Local and non-local effects (on the posterior chain) of four weeks of foot exercises: a randomized controlled trial.

This study investigated the local, remote, and contralateral effects of a four-week intrinsic foot muscle exercise intervention in recreationally active participants on foot parameters, flexibility, and performance of the posterior chain (PC). Twenty-eight healthy participants (12f, 16m) were randomly assigned to a control group or performed 2 × 6 min of foot exercises twice daily unilaterally at least five days/week for four weeks. At baseline (M1), after the intervention (M2), and after a four-week wash-out period (M3), we assessed bilateral Foot Posture Index-6, medial longitudinal arch mobility, single-leg stance balance, range of motion (ROM) (first metatarsophalangeal joint and ankle), and flexibility and performance of the PC. The FPI-6 score changes over time differed significantly between groups for both legs, improving by 26% in the trained- (p < .001) and 11% in the untrained leg (p = .02) in the intervention group from M1 to M2. Improvements were maintained at M3 for the trained leg (p = .02). Ankle range of motion and balance of the trained leg improved from M1 to M2, yet only became significant at M3 (ROM: p = .02; balance: p = .007). The other parameters did not change significantly. A four-week foot exercise intervention might have local but no remote effects in healthy young adults.German Clinical Trial Register (DRKS00027923) (24/08/2022).

Translation, cross-cultural adaptation and validation of psychometric properties of foot function index in Urdu-speaking population with ankle and foot disorders.

BACKGROUND: Foot and ankle problems are frequently prevalent, especially among the elderly, ranging from 70 to 80%. In primary care, foot, and ankle complaints stand out as one of the most frequent reasons for orthopedic consultations. Patient-reported outcome measures are significant in the assessment burden of any condition on the effects of intervention as well as research. The Foot Function Index (FFI) is a region-specific tool that was identified as one of the most commonly used evaluation tools for foot complaints. This study aimed to translate, cross-cultural adapt, and test the psychometric properties of FFI in the Urdu language. METHODOLOGY: The FFI was translated into Urdu language (FFI-U) following Beaton et al. translation guidelines. The data were collected from 230 Urdu-speaking participants with different foot and ankle pathologies. Data collection started after the written informed consent from the participants. All participants completed the FFI-U, Visual Analogue Scale (VAS), SF-36, and the Foot and Ankle Outcome Score (FAOS) at baseline while only 30 participants completed ULFI-U after one week for test-retest reliability. The psychometric properties involved reliability and validity testing. Reliability was assessed where internal consistency was measured using Cronbach's alpha and test-retest reliability through the intra-class correlation coefficient (ICC). FFI-U was tested for face validity and construct validity (convergent and discriminant). Psychometric criteria were examined against priori hypotheses, and alpha level (p-value < 0.05) was considered statistically significant. RESULTS: FFI-U demonstrated good reliability with internal consistency (α = 0.86) and test-retest reliability with intra-class correlation coefficient = 0.845 (0.78-0.89). A moderate correlation was found using Pearson correlation between FFI-U total score and physical components of SF-36, VAS (pain, disability), and FAOS (γ= -0.65, 0.72, 0.71, -0.68) respectively, indicating convergent validity however, a weak correlation was found with mental components of SF-36 (γ=-0.25) demonstrating discriminant validity. Face validity was assessed at the pre-final testing stage by interviewing patients. There were no floor and ceiling effects found for FFI-U. CONCLUSION: The FFI-U has been found reliable, valid, and feasible tool to be used as a patient-reported outcome measure to assess functional levels with different foot and ankle disorders in Urdu speaking population.

Clinical comprehensive of microfracture, autologous chondrocyte implantation, and periosteum-covered iliac bone grafting for Hepple stage IV-V lesions.

