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Clinical Scenario: Ankle sprains are one of the most common injuries in athletics, and many lead to recurrent sprains, chronic ankle instability, and persistent symptoms. Treatment improvements are needed. Platelet-rich plasma (PRP) involves formulating autologous plasma with higher platelet concentration to be injected in the desired tissue. There is currently high-quality evidence supporting the use of PRP with lateral epicondylitis and knee osteoarthritis to accelerate the healing process and decrease pain. Clinical Question: Does the injection of PRP relieve pain faster and improve function compared with no injection or placebo in patients with a lateral ankle sprain? Summary of Key Findings: A computerized search yielded 191 studies; of these, 3 studies fit the inclusion and exclusion criteria. PRP injection reduces pain and increases function after lateral ankle sprain 5 to 8 weeks after intervention. Clinical Bottom Line: The use of PRP after lateral ankle sprain to decrease pain and increase function is supported with moderate evidence. Strength of Recommendation: Based on the Strength of Recommendation Taxonomy, evidence from the included studies is considered as level B, reflecting limited quality patient-oriented evidence. [ABSTRACT FROM AUTHOR]

Context: Foot/ankle pain is common among runners. Inadequate management of runners with foot/ankle pain can lead to lost training time, competition removal, and other activity limitations. Neurodynamics, which refers to the integrated biomechanical, physiological, and structural function of the nervous system during movement, can be overlooked in patients with foot/ankle pain. Although a link between the cervical spine, neurodynamics, and upper quarter pain has been studied, less is known about the relationship between the lumbar spine and lower quarter. This case series describes the successful management of 3 runners with foot/ankle pain. Case Presentations: Three female runners (ages 23, 24, and 45 y) presented to physical therapy with foot/ankle pain and difficulty running. Each patient had positive examination findings with local foot/ankle testing. A comprehensive lumbar spine examination demonstrated impairments in range of motion and joint mobility that were hypothesized to be contributing. Positive lower quarter neurodynamic tests were also found. Management and Outcomes: All patients were treated with nonthrust lumbar spine mobilization and lower quarter neural tissue mobilization. Changes in the Patient-Specific Functional Scale, Numerical Pain Rating Scale, Lower Extremity Functional Scale, and Global Rating of Change occurred after intervention targeting the lumbar spine and lower-extremity neurodynamics in all patients. Conclusions: This case series demonstrates the importance of including a thorough lumbar spine examination and neurodynamic testing to identify appropriate interventions while managing patients with foot/ankle pain, even when patients have signs indicative of local ankle/foot pathology. These examination procedures should be performed particularly when a patient is not responding to management targeting local foot/ankle structures. [ABSTRACT FROM AUTHOR]

Context: The aim of this study was to analyze the muscle activity of the hamstring muscles and the lateral gastrocnemius during different variants of the single-leg bridge (SLB) in futsal players. Design: Cross-sectional study. Methods: Twenty-two futsal players (age = 24.8 [3.9] y) volunteered to participate in this study. The participants performed 3 variations of the SLB with the knee flexed at 45°. The first position was performed with the ankle in plantar position with flat support, the second with the ankle in dorsiflexion (DF) with heel support, and the third with the ankle in DF and external rotation (ER) with heel support. The Wilcoxon rank-sum test assessed the difference between variables for samples with the rank-biserial correlation effect size. Spearman correlation coefficients were used to examine the associations of the percentage maximal voluntary isometric contraction for each muscle with peak force and rate of force development with 3 different variances of the SLB. Results: The variation of ankle DF and ER with heel support generated higher muscle activity in BF in concentric (P<.01, effect size [ES] = -0.613); isometric (P<.042, ES = -0.494); and eccentric (P<.005, ES = -0.668) contraction than ankle DF with heel support. In contrast, the variation of ankle DF and ER with heel support generated fewer muscle activity in lateral gastrocnemius in concentric (P < .001, ES = 0.779); isometric (P < .003, ES = 0.708); and eccentric (P < .014, ES = 0.589) contraction than ankle DF with heel support. Conclusions: The position of DF and ER was the best position in SLB to train the BF. It could be convenient to start rehabilitation of the BF with flat foot postition or ankle in DF with heel support and progress with the position of the ankle in DF and ER with heel support. [ABSTRACT FROM AUTHOR]

Context: Individuals with chronic ankle instability (CAI) demonstrate reduced spinal reflex modulation and corticospinal excitability of the soleus, which may contribute to decreased balance performance. Objective: To determine the effects of a single session of balance training on Spinal-reflexive excitability modulation and corticospinal excitability in those with CAI. Design: Randomized controlled trials. Setting: Research laboratory. Participants: Thirty participants with CAI were randomly assigned to the balance training (BAL) or control (CON) group. Main Outcome Measures: Modulation of soleus spinal-reflexive excitability was measured by calculating relative change in normalized Hoffmann reflexes (ratio of the H-reflex to the M-wave) from prone to single-leg standing. Corticospinal excitability was assessed during single-leg stance using transcranial magnetic stimulation, outcomes of which included active motor threshold (AMT), motor evoked potential, and cortical silent period (CSP). Balance performance was measured with center of pressure velocity in anterior to posterior and medial to lateral directions. Separate 2x2 repeated-measures analyses of variance were employed to determine the effect of group (BAL and CON) and time (baseline and posttraining) on each dependent variable. Results: There were significant group by time interactions in the modulation of soleus spinal-reflexive excitability (F1.27 = 4.763, P=-04); CSP at 100% AMT (F F1.27 = 4.727, P = .04); and CSP at 120% AMT (F F1.27 16.057, f < .01). A large effect size suggests increased modulation of spinal-reflexive excitability (d = 0.81 [0.03 to 1.54]) of the soleus in BAL compared with CON at posttest, while CSP at 100% (d = 0.95 [0.17 to 1.70]) and 120% AMT (d = 1.10 [0.29 to 1.84]) was reduced in BAL when compared with CON at posttest. Conclusion: After a single session of balance training, individuals with CAI initiated increases in spinal reflex modulation and corticospinal excitability of the soleus. Thus, individuals with CAI who undergo balance training exhibit positive neural adaptations that are linked to improvements in balance performance. [ABSTRACT FROM AUTHOR]

Context: An easy-to-administer, function-based questionnaire to assess patients with various foot problems was required for a Greek-speaking population. This study aimed to translate and cross-culturally adapt the Quick Foot and Ankle Ability Measure (Quick-FAAM) into Greek and evaluate its reliability and validity. Design: Cross-sectional study. Methods: Established international guidelines for the cross-cultural adaptation of questionnaires were followed. The face and content validity of the Greek version of the Quick-FAAM (Quick-FAAM-GR), as well as the internal consistency and test-retest reliability upon repeated administration after 5 days, were examined. In addition, the construct validity of the scale was examined via exploratory factor analysis as well as by testing for associations with the Manchester Foot Pain and Disability Index, the 12-item Short-Form Survey (version 2), and a functional balance assessment test--the Y-Balance Test. Results: Sixty participants (18 women) with self-reported chronic ankle instability symptoms, with a median (interquartile range) age of 27 (7.7) years, participated in the study. Half of the participants were included in the test-retest reliability study. The Quick-FAAM-GR demonstrated face and content validity. Excellent internal consistency (Cronbach a =.961) and intrarater test-retest reliability (intraclass correlation coefficient ICC[2,1] = .93) were demonstrated, with a comparable error margin to the original version (standard error of the measurement = 2.1, 95% minimum detectable change = 5.9). Associations of the Quick-FAAM-GR scores to other questionnaires ranged from weak to strong (Spearman rho), all being statistically significant (Manchester Foot Pain and Disability Index from -.26, P = .04, to -.67, P< .001, and 12-item Short-Form Survey, version 2, between .41 and .72, P<.001), and to the Y-Balance Test between lower-limb differences (-.35 to -.58, P< .001). The exploratory factor analysis confirmed the single- factor structure of this scale. No floor/ceiling effects were observed. Conclusions: The Greek Quick-FAAM has proven to be a valid and reliable tool for evaluating chronic ankle instability and can be used for clinical and research purposes in Greek- speaking individuals. [ABSTRACT FROM AUTHOR]

Spasticity is a common impairment within pediatric neuromusculoskeletal disorders. How spasticity contributes to gait deviations is important for treatment selection. Our aim was to evaluate the pathophysiological mechanisms underlying gait deviations seen in children with spasticity, using predictive simulations. A cluster analysis was performed to extract distinct gait patterns from experimental gait data of 17 children with spasticity to be used as comparative validation data. A forward dynamic simulation framework was employed to predict gait with either velocity- or force-based hyperreflexia. This framework entailed a generic musculoskeletal model controlled by reflexes and supraspinal drive, governed by a multiobjective cost function. Hyperreflexia values were optimized to enable the simulated gait to best match experimental gait patterns. Three experimental gait patterns were extracted: (1) increased knee flexion, (2) increased ankle plantar flexion, and (3) increased knee flexion and ankle plantar flexion when compared with typical gait. Overall, velocity-based hyperreflexia outperformed force-based hyperreflexia. The first gait pattern could mostly be explained by rectus femoris and hamstrings velocity-based hyperreflexia, the second by gastrocnemius velocity-based hyperreflexia, and the third by gastrocnemius, soleus, and hamstrings velocity-based hyperreflexia. This study shows how velocity-based hyperreflexia from specific muscles contributes to different spastic gait patterns, which may help in providing targeted treatment. [ABSTRACT FROM AUTHOR]

