Contralateral Peak Plantar Pressures with a Postoperative Boot

2011 ◽  
Vol 101 (2) ◽  
pp. 127-132 ◽  
Author(s):  
Jamie N. Mieras ◽  
Tanya J. Singleton ◽  
Stephen L. Barrett
Keyword(s):  
Structural Properties ◽  
Plantar Pressure ◽  
Limb Length Discrepancy ◽  
Pressure Reduction ◽  
Length Discrepancy ◽  
Patient Complaints ◽  
Plantar Pressures ◽  
Frequent Use ◽  
Significant Difference ◽  
Better Than

Background: Frequent use of walking boots in podiatric medicine often elicits patient complaints and sequelae from the imposed limb-length discrepancy. This study was designed primarily to determine whether peak plantar pressures are decreased in the contralateral foot when a moderately worn athletic shoe is worn opposite a high-calf walking boot and, if so, secondarily to determine whether a specialized surgical shoe worn on the contralateral foot can also effectively reduce this pressure. The pressure reductions were then compared to determine whether significantly greater plantar pressure reduction was provided by either the athletic shoe or the surgical shoe. Methods: Participants without a foot abnormality walked on a treadmill in four footwear combinations: barefoot bilaterally, high-calf rocker-bottom sole (HCRB) walking boot/ barefoot, HCRB walking boot/athletic shoe, and HCRB walking boot/modified walking boot shoe. Measurements were taken with the participants wearing socks. Peak plantar calcaneal pressures were collected. Results: Peak plantar pressures under the calcaneus opposite the HCRB walking boot were significantly reduced from barefoot pressures when either an athletic shoe or the modified walking boot shoe was worn. However, no significant difference was seen when comparing the reduction by the athletic shoe with that by the modified walking boot. Conclusions: Wearing an athletic shoe on the foot opposite an HCRB walking boot reduces calcaneal pressures; however, wearing a modified device with structural properties of an HCRB walking boot sole is no better than an athletic shoe at reducing peak calcaneal pressures. (J Am Podiatr Med Assoc 101(2): 127–132, 2011)

Is TCC-EZ a Suitable Alternative to Gold Standard Total-Contact Casting?

2021 ◽  
Vol 111 (5) ◽  
Author(s):  
Umangi K. Bhatt ◽  
Hui Ying Foo ◽  
Mahalia P. McEvoy ◽  
Sarah J. Tomlinson ◽  
Cara Westphal ◽  
...  
Keyword(s):  
Gold Standard ◽  
Peak Pressure ◽  
Pressure Reduction ◽  
Reduced Pressure ◽  
Suitable Alternative ◽  
Total Contact Cast ◽  
Plantar Pressures ◽  
Signed Rank ◽  
Significant Difference ◽  
Peak Pressures

Background The total-contact cast (TCC) is the gold standard for off-loading diabetic foot ulcers (DFUs) given its nonremovable nature. However, this modality remains underused in clinical settings due to the time and experience required for appropriate application. The TCC-EZ is an alternative off-loading modality marketed as being nonremovable and having faster and easier application. This study aims to investigate the potential of the TCC-EZ to reduce foot plantar pressures. Methods Twelve healthy participants (six males, six females) were fitted with a removable cast walker, TCC, TCC-EZ, and TCC-EZ with accompanying brace removed. These off-loading modalities were tested against a control. Pedar-X technology measured peak plantar pressures in each condition. Statistical analysis of four regions of the foot (rearfoot, midfoot, forefoot, and hallux) was conducted with Friedman and Wilcoxon signed rank tests. Significance was set at P < .05. Results All of the off-loading conditions significantly reduced pressure compared with the control, except the TCC-EZ without the brace in the hallux region. There was no statistically significant difference between TCC-EZ and TCC peak pressure in any foot region. The TCC-EZ without the brace obtained significantly higher peak pressures than with the brace. The removable cast walker produced similar peak pressure reduction in the midfoot and forefoot but significantly higher peak pressures in the rearfoot and hallux. Conclusions The TCC-EZ is a viable alternative to the TCC. However, removal of the TCC-EZ brace results in minimal plantar pressure reduction, which might limit clinical applications of the TCC-EZ.