Chronic ankle pain significantly impairs daily activities and athletic performance with osteochondral lesions of the talus (OLT) in Hepple stages IV and V, which are often causative factors. This study aimed to assess the efficacy and safety of autologous osteochondral transplantation (AOT) for the treatment of these conditions. This retrospective study was conducted from May 2020 to May 2023 at Cangzhou Traditional Chinese and Western Medicine Combined Hospital, including patients with a diagnosis of Hepple stage IV or V OLT confirmed by magnetic resonance imaging (MRI) and arthroscopy. Surgical interventions involved arthroscopic debridement, followed by AOT or limited arthrotomy based on the location and size of the lesion. Preoperative and postoperative evaluations used the Visual Analog Scale, American Orthopedic Foot and Ankle Society Ankle-Hindfoot Scale, MRI-Based Cartilage Repair Tissue Scoring, and the International Knee Documentation Committee Knee Evaluation Form. Statistical analysis was conducted using paired-sample t tests to compare the preoperative and postoperative data. Twenty patients were included, revealing significant postoperative improvements in Visual Analog Scale, American Orthopedic Foot and Ankle Society, and MRI-based cartilage repair tissue scores (P < .05). The radiographic findings suggested effective cartilage regeneration. No adverse effects were observed in the donor knee sites, as confirmed by the stable pre- and postoperative International Knee Documentation Committee Knee Evaluation Form scores. Recovery of physical abilities was achieved on average within 7.3 weeks for daily activities and 13.4 weeks for sports activities. AOT effectively treats Hepple stage IV-V OLT, improves ankle function, promotes cartilage regrowth, and allows quick resumption of daily and athletic activities without compromising donor-site integrity.

Rehabilitation for ankle fractures in adults.

