Factors associated with clinical severity in chronic venous disease: The role of functional parameters.

INTRODUCTION: Chronic venous disease (CVD) is a highly prevalent disease that presents a wide spectrum of clinical expressions due to abnormalities in the venous system. Patients often have major functional changes that can limit daily activities. However, the functional factors associated with the severity of the disease remain poorly understood. OBJECTIVE: To identify the functional factors associated with CVD severity. METHODS: Seventy-five patients with CVD (92.0% females, 49.6 ± 13.3 years) were evaluated through clinical examination, lower limb perimetry, ankle range of motion (AROM), and lower limb muscle strength by the Heel Rise test, and Sit-to-stand test. Patients were stratified according to the disease severity as mild (telangiectasia, varicose veins, or edema in the lower limbs) or severe CVD (trophic changes or venous ulcer). RESULTS: Patients with severe CVD (n = 13) were older (p = 0.002), predominantly male (p = 0.007), with reduced AROM in dorsiflexion (p = 0.028) and inversion (p = 0.009), reduced lower limb strength by the Heel Rise test (p = 0.040), and greater circumference of the calf (p = 0.020), ankle (p = 0.003), and plantar arch (p = 0.041) when compared to mild CVD (n = 62). Advanced age, male sex, lower ankle range of motion in dorsiflexion, and greater ankle and plantar arch circumferences were associated with CVD severity. However, the ankle circumference (OR 1.258, 95% CI: 1.008-1.570; p = 0.042), together with advanced age and male sex, was the only functional variable that remained independently associated with CVD severity. CONCLUSION: The increased ankle circumference was a determinant of the CVD severity and may assist in risk stratification and guide treatment goals in this population.

An Applied Anatomical Study on the Inferior Extensor Retinaculum of Ankle / Un Estudio de Anatomía Aplicada del Retináculo Extensor Inferior del Tobillo

SUMMARY: Through anatomical observations, the anatomical characteristics of the inferior extensor retinaculum of ankle (IER) of the ankle joint were elucidated, and its potential applications in treating lateral ankle instability or other conditions were discussed. A total of 12 adult foot specimens were dissected to expose the inferior extensor retinaculum of ankle, and a standard model was established. The pre-experimental scheme guided the recording of general findings, adjacent structures, lateral attachment in the tarsal sinus region, and influence on movement of inferior tendons. 1, attachment mean width: lateral band of IER 6.6±1.38 mm, oblique superomedial band of IER (32.3±3.97 mm), oblique inferomedial band of IER (30.0±5.30 mm) ; 2, mean length: lateral band of IER (78.1±4.20 mm) , oblique superomedial band of IER (14.2±0.80 mm), oblique inferomedial band of IER (71.8±2.61 mm); 3, maximum mean thickness: lateral band of IER (1.52±0.03 mm), oblique superomedial band of IER (0.89±0.05 mm), oblique inferomedial band of IER (0.73±0.16 mm); 4, the closest distance between IER and the tip of lateral malleolus: 23.9±0.83 mm; 5, mean width of the fiber tunnel:lateral fiber tunnel (11.9±1.16 mm), intermedium fiber tunnel (6.8±1.24 mm), medial fiber tunnel (8.6±0.79 mm); 6, mean distance from tunnel midpoint to lateral malleolar tip: lateral fiber tunnel (38.0±3.74 mm), intermedium fiber tunnel (69.8±4.15 mm), medial fiber tunnel (181.1±6.00 mm); 7, the distance between medial dorsal cutaneous nerve and the tip of lateral malleolus on the level of the IER (79.2±8.3 mm) the distance between intermediate cutaneous nerve of dorsum and the tip of lateral malleolus on the level of the IER (57.9±1.02 mm). The inferior extensor retinaculum of ankle is a crucial restraint unit of the anterior ankle tendon, and a comprehensive understanding of its anatomical characteristics holds significant implications for treating chronic ankle instability and exploring potential clinical applications.

A través de observaciones anatómicas, se dilucidaron las características anatómicas del retináculo extensor inferior (IER) de la articulación del tobillo y se discutieron sus posibles aplicaciones en el tratamiento de la inestabilidad lateral de esta articulación u otras afecciones. Se disecaron 12 muestras de pies de individuos adultos para exponer el retináculo extensor inferior del tobillo y se estableció un modelo estándar. El esquema preexperimental guió el registro de los hallazgos generales, las estructuras adyacentes, la inserción lateral en la región del seno tarsal y la influencia en el movimiento de los tendones inferiores. Se determino: 1. Ancho medio de inserción: banda lateral de IER (6,6 ± 1,38 mm), banda superomedial oblicua de IER (32,3 ± 3,97 mm), banda inferomedial oblicua de IER (30,0 ± 5,30 mm); 2. Longitud media: banda lateral de IER (78,1 ± 4,20 mm), banda superomedial oblicua de IER (14,2 ± 0,80 mm), banda inferomedial oblicua de IER (71,8 ± 2,61 mm); 3. Espesor medio máximo: banda lateral de IER (1,52 ± 0,03 mm), banda superomedial oblicua de IER (0,89 ± 0,05 mm), banda inferomedial oblicua de IER (0,73 ± 0,16 mm); 4. Distancia más próxima entre IER y el ápice del maléolo lateral: (23,9 ± 0,83 mm); 5.Ancho medio del túnel de fibra: túnel de fibra lateral (11,9 ± 1,16 mm), túnel de fibra intermedio (6,8 ± 1,24 mm), túnel de fibra medial (8,6 ± 0,79 mm); 6. Distancia media desde el punto medio del túnel hasta la punta del maléolor lateral: túnel de fibra lateral (38,0 ± 3,74 mm), túnel de fibra intermedio (69,8 ± 4,15 mm), túnel de fibra medial (181,1 ± 6,00 mm); 7. Distancia entre el nervio cutáneo dorsal medial y el a´pice del maléolo lateral en el nivel del IER (79,2 ± 8,3 mm); la distancia entre el nervio cutáneo intermedio dorsal y el ápice del maléolo lateral en el nivel del IER (57,9 ±1,02 mm). El retináculo extensor inferior del tobillo es una unidad de restricción crucial del tendón anterior del tobillo, y una comprensión integral de sus características anatómicas tiene implicaciones significativas para el tratamiento de la inestabilidad crónica del tobillo y la exploración de posibles aplicaciones clínicas.

An Assessment of Ankle Function, Oxidative Damage, and Inflammatory Factor Levels in Minimally Invasive Ankle Joint Fusion Surgery for the Treatment of Traumatic Ankle Osteoarthritis

SUMMARY: Traumatic ankle osteoarthritis is a degenerative condition resulting from traumatic injuries. The objective of this study was to evaluate the impact of minimally invasive ankle joint fusion surgery on ankle function, oxidative damage, and inflammatory factor levels in traumatic ankle osteoarthritis patients. A total of 112 traumatic ankle osteoarthritis patients treated in our hospital from January 2022 to January 2023 were enrolled. They were randomly rolled into a control group (Group C) and an experimental group (Group E), with the former undergoing conventional open ankle joint fusion surgery and the latter receiving minimally invasive ankle joint fusion surgery. A comparison was made between the two groups based on American Orthopedic Foot and Ankle Society (AOFAS), bony fusion rates, and visual analog scale (VAS) scores at pre-operation, and at 1, 2, and 3 months post-operation. Additionally, serum oxidative damage indicators and inflammatory factor levels were measured to evaluate the recovery effects in both groups. Relative to Group C, Group E showed drastically increased AOFAS scores and bony fusion rates (P<0.05), as well as greatly decreased VAS scores (P<0.05). Moreover, Group E exhibited more pronounced improvements in oxidative damage indicators and inflammatory factors versus Group C (P<0.05). Minimally invasive ankle joint fusion surgery drastically improves ankle function in traumatic ankle osteoarthritis patients and reduces levels of oxidative damage and inflammatory response. This provides an important clinical treatment option.

