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)d...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.展开更多
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...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.展开更多
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 whil...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.展开更多
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 ri...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.展开更多
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 momen...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.展开更多
Background: The Buechel-Pappas (BP) meniscal bearing total ankle replace-ment was initially developed as a “shallow-sulcus” talar component device using cobalt-chromium-molybdenum alloy, in 1978, and later, modified...Background: The Buechel-Pappas (BP) meniscal bearing total ankle replace-ment was initially developed as a “shallow-sulcus” talar component device using cobalt-chromium-molybdenum alloy, in 1978, and later, modified to a “deep-sulcus” talar component device using titanium nitride (TiN) ceramic and porous coating in 1989. Wear related osteolytic cysts were noted in the tibia and talus surrounding these devices that compromised long term fixation and stability when using standard ultra-high molecular weight polyethylene (UHMWPe) as a bearing material. This study explores the use of highly cross-linked UHMWPe (HXLPe) to minimize osteolysis by replacing standard UHMWPe with this more wear-resistant material. Methods: There were 12 primary and 8 revision total ankle replacements followed for 13 to 15 years. HXLPe was used in all meniscal bearings, either as primary or revision implants. All stable metallic tibial and talar components were retained in revision cases. Osteolytic cysts greater than 10 mm in diameter were bone grafted with homologous morselized banked bone through cortical windows in the tibia or talus. No adjuvant screw fixation was used to stabilize any metallic implant. Results: No HXLPe bearings failed in this study, and no re-revisions were performed. No primary total ankle replacement failed in this study, and there were no substantial osteolytic cysts (>2 mm) observed in primary total ankle replacements on plain X-rays. All bone grafted osteolytic cysts in revision ankle replacements remained stable, even though partial resorption of the grafted material was identified in most of the ankles. No loosening of porous coated and TiN coated tibial and talar components were seen;the longest surviving metal components in the revision group was 24 years with the revised bearing at 15 years. Conclusions: HXLPe has greatly improved wear resistance in meniscal-bearing BP total ankle replacements in both primary and revision arthroplasties. Osteolytic cysts can be successfully bone grafted during bearing exchange revisions. Primary and revision, cementless BP metallic total ankle components have remained well-fixed to bone in the long term (greater than 20 years), without the use of adjuvant screw fixation.展开更多
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...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.展开更多
Ankle injury is one of the most common joint diseases that people experience during exercise.Most people have suffered ankle injuries at least once in their lives.The studies have shown that the ankle joint provides t...Ankle injury is one of the most common joint diseases that people experience during exercise.Most people have suffered ankle injuries at least once in their lives.The studies have shown that the ankle joint provides the most power and torques during the act of walking,compared to the knee and hip joints.This paper presents an ankle joint exoskeleton device,which is mainly used to provide assistance and protection to the human ankle joint with a pneumatic assist drive during walking.The pneumatic pressure smart shoes for this ankle exoskeleton were designed for detecting the human gaits to control the exoskeleton with certain supporting forces to the ankle joints at the appropriate timing.Each smart shoe has two sensors placed in between the wearable layer and the sole.The changes of the foot pressures were measured by the sensors for a microcontroller to control the exoskeleton.Two sets of experimental tests which were 2-month trials and gait selection were used to test the shoes.The experiments of 2-month trials were made to evaluate the stability of the shoes.The results showed that the shoes had no damages,no air leakage,and no malfunctions after the trials.The trials of gait selection were made to test the recognition rate which reached at 99.9%for the shoe system.The results showed that the design of the pneumatic smart shoes for the ankle-assisted exoskeleton met the requirements.展开更多
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 ...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.展开更多
A variety of prosthetic ankles have been successfully developed to reproduce the locomotor ability for lower limb amputees in daily lives. However, they have not been shown to sufficiently improve the natural gait mec...A variety of prosthetic ankles have been successfully developed to reproduce the locomotor ability for lower limb amputees in daily lives. However, they have not been shown to sufficiently improve the natural gait mechanics commonly observed in comparison to the able-bodied, perhaps due to over-simplified designs of functional musculoskeletal structures in prostheses. In this study, a flexible bionic ankle prosthesis with joints covered by soft material inclusions is developed on the basis of the human musculoskeletal system. First, the healthy side ankle–foot bones of a below-knee amputee were reconstructed by CT imaging. Three types of polyurethane rubber material configurations were then designed to mimic the soft tissues around the human ankle, providing stability