Foot最新文献

Study design

Evaluation of the psychometric properties of a translated, culturally adapted questionnaire.

Objective

Translating, culturally adapting, and validating the Italian version of the Cumberland Ankle Instability Tool (CAIT-I).

Summary of background data

Ankle sprains are one of the most common musculoskeletal injuries and can lead to chronic ankle instability (CAI). The International Ankle Consortium recommends the Cumberland Ankle Instability Tool (CAIT) as a valid and reliable self-report questionnaire assessing the presence and severity of CAI. At this moment, there is no validated Italian version of CAIT.

Methods

The Italian version of the CAIT (CAIT-I) was developed by an expert committee. Test-retest reliability of the CAIT-I was measured in 286 healthy and injured participants within a 4–9-day period, by using Intraclass Correlation Coefficients (ICC_2,1). Construct validity, exploratory factor analysis, internal consistency and sensitivity were examined in a sample of 548 adults. Instrument responsiveness over 4 time points was determined in a subgroup of 37 participants.

Results

The CAIT-I demonstrated excellent test-retest reliability (ICC≥0.92) and good internal consistency (α = .84). Construct validity was confirmed. Identified cut-off for the presence of CAI was 24.75, with sensitivity= 0.77 and specificity= 0.65. There were significant differences across time for CAIT-I scores (P < .001), demonstrating responsiveness to change, but no floor or ceiling effects.

Conclusion

The CAIT-I demonstrates acceptable psychometric performance as a screening and outcome measure. The CAIT-I is a useful tool to assess the presence and severity of CAI.

AAFD comprises ligamentous failure and tendon overload, mainly focused on the symptomatic posterior tibial tendon and the spring ligament. Increased lateral column (LC) instability arising in AAFD is not defined or quantified. This study aims to quantify the increased LC motion in unilateral symptomatic planus feet, using the contralateral unaffected asymptomatic foot as an internal control. In this case matched analysis, 15 patients with unilateral stage 2 AAFD foot and an unaffected contralateral foot were included. Lateral foot translation was measured as a guide to spring ligament competency. Medial and LC dorsal sagittal instability were assessed by direct measurement of dorsal 1st and 4th/5th metatarsal head motion and further video analysis. The mean increase in dorsal LC sagittal motion (between affected vs unaffected foot) was 5.6 mm (95% CI [4.63–6.55], p < 0.001). The mean increase in the lateral translation score was 42.8 mm (95% CI [37.48–48.03], p < 0.001). The mean increase in medial column dorsal sagittal motion was 6.8 mm (95% CI [5.7–7.8], p < 0.001). Video analysis also showed a statistically significant increase in LC dorsal sagittal motion between affected and unaffected sides (p < 0.001). This is the first study that quantifies a statistically significant increased LC dorsal motion in feet with AAFD. Understanding its pathogenesis and its link to talonavicular/spring ligament laxity improves foot assessment and may allow the development of future preventative treatment strategies.

Background

Plantar pressure distribution during walking in patients with painful Ledderhose disease is unknown.

Research question

Do patients with painful Ledderhose disease have an altered plantar pressure distribution during walking compared to individuals without foot pathologies? It was hypothesized that plantar pressure is shifted away from the painful nodules.

Methods

Pedobarography data of 41 patients with painful Ledderhose disease (cases, mean age: 54.2 ± 10.4 years) was collected and compared to pedobarography data from 41 individuals without foot pathologies (controls, mean age: 21.7 ± 2.0 years). Peak Pressure (PP), Maximum Mean Pressure (MMP) and Force-Time Integral (FTI) were calculated for eight regions (heel, medial midfoot, lateral midfoot, medial forefoot, central forefoot, lateral forefoot, hallux and other toes) under the soles of the feet. Differences between cases and controls were calculated and analysed by means of linear (mixed models) regression.

Results

Proportional differences in PP, MMP and FTI showed increased values for the cases compared to the controls, especially in the heel, hallux and other toes regions, and decreased values in the medial- and lateral midfoot regions. In naïve regression analysis, being a patient was a predictor for increased- and decreased values for PP, MMP and FTI for several regions. When dependencies in the data were taken into account with linear mixed-model regression analysis, the increased- and decreased values for the patients were most prevalent for FTI at the heel, medial midfoot, hallux and other toes regions.

