Barefoot pressure distribution of diabetic patients and non-diabetic volunteer subjects after sensorimotor training with an unstable shoe construction.

BACKGROUND: Forty-three percent of all diabetic foot ulcers occur under the medial forefoot due to a medial deviation of elevated pressures and premature forefoot ground contact in neuropathic diabetic patients. A 6-week sensorimotor training period with an unstable shoe construction reduces in-shoe peak pressures and contact times under the medial aspect of the forefoot. METHODS: The study was designed as a Randomised Control Trial with two diabetic groups (one served as intervention group and one as control group) and one non-diabetic intervention group. Measurements for barefoot pressure distribution and contact times were taken by means of an Emed® pressure measurement platform (Novel GmbH, Munich) before and after 6 weeks. During this time the diabetic and the non-diabetic intervention groups were required to wear an unstable shoe construction (Masai Barefoot Technology, MBT®) for at least four hours per day. FINDINGS: Results for the non-diabetic intervention group showed significantly later contact times for the medial portion of the forefoot, resulting in shorter contact times. Peak pressure was also reduced under the medial aspect of the foot while it was increased under the lateral aspect of the foot. Changes for the diabetic intervention group followed the same pattern while the values of the diabetic control group shifted away from the reference values. INTERPRETATION: A 6-week sensorimotor training period with an unstable shoe construction can change barefoot peak pressures and contact times in non-diabetic subjects and in diabetic patients in the most endangered area, i.e. the medial forefoot.

Progressive rehabilitation of the sprained ankle: A novel treatment method.

OBJECTIVES: This randomised, single blinded cohort study was designed to assess the immediate effect of manual fascial manipulation on walking pain and the range of ankle dorsiflexion within the first 4 days after ankle trauma. METHODS: Measurements were taken from 19 subjects, 5 female and 14 male, who presented with grade I-III ankle sprains. Ankle dorsiflexion was photographed in a standardised position and calculated by means of the Dartfish® Advanced Video Analysis Software and SPSS® (version 17) was used to compare the pre- and post-treatment data. RESULTS: After one treatment session 13 of the 19 subjects were walking pain free and 3 of the 19 where walking with only little pain. The highly significant (p<0.001) mean improvement of ankle dorsiflexion was 7.9° (±5.8°). All, apart from one subject, whom were walking pain free after treatment showed a minimum of 4° increased dorsiflexion. CONCLUSION: Early fascia work around the injured ankle improves ankle dorsiflexion and reduces walking pain. It may reduce the delay of tissue healing and, thus, optimise further rehabilitation of the sprained ankle which may also reduce socio-economic costs.

Comparison of gait kinematics in total and unicondylar knee replacement surgery.

INTRODUCTION: This study is aimed to compare kinematic gait data of patients who have undergone total and unicondylar knee replacement. MATERIALS AND METHODS: This single-surgeon retrospective cohort study evaluated 13 patients with unilateral total knee arthroplasty (TKA) and 14 unicondylar knee arthroplasty (UKA). Gait analysis was carried out using a Vicon motion analysis system. The limits of knee flexion during stance phase, at heel strike and at loading response were measured. RESULTS: The total range of motion of the UKA knees was significantly greater than the TKA knees. UKA knees exhibited significantly greater knee extension during the stance phase than the TKA knees. Unlike TKA, UKA knees demonstrated improved knee flexion during the gait cycle when compared to the contralateral non-operated knee. The hips also demonstrated near normal hip flexion in UKA patients. Predictably, UKA knees had significantly greater varus compared with TKA in the coronal plane. Spatiotemporal variables demonstrated similar walking speed and step length to aid a fair comparison between knee replacement groups. CONCLUSIONS: The UKA knees moved more physiologically in the sagittal plane with a greater range of motion during gait. Despite having a stiff gait pattern, the patients undergoing TKA demonstrated a more neutral alignment in the coronal plane. Neither type of knee arthroplasty restored knee kinematics to those of the non-operated side.

