Search results for: heel%20lift

Authors: Parya Salimitari, Farhad Tabatabai Ghomsheh, Siyamak Khorramymehr, Hossein Taghadosi, Mohammad Hossein Dashti

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The aim of this study was to evaluate the effect of heel height on the knee joint direction in Genu recurvatum patients compared to normal state. The test was performed on a patient with Genu recurvatum and a healthy person with similar and match biomechanical conditions. Subjects were tested under six different positions of shoes with heels 0, 1, 2, 3, 4 and 5 cm after marking during the gate. The results of the spatial temporal geometry obtained from Vicon Motion System (six-camera T10 model, Oxford Metrics Ltd., Oxford, UK), and were used to compute and analyze the kinematic results. In this study, we tried to determine the effect of shoe heel intervention on knee joint direction correction. The results indicate that the 1 cm heel has been optimized and significantly improved in knee joint flexion and flexion-extension angle so that the difference in knee flexion-extension angle between the patient and the healthy person at some stages of walking has reached zero (good posture). The 3 cm heel compared with the 0 cm heel has reduced the knee recurvatum index (KRI) by up to 21.74% in the patient (from 219.233 mm to 47.6714 mm). According to the findings of this study, it can be concluded that heel increase is effective in correcting knee joints in Genu recurvatum and the optimum heel height is 1 cm.

Keywords: joint alignment of knee, gait analysis, genu recurvatum, heel lift, kinematics, motion-analysis

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Authors: Jobin Varghese, V. M. Akhil, P. K. Rajendrakumar, K. S. Sivanandan

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The major contributor to the human locomotion is the knee flexion and extension. During heel strike, a huge amount of energy is transmitted through the leg towards knee joint, which in fact is damped at heel and leg muscles. During high shocks, although it is damped to a certain extent, the balance force transmits towards knee joint which could damage the knee. Due to the vital function of the knee joint, it should be protected against damage due to additional load acting on it. This work concentrates on the development of spring mass damper system which exactly replicates the stiffness at the heel and muscles and the objective function is optimized to minimize the force acting at the knee joint. Further, the data collected using force plate are put into the model to verify its integrity and are found to be in good agreement.

Keywords: spring, mass, damper, knee joint

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Authors: Seyed Abolhasan Naeini, Elham Ghanbari Alamooti

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Static stability of soil slopes using numerical simulation by a finite element code, ABAQUS, has been investigated, and safety factors of the slopes achieved in the case of static load of a 10-storey building. The embankments have the same soil condition but different loading distance from the slope heel. The numerical method for estimating safety factors is 'Strength Reduction Method' (SRM). Mohr-Coulomb criterion used in the numerical simulations. Two steps used for measuring the safety factors of the slopes: first is under gravity loading, and the second is under static loading of a building near the slope heel. These safety factors measured from SRM, are compared with the values from Limit Equilibrium Method, LEM. Results show that there is good agreement between SRM and LEM. Also, it is seen that by increasing the distance from slope heel, safety factors increases.

Keywords: limit equilibrium method, static stability, soil slopes, strength reduction method

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Authors: Animesh Gupta

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Objective: The purpose of this study is to evaluate the versatility and outcome of lateral supra malleolar flap (LSMF) in soft tissue reconstruction of the regions including the distal leg, ankle, dorsal foot and heel. Methods: From March 2021 to April 2023, 18 patients with soft tissue defects in the regions, including the distal leg, ankle, dorsal foot and heel, who underwent LSMF repair for lower limb wound reconstruction were analyzed. The location, size of the defects, etiology, outcome, complications, and other alternative options were studied and presented. Results: The follow-up period of the cases was 3-6 months after surgery. All flaps were successful; however, one flap was complicated by venous congestion and was managed by loosening a few sutures and the patient was required to elevate the affected limb to resolve the issue. Conclusion: The LSMF has numerous advantages in repairing soft tissue defects in areas involving the ankle, distal leg, heel and dorsum of the foot. In comparison to reverse sural flaps for repairing defects in the heel and lower leg, LSMF offers shorter operation time, shorter hospitalization, lower cost, and fewer postoperative complications.

