Celiac disease manifested by polyneuropathy and swollen ankles

A 27-year-old male started to have his ankles swollen during his military service. He was examined at a military hospital where electromyoneurography showed the signs of distal sensory-motor polyneuropathy with axon demyelinization and weak myopathic changes, whereas histopathological examination of gastrocnemius muscle biopsy revealed some mild and nonspecific myopathy. Besides, he was found to have subcutaneous ankle tissue edemas and hypertransaminasemia. Due to these reasons, he was dismissed from the military service and examined at another hospital where bone osteodensitometry revealed low bone mineral density of the spine. However, his medical problems were not resolved and after the second discharge from hospital he was desperately seeing doctors from time to time. Finally, at our institution he was shown to have celiac disease (CD) by positive serology (antitissue transglutaminase and antiendomysial antibodies) and small bowel mucosal histopathological examination, which showed total small bowel villous atrophy. Three months after the initiation of gluten-free diet, his ankle edema disappeared, electromyoneurographic signs of polyneuropathy improved and liver aminotransferases normalized. Good knowledge of CD extraintestinal signs and serologic screening are essential for early CD recognition and therapy.

The Use of Human Amniotic Allograft on Osteochondritis Dissecans of the Talar Dome: A Comparison with and without Allografts in Arthroscopically Treated Ankles

Arthroscopy of the ankle with micro-fracture technique is one way to initially treat symptomatic talar dome lesions. Human amniotic allograft has been used in similar bone, soft tissue and cartilage defects to aid in healing of tissue using graft cells that have not differentiated into a particular cell line. Patients were taken from the primary surgeon’s practice to include those who had undergone arthroscopy with micro-fracture technique for treatment of a talar dome lesion less than 2 cm2. 101 patient surgeries were completed arthroscopically without additional major procedures. 54 surgeries were completed with human amniotic allograft;47 were completed without (control group). Modified ACFAS ankle scores were taken pre-operatively, 3, 12 and 24 months post-operatively. Visual analog pain scores were taken pre-operatively and 24 months post-operatively. Results comparing pre-operative modified ACFAS scores between the control and graft groups were not significantly different (p = 0.14). There was a significant improvement in both groups’ scores following ankle arthroscopy with micro-fracture as expected. However, the amniotic tissue group did significantly better when comparing the post-operative scores between the control and graft group. Pain scores comparing control and amniotic patient groups were significant (p < 0.001) with amniotic allograft patients achieving a greater improvement in pain reduction than the control both early and at 24 months. There were no complications, wound dehiscence or infections recorded. Combining ankle arthroscopy/micro-fracture technique with human amniotic allograft on talar dome lesions, less than 2 cm2, significantly improves the patients’ pain and ACFAS scores.

The Knees-Ankles-Toe in Cosmic Rays and the Periodic Table of Elementary Particles

This paper posits the discovery of the new elementary particles from the energy spectrum for the knees-ankles-toe of cosmic rays. The energy spectrum from 109 eV to 1020 eV appears to follow a single power law except few breaks at the knees-ankles-toe. The power index increases at the first knee and the second knee, and decreases at the ankle. Above 4 × 1019 eV, the power index increases as the “toe”. The fine structure of the cosmic ray spectrum shows that an ankle with decrease in power index is in between the first knee and the second knee, resulting in two knees, two ankles, and one toe. This paper posits that the knees-ankles-toe are explained by the very high-energy fermions and bosons in the periodic table of elementary particles that places all known leptons, quarks, gauge bosons, and the Higgs boson in the table with the calculated masses in good agreement with observed values. In the periodic table, some high-energy dimensional fermions (Fd where d= dimensional orbital number from 5 to 11) and bosons (Bd) are involved in the knees-ankles-toe. At the knees and the toe, some parts of the energies from the energy sources of cosmic rays are spent to generate Fd and Bd, resulting in the increase of power index. The ankles are the the middle points (midpoints) between the adjacent dimensional fermions and bosons. At a midpoint, the energy is too high to keep the thermally unstable high-energy dimensional particle,resulting in the decay and the decrease of power index. The calculated masses of B8, the midpoint, F9, the midpoint, and B9, are 1.7 × 1015, 2 × 1016, 2.4 × 1017, 2.8 × 1018, and 3.2 × 1019 eV, respectively, which are in good agreement with observed 3 × 1015, 2 × 1016, 3 × 1017, 3 × 1018, and 4 × 1019 eV for the first knee, the first ankle, the second knee, the second ankle, and the toe, respectively. The mass of F10 is 4.4 × 1021 eV beyond the GZK limit, so F10 and above are not observed.