Comparison of 3 ankle braces in reducing ankle inversion in a basketball rebounding task.

Lateral ankle injury incidence rates are very high in the sport of basketball, with a significant proportion occurring during rebounding. Ankle braces are often used as preventative and rehabilitative techniques in the hope of minimizing the likelihood of experiencing excessive ankle inversion. This study aims to evaluate the effect of different ankle braces in preventing ankle inversion during a basketball rebounding task. Sixteen subjects participated in the study (11 males, 5 females; mean age = 26.94 years, SD = 5.32; mean height 1.72 m, SD = 0.08; mean weight 73.95 kg, SD = 13.68). Participants performed a simulated rebounding task in multiple braced conditions: unbraced (UB), Ossur Formfit (OF), Talarmade Ankleguard Air/Gel Stirrup (TAG) and Bauerfeind Malleoloc (BF). Ankle and foot inversion angles, ankle inversion moments and peroneus longus EMG activity were recorded and analysed to determine the effectiveness of each condition to resist inversion. All braced conditions reduced ankle and foot inversion angles compared to UB. In the non-dominant limb, OF showed reduced maximum ankle inversion compared to BF (non-dominant mean difference = 0.630°, p < 0.001) and reduced foot inversion compared to TAG (non-dominant mean difference = 0.966°, p = 0.035). Compared to UB, OF and TAG increased ankle inversion moments in the dominant ankle and showed decreases in the non-dominant ankle. BF reduced mean peak peroneus longus EMG activity compared to all other trials. Whilst statistically significant differences that were demonstrated between several braced conditions are relatively small, they are clinically significant knowing that the maximum barefoot inversion whilst standing is less than 17 degrees.

The effects of wearing an Ankle Stabilizing Orthosis (ASO) Ankle Brace on ankle joints kinetics and kinematics during a basketball rebounding task.

Following an ankle injury, athletes sometimes brace the injured ankle in hopes of minimizing the likelihood of suffering a recurring injury. This study aims to evaluate the effects of wearing an Ankle Stabilizing Orthosis (ASO) ankle brace unilaterally on the dominant side on bilateral ankle joint kinetics and kinematics and peroneus longus EMG activity. Since a significant proportion of ankle injuries in basketball occur during rebounding, data was collected during a simulated rebounding task. Rebounding is defined as the act of retrieving a missed shot attempt. Subjects oftentimes jump vertically to acquire the basketball as it rebounds from the backboard or rim. Sixteen subjects participated in the study (11 males, 5 females; mean age = 26.94 years, SD = 5.32; mean height 1.72 m, SD = 0.08; mean weight 73.95 kg, SD = 13.68). Participants completed the rebounding task in braced (ASO) and unbraced (UB) conditions. Ankle and foot inversion angles, ankle inversion moments and peroneus longus EMG activity were recorded and analysed to determine the effects of wearing an ankle brace unilaterally. In the dominant limb, when compared to UB, ASO reduced ankle and foot inversion, and increased ankle inversion moments. No significant differences were observed in peroneus longus EMG activity. In the non-dominant limb, no significant differences were observed for any of the parameters. These results suggest that wearing an ASO ankle brace on the dominant ankle reduces maximum ankle and foot inversion angles without posing an increased risk to the unbraced leg. However, the increased ankle inversion moments in the braced ankle suggest that there are adjustments regarding force distribution, perhaps due to the restricted range of motion.

Accuracy and repeatability of a semi-quantitative barefoot pressure measurement method for clinical use: The Derks Calculation Method.