Keywords: lateral supra malleolar flap, LSMF, soft tissue reconstruction, lower leg defect

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Authors: Krambia-Kapardis Maria, Neophytidou Christina

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Lobbying is an inherent aspect within the democratic regimes across the globe. Although it can provide decision-makers with valuable knowledge and grant access to stakeholders in the decision-making process, it can also lead to undue influence and unfair competition at the expense of the public interest if it not transparent. Given the multi-level governance structure of the EU, it is no surprise that the EU policy-making arena has become a place-to-be for lobbyists. However, in order to ensure that influence is legitimate and not biased of any business interests, lobbying must be effectively regulated. A comparison with the US and Canadian lobbying regulatory framework and utilising some good practices from EU countries it is apparent that lobbying is the Achilles’ heel to transparency in the EU. It is evident that EU institutions suffer from ineffective regulations and could in fact benefit from a more robust, mandatory and better implemented system of lobbying regulation.

Keywords: EU, lobbying regulation, transparency, democratic regimes

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Authors: Yan Zhang, Jan Awrejcewicz, Lin Fu

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High-heeled shoes force the foot into plantar flexion position resulting in foot arch rising and disturbance of the articular congruence between the talus and tibiofibular mortice, all of which may increase the challenge of balance maintenance. Plantar pressure distribution of the stance limb during the star excursion balance test (SEBT) contributes to the understanding of potential sources of reaching excursions in SEBT. The purpose of this study is to evaluate the dynamic posture control while wearing high-heeled shoes using SEBT in a combination of plantar pressure measurement. Twenty healthy young females were recruited. Shoes of three heel heights were used: flat (0.8 cm), low (4.0 cm), high (6.6 cm). The testing grid of SEBT consists of three lines extending out at 120° from each other, which were defined as anterior, posteromedial, and posterolateral directions. Participants were instructed to stand on their dominant limb with the heel in the middle of the testing grid and hands on hips and to reach the non-stance limb as far as possible towards each direction. The distal portion of the reaching limb lightly touched the ground without shifting weight. Then returned the reaching limb to the beginning position. The excursion distances were normalized to leg length. The insole plantar measurement system was used to record peak pressure, contact area, and pressure-time integral of the stance limb. Results showed that normalized excursion distance decreased significantly as heel height increased. The changes of plantar pressure in SEBT as heel height increased were more obvious in the medial forefoot (MF), medial midfoot (MM), rearfoot areas. At MF, the peak pressure and pressure-time integral of low and high shoes increased significantly compared with that of flat shoes, while the contact area decreased significantly as heel height increased. At MM, peak pressure, contact area, and pressure-time integral of high and low shoes were significantly lower than that of flat shoes. To reduce posture instability, the stance limb plantar loading shifted to medial forefoot. Knowledge of this study identified dynamic posture control deficits while wearing high-heeled shoes and the critical role of the medial forefoot in dynamic balance maintenance.

Keywords: dynamic posture control, high-heeled shoes, plantar pressure, star excursion balance test.

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Authors: Lovro Štefan

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Background: The main purpose of the present study was to explore the correlations between physical activity and peak plantar pressure in dynamic mode. Methods: Participants were one hundred forty-six first-year university students (30.8% girls). Plantar pressure generated under each region of the foot (forefoot, midfoot, and heel) was measured by using Zebris dynamometric platform (Isny, Germany). The level of physical activity (PA) was calculated with the International Physical Activity questionnaire (IPAQ - short form). Results: In boys, forefoot peak plantar pressure was correlated with moderate PA (MPA; r=-0.21), vigorous PA (VPA; r=-0.18), and moderate-to-vigorous PA (MVPA; r=-0.28). No significant correlations with other foot regions (p>0.05) were observed. In girls, forefoot peak plantar pressure was correlated with MPA (r =-0.30), VPA (r=-0.39) and MVPA (r=-0.38). Also, heel peak pressure was significantly correlated with MPA (r=-0.33), while no significant correlations with VPA (r=0.05) and MVPA (r=-0.15) were observed. Conclusion: This study shows that different intensities of PA were mostly correlated with forefoot peak plantar pressure in both boys and girls. Therefore, strategies that reduce plantar pressure through a more active lifestyle should be implemented within the education system.

Keywords: pedobarography, youth, exercise, associations

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Authors: S. Thanabanjerdsin, F. Srisuriyachai, J. Chewaroungroj