Analysis of a passive ankle exoskeleton for reduction of metabolic costs during walking

Modern conflicts demand substantial physical and psychological exertion,often resulting in fatigue and diminished combat or operational readiness.Several exoskeletons have been developed recently to address these challenges,presenting various limitations that affect their operational or everyday usability.This article evaluates the performance of a dual-purpose passive ankle exoskeleton developed for the reduction of metabolic costs during walking,seeking to identify a force element that could be applied to the target population.Based on the 6-min walk test,twenty-nine subjects participated in the study using three different force elements.The results indicate that it is possible to reduce metabolic expenditure while using the developed exoskeleton.Additionally,the comfort and range of motion results verify the exoskeleton's suitability for use in uneven terrain and during extended periods.Nevertheless,the choice of the force element should be tailored to each user,and the control system should be adjustable to optimise the exoskeleton's performance.

Type Synthesis of Self-Alignment Parallel Ankle Rehabilitation Robot with Suitable Passive Degrees of Freedom

The current parallel ankle rehabilitation robot(ARR)suffers from the problem of difficult real-time alignment of the human-robot joint center of rotation,which may lead to secondary injuries to the patient.This study investigates type synthesis of a parallel self-alignment ankle rehabilitation robot(PSAARR)based on the kinematic characteristics of ankle joint rotation center drift from the perspective of introducing"suitable passive degrees of freedom(DOF)"with a suitable number and form.First,the self-alignment principle of parallel ARR was proposed by deriving conditions for transforming a human-robot closed chain(HRCC)formed by an ARR and human body into a kinematic suitable constrained system and introducing conditions of"decoupled"and"less limb".Second,the relationship between the self-alignment principle and actuation wrenches(twists)of PSAARR was analyzed with the velocity Jacobian matrix as a"bridge".Subsequently,the type synthesis conditions of PSAARR were proposed.Third,a PSAARR synthesis method was proposed based on the screw theory and type of PSAARR synthesis conducted.Finally,an HRCC kinematic model was established to verify the self-alignment capability of the PSAARR.In this study,93 types of PSAARR limb structures were synthesized and the self-alignment capability of a human-robot joint axis was verified through kinematic analysis,which provides a theoretical basis for the design of such an ARR.

Configuration and Kinematics of a 3-DOF Generalized Spherical Parallel Mechanism for Ankle Rehabilitation

The kinematic equivalent model of an existing ankle-rehabilitation robot is inconsistent with the anatomical structure of the human ankle,which influences the rehabilitation effect.Therefore,this study equates the human ankle to the UR model and proposes a novel three degrees of freedom(3-DOF)generalized spherical parallel mechanism for ankle rehabilitation.The parallel mechanism has two spherical centers corresponding to the rotation centers of tibiotalar and subtalar joints.Using screw theory,the mobility of the parallel mechanism,which meets the requirements of the human ankle,is analyzed.The inverse kinematics are presented,and singularities are identified based on the Jacobian matrix.The workspaces of the parallel mechanism are obtained through the search method and compared with the motion range of the human ankle,which shows that the parallel mechanism can meet the motion demand of ankle rehabilitation.Additionally,based on the motion-force transmissibility,the performance atlases are plotted in the parameter optimal design space,and the optimum parameter is obtained according to the demands of practical applications.The results show that the parallel mechanism can meet the motion requirements of ankle rehabilitation and has excellent kinematic performance in its rehabilitation range,which provides a theoretical basis for the prototype design and experimental verification.

