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Objective: The aim of the study was to investigate the effects of a 4-wk inpatient rehabilitation program on postural control and gait in pediatric patients with cancer. Design: Eighty-eight patients with brain tumors (n = 59) and bone/soft tissue sarcomas (n = 29) were evaluated. Postural control was assessed examining the velocity of the center of pressure and single-leg stance time on a pressure distribution platform. Walk ratio, a measure of neuromotor control, was used to evaluate intervention effects on gait. Results: Repeated measures analysis of variance showed improvements in postural control measures, indicated by a decrease in velocity of center of pressure of -0.4 cm/sec (F1,80 = 7.175, P = 0.009, ηp² = 0.082) and increase in single-leg stance time (mean [median] = 1.1[2.6]sec, respectively; F1,80 = 12.617, P = 0.001, ηp² = 0.136). Walk ratio increased by 0.2 mm/steps per min (F1,82 = 3.766, P = 0.056, ηp² = 0.044). Mean changes in dependent variables did not differ between both patient groups (P > 0.05). Conclusions: The results indicate benefits of an inpatient rehabilitation program comprising standard physical therapy as well as aquatic and hippo therapy on postural control and gait after treatment of pediatric patients with cancer. [ABSTRACT FROM AUTHOR]

Excessive foot loading has been considered as a contributing factor for fatigue fractures of the metatarsal bones and may thus be potentially limiting the individual's training capacity and athletic performance. This study investigated the fatiguing effects of long-distance running on foot loading characteristics in a cohort of runners and triathletes. Twenty-three experienced runners were measured before, during and after a 25-km training run with in-shoe plantar pressure measurements with PEDAR insoles. An EMED platform was used to compare plantar pressures during barefoot walking before and after the run. The comparisons revealed distinct foot loading changes, especially a significant load reduction under the toes (up to 30% difference) and midfoot (up to 14% difference) and significantly increased loading under the central forefoot (up to 14% difference). These results confirm the potentially detrimental effect of running when fatigued and may help to understand the occurrence of fatigue fractures in the metatarsals. The findings could be used to design appropriate footwear and/or insoles in order to prevent overloading in extended running. [ABSTRACT FROM PUBLISHER]

Background: Deficits in motor control can be observed with a decrease in plantar sensation. There is evidence that changing the plantar feedback leads to kinematic, kinetic and neuromuscular adaptations in static as well as dynamic conditions. The effect of changes in plantar feedback on the modulation of gait has not been clarified conclusively. Objectives: The purpose of this paper was to provide a review of studies reporting the effects of changes in plantar feedback on human gait characteristics. Method: The databases Medline (PubMed), Cochrane Central Register of Controlled Trials and PEDro (Physiotherapy Evidence Database) were searched for clinical (CTs) and randomized controlled trials (RCTs) concerning foot sensation and gait. Results: Twenty-three studies were included in the evaluation. Several methods were used to affect the sensitivity of the foot sole. After cooling or sedating the foot sole, predominant changes occur in decreased peak pressures, muscle activities and joint angles, and relocation of the centre of pressure under the foot was found. Walking on uneven surfaces results in a decrease in gait velocity, cadence and step length and also an increase in step variability. The use of textured insoles during walking leads to increased knee, hip and ankle angles, forces and moments in neurological patients with decreased foot sensation. In particular, individuals with sensory deficits show significant gait improvements when using textured or vibrating insoles. Conclusions: Changes in plantar feedback lead to stimulation-specific adaptations of gait characteristics. Further prospective RCTs should be performed to investigate interventions for enhancing plantar receptor feedback for the prevention of falls and the treatment of injuries and movement disorders. [ABSTRACT FROM AUTHOR]

Abstract: The foot sole is loaded during stance and gait and plantar cutaneous mechanoreceptors sense the local stress distribution. It is not clear whether the perception thresholds of these mechanoreceptors change during the day and how they respond to walking activities. The primary aim of the present study was to investigate diurnal changes of plantar sensitivity. Furthermore, the aim was to find out whether daily changes depend on the individual level of step activity. Twenty-six healthy subjects, 17 women and 9 men, aged 28.6±6.7years participated in the study. Detection thresholds to light touch were measured in six plantar regions with Semmes–Weinstein monofilaments in the morning, noon and afternoon. Step activity was recorded with a StepWatch™ Activity Monitor and analyzed for three periods (8a.m.–4p.m., 8a.m.–12p.m., 12p.m.–4p.m.). The hallux, the 3rd metatarsal head and the heel showed significantly decreased detection thresholds from 8a.m. to 4p.m. (p ≤0.05). A fair correlation between the decrease of detection threshold and the total number of steps was found for the 3rd metatarsal head and the heel (p ≤0.05). Foot sole sensation appears to improve during the day and seems to be associated with the step activity. This may reflect an improving transfer of afferent information to the central nervous system during the day as well as an adaptation of receptors to gait activity. [Copyright &y& Elsevier]

Abstract: The plantar surface of the foot senses local pressures during stance and locomotion. These foot loading characteristics may be affected by long distance running. Little is known about the physiological effects of sports-related loading on plantar sensitivity and their relationship with plantar foot loading. The purpose of this study was to investigate the acute effects of long distance running on plantar sensitivity to touch and their relationship with foot loading characteristics. It was hypothesized that plantar sensation would decrease after long distance running and may be related to foot loading characteristics. In 15 middle-aged runners, sensory detection thresholds to light touch and plantar pressures were measured before and after a 10km run. After the run, no significant changes in sensory perception thresholds were observed so that correlations between foot sensitivity and foot loading could not be calculated. A significant decrease of force–time integrals and maximum forces was demonstrated in the whole foot (−6.2%, p =0.003; −3.9%, p =0.001) and the heel (−10.5%, p =0.003; −8.5%, p =0.002). Furthermore, maximum force was significantly reduced in the lateral midfoot (−6.4%, p =0.002). In conclusion, a sub-maximal 10km running exercise appears to have no significant acute effects on plantar sensitivity, plantar pressure distribution and peak forces. [Copyright &y& Elsevier]

Abstract: Children under 10 years of age are less efficient than adults regarding their dynamic balance control . The development of the somatosensory system is necessary for the control of posture and balance. The foot, as the final link between body and ground, transfers internal forces during gait. The coordination of force transfer needs to be balanced between both feet thus leading to a potential asymmetry of foot loading. The magnitude of asymmetry in infants’ gait has been previously studied. However, the individual development and improvement of gait symmetry should also be considered. Therefore, the aim of this study was to retrospectively evaluate the longitudinal development of foot loading symmetries from the onset of independent walking. Sixty-two healthy infants were followed over the course of 4 years by means of plantar pressure distribution measurements (mean age of 15 months at study start and 63 months at the end). The subjects attended a total of nine measurements scheduled every 6 months. Foot loading data was recorded during walking with the emed® pressure platform to evaluate contact area, peak pressure, force-time integral, relative maximum force and contact time. An absolute symmetry index was calculated for all parameters. Furthermore, the infants’ data were compared to the data of 26 healthy adults. The adults were measured once and the data acquisition followed exactly the same procedures as the infants’ data. In conclusion, foot loading is asymmetric with the onset of independent walking and shows improved symmetry with increasing age dependent on the foot loading parameters. [Copyright &y& Elsevier]

