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Journal of Foot and Ankle Research Nov 2023A comprehensive insight into the effects of subtalar- and mid-tarsal joint osteoarthritis on lower limb's biomechanical characteristics during walking is lacking. Our...
BACKGROUND
A comprehensive insight into the effects of subtalar- and mid-tarsal joint osteoarthritis on lower limb's biomechanical characteristics during walking is lacking. Our goal was to assess joint kinematics and kinetics and compensatory mechanisms in patients with subtalar and mid-tarsal joint osteoarthritis.
METHODS
Patients with symptomatic and radiographically confirmed osteoarthritis of the subtalar and mid-tarsal (n = 10) and an asymptomatic control group (n = 10) were compared. Foot joint kinematics and kinetics during the stance phase of walking were quantified using a four-segment foot model.
RESULTS
During pre-swing phase, the tibio-talar range of motion in the sagittal plane of the patient group decreased significantly (P = 0.001), whereas the tarso-metatarsal joint range of motion in the sagittal plane was greater in the pre-swing phase (P = 0.003). The mid-tarsal joint showed lower transverse plane range of motion in the patient group during the loading response and pre-swing phase (P < 0.001 resp. P = 0.002). The patient group showed a lower Tibio-talar joint peak plantarflexion moment (P = 0.004), peak plantarflexion velocity (P < 0.001) and peak power generation in the sagittal plane (P < 0.001), and a lower mid-tarsal joint peak adduction and abduction velocity (P < 0.001 resp. P < 0.001) and peak power absorption (P < 0.001).
CONCLUSIONS
These findings suggest that patients with subtalar and mid-tarsal joint osteoarthritis adopt a cautious walking strategy potentially dictated by pain, muscle weakness, kinesiophobia and stiffness. Since this poorly responding population faces surgical intervention on the short term, we recommend careful follow-up after fusion surgery since biomechanical outcome measures associated to this post-surgical stage is lacking.
Topics: Humans; Biomechanical Phenomena; Conservative Treatment; Subtalar Joint; Foot; Walking; Osteoarthritis; Tarsal Joints; Ankle Joint; Range of Motion, Articular
PubMed: 38017488
DOI: 10.1186/s13047-023-00689-x -
Clinical Biomechanics (Bristol, Avon) Nov 2014Stiffness of an ankle-foot orthosis plays an important role in improving gait in patients with a history of stroke. To address this, the aim of this case series study...
The effect of ankle-foot orthosis plantarflexion stiffness on ankle and knee joint kinematics and kinetics during first and second rockers of gait in individuals with stroke.
BACKGROUND
Stiffness of an ankle-foot orthosis plays an important role in improving gait in patients with a history of stroke. To address this, the aim of this case series study was to determine the effect of increasing plantarflexion stiffness of an ankle-foot orthosis on the sagittal ankle and knee joint angle and moment during the first and second rockers of gait.
METHODS
Gait data were collected in 5 subjects with stroke at a self-selected walking speed under two plantarflexion stiffness conditions (0.4Nm/° and 1.3Nm/°) using a stiffness-adjustable experimental ankle-foot orthosis on a Bertec split-belt fully instrumented treadmill in a 3-dimensional motion analysis laboratory.
FINDINGS
By increasing the plantarflexion stiffness of the ankle-foot orthosis, peak plantarflexion angle of the ankle was reduced and peak dorsiflexion moment was generally increased in the first rocker as hypothesized. Two subjects demonstrated increases in both peak knee flexion angle and peak knee extension moment in the second rocker as hypothesized. The two subjects exhibited minimum contractility during active plantarflexion, while the other three subjects could actively plantarflex their ankle joint.
INTERPRETATION
It was suggested that those with the decreased ability to actively plantarflex their ankle could not overcome excessive plantarflexion stiffness at initial contact of gait, and as a result exhibited compensation strategies at the knee joint. Providing excessively stiff ankle-foot orthoses might put added stress on the extensor muscles of the knee joint, potentially creating fatigue and future pathologies in some patients with stroke.
Topics: Aged; Ankle Joint; Biomechanical Phenomena; Braces; Female; Foot Orthoses; Gait Disorders, Neurologic; Humans; Knee Joint; Male; Middle Aged; Orthotic Devices; Range of Motion, Articular; Stroke; Stroke Rehabilitation; Walking; Weight-Bearing
PubMed: 25241248
DOI: 10.1016/j.clinbiomech.2014.09.001 -
The Knee Jun 2023To explore the effects and mechanism of millimeter-wave treatment on the development of joint stiffness in the immobilized knee rat model.
