Total ankle replacement versus ankle fusion for end-stage ankle arthritis: A meta-analysis.

PURPOSE: This study aims to systematically review the efficacy and safety of total ankle replacement (TAR) and ankle fusion (AF) as treatment options for end-stage ankle arthritis. METHODS: A comprehensive literature search was conducted on data from multiple databases, including PubMed, The Cochrane Library, Construction and Building Materials, Embase, Web of Science, and Scopus for RCTs and prospective cohort studies comparing TAR and AF in patients with end-stage ankle arthritis from inception up to June, 2023. Our primary outcomes of interest included patients' clinical function scores and complications. We employed Review Manager 5.4 and Stata/MP 14.0 software for the meta-analysis. RESULTS: Our analysis incorporated 13 comparative studies, including 11 prospective studies, one pilot RCT, and one RCT. The pooled results revealed no significant difference in postoperative Short Form-36 scores between the TAR and AF groups (MD = -1.19, 95% CI: -3.89 to 1.50, p = .39). However, the postoperative Foot and Ankle Ability Measure scores in the AF group were significantly higher than in the TAR group (MD = 8.30, 95% CI: 1.01-15.60, p = .03). There was no significant difference in postoperative complication rates between the TAR and AF groups (RR = 0.95, 95% CI: 0.59 to 1.54, p = .85). CONCLUSION: Currently available evidence suggests no significant disparity in postoperative outcomes between TAR and AF. In the short term, TAR demonstrates better clinical scores than AF and lower complication rates. Conversely, in the long term, AF exhibits superior clinical scores and lower complication rates, although this difference is not statistically significant.

Unicompartmental Knee Arthroplasty for Osteoarthritis Eliminates Lateral Thrust: Associations between Lateral Thrust Detected by Inertial Measurement Units and Clinical Outcomes.

The purpose of this study was to investigate the relationship between clinical outcomes and lateral thrust before and after unicompartmental knee arthroplasty (UKA) using inertial measurement sensor units. Eleven knees were evaluated with gait analysis. The varus angular velocity was used to evaluate lateral thrust. The femorotibial angle (FTA) and hip-knee-ankle angle (HKA) were used to evaluate lower-limb alignment, and the Oxford Knee Score (OKS) and Japanese Orthopaedic Association Score (JOA) were used to evaluate clinical outcomes. The mean pre-UKA peak varus velocity was 37.1 ± 9.8°/s, and that for post-UKA was 28.8 ± 9.1°/s (p = 0.00003), such that instabilities clearly improved. Assuming the definition of lateral thrust is when the varus angular velocity is more than 28.1°/s, 81.8% of patients had lateral thrust preoperatively, but this decreased to 55.6% postoperatively, such that the symptoms and objective findings improved. Both OKS and JOA improved after surgery. In addition, HKA was -7.9° preoperatively and -5.8° postoperatively (p = 0.024), and FTA was 181.4° preoperatively and 178.4° postoperatively (p = 0.012). There was a positive correlation between postoperative JOA and FTA, indicating that changes in postoperative alignment affected clinical outcomes. This study quantitatively evaluated the disappearance of lateral thrust by UKA, and it found that the stability can be achieved by UKA for unstable knees with lateral thrust.

Morphometric assessment of tibial nerve and its branches around the ankle.

It is essential to understand the considerable variations in bifurcation patterns of the tibial nerve (TN) and its peripheral nerves at the level of the tarsal tunnel to prevent iatrogenic nerve injury during surgical nerve release or nerve block. A total of 16 ankles of 8 human cadavers were dissected to investigate the branching patterns of the TN, using 2 imaginary lines passing through the tip of the medial malleolus (MM) as reference lines. Bifurcation patterns and detailed information on the relative locations of the medial plantar, lateral plantar, medial calcaneal, and inferior calcaneal nerves to the reference lines were recorded. The most common bifurcation pattern was Type 1 in 12 ankles (75%), followed by Type 2 in 2 ankles (13%). One medial calcaneal nerve (MCN) was seen in 11 (69%) specimens and 2 MCN branches were seen in 5 (31%) specimen. 88% of the MCN branches bifurcated from the TN, whereas 6% originated from both TN and lateral plantar nerve (LPN). At the level of the tip of the MM, 2 of 7 parameters showed statistically significant difference between both sexes (P < .05). There was a statistically significant difference between left and right ankles in 2 of 7 measurements (P < .05). Further morphometric analysis of the width, distance, and angle between the TN branches and the tip of MM showed a highly variable nature of the location of the peripheral nerve branches.