Abstract: Background: Diabetes mellitus is one of the most common diseases worldwide and the number of patients is expected to increase dramatically in future. Plantar ulceration is partly caused by high plantar pressures and a major complication in diabetic patients. Purpose: The aim of this study was to investigate the pressure-relieving effects of two vacuum orthoses in patients with diabetes mellitus. Methods: Twenty patients with diabetes mellitus were included. They presented with plantar callosities but no ulceration. Exclusion criteria included the use of walking aids and other systemic diseases. Plantar pressure distribution was measured with sensor insoles (Pedar-X, Novel GmbH) during walking in two vacuum orthoses, a post-operative shoe and an off-the-shelf shoe as reference condition. Statistical analysis was conducted using Friedman and Wilcoxon signed-rank tests. Results: Significant differences in plantar pressure distribution were found between the four walking conditions. The contact area increased in the midfoot with the vacuum orthoses. Maximum force and peak pressures showed a significant decrease under the rearfoot and forefoot and increased in the midfoot area during walking with both vacuum orthoses. The high-cut vacuum orthosis revealed equal pressure relief under the forefoot and significantly lower rearfoot pressures compared to the post-operative shoe. Conclusions: The vacuum orthoses demonstrated a comparable pressure-relieving efficacy under the forefoot to post-operative shoes. Using vacuum orthosis significantly benefited re-distribution of plantar pressure and the roll-over process. Clinical significance of the pressure-relieving efficacy could not be confirmed in this investigation and has to be addressed in further studies. [Copyright &y& Elsevier]

Custom-made prosthesis in primary hip arthroplasty based on the concept of a better press-fitting to reach superior clinical results in comparison to conventional implants. Mid-term results provide a more complete picture with respect to gait and electromyographic analyses. The custom-made femoral component (Adaptiva®) was implanted in 24 hips and compared to 23 hips with a conventional implant (Alloclassic-SL). The mean retrospective follow-up times were 3.9 (3–4.9) years and 4.8 (3.1–5.1) years. Clinically, the Harris Hip Score (HHS) and the SF 36 were recorded. Motion analysis data (body kinematics, kinetics and muscle activities) were recorded with 3D gait analysis. Neither the HHS nor the SF-36 revealed any statistical differences between the two groups ( P > 0.05). The radiographic parameters did not show the intended physiologic load transfer. Periprosthetic changes indicated a more distal load transfer of the customized stem. Gait analysis revealed in comparison to the controls (45.03°), a reduced mean hip range of motion in the sagittal plane by 11.4% (39.9°) in the customized stem group versus 17.4% (37.2°) in the conventional stem group. In keeping with the limited range of hip motion kinematic impairments of the ipsilateral knee and ankle joints were detected. The electromyographic amplitudes of the tensor fasciae latae and gluteus medius muscles both for stabilizing the hip joint in the stance phase were significantly higher in both groups. Compared to a conventional cementless hip prosthesis the custom-made device did not improve the mid-term clinical and radiographic outcome. Despite the individualized reconstruction of the biomechanical hip geometry objective gait analysis failed to show a benefit. [ABSTRACT FROM AUTHOR]

Abstract: Objectives: Impaired foot function may jeopardize the mobility of patients with rheumatoid arthritis (RA). However, there are still no guidelines concerning the adequate early treatment of painful rheumatoid feet which do not yet require surgery. An assessment method for RA feet appears necessary in order to detect foot problems before functional limitations develop. Therefore, the aim of the present study was to evaluate the use of pedobarographic measurements for detecting changes in plantar loading characteristics and their relationship to foot pain in patients with RA. Methods: One hundred and twelve patients with RA (55.0±11.0 years of age) were divided into three groups according to their Health Assessment Questionnaire (HAQ) Score and compared to a control group of 20 healthy adults (CG). Thirty-six patients with good physical capacity belonged to group 1 (RA1; HAQ-score: 0–1.0), 38 patients with moderate capacity to group 2 (RA2; score: 1.1–2.0) and 38 patients with low capacity to group 3 (RA3; score: 2.1–3.0). Each patient''s foot pain was clinically assessed. Pedobarography was used to analyze foot loading parameters while walking barefoot. Results: In the forefoot, average pressures under the lateral forefoot were higher in RA1 patients than in RA2 patients and controls (p <0.05) despite an inconspicuous clinical examination of the foot in RA1 patients. RA1 patients also demonstrated higher plantar pressures than RA2 under the second metatarsal head (p <0.05). In contrast, no significant differences in maximum force could be demonstrated between patient groups. Furthermore, in RA3 patients with lower physical capacity, foot pain was increased as compared to RA1 and RA2 patients. Conclusion: In RA patients, pedobarographic patterns show specific changes which characterize the level of functional capacity. In patients with foot involvement, pedobarographic measurements can be useful during the earlier stages of the disease, when clinical examination does not yet indicate the need for more aggressive treatment or orthopedic interventions. [Copyright &y& Elsevier]

With lateral ankle sprains being the most frequent sports-related injury, there is an evident demand for the preventive measures in active individuals with chronic ankle instability. Braces are commonly used for prevention and treatment of ankle injuries. Various investigations—mostly performed with healthy subjects—focused on this problem, yet they often compared only a few models or used only limited testing procedures. However, controversy exists whether braces affect sports performance. The purpose of the present study was to compare the effects of ten different ankle braces—one rigid, five semirigid, four soft models—in a comprehensive evaluation with multiple testing procedures in 34 subjects with self-reported chronic ankle instability. The multiple testing procedures evaluated objective performance-related parameters and subjective parameters related to comfort and stability. The subjects performed an agility course with maximal effort. The course included a vertical jump and a cutting maneuver, both on a force platform, a single leg hopping test on level and inclined plates, a combined straight and curve sprint and sidesteps. Three valid trials were measured and averaged for each brace and every subject. Subjective aspects were evaluated with a questionnaire about handling, perceived restrictions, support and comfort; it was completed after each brace was worn and tried. With regard to the objective parameters, no significant differences were found between the braces except for the rigid brace which showed decreased values for the vertical jump and longer times for the other tests compared to all other braces. The subjective evaluation of the braces revealed significant differences with respect to comfort and handling and therefore, permitted a distinction between semirigid and soft braces. Although significant differences between braces were found in subjective performance restriction, no significant differences were revealed in the objective evaluation. From that point of view, patients could choose a brace model according to their individual needs. A comfortable brace might have a positive influence on the athlete’s state of mind although other aspects like the brace’s stabilizing effect play an additional role and should also be taken into account for recommendation of braces. [ABSTRACT FROM AUTHOR]