Significance

In patients with painful Ledderhose disease, during walking, a shift of pressure was found towards the proximal and distal foot regions, while offloading the midfoot regions.

Acute lateral ankle sprains are common amongst athletes, and screening is essential in preventing these long-term sequelae. Self-reported questionnaires, such as the Cumberland Ankle Instability Tool (CAIT), may help identify individuals with chronic ankle instability. To date, a Cantonese-Chinese version of the CAIT does not exist.

A cross-cultural adaptation and validation of the CAIT were carried out: 46 individuals who were native in Cantonese completed the Cantonese-Chinese version of the CAIT and Chinese Foot and Ankle Outcome Score.

For the test-retest analysis, the intraclass correlation coefficient was 0.874. Internal consistency showed a Cronbach’s ɑ value of 0.726. Construct validity against the FAOS was fair but statistically significant with a Spearman’s correlation coefficient of 0.353, 0.460, 0.303, 0.369 and 0.493 for the categories of symptoms, pain, daily function, sports function, and quality of life, respectively.

A cutoff score of 20.5 was determined to differentiate healthy individuals from those with chronic ankle instability for this study population. The original English CAIT was successfully translated, cross-culturally adapted and validated into Cantonese-Chinese.

There is no literature to support the existence of an effective standardised assessment tool in South Africa that aids the podiatrist in the early diagnosis of developmental delay in the paediatric patient from age one to five. Podiatrists in South Africa (SA) need a suitable assessment tool to evaluate child development. A potential proforma that could be used by South African podiatrists is the Gait and Lower Limb Observation Proforma (GALLOP) Assessment Tool.

Aim

The aim of this research was to evaluate the “ease of use” and “usefulness” of the GALLOP Assessment Tool for podiatrists to effectively assess the paediatric patient from age one to age five.

Methods

The study was of a mixed methods descriptive design type, targeting all Health Professions Council of South Africa (HPCSA) registered podiatrists in the Johannesburg Metropolitan Municipal area. After allowing the participants to use the GALLOP Assessment Tool for a period of time, a survey was conducted to establish the “ease of use” and “usefulness” of the GALLOP Assessment Tool.

Results

All participants agreed that the GALLOP Assessment Tool would be beneficial to South African podiatrists and that the assessment tool does not need to be improved upon.

Purpose

Syndesmotic injuries are associated with long recovery times and high morbidity. Systematic reviews show a trend toward better outcomes of suture buttons compared to screw fixation. The anteroinferior tibiofibular ligament (AITFL) confers the most significant component of translational and rotatory stability. Techniques have developed which reinforce the AITFL. This study aimed to assess results of syndesmotic stabilisation with dynamic stabilisation and reinforcement of the AITFL, with an early mobilisation program.

Materials and methods

Retrospective case series of 30 patients (mean age 31 years). Syndesmotic instability was confirmed with clinical examination, MRI and weightbearing-CT. Dynamic syndesmotic stabilisation with a single suture button was performed followed by the placement of an Internal Brace over the AITFL. A standardised postoperative rehabilitation protocol was established. Foot and Ankle Ability Measure (FAAM) scores were collected postoperatively.

Results

The average follow-up was 13 months. The total FAAM score for ADL was 95 ± 4.9 % (range, 83 – 100 %) and for sport activities 87 ± 13.6 % (range, 50 – 100 %). The rating of mean postoperative function for ADL was 94 ± 5.5 % (range, 80 – 100 %) and 90 ± 13 % (range, 35 – 100 %) for sportv. The difference between acute and chronic injuries was statistically higher (p < 0.05) for daily activities and sport, but the rating of current level of sport activites as well as for daily activites did not show a significant difference (p = 0.9296 and p = 0.1615, respectively). Twenty-seven patients (90 %) rated their overall current level of function as normal or nearly normal.

Conclusion

This technique aims to directly stabilise the AITFL and the interosseous components of the syndesmosis, and allow early mobilisation and return to sport at 10 weeks. Early results show the procedure is safe, with comparable results to the literature. Acute injuries showed better results of the FAAM score than chronic injuries.

Context

Achilles tendon (AT) injuries are common in female runners and military personnel where increased AT loading may be a contributing factor. Few studies have examined AT stress during running with added mass. The purpose was to examine the stress, strain, and force placed on the AT, kinematics and temporospatial variable in running with different amounts of added mass.

