Changes in plantar pressure distribution after Achilles tendon augmentation with flexor hallucis longus transfer.

BACKGROUND: Augmentation of the Achilles tendon with flexor hallucis longus is an established method to treat neglected ruptures and severe cases of chronic tendinopathy. After transfer of the muscle/tendon, good pain reduction and improved plantar flexion have been reported. To date, only one study has investigated the effect of FHL transfer on forefoot biomechanics. Theoretically, there should be a partial transfer of forefoot loading towards the lateral metatarsal heads during push-off, resulting in an asymmetric gait. METHODS: 13 patients were examined clinically and using pedobarography with a mean follow-up of 46 months (minimum 24) after Achilles tendon augmentation with flexor hallucis longus. Parameters of the forefoot were investigated to detect differences in pressure and force distribution, load transfer to other areas of the forefoot, and asymmetries compared to the non-operated leg. The results are discussed with regard to clinical relevance. FINDINGS: Clinically, there were no subjective or objective gait asymmetries. All patients were free of pain and without restrictions during normal walking. In general, pedobarography showed an unloading of the first toe with a load transfer to the metatarsal heads on the operated side. All results featured high inter-subject and within-subject variability. INTERPRETATION: Due to the high within-subject variability, there is inconsistency within the results making interpretation difficult. However, the results confirm the hypothesis that unloading of the first toe during push-off and an asymmetrical loading pattern can be measured after harvesting of the flexor hallucis longus. The clinical situation of the patients did not reflect a visible amount of gait asymmetry. Differences in loading patterns 2 years after flexor hallucis longus transfer for Achilles tendon augmentation appear to be well compensated.

[Physical characterization of the therapeutic device Posturomed as a measuring device--presentation of a procedure to characterize balancing ability]. / Physikalische Charakterisierung des Therapiegerätes Posturomed als Messgerät--Vorstellung eines Verfahrens zur Quantifizierung des Balancevermögens.

Training measures to improve neuromuscular coordination are becoming ever more popular for both prevention and rehabilitation, not only in athletes but also patients receiving joint replacements. Numerous proprioceptive training measures and devices are used to train the sense of balance. Parameters suitable for quantifying the results of therapy are largely lacking. Herein, a simple method for quantifying the balancing on one leg using the therapeutic device (Posturomed) commonly employed to train balance in the upright stance. The horizontal movements of the oscillating suspended platform were recorded in two orthogonal directions using a non-contact measurement system. To simulate disturbance of the upright stance, a mechanical deflection device was applied to the platform. The physical characterization of the measuring system was done using rigid masses. 13 volunteers adopting a one-legged stance were investigated. The measured displacement in the medio-lateral (ML) and AP directions were used to establish a balance index. Examination of the oscillatory behaviour of the platform revealed the path signal to be a suitable parameter for analyzing the platform movements. Differences in balance characteristics between AP and ML movements could be quantified. Frontal disturbance of the upright stance is equilibrated more effectively than lateral disturbances. Combined with a non-contact path measuring system the therapeutic device is suitable for characterizing balancing ability in an upright one-legged stance. To obtain more detailed information on the neuromuscular mechanisms involved, further studies are needed.