Foot Plantar Pressure Profile Alteration after Microsurgical Great Toe-to-thumb Transfer.

Background: Microsurgical great toe-to-thumb transfer (mGTT) is a widely used procedure when immediate replantation of thumb is not feasible. The aim of this study was to investigate the alteration of plantar pressure profile of the donor foot after mGTT. Methods: Twenty patients receiving microsurgical great toe-to-hand transfer between 1985 to 2014, and 16 healthy subjects were recruited. Group 1 consisted of 20 feet receiving mGTT, whereas group 2 consisted of 32 normal feet as control. The flap design in this study was to preserve 1 cm of the proximal phalanx to maintain the attachment of the plantar aponeurosis and intrinsic muscles. The Taiwan Chinese version of the Foot Function Index was used for patient-reported outcome measurement. A novel Emed-X system was used for dynamic plantar pressure measurement. A total of four parameters were collected, including peak pressure, contact area, contact time, and pressure-time integral. Results: In group 1, the peak pressure redistributed under the first metatarsal bone and was significantly higher than group 2 (P < 0.05). There was no significant change of the contact area between the midfoot region of group 1 and group 2 (P > 0.05). Furthermore, similar foot clearance efficiency was demonstrated in group 1 and group 2 (P > 0.05). Conclusions: The windlass effect of the foot will not be affected when performing mGTT with preservation of 1 cm of the proximal phalanx. Therefore, this surgical procedure is highly recommended for clinical application.

Improvement of Pain and Function by Using Botulinum Toxin Type A Injection in Patients with an Osteoarthritic Knee with Patellar Malalignment: An Electromyographic Study.

Objective: To determine the pain and electromyographic (EMG) amplitude ratio of the vastus medialis oblique (VMO) to the vastus lateralis (VL) after botulinum toxin type A (BTA) was injected in the bilateral osteoarthritic knee of patients with patellar malalignment for analysis. Material and methods: A total of fifteen patients were recruited; the more symptomatic knee of each patient received a BTA injection (BTA side). The other set of patients were left untreated. In all, fifteen healthy participants comprised the control group. The Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) and numeric rating scale (NRS) for pain were assessed. The EMG amplitude of VL and VMO activity was recorded using an isokinetic dynamometer and synchronized using the BIOPAC MP100. The data were collected before and at 4, 8, and 12 weeks post−BTA injection. Results: The EMG ratios of the patient group were lower than those of the control group at all testing velocities (p < 0.05). The VMO/VL ratio improved significantly on the BTA side only. The VMO/VL ratios on the BTA side were higher than those on the untreated side (p < 0.05). Knee pain decreased significantly after the BTA injection. The EMG ratios were negatively correlated with the NRS and WOMAC scores. Conclusion: BTA injection effectively reduces knee pain and restores the EMG ratio between the VMO and VL.

Intra-articular intervention by hyaluronic acid for knee osteoarthritis can modify locomotor pattern of muscle activity.

OBJECTIVE: To evaluate the muscle activation pattern of lower extremities can be modified by intraarticular injection of hyaluronic acid( IAHA). MATERIAL AND METHOD: Twenty-three subjects with knee OA and 14 age-matched non-knee OA control subjects were recruited from an outpatient clinic. Three-dimensional gait analysis with using the MA- 100 EMG system was applied to measure the muscles activities. The quadriceps (QUA), hamstrings (HAM), tibialis anterior (TA), and medial gastrocnemius (MG) muscles were selected for this study. For the knee OA group, bilateral IA knee joint injections with HA were performed. RESULTS: During the stance phase of gait cycle, the quadriceps, hamstring, and tibialis anterior muscles had longer muscle contraction duration in the knee OA patients as compared with the control group. The muscle activities of quadriceps, hamstrings, tibialis anterior, and medial gastrocnemius muscles recovered to a pattern similar to the control group after the completion of IA HA injections in knee OA patients. The H/Q ratio improved significantly after the IA HA injections, and also lasted up to a period of six months (p<0.01). CONCLUSION: IA HA is an available treatment option as it effectively decreases co-contraction and improves motor activity of the lower extremity muscles. The improved muscle activities lasted up to a period up to six months.

Kinetics features changes before and after intra-articular hyaluronic acid injections in patients with knee osteoarthritis.

