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PeerJ 2023Knowledge of the muscle's lengths at which maximum active isometric force is attained is important for predicting forces during movement. However, there is limited...
BACKGROUND
Knowledge of the muscle's lengths at which maximum active isometric force is attained is important for predicting forces during movement. However, there is limited information about the force-length properties of a human muscle that plays crucial roles during locomotion; the tibialis anterior (TA). We therefore aimed to estimate TA's force-length relation from dorsiflexor torque-angle curves constructed from eight women and eight men.
METHODS
Participants performed maximal voluntary fixed-end contractions with their right ankle dorsiflexors from 0° to 30° plantar flexion. Muscle fascicle lengths were estimated from B-mode ultrasound images, and net ankle joint torques were measured using dynamometry. Fascicle forces were estimated by dividing maximal active torques by literature-derived, angle-specific tendon moment arm lengths while assuming a fixed 50% force contribution of TA to the total dorsiflexor force and accounting for fascicle angles.
RESULTS
Maximal active torques were higher at 15° than 20° and 30° plantar flexion (2.4-6.4 Nm, ≤ 0.012), whereas maximal active TA fascicle forces were higher at 15° than 0°, 20° and 30° plantar flexion (25-61 N, ≤ 0.042), but not different between 15° and 10° plantar flexion (15 N, = 0.277). TA fascicle shortening magnitudes during fixed-end contractions were larger at 15° than 30° plantar flexion (3.9 mm, = 0.012), but less at 15° than 0° plantar flexion (-2.4 mm, = 0.001), with no significant differences (≤0.7 mm, = 0.871) between TA's superficial and deep muscle compartments. Series elastic element stiffness was lowest and highest at lengths 5% shorter and 5% longer than optimum fascicle length, respectively (-30 and 15 N/mm, ≤ 0.003).
DISCUSSION
TA produced its maximum active force at 10-15° plantar flexion, and its normalized force-length relation had ascending and descending limbs that agreed with a simple scaled sarcomere model when active fascicle lengths from within TA's superficial or deep muscle compartment were considered. These findings can be used to inform the properties of the contractile and series elastic elements of Hill-type muscle models.
Topics: Male; Humans; Female; Young Adult; Isometric Contraction; Muscle, Skeletal; Tendons; Muscle Contraction; Ankle Joint
PubMed: 37461407
DOI: 10.7717/peerj.15693 -
Clinical Biomechanics (Bristol, Avon) Jul 2023While the effect of static stretching for individuals with cerebral palsy is questionable, recent results suggest that the combination with activation seems promising to... (Randomized Controlled Trial)
Randomized Controlled Trial
Eight weeks of proprioceptive neuromuscular facilitation stretching and static stretching do not affect muscle-tendon properties, muscle strength, and joint function in children with spastic cerebral palsy.
BACKGROUND
While the effect of static stretching for individuals with cerebral palsy is questionable, recent results suggest that the combination with activation seems promising to improve muscle-tendon properties and function. Therefore, this study analyzed the effects of 8-week proprioceptive neuromuscular facilitation stretching on the gastrocnemius medialis muscle-tendon properties, muscle strength, and the ankle joint in children with spastic cerebral palsy in comparison to static stretching.
METHODS
Initially, 24 children with spastic cerebral palsy were randomly assigned to a static stretching (10.7 ± 1.8 years) or proprioceptive neuromuscular facilitation stretching group (10.9 ± 2.6 years). Plantar flexors were manually stretched at home for 300 s and ∼ 250-270 s per day four times a week for eight weeks, respectively. Assessments of ankle joint function (e.g., range of motion), muscle-tendon properties, and isometric muscle strength were conducted using 3D motion capture, 2D ultrasound, dynamometry, and electromyography. A mixed analysis of variance was used for the statistical analysis.
FINDINGS
Stretching adherence was high in the proprioceptive neuromuscular facilitation stretching (93.1%) and static stretching group (94.4%). No significant changes (p > 0.05) were observed in ankle joint function, muscle-tendon properties, and isometric muscle strength after both interventions. Moreover, no differences (p > 0.05) were found between the stretching techniques.
