Effects of Rhythm Step Training on Foot and Lower Limb Balance in Children and Adolescents with Flat Feet: A Radiographic Analysis.

Background and Objectives: Owing to the recent reports regarding the efficacy of rhythm step training (RST) in lower limb muscle development and motor skill enhancement, this study aimed to evaluate the effects of RST on foot and lower limb balance in children and adolescents diagnosed with flat feet using radiographic analysis. Materials and Methods: A total of 160 children and adolescents diagnosed with flat feet from a hospital in Seoul were randomly assigned to the general flat feet training (GFFT) (n = 80) or RST (n = 80) group. Patients in both groups exercised for 50 min once a week for 12 weeks. Key variables, such as quadriceps angle (Q-angle), calcaneal pitch angle (CPA), calcaneal-first metatarsal angle (CFMA), and navicular-cuboid overlap ratio (OR) were measured before and after the intervention. Results: Significant improvements in Q-angle (p < 0.001), CPA (p < 0.001), CFMA (p < 0.001), and navicular-cuboid OR (p < 0.001) were observed in the RST group compared to the GFFT group. RST was found to be more effective in normalizing the biomechanical function of the calcaneus and improving lower limb function. Conclusions: RST significantly enhances foot and lower limb balance in children and adolescents with flat feet, suggesting its potential use as an effective intervention for this population. The study did not specifically analyze the effects of various components of rhythm training, such as music, exercise intensity, and frequency, on the outcomes. Further research is needed to determine how each of these elements individually influences the results.

Patients' perspectives on the conventional synthetic cast vs a newly developed open cast for ankle sprains.

BACKGROUND: Orthopedic physicians typically apply a cast to immobilize a body part that has been injured. There have been no significant structural changes or advances in synthetic casts since the development of the modern cast. The Opencast® is a recently developed type of cast that allows ventilation and direct visual inspection of the skin to avoid cast-related complications. Although this novel cast appears to have more benefits than the conventional synthetic cast, its clinical efficacy and advantages have not been established. AIM: To investigate the clinical efficacy and advantages of the newly developed Opencast® based on patients' perspectives in those with ankle inversion injury. METHODS: A specifically designed questionnaire consisting of 19 items was used to compare patients' opinions and concerns of the Opencast® and the conventional synthetic cast. The items were focused on subjective patient satisfaction, discomfort, and adverse effects while wearing the cast. Patients with an ankle inversion injury diagnosed as a high-grade ankle sprain were enrolled. The subjects were randomized and instructed to fill the questionnaire after wearing a synthetic cast or an Opencast® for 2 wk. They were then required to fill the questionnaire again, after switching to the alternative type of cast for 2 more weeks. RESULTS: A total of 22 subjects participated in the study. The synthetic cast appeared to be more rigid and stable than the Opencast®, but there was no significant difference in the amount of pain relief. The likelihood of adverse effects when wearing the synthetic cast was significantly higher. Patient satisfaction tended to be rated higher after wearing the Opencast®. Opencast® showed more subjective vulnerability than the synthetic cast, but there was no significant difference in the redo rate. Patients were more anxious about removal of the synthetic cast than of the Opencast®. CONCLUSION: The results indicate that the Opencast® could replace the conventional synthetic cast as it offers increased patient satisfaction, which would in turn increase compliance to treatment.

Dynamic First Tarsometatarsal Instability During Gait Evaluated by Pedobarographic Examination in Patients With Hallux Valgus.

BACKGROUND: This study aimed to investigate the pedobarographic characteristics of tarsometatarsal instability and to identify factors associated with pedobarographic first tarsometatarsal instability in patients with hallux valgus. METHODS: Fifty-seven patients (mean age, 59.7 years; standard deviation, 11.4 years; 6 men and 51 women) with a hallux valgus angle (HVA) greater than 15 degrees were included. All patients underwent a pedobarographic examination along with weightbearing anteroposterior (AP) and lateral foot radiography. Radiographic measurements were compared between the 2 groups with and without pedobarographic first tarsometatarsal instability. The association between the radiographic and pedobarographic parameters of the first tarsometatarsal instability was analyzed using the chi-square test. Binary logistic regression analysis was performed to identify significant factors affecting pedobarographic first tarsometatarsal instability. RESULTS: The HVA (P < .001), intermetatarsal angle (P = .001), and AP talo-first metatarsal angle were significantly different between the pedobarographically stable and unstable tarsometatarsal groups. There was no significant association between radiographic and pedobarographic instability of the first tarsometatarsal joint (P = .924). The HVA was found to be the only significant factor affecting pedobarographic tarsometatarsal joint instability (P = .001). CONCLUSION: The pedobarographic examination has possible clinical utility in evaluating first tarsometatarsal joint instability in patients with hallux valgus. Patients with a greater HVA should be assessed for the presence of first tarsometatarsal instability, and the necessity of the Lapidus procedure should be considered. LEVEL OF EVIDENCE: Level III, comparative study.

Fracture of the coracoid process with acute subscapularis tear without shoulder dislocation.

Coracoid process fracture is an uncommon injury and can be easily missed. An associated acute subscapularis tear is still rare. Herein, we describe a 61 year old male who fell from a 2 meter height (stair case) and presented with isolated coracoid process fracture with acute subscapularis tear without dislocation of (R) shoulder joint. The plain x-rays, CT scan and MR arthrography comprised the diagnosis. He was operated upon with reattachment of subscapularis to lesser tuberosity and conjoint tendons to pectoralis major. At 6 mo followup he had good range of motion and his MRI revealed complete healing.

Multiple osteochondritis dissecans of knee joint in a patient with Wilson disease, focusing on magnetic resonance findings.

A 17-year-old man was admitted with a complaint of knee pain. He was diagnosed with Wilson disease by ophthalmologic and laboratory studies during hospitalization. Initial plain radiography of both knees showed multiple osteochondritis dissecans (OCD) on the medial and lateral femoral condyles of both knees. Subsequent magnetic resonance imaging showed multiple OCDs, which were symmetric on both knees. Subchondral cysts on the medial condyle and trochlear dysplasia were additionally evident on both femurs. We report this case with a focus on the imaging findings.