La osteoartritis traumática del tobillo es una afección degenerativa resultante de lesiones traumáticas. El objetivo de este estudio fue evaluar el impacto de la cirugía mínimamente invasiva de fusión de la articulación talocrural sobre la función del tobillo, el daño oxidativo y los niveles de factor inflamatorio en pacientes con osteoartritis traumática del tobillo. Se inscribieron un total de 112 pacientes con artrosis traumática de tobillo tratados en nuestro hospital desde enero de 2022 hasta enero de 2023. Fueron divididos aleatoriamente en un grupo de control (Grupo C) y un grupo experimental (Grupo E), donde el primero se sometió a una cirugía de fusión de la articulación talocrural abierta convencional y el segundo recibió una cirugía de fusión de la articulación talocrural mínimamente invasiva. Se realizó una comparación entre los dos grupos según la Sociedad Estadounidense de Ortopedia de Pie y Tobillo (AOFAS), las tasas de fusión ósea y las puntuaciones de la escala visual analógica (EVA) antes de la operación y 1, 2 y 3 meses después de la operación. Además, se midieron los indicadores de daño oxidativo sérico y los niveles de factor inflamatorio para evaluar los efectos de la recuperación en ambos grupos. En relación con el grupo C, el grupo E mostró puntuaciones AOFAS y tasas de fusión ósea drásticamente aumentadas (P <0,05), así como puntuaciones VAS muy disminuidas (P <0,05). Además, el grupo E exhibió mejoras más pronunciadas en los indicadores de daño oxidativo y factores inflamatorios en comparación con el grupo C (P <0,05). La cirugía de fusión de la articulación talocrural mínimamente invasiva mejora drásticamente la función del tobillo en pacientes con osteoartritis traumática del tobillo y reduce los niveles de daño oxidativo y la respuesta inflamatoria. Esto proporciona una importante opción de tratamiento clínico.

Minimally Invasive Tibiotalocalcaneal Arthrodesis with Blocked Retrograde Intramedullary Nail - Report of Three Cases.

Ankle osteoarthritis (AOA) is associated with pain and variable functional limitation, demanding clinical treatment and possible surgical indication when conservative measures are ineffective - arthrodesis has been the procedure of choice, because it reduces pain, restores joint alignment and makes the segment stable, preserving gait. The present study reports 3 cases (3 ankles) of male patients between 49 and 63 years old, with secondary AOA, preoperative American Orthopaedic Foot and Ankle Society Ankle-Hindfoot Scale (AOFAS AHS) of 27 to 39 points, treated by minimally invasive tibiotalocalcaneal arthrodesis using blocked retrograde intramedullary nail. Hospital stay was of 1 day, and the patients were authorized for immediate loading with removable ambulation orthotics, as tolerated. The physical therapy treatment, introduced since hospitalization, was maintained, prioritizing gait training, strength gain, and proprioception. Clinical and radiographic follow-up was performed at weeks 1, 2, 6, 12 and 24. After evidence of consolidation (between the 6 th and 10 th weeks), the orthotics were removed. One patient complained of pain in the immediate postoperative period and, at the end of the 1 st year, only one patient presented pain during rehabilitation, which was completely resolved with analgesics. Currently, the patients do not present complaints, returning to activities without restrictions - one of them, to the practice of soccer and rappelling. The postoperative AOFAS AHS was from 68 to 86 points.

Ankle arthroscopy does not elevate complication rates in ankle fractures.

INTRODUCTION: Ankle fractures rank as the second most common lower limb fractures, and surgical intervention is essential for unstable ankle fractures. The use of ankle arthroscopy in such cases offers several advantages. This study aim is to assess whether arthroscopy influenced on complication rates in 171 ankle fractures treated with arthroscopic assistance. METHODS: This retrospective epidemiological analysis encompassed adult ankle fractures between December 2018 and December 2021. Initially, 173 patients were considered, but two were excluded, leaving a final sample of 171 patients. Postoperative complications were categorized as major or minor. RESULTS: The study included 171 patients with surgically treated ankle fractures assisted by arthroscopy, comprising 76 females and 95 males, with an average age of 41.9 years. Syndesmosis injuries were treated in all diagnosed cases (55.0%), and deltoid ligament injuries received attention when identified (33.7%). Arthroscopic techniques were preferred over open techniques (47.4%). Ten patients experienced complications, consisting of 2 major and 8 minor complications (5.8%). DISCUSSION: Our study's epidemiological findings align with prior literature, demonstrating that intra-articular injuries accompany 63% to 79% of ankle fractures. Arthroscopy allows for both diagnosis and treatment within the same procedure, including joint lavage to reduce inflammation. We diagnosed 57 deltoid injuries and identified a statistical relationship between chondral, syndesmotic, and deltoid ligament injuries. Infection is a common complication in ankle fracture surgery, with rates ranging from 1.44% to 16%. Our study yielded a 5.8% complication rate, comprising 1.2% major and 4.6% minor complications. Patients undergoing ORIF with arthroscopic assistance had a lower prevalence of infection. CONCLUSION: The use of arthroscopic assistance in the surgical treatment of ankle fractures does not increase the overall complication rate. LEVEL OF EVIDENCE: IV.

Minimally Invasive Tibiotalocalcaneal Arthrodesis with Blocked Retrograde Intramedullary Nail - Report of Three Cases / Artrodese tibiotalocalcaneana minimamente invasiva com haste intramedular retrógrada bloqueada - Relato de três casos

Abstract Ankle osteoarthritis (AOA) is associated with pain and variable functional limitation, demanding clinical treatment and possible surgical indication when conservative measures are ineffective - arthrodesis has been the procedure of choice, because it reduces pain, restores joint alignment and makes the segment stable, preserving gait. The present study reports 3 cases (3 ankles) of male patients between 49 and 63 years old, with secondary AOA, preoperative American Orthopaedic Foot and Ankle Society Ankle-Hindfoot Scale (AOFAS AHS) of 27 to 39 points, treated by minimally invasive tibiotalocalcaneal arthrodesis using blocked retrograde intramedullary nail. Hospital stay was of 1 day, and the patients were authorized for immediate loading with removable ambulation orthotics, as tolerated. The physical therapy treatment, introduced since hospitalization, was maintained, prioritizing gait training, strength gain, and proprioception. Clinical and radiographic follow-up was performed at weeks 1, 2, 6, 12 and 24. After evidence of consolidation (between the 6th and 10th weeks), the orthotics were removed. One patient complained of pain in the immediate postoperative period and, at the end of the 1st year, only one patient presented pain during rehabilitation, which was completely resolved with analgesics. Currently, the patients do not present complaints, returning to activities without restrictions - one of them, to the practice of soccer and rappelling. The postoperative AOFAS AHS was from 68 to 86 points.