Background: Transcranial direct current stimulation (tDCS) has been demonstrated to facilitate motor performance in healthy individuals; however, results are variable. The neuromodulatory effects of tDCS during visuomotor tasks may be influenced by extrinsic visual feedback, However, this interaction between tDCS and visual feedback has not been explored for the lower limb. Hence, our objective was to explore if tDCS over the primary lower limb motor cortex differentially facilitates motor performance based on the availability of visual feedback. Methods: Twenty -two neurotypical adults performed ankle plantarflexion and dorsiflexion movements while tracking a sinusoidal target. Spatiotemporal, spatial. and temporal error were calculated between the ankle position and target. Participants attended two sessions, a week apart. with (Stim) and without (No-Stim) anodal tDCS. Sessions were divided into two blocks containing randomized visual feedback conditions: full, no, and blindfold. During Stim sessions. the first block included the application of tDCS to the lower limb M1. Results: Spatiotemporal and spatial error increased as feedback faded (p < .001). A two-way repeated-measures analysis of variance showed a significant interaction between tDCS and visual feedback (p < .05) on spatiotemporal error. Post hoc analyses revealed a significant improvement in spatiotemporal error when visual feedback was absent (p < .01). Spatial and temporal errors were not significantly affected by stimulation or visual feedback. Discussion: Our results suggest that tDCS enhances spatiotemporal ankle motor performance only when visual feedback is not available. These findings indicate that visual feedback may play an important role in demonstrating the effectiveness of tDCS. [ABSTRACT FROM AUTHOR]

Background: The diabetic foot (DF) ulcer is the severe complication of type 2 diabetes mellitus (T2DM). Sarcopenia is characterized as the loss of muscle mass and strength, resulting in the increased risk of fracture and physical disability. Sarcopenia may affect the foot-ankle function in DF ulcer patients, compromise the quality of life. Objective: The aim was to clarify the effect of sarcopenia on foot-ankle function in patients with DF ulcer. Methods: In total of 108 T2DM patients with DF ulcer were enrolled. Based on the examination of muscle mass by dual energy X-ray absorptiometry (DXA) and grip strength and 5x sit-to-stand test, the DF patients were divided into sarcopenia and non-sarcopenia groups. The severity of DF ulcer was evaluated by Wagner classification. The foot-ankle function was evaluated by American Orthopaedic Foot and Ankle Society (AOFAS) Ankle-Hindfoot Score. Results: DF patients with sarcopenia showed advanced age, lower BMI, longer duration of T2DM, and more severe Wagner classification, reduced appendicular skeletal muscle mass index (ASMI), grip strength, transcutaneous oxygenpressure (TcPO2) and prolonged time of 5X sit-to-stand test. The stratified comparison analysis indicated that severity of sarcopenia and DF ulcer, reduced TcPO2, and grip strength were aggravated with the impaired foot-ankle function (P < 0.05). Multivariate Logistic analysis showed that age, TcPO2, and severe sarcopenia were risk factors deteriorating the foot-ankle function. Conclusion: The sarcopenia is a key risk factor of decreasing foot-ankle function in patients with DF ulcer. Thus, the prevention of muscle mass and strength loss could be considered as part of comprehensive therapy for DF ulcer. [ABSTRACT FROM AUTHOR]

[Display omitted] • EEG can track modulation of cortical proprioceptive processing to joint rotations. • Volitional muscle activation intensifies the cortical proprioceptive processing. • Cortical inhibition is enhanced during passive joint-rotation stimulation. • Mechanisms likely at muscle, spinal, sub-cortical and cortical levels. Cortical proprioceptive processing of intermittent, passive movements can be assessed by extracting evoked and induced electroencephalographic (EEG) responses to somatosensory stimuli. Although the existent prior research on somatosensory stimulations, it remains unknown to what extent ongoing volitional muscle activation modulates the proprioceptive cortical processing of passive ankle-joint rotations. Twenty-five healthy volunteers (28.8 ± 7 yr, 14 males) underwent a total of 100 right ankle-joint passive rotations (4° dorsiflexions, 4 ± 0.25 s inter-stimulus interval, 30°/s peak angular velocity) evoked by a movement actuator during passive condition with relaxed ankle and active condition with a constant plantarflexion torque of 5 ± 2.5 Nm. Simultaneously, EEG, electromyographic (EMG) and kinematic signals were collected. Spatiotemporal features of evoked and induced EEG responses to the stimuli were extracted to estimate the modulation of the cortical proprioceptive processing between the active and passive conditions. Proprioceptive stimuli during the active condition elicited robustly ∼26 % larger evoked response and ∼38 % larger beta suppression amplitudes, but ∼42 % weaker beta rebound amplitude over the primary sensorimotor cortex than the passive condition, with no differences in terms of response latencies. These findings indicate that the active volitional motor task during naturalistic proprioceptive stimulation of the ankle joint enhances related cortical activation and reduces related cortical inhibition with respect to the passive condition. Possible factors explaining these results include mechanisms occurring at several levels of the proprioceptive processing from the peripheral muscle (i.e. mechanical, muscle spindle status, etc.) to the different central (i.e. spinal, sub-cortical and cortical) levels. [ABSTRACT FROM AUTHOR]

ABSTRACT Objectives Methods Results Conclusions Currently, there are various surgical options for the treatment of lateral ankle sprains, and deciding which surgical option to use is a question worth considering. Furthermore, there is a relative scarcity of mechanical research comparing suture anchor repair (SAR) and suture tape augmentation (STA) internal brace for the repair of the anterior talofibular ligament (ATFL). Therefore, this study aimed to compare the efficacy of arthroscopically all‐inside ATFL SAR and STA for reconstruction to treat lateral ankle sprains through biomechanical testing.Eighteen fresh‐frozen cadaver ankles were used for the study and divided into one of three groups: (1) intact ATFL group, (2) arthroscopically reconstructed with suture tape augmentation internal brace of the ATFL (STA group), and (3) arthroscopically repaired ATFL with suture anchors (SAR group). We used custom fixtures to test the specimens for loading to ultimate failure and stiffness.The mean load to failure of the STA group (311.20 ± 52.56 N) was significantly higher than that of the intact ATFL group (157.37 ± 63.87 N; p = 0.0016) and the SAR group (165.27 ± 66.81 N; p = 0.0025). The mean stiffness of the STA group (30.10 ± 5.10 N/mm) was significantly higher than that of the intact ATFL (14.17 ± 6.35 N/mm; p = 0.0012) and the SAR group (15.15 ± 6.89 N/mm; p = 0.0021). The suture anchor repair withstood failure loads and stiffness similar to the intact ATFL.In terms of failure load and stiffness, the reconstructive outcome of ATFL reconstruction with STA is markedly superior to that of SAR reconstruction of the ATFL and the intact ATFL. Additionally, the novel technique of the SAR was a reliable technique that offered biomechanical properties similar to intact ATFL. [ABSTRACT FROM AUTHOR]

The level of dynamic mechanical instability between the bony parts of the ankle joint provides important information on biomechanical function. However, the dynamics of the distance between the talus and lateral malleolus during gait remain unclear. This study aimed to compare the distance between the talus and lateral malleolus and the ankle joint angles during the stance phase of gait between individuals with chronic ankle instability (CAI) and healthy adults. The comparison was conducted using a synchronized ultrasound (US) imaging with a three-dimensional motion analysis (MA) system. This cross-sectional study included 12 participants (5 males, 7 females; age, 20.5 ± 1.8 years; height, 166.6 ± 9.4 cm; body weight, 60.2 ± 5.3 kg; body mass index, 21.7 ± 2.0 kg/m2; 16 feet) with CAI and 10 healthy controls (4 males, 6 females; age, 21.2 ± 1.6 years; height, 164.6 ± 10.5 cm; body weight, 56.8 ± 11.3 kg; body mass index, 20.8 ± 2.6 kg/m2; 20 feet). The distance between the talus and lateral malleolus during gait was significantly increased in the CAI group compared with that in the control group throughout the stance phase. The ankle dorsiflexion angle was smaller in the CAI group during the middle and terminal stance phases. Additionally, the ankle inversion angle was greater in the CAI group than in the control group. Our findings show the application of the synchronized US and MA system in the assessment of mechanical instability in CAI group, which may be used to determine treatment efficacy. [ABSTRACT FROM AUTHOR]

Current treatment strategy for managing Weber B ankle fractures is mainly governed by mortise congruency, malleolar alignment, deltoid ligament competence and fracture stability. While nonoperative treatment has yielded good functional outcomes in satisfactorily aligned stable injuries, a biomechanical rationale is not firmly established. Furthermore, current radiographic analysis is obscured by observer inaccuracy and beam rotation. This study aimed to utilize weightbearing CT and computational biomechanics to analyse 3D mortise displacement and contact mechanics in Weber-B ankle fractures and compare them with the uninjured contralateral side. 32 patients were included who sustained a Weber-B ankle fracture and underwent bilateral weightbearing CT imaging at injury. Segmentation into 3D models of bone was performed semi-automatically, and individualized cartilage layers were modeled based on a previously validated methodology. The 3D mortise congruency was evaluated by use of following parameters: alpha angle, fibular length, talocrural angle, medial gutter- and tibiofibular clear space- distance mapping. Contact mechanics were evaluated by the mean and maximum contact stress of the tibiotalar articulation. Statistical analysis revealed that there were no significant differences for all anatomical parameters. There was also no significant difference between the mean contact stress of the injured (2.10 ± 0.42 MPa) and uninjured side (2.10 ± 0.41 MPa), nor the maximum contact stress of the injured (7.67 ± 1.55 MPa) and uninjured (7.47 ± 1.67), respectively. Contact mechanics were unaffected in congruent Weber-B fractures. These findings support consideration of nonoperative management in such cases, given their presumably low risk for posttraumatic arthritic development in the long term. Level of Evidence: Level III; retrospective case-control study. [ABSTRACT FROM AUTHOR]