AIM
To explore the effects and mechanism of millimeter-wave treatment on the development of joint stiffness in the immobilized knee rat model.
METHODS
Twenty-four Sprague-Dawley (SD) rats were randomly divided into the control group (O, n = 8), the surgical control group (OC, n = 8), and the millimeter-wave treatment group (MO, n = 8). After immobilized knee modeling, the knee mobility and quadriceps diameter was measured at the 6th week. Hematoxylin and eosin and Masson staining were performed to detect the pathology and fibrous lesions of the knee joint. Furthermore, the expression of TGF-β1 and Collagen I was quantified by immunohistochemical assay in the knee capsule, and Western blotting was performed to quantify the protein expression of NF-κB and MuRF1 in skeletal muscle.
RESULTS
Compared with the O group, knee mobility, and quadriceps diameter was decreased (P < 0.01), and articular capsule fibrosis and quadriceps atrophy occurred in all rats with fixed knee joints. Compared with the OC group, millimeter-wave treatment significantly increased articular mobility and the quadriceps diameter; and improved the fibrotic lesions of the joint capsule and quadriceps atrophy. Moreover, levels of TGF-β1, Collagen I, and MuRF1 were upregulated (P < 0.01) by knee immobilization, and collagen fiber content in the articular capsule was also increased (P < 0.01). However, millimeter-wave treatment reversed it. The most noteworthy result was that NF-κB expression was not significantly different in all groups.
CONCLUSION
Millimeter-wave treatment reversed joint contracture and quadriceps atrophy caused by joint fixation, inhibited TGF-β1 and Collagen I protein expression of the joint capsule and reduced MuRF1 expression of the quadriceps muscle, thereby inhibiting the development of joint stiffness.
Topics: Animals; Rats; Atrophy; Collagen Type I; Contracture; Joint Capsule; Joint Diseases; Knee Joint; NF-kappa B; Range of Motion, Articular; Rats, Sprague-Dawley; Transforming Growth Factor beta1
PubMed: 37086540
DOI: 10.1016/j.knee.2023.03.019 -
Scientific Reports Sep 2021Chronic rheumatological manifestations similar to those of rheumatoid arthritis (RA) are described after chikungunya virus infection. We aimed to compare the relevance... (Comparative Study)
Comparative Study
Chronic rheumatological manifestations similar to those of rheumatoid arthritis (RA) are described after chikungunya virus infection. We aimed to compare the relevance of joint counts and symptoms to clinical outcomes in RA and chronic chikungunya disease. Forty patients with chronic chikungunya arthralgia and 40 patients with RA were enrolled in a cross-sectional study. The association of tenderness and swelling, clinically assessed in 28 joints, and patient evaluations of pain and musculoskeletal stiffness with modified Health Assessment Questionnaire (HAQ) and quality of life (QoL) assessments were investigated. Tender and swollen joint counts, pain and stiffness scores were all associated with the HAQ disability index in RA (all r > 0.55, p ≤ 0.0002), but only stiffness was significantly associated with disability in chikungunya (r = 0.38, p = 0.02). Joint counts, pain and stiffness were also associated with most QoL domains in RA patients. In contrast, in chikungunya disease, tender joint counts were associated only with one QoL domain and swollen joints for none, while pain and stiffness were associated with several domains. Our results confirm the relevance of joint counts in RA, but suggest that in chronic chikungunya disease, joint counts have more limited value. Stiffness and pain score may be more important to quantify chikungunya arthritis impact.
Topics: Adult; Arthritis; Arthritis, Rheumatoid; Chikungunya Fever; Chikungunya virus; Cross-Sectional Studies; Disability Evaluation; Disabled Persons; Female; Humans; Joints; Middle Aged; Pain; Quality of Life; Severity of Illness Index
PubMed: 34535727
DOI: 10.1038/s41598-021-98164-9 -
Sensors (Basel, Switzerland) Feb 2021This study involves measurements of bi-axial ankle stiffness in older adults, where the ankle joint is passively moved along the talocrural and subtalar joints using a...
