The impact of a total knee arthroplasty on jaw movements,upper body posture,plantar pressure distribution,and postural control

ABSTRACT

Objective: The purpose of this study was to examine the influence of a total knee arthroplasty (TKA) on linked cranial and caudal structures.

Methods: Thirty-five (14f/21m) subjects participated in this study: 15 subjects (9f, 6m) pre- and post- TKA and a control group of 20 subjects (5f, 15m). The measurements included: jaw condyle position and movement, back scan, plantar pressure distribution, and body sway.

Results: There were no significant differences in electronic position analysis of the jaw; however, the protrusion of the TKA group improved (p = 0.001). The test group had a more anteriorly inclined thoracic spine and a less pronounced lumbar lordosis. Before and after surgery, the body sway in the test group was larger.

Conclusion: The TKA affected most prominently the static mechanisms of the postural control and the spine position. The trajectories of the mandible during protrusion also changed slightly.     

Pressure distribution and perceived comfort in casual footwear

The aim of this investigation was to establish the relationship between short-term perceived comfort and pressure distribution on the dorsal and plantar surfaces of the foot, while walking in a range of commercially available casual footwear. The study was carried out in the biomechanics laboratory of Manchester Metropolitan University using 15 male subjects without foot pathology. Perceived upper and plantar comfort were measured using a specially designed questionnaire, while dorsal and plantar pressure distributions were measured using a rectangular sensor pad recording at 30 Hz and a Mikro-EMED insole recording at 100 Hz respectively. Analysis of variance tests were used to determine differences in perceived comfort and pressure distribution between three pairs of shoes. The findings of this study suggest that an increase in total plantar force and force-time integral may relate to a decrease in perceived plantar comfort. For the three shoes examined in this study, overall peak plantar pressure, the pressure-time integral, and total plantar area did not appear to be linked to perceived plantar comfort. Findings for the shoe upper indicate that decreased dorsal forces and pressures may be related to decreased upper comfort. These findings suggest that the measurement of pressure distribution at the foot-shoe interface could be a useful tool in identifying the causes of discomfort in footwear.     

带血管蒂舟骨瓣移位术的应用解剖

目的:为治疗距骨骨折提供新术式的解剖学基础.方法:在30侧灌注红色乳胶的成人下肢标本上,对舟骨背侧面形态、血供来源进行观测.结果:舟骨背侧面动脉主要来自内踝前动脉、跗内侧动脉以及足底内侧动脉浅支,分别发3～5支、1～3支和1～2支外径在0.2～1.0mm之间的骨膜支,形成骨膜动脉网.结论:以内踝前血管为蒂,可切取舟骨背侧2.0cm×1.0cm×0.5cm大小的骨瓣,用于距骨颈骨折修复.术式经临床应用证实,手术简便,效果可靠.     

Randomized, placebo-controlled, double-blind clinical trial evaluating the treatment of plantar fasciitis with an extracoporeal shockwave therapy (ESWT) device: a North American confirmatory study.

Despite numerous publications and clinical trials, the results of treatment of recalcitrant chronic plantar fasciitis with extracorporeal shockwave therapy (ESWT) still remain equivocal as to whether or not this treatment provides relief from the pain associated with this condition. The objective of this study was to determine whether extracorporeal shock wave therapy can safely and effectively relieve the pain associated with chronic plantar fasciitis compared to placebo treatment, as demonstrated by pain with walking in the morning. This was set in a multicenter, randomized, placebo-controlled, double-blind, confirmatory clinical study undertaken in four outpatient orthopedic clinics. The patients, 114 adult subjects with chronic plantar fasciitis, recalcitrant to conservative therapies for at least 6 months, were randomized to two groups. Treatment consisted of approximately 3,800 total shock waves (+/-10) reaching an approximated total energy delivery of 1,300 mJ/mm(2) (ED+) in a single session versus placebo treatment. This study demonstrated a statistically significant difference between treatment groups in the change from baseline to 3 months in the primary efficacy outcome of pain during the first few minutes of walking measured by a visual analog scale. There was also a statistically significant difference between treatments in the number of participants whose changes in Visual Analog Scale scores met the study definition of success at both 6 weeks and 3 months posttreatment; and between treatment groups in the change from baseline to 3 months posttreatment in the Roles and Maudsley Score. The results of this study confirm that ESWT administered with the Dornier Epos Ultra is a safe and effective treatment for recalcitrant plantar fasciitis.     