Initial Experience of NIR-II Fluorescence Imaging-Guided Surgery in Foot and Ankle Surgery

Optical imaging in the second near-infrared(NIR-II;900-1880 nm)window is currently a popular research topic in the field of biomedical imaging.This study aimed to explore the application value of NIR-II fluorescence imaging in foot and ankle surgeries.A lab-established NIR-II fluorescence surgical navigation system was developed and used to navigate foot and ankle surgeries which enabled obtaining more high-spatial-frequency information and a higher signal-to-background ratio(SBR)in NIR-II fluorescence images compared to NIR-I fluorescence images;our result demonstrates that NIR-II imaging could provide higher-contrast and larger-depth images to surgeons.Three types of clinical application scenarios(diabetic foot,calcaneal fracture,and lower extremity trauma)were included in this study.Using the NIR-II fluorescence imaging technique,we observed the ischemic region in the diabetic foot before morphological alterations,accurately determined the boundary of the ischemic region in the surgical incision,and fully assessed the blood supply condition of the flap.NIR-II fluorescence imaging can help surgeons precisely judge surgical margins,detect ischemic lesions early,and dynamically trace the perfusion process.We believe that portable and reliable NIR-II fluorescence imaging equipment and additional functional fluorescent probes can play crucial roles in precision surgery.

Functional assessment and influencing factors after staged functional training in patients with ankle fractures

BACKGROUND The recovery of limb function after ankle fracture surgery is a gradual process.The main purpose of implementing early functional exercise,joint mobility,muscle contraction function,passive ankle flexion and extension exercises,or physical factor therapy techniques is to achieve the rapid recovery of normal physiological limb function.However,currently the most effective rehabilitation training method is staged limb functional exercise,which promotes rapid recovery of limb function while preventing adverse consequences caused by overwork or insufficient training.Staged limb functional exercise divides the rehabilitation process into multiple stages,each of which has specific training objectives and contents.This method helps patients gradually restore limb function.Nevertheless,some patients still exhibit poor limb function after standardized exercise.Therefore,a functional evaluation should be performed to analyze the impact of staged functional training after ankle fracture surgery.AIM To perform a functional evaluation and determine the influencing factors of staged functional training in patients with ankle fracture.METHODS A retrospective study enrolled 150 patients who underwent surgical treatment for ankle fracture from May 2020 to May 2022 at our hospital.Univariate and multivariate linear regression analyses were performed on general data,functional exercise compliance scale for orthopedic patients,Social Support Rating Scale(SSRS),American Orthopedic Foot and Ankle Score(AOFAS)Ankle-Hindfoot Score,and pain factors[serum bradykinin(BK),prostaglandin E2(PGE2),5-hydroxytryptamine(5-HT)].RESULTS Based on the AOFAS Ankle-Hindfoot Scale,the cases were divided into the excellent function(n=111)and ordinary function(n=39)groups.Univariate analysis revealed that monthly family income,education level,diabetes mellitus,functional exercise compliance scale of orthopedic patients score,SSRS,BK,PGE2,and 5-HT significantly influenced limb function after ankle fracture(P<0.05);Multiple linear regression analysis showed that the functional exercise compliance scale score,SSRS,BK,PGE2,and 5-HT were independent risk factors affecting functional performance after staged functional exercise(P<0.05).CONCLUSION Exercise compliance,SSRS,and pain level are the independent risk factors affecting functional performance after staged functional training following ankle surgery.Clinical nursing care after ankle surgery should include analgesic and health education measures to ensure optimal recovery of limb function.

