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ABSTRACT Objective: To understand the influence of sports fatigue on plantar pressure distribution of healthy male college students and provide a theoretical basis for improving their awareness of foot health. Methods: Forty-nine ordinary male college students jogged along the 800-meter runway to moderate fatigue. All the subjects took off their shoes and socks and walked naturally with their usual gait. The dynamic plantar pressure of each foot was measured twice in one step. FootscanUSB2 Belgian flat-plate plantar pressure testing system was used for testing. Results: The average dynamic peak plantar pressure was (206.38 44.59) N for boys, and the changes of AA and CB walking speed in the arch did not change significantly. After fatigue, the peak pressure of FM, AA, RH5 in left foot and FM, AA, CB in right foot decreased significantly (P < 0.05, P < 0.01). The peak time of RH and CB in the left foot was significantly shorter than that before fatigue (P < 0.05, P < 0.01), while FMF, AA, C areas had no significant change but tended to be delayed. There were significant differences in peak force-time between boys' left and right feet except for the fifth metatarsal bone (P < 0.05). There is a significant difference in the peak force-time between the second and fifth toes of the left foot (P< 0.01), and there is a gender difference in the peak force-time between the second metatarsal and the third metatarsal (P < 0.05). Conclusion: Sports fatigue leads to the decrease of physiological functions such as muscle strength of lower limbs, which leads to the corresponding changes in gait stages, plantar pressure distribution parameters, and foot balance. Level of evidence II; Therapeutic studies - investigation of treatment results.
RESUMO Objetivo: Entender a influência da fadiga esportiva na distribuição da pressão plantar de estudantes universitários masculinos saudáveis e fornecer uma base teórica para melhorar sua consciência sobre a saúde dos pés. Métodos: Quarenta e nove estudantes universitários masculinos comuns correram ao longo da pista de 800 metros para moderar a fadiga. Todos os sujeitos tiraram seus sapatos e meias e caminharam naturalmente com sua marcha habitual. A pressão plantar dinâmica de cada pé foi medida duas vezes em um único passo. O sistema de teste de pressão plantar de placa plana belga FootscanUSB2 foi usado para testes. Resultados: A pressão plantar dinâmica média de pico foi (206.38 44.59) N para meninos, e as alterações de velocidade de caminhada AA e CB no arco não mudaram significativamente. Após a fadiga, a pressão de pico de FM, AA, RH5 no pé esquerdo e FM, AA, CB no pé direito diminuiu significativamente (P < 0,05, P < 0,01). O tempo de pico de RH e CB no pé esquerdo foi significativamente menor do que antes da fadiga (P < 0,05, P < 0,01), enquanto as áreas FMF, AA, C não tiveram nenhuma mudança significativa, mas tenderam a ser atrasadas. Havia diferenças significativas no tempo de pico de força entre o pé esquerdo e direito dos meninos, exceto para o quinto metatarso (P < 0,05). Houve uma diferença significativa no tempo de pico de força entre o segundo e o quinto dedos do pé esquerdo (P< 0,01), e há uma diferença de gênero no tempo de pico de força entre o segundo metatarso e o terceiro metatarso (P < 0,05). Conclusão: A fadiga esportiva leva à diminuição das funções fisiológicas, tais como a força muscular dos membros inferiores, o que leva às mudanças correspondentes nos estágios de marcha, parâmetros de distribuição da pressão plantar e equilíbrio do pé. Nível de evidência II; Estudos terapêuticos - investigação de resultados de tratamento.
RESUMEN Objetivo: Comprender la influencia de la fatiga deportiva en la distribución de la presión plantar de los estudiantes universitarios varones sanos y proporcionar una base teórica para mejorar su conciencia sobre la salud de los pies. Métodos: Cuarenta y nueve estudiantes universitarios varones normales trotaron a lo largo de una pista de 800 metros hasta alcanzar una fatiga moderada. Todos los sujetos se quitaron los zapatos y los calcetines y caminaron de forma natural con su marcha habitual. Se midió la presión plantar dinámica de cada pie dos veces en un único paso. Para las pruebas se utilizó el sistema belga de pruebas de presión plantar FootscanUSB2. Resultados: El promedio de la presión plantar dinámica máxima fue de (206.38 44.59) N para los niños, y los cambios de la velocidad de marcha AA y CB en el arco no cambiaron significativamente. Después de la fatiga, la presión máxima de FM, AA, RH5 en el pie izquierdo y de FM, AA, CB en el pie derecho disminuyó significativamente (P < 0,05, P < 0,01). El tiempo de pico de RH y CB en el pie izquierdo fue significativamente menor que antes de la fatiga (P < 0,05, P < 0,01), mientras que las áreas FMF, AA, C no tuvieron cambios significativos, pero tendieron a retrasarse. Hubo diferencias significativas en el pico de fuerza-tiempo entre los pies izquierdo y derecho de los niños, excepto en el quinto hueso metatarsiano (P < 0,05). Hay una diferencia significativa en el pico de fuerza-tiempo entre el segundo y el quinto dedo del pie izquierdo (P < 0,01), y hay una diferencia de género en el pico de fuerza-tiempo entre el segundo metatarsiano y el tercer metatarsiano (P < 0,05). Conclusión: La fatiga deportiva conduce a la disminución de funciones fisiológicas como la fuerza muscular de los miembros inferiores, lo que conlleva los correspondientes cambios en las fases de la marcha, los parámetros de distribución de la presión plantar y el equilibrio del pie. Nivel de evidencia II; Estudios terapéuticos - investigación de resultados de tratamiento.