Resumo A osteoartrite do tornozelo (OAT) está associada a quadro álgico e limitação funcional variável, demandando tratamento clínico e eventual indicação cirúrgica quando as medidas conservadoras são inefetivas - a artrodese tem sido o procedimento de escolha, por reduzir a dor, restaurar o alinhamento articular e tornar o segmento estável, preservando a marcha. O presente estudo relata 3 casos (3 tornozelos) de pacientes do sexo masculino, com entre 49 e 63 anos de idade, portadores de OAT secundária, American Orthopaedic Foot and Ankle Society Ankle-Hindfoot Scale (AOFAS AHS, na sigla em inglês) pré-operatória de 27 a 39 pontos, tratados mediante artrodese tibiotalocalcaneana minimamente invasiva utilizando haste intramedular retrógrada bloqueada. A permanência hospitalar foi de 1 dia, e os pacientes foram autorizados para carga imediata com órteses removíveis para deambulação, conforme tolerado. O tratamento fisioterápico, introduzido desde o internamento, foi mantido, priorizando-se treino de marcha, ganho de força e propriocepção. Foi realizado acompanhamento clínico e radiográfico nas semanas 1, 2, 6, 12 e 24. Após evidências de consolidação (entre a 6ª e a 10ª semanas), as órteses foram retiradas. Um paciente queixou-se de dor no pós-operatório imediato e, ao final do 1° ano, apenas 1 paciente apresentou dor durante a reabilitação, resolvida completamente com analgésicos. Atualmente, os pacientes não apresentam queixas, retornando às atividades sem restrições - um deles, à prática de futebol e rapel. A AOFAS AHS pós-operatória foi de 68 a 86 pontos.

Ankle fractures malreduction rate and its causes in two Brazilian tertiary training hospitals.

INTRODUCTION: Ankle fractures are one of the most frequent injuries managed by any trauma surgeon. Literature has shown that adequate reduction is of utmost importance to achieve satisfactory functional outcomes. However, malreduction rates remain high worldwide. The objective of the present study is to evaluate the quality of ankle fracture reduction in two major trauma centers in a large Brazilian city and to analyze the factors associated with malreduction METHODS: Epidemiologic data of 382 patients (189 men; 193 women) aged between 7 and 87 years who underwent osteosynthesis of the ankle in two trauma centers in a large Brazilian city. Electronic clinical records, preoperative and immediate postoperative radiographs in anteroposterior (AP), lateral and mortise views were evaluated. Pettrone's criteria were used to evaluate the quality of ankle fractures reduction. All radiographs were independently evaluated by two foot and ankle senior surgeons RESULTS: Overall, malreduction rate was 22.2%. Forty-seven (55.2%) fractures classified as malreduced had medial malleolar displacement The results showed three factors that significantly affected the quality of reduction (p<0.05), patients over 60 years, open fractures and fracture-dislocations. Patients aged over 60 years were twice more likely to have poor reduction of ankle fractures than younger ones. The risk of poor fracture reduction among those individuals with open fractures is 2.15 times greater than among patients with closed injuries. Fracture-dislocation imposed a 2.7 higher risk for malreduction DISCUSSION: We found a malreduction rate below most series previously published. Further results agree with the literature. Elderly people aged over 60 years, fracture dislocations and open fractures are associated with worse results, influencing the quality of the reduction, clinical outcomes, and the development of post-traumatic arthrosis CONCLUSION: Ankle fractures malreduction are associated with higher age, open fractures, and fracture-dislocations.

TIBIOCALCANEAL ARTHRODESIS: A COMPARISON OF ANTERIOR APPROACH AND TRANSFIBULAR APPROACH.

Objective: The aim of this study was to evaluate the clinical and radiologic results and complications of patients who underwent ankle arthrodesis performed by the transfibular approach and anterior approach in end-stage ankle osteoarthritis. Methods: Between 2016 and 2022, 41 patients who satisfied the inclusion criteria for this retrospective comparative analysis were included. Of them, 19 patients are included in the anterior approach group and 22 patients are included in the transfibular approach group. The mean age of the participants is 58.9 years. Collected data included the BMI, American Orthopedic Foot and Ankle Society (AOFAS) hindfoot scale, visual analogue scale (VAS) score, diabetes, smoking, time to fusion, nonunion, union rate, preoperative and postoperative coronal tibiotalar angle and complications. Result: The mean time to bone union was 14.3 weeks (range 11-17 weeks) in the anterior approach group, and 11.3 weeks in the transfibular approach group. Statistically significant difference was found between the two groups. Nonunion occurred in one case in the transfibular approach group and three cases in the anterior approach group. There was no significant difference in the nonunion rate between the both groups (p = 0.321). VAS score, and AOFAS score of the two groups were similar and no significant differences were found (p = 0.491, p = 0.448, p = 0.146, p = 0.073, p = 0.173, p = 0.506, respectively). Conclusions: A stable and firm ankle arthrodesis and plantigrade foot can be achieved with both transfibular approach and anterior approach technique. Level of Evidence III, Retrospective Comparative Study.

Objetivo: Avaliar os resultados clínicos e radiológicos e as complicações de pacientes submetidos à artrodese de tornozelo realizada por abordagem transfibular e abordagem anterior em fase terminal de osteoartrite de tornozelo. Métodos: Foram incluídos 41 pacientes atendidos entre 2016 e 2022 que satisfizeram os critérios de inclusão para esta análise comparativa retrospectiva. Destes, 19 incluídos no grupo de abordagem anterior e 22 no grupo de abordagem transfibular. A média de idade foi de 58,9 anos. Os dados coletados incluíram o índice de massa corporal (IMC), a escala de retropé da American Orthopedic Foot and Ankle Society (AOFAS), o escore da escala visual analógica (EVA), assim como a presença de diabetes, tabagismo, tempo de fusão, não união, taxa de união, ângulo tibiotalar coronal pré e pós-operatório e complicações. Resultado: O tempo médio de consolidação óssea foi de 14,3 semanas (variação de 11 a 17 semanas) no grupo de abordagem anterior e 11,3 semanas no grupo de abordagem transfibular. Foi encontrada diferença estatisticamente significante entre os dois grupos. A consolidação não ocorreu em um caso no grupo de abordagem transfibular e em três casos no grupo de abordagem anterior. Não houve diferença significativa na taxa de não consolidação entre os dois grupos (p = 0,321). Os escores nas escalas EVA e AOFAS dos dois grupos foram semelhantes, não sendo encontradas diferenças significativas (p = 0,491, p = 0,448, p = 0,146, p = 0,073, p = 0,173, p = 0,506, respectivamente). Conclusões: Uma artrodese estável e firme do tornozelo e um pé plantígrado podem ser obtidos tanto com a abordagem transfibular quanto com a técnica de abordagem anterior. Nível de Evidência III, Estudo Comparativo Retrospectivo.