BACKGROUND: Ankle fracture is one of the most common lower limb fractures. Whilst immobilisation of the ankle can support and protect the fracture site during early healing, this also increases the risk of ankle weakness, stiffness, and residual pain. Rehabilitation aims to address the after-effects of this injury, to improve ankle function and quality of life. Approaches are wide-ranging and include strategies to improve ankle joint movement, muscle strength, or both. This is an update of a Cochrane review last published in 2012. OBJECTIVES: To assess the effects of rehabilitation interventions following surgical or non-surgical management of ankle fractures in adults. SEARCH METHODS: We searched CENTRAL, MEDLINE, Embase, three other databases, and two clinical trials registers in May 2022, and conducted additional searches of CENTRAL, MEDLINE, and Embase in March 2023. We also searched reference lists of included studies and relevant systematic reviews. SELECTION CRITERIA: We included randomised controlled trials (RCTs) and quasi-RCTs comparing any rehabilitation intervention delivered to adults with ankle fracture. Interventions could have been given during or after the initial fracture management period (typically the first six weeks after injury), which may or may not have included surgical fixation. We excluded participants with multi-trauma, pathological fracture, or with established complications secondary to ankle fracture. DATA COLLECTION AND ANALYSIS: We used standard methodological procedures expected by Cochrane. We collected data for five outcomes: activity limitation (ankle function), health-related quality of life (HRQoL), participant satisfaction with treatment, pain, and adverse events (we focused on re-operation, defined as unplanned return to theatre). We report the findings up to six months after injury. MAIN RESULTS: We included 53 studies (45 RCTs, 8 quasi-RCTs) with 4489 adults with ankle fracture. In most studies, orthopaedic management included surgical fixation but was non-surgical in five studies, and either surgical or non-surgical in six studies. Here, we summarise the findings for three common rehabilitation comparisons; these included the most data and were the most clinically relevant. Because of different intervention approaches, we sometimes included a study in more than one comparison. Data for other less common comparisons were also available but often included few participants and were imprecise. All studies were unavoidably at high risk of performance and detection bias. We downgraded the certainty of all evidence for this reason. We also downgraded for imprecision and when we noted inconsistencies between studies that precluded meta-analysis of data. Early (within 3 weeks of surgery) versus delayed weight-bearing (12 studies, 1403 participants) Early weight-bearing probably leads to better ankle function (mean difference (MD) 3.56, 95% confidence interval (CI) 1.35 to 5.78; 5 studies, 890 participants; moderate-certainty evidence); however, this does not include a clinically meaningful difference. Early weight-bearing may offer little or no difference to HRQoL compared to delayed weight-bearing (standardised mean difference (SMD) 0.15, 95% CI -0.01 to 0.30; 5 studies, 739 participants; low-certainty evidence); when translated to the EQ-5D scale (a commonly-used HRQoL questionnaire), any small difference was not clinically important. We were unsure whether there were any differences in participant satisfaction or pain because these outcomes had very low-certainty evidence. For adverse events, there may be little or no difference in re-operation (risk ratio (RR) 0.50, 95% CI 0.09 to 2.68; 7 studies, 1007 participants; low-certainty evidence). Removable versus non-removable ankle support (25 studies, 2206 participants) Following surgery, using a removable ankle support may lead to better ankle function (MD 6.39, 95% CI 1.69 to 11.09; 6 studies, 677 participants; low-certainty evidence). This effect included both a clinically important and unimportant difference. There is probably an improvement in HRQoL with a removable ankle support, although this difference included both a clinically important and unimportant difference when translated to the EQ-5D scale (SMD 0.30, 95% CI 0.11 to 0.50; 3 studies, 477 participants; moderate-certainty evidence). No studies reported participant satisfaction. We were unsure of the effects on pain because of very low-certainty evidence (1 study, 29 participants). There may be little or no difference in re-operations (RR 1.20, 95% CI 0.39 to 3.71; 6 studies, 624 participants; low-certainty evidence). Following non-surgical management, there may be little or no difference between removable and non-removable ankle supports in ankle function (MD 1.08, 95% CI -3.18 to 5.34; 3 studies, 399 participants), and HRQoL (SMD -0.04, 95% CI -0.24 to 0.15; 3 studies, 397 participants); low-certainty evidence. No studies reported participant satisfaction. We were unsure of the effects on pain (2 studies, 167 participants), or re-operation because of very low-certainty evidence (1 study, 305 participants). Physical therapy interventions versus usual care or other physical therapy interventions (9 studies, 857 participants) Types of interventions included the use of active controlled motion, a spring-loaded ankle trainer, an antigravity treadmill, and variations of enhanced physiotherapy (e.g. additional stretching, joint mobilisation, neuromuscular exercises), delivered during or after the initial fracture management period. We were unable to pool data because of the differences in the design of interventions and their usual care comparators. Studies often included very few participants. The certainty of the evidence for all outcomes in this comparison was very low, and therefore we were unsure of the effectiveness of these therapies. No studies in this comparison reported re-operation. AUTHORS' CONCLUSIONS: Early weight-bearing may improve outcomes in the first six months after surgery for ankle fracture, but the difference is likely to be small and may not always be clinically important. A removable ankle support may also provide a better outcome, but again, the difference may not always be clinically important. It is likely that neither approach increases the re-operation risk. We assume that the findings for these comparisons are applicable to people with closed ankle fractures, and that satisfactory fracture stabilisation had been achieved with surgery. For people who have non-surgical treatment, there is no evidence that either a removable or non-removable ankle support may be superior. We were uncertain whether any physical therapy interventions were more effective than usual care or other physical therapy interventions. We encourage investigators of future studies on rehabilitation interventions for ankle fracture to use a core outcome set.

Assessing the reliability of a digital inclinometer app for measuring hip, knee, and ankle proprioception.

Proprioception can be defined as the ability of an individual to detect motion and position of the various joints in their bodies. Current tools for measuring proprioception lack consensus on their accuracy and validity; they also each have their own limitations, and, furthermore, present barriers to use for clinicians. We propose a new and reliable method for evaluating hip, knee, and ankle proprioception by utilizing a digital inclinometer app to measure joint position sense. The digital inclinometer app recorded the active joint position sense error after each of five trials for the hip and knee joint and ten trials for the ankle joint. To quantify the reliability of the digital inclinometer app, single-measurement and average-measurement intra-class correlation coefficients (ICC) along with the associated 95% confidence intervals (95% CI) were calculated for each joint's position sense error across trials. Both the hip (ICC (2,k) = 0.849 (95% CI = [0.783-0.897])) and knee joint (ICC (2,k) = 0.837 (95% CI = [0.750-0.897])) were found to have moderate to good reliability when the middle three of five trials were analyzed. Unlike the hip and knee, moderate to good reliability for ankle proprioception (ICC (2,k) = 0.785 (95% CI = [0.539-0.893])) was only achieved with the middle eight of ten trials. The results of this study indicate that this digital inclinometer app is able to accurately record joint position sense at the hip, knee, and ankle when the appropriate number of trials are collected; thus, allowing this tool and methodology to be considered for use in both clinical and research environments to measure proprioception, and furthermore, quantify proprioceptive deficits.

