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Purpose: This study investigated the test–retest reliability and usefulness of the foot–ankle rebound-jump test (FARJT) for measuring foot–ankle reactive strength metrics in athletes. Methods: Thirty-six highly trained, healthy athletes (5 female; 21.5 [3.9] y; 1.80 [0.10] m; 72.7 [10.4] kg) performed 8 repeated bilateral vertical foot–ankle rebound jumps on 2 testing days. Testing days were 1 week apart, and these sessions were preceded by a familiarization session. Reactive strength metrics were calculated by dividing jump height (in meters) by contact time (in seconds) for the reactive strength index (RSI) and flight time (in seconds) by contact time (in seconds) for the reactive strength ratio (RSR). The mean of 4 jumps (excluding the first and last 2 jumps) on each testing session were considered for RSI and RSR reliability and usefulness analysis. Results: We found a high reliability of the FARJT for RSI (intraclass correlation coefficient [ICC] >.90 and coefficient of variation [CV] = 12%) and RSR (ICC ≥.90 and CV = 8%). Regarding their usefulness, both RSI and RSR were rated as "marginal" in detecting the smallest worthwhile change (typical error > smallest worthwhile change) and "good" in detecting a moderate change in performance. Conclusions: The results showed that a FARJT is a highly reliable test for measuring foot–ankle reactive strength in athletes and useful for quantifying changes, for example, following a training block. However, its usefulness as an accurate daily or weekly monitoring tool in practice is questionable. [ABSTRACT FROM AUTHOR]

Purpose: Optimal ankle dorsiflexion range of motion plays a vital role in attaining the essential crouched posture necessary for excelling in speed skating. The purpose of this study was to determine how the ankle dorsiflexion angle evolves throughout a day of training and to identify the factors that influence this angle. Methods: Thirty short-track speed skaters, from 2 teams, participated in this study. The maximum ankle dorsiflexion angle was obtained in a lunge position facing a wall, using a digital inclinometer. All measures were obtained 3 times per side, 6 times per day, on 2 training days separated by at least a week. We conducted multiple tests to study the impact of repetition, day, side, team level, sex, and moment on the ankle dorsiflexion angle. Results: The 3 times repeated measures and the 2 days of training did not have a significant influence on the results. There was a statistically significant difference between the first time point of the day and the 5 other time points for both ankles. Moreover, the influence of sex and team level was not statistically significant. Conclusions: The results indicate that there are significant changes in ankle dorsiflexion range of motion but only after the first warm-up of the day. Such findings could enable team staff to enhance athletes' precompetition preparation and tailor ankle mobility training regimens more effectively. [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]

Prior studies have explored the relationship between knee valgus and musculoskeletal variables to formulate injury prevention programs, primarily for females. Nonetheless, there is insufficient evidence pertaining to professional male soccer players. Here, the aim was to test the correlation of lateral trunk inclination, hip adduction, hip internal rotation, ankle dorsiflexion range of motion, and hip isometric strength with knee valgus during the single-leg vertical jump test. Twenty-four professional male soccer players performed a single-leg vertical hop test, hip strength assessments, and an ankle dorsiflexion range of motion test. A motion analysis system was employed for kinematic analysis. Maximal isometric hip strength and ankle dorsiflexion range of motion were tested using a handheld dynamometer and a digital inclinometer, respectively. The correlation of peak knee valgus with peak lateral trunk inclination was.43 during the landing phase (P =.04) and with peak hip internal rotation was −.68 (P <.001). For knee valgus angular displacement, only peak lateral trunk inclination presented a moderate positive correlation (r =.40, P =.05). This study showed that trunk and hip kinematics are associated with knee valgus, which could consequently lead to increased knee overload in male professional soccer players following a unilateral vertical landing test. [ABSTRACT FROM AUTHOR]

Context: Posterior shoulder tightness evaluated as limited glenohumeral internal rotation and horizontal adduction is a risk factor for throwing-related shoulder and elbow injuries. Given that the throwing motion uses the entire body kinematics, limited lower-limb flexibility might be associated with posterior shoulder tightness. Therefore, we aimed to investigate the relationships between posterior shoulder tightness and lower-limb flexibility in college baseball players. Design: Cross-sectional study. Setting: University laboratory. Participants: Twenty-two college baseball players (20 right-handed and 2 left-handed). Methods: To investigate the relationships between glenohumeral range of motion and lower-limb flexibility using simple linear regression analysis, we measured passive range of motion of glenohumeral internal rotation and horizontal adduction, hip internal/external rotation in the prone/sitting position, ankle dorsiflexion, and quadriceps and hamstrings flexibility from both shoulders and legs. Results: Our analysis indicated that decreases in the lead leg hip external rotation in the prone position were moderately associated with limitations in glenohumeral internal rotation (R2 =.250, β [95% confidence interval, CI] = 0.500 [0.149 to 1.392], P =.018) and horizontal adduction (R2 =.200, β [95% CI] = 0.447 [0.051 to 1.499], P =.019) on the throwing shoulder. Furthermore, there were significant moderate relationships between decreases in glenohumeral internal rotation and limited lead leg quadriceps flexibility (R2 =.189, β [95% CI] = 0.435 [0.019 to 1.137], P =.022), and between decreases in glenohumeral horizontal adduction and limited stance leg ankle dorsiflexion (R2 =.243, β [95% CI] = 0.493 [0.139 to 1.438], P =.010). Conclusion: College baseball players with limited lower-limb flexibilities including the lead leg hip external rotation in the prone position, the lead leg quadriceps flexibility, and the stance leg ankle dorsiflexion showed excessive posterior shoulder tightness. The current results support the hypothesis that lower-limb flexibility is associated with posterior shoulder tightness in college baseball players. [ABSTRACT FROM AUTHOR]

Our study aimed to examine preoperative differences in strength and balance between dominant foot (DF) and nondominant foot (non-DF) of individuals undergoing ligament stabilization surgery in the general population. Patients with records of preoperative evaluation, including isokinetic dynamometric strength evaluation, Y-balance test (YBT), and Foot and Ankle Outcome Score (FAOS), were included in the study. The DF was the preferred leg for accurately kicking a ball through a goal. Statistical analysis determined the differences between DF and non-DF and the correlations between muscle strength, balance, and FAOS. There was no statistically significant difference between DF and non-DF regarding evertor and invertor muscle strength (p=0.082–0.951). The YBT revealed no significant difference between the two groups (p=0.082–0.951). There was a significant correlation between the evertor peak torque and total work deficits at 30°/s (p=0.022), as well as the evertor peak torque deficit at 120°/s (p=0.048). No significant differences in muscle strength and balance were found between DF and non-DF in nonathletes with chronic ankle instability. Peroneal muscle strength deficit was associated with functional impairment. Tailored interventions are needed to address limb dominance and muscle strength deficits in CAI management. [ABSTRACT FROM AUTHOR]

The peroneus longus graft has gained much attention in recent years as a reliable autograft for primary ACL surgery. Critics have voiced concerns related to its impact on ankle biomechanics. The current review aims to synthesize the available literature on ankle biomechanics after peroneus harvest. The quantum of evidence available shows that PL harvest does not significantly impact ankle eversion or plantarflexion strength. Its impact on gait needs to be studied more deeply before any significant conclusions can be drawn. [ABSTRACT FROM AUTHOR]