Design

Repeated measure design

Methods

Twenty-three female runners with a rear-foot strike pattern were participants. AT stress, strain, and force were measured during running using a musculoskeletal model that used kinematic (180 Hz) and kinetic data (1800 Hz) as input. Ultrasound data were used to measure AT cross sectional area. A repeated measures multivariate analysis of variance (α = 0.05) was used on AT loading variables, kinematics and temporospatial variables.

Results

Peak AT stress, strain, and force were greatest during the 9.0 kg added load running condition (p < .0001). There was a 4.3% and 8.8% increase in AT stress and strain during the 4.5 kg and 9.0 kg added load conditions, respectively, compared to baseline. Kinematics at the hip and knee changed with added load but not at the ankle. Small changes in temporospatial variables were seen.

Conclusion

Added load increased stress on the AT during running. There may be an increased risk for AT injury with added load. Individuals may consider slowly progressing training with added load to allow for increased AT loading.

Background

Flexible flatfoot (FFF) cause biomechanical and sensorimotor disorders of the foot and ankle complex and reduce of postural stability. Postural stability is an important movement skill that affects the performance of taekwondo (TKD) athletes and can lead to fall injuries. The purpose of this study is the effect 12-week application of foot orthosis (FOs) on dynamic balance in TKD athletes with FFF.

Method

In this trial, 30 girls of the TKD athletes with FFF were recruited. They were randomly assigned to experimental and control groups (15 subjects in each group). The experimental group used FOs with medial longitudinal arch support for 12 weeks, and the control group did not have any intervention. The outcome measures include navicular drop and balance in three directions: anterior-posterior, medial-lateral and overall stability. Covariance analysis was used to compare the results between two groups.

Results

The covariance results showed that the experimental group compared to the control group with a high effect size had a significant difference in reducing of navicular drop (P = 0.000, ηp2 =0.512), anterior-posterior sway (P = 0.000, (ηp2 =0.397) medial-lateral sway (P = 0.019, ηp2 = 0.186) and overall stability sway (P = 0.008, ηp2 = 0.232).

Conclusions

The FOs with medial longitudinal arch support leads to FFF correction and provides mechanical stability of the foot and ankle complex. Also, the impulses sent from plantar receptors are increased and a better understanding of postural sway is transmitted to the central nervous system and balance strategies are improved.

Objective

The aim of the study was to evaluate and compare effective therapeutic options for hindfoot pain, develop and investigate the effectiveness of tele-rehabilitation systems, and ensure patients perform their exercises and preventive measures regularly and accurately, while monitoring results.

Methods

Hindfoot pain (HP) patients (N = 77 with 120 feet) were admitted to this study and divided into two pathologies; Plantar Fasciitis and Achilles Tendinopathy. Patients in each pathology were randomized into three different rehabilitation programs-web-based telerehabilitation (PF-T & AT-T), -hands-on healing techniques combined with exercise (PF-C & AT-C)-unsupervised home exercise (PF-H & AT-H) program. Disability, activity restrictions, first-step pain, dorsiflexion-plantar flexion range of motion and kinesiophobia scores were recorded. The outcomes of the study groups were collected pre-post intervention (8thweek). Telerehabilitation system was developed via user-driven innovation and tested before using formally.

Results

Each group had significant improvements in pain, disability, functional status and kinesiophobia (p < 0.001). In terms of functional status, PF-C had a statistically significant difference from others (p < 0.001). There was no difference between the groups for the pain scores in both pathologies. (p > 0.001). However, web-based telerehabilitation (PF-T & AT-T) were found to be more effective on kinesiophobia compared to the other groups (p < 0.001).

Conclusions

The presented web-based telerehabilitation system for management of hindfoot pain is an effective way and might be preferred instead of unsupervised home exercise specially for kinesiophobia. Additionally, Foot and ankle stretching and strengthening exercises protocols, myofascial releasing and mulligan concept manual therapy are effective modalities in terms of ROM, VISA-A, FAAM, FFI, TSK and VAS scores for hindfoot pain. The results indicated that three promised different rehabilitation protocols could be an effective strategy for HP.

This case report illustrates the outcome of a deep infection following internal fixation of a fracture of the big toe. Hallux amputation could be avoided through staged salvage procedure. This paper can assist readers on how to effectively and safely recognize and treat this type of injury.