Template models, such as the Bipedal Spring-Loaded Inverted Pendulum and the Virtual Pivot Point, have been widely used as low-dimensional representations of the complex dynamics in legged locomotion. Despite their ability to qualitatively match human walking characteristics like M-shaped ground reaction force (GRF) profiles, they often exhibit discrepancies when compared to experimental data, notably in overestimating vertical center of mass (CoM) displacement and underestimating gait event timings (touchdown/ liftoff). This paper hypothesizes that the constant leg stiffness of these models explains the majority of these discrepancies. The study systematically investigates the impact of stiffness variations on the fidelity of model fittings to human data, where an optimization framework is employed to identify optimal leg stiffness trajectories. The study also quantifies the effects of stiffness variations on salient characteristics of human walking (GRF profiles and gait event timing). The optimization framework was applied to 24 subjects walking at 40% to 145% preferred walking speed (PWS). The findings reveal that despite only modifying ground forces in one direction, variable leg stiffness models exhibited a >80% reduction in CoM error across both the B-SLIP and VPP models, while also improving prediction of human GRF profiles. However, the accuracy of gait event timing did not consistently show improvement across all conditions. The resulting stiffness profiles mimic walking characteristics of ankle push-off during double support and reduced CoM vaulting during single support. [ABSTRACT FROM AUTHOR]

This study aimed to develop an effective VR locomotion technique for walking through virtual environments with sloped ground. Thus, this paper presents a novel method for inducing the sensation of walking on a slope in walking-in-place (WIP) using ankle tendon electrical stimulation (TES), which induces the body tilt sensation. We conducted two experiments to evaluate the effectiveness of the proposed method. In Experiment 1, we evaluated the sensation of ascending and descending slopes induced by the proposed method in a setup where electricity flows when the feet are grounded by comparing it to the sensation on a real slope. Experiment 1 demonstrated a marginally significant effect of electrical stimulation on the sensation of ascending or descending slopes. We attributed this to the short duration of ankle TES and the influence of the user's interpretation of the ankle TES. Based on the findings, Experiment 2 was conducted in a setup where ankle TES was constantly applied. The results indicated that participants who focused on the subjective body tilt sensation elicited by TES and those unaware of the TES effect experienced an ascending sensation with an anterior ankle TES and a descending sensation with a posterior ankle TES. Conversely, those who focused on the tactile or force sensation induced by ankle TES experienced the opposite effect. Based on this finding, we have constructed an implementation guide for a WIP system that incorporates ankle TES to present the desired sensation of ascending or descending slopes in virtual environments. [ABSTRACT FROM AUTHOR]

Foot and ankle disorders are a very common diseases, represent a risk factor for falls in older people, and are associated with difficulty performing activities of daily living. With an increasing demand for cost-effective and high-quality clinical services, wearable technology can be strategic in extending our reach to patients with foot and ankle disorders. In recent years, wearable sensors have been increasingly utilized to assess the clinical outcomes of surgery, rehabilitation, and orthotic treatments. This article highlights recent achievements and developments in wearable sensor-based foot and ankle clinical assessment. An increasing number of studies have established the feasibility and effectiveness of wearable technology tools for foot and ankle disorders. Different methods and outcomes for feasibility studies have been introduced, such as satisfaction and efficacy in rehabilitation, surgical, and orthotic treatments. Currently, the widespread application of wearable sensors in clinical fields is hindered by a lack of robust evidence; in fact, only a few tests and analysis protocols are validated with cut-off values reported in the literature. However, nowadays, these tools are useful in quantifying clinical results before and after clinical treatments, providing useful data, also collected in real-life conditions, on the results of therapies. [ABSTRACT FROM AUTHOR]

This study proposes a wearable gait assessment method using inertial measurement units (IMUs) to evaluate gait ability in daily environments. By focusing on the estimation of the margin of stability (MoS), a key kinematic stability parameter, a method using a convolutional neural network, was developed to estimate the MoS from IMU acceleration time-series data. The relationship between MoS and other stability indices, such as the Lyapunov exponent and the multi-site time-series (MSTS) index, using data from five IMU sensors placed on various body parts was also examined. To simulate diverse gait conditions, treadmill speed was varied, and a knee–ankle–foot orthosis was used to restrict left knee extension, inducing gait asymmetry. The model achieved over 90% accuracy in classifying MoS in both forward and lateral directions using three-axis acceleration data from the IMUs. However, the correlation between MoS and the Lyapunov exponent or MSTS index was weak, suggesting that these indices may capture different aspects of gait stability. [ABSTRACT FROM AUTHOR]

Background: Gait and posture analysis plays a crucial role in understanding human movement, with significant applications in rehabilitation, sports science, and clinical settings. The GaitON® system, a 2D motion analysis tool, provides an accessible and cost-effective method for assessing gait and posture. However, its reliability in clinical practice, particularly for intra-rater consistency, remains to be evaluated. This study aims to assess the intra-rater reliability of the GaitON® system in a healthy population, focusing on gait and posture parameters. Methods: A total of 20 healthy participants (10 males and 10 females) aged 18 to 50 years were recruited for the study. Each participant underwent gait and posture assessments using the GaitON® system on two separate occasions, spaced one week apart. Video recordings from anterior and posterior views were used to analyze gait, while images from anterior, posterior, and lateral views were captured to assess posture with markers placed on key anatomical landmarks. The reliability of the measurements was analyzed using intraclass correlation coefficients (ICC), a standard error of measurement (SEM), and the smallest detectable difference (SDD) method. Results: The GaitON® system demonstrated excellent intra-rater reliability across a wide range of gait and posture parameters. ICC values for gait parameters, including hip, knee, and ankle joint angles, ranged from 0.90 to 0.979, indicating strong consistency in repeated measurements. Similarly, ICC values for posture parameters, such as the head alignment, shoulder position, and ASIS alignment, were above 0.90, reflecting excellent reliability. SEM values were low across all parameters, with the smallest SEM recorded for the hip joint angle (0.37°), and SDD values further confirmed the precision of the system. Conclusion: The GaitON® system provides reliable and consistent measurements for both gait and posture analysis in healthy individuals. Its high intra-rater reliability and low measurement error make it a promising tool for clinical and sports applications. Further research is needed to validate its use in clinical populations and compare its performance to more complex 3D motion analysis systems. [ABSTRACT FROM AUTHOR]

High-altitude landing maneuvers can pose a significant injury risk, particularly when performed with different landing techniques. This study aims to compare the biomechanical parameters and injury risks associated with two landing positions—staggered foot landing and simultaneous bilateral landing—using Xsens inertial units and electromyography (EMG) sensors. A total of 26 university students (13 males, 13 females) participated in this study. Kinematic data were collected using inertial measurement units (IMUs), muscle activity was recorded with EMG, and ground reaction forces were captured using 3D force plates. The data were processed and analyzed using the AnyBody modeling system to simulate joint forces, moments, and muscle activation. This study found that simultaneous bilateral landing exhibited greater hip flexion-extension, knee flexion-extension, and ankle inversion. Vertical joint forces were also significantly higher in the hip, knee, and ankle during simultaneous bilateral landing. Staggered foot landing showed higher muscle forces in the gluteus maximus, iliopsoas, and quadriceps femoris (p < 0.001). The EMG analysis revealed significant differences in the biceps femoris (p = 0.008) and quadriceps femoris (p < 0.001). These findings suggest that simultaneous bilateral landing increases joint load, while staggered foot landing increases muscle activation, which may lead to different injury risks between the two techniques. [ABSTRACT FROM AUTHOR]

Objective: To investigate the effects of mild fatigue on the biomechanics of the lower limbs of young male volleyball players while performing single leg landing tasks. Methods: A total of ten young male volleyball players were recruited as participants in this study. After the single leg landing was performed, we compared the performance between those with and without fatigue (post- and non-fatigue, respectively). Kinematics and kinetics were collected using instruments, and related captured data were imported into OpenSim to analyze the hip, knee, and ankle joints. Results: We found that the ankle dorsiflexion angle at initial contact was significantly decreased in the post-fatigue group compared to the non-fatigue one. Meanwhile, the peak gluteus maximus force, peak gluteus medius force, peak tibialis posterior force, and peak gastrocnemius force significantly increased. There were no significant differences in the hip and knee joint flexion angles as well as the quadriceps and biceps femoris long head forces between the two groups. Conclusions: Mild fatigue can affect the performance of single leg landing, and players need to control the lower limbs by generating a higher muscle force to cope with the instability induced by fatigue. In a fatigued state, following initial contact with the ground, a decreased ankle dorsiflexion angle necessitates an increase in gastrocnemius and tibialis posterior muscle force to maintain stance during landing. [ABSTRACT FROM AUTHOR]

