Two-dimensional frontal plane projection angle can identify subgroups of patellofemoral pain patients who demonstrate dynamic knee valgus.

BACKGROUND: Identifying individuals with patellofemoral pain who demonstrate similar modifiable factors including dynamic knee valgus may be useful in establishing subgroups of patients that can undergo individualised management strategies. However, a lack of objective assessment criteria means that the findings are of limited value to clinicians aiming to distinguish between patients with and without altered frontal plane knee kinematics. Therefore, the aim of the study was to investigate dynamic knee valgus in individuals with and without patellofemoral pain by determining frontal plane knee alignment during functional activity. METHODS: Thirty recreationally active individuals with patellofemoral pain and 30 non-injured individuals had frontal plane knee alignment assessed via two-dimensional analysis of the frontal plane projection angle during single limb stance and single limb squats to 60° of knee flexion. FINDINGS: Individuals with patellofemoral pain demonstrated excessive frontal plane knee alignment (P = .003; ES = 0.68) compared to uninjured participants during single limb squats. In addition, assessing frontal plane knee alignment using two-dimensional analysis had fair specificity and sensitivity of discriminating patellofemoral pain injury. INTERPRETATION: Clinical quantification of two-dimensional frontal plane knee alignment may be utilised to subgroup patients with patellofemoral pain that display dynamic knee valgus during single limb squats. Furthermore, this may be a useful clinical tool to determine individuals that may be at risk of developing pain in the future.

The mechanism of soft tissue damage: It is all in the rub.

UNLABELLED: Understanding mechanisms of injury to the skin and soft tissue are an important feature in optimizing management strategies. As technology advances and innovative wound products evolve, the need for the awareness of such developments is key to enhancing knowledge and their clinical application. This article provides an overview of the role of repetitive loading of the skin and tissues and the influence of thickness and mobility of these structures. The role of friction and pressure strategies is also discussed along with a brief overview of new products. CLINICAL RELEVANCE: Pressure and friction are important parameters in the management of wounds. Clinicians should be aware of these concepts and be cognizant of new technologies that are available for the reduction of these parameters.

Quantifying frontal plane knee motion during single limb squats: reliability and validity of 2-dimensional measures.

BACKGROUND: Clinical assessment of lower limb kinematics during dynamic tasks may identify individuals who demonstrate abnormal movement patterns that may lead to etiology of exacerbation of knee conditions such as patellofemoral joint (PFJt) pain. PURPOSE: The purpose of this study was to determine the reliability, validity and associated measurement error of a clinically appropriate two-dimensional (2-D) procedure of quantifying frontal plane knee alignment during single limb squats. METHODS: Nine female and nine male recreationally active subjects with no history of PFJt pain had frontal plane limb alignment assessed using three-dimensional (3-D) motion analysis and digital video cameras (2-D analysis) while performing single limb squats. The association between 2-D and 3-D measures was quantified using Pearson's product correlation coefficients. Intraclass correlation coefficients (ICCs) were determined for within- and between-session reliability of 2-D data and standard error of measurement (SEM) was used to establish measurement error. RESULTS: Frontal plane limb alignment assessed with 2-D analysis demonstrated good correlation compared with 3-D methods (r = 0.64 to 0.78, p < 0.001). Within-session (0.86) and between-session ICCs (0.74) demonstrated good reliability for 2-D measures and SEM scores ranged from 2° to 4°. CONCLUSION: 2-D measures have good consistency and may provide a valid measure of lower limb alignment when compared to existing 3-D methods. CLINICAL RELEVANCE: Assessment of lower limb kinematics using 2-D methods may be an accurate and clinically useful alternative to 3-D motion analysis when identifying individuals who demonstrate abnormal movement patterns associated with PFJt pain. LEVEL OF EVIDENCE: 2b.

Systematic review of contracture reduction in the lower extremity with dynamic splinting.

INTRODUCTION: Joint contractures are relatively common disorders that can result in significant, long-term morbidity. Initial treatment is non-operative and often entails the use of mechanical modalities such as dynamic and static splints. Although widely utilized, there is a paucity of data that support the use of such measures. The purpose of this systematic review was to evaluate the safety and efficacy of dynamic splinting as it is used to treat joint contracture in lower extremities, and to determine if duration on total hours of stretching had an effect on outcomes. METHODS: Reviews of PubMed, Science Direct, Medline, AMED, and EMBASE websites were conducted to identify the term 'contracture reduction' in manuscripts published from January 2002 to January 2012. Publications selected for inclusion were controlled trials, cohort studies, or case series studies employing prolonged, passive stretching for lower extremity contracture reduction. A total of 354 abstracts were screened and eight studies (487 subjects) met the inclusion criteria. The primary outcome measure was change in active range of motion (AROM). RESULTS: The mean aggregate change in AROM was 23.5º in the eight studies examined. Dynamic splinting with prolonged, passive stretching as home therapy treatment showed a significant direct, linear correlation between the total number of hours in stretching and restored AROM. No adverse events were reported. DISCUSSION: Dynamic splinting is a safe and efficacious treatment for lower extremity joint contractures. Joint specific stretching protocols accomplished greater durations of end-range stretching which may be considered to be responsible for connective tissue elongation.

