Impact Sound Across Rearfoot, Midfoot, and Forefoot Strike During Overground Running.

CONTEXT: Three foot-strike techniques are common in runners. If these techniques generate different sounds at the point of impact with the ground, lower limb kinetics may be influenced. No previous authors have determined whether such relationships exist. OBJECTIVES: To determine foot-ground impact sound characteristics and compare the impact-sound characteristics across foot-strike techniques and the relationships between impact-sound characteristics and vertical loading rates. DESIGN: Cross-sectional study. SETTING: Gait analysis laboratory. PATIENTS OR OTHER PARTICIPANTS: A total of 30 runners (15 women, 15 men; age = 23.5 ± 4.0 years, height = 1.67 ± 0.1 m, mass = 58.1 ± 8.2 kg) completed overground running trials with rearfoot-strike, midfoot-strike (MFS), and forefoot-strike (FFS) techniques in a gait analysis laboratory. MAIN OUTCOME MEASURE(S): Impact sound was measured using a shotgun microphone, and the peak sound amplitude, median frequency, and sound duration were analyzed. Separate linear regressions, clustering participants due to repeated measures, were used to compare the sound characteristics across foot-strike techniques. Kinetic data were collected from a force plate, and the vertical loading rates were calculated. Pearson correlation was used to determine the relationship between sound characteristics and kinetics. RESULTS: Landing with an MFS or FFS resulted in greater peak sound amplitude (P < .001) and shorter sound duration (P < .001) than a rearfoot strike. The MFS exhibited the highest median frequency among the 3 foot-strike patterns, followed by the FFS (P < .001). We did not find a significant relationship between vertical loading rates and any impact sound characteristics (P > .115). CONCLUSIONS: The results suggest that impact-sound characteristics may be used to differentiate foot-strike patterns in runners. However, these did not relate to lower limb kinetics. Therefore, clinicians should not solely rely on impact sound to infer impact loading.

A New Bariatric Procedure: The Stomach Sparing Gastric Sleeve™.

A new restrictive procedure has emerged over the last decade known as the total vertical gastric plication or greater curvature plication (GCP). After our initial experience, the original technique was modified and a new standardized procedure was registered as the Stomach Sparing Gastric Sleeve™ (SSGS). The SSGS reduces the capacity of the stomach by in-folding the greater curvature with containment sutures, creating a sleeve-like stomach. Between March 2012 and August 2015 patients that met the National Institutes of Health (NIH) criteria for gastric banding underwent treatment with the SSGS. The standardized technique requires the use of a customized fenestrated orogastric calibration device. The stomach is then imbricated or in-folded in two layers and containment non-absorbable sutures are placed longitudinally. The two layers of non-absorbable sutures are continuous starting 1 cm below the esophageal gastric (EG) junction and continued distally 3-4 cm from the pylorus spaced evenly at 1 cm intervals and sero-muscular thickness. Symmetry of anteroposterior distribution is also observed leading to the formation of a sleeve-like shaped stomach. Initial and subsequent weight (kg), body mass index (Kg/m²), excess weight loss (%EWL) and complications were recorded. Repeated measures of analysis of variance (ANOVA) were used to assess weight change. The SSGS was performed on the last 624 cases (mean age 43.1±11.6 years). The follow-up time was 3 years, with an %EWL of 56.36±21.83 during the first year and a maintenance of 49.37±30.82 by the third year of follow-up (p=<0.0005). Patients with a BMI of 20-30 Kg/m² had an EWL of 60.46% during the first 6 months after surgery and an EWL of 74.84% in the first year and a maintained EWL after 3 years of 60.45%. The surgical mean time was 45 min. There were no conversions to the open approach. A 0% mortality and 1.12% morbidity were reported. The SSGS has a weight loss comparable to other restrictive procedures, with excellent mid-term excess weight loss in the 20-30 Kg/m² BMI category. This new technique is an improvement over the original technique, as it has been modified specifically to address the complications of the original non-standardized gastric plication. The benefits of this restrictive technique are that it requires no stapling, dividing, or rerouting of the intestines, as well as no need to implant a foreign body device. The disadvantages observed were a steep learning curve and lack of a standardized technique until this publication.