Optimization method for ankle strength training during exercise / Método de otimização no treino de força do tornozelo durante o exercício / Método para optimizar el entrenamiento de la fuerza del tobillo durante el ejercicio

ABSTRACT Introduction Good ankle joint strength is a precondition for high-quality exercise and is an important factor in preventing joint injuries. Objective Explore the method of optimizing ankle strength training during exercise. Methods 40 volunteers were selected and randomly divided into an experimental group and a control group. The 20 athletes in the experimental group were trained three times a week for six weeks using a control variable method, while the control group performed only professional daily physical training. Pre-training and post-training methods were used to collect and investigate the data regarding the effect of strength training on the ankle joint and its impact on skill and strength tests submitted to the athletes. Results Ankle strength training can improve ankle muscle strength and athletes' ability to run and jump (P > 0.05). Conclusion Ankle joint strength training may improve athletes' baseline sporting ability, improve ankle joint muscle strength, reduce the likelihood of joint injuries, and contribute to improved outcomes of various abilities, meriting further study and replication. Level of evidence II; Therapeutic studies - investigation of treatment outcomes.

RESUMO Introdução A boa força articular do tornozelo é uma pré-condição para exercícios físicos de alta qualidade além de ser um fator importante na prevenção de lesões articulares. Objetivo Explorar o método de otimização do treino de força do tornozelo durante o exercício físico. Métodos 40 voluntários foram selecionados e aleatoriamente divididos em grupo experimental e grupo de controle. Os 20 atletas do grupo experimental foram treinados três vezes por semana durante 6 semanas usando um método de variáveis de controle enquanto o grupo controle efetuou apenas o treinamento físico diário profissional. Foram utilizados métodos pré-treino e pós-treino para coleta e investigação dos dados quanto ao efeito do treinamento de força sob a articulação do tornozelo e seu impacto em testes de habilidade e força submetidos aos atletas. Resultados O treinamento de força do tornozelo pode melhorar a força muscular do tornozelo e melhorar a capacidade dos atletas de correr e saltar (P > 0,05). Conclusão O treino de força articular do tornozelo pode melhorar a capacidade esportiva basal dos atletas, melhorar a força muscular da articulação do tornozelo, reduzir a probabilidade de lesões articulares e contribuir na melhoria dos resultados de várias habilidades, merecendo maiores estudos e replicação. Nível de evidência II; Estudos terapêuticos - investigação dos desfechos do tratamento.

RESUMEN Introducción Una buena resistencia de la articulación del tobillo es una condición previa para la realización de ejercicio físico de alta calidad y un factor importante en la prevención de lesiones articulares. Objetivo Explorar el método para optimizar el entrenamiento de la fuerza del tobillo durante el ejercicio. Métodos Se seleccionaron 40 voluntarios y se dividieron aleatoriamente en grupo experimental y grupo de control. Los 20 atletas del grupo experimental se entrenaron tres veces a la semana durante 6 semanas con un método variable de control, mientras que el grupo de control sólo realizó un entrenamiento físico profesional diario. Se utilizaron métodos de pre-entrenamiento y post-entrenamiento para recoger e investigar los datos relativos al efecto del entrenamiento de fuerza bajo la articulación del tobillo y su impacto en las pruebas de habilidad y fuerza a las que se sometieron los atletas. Resultados El entrenamiento de la fuerza del tobillo puede mejorar la fuerza muscular del tobillo y mejorar la capacidad de los atletas para correr y saltar (P > 0,05). Conclusión El entrenamiento de la fuerza de la articulación del tobillo puede mejorar la capacidad deportiva de base de los atletas, mejorar la fuerza muscular de la articulación del tobillo, reducir la probabilidad de lesiones articulares y contribuir a mejorar los resultados de varias habilidades, mereciendo más estudios y réplicas. Nivel de evidencia II; Estudios terapêuticos - investigación de los resultados del tratamiento.

Tibiocalcaneal arthrodesis: a comparison of anterior approach and transfibular approach / Artrodese tibiocalcaneana: comparação entre abordagem anterior e a abordagem transfibular

ABSTRACT Objective: The aim of this study was to evaluate the clinical and radiologic results and complications of patients who underwent ankle arthrodesis performed by the transfibular approach and anterior approach in end-stage ankle osteoarthritis. Methods: Between 2016 and 2022, 41 patients who satisfied the inclusion criteria for this retrospective comparative analysis were included. Of them, 19 patients are included in the anterior approach group and 22 patients are included in the transfibular approach group. The mean age of the participants is 58.9 years. Collected data included the BMI, American Orthopedic Foot and Ankle Society (AOFAS) hindfoot scale, visual analogue scale (VAS) score, diabetes, smoking, time to fusion, nonunion, union rate, preoperative and postoperative coronal tibiotalar angle and complications. Result: The mean time to bone union was 14.3 weeks (range 11-17 weeks) in the anterior approach group, and 11.3 weeks in the transfibular approach group. Statistically significant difference was found between the two groups. Nonunion occurred in one case in the transfibular approach group and three cases in the anterior approach group. There was no significant difference in the nonunion rate between the both groups (p = 0.321). VAS score, and AOFAS score of the two groups were similar and no significant differences were found (p = 0.491, p = 0.448, p = 0.146, p = 0.073, p = 0.173, p = 0.506, respectively). Conclusions: A stable and firm ankle arthrodesis and plantigrade foot can be achieved with both transfibular approach and anterior approach technique. Level of Evidence III, Retrospective Comparative Study.

RESUMO Objetivo: Avaliar os resultados clínicos e radiológicos e as complicações de pacientes submetidos à artrodese de tornozelo realizada por abordagem transfibular e abordagem anterior em fase terminal de osteoartrite de tornozelo. Métodos: Foram incluídos 41 pacientes atendidos entre 2016 e 2022 que satisfizeram os critérios de inclusão para esta análise comparativa retrospectiva. Destes, 19 incluídos no grupo de abordagem anterior e 22 no grupo de abordagem transfibular. A média de idade foi de 58,9 anos. Os dados coletados incluíram o índice de massa corporal (IMC), a escala de retropé da American Orthopedic Foot and Ankle Society (AOFAS), o escore da escala visual analógica (EVA), assim como a presença de diabetes, tabagismo, tempo de fusão, não união, taxa de união, ângulo tibiotalar coronal pré e pós-operatório e complicações. Resultado: O tempo médio de consolidação óssea foi de 14,3 semanas (variação de 11 a 17 semanas) no grupo de abordagem anterior e 11,3 semanas no grupo de abordagem transfibular. Foi encontrada diferença estatisticamente significante entre os dois grupos. A consolidação não ocorreu em um caso no grupo de abordagem transfibular e em três casos no grupo de abordagem anterior. Não houve diferença significativa na taxa de não consolidação entre os dois grupos (p = 0,321). Os escores nas escalas EVA e AOFAS dos dois grupos foram semelhantes, não sendo encontradas diferenças significativas (p = 0,491, p = 0,448, p = 0,146, p = 0,073, p = 0,173, p = 0,506, respectivamente). Conclusões: Uma artrodese estável e firme do tornozelo e um pé plantígrado podem ser obtidos tanto com a abordagem transfibular quanto com a técnica de abordagem anterior. Nível de Evidência III, Estudo Comparativo Retrospectivo.