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Drilling horizontal well is one of the most cost-effective method to exploit reservoir by increasing exposure area between well and formation. Together with horizontal well technology, intelligent completion is often co-utilized to increases petroleum production by monitoring/control downhole production. Combination of both technological results in an opportunity to lower water cresting phenomenon, a detrimental problem that does not lower only oil recovery but also cause environmental problem due to water disposal. Flow of reservoir fluid is a result from difference between reservoir and wellbore pressure. In horizontal well, reservoir fluid around the heel location enters wellbore at higher rate compared to the toe location. As a consequence, Oil-Water Contact (OWC) at the heel side of moves upward relatively faster compared to the toe side. This causes the well to encounter an early water encroachment problem. Installation of Inflow Control Valve (ICV) in particular sections of horizontal well can involve several parameters such as number of ICV, water cut constrain of each valve, length of each section. This study is mainly focused on optimization of ICV configuration to minimize water production and at the same time, to enhance oil production. A reservoir model consisting of high aspect ratio of oil bearing zone to underneath aquifer is drilled with horizontal well and completed with variation of ICV segments. Optimization of the horizontal well configuration is firstly performed by varying number of ICV, segment length, and individual preset water cut for each segment. Simulation results show that installing ICV can increase oil recovery factor up to 5% of Original Oil In Place (OOIP) and can reduce of produced water depending on ICV segment length as well as ICV parameters. For equally partitioned-ICV segment, more number of segment results in better oil recovery. However, number of segment exceeding 10 may not give a significant additional recovery. In first production period, deformation of OWC strongly depends on number of segment along the well. Higher number of segment results in smoother deformation of OWC. After water breakthrough at heel location segment, the second production period begins. Deformation of OWC is principally dominated by ICV parameters. In certain situations that OWC is unstable such as high production rate, high viscosity fluid above aquifer and strong aquifer, second production period may give wide enough window to ICV parameter to take the roll.

Keywords: horizontal well, water cresting, inflow control valve, reservoir simulation

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Authors: Ahmad Saad, Shuja Abbas, Breanna Marine

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Introduction: This study explores the potential applications of autologous pedal fat pad grafting as a minimally invasive therapeutic strategy for addressing pedal fat pad loss. Without adequate shock absorbing tissue, a patient can experience functional deficits, ulcerations, loss of quality of life, and significant limitations with ambulation. This study details a novel technique involving autologous adipose grafting from the abdomen to enhance plantar fat pad thickness in a patient involved in a severe motor vehicle accident which resulted in total fat pad loss of the heel. Autologous adipose grafting (AAG) was used following adipose allografting in an effort to recreate a normal shock absorbing surface to allow return to activities of daily living and painless ambulation. Methods: A 46-year-old male sustained multiple open pedal fractures and necrosis to the heel fat pad after a motorcycle accident, which resulted in complete loss of the calcaneal fat pad. The patient underwent serial debridement’s, utilization of wound vac therapy and split thickness skin grafting to accomplish complete closure, despite complete loss of adipose to area. Patient presented with complaints of pain on ambulation, inability to bear weight on the heel, recurrent ulcerations, admitted had not been ambulating for two years. Clinical exam demonstrated complete loss of the plantar fat pad with a thin layer of epithelial tissue overlying the calcaneal bone, allowing visibility of the osseous contour of the calcaneus. Scar tissue had formed in place of the fat pad, with thickened epithelial tissue extending from the midfoot to the calcaneus. After conservative measures were exhausted, the patient opted for initial management by adipose allograft matrix (AAM) injections. Post operative X-ray imaging revealed noticeable improvement in calcaneal fat pad thickness. At 1 year follow up, the patient was able to ambulate without assistive devices. The fat pad at this point was significantly thicker than it was pre-operatively, but the thickness did not restore to pre-accident thickness. In order to compare the take of allograft versus autografting of adipose tissue, the decision to use adipose autograft through abdominal liposuction harvesting was deemed suitable. A general surgeon completed harvesting of adipose cells from the patient’s abdomen via liposuction, and a podiatric surgeon performed the AAG injection into the heel. Total of 15 cc’s of autologous adipose tissue injected to the calcaneus. Results: There was a visual increase in the calcaneal fat pad thickness both clinically and radiographically. At the 6-week follow up, imaging revealed retention of the calcaneal fat pad thickness. Three months postop, patient returned to activities of daily living and increased quality of life due to their increased ability to ambulate. Discussion: AAG is a novel treatment for pedal fat pad loss. These treatments may be viable and reproducible therapeutic choices for patients suffering from fat pad atrophy, fat pad loss, and/or plantar ulcerations. Both treatments of AAM and AAG exhibited similar therapeutic results by providing pain relief for ambulation and allowing for patients to return to their quality of life.

