Closed chain dorsiflexion and the regional interdependence implications on fundamental movement patterns in collegiate athletes.

PURPOSE: An association between limited ankle closed kinetic chain dorsiflexion range of motion (CKCDFROM) and movement dysfunction in the lower quarter is often implied, limited research exists linking CKCDFROM and gross movement patterns, such as the squatting. The purpose of this study is to investigate the association between CKCDFROM and movement patterns in collegiate athletes, as measured by the functional movement screen (FMS). MATERIALS AND METHODS: A quasi-experimental observational analytical cohort study with 147 athletes from five Division III collegiate men's and women's athletic teams were included in the study. CKCDFROM was assessed utilizing the lunge test. Movement patterns, specifically the deep squat (DS) and inline lunge (ILL) were assessed utilizing the FMS qualitative criteria. Descriptive statistical analysis examined the association between CKCDFROM limitations and a dysfunctional deep squat or ILL. RESULTS: Seventy-nine (53.7%) and 30 (20.4%) participants scored a "1" on their FMS deep squat test and ILL, respectively. Participants who scored a "1" on the deep squat and ILL were 3.75 times as likely (3.75 odds ratio; 95% CI 1.57-9.14; p = 0.002) and 1.53 times as likely (1.53 odds ratio; 95% CI 0.65-3.60; p = 0.392), respectively, to have at least one ankle CKCDFROM limitation. The deep squat (DS) was statistically significant, but the ILL did not rise to the level of significance. DISCUSSION: Physical therapists should consider regional interdependence implications of movement dysfunction stemming from impairments within the kinetic chain. CONCLUSION: A dysfunctional lower extremity movement pattern might be associated with a lack of CKCDFROM. Clinicians will likely benefit from assessing CKCDFROM in those exhibiting dysfunctional squatting and/or lunging.

Does QUICK TAPE Offer Comparable Support and Off-loading as Low-Dye Taping?

BACKGROUND: Low-Dye taping is commonly used to manage foot pathologies and pain. Precut one-piece QUICK TAPE was designed to facilitate taping. However, no study to date has demonstrated that QUICK TAPE offers similar support and off-loading as traditional taping. METHODS: This pilot study compared the performance of QUICK TAPE and low-Dye taping in 20 healthy participants (40 feet) with moderate-to-severe pes planus. Study participants completed arch height index (AHI), dynamic plantar assessment with a plantar pressure measurement system, and subjective rating in three conditions: barefoot, low-Dye, and QUICK TAPE. The order of test conditions was randomized for each participant, and the taping was applied to both feet based on a standard method. A generalized estimating equation with an identity link function was used to examine differences across test conditions while accounting for potential dependence in bilateral data. RESULTS: Participants stood with a significantly greater AHI (P = .007) when either taping was applied compared with barefoot. Participants also demonstrated significantly different plantar loading when walking with both tapings versus barefoot. Both tapings yielded reduced force-time integral (FTI) in the medial and lateral forefoot and increased FTI under toes. Unlike previous studies, however, no lateralization of plantar pressure was observed with either taping. Participants ranked both tapings more supportive than barefoot. Most participants (77.8%) ranked low-Dye least comfortable, and 55.6% preferred QUICK TAPE over low-Dye. CONCLUSIONS: Additional studies are needed to examine the clinical utility of QUICK TAPE in individuals with foot pathologies such as heel pain syndrome and metatarsalgia.

Comparison of two pixelated insoles using in-shoe pressure sensors to determine percent offloading: case studies.