Ankle fractures can lead to issues such as limited dorsiflexion, strength deficits, swelling, stiffness, balance disorders, and functional limitations, which complicate daily activities. This study aimed to describe neuromuscular adaptations at 6 and 12 months post-surgery during static and dynamic balance tasks, specifically using the Y-Balance Test (YBT). Additionally, the relationship between neuromuscular patterns, balance, and musculoskeletal deficits was evaluated. In 21 participants (14 at 6 months and 21 at 12 months) with bimalleolar fractures, hip strength, ankle dorsiflexion, ankle functionality, and static and dynamic balance were assessed using electromyography of five lower limb muscles (tibialis anterior, peroneus longus, lateral gastrocnemius, biceps femoris, and gluteus medius). A significant interaction effect (limb × proximal [hip]—distal [ankle] muscle) (F = 30.806, p < 0.001) was observed in the anterior direction of the Y-Balance Test (YBTA) at 6 months post-surgery. During the YBTA and YBT posteromedial (YBTPM), it was found that a lower dorsiflexion range of movement was associated specifically at 6 months with greater activation of the lateral gastrocnemius. However, these differences tended to diminish by 12 months. These findings suggest that neuromuscular patterns differ between operated and non-operated limbs during the YBTA at 6 months post-surgery. The Y-Balance Test, particularly its anterior direction, effectively highlighted these neuromuscular changes. This is a preliminary study; further research is needed to explore these findings in depth. [ABSTRACT FROM AUTHOR]

Objective: Diffuse‐type tenosynovial giant cell tumors (Dt‐TGCTs) commonly occur in the knee joint and tend to recur postoperatively. However, limited clinical data are available on ankle joint involvement especially associated multiportal arthroscopic treatment outcomes. The purpose of this study was to report the clinical results of multiportal arthroscopy‐assisted resection of Dt‐TGCTs of the ankle. Methods: We retrospectively reviewed the clinical data of 33 patients with Dt‐TGCT of the ankle who underwent multiportal arthroscopic treatment between August 2011 and December 2020. Clinical follow‐up included the visual analogue scale (VAS) score, American Orthopedic Foot and Ankle Society (AOFAS) score, Kofoed score, and recurrence rate to assess surgical outcomes. The number of patients who achieved the patient acceptable symptom state (PASS) based on the AOFAS score was also examined. Additionally, the patients were categorized into two groups based on the final surgical approach: Group A who underwent multiportal arthroscopic synovectomy and Group AO who underwent combined arthroscopic and open surgical excision. Intergroup comparisons were conducted. Intraoperative characteristics, such as the number of patients with involvement of the tarsal tunnel and fibularis tendon and the Outerbridge grading of cartilage damage, were recorded to assess the selection of surgical procedures. Results: Among the 33 patients, 15 were assigned to Group A, and 18 were in Group AO. The median follow‐up duration for the 33 patients was 77 months (range, 28–142 months). The median VAS score was 1 (range, 0–4), the AOFAS score was 96 (range, 65–100), and the Kofoed score was 96 (range, 67–100). A total of 27 patients (82%) achieved PASS based on AOFAS scores, while five patients (15%) had recurrence. No statistically significant difference was observed between the two groups in recurrence rate, follow‐up VAS score, AOFAS score, Kofoed score, or number of patients who reached the PASS (p > 0.05). In the AO group, 16 cases of Dt‐TGCT involved the tarsal tunnel, and 11 cases involved the fibularis tendon. All these patients exhibited extension beyond the joint. In contrast, only one patient in Group A had involvement of the tarsal tunnel. Statistically significant differences were observed between the groups (p < 0.001). Conclusion: This study demonstrated that, with the assistance of a multiportal arthroscopic approach, surgical excision of Dt‐TGCT in the ankle resulted in favorable clinical outcomes with a relatively low recurrence rate. Additionally, patients with extra‐articular involvement were more likely to require concomitant open surgery. [ABSTRACT FROM AUTHOR]

Introduction In prolonged care scenarios, where medical evacuations are significantly delayed, the treatment and transport of casualties with extremity musculoskeletal injuries will drain combat units' human resources. Developing enhanced splinting techniques to restore casualty mobility and function can alleviate this drain. To guide this development, a panel of tactical combat and wilderness medicine experts was assembled to determine which extremity musculoskeletal injuries had the greatest impact on unit capabilities, and the materials available for splinting these injuries. Information Gathering Unstructured consultations with panel members yielded preliminary lists of injuries and materials. These lists were consolidated and redistributed to panel members for final evaluation where they ranked the injuries based on frequency and human resource cost and assessed the accessibility of materials. Responses for the final evaluation were statistically analyzed using Wilcoxon rank-sum tests and Placket Luce models. Lessons Learned Aggregated responses indicated that panel members thought that knee and ankle ligamentous injuries and radial head fractures were the most frequently occurring injuries, although closed distal femoral fractures, below knee amputations, and open tibia fractures would require the most demand for injury care. Assessing the combined impact of frequency and human resource cost indicated that knee and ankle ligamentous injuries and closed tibia fractures had the greatest impact on unit readiness. Responses also indicated that a variety of materials would be available for applying or improvising splints. Conclusion Although the combined impact of knee and ankle ligamentous injuries were ranked the highest, limitations in relative rankings and the existence of effective low-cost treatments for these injuries suggest that greater gains in unit effectiveness would come from focusing on developing solutions for fractures with higher human resource cost, such as leg and arm fractures. This information can be used to develop enhanced splints that can preserve unit readiness in the field. [ABSTRACT FROM AUTHOR]

Our hypothesis is that the peroneus longus (PL) is a great option for ligament reconstruction in the knee, and therefore the objective of the study is to determine if the use of this graft is safe and does not cause secondary damage to the harvested area. A prospective study was conducted between April 2019 and September 2022. Patients who underwent any type of knee ligament reconstruction using the PL or just the anterior half (AHPL) as grafts were followed up. These patients were evaluated according to the Tegner–Lysholm score and the International Knee Documentation Committee (IKDC) guidelines for functional evaluation of the knee and the American Orthopedic Foot and Ankle Score (AOFAS) and the Foot and Ankle Disability Index (FADI) for the functional evaluation of the ankle. Most patients had an increase in the IKDC score, Tegner–Lysholm score, AOFAS and FADI regardless of the graft used in the surgical procedure, with mean values at the 24-month follow-up of, respectively, 99.02± 0.02, 98.69± 0.08, 99.92± 0.07, and 99.92± 0.07 for those with PL grafts and 99.31± 0.54, 98.88± 0.95, 100± 0.00, and 100± 0.00 for those with AHPL grafts. The differences in the scores between the two graft groups during each of the follow-up periods were significant (P = 0.001). The use of the peroneus longus tendon as a graft in knee surgeries was shown to be adequate for achieving good knee functional results. [ABSTRACT FROM AUTHOR]

Objectives: According to the conventional postoperative procedure after total ankle arthroplasty (TAA), mobilization and weight-bearing is currently started after completion of wound healing. Recently, early mobilization for dorsiflexion after TAA with modified antero-lateral approach was reported to be feasible and safe. To investigate the further possibility of expediting rehabilitation, this study evaluated the feasibility and safety of early full weight-bearing and gait exercise after cemented TAA. Materials and Methods: This retrospective, observational study investigated 23 consecutive ankles (OA: 14 ankles, RA: 9 ankles) that had received cemented TAA with a modified antero-lateral approach. These ankles were divided into three groups 1. conventional postoperative protocol, 2. early dorsiflexion protocol, 3. early dorsiflexion+full weight-bearing protocol. Postoperative wound complications were observed and recorded. Number of days for hospitalization was also evaluated. Results: No postoperative complications related to wound healing were observed even after early full weight-bearing and gait exercise. Days for hospitalization was significantly shortened in early full weight-bearing and gait exercise group (group 3) from 35-38 days to 24 days. Conclusions: Within this small number of cases, early full weight-bearing and gait exercise from 7 days after cemented TAA was feasible and safe with the modified antero-lateral approach. Combination of early dorsiflexion mobilization and weight-bearing/gait exercise contributed to shortening the hospitalization day. Innovations in postoperative procedures for rehabilitation after TAA can be expected. [ABSTRACT FROM AUTHOR]

Objectives: Foot and ankle impairments are major issues in patients with rheumatoid arthritis (RA). Foot deformities often lead to skin disorders, such as callosities, ingrown toenails, and interdigital tinea pedis. This study was aimed at investigating the efficacy and limitations of foot care by experts in patients with RA. Methods: Thirty-one patients with RA who began receiving foot care from nurses at our institution between September 2020 and February 2023 were included. Responses to a survey using the self-administered foot evaluation questionnaire (SAFE-Q) for patient-reported outcome measures were compared at baseline, the second visit (1.3 ± 0.5 months after baseline), and the third visit (3.6 ± 1.6 months after baseline). Results: Scores for 'Pain and pain-related' and 'General health and well-being' components of SAFE-Q markedly improved after foot care. On the other hand, there were no significant differences in the scores for 'Physical functioning and daily living', 'Social functioning', and 'Shoe-related' components during observation periods. Conclusions: Foot care for rheumatoid feet is effective in providing pain relief and improving general health and well-being. However, physical and social functioning and footwear issues did not improve. Clinicians must understand the effects and limitations of foot care in patients with RA. [ABSTRACT FROM AUTHOR]