and flexibility. Finite element simulations were conducted to determine the proper design of the rubber materials, evaluate the ankle stiffness under different external conditions, and calculate the rotation axes of the ankle during walking. The results showed that the bionic ankle had variable stiffness properties and could adapt to various road surfaces. It also had rotation axes similar to that of the human ankle, thus restoring the function of the talocrural and subtalar joints. The inclination and deviation angles of the talocrural axis, 86.2° and 75.1°, respectively, as well as the angles of the subtalar axis, 40.1° and 29.9°, were consistent with the literature. Finally, dynamic characteristics were investigated by gait measurements on the same subject, and the flexible bionic ankle prosthesis demonstrated natural gait mechanics during walking in terms of ankle angles and moments.展开更多
Cable-driven ankle–foot exoskeletons have attracted numerous researchers over the previous decade.The assistive forces of most exoskeletons pulled the back bottom of the shoes,across talocrural and subtalar joints.Th...Cable-driven ankle–foot exoskeletons have attracted numerous researchers over the previous decade.The assistive forces of most exoskeletons pulled the back bottom of the shoes,across talocrural and subtalar joints.The talocrural joint is inherently mediolateral unstable at the plantarflexion position due to its sliding mortise structure,while the subtalar joint allows inversion/eversion.In this paper,a biologically inspired cross-type double-cable-driven ankle–foot exotendon was proposed to assist not only the plantarflexion moment but also the movement stability.The novel structure was bio-inspired by the behind-calf anatomically symmetric layout and under-foot cross-configuration of the ankle–foot muscles.To examine the combined functions,we conducted a forward pelvis perturbed standing experiment on five subjects without and with exotendon assistance and recorded the biomechanical data.Compared to the unpowered condition,the biological ankle plantarflexion moment was reduced by 39 with 0.1 Nm/kg exotendon assistance for one leg.Besides,the forward margin of stability was increased by 17 during the late perturbation period,which indicated the improvement of balance in the sagittal plane.In addition,the standard deviation of the lateral CoP and three-dimensional marker trajectories for the ankle condylar and heel all descended,which provided evidence for ankle–foot stability improvement.The results suggested that the proposed biological exotendon can provide the compound ankle–foot assistance,reducing plantarflexion moment and improving movement stability.展开更多
Aiming at the problem that the existing ankle rehabilitation robot is difficult to fully fit the complex motion of human ankle joint and has poor human-machine motion compatibility,an equivalent series mechanism model...Aiming at the problem that the existing ankle rehabilitation robot is difficult to fully fit the complex motion of human ankle joint and has poor human-machine motion compatibility,an equivalent series mechanism model that is highly matched with the actual bone structure of the human ankle joint is proposed and mapped into a parallel rehabilita-tion mechanism.The parallel rehabilitation mechanism has two virtual motion centers(VMCs),which can simulate the complex motion of the ankle joint,adapt to the individual differences of various patients,and can meet the reha-bilitation needs of both left and right feet of patients.Firstly,based on the motion properties and physiological structure of the human ankle joint,the mapping relationship between the rehabilitation mechanism and ankle joint is determined,and the series equivalent model of the ankle joint is established.According to the kinematic and con-straint properties of the ankle equivalent model,the configuration design of the parallel ankle rehabilitation robot is carried out.Secondly,according to the intersecting motion planes theory,the full-cycle mobility of the mechanism is proved,and the continuous axis of the mechanism is judged based on the constraint power and its derivative.Then,the kinematics of the parallel ankle rehabilitation robot is analyzed.Finally,based on the OpenSim biomechanical soft-ware,a human-machine coupling rehabilitation simulation model is established to evaluate the rehabilitation effect,which lays the foundation for the formulation of a rehabilitation strategy for the later prototype.展开更多
BACKGROUND Heterotopic ossification(HO)refers to the formation of new bone in non-skeletal tissues such as muscles,tendons or other soft tissues.Severe muscle and soft tissue injury often lead to the formation of HO.H...BACKGROUND Heterotopic ossification(HO)refers to the formation of new bone in non-skeletal tissues such as muscles,tendons or other soft tissues.Severe muscle and soft tissue injury often lead to the formation of HO.However,anterior HO of the ankle is rarely reported.CASE SUMMARY We report a patient with massive HO in front of the ankle joint for 23 years.In 1998,the patient was injured by a falling object on the right lower extremity,which gradually formed a massive heterotopic bone change in the right calf and dorsum of the foot.The patient did not develop gradual ankle function limitations until nearly 36 mo ago,and underwent resection of HO.Even after 23 years and resection of HO,the ankle joint was still able to move.CONCLUSION It is recommended that the orthopedist should be aware of HO and distinguish it from bone tumor.展开更多