Isokinetic muscle strength characteristics of lower limb joints in long jumpers / Características da força muscular isocinética das articulações dos membros inferiores dos saltadores de salto em distância / Características de la fuerza muscular isocinética de las articulaciones de los miembros inferiores en saltadores de longitud

ABSTRACT Introduction: Joint strength of the lower limbs plays a decisive role in the competitive ability of long jumpers. Special strength training based on science and targeted at the strength of the lower limb joints is an essential topic for long jumpers. Objective: To analyze isokinetic muscle strength characteristics of lower limb joints in long jumpers. Methods: Voluntary jumpers were submitted to isokinetic concentric contraction tests of the lower limbs and hip joints. We also analyzed the effect of strength training on lower limb joint injury. Results: The knee muscles of the athletes have reduced eccentric contractility. The ankle of the athlete has the most vulnerable joint to injuries in the sport. Conclusion: The explosive force and eccentric contractility of long jumpers' lower limb extensor muscles have the most significant impact on joint thrust and extension speed. Athletes need muscle strength training to develop isokinetic muscle strength. This can effectively prevent injury to lower extremity joint movements. The research findings of this paper can provide a specific theoretical basis for formulating scientific training for long jumpers. Level of evidence II; Therapeutic studies - investigation of treatment outcomes.

RESUMO Introdução: A força conjunta dos membros inferiores desempenha um papel decisivo na capacidade competitiva nos saltadores de salto em distância. O treinamento de força especial baseado na ciência e direcionado para a força das articulações dos membros inferiores é um tópico essencial para os saltadores. Objetivo: Analisar as características de força muscular isocinética das articulações dos membros inferiores em saltadores de salto em distância. Métodos: Saltadores voluntários foram submetidos à testes de contração concêntrica isocinética dos membros inferiores e articulação do quadril. Efetuou-se também a análise do efeito do treinamento de força na lesão das articulações dos membros inferiores. Resultados: Os músculos dos joelhos dos atletas têm uma contratilidade excêntrica reduzida. O tornozelo dos atletas possui a articulação mais vulnerável a lesões no esporte. Conclusão: A força de explosão e a capacidade de contração excêntrica dos músculos extensores dos membros inferiores dos saltadores de salto longo têm o impacto mais significativo no empuxo das articulações e na velocidade de extensão. Os atletas precisam de treinamento de força muscular para desenvolver a força muscular isocinética. Isto pode efetivamente evitar lesões nos movimentos das extremidades inferiores das articulações. Os resultados da pesquisa deste trabalho podem fornecer uma base teórica específica para a formulação do treinamento científico para os saltadores de salto longo. Nível de evidência II; Estudos terapêuticos - investigação dos resultados do tratamento.

RESUMEN Introducción: La fuerza articular de los miembros inferiores desempeña un papel decisivo en la capacidad competitiva de los saltadores de longitud. El entrenamiento de fuerza especial basado en la ciencia y dirigido a la fuerza de las articulaciones de los miembros inferiores es un tema esencial para los saltadores. Objetivo: Analizar las características de la fuerza muscular isocinética de las articulaciones de los miembros inferiores en saltadores de longitud. Métodos: Los saltadores voluntarios fueron sometidos a pruebas de contracción concéntrica isocinética de los miembros inferiores y de las articulaciones de la cadera. También se realizó un análisis del efecto del entrenamiento de fuerza en las lesiones de las articulaciones de los miembros inferiores. Resultados: Los músculos de la rodilla de los atletas tienen una contractilidad excéntrica reducida. El tobillo de los atletas tiene la articulación más vulnerable a las lesiones en el deporte. Conclusión: La fuerza de explosión y la contractilidad excéntrica de los músculos extensores de las extremidades inferiores de los saltadores de longitud tienen el impacto más significativo en el empuje articular y la velocidad de extensión. Los atletas necesitan entrenar la fuerza muscular para desarrollar la fuerza muscular isocinética. Esto puede prevenir eficazmente las lesiones en los movimientos de las articulaciones de las extremidades inferiores. Los resultados de la investigación de este trabajo pueden proporcionar una base teórica específica para la formulación del entrenamiento científico de los saltadores de longitud. Nivel de evidencia II; Estudios terapéuticos - investigación de los resultados del tratamiento.

ARTHROSCOPIC FOOT AND ANKLE SURGERY: BRAZILIAN SURGEON PROFILE.

Objective: To study the profile of the practice of arthroscopy among ankle and foot surgeons in Brazil and its evolution in recent years. Methods: Observational, cross-sectional study, using a survey sent to all members of the Associação Brasileira de Medicina e Cirurgia do Tornozelo e Pé (ABTPé) in 2017 and 2019. Results: In total, 75 surgeons participated in 2017 and 82 in 2019 and most had over 10 years of experience. Of these, 56 participants in 2017 (75%) and 68 in 2019 (82%) used arthroscopy. The number of specialists with no to five years of experience (p = 0.027) and who learned the technique during fellowship (p = 0.007) increased. The use of the 4.0 mm optics and 30° optics (p = 0.040) increased whereas the routine use of traction (p = 0.049) and radiofrequency (p = 0.002) decreased. The main pathology treated with anterior ankle arthroscopy was bone injury. The most frequent complication was neuropraxia. Conclusion: Most of the foot and ankle surgeons who use arthroscopy have more than 10 years of experience, performed anterior access, and are concentrated in the Southeast region of the country. The number of younger surgeons who learned the technique during fellowship increased. Level of Evidence III, Cross-Sectional Comparative Study.

Objetivo: Mostrar o perfil da prática da artroscopia entre cirurgiões de tornozelo e pé no Brasil e sua evolução nos últimos anos. Métodos: Estudo observacional, transversal, realizado por meio de questionário eletrônico enviado para todos os membros da Associação Brasileira de Medicina e Cirurgia do Tornozelo e Pé (ABTPé) em 2017 e 2019. Resultados: Obtivemos 75 respondentes em 2017 e 82 em 2019; a maioria tinha mais de 10 anos de experiência. Dos respondentes, 56 realizavam artroscopia em 2017 (75%) e 68 em 2019 (82%). Foi observado aumento no número de especialistas com até 5 anos de experiência (p = 0,027) e que aprenderam a técnica durante o estágio de especialização (p = 0,007). Houve aumento no uso da ótica de 4,0 mm e 30° de angulação (p = 0,040), e diminuição do uso rotineiro de tração (p = 0,049) e de radiofrequência (p = 0,002). A principal patologia tratada com artroscopia anterior do tornozelo foi o impacto ósseo, e a complicação mais frequente foi a neuropraxia. Conclusão: A maioria dos cirurgiões de pé e tornozelo que utiliza artroscopia tem mais de 10 anos de experiência, usa o acesso anterior e concentra-se na região Sudeste do país. Foi observado aumento no número de cirurgiões mais novos e que aprenderam a técnica durante o estágio de especialização. Nível de Evidência III, Estudo Transversal Comparativo.