Individuals with neuromuscular pathologies are often prescribed an ankle-foot orthosis (AFO) to improve their gait mechanics by decreasing pathological movements of the ankle and lower limb. AFOs can resist or assist excessive or absent muscular forces that lead to tripping, instability, and slow inefficient gait. However, selecting the appropriate AFO with mechanical characteristics, which limit pathological ankle motion in certain phases of the gait cycle while facilitating effective ankle movement during other phases, requires careful clinical decision-making. The aim of this study is to propose an explicit methodology for the adjustment of multi-function articulated AFOs in clinical settings. A secondary aim is to outline the evidence supporting this methodology and to identify gaps in the literature as potential areas for future research. An emerging class of AFO, the multi-function articulated AFO, offers features that permit more comprehensive, iterative, and reversible adjustments of AFO ankle alignment and resistance to ankle motion. However, no standard method exists for the application and optimization of these therapeutic devices in the clinical setting. Here we propose an evidence-guided methodology applicable to the adjustment of multi-function articulated AFOs in the clinical setting. Characteristic load-deflection curves are given to illustrate the idealized yet complex resistance-angle behavior of multi-function articulated AFOs. Research is cited to demonstrate how these mechanical characteristics can help mitigate specific pathologic ankle and knee kinematics and kinetics. Evidence is presented to support the effects of systematic adjustment of high resistance, alignable, articulated AFOs to address many typical pathomechanical patterns observed in individuals with neuromuscular disorders. The published evidence supporting most decision points of the algorithm is presented with identified gaps in the evidence. In addition, two hypothetical case examples are given to illustrate the application of the method in optimizing multi-function articulated AFOs for treating specific gait pathomechanics. This method is proposed as an evidence-guided systematic approach for the adjustment of multi-function articulated AFOs. It utilizes observed gait deviations mapped to specific changes in AFO alignment and resistance settings as a clinical tool in orthotic treatment for individuals with complex neuromuscular gait disorders. [ABSTRACT FROM AUTHOR]

In the present study, we examined the immediate effect of allowing healthy participants to view their mirror-reflected body image on static and dynamic balance. We placed a mirror to allow participants to frontally view their own body image while maintaining a quiet stance or while engaged in a dynamic postural standing task. On measures of body sway during quiet stance, there were no effects of this visual feedback, supporting the view that human beings have no central mechanism for viewing the mirror-reflected body image to control body sway during quiet stance. However, the body deviated forward during quiet stance while viewing the mirror-reflected body image, indicating that viewing the mirror-reflected body image contributed to the anterior-posterior positioning of the body, as mediated by an ankle control strategy. For the dynamic standing task, viewing the body image induced unstable peaks of rhythmic lateral shifting of the body weight over the feet. This indicates that viewing the body image caused unstable motor commands for rhythmic lateral weight shifting. When participants made a transition from a bipedal to a unipedal stance in response to a cue, viewing the body image shortened the onset latency of the body sway. Accordingly, viewing the body image seemed to accelerate the motor execution involved in lateral weight shifting, possibly due to predictive activation of the motor system before movement onset. Considered collectively, we found static and dynamic stance balance to be influenced by viewing one's mirror-reflected body image. Viewing the mirror-reflected body image may be a means of changing static and dynamic balance in patients with impaired postural control. [ABSTRACT FROM AUTHOR]

We evaluated whether the clinical outcomes, including postoperative knee range of motion (ROM), after unicompartmental knee arthroplasty (UKA) were associated with the sagittal spinopelvic parameters and coronal alignment of the full lower extremity. Forty-two patients (50 knees: six men, seven knees; 36 women, 43 knees) who underwent medial UKA between April 2015 and December 2022 were included. Preoperative radiographic examinations of the index for sagittal spinopelvic alignment included the sagittal vertical axis (SVA), lumbar lordosis, sacral slope (SS), pelvic tilt (PT), and pelvic incidence. The anteroposterior hip-knee-ankle angle (HKAA) was calculated. The relationship of clinical outcomes and the risk of knee flexion angle ≤125° and knee flexion contracture ≥10° 1-year post-UKA with radiographic parameters were evaluated. Preoperative HKA angle affected postoperative knee flexion angle ≤125° (p = 0.017, 95% confidence interval [CI]: 0.473–0.930) in logistic regression analysis. Patients with a knee flexion angle ≤125° had a higher preoperative HKAA (9.8 ± 3.0°), higher SVA (83.8 ± 37.0 mm), and lower SS (23.7 ± 9.0°) than those with a flexion angle >125° (preoperative HKAA: 6.6 ± 4.0°, SVA: 40.3 ± 46.5 mm, SS: 32.0 ± 6.3°) (p = 0.029, 0.012, and 0.004, respectively). PT related to postoperative knee flexion contracture ≥10° (p = 0.010, 95% CI: 0.770–0.965) in the logistic regression analysis. Patients with flexion contracture ≥10° had higher PT (35.0 ± 6.6°) and SVA (82.2 ± 40.5 mm) than those with flexion contracture <10° (PT, 19.3 ± 9.0°; SVA, 42.4 ± 46.5 mm) (p = 0.001 and 0.028, respectively). The postoperative clinical outcome was correlated with the postoperative knee flexion angle and SVA (p = 0.036 and 0.020, respectively). The preoperative HKAA affected postoperative knee flexion angle, and the knee flexion contracture and clinical outcomes post-UKA were associated with PT and SVA, respectively. To predict outcomes for knee ROM and clinical scores after UKA, radiographic examination, including the sagittal spinopelvic parameters and the coronal view of the full lower extremity, is essential. [ABSTRACT FROM AUTHOR]

Background: High tibial osteotomy (HTO) aims to realign the varus knee to alleviate stress in the medial compartment. However, detailed information on the impact of HTO on stress distribution across the tibiofemoral joint surface still needs to be completely elucidated. Purpose/Hypothesis: The present study aimed to analyze the subchondral bone density distribution to validate the alignment threshold causing paradoxical changes. We hypothesized that there would be a paradoxical stress change in the medial compartment beyond a specific threshold for lower limb realignment after HTO. Study Design: Case series; Level of evidence, 4. Methods: A retrospective clinical study of 32 knees from 30 patients who underwent medial opening-wedge HTO between 2015 and 2019 was conducted at Hokkaido University Hospital. The subchondral bone density across the tibiofemoral joint was analyzed using computed tomography–osteoabsorptiometry before and after HTO. The high-density area (HDA) within the medial and lateral compartments and their subregions, which were quartered in the coronal plane, was specifically examined. Results: The hip-knee-ankle angle, medial proximal tibial angle (MPTA), joint line obliquity (JLO), and joint line convergence angle significantly changed after HTO (P <.01). The HDA of the medial compartment to the total HDA ratio decreased from 83% to 77%. Paradoxically, the HDA in the most central subregion of the medial compartment increased from 24% to 30%. There were significant differences between MPTA and JLO in patients with and without paradoxical changes in the HDA. MPTA and JLO cutoff values causing paradoxical changes in the HDA were 94° and 4°, respectively. Conclusion: There was a paradoxical stress increase in the M4 region at the medial compartment associated with the MPTA and JLO beyond specific thresholds. Therefore, surgical planning should be cautiously performed to prevent overcorrection, which can lead to adverse stress distribution changes. [ABSTRACT FROM AUTHOR]

Introduction: A concern expressed by the clinical community is that the constraint of motion provided by an ankle foot orthosis (AFO) may lead the user to become dependent on its stiffness, leading to learned non-use. To examine this, we hypothesized that using an experimental AFO-footwear combination (exAFO-FC) that constrains ankle motion during walking would result in reduced soleus and tibialis anterior EMG compared to free (exAFOFC) and control (no AFO, footwear only) conditions. Method: A total of 14 healthy subjects walked at their preferred speed (1.34 ± 0.09 m·s-1) for 15min, in three conditions, namely, control, free, and stop. Results: During the stance phase of walking in the stop condition, ipsilateral soleus integrated EMG (iEMG) declined linearly, culminating in a 32.1% reduction compared to the control condition in the final 5 min interval of the protocol. In contrast, ipsilateral tibialis anterior iEMG declined in a variable fashion culminating in an 11.2% reduction compared to control in the final 5 min interval. During the swing phase, the tibialis anterior iEMG increased by 6.6% compared to the control condition during the final 5 min interval. The contralateral soleus and tibialis anterior exhibited increased iEMG in the stop condition. Discussion: An AFO-FC functions as a biomechanical motion control device that influences the neural control system and alters the output of muscles experiencing constraints of motion. [ABSTRACT FROM AUTHOR]