scholarly journals PARTIAL TRANSPHYSEAL ANTERIOR CRUCIATE LIGAMENT RECONSTRUCTION: CLINICAL, FUNCTIONAL, AND RADIOGRAPHIC OUTCOMES

2019 ◽  
Vol 7 (3_suppl) ◽  
pp. 2325967119S0008
Author(s):  
Nirav K. Pandya ◽  
Christina Allen ◽  
Emily Monroe ◽  
Caitlin Chambers
Keyword(s):  
Acl Reconstruction ◽  
Graft Failure ◽  
Cruciate Ligament ◽  
Limb Length Discrepancy ◽  
Limb Length ◽  
Growth Disturbance ◽  
Length Discrepancy ◽  
Radiographic Outcomes ◽  
Significant Difference ◽  
Femoral Physis

BACKGROUND Partial transphyseal anterior cruciate ligament (ACL) reconstruction is a technique utilized in the skeletally immature population. The femoral tunnel is placed in the distal femoral epiphysis whereas the tibial tunnel is placed in a transphyseal fashion medial to the tibial tubercle. This technique was introduced in an effort to lessen insult to the distal femoral physis of skeletally immature adolescents while also avoiding the technical difficulty of placing an intra-epiphyseal tunnel in the proximal tibia which at times can be non-anatomic. There is limited literature examining this technique. In this study we analyzed the concurrent surgical procedures, re-operation and graft failure rates, and radiographic outcomes in adolescents undergoing partial transphyseal ACL reconstruction. METHODS Consecutive patients undergoing partial transphyseal ACL reconstruction by the two senior authors (NP and CA) were retrospectively reviewed. Inclusion criteria consisted of patients with symptomatic ACL rupture with open distal femoral physes and at least two years of growth remaining by chronologic and physiologic age as determined by growth and pubertal history. All patients received hamstring autograft. Femoral tunnels were drilled in an intra-epiphyseal location utilizing small angle guides under fluoroscopic guidance. Transphyseal tibial tunnels were drilled in standard fashion with a tip-aiming guide while minimizing thermal damage from slow reaming, avoiding horizontal tunnel placement, and using extraphyseal graft fixation to lessen insult to the proximal tibial physis. Radiographic outcomes including bilateral limb length (LL) and alignment as judged by mechanical axis deviation (MAD), mechanical lateral distal femoral angle (mLDFA), and medial proximal tibial angle (MPTA) were measured on long standing anterior-to-posterior (AP) view radiographs. Growth disturbance was defined as = 1 cm leg length discrepancy, = 1 cm difference in MAD, or 5-degree difference in mLDFA or MPTA as compared to the non-operative side and MAD/mLDFA/MPTA outside of established range of normal values. Clinical outcomes including graft failure and need for repeat operation were recorded at each follow-up visit. Operative extremity alignment measurements were compared to non-operative extremity measurements utilizing a paired students t-test. RESULTS Twenty-four patients with average follow up of 31.5 ± 17.1 months met inclusion criteria for this study. Five female and 19 male patients were enrolled consisting of 13 left and 11 right knees. Average age at time of surgery was 12.3 ± 0.9 years (10.1-13.8 years). The average ACL graft size was 7.8 mm ± 0.5 mm (6-9 mm). Ten patients (41.7%) had concurrent meniscal surgery, with seven (29.2%) undergoing partial lateral meniscectomy, two (8.3%) lateral meniscus repairs, and one patient (4.2%) with medial and lateral meniscal repairs. Six patients (25.0%) required re-operation at an average of 29.2 ± 17.3 months (1.5-49.5 months) for removal of hardware (n=3), revision ACL reconstruction (n=2), and meniscus surgery (n=1). Two patients had ACL graft failure (8.3%) during sporting activity and underwent revision ACL reconstruction at 19.7 months and 49.5 months post-operatively. There were no contralateral ACL tears. As shown in Table 1, comparison of the mean alignment and limb length measurements between all patients’ operative to nonoperative extremity revealed no significant difference in femur length, MAD, MLDFA, or MPTA. There was a small but statistically significant difference in operative versus non-operative tibia length (390.2 cm versus 392.4 cm, p=0.0004) and limb length (880.9 cm versus 884.0 cm, p=0.02). In analyzing individual patients’ limb length or alignment differences, five patients (20.8%) were identified with a growth disturbance. One patient had isolated shortening of the operative extremity, two with significant lateral deviation of the MAD, and two with both shortening and lateral MAD translation. No patients had significant side-to-side difference in mLDFA or MPTA. Femoral shortening accounted for the majority of the limb length discrepancy in two of the three patients with significant limb length discrepancy. All patients returned to sport. CONCLUSIONS / SIGNIFICANCE Partial transphyseal ACL reconstruction has a 25.0% re-operation rate, most often for hardware removal, and an 8.3% graft failure rate. Overall, approximately 20% of patients undergoing partial transphyseal ACL reconstruction had a growth disturbance but none required surgical intervention for these disturbances. While the partial transphyseal technique spares the distal femoral physis, femur-dominant limb length discrepancy can still occur. Drilling and graft placement across the tibial physis appears to be safe. Further studies are needed to directly compare the radiographic, functional, and clinical outcomes of partial transphyseal ACL reconstruction with transphyseal and all-epiphyseal techniques in the pediatric population. [Table: see text]