Efficacy and complication of keyhole surgery and open surgery for repairing fibular collateral ligament in the persistent lateral ankle joint instability treatment: A protocol for systematic review and meta analysis.

BACKGROUND: Over the past few years, there has been growing interest in identifying and treating persistent lateral ankle joint instability. Many medical professionals believe that early intervention is important to address this instability. METHODS: Four databases on the outcomes of open and keyhole surgery for repairing the fibular collateral ligament in the treatment of chronic lateral ankle joint instability were acquired from the computer during controlled trials. Data analysis was conducted after the rigorous literature quality evaluation using Stata software. RESULTS: This meta-analysis finally included 11 articles. Eleven studies reported complications were significantly lower in the treated group (odds ratio: 0.55; 95% confidence interval [CI]: 0.32-0.94; P < .05) compared to the untreated group, as were American Orthopedic Foot and Ankle Society scores (standard mean difference [SMD]: 3.77; 95% CI: 1.17-6.37; P < .01), visual analog scale scores (SMD: -0.69; 95% CI: -1.24 to -0.14; P < .05), Karlsson scores (SMD: 2.78; 95% CI: 0.35-5.21; P < .05), and Tegner scores (SMD: 0.41; 95% CI: -0.13 to 0.95; P = .139). CONCLUSION: According to complications, American Orthopedic Foot and Ankle Society scores, visual analog scale scores, and Karlsson scores, the study findings suggested that keyhole surgery may be beneficial in patients with persistent lateral ankle joint instability. Following this, the growing number of high-quality studies needs to confirm the results reported in this study.

Influence of whole-body vibration and drop jump on the range of motion in the ankle joint and running parameters-A randomized crossover study.

BACKGROUND AND PURPOSE: Warm-up (WU) is a commonly practiced technique aimed at preparing athletes for physical activity. Although coaches and athletes consider WU essential, there is still an ongoing debate about its effectiveness. This might be due to the fact that WU procedures often rely on experiences rather than scientific research. During WU, athletes may pursue intermediate goals such as ensuring proper ranges of motion in joints, which seem crucial particularly for runners' ankle joints. Hence, the aim of this study was to evaluate influence of whole-body vibration (WBV), drop jump (DJ), and a combination of both (WBV + DJ) in terms of ankle dorsiflexion and running parameters among recreational runners. METHODS: Sixteen runners performed as a WU: five sets of 30 s calf raises without WBV (CTRL), five sets of 30 s calf raises during WBV, five sets of six DJ, five sets of 30 s calf raises during WBV followed by 6 DJ. Range of motion (ROM) of the ankle joint was measured in a prone position using an inclinometer for the soleus and gastrocnemius muscles, separately. Measurements were conducted before and after WU, and after a 3000 m run. RESULTS: There was no interaction for time and WU for left (p = 0.926) and right (p = 0.738) soleus muscle as well as for left (p = 0.748) and right (p = 0.197) gastrocnemius muscles. No difference (p = 0.914) for the running time was found. DISCUSSION: WBV, drop jumps, or a combination of both did not affect ankle dorsiflexion and running time.

Locally obtained autologous bone grafts are effective for achieving arthrodesis while managing foot and ankle charcot's neuroarthropathy: short to mid-term results from a specialized north African foot and ankle surgery unit.