Purpose: The purpose of our work was to demonstrate the surgical technique of ankle arthrodesis using the minimally-invasive transfibular (MITF) approach, which minimizes soft tissue damage and is advantageous for high-risk patients. Methods: In this prospective study, a total of 12 patients with end-stage varus ankle osteoarthritis, including high-risk individuals, underwent ankle arthrodesis using the MITF approach. The technique involves a unique osteotomy at the joint space level, minimizing soft tissue detachment from the fibula. The primary outcomes assessed included bony union, time to weight-bearing, correction of varus deformity, and functional outcomes measured by the American Orthopedic Foot and Ankle Society (AOFAS) hindfoot scale. However, the study's limitations encompass a small sample size and the absence of a control group. Results: At 6 months post-operation, all patients achieved bony union, with a mean time to union of 13.7 ± 5.2 weeks. The average time to initiate weight-bearing without additional support was 11.2 ± 3.8 weeks. Preoperative varus deformity (17.08 ± 8.36 degrees) and talar tilt (8.75 ± 4.33 degrees) were successfully corrected, with postoperative alignment within 0–5 degrees of valgus. Functional outcomes showed a significant improvement in AOFAS scores from 37.83 ± 7.79 points preoperatively to 77.42 ± 5.63 points one year after surgery (p = 0.002). Minor complications occurred in two patients, both effectively treated with local therapy and antibiotics. Conclusions: The MITF approach for ankle arthrodesis demonstrates promising results in addressing end-stage varus ankle osteoarthritis, even in high-risk patients. However, the study's limitations highlight the need for a prospective comparative clinical trial with a larger sample size to ascertain the technique's effectiveness and safety definitively. [ABSTRACT FROM AUTHOR]

BACKGROUND: Patients with Parkinson's disease frequently experience problems with balance and gait. OBJECTIVE: This study examined the influences of regular ankle isokinetic muscle strength training on muscle strength and balance ability amongst elderly women with mild Parkinson's disease. METHODS: A total of 55 elderly women with mild Parkinson's disease were randomly divided into the experimental group (n = 28) and the control group (n = 27) for 16 weeks. The experimental group was trained for 16 weeks by using isokinetic muscle strength training. RESULTS: After 16 weeks of training in the experimental group, the peak torque (PT) of ankle (average of the left and right sides) dorsiflexion, plantarflexion, eversion and inversion, and the standing balance index revealed that the left and right stability and overall stability indexes significantly increased by 25.9%, 43.5%, 62.7%, 82.8%, 37.1% and 32.2%, respectively (p < 0.05). The experimental group exhibited significantly increased PT of ankle dorsiflexion, plantarflexion, eversion and inversion. Moreover, the left and right stability and overall stability indexes were significantly improved compared with those of the control group (p < 0.05). This study found a linear regression relationship between the PT of ankle inversion and overall stability index. CONCLUSION: This study determined that ankle isokinetic muscle strength training improved ankle dorsiflexion, plantarflexion, eversion and inversion muscle strength, and balance ability amongst elderly women with mild Parkinson's disease. However, it did not improve stability in the anterior and posterior directions. Ankle inversion muscle strength is more likely to affect overall balance. [ABSTRACT FROM AUTHOR]

Lateral ankle sprain (LAS) is one of the most common types of injury in professional football (soccer) players with high risk of recurrence. The rehabilitation after LAS in professional football players is often still time-based and relies on anecdotal experience of clinicans. There is still a lack of utilization of criteria-based rehabilitation concepts after LAS in professional football. The aims of this clinical commentary are (1) to critically discuss the need for criteria-based rehabilitation concepts after LAS in professional football players, (2) to highlight the current lack of these approaches and (3) to present a novel clinical guideline-based rehabilitation algorithm. Short time-loss (15 days) and high recurrence rate (17%) raise the question of trivialization of LAS in professional football. Despite consequences for many stakeholders involved (players, teams, clubs, insurers), there is still a lack of of criteria-based, step-by-step approaches. The use of a criteria-based rehabilitation approach might reduce the high recurrence rate after LAS in professional football players and will lead, in turn, to increased long-term player availability. Practical experiences of he authors demonstrate the feasibility of such an approach. The effectiveness of this novel rehabilitation algorithm remains to be evaluated in future studies. Level of Evidence: 5 INTERNATIONAL JOURNAL OT SPOKR PHYSICAL TOEBAfY [ABSTRACT FROM AUTHOR]

This study aimed to validate a 7-sensor inertial measurement unit system against optical motion capture to estimate bilateral lower-limb kinematics. Hip, knee, and ankle sagittal plane peak angles and range of motion (ROM) were compared during bodyweight squats and countermovement jumps in 18 participants. In the bodyweight squats, left peak hip flexion (intraclass correlation coefficient [ICC] =.51), knee extension (ICC =.68) and ankle plantar flexion (ICC =.55), and hip (ICC =.63) and knee (ICC =.52) ROM had moderate agreement, and right knee ROM had good agreement (ICC =.77). Relatively higher agreement was observed in the countermovement jumps compared to the bodyweight squats, moderate to good agreement in right peak knee flexion (ICC =.73), and right (ICC =.75) and left (ICC =.83) knee ROM. Moderate agreement was observed for right ankle plantar flexion (ICC =.63) and ROM (ICC =.51). Moderate agreement (ICC >.50) was observed in all variables in the left limb except hip extension, knee flexion, and dorsiflexion. In general, there was poor agreement for peak flexion angles, and at least moderate agreement for joint ROM. Future work will aim to optimize methodologies to increase usability and confidence in data interpretation by minimizing variance in system-based differences and may also benefit from expanding planes of movement. [ABSTRACT FROM AUTHOR]

The aim of our study was to compare the force steadiness and the discharge characteristics of motor units in the tibialis anterior (TA) during ankle dorsiflexion and foot adduction produced by submaximal isometric contractions with the dominant and non-dominant foot. Fifteen young men performed maximal and submaximal contractions at five target forces with both legs, and motor unit activity in TA was recorded using high-density electromyography. Maximal force and the fluctuations in force during submaximal contractions were similar between the two legs (p > 0.05). Motor unit activity was characterized by measures of mean discharge rate (MDR), coefficient of variation for interspike interval (CoV for ISI), and standard deviation of the filtered cumulative spike train (SD of fCST). There were no statistically significant differences in motor unit activity between legs during ankle dorsiflexion. In contrast, the MDR and the CoV for ISI but not the SD of fCST, were greater for the non-dominant foot compared with the dominant foot during foot adduction. Nonetheless, these differences in motor unit activity were not sufficient to influence the force fluctuations during the submaximal contractions. These results indicate that control of the force produced by TA during the two actions was not influenced by limb dominance. [ABSTRACT FROM AUTHOR]

To determine how lateral shuffling/lateral shuffle (LS) -induced fatigue affects ankle proprioception and countermovement jump (CMJ) performance. Eighteen male college athletes performed 6 modes of a repeated LS protocol with 2 distances (2.5 and 5 m) and 3 speeds (1.6, 1.8, and 2.0 m/s). After LS, ankle inversion proprioception (AIP) was measured using the active movement extent discrimination apparatus (AMEDA). CMJ, blood lactate (BLa), heart rate (HR) and rating of perceived exertion (RPE) were measured before and after LS. The number of changes of direction (CODs) in each protocol was recorded. LS-induced fatigue was evident in BLa, HR and RPE (all p < 0.05), increasing with shorter shuffle distance and faster speed. RM-ANOVA showed a significant distance main effect on both AIP (p < 0.01) and CMJ (p < 0.05), but the speed main effect was only significant for CMJ (p ≤ 0.001), not AIP (p = 0.87). CMJ performance was correlated with BLa, HR and RPE (r values range from -0.62 to -0.32, all p ≤ 0.001). AIP was only correlated with CODs (r = -0.251, p < 0.01). These results suggested that in LS, shorter distance, regardless of speed, was associated with worse AIP, whereas subsequent CMJ performance was affected by both LS distance and speed. Hence, AIP performance was not related to physiological fatigue, but CMJ performance was. Results imply that LS affects processing proprioceptive input and producing muscular output differently, and that these two aspects of neuromuscular control are affected by physiological fatigue to varying degrees. These findings have implications for injury prevention and performance enhancement. [ABSTRACT FROM AUTHOR]