Reciprocal inhibition and coactivation are strategies of the central nervous system used to perform various daily tasks. In automatic postural responses (APR), coactivation is widely investigated in the ankle joint muscles, however reciprocal inhibition, although clear in manipulative motor actions, has not been investigated in the context of APRs. The aim was to identify whether reciprocal inhibition can be observed as a strategy in the recruitment of gastrocnemius Medialis (GM), Soleus (So) and Tibialis Anterior (TA) muscles in low- and high-velocity forward and backward perturbations. We applied two balance perturbations with a low and a high velocity of displacement of the movable platform in forward and backward conditions and we evaluated the magnitude and latency time of TA, GM and So activation latency, measured by electromyography (EMG). In forward perturbations, coactivation of the three muscles was observed, with greater activation amplitude of the GM and lesser amplitude of the So and TA muscles. For backward, the pattern of response observed was activation of the TA muscle, a decrease in the EMG signal, which characterizes reciprocal inhibition of the GM muscle and maintenance of the basal state of the So muscle. This result indicates that backward perturbations are more challenging. [ABSTRACT FROM AUTHOR]

This study aimed to investigate whether patients with low back pain (LBP) had impaired lower limb proprioception and its association with somatosensory acuity. Thirty patients with LBP and 30 asymptomatic people volunteered, using Sway Discrimination Apparatus tests to assess somatosensory acuity during voluntary anteroposterior and mediolateral postural sway. Results showed significantly reduced somatosensory acuity in mediolateral sway in LBP patients (p = 0.005) with ankle, knee, and hip proprioception showing significantly impairment compared to asymptomatic controls (all p ≤ 0.012). Regression analysis showed that ankle and hip proprioception were significantly associated with somatosensory perception (0.001 ≤ p ≤ 0.026, 0.067 ≤ R2≤ 0.235). Overall, findings suggested a global deterioration of lower limb proprioception in LBP patients, with ankle and hip proprioception playing crucial role in somatosensory perception. [ABSTRACT FROM AUTHOR]

Aim: To determine the association of diabetes‐related characteristics with fractures at different sites in individuals with type 2 diabetes (T2D). Materials and Methods: We conducted a cohort study using the Clinical Practice Research Datalink (CPRD) GOLD. Patients aged over 30 years with T2D were identified within the CPRD. Patients were followed from the start of diabetes treatment until the end of data collection, death, or the occurrence of a fracture. Cox proportional hazards models were used to estimate the hazard ratios for the association of the individual characteristics (diabetes duration, glycated haemoglobin [HbA1c] level, and microvascular complications) with fracture risk, adjusted for demographics, comorbidities and comedication. Results: A diabetes duration of >10 years was associated with an increased risk of any fracture and major osteoporotic fractures (MOFs), while a diabetes duration of >8 years was associated with an increased hip fracture risk, compared to a duration <2 years. An HbA1c level <6% was associated with an increased fracture risk compared to HbA1c values of 6% to <7%. The presence of one or two microvascular complications was associated with an increased risk of any fracture and MOFs and the presence of two microvascular complications was associated with an increased hip fracture risk, compared to no microvascular complications. Conclusion: In conclusion, our study shows that a diabetes duration of 10 years or more, strict glycaemic control resulting in HbA1c levels below 6%, and/or the presence of at least one microvascular complication increased the risk of any fracture, hip fractures, MOFs, and humerus fractures, but not ankle, scapula or skull fractures. [ABSTRACT FROM AUTHOR]

Background: Etiology of osteochondral lesions of the talus (OLT) is multifactorial and may develop from trauma, genetics, or hypovascularity. The talar dome is supplied by the posterior tibial artery (PTA) and, to a lesser degree, the sinus tarsi artery (STA). The role of talar dome hypovascularity on OLT remains poorly studied. We aimed to determine any relationship between the diameter of PTA (dPTA) and STA (dSTA) and the incidence and characteristics of talus OLT. Methods: This retrospective study included 77 patients with OLT and 77 subjects as a matched control group (age range: 30-40 years). Using magnetic resonance imaging, the dPTA was measured 1 cm above the tibial plafond, at the plafond, and at the level of medial malleolar tip. Likewise, dSTA was measured at the level of the talar neck. The area, volume, depth, localization, and surgical intervention for OLT were recorded as well. Results: The study group had significantly smaller dPTA at all 3 levels (1.05 ± 0.22 mm, 0.99 ± 0.18 mm, 0.98 ± 0.31 mm, proximal to distal, respectively) compared with controls (1.25 ± 0.23 mm, 1.20 ± 0.22 mm, 1.14 ± 0.18 mm, respectively) (P <.001). The dSTA was also significantly smaller in the study group compared with the control group (0.5 ± 0.11 mm vs 0.57 ± 0.08 mm, respectively; P =.001). The mean dPTA (of all 3 levels) cutoff value for predicting the occurrence of OLT was 1.1 mm with 74% sensitivity and 75% specificity. A significant inverse correlation was observed between OLT area and arterial diameters (P <.001). Conclusion: Smaller luminal dPTA and dSTA appear to be associated with higher incidence of OLT, with defect size inversely correlated to arterial diameter. [ABSTRACT FROM AUTHOR]

Background: Therapeutic strategies for ankle osteoarthritis (OA) are determined based on OA staging, alignment, and articular cartilage conditions. However, it is difficult to evaluate the degeneration of the remaining cartilage using imaging modalities. Subchondral bone plays a crucial role in maintaining cartilage homeostasis. Measurement of local Hounsfield unit (HU) values allows for the quantitative assessment of small changes in the subchondral bone. This study aimed to evaluate a relationship between the HU values of the subchondral bone and the histologic findings of articular cartilage in ankle OA. Methods: The talar articular surface was harvested from 14 ankles during arthroplasty. The talus was divided into anterior, middle, and posterior parts, and histologic specimens were prepared. Safranin O staining was performed and histologic findings were evaluated using the modified Mankin score. The regions of interest (ROIs) were set in the medial, central, and lateral regions of the specimens and computed tomography (CT) images, and the relationship between the HU values and histologic findings was analyzed. Results: As OA progressed, cartilage defects increased. In conjunction with cartilage degeneration, the subchondral bone plate thickened, and the HU values increased. The HU value significantly and positively correlated with the modified Mankin score (r = 0.756), subchondral bone thickness (r = 0.674, P <.01), and trabecular bone area (r = 0.637). The cutoff HU values were 594 (sensitivity, 0.813; specificity, 0.944) for 3 points and 727 (sensitivity, 0.929; specificity, 0.782) for 11 points on the modified Mankin score. Conclusion: Significant correlations between HU values and cartilage degeneration in ankle OA were noted. Measuring HU values on CT images can be useful for evaluating the joint surface condition, including histologic findings of the remaining cartilage. [ABSTRACT FROM AUTHOR]

Lisfranc injuries are uncommon but frequently misdiagnosed and carry a high rate of morbidity. This review highlights the pearls and pitfalls of Lisfranc injuries, including presentation, diagnosis, and management in the emergency department (ED) based on current evidence. Lisfranc injuries are caused by high- or low-energy trauma to the tarsometatarsal (TMT) joint complex. The severity of injury exists on a spectrum, ranging from minor subluxations to fractures and dislocations involving the TMT joint complex. They can be complicated by compartment syndrome, neurovascular compromise, and open fractures. Prompt diagnosis is critical in preventing chronic pain and mobility challenges, as even small subluxations can result in significant morbidity. Lisfranc injuries should be considered in all patients with a foot injury. Patients with Lisfranc injuries most commonly present with midfoot pain, swelling, or ecchymosis. Despite the importance of a timely diagnosis, Lisfranc injuries are commonly missed on plain radiographs due to their often subtle findings. When x-rays are negative but there is significant clinical suspicion, emergency clinicians should obtain advanced imaging such as computed tomography to aid in diagnosis. All Lisfranc injuries should be discussed with orthopedic surgery to determine definitive management. Patients who can be discharged should be made non-weightbearing and placed in a short-leg splint. The consideration of Lisfranc injuries can help emergency clinicians make a timely diagnosis to prevent future complications. [ABSTRACT FROM AUTHOR]

We aimed to investigate whether there is clinical and MRI evidence of healing of lateral ligaments 6 weeks after acute lateral ankle sprain (LAS). We prospectively enrolled 18 participants (age 32.7 ± 7.5 years) who sustained an acute LAS and underwent conservative treatment. An ankle MRI was acquired up to 48 hours and 6 weeks following the LAS. A partial tear of the anterior talofibular ligament (ATFL) was observed in 10/18 and a complete tear in 8/18 of the patients. The calcaneofibular ligament (CFL) was partially torn in 11/18 and completely torn in 1/18 of the patients. The healing status, intensity, and thickness of the ligaments, Anterior Drawer Test (ADT), and FAOS scale were assessed. A control group (CG) was composed by 17 participants (age 40 ± 13.9 years). Six weeks after the LAS, 89% of the participants presented MRI evidence of ATFL healing. The repaired ATFL was thicker in comparison with the CG (p <.001). The cut-off of 2.5 mm for ATFL thickness in the 6th week maximized sensitivity (62.5%) and specificity (100%). CFL and PTFL presented 94% and 100% of healing signs, respectively. In the 6th week, 11/18 (61%) participants showed mild residual instability and a mean FAOS of 80 ± 11. The MRI revealed signs of the repair process in 89% of ATFL and 94% of CFL tears, 6 weeks after a moderate or severe LAS. The MRI findings were concomitant with enhancements in mechanical ankle stability and function. [ABSTRACT FROM AUTHOR]