Foot and ankle surgery:Tourniquet placement site to cause as little postoperative pain as possible

There is controversy in the literature on where to place the tourniquet(thigh,calf,ankle)for foot and ankle surgery.While some authors prefer the ankle tourniquet to the calf tourniquet,others state that the surgeon can decide between using the thigh tourniquet or the ankle tourniquet,since there was no difference in postoperative pain between them.Where to place the tourniquet during foot and ankle surgery to cause the least possible postoperative pain to the patient as a result of the tourniquet is a common question in clinical practice.The reality is that,unfortunately,there is no consensus on this issue.Perhaps the only possible way to answer this question would be to conduct a comparative study with sufficient statistical power to reach scientifically sound conclusions.It does not seem easy to carry out such a study,but it would be important to be able to answer the question posed in the title of this Editorial once and for all.

Needle arthroscopic-assisted repair of tibio-fibular syndesmosis acute injury:A case report

BACKGROUND Acute injuries to the tibiofibular syndesmosis,often associated with high ankle sprains or malleolar fractures,require precise diagnosis and treatment to prevent long-term complications.This case report explores the use of needle arthroscopy as a minimally invasive technique for the repair of tibiofibular syndesmosis injuries.CASE SUMMARY We report on a 40-year-old male patient who presented with a trimalleolar fracture and ankle subluxation following a high ankle sprain.Due to significant swelling and poor soft tissue quality,initial management involved external stabilization.Subsequently,needle arthroscopy was employed to assess and treat the tibiofibular syndesmosis injury.The procedure,performed under spinal anesthesia and fluoroscopic control,included nanoscopic evaluation of the ankle joint and reduction of the syndesmosis using a suture button.Follow-up assessments showed significant improvement in pain levels,range of motion,and functional scores.At 26 weeks post-procedure,the patient achieved full range of motion and pain-free status.Needle arthroscopy offers a promising alternative for the management of acute tibiofibular syndesmosis injuries,combining diagnostic and therapeutic capabilities with minimal invasiveness.CONCLUSION This technique may enhance clinical outcomes and reduce recovery times,warranting further investigation and integration into clinical practice.

Academic productivity correlates with industry earnings in foot and ankle fellowship programs in the United States:A retrospective analysis

BACKGROUND The study investigates the connection between academic productivity and industry earnings in foot and ankle orthopedic surgery fellowships.Utilizing metrics like the H-index and Open Payments Database(OPD)data,it addresses a gap in understanding the relationship between scholarly achievements and financial outcomes,providing a basis for further exploration in this specialized medical field.AIM To elucidate the trends between academic productivity and industry earnings across foot and ankle orthopedic surgery fellowship programs in the United States.METHODS This study is a retrospective analysis of the relationship between academic productivity and industry earnings of foot and ankle orthopedic surgery fellowships at an individual faculty and fellowship level.Academic productivity was defined via H-index and recorded from the Scopus website.Industry earnings were recorded from the OPD.RESULTS Forty-eight foot and ankle orthopedic surgery fellowships(100%of fellowships)in the United States with a combined total of 165 physicians(95.9%of physicians)were included.Mean individual physician(n=165)total life-time earnings reported on the OPD website was United States Dollar(USD)451430.30±1851084.89(range:USD 25.16-21269249.85;median:USD 27839.80).Mean physician(n=165)H-index as reported on Scopus is 14.24±12.39(range:0-63;median:11).There was a significant but weak correlation between individual physician H-index and individual physician total life-time earnings(P<0.001;Spearman’s rho=0.334)and a significant and moderate positive correlation between combined fellowship H-index and total life-time earnings per fellowship(P=0.004,Spearman’s rho=0.409).CONCLUSION There is a significant and positive correlation between academic productivity and industry earnings at foot and ankle orthopedic surgery fellowships in the United States.This observation is true on an individual physician level as well as on a fellowship level.