BACKGROUND: Many studies have reported that exercise increases physical flexibility; however, no study has verified whether patients perceive an increase in physical flexibility after exercise. OBJECTIVE: This study investigates the correlations between increased duration of exercise and the self-rated flexibility (SRF) and those between the SRF and quantitative flexibility. Variations in the SRF between males and females were also investigated. METHODS: The SRF of the hip (S-Hip) and ankle (S-Ankle) were rated by participants who completed a questionnaire. The range of motion of the hip (M-Hip) and ankle (M-Ankle) were measured using the straight leg raise test and dorsiflexion, respectively. RESULTS: No significant correlation between exercise duration and S-Hip and S-Ankle were identified. S-Hip and S-Ankle (p < 0.001) and S-Hip and M-Hip (p < 0.001) were significantly correlated, though S-Ankle and M-Ankle were not (p = 0.660). The exercise duration, S-Hip, and S-Ankle were not significantly different between males and females. CONCLUSIONS: Given the significant correlation between hip flexibility and SRF and no gender effect, SRF may serve as a useful clinical indicator. [ABSTRACT FROM AUTHOR]

Objective. The purpose of this study will be to determine the efficacy of low intensity lower extremity resistance training with and without blood flow restriction (BFR) on quadriceps muscle strength and thickness in veterans with advanced multiple sclerosis (MS). Methods. This will be an assessor-blinded, 2-group (1 to 1 allocation) randomized controlled trial targeting an enrollment of 58 participants with advanced MS as defined by Patient-Determined Disease Steps scale levels 4 to 7. Both groups will complete 10 weeks of twice weekly low-load resistance training (20%-30% of 1-repetition max) targeting knee and hip extension, knee flexion, and ankle plantarflexion. The intervention group will perform all training using BFR, with limb occlusion pressures between 60% and 80% of maximal limb occlusion pressure. Primary outcomes will be quadriceps muscle strength and thickness. Secondary outcomes will include knee flexion and ankle plantarflexion strength, functional mobility, physical activity, and patient-reported measures. All outcomes will be assessed at baseline before the intervention, immediately after the intervention, and at a 2-month follow-up assessment. The change between groups postintervention and after the 2-month follow-up will be reported for all outcomes. All analyses will assume a 2-sided test of hypothesis (α =.05). Impact. There is very little evidence for the efficacy of exercise interventions in people with MS who have advanced mobility disability. Resistance training with BFR may be an important approach for people with advanced MS who may not tolerate more conventional, moderate-to-high intensity resistance training. The results of this study will inform clinicians regarding exercise decisions for people with advanced MS and future investigations on the role of BFR in people with MS. [ABSTRACT FROM AUTHOR]

Objectives: Diabetic foot syndrome is becoming increasingly common in India with a prevalence ranging from 24.9% to 49%. Diabetic foot syndrome patients have an increased likelihood of developing ulcers in their feet. Accordingly, this study evaluates the influence of photobiomodulation on altered plantar pressure distribution and ankle biomechanics in individuals with diabetic foot syndrome. Methods: A total of 20 diabetic foot syndrome patients with an absence of 10 g monofilament in one out of six sites at the plantar surface of feet, a biothesiometer for vibration perception threshold of >20 V, and diminished or absent ankle reflexes were included. The evaluation of ankle biomechanics was performed by SIMI motion analysis. In addition, the plantar pressure distribution was measured by the WinTrack pressure platform at baseline and the end of 10 sessions. They were treated with scanning mode on the foot plantar surface and probe laser at the popliteal fossa region for three sessions per week, for ten sessions. Results: Plantar pressure parameters were significantly improved (P<0.01) and ankle biomechanics (P<0.01) after the intervention, respectively, except for no significant difference in the total contact area and ankle midstance kinematics. Discussion: Photobiomodulation therapy can be an effective treatment for improving foot plantar pressure redistribution and ankle biomechanics in individuals with diabetic foot syndrome [ABSTRACT FROM AUTHOR]

Background: The aim of this study is to evaluate the use of isolated gastrocnemius release in the treatment of Achilles tendinopathy. The primary outcome is the change in patient-reported pain outcomes. Secondary outcomes include the change in patient-reported foot and ankle function, ankle range of motion and strength, patient satisfaction and rate of surgical complications. Methods: A systematic review was undertaken of studies involving patients treated with an isolated gastrocnemius release for Achilles tendinopathy. Randomised controlled trials, cohort studies, case–control studies and case series were eligible and identified from the following databases: MEDLINE and EMBASE. Results: Isolated gastrocnemius release results in improved patient-reported outcome scores for pain and foot and ankle function. There is an increase in ankle range of motion but a reduction in ankle strength. Patients report a high rate of overall satisfaction. The most common surgical complications are sural nerve injury and wound infection. Conclusions: Isolated gastrocnemius release may offer maintained and clinically meaningful improvements in pain and foot and ankle function with an associated reduction in ankle strength. [ABSTRACT FROM AUTHOR]

BACKGROUND: Haemophilic arthropathy is likely to influence posture and muscle stiffness in adolescent male haemophilia patients (HP). OBJECTIVE: This study aimed to investigate the possible change in upright standing posture and stiffness of the superficial postural muscles in HP. METHODS: Twenty-two HP aged between 12 and 19 years and twenty-two healthy peers were included in the study. The photogrammetry was used to assess the upright standing posture from sagittal and frontal planes. Also, stiffness of the superficial postural muscles was evaluated using the myotonometry. RESULTS: A significant difference was found in the craniovertebral, lumbar lordosis, knee flexion-valgus, and ankle plantar flexion angles between the groups (p < 0.05). Craniovertebral, knee flexion, and knee valgus angles were lower; whereas lumbar lordosis and ankle plantar flexion angles were higher in HP compared to the healthy peers. Stiffness of the rectus femoris muscle was lower in HP (p < 0.001). CONCLUSION: This study revealed that the ankle, knee, lumbar, and craniovertebral segments' posture angles were changed and the stiffness of the rectus femoris muscle decreased in HP. Postural alterations and reduced rectus femoris stiffness should be considered in management of the musculoskeletal complications of haemophilia. [ABSTRACT FROM AUTHOR]

The anterior cruciate ligament (ACL) injury stands as a significant concern in judo, necessitating preventive measures. The primary injury mechanism involves knee collapse in valgus, often linked to deficiencies in core strength, neuromuscular control, external rotators, hip abductors, and limitations in ankle and hip mobility. Sex-wise, the injury is more prevalent in women across various sports. Therefore, in the present study we observed this possible intersexual disparity in the difference of movement patterns among elite judokas according to their sex, in order to identify those athletes with a higher risk of ACL injury. Notably, there were no discernible differences between sexes in the single leg squat test. Both men and women exhibited compromised neuromuscular control in the non-dominant leg. While ankle dorsiflexion and hip external rotation showed no gender disparities, differences in internal rotation were noted. This particular movement restriction may elevate the risk of ACL injury. [ABSTRACT FROM AUTHOR]

Purpose: This research compares the effectiveness of weight-bearing exercise on a rebounder, as well as ankle exercise therapy on biomechanics and quality of life (QoL) in patients with diabetic neuropathic feet. Methods: The present investigation is a clinical trial study with two experimental groups and one control group. A total of 48 women... [ABSTRACT FROM AUTHOR]