Ankle arthrodesis is an effective surgical intervention for end-stage arthritis or severe ankle joint deformity. Both internal (IF) and external fixation (EF) techniques are valid options, but there is controversy regarding the most effective technique. This study compares the safety and efficacy of EF and IF fixation techniques for ankle arthrodesis. A systematic review and meta-analysis was conducted according to the Preferred reporting items for systematic reviews and meta-analyses (PRISMA) Guidelines. A literature search of electronic databases, including MEDLINE, EMBASE, and the Cochrane Central Register of Controlled Trials (CENTRAL), was performed to identify all studies directly comparing the two techniques. Both fixed and random effects models of analysis were used depending on heterogeneity. Odds of union in the EF and IF groups were comparable (OR = 0.60, CI 0.36-1.02, p =.06) however, EF was associated with greater odds of deep hardware infections (OR = 3.67, 1.97-6.83, p <.05) and amputations (OR = 3.17, CI 1.06-9.54, p =.04). Odds of revision surgery and superficial wound complications were similar between groups. EF techniques had significantly longer operation times (MD = 31.23, CI-25.11-37.34, p <.05) and intraoperative blood loss (MD = 44.1, CI 28.77-59.43, p <.05). No significant difference was noted in pain and functionality scores. IF and EF techniques have reasonable union rates with similar postoperative outcomes. [ABSTRACT FROM AUTHOR]

Most exoskeletons designed to assist users in load-bearing tasks face a mechanical dilemma in their conception. Designers may find a compromise between stiff active actuators-based architectures which are powerful but bulky and compliant actuator-based designs which are much less assistive but less constraining for users. This article presents a new open-source simulation-based design tool and a human-centered method that lets orthosis designers explore different device configurations and evaluate some performance criteria. This framework was applied in three different young-adult subjects. The effects of design personalization on user morphology and gait were studied. First, an ankle–foot orthosis designed to support a 20 kg backpack was defined according to the user's height, weight, and walking speed. Then, a simulation of the subjects fitted with their customized design walking at a self-selected speed on flat ground carrying this additional load was performed. First, the results showed that the designed method inspired by natural joint stiffness behavior provided viable personalized mechanisms. Second, significant reductions in peak joint torque and mean joint activity were observed when comparing muscle-generated torques while the subject was wearing the 20 kg backpack with ankle–foot orthoses on both legs or without. Finally, it shows the value of an open-access tool for exploring the coupling of passive and active actuators to generate lighter and more compliant designs. [ABSTRACT FROM AUTHOR]

Osteoporosis results in low-trauma fractures affecting millions globally, in particular elderly populations. Despite the inclusion of physical activity in fracture prevention strategies, the optimal bone-strengthening exercises remain uncertain, highlighting the need for a deeper understanding of lower limb joint loading dynamics across various exercise types and levels. This study examines lower limb joint loading during high-impact exercises across different intensities. A total of 40 healthy, active participants were recruited (mean ± SD: age of 40.3 ± 13.1 yr; height 1.71 ± 0.08 m; and mass 68.44 ± 11.67 kg). Motion capture data and ground reaction forces of 6 different exercises: a self-selected level of walking, running, countermovement jump, squat jump, unilateral hopping, and bilateral hopping were collected for each participant. Joint reaction forces were estimated using lower body musculoskeletal models developed in OpenSim. Running and hopping increased joint forces compared to walking, notably at the hip (83% and 21%), knee (134% and 94%), and ankle (94% and 77%), while jump exercises reduced hip and ankle loading compared to walking (36% and 19%). Joint loading varied with exercise type and intensity, with running faster increasing forces on all joints, particularly at the hip. Sprinting increased forces at the hip but lowered knee and ankle forces. Higher jumps intensified forces on all joints, while faster hopping reduced forces. The wide variation of lower limb joint loading observed across the exercises tested in this study underscores the importance of implementing diverse exercise routines to optimize overall bone health and strengthen the musculoskeletal structure. Practitioners must therefore ensure that exercise programs include movements that are specifically suitable for their intended purpose. Lay Summary: Osteoporosis is a global health concern, particularly among the elderly, leading to increased risk of fractures. Although physical activity is recommended to prevent fractures, the most effective bone-strengthening exercises remain unclear. This study aimed to quantify how different high-impact exercises affect lower limb joint loading dynamics. Forty healthy, active participants with an average age of 40 yr performed 6 exercises: walking, running, jumping, and hopping, at various intensities. Motion capture technology and computational modeling were used to analyze joint forces at the hip, knee, and ankle. Results showed that running and hopping increased joint forces compared to walking, particularly at the hip and knee. Conversely, jumping exercises reduced hip and ankle loading. Joint loading varied across exercise types and intensities; for example, running faster increased forces primarily on the hip, while jumping higher increased forces on all joints. Conversely, faster hopping reduced forces. These findings highlight the importance of incorporating diverse exercises into bone-strengthening routines to optimize overall bone health and musculoskeletal strength. Healthcare practitioners should tailor exercise programs to individual needs, ensuring they include appropriate movements for desired outcomes. Graphical Abstract [ABSTRACT FROM AUTHOR]

Context: Previous research has demonstrated that using a multicomponent approach to ankle injury preventions can significantly reduce ankle injuries; however, these studies lack specific intervention recommendations. Objective: To evaluate the exercise components of prevention programs on ankle injuries specifically in high school athletes. Secondary objectives were to assess the overall effectiveness of prevention programs on ankle injuries in this population and how compliance and education may impact success. Data Sources: A total of 5 databases were searched through September 26, 2022. Study Selection: Study inclusion criteria included randomized control trials (RCTs) investigating exercise interventions in high school athletes aged 13 to 19 years, participation in sports competition, reporting of injury incidence, and specific exercise interventions used. Study Design: Systematic review and meta-analysis. Level of Evidence: Level 1. Data Extraction: Pooled overall ankle injury incidence rate ratio and 95% CIs were calculated using random-effects meta-analysis. Results: A total of 10 studies were included, of which 9 used multicomponent exercise interventions and 1 used only balance training. Of the 10 studies, 3 demonstrated statistically significant reduction in ankle injuries. When data from all 10 studies were pooled and analyzed, there was a statistically significant overall reduction (incidence rate ratio, 0.74; 95% CI 0.60-0.91) in ankle injuries when comparing intervention groups with controls. Conclusion: The most effective injury prevention programs included multiple components, emphasized strengthening and agility exercises, and promoted high adherence to the intervention. The importance of coach and player education on how and why to perform an injury prevention program as well as the frequency and duration of programs was also important. Exercise-based injury prevention programs may reduce ankle injury incidence in youth athletes by 26% when pooling data from a multitude of sport types/settings. [ABSTRACT FROM AUTHOR]

Running style is temporally defined by a duty factor and stride frequency and believed to be related to the loading experienced during ever step. However, the exact relationship between both temporal variables and loading magnitude is still unknown. We aimed to identify the relationship between a duty factor and stride frequency with external load measures, joint reaction forces and joint moments. Thirty-one healthy female recreational runners ran across a 25-m runway at a speed of 2.30 ± 0.05 m·s-1. Ground reaction forces and motion capture data were used to determine the maximal vertical ground reaction force, the vertical instantaneous loading rate, peak braking force, peak joint extension moments and peak joint reaction forces at the knee and the ankle. The habitual duty factor and stride frequency of runners did not correlate with each other. The duty factor was found to be a significant predictor of maximal vertical ground reaction force (R2 = 0.585), peak braking force (R2 = 0.153), peak knee extension moment (R2 = 0.149), ankle plantar flexion moment (R2 = 0.225) and peak joint reaction forces at the knee (R2 = 0.591) and the ankle (R2 = 0.592), but not of the vertical instantaneous loading rate. Stride frequency had no significant predictive value. In conclusion, the maximal loading and potential injury risk of female recreational runners running with high duty factors are lower compared to those of peers running with lower duty factors. [ABSTRACT FROM AUTHOR]

The dynamical nature of gait increases fall risk for older adults as the Center of Mass (COM) is constantly displaced inside and outside the Base of Support (BOS). Foot placement and leg joint moments are the primary mechanisms controlling dynamic balance. The Margin of Stability (MOS) quantifies the distance between the COM dynamical state and the BOS. While research examined how aging affects the relationship between foot placement and MOS, the relationship to leg moments is unexamined. Examining this relationship would elucidate whether aging increases fall risk from changes in the joint moments controlling the COM. Fourteen older (66.9 ± 4.3 years) and sixteen young (26.3 ± 3.6 years) adults walked along a 12m path for three trials. The MOS, hip and ankle moments in sagittal and frontal planes were analyzed. For the knee, only the sagittal plane was analyzed. MOS was calculated as the distance between the extrapolated-COM and the Center of Pressure per step. Statistical Parametric Mapping independent t-tests assessed group differences. Cross-correlation quantified MOS and joint moment relationships per plane during single-stance. No group differences in walking speed were observed. A larger frontal plane MOS, hip abduction and ankle eversion moment occurred for older adults. Cross-correlation demonstrated moderate and strong relationships for the hip-MOS for both groups in the sagittal plane. Older adults had a larger sagittal plane hip-MOS correlation than young adults. The larger mediolateral MOS in older adults may indicate attempts to avoid lateral balance loss by shifting their COM away from their BOS lateral boundaries during single-stance. However, this strategy moves the COM toward the BOS medial borders potentially pre-maturely terminating the contralateral swing phase during medial destabilization. The stronger sagittal plane hip-MOS relationship in older adults may reflect increased coupling between hip moments and the COM to control dynamic balance. [ABSTRACT FROM AUTHOR]