Keywords: podiatry, wound, adipose, allograft, autograft, wound care, limb reconstruction, injection, limb salvage

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Authors: Mansour Eslami, Fereshte Habibi

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Limb length discrepancy (LLD), or anisomeric, is defined as a condition in which paired limbs are noticeably unequal. Individuals with LLD during walking use compensatory mechanisms to dynamically lengthen the short limb and shorten the long limb to minimize the displacement of the body center of mass and consequently reduce body energy expenditure. Due to the compensatory movements created, LLD greater than 1 cm increases the odds of creating lumbar problems and hip and knee osteoarthritis. Insoles are non-surgical therapies that are recommended to improve the walking pattern, pain and create greater symmetry between the two lower limbs. However, it is not yet clear what effect insoles have on the variables related to injuries during walking. The aim of the present study was to evaluate the effect of internal and external heel lift insoles on pelvic kinematic in sagittal and frontal planes and lower extremity joint moments in individuals with mild leg length discrepancy during the stance phase of walking. Biomechanical data of twenty-eight men with structural leg length discrepancy of 10-25 mm were collected while they walked under three conditions: shoes without insole (SH), with internal heel lift insoles (IHLI) in shoes, and with external heal lift insole (EHLI). The tests were performed for both short and long legs. The pelvic kinematic and joint moment were measured with a motion capture system and force plate. Five walking trials were performed for each condition. The average value of five successful trials was used for further statistical analysis. Repeated measures ANCOVA with Bonferroni post hoc test were used for between-group comparisons (p ≤ 0.05). In both internal and external heel lift insoles (IHLI, EHLI), there was a significant decrease in the peak values of lateral and anterior pelvic tilts of the long leg, hip, and knee moments of a long leg and ankle moment of short leg (p ≤ 0.05). Furthermore, significant increases in peak values of lateral and anterior pelvic tilt of short leg in IHLI and EHLI were observed as compared to Shoe (SH) condition (p ≤ 0.01). In addition, a significant difference was observed between the IHLI and EHLI conditions in peak anterior pelvic tilt of long leg and plantar flexor moment of short leg (p=0.04; p= 0.04 respectively). Our findings indicate that both IHLI and EHLI can play an important role in controlling excessive pelvic movements in the sagittal and frontal planes in individuals with mild LLD during walking. Furthermore, the EHLI may have a better effect in preventing musculoskeletal injuries compared to the IHLI.

Keywords: kinematic, leg length discrepancy, shoe insole, walking

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Authors: Jonathan de Rothewelle

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Heeled shoes are notoriously bad for physical health. The vast majority of Americans have suffered lower extremity pain at some point in their lives; women have been in pain for centuries. More recently, however, with an increase in number due to cultural shifts in acceptability, more men wear heeled shoes. Men who wear heels (MWWH) also suffer lower limb pain. In my hypothesis, their pathologies should be treated as unique due to males’ difference in body mass, center of gravity, posture, gait, and foot anatomy when compared with their female counterparts. These differences alone warrant a closer examination of the pathologies associated with the wearing of heeled shoes among male populations. This research performs a broad literature review on the differences between male and female anatomy and discusses implications on heel wearing. This research discusses the need for further inquiry and makes recommendations for future study.

Keywords: heeled shoes, gait, pathologies, biological sex

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Authors: Nicholas Fieseler

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The nature of religion implicit in popular culture is relevant both in and out of the university. The traditional rules-based conception of religion and the ethical systems that emerge from them do not necessarily convey the behavior of daily life as it exists apart from spaces deemed sacred. This paper proposes to examine the religion implicit in the popular culture phenomenon of professional wrestling and how that affects the understanding of popular religion. Pro wrestling, while frequently dismissed, offers a unique manner through which to re-examine religion in popular culture. A global phenomenon, pro wrestling occupies a distinct space in numerous countries and presents a legitimate reflection of human behavior cross-culturally on a scale few other phenomena can equal. Given its global viewership of millions, it should be recognized as a significant means of interpreting the human attraction to violence and its association with religion in general. Hans Urs von Balthasar’s theory of Theodrama will be used to interrogate the inchoate religion within pro wrestling. While Balthasar developed theodrama within the confines of Christian theology; theodrama contains remarkable versatility in its potential utility. Since theodrama re-envisions reality as drama, the actions of every human actor on the stage contributes to the play’s development, and all action contains some transcendent value. It is in this sense that even the “low brow” activity of pro wrestling may be understood in religious terms. Moreover, a pro wrestling storyline acts as a play within a play: the struggles in a pro wrestling match reflect the human attitudes toward life as it exists in the sacred and profane realms. The indistinct lines separating traditionally good (face) from traditionally bad (heel)wrestlers mirror the moral ambiguity in which many people interpret life. This blurred distinction between good and bad, and large segments of an audience’s embrace of the heel wrestlers, reveal ethical constraints that guide the everyday values of pro wrestling spectators, a moral ambivalence that is often overlooked by traditional religious systems, and which has hitherto been neglected in the academic literature on pro wrestling. The significance of interpreting the religion implicit in pro wrestling through a the dramatic lens extends beyond pro wrestling specifically and can examine the religion implicit in popular culture in general. The use of theodrama mitigates the rigid separation often ascribed to areas deemed sacred/ profane, ortranscendent / immanent, enabling a re-evaluation of religion and ethical systems as practiced in popular culture. The use of theodrama will be expressed by utilizing the pro wrestling match as a literary text that reflects the society from which it emerges. This analysis will also reveal the complex nature of religion in popular culture and provides new directions for the academic study of religion. This project consciously bridges the academic and popular realms. The goal of the research is not to add only to the academic literature on implicit religion in popular culture but to publish it in a form which speaks to those outside the standard academic audiences for such work.