BACKGROUND: This study was designed to assess the accuracy and repeatability of the Derks Calculation Method in the normal foot during walking. METHODS: Measurements were taken from 25 healthy subjects (age 32.0 ± 12.4), 23 females and 2 males, on five separate occasions at seven days, three weeks, three months, and nine months apart by means of a mid-gait method. Values were calculated for internal rotation (IR) and external rotation of the heel (ER), heel valgus/varus (HV), heel length (HL), heel width (HW), width of the midfoot (WM) and the forefoot (WF), and the length of the foot (LF). RESULTS: For all five separate occasions and in 87.5% of the parameters investigated, the coefficient of repeatability (CR, expressed as a percentage of the mean) was less than 5%. One parameter showed a high CR - heel valgus/varus (HV) was extremely high (>800%). The maximum 95% Confidence Interval (CI) for the five different occasions was no higher than 0.2 cm for IR, ER and HV with a standard error (SE) of 0.01 and >0.01 respectively. The maximum 95% CI for WF was 0.4 cm (SE 0.1), and for HW, WM and LF the maximum 95% CI was 0.7 cm (SE 0.1 or 0.2). HL showed the highest 95% CI (0.9 cm) with an SE of 0.2. CONCLUSION: The Derks Calculation Method was found to be accurate and repeatable if HV was excluded, which renders this method a viable clinical tool in settings where sophisticated computerised systems are still unavailable.

Comparison of gait kinetics in total and unicondylar knee replacement surgery.

Introduction The aim of this study was to compare kinetical data from gait analysis of patients who have undergone total and uni-condylar knee replacement. Materials and methods Thirteen patients with unilateral total knee arthroplasty (TKA) and 13 unicondylar knee arthroplasty (UKA), were included, all performed by the same surgeon more than one year prior. The Vicon gait analysis system was used. Statistical power was calculated using SPSS. Results No significant difference was found in the spatiotemporal parameters of gait and survival years of the knee prosthesis between the two groups. The UKA group was found to have significantly larger moments than the TKA group in knee adduction on the operated side and knee flexion moment on the unoperated side during the loading phase. The maximum and minimum sagittal plane moments of the operated sides in the TKA group were significantly lower than the unoperated side. The difference was most significant at pre-swing. The maximum and minimum moments on the operated sides in the UKA group were significantly lower for the knee flexion and adduction moments when compared with the unoperated side and were most prevalent during the loading phase. Conclusions These results are relevant in terms of prosthesis wear. The TKA knees had smaller magnitude moments than the UKA knees in the sagittal and coronal planes. This could explain the higher revision rates for UKA. In both groups, the non-operated knees had significantly larger moments than the operated knees, which implies that after unilateral knee replacement of either type, the non-operated knee is being put under greater stress.

Motor system dysfunction in the schizophrenia diathesis: Neural systems to neurotransmitters.

Motor control is a ubiquitous aspect of human function, and from its earliest origins, abnormal motor control has been proposed as being central to schizophrenia. The neurobiological architecture of the motor system is well understood in primates and involves cortical and sub-cortical components including the primary motor cortex, supplementary motor area, dorsal anterior cingulate cortex, the prefrontal cortex, the basal ganglia, and cerebellum. Notably all of these regions are associated in some manner to the pathophysiology of schizophrenia. At the molecular scale, both dopamine and γ-Aminobutyric Acid (GABA) abnormalities have been associated with working memory dysfunction, but particularly relating to the basal ganglia and the prefrontal cortex respectively. As evidence from multiple scales (behavioral, regional and molecular) converges, here we provide a synthesis of the bio-behavioral relevance of motor dysfunction in schizophrenia, and its consistency across scales. We believe that the selective compendium we provide can supplement calls arguing for renewed interest in studying the motor system in schizophrenia. We believe that in addition to being a highly relevant target for the study of schizophrenia related pathways in the brain, such focus provides tractable behavioral probes for in vivo imaging studies in the illness. Our assessment is that the motor system is a highly valuable research domain for the study of schizophrenia.

Effect of Vitamin K on Vascular Health and Physical Function in Older People with Vascular Disease--A Randomised Controlled Trial.