The rocker sole and solid-ankle cushion-heel (SACH) heels are the most commonly prescribed external shoe modification. Only a limited number of scientific evidence exists to support these interventions in clinical practice. The objective of this study was to determine the effects of rocker soles and SACH heels on kinematics during gait. In this study, we investigated the gait parameters during level walking, stair climbing and stair descending in healthy volunteers and assessed the effects of the modified shoes on the motion of the forefoot and hindfoot compared with the traditional shoes. Eleven normal subjects participated in this study. A six-camera motion analysis system was used to capture motion trajectories. The three-dimensional (3D) coordinates of the markers were used to calculate the angles of flexion-extension, valgus–varus, and internal–external rotation at the hindfoot and forefoot joints in a gait cycle by the custom software for foot kinematic analysis. The results showed that the rocker soles offer several advantages from the viewpoint of gait kinematics. The forefoot joint excursion in sagittal plane while wearing rocker shoes was significantly less than that while wearing traditional shoes during level walking, stair climbing and stair descending. It means that they could mimic the action of the forefoot joint, aid in roll off, and simulate forefoot dorsiflexion. Since the bony structures mechanically link the forefoot joint and hindfoot joint to a triplanar axis of motion, they could be used whenever there is minimal or no motion at the forefoot joint or hindfoot joint, because of, for example, fusion, fracture, cast immobilization, orthosis design, pain, or arthritis. [Copyright &y& Elsevier]

Objective. This study was performed to evaluate correlations between the DynaPort activity of daily living monitor and the step activity monitor.Design. Experimental study with repeated measures.Background. Physical activity becomes more important to assess quality of life, e.g. after clinical interventions such as joint replacement surgery.Methods. Nine subjects wore both devices simultaneously for two days. Limitations and technical problems caused by the devices were assessed by a questionnaire. Correlation coefficients were calculated between parameters derived from both instruments.Results. Only small limitations and problems were reported. Significant correlations were found between the number of steps (step activity monitor) and the percentage of locomotion (DynaPort) (r=0.95), between the number of steps and the physical activity index (DynaPort) (r=0.71) and between the physical activity index and the percentage of locomotion (r=0.76). Wilcoxon-tests between the first and second measurement of each subject did not reveal significant differences but correlation coefficients were poor (r=0.16–0.36).Conclusions. After one day of simultaneously wearing both devices, the percentage of locomotion can be obtained using only the step activity monitor for additional days. Poor correlations between the first and the second measurements of each subject underline the necessity to record further days to acquire the level of human physical activity.Relevance.Different devices are available for an objective assessment of patients’ level of physical activity. To minimize the restrictions for patients during the measurements, interactions between different devices should be assessed. We determined correlations between both devices to relate the steps counted by the step activity monitor to parameters of the DynaPort. [Copyright &y& Elsevier]

In order to assess the changes in talocrural joint contact stress after rotationplasty, 10 lower-leg cadaver specimens were axially loaded with 600 N and investigated in two loading situations: (1) Normal loading with a plantigrade foot; (2) in an equinus position of a simulated rotationplasty. Joint contact stress in the talar facet of the talocrural joint was determined with Fuji Prescale film cut to size and analyzed with digital image analysis for joint contact area, mean and peak pressure, contact force, and location of the load application on the trochlea tali. The results demonstrate a significant transfer on the loading zone to the posterior part of the talus (p=0.005), a significant reduction of the contact area (p=0.005) and force (p=0.005), and a significant increase of the mean (p=0.022) and maximum pressures (p=0.013). These results indicate that the rotationplasty causes pronounced changes in joint loading characteristics. [Copyright &y& Elsevier]

Highlights: [•] Plantar pressure patterns were investigated in children walking with normal, slow and fast gait speed. [•] Foot loading is affected by gait speed changes but the effects are not uniform across the whole plantar surface. [•] The load is transferred more toward the medial forefoot with faster gait speed. [•] These mechanisms should be kept in mind when comparing results from repeated measurements. [Copyright &y& Elsevier]

Highlights: [•] Plantar pressure patterns were investigated in out-toeing and in-toeing gait. [•] Foot loading may be deliberately altered by in-toeing or out-toeing gait. [•] In-toeing increased loads in the lateral midfoot and forefoot areas. [•] Out-toeing intensified medial loading. [•] These mechanisms might be used for off-loading specific plantar regions. [Copyright &y& Elsevier]

A letter to the editor in response to the article "Do Activity Levels Increase After Total Hip and Knee Arthroplasty?" by P. Harding and colleagues that was published in one of the previous 2014 issue of the periodical is presented.

An abstract of the article "In-shoe plantar pressure changes between forward and backward running," by Dieter Rosenbaum, Clivia Schubert, and Thorsten Sterzing is presented.

Background: Knee osteoarthritis (KOA) is a painful disease commonly caused by high loads on the articular cartilage. Orthotic interventions aim to reduce mechanical loading, thereby alleviating pain. Traditional orthotics appear effective, but high drop-out rates have been reported over prolonged periods.Research Question: The aim of this study was to examine the effect of a novel ankle-foot orthosis (AFO) on gait parameters, physical function and activity of KOA patients.Methods: 29 clinically diagnosed KOA patients with varus malalignment wore an AFO for 6 weeks. Prior to and after the intervention period, 3D gait analysis, physical function tests and the KOOS questionnaire were administered. Physical activity was objectively assessed with accelerometers.Results: The AFO immediately reduced the first peak of the knee adduction moment (KAM) and the KAM impulse by 41% and 19%. The knee flexion moment (KFM) was increased by 48%. After six weeks, the first KAM peak and KAM impulse were decreased by 27% and 19% while using the AFO. The KFM was increased by 71%. Furthermore, patients completed the functional tests faster (1.4-2.6%). The KOOS scores decreased significantly. No significant differences were found in physical activity parameters.Significance: The six-week AFO application significantly reduced the KAM. The patients' physical function appeared improved; yet these improvements were only minor and therefore arguably clinically irrelevant. The KFM appeared to be negatively affected after six weeks, as were the scores on the KOOS subscales. In summary, even though the AFO reduced the KAM and improved physical function, the clinical benefit for KOA patients with varus malalignment after the 6-week AFO application is debatable. [ABSTRACT FROM AUTHOR]

Purpose: Dynamic intraligamentary stabilization (DIS) has been introduced as a new technique to repair the torn anterior cruciate ligament (ACL) and to restore knee joint kinematics after an acute ACL tear. Aim of the present study was to compare the early post-operative activity, restoration of gait pattern and functional results after DIS in comparison with primary ACL reconstruction (ACLR) for acute ACL tears. It was hypothesized that functional results, post-operative activity and changes in gait pattern after DIS are comparable to those after ACLR.Methods: Sixty patients with acute ACL tears were included in this study and underwent either DIS or ACLR with an anatomic semitendinosus autograft in a randomized manner. Patients were equipped with an accelerometric step counter for the first 6 weeks after surgery in order to monitor their early post-operative activity. 3D gait analysis was performed at 6 weeks and 6 months after surgery. Temporal-spatial, kinematic and kinetic parameters were extracted and averaged for each subject. Functional results were recorded at 6 weeks, 6 months and 12 months after surgery using the Tegner activity scale, International Knee Documentation Committee score and Lysholm score.Results: Patients who underwent DIS showed an increased early post-operative activity with significant differences at week 2 and 3 (p = 0.0241 and 0.0220). No significant differences between groups were found for knee kinematic and kinetic parameters or the functional scores at any time of the follow-up. Furthermore, the difference in anterior tibial translation was not significantly different between the two groups (n.s.).Conclusion: Early functional results and changes in gait pattern after DIS are comparable to those of primary ACLR. Therefore, ACL repair may be an alternative to ACLR in this cohort of patients.Level Of Evidence: I. [ABSTRACT FROM AUTHOR]