Keywords: ethics, popular religion, professional wrestling, theodrama

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Authors: Aliza Lee, Mark Wilt, John Bonk, Scott Floyd, Bradley Hoffman, Karen Uchmanowicz

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Bipartite medial cuneiforms are relatively rare but may play a significant role in biomechanical and gait abnormalities. It is believed that a bipartite medial cuneiform may alter the available range of motion due to its larger morphological variant, thus limiting the metatarsal plantarflexion needed to achieve adequate hallux dorsiflexion for normal gait. Radiographic and clinical assessments were performed on 2 patients who reported foot pain along the first ray. Both patients had visible bipartite medial cuneiforms on MRI. Using gait plate and Metascan™ analysis, both were noted to have four measurements far beyond the expected range. Medial and lateral heel peak pressure, hallux peak pressure, and 1st metatarsal peak pressure were all noted to be increased. These measurements are believed to be increased due to the hindrance placed on the available ROM of the 1st ray by the increased size of the medial cuneiform. A larger patient population would be needed to fully understand this developmental anomaly.

Keywords: bipartite medial cuneiforms, cuneiform, developmental anomaly, gait abnormality

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Authors: Amir Abbas Kamanbedast, Abbas Saki

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Stepped spillways are composed of several steps, which start from around the spillway crest and continue to the downstream heel. Recently, such spillways have been receiving increasing attention due to the significant effect of the associated stairs on the flow’s rate of energy dissipation. Energy dissipation in the stepped spillways across the overflow can be explained by the watercourse contact with the stairs (i.e., large, harsh surfaces). In this context, less energy must be dissipated at the end of the spillway, and, hence, a smaller (less expensive) energy-dissipating structure is required. In this study, a stepped spillway was simulated using the model Fluent 3, and a standard model was used to model the flow disturbance. For this purpose, the energy dissipation from the stepped spillway was investigated in terms of the different numbers of stairs involved. Using k-ε, the disturbances of the numerical method for velocity and of flow depth at the downstream overflow were obtained, and, then, the energy that was dissipated throughout the spillway was calculated. Our results showed that an increase in the number of stairs can considerably increase the amount of energy dissipation for the fixed, upstream energy. In addition, the results of the numerical analyses were provided as isobar and velocity curves so points that were sensitive to cavitation could be determined.

Keywords: stepped spillway, fluent software, turbulence model of k-ε, VOF model

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Authors: Tong-Hsien Chow

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Background: Plantar pressure measurement is an effective method for assessing plantar loading and can be applied to evaluating movement performance of the foot. The purpose of this study is to explore the sprint athletes’ plantar loading characteristics and pain profiles in static standing. Methods: Experiments were undertaken on 80 first-division college sprint athletes and 85 healthy non-sprinters. ‘JC Mat’, the optical plantar pressure measurement was applied to examining the differences between both groups in the arch index (AI), three regional and six distinct sub-regional plantar pressure distributions (PPD), and footprint characteristics. Pain assessment and self-reported health status in sprint athletes were examined for evaluating their common pain areas. Results: Findings from the control group, the males’ AI fell into the normal range. Yet, the females’ AI was classified as the high-arch type. AI values of the sprint group were found to be significantly lower than the control group. PPD were higher at the medial metatarsal bone of both feet and the lateral heel of the right foot in the sprint group, the males in particular, whereas lower at the medial and lateral longitudinal arches of both feet. Footprint characteristics tended to support the results of the AI and PPD, and this reflected the corresponding pressure profiles. For the sprint athletes, the lateral knee joint and biceps femoris were the most common musculoskeletal pains. Conclusions: The sprint athletes’ AI were generally classified as high arches, and that their PPD were categorized between the features of runners and high-arched runners. These findings also correspond to the profiles of patellofemoral pain syndrome (PFPS)-related plantar pressure. The pain profiles appeared to correspond to the symptoms of high-arched runners and PFPS. The findings reflected upon the possible link between high arches and PFPS. The correlation between high-arched runners and PFPS development is worth further studies.