Chronic Ankle Instability: Therapeutic Exercise and Data Analysis

Background and Objectives: Ankle injuries are the most common type of injury in healthy active individuals. If not treated properly, recurrent sprains can lead to a condition of chronic ankle instability (CAI). The present paper examines some subjects with a previous history of acute inversion ankle sprain who have developed a subsequent condition of instability, grouping them according to inclusion criteria and analyzing them through four field tests considered objective by the scientific literature: SEBT test, BEES test, TIBT test, SHT test. The data obtained were stored in order to compare them following a re-education protocol aimed at improving proprioception, balance, walking and strengthening the extrinsic and intrinsic muscles of the foot. per year. The subjects were then divided into two categories: subjects with CAI > 1 year and subjects with CAI ≤ 1 year. A protocol lasting 6 weeks was administered to both groups, trying to work on improving balance in single stance, improving static and dynamic stability, strengthening the gluteus medius and maximus (pelvis stabilizers) and strengthening of the intrinsic muscles of the foot. At the end of the protocol the subjects were all re-evaluated with the same field tests used previously and the data obtained were compared both with the pre-protocol data and with the data measured by the control subjects.

Exploring influences and risk of bias of studies on return to sport and work after lateral ankle sprain:A systematic review and metaanalysis

BACKGROUND Lateral ankle sprains are the most common traumatic musculoskeletal injuries of the lower extremity,with an incidence rate of 15%-20%.The high incidence and prevalence highlights the economic impact of this injury.Ankle sprains lead to a high socioeconomic burden due to the combination of the high injury incidence and high medical expenses.Up to 40%of patients who suffer from an ankle sprain develop chronic ankle instability.Chronic instability can lead to prolonged periods of pain,immobility and injury recurrence.Identification of factors that influence return to work(RTW)and return to sports(RTS)after a lateral ankle sprain(LAS)may help seriously reduce healthcare costs.AIM To explore which factors may potentially affect RTW and RTS after sustaining an LAS.METHODS EMBASE and PubMed were systematically searched for relevant studies published until June 2023.Inclusion criteria were as follows:(1)Injury including LAS or chronic ankle instability;(2)Described any form of treatment;(3)Assessment of RTW or RTS;(4)Studies published in English;and(5)Study designs including randomized controlled clinical trials,clinical trials or cohort studies.Exclusion criteria were:(1)Studies involving children(age<16 year);or(2)Patients with concomitant ankle injury besides lateral ankle ligament damage.A quality assessment was performed for each of the included studies using established risk of bias tools.Additionally quality of evidence was assessed using the GRADEpro tool in cases where outcomes were included in the quantitative analysis.A best evidence synthesis was performed in cases of qualitative outcome analysis.For all studied outcomes suitable for quantitative analysis a forest plot was created to calculate the effect on RTW and RTS.RESULTS A total of 8904 patients were included in 21 studies,10 randomized controlled trials,7 retrospective cohort studies and 4 prospective cohort studies.Fifteen studies were eligible for meta-analysis.The overall RTS rate ranged were 80%and 83%in the all treatments pool and surgical treatments pool,respectively.The pooled mean days to RTS ranged from 23-93 d.The overall RTW rate was 89%.The pooled mean time to RTW ranged from 5.8-8.1 d.For patients with chronic ankle instability,higher preoperative motivation was the sole factor significantly and independently(P=0.001)associated with the rate of and time to RTS following ligament repair or reconstruction.Higher body mass index was identified as a significant factor(P=0.04)linked to not resuming sports or returning at a lower level(median 24,range 20-37),compared to those who resumed at the same or higher level(median 23,range 17-38).Patients with a history of psychological illness or brain injury,experienced a delay in their rehabilitation process for sprains with fractures and unspecified sprains.The extent of the delayed rehabilitation was directly proportional to the increased likelihood of experiencing a recurrence of the ankle sprain and the number of ankle-related medical visits.We also observed that 10%of athletes who did return to sport after lateral ankle sprain without fractures described non-ankle-related reasons for not returning.CONCLUSION All treatments yielded comparable results,with each treatment potentially offering unique advantages or benefits.Preoperative motivation may influence rehabilitation after LAS.Grading which factor had a greater impact was not possible due to the lack of comparability among the included patients.

