Charcot foot: Skin temperature as a good clinical parameter for predicting disease outcome

Twenty-eight diabetics presenting with acute Charcot foot were immobilized and the temperature difference between limbs measured at each month. All patients had monthly follow-up visits for a year and the relapse rate was zero. We found that skin temperature is a good parameter to ensure safe immobilization withdrawal. (C) 2011 Elsevier Ireland Ltd. All rights reserved.

Attenuation of foot pressure during running on four different surfaces: asphalt, concrete, rubber, and natural grass

The practice of running has consistently increased worldwide, and with it, related lower limb injuries. The type of running surface has been associated with running injury etiology, in addition other factors, such as the relationship between the amount and intensity of training. There is still controversy in the literature regarding the biomechanical effects of different types of running surfaces on foot-floor interaction. The aim of this study was to investigate the influence of running on asphalt, concrete, natural grass, and rubber on in-shoe pressure patterns in adult recreational runners. Forty-seven adult recreational runners ran twice for 40 m on all four different surfaces at 12 +/- 5% km . h(-1). Peak pressure, pressure-time integral, and contact time were recorded by Pedar X insoles. Asphalt and concrete were similar for all plantar variables and pressure zones. Running on grass produced peak pressures 9.3% to 16.6% lower (P < 0.001) than the other surfaces in the rearfoot and 4.7% to 12.3% (P < 0.05) lower in the forefoot. The contact time on rubber was greater than on concrete for the rearfoot and midfoot. The behaviour of rubber was similar to that obtained for the rigid surfaces - concrete and asphalt - possibly because of its time of usage (five years). Running on natural grass attenuates in-shoe plantar pressures in recreational runners. If a runner controls the amount and intensity of practice, running on grass may reduce the total stress on the musculoskeletal system compared with the total musculoskeletal stress when running on more rigid surfaces, such as asphalt and concrete.

EVALUATION OF THE PASSIVE RESISTIVE TORQUE IN FEMALE ATHLETES WITH ANKLE SPRAIN

Introduction: The ankle sprain is one of the most common injuries in athletes. Direct evaluation of the ligament laxity can be obtained through the objective measurement of extreme passive inversion and eversion movements, but there are few studies on the use of the evaluation of the passive resistive torque of the ankle to assess the capsule and ligaments resistance. Objective: The aim of this study was to compare the inversion and eversion passive torque in athletes with and without ankle sprains history. Method: 32 female basketball and volleyball athletes (16.06 +/- 0.8 years old; 67.63 +/- 8.17 kg; 177.8 +/- 6.47 cm) participated in this study. Their ankles were divided into two groups: control group (29), composed of symptom-free ankles, and ankle sprain group, composed of ankles which have suffered injury (29). The resistive torque at maximum passive ankle movement was measured by the isokinetic dynamometer and the muscular activity by electromyography system. The athletes performed 2 repetitions of inversion and eversion movement at 5, 10 and 20 degrees/s and the same protocol only at maximum inversion movement. Results: The resistive passive torque during the inversion and eversion was lower in the ankle sprain group. This group also showed lower torques at the maximum inversion movement. No differences were observed between inversion and eversion movement. Conclusions: Ankle sprain leads to lower passive torque, indicating reduction of the resistance of the lateral ankle ligaments and mechanical laxity.

Ankle-Brachial Index: A Simple Way to Predict Mortality among Patients on Hemodialysis - A Prospective Study

Background: Ankle-brachial index (ABI) can access peripheral artery disease and predict mortality in prevalent patients on hemodialysis. However, ABI has not yet been tested in incident patients, who present significant mortality. Typically, ABI is measured by Doppler, which is not always available, limiting its use in most patients. We therefore hypothesized that ABI, evaluated by a simplified method, can predict mortality in an incident hemodialysis population. Methodology/Principal Findings: We studied 119 patients with ESRD who had started hemodialysis three times weekly. ABI was calculated by using two oscillometric blood pressure devices simultaneously. Patients were followed until death or the end of the study. ABI was categorized in two groups normal (0.9-1.3) or abnormal (<0.9 and >1.3). There were 33 deaths during a median follow-up of 12 months (from 3 to 24 months). Age (1 year) (hazard of ratio, 1.026; p = 0.014) and ABI abnormal (hazard ratio, 3.664; p = 0.001) were independently related to mortality in a multiple regression analysis. Conclusions: An easy and inexpensive technique to measure ABI was tested and showed to be significant in predicting mortality. Both low and high ABI were associated to mortality in incident patients on hemodialysis. This technique allows nephrologists to identify high-risk patients and gives the opportunity of early intervention that could alter the natural progression of this population.

