Wearing high-heeled shoes on a side slope makes standing balance unstable.

INTRODUCTION: Many women wearing high-heeled footwear are at high risk of falls. Past studies have examined the balance on level ground or balance during walking. We measured the standing balance on the ground and side slopes for 18 healthy women. METHOD: Body sway was evaluated based on the center of pressure (COP) while participants stood on level ground on a side slope. The total locus length as well as rectangular and outer peripheral areas were then measured using a Zebris system. Measurements were compared under bare feet, normal shoe, and high-heeled shoe conditions. RESULTS: On level ground, there were no significant differences among the three conditions. On the side slope, the total locus length (TLL), rectangular area (RA) and outer peripheral areas (OPA) were significantly greater for the high-heeled shoes than for the bare feet and normal shoes. Standing on the side slope caused larger body sway than on the level ground, along with a higher risk of falling. DISCUSSION: In TLL, OPA, and RA, the COP moved outside substantially when participants stood on a slope in high heels than in shoes. High heels were highly unstable for standing on a slope since the ankle joint of one leg is in plantar flexion, the foot is pronated, and the other side is plantarflexed at the ankle with pronation of the foot. CONCLUSION: High-heeled shoes significantly alter a person's balance when standing on a side slope, suggesting a high risk of falling.

Recovery process of the muscle activities during walking with efficient early quadriceps training and gait exercises after total knee arthroplasty.

BACKGROUND: Total knee arthroplasty (TKA) by the trivector approach is less invasive to the knee extensor mechanism; early quadriceps training is possible and a good prognosis is expected after surgery. However, investigations regarding lower limb muscle activity during gait have not been reported after using the trivector approach. To determine an effective postoperative rehabilitation program, we analyzed the recovery processes of leg muscle activities during walking. METHODS: Fourteen subjects with severe knee osteoarthritis (OA) who underwent early exercises after TKA by trivector approach were included in the TKA group. The control group consisted of eight patients with mild knee OA. Surface electromyography of the vastus medialis (VM), vastus lateralis (VL), and rectus femoris (RF) muscles were recorded and gait speed and step length were measured. The TKA group was measured postoperatively at 3, 12, and 24 weeks. RESULTS: Gait speed of TKA group significantly increased at 12 weeks post-surgery and recovered equal to the control group at 24 weeks. Additionally, step length reached the level of control subjects at 24 weeks. Postoperative activity of VM returned to that of the control group at 12 weeks. VL continued decreasing until 12 weeks compared with the preoperative values, but gradually increased and became equal to the control group at 24 weeks. RF slightly increased at 3 weeks postoperation and remained stable. CONCLUSIONS: VM injury by the trivector approach might be small and temporary.Functional recovery of VL was important and early starting rehabilitation program up to 24 weeks is appropriate.

Stabilization of postural sway on a sideward slope using cuboid support insoles.

[Purpose] The purpose of this study was to elucidate whether insoles alter postural sway on a sideward slope rather than on level ground. [Participants and Methods] This study involved 20 flat-footed individuals and 20 normal-footed individuals. The postural sway was determined based on the total length of the locus and the body sway area, which were measured using the Zebris system. The participants were divided into three groups: the BMZ insoles, Superfeet insoles, and no insole groups. These insoles were worn by the participants with their normal shoes worn daily. [Results] The total length of the locus of the BMZ group was significantly lower than those of the Superfeet and no-insole groups. The body sway area did not significantly differ based on the insole condition. [Conclusion] BMZ insoles improve postural sway in both normal-footed and flat-footed individuals on a sideward slope.

Distribution of sole Pacinian corpuscles: a histological study using near-term human feet.

INTRODUCTION: Fast-adapting afferent input from the sole Pacinian corpuscles (PCs) is essential for walking. However, the distribution of PCs in the plantar subcutaneous tissue remains unknown. MATERIALS AND METHODS: Using histological sections tangential to the plantar skin of eight near-term fetuses, we counted 528-900 PCs per sole. RESULTS: Almost half of the sole PCs existed at the level of the proximal phalanx, especially on the superficial side of the long flexor tendons and flexor digitorum brevis. Conversely, the distribution was less evident on the posterior side of the foot. The medial margin of the sole contained fewer PCs than the lateral margin, possibly due to the transverse arch. In contrast to a cluster formation in the anterior foot, posterior PCs were almost always solitary, with a distance greater than 0.5 mm to the nearest PC. DISCUSSION AND CONCLUSION: Because a receptive field of PCs is larger than that of the other receptors, fewer solitary PCs might cover the posterior sole. In infants, the amount of anterior sole PCs seemed to determine the initial walking pattern using the anterior foot without heel contact. Anterior PCs concentrated along flexor tendons might play a transient role as tendon organs during the initial learning of walking. During a lesson in infants, mechanical stress from the tendon and muscle was likely to degrade the PCs. In the near term, the sole PCs seemed not to be a mini-version of the adult morphology but suggested an infant-specific function.