BACKGROUND AND AIMS: Vitamin K insufficiency is common and linked to an increased risk of cardiovascular disease and osteoporotic fractures. The aim of this study was to examine whether daily supplementation with oral vitamin K could improve vascular health and physical function in older people with established vascular disease. METHODS AND RESULTS: A double blind, randomised, placebo-controlled trial. Participants aged ≤ 70 years with a history of vascular disease were randomised to receive 6 months of daily oral 100mcg vitamin K2 (MK7 subtype) or matching placebo with outcomes measured at 0, 3 and 6 months. The primary outcome was between-group difference in endothelial function assessed using flow-mediated dilatation of the brachial artery at 6 months. Secondary outcomes included carotid-radial pulse wave velocity, augmentation index, blood pressure, carotid intima-media thickness, C-reactive protein, B-type natriuretic peptide, cholesterol and desphospho-uncarboxylated matrix Gla protein levels. Handgrip strength and the Short Physical Performance Battery assessed physical function, while postural sway was measured using a 3-dimensional force platform. RESULTS: 80 participants were randomised, mean age 77 (SD 5) years; 44/80 were male. Vitamin K levels rose in the intervention arm compared to placebo (+48 pg/ml vs -6 pg/ml, p=0.03) at 6 months. Desphospho-uncarboxylated Matrix Gla protein levels fell in the intervention group compared to placebo at 6 months (-130 [SD 117] pmol/L vs +13 [SD 180] pmol/L, p<0.001). No change was seen in endothelial function (between group difference -0.3% [95%CI -1.3 to 0.8], p=0.62). A modest, non-significant improvement in pulse wave velocity was seen in the vitamin K group (-0.8m/s [95%CI -1.8 to 0.3], p=0.15) while all other vascular and physical function outcomes unchanged. CONCLUSIONS: Six months of vitamin K2 supplementation did not improve markers of vascular health or physical function in older patients with vascular disease.

Application of radioisotope XRF and thermoluminescence (TL) dating in investigation of pottery from Tell AL-Kasra archaeological site, Syria.

Statistical analysis based on chemical composition, using radioisotope X-ray fluorescence, have been applied on 39 ancient pottery fragments coming from the excavation at Tell Al-Kasra archaeological site, Syria. Three groups were defined by applying Cluster and Factor analysis statistical methods. Thermoluminescence (TL) dating was investigated on three sherds taken from the bathroom (hammam) on the site. Multiple aliquot additive dose (MAAD) was used to estimate the paleodose value, and the gamma spectrometry was used to estimate the dose rate. The average age was found to be 715±36 year.

Footwear in rock climbing: Current practice.

BACKGROUND: Many rock climbers wear ill-fitting and excessively tight footwear during activity. However, there is insufficient evidence of the extent or harms of this practice. OBJECTIVES: To investigate footwear use in rock climbers with a focus on issues surrounding fit. METHODS: A cross-sectional study with active rock climbers of over one year of experience completing a survey on their activity and footwear. Additionally, the authors quantified foot and shoe lengths and sizes alongside demographic data. RESULTS: Ill-fitting and excessively tight footwear was found in 55 out of 56 rock climbers. Foot pain during activity was also commonplace in 91% of the climbers. A mean size reduction of almost 4 UK shoe sizes was found between the climbers' street shoe size and that of their climbing footwear using a calibrated foot/shoe ruler. There is an unfortunate association of climbers of higher abilities seeking a tighter shoe fit (p<0.001). CONCLUSION: With the elucidation of footwear use amongst rock climbers, further investigation may aim to quantify its impact and seek a solution balancing climbing performance while mitigating foot injury.

Efficacy of low-level laser therapy applied at acupuncture points in knee osteoarthritis: a randomised double-blind comparative trial.