BACKGROUND Advances in minimally invasive surgery and improved post-operative pain management make it possible to consider performing even major foot/ankle operations as day-case.This could have significant benefits f...BACKGROUND Advances in minimally invasive surgery and improved post-operative pain management make it possible to consider performing even major foot/ankle operations as day-case.This could have significant benefits for patients and the health service.However there are theoretical concerns about post-operative complications and patient satisfaction due to pain.AIM To scope the current practice of foot and ankle surgeons on day-case surgery for major foot and ankle procedures in the United Kingdom(UK).METHODS An online survey(19 questions)was sent to UK foot and ankle surgeons via the British Orthopaedic Foot&Ankle Society membership list in August 2021.Major foot and ankle procedures were defined as surgery that is usually performed as an inpatient in majority of centres and day-case as same day discharge,with day surgery as the intended treatment pathway.RESULTS 132 people responded to the survey invitation with 80%working in Acute NHS Trusts.Currently 45%of respondents perform less than 100 day-case surgeries per year for these procedures.78%felt that there was scope to perform more procedures as day-case at their centre.Post-operative pain(34%)and patient satisfaction(10%)was not highly measured within their centres.Lack of adequate physiotherapy input pre/post-operatively(23%)and lack of out of hours support(21%)were the top perceived barriers to performing more major foot and ankle procedures as day-case.CONCLUSION There is consensus among UK surgeons to do more major foot/ankle procedures as day-case.Out of hours support and physiotherapy input pre/post-op were perceived as the main barriers.Despite theoretical concerns about post-operative pain and satisfaction this was only measured by a third of those surveyed.There is a need for nationally agreed protocols to optimise the delivery of and measurement of outcomes in this type of surgery.At a local level,the provision of physiotherapy and out of hours support should be explored at sites where this is a perceived barrier.展开更多
BACKGROUND Tuberculosis remains a complicated problem.A lack of awareness accompanied by difficulty in diagnosis hinders the management of tuberculosis.Delayed management,particularly in osteoarticular regions,results...BACKGROUND Tuberculosis remains a complicated problem.A lack of awareness accompanied by difficulty in diagnosis hinders the management of tuberculosis.Delayed management,particularly in osteoarticular regions,results in unnecessary procedures,including joint-sacrificing surgery.CASE SUMMARY Three cases of subclinical ankle joint tuberculosis without clear signs of tuberculosis were presented.The efficacy of technetium-99m-ethambutol scintigraphy in diagnosing early-stage tuberculous arthritis is reported.CONCLUSION The reports suggested that scintigraphy is recommended to diagnose subclinical tuberculous arthritis,especially in tuberculosis endemic regions.展开更多
Background: Lower extremity Peripheral artery disease (PAD) is caused by atherosclerosis, or Plaque buildup, that reduces the blood flow to the legs and feet. PAD affects approximately 230 million adults worldwide and...Background: Lower extremity Peripheral artery disease (PAD) is caused by atherosclerosis, or Plaque buildup, that reduces the blood flow to the legs and feet. PAD affects approximately 230 million adults worldwide and is associated with an increased risk of coronary heart disease, stroke, and leg amputation. The first-line method for diagnosis of PAD is the Ankle Brachial Index (ABI), which is the ratio of ankle to brachial higher systolic pressure measured in ankles and arms. The Toe Brachial Index (TBI), which is the ratio of the toe systolic pressure to brachial higher systolic pressure measured in both arms, is considered to be an alternative to the ABI in screening for PAD. The ABI and TBI are measured on the right and left side, and the lower of these numbers is the patient’s overall ABI and TBI. Clinical studies and meta-analysis reviews have shown that the conventional ABI measurement, which uses a cuff, and handheld sphygmomanometer and continuous-wave Doppler tracings, provides an acceptable-to-high specificity level but low sensitivity when compared with vascular color Doppler ultrasound, and/or angiography methods. Another study has shown that the TBI measurement has greater sensitivity but lower specificity than the ABI when compared with vascular color Doppler ultrasound diagnostic based on waveforms. The aim of this clinical study was to evaluate the specificity and sensitivity of the VasoPad System comparing its results to the vascular color doppler ultrasound waveforms. Materials and Methods: The VasoPad System is an automated device using the pulse wave method to measure the arms and ankles dorsalis and tibial posterior artery blood pressures, the photoplethysmography second derivative (PTGSD) to estimate the toe systolic pressure, a patented photoplethysmography (PTG) index marker and volume plethysmography via cuffs during deflation. Vascular Color Doppler ultrasound can diagnose stenosis through the direct visualization of atherosclerosis or plaques and through waveform analysis. The vascular color Doppler ultrasound provides 3 waveform types. The type 1, triphasic waveform is normal blood flow and no atherosclerosis or plaque, the type 2, diphasic waveform is seen when there are atherosclerosis plaques, but normal blood flow, and the type 3, monophasic waveform reflects stenosis with diameter reduction > 50%. Results: The sum of the overall ABI and TBI VasoPad values, called Sum of Brachial Indices (SBI), gave a specificity of 88.89% and sensitivity of 100% for detecting vascular color Doppler ultrasound biphasic and monophasic waveforms versus triphasic waveforms with a cutoff ≤ 1.36 (P Conclusion: The VasoPad was useful for detecting PAD, which is fully defined as having vessel stenosis > 50% (Doppler monophasic waveforms) but also early stage of atherosclerosis plaque of the lower extremities (Doppler biphasic waveforms). The VasoPad method provided a remarkable sensitivity of 100% and a specificity level similar to those of the conventional ABI test method compared with the vascular color Doppler ultrasound. In addition to being useful to screen and detect PAD, the VasoPad offers early detection of lower extremity atherosclerosis, with normal blood flow (Doppler biphasic waveforms), which could provide greater treatment options and thus reduce the overall number of lower extremity complications.展开更多