Ankle and hindfoot motion of healthy adults during running revealed by dynamic biplane radiography: Side-to-side symmetry, sex-specific differences, and comparison with walking.

This study aimed to characterize ankle and hindfoot kinematics of healthy men and women during overground running using biplane radiography, and to compare these data to those previously obtained in the same cohort during overground walking. Participants ran across an elevated platform at a self-selected pace while synchronized biplane radiographs of their ankle and hindfoot were acquired. Motion of the tibia, talus, and calcaneus was tracked using a validated volumetric model-based tracking process. Tibiotalar and subtalar 6DOF kinematics were obtained. Absolute side-to-side differences in ROM and kinematics waveforms were calculated. Side-to-side and sex-specific differences were evaluated at 10 % increments of stance phase with mixed model analysis. Pearson correlation coefficients were used to assess the relationship between stance-phase running and walking kinematics. 20 participants comprised the study cohort (10 men, mean age 30.8 ± 6.3 years, mean BMI 24.1 ± 3.1). Average absolute side-to-side differences in running kinematics waveforms were 5.6°/2.0 mm or less at the tibiotalar joint and 5.2°/3.2 mm or less at the subtalar joint. No differences in running kinematics waveforms between sides or between men and women were detected. Correlations were stronger at the tibiotalar joint (42/66 [64 %] of correlations were p < 0.05), than at the tibiotalar joint (38/66 [58 %] of correlations were p < 0.05). These results provide a normative reference for evaluating native ankle and hindfoot kinematics which may be informative in surgical or rehabilitation contexts. Sex-specific differences in ankle kinematics during overground running are likely not clinically or etiologically significant. Associations seen between walking and running kinematics suggest one could be used to predict the other.

The impact of pediatric obesity on biomechanical differences across the gait cycle at three walking speeds.

BACKGROUND: Obesity impacts a child's ability to walk with resulting biomechanical adaptations; however, existing research has not comprehensively compared differences across the gait cycle. We examined differences in lower extremity biomechanics across the gait cycle between children with and without obesity at three walking speeds. METHODS: Full gait cycles of age-matched children with obesity (N = 10; BMI: 25.7 ± 4.2 kg/m2) and without obesity (N = 10; BMI: 17.0 ± 1.9 kg/m2) were analyzed at slow, normal, and fast walking speeds. Main and interaction effects of group and speed across hip, knee, and ankle joint angles and moments in sagittal, frontal, and transverse planes were analyzed using one-dimensional statistical parametric mapping. FINDINGS: Compared to children without obesity, children with obesity had greater hip adduction during mid-stance, while also producing greater hip extensor moments during early stance phase, abductor moments throughout most of stance, and hip external rotator moments during late stance. Children with obesity recorded greater knee flexor, knee extensor and knee internal rotator moments during early stance, and knee external rotator moments in late stance than children without obesity; children with obesity also demonstrated greater ankle plantarflexor moments throughout mid and late stance. Interaction effects existed within joint kinetics data; children with obesity produced greater hip extensor moments at initial contact and toe-off when walking at fast compared to normal walking speed. INTERPRETATION: While few kinematic differences existed between the two groups, children with obesity exhibited greater moments at the hip, knee, and ankle during critical periods of controlling and stabilizing mass.

The relationship between joint kinematic patterns during single-leg drop landing and perceived instability in individuals with chronic ankle instability.

