Forefoot deformation during stance: does the forefoot collapse during loading?

This study presents a specific description of forefoot deformation during the stance phase of normal human walking based on the combined analysis of pressure and three-dimensional optoelectronic measurements. Forefoot deformation is measured in forty healthy subjects using (1) a six-camera motion capture system (sampled at 250 Hz) tracking five reflective skin markers attached to the forefoot, (2) a pressure platform (sampled at 500 Hz) and (3) a forceplate (sampled at 1250 Hz). Forefoot deformation is characterized by the forefoot width, the mediolateral metatarsal arch height and the plantar pressure under the metatarsal heads. Using this setup, a typical pattern of forefoot motion is described during stance phase: From a flexible, compliant configuration at the beginning of stance phase, characterized by a decrease in mediolateral metatarsal arch height and a controlled increase in forefoot width, the forefoot turns into a stable configuration during midstance. Subsequently, the increase in mediolateral arch height and the decrease in forefoot width describe the transformation into a tight configuration during final stance. This transfer from a compliant into a rigid configuration through stance phase rejects the idea of the forefoot as a collapsing structure under increased loading.

Magnetic resonance imaging of anatomical variants of the subtalar joint.

OBJECTIVE: To evaluate MRI with thin slices to depict anatomical variations of the subtalar and talocalcaneonavicular joints. METHODS AND MATERIALS: Ankle MRI was performed in 51 patients. The articular configurations were differentiated on sagittal T1-weighted and three-dimensional (3D) DESS images. Multiplanar reconstructions were performed. The variation in curvature of the posterior facet of the calcaneus and talus was analysed. 3D surface-rendered images of the calcaneus were obtained. All images were studied by an experienced physical therapist. RESULTS: Analysis revealed that 18 (36.7%) of the subjects had 3 distinct facets on the calcaneus. A missing anterior facet was revealed in five (10.2%) of subjects. Twenty-six (53.1%) subjects showed a fusion of the anterior and middle facets. In four cases, an articulation was found between the talus and the cuboid bone. At the posterior talocalcaneal articulation, variations were observed of the curvature of the medial side of the joint. CONCLUSIONS: The configuration of the facets of the talocalcaneal joints can be analysed on MR images. On 3D images, an articular connection was seen between the talus and the cuboid bone, as well as variations in the curvature of the posterior talocalcaneal joint. These anatomical variations may have implications for mobility and stability of the ankle.

Lack of impairment of kinaesthetic sensibility in cervicogenic headache patients.

To compare the cervical kinaesthetic sensibility of cervicogenic headache (CEH) patients and asymptomatic controls, the head repositioning accuracy of 10 CEH patients and 23 asymptomatic controls was measured. Should an impaired kinaesthetic sensibility be demonstrated, its assessment could be of diagnostic value in the evaluation of patients with suspected CEH. Additionally, specific exercises to improve cervical kinaesthesia could be prescribed. Kinaesthetic sensibility was assessed using a head repositioning task: subjects were asked to relocate their heads as accurately as possible to a previously memorized head position following an active movement (flexion, extension and left and right rotations). The repositioning error was registered using a validated magnetic tracking device (Flock of Birds). No significant differences were found between the asymptomatic controls and the CEH patients (independent-samples T-test, P < 0.05). We conclude that cervical kinaesthetic sensibility is not impaired in non-traumatic CEH. The use of kinaesthetic assessment and treatment in this patient group seems to be limited.

The role of the Rolimeter in quantifying knee instability compared to the functional outcome of ACL-reconstructed versus conservatively-treated knees.

The purpose of this study is to correlate the measurement of anterior knee laxity using the Rolimeter with the functional outcome of anterior cruciate ligament (ACL) deficient knees. We tested 29 patients (12 males/17 females) with an average age of 33 years (range 19-47) that had been treated for ACL rupture, either by reconstruction or conservatively. The average follow-up at time of testing was 33 months (range 6-67).Functional outcome was graded by means of a questionnaire based on the IKDC score, the sports activity rating scale (SARS), the Cincinnati knee-rating system and the activities of daily living (ADL) scale, and by two functional knee tests (the one-leg hop test and the cross-over hop test). The anterior knee laxity was measured for both knees with the Rolimeter, and the side-to-side difference was calculated. We have found no correlation between the joint laxity and the functional outcome score.(P>0.05). When we compared both groups, we found a significant, though very low, correlation between the laxity and the functional questionnaire for the reconstructed group. (r=0.51, P=0.036). Therefore, the joint laxity measurement does not necessarily reflect the functional outcome of ACL-deficient knees. An explanation can be found in the importance of the proprioception and neuromuscular control in compensating the ACL-deficient knee.

Hip fracture treatment: outcome and socio-economic aspects. A one-year survey in a Belgian University Hospital.