Correlation between limb length discrepancy and asymmetrical rearfoot position

1993 ◽  
Vol 83 (11) ◽  
pp. 625-633 ◽  
Author(s):  
RL Blake ◽  
HJ Ferguson
Keyword(s):  
Limb Length Discrepancy ◽  
Limb Length ◽  
Control Group ◽  
Vertical Angle ◽  
Short Side ◽  
Length Discrepancy ◽  
Heel Contact ◽  
Significant Difference ◽  
The Right ◽  
Two Sides

Ten subjects with a known limb length discrepancy were filmed with the two-dimensional Motion Analysis Foot Trak System; eight were filmed running and walking and two were filmed walking only. A control group of ten subjects with no measured limb length discrepancy was filmed in the same manner (eight walking and running and two walking only). The calcaneus-to-vertical angle was recorded for the entire stance gait cycle (heel contact to toe-off). Analysis of the data between the short and long side showed a significant difference in calcaneal position between the two sides at midstance, with the longer side being more everted by 3 degrees or greater than the short side in most cases. There was no significant difference in the calcaneus-to-vertical angle at heel contact between the long and short side. There was no significant difference between the calcaneus-to-vertical angles of the right and left sides of the ten control subjects, either walking or running.

Can the Use of a Terminal Device Augment Plantar Pressure Reduction with a Total Contact Cast?

2003 ◽  
Vol 24 (6) ◽  
pp. 500-505 ◽  
Author(s):  
Raja Dhalla ◽  
Jeffrey E. Johnson ◽  
Jack Engsberg
Keyword(s):  
Plantar Pressure ◽  
Healthy Adult ◽  
Statistical Significance ◽  
The Novel ◽  
Pressure Reduction ◽  
Total Contact Cast ◽  
Plantar Pressures ◽  
Treatment Standard ◽  
The Right ◽  
Adult Volunteers