Keywords: sprint athletes, arch index, plantar pressure distributions, high arches, patellofemoral pain syndrome

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Authors: Ma. Roxanne Fernandez, Josie Athens, Balsalobre-Fernandez, Masayoshi Kubo, Kim Hébert-Losier

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Objectives: The calf raise test (CRT) is used in rehabilitation and sports medicine to evaluate calf muscle function. For testing, individuals stand on one leg and go up on their toes and back down to volitional fatigue. The newly developed Calf Raise application (CRapp) for iOS uses computer-vision algorithms enabling objective measurement of CRT outcomes. We aimed to validate the CRapp by examining its concurrent validity and agreement levels against laboratory-based equipment and establishing its intra- and inter-rater reliability. Methods: CRT outcomes (i.e., repetitions, positive work, total height, peak height, fatigue index, and peak power) were assessed in thirteen healthy individuals (6 males, 7 females) on three occasions and both legs using the CRapp, 3D motion capture, and force plate technologies simultaneously. Data were extracted from two markers: one placed immediately below the lateral malleolus and another on the heel. Concurrent validity and agreement measures were determined using intraclass correlation coefficients (ICC₃,ₖ), typical errors expressed as coefficient of variations (CV), and Bland-Altman methods to assess biases and precision. Reliability was assessed using ICC3,1 and CV values. Results: Validity of CRapp outcomes was good to excellent across measures for both markers (mean ICC ≥0.878), with precision plots showing good agreement and precision. CV ranged from 0% (repetitions) to 33.3% (fatigue index) and were, on average better for the lateral malleolus marker. Additionally, inter- and intra-rater reliability were excellent (mean ICC ≥0.949, CV ≤5.6%). Conclusion: These results confirm the CRapp is valid and reliable within and between users for measuring CRT outcomes in healthy adults. The CRapp provides a tool to objectivise CRT outcomes in research and practice, aligning with recent advances in mobile technologies and their increased use in healthcare.

Keywords: calf raise test, mobile application, validity, reliability

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Authors: Chul Hyun Park

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Background:Repair using the Achillon deviceis a representative mini-open repair technique;however, the limitations of this technique includethe need for special instruments and decreasedrepair strength.A modifiedmini-open repair using ring forcepsmight overcome these limitations. Purpose:This study was performed to compare the Achillon device with ring forceps in mini-open repairsof acute Achilles tendon rupture. Study Design:This was a retrospective cohort study, and the level of evidence was3. Methods:Fifty patients (41 men and 9 women), withacute Achilles tendon rupture on one foot, were consecutively treated using mini-open repair techniques. The first 20 patients were treated using the Achillon device (Achillon group) and the subsequent 30 patients were treated using a ring forceps (Forcep group). Clinical, functional, and isokinetic results,and postoperative complications were compared between the two groups at the last follow-up. Clinical evaluations wereperformed using the American Orthopedic Foot and Ankle Society (AOFAS) score, Achilles tendon Total Rupture Score (ATRS), length of incision, and operation time. Functional evaluationsincludedactive range of motion (ROM) of the ankle joint, maximum calf circumference (MCC), hopping test, and single limb heel-rise (SLHR) test. Isokinetic evaluations were performed using the isokinetic test for ankle plantar flexion. Results:The AOFAS score (p=0.669), ATRS (p=0.753), and length of incision (p=0.305) were not significantly different between the groups. Operative times in the Achillon group were significantly shorter than that in the Forcep group (p<0.001).The maximum height of SLHR (p=0.023) and number of SLHRs (p=0.045) in the Forcep group were significantly greater than that in the Achillon group. No significant differences in the mean peak torques for plantar flexion at angular speeds of 30°/s (p=0.219) and 120°/s (p=0.656) were detected between the groups. There was no significant difference in the occurrence of postoperative complications between the groups (p=0.093). Conclusion:The ring forceps technique is comparable with the Achillon technique with respect to clinical, functional, and isokinetic results and the postoperative complications. Given that no special instrument is required, the ring forceps technique could be a better option for acute Achilles tendon rupture repair.