PURPOSE: We aimed to report the union rate after only utilizing a locally obtained autologous bone graft while correcting the deformity and performing joint arthrodesis in patients with foot and ankle Charcot neuropathy (CN) and to report on the radiographic, functional, complications incidence outcomes at a minimum of two years of follow up. METHODS: We included 24 patients having a mean age of 55.4 ± 10.1 years diagnosed with CN of the foot, ankle, or both. Seven (29.2%) cases were classified as Brodsky type 1, 11 (45.8%) as type 3 A, and six (25%) were type 4. Hindfoot and Midfoot bi-columnar arthrodesis was performed in 70.8% and 29.2% of the patients, respectively. Eight (33.3%) cases had preoperative ulcers. Functional outcomes were evaluated using a modified AOFAS score. Arthrodesis site union was assessed clinically and radiographically. All patients were available for a mean follow up of 35.7 ± 9.5 (24-54) months. RESULTS: Arthrodesis site union was achieved in 23 (95.8%) cases after a mean of 4 ± 1.7 (2-7.5) months. The mean modified AOFAS score was 72.4 ± 10.41 (46-83) points; 79.2% achieved excellent and good scores. Ulcers healed in 87.5% of the patients. Twenty-two (91.7%) patients were satisfied with their functional results. Infection incidence was 12.5%, and no patients required revision or amputation. CONCLUSION: Foot and ankle Charcot neuroarthropathy deformity correction by arthrodesis of the affected joint as a salvage management option resulted in acceptable clinical and radiological outcomes. To enhance the local environment for arthrodesis consolidation, locally obtained autografts led to higher union rates and avoided the drawbacks of using other graft types.

Simplified arthroscopic anterior talofibular ligament repair with inferior extensor retinaculum reinforcement: technical notes and preliminary results.

PURPOSE: Compared with open surgery, arthroscopic anterior talofibular ligament (ATFL) repair has many advantages and good clinical outcome. Inferior extensor retinaculum (IER) reinforcement is a supplement procedure that increase the strength of the ATFL. There is still no gold standard for arthroscopic ATFL repair. The purposes of this study were to describe a simplified technique for arthroscopic ATFL repair with IER reinforcement and to analyze its preliminary clinical results. METHODS: Twenty-seven patients with chronic lateral ankle instability (CLAI) who underwent this simplified surgery were analyzed in this retrospective study. The patients' characteristics and operative times were evaluated. Intraoperative photos, radiographs from the anterior drawer test and talar tilt test and postoperative MR images were recorded. The American Orthopaedic Foot and Ankle Society (AOFAS) ankle-hindfoot score and visual analog scale (VAS) score were also recorded. With the assistance of a needle, we performed ATFL repair and IER reinforcement with one Pushlock anchor and nonabsorbable sutures. RESULTS: No complications namely skin necrosis, superficial fibular nerve injury or wound infection, were reported. The AOFAS score and VAS score improved from 64.74 ± 9.47 and 6.00 ± 1.56 to 90.74 ± 6.46 and 1.07 ± 1.09, respectively. The talar advancement and talar tilt angle were improved after surgery. One year after the operation, the ATFL appeared to be continuous on MR images. CONCLUSION: In this study, we proposed a simple and effective arthroscopic ATFL repair with IER reinforcement technique. The short-term follow-up examination revealed satisfactory clinical outcomes. Our technique might be a new surgical option for the treatment of CLAI.

Coccidiomycosis septic arthritis presenting as ankle monoarthritis in a patient with presumed psoriatic arthritis.

A man in his 50s with a history of psoriasis was evaluated for acute on chronic left ankle pain. His symptoms were attributed to psoriatic arthritis, and he tried several immunosuppressive regimens without improvement. Further diagnostic workup confirmed Coccidioides immitis/posadasii septic monarthritis thought secondary to a known remote history of Valley fever while residing in Arizona and subsequent reactivation in the setting of immunosuppression. The patient ultimately required prolonged anti-fungal therapy and multiple surgical debridements.Although psoriatic arthritis can present as monarthritis, it is uncommon, with more likely differential considerations including crystal arthropathies, trauma and both typical and atypical infections. Acute monarthritis should always prompt concern for a septic joint, even in a patient with autoimmune disease. The specific history elicited from the patient, including residence in an endemic region, and known prior Coccidioides infection, increased suspicion for Coccidioides and led to the correct diagnosis and management.