Limited ankle dorsiflexion range of motion is one of the most important risk factors for lower limb injury, which changes the biomechanics and the neuromuscular control of the lower limb muscles. This study aims to test the effectiveness of a comprehensive corrective exercise program (CCEP) on the range of motion, proprioception, dynamic balance, and muscle activation in female athletes with limited weight-bearing lunge ankle dorsiflexion range of motion. 30 female athletes aged 15 to 25 years with dorsiflexion under 34° were randomized to two groups. The intervention group (n = 15) received eight weeks of CCEP including soft tissue mobilization, joint mobilization, stretching, and strengthening, and the control (n = 15) group did not receive any intervention. range of motion, proprioception, dynamic balance, and muscle activation were assessed before and after the intervention. The training group showed clinically acceptable and statistically significant changes in ankle dorsiflexion range of motion (ES = 0.714), balance (ES = 0.423), and proprioception (ES = 0.253; P < 0.05). There were significant changes in the activity of the tibialis anterior and soleus muscles in the dynamic overhead squat test (descending and ascending phases) and the activity of the medial gastrocnemius in the descending phase decreased significantly (P < 0.05). No significant change was observed in the activity of the peroneus longus muscle (P > 0.05). The findings show that CCEP appears to be beneficial in increasing dorsiflexion range of motion, proprioception, balance, and decreasing ankle muscle activity among individuals with limited ankle dorsiflexion. Improving the dorsiflexion range of motion may be promising for reducing ankle sprain injury. [ABSTRACT FROM AUTHOR]

Background: Functional correlates of spastic myopathy, the muscle disorder of spastic paresis, are unknown. Objective: To explore reciprocal relationships between clinical and structural parameters of plantar flexors with i) ambulation speed, ii) dorsiflexion and plantarflexion torques in chronic hemiparesis. Methods: Cross-sectional trial in chronic stroke-induced hemiparesis (>6 months). Plantar flexors were quantified through i) the Five Step Assessment: maximal extensibility (XV1), active range of dorsiflexion (XA); ii) ultrasonography: fascicle length (Lf) and thickness (Th) of medial gastrocnemius (GAS) and soleus (SOL), knee extended in an isokinetic ergometer, ankle at 80% XV1-GAS. Maximal isometric torques in plantar flexion (PF) and dorsiflexion (DF) and maximal barefoot 10-meter ambulation speed were collected. Relationships between structural, biomechanical, clinical and functional parameters were explored using non-parametric testing (Spearman). Results: Twenty-one subjects (age 58.0±8.4, mean±SD, time since lesion 7.8±5.7 years) were recruited, with the following characteristics: ambulation speed, 0.77±0.37m/sec; XV1-SOL 92.7±10.3°; XV1-GAS 91.3±9.6°; XA-SOL 86.9±10.0°; XA-GAS 7676±14.2°; LfGAS, 58.2±18.3mm; ThGAS, 17.1±3.6 mm; LfSOL, 36.0±9.6 mm; ThSOL, 13.8±3.3mm; PF peak-torque 46.5±34.1Nm, DF peak-torque, 20.1±19.1Nm. XA-SOL and XA-GAS strongly correlated with XV1-SOL and XV1-GAS respectively (ρ = 0.74, p = 4E-04; resp ρ = 0.60, p = 0.0052). Ambulation speed moderately correlated with LfGAS (ρ = 0.51, p = 0.054), ThGAS (ρ = 0.58, p = 0.02) and LfSOL (ρ = 0.63, p = 0.009). DF and PF peak-torques both correlated with LfGAS (ρ = 0.53, p = 0.04) a; resp. ρ = 0.71, p = 0.0015). Conclusion: In chronic hemiparesis, active dorsiflexion is mostly determined by plantar flexor extensibility. Plantar flexor fascicle shortening is associated with reduced ambulation speed and ankle torques. Attempts to restore plantar flexor extensibility might be important objectives for gait rehabilitation in chronic hemiparesis. [ABSTRACT FROM AUTHOR]

The cause of sport injuries are multifactorial and necessitate sophisticated statistical approaches for accurate identification of risk factors predisposing athletes to injury. Pattern recognition analyses have been adopted across sporting disciplines due to their ability to account for repeated measures and non-linear interactions of datasets, however there are limited examples of their use in injury risk prediction. This study incorporated two-years of rigorous monitoring of athletes with 1740 individual weekly data points across domains of training load, performance testing, musculoskeletal screening, and injury history parameters, to be one of the first to employ a pattern recognition approach to predict the risk factors of specific non-contact lower limb injuries in Rugby Union. Predictive models (injured vs. non-injured) were generated for non-contact lower limb, non-contact ankle, and severe non-contact injuries using Bayesian pattern recognition from a pool of 36 Senior Academy Rugby Union athletes. Predictors for non-contact lower limb injuries included dorsiflexion angle, adductor strength, and previous injury history (area under the receiver operating characteristic (ROC) = 0.70) Dorsiflexion angle parameters were also predictive of non-contact ankle injuries, along with slower sprint times, greater body mass, previous concussion, and previous ankle injury (ROC = 0.76). Predictors of severe non-contact lower limb injuries included greater differences in mean training load, slower sprint times, reduced hamstring and adductor strength, reduced dorsiflexion angle, greater perceived muscle soreness, and playing as a forward (ROC = 0.72). The identification of specific injury risk factors and useable thresholds for non-contact injury risk detection in sport holds great potential for coaches and medical staff to modify training prescriptions and inform injury prevention strategies, ultimately increasing player availability, a key indicator of team success. [ABSTRACT FROM AUTHOR]

Background Objectives Methods Results Conclusions The functional connectivity (FC) has emerged as a valuable tool for comprehending the cerebral operational mechanism. Understanding the FC changes in patients with chronic ankle instability (CAI) helps reveal the underlying central nervous system mechanisms of the disease and provides clues for developing personalized treatment plans.To explore differences between low‐ and high‐order FC in patients with CAI and healthy controls, as well as the correlation among the feature connections and clinical data.In our study, we recruited 40 patients with CAI and 42 healthy individuals who had not experienced ankle injuries. All participants underwent clinical assessments of ankle joints, collected the number of ankle sprains within the past 6 months, and performed resting‐state functional magnetic resonance imaging (rs‐fMRI) scans. Pearson correlation and matrix variate normal distribution (MVND) were used to construct low‐order and high‐order FC networks, respectively. Feature selections between groups were performed by two‐sample t‐tests, and a multi‐kernel support vector machine (MK‐SVM) was subsequently applied to combine the multiple connection patterns for the classification. Using leave‐one‐out cross‐validation (LOOCV) to assess classification performance and identify the consensus connections contributing most to classification.FC was reduced in certain brain regions of CAI patients. More consensus connections were recognized in low‐order FC network than in high‐order FC network. The highest classification accuracy of 91.30% was achieved by combining three connection patterns. The most discriminating functional connections were primarily centered on the default mode network and spanned the visual network, sensorimotor network, ventral attention network, and central executive network. In addition, FC strength in the left cingulate and paracingulate gyrus (DCG.L) and right superior temporal gyrus (STG.R) was negatively correlated with the number of ankle sprains in the past 6 months in all FC networks (p < 0.05).Abnormalities in connectivity in patients with CAI were observed in both low‐ and high‐order FC networks. The adaptive changes in the brain related to CAI may extend beyond the sensorimotor networks, primarily involving higher‐level default mode networks associated with attention. Moreover, the FC strength between DCG.L and STG.R may predict the risk of ankle re‐sprains and help clinicians develop personalized treatment plans. [ABSTRACT FROM AUTHOR]

Background: Lateral ankle sprains rank among the most prevalent musculoskeletal injuries, while chronic ankle instability (CAI) is its most common cascade. In addition to the conflicting results of the previous studies and their methodological flaws, the specific gait loading strategy is still not well studied. Purpose: The study aimed to investigate the fluctuations in gait loading strategy in people with chronic ankle instability compared to health control. Methods: A total of 56 male subjects participated in this study and were allocated into two groups: (A) CAI group: 28 subjects with unilateral CAI (age 24.79 ± 2.64 and BMI 26.25 ± 3.50); and (B) control group: 28 subjects without a history of ankle sprains (age 24.57 ± 1.17 and BMI 26.46 ± 2.597). Stance time, weight acceptance time, and load distribution were measured to investigate gait loading strategy. Results: The study findings revealed that the CAI group had a significant higher load over the lateral rearfoot. However, MANOVA indicates that there was no overall significant difference in gait loading strategy between the CAI and control groups. Furthermore, in terms of stance time, time of weight acceptance phase, load over medial foot, and load over lateral foot, CAI and healthy controls seemed to walk similarly. Conclusions: The findings revealed that individuals with CAI had the significant alteration in the lateral rearfoot loading, suggesting a potential compensatory mechanism to address instability during the weight acceptance phase. This could manifest a laterally deviated center of pressure and increased frontal plane inversion during the early stance phase. However, it is acknowledged that these alterations could be both the result and the origin of CAI. The study highlights the vulnerability of CAI during the early stance phase, emphasizing the need for gait reeducation as individuals return to walking as healthcare clinicians should focus on treatment modalities aimed at reducing rearfoot inversion in individuals with CAI. [ABSTRACT FROM AUTHOR]