Keywords: achilles tendon, acute rupture, repair, mini-open

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Authors: Jason Blair, Adeboye Adebayo, Mohamed Saad, Jeannette M. Byrne, Fabien A. Basset

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Running economy is a key physiological parameter of an individual’s running efficacy and a valid tool for predicting performance outcomes. Of the many factors known to influence running economy (RE), footwear certainly plays a role owing to its characteristics that vary substantially from model to model. Although minimalist footwear is believed to enhance RE and thereby endurance performance, conclusive research reports are scarce. Indeed, debates remain as to which footwear characteristics most alter RE. The purposes of this study were, therefore, two-fold: (a) to determine whether wearing minimalist shoes results in better RE compared to shod and to identify relationships with kinematic and muscle activation patterns; (b) to determine whether changes in RE with minimalist shoes are still evident following a fatiguing bout of exercise. Well-trained male distance runners (n=10; 29.0 ± 7.5 yrs; 71.0 ± 4.8 kg; 176.3 ± 6.5 cm) partook first in a maximal O₂ uptake determination test (VO₂ₘₐₓ = 61.6 ± 7.3 ml min⁻¹ kg⁻¹) 7 days prior to the experimental sessions. Second, in a fully randomized fashion, an RE test consisting of three 8-min treadmill runs in shod and minimalist footwear were performed prior to and following exercise induced fatigue (EIF). The minimalist and shod conditions were tested with a minimum of 7-day wash-out period between conditions. The RE bouts, interspaced by 2-min rest periods, were run at 2.79, 3.33, and 3.89 m s⁻¹ with a 1% grade. EIF consisted of 7 times 1000 m at 94-97% VO₂ₘₐₓ interspaced with 3-min recovery. Cardiorespiratory, electromyography (EMG), kinematics, rate of perceived exertion (RPE) and blood lactate were measured throughout the experimental sessions. A significant main speed effect on RE (p=0.001) and stride frequency (SF) (p=0.001) was observed. The pairwise comparisons showed that running at 2.79 m s⁻¹ was less economic compared to 3.33, and 3.89 m s⁻¹ (3.56 ± 0.38, 3.41 ± 0.45, 3.40 ± 0.45 ml O₂ kg⁻¹ km⁻¹; respectively) and that SF increased as a function of speed (79 ± 5, 82 ± 5, 84 ± 5 strides min⁻¹). Further, EMG analyses revealed that root mean square EMG significantly increased as a function of speed for all muscles (Biceps femoris, Gluteus maximus, Gastrocnemius, Tibialis anterior, Vastus lateralis). During EIF, the statistical analysis revealed a significant main effect of time on lactate production (from 2.7 ± 5.7 to 11.2 ± 6.2 mmol L⁻¹), RPE scores (from 7.6 ± 4.0 to 18.4 ± 2.7) and peak HR (from 171 ± 30 to 181 ± 20 bpm), expect for the recovery period. Surprisingly, a significant main footwear effect was observed on running speed during intervals (p=0.041). Participants ran faster with minimalist shoes compared to shod (3:24 ± 0:44 min [95%CI: 3:14-3:34] vs. 3:30 ± 0:47 min [95%CI: 3:19-3:41]). Although EIF altered lactate production and RPE scores, no other effect was noticeable on RE, EMG, and SF pre- and post-EIF, except for the expected speed effect. The significant footwear effect on running speed during EIF was unforeseen but could be due to shoe mass and/or heel-toe-drop differences. We also cannot discard the effect of speed on foot-strike pattern and therefore, running performance.

Keywords: exercise-induced fatigue, interval training, minimalist footwear, running economy

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Authors: Claudia Norambuena, Myissa Weiss, Maria Ruiz Maya, Matthew Straley, Elijah Hammond, Benjamin Chesebrough, David Grow

Abstract:

The purpose of this project is to develop a low-cost, portable sensor device that can be used at home for long-term analysis of gait and balance abnormalities. One area of particular concern involves the asymmetries in movement and balance that can accompany certain types of injuries and/or the associated devices used in the repair and rehabilitation process (e.g. the use of splints and casts) which can often increase chances of falls and additional injuries. This device has the capacity to monitor a patient during the rehabilitation process after injury or operation, increasing the patient’s access to healthcare while decreasing the number of visits to the patient’s clinician. The sensor device may thereby improve the quality of the patient’s care, particularly in rural areas where access to the clinician could be limited, while simultaneously decreasing the overall cost associated with the patient’s care. The device consists of nine interconnected accelerometer/ gyroscope/compass chips (9-DOF IMU, Adafruit, New York, NY). The sensors attach to and are used to determine the orientation and acceleration of the patient’s lower abdomen, C7 vertebra (lower neck), L1 vertebra (middle back), anterior side of each thigh and tibia, and dorsal side of each foot. In addition, pressure sensors are embedded in shoe inserts with one sensor (ESS301, Tekscan, Boston, MA) beneath the heel and three sensors (Interlink 402, Interlink Electronics, Westlake Village, CA) beneath the metatarsal bones of each foot. These sensors measure the distribution of the weight applied to each foot as well as stride duration. A small microntroller (Arduino Mega, Arduino, Ivrea, Italy) is used to collect data from these sensors in a CSV file. MATLAB is then used to analyze the data and output the hip, knee, ankle, and trunk angles projected on the sagittal plane. An open-source program Processing is then used to generate an animation of the patient’s gait. The accuracy of the sensors was validated through comparison to goniometric measurements (±2° error). The sensor device was also shown to have sufficient sensitivity to observe various gait abnormalities. Several patients used the sensor device, and the data collected from each represented the patient’s movements. Further, the sensors were found to have the ability to observe gait abnormalities caused by the addition of a small amount of weight (4.5 - 9.1 kg) to one side of the patient. The user-friendly interface and portability of the sensor device will help to construct a bridge between patients and their clinicians with fewer necessary inpatient visits.

Keywords: biomedical sensing, gait analysis, outpatient, rehabilitation

Procedia PDF Downloads 253

Authors: Emily Moore, Andrew Gaukroger, Matthew Solan, Lucy Bailey, Alexandra Boxall, Andrew Carne, Chintu Gadamsetty, Charlotte Morley, Katy Western, Iwona Kolodziejczyk

Abstract:

Introduction: Rupture of the Achilles tendon is common and has a long recovery period. Most cases are managed non-operatively. Foot and Ankle Surgeons advise an ultrasound scan to check the gap between the torn ends. A large gap (with the ankle in equinus) is a relative indication for surgery. The definitive decision regarding surgical versus non-operative management can only be made once an ultrasound scan is undertaken and the patient is subsequently reviewed by a Foot and Ankle surgeon. To get to this point, the patient journey involves several hospital departments. In nearby trusts, patients reattend for a scan and go to the plaster room both before and after the ultrasound for removal and re-application of the cast. At a third visit to the hospital, the surgeon and patient discuss options for definitive treatment. It may take 2-3 weeks from the initial Emergency Department visit before the final treatment decision is made. This “wasted time” is ultimately added to the recovery period for the patient. In this hospital, Achilles rupture patients are seen in a weekly multidisciplinary OneStop Heel Pain clinic. This pathway was already efficient but subject to occasional frustrating delays if a key staff member was absent. A new pathway was introduced with the goal to reduce delays to a definitive treatment plan. Method: A retrospective series of Achilles tendon ruptures managed according to the 2019 protocol was identified. Time taken from the Emergency Department to have both an ultrasound scan and specialist Foot and Ankle surgical review were calculated. 30 consecutive patients were treated with our new pathway and prospectively followed. The time taken for a scan and for specialist review were compared to the 30 consecutive cases from the 2019 (pre-COVID) cohort. The new pathway includes 1. A new contoured splint applied to the front of the injured limb held with a bandage. This can be removed and replaced (unlike a plaster cast) in the ultrasound department, removing the need for plaster room visits. 2. Urgent triage to a Foot and Ankle specialist. 3. Ultrasound scan for assessment of rupture gap and deep vein thrombosis check. 4. Early decision regarding surgery. Transfer to weight bearing in a prosthetic boot in equinuswithout waiting for the once-a-week clinic. 5. Extended oral VTE prophylaxis. Results: The time taken for a patient to have both an ultrasound scan and specialist review fell > 50%. All patients in the new pathway reached a definitive treatment decision within one week. There were no significant differences in patient demographics or rates of surgical vs non-operative treatment. The mean time from Emergency Department visit to specialist review and ultrasound scan fell from 8.7 days (old protocol) to 2.9 days (new pathway). The maximum time for this fell from 23 days (old protocol) to 6 days (new pathway). Conclusion: Teamwork and innovation have improved the experience for patients with an Achilles tendon rupture. The new pathway brings many advantages - reduced time in the Emergency Department, fewer hospital visits, less time using crutches and reduced overall recovery time.

Keywords: orthopaedics, achilles rupture, ultrasound, innovation

Procedia PDF Downloads 84