This study involves measurements of bi-axial ankle stiffness in older adults, where the ankle joint is passively moved along the talocrural and subtalar joints using a custom ankle movement trainer. A total of 15 elderly individuals participated in test-retest reliability measurements of bi-axial ankle stiffness at exactly one-week intervals for validation of the angular displacement in the device. The ankle's range of motion was also compared, along with its stiffness. The kinematic measurements significantly corresponded to results from a marker-based motion capture system (dorsi-/plantar flexion: = 0.996; inversion/eversion: = 0.985). Bi-axial ankle stiffness measurements showed significant intra-class correlations (ICCs) between the two visits for all ankle movements at slower (2.14°/s, ICC = 0.712) and faster (9.77°/s, ICC = 0.879) speeds. Stiffness measurements along the talocrural joint were thus shown to have significant negative correlation with active ankle range of motion ( = -0.631, = 0.012). The ankle movement trainer, based on anatomical characteristics, was thus used to demonstrate valid and reliable bi-axial ankle stiffness measurements for movements along the talocrural and subtalar joint axes. Reliable measurements of ankle stiffness may help clinicians and researchers when designing and fabricating ankle-foot orthosis for people with upper-motor neuron disorders, such as stroke.
Topics: Aged; Ankle; Ankle Joint; Biomechanical Phenomena; Humans; Range of Motion, Articular; Reproducibility of Results; Subtalar Joint
PubMed: 33562234
DOI: 10.3390/s21041162 -
The Bone & Joint Journal Oct 2015Primary total knee arthroplasty (TKA) is a reliable procedure with reproducible long-term results. Nevertheless, there are conditions related to the type of patient or... (Review)
Review
Primary total knee arthroplasty (TKA) is a reliable procedure with reproducible long-term results. Nevertheless, there are conditions related to the type of patient or local conditions of the knee that can make it a difficult procedure. The most common scenarios that make it difficult are discussed in this review. These include patients with many previous operations and incisions, and those with severe coronal deformities, genu recurvatum, a stiff knee, extra-articular deformities and those who have previously undergone osteotomy around the knee and those with chronic dislocation of the patella. Each condition is analysed according to the characteristics of the patient, the pre-operative planning and the reported outcomes. When approaching the difficult primary TKA surgeons should use a systematic approach, which begins with the review of the existing literature for each specific clinical situation.
Topics: Arthroplasty, Replacement, Knee; Humans; Joint Deformities, Acquired; Knee Joint; Osteoarthritis, Knee; Osteotomy; Patellar Dislocation; Preoperative Care; Reoperation; Treatment Outcome
PubMed: 26430084
DOI: 10.1302/0301-620X.97B10.36920 -
Seminars in Arthritis and Rheumatism Feb 2021To determine the incidence and progression of ankle osteoarthritis (OA) and associated risk factors in a community-based cohort of African Americans and whites.
OBJECTIVE
To determine the incidence and progression of ankle osteoarthritis (OA) and associated risk factors in a community-based cohort of African Americans and whites.
METHODS
Data were from 541 participants who had standardized lateral and mortise radiography of the ankles in weight bearing at baseline (2013-2015) and follow-up (2017-2018). Incident radiographic ankle OA (rAOA) was defined as a Kellgren-Lawrence grade (KLG) ≥ 1 at follow-up among ankles with baseline KLG < 1; progressive rAOA was a ≥ 1 KLG increase at follow-up among ankles with KLG ≥ 1 at baseline. Symptoms were assessed using self-reported pain, aching, and stiffness (PAS) on most days and the Foot and Ankle Outcome Score (FAOS) symptoms subscale. Ankle-level logistic regression models were used to assess associations of ankle outcomes with covariates (age, sex, race, body mass index [BMI], smoking, number of symptomatic joints, comorbidities, prior ankle injury, and knee or foot OA).
RESULTS
Among ankles without rAOA at baseline, 28% developed incident rAOA, 37% had worsening FAOS symptoms, and 7% had worsening PAS. Incident rAOA and worsening ankle symptoms were associated with higher BMI and symptoms in other joints. Among ankles with baseline rAOA, 4% had progressive rAOA, 35% had worsening of FAOS symptoms, and 9% had worsening PAS. rAOA progression was associated with ankle injury and concomitant knee or foot OA; worsening of symptoms was associated with higher BMI and other symptomatic joints.
CONCLUSIONS
Not all ankle OA is post-traumatic. Smoking prevention/cessation, a healthy weight, and injury prevention may be methods for reducing the incidence and progression of rAOA.
Topics: Ankle; Ankle Joint; Disease Progression; Humans; Incidence; Knee Joint; Osteoarthritis; Osteoarthritis, Knee
PubMed: 33385863
DOI: 10.1016/j.semarthrit.2020.10.015 -
Journal of Neurophysiology Jan 2009The perturbation method has been used to measure stiffness of the human arm with a manipulator. Results are averages of stiffness during short perturbation intervals...