Background: The peripheral complications of diabetes mellitus remain a significant risk to lower-limb morbidity. In New Zealand, risk of diabetes, comorbidity and lower-limb amputation are highly-differential between demographic groups, particularly ethnicity. There is growing and convincing evidence that the use of pedobarography - or plantar pressure measurement - can usefully inform diabetic foot care, particularly with respect to the prevention of re-ulceration among high-risk patients. Methods: For the current feasibility study, we embedded pedobarographic measurements into three unique diabetic foot clinic settings in the New Zealand context, and collected pedobarographic data from n = 38 patients with diabetes using a platform-based (Novel Emed) and/or in-shoe-based system (Novel Pedar). Our aim was to assess the feasibility of incorporating pedobarographic testing into the clinical care of diabetic feet in New Zealand. Results and Conclusions: We observed a high response rate and positive self-reported experience from participants. As part of our engagement with participants, we observed a high degree of lower-limb morbidity, including current ulceration and chronic foot deformities. The median time for pedobarographic testing (including study introduction and consenting) was 25 min. Despite working with a high-risk population, there were no adverse events in this study. In terms of application of pedobarography as a clinical tool in the New Zealand context, the current feasibility study leads us to believe that there are two avenues that deserve further investigation: a) the use of pedobarography to inform the design and effectiveness of offloading devices among high-risk diabetic patients; and b) the use of pedobarography as a means to increase offloading footwear and/or orthoses compliance among high-risk diabetic patients. Both of these objectives deserve further examination in New Zealand via clinical trial. [ABSTRACT FROM AUTHOR]

Objective: Backward locomotion in humans occurs during leisure, rehabilitation, and competitive sports. Little is known about its general biomechanical characteristics and how it affects lower extremity loading as well as muscle coordination. Thus, the purpose of this research was to analyze in-shoe plantar pressure patterns and lower extremity muscle activity patterns for backward compared to forward running.Methods: On a treadmill, nineteen runners performed forward running at their individually preferred speed, followed by backward running at 70% of their self-selected forward speed. In-shoe plantar pressures of nine foot regions and muscular activity of nine lower extremity muscles were recorded simultaneously over a one-minute interval. Backward and forward running variables were averaged over the accumulated steps and compared with Wilcoxon-signed rank tests (p<.05).Results: For backward compared to forward running, in-shoe plantar pressure distribution showed a load increase under metatarsal heads I and II, as well as under the medial midfoot. This was indicated by higher maximum forces and peak pressures, and by longer contact times. Muscle activity showed significantly higher mean amplitudes during backward running in the semitendinosus, rectus femoris, vastus lateralis, and gluteus medius during stance, and in the rectus femoris during swing phase, while significantly lower mean amplitudes were observed in the tibialis anterior during swing phase.Conclusion: Observations indicate plantar foot loading and muscle activity characteristics that are specific for the running direction. Thus, backward running may be used on purpose for certain rehabilitation tasks, aiming to strengthen respective lower extremity muscles. Furthermore, the findings are relevant for sport specific backward locomotion training. Finally, results provide an initial baseline for innovative athletic footwear development aiming to increase comfort and performance during backward running. [ABSTRACT FROM AUTHOR]

Plantar pressure characteristics during fencing movements may provide more specific information about the influence of foot loading on overload injury patterns. Twenty-nine experienced fencers participated in the study. Three fencing-specific movements (lunge, advance, retreat) and normal running were performed with three different shoe models: Ballestra (Nike, USA), Adistar Fencing Lo (Adidas, Germany), and the fencers' own shoes. The Pedar system (Novel, Munich, Germany) was used to collect plantar pressures at 50 Hz. Peak pressures, force–time integrals and contact times for five foot regions were compared between four athletic tasks in the lunge leg and supporting leg. Plantar pressure analysis revealed characteristic pressure distribution patterns for the fencing movements. For the lunge leg, during the lunge and advance movements the heel is predominantly loaded; during retreat, it is the hallux. For the supporting leg, during the lunge and advance movements the forefoot is predominantly loaded; during retreat, it is the hallux. Fencing-specific movements load the plantar surface in a distinct way compared with running. An effective cushioning in the heel and hallux region would help to minimize foot loading during fencing-specific movements. [ABSTRACT FROM PUBLISHER]

Abstract: Background: After foot surgery or in diseases such as diabetes, orthopaedic shoes with an elevated sole construction are used to off-load the affected foot. The height difference between the shoes results in a leg length discrepancy and an abnormal gait pattern arises which can cause long-term discomfort in the joints of the lower extremity and the lower back. To compensate for this discrepancy and to ensure a symmetrical gait pattern a Twin Shoe (Darco) has been designed. Aim: To investigate the effect of wearing orthopaedic shoes in combination with the Twin Shoe on normal gait biomechanics. Study design: Cross-sectional study in a laboratory setting. Methods: Normal gait was recorded in 15 healthy subjects with a gait analysis system. Four different shoe conditions were measured. Selected biomechanical parameters were calculated and compared between the shoe conditions. Results: Walking in orthopaedic shoes with an elevated sole without compensation on the contralateral side leads to significant asymmetrical joint movements and higher loads in feet, knees, hips and the lower back during gait. By using the Twin Shoe these abnormal patterns were improved but not entirely compensated. Conclusions: Using the Twin Shoe as a partner to orthopaedic shoes with an elevated sole construction improves gait asymmetry and increased loading of joints induced by functional leg length discrepancy. [ABSTRACT FROM AUTHOR]

Abstract: The purpose of the present study was to provide normative data for foot loading patterns and foot form parameters in order to support decisions about the normal or abnormal development of the growing foot during childhood. In a longitudinal design, 36 healthy German children were followed over the course of nine years. The children had a mean age of 14.6±1.8 months at the first appointment and 122.8±2.0 months at the last appointment. The children participated in 17 measurement appointments every 3, 6 or 12 months. Dynamic foot loading was evaluated with plantar pressure measurements during walking and static footprints were taken to determine changes in foot form. During the investigation period an increase of peak pressures of the total foot by 190%, of the relative maximum force of the total foot by 20% and the foot length by 90% was observed. A decrease for the relative maximum force under the midfoot (63%) and for the arch index (49%) could also be demonstrated. Furthermore, body height showed a significant influence on foot length and midfoot width. Body weight had a significant influence on the static parameter midfoot width. Between genders, boys showed a significant wider midfoot and a smaller forefoot contact area as compared to girls. The established database can be used as comparative values for clinical decisions about the normal foot development. [Copyright &y& Elsevier]