Between October 1, 1997 and September 30, 1998, 201 consecutive hip fractures in patients over the age of 50 were registered according to the SAHFE (Standardised Audit of Hip Fractures in Europe) protocol. The mean age was 81.3 years; 75% were females, more than 40% were admitted from an institution and fewer than 10% were completely fit. Almost 60% of the fractures occurred in the trochanteric region while less than 40% were intracapsular. All fractures but one were operated on, according to a standardised protocol. More than half the patients were treated with a dynamic hip screw, more than 30% with a cemented biarticulated hemiarthroplasty and fewer than 15% with cannulated screws. The mean admission time in the orthopedic department was 18.7 days and was poorly correlated with the type of surgery or with the place to which the patients were discharged. After hospitalisation, most patients admitted from an institution went back to that institution. More than one-third of the patients admitted from their home went back home but over 40% used rehabilitation facilities. After four months, 32 patients had died, 27 were lost to follow-up and six had been reoperated. Of the independent patients, at least 24% were institutionalised and more than 60% lived at home. Although hip fractures in the elderly are expensive and debilitating, adequate operative treatment and rehabilitation can reduce costs by limiting the hospital stay, lowering reoperation rates and by favouring reintegration into their prefracture surroundings.

Control of acceleration during sudden ankle supination in people with unstable ankles.

STUDY DESIGN: Comparative study of differences in functional control during ankle supination in the standing position in matched stable and unstable ankles (ex post facto design). OBJECTIVES: To document acceleration and deceleration during ankle supination in the standing position and to determine differences in control of supination perturbation between stable and unstable ankles. BACKGROUND: Repetitive ankle sprain can be explained by mechanical instability only in a minority of cases. Exercise therapy for ankle instability is based on clinical experience. Joint stability has not yet been measured in dynamic situations that are similar to the situations leading to a traumatic sprain. The process of motor control during accelerating ankle supination has not been adequately addressed in the literature. METHODS AND MEASURES: Patients with complaints of ankle instability (16 unstable ankles) and nonimpaired controls (18 stable ankles) were examined (N = 17 subjects, 10 women and 7 men). The average age was 23.7 +/- 5.0 years (range, 20-41 y). Control of supination speed was studied during 50 degrees of ankle supination in the standing position using accelerometry (total supination time and deceleration times) and electromyography (latency time). Timing of motor response was estimated by measuring electromechanical delay. RESULTS: The presence of an early, sudden, and presumably passive slowdown of ankle supination in the standing position was observed. Peroneal muscle motor response was detected before the end of the supination. Unstable ankles showed significantly shorter total supination time (109.3 ms versus 124.1 ms) and significantly longer latency time (58.9 ms versus 47.7 ms). CONCLUSIONS: Functional control in unstable ankles is less efficient in decelerating the ankle during the supination test procedures used in our study. Our conclusions are based on significantly faster total supination and significantly slower electromyogram response in unstable ankles. The results support the hypothesis that both decelerating the total supination movement during balance disturbance and enhancing the speed of evertor activation through exercise can be specific therapy goals.

Static and dynamic roentgenographic analysis of ankle stability in braced and nonbraced stable and functionally unstable ankles.

Patients suffering from functional ankle instability were selected based on a structured interview. Talar tilt was measured using supine ankle stress roentgenographs and standing talar tilt was measured using erect ankle stress roentgenographs. A digital roentgenocinematographic analysis of a 50 degrees ankle sprain simulation was performed to measure dynamic talar tilt and inversion distance between two video images (inversion speed). A significant decrease in pathologic supine talar tilt in unstable ankles was found in the braced compared with the nonbraced situation (talar tilt = 13.1 degrees versus 4.8 degrees with brace). The talar tilt with the brace after activity was still significantly lower than the initial value without the brace. The standing talar tilt of unstable ankles was shown to be significantly lower with the orthosis than without (standing talar tilt = 16.6 degrees versus 12.0 degrees with brace). Roentgenocinematographic evaluation of ankle sprain simulation showed that the mean dynamic talar tilt during simulated sprain decreased significantly in the braced ankles compared with the nonbraced ankles (dynamic talar tilt = 9.8 degrees versus 6.4 degrees braced). A significant decrease in the digital measurement of inversion distance (from 110.6 pixels to 92.4 pixels) was observed in the total sample of 39 ankles during the initial high-speed phase of the simulated sprain. The brace significantly slows down the inversion speed.

Objective roentgenologic measurements of the influence of ankle braces on pathologic joint mobility. A comparison of 9 braces.

The stabilizing effect of external support (taping and nine different ankle braces) was tested in a total of 220 functionally unstable ankles. A standard surface EMG controlled stress Roentgen test protocol was used, measuring talar tilt (TT) without support and with tape bandage or brace. Different levels of TT restraining by external support could be identified. Tape bandage and two braces had a highly significant influence on the talar tilt. The mean TT without support was decreased by using from 13.4 degrees to 4.9 degrees, by using one brace to 4.8 degrees and by using another brace to 5.9 degrees. These two braces are effective for protection during functional treatment. A classification into three grades of effectiveness is proposed. It is concluded that the stabilizing influence offered by bandages and braces should be measured before using the external support as a treatment device for acute ankle sprain and as a reliable protection against sprain injuries in daily living and sports.

Pressure algometry in manual therapy.