X-ray image characteristics and related measurements in the ankles of 118 adult patients with Kashin-Beck disease

Background Kashin-Beck disease （KBD） is a chronic,degenerative osteoarthropathy that causes severe skeletal deformation.Although many researchers have proven that almost all KBD patients who showed an increaseing proximo-distal gradient had radiographic abnormalities of the ankle,few detailed description of radiographic changes in the ankles of patients with KBD has been reported,especially for variable measurements of ankle changes.The purpose of this study was to demonstrate the radiographic characteristics of the ankles of adult KBD patients.Methods One hundred and eighteen adult KBD patients from september to October 2010 in Rongtang county in China were examined with lateral radiographs of the right ankle.The morphological abnormalities in the talus,calcaneus,navicular bone,distal tibia,and joint space were analyzed,and the calcaneus length,height,length-height ratio,tuber angle,front angle,plantar angle,and distal tibia anteroposterior （AP） length were measured using Riepert＇s method.Results Eighty-one patients （68.6％） had abnormal ankle radiographs; 72 （88.9％） patients had talus changes,69 （85.2％） patients had calcaneus changes,28 （34.6％） patients had navicular bone changes,and 48 （59.2％） patients had distal tibia changes.For 118 KBD patients,the average calcaneus length was 7.4 cm,height was 4.3 cm,and the length-height ratio was 1.7.The calcaneus tuber angle was 28.2°,front angle was 38.0° and the plantar angle was 74.2°.The distal tibia anteroposterior length was 4.05 cm.Compared with 50 normal adults （control group）,significant differences were found for the calcaneus length,the calcaneus length-height ratio,and the distal tibia AP length.Conclusions Patients with KBD have characteristic abnormalities on ankle radiographs; talus depression and deformity,calcaneus shortening deformity,and distal tibia deformity with AP length widening were the most typical changes.

Risk factors for chronic ankle instability after first episode of lateral ankle sprain:A retrospective analysis of 362 cases

Background:Chronic ankle instability(CAI) is a common sequela following an acute lateral ankle sprain(LAS).To treat an acture LAS more effectively and efficiently,it is important to identify patients at substantial risk for developing CAI.This study identifies magnetic resonance imaging(MRI) manifestations for predicting CAI development after a first episode of LAS and explores appropriate clinical indications for ordering MRI scans for these patients.Methods:All patients with a first-episode LAS who received plain radiograph and MRI scanning within the first 2 weeks after LAS from December 1,2017 to December 1,2019 were identified.Data were collected using the Cumberland Ankle Instability Tool at final follow-up.Demographic and other related clinical variables,including age,sex,body mass index,and treatment were also recorded.Univariable and multivariable analyses were performed successively to identify risk factors for CAI after first-episode LAS.Results:A total 131 out of 362 patients with a mean follow-up of 3.0± 0.6 years(mean ± SD;2.0—4.1 years) developed CAI after first-episode LAS.According to multivariable regression,development of CAI after first-episode LAS was associated with 5 prognostic factors:age(odds ratio(OR)=0.96,95% confidence interval(95%CI):0.93-1.00,p=0.032);body mass index(OR=1.09,95%CI:1.02-1.17,p=0.009);posterior talofibular ligament injury(OR=2.17,95%CI:1.05-4.48,p=0.035);large bone marrow lesion of the talus(OR=2.69,95%CI:1.30-5.58,p=0.008),and Grade 2 effusion of the tibiotalar joint(OR=2.61,95%CI:1.39-4.89,p=0.003).When patients had at least 1 positive clinical finding in the 10-m walk test,anterior drawer test,or inversion tilt test,they had a 90.2% sensitivity and 77.4% specificity in terms of detecting at least 1 prognostic factor by MRI.Conclusion:MRI scanning is valuable in predicting CAI after first-episode LAS for those patients with at least 1 positive clinical finding in the10-m walk test,anterior drawer test,and inversion tilt test.Further prospective and large-scale studies are necessary for validation.