Tensile load on the flexor digitorum profundus tendon during palmar and lateral blocking exercises: Influence on blocking force and distal interphalangeal joint flexion angle.

STUDY DESIGN: This is a basic science research. INTRODUCTION: Isolating excursion of the flexor digitorum profundus (FDP) in zones I and II is common practice in the current management after flexor tendon repair. During this procedure, the proximal interphalangeal joint is sometimes fully extended with unmeasured external forces at the middle phalanx when the distal interphalangeal joint is actively flexed. PURPOSE OF THE STUDY: The purpose of the study was to investigate the incremental effect of external force with palmar blocking versus lateral blocking and increased angles of flexion on internal tendon forces at the repair site for a safer application of force by the treating therapist. METHODS: Eight human cadaveric fingers were studied. To simulate palmar or lateral finger blocking, a compression force of blocking was applied from 5N (510 grams) to 25N (2,550 grams) on the skin surface of the palmar or the lateral aspect of each of these middle phalanges in 5N increments. The tensile load on the FDP tendon during distal interphalangeal joint flexion from 0° to 60° was measured in 10° increments. RESULTS: During palmar blocking, the tensile load was significantly increased with increases in palmar blocking force. However, no significant increase in the tensile load on the FDP tendon was observed at any lateral blocking. DISCUSSION: Lateral blocking exercise can be performed with less tensile force on the FDP tendon when performing blocking exercise after flexor tendon injury repair. CONCLUSIONS: This study supports the concept that lateral blocking with incremental joint angles allows a safer application of force for the healing tendon.

Can an insole for obese individuals maintain the arch of the foot against repeated hyper loading?

BACKGROUND: Insoles are often applied as preventive therapy of flatfoot deformity, but the therapeutic effects on obese individuals are still controversial. We aimed to investigate the effect of insole use on time-dependent changes in the foot arch during a repeated-loading simulation designed to represent 20,000 contiguous steps in individuals with a BMI value in the range of 30-40 kg/m2. METHODS: Eighteen cadaveric feet were randomly divided into the following three groups: normal, obese, and insole. Ten thousand cyclic loadings of 500 N (normal group) or 1000 N (obese and insole groups) were applied to the feet. We measured time-dependent change in arch height and calculated the bony arch index (BAI), arch flexibility, and energy absorption. RESULTS: The normal group maintained more than 0.21 BAI, which is the diagnostic criterion for a normal arch, throughout the 10,000 cycles; however, BAI was less than 0.21 at 1000 cycles in the obese group (mean, 0.203; 95% confidence interval [CI] 0.196-0.209) and at 6000 cycles in the insole group (mean, 0.200; 95% CI, 0.191-0.209). Although there was a significant time-dependent decrease in flexibility and energy absorption in both the obese and insole groups (P < 0.001), the difference between 1 and 10,000 cycles were significantly smaller in the insole group than in the obese group (P = 0.024). CONCLUSIONS: Use of insoles for obese individuals may help to slow time-dependent foot structural changes. However, the effect was not enough to maintain the foot structure against repeated hyper loadings.

Measurement of strain and tensile force of the supraspinatus tendon under conditions that simulates low angle isometric elevation of the gleno-humeral joint: Influence of adduction torque and joint positioning.

BACKGROUND: Recently, supraspinatus muscle exercise has been reported to treat rotator cuff disease and to recover shoulder function. However, there have been no report on the direct measurement of strain on the supraspinatus tendon during simulated isometric gleno-humeral joint elevation. METHODS: Ten fresh-frozen shoulder specimens with the rotator cuff complex left intact were used as experimental models. Isometric gleno-humeral joint elevation in a sitting position was reproduced with low angle of step-by-step elevation in the scapular plane and strain was measured on the surface layer of the supraspinatus tendon. FINDINGS: In isometric conditions, applied tensile force of the supraspinatus tendon increased significantly with increases in adduction torque on the gleno-humeral joint. Significant increases in the strain on the layer were observed by increase in adduction torque, which were recorded in isometric elevation at -10° and 0°, but little increase in the strain was observed at 10° or greater gleno-humeral elevation. INTERPRETATION: Increased strain on the surface layer of the supraspinatus tendon was observed during isometric gleno-humeral elevation from -10 to 0°. These findings demonstrate a potential risk of inducing overstretching of the supraspinatus tendon during supraspinatus muscle exercise.

