPOD NMS460 showed more effective recovery and no specific side effects than surgical interventions in similar conditions. Besides, after a three-month intervention, her affected ankle dorsiflexion recovered to almost her usual status. The reason why this device has such an effect may be that it has the benefits of TENS and PRF. Besides, some studies have revealed the nerve-repair effect of TENS and PRF. In conclusion, we believe that this device is fairly promising and may be qualified to be used in other patients with foot drop.

Comprehensive Rehabilitation of a Patient With Foot Drop Secondary to Lumbar Canal Stenosis: A Case Report.

One of the most prevalent degenerative musculoskeletal conditions is lumbar spinal canal stenosis (LSS), which is characterized by narrowing of the lumbar spinal canal that pressures the nerve roots and cauda equine. LSS, when treated surgically, usually presents with foot drop as its major complication. Foot drop is a common presentation of several clinical diseases, traditionally characterized as severe weakening of ankle and toe dorsiflexion. Foot drop has a great impact on patients' lives, lowering their quality of life and affecting their activities of daily living. Ankle dorsiflexion weakness leads to foot drop and a high-stepping gait, which can cause multiple falls and accidents. This case study aimed to assess the efficacy of a customized physiotherapy program in a 50-year-old woman with paraparesis along with left foot drop and post-surgery complications following lumbar decompression and spinal fusion at L3-S1 (lumbar-sacral) level after a jerk experienced by her while working out in the gym. The objective was to determine the impact of individualized exercises on the patient's strength, gait, balance, and pelvic floor function over a 12-week rehabilitation period. The interventions included lower limb exercises (stretching exercises, strengthening exercises, and weight-bearing exercises), pelvic floor exercises, and core stability training. The findings demonstrated significant improvements in the patient's functional outcomes, as evidenced by enhanced scores in the Berg Balance Scale, Manual Muscle Testing, Dynamic Gait Index, Barthel Index, and Stanmore Assessment Questionnaire. Notable progress was observed in the strength, balance, gait, and pelvic floor function, highlighting the positive influence of targeted physiotherapeutic interventions. This case underscores the importance of tailored exercise plans in addressing the complexities of post-surgery challenges, emphasizing the potential for comprehensive recovery and improved overall quality of life through personalized physiotherapy.

Functional evaluation of a novel fibreglass-reinforced polyamide custom dynamic AFO for foot drop patients: A pilot study.

BACKGROUND: Ankle-foot orthoses (AFOs) are orthopaedic devices often prescribed to treat foot drop. For patients who are not satisfied with off-the-shelf solutions, custom AFOs personalized to the patient's lower limb anatomy are required. Dynamic AFOs provide stability while allowing for physiological ankle mobility in the stance phase of walking. RESEARCH QUESTION: Can a morphology-based dynamic custom AFO made of fiberglass-reinforced polyamide restore a quasi-normal gait pattern and improve comfort in patients with foot drop? METHODS: In this pilot study, the legs and feet of ten foot drop patients (age=64.9 ± 11.4 years; BMI=26.2 ± 2.1 kg/m2) were scanned using a Kinect-based 3D scanner. A custom AFO was designed and produced for each patient using a fiberglass-reinforced polyamide through selective laser sintering. To assess kinematics, skin markers were placed on relevant bony landmarks according to a validated protocol. Each patient was instructed to walk at a self-selected comfortable speed under three conditions: wearing the custom AFO, wearing an off-the-shelf orthosis (Codivilla spring), and without any AFO (shod condition). Muscle activation in the tibialis anterior, gastrocnemius, rectus femoris and biceps femoris muscles in both legs was recorded using wireless sEMG sensors. The comfort and of each AFO was evaluated using a Visual Analogue Scale. RESULTS: The custom AFO resulted in significant increase of stride length and walking speed compared to the shod condition. Except for the hip joint, which exhibited greater maximum flexion and reduced range of motion, the kinematic parameters of all other joints were similar to those observed in a healthy control population. Furthermore, the custom AFO received significantly higher comfort scores compared to the Codivilla spring. SIGNIFICANCE: This study has provided evidence supporting the effectiveness of custom orthotic solutions in restoring lower limb kinematics and improving the perceived comfort in foot drop patients compared to off-the-shelf solutions.

Comparison of Staple, Anchor, and Tenodesis Screw for Posterior Tibialis Tendon Fixation: A Biomechanical Analysis.

Various posterior tibialis tendon fixation techniques are described in literature. Suture anchor, staple and tenodesis screws are widely used for posterior tibialis tendon transfer, but their stiffness and the maximal ultimate failure load were not tested before. We aimed to compare the initial ultimate failure load and stiffnesses of suture anchor, staple and tenodesis screws on bovine tendon fixation to bovine metaphyseal bone. Thirty-five fresh bovine ankle joints and hooves were obtained from a local abattoir. Metatarsals bones with long extensor tendons were harvested. Staple group had 15, suture anchor group had 10, and tenodesis screw group had 10 samples. All fixations were tested with Instron® ElectroPuls® E10000 Test Instrument. Ultimate failure load and failure location were noted. Staple group's median ultimate failure load was 210.03 N (IQR: 133.43), suture anchor group's was 124.33 N (IQR: 63.67), and tenodesis screw group's was 394.46 N (IQR:115.09). Median stiffness of the staple group was 19.87 N/m (IQR: 15.29); the tenodesis screw group's was 20.28 N/m (IQR: 6.18), the anchor group's was 8.54 N/m (IQR: 4.35). Staples' failure occurred on tendon-staple interface, while suture anchors' occurred on anchor-suture interface and tenodesis screws' occurred on tendon-suture interface. Tenodesis screws' ultimate failure load was the highest (tenodesis vs anchor and staple p < .001 and p = .032, respectively). Staple fixation is less expensive than the other methods and can provide sufficient fixation strength but was weaker than the tenodesis screw fixation. Staples are still a good choice for tendon to bone fixation, whereas the suture anchors provide lower fixation strength at a higher cost.