Background: The medial longitudinal arch (MLA) plays a major role in maintaining the biomechanics of the foot and is maintained with the help of active and passive systems. Dysfunction of active and passive support system can lead to a reduction of navicular height, leading to excessive pronation of the foot known as pes planus. Pes planus is caused by injury, prolonged stress on the foot, obesity, and faulty biomechanics which will result in posterior tibial tendon dysfunction, collapse of the foot archand flat foot. The patients with posterior tibial tendon dysfunction and pesplanus have reduced dorsiflexion and increased eversion. So, the aim was to study the effects of instrument assisted soft tissue mobilization and foot strengthening exercise on navicular height and ankle range of motion in college students with flexible flat feet. Method: Total 40 students were recruited for the study as per selection criteria and were divided into two groups (20 in each group). Group A was treated with Instrument Assisted Soft Tissue Mobilization (IASTM)and group B was treated with Foot Strengthening Exercise for five days a week for 4 weeks. Inter-group analysis by Mann Whitney U-test showed statistically significant improvement in navicular height and ankle range of motion (P value ≤ 0.001). Conclusion: This study showed statistically significant improvement in navicular height and ankle ROM with the use of IASTM and foot strengthening exercise. However, IASTM was found to be more effective in improving ankle ROM and foot strengthening exercise was found to be more effective in increasing navicular height. [ABSTRACT FROM AUTHOR]

Introduction: Stroke is the sudden loss of neurological function caused by an interruption of the blood flow to the brain. Initially, some 80% of all patients with stroke experience motor impairments of the contralateral limb, i.e hemiparesis. Mirror therapy is relatively new therapeutic intervention that focuses on moving the unimpaired limb. Likewise, another technique called Mental imagery is the cognitive rehearsal of a task in the absence of movement. Aim and Objectives: To compare mirror therapy and mental imagery in improving ankle motor recovery in acute stroke patients. Methodology: 30 stroke patients were selected in the study, and were randomly assigned into two groups. Group A i.e. Mirror Therapy group (n=15) or the Group B i.e. Mental Imagery group (n=15). Both the groups received 30 minutes of their respective therapy that is mirror therapy and mental imagery and in addition to 30 minutes of conventional therapy which included neuro developmental facilitation technique, stretching, gait training that is a total of 1 hour per day for 5 days a week for 4 weeks. Modified Ashworth Scale, 10 Meter Walk test (10MWT), Fugl-Meyer assessment Lower extremity (FMA-LE) scale were administered pre and post intervention to assess the ankle motor function. Results: Only Fugl Meyer Assessment scores on comparison between Group A (Mirror Therapy) and Group B (Mental Imagery) revealed that statistically significant improvement was found in Group B (Mental Imagery) (t-value: 2.140; p-value: .041*). Conclusion: The present study concluded that Mental Imagery proved to be more effective than Mirror Therapy in improving ankle motor recovery in acute stroke patients. [ABSTRACT FROM AUTHOR]

This study aims to determine the reliability of the hand-eye coordination Software. The integrated control of hand and eye movements, as well as the processing of visual information to support attainment and acquisition and the use of hand proprioception to guide the eyes, are known as hand-eye coordination. Thus, this study aims to determine the reliability of the tests, so the research was conducted thrice with an interval of 6-7 days (testretest). 28 Young Adults (18- 35 years of age) have participated in the study. The analysis includes finger-pointing tasks performed only with the use of Hand-eye coordination software prepared by the Software engineer. In this Software, Visual targets in the form of a ball then appeared on the screen on the left, on the right, or in the center in random order., and participants were asked to point an index finger of the leading hand as rapidly and precisely as possible at all targets on the screen. After touching the target (indicated by its disappearance), the participant immediately placed his/her hand back in the designated starting position (touchpad).Each participant was required to repeat this finger-pointing task. The accuracy value after 1 minute was recorded and the average accuracy value was calculated and used in the analysis A smaller value indicates greater touch accuracy. In addition, the average reaction time (in milliseconds) was also measured. Based on the data analysis, the reliability score is 0.806 (Cronbach's Alpha), which indicates a high level of internal Consistency. [ABSTRACT FROM AUTHOR]

Context: Elite golfers have a high incidence of low back pain. Recent reviews have emphasized the need for investigation into how to prevent low back pain in golfers, prompting the current study. Design: Prospective longitudinal cohort study. Methods: Forty-one injury-free golfers were included in this study. At baseline, lower quadrant joint angles and club and ball performance were measured while each golfer performed 10 drives. The golfers were then monitored for 6 months and were allocated into 2 groups depending on whether or not they developed low back pain. The initial, baseline kinematic variables of the low back pain group and the uninjured group were then compared. Results: Over the 6-month monitoring period, 17 (41%) of the golfers developed low back pain. At baseline assessment, the low back pain group had 4° less lead ankle dorsiflexion at setup (P = .01; effect size = 0.82), 6° less lead knee flexion at the top of the backswing (P = .05; effect size = 0.64), 6° less lead ankle dorsiflexion at the top of the backswing (P = .01; effect size = 0.82), 6° more trail hip adduction at the top of the backswing (P = .02; effect size = 0.79), 9° more trail knee flexion at impact (P = .05; effect size = -0.64), and 6° more trail hip adduction at the end of follow through (P < .00; effect size = 1.00). Conclusion: Golfers who developed low back pain during the 6-month monitoring period displayed distinct differences in biomechanics at baseline when all golfers were injury free. These biomechanical differences may be considered a precursor to injury. Three-dimensional motion analysis may indicate whether elite golfers are at risk of developing low back pain. Research is needed to assess whether targeted exercise and sports drills aimed at addressing the biomechanical risk factors identified may prevent low back pain in elite golfers. [ABSTRACT FROM AUTHOR]

The purpose was to compare two non-laboratory based running retraining programs on lower limb and trunk kinematics in recreational runners. Seventy recreational runners (30 ± 7.3 years old, 40% female) were randomised to a barefoot running group (BAR), a group wearing a digital metronome with their basal cadence increased by 10% (CAD), and a control group (CON). BAR and CAD groups included intervals from 15 to 40 min over 10 weeks and 3 days/week. 3D sagittal kinematics of the ankle, knee, hip, pelvis, and trunk were measured before and after the retraining program, at comfortable and high speeds. A 3 × 2 mixed ANOVA revealed that BAR and CAD groups increased knee and hip flexion at footstrike, increased peak hip flexion during stance and flight phase, decreased peak hip extension during flight phase, and increased anterior pelvic tilt at both speeds after retraining. In addition, BAR increased ankle plantar flexion at footstrike and increased anterior trunk tilt. Both retraining programs demonstrated significant moderate to large effect size changes in parameters that could reduce the mechanical risks of injury associated with excessive knee stress, which is of interest to coaches, runners and those prescribing rehabilitation and injury prevention programs. [ABSTRACT FROM AUTHOR]

BACKGROUND: To measure hamstring flexibility, the active knee extension (AKE) test is preferred over the straight leg raise (SLR) test as it can be used to measure hamstring flexibility more selectively. However, hamstring stretching is primarily conducted in the SLR position (maximal hip flexion in the supine position) as it allows for maximal hip flexion in the supine position. OBJECTIVE: This study evaluates the effects of proprioceptive neuromuscular facilitation (PNF) stretching in the AKE position (maximal knee extension with 90∘ flexion of the hip in the supine position) on hip, knee, and ankle flexibility. METHODS: SLR, AKE, and active dorsiflexion (ADF) tests were used to determine the range of motion (ROM) before (pre-ROM) and after (post-ROM) stretching. PNF stretching consisted of maximal isometric knee flexion at the end range with external resistance to prevent knee flexion. One set of PNF stretches (five trials of six seconds each) was conducted. RESULTS: The post-ROMs of hip, knee, and ankle measured via the SLR, AKE, and ADF tests, respectively, were significantly higher than the pre-ROMs. CONCLUSIONS: The improvement in knee flexibility was greater than the improvement in hip and ankle flexibility. The AKE position is recommended in clinical settings during PNF stretching for individuals with hamstring tightness. Furthermore, PNF stretching in the AKE position increases the ADF ROM. [ABSTRACT FROM AUTHOR]