Implications of obesity in patients with foot and ankle pathology

Obesity is a growing problem defined as a body mass index of greater than 30 kg/m2.It is predicted that by 2030,48.9%of adults will be classified as obese which expands surgical risk factors to a broad population while increasing healthcare costs at the same time in different socioeconomic groups.This specific population has been widely studied in multiple surgical fields and published studies have shown the implications in each of these fields.The impact of obesity on orthopedic surgical outcomes has been previously reported in several total hip and knee arthroscopy studies,with evidence indicating that obesity is strongly associated with an increased risk of post operative complications together with higher revision rates.In line with increasing interest on the impact of obesity in orthopedics,there has been a similar output of publications in the foot and ankle literature.This review article evaluates several foot and ankle pathologies,their risk factors associated with obesity and subsequent management.It provides an updated,comprehensive analysis of the effects of obesity on foot and ankle surgical outcomes,with the ultimate aim of educating both surgeons and allied health professionals about the risks,benefits,and modifiable factors of operating on obese patients.

A lateral ankle sprain during a lateral backward step in badminton:A case report of a televised injury incident

Background:This study presents a kinematic analysis of an acute lateral ankle sprain incurred during a televised badminton match.The kinematics of this injury were compared to those of 19 previously reported cases in the published literature.Methods:Four camera views of an acute lateral ankle sprain incurred during a televised badminton match were synchronized and rendered in3-dimensional animation software.A badminton court with known dimensions was built in a virtual environment,and a skeletal model scaled to the inj ured athlete’s height was used for skeletal matching.The ankle joint angle and angular velocity profiles of this acute injury were compared to the summarized findings from 19 previously reported cases in the published literature.Results:At foot strike,the ankle joint was 2° everted,33° plantarflexed,and 18° internally rotated.Maximum inversion of 114° and internal rotation of 69° was achieved at 0.24 s and 0.20 s after foot strike,respectively.After the foot strike,the ankle joint moved from an initial position of plantarflexion to dorsiflexion-from 33° plantarflexion to 53° dorsiflexion(range=86°).Maximum inversion,dorsiflexion,and internal rotation angular velocity were 1262°/s,961°/s,and 677°/s,respectively,at 0.12 s after foot strike.Conclusion:A forefoot landing posture with a plantarflexed and internally rotated ankle joint configuration could incite an acute lateral ankle sprain injury in badminton.Prevention of lateral ankle sprains in badminton should focus on the control and stability of the ankle joint angle during forefoot landings,especially when the athletes perform a combined lateral and backward step.

Locking plates for distal fibula fractures in young and elderly patients:A retrospective study

BACKGROUND Ankle fractures are common injuries in the young and elderly populations.To prevent post-traumatic arthritis,an anatomic reconstruction of the ankle structure is mandatory.Open reduction and internal fixation is the treatment of choice among orthopaedics.Conventional plates allow stability of the fracture if bone quality is present.Locking plates might offer an advantage for the treatment of lateral malleolar fracture in patients with comminution,severe instability,distal fractures,or osteoporotic bone.Our hospital introduced a new locking plate for fracture of the distal fibula.AIM To evaluate locking plates in terms of outcomes and complications in young and elderly patients.METHODS We retrospectively reviewed a total of 67 patients treated for displaced distal fibula fractures.Demographic data,number of comorbidities,use of inter fragmentary screw,complication,time of fracture healing,partial or full weight bearing,and reoperation were recorded for all patients.Clinical outcome was assessed by the American Orthopedic Foot and Ankle Society clinical scoring system.Radiographs were obtained at 4,8,12,16,20,and 24 wk until radiographic union was obtained.RESULTS All patients displayed complete bony union on radiographic assessment,and no patients developed any serious complications.We observed two superficial infections,one delayed wound healing,and two plate intolerances.Significant differences were observed between the two age groups in terms of radiographic healing(11.9 wk in younger patients vs 13.7 wk in older patients;P=0.011)and in the American Orthopedic Foot and Ankle Society score at 6 mo after surgery(88.2 in younger patients vs 86.0 in older patients;P=0.001)and at 12 mo after surgery(92.6 in younger patients vs 90.0 in older patients;P=0.000).CONCLUSION Locking plates provide a stable and rigid fixation in multifragmentary and comminuted fractures or in the presence of poor bone quality.