OBJECTIVE: To evaluate the efficacy of low-level laser therapy (LLLT) applied to acupuncture points on the knee joint in combination with exercise and advice in patients with knee osteoarthritis. DESIGN: Randomised, double-blind, comparative clinical trial. PARTICIPANTS: Forty-nine patients with knee osteoarthritis were assigned at random into two groups: active laser group (n=26) and placebo laser group (n=23). INTERVENTION: Using a gallium aluminium arsenide laser device, patients received either active or placebo LLLT at five acupuncture points on the affected knee during nine sessions. OUTCOME MEASURES: Patients were assessed using a visual analogue scale (VAS) and the Saudi Knee Function Scale (SKFS) at baseline, the fifth treatment session, the last treatment session, 6 weeks post intervention and 6 months post intervention. RESULTS: VAS scores showed a significant improvement in the active laser group compared with the placebo laser group at 6 weeks post intervention [mean difference -1.3, 95% confidence interval (CI) of the difference -2.4 to -0.3; P=0.014] and 6 months post intervention (mean difference -1.8, 95% CI of the difference -3.0 to -0.7; P=0.003) using the independent samples test. SKFS scores also showed a significant improvement in the active laser group compared with the placebo laser group at the last treatment session (median difference -15, 95% CI of the difference -27 to -2; P=0.035) and 6 months post intervention (median difference -21, 95% CI of the difference -34 to -7; P=0.006) using the Mann-Whitney U test. CONCLUSIONS: The results demonstrate that short-term application of LLLT to specific acupuncture points in association with exercise and advice is effective in reducing pain and improving quality of life in patients with knee osteoarthritis.

Assessment of talipes equinovarus treated by Ponseti technique: three-year preliminary report.

BACKGROUND: The Ponseti method has become increasingly popular in the treatment of congenital talipes equinovarus (CTEV). Current methods of assessment focus on clinical, functional and radiological outcomes which are subjective and often difficult to repeat. However, integration of biomechanical evaluation can provide objective and quantifiable analysis. This study aims to evaluate the treatment outcome of CTEV patients on the basis of long-term clinical, functional and biomechanical assessment. METHODS: Following treatment, five children with CTEV were reviewed annually for the period 2008-2010. Clinical and functional outcomes were graded using parental questionnaires and clinical examination. Biomechanical parameters were evaluated using digital foot pressure studies. RESULTS: The study group recorded good clinical and functional outcomes. However, biomechanical studies have been able to identify subtle abnormalities that would be unapparent otherwise on clinical examination. CONCLUSIONS: It is recommended that biomechanical assessment be integrated into the overall evaluation of the outcome of CTEV after treatment.

Keller's arthroplasty in adults with hallux valgus and hallux rigidus.

BACKGROUND: The role of Keller's resection arthroplasty in the management of adult hallux valgus with hallux rigidus is debatable. There are no studies addressing this particular problem. METHODS: This study is a retrospective review of 32 patients (49 feet), conducted by an independent assessor. Subjective and objective criteria were used to assess the results of surgery. There were 30 women and 2 men with an average age at surgery of 62.5years. RESULTS: The results of surgery in terms of relief of pain, cosmesis and use of regular footwear were satisfactory. Excellent and good subjective results were obtained in 39% and 37% of cases respectively. Radiological analysis revealed decrease in the intermetatarsal and first metatarsophalangeal angle in a significant number of cases. Final results assessed by Vallier's modification of Bonney and MacNab criteria, revealed excellent to good results in 87% of feet. A significant number of complications were noted but there was no association between the occurrence of complications and the final result or the subjective functional grade. There was no association between the amount of resection of proximal phalanx and occurrence of metatarsalgia or the final outcome. CONCLUSION: The results of this study suggest that Keller's arthroplasty has a role in patients with adult hallux valgus associated with degenerative changes in the first metatarsophalangeal joint.

The influence of shoe sole's varying thickness on lower limb muscle activity.