Background: Bone mineral density (BMD) accrual during childhood and adolescence is important for attaining peak bone mass. BMD decrements have been reported in survivors of childhood bone sarcomas. However, little is known about the onset and development of bone loss during cancer treatment. The objective of this crosssectional study was to evaluate BMD in newly diagnosed Ewing's and osteosarcoma patients by means of dualenergy x-ray absorptiometry (DXA) after completion of neoadjuvant chemotherapy. Methods: DXA measurements of the lumbar spine (L2-4), both femora and calcanei were performed perioperatively in 46 children and adolescents (mean age: 14.3 years, range: 8.6-21.5 years). Mean Z-scores, areal BMD (g/cm²), calculated volumetric BMD (g/cm³) and bone mineral content (BMC, g) were determined. Results: Lumbar spine mean Z-score was -0.14 (95% CI: -0.46 to 0.18), areal BMD was 1.016 g/cm² (95% CI: 0.950 to 1.082) and volumetric BMD was 0.330 g/cm³ (95% CI: 0.314 to 0.347) which is comparable to healthy peers. For patients with a lower extremity tumor (n = 36), the difference between the affected and non-affected femoral neck was 12.1% (95% CI: -16.3 to -7.9) in areal BMD. The reduction of BMD was more pronounced in the calcaneus with a difference between the affected and contralateral side of 21.7% (95% CI: -29.3 to -14.0) for areal BMD. Furthermore, significant correlations for femoral and calcaneal DXA measurements were found with Spearman-rho coefficients ranging from r = 0.55 to r = 0.80. Conclusions: The tumor disease located in the lower extremity in combination with offloading recommendations induced diminished BMD values, indicating local osteopenia conditions. However, the results revealed no significant decrements of lumbar spine BMD in pediatric sarcoma patients after completion of neoadjuvant chemotherapy. Nevertheless, it has to be taken into account that bone tumor patients may experience BMD decrements or secondary osteoporosis in later life. Furthermore, the peripheral assessment of BMD in the calcaneus via DXA is a feasible approach to quantify bone loss in the lower extremity in bone sarcoma patients and may serve as an alternative procedure, when the established assessment of femoral BMD is not practicable due to endoprosthetic replacements. [ABSTRACT FROM AUTHOR]

Abstract: It has long been assumed that foot function and morphology differ between ethnicities. However, quantitative research proving or disproving this relationship is sparse. As a starting point, the objective of this study was to investigate the plantar loading characteristics and foot geometry of athletes from three ethnicities, being Caucasian, Maori and Pacific Islanders. Four plantar pressure parameters were compared in 28 male elite rugby league players using an EMED-AT plantar pressure distribution platform [Novel GmbH, Munich, Germany] and the five-step method. Foot geometry measures were also taken, including arch index, coefficient of spreading, hallux angle and sub-arch angle. Five trials were collected per foot at a self-selected speed. It was found that Caucasian and Maori subjects had a relatively wider forefoot than the Pacific Island subjects; however the Pacific Islanders'' foot was found to be wider than both these ethnicities in absolute terms. While Caucasian subjects loaded the toes to a much greater extent than the Maori and Pacific Island subjects, the latter demonstrated a greater loading of the mid and forefoot regions. Pacific Island subjects revealed a significantly more pronounced hallux valgus angle as compared to the Caucasian and Maori subjects. The results of this study may be relevant for/should be taken into consideration in footwear design issues, where allowances need to be made during the design process for anatomical differences between ethnicities. However these observations cannot be generalised to whole ethnic populations, and further research is required on non-athletes to build on the current research findings. [Copyright &y& Elsevier]

Purpose. Rotationplasty has proven its efficacy in the treatment of malignant bone tumors of the lower extremity in predominantly young patients. To our knowledge this procedure has not been reported in patients over 60 years before. Materials and Methods. 3 patients over 60 years with an A1-rotationplasty because of a sarcoma were included in this study. Complications and functional results were recorded. In one patient an electromyography was done. Results. Despite electromyography showing good adaptation of the muscles to the altered function, the functional results of these three patients were limited. two out of three patients needed a cane for walking distances over 200 meters. No secondary amputation was necessary. Discussion. Our study demonstrates that rotationplasty is an alternative to an above-knee amputation in older patients but with poorer functional results in comparison to younger patients. However, limb-salvage surgery should be preferred whenever possible. [ABSTRACT FROM AUTHOR]

Abstract: The objective of this study was to determine the reliability of repeated plantar pressure distribution measurements during normal gait across multiple testing sessions. Testing sessions were conducted on 5 separate days at approximately the same time of day. Nine subjects (five males, four females, age 26±8.4 years) who were free of any musculoskeletal injury were recruited. A capacitive pressure distribution platform (EMED AT, Novel GmbH, Munich, Germany), sampling at 50Hz was used to collect plantar pressure patterns during barefoot walking at a self-selected speed. Four parameters were investigated: peak pressure, maximum force, impulse, and contact time, and these were investigated in 10 areas of the foot after using the PRC mask method of subdividing the foot into ten anatomical areas of interest. Individual means of all the five repeated trials for each foot were calculated, and these values were used to calculate intraclass correlation coefficients (ICC) and coefficients of variation (CoV) for all parameters. The results of this investigation show a generally good level of reliability, the quality of which is dependent on the region of the foot and the parameter investigated. Areas with typically high loading characteristics, such as the central forefoot showed a higher level of reliability in the ICC''s (>0.9) than less loaded areas such as the medial midfoot (<0.8). The conclusion of this study is that plantar pressure distribution measurements can be used in comparative evaluations since the measures of repeatability are satisfactory for the parameters and foot regions usually used in the investigation of clinical populations such as neuropathic diabetics. [Copyright &y& Elsevier]

Background: Previous studies have shown that eccentric training has a positive effect on chronic Achilles tendinopathy. A new strategy for the treatment of chronic Achilles tendinopathy is the AirHeel brace. Hypothesis: AirHeel brace treatment improves the clinical outcome of patients with chronic Achilles tendinopathy. The combination of the AirHeel brace and an eccentric training program has a synergistic effect. Study Design: Randomized controlled clinical trial; Level of evidence, 1. Methods: One hundred patients were randomly assigned to 1 of 3 treatment groups: (1) eccentric training, (2) AirHeel brace, and (3) combination of eccentric training and AirHeel brace. Patients were evaluated at 6, 12, and 54 weeks after the beginning of the treatment protocol with ultrasonography, visual analog scale (VAS) for pain, American Orthopaedic Foot and Ankle Society (AOFAS) ankle score, and Short Form-36 (SF-36). Results: The VAS score for pain, AOFAS score, and SF-36 improved significantly in all 3 groups at all 3 follow-up examinations. At the 3 time points (6 weeks, 12 weeks, and 54 weeks) of follow-up, there was no significant difference between all 3 treatment groups. In all 3 groups, there was no significant difference in tendon thickness after treatment. Conclusions: The AirHeel brace is as effective as eccentric training in the treatment of chronic Achilles tendinopathy. There is no synergistic effect when both treatment strategies are combined. Clinical Relevance: The AirHeel brace is an alternative treatment option for chronic Achilles tendinopathy. [ABSTRACT FROM AUTHOR]