BACKGROUND: Perceived instability is a primary symptom among individuals with chronic ankle instability. However, the relationship between joint kinematics during landing remains unclear. Therefore, we investigated the relationships between landing kinematics and perceived instability in individuals with chronic ankle instability. METHODS: In 32 individuals with chronic ankle instability, we recorded ankle, knee, and hip joint angles during a single-leg drop landing. Joint angle waveforms during 200 ms before and after initial contact were summarized into single values using two methods: peak joint angles and principal component scores via principal component analysis. Using Spearman's rank correlation coefficient (ρ), we examined the relationships of peak joint angles and principal component scores with the Cumberland Ankle Instability Tool score, with a lower score indicating a greater perceived instability (α = 0.05). FINDINGS: The second principal component scores of ankle angle in the horizontal and sagittal planes significantly correlated with the Cumberland Ankle Instability Tool score (Horizontal: ρ = 0.507, P = 0.003; Sagittal: ρ = -0.359, P = 0.044). These scores indicated the differences in the magnitude of angles before and after landing. Significant correlations indicated a greater perceived instability correlated with smaller internal rotation and plantarflexion before landing and smaller external rotation and dorsiflexion after landing. In contrast, no peak joint angles correlated with the Cumberland Ankle Instability Tool score (P > 0.05). INTERPRETATION: In individuals with chronic ankle instability, ankle movements during landing associated with perceived instability may be a protective strategy before landing and potentially cause ankle instability after landing.

[Effectiveness comparison of a new hook-shaped anatomical locking plate and conventional anatomical locking plate in treatment of Danis-Weber type A lateral malleolus fractures].

Objective: To investigate the effectiveness of a new hook-shaped anatomical locking plate in the treatment of Danis-Weber type A lateral malleolus fractures. Methods: A retrospective analysis was performed on the clinical data of 45 patients with Danis-Weber type A lateral malleolus fractures who met the selection criteria between November 2020 and November 2022. According to the surgical methods, they were divided into the observation group (treated with the new hook-shaped anatomical locking plate, 23 cases) and the control group (treated with the conventional lateral malleolus anatomical locking plate, 22 cases). There was no significant difference in baseline data such as gender, age, cause of injury, Danis-Weber type of fracture, time from injury to operation, and combined ligament injury between the two groups ( P>0.05). The operation time, partial weight-bearing time, return to work time, and postoperative complications were recorded and compared between the two groups. The function and pain of ankle joint were evaluated by the range of motion of ankle dorsiflexion, plantarflexion, varus, valgus, and visual analogue scale (VAS) score at 1 and 3 months after operation, and at last follow-up, and the American Orthopaedic Foot and Ankle Society (AOFAS) score at 3 months after operation and at last follow-up. Results: All patients were followed up 10-18 months (mean, 15.1 months). There was no significant difference in operation time between the two groups ( P>0.05); the postoperative partial weight-bearing time and return to work time of the observation group were significantly earlier than those of the control group ( P<0.05). During the follow-up, there was 1 case of joint stiffness in the observation group, and 1 case of joint surface displacement, 1 case of joint stiffness, and 1 case of traumatic arthritis in the control group. There was no significant difference in the incidences of complications between the two groups ( P>0.05). With the extension of time after operation, the range of motion of ankle dorsiflexion, plantarflexion, varus, valgus, and VAS score of the two groups gradually improved, and there were significant differences between different time points ( P<0.05); At 1 and 3 months after operation, the above indexes in the observation group were significantly better than those in the control group ( P<0.05), and there was no significant difference between the two groups at last follow-up ( P>0.05). The difference of AOFAS score between the last follow-up and 3 months after operation in the observation group was significantly better than that in the control group ( P<0.05). Conclusion: Compared with the conventional lateral malleolus anatomical locking plate, the new hook-shaped anatomical locking plate has a more reliable fixation effect in the treatment of Danis-Weber type A lateral malleolus fracture, which is conducive to early functional exercise of the ankle joint, so that patients can bear weight earlier and return to work earlier, and the operation time is not significantly prolonged, and the effectiveness is satisfactory.

[Effectiveness of transverse double "8"-shaped tension band technique for Lawrence zone â fracture of the fifth metatarsal base].