Machine Learning Based Abnormal Gait Classification with IMU Considering Joint Impairment.

Gait analysis systems are critical for assessing motor function in rehabilitation and elderly care. This study aimed to develop and optimize an abnormal gait classification algorithm considering joint impairments using inertial measurement units (IMUs) and walkway systems. Ten healthy male participants simulated normal walking, walking with knee impairment, and walking with ankle impairment under three conditions: without joint braces, with a knee brace, and with an ankle brace. Based on these simulated gaits, we developed classification models: distinguishing abnormal gait due to joint impairments, identifying specific joint disorders, and a combined model for both tasks. Recursive Feature Elimination with Cross-Validation (RFECV) was used for feature extraction, and models were fine-tuned using support vector machine (SVM), random forest (RF), and extreme gradient boosting (XGB). The IMU-based system achieved over 91% accuracy in classifying the three types of gait. In contrast, the walkway system achieved less than 77% accuracy in classifying the three types of gait, primarily due to high misclassification rates between knee and ankle joint impairments. The IMU-based system shows promise for accurate gait assessment in patients with joint impairments, suggesting future research for clinical application improvements in rehabilitation and patient management.

Evaluating the Performance of Joint Angle Estimation Algorithms on an Exoskeleton Mock-Up via a Modular Testing Approach.

A common challenge for exoskeleton control is discerning operator intent to provide seamless actuation of the device with the operator. One way to accomplish this is with joint angle estimation algorithms and multiple sensors on the human-machine system. However, the question remains of what can be accomplished with just one sensor. The objective of this study was to deploy a modular testing approach to test the performance of two joint angle estimation models-a kinematic extrapolation algorithm and a Random Forest machine learning algorithm-when each was informed solely with kinematic gait data from a single potentiometer on an ankle exoskeleton mock-up. This study demonstrates (i) the feasibility of implementing a modular approach to exoskeleton mock-up evaluation to promote continuity between testing configurations and (ii) that a Random Forest algorithm yielded lower realized errors of estimated joint angles and a decreased actuation time than the kinematic model when deployed on the physical device.

The effect of ankle-foot orthoses on gait characteristics in people with Charcot-Marie-Tooth disease: A systematic review and meta-analysis.

INTRODUCTION: Ankle-foot orthoses (AFOs) are commonly prescribed for people with Charcot-Marie-Tooth disease (CMT) to improve gait efficiency and reduce the occurrence of tripping and falls. The aim of this study was to systematically review evidence on the effects of AFOs on gait kinematics and kinetics and postural stability/balance in people with CMT. METHODS: Studies were identified from electronic databases and screened for inclusion online using Rayyan. Data from all eligible studies were extracted into a standardised Excel spreadsheet. Methodological quality was assessed using the Joanna Briggs Institute Critical Appraisal Checklists. Where available, continuous outcomes were pooled to estimate standardised mean differences in random-effects meta-analyses. RESULTS: A total of 15 studies were included with variable methodological quality. Sample sizes ranged from 1 to 32 with significant variability in participant characteristics, AFO designs and testing procedures. Data from eight studies were available for meta-analysis. Although AFOs impacted walking velocity, stride length, step length, cadence, ankle dorsiflexion, plantarflexion, knee and hip flexion and ankle plantarflexion and dorsiflexion moments, the effect sizes were small-to-moderate and non-significant. There were insufficient data available for pooled analyses of outcomes related to postural stability/balance. CONCLUSION: Although AFOs positively affect a number of gait and balance parameters, the small participant numbers, variability in participant characteristics, AFO designs and testing procedures adopted by the available studies resulted in the absence of statistically significant effects when data were pooled. The results from this review also highlight the importance of device customisation based on the individual needs of people with CMT and their degree of gait impairment.