The perturbation method has been used to measure stiffness of the human arm with a manipulator. Results are averages of stiffness during short perturbation intervals (<0.4 s) and also vary with muscle activation. We therefore propose a novel method for estimating static arm stiffness from muscle activation without the use of perturbation. We developed a mathematical muscle model based on anatomical and physiological data to estimate joint torque solely from EMG. This model expresses muscle tension using a quadratic function of the muscle activation and parameters representing muscle properties. The parameters are acquired from the relation between EMG and measured torque. Using this model, we were able to reconstruct joint torque from EMG signals with or without co-contraction. Joint stiffness is directly obtained by differentiation of this model analytically. We confirmed that the proposed method can be used to estimate joint torque, joint stiffness, and stiffness ellipses simultaneously for various postures with the same parameters and produces results consistent with the conventional perturbation method.
Topics: Adult; Algorithms; Arm; Biomechanical Phenomena; Efferent Pathways; Electrodes; Electromyography; Feedback; Female; Hand; Humans; Joints; Male; Models, Neurological; Muscle, Skeletal; Posture; Shoulder; Young Adult
PubMed: 19005007
DOI: 10.1152/jn.00584.2007 -
Advances in Therapy Nov 2013Osteoarthritis (OA) constitutes a growing public health burden and the most common cause of disability in the United States. Non-pharmacologic modalities and... (Review)
Review
INTRODUCTION
Osteoarthritis (OA) constitutes a growing public health burden and the most common cause of disability in the United States. Non-pharmacologic modalities and conservative pharmacologic therapies are recommended for the initial treatment of OA, including acetaminophen, and topical and oral non-steroidal anti-inflammatory drugs. However, safety concerns continue to mount regarding the use of these treatments and none have been shown to impact disease progression. Viscosupplementation with injections of hyaluronans (HAs) are indicated when non-pharmacologic and simple analgesics have failed to relieve symptoms (e.g., pain, stiffness) associated with knee OA. This review evaluates literature focusing on the efficacy and/or safety of HA injections in treating OA of the knee and in other joints, including the hip, shoulder, and ankle.
METHODS
Relevant literature on intra-articular (IA) HA injections as a treatment for OA pain in the knee and other joints was identified through PubMed database searches from inception until January 2013. Search terms included "hyaluronic acid" or "hylan", and "osteoarthritis".
DISCUSSION
Current evidence indicates that HA injections are beneficial and safe for patients with OA of the knee. IA injections of HAs treat the symptoms of knee OA and may also have disease-modifying properties, potentially delaying progression of OA. Although traditionally reserved for second-line treatment, evidence suggests that HAs may have value as a first-line therapy in the treatment of knee OA as they have been shown to be more effective in earlier stages and grades of disease, more recently diagnosed OA, and in less severe radiographic OA.
CONCLUSION
For primary care physicians who treat and care for patients with OA of the knee, IA injection with HAs constitutes a safe and effective treatment that can be routinely administered in the office setting.
Topics: Aged; Ankle Joint; Female; Humans; Hyaluronic Acid; Injections, Intra-Articular; Male; Middle Aged; Osteoarthritis, Hip; Osteoarthritis, Knee; Pain Measurement; Patient Safety; Physicians, Primary Care; Primary Health Care; Randomized Controlled Trials as Topic; Risk Assessment; Severity of Illness Index; Shoulder Joint; Temporomandibular Joint; Treatment Outcome; Viscosupplementation
PubMed: 24203348
DOI: 10.1007/s12325-013-0068-6 -
Sensors (Basel, Switzerland) Dec 2021A knee exoskeleton with an adaptive instantaneous rotation center and impact absorption is used for rehabilitation. Due to the human knee joint's special physiological...
A knee exoskeleton with an adaptive instantaneous rotation center and impact absorption is used for rehabilitation. Due to the human knee joint's special physiological structure and motion characteristics, the exoskeleton mechanism needs to be designed for both static and dynamic aspects. Therefore, a novel knee exoskeleton mechanism was designed. To adapt to the rotation center of the knee joint, a mechanism with cross-configuration was designed according to the equivalent degree of freedom and the stiffness of the springs was calculated by its combination with gait motion, so that the average force of the human body was minimized. A dynamic model of the exoskeleton was established. To overcome the uncertainty in the parameters of the human and robotic limbs, an adaptive controller was designed and a Lyapunov stability analysis was conducted to verify the system. A simulation was conducted and experimental results show that the tracking error of the knee joint angle between the actual and desired trajectory was within the range of -1 to 1 degree and indicate the effectiveness of the controller.
Topics: Exoskeleton Device; Gait; Humans; Knee; Knee Joint; Lower Extremity
PubMed: 34960484
DOI: 10.3390/s21248390