Lateral ankle sprains, predominantly involving the anterior talofibular ligament (ATFL) and calcaneofibular ligament (CFL), constitute a significant portion of sports-related injuries, with a notable rate of recurrence and progression to chronic instability. Precise diagnosis and effective treatment of the ATFL and CFL injuries are crucial in preventing long-term complications. Musculoskeletal (MSK) diagnostic ultrasound has emerged as a pivotal tool in the rehabilitation sector, particularly in assessing lateral ankle ligament injuries. This article will highlight its benefits over traditional diagnostic methods and the emerging role of MSK diagnostic ultrasound as a superior tool for accurate, cost-effective, and comprehensive assessment of these injuries. We discuss the technology's ability to provide objective, real-time imagery, facilitating accurate diagnosis, treatment planning, and injury monitoring emphasizing the need for a standardized approach to ultrasound evaluation to improve diagnostic accuracy and patient outcomes. [ABSTRACT FROM AUTHOR]

Individual performance in team sports is a multifactorial reflection of how well a player can cope and accomplish tasks in varied playing situations. Thus, performance analysis should not only focus on outcomes, but also on underlying mechanisms of those outcomes. We adopted principles of the ecological dynamics approach (EDA) to investigate the effect of introducing constraints on players' joint coordination responses for a football-specific performance drill outcome. Seventeen talented youth football (soccer) players performed a football-specific drill under different conditions: basic constraints, additional defender dummies, stroboscopic glasses, and a combination of the latter two constraints. We recorded these players' execution time, passing accuracy, and lower extremity joint kinematics. We calculated joint coordination for hip-knee, knee-ankle, and trunk-hip couplings. The added constraints negatively affected execution time and passing accuracy, and caused changes in joint coordination. Furthermore, we identified a relationship between execution time and joint coordination. This study serves as an example how the EDA can be adopted to investigate mechanisms that underlie individual performance in team sports. [ABSTRACT FROM AUTHOR]

Background and objectives: In anterior cruciate ligament reconstruction, the strength of the graft was found to be unsatisfactory usually the anterior half of the peroneus longus tendon was taken for supplementation, but the effect on foot and ankle function and gait in the donor area is unclear. This study aims to explore the changes in the ankle and gait after using the harvested anterior half of the peroneus longus tendon as a reconstruction graft for the anterior cruciate ligament. Methods: A total of 20 patients, 6 males and 14 females, aged 18 to 44 years, with unilateral anterior cruciate ligament injuries, underwent reconstruction using the harvested anterior half of the peroneus longus tendon as a graft between June 2021 and December 2021. The part on which the anterior half of the peroneus longus tendon was harvested was considered the experimental group, while the contralateral foot was the control group. At the 6-month follow-up, the Lysholm knee score, AOFAS ankle score, and gait-related data (foot length, arch index, arch volume, arch volume index, and gait cycle parameters: percentage of time in each gait phase, step frequency, step length, foot strike angle, and push-off angle) were assessed using a 3D foot scanner and wearable sensors for both groups. Results: All 20 patients completed the six-month follow-up. There were no statistically significant differences between the experimental and control groups regarding knee scores, ankle scores, foot length, arch index, arch volume, arch volume index, step frequency, and step length (P > 0.05). However, there were statistically significant differences between the experimental and control groups in terms of the gait cycle parameters, including the percentage of time in the stance, mid-stance, and push-off phases, as well as foot strike angle and push-off angle (P < 0.05). Conclusion: Through our study of the surgical experimental group we have shown that harvesting the anterior half of the peroneus longus tendon does not affect foot morphology and gait parameters; however, it does impact the gait cycle. [ABSTRACT FROM AUTHOR]

Preinjury Knee and Ankle Mechanics during Running Are Reduced among Collegiate Runners Who Develop Achilles Tendinopathy. Med. Sci. Sports Exerc., Vol. 56, No. 1, pp. 128-133, 2024. Introduction: Achilles tendinopathies (AT) are common in runners, but prospective data assessing running mechanics associated with developing AT are limited. Asymmetry in running mechanics is also considered a risk factor for injury, although it is unknown if the problematic mechanics occur on the injured limb only or are present bilaterally. Purpose: This study aimed to prospectively identify differences in preinjury running biomechanics in collegiate runners who did and did not develop AT and determine if between-limb asymmetries were associated with which limb developed AT. Methods: Running gait data were obtained preseason on healthy collegiate cross-country runners, and AT incidence was prospectively recorded each year. Spatiotemporal, ground reaction forces, and joint kinematics and kinetics were analyzed. Linear mixed-effects models assessed differences in biomechanics between those who did and did not develop AT during the subsequent year. Generalized linear mixed-effects models determined if the asymmetry direction was associated with which limb developed an AT, with odds ratios (OR) and 95% confidence intervals (95% CI) reported. Results: Data from 106 runners were analyzed and 15 developed AT. Preinjury biomechanics of runners who developed AT showed less peak knee flexion (noninjured: 45.9° (45.2°–46.6°), injured: 43.2° (41.5°–44.9°), P < 0.001), ankle dorsiflexion (noninjured: 28.7° (28.0°–30.2°), injured: 26.0° (23.8°–28.3°), P = 0.01), and knee extensor moment (noninjured: −2.18 (N·m)·kg-1 (−2.24 to −2.12 (N·m)·kg-1 ), injured: −2.00 (N·m)·kg-1 (−2.17 to -1.84 (N·m)·kg-1 ), P = 0.02). The limb demonstrating less peak knee flexion had greater odds of sustaining an AT (OR, 1.29 (1.00–1.65), P = 0.05). Conclusions: Knee and ankle kinematics, in addition to knee kinetics, were associated with developing an AT. Monitoring these mechanics may be useful for prospectively identifying runners at risk of developing AT. [ABSTRACT FROM AUTHOR]

Background: The treatment of distal tibia fractures (DTF) has historically been a difficult challenge for orthopedic surgeons because of the particular characteristics of this anatomical region. Intra medullary nailing (IMN) remains the best treatment option. However, achieving and maintaining perfect reduction and stable fixation with IMN can be technically challenging due to the large medullary cavity within a short distal fragment. The aim of our study is to determine the risk factors for malunion in DTF treated with IMN. Methods: It is a retrospective study including DTF treated surgically by IMN in the Orthopedics and Trauma Department at a tertiary hospital over a period of 7 years. The quality of reduction was evaluated by radiological assessment of the antero-posterior (AP) and lateral views of the tibia and ankle at the last follow-up. Results: Our series included 90 patients with an average age of 44.8 years. Sex-ratio was 2.6. Tobacco use was reported in 35.6% of the patients. Diabetes was present in 11.1% of the patients, and 12.2% of them had open fractures. According to the OTA/AO classification, the majority of injuries were classified as type A1 (76.7%). Fibula fractures were present in 86.7% of cases. The mean follow-up was 48 months. Malunion occurred in 13 cases. Based on the univariate analysis, smoking and dynamic fixation were significantly associated with malunion. In the multiple logistic regression analysis, dynamic fixation was found to be a significant factor that increased the risk of malunion by 7.5 times. Conclusion: Neither patient demographics nor fracture characteristics were risk factors for malunion. Nevertheless, it should be noted that dynamic nailing must be avoided as it is associated with a higher risk of malunion. Furthermore, one to two medial to lateral distal locking screws provide sufficient stability without the need for additional fibular fixation. Trial registration: Not applicable. [ABSTRACT FROM AUTHOR]

As people age there is a proximal shift of joint moment generation from ankle plantarflexion and knee extension toward hip extension and flexion moments. This age-related redistribution has been documented in the context of propulsive force generation during the push-off phase with less evidence in the context of weight bearing. Additionally, these sagittal plane joint moments have been a primary focus of studies though the hip frontal plane moment also contributes to vertical support but has received less attention. Furthermore, how aging affects the relationships between changes in sagittal and frontal joint moments and changes in vertical support force as a function of walking speed remains unclear How does aging affect the contributions of sagittal and frontal plane joint moments to weight-bearing across different walking speeds? Gait analysis was performed on 24 young and 17 healthy older subjects walked on the treadmill at their preferred and 30 % faster speeds. Stepwise linear regression analysis was performed to determine the joint moments that predict the peak amplitudes of the vertical ground reaction force (VGRF) across different walking speeds. Hip abduction and knee extension moments were the primary contributors to leading limb weight-bearing in young, whereas hip extension moment was the primary contributor in older adults. Ankle plantarflexion moment was the main contributor to trailing limb weight-bearing in young and hip flexion moment was the main contributor in older adults. From preferred to faster walking speed changes in knee extension moment were the primary contributor to changes in the trailing limb weight-bearing in young whereas changes in hip extension moment were the primary contributor in olderadults. These findings suggested that older and younger adults used different joint moment contributions to produce leading limb and trailing limb vertical support forces across different walking speeds. • Older and younger adults used different weight-bearing strategies during gait. • Hip abduction moment is a key factor to leading limb weight bearing only in young. • Distal to proximal joint moment redistribution was observed in older adults. • Older adults showed reduced trailing limb weight bearing at fast walking speed. [ABSTRACT FROM AUTHOR]