Impact of double-tiered subchondral support procedure with a polyaxial locking plate on the stability of distal radius fractures using fresh cadaveric forearms: Biomechanical and radiographic analyses.

BACKGROUND: The present study compared the changes in biomechanical and radiographic properties under cyclic axial loadings between the 'double-tiered subchondral support' (DSS) group (wherein two rows of screws were used) and the 'non-DSS' (NDSS) group (wherein only one row of distal screws was used) using cadaveric forearm models of radius fractures fixed with a polyaxial locking plate. MATERIAL AND METHODS: Fifteen fresh cadaveric forearms were surgically operated to generate an Arbeitsgemeinschaft für Osteosynthesefragen (AO) type 23-C2 fracture model with the fixation of polyaxial volar locking plates. The model specimens were randomized into two groups: DSS (n = 7) and NDSS (n = 8). Both the groups received 4 locking screws in the most distal row, as is usually applied, whereas the DSS group received 2 additional screws in the second row inserted at an inclination of about 15° to support the dorsal aspect of the dorsal subchondral bone. Cyclic axial compression test was performed (3000 cycles; 0-250 N; 60 mm/min) to measure absolute rigidity and displacement, after 1, 1000, 2000 and 3000 cycles, and values were normalized relative to cycle 1. These absolute and normalized values were compared between those two groups. Radiographic images were taken before and after the cyclic loading to measure changes in volar tilt (ΔVT) and radial inclination (ΔRI). RESULTS: The DSS group maintained significantly higher rigidity and lower displacement values than the NDSS group during the entire loading period. Radiographic analysis indicated that the ΔVT values of the DSS group were lower than those of the NDSS group. In contrast, the fixation design did not influence the impact of loading on the ΔRI values. CONCLUSIONS: Biomechanical and radiographic analyses demonstrated that two rows of distal locking screws in the DSS procedure conferred higher stability than one row of distal locking screws.

Fetal development of ligaments around the tarsal bones with special reference to contribution of muscles.

Through a histological examination of eight mid-term human fetuses (10-15 weeks) and seven late-stage fetuses (30-34 weeks), we attempted to determine how and when fetal ligaments around the tarsal bones form the regular arrangement seen in adults. Ligaments along the dorsal aspect of the tarsal bones developed early as an elongation of the perichondrium, in contrast to the late development of the plantar-sided ligaments. In contrast, a distal elongation of the tibialis posterior tendon was a limited plantar ligament in the early stage; finally, it extended from the navicular, ran obliquely to cross the dorsal side of the fibularis longus tendon, and inserted to the lateral cuneiform and fourth metatarsal. In the late stage, the adductor hallucis muscle origin provided multiple ligamentous structures along the cuneiforms and metatarsals. The tarsal sinus contained multiple fibrous bundles (possibly, the putative interosseous talocalcanean ligaments) that were derived from (1) insertion tendons of the extensor digitorus brevis muscle and (2) the fibrous sheath of the extensor digitorus longus tendon. The aponeurotic origin of the quadratus plantae muscle seemed to contribute to formation of the long plantar ligament. Therefore, tarsal ligaments appeared likely to develop from the long tendons, their fibrous sheaths and aponeuroses and intramuscular tendons of the proper foot muscles. Under in utero conditions with little or no stress from the plantar side of the foot, the muscle-associated connective tissue seems to play a crucial role in providing a regular arrangement of the ligaments in accordance with tensile stress from muscle contraction.

The adductor part of the adductor magnus is innervated by both obturator and sciatic nerves.