Effects of ankle joint degree of freedom of knee-ankle-foot orthoses on loading patterns and triceps surae muscle activity on the paretic side in individuals with subacute severe hemiplegia: a retrospective study.

BACKGROUND: Individuals with subacute severe hemiplegia often undergo alternate gait training to overcome challenges in achieving walking independence. However, the ankle joint setting in a knee-ankle-foot orthosis (KAFO) depends on trunk function or paralysis stage for alternate gait training with a KAFO. The optimal degree of ankle joint freedom in a KAFO and the specific ankle joint conditions for effective rehabilitation remain unclear. Therefore, this study aimed to investigate the effects of different degrees of freedom of the ankle joint on center-of-pressure (CoP) parameters and muscle activity on the paretic side using a KAFO and to investigate the recommended setting of ankle joint angle in a KAFO depending on physical function. METHODS: This study included 14 participants with subacute stroke (67.4 ± 13.3 years). The CoP parameters and muscle activity of the gastrocnemius lateralis (GCL) and soleus muscles were compared using a linear mixed model (LMM) under two ankle joint conditions in the KAFO: fixed at 0° and free ankle dorsiflexion. We confirmed the relationship between changes in CoP parameters or muscle activity under different conditions and physical functional characteristics such as the Fugl-Meyer Assessment of Lower Extremity Synergy Score (FMAs) and Trunk Impairment Scale (TIS) using LMM. RESULTS: Anterior-posterior displacement of CoP (AP_CoP) (p = 0.011) and muscle activity of the GCL (p = 0.043) increased in the free condition of ankle dorsiflexion compared with that in the fixed condition. The FMAs (p = 0.004) and TIS (p = 0.008) demonstrated a positive relationship with AP_CoP. A positive relationship was also found between TIS and the percentage of medial forefoot loading time in the CoP (p < 0.001). CONCLUSIONS: For individuals with severe subacute hemiplegia, the ankle dorsiflexion induction in the KAFO, which did not impede the forward tilt of the shank, promotes anterior movement in the CoP and muscle activity of the GCL. This study suggests that adjusting the dorsiflexion mobility of the ankle joint in the KAFO according to improvement in physical function promotes loading of the CoP to the medial forefoot.

The Effect of Strength and Balance Training on Kinesiophobia, Ankle Instability, Function, and Performance in Elite Adolescent Soccer Players with Functional Ankle Instability: A Prospective Cluster Randomized Controlled Trial.

We aimed to implement strength and balance training for elite adolescent male soccer players with functional ankle instability (FAI) to assess kinesiophobia, ankle instability, ankle function, and performance. This cluster randomized controlled trial comprised 51 elite adolescent male soccer players with FAI recruited from six different teams, divided into strength, balance, and control groups (SG, n = 17; BG, n = 17; and CG, n = 17, respectively). The SG and BG underwent strength and balance training sessions three times per week for 6 weeks. Primary outcomes were the Tampa scale for kinesiophobia-17 (TSK) and Cumberland ankle instability tool (CAIT) scores to assess kinesiophobia and FAI, respectively. Secondary outcomes were ankle strength (four directions), dynamic balance, static balance (ellipse, displacement, velocity), and performance (figure 8 and side-hop tests). A significant interaction effect was observed for both TSK and CAIT post-intervention (both, P < 0.01). In post hoc analyses, the BG had significantly better outcomes in reducing TSK. The SG and BG showed greater improvements in CAIT scores. Regression analysis indicated that CAIT severity correlated significantly with TSK (P = 0.039, R = 0.289). For secondary outcomes, the SG and BG were superior in terms of ankle dorsiflexion/inversion strength, static balance displacement, and figure-8 and side-hop tests (all, P < 0.05). The BG showed significantly better static balance ellipse results (P < 0.05). The 6-week intervention significantly enhanced kinesiophobia management, ankle stability, and performance. Balance training effectively mitigated kinesiophobia and improved balance, compared with strength training alone. Even small variations in CAIT severity can influence kinesiophobia, highlighting the potential benefits of balance training. Integrating balance training into training programs can address both physical and psychological aspects of ankle instability. Research is recommended to explore the longitudinal effects of these interventions and their potential to prevent injury recurrence.