OBJECTIVES: To examine the kinetic features in patients with knee osteoarthritis (OA) after intra-articular hyaluronic acid (IAHA) injections in different time periods. DESIGN: A single group repeated measures study. SETTING: Gait laboratory in a tertiary hospital. PARTICIPANTS: Twenty-five subjects with bilateral symptomatic knee OA and 15 healthy control subjects. INTERVENTION: Gait analyses were performed in both control and OA groups before (baseline), and after the completion of IAHA injections (1 week, 3 months, and 6 months). MAIN OUTCOME MEASURES: Knee pain and functional indices were assessed using a visual analogue scale (VAS) and the Lequesne function Index (LI). Joint kinetic changes were analyzed in the frontal and sagittal planes with 6-camera motion analysis system and two AMTI force plates. RESULTS: VAS and LI scores were both improved in OA group after IAHA injections (p<0.001). In the frontal plane, increased knee adduction moment (p<0.001) after IAHA treatment was observed and would last up to a period of 6 months. In the sagittal plane, lower knee extension moments at early stance, and larger knee flexion moments at terminal stance were demonstrated after the completion of IAHA injections (p<0.05). CONCLUSIONS: This study revealed that IAHA injections can provide significant pain relief and improvement in activity of daily living function for patients with knee OA. However, the reduction in pain and the increase in knee adduction moment may last up to 6 months. This may cause excessive loading on the knee joints, which may further accelerate the rate of knee degeneration. As a result, longer study time is needed to determine whether the observed kinetic findings in this study are associated with detrimental outcomes on the knee joints.

Anterior knee pain caused by patellofemoral pain syndrome can be relieved by Botulinum toxin type A injection.

OBJECTIVE: To investigate the therapeutic effects of Botulinum toxin type A (BTA) for anterior knee pain caused by patellofemoral pain syndrome (PFPS). DESIGN: Prospective case control study for intervention. SETTING: A tertiary hospital rehabilitation center. PARTICIPANTS: Twelve bilateral PFPS patients with anterior knee pain were recruited. The worse pain knee was selected for injection, and the counterpart was left untreated. INTERVENTION: Injection of BTA to vastus lateralis (VL) muscle. MAIN OUTCOME MEASURES: Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) was used to assess pain, stiffness, and functional status of the knee, and CYBEX isokinetic dynamometer to assess isokinetic muscle force before and after BTA application to VL. RESULTS: Remarkable improvement after receiving BTA injection was obtained not only in the questionnaire of WOMAC (p<0.05), but also in knee flexion torque (p<0.05). No significant change of knee extension torque was noted (p=0.682). CONCLUSION: BTA injection is a good alternative treatment to improve anterior knee pain, knee function and isokinetic flexion torque.

Muscle activation features of the osteoarthritic knee with patellar lateral subluxation.

OBJECTIVE: The aim of the study was to compare the muscle activation feature of vastus medialis obliquus (VMO) and vastus lateralis (VL) between the osteoarthritic knee patients with patellar lateral subluxation (Group 1B) and without patellar lateral subluxation (Group 1A). METHODS: Isokinetic muscle strength of the knee extensor was evaluated using a CYBEX NORM dynamometer with angular velocities of 80, 120 and 240 degrees/second (°/sec) respectively, contraction activities of VMO and VL muscle were recorded with synchronized surface electromyography (sEMG). Age-matched healthy subjects were recruited and served as control group (Group 2). The VMO/VL ratio of EMG between Group 1A, Group 1B and Group 2 were compared. RESULTS: The peak torque in Group A was 40.7 ± 12.9, in Group B was 39.6 ± 12.9 and in Group C was 60.2 ± 9.5 respectively at 80°/sec angular velocity (p < 0.01). There were no significant difference between Group 1A and Group 1B in the three trial of tested velocities (p > 0.01). The sEMG ratios of VMO/VL of Group 1B calculated at angular velocities of 80/sec was 0.769 ± 0.15, 120°/sec was 0.818 ± 0.22 and 240°/ sec was 0.850 ± 0.22, all those were lower than Group 1A and Group 2 (p<0.01). CONCLUSION: Musculature imbalance of VMO and VL may explain the different muscle activation pattern in osteoarthritic knee patients with and without patellar lateral subluxation.

The effects of heel-elevated total contact insole on rearfoot pressure reduction in heel injury patients who had neurosensory impairment after receiving reconstructive flap operations.

OBJECTIVE: To evaluate the effects of a custom-molded heel-elevated total contact insole (TCI) on rearfoot pressure reduction and heel cushion for patients with heel-reconstruction. METHODS: Eleven patients with unilateral heel-reconstruction were recruited in this study. Maximal force and plantar pressures (peak pressure and pressure-time integral) at three different areas (heel Midfoot and forefoot) were measured under 3 randomized conditions (shoe-only flat insole and heel- elevated TCI) after wearing a heel-elevated TCI for 3 months. Ulceration inspection and pain intensity were evaluated before and 3 months after wearing a heel-elevated TCI Results: Pain intensity was decreased and walking velocity was improved in all patients (p<0.01), and ulcerations were completely healed in all of the five patients who had heel ulcers 3 months after wearing heel-elevated TCIs. Compared to shoe-only condition, the heel-elevated TCI was effectively reduced maximal force and plantar pressures in heel area (p<0.01) while part of the body weight was shifted from heel to midfoot and forefoot. Plantar pressures in heel area were more effectively reduced in the heel-elevated TCI than in the flat insole (p<0.05). CONCLUSION: These findings suggested that heel-elevated TCI provided more effective heel pressure reduction and shock absorption, and resulted in improvement of clinical symptoms.