Abstract: The purpose of the present study was to provide normative data for foot loading patterns and foot shape parameters in order to support decisions about the normal or abnormal development of the growing foot during childhood. In a longitudinal design, 90 healthy German children were followed over the course of 6–48 months. The children had a mean age of 15 months at the first appointment and 63 months at the last appointment. The children participated in 11 measurement appointments every 3 months or 6 months. Dynamic foot loading was evaluated with plantar pressure measurements during walking and static footprints were taken to determine changes in foot shape. During the investigation period a significant increase of peak pressure in almost every foot region was observed. Peak pressure of the total foot increased by 92%. Only for the midfoot region a significantly decreased impulse by about 15% per year and a significant decrease of the contact area by 9% per year could be observed. A significant influence of gender was observed for peak pressures and impulses in some foot regions as well as for the midfoot width and the foot shape index. The established database can be used as comparative values for clinical decisions about the normal development. [Copyright &y& Elsevier]

Evaluation of the clinical and functional results of a new prosthetic knee design with conservation of the physiologic properties of the patellofemoral joint. After total knee arthroplasty there are often patella problems. Some of them may be a result of excessive retropatellar pressure caused by the prosthetic design. Twelve patients with an average age of 68.6 years were evaluated after a follow-up of 16.4 months after implantation of a new prosthetic design. The clinical results were evaluated with the Hospital for Special Surgery Scores (HSS) and the Knee Society Clinical Rating Systems (KSS). Pain was rated on a Visual Analog Scale (VAS). Quality of life was determined with the SF-36 questionnaire. Furthermore, clinical gait analysis was performed with a 3D motion analysis system and force plates as well as surface electromyography of seven lower extremity muscles. The HSS-Score reached a mean value of 79.3 points. The KSS reached 82.3 points for the knee score and 75 points for the functional score. The VAS for pain revealed an average value of 1.7. For the gait analysis only three parameters indicated significant differences between the affected and the contralateral leg. The mean EMG amplitude revealed a significant difference only for the biceps femoris. The clinical and functional outcome of a new prosthesis design show satisfactory results. Even if the presented results appear promising, a further application and long term results are needed. [ABSTRACT FROM AUTHOR]

Background: Stress fractures are common overuse injuries in runners and appear most frequently in the metatarsals. Purpose: To investigate fatigue-related changes in surface electromyographic activity patterns and plantar pressure patterns during treadmill running as potential causative factors for metatarsal stress fractures. Study Design: Prospective cohort study with repeated measurements. Methods: Thirty experienced runners volunteered to participate in a maximally exhaustive run above the anaerobic threshold. Surface electromyographic activity was monitored for 14 muscles, and plantar pressures were measured using an in-shoe monitoring system. Fatigue was documented with blood lactate measurements. Results: The results demonstrated an increased maximal force (5%, p < .01), peak pressure (12%, P < .001), and impulse (9%, P< .01) under the second and third metatarsal head and under the medial midfoot (force = 7%, P < .05; pressure = 6%, P < .05; impulse = 17%, P < .01) toward the end of the fatiguing run. Contact area and contact time were only slightly affected. The mean electromyographic activity was significantly reduced in the medial gastrocnemius (-9%, P < .01), lateral gastrocnemius (-12%, P < .01), and soteus (-9%, P < .001) muscles. Conclusion: The demonstrated alteration of the rollover process with an increased forefoot loading may help to explain the incidence of stress fractures of the metatarsals under fatiguing loading conditions. [ABSTRACT FROM AUTHOR]

Background: For demanding activities in daily life, such as negotiating stairs, ramps and uneven ground, the functionality of conventional prosthetic feet ("Daily Life Feet" - DLF) is often limited. With the introduction of microprocessor-controlled feet (MPF) it was expected that the functional limitations of DLF might be reduced. The purpose of the present study was to investigate biomechanical gait parameters with DLF and MPF when walking on a specifically designed ramp involving abruptly changing inclination angles as a scenario reflecting typical situations related to walking on uneven ground.Research Question: The specific aim of the study was to answer the research question if the advanced adaptability of MPF to different ground slopes would lead to more natural motion patterns and reduced joint loading compared with DLF feet.Methods: A specifically designed ramp was installed within a gait lab. During downward motion on this ramp biomechanical parameters - ground reaction forces, joint moments and joint angles were obtained both with DLF and MPF used by four transtibial amputees. A control group of 10 non-amputees (NA) was measured with for comparison.Results: The NA group managed the ramp element with the abruptly changing inclination with a specific ankle joint adaptation. Compared to DLF the MPF considerably improved the ankle adaptation to the abruptly changing inclination which was reflected by a significantly increased stance phase dorsiflexion which was comparable to the NA group. The peak value of the knee extension moment on the prosthetic side was significantly increased with DLF, whereas it was almost normal with MPF (DLF: 0.71 ± 0.13 Nm/kg, MPF: 0.42 ± 0.12 Nm/kg, NA: 0.36 ± 0.07 Nm/kg, p < 0.05 and p < 0.01). The external knee adduction moment was generally reduced for the transtibial amputees and did not show differences between foot designs.Significance: The adaptable ankle joint motion of the MPF is a crucial requirement for a more natural motion pattern and leads to a reduction of sagittal knee joint loading on the prosthetic side. [ABSTRACT FROM AUTHOR]

Background: A scientifically sound validated foot and ankle specific score validated ab initio for different languages is missing. The aim of a project of the European Foot and Ankle Society (EFAS) was to develop, validate, and publish a new score(the EFAS-Score) for different European languages.Methods: The EFAS Score was developed and validated in three stages: (1) item (question) identification, (2) item reduction and scale exploration, (3) confirmatory analyses and responsiveness. The following score specifications were chosen: scale/subscale (Likert 0-4), questionnaire based, outcome measure, patient related outcome measurement. For stage 3, data were collected pre-operatively and at a minimum follow-up of 3 months and mean follow-up of 6 months. Item reduction, scale exploration, confirmatory analyses and responsiveness were executed using analyses from classical test theory and item response theory.Results: Stage 1 resulted in 31 general and 7 sports related questions. In stage 2, a 6-item general EFAS Score was constructed using English, German, French and Swedish language data. In stage 3, internal consistency of the scale was confirmed in seven languages: the original four languages, plus Dutch, Italian and Polish (Cronbach's Alpha >0.86 in all language versions). Responsiveness was good, with moderate to large effect sizes in all languages, and significant positive association between the EFAS Score and patient-reported improvement. No sound EFAS Sports Score could be constructed.Conclusions: The multi-language EFAS Score was successfully validated in the orthopaedic ankle and foot surgery patient population, including a wide variety of foot and ankle pathologies. All score versions are freely available at www.efas.co. [ABSTRACT FROM AUTHOR]