Objective: To explore the effectiveness of transverse double "8"-shaped tension band technique in the treatment of Lawrence zoneⅠfracture of the 5th metatarsal base. Methods: Between February 2019 and October 2021, 15 patients with Lawrence zoneⅠfracture of the 5th metatarsal base were treated with transverse double "8"-shaped tension band technique. There were 8 males and 7 females, with a median age of 40 years (range, 23-59 years). The fractures were caused by sprains. The time from injury to operation was 3-7 days (mean, 4.1 days). X-ray films were taken to observe the fracture healing and the anchor looseness and detachment. The foot function was evaluated by American Orthopaedic Foot and Ankle Society (AOFAS) score, visual analogue scale (VAS) score, and the eversion angle of the calcaneal talus joint. Results: The incisions healed by first intention after operation in 14 cases and the incision healed poorly in 1 case. All patients were followed up 8-12 months (median, 10 months). The imaging examination showed that all fractures healed well, with a healing time of 10-14 weeks (mean, 11.7 weeks). At last follow-up, AOFAS score was 82-100 (median, 98); 13 cases were excellent and 2 cases were good, with an excellent and good rate of 100%. VAS score was 0-3 (median, 1). Three cases had mild limited ankle joint range of motion, while 12 cases had normal range of motion. The eversion angle of the calcaneal talus joint was 25°-32° (median, 30°). Conclusion: The application of transverse double "8"-shaped tension band technique for Lawrence zone Ⅰ fracture of the 5th metatarsal base has advantages such as simple operation, avoidance of secondary operation, and reduction of foreign body sensation, with definite effectiveness.

A case of synovial chondromatosis of the knee with 87 free bodies and review of literature.

BACKGROUND: Synovial chondromatosis is a non-malignant synovial disorder characterized by the presence of cartilage formation within the synovial membrane, leading to the emergence of multiple cartilaginous nodules that may be either attached or unattached. The presence of this anatomical feature is frequently observed in articulations such as the knee, hip, elbow, and ankle. CASE REPORT: In this study, we present a case of synovial chondromatosis in the knee joint of a healthy male in his early 60s. Notably, the patient exhibited the simultaneous presence of 87 large loose bodies. The occurrence of a substantial quantity of unattached entities of notable dimensions within the joint is highly uncommon. CONCLUSIONS: The patient had several synovial chondromas, a rare disease. Synovial chondromatosis is a benign disorder; however, growing synovium can cause pyogenic cartilage nodules. Most loose bodies in joints can abrade and degenerate articular cartilage, causing long-term discomfort. Thus, an early-stage procedure to remove loose bodies and carefully excise synovial tissue is necessary to treat this condition.

[Tibiotalocalcaneal arthrodesis for end-stage ankle and hindfoot arthropathy: Short- and mid-term clinical outcomes].

OBJECTIVE: To analyze the clinical data of patients with end-stage ankle and hindfoot arthropathy who underwent tibiotalocalcaneal (TTC) arthrodesis by the same surgeon, explore the short- and mid-term clinical results, complications and functional improvement, and discuss the clinical prognosis and precautions of TTC arthrodesis. METHODS: Retrospective analysis was made on the clinical data of 40 patients who underwent TTC arthrodesis by the same surgeon from March 2011 to December 2020. In this study, 23 males and 17 females were included, with an average age of (49.1±16.0) years. All the patients underwent unilateral surgery. The clinical characteristics, imaging manifestations, main diagnosis and specific surgical techniques of the patients were recorded. The clinical outcomes were evaluated by comparison of the American Orthopaedic Foot and Ankle Society (AOFAS) ankle-hindfoot score and visual analogue scale (VAS) between pre-operation and at the last follow-up. The fusion healing time, symptom improvement (significant improvement, certain improvement, no improvement or deterioration) and postoperative complications were also recorded. RESULTS: The median follow-up time was 38.0 (26.3, 58.8) months. The preoperative VAS score was 6.0 (4.0, 7.0), and the AOFAS score was 33.0 (25.3, 47.3). At the last follow-up, the median VAS score was 0 (0, 3.0), and the AOFAS score was 80.0 (59.0, 84.0). All the significantly improved compared with their preoperative corresponding values (P < 0.05). There was no wound necrosis or infection in the patients. One patient suffered from subtalar joint nonunion, which was syphilitic Charcot arthropathy. The median bony healing time of other patients was 15.0 (12.0, 20.0) weeks. Among the included patients, there were 25 cases with significant improvement in symptom compared with that preoperative, 8 cases with certain improvement, 4 cases with no improvement, and 3 cases with worse symptoms than that before operation. CONCLUSION: TTC arthrodesis is a reliable method for the treatment of the end-stage ankle and hindfoot arthropathy. The function of most patients was improved postoperatively, with little impact on daily life. The causes of poor prognosis included toe stiffness, stress concentration in adjacent knee joints, nonunion and pain of unknown causes.