The hip adductor group, innervated predominantly by the obturator nerve, occupies a large volume of the lower limb. However, case reports of patients with obturator nerve palsy or denervation have described no more than minimal gait disturbance. Those facts are surprising, given the architectural characteristics of the hip adductors. Our aim was to investigate which regions of the adductor magnus are innervated by the obturator nerve and by which sciatic nerve and to consider the clinical implications. Twenty-one lower limbs were examined from 21 formalin-fixed cadavers, 18 males and 3 females. The adductor magnus was dissected and was divided into four parts (AM1-AM4) based on the locations of the perforating arteries and the adductor hiatus. AM1 was supplied solely by the obturator nerve. AM2, AM3, and AM4 received innervation from both the posterior branch of the obturator nerve and the tibial nerve portion of the sciatic nerve in 2 (9.5%), 20 (95.2%), and 6 (28.6%) of the cadavers, respectively. The double innervation in more than 90% of the AM3s is especially noteworthy. Generally, AM1-AM3 corresponds to the adductor part, traditionally characterized as innervated by the obturator nerve, and AM4 corresponds to the hamstrings part, innervated by the sciatic nerve. Here, we showed that the sciatic nerve supplies not only the hamstrings part but also the adductor part. These two nerves spread more widely than has generally been believed, which could have practical implications for the assessment and treatment of motor disability.

Standing balance on the ground -the influence of flatfeet and insoles.

[Purpose] The aim of this study was to determine whether insoles change standing balance on the ground in normal and flat-footed subjects. [Subjects] Twenty subjects with flatfeet and 20 subjects with normal feet were included in this study. [Methods] Body sway was evaluated based on the center of pressure while subjects stood on the ground. Body sway was measured during upright standing with the feet 10 cm apart for 30 seconds. The total locus length and the area of body sway were then measured using a zebris system. Measurements were made under three sets of conditions: using BMZ insoles, which supported the cuboid; using Superfeet insoles, which supported the medial longitudinal arch; and with no insoles. [Results] The 3 insole conditions were compared. On level ground, the total locus length for the Superfeet insole was significantly less than those for the BMZ insole and no insole. [Conclusion] On level ground, Superfeet feet insoles were effective in stabilizing standing balance in both flat-footed and normal-footed subjects.

Dynamic effect of the tibialis posterior muscle on the arch of the foot during cyclic axial loading.

BACKGROUND: The most common cause of acquired flatfoot deformity is tibialis posterior tendon dysfunction. The present study compared the change in medial longitudinal arch height during cyclic axial loading with and without activated tibialis posterior tendon force. METHODS: Fourteen normal, fresh frozen cadaveric legs were used. A total of 10,000 cyclic axial loadings of 500 N were applied to the longitudinal axis of the tibia. The 32-N tibialis posterior tendon forces were applied to the specimens of the active group (n=7). Specimens of another group (non-active group, n=7) were investigated without the tibialis posterior tendon force. The bony arch index was calculated from the displacement of the navicular height. FINDINGS: The mean initial bony arch indexes with maximal weightbearing were 0.239 (SD 0.009) in active group and 0.239 (SD 0.014) in non-active group. After 7000 cycles, the bony arch indexes with maximal weightbearing were significantly greater in the active group (mean 0.214, SD 0.013) than in the non-active group (mean 0.199, SD 0.013). The mean bony arch indexes with maximal weightbearing after 10,000 cycles were 0.212 (SD 0.011) in the active group and 0.196 (SD 0.015) in the non-active group. INTERPRETATION: The passive supportive structures were inadequate, and the tibialis posterior muscle was essential to maintain the medial longitudinal arch of the foot in the dynamic weightbearing condition. The findings underscore that physical therapy and arch supportive equipments are important to prevent flatfoot deformity in the condition of weakness or dysfunction of the tibialis posterior muscle.

Microscopic analysis of the iliofemoral and ischiofemoral ligaments in the hip joint: collagen fiber direction and crimp distribution.

Since no previous studies have described the functional significance of the iliofemoral and ischiofemoral ligaments on the basis of microscopic analyses, we examined the direction of collagen fiber alignment and crimp distribution of the collagen fibers in sections cut in different directions. Polarized microscopic images of sections along the longitudinal (L) and transverse (T) planes of each ligament were obtained from 20 cadavers (8 males and 12 females, age at death 81.7 ± 9.4 years old). Results showed that the microscopic direction of collagen fibers in the iliofemoral ligament was parallel to the macroscopic direction, suggesting that this ligament may play a part in restricting extension of the hip joint. In contrast, the microscopic direction of collagen fibers in the ischiofemoral ligament was not parallel to the macroscopic direction, suggesting that this ligament may contribute not only to the restriction of medial rotation but also retstriction of flexion of the hip joint. From the low density of the crimp distribution in the L plane, the iliofemoral ligament may contribute to stability of the hip joint in the standing position in the living body. In conclusion, the microscopic observations of the direction of collagen fibers as well as the crimp distribution shown in the present study provide a better understanding of the functional significance of the iliofemoral and ischiofemoral ligaments.