Clinical value of ankle flexion and extension exercises combined with a psychological intervention in knee osteoarthritis

BACKGROUND Considering the limited effectiveness of clinical interventions for knee osteoarthritis(KOA),it is necessary to continue to explore appropriate and effective treatment strategies to improve the condition of KOA patients.AIM To clarify the influence of ankle flexion and extension exercises combined with a psychological intervention on the psychological status and activities of daily living(ADLs)of patients with KOA.METHODS The research participants were 116 KOA patients admitted to The First Affiliated Hospital of Guizhou University of Traditional Chinese Medicine between May 2019 and May 2022,including 54 patients receiving routine treatment,care and psychological intervention(control group)and 62 patients additionally treated with ankle flexion and extension exercises(research group).The two groups were comparatively analyzed in terms of psychological status(Self-rating Anxiety/Depression Scale,SDS/SAS),ADLs,knee joint function(Lysholm Knee Scoring Scale),pain(Visual Analog Scale,VAS),fatigue(Multidimensional Fatigue Inventory,MFI),and quality of life(QoL;Short-Form 36 Item Health Survey,SF-36).RESULTS After evaluation,it was found that the postinterventional SDS,SAS,VAS,and MFI scores in the research group were significantly reduced compared with the baseline(before the intervention)values and those of the control group,while the postinterventional Lysholm,ADL and SF-36 scores were markedly elevated.CONCLUSION Therefore,ankle flexion and extension exercises are highly effective in easing negative psychological status,enhancing ADLs,daily living ability,knee joint function and QoL,and relieving pain and fatigue in KOA patients,thus warranting clinical promotion.

Examining the intrinsic foot muscles'capacity to modulate plantar flexor gearing and ankle joint contributions to propulsion in vertical jumping

Background:During human locomotion,a sufficiently stiff foot allows the ankle plantar flexors to generate large propulsive powers.Increasing foot stiffness(e.g.,via a carbon plate)increases the ankle’s external moment arm in relation to the internal moment arm(i.e.,increasing gear ratio),reduces plantar flexor muscles’shortening velocity,and enhances muscle force production.In contrast,when activation of the foot’s intrinsic muscles is impaired,there is a reduction in foot and ankle work and metatarsophalangeal joint stiffness.We speculated that the reduced capacity to actively control metatarsophalangeal joint stiffness may impair the gearing function of the foot at the ankle.Methods:We used a tibial nerve block to examine the direct effects of the intrinsic foot muscles on ankle joint kinetics,in vivo medial gastrocnemius’musculotendinous dynamics,and ankle gear ratio on 14 participants during maximal vertical jumping.Results:Under the nerve block,the internal ankle plantar flexion moment decreased(p=0.004)alongside a reduction in external moment arm length(p=0.021)and ankle joint gear ratio(p=0.049)when compared to the non-blocked condition.Although medial gastrocnemius muscle-tendon unit and fascicle velocity were not different between conditions,the Achilles tendon was shorter during propulsion in the nerve block condition(p<0.001).Conclusion:In addition to their known role of regulating the energetic function of the foot,our data indicate that the intrinsic foot muscles also act to optimize ankle joint torque production and leverage during the propulsion phase of vertical jumping.