INTERPRETATION
The findings support the idea that manual stretching (neither proprioceptive neuromuscular facilitation stretching nor static stretching) performed in isolation for eight weeks may not be appropriate to evoke significant changes in muscle-tendon properties, voluntary muscle strength, or joint function in children with spastic cerebral palsy.
CLINICAL TRIAL REGISTRATION NUMBER
NCT04570358.
Topics: Humans; Child; Muscle Stretching Exercises; Cerebral Palsy; Tendons; Muscle, Skeletal; Range of Motion, Articular; Muscle Strength
PubMed: 37329655
DOI: 10.1016/j.clinbiomech.2023.106011 -
Journal of Foot and Ankle Research Dec 2023People with diabetic peripheral neuropathy (DPN) and limited joint mobility syndrome (LJMS) can experience increased forefoot peak plantar pressures (PPPs), a known risk... (Randomized Controlled Trial)
Randomized Controlled Trial
INTRODUCTION
People with diabetic peripheral neuropathy (DPN) and limited joint mobility syndrome (LJMS) can experience increased forefoot peak plantar pressures (PPPs), a known risk factor for ulceration. The aim of this study was to investigate whether ankle and 1st metatarsophalangeal (MTP) joint mobilisations and home-based stretches in people with DPN improve joint range of motion (ROM) and reduce forefoot PPPs.
DESIGN AND METHODS
Sixty-one people with DPN (IWGDF risk 2), were randomly assigned to a 6-week programme of ankle and 1 MTP joint mobilisations (n = 31) and home-based stretches or standard care only (n = 30). At baseline (T0); 6-week post intervention (T1) and at 3 months follow-up (T2), a blinded assessor recorded dynamic ankle dorsiflexion range using 3D (Codamotion) motion analysis and the weight bearing lunge test, static 1st MTP joint dorsiflexion ROM, dynamic plantar pressure and balance.
RESULTS
At T1 and T2 there was no difference between both groups in ankle dorsiflexion in stance phase, plantar pressure and balance. Compared to the control group, the intervention group showed a statistically significant increase in static ankle dorsiflexion range (Left 1.52 cm and 2.9cms, Right 1.62 cm and 2.7 cm) at 6 (T1) and 18 weeks (T2) respectively p < 0.01). Between group differences were also seen in left hallux dorsiflexion (2.75°, p < 0.05) at T1 and in right hallux dorsiflexion ROM (4.9°, p < 0.01) at T2 follow up. Further, functional reach showed a significant increase in the intervention group (T1 = 3.13 cm p < 0.05 and T2 = 3.9 cm p < 0.01). Intervention adherence was high (80%).
CONCLUSIONS
Combining ankle and 1 MTP joint mobilisations with home-based stretches in a 6-week programme in people with DPN is effective in increasing static measures of range. This intervention may be useful for improving ankle, hallux joint mobility and anteroposterior stability limits in people with diabetes and neuropathy but not for reducing PPP or foot ulcer risk.
TRIAL REGISTRATION
https://classic.
CLINICALTRIALS
gov/ct2/show/NCT03195855 .
Topics: Humans; Ankle; Diabetic Neuropathies; Ankle Joint; Risk Factors; Foot Ulcer; Range of Motion, Articular; Diabetes Mellitus
PubMed: 38057930
DOI: 10.1186/s13047-023-00690-4 -
Journal of Sport and Health Science Sep 2023Chronic ankle instability (CAI) is a common sequela following an acute lateral ankle sprain (LAS). To treat an acute LAS more effectively and efficiently, it is...
BACKGROUND
Chronic ankle instability (CAI) is a common sequela following an acute lateral ankle sprain (LAS). To treat an acute 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 the 10-m walk test, anterior drawer test, and inversion tilt test. Further prospective and large-scale studies are necessary for validation.
Topics: Humans; Ankle Joint; Ankle; Retrospective Studies; Risk Factors; Joint Instability; Ankle Injuries
PubMed: 36931594
DOI: 10.1016/j.jshs.2023.03.005 -
Frontiers in Bioengineering and... 2023Total talus replacement is a promising alternative treatment for talus fractures complicated by avascular necrosis and collapse. This surgical option replaces the human...