OBJECTIVE: The gold standard for offloading neuropathic forefoot and midfoot wounds is the total contact cast (TCC). However, in practice TCC is rarely used and is contraindicated in patients with fluctuating oedema, poor perfusion, lack of adequate tissue oxygenation and morbid obesity. It can also be too restrictive for patients, inevitably resulting in treatment rejection and delayed healing. This paper examines the role of shoe-based offloading devices as an alternative in reducing plantar pressure and optimising the healing of neuropathic ulcers. METHOD: Healthy subjects were recruited and fitted for two types of pixelated insoles: PegAssist (PA) insole system (Darco International, US) and FORS-15 (FORS) offloading insole (Saluber, Italy). An area of discreet, elevated high pressure was created by adding a 1/4-inch-thick felt pad to the plantar skin under the first metatarsal head. Subjects walked barefoot in surgical shoes with standard insoles (Condition 1), barefoot in pixelated insoles (Condition 2), barefoot with pixels removed (Condition 3). Dynamic plantar pressures were measured using F-Scan and the results were analysed to determine plantar pressure changes in each condition. RESULTS: Using PA, the percentage reduction of plantar pressure (kPa) under the first metatarsal between Condition 1 and Condition 2 was 10.54±15.81% (p=0.022), between Condition 2 and Condition 3 was 40.13±11.11% (p<0.001), and between Condition 1 and Condition 3 was 46.67±12.95 % (p<0.001). Using FORS, the percentage reduction between Condition 1 and Condition 2 was 24.25±23.33% (p=0.0029), between Condition 2 and Condition 3 was 23.61±19.45% (p<0.001), and between Condition 1 and Condition 3 was 43.39±18.70% (p<0.001). A notable difference in the findings between the two insoles was the presence of a significant edge effect associated with PA, indicating that the offloading was not entirely successful. No edge effect was detected with FORS. CONCLUSION: Our current analysis shows that pixelated insoles exhibit potential for supplemental offloading in surgical shoes. These devices could provide an alternative way for physicians to offload plantar wounds and expedite closure for patients that cannot tolerate a TCC or other restrictive devices.

Podiatric Resident Performance on a Basic Competency Examination in Musculoskeletal Medicine.

A basic competency examination in musculoskeletal medicine has previously been administered to residents across a variety of medical specialties and has demonstrated that medical school preparation in musculoskeletal medicine might be inadequate. The objectives of the present study were to assess podiatric surgical resident performance on this examination and to assess podiatric surgical residency director opinions of the level of importance of the test subject areas. A total of 117 podiatric surgical residents from 15 residency programs completed the 25-question examination. The residents scored a mean ± standard deviation of 60.32% ± 12.60% (range 22.00% to 92.00%). On the 7 questions rated by podiatric residency directors as ≥8 on a 10-point scale of relative importance, this score improved to 84.92% ± 11.93% (range 39.29% to 100.0%). Senior level residents did not outperform junior level residents (60.76% versus 60.44%; p = .898), and those who had completed a general orthopedics rotation at some point in their education did not outperform those who had not (61.12% versus 58.64%; p = .370). The podiatric residency directors assigned a mean ± standard deviation importance score of 6.97 ± 2.07 out of 10 for the 25 questions and suggested a mean ± standard deviation passing score of 69.14% ± 9.03% for the examination. The results of the present investigation provide original data on podiatric surgical resident performance on a basic competency examination in musculoskeletal medicine. Although the residents scored well for some specific test areas, the overall performance was similar to that of previous iterations of the examination given to general surgery and internal medicine residents. The lower scores compared with those from the orthopedic and physical therapy specialties might indicate a need for improved general musculoskeletal medicine education within the podiatric curriculum.

Use of an all-suture anchor for re-creation of the anterior talofibular ligament: a case report.

The lateral ankle ligament complex is typically injured during athletic activity caused by an inversion force on a plantar flexed foot. Numerous open surgical procedures to reconstruct the lateral ankle complex have been described. In contrast, we present a case report in which an all-suture anchor was used arthroscopically to re-create the anterior talofibular ligament in conjunction with ankle arthroscopy. A retrospective analysis of a 55-year-old male with a work-related inversion ankle sprain was performed with 14 months of follow-up. Objective and subjective assessments were obtained using range of motion measures, a strength assessment, and the Foot Function Index. An all-suture anchor was deployed through the anterolateral portal and secured in both the fibula and talus, re-creating the anterior talofibular ligament at its origin and insertion. Active range of motion physical therapy began at 2 weeks postoperatively. The patient started a neuromuscular re-education program at 5 weeks with minimal pain or discomfort. A return to full duty was achieved at 3 months postoperatively. To our knowledge, the use of an all-suture anchor has not been previously reported for lateral ankle complex re-creation. It is hoped that this approach to anterior talofibular ligament repair will decrease the incidence of complications and improve outcomes.