Intrarater and interrater reliability of first metatarsophalangeal joint dorsiflexion: goniometry versus visual estimation.

BACKGROUND: Visual estimation (VE) and goniometric measurement (GM) are commonly used to assess first metatarsophalangeal joint dorsiflexion. The purposes of this study were to determine the intrarater and interrater reliability of VE and GM and to establish whether reliability was influenced by the experience of the examiner. METHODS: Ten experienced and ten inexperienced examiners evaluated three real-size photographs of a first metatarsophalangeal joint positioned in various degrees of dorsiflexion on two separate occasions. RESULTS: Experienced examiners demonstrated excellent intrarater and interrater reliability for GM (intraclass correlation coefficient [ICC], >0.953; standard error of measurement [SEM], 1.8°-2.5°) compared with inexperienced examiners, who showed fair-to-good intrarater and interrater reliability (ICC, 0.322-0.597; SEM, 2.0°-3.0°). For VE, inexperienced examiners demonstrated fair-to-good interrater and excellent intra-rater reliability (ICC, 0.666-0.808), which was higher compared with experienced examiners (ICC, 0.167-0.672). The SEM (2.8°-4.4°) was less varied than that of experienced examiners (SEM, 3.8°-6.4°) for VE, but neither group's SEMs were clinically acceptable. CONCLUSIONS: Although minimal differences between intrarater and interrater reliability of GM and VE are noted, this study suggests that GM is more reliable than VE is when used by experienced examiners. These findings support the continued use of GM for first metatarsophalangeal joint dorsiflexion assessment.

Influence of turnout on foot posture and its relationship to overuse musculoskeletal injury in professional contemporary dancers: a preliminary investigation.

BACKGROUND: The angle of turnout is thought to predispose professional dancers to overuse musculoskeletal injuries of the lower limb; yet, the influence of angle of turnout on foot posture is currently unknown. METHODS: Twelve professional contemporary dancers (five women and seven men; mean age, 26.8 years) were recruited. The angle of gait and angle of turnout were measured using a quasi-static clinical tracing method. Foot posture was assessed in the base of gait and angle of turnout using the Foot Posture Index. Each dancer completed a dance history and injury questionnaire. RESULTS: The results show a tendency toward a pronated foot posture (mean, 9°) in the angle of turnout position. A significant relationship was noted between the Foot Posture Index and angle of turnout (ρ = 0.933-0.968, P < .01) and between the number of reported injuries and change in foot posture in the angle of turnout (ρ = 0.789, P < .01) (right foot only). Twenty-eight injuries were reported; male dancers experienced a mean of 2.8 injuries and females a mean of 1.6 injuries. An inverse relationship was noted between age at training initiation and total reported injuries (r =-0.867, P < .01). All of the dancers reported a history of injury to the spine or lower limb, and 9 of the 12 reported an injury within the previous 12 months. CONCLUSIONS: Turnout is one of the most fundamental aspects of dance technique. This study suggests a trend toward pronation in angle of turnout and a link to lower-limb musculoskeletal injury.

Quantifying the quasi-static angle and base of gait: a preliminary investigation comparing footprints and a clinical method.

Although the angle and base of gait are useful parameters commonly measured in podiatric medical practice, a standardized procedure has yet to be defined. Static footprints and clinical tracings of the perimeters of both feet were investigated in 25 asymptomatic subjects (17 women and 8 men). The intrarater reliability of each measurement condition was assessed using intraclass correlation coefficients and ranged from 0.965 to 0.981 for the angle of gait and from 0.979 to 0.986 for the base of gait. Both sets of data were compared using paired t-tests and demonstrated no significant differences (P > .001) for the angle and base of gait. The results suggest that footprint data and a simple clinical tracing of the foot are similar, providing a useful clinical tool for static assessment of the angle and base of gait.

Future of gait analysis: a podiatric medical perspective.

Despite the plethora of information on human gait analysis, its continued use as a clinical tool remains uncertain. Analysis of gait dysfunction has become integral to podiatric medical practice, and, like many specialized fields, it is rapidly changing to meet the needs of the future. Practice in the 21st century is predicated on the concept of multidisciplinary working approaches and a growing trend toward evidence-based practice, in which gait analysis could play a prominent role. This article provides a historical synopsis of instrumented gait analysis and its associated subcomponents and discusses the salient issues concerning its future role in podiatric medicine.