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To explore the clinical value of repairing massive soft tissue defects of shank and foot with diverse combined flaps with the help of 3D-CTA technique. Methods From March, 2011 to May, 2018, 7 pa-tients with massive soft tissue defects (defect area:21 cm×14 cm-53 cm×16 cm) of shank and foot were treated with combined flaps, including free anterolateral thigh flaps(ALTP) combined with local transferred sural neurocuta-neous vascular flaps in 2 cases, free ALTP combined with local transferred supracondylar flap in 2 cases, free thora-co-umbilical flaps plus local transferred gastrocnemius muscular flaps in 1 case, and free ALTP plus free thoraco-um-bilical flap in 1 case.Free ALTP and free thoraco-umbilical flap respectively combined with double bridge flaps using the both ends of posterior tibial vessel from the healthy limb to form vascular pedicles in 1 case. All cases received 3D-CTA to observe the distribution and anastomosis of perforator vessel. Regular followed-up was made post-opera-tively. Results All patients had been followed-up for 6-18 months. Outpatient service combined with telephone follow-up was adopted. All flaps survived, and flap shape, colour and lustre, elasticity got good recover. At the last follow-up, thermann scale function assessment: 4 cases were excellent, 2 were good, and 1 was fair. Conclusion It is a feasible and effective method to repair massive soft tissue defects of shank and foot using differently combined flaps. Although the surgery can be risky, the method can effectively reduce the rate of limb disability, restore the limb func-tion and shorten the course of treatment.Preoperative 3D-CTA can get the vessel anatomical structure and diameter at donor and recipient sites, which will guide the operation program design and implementation so as to shorten the oper-ation time and improve the accuracy rate of vascular anastomosis.
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<p><b>OBJECTIVE</b>To discuss the surgical method and clinical efficacy for open tarsometatarsal joint injuries.</p><p><b>METHODS</b>From March 2011 to January 2015, 21 patients with open tarsometatarsal joint injuries were treated with stage-surgery method, including 14 males and 7 females with an average age of 45.6 years old ranging from 20 to 75 years. Injury site occurred in the left foot of 13 cases and right foot of 8 cases. Traffic injury was in 5 cases, crush injury in 6 cases, heavy crushing was in 10 cases. According to Myerson to classify for tarsometatarsal joint injury, 5 cases were type B2, 9 cases were type C1, and 7 cases were type C2. And according to Gustilo to typing for soft tissue injury, 5 cases were type IIB, 10 cases were type IIIA, 6 cases were type IIIB. Fracture healingand complications were observed after operation and clinical effects were evaluated according to the midfoot score of AOFAS.</p><p><b>RESULTS</b>All the patients were followed up from 11 to 40 months with an average of 16.2 months. The fracture healing time was from 10 to 16 weeks with an average of 12.3 weeks. No complications such as deep infection, nonunion and osteomyelitis were found. Midfoot score of AOFAS at last follow-up was 83.0±14.9, 9 cases got excellent results, 8 good, 2 fair, 2 poor. Two patients complicated with severe traumatic arthritis once again underwent tarsometatarsal arthrodesis.</p><p><b>CONCLUSIONS</b>For the treatment of open tarsometatarsal joint injury, reasonable debridement, comprehensive assessment for the soft tissue injury, correctly grasp the surgical indications and time of internal fixation, can reduce the incidence of deep infection and osteomyelitis.</p>
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Objective To investiGate the clinical effect of skin flap transplantation to repair traumatic tissue defects. Methods One hundred and twenty-eiGht cases with skin and soft tissure defects of foot injury were treated from January 2007 to December 20l2. AccordinG to the situation of foot soft tissue defects,there were dorsal metatarsal artery island flap in l7 cases,the medial plantar flap in 8 cases,the flap of lateral foot in 9 cases,the fibula free flap in l4 cases,the sural neurovascular fascia cutaneous island flap in l7 cases,the anterolateral femoral flap in 45cases,and the chest-umbilicus flap in l8 cases. Results One hudred and twenty-eiGht cases of the flap survived completely,and follow-up visit time lasted from 2 month to l year and the satisfactory results of appearance and functions were achieved in 98 cases. Twenty-eiGht cases of flap were somewhat swellinG. Conclusion DependinG on the soft tissue defect in the situation to choose the appropriate skin flap to repair the foot soft tissue defect after trauma have many advantaGes,such as low infection rate,shorter lenGth of stay and the function and pedal contour were reserved maximally .