Hypotheses/Purpose: Total contact casting (TCC) has been shown to promote the healing of plantar neurotrophic ulcers by reducing plantar pressures and has become the established treatment standard by which all others are measured. The purpose of this study was to determine if terminal cast devices (cast shoes and heels) significantly affect the amount of plantar pressure reduction when used with a total contact cast. Methods/Results: Plantar pressures were measured in the right feet of 28 healthy adult volunteers using the Novel EMED PEDAR system (Novel GmbH, Munich, Germany) for six conditions: athletic shoe (i.e., control), TCC alone, TCC with a conventional cast shoe (EBI, Parsipanny, NJ), TCC with a custom rigid rocker cast shoe (NPS, St. Louis, MO), TCC with a rubber rocker heel (Cast Walker, DM Systems Inc., Evanston, IL), and TCC with a traditional flat rubber heel (Zimmer, Warsaw, IN). Peak plantar pressures were recorded from the forefoot, midfoot, and hindfoot. Analysis of variance (ANOVA) was used to determine statistical significance. The greatest reductions in forefoot plantar pressures compared to the athletic shoe control were seen in the TCC with the conventional cast shoe and the TCC with the rigid rocker shoe; a mean plantar pressure reduction of 30% was observed for both conditions ( p <.001). Significant midfoot plantar pressure reductions ( p <.001) were achieved with the TCC alone, TCC with the conventional cast shoe, TCC with the rigid rocker heel, TCC with the flat rubber heel, and TCC with the rubber rocker heel. Mean reductions were 42%, 51%, 47%, 40%, and 46%, respectively. While athletic shoe peak hindfoot pressures were only reduced by 15% by TCC alone, the addition of the rubber rocker heel to TCC reduced athletic shoe pressures by 32% and the addition of the flat rubber heel to TCC reduced athletic shoe pressures by 29%. The reductions with TCC and the heels were both significant when using the athletic shoe as the control ( p <.001) and the TCC alone as the control ( p <.05). Conclusion: Plantar pressure reduction with TCC can be augmented with the addition of a terminal cast device and the effects shown in this study are significantly different than previously reported. These results suggest that terminal cast devices should be chosen according to location of the neuropathic ulcer. In this study, forefoot pressures were reduced the most with TCC and either the conventional cast shoe or the rigid rocker shoe. The authors therefore recommend these combinations for forefoot ulcers. TCC alone or combined with any of the terminal devices proved equally effective for midfoot plantar pressure reduction. Hindfoot ulcers should be treated with TCC and the rubber rocker heel or the flat rubber heel as these provided the best hindfoot pressure reductions.

scholarly journals Predictor index of functional limb length discrepancy

2020 ◽  
Vol 28 (2) ◽  
pp. 230949902094165
Author(s):  
Vivek Ajit Singh ◽  
Sasidaran Ramalingam ◽  
Amber Haseeb ◽  
Nor Faissal Bin Yasin
Keyword(s):  
Knee Flexion ◽  
Evaluation Method ◽  
Reaction Force ◽  
Lower Extremities ◽  
Limb Length Discrepancy ◽  
Functional Adaptation ◽  
Limb Length ◽  
Heel Strike ◽  
Length Discrepancy ◽  
Significant Difference

Introduction: Limb length discrepancy (LLD) of lower extremities is underdiagnosed due to compensatory mechanisms during locomotion. The natural course of compensation leads to biomechanical alteration in human musculoskeletal system leading to adverse effects. General consensus accepts LLD more than 2 cm as significant to cause biomechanical alteration. No studies were conducted correlating height and lower extremities true length (TL) to signify LLD. Examining significant LLD in relation to height and TL using dynamic gait analysis with primary focus on kinematics and secondary focus on kinetics would provide an objective evaluation method. Methodology: Forty participants with no evidence of LLD were recruited. Height and TL were measured. Reflective markers were attached at specific points in lower extremity and subjects walked in gait lab at a self-selected normal walking pace with artificial LLDs of 0, 1, 2, 3, and 4 cm simulated using shoe raise. Accommodation period of 30 min was given. Infrared cameras were used to capture the motion. Primary kinematic (knee flexion and pelvic obliquity (PO)) and secondary kinetic (ground reaction force (GRF)) were measured at right heel strike and left heel strike. Functional adaptation was analyzed and the postulated predictor indices (PIs) were used as a screening tool using height, LLD, and TL to notify significance. Results: There was a significant knee flexion component seen in height category of less than 170 cm. There was significant difference between LLD 3 cm and 4 cm. No significant changes were seen in PO and GRF. PIs of LLD/height and LLD/TL were analyzed using receiver operating characteristic curve. LLD/height as a PI with value of 1.75 was determined with specificity of 80% and sensitivity of 76%. Conclusion: A height of less than 170 cm has significant changes in relation to LLD. PI using LLD/height appears to be a promising tool to identify patients at risk.

scholarly journals Pedobarography Study Among Malay Population In The District Of Kuantan, Pahang: A Preliminary Report