With the amalgamation of wearable systems equipped with inertial sensors, such as a gyroscope, and machine learning a therapy regimen can be objectively quantified, and then the initial phase and final phase of a one ...With the amalgamation of wearable systems equipped with inertial sensors, such as a gyroscope, and machine learning a therapy regimen can be objectively quantified, and then the initial phase and final phase of a one year therapy regimen can be distinguished through machine learning. In the context of rehabilitation of a hemiplegic ankle, a longitudinal therapy regimen incorporating stretching and then a series of repetitions for raising and lowering the foot of the hemiplegic ankle can be applied over the course of a year. Using a smartphone equipped with an application to function as a wearable and wireless gyroscope platform mounted to the dorsum of the foot by an armband, the initial phase and final phase of a one year longitudinally applied therapy regimen can be objectively quantified and recorded for subsequent machine learning. Considerable classification accuracy is attained to distinguish between the initial phase and final phase by a support vector machine for a one year longitudinally applied hemiplegic ankle therapy regimen based on the gyroscope signal data obtained by a smartphone functioning as a wearable and wireless inertial sensor system. .展开更多
Introduction and Background: Ankle injury is one of the most frequent presenting injuries to the emergency room and ankle fractures are common fracture in the lower limbs injuries that may require operative treatment ...Introduction and Background: Ankle injury is one of the most frequent presenting injuries to the emergency room and ankle fractures are common fracture in the lower limbs injuries that may require operative treatment with variable outcomes. Materials and Methods: Sixty-three patients were included in my retrospective study, and all with a displaced fracture of the ankle caused by high energy trauma were treated by open reduction and rigid internal fixation. Results: After follow-up at six weeks and twelve weeks, the results were satisfactory in fifty-five percent out of all the sixty-three patients. Conclusions and Recommendations: Ankle fractures occur mainly in young males of the age group between 26 and 35 years, mostly caused by fall down and motor vehicle accident.展开更多
Objective:To analyze the clinical effect of traditional Chinese medicine rehabilitation in treating adolescent ankle sports injuries.Methods:From December 2020 to December 2022,adolescent patients with ankle joint spo...Objective:To analyze the clinical effect of traditional Chinese medicine rehabilitation in treating adolescent ankle sports injuries.Methods:From December 2020 to December 2022,adolescent patients with ankle joint sports injuries admitted to our hospital were selected as observation objects,and 67 patients were divided into a control group(n=33,routine rehabilitation treatment)and an experimental group(n=34,traditional Chinese medicine rehabilitation treatment)according to the computer grouping method.Compare the treatment results.Results:(i)The treatment received in the experimental group had an efficacy of 94.11%,which was higher than that of the control group(75.75%),and statistical significance was established(P<0.05).(ii)Before treatment,there was no difference in ankle joint pain,ankle joint activity,and ankle joint function scores between the control group and the experimental group(P>0.05);after treatment,the ankle joint pain,ankle joint activity,and ankle joint function scores in the experimental group were significantly higher than those in the control group(P<0.05).(iii)The experimental group had higher scores on physiological function,physiological function,physical pain,general health status,energy,social function,emotional function,and mental health compared to the control group(P<0.05).Conclusion:Traditional Chinese medicine rehabilitation is effective in treating ankle injuries caused by sports in adolescents and improve their quality of life.Therefore,it should be popularized.展开更多
Objective:To analyze the value of applying evidence-based nursing in the perioperative care of patients with ankle fractures and propose corresponding measures to improve the quality of patient care.Methods:The study ...Objective:To analyze the value of applying evidence-based nursing in the perioperative care of patients with ankle fractures and propose corresponding measures to improve the quality of patient care.Methods:The study started in May 2022 and was terminated in March 2023.During this period,50 patients with ankle fractures treated by our hospital were selected as research subjects.They were divided into a control group and a research group.The control group had 25 patients who received routine care,and the research group had 25 who received evidence-based care.The nursing effects of the two groups were observed and compared.Results:The pain scores,quality of life,incidence of adverse reactions,and nursing satisfaction of patients in the research group were all significantly better than those in the control group(P<0.05).Conclusion:Evidence-based nursing can effectively improve the quality of care,reduce the risk of adverse reactions,and promote patient recovery,so it is suitable for clinical implementation.展开更多
文摘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.