Objectives: To quantitatively investigate the anatomy of the anterior talofibular ligament (ATFL) and calcaneofibular ligament (CFL) for surgical reconstruction procedures in chronic ankle instability (CAI). Methods: 3D MRI was performed on five fresh-frozen cadaveric ankles using six different spatial resolutions (0.3 × 0.3 × 0.3 mm3, 0.45 × 0.45 × 0.45 mm3, 0.6 × 0.6 × 0.6 mm3, 0.75 × 0.75 × 0.75 mm3, 0.9 × 0.9 × 0.9 mm3, 1.05 × 1.05 × 1.05 mm3). After comparing the MRI results with cadaver dissection, a resolution of 0.45 × 0.45 × 0.45 mm³ was selected for bilateral ankles MRI on 24 volunteers. Classification of the ATFL and four distances of surgically relevant bony landmarkers were analyzed (distance 1 and 3, the fibular origin of the ATFL and CFL to the tip of fibula, respectively; distance 2, the talar insertion of the ATFL to the bare zone of talus; distance 4, the calcaneal insertion of the CFL to the peroneal tubercle). Results: In subjective evaluation, the interobserver ICC was 0.95 (95% confidence interval (CI): 0.94–0.97) between two readers. The spatial resolution of 0.3 × 0.3 × 0.3 mm3 and 0.45 × 0.45 × 0.45 mm3 received highest subjective score on average and demonstrated highest consistency with autopsy measurements in objective evaluation. Measurements on the 48 volunteer ankles, distance 1 in type I and II were 12.65 ± 2.08 mm, 13.43 ± 2.06 mm (superior-banded in Type II) and 7.69 ± 2.56 mm (inferior-banded in Type II) (means ± SD), respectively. Distance 2 in type I and II were 10.90 ± 2.24 mm, 11.07 ± 2.66 mm (superior-banded in Type II), and 18.44 ± 3.28 mm (inferior-banded in Type II), respectively. Distance 3 and 4 were 4.71 ± 1.04 mm and 14.35 ± 2.22 mm, respectively. Conclusion: We demonstrated the feasibility of quantifying the distances between bony landmarkers for surgical reconstruction surgery in CAI using high-resolution 3D MRI. Critical relevance statement: High-resolution 3D MRI examination may have a guiding effect on the preoperative evaluation of chronic ankle instability patients. Key Points: Spatial resolutions of 0.3 × 0.3 × 0.3 mm3 and 0.45 × 0.45 × 0.45 mm3 demonstrated highest consistency with autopsy measurements. The spatial resolution of 0.45 × 0.45 × 0.45 mm3 was conformed more to clinical needs. 3D MRI can assist surgeons in developing preoperative plans for chronic ankle instability. [ABSTRACT FROM AUTHOR]

A 27-year-old female presented with persistent right medial plantar pain that developed over six months following an ankle sprain. The pain, described as sharp and radiating to the toes, progressively worsened, affecting her ability to walk. An initial ultrasound examination suggested medial plantar nerve compression by a lipoma, prompting her referral for ultrasound-guided hydrodissection. During the pre-procedure assessment, sono-palpation (palpation using the ultrasound transducer) localized the pain to the Master Knot of Henry—where the medial plantar nerve, artery, and flexor tendons intersect. No lipoma but a normal fat pad was observed. Ultrasound-guided hydrodissection with 5% dextrose mixed with lidocaine and saline was performed. After two sessions, her pain significantly decreased, with her visual analogue scale score dropping from 8 to 5 after the first session and to 2 after the second, allowing her to resume normal activities. This case highlights the value of ultrasound in accurately diagnosing and treating conditions involving the Master Knot of Henry. [ABSTRACT FROM AUTHOR]

Background/Objectives: To assess magnetic resonance image (MRI) findings in children and adolescents with atraumatic non-overload ankle pain and to identify potential anatomic risk factors. Methods: In total, 310 MRIs of 6- to 20-year-old patients were evaluated regarding detectable ankle pathologies. A total of 147 patients (68 males; 79 females) suffered from atraumatic non-overload ankle pain. The findings were compared to a control group (163 patients: 89 males; 74 females), including patients with ankle trauma in the 4 weeks prior to MRI examination. A t-test for unpaired samples and a binary logistic regression model were used to identify significant differences between both groups and determine potential anatomic risk factors. Results: In the group with atraumatic ankle pain, 95 patients (64.6%) showed at least one pathology. Anterolateral impingement of the upper ankle joint was found in 29 patients (19.7%). Its occurrence was significantly higher in atraumatic non-overload patients than in the control group (p = 0.043). Moreover, a significant correlation between anterolateral impingement of the upper ankle and the presence of hindfoot valgus malposition (n = 25; 17.0%) could be proven in atraumatic non-overload patients (p = 0.035). Conclusions: Anterolateral impingement of the upper ankle joint is frequently observed in children and adolescents suffering from atraumatic non-overload ankle pain, whereby a hindfoot valgus malposition seems to present an anatomic risk factor. [ABSTRACT FROM AUTHOR]

Ankle–foot orthoses (AFOs) are commonly prescribed to children with cerebral palsy (CP). The conventional AFO successfully controls the first and second ankle rocker, but it fails to correct the third ankle rocker, which negatively effects push-off power. The current study evaluated a new powered AFO (PAFO) design, developed to address the shortcomings of the conventional AFO. Eight children with spastic CP (12.4 ± 3.4 years; GMFCS I-III; 4/4-♂/♀; 3/5-bi/unilateral) were included. Sagittal kinematic and kinetic data were collected from 20 steps during barefoot walking, with conventional AFOs and PAFOs. In the PAFO-condition, an actuation unit was attached to a hinged AFO and through push–pull cables to a backpack that was carried by the child and provided patient-specific assistance-as-needed. SnPM-analysis indicated gait cycle sections that differed significantly between conditions. For the total group, differences between the three conditions were found in ankle kinematics (49.6–66.1%, p = 0.006; 88.0–100%, p = 0.011) and angular velocity (0.0–6.0%, p = 0.001; 45.1–51.1%, p = 0.006; 62.2–73.0%, p = 0.001; 81.2–93.0%, p = 0.001). Individual SnPM-analysis revealed a greater number of significant gait cycle sections for kinematics and kinetics of the ankle, knee, and hip. These individual results were heterogeneous and specific per gait pattern. In conclusion, the new PAFO improved the ankle range-of-motion, angular velocity, and power during push-off in comparison to the conventional AFO. [ABSTRACT FROM AUTHOR]

Fatigue specifically affects the force production capacity of the working muscle, leading to a decline in athletes' performance. This study investigated the impact of fatigue on ankle flexor muscle activity and ground reaction forces (GRFs) in elite table tennis players, with a focus on the implications for performance and injury risk. Twelve elite male table tennis athletes participated in this study, undergoing a fatigue protocol that simulated intense gameplay conditions. Muscle activity of the soleus (SOL) and gastrocnemius lateralis (GL) muscles, heel height, and GRFs were measured using a combination of wireless electromyography (EMG), motion capture, and force plate systems. Results showed a significant decrease in muscle activity in both legs post-fatigue, with a more pronounced decline in the right leg. This decrease in muscle activity negatively affected ankle joint flexibility, limiting heel lift-off. Interestingly, the maximal anteroposterior GRF generated by the left leg increased in the post-fatigue phase, suggesting the use of compensatory strategies to maintain balance and performance. These findings underscore the importance of managing fatigue, addressing muscle imbalances, and improving ankle flexibility and strength to optimize performance and reduce the risk of injuries. [ABSTRACT FROM AUTHOR]

ABSTRACT Objective Methods Results Conclusions The failure rate of foot and ankle soft tissue defect reconstruction with flap is relatively high, often posing a significant burden on patients. The aim of this study is to explore the effectiveness of repeated stretch sutures in repairing skin and soft tissue defects of the ankle and foot.Twenty‐three patients with ankle and foot skin and soft tissue defects were retrospectively analyzed between February 2016 and February 2019. Sutures were repeatedly stretched every 3–5 days. Local skin grafting was performed if necessary after wound surfaces disappeared or exposed tendons and bones were covered by soft tissue. Wound healing time, postoperative healing area, Vancouver Scar Assessment Scale, sensation, and function of the new skin were evaluated.Healing time was 17–35 (24.43 ± 5.29) days. Ten patients wholly healed, and 13 healed by approximately 70.08% ± 6.59%. The Vancouver Scar Assessment Scale average score was 2.83 ± 1.19 points, of which 15 cases were excellent (0–3 points) and 8 cases were good (4–7 points). The sensation and function of the new skin after repair were equivalent to those of normal skin after the last follow‐up.Applying repeated tension sutures on the skin and soft defects of the ankle and foot reduced the skin graft area and decreased complex high‐risk surgical flaps' use and transplantation area. [ABSTRACT FROM AUTHOR]