Total talus replacement is a promising alternative treatment for talus fractures complicated by avascular necrosis and collapse. This surgical option replaces the human talus bone with a customized talus implant and can maintain ankle joint functionality compared to traditional treatment (e.g., ankle fusion). However, the customized implant is costly and time-consuming due to its customized nature. To circumvent these drawbacks, universal talus implants were proposed. While they showed clinically satisfactory results, existing talus implants are heavier than biological talus bones as they are solid inside. This can lead to unequal weight between the implant and biological talus bone, and therefore leading to other complications. The reduction of the implants' weight without compromising its performance and congruency with surrounding bones is a potential solution. Therefore, this study aims to design a lightweight universal talus implant using topology optimization. This is done through establishing the loading and boundary conditions for three common foot postures: neutral, dorsi- and plantar-flexion. The optimized implant performance in terms of mass, contact characteristics with surrounding joint cartilage and stress distributions is studied using a 3D Finite Element (FE) model of the ankle joint. The mass of the optimized implant is reduced by approximately 66.6% and its maximum stresses do not exceed 70 MPa, resulting in a safety factor of 15.7. Moreover, the optimized and solid implants show similar contact characteristics. Both implants produced peak contact pressures that were approximately 19.0%-196% higher than those produced by the biological talus. While further mechanical testing under loading conditions is required to determine clinical feasibility, preliminarily, the use of a lightweight universal implant is expected to provide the patient with a more natural feel, and a reduced waiting period until surgery.
PubMed: 37691900
DOI: 10.3389/fbioe.2023.1228809 -
Folia Morphologica Jun 2024The lateral ankle joint is composed of three ligaments: the anterior talofibular ligament (ATFL), posterior talofibular ligament (PTFL) and calcaneofibular ligament...
The lateral ankle joint is composed of three ligaments: the anterior talofibular ligament (ATFL), posterior talofibular ligament (PTFL) and calcaneofibular ligament (CFL). The ATFL and CFL demonstrate morphological variation, especially regarding their shape and number of bands. During standard anatomical dissection, an unusual type of triple CFL was observed: the CFL was composed of two bands originating on the lateral malleolus, and the presence of a lateral talocalcaneal ligament (LTC) originating on the talus bone. The insertion point of each band was located on the calcaneal bone. An understanding of these anatomical patterns provides a clearer view of ankle joint biomechanics, and improved the planning and performance of surgical treatment.
PubMed: 38842080
DOI: 10.5603/fm.100002 -
Scientific Reports Nov 2023The research into the prevention of sports injuries among the population, particularly juveniles, has become crucial due to the increasing participation in physical...
The research into the prevention of sports injuries among the population, particularly juveniles, has become crucial due to the increasing participation in physical exercises like fitness. To assess the difference in T2 values of ankle talar cartilage between weightlifters and healthy volunteers using quantitative magnetic resonance imaging (MRI) technique T2 mapping. Study design: Prospective. Prospective evaluation of T2 values of ankle cartilage of 50 weightlifters (30 adults and 20 juveniles) and 100 healthy volunteers (80 adults and 20 juveniles) using Siemens 3.0 T MRI with PDWI, T1WI, and T2 mapping sequences. Three physicians manually divided the talar cartilage of the ankle joint into six regions of interest. Three physicians utilized the anterior and posterior cut edges of the tibial cartilage as markers to identify the corresponding anterior and posterior cut edges of the talar cartilage on the sagittal MRI images. The medial and lateral sides were defined as half of the talar articular surface on the coronal plane. Differences in T2 values in each cartilage region were compared using independent sample T test or Mann-Whitney U test. The T2 values of talar cartilage were significantly increased in the athlete group relative to the volunteer group (35.11 and 31.99, P < 0.001), with the most significant difference observed in the juvenile athlete group compared to the volunteer group (34.42 and 28.73, P < 0.001). There was a significant difference in the T2 value of ankle talar cartilage between weightlifters and healthy volunteers, and juveniles may be more vulnerable to overuse sports injuries. This study contributes to understanding the cartilage health of juvenile athletes and the prevention of sports injuries.