文摘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.
文摘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.
基金supported by the Biomedicine Supporting Program of Shanghai "Science and Technology Innovation Plan" (19441902400)the Ningxia Hui Autonomous Region Key R&D program (2020BCH01001)+1 种基金the Shanghai "Science and Technology Innovation Action Plan" Domestic Science and Technology Cooperation Project (20025800200)the Clinical Research Program of Shanghai Municipal Health Commission (201940367)。
文摘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.
基金funded by an Australian Research Council Linkage Grant(LP160101316),in collaboration with Asics Oceania and The Australian Sports Commission。
文摘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.
文摘Background: The Buechel-Pappas (BP) meniscal bearing total ankle replace-ment was initially developed as a “shallow-sulcus” talar component device using cobalt-chromium-molybdenum alloy, in 1978, and later, modified to a “deep-sulcus” talar component device using titanium nitride (TiN) ceramic and porous coating in 1989. Wear related osteolytic cysts were noted in the tibia and talus surrounding these devices that compromised long term fixation and stability when using standard ultra-high molecular weight polyethylene (UHMWPe) as a bearing material. This study explores the use of highly cross-linked UHMWPe (HXLPe) to minimize osteolysis by replacing standard UHMWPe with this more wear-resistant material. Methods: There were 12 primary and 8 revision total ankle replacements followed for 13 to 15 years. HXLPe was used in all meniscal bearings, either as primary or revision implants. All stable metallic tibial and talar components were retained in revision cases. Osteolytic cysts greater than 10 mm in diameter were bone grafted with homologous morselized banked bone through cortical windows in the tibia or talus. No adjuvant screw fixation was used to stabilize any metallic implant. Results: No HXLPe bearings failed in this study, and no re-revisions were performed. No primary total ankle replacement failed in this study, and there were no substantial osteolytic cysts (>2 mm) observed in primary total ankle replacements on plain X-rays. All bone grafted osteolytic cysts in revision ankle replacements remained stable, even though partial resorption of the grafted material was identified in most of the ankles. No loosening of porous coated and TiN coated tibial and talar components were seen;the longest surviving metal components in the revision group was 24 years with the revised bearing at 15 years. Conclusions: HXLPe has greatly improved wear resistance in meniscal-bearing BP total ankle replacements in both primary and revision arthroplasties. Osteolytic cysts can be successfully bone grafted during bearing exchange revisions. Primary and revision, cementless BP metallic total ankle components have remained well-fixed to bone in the long term (greater than 20 years), without the use of adjuvant screw fixation.
文摘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.
基金supported by Guangzhou Science and Technology Plan-Industry University Research Project (No.20180601ZB0278).
文摘Ankle injury is one of the most common joint diseases that people experience during exercise.Most people have suffered ankle injuries at least once in their lives.The studies have shown that the ankle joint provides the most power and torques during the act of walking,compared to the knee and hip joints.This paper presents an ankle joint exoskeleton device,which is mainly used to provide assistance and protection to the human ankle joint with a pneumatic assist drive during walking.The pneumatic pressure smart shoes for this ankle exoskeleton were designed for detecting the human gaits to control the exoskeleton with certain supporting forces to the ankle joints at the appropriate timing.Each smart shoe has two sensors placed in between the wearable layer and the sole.The changes of the foot pressures were measured by the sensors for a microcontroller to control the exoskeleton.Two sets of experimental tests which were 2-month trials and gait selection were used to test the shoes.The experiments of 2-month trials were made to evaluate the stability of the shoes.The results showed that the shoes had no damages,no air leakage,and no malfunctions after the trials.The trials of gait selection were made to test the recognition rate which reached at 99.9%for the shoe system.The results showed that the design of the pneumatic smart shoes for the ankle-assisted exoskeleton met the requirements.
基金The authors acknowledge funding from the Badminton World Federation for this study。
文摘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.
基金supported by the National Key Research and Development Program of China(No.2018YFC2001300)the National Natural Science Foundation of China(No.52005209,91948302,No.91848204,No.52021003)the Natural Science Foundation of Jilin Province(No.20210101053JC,No.20220508130RC).