Stretching positions for the coracohumeral ligament: Strain measurement during passive motion using fresh/frozen cadaver shoulders.

BACKGROUND: Contracture of the coracohumeral ligament is reported to restrict external rotation of the shoulder with arm at the side and restrict posterior-inferior shift of the humeral head. The contracture is supposed to restrict range of motion of the glenohumeral joint. METHODS: To obtain stretching position of the coracohumeral ligament, strain on the ligament was measured at the superficial fibers of the ligament using 9 fresh/frozen cadaver shoulders. By sequential measurement using a strain gauge, the ligament strain was measured from reference length (L0). Shoulder positions were determined using a 3 Space Tracker System. Through a combination of previously reported coracohumeral stretching positions and those observed in preliminary measurement, ligament strain were measured by passive external rotation from 10° internal rotation, by adding each 10° external rotation, to maximal external rotation. RESULTS: Stretching positions in which significantly larger strain were obtained compared to the L0 values were 0° elevation in scapula plane with 40°, 50° and maximum external rotation (5.68%, 7.2%, 7.87%), 30° extension with 50°, maximum external rotation (4.20%, 4.79%), and 30° extension + adduction with 30°, 40°, 50° and maximum external rotation (4.09%, 4.67%, 4.78%, 5.05%)(P < 0.05). No positive strain on the coracohumeral ligament was observed for the previously reported stretching positions; ie, 90° abduction with external rotation or flexion with external rotation. CONCLUSIONS: Significant strain of the coracohumeral ligament will be achieved by passive external rotation at lower shoulder elevations, extension, and extension with adduction.

Association between a history of falls and the ability to multi-task in community-dwelling older people.

BACKGROUND AND AIMS: Many older people fall when they perform tasks which require increased attention. The aim of this study was to determine differences in reaction times, during simple-, dual- and triple-task conditions requiring differing levels of motor coordination, balance control and cognitive attention, between groups of fallers and non-fallers in community-dwelling older individuals. METHODS: The study involved the recruitment of 87 older individuals living at home, 57 women and 30 men aged 75 to 91 years. Reaction times, measured by pushing a handheld button as quickly as possible in response to a visual stimulus, were measured in four conditions: 1) quiet standing (simple-task); 2) counting backward during quiet standing (dual-task with cognitive demand); 3) stepping in place (dual-task with balance demand); and 4) counting backward while stepping in place (triple-task with cognitive and balance demands). RESULTS: Twenty-nine (33.3%) participants had fallen at least once during the past year. There were no statistically significant differences in reaction times between non-fallers and fallers during any of the tasks. Reaction times were significantly longer during the dual- and triple-tasks compared with the simple-task conditions in both groups. The ratio between reaction times during dual-tasks with balance demands (stepping in place) and those in the simple-task condition were significantly related to a history of falls and showed the highest odds ratio (OR 3.16, 95% CI 1.06- 9.45, p=0.04). CONCLUSIONS: Relative changes in reaction times during a dual-task with balance demands were related to a history of falls in community-dwelling older individuals. Reaction times in dual-task conditions with a balance demand were more sensitive to past falls than those during a dual-task with cognitive demands.

Does distal tibiofibular joint mobilization decrease limitation of ankle dorsiflexion?

Limitation of ankle motion is in many cases treated by joint mobilization (JM), a kind of manual physical therapy technique. Until now, the JM approach has mainly focused on the talocrural joint, with less attention to the distal tibiofibular joint. We applied cyclic loading to the lateral malleolus as in JM in order to clarify the relationship between the dorsiflexion angle and the excursion of the lateral malleolus. Seven normal, fresh-frozen cadaver legs were used. To each specimen, cyclic loading with a 30N force was applied 1000 times to the lateral malleolus at a speed of 15N/s. The displacement of the lateral malleolus was measured with a magnetic tracking system. The maximum dorsiflexion angle was measured before and after cyclic loading. After the first 100 and 1000 times of cyclic loading, the tibia was displaced 0.44+/-0.30mm and 0.75+/-0.36mm, respectively, and the fibula was displaced 0.44+/-0.28mm and 0.92+/-0.39mm, respectively. The average dorsiflexion angle increased from 14.36+/-7.51 degrees to 16.74+/-7.21 degrees after cyclic loading (P<0.05). Movement of the distal tibiofibular joint led to a significant increase in the range of ankle dorsiflexion. These results suggest that tibiofibular JM would be effective for limitation of ankle dorsiflexion.