2018 ◽  
Vol 17 (1) ◽  
Author(s):  
Muhammad Haidar bin Nasuruddin ◽  
Aminudin bin Che Ahmad ◽  
Mohd Adham Syah bin Ayeop ◽  
Nik Mohd. Fatmy Bin Nik Mohd. Najmi
Keyword(s):  
Plantar Pressure ◽  
Normal Values ◽  
Developed Countries ◽  
Foot Pressure ◽  
Related Disease ◽  
The Past ◽  
Plantar Pressures ◽  
Significant Difference ◽  
Standard Value ◽  
Malay Population

Introduction: Plantar foot pressure has been widely used in managing foot-related disease in developed countries for the past 2 decades. However, in Malaysia, it is still at its infancy. Studies showed that the normal values are not affected by gender and body mass index (BMI), but vary between one race to another. Currently, to the best of author’s review, there is no standard value available for Malaysian or Southeast Asia population. This study is designed to measure pressure values observed in the normal foot of Malay population in Kuantan and its difference between different gender and BMI. Materials and Methods: Measurements were taken from 184 healthy subjects, 79 males and 105 females. Age and BMI were identified. Plantar pressures were measured using Emed-q100 pedobarography platform device with its emed/E (Expert) software Results: The median plantar pressure was 480kPa (IQR 205). There was no significant difference between genders (p=0.483) and BMI (p=0.076) Conclusion: This result is not meant to represent the whole Malay population but rather to be used as an early reference for plantar pressure studies among Malay population. More studies are needed to more accurately describe the value of the population.

Transplantation of coral fragment, Acropora formosa (Scleractinia)

2014 ◽  
pp. 1
Author(s):  
Hanny Tioho ◽  
Maykel A.J Karauwan
Keyword(s):  
Fragment Size ◽  
Observation Time ◽  
Minimum Size ◽  
Average Growth Rate ◽  
Average Growth ◽  
Significant Difference ◽  
Acropora Formosa ◽  
Survival And Growth ◽  
One Way Anova ◽  
Better Than

The minimum size of coral transplants, Acropora formosa, was assessed to support their survival and growth. For this, 150 coral fragments of different sizes (5, 10, 15 cm) were transplanted close to the donor colony. Their survivorship and growth were observed for 12 months. At the end of the observation time, 90% of 15 cm-transplanted coral fragments survived, while the others (10cm and 5 cm) did 86% and 82% respectively. The average growth rate of 5 cm-coral fragments was 0.860 cm/month, while 10 and 15 cm-fragments were 0.984 cm/month and 1.108 cm/month respectively. One-way ANOVA showed that there was significant difference (p<0.05) among the three (5, 10, 15 cm) transplant initial sizes in which the longest fragment size tended to survive longer than the smaller one.  However, the smaller transplants grew better than the bigger one, 10.318 cm/year (206%) for 5 cm-transplant, 11.803 cm/year (118%) for 10 cm-transplant, and 13.299 cm/year (89%) for 15 cm-transplant, respectively. Ukuran minimal fragmen karang Acropora formosa yang ditransplantasi diduga untuk mendukung ketahanan hidup dan pertumbuhannya. Untuk itu, 150 fragmen karang ditransplantasi ke lokasi yang berdekatan dengan koloni induknya.  Ketahanan hidup dan pertumbuhan semua fragmen karang yang ditransplantasi diamati selama 12 bulan.  Pada akhir pengamatan, 90% dari fragmen karang berukuran 15 cm yang ditransplantasi dapat bertahan hidup, sedangkan yang lainnya (ukuran 10 cm dan 5 cm) masing-masing sebesar 86% dan 82%.  Rata-rata laju pertumbuhan fragmen karang dengan ukuran awal 5 cm adalah 0,860 cm/bulan, sedangkan ukuran fragmen 10 dan 15 cm masing-masing adalah 0,984 cm/bulan and 1,108 cm/bulan. ANOVA satu arah menunjukkan adanya perbedaan yang nyata (p<0.05) antara ketiga ukuran fragmen yang berbeda, di mana ukuran fragmen karang yang lebih panjang cenderung mempunyai ketahanan hidup yang lebih baik. Namun demikian, ukuran transplant yang lebih kecil memiliki pertumbuhan lebih baik dibandingkan dengan ukuran yang lebih besar, yakni10,318 cm/tahun (206%) untuk transplant berukuran 5 cm, 11,803 cm/tahun (118%) untuk 10 cm, dan 13,299 cm/tahun (89%) untuk ukuran 15 cm.