Effects of ankle-foot orthoses on gait parameters in post-stroke patients with different Brunnstrom stages of the lower limb: a single-center crossover trial.

BACKGROUND: Ankle-foot orthoses (AFO) can improve gait posture and walking ability in post-stroke patients. However, the effect of AFO on gait parameters in post-stroke patients according to the Brunnstrom stage of stroke recovery of the lower limbs remains unclear. The study aimed to investigate whether stroke patients with different Brunnstrom stages benefit from wearing AFO. METHODS: Twenty-five post-stroke participants included 18 men (50 ± 13 years) and 7 women (60 ± 15 years). The patients were divided based on Brunnstrom stage III or IV of the lower limbs. All patients underwent the gait and timed up and go (TUG) test using a gait analysis system while walking barefoot or with an AFO. The spatiotemporal and asymmetric parameters were analyzed. RESULTS: All 25 patients completed the study. Significant differences were observed between barefoot and AFO use in TUG time (P < 0.001) but not walking velocity (P > 0.05). The main effect of the swing time ratio was significant in both groups (P < 0.05); however, the main effects of stride length, stance time, and gait asymmetry ratio were nonsignificant (P > 0.05). For barefoot versus AFO, the main effects of stride length (P < 0.05) and swing time (P < 0.01) ratios were significant, whereas those of stance time and gait asymmetry ratio were nonsignificant (P > 0.05). CONCLUSIONS: Post-stroke patients with lower Brunnstrom stages benefitted more from AFO, particularly in gait asymmetry.

Epidemiology and Characteristics of Ankle and Foot Injuries in Electric Scooter-Related Accidents.

Background: The use of electric scooters (e-scooters) continues to increase as a simple, inexpensive means of transport, resulting in a sharp increase in the incidence of scooter-related accidents. No study to date has closely examined the injury extent to the lower leg, joints, and extremities from e-scooter-related accidents. Here, we investigated the epidemiology and injury patterns of such accidents, focusing on injuries to the ankle and foot. Methods: Based on data from a single tertiary hospital's database, the demographics of 563 patients with scooter-associated injuries were analyzed retrospectively. Among the patients, 229 patients who were injured by e-scooter riding were further investigated. Based on the data, the general demographics of whole scooter-associated injuries and the injury characteristics and fracture cases of the lower leg, ankle, and foot were analyzed. Results: During the 4-year study period, the number of patients injured by e-scooters increased every year. Lower extremities were the most common injury site (67.2%) among riders, whereas injuries to the head and neck (64.3%) were more common in riders of non-electric scooters. Among the lower leg, ankle, and foot injuries of riders (52 cases), the ankle joint (53.8%) was the most commonly injured site, followed by the foot (40.4%) and lower leg (21.2%). The fracture group scored significantly higher on the Abbreviated Injury Scale than the non-fracture group (p < 0.001). Among the fracture group (20 cases), ankle fractures (9 cases) were most common, including pronation external rotation type 4 injuries (4 cases) and pilon fractures (2 cases). Five patients (25%) had open fractures, and 12 patients (60%) underwent surgical treatment. Conclusions: The ankle and foot are the most common injury sites in e-scooter-related accidents. Given the high frequency and severity of e-scooter-related ankle and foot injuries, we suggest that more attention be paid to preventing these types of injuries with greater public awareness of the dangers of using e-scooters.

Coverage of defects over Posterior aspect of Ankle Joint and Heel with Lateral Calcaneal Artery Flap- Experience in Mymensingh Medical College Hospital.