Topics: Adult; Humans; Ankle Joint; Ankle; Athletic Injuries; Cartilage, Articular; Tibia; Magnetic Resonance Imaging
PubMed: 37932324
DOI: 10.1038/s41598-023-46259-w -
Journal of Neuroengineering and... Jun 2023Individualized, targeted, and intense training is the hallmark of successful gait rehabilitation in people post-stroke. Specifically, increasing use of the impaired...
BACKGROUND
Individualized, targeted, and intense training is the hallmark of successful gait rehabilitation in people post-stroke. Specifically, increasing use of the impaired ankle to increase propulsion during the stance phase of gait has been linked to higher walking speeds and symmetry. Conventional progressive resistance training is one method used for individualized and intense rehabilitation, but often fails to target paretic ankle plantarflexion during walking. Wearable assistive robots have successfully assisted ankle-specific mechanisms to increase paretic propulsion in people post-stroke, suggesting their potential to provide targeted resistance to increase propulsion, but this application remains underexamined in this population. This work investigates the effects of targeted stance-phase plantarflexion resistance training with a soft ankle exosuit on propulsion mechanics in people post-stroke.
METHODS
We conducted this study in nine individuals with chronic stroke and tested the effects of three resistive force magnitudes on peak paretic propulsion, ankle torque, and ankle power while participants walked on a treadmill at their comfortable walking speeds. For each force magnitude, participants walked for 1 min while the exosuit was inactive, 2 min with active resistance, and 1 min with the exosuit inactive, in sequence. We evaluated changes in gait biomechanics during the active resistance and post-resistance sections relative to the initial inactive section.
RESULTS
Walking with active resistance increased paretic propulsion by more than the minimal detectable change of 0.8 %body weight at all tested force magnitudes, with an average increase of 1.29 ± 0.37 %body weight at the highest force magnitude. This improvement corresponded to changes of 0.13 ± 0.03 N m kg in peak biological ankle torque and 0.26 ± 0.04 W kg in peak biological ankle power. Upon removal of resistance, propulsion changes persisted for 30 seconds with an improvement of 1.49 ± 0.58 %body weight after the highest resistance level and without compensatory involvement of the unresisted joints or limb.
CONCLUSIONS
Targeted exosuit-applied functional resistance of paretic ankle plantarflexors can elicit the latent propulsion reserve in people post-stroke. After-effects observed in propulsion highlight the potential for learning and restoration of propulsion mechanics. Thus, this exosuit-based resistive approach may offer new opportunities for individualized and progressive gait rehabilitation.
Topics: Humans; Ankle; Ankle Joint; Extremities; Gait; Body Weight
PubMed: 37391851
DOI: 10.1186/s12984-023-01204-w -
Journal of Orthopaedic Case Reports Nov 2023A dislocated knee is a potential limb-threatening injury. Simultaneous dislocation of knee and ankle joint in an ipsilateral limb is a very rare pattern of injury. A few...
INTRODUCTION
A dislocated knee is a potential limb-threatening injury. Simultaneous dislocation of knee and ankle joint in an ipsilateral limb is a very rare pattern of injury. A few cases of ipsilateral hip and knee dislocation were described in literature. Rare injury such as posterior dislocation knee with ipsilateral ankle fracture dislocation cases was also presented. However, lateral dislocation of knee along with the same side ankle fracture dislocation is a rare scenario. To the best of our knowledge, these two simultaneous lesions do not seem to have been reported previously. Immediate management of such injury is to reduce both joint and stabilization with external fixator and definitive surgery in the second stage when soft-tissue condition allows.
CASE REPORT
We describe a rare case of a 37-year-old farmer having injury to his right leg with tiller machine. Lateral right knee dislocation and right ankle fracture dislocation reduced in the emergency department. In emergency OT, external fixator applied for knee and ankle stabilization. When swelling subsides in ankle, fracture fixation is done with plates and screws. Knee fixator is kept for 6 weeks then knee physiotherapy started.
CONCLUSION
Dislocation of any joint is treated as an orthopedic emergency. Simultaneous dislocation of knee and ankle joints in an ipsilateral limb is a challenging situation for even the experienced surgeon. The outcome of such patients varies with associated injuries and time took for relocation and meticulous physical examination, with a high index of clinical suspicion is needed in diagnosing and management of such cases.
PubMed: 38025347
DOI: 10.13107/jocr.2023.v13.i11.4026