BACKGROUND: The lateral ligament injury of the ankle is acknowledged to be the most common ankle injury sustained in sport. Increased peroneus longus muscle contraction in the shod population has already been documented. This study aimed to quantify the effect of shoe sole's varying thickness on peroneus longus muscle activity. METHODS: Electromyographic recordings of the peroneus longus muscle activity following unanticipated inversion of the foot from 0° to 20° in a two-footplate tilting platform were collected from 38 healthy participants. The four test conditions were: barefoot, standard shoe, and shoes with 2.5 cm and 5 cm sole adaptation respectively. RESULTS: Compared to the barefoot condition, there is an increase in the magnitude of muscle contraction on wearing shoes, which further increases with thickening shoe soles. The peroneus longus was responding earlier in the shod conditions when compared to the barefoot, although the results were variable within the three shod conditions. CONCLUSION: Footwear with increasing shoe sole thickness evokes a correspondingly stronger protective eversion response from the peroneus longus to counter the increasing moment at the ankle-subtalar joint complex following sudden foot inversion. Hence, fashion footwear with thicker sole is likely to increase the risk of lateral ligament injury of the ankle when such protective response is overwhelmed. Similarly, the clinicians need to be cautious regarding the amount of shoe raise that they could provide for patients with limb length discrepancy without any detrimental untoward side effects.

Harmful cleats of football boots: a biomechanical evaluation.

BACKGROUND: Football players wear boots of varying cleat designs with some preferring the bladed cleats while others opting for the conventional studded cleats. The current study compares biomechanically the boots with differing cleat designs and their effect on feet, if any. METHODS: Twenty-nine healthy male volunteers were recruited from amateur football teams. They were asked to perform three trials each of two activities: a straight run and a run cutting at a 60° angle wearing bladed and studded Adidas®-F series boots on artificial turf. Plantar pressure values were recorded using the Pedar®-X in-shoe pressure measuring device. Peak pressure and pressure-time integral were analysed over 11 clinically relevant areas under the foot. RESULTS: While the in-shoe pressure and pressure-time integral were higher under the medial half of the foot with studded boots, they were higher under the lateral half of the foot with the bladed design. CONCLUSIONS: The studded boots can be considered safer as the pressure distribution across the foot and the pattern of centre of pressure progression mimicked the normal motif, whereas the bladed boots could potentially be deemed relatively more harmful due to the unnatural increased loading under the lateral half of the foot, predisposing the foot to injuries.

Classification of the reduced vertical component of the ground reaction force in late stance in cerebral palsy gait.

Children with cerebral palsy (CP) often experience significant problems supporting their bodyweight (BW) and decelerating the downward velocity of the centre of mass (CoM) in late stance. This is seen as a decreased second peak of vertical ground reaction force (GRF) nominated FZ(2). This study categorises gait data by the degree of reduced FZ(2). Kinetic data were analysed from a CP database. Data from 129 patients, able to walk barefoot unaided, were investigated. Of these, 84 had kinetic data, 59 diplegics (both legs) and 15 hemiplegics (affected leg only), thus providing data from 133 legs. A reduced FZ(2) was observed in 116 legs (87%). Of the 133 legs, 44% failed to generate FZ(2)>BW. By including the Type 2 data this figure rises to, a staggering 66% who are having difficulty supporting BW at this stage of the stance phase. Only 12% of the legs showed a normal pattern (FZ(2) approximately equal to FZ(1)). In conclusion, the majority of CP children referred to the gait laboratory exhibited some degree of reduced FZ(2) and can be categorised as having a 'Ben Lomonding' gait pattern. 'Ben Lomonding,' is the term used to describe this phenomenon of reduced FZ(2), as the shape of the GRF graph resembles the shape of the Scottish mountain, Ben Lomond, which has two peaks, the second peak being much smaller than the first. Crucially, clinicians should be aware that nearly half of the CP children in this study were in difficulty supporting their BW in late stance and must use compensatory mechanisms to prevent collapse of the affected limb.