Comparison of multisensory and strength training for postural control in the elderly

Objective: The objective of this study was to analyze the efficacy of multisensory versus muscle strengthening to improve postural control in healthy community-dwelling elderly. Participants: We performed a single-blinded study with 46 community-dwelling elderly allocated to strength (GS, n = 23; 70.18 +/- 4.8 years 22 women and 1 man) and multisensory exercises groups (GM, n = 23; 68.8 +/- 5.9 years; 22 women and 1 man) for 12 weeks. Methods: We performed isokinetic evaluations of muscle groups in the ankle and foot including dorsiflexors, plantar flexors, inversion, and eversion. The oscillation of the center of pressure was assessed with a force platform. Results: The GM group presented a reduction in the oscillation (66.8 +/- 273.4 cm(2) to 11.1 +/- 11.6 cm(2); P = 0.02), which was not observed in the GS group. The GM group showed better results for the peak torque and work than the GS group, but without statistical significance. Conclusion: Although the GM group presented better results, it is not possible to state that one exercise regimen proved more efficacious than the other in improving balance control.

Perception of social support by individuals with diabetes mellitus and foot ulcers

OBJECTIVE: To evaluate the perception of social support and the relationship of sociodemographic, clinical and metabolic control variables in individuals with diabetes mellitus and foot ulcers in an outpatient unit. METHODS: A quantitative cross-sectional approach was carried out using a social support network inventory. RESULTS: Participants had a high perception of social support; family and health professionals were identified as the main support sources. Fasting plasma glucose values were directly related with social support. CONCLUSION: Family members were identified as the main support source, which emphasizes their importance in the health care process.

Isokinetic analysis of ankle and ground reaction forces in runners and triathletes

OBJECTIVE: To analyze and compare the vertical component of ground reaction forces and isokinetic muscle parameters for plantar flexion and dorsiflexion of the ankle between long-distance runners, triathletes, and nonathletes. METHODS: Seventy-five males with a mean age of 30.26 (±6.5) years were divided into three groups: a triathlete group (n=26), a long-distance runner group (n = 23), and a non-athlete control group. The kinetic parameters were measured during running using a force platform, and the isokinetic parameters were measured using an isokinetic dynamometer. RESULTS: The non-athlete control group and the triathlete group exhibited smaller vertical forces, a greater ground contact time, and a greater application of force during maximum vertical acceleration than the long-distance runner group. The total work (180º/s) was greater in eccentric dorsiflexion and concentric plantar flexion for the non-athlete control group and the triathlete group than the long-distance runner group. The peak torque (60º/s) was greater in eccentric plantar flexion and concentric dorsiflexion for the control group than the athlete groups. CONCLUSIONS: The athlete groups exhibited less muscle strength and resistance than the control group, and the triathletes exhibited less impact and better endurance performance than the runners.

Instrumentos de avaliação para limitações funcionais associadas à instabilidade crônica de tornozelo: uma revisão sistemática da literatura

A instabilidade de tornozelo é definida como a sua tendência para sofrer falseios e entorses de repetição após a ocorrência de entorse lateral. Como a presença de instabilidade é definida por meio das queixas relatadas pelo indivíduo, apresenta caráter subjetivo, sendo importante identificar o melhor instrumento de avaliação para a determinação de sua presença e/ou gravidade. O objetivo deste estudo foi revisar, de forma sistemática, instrumentos de avaliação concebidos para pacientes com instabilidade crônica de tornozelo. Foram realizadas pesquisas bibliográficas nas bases de dados PubMed, Embase, BVS, LILACS e SciELO para identificar os instrumentos elegíveis. No total, seis estudos foram incluídos e apresentaram cinco instrumentos diferentes - Foot and Ankle Disability Index (FADI), Ankle Joint Functional Assessment Tool (AJFAT), Foot and Ankle Ability Measure (FAAM), Ankle Joint Functional Assessment Tool (AII) e Cumberland Ankle Instability Tool (CAIT). Foram encontrados instrumentos com qualidade que detectam limitações funcionais em indivíduos com instabilidade crônica de tornozelo, não sendo instrumentos válidos para diagnóstico de instabilidade. O CAIT mostrou-se a ferramenta mais completa, mas não foi validada em uma população específica de indivíduos com condição de instabilidade do tornozelo. Observa-se a necessidade de mais estudos clinimétricamente válidos a fim de atestar a sua validade para se obter uma ferramenta eficaz e completa da instabilidade funcional do tornozelo.