Functional training on ankle sprain rehabilitation in soccer players / Treinamento funcional sobre a reabilitação da entorse de tornozelo nos jogadores de futebol / Entrenamiento funcional en la rehabilitación del esguince de tobillo en los jugadores de fútbol

ABSTRACT Introduction An ankle sprain is a common soccer injury. Functional training is used to rehabilitate muscle strength with undiscovered benefits on soccer players' recovery. Objective Explore the functional training effects on ankle injury recovery in soccer players. Methods 29 amateur soccer players were randomly assigned to control (n=15) and experimental (n=14) groups with no statistical difference in age or sex (P>0.05). The experimental group used functional rehabilitation training, while the control group was treated with traditional rehabilitation methods. Both groups practiced 30 to 40 minutes of rehabilitation, three times a week, for two months. Mathematical statistics were used to analyze the effects of different injury rehabilitation on the two groups, estimating the ankle joint continuous motion angle by the tibialis anterior muscle electromyogram responses. Results The ankle instability assessment questionnaires were statistically different between the two groups of patients after rehabilitation training (P<0.05). There was a statistical difference in the agility test after the intervention. The ankle capacity score and agility test score were better in the experimental group (P<0.05). Conclusion Functional rehabilitation training can improve ankle performance after a sprain. This training can also help athletes avoid future sprains and is recommended as preventive training. Evidence Level II; Therapeutic Studies - Investigating the result.

RESUMO Introdução Entorse no tornozelo é uma lesão comum no futebol. O treinamento funcional é utilizado na reabilitação da força muscular com benefícios ainda explorados sobre a recuperação dos jogadores de futebol. Objetivo Explorar os efeitos do treinamento funcional na recuperação das lesões no tornozelo em jogadores de futebol. Métodos 29 jogadores de futebol amador foram aleatoriamente distribuídos em grupo controle (n=15) e experimental (n=14) sem diferença estatística de idade ou sexo (P>0,05). O grupo experimental utilizou treinamento de reabilitação funcional enquanto o grupo controle foi tratado com os métodos tradicionais de reabilitação. Ambos os grupos praticaram 30 a 40 minutos de reabilitação, três vezes por semana, durante dois meses. Estatísticas matemáticas foram utilizadas para analisar os efeitos da reabilitação de lesões diferentes nos dois grupos por estimativa do ângulo de movimento contínuo na articulação do tornozelo com as respostas do eletromiograma do músculo tibial anterior. Resultados Os questionários de avaliação da instabilidade do tornozelo entre os dois grupos de pacientes após o treinamento de reabilitação foram estatisticamente diferentes (P<0,05). Houve diferença estatística no teste de agilidade após a intervenção. A pontuação na capacidade do tornozelo e o escore no teste de agilidade foram melhores no grupo experimental (P<0,05). Conclusão O treinamento de reabilitação funcional pode melhorar o desempenho do tornozelo após a entorse. Este treinamento também pode ajudar os atletas a evitarem futuros entorses, sendo recomendado como treino preventivo. Nível de evidência II; Estudos Terapêuticos - Investigação de Resultados.

RESUMEN Introducción El esguince de tobillo es una lesión común en el fútbol. El entrenamiento funcional se utiliza en la rehabilitación de la fuerza muscular con beneficios aún explorados en la recuperación de los jugadores de fútbol. Objetivo Explorar los efectos del entrenamiento funcional en la recuperación de lesiones de tobillo en jugadores de fútbol. Métodos 29 jugadores de fútbol amateur fueron distribuidos aleatoriamente en los grupos de control (n=15) y experimental (n=14) sin diferencias estadísticas en cuanto a edad o sexo (P>0,05). El grupo experimental utilizó un entrenamiento de rehabilitación funcional mientras que el grupo de control fue tratado con métodos de rehabilitación tradicionales. Ambos grupos practicaron entre 30 y 40 minutos de rehabilitación, tres veces por semana, durante dos meses. Se utilizó la estadística matemática para analizar los efectos de las diferentes rehabilitaciones de lesiones en los dos grupos mediante la estimación del ángulo de movimiento continuo en la articulación del tobillo con las respuestas del electromiograma del músculo tibial anterior. Resultados Los cuestionarios de evaluación de la inestabilidad del tobillo entre los dos grupos de pacientes después del entrenamiento de rehabilitación fueron estadísticamente diferentes (P<0,05). Hubo una diferencia estadística en la prueba de agilidad después de la intervención. La puntuación de la capacidad del tobillo y la puntuación de la prueba de agilidad fueron mejores en el grupo experimental (P<0,05). Conclusión El entrenamiento de rehabilitación funcional puede mejorar el rendimiento del tobillo tras un esguince. Este entrenamiento también puede ayudar a los atletas a evitar futuros esguinces y se recomienda como entrenamiento preventivo. Nivel de evidencia II; Estudios terapéuticos - Investigación de resultados.

Outcomes of a Modified Arthroscopic-assisted Reconstruction Technique for Lateral Ankle Instability / Resultados de uma técnica modificada de reconstrução assistida por artroscopia para instabilidade lateral do tornozelo

Abstract Objective The present study assesses the results of a minimally invasive surgical technique for acute and chronic ankle instability management. Methods The present case series study retrospectively evaluated 40 patients undergoing arthroscopic-assisted percutaneous ankle ligament reconstruction from 2013 to 2019. Results The present study included 17 males and 23 females with an average age of 38.3 years old. Postintervention follow-up using American Orthopaedic Foot and Ankle Society (AOFAS) Ankle-Hindfoot scores identified improvement of > 30 points in function and pain control. The most frequently occurring associated injuries were osteochondral (35%). No patient required reintervention or had infection during follow-up. Conclusion The technique in the present study is easy and achieves satisfactory results for function and pain control. Level of Evidence IV.

Resumo Objetivo O presente estudo avalia os resultados de uma técnica cirúrgica minimamente invasiva para o manejo da instabilidade aguda e crônica do tornozelo. Métodos O presente estudo de uma série de casos avaliou retrospectivamente 40 pacientes submetidos à reconstrução percutânea assistida por artroscopia do ligamento do tornozelo entre 2013 e 2019. Resultados O estudo incluiu 17 homens e 23 mulheres com idade média de 38,3 anos. O acompanhamento pós-intervenção utilizou a pontuação American Orthopaedic Foot and Ankle Society (AOFAS, na sigla em inglês). As pontuações do tornozelo-retropé identificaram melhora > 30 pontos na função e no controle da dor. As lesões associadas mais frequentes foram as osteocondrais (35%). Nenhum paciente precisou de reintervenção ou teve infecção durante o acompanhamento. Conclusão A técnica do presente estudo é fácil e consegue resultados satisfatórios para a função e o controle da dor. Nível de Evidência IV.

Treatment of Distal Tibiofibular Syndesmosis Injury Associated with Ankle Fractures with Suture Button.

Objective To evaluate the results obtained from the surgical treatment of malleolar ankle fractures associated with distal tibiofibular syndesmosis (DTFS) injury submitted to conventional surgical procedure for fracture fixation and DTFS fixation by suture button (SB). Methods Forty-nine patients were retrospectively evaluated, with a mean age of 45 years old and a mean follow-up of 34.1 months. Clinical and functional evaluation was based on the visual analogue scale (VAS) and on the American Foot and Ankle Society Score (AOFAS) for ankle and hindfoot, return to routine activities, and return to sport. Results The postoperative mean AOFAS and VAS were, respectively, 97.06 (confidence interval [CI 95%: 95.31-98.81] and 0.16 [CI 95% 0,04 - 0,29]. All patients returned to previous daily activities, and only 12 showed some residual symptom. There was no postoperative instability in any patient. Forty-six patients returned to sports activities and, of these, only 1 did not return to the level prior to the injury. Only two patients presented SB-related alterations. There was no report of dissatisfaction. Conclusion In malleolar fractures of the ankle with DTFS injury, the fixation of syndesmosis with SB demonstrated excellent postoperative results. Level of Evidence IV, retrospective case series.