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Objective To discuss the treatment and clinical outcome of open to the tarsometatarsal joint injury. Methods From April 2009 to April 2010,14 patients,10 males and 4 females,with open to the tarsometatarsal joint injury were treated in our department.They were 45 years old on average (from 21 to 67 years old).Five of them had the tarsometatarsal complex involved.According to Chiodo and Myerson's classification,all the injuries were of three-column type. Medial and lateral column shortening was respectively concomitant in 2 cases.Two patients had combined soft tissue defects and one patient degloved dorsal skin.A thorough debridement and Kirschner wire fixation following reduction were performed for all patients in the emergency room.A mini external fixator was applied in patients with medial or lateral column shortening.The degloved skin was thinned and grafted in situ,followed by vacuum sealing drainage (VSD) to cover the wound.The soft tissue defect was covered by VSD after debridement.All the patients had a definitive internal fixation after the soft tissue condition improved, and 3 of them had soft tissue coverage simultaneously.Functional outcomes were scored by American Orthopedic Foot Ankle Society (AOFAS) system. Results One patient with degloving injury had partial skin necrosis which was treated by debridement,definitive internal fixation and local flap transfer on the 13th day after emergency operation.A definitive internal fixation and skin graft were performed in 2 patients with soft tissue defects respectively on the 7th or 11th day post-operation.No wound infection or necrosis occurred in other patients.Twelve patients were followed up for an average period of 18 months (from 13 to 25 months).Solid union was obtained 12 weeks on average (from 10 to 16 weeks) after the secondary surgery.No flap necrosis,infection,nonunion or osteomyelitis occurred during the follow-up.Two patients had tarsometatarsal arthrodesis at the 12th or 14th month respectively due to severe pain and function limitation caused by post-traumatic arthritis.The mean AOFAS midfoot score at the last follow-up was 72 (from 61 to 89). ConclusionsAs tnanagement of open to the tarsometatarsal joint injury is a great challenge,surgeons must take soft tissue condition into consideration.Tenporary Kirschner wire fixation or in combination with external fixation after early thorough debridement,reduction and alignment restoration,followed by secondary definitive internal fixation until soft tissue condition improves is a safe and effective treatment strategy to decrease soft tissue complications and obtain stable fixation.
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Objective To measure stress distribution of the main bone architecture of the normal adult cadaveric foot and discuss the effect of plantar ligament injury on stress distribution. Methods Seven fresh adult cadaveric feet were used and 10 strain gauges attached to the bones of the longitudinal foot arch,including the calcaneus,navicular,medial cuneiform,1-5 metatarsal trunk,the distal part of the tibia and fibular,respectively.After the loading Was added to 700 N by almighty test machine,resistance strainmeter was used to measure surface strain of these bones.The results were processed statistically. Results The strain was varied based on different bone segments attached and increased with loading.Tensile force was always found at the medial part of the navicular,the distal part of the tibia and fibular,while the others showed compression all the time.Peak strain was found at calcaneus.followed by the second and third metatarsal.Strain on the surface of the bone segments changed greatly with different ligament injury(P＜0.05).Conclusion The bone surface stress of the longitudinal foot arch changes significantly when the plantar ligament is injured.
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[Objective]To explore displacement and plantar pressure distribution of the forefoot before and after the plantar fascia and other plantar ligaments were sectioned.[Method]Seven fresh adult cadaveric feet were tested with the main plantar ligaments exposed,including the plantar fascia,spring ligament,short plantar ligament and long plantar ligament.The displacements of the metatarsals were recorded and calculated with digital speckle correlation measurement(DSCM),also F-scan insoles were put under the plantar aspect of the feet when the speciments were loaded to 700N vertically.The special shifts and plantar pressure data of the metatarsals was collected and stored before and after the main plantar ligaments were sectioned.[Result]The transverse movements of the metatarsals did not change significantly,the same as their vertical displacements except the first metatarsal after the plantar fascia was sectioned,while the peak pressure shifted laterally.When the four major plantar ligaments were all injured,all of the above changed significantly.[Conclusion]The plantar fasciotomy will not consequentially lead to collapse of the forefoot structure.But the redistribution of the plantar pressure and the compensation of other ligaments may result in later complication.