Spatial mechanisms for modelling the human ankle passive motion

Knowledge on how ligaments and articular surfaces guide passive motion at the human ankle joint complex is fundamental for the design of relevant surgical treatments. The dissertation presents a possible improvement of this knowledge by a new kinematic model of the tibiotalar articulation. In this dissertation two one-DOF spatial equivalent mechanisms are presented for the simulation of the passive motion of the human ankle joint: the 5-5 fully parallel mechanism and the fully parallel spherical wrist mechanism. These mechanisms are based on the main anatomical structures of the ankle joint, namely the talus/calcaneus and the tibio/fibula bones at their interface, and the TiCaL and CaFiL ligaments. In order to show the accuracy of the models and the efficiency of the proposed procedure, these mechanisms are synthesized from experimental data and the results are compared with those obtained both during experimental sessions and with data published in the literature. Experimental results proved the efficiency of the proposed new mechanisms to simulate the ankle passive motion and, at the same time, the potentiality of the mechanism to replicate the ankle’s main anatomical structures quite well. The new mechanisms represent a powerful tool for both pre-operation planning and new prosthesis design.

An New Energetic Approach to the Modeling of Human Joint Kinematics: Application to the Ankle

The objective of this dissertation is to develop and test a predictive model for the passive kinematics of human joints based on the energy minimization principle. To pursue this goal, the tibio-talar joint is chosen as a reference joint, for the reduced number of bones involved and its simplicity, if compared with other sinovial joints such as the knee or the wrist. Starting from the knowledge of the articular surface shapes, the spatial trajectory of passive motion is obtained as the envelop of joint configurations that maximize the surfaces congruence. An increase in joint congruence corresponds to an improved capability of distributing an applied load, allowing the joint to attain a better strength with less material. Thus, joint congruence maximization is a simple geometric way to capture the idea of joint energy minimization. The results obtained are validated against in vitro measured trajectories. Preliminary comparison provide strong support for the predictions of the theoretical model.

New mechanisms for modelling the motion of the human ankle complex

The relevance of human joint models was shown in the literature. In particular, the great importance of models for the joint passive motion simulation (i.e. motion under virtually unloaded conditions) was outlined. They clarify the role played by the principal anatomical structures of the articulation, enhancing the comprehension of surgical treatments, and in particular the design of total ankle replacement and ligament reconstruction. Equivalent rigid link mechanisms proved to be an efficient tool for an accurate simulation of the joint passive motion. This thesis focuses on the ankle complex (i.e. the anatomical structure composed of the tibiotalar and the subtalar joints), which has a considerable role in human locomotion. The lack of interpreting models of this articulation and the poor results of total ankle replacement arthroplasty have strongly suggested devising new mathematical models capable of reproducing the restraining function of each structure of the joint and of replicating the relative motion of the bones which constitute the joint itself. In this contest, novel equivalent mechanisms are proposed for modelling the ankle passive motion. Their geometry is based on the joint’s anatomical structures. In particular, the role of the main ligaments of the articulation is investigated under passive conditions by means of nine 5-5 fully parallel mechanisms. Based on this investigation, a one-DOF spatial mechanism is developed for modelling the passive motion of the lower leg. The model considers many passive structures constituting the articulation, overcoming the limitations of previous models which took into account few anatomical elements of the ankle complex. All the models have been identified from experimental data by means of optimization procedure. Then, the simulated motions have been compared to the experimental one, in order to show the efficiency of the approach and thus to deduce the role of each anatomical structure in the ankle kinematic behavior.

The use of weightbearing radiographs to assess the stability of supination-external rotation fractures of the ankle

Isolated lateral malleolar fractures usually result from a supination-external rotation (SER) injury and may include a deltoid ligament rupture. The necessity of operative treatment is based on the recognition of a relevant medial soft-tissue disruption. Currently used tests to assess ankle stability include manual stress radiographs and gravity stress radiographs, but seem to overestimate the need for fracture fixation.

Delayed gadolinium-enhanced MRI of cartilage in the ankle at 3 T: feasibility and preliminary results after matrix-associated autologous chondrocyte implantation

To demonstrate the feasibility of delayed gadolinium-enhanced magnetic resonance imaging (MRI) of cartilage (dGEMRIC) in the ankle at 3 T and to obtain preliminary data on matrix associated autologous chondrocyte (MACI) repair tissue.