Superior peroneal retinaculum reattachment for an atraumatic peroneus brevis tendon subluxation: a case report.

BACKGROUND: Peroneal tendon subluxation is a rare pathology, generally associated with sport-induced trauma, that occurs due to the rupture of the superior peroneal retinaculum. The diagnosis is mainly clinical, but the use of imaging techniques, such as dynamic ultrasound and magnetic resonance imaging, may contribute to its clarification. Treatment may be conservative or surgical, although there is no consensus on the most appropriate technique to be employed. We report a case of subluxation of the peroneus brevis tendon, with no apparent traumatic cause, in which there was a need for a surgical approach after the failure of conservative treatment. CASE PRESENTATION: A 25-year-old White woman presented pain and locking of the lateral side of the left foot 2 years earlier, with no history of trauma. The patient felt pain upon palpation and presented snapping during flexion-extension of the left ankle. On dynamic ultrasonography, an anterior subluxation of the peroneus brevis tendon occurred when the ankle was in dorsiflexion, suggesting superior peroneal retinaculum injury. Surgical correction was recommended after 2 months of conservative treatment with no improvement. The chosen surgical technique was isolated reattachment of the superior peroneal retinaculum, which proved successful. CONCLUSIONS: Peroneal tendon subluxation has no established preferred surgical technique. This case demonstrates superior peroneal retinaculum repair as an efficient surgical approach for this condition. Furthermore, the atraumatic mechanism of injury in this case, along with the unknown true incidence of peroneal tendon subluxation, highlights the need to consider this pathology in cases of ankle injuries.

Treatment of Distal Tibiofibular Syndesmosis Injury Associated with Ankle Fractures with Suture Button / Tratamento da lesão da sindesmose tibiofibular distal associada às fraturas do tornozelo com suture button

Abstract Objective To evaluate the results obtained from the surgical treatment of malleolar ankle fractures associated with distal tibiofibular syndesmosis (DTFS) injury submitted to conventional surgical procedure for fracture fixation and DTFS fixation by suture button (SB). Methods Forty-nine patients were retrospectively evaluated, with a mean age of 45 years old and a mean follow-up of 34.1 months. Clinical and functional evaluation was based on the visual analogue scale (VAS) and on the American Foot and Ankle Society Score (AOFAS) for ankle and hindfoot, return to routine activities, and return to sport. Results The postoperative mean AOFAS and VAS were, respectively, 97.06 (confidence interval [CI 95%: 95.31-98.81] and 0.16 [CI 95% 0,04 - 0,29]. All patients returned to previous daily activities, and only 12 showed some residual symptom. There was no postoperative instability in any patient. Forty-six patients returned to sports activities and, of these, only 1 did not return to the level prior to the injury. Only two patients presented SB-related alterations. There was no report of dissatisfaction. Conclusion In malleolar fractures of the ankle with DTFS injury, the fixation of syndesmosis with SB demonstrated excellent postoperative results. Level of Evidence IV, retrospective case series.

Resumo Objetivo Avaliar os resultados obtidos do tratamento cirúrgico das fraturas maleolares do tornozelo associadas a lesão da sindesmose tibiofibular distal (STFD) submetidas a procedimento cirúrgico convencional de fixação da fratura e fixação da STFD pelo suture button (SB). Métodos Avaliou-se retrospectivamente 49 pacientes com uma média de idade de 45 anos e seguimento médio de 34,1 meses. A avaliação clínica e funcional foi baseada na escala visual analógica (EVA) e na escala American Foot and Ankle Society Score (AOFAS, na sigla em inglês) para tornozelo e retropé, retorno às atividades da rotina e retorno ao esporte. Resultados As médias pós-operatórias das escalas AOFAS e EVA foram, respectivamente, 97,06 (índice de confiança [IC 95%: 95,31 - 98,81] e 0,16 [IC 95% 0,04 - 0,29]. Todos os pacientes retornaram às atividades prévias do cotidiano, sendo que apenas 12 apresentaram algum sintoma residual. Não se verificou instabilidade pós-operatória em nenhum paciente. Ao todo, 46 pacientes retornaram às atividades desportivas e, destes, apenas 1 não retornou ao nível prévio à lesão. Apenas dois pacientes apresentaram alterações relacionadas ao SB. Não houve relato de insatisfação. Conclusão Em fraturas maleolares do tornozelo com lesão da STFD, a fixação da sindesmose com o SB demonstrou excelentes resultados pós-operatórios. Nível de Evidência IV, série de casos retrospectiva.

Characteristics and prevention of sports injuries in taekwondo training / Características e prevenção de lesões esportivas no treinamento de taekwondo / Características y prevención de lesiones deportivas en el entrenamiento de tae kwon do

ABSTRACT Introduction: With the extensive and in-depth development of Taekwondo in China, more and more people participate in Taekwondo training. Due to the lack of experience of some coaches and the misunderstanding of scientific sports training by young athletes, injuries occur from time to time. This has a bad effect on Taekwond itself, and it can also damage the health of athletes. Objective: This article discusses joint injuries in Taekwondo and analyzes the characteristics of Taekwondo sports injuries and preventive methods. Methods: This article uses a questionnaire applied to young athletes to gain an understanding of the sports injuries situation. Results: The most common injury sites were feet and joints. The nature of the injuries is mostly soft tissue injury, ligament laceration, and muscle strain. The most serious injuries are kidney and perineal damage. Conclusion: Improving the level of training, strengthening medical supervision, and paying attention to the timely treatment of acute injuries are important ways to reduce the occurrence of trauma. Level of evidence II; Therapeutic studies - investigation of treatment results.

RESUMO Introdução: Com o desenvolvimento extenso e profundo do Taekwondo na China, cada vez mais pessoas participam do treinamento nesse esporte. Com a falta de experiência de alguns treinadores e a compreensão errônea de jovens atietas quanto ao treinamento esportivo científico, de vez em quando ocorrem lesões. Isso tem efeito negativo sobre o próprio Taekwondo e também pode prejudicar a saúde dos atletas Objetivo: Este artigo discute lesões articulares no Taekwondo e analisa as características das lesões do esporte, bem como os métodos de prevenção. Métodos: Este artigo aplicou um questionário a jovens atletas para obter uma compreensão da situação das lesões esportivas. Resultados: Os locais de lesão mais comuns foram pés e articulações. A natureza das lesões é principalmente nos tecidos moles, laceração de ligamento e tensão muscular. As lesões mais graves são danos renais e perineais. Conclusões: Melhorar o nível de treinamento, fortalecer a supervisão médica e prestar atenção ao tratamento oportuno de lesões agudas são maneiras importantes de reduzir a ocorrência de traumas. Nível de Evidência II; Estudos terapêuticos - Investigação dos resultados do tratamento.