Background: Knee osteoarthritis patients may become physically inactive due to pain and functional limitations. Whether physical activity exerts a protective or harmful effect depends on the frequency, intensity, time and type (F.I.T.T.). The F.I.T.T. dimensions should therefore be assessed during daily life, which so far has hardly been feasible. Furthermore, physical activity should be assessed within subgroups of patients, as they might experience different activity limitations. Therefore, this study aimed to objectively describe physical activity, by assessing the F.I.T.T. dimensions, and sedentary behaviour of knee osteoarthritis patients during daily life. An additional goal was to determine whether activity events, based on different types and durations of physical activity, were able to discriminate between subgroups of KOA patients based on risk factors.Methods: Clinically diagnosed knee osteoarthritis patients (according to American College of Rheumatology criteria) were monitored for 1 week with a tri-axial accelerometer. Furthermore, they performed three functional tests and completed the Knee Osteoarthritis Outcome Score. Physical activity levels were described for knee osteoarthritis patients and compared between subgroups.Results: Sixty-one patients performed 7303 mean level steps, 319 ascending and 312 descending steps and 601 bicycle crank revolutions per day. Most waking hours were spent sedentary (61%), with 4.6 bouts of long duration (> 30 min). Specific events, particularly ascending and descending stairs/slopes, brief walking and sedentary bouts and prolonged walking bouts, varied between subgroups.Conclusions: From this sample of KOA patients, the most common form of activity was level walking, although cycling and stair climbing activities occurred frequently, highlighting the relevance of distinguishing between these types of PA. The total active time encompassed a small portion of their waking hours, as they spent most of their time sedentary, which was exacerbated by frequently occurring prolonged bouts. In this study, event-based parameters, such as stair climbing or short bouts of walking or sedentary time, were found more capable of discriminating between subgroups of KOA patients compared to overall levels of PA and sedentary time. Thereby, subtle limitations in physical behaviour of KOA-subgroups were revealed, which might ultimately be targeted in rehabilitation programs.Trial Registration: German Clinical Trials Registry under ' DRKS00008735 ' at 02.12.2015. [ABSTRACT FROM AUTHOR]

Objective: Existing research recognizes low levels of physical activity in pediatric patients with cancer, but much uncertainty exists about their capability to self-reflect physical activity levels. The objective of this study was to compare results of subjective self-reports and objective accelerometers regarding levels of daily walking as well as moderate-to-vigorous physical activities. Methods: Results of the objective assessment tool StepWatchTM Activity Monitor and self-reporting with a standardized questionnaire were compared in 28 children and adolescents during cancer treatment. Results: The patients were 13.8±2.8 years of age and 3.4±2.0 months after cancer diagnosis. The Bland-Altman plots indicated a fairly symmetrical under- and over-estimation for daily minutes of walking with the limits of agreement ranging from -100.8 to 87.3 min (d = -6.7 min). Mean difference for moderate-to-vigorous physical activity was almost zero but limits of agreement are ranging from -126.8 to 126.9 min. The comparison for the days with at least 60 min of moderate-to-vigorous physical activity showed a marked difference with 3.0±2.6 self-reported days versus only 0.1±0.4 measured days. Conclusions: These findings suggest that physical activity in pediatric cancer patients should preferably be assessed with objective methods. Greater efforts are needed to implement supervised exercise interventions during treatment incorporating methods to improve self-reflection of physical activity. [ABSTRACT FROM AUTHOR]

Purpose: Chronic health conditions and impaired quality of life are commonly experienced in childhood cancer survivors. While rehabilitation clinics support patients in coping with the disease, studies evaluating an inpatient rehabilitation program on promoting physical activity (PA) and health-related quality of life (HRQoL) are missing.Methods: A 4-week inpatient rehabilitation program was prospectively evaluated. One hundred fifty patients with leukemia or lymphoma (N = 86), brain tumors (N = 38), and sarcomas (N = 26) were enrolled on average 17 months after cessation of acute medical treatment. PA amount and cadence (indicating the intensity of walking activity) using the StepWatch™ 3 Activity Monitor and HRQoL global and physical well-being scores using the KINDL(®) questionnaire were assessed before, immediately after, and 6 and 12 months following the program and analyzed using multiple linear mixed models.Results: Significant effects on PA were only found at 12-month follow-up for amount and cadence variables (all p < 0.05). While leukemia and lymphoma patients revealed the highest PA level throughout the study, rehabilitation effects were more pronounced for cadence variables in brain tumor and sarcoma patients. The rehabilitation program had immediate (t = 4.56, p < 0.001) and sustainable effects on HRQoL global scores (6-month follow-up, t = 4.08, p < 0.001; 12-month follow-up, t = 3.13, p < 0.006).Conclusions: Immediate and sustainable increases in HRQoL indicate that a 4-week rehabilitation program is beneficial for improving psychosocial well-being, while the significant increase in PA levels could be related to general recovery as well. The lack of a control group hampers the evaluation of the rehabilitation program on promoting PA levels in pediatric cancer patients. [ABSTRACT FROM AUTHOR]

Purpose: Purpose of the present study was to investigate the acute effects of a cold compression bandage on pain, swelling and skin-surface temperature after the first 24 h after arthroscopic surgery of the shoulder in a stationary setting and to compare it with cold therapy using only a cold pack. It was hypothesized that using the bandage is more effective in reducing pain and swelling after 24 h compared with using only a cold pack.Methods: Fifty-two patients (53 ± 12.2 years) were randomly assigned to two groups after arthroscopic surgery. The first group wore a cold compression bandage, and the second group a conventional frozen cold pack. Pain, swelling and skin-surface temperature were measured 2, 8 and 24 h after surgery. Differences within and between groups were analysed.Results: Both groups showed a significant reduction of the circumference of the arm 15 and 20 cm proximal of the lateral epicondyle 24 h after surgery (cold compression: p = 0.003; p < 0.001; cold: p < 0.001). Pain at rest was significantly reduced with cold compression bandage 24 h after surgery (p = 0.001). Skin temperature increased in both groups 24 h after surgery (bandage: p < 0.001; cold pack: p = 0.002). After 24 h, pain during activity was significantly decreased in the group wearing the bandage compared with the group using the cold pack (p = 0.026).Conclusions: Based on the results of this study, no recommendation can be made with respect to the question whether cold compression therapy or cold therapy should be preferred immediately after arthroscopic surgery of the shoulder. Clinicians should question the need of expensive cold compression bandages in the short-term post-operative treatment after arthroscopic surgery of the shoulder.Level Of Evidence: II. [ABSTRACT FROM AUTHOR]

Gait initiation is the task commonly used to investigate the anticipatory postural adjustments necessary to begin a new gait cycle from the standing position. In this study, we analyzed whether and how foot-floor interface characteristics influence the gait initiation process. For this purpose, 25 undergraduate students were evaluated while performing a gait initiation task in three experimental conditions: barefoot on a hard surface (barefoot condition), barefoot on a soft surface (foam condition), and shod on a hard surface (shod condition). Two force plates were used to acquire ground reaction forces and moments for each foot separately. A statistical parametric mapping (SPM) analysis was performed in COP time series. We compared the anterior-posterior (AP) and medial-lateral (ML) resultant center of pressure (COP) paths and average velocities, the force peaks under the right and left foot, and the COP integral x force impulse for three different phases: the anticipatory postural adjustment (APA) phase (Phase 1), the swing-foot unloading phase (Phase 2), and the support-foot unloading phase (Phase 3). In Phase 1, significantly smaller ML COP paths and velocities were found for the shod condition compared to the barefoot and foam conditions. Significantly smaller ML COP paths were also found in Phase 2 for the shod condition compared to the barefoot and foam conditions. In Phase 3, increased AP COP velocities were found for the shod condition compared to the barefoot and foam conditions. SPM analysis revealed significant differences for vector COP time series in the shod condition compared to the barefoot and foam conditions. The foam condition limited the impulse-generating capacity of COP shift and produced smaller ML force peaks, resulting in limitations to body-weight transfer from the swing to the support foot. The results suggest that footwear and a soft surface affect COP and impose certain features of gait initiation, especially in the ML direction of Phase 1. [ABSTRACT FROM AUTHOR]