The influence of flatfoot deformity on the gliding resistance of tendons about the ankle.

BACKGROUND: Various tendinopathies occur about the ankle, but there are few publications investigating their etiology or pathoanatomy. The purpose of this investigation was to determine the gliding resistance of the tendons about the posteromedial ankle: the posterior tibial (PT), flexor digitorum longus (FDL), and flexor hallucis longus (FHL) tendons. MATERIALS AND METHODS: The gliding abilities of the posterior tibial, flexor digitorum longus, and flexor hallucis longus tendons at the ankle-hindfoot level were compared, in terms of gliding resistance, with use of a system that was developed in this laboratory. Six cadaveric specimens were used and tested in a dorsiflexed position, then in simulated flatfoot in a dorsiflexed position. RESULTS: The gliding resistance was found to be significantly greater in the simulated flatfoot in dorsiflexion compared to the dorsiflexed position with an intact arch for the PT, FDL, and FHL tendons. The gliding resistance was significantly higher in the PT tendon than FDL or FHL tendons in the flatfoot/dorsiflexion condition. There was no significant difference between the FDL and FHL tendons in resistance in either condition. CONCLUSION: We concluded that the gliding ability of the PT tendon was inferior to that of the FDL and FHL tendons in a simulated flatfoot model. CLINICAL RELEVANCE: The findings of the present study are consistent with the clinical observations that tendinitis and rupture of the PT tendon commonly occurs at the malleolar level, whereas FDL and FHL ruptures do not. A pre-existing flexible flatfoot deformity may be associated with PT tendon dysfunction in the adult due to poor gliding ability of the PT tendon.

Mechanical stability of the subtalar joint after lateral ligament sectioning and ankle brace application: a biomechanical experimental study.

BACKGROUND: The roles of each ligament supporting the subtalar joint have not been clarified despite several biomechanical studies. The effects of ankle braces on subtalar instability have not been shown. HYPOTHESIS: The ankle brace has a partial effect on restricting excessive motion of the subtalar joint. STUDY DESIGN: Controlled laboratory study. METHODS: Ten normal fresh-frozen cadaveric specimens were used. The angular motions of the talus were measured via a magnetic tracking system. The specimens were tested while inversion and eversion forces, as well as internal and external rotation torques, were applied. The calcaneofibular ligament, cervical ligament, and interosseous talocalcaneal ligament were sectioned sequentially, and the roles of each ligament, as well as the stabilizing effects of the ankle brace, were examined. RESULTS: Complete sectioning of the ligaments increased the angle between the talus and calcaneus in the frontal plane to 51.7 degrees + or - 11.8 degrees compared with 35.7 degrees + or - 6.0 degrees in the intact state when inversion force was applied. There was a statistically significant difference in the angles between complete sectioning of the ligaments and after application of the brace (34.1 degrees + or - 7.3 degrees ) when inversion force was applied. On the other hand, significant differences in subtalar rotation were not found between complete sectioning of the ligaments and application of the brace when internal and external rotational torques were applied. CONCLUSION: The ankle brace limited inversion of the subtalar joint, but it did not restrict motion after application of internal or external rotational torques. CLINICAL RELEVANCE: In cases of severe ankle sprains involving the calcaneofibular ligament, cervical ligament, and interosseous talocalcaneal ligament injuries, application of an ankle brace might be less effective in limiting internal-external rotational instabilities than in cases of inversion instabilities in the subtalar joint. An improvement in the design of the brace is needed to restore better rotational stability in the subtalar joint.

The range of glenohumeral joint motion in activities of daily living after rotator cuff repair: a cadaveric biomechanical study.

This study was conducted to quantify the restriction of glenohumeral motion and activities of daily living (ADL) after rotator cuff repair. Eight fresh cadaveric shoulders were used. The ranges of passive shoulder motions in models of the intact cuff tendon, and repaired small cuff and large cuff tears were measured using a 6-degree-of-freedom electromagnetic tracking device. The range of motion for reach, perineal care, hair combing, and washing the axilla were also measured as simulated ADL. Elevation, horizontal adduction, and abduction were significantly restricted in the repaired small-tear model, whereas glenohumeral motion in all directions was significantly restricted in the repaired large-tear model. The repair of the small tear significantly restricted perineal care alone, whereas the repair of the large tear significantly restricted all ADL except hair combing. These findings could be helpful in managing restricted shoulder motion and in instructing patients in acceptable ADL after rotator cuff repair.