SUMMARY. The pressure pain threshold (PPT), i.e. the least stimulus intensity at which a subject perceives pain, was studied in 30 patients with chronic unilateral pain in the shoulder and arm region.Fourteen trigger points were investigated on both sides of the body using pressure algometry. Eight paravertebral points and six points in the shoulder and arm region were evaluated. Each location was examined twice. The patients were tested by one examiner.The intraobserver reliability of PPT measurements was considered to be good. The Intraclass Correlation Coefficients of reliability (ICC), based on two repeated PPT measurements varied between 0.64 and 0.96. The painful side of the body was found to be more sensitive than the non-painful side, although there was not always a significant difference at the 0.05 level. The PPT was found to be higher in males than in females (P < 0.05). Females demonstrated lower PPTs than males at each trigger point. It was established that pressure tenderness varies over individual trigger points. Significant regional differences in PPT values were observed (P < 0.05). PPT values decreased in a cranial direction in the spine and in a caudal direction in the upper limb.Although the authors expected to find segmentally reduced PPT values on the painful side of the body, a generalized reduction of PPT values was present at all peripheral and spinal segmental sites. Some correlations between segmentally related trigger points were found by factor analysis. Copyright 1996 Harcourt Publishers Ltd.

Magnetic resonance imaging (MRI) of the ankle and hindfoot.

While Magnetic Resonance Imaging (MRI) has become a routine diagnostic method to deal with pathology of the knee, little has been published about foot and ankle lesions. This is probably due to the anatomic complexity of bone and ligamentous structures of these small joints, necessitating the use of very thin slices from various orientation planes (orthogonal and oblique planes). A special technique is needed allowing a 3-dimensional (3D) analysis, using inframillimetric slices and more sophisticated equipment than for 2-dimensional (2D) MRI (high fields with good homogeneity, specialized image processors...). An initial potential indication of the method is the precise diagnosis of lateral ligamentous components in severe sprains. MRI may determine if surgical therapy is needed. The ligamentous components are reconstructed along their specific planes thanks to the 3D method. Furthermore, assessment of the ligamentous damage is also possible in chronic ankle instability (elongation, fibrotic appearance...). Thanks to the multiplanar approach, associated lesions of articular cartilage can be revealed in ankle sprains. The high sensitivity of MRI in slight modifications of medullary bone allows the early diagnosis of "occult" fractures (not seen on conventional radiographs), osteonecrosis, osteochondrosis and reflex sympathetic dystrophy syndrome. Finally, MRI easily displays all ankle and foot tendons and fascia and is particularly helpful in depicting partial tears and postoperative complications.

The accuracy of three-dimensional magnetic resonance imaging in the diagnosis of ruptures of the lateral ligaments of the ankle.

In a prospective study, the diagnostic accuracy of three-dimensional magnetic resonance imaging in the evaluation of ruptures of the lateral ligaments of the ankle was determined by comparing three-dimensional magnetic resonance findings with operative findings. In a series of 18 consecutive cases of acute significant inversion trauma to the ankle, a three-dimensional fast imaging with steady-state precession pulse sequence (3D FISP) was performed. The study included only those cases in which views showed a difference in talar tilt of 15 degrees or more, and a difference in anteroposterior drawer of 10 mm or more between the imaged and the normal ankle. All ankles were scheduled for surgical exploration. Compared with operative findings, the sensitivity, specificity, and accuracy of 3D FISP imaging were, respectively, 100%, 50%, and 94.4% for ruptures of the anterior talofibular ligament and 91.7%, 100%, and 94.4% for ruptures of the calcaneofibular ligament. We believe that 3D FISP magnetic resonance imaging is a noninvasive, fast, and very accurate diagnostic aid to operative planning for double ligament tears in younger competitive athletes.

[Tuberculous laryngitis: not so rare?]. / La laryngite tuberculeuse: pas si rare?

It is a well-known fact that tuberculosis is a major health problem in developing countries. What about its incidence in European countries, especially in Belgium? We present a case of laryngeal tuberculosis in which the clinical appearance of laryngeal malignancy was amazing. The histopathological examination revealed tuberculosis. The laryngeal involvement is the first and single sign of the primary pulmonary form. Recent Belgian epidemiological data are illustrated.

Comparative radiologic study of the influence of ankle joint bandages on ankle stability.

A comparative radiologic study was carried out to test the stabilizing value of ankle strapping and taping on unstable tibiotalar joints. Unstable ankle joints of 51 athletes were examined without bandages, with strapping, and with taping before and after an activity program. The use of taping proved to give the greatest decrease of the talar tilt (TT) angle. This improvement was greater, even after activity, than the stabilization obtained by strapping before any activity.

Comparative radiological study of the influence of ankle joint strapping and - - taping on ankle stability*.

A comparative radiological study was carried out to test the stabilizing value of ankle strapping and taping on unstable tibiotalar joints. Unstable ankle joints of 51 sportsmen were examined without bandages, with strapping, and with taping before and after an activity program. The use of taping proved to give the greatest decrease of the talar tilt angle. This improvement was still greater, even after activity, than the stabilization obtained by strapping, before any activity. J Orthop Sports Phys Ther 1985;7(3):110-114.