Reduced motor performance may particularly limit reintegration into normal life after cessation of treatment in pediatric cancer patients. This study aimed at analyzing motor performance at the end of the acute treatment phase and reveals potential risk factors for motor deficits. A childhood cancer population with different tumor entities was assessed with the MOON test, which allows for comparison with age- and gender-matched reference values of healthy children, at the end of the acute treatment phase. Forty-seven patients were tested at 7.0 ± 2.6 months after diagnosis. Significant reductions of motor performance affected muscular explosive strength ( P < 0.001), handgrip strength ( P < 0.001), muscular endurance of legs ( P = 0.035), hand-eye coordination ( P < 0.001), static balance ( P = 0.003), speed ( P = 0.012), and flexibility ( P < 0.001). Loss of upper extremity coordination did not achieve statistical significance. Associations between single motor deficits and the tumor entity, age, body mass index, and inactivity during treatment were revealed, whereas no associations were found for gender and vincristine application. Conclusion: Overall, motor performance was low in the patient group studied. We recommend that individualized exercise interventions to attenuate motor deficits and promote physical activity are needed during cancer treatment in order to enhance motor performance and improve social participation during and after cancer therapy. [ABSTRACT FROM AUTHOR]

Context: Various designs of braces including hinged and nonhinged models are used to provide external support of the ankle. Hinged ankle braces supposedly allow almost free dorsiflexion and plantar flexion of the foot in the sagittal plane. It is unclear, however, whether this additional degree of freedom affects the stabilizing effect of the brace in the other planes of motion. Objective: To investigate the dynamic and passive stabilizing effects of 3 ankle braces, 2 hinged models that provide free plantar flexion–dorsiflexion in the sagittal plane and 1 ankle brace without a hinge. Design: Crossover study. Setting: University Movement Analysis Laboratory. Patients or Other Participants: Seventeen healthy volunteers (5 women, 12 men; age=25.4 ± 4.8 years; height=180.3 ± 6.5 cm; body mass = 75.5 ± 10.4 kg). Intervention(s): We dynamically induced foot inversion on a tilting platform and passively induced foot movements in 6 directions via a custom-built apparatus in 3 brace conditions and a control condition (no brace). Main Outcome Measure(s): Maximum inversion was determined dynamically using an in-shoe electrogoniometer. Passively induced maximal joint angles were measured using a torque and angle sensor. We analyzed differences among the 4 ankle-brace conditions (3 braces, 1 control) for each of the dependent variables with Friedman and post hoc tests (P < .05). Results: Each ankle brace restricted dynamic foot-inversion movements on the tilting platform as compared with the control condition, whereas only the 2 hinged ankle braces differed from each other, with greater movement restriction caused by the Ankle X model. Passive foot inversion was reduced with all ankle braces. Passive plantar flexion was greater in the hinged models as compared with the nonhinged brace. Conclusions: All ankle braces showed stabilizing effects against dynamic and passive foot inversion. Differences between the hinged braces and the nonhinged brace did not appear to be clinically relevant. [ABSTRACT FROM AUTHOR]

Background: While research on exercise interventions during anticancer treatment is well-established in adults, only very few studies exist in children. However, pediatric patients experience great limitations to being physically active, and appropriate interventions are desired. Procedure: The present study aimed at investigating the effects of individualized exercise interventions during inpatient stays on pediatric patients with a malignant bone tumor. The parameter of interest was physical activity (PA). Patients' PA during home stays was assessed 6 weeks as well as 3, 6, 12, and 18 months post-surgery. Patients were distinguished into an intervention group and a control group. All patients received endoprosthetic replacement of the affected bone in the same institution. Results: A constant increase in all PA parameters was observed during follow-up. Exercise interventions were possible and appeared worthwhile. The intervention group showed better PA results at all measurements; however, no significant differences between groups were found. Furthermore, differences decreased especially after the cessation of the intervention. General problems in reaching appropriate power and compliance were observed. Conclusions: Individualized exercise interventions in pediatric bone tumor patients are possible and appear to be beneficial. Such interventions should be implemented in adjuvant care; however, future research is needed to understand more about the effects of different interventions. [ABSTRACT FROM AUTHOR]

Purpose: The purpose of this study was to evaluate the effects of different types of lateral meniscus root tears in terms of tibiofemoral contact stress. Methods: Ten porcine knees each underwent five different testing conditions with the menisci intact, a simulated lateral posterior root tear with and without cutting the meniscofemoral ligament and with an artificial tear of the posterior root of the medial meniscus. Biomechanical testing was performed at 30° of flexion with an axial load of 100 N. A pressure sensor (st Sensor Type S2042, Novel, Munich) was used to measure the tibiofemoral contact area and the tibiofemoral contact pressure. Data were analyzed to assess the differences in contact area and tibiofemoral peak contact pressure among the five meniscal conditions. Results: There was no significant difference in mean contact pressure between the state with the menisci intact and an isolated posterior root tear of the lateral meniscus. In case of a root tear and a tear of the meniscofemoral ligament, the contact area decreased in comparison with the intact state of the menisci. After additional cutting of the meniscofemoral ligament, the tibiofemoral contact pressure was significantly higher in comparison with the intact state and the avulsion injury. In the medial compartment, joint compression forces were significantly increased in comparison with the intact state after cutting the posterior root of the medial meniscus ( P < 0.05). Conclusions: The consequence of a medial meniscus root tear is well known and was verified by this analysis. The results of the present study show that the biomechanical consequences of a lateral meniscus root tear depend on the state of the meniscofemoral ligament. An increase in tibiofemoral contact pressure is only to be expected in combined injuries of the meniscus root and the meniscofemoral ligaments. Clinical relevance: Posterior lateral meniscus root tear might have a better prognosis in terms of the development of osteoarthritis when the meniscofemoral ligament is intact. [ABSTRACT FROM AUTHOR]

Abstract: The purpose of this study was to describe the effects of lower limb positioning and shoe conditions on stability levels of selected single leg ballet poses performed in demi-pointe position. Fourteen female non-professional ballet dancers (mean age of 18.4±2.8 years and mean body mass index of 21.5±2.8kg/m2) who had practiced ballet for at least seven years, without any musculoskeletal impairment volunteered to participate in this study. A capacitive pressure platform allowed for the assessment of center of pressure variables related to the execution of three single leg ballet poses in demi pointé position: attitude devant, attitude derriére, and attitude a la second. Peak pressures, contact areas, COP oscillation areas, anterior–posterior and medio-lateral COP oscillations and velocities were compared between two shoe conditions (barefoot versus slippers) and among the different poses. Barefoot performances produced more stable poses with significantly higher plantar contact areas, smaller COP oscillation areas and smaller anterior–posterior COP oscillations. COP oscillation areas, anterior–posterior COP oscillations and medio-lateral COP velocities indicated that attitude a la second is the least challenging and attitude derriére the most challenging pose. [Copyright &y& Elsevier]