Ultrasonographic Evaluation in Plantar Fasciitis

The heels of 23 patients who were diagnosed with unilateral/bilateral plantar fasciitis were evaluated via ultrasonography and compared with their asymptomatic feet and a control group of 23 people. Plantar fascial thickness, echogenity, and heel pad thickness were evaluated, and the results were statistically analyzed. For symptomatic feet, increased thickness of the fascia and reduced echogenity were constant ultrasonographic findings (mean, 4.79 mm for symptomatic feet; 2.17 mm for control group, P < .05). No significant difference was found between heel pads of the diseased and healthy feet (mean, 12.96 mm for symptomatic feet; 13.10 mm for control group; P > .05). Ultrasonography seems to be a valuable, noninvasive diagnostic tool for the evaluation of plantar fasciitis.     

Anatomical study of the communicating branches between the medial and lateral plantar nerves

The plantar areas of the foot have specific biomechanical characteristics and play a distinct role in balance and standing. For the forefoot surgeon, knowledge of the variations in the anatomy of communicating branches is important for plantar reconstruction, local injection therapy and an excision of interdigital neuroma. The anatomy of the communicating branches of the plantar nerves between the fourth and third common plantar digital nerves in the foot were studied in 50 adult men cadaveric feet. A communicating branch was present between the third and fourth intermetatarsal spaces nerves in all eight left feet and in six right feet (overall, 28%), and absent in 36 (72%). A communicating branch was found in 14 ft. Ten of the 14 communications were from the lateral to the medial plantar nerve. The length of the communicating branch ranged from 8 to 56 mm (average 16.4 mm) and its diameter was 0.2–0.6 times of the fourth common plantar digital nerve. The angle of the communicating branch with the common plantar digital nerve from which it originated was less than 30° in 11 ft, 30–59° in 27 ft, 60–80° in 8 ft, and more than 80° in 4 ft. Classification of the branch is based on the branching pattern of the communicating branch and explains variations in plantar sensory innervations. We think that the perpendicular coursing communicating branch is at higher risk to be severed during surgery.     

足内侧皮瓣的应用解剖

解剖观测了30侧成人下肢足内侧区皮肤血管.足底内侧动脉深支、浅支、内踝前动脉和跗内侧动脉,分别发4.5(3～8)支、7.4(3～12)支、5.9(2～12)支和2.8(1～6)支,外径在0.2～0.8mm之间的皮支分布足内侧区,动脉间吻合恒定.经选择性动脉注射显示,皮瓣面积约为9×6cm～10×8cm.以上述动脉为蒂的足内侧皮瓣,可转位修复内踝、跟腱、足跟和足底远侧区的软组织缺损,临床应用了12例均获得成功.     

Medial plantar nerve conduction velocities among patients with vibration syndrome due to chain-saw work

Objective: The present study examined the effect of the vibration syndrome (VS) on the peripheral nervous system in the lower extremities. Methods: Thirty-eight patients with VS due to previous exposure to vibration from chain-saw work and 55 age-matched controls were examined for sensory nerve conduction velocities in the medial plantar nerve (SCV-P). The patient group was divided into two subgroups, one with (n=19) and the other without vibration-induced white finger (VWF; n=19). Results: Analysis of variance of SCV-P for the three groups showed significant difference (F _2,89=10.65, P < 0.0001). A significant difference was found between the controls and the VWF⁺ group (P < 0.0001) but not between the controls and the VWF⁻ group (P=0.0508) by multiple comparison using Scheffe's method. Conclusion: These findings suggest that VS affects the peripheral nervous system function in the lower extremities via mediation of circulatory disturbance manifested as VWF. Received: 7 May 1998 / Accepted: 15 June 1999     

Are single fractions of radiotherapy suitable for plantar fasciitis?

The use of radiotherapy for plantar fasciitis has never been reported in Australasia and is scarcely found in the English language medical literature, but it is commonly used in Europe, especially in Germany. In Europe, treatment courses consisting of multiple small fractions have been associated with high levels of pain relief. In the present report, the use of single fractions or radiotherapy was evaluated by reviewing seven consecutive patients referred for treatment and by applying objective and subjective criteria for pain relief. One patient died of unrelated causes soon after treatment and one declined to receive radiotherapy. Four patients each received a single dose of 8 Gy resulting in complete pain relief. One patient was treated with 8 Gy and 12 weeks later was retreated achieving partial pain relief. A follow‐up interview was conducted after a mean of 15.6 months, ranging from 1.5 to 30 months. No acute or late effects occurred; however, the possibility that delayed effects may yet occur, particularly carcinogenesis, cannot be excluded. Radiotherapy for this common condition should be investigated further as it might be safer and more effective than other methods currently in use.