文摘A variety of prosthetic ankles have been successfully developed to reproduce the locomotor ability for lower limb amputees in daily lives. However, they have not been shown to sufficiently improve the natural gait mechanics commonly observed in comparison to the able-bodied, perhaps due to over-simplified designs of functional musculoskeletal structures in prostheses. In this study, a flexible bionic ankle prosthesis with joints covered by soft material inclusions is developed on the basis of the human musculoskeletal system. First, the healthy side ankle–foot bones of a below-knee amputee were reconstructed by CT imaging. Three types of polyurethane rubber material configurations were then designed to mimic the soft tissues around the human ankle, providing stability and flexibility. Finite element simulations were conducted to determine the proper design of the rubber materials, evaluate the ankle stiffness under different external conditions, and calculate the rotation axes of the ankle during walking. The results showed that the bionic ankle had variable stiffness properties and could adapt to various road surfaces. It also had rotation axes similar to that of the human ankle, thus restoring the function of the talocrural and subtalar joints. The inclination and deviation angles of the talocrural axis, 86.2° and 75.1°, respectively, as well as the angles of the subtalar axis, 40.1° and 29.9°, were consistent with the literature. Finally, dynamic characteristics were investigated by gait measurements on the same subject, and the flexible bionic ankle prosthesis demonstrated natural gait mechanics during walking in terms of ankle angles and moments.
基金This work was supported by the National Natural Science Foundation of China(Grant No.U21A20121,Grant No.52027806)。
文摘Cable-driven ankle–foot exoskeletons have attracted numerous researchers over the previous decade.The assistive forces of most exoskeletons pulled the back bottom of the shoes,across talocrural and subtalar joints.The talocrural joint is inherently mediolateral unstable at the plantarflexion position due to its sliding mortise structure,while the subtalar joint allows inversion/eversion.In this paper,a biologically inspired cross-type double-cable-driven ankle–foot exotendon was proposed to assist not only the plantarflexion moment but also the movement stability.The novel structure was bio-inspired by the behind-calf anatomically symmetric layout and under-foot cross-configuration of the ankle–foot muscles.To examine the combined functions,we conducted a forward pelvis perturbed standing experiment on five subjects without and with exotendon assistance and recorded the biomechanical data.Compared to the unpowered condition,the biological ankle plantarflexion moment was reduced by 39 with 0.1 Nm/kg exotendon assistance for one leg.Besides,the forward margin of stability was increased by 17 during the late perturbation period,which indicated the improvement of balance in the sagittal plane.In addition,the standard deviation of the lateral CoP and three-dimensional marker trajectories for the ankle condylar and heel all descended,which provided evidence for ankle–foot stability improvement.The results suggested that the proposed biological exotendon can provide the compound ankle–foot assistance,reducing plantarflexion moment and improving movement stability.
基金Supported by National Natural Science Foundation of China(Grant No.52075145)S&T Program of Hebei Province of China(Grant No.20281805Z)+1 种基金Hebei Provincial Natural Science Foundation of China(Grant No.E2022202130)Central Government Guides Basic Research Projects of Local Science and Technology Development Funds of China(Grant No.206Z1801G).
文摘Aiming at the problem that the existing ankle rehabilitation robot is difficult to fully fit the complex motion of human ankle joint and has poor human-machine motion compatibility,an equivalent series mechanism model that is highly matched with the actual bone structure of the human ankle joint is proposed and mapped into a parallel rehabilita-tion mechanism.The parallel rehabilitation mechanism has two virtual motion centers(VMCs),which can simulate the complex motion of the ankle joint,adapt to the individual differences of various patients,and can meet the reha-bilitation needs of both left and right feet of patients.Firstly,based on the motion properties and physiological structure of the human ankle joint,the mapping relationship between the rehabilitation mechanism and ankle joint is determined,and the series equivalent model of the ankle joint is established.According to the kinematic and con-straint properties of the ankle equivalent model,the configuration design of the parallel ankle rehabilitation robot is carried out.Secondly,according to the intersecting motion planes theory,the full-cycle mobility of the mechanism is proved,and the continuous axis of the mechanism is judged based on the constraint power and its derivative.Then,the kinematics of the parallel ankle rehabilitation robot is analyzed.Finally,based on the OpenSim biomechanical soft-ware,a human-machine coupling rehabilitation simulation model is established to evaluate the rehabilitation effect,which lays the foundation for the formulation of a rehabilitation strategy for the later prototype.
