Prophylactic ankle brace use in high school volleyball players: a prospective study.

INTRODUCTION: The purpose of this study was to determine the effect of prophylactic ankle bracing on the incidence of ankle injuries in a high school population of interscholastic volleyball players followed prospectively for one season. MATERIALS AND METHODS: The study was designed to evaluate the effect of different types of ankle braces on the incidence of ankle sprains in high school volleyball players. There were 957 players in the group that wore braces and 42 in the control group who did not wear a brace. Information was collected on age, sex, previous injury, incidence of injury, and time off from play. Only the dominant ankle was studied. RESULTS: Overall, the use of a prophylactic ankle brace did not significantly alter the incidence of ankle sprains in high school volleyball players. However, in players without a previous ankle sprain, the use of an ankle brace did make a significant difference in two of the braced groups. The Active Ankle Trainer II and the Aircast Sports Stirrup protected volleyball players from a sprain only if they had not had a previous sprain. If the player had a history of a previous ankle sprain, these two brace groups did not protect the ankle from another ankle sprain (p < 0.05). In addition, there were significantly more injuries in the female group of players who wore a non-rigid brace versus those who wore a more rigid brace. CONCLUSION: This information may be helpful in deciding whether to recommend prophylactic ankle braces in volleyball players.

Surgical advancements: arthroscopic alternatives to open procedures: great toe, subtalar joint, Haglund's deformity, and tendoscopy.

Advancements in surgical techniques have broadened the use of arthroscopy as a viable alternative to open procedures in evaluating and treating common foot, ankle, and tendon injuries. These techniques can result in a shorter and more comfortable recovery, decreased postoperative pain, and fewer complications. This article discusses diagnostic and technical points in relation to advanced uses of the arthroscope.

Radial extracorporeal shock wave therapy is safe and effective in the treatment of chronic recalcitrant plantar fasciitis: results of a confirmatory randomized placebo-controlled multicenter study.

BACKGROUND: Radial extracorporeal shock wave therapy is an effective treatment for chronic plantar fasciitis that can be administered to outpatients without anesthesia but has not yet been evaluated in controlled trials. HYPOTHESIS: There is no difference in effectiveness between radial extracorporeal shock wave therapy and placebo in the treatment of chronic plantar fasciitis. STUDY DESIGN: Randomized, controlled trial; Level of evidence, 1. METHODS: Three interventions of radial extracorporeal shock wave therapy (0.16 mJ/mm(2); 2000 impulses) compared with placebo were studied in 245 patients with chronic plantar fasciitis. Primary endpoints were changes in visual analog scale composite score from baseline to 12 weeks' follow-up, overall success rates, and success rates of the single visual analog scale scores (heel pain at first steps in the morning, during daily activities, during standardized pressure force). Secondary endpoints were single changes in visual analog scale scores, success rates, Roles and Maudsley score, SF-36, and patients' and investigators' global judgment of effectiveness 12 weeks and 12 months after extracorporeal shock wave therapy. RESULTS: Radial extracorporeal shock wave therapy proved significantly superior to placebo with a reduction of the visual analog scale composite score of 72.1% compared with 44.7% (P = .0220), and an overall success rate of 61.0% compared with 42.2% in the placebo group (P = .0020) at 12 weeks. Superiority was even more pronounced at 12 months, and all secondary outcome measures supported radial extracorporeal shock wave therapy to be significantly superior to placebo (P < .025, 1-sided). No relevant side effects were observed. CONCLUSION: Radial extracorporeal shock wave therapy significantly improves pain, function, and quality of life compared with placebo in patients with recalcitrant plantar fasciitis.

The effects of obesity on orthopaedic foot and ankle pathology.

BACKGROUND: It is believed that obese individuals may have an increased number of foot and ankle problems. The World Health Organization recommends a standard classification of adult overweight and obesity using the following body mass index (BMI) calculations: a BMI of 25.0 to 29.9 kg per m(2) is defined as overweight; a BMI of 30.0 kg per m(2) or more is defined as obesity. The purpose of this paper was to report a survey of 1411 patients in an orthopaedic foot and ankle practice and compare the incidence of orthopaedic foot and ankle complaints with the BMI. METHOD: One thousand four hundred and eleven adults, including 887(62.4%) women and 535(37.6%) men, were evaluated in this study. The BMI was calculated for each subject using the standards of the World Health Organization. The subjects were divided into two groups: normal and overweight. The normal weight subjects had a BMI of 18.5 to 24.9 (n = 684; 48.1%) and the overweight or obese group had a BMI greater than or equal to 25 (n = 738; 51.9%). RESULTS: In this study, being overweight or obese significantly increased the chances of having tendinitis in general. If the subjects were overweight or obese, there was an increased likelihood, although not significant, of plantar fasciitis and osteoarthritis. If the individuals were of normal weight, there was an increased likelihood of hallux valgus. CONCLUSIONS: Tendinitis, plantar fasciitis, and osteoarthritis usually are secondary to overuse and increased stress on the soft tissues and joints, which may be directly related to increased weight on these structures.

Arthroscopy of the posterior subtalar joint.

The subtalar joint is a complex and functionally important joint of the lower extremity. It plays a major role in the movement of inversion and eversion of the foot. With the development of small-joint arthroscopes and instrumentation, surgeons became interested in posterior subtalar joint arthroscopy. Diagnostic and therapeutic indications for this technique have increased; however, arthroscopic subtalar surgery is technically difficult and should be performed by an experienced arthroscopist. The number of reports dealing with posterior subtalar arthroscopy remains relatively small.