Ankle arthroscopy is commonly performed using a thigh tourniquet and is thought to improve visibility and reduce operative time. However, the current evidence is unclear as to whether the use of a tourniquet provides these benefits. The aim of this study was to investigate whether there is any clinical benefit of using a tourniquet in ankle arthroscopy. A systematic review following PRISMA guidelines was undertaken. All clinical studies published in Medline, Embase, PubMed and the Cochrane Library Database from inception until January 2023 reporting on the use of a tourniquet in ankle arthroscopy were included. 180 studies were identified of which 3 (164 patients) met the inclusion criteria. All studies showed no statistically significant difference in mean surgical time and complication rate between the tourniquet and non-tourniquet groups. Overall, the quality of the evidence was moderate to poor without data in favour or against the routine use of tourniquets in ankle arthroscopy. The current literature suggests that there are no significant differences in mean surgical time and complication rate between the tourniquet and non-tourniquet groups. [ABSTRACT FROM AUTHOR]

Introduction: Ankle-foot orthosis (AFO) and functional electrical stimulation (FES) are commonly used interventions for patients with foot drop caused by a central neurological origin. The aimof this systematic review is to analyze the available evidence on the improvement of gait endurance in people with foot drop caused by a central neurological origin when comparing effectiveness of AFO and FES. The secondary aim is to evaluate the available evidence for the difference between the use of FES and AFO on perception of walking function. Methods: A literature search was conducted using MEDLINE/PubMed, Cochrane, JBI, CINAHL, Nursing and Allied Health, Ovid Emcare, PsycInfo, Scopus, and Web of Science. All articles published through July 2020 were included in this review. Randomized control trials or crossover trials addressing the comparison of AFO to FES in people with foot drop of central neurological origin on gait endurance and perception of improvement in walking function were assessed. PEDro scale was used to assess methodological quality. Two independent reviewers screened titles, abstracts, and full articles, and a third reviewer resolved any disagreements. Results: Twenty-five records were screened with 16 full-text articles assessed for eligibility using the PEDro score. Eleven final studies (PEDro scores range from 5 to 7) were included in qualitative analysis. Only two of the nine studies that evaluated gait endurance reported significant improvement in gait endurance in favor of FES. Seven of the eight studies evaluated the participant preference of device for various walking functions, which showed significance in favor of the use of FES. Conclusions: Our review reveals inconclusive evidence to support the use of FES compared with AFO for improving gait endurance. However, qualitative analysis of device preference for walking by participants reveals that FES was the preferred device in this population compared with AFO. Clinical Relevance: For patients with foot drop of central nervous system pathology, FES or AFO can be used to improve gait endurance. However, FES may be the preferred device by participants for their walking function. [ABSTRACT FROM AUTHOR]

Background: Early identification of people at risk for cognitive decline is an important step in delaying the occurrence of cognitive impairment. This study investigated whether multimodal signals assessed using electroencephalogram (EEG) and gait kinematic parameters could be used to identify individuals at risk of cognitive impairment. Methods: The survey was conducted at the Veterans Medical Research Institute in the Veterans Health Service Medical Center. A total of 220 individuals volunteered for this study and provided informed consent at enrollment. A cap-type wireless EEG device was used for EEG recording, with a linked-ear references based on a standard international 10/20 system. Three-dimensional motion capture equipment was used to collect kinematic gait parameters. Mild cognitive impairment (MCI) was evaluated by Seoul Neuropsychological Screening Battery-Core (SNSB-C). Results: The mean age of the study participants was 73.5 years, and 54.7% were male. We found that specific EEG and gait parameters were significantly associated with cognitive status. Individuals with decreases in high-frequency EEG activity in high beta (25-30 Hz) and gamma (30-40 Hz) bands increased the odds ratio of MCI. There was an association between the pelvic obliquity angle and cognitive status, assessed by MCI or SNSB-C scores. Results from the ROC analysis revealed that multimodal signals combining high beta or gamma and pelvic obliquity improved the ability to discriminate MCI individuals from normal controls. Conclusion: These findings support prior work on the association between cognitive status and EEG or gait, and offer new insights into the applicability of multimodal signals to distinguish cognitive impairment. [ABSTRACT FROM AUTHOR]

Background:. Ankle sprain happens more regularly in the athletic population. It results from the straining of ankle ligaments or collagen which produces the partial or full disruption of the ligaments fibers. Ankle injuries most commonly occur in the climbing of the wall, indoor volleyball and events that occur in the grassland. This study was designed to inspect the effectiveness of balance training and strengthening exercise among the athletes with ankle sprain. Purpose: To compare the effectiveness of balance training and strengthening exercise on pain and functional performance among the athletes with ankle sprain. Materials and Methods: Total of 50 participants were selected according to the inclusion and exclusion criteria from the ortho speciality Neha clinic. The participants were treated for four weeks. The study duration from October 2022 to july 2023. Subjects willing to participate were randomly allocated into two groups: balance training group and strengthening exercise group. All the subjects underwent pretest measurement with VAS, FAAM and the same procedure repeated for post-test at the end of 4 weeks. Results: The collected data was statistically analyzed using an unpaired t-test. When comparing the balance training group to the strengthening exercise group, the balance training group indicates more significant effects (p<0.0001) than the strengthening exercise in lowering pain and improving the functional performance, as assessed by VAS and FAAM. Conclusion: Balance training was found to be more effective than strengthening exercise in reducing pain and improving functional performance among athletes with ankle sprain. [ABSTRACT FROM AUTHOR]

Classical ballet dancing is a good model for studying the long-term activity-dependent plasticity of the central nervous system in humans, as it requires unique ankle movements to maintain ballet postures. The purpose of this study was to investigate whether postactivation depression is changed through long-term specific motor training. Eight ballet dancers and eight sedentary subjects participated in this study. The soleus Hoffmann reflexes were elicited at after the completion of a slow, passive dorsiflexion of the ankle. The results demonstrated that the depression of the soleus Hoffmann reflex (i.e., postactivation depression) was larger in classical ballet dancers than in sedentary subjects at two poststretch intervals. This suggests that the plastic change through long-term specific motor training is also expressed in postactivation depression of the soleus Hoffmann reflex. Increased postactivation depression would strengthen the supraspinal control of the plantarflexors and may contribute to fine ankle movements in classical ballet dancers. [ABSTRACT FROM AUTHOR]