Isolation of an Anti-fatigue Preparation from Cellulase-treated Maca by Hydroalcoholic Extraction

2017 ◽  
Vol 17 (1) ◽  
pp. 93-98
Author(s):  
Zheng Yue ◽  
Zhang Wen-Cheng ◽  
Wu Ze-Yu ◽  
Fu Chuan-Xiang ◽  
Gao Han ◽  
...  
Keyword(s):  
Positive Control ◽  
Glycogen Storage ◽  
Hepatic Glycogen ◽  
Time To Exhaustion ◽  
High Dose ◽  
Hydroalcoholic Extract ◽  
Swimming Time ◽  
Significant Difference ◽  
Pre Treatment ◽  
Better Than

The purpose of this study was to evaluate the anti-fatigue activity of maca hydroalcoholic extract (ME), which mainly contains macamides and polysaccharides. ME was prepared by circumfluence extraction with enzymatic pre-treatment. Anti-fatigue activity of ME was investigated in weight-loaded forced swimming mice, with pure macamides and commercially available maca tablet as positive control. Compared with normal group, pure macamides treatment group could prolong the swimming time to exhaustion, but there was no statistically significant difference (P > 0.05); while ME (middle-dose and high-dose groups) could effectively prolong the swimming durations (P < 0.05). Supplementation with pure macamides significantly decreased blood lactic acid (BLA), whereas ME significantly increased hepatic glycogen (HG), decreased BLA, and blood urea nitrogen (BUN) compared with those in normal control (P < 0.05). The results suggested that the anti-fatigue effect of ME was better than that of pure macamides, which can be explained by the increase of glycogen storage and the reduction of metabolites accumulation.

EMOTIONAL INTELLIGENCE AND ACADEMIC ACHIEVEMENT OF ADOLESCENTS WITH REFERENCE TO GENDER

2017 ◽  
Vol 4 (24) ◽  
Author(s):  
Nisha Chandel ◽  
Seema Chopra
Keyword(s):  
Academic Achievement ◽  
Emotional Intelligence ◽  
Female Adolescents ◽  
Intelligence Scale ◽  
Male And Female ◽  
Male Adolescents ◽  
Significant Difference ◽  
Understanding Emotions ◽  
School Records ◽  
Better Than

The present study was undertaken to find out emotional intelligence and academic achievement of male and female adolescents. The sample consists of 82 students( 41 male and 41 female adolescents) from different schools in Hamirpur district of Himachal Pradesh. Emotional intelligence was assessed with the help of Emotional Intelligence Scale developed by Singh and Narain (2014) and academic achievement score were taken from the school records. The results revealed that there exists a significant difference in emotional intelligence of male and female adolescents. It was found that there existed significant difference in academic achievement of female adolescents and male adolescents. The mean emotional intelligence of female adolescents was better than of male adolescents. On the dimensions of emotional intelligence, it was found that there was no significant difference between male and female adolescents on understanding emotions, empathy and handling relations dimensions of emotional intelligence; while it was reported that there was significant difference between male and female adolescents on understanding motivation dimension of emotional intelligence On the other hand, it was found that there existed significant difference in academic achievement of female adolescents and male adolescents.

How Well is the Revised Common Lectionary Standing the Test of Time?

2018 ◽  
Vol 130 (7) ◽  
pp. 305-311
Author(s):  
Chris Knights
Keyword(s):  
Hard Material ◽  
Frequent Use ◽  
Better Than

This article offers an evaluation of the Revised Common Lectionary (RCL) and suggests that, while it has many strengths, there are some issues with it—how common it might actually be, the repetition of some passages and the exclusion of many others, either because they contain hard material or because they are too long, the frequent use of ‘Reader’s Digest’ abbreviated versions of texts, the designation ‘ semi-continuous’ and the often obscure way ‘related’ OT lections do actually relate to the set Gospel. It concludes that, while the RCL is better than its predecessors, a slavish use of it is less than helpful.

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