SPECT/CT of Total Ankle Arthroplasty.

Use of SPECT/CT (Single Photon Emission Computed Tomography/Computed Tomography) is increasing providing additional information in patients with inconclusive clinical examination and unremarkable imaging findings presenting with chronic pain after total ankle arthroplasty. To differentiate the cause of pain after total ankle arthroplasty can be challenging. SPECT/CT combines structural and metabolic imaging as a hybrid tool leading to higher specificity and overall diagnostic accuracy presumably in cases of gutter impingement, prosthetic loosening, and osteoarthritis of adjacent joints. Moreover, SPECT/CT can complement diagnostic work up in periprosthetic joint infections. Basal tracer enhancement has to be considered for the interpretation of imaging findings.

Cone-Beam Weight-Bearing Computed Tomography of Ankle Arthritis and Total Ankle Arthroplasty.

Weight-bearing computed tomography has multiple advantages in evaluating the hindfoot and ankle. It can assess hindfoot and ankle alignment, pathology in ankle arthritis, and complications related to total ankle replacements. It is an essential tool in ankle osteoarthritis diagnostic, preoperative planning, and total ankle replacement outcomes. It allows for better accuracy and reproducibility of alignment and implant size. In addition, it has the potential to more assertively detect complications related to weight bearing.

Magnetic Resonance Imaging of Total Ankle Arthroplasty: State-of-The-Art Assessment of Implant-Related Pain and Dysfunction.

Total ankle arthroplasty (TAA) is an effective alternative for treating patients with end-stage ankle degeneration, improving mobility, and providing pain relief. Implant survivorship is constantly improving; however, complications occur. Many causes of pain and dysfunction after total ankle arthroplasty can be diagnosed accurately with clinical examination, laboratory, radiography, and computer tomography. However, when there are no or inconclusive imaging findings, magnetic resonance imaging (MRI) is highly accurate in identifying and characterizing bone resorption, osteolysis, infection, osseous stress reactions, nondisplaced fractures, polyethylene damage, nerve injuries and neuropathies, as well as tendon and ligament tears. Multiple vendors offer effective, clinically available MRI techniques for metal artifact reduction MRI of total ankle arthroplasty. This article reviews the MRI appearances of common TAA implant systems, clinically available techniques and protocols for metal artifact reduction MRI of TAA implants, and the MRI appearances of a broad spectrum of TAA-related complications.

Presurgical and Postsurgical MRI Evaluation of Osteochondral Lesions of the Foot and Ankle: A Primer.

The gold standard diagnostic imaging tool for ankle OCLs is magnetic resonance imaging, which allows precise evaluation of the articular cartilage and assessment of the surrounding soft tissue structures. Post-operative morphologic MRI assessment via MOCART scores provide semi-quantitative analysis of the repair tissue, but mixed evidence exists regarding its association with post-operative outcomes. Post-operative biochemical MRIs allow assessment of the collagen network of the articular cartilage via T2-mapping and T2∗ mapping, and assessment of the articular glycosaminoglycan content via delayed gadolinium-enhanced MRI of cartilage (dGEMRIC), T1rho mapping and sodium imaging.

Osteomyelitis and Septic Arthritis of the Foot and Ankle: Imaging Update.

Radiography is considered the first-line screening exam for clinically suspected osteomyelitis. However, additional evaluation is generally needed. MRI is the definitive diagnostic exam with high sensitivity and specificity combined with excellent anatomic definition. Gadolinium contrast can be useful to detect areas of devitalization before surgery. Bone marrow edema on fluid-sensitive images and low signal intensity on T1-weighted images in the presence of secondary MRI findings, including ulcer, sinus tract, and cellulitis with or without abscess are typical findings of osteomyelitis. If MRI is contraindicated, three phase bone scan can be used. Early diagnosis and treatment is essential.