Lateral calcaneal artery flap is randomly used by many Plastic Surgeons for covering any defect on the posterior aspect of heel. A prospective observational study was conducted in the Department of Burn and Plastic Surgery, Mymensingh Medical College Hospital, Mymensingh, Bangladesh from January 2020 to June 2022, to see the outcome of the flap for coverage of defects over the posterior aspect of ankle joint and heel. A total number of 09 patients, selected by purposive sampling, were included in the study. The age of the patients ranged from 06 years to 70 years. The cause of the defects were post traumatic in 07 cases, electric burn in 01 case and pressure sore in 01 case. The defect sizes varied from 3×2 to 6×3cm. and flap size ranged from 4×2.5 to 7×4.5cm. The follow-up period ranged from 3 to 6 months. All the flaps survived completely without any complications; except in two cases. In one case, there was marginal epidermal necrolysis that healed secondarily without the need of any further surgical intervention. In the other case, there was gangrene of about 0.5 cm area at the flap tip, which was debrided and the resulting wound healed secondarily. The average operating time was 63 minutes. The results were satisfactory on the context of adequate coverage, and flap and donor site morbidity. So, the lateral calcaneal artery flap can be a good and safe option for the coverage of posterior ankle and heel defects.

The role of Ottawa ankle rules in geriatric emergency department visits.

BACKGROUND: Ankle injuries are a common reason for visits to the emergency department (ED). An effective diagnosis and treatment process is crucial for the swift recovery of patients and for alleviating congestion in EDs. This study aims to evaluate the adequacy and effectiveness of the Ottawa Ankle Rules (OAR) in geriatric patients presenting to the emergency department (ED). METHODS: Between February 2022 and November 2022, 160 patients aged 65 and older (118 women, 42 men) who presented to the ED with isolated ankle injuries were included in the study. We calculated the sensitivity, specificity, positive predictive value, and negative predictive value of the OAR. RESULTS: The study found fractures in 37.5% of patients. The sensitivity of the OAR was 98.33%, the specificity was 86%, the negative predictive value was 98.85%, and the positive predictive value was 80.82%. CONCLUSION: This study demonstrates that the OAR is highly sensitive in the geriatric population but shows some limitations in terms of specificity and positive predictive value. These results support the effectiveness of using the OAR in evaluating ankle injuries in the geriatric population but also highlight the need for cautious application due to the potential for false-positive outcomes.

Relationship between the strength of the ankle and toe muscles and functional stability in young, healthy adults.

This study investigates the relationship between ankle and toe strength and functional stability in young adults, with a sample comprising sixteen females and fourteen males. The research employed force platform data to determine the center of foot pressure (COP) and calculated the forward functional stability index (FFSI) through foot anthropometric measurements. Strength measurements of toe and ankle muscles, during maximal isometric flexion and extension, were conducted using force transducers. Notable positive correlations were found between toe flexor strength and FFSI (left flexor: r = 0.4, right flexor: r = 0.38, p < 0.05), not influenced by foot anthropometry. Contrarily, no significant correlation was observed between ankle muscle strength and FFSI, despite a positive correlation with the COP range. The moderate correlation coefficients suggest that while toe flexor strength is a contributing factor to functional stability, it does not solely determine functional stability. These findings highlight the critical role of muscle strength in maintaining functional stability, particularly during forward movements and emphasize the utility of FFSI alongside traditional COP measures in balance assessment. It is recommended to employ a multifaceted approach is required in balance training programs.

Association Between Altmetrics and Traditional Bibliometrics in the Journal of the American Podiatric Medical Association and The Journal of Foot and Ankle Surgery.

BACKGROUND: As the dissemination of scientific knowledge pervades social media, appraising impact with traditional bibliometrics led to the creation of alternative metrics, termed altmetrics. Lacking existent foot and ankle surgery literature altmetric analysis, we analyzed the 10 most-cited articles in the Journal of the American Podiatric Medical Association (JAPMA) and The Journal of Foot and Ankle Surgery (JFAS) in 2013 and 2017. METHODS: Citation count, Altmetric Attention Score (AAS), Mendeley Reads, and professional society-affiliated Twitter ages were collected and analyzed with descriptive statistics. Pearson correlation coefficient identified relationships between traditional and nontraditional metrics. RESULTS: The 40 articles showed a high median and large range in total citations for JAPMA (13.5 [range, 5-27]) and JFAS (28 [range, 5-69]). Media AAS Mendeley Reads also showed a high median with wide range for both JAPMA (32.5 [range, 0-135]) and JFAS (25 [range, 0-113)]. No significant correlation between total citations and AAS was seen in 2013 (r = -0.205; P = .388) or 2017 (r = -0.029; P = .903). The correlation between total citation count and Mendeley reads was significant in 2017 (r = 0.646; P = .002) but not in 2013 (r = -0.078; P = .744). Although cumulative AAS increased from 2013 to 2017 by 68.75%, with Twitter contributing most to both periods, there existed no significant correlation with Twitter age and the correlation coefficient between AAS and total citations (r = 0.655; P = .173). CONCLUSIONS: The results of this investigation show the utility and predictivity of alternative metrics in complementing traditional bibliometrics and encourage the promotion of publications through journal-specific social media.