The effect of varying footwear configurations on the peroneus longus muscle function following inversion.

BACKGROUND: The ankle is one of the most commonly injured joints with inversion injury affecting its lateral ligament complex being the commonest of all. Shoes are one of the known risk factors for such an injury. OBJECTIVE: This study seeks to examine the impact of varying shoe configurations on the protective function of the peroneus longus muscle during unanticipated foot inversion. METHODS: The peak amplitude, latency and post-peak average amplitude of the ipsilateral peroneus longus muscle were recorded by surface electromyography following unanticipated inversion of the feet of 35 subjects in a two-footplate tilting platform from 0° to 20°. The test conditions were barefoot, standard training shoe, shoe with a sole flare, and an above the ankle laced boot. RESULTS: Analysis revealed significant differences in peak muscle contraction between shod and unshod conditions. The standard shoe and the flared sole design showed greater statistically significant differences from the unshod condition, than the boot. The muscle was responding earlier in the shod conditions compared to the barefoot. The post-peak average amplitude with the standard shoe and the flared sole shoe were significantly different from the barefoot condition. CONCLUSION: Albeit no marked differences could be demonstrated between the tested shoes, the inherent construct of the laced boot probably attempts to protect the ankle-subtalar joint complex evidenced by evoking a less strong peroneus longus muscle's protective response.

Differences in foot pressures between Caucasians and Indians.

BACKGROUND: Indians are the largest single ethnic minority group in the United Kingdom and form more than one million of the current population. No studies have investigated foot pressure differences between Caucasians and Indians. OBJECTIVE: The aim of our study was to investigate the in-shoe pressure differences in Caucasians and Indians using the Pedar(®)-m (Novel GmbH, Germany). METHODS: The study included 12 Caucasians and 21 Indians. Peak pressure (PP), contact area (CA), contact time (CT), pressure-time integral (PTI), force-time integral (FTI), instant of peak pressure (IPP), maximum force (MaxF) and mean force (MeanF) were recorded. RESULTS: Caucasians had higher significant PP compared to Indians under the heel (293 kPa vs. 251 kPa; P<0.001), 1st metatarsal head (294 kPa vs. 233 kPa; P=0.01), 2nd metatarsal head (266 kPa vs. 236 kPa; P=0.03), 3rd metatarsal head (254 kPa vs. 223 kPa; P=0.04), and the 5th metatarsal head (168 kPa vs. 133 kPa; P=0.04). There was no significant difference in the contact area between the two race groups. The PTI was statistically significantly higher in Caucasians in the region of the 1st metatarsal head (79 kPas vs. 62 kPas; P=0.03) and 5th metatarsal head (58 kPas vs. 44 kPas; P=0.03). There were no significant differences among CT, FTI, IPP, MaxF and MeanF among them. CONCLUSION: The PP under the heel, 1st, 2nd, 3rd and 5th metatarsal heads and the PTI under the 1st and 5th metatarsal heads in Caucasians is higher than in Indians. There is no difference in the CA.

Objective assessment of the alterations in wrist mobility with the fastrak(®) system following dorsal capsulodesis.

The treatment for scapholunate dissociation is challenging and its management is varied depending on type, severity and duration of injury, and surgeon's preferred technique. This study aimed to objectively assess the variations in the range and patterns of wrist movements using the Fastrak(®) system in patients having undergone Blatt's dorsal capsulodesis (BDC). The wrist movements were successively measured between the operated and unoperated wrists, while the patients performed set tasks. Seventeen patients agreed to participate in the study. Following BDC the mean flexion loss was 23° (range 10°-38°). However, functional tasks revealed that the BDC did not adversely affect the function of the operated wrist. This novel study demonstrates objectively the functional restrictions that patients are likely to experience postoperatively following BDC. It would be interesting to note the pattern of wrist motion using the Fastrak(®) system in various other clinical settings.