基金Supported by Scientific research project of Hunan Education Department,No.21B0075Science project of Hunan Provincial Health Commission,No.B2015-82。
文摘BACKGROUND Heterotopic ossification(HO)refers to the formation of new bone in non-skeletal tissues such as muscles,tendons or other soft tissues.Severe muscle and soft tissue injury often lead to the formation of HO.However,anterior HO of the ankle is rarely reported.CASE SUMMARY We report a patient with massive HO in front of the ankle joint for 23 years.In 1998,the patient was injured by a falling object on the right lower extremity,which gradually formed a massive heterotopic bone change in the right calf and dorsum of the foot.The patient did not develop gradual ankle function limitations until nearly 36 mo ago,and underwent resection of HO.Even after 23 years and resection of HO,the ankle joint was still able to move.CONCLUSION It is recommended that the orthopedist should be aware of HO and distinguish it from bone tumor.
文摘BACKGROUND Advances in minimally invasive surgery and improved post-operative pain management make it possible to consider performing even major foot/ankle operations as day-case.This could have significant benefits for patients and the health service.However there are theoretical concerns about post-operative complications and patient satisfaction due to pain.AIM To scope the current practice of foot and ankle surgeons on day-case surgery for major foot and ankle procedures in the United Kingdom(UK).METHODS An online survey(19 questions)was sent to UK foot and ankle surgeons via the British Orthopaedic Foot&Ankle Society membership list in August 2021.Major foot and ankle procedures were defined as surgery that is usually performed as an inpatient in majority of centres and day-case as same day discharge,with day surgery as the intended treatment pathway.RESULTS 132 people responded to the survey invitation with 80%working in Acute NHS Trusts.Currently 45%of respondents perform less than 100 day-case surgeries per year for these procedures.78%felt that there was scope to perform more procedures as day-case at their centre.Post-operative pain(34%)and patient satisfaction(10%)was not highly measured within their centres.Lack of adequate physiotherapy input pre/post-operatively(23%)and lack of out of hours support(21%)were the top perceived barriers to performing more major foot and ankle procedures as day-case.CONCLUSION There is consensus among UK surgeons to do more major foot/ankle procedures as day-case.Out of hours support and physiotherapy input pre/post-op were perceived as the main barriers.Despite theoretical concerns about post-operative pain and satisfaction this was only measured by a third of those surveyed.There is a need for nationally agreed protocols to optimise the delivery of and measurement of outcomes in this type of surgery.At a local level,the provision of physiotherapy and out of hours support should be explored at sites where this is a perceived barrier.
文摘BACKGROUND Tuberculosis remains a complicated problem.A lack of awareness accompanied by difficulty in diagnosis hinders the management of tuberculosis.Delayed management,particularly in osteoarticular regions,results in unnecessary procedures,including joint-sacrificing surgery.CASE SUMMARY Three cases of subclinical ankle joint tuberculosis without clear signs of tuberculosis were presented.The efficacy of technetium-99m-ethambutol scintigraphy in diagnosing early-stage tuberculous arthritis is reported.CONCLUSION The reports suggested that scintigraphy is recommended to diagnose subclinical tuberculous arthritis,especially in tuberculosis endemic regions.
文摘Background: Lower extremity Peripheral artery disease (PAD) is caused by atherosclerosis, or Plaque buildup, that reduces the blood flow to the legs and feet. PAD affects approximately 230 million adults worldwide and is associated with an increased risk of coronary heart disease, stroke, and leg amputation. The first-line method for diagnosis of PAD is the Ankle Brachial Index (ABI), which is the ratio of ankle to brachial higher systolic pressure measured in ankles and arms. The Toe Brachial Index (TBI), which is the ratio of the toe systolic pressure to brachial higher systolic pressure measured in both arms, is considered to be an alternative to the ABI in screening for PAD. The ABI and TBI are measured on the right and left side, and the lower of these numbers is the patient’s overall ABI and TBI. Clinical studies and meta-analysis reviews have shown that the conventional ABI measurement, which uses a cuff, and handheld sphygmomanometer and continuous-wave Doppler tracings, provides an acceptable-to-high specificity level but low sensitivity when compared with vascular color Doppler ultrasound, and/or angiography methods. Another study has shown that the TBI measurement has greater sensitivity but lower specificity than the ABI when compared with vascular color Doppler ultrasound diagnostic based on waveforms. The aim of this clinical study was to evaluate the specificity and sensitivity of the VasoPad System comparing its results to the vascular color doppler ultrasound waveforms. Materials and Methods: The VasoPad System is an automated device using the pulse wave method to measure the arms and ankles dorsalis and tibial posterior artery blood pressures, the photoplethysmography second derivative (PTGSD) to estimate the toe systolic pressure, a patented photoplethysmography (PTG) index marker and volume plethysmography via cuffs during deflation. Vascular Color Doppler ultrasound can diagnose stenosis through the direct visualization of atherosclerosis or plaques and through waveform analysis. The vascular color Doppler ultrasound provides 3 waveform types. The type 1, triphasic waveform is normal blood flow and no atherosclerosis or plaque, the type 2, diphasic waveform is seen when there are atherosclerosis plaques, but normal blood flow, and the type 3, monophasic waveform reflects stenosis with diameter reduction > 50%. Results: The sum of the overall ABI and TBI VasoPad values, called Sum of Brachial Indices (SBI), gave a specificity of 88.89% and sensitivity of 100% for detecting vascular color Doppler ultrasound biphasic and monophasic waveforms versus triphasic waveforms with a cutoff ≤ 1.36 (P Conclusion: The VasoPad was useful for detecting PAD, which is fully defined as having vessel stenosis > 50% (Doppler monophasic waveforms) but also early stage of atherosclerosis plaque of the lower extremities (Doppler biphasic waveforms). The VasoPad method provided a remarkable sensitivity of 100% and a specificity level similar to those of the conventional ABI test method compared with the vascular color Doppler ultrasound. In addition to being useful to screen and detect PAD, the VasoPad offers early detection of lower extremity atherosclerosis, with normal blood flow (Doppler biphasic waveforms), which could provide greater treatment options and thus reduce the overall number of lower extremity complications.