RESUMEN Introducción: Con el amplio y profundo desarrollo del Tae Kwon Do en China, cada vez más personas participan en el entrenamiento de este deporte. Debido a la falta de experiencia de algunos entrenadores y a la comprensión errónea de jóvenes atletas sobre el entrenamiento deportivo científico, ocasionalmente se producen lesiones. Esto tiene un efecto negativo en el propio Tae Kwon Do y también puede perjudicar la salud de los atletas. Objetivo: Este artículo trata de las lesiones articulares en el Tae Kwon Do y analiza las características de las lesiones en este deporte, así como los métodos de prevención. Métodos: En este artículo se aplicó un cuestionario a jóvenes atletas para conocer la situación de las lesiones deportivas. Resultados: Los lugares más comunes de las lesiones fueron los pies y las articulaciones. La naturaleza de las lesiones es principalmente en los tejidos blandos, rotura de ligamentos y tensión muscular. Las lesiones más graves son los daños renales y perineales. Conclusiones: Mejorar el nivel de entrenamiento, reforzar la supervisión médica y prestar atención al tratamiento oportuno de las lesiones agudas son formas importantes de reducir la incidencia de traumatismos. Nivel de Evidencia II; Estudios terapéuticos - Investigatión de los resultados del tratamiento.

Effect of football on rehabilitation of ankle injury patients / Efeito do futebol na reabilitação de pacientes com lesão no tornozelo / Efecto del fútbol en la rehabilitación de pacientes con lesiones de tobillo

ABSTRACT Introduction: Brief introduction: Ankle tendon and ligament sports injuries are common in football players. Objective: To continue to improve special strength training related to the characteristics of football after rehabilitation of injured ankle tendons and ligaments. Methods: Two master football sportsmen were rehabilitated by multi-point equal-length, short-arc and long-arc equal-speed training combined with balance ability exercises. Results: There were two long muscle L be maintain muscle tone plantar flexors force four times of 96 n/m, n/m 121, 140 n/m, 145 n/m than back flexors force of 63 n/m, 52 n/m, 60 n/m, 74 n/m tall. Plantar flexor fatigue was 57%, 30%, 29%, 12%, 28%, 18%, 20%, 21%. Conclusions: With the passing of time, the relative peak moment value of the right ankle plantar flexor muscle group of the two patients kept rising, the dorsiflexor muscle was basically flat, and the work fatigue index decreased step by step, indicating that the right ankle muscle strength level was significantly improved, the anti-fatigue ability was improved, and the rehabilitation treatment had a good effect. Level of evidence II; Therapeutic studies - investigation of treatment results.

RESUMO Introdução: Introdução breve: Lesões esportivas nos tendões e ligamentos do tornozelo são comuns em jogadores de futebol. Objetivo: Atingir melhora no treinamento de força especial relacionado com as lesões características do futebol depois de reabilitação de tendões e ligamentos do tornozelo. Métodos: Dois futebolistas de primeira linha foram reabilitados por treinamento multipontos de comprimento igual, arco curto e arco longo em velocidade igual, combinado com exercícios de habilidade de equilíbrio. Resultados: Havia dois músculos longos L para manter o tônus muscular, força dos flexores plantares antes e depois de quatro vezes de 96 n/m, 121 n/m, 140 n/m, 145 n/m e força dos flexores dorsais de 63 n/m, 52 n/m, 60 n/m, 74 n/m de altura. A fadiga do flexor plantar foi de 57%, 30%, 29%, 12%, 28%, 18%, 20%, 21%. Conclusões: Com o passar do tempo, o valor do momento de pico relativo do grupo de músculos flexores plantares do tornozelo direito dos dois pacientes continuou aumentando; o músculo flexor do dorso estava basicamente plano e o índice de fadiga no trabalho diminuiu gradativamente, indicando que o nível de força muscular do tornozelo direito melhorou significativamente, assim como a capacidade antifadiga e, portanto, que o tratamento de reabilitação teve efeito positivo. Nível de Evidência II; Estudos terapêuticos - Investigação dos resultados do tratamento.

RESUMEN Introducción: Breve introducción: Las lesiones deportivas en los tendones y ligamentos del tobillo son comunes en los jugadores de fútbol. Objetivo: Lograr una mejora en el entrenamiento de fuerza especial relacionado con las lesiones características del fútbol tras la rehabilitación de los tendones y ligamentos del tobillo. Métodos: Dos jugadores de fútbol de alto nivel fueron rehabilitados mediante un entrenamiento multipunto de igual longitud, arco corto y arco largo a igual velocidad, combinado con ejercicios de habilidad de equilibrio. Resultados: Hubo dos músculos L largos para mantener el tono muscular, fuerza de los flexores plantares antes y después de cuatro veces de 96 n/m, 121 n/m, 140 n/m, 145 n/m y fuerza de los flexor dorsales de 63 n/m, 52 n/m, 60 n/m, 74 n/m de altura. La fatiga de los flexores plantares fue del 57%, 30%, 29%, 12%, 28%, 18%, 20%, 21%. Conclusiones: Con el paso del tiempo, el valor del momento máximo relativo del grupo de músculos flexores plantares del tobillo derecho de los dos pacientes continuó aumentando; el músculo flexor dorsal estaba básicamente plano y el índice de fatiga de trabajo disminuyó gradualmente, lo que indica que el nivel de fuerza muscular del tobillo derecho mejoró significativamente, al igual que la capacidad antifatiga, y, por tanto, que el tratamiento de rehabilitación tuvo un efecto positivo. Nivel de Evidencia II; Estudios terapéuticos - Investigación de los resultados del tratamiento.

Correlation between the range of motion of the tibiotarsal joint and blood circulation in the lower limbs in diabetic individuals

SUMMARY OBJECTIVE: The aim of this study was to evaluate the relationship between the range of motion and lower-limb hemodynamic indices in the tibiotarsal joint of individuals with diabetic neuropathy. METHODS: Twenty volunteers of both sexes, with a mean age of 61.45±7.05 years, were diagnosed with type 2 diabetes mellitus and diabetic peripheral neuropathy. Arterial blood flow was assessed using Doppler ultrasound, and the variables such as average velocity, pulsatility index, and resistivity index were also evaluated. A range of dorsiflexion and plantar flexion joint movements were assessed using digital goniometry before and after exercise. Data distribution was assessed using the Shapiro-Wilk test, followed by Pearson's correlation for normal data and Spearman's correlation for non-normal data, in order to verify the association between variables. RESULTS: A moderate correlation was found between dorsiflexion and pulse rate on two occasions before (rs=0.497) and after initial evaluation (rs=0.511). A low correlation was found between plantar flexion and mean velocity (rs=-0.357), pulsatility index (rs=0.439), and resistivity index (rs=0.328); dorsiflexion and mean velocity (rs=0.374), pulse rate (rs=0.332), and resistance index (rs=0.327) before evaluation, and peak (rs=0.346) was observed after the evaluation of blood circulation. CONCLUSION: There is a correlation between the range of motion of the tibiotarsal joint and the blood circulation of diabetics, ranging from moderate to poor for the different variables evaluated.