Context: It is unclear if lower-extremity joint cooling alters biomechanics during a functional movement. Objective: To investigate the effects of unilateral lower-extremity cryotherapy on movement alterations during a single-leg drop jump. Design: A crossover design. Setting: Laboratory. Patients: Twenty healthy subjects (10 males and 10 females; 23 y, 169 cm, 66 kg). Intervention(s): Subjects completed a single-leg drop jump before and after a 20-minute ankle or knee joint cooling on the right leg, or control (seated without cooling) on 3 separate days. Main outcome measures: Time to peak knee flexion, vertical ground reaction force, lower-extremity joint angular velocity (sagittal plane only), and angle and moment (sagittal and frontal planes) in the involved leg over the entire ground contact (GC; from initial contact to jump-off) during the first landing. Time to peak knee flexion was compared using an analysis of variance; the rest of the outcome measures were analyzed using functional analyses of variance (P < .05). Results: Neither joint cooling condition changed the time to peak knee flexion (F2,95 = 0.73, P = .49). Ankle joint cooling reduced vertical ground reaction force (55 N at 4% of GC), knee joint angular velocity (44°/s during 5%-9% of GC), and knee varus moment (181 N·m during 18%-20% of GC). Knee joint cooling resulted in a reduction in knee joint angular velocity (24°/s during 37%-40% of GC) and hip adduction moment (151 N·m during 46%-48% of GC), and an increase in hip joint angular velocity (16°/s during 49%-53% of GC) and plantarflexion angle (1.5° during 11%-29% of GC). Conclusion: Resuming activity immediately after lower-extremity joint cooling does not seem to predispose an individual to injury during landing because altered mechanics are neither overlapping with the injury time period nor of sufficient magnitude to lead to an injury. [ABSTRACT FROM AUTHOR]

Differences in walking biomechanics between groups or conditions should be greater than the measurement error to be considered meaningful. Reliability and minimum detectable differences (MDDs) have not been determined for lower-extremity angles and moments during walking within a session, as needed for interpreting differences in cross-sectional studies. Thus, the purpose of this study was to determine within-session reliability and MDDs for peak ankle, knee, and hip angles and moments during walking. Three-dimensional gait analysis was used to record walking at 1.25 m/s (±5%) in 18 men, 18-50 years of age. Peak angles and moments were calculated for 2 sets of 3 trials. Intraclass correlation coefficients (3, 3) were used to determine within-session reliability. In addition, MDDs were calculated. Within-session reliability was good to excellent for all variables. The MDDs ranged from 0.9° to 3.6° for joint angles and 0.06 to 0.15 N·m/kg for joint moments. Within-session reliability for peak ankle, knee, and hip angles and moments was better than the between-session reliability reported previously. Overall, our MDDs were similar or smaller than those previously reported for between-session reliability. The authors recommend using these MDDs to aid in the interpretation of cross-sectional comparisons of lower-extremity biomechanics during walking in healthy men. [ABSTRACT FROM AUTHOR]

Background: Orthopedic surgery is a specialty at risk for medical malpractice claims. We aimed to assess the frequency of alleged malpractice cases related to orthopedic surgery in the Netherlands from the last 15 years. Methods: We systematically searched the database of the Dutch Medical Disciplinary Court for verdicts related to orthopedic surgery between January 2009 and July 2023 and extracted case data and data on allegations and outcomes. Results: We identified 158 verdicts (mean of 10.5 per year), of which 151 (96%) were filed against specialists and 7 (4%) against residents. Cases were most frequently classified as incorrect treatment/diagnosis (n = 107, 67.7%). Cases were related to the subspecialties of knee (n = 34, 21.5%), hip (n = 31, 19.6%), ankle (n = 25, 15.8%), spine (n = 22, 13.9%), and shoulder (n = 19, 12.0%). A total of 32 cases (20.3%) were judged as partially founded and 9 (6%) as founded. The Dutch Medical Disciplinary Court imposed 28 warnings, 10 reprimands, and 3 temporary suspensions. A total of 68 appeals were submitted, of which 95% were rejected for filing patients. In three instances, unfounded verdicts were changed to two warnings and a reprimand. In four appeals by an orthopedic surgeon, a warning and reprimand were dismissed, and two reprimands were changed to warnings. Conclusions: The amount of malpractice cases against orthopedic surgeons in the Netherlands is relatively low. The cases in our study may improve our understanding of allegations against physicians and improve the quality of patient care. [ABSTRACT FROM AUTHOR]

Importance: Recently, peroneus longus (PL) autograft as a graft choice for ligament surgeries have attracted interest due to studies showing good clinical outcomes and minimal donor site morbidity. There remain concerns related to these grafts, especially the potential impact on ankle functions. Aims/Objective: The purpose of this review and meta-analysis is to summarize the available evidence for ankle functional outcomes after PL harvest. This will provide objective clinical evidence for surgical decision making. Evidence Review: Cochrane, Embase, Medline, and Google Scholar were all searched for articles published between January 2001 and May 2021. For the aim of a systematic review, certain inclusion and exclusion criteria were adopted in accordance with PRISMA recommendations. The primary outcome measure was the assessment of ankle functional outcomes using validated instruments (such as AOFAS score, FADI score etc.) Findings: A total of twelve studies representing pooled patient populations of 537 patients were included in this review. The average follow-up duration was 17 months (range; 6–32 months) across all studies. All twelve studies assessed AOFAS score and six studies also additionally assessed FADI score. The pooled mean outcomes measured showed a slight decrease in post-operative as compared to pre-operative AOFAS and FADI score (mean difference of AOFAS 1.92, 95% CI 1.021–3.123, p value < 0.05 and mean difference for FADI 1.50, 95% CI 0.561–2.445, p value < 0.05). Though statistically significant the magnitude of variance implies minimal clinical impact. Conclusion and Relevance: This review and meta-analysis found that PL autograft harvest leads to statistically significant but minimal impact on ankle functional outcomes. This, in conjunction with various studies on ankle parameters after PL harvest, shows that PL harvest leads to minimal impact on ankle outcomes and function. Level of Evidence: Systematic review Level III. [ABSTRACT FROM AUTHOR]

The ankle is the cause of many musculoskeletal injuries. Knowledge of ankle anatomy and physiology can provide an initial framework to help clinicians formulate a differential diagnosis. A thorough history should be obtained, with a focus on mechanism of injury and symptom duration to hone the differential diagnosis and physical examination. Specific diagnostic maneuvers allow for evaluation of individual structures and assessment of ankle stability. The Ottawa Ankle Rules can assess the need for x-rays and help rule out underlying fracture. Lateral and medial ankle sprains and Achilles tendinopathy are among the most common ankle conditions in the primary care setting. These sprains are managed with ankle protection with a splint, brace, or other device; the rest, ice, compression, and elevation (RICE) protocol; and a short course of nonsteroidal anti-inflammatory drugs (NSAIDs). Management of Achilles tendon conditions typically consists of the RICE protocol, activity reduction, physical therapy or clinician-directed exercises, NSAIDs, and, in severe cases, short-term immobilization. For patients with stable ankle fractures, various orthoses can be used for immobilization. Orthopedic consultation should be sought for patients with unstable ankle fractures. [ABSTRACT FROM AUTHOR]

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Copyright of Enfermagem Brasil is the property of Atlantica Editora and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

This study investigated the exercise-induced effects on the neuromuscular function of ankle evertors, balance control associated with trail running, and sexrelated interactions. Fourteen male and 14 female medium-level runners completed a 16-km (400 D+) course. At rest and immediately after running, maximal voluntary isometric contraction (MVC) and rate of force development (RFD) for knee extension and ankle eversion, electromyographic (EMG) activity of peroneus muscles during MVC plateau (EMG) and the first 200 ms (EMG200), ankle angular velocity (ωINV) during 20 weight-bearing inversion movements, and balance control during destabilizing single-leg task were evaluated. Repeated measures ANOVA-revealed changes in knee and ankle MVC (ankle: P = 0.0004, -12%) and RFD (ankle: P < 0.0001, -19%),EMG (P < 0.0001, -17%),EMG200 (P < 0.0001, -19%), and ankle vINV (P < 0.0001, +35%) in response to trail running. Single-leg balance was not impaired. Sex-related differences were observed in EMG and EMG200 with higher values in men than in women. MVC and RFD were greater in men when expressed in absolute values, but not different relative to body mass. Single-leg balance and ankle vINV did not differ between men and women. Finally, none of these variables showed any sex-related difference when considering pre-exercise to postexercise changes. This study demonstrated impairment in neuromuscular function of evertor muscles and ability in braking inversion in response to trail running. Sex-related differences were observed in neuromuscular activity but not in fatigability. These data suggest that coaches might implement strength exercises specifically designed for ankle lateral stability into their training program. [ABSTRACT FROM AUTHOR]