文摘With the amalgamation of wearable systems equipped with inertial sensors, such as a gyroscope, and machine learning a therapy regimen can be objectively quantified, and then the initial phase and final phase of a one year therapy regimen can be distinguished through machine learning. In the context of rehabilitation of a hemiplegic ankle, a longitudinal therapy regimen incorporating stretching and then a series of repetitions for raising and lowering the foot of the hemiplegic ankle can be applied over the course of a year. Using a smartphone equipped with an application to function as a wearable and wireless gyroscope platform mounted to the dorsum of the foot by an armband, the initial phase and final phase of a one year longitudinally applied therapy regimen can be objectively quantified and recorded for subsequent machine learning. Considerable classification accuracy is attained to distinguish between the initial phase and final phase by a support vector machine for a one year longitudinally applied hemiplegic ankle therapy regimen based on the gyroscope signal data obtained by a smartphone functioning as a wearable and wireless inertial sensor system. .
文摘Introduction and Background: Ankle injury is one of the most frequent presenting injuries to the emergency room and ankle fractures are common fracture in the lower limbs injuries that may require operative treatment with variable outcomes. Materials and Methods: Sixty-three patients were included in my retrospective study, and all with a displaced fracture of the ankle caused by high energy trauma were treated by open reduction and rigid internal fixation. Results: After follow-up at six weeks and twelve weeks, the results were satisfactory in fifty-five percent out of all the sixty-three patients. Conclusions and Recommendations: Ankle fractures occur mainly in young males of the age group between 26 and 35 years, mostly caused by fall down and motor vehicle accident.
文摘Objective:To analyze the clinical effect of traditional Chinese medicine rehabilitation in treating adolescent ankle sports injuries.Methods:From December 2020 to December 2022,adolescent patients with ankle joint sports injuries admitted to our hospital were selected as observation objects,and 67 patients were divided into a control group(n=33,routine rehabilitation treatment)and an experimental group(n=34,traditional Chinese medicine rehabilitation treatment)according to the computer grouping method.Compare the treatment results.Results:(i)The treatment received in the experimental group had an efficacy of 94.11%,which was higher than that of the control group(75.75%),and statistical significance was established(P<0.05).(ii)Before treatment,there was no difference in ankle joint pain,ankle joint activity,and ankle joint function scores between the control group and the experimental group(P>0.05);after treatment,the ankle joint pain,ankle joint activity,and ankle joint function scores in the experimental group were significantly higher than those in the control group(P<0.05).(iii)The experimental group had higher scores on physiological function,physiological function,physical pain,general health status,energy,social function,emotional function,and mental health compared to the control group(P<0.05).Conclusion:Traditional Chinese medicine rehabilitation is effective in treating ankle injuries caused by sports in adolescents and improve their quality of life.Therefore,it should be popularized.
文摘Objective:To analyze the value of applying evidence-based nursing in the perioperative care of patients with ankle fractures and propose corresponding measures to improve the quality of patient care.Methods:The study started in May 2022 and was terminated in March 2023.During this period,50 patients with ankle fractures treated by our hospital were selected as research subjects.They were divided into a control group and a research group.The control group had 25 patients who received routine care,and the research group had 25 who received evidence-based care.The nursing effects of the two groups were observed and compared.Results:The pain scores,quality of life,incidence of adverse reactions,and nursing satisfaction of patients in the research group were all significantly better than those in the control group(P<0.05).Conclusion:Evidence-based nursing can effectively improve the quality of care,reduce the risk of adverse reactions,and promote patient recovery,so it is suitable for clinical implementation.