The Impact of Forward Head Posture on Neck and Ankle Joint Position Sense: A Cross-Sectional Study.

BACKGROUND: Forward head posture (FHP) decreases the neck position sense and creates tension in the neck muscles, which inversely affects the mechanics of the distal joints through body myofascia. Thus, this study investigated the effects of FHP on neck and ankle joint position sense, and conducted a comparison between the joint position sense of the right and left ankle. METHODS: Fifty-seven subjects were assigned according to the craniovertebral angle (CVA) into the FHP group (CVA <49°; n = 27) or the control group (CVA >49°; n = 30). Head and ankle joint repositioning accuracy was measured by using a cervical range-of-motion device and an isokinetic dynamometer, respectively. RESULTS: There was a significant increase in the joint position error (JPE) of the cervical flexion, extension, and right and left side bending motions of the FHP group compared to the control group (P < .05). There were significant increases in the JPE of the right and left ankle dorsiflexion and plantarflexion of the FHP group compared to the healthy group (P < .05). Moreover, the JPE of the right ankle dorsiflexion and plantarflexion of the FHP group were significantly higher than the left ankle (P < .05). CONCLUSIONS: The FHP decreases the position sense of cervical flexion, extension, and right and left side bending motions, and the plantarflexion and dorsiflexion of both ankle joints, especially the right ankle joint.

Torques in the human upper ankle joint level and their importance in conservative and surgical treatment.

The paper deals with the torques of external muscles acting on the upper ankle joint under weight-bearing conditions and their importance in diagnosing and treating the human foot. Experimental data were collected and calculations were performed. Based on the experiments with the biomechanical model of the foot and upper ankle joint, it was shown how the changes in the force arms of the external muscles of the foot under weight-bearing conditions, change the torque. The real values of muscle forces and torques of the external muscles of the foot were calculated. Taking into account the distance of the lines of muscle action from the axis of rotation of the upper ankle joint the rotational force of the muscles was calculated. The influence of changing the force arm on the rotational efficiency of the muscle balancing the moment of gravity was shown. Knowledge of muscle torque under weight-bearing conditions is crucial for correctly assessing foot biomechanics. It has been shown that torque (gravitational and muscular), not pure force, is crucial when assessing the rotational capacity of the analyzed joint. A change in the approach to diagnostics and treating paresis or weakness of extrinsic foot muscles was proposed through the manipulation of the distance of their action line from the axis of joint rotation.

In-silico simulations to study the effects of ankle-joint misalignments in Ankle-Foot-Orthoses during level walking.

Exoskeletons and orthotic devices are commonly used in physical rehabilitation. However, these devices, fitting intimately with the human body, often lead to skin-related issues amongst users. Misalignments between orthotic and anatomical joints cause relative sliding motion between the limb and orthosis and also cause pressure points on the limb, which may contribute to these skin problems. This research quantifies the effects of sagittal plane ankle-joint misalignments for an ankle-foot orthosis (AFO) user during walking. A 2D mathematical model that simulates the effects of sagittal plane ankle-joint misalignments in terms of relative motion between the limb and the orthosis was developed using MATLAB software. The orthotic ankle-joint was systematically misaligned against the anatomical ankle-joint to generate various misalignment conditions. Published gait data of 5 healthy subjects was used to generate walking kinematics which was then superimposed with an articulated AFO. The simulations showed that Anterior-Posterior misalignments resulted in greater pistoning motion than Proximal-Distal misalignments. Combined misalignments (Posterior-Distal, Anterior-Proximal, Posterior-Proximal, and Anterior-Distal) resulted in higher overall relative motions between the limb and AFO. The model also predicted pressure points on the shank and foot caused by misalignments. This study demonstrates that misaligned ankle-joints in AFOs lead to relative sliding motion and pressure points during walking.