A pilot investigation into the relationship between static diagnosis of ankle equinus and dynamic ankle and foot dorsiflexion during stance phase of gait: Time to revisit theory?

BackgroundAlthough the clinical assessment of ankle dorsiflexion has traditionally been measured utilising various goniometric means, the validity of this static examination has never been investigated. Since any impairment in ankle flexibility is likely to result in injuries, it is imperative that the correct examination technique is conducted.Hypothesis/PurposeTo determine whether a clinical diagnosis of ankle equinus, or limited ankle dorsiflexion, correlates with a decreased dorsiflexion range of movement of the foot and ankle during gait.MethodsTwenty participants with a clinical diagnosis of ankle equinus underwent optoelectronic motion capture utilising the Rizzoli foot model. Participants were divided into two groups, Group A with <−5° of dorsiflexion and Group B with −5° to 0° of ankle dorsiflexion.ResultsParticipants in Group B had a mean dynamic ankle dorsiflexion angle of 13.9°, while those in Group A had a mean dorsiflexion angle of 4.4°, resulting in a significant difference (p = 0.004) between the two groups. Likewise, foot mean dynamic dorsiflexion angle of Group B was 17.13° and Group A 8.6° (p = 0.006).ConclusionThere is no relationship between a static diagnosis of ankle dorsiflexion at 0° with dorsiflexion during gait. On the other hand, those subjects with less than −5° of dorsiflexion during static examination did exhibit reduced ankle range of motion during gait.     

Overtightening of the syndesmosis revisited and the effect of syndesmotic malreduction on ankle dorsiflexion

BackgroundAnkle syndesmotic injuries are a significant source of morbidity and require anatomic reduction to optimize outcomes. Although a previous study concluded that maximal dorsiflexion during syndesmotic fixation was not required, methodologic weaknesses existed and several studies have demonstrated improved ankle dorsiflexion after removal of syndesmotic screws.The purposes of the current investigation are: (1) To assess the effect of compressive syndesmotic screw fixation on ankle dorsiflexion utilizing a controlled load and instrumentation allowing for precise measurement of motion. (2) To assess the effect of anterior & posterior syndesmotic malreduction after compressive syndesmotic screw fixation on ankle dorsiflexion.Material and methodsFifteen lower limb cadaveric leg specimens were utilized for the study. Ankle dorsiflexion was measured utilizing a precise micro-sensor system after application of a consistent load in the (1) intact state, (2) after compression fixation with a syndesmotic screw and (3) after anterior & (4) posterior malreduction of the syndesmosis.ResultsFollowing screw compression of the nondisplaced syndesmosis, dorsiflexion ROM was 99.7 ± 0.87% (mean ± standard error) of baseline ankle ROM. Anterior and posterior malreduction of the syndesmosis resulted in dorsiflexion ROM that was 99.1 ± 1.75% and 98.6 ± 1.56% of baseline ankle ROM, respectively. One-way ANOVA was performed showing no statistical significance between groups (p-value = 0.88).Two-way ANOVA comparing the groups with respect to both the reduction condition (intact, anatomic reduction, anterior displacement, posterior displacement) and the displacement order (anterior first, posterior first) did not demonstrate a statistically significant effect (p-value = 0.99).ConclusionMaximal dorsiflexion of the ankle is not required prior to syndesmotic fixation as no loss of motion was seen with compressive fixation in our cadaver model. Anterior or posterior syndesmotic malreduction following syndesmotic screw fixation had no effect on ankle dorsiflexion. Poor patient outcomes after syndesmotic malreduction may be due to other factors and not loss of dorsiflexion motion.Level of Evidence: IV     

Doctor,when can I drive? — Range of functional ankle motion during driving

BackgroundDriving a motor vehicle needs a specific joint mobility and yet only limited knowledge exists regarding the necessary ankle range of motion. The goal of this study is to characterize the sequence and range of ankle motion.MethodsThe arc of plantarflexion/dorsiflexion and supination/pronation was recorded in the right and left ankle using electrogoniometers while thirty laps were driven by fifteen healthy participants around a course in a manual transmission car with a left sided steering wheel. The driver was required to perform the following maneuvers during each lap: (I) Vehicle acceleration and gear change, (II) Sudden evasion, (III) Routine turning, (IV) Rapid turning, (V) Vehicle acceleration followed by emergency braking.ResultsDriving required the right ankle to plantarflex 13 ± 9 and dorsiflex 22 ± 7 while supinating 15 ± 7 degrees and pronating minimally. The left ankle plantarflexed 19 ± 10and dorsiflexed 17 ± 10 while supinating 15 ± 7 degrees and pronating minimally. The right ankle dorsiflexed significantly more (p = 0.00), and yet the left ankle had a significantly higher maximum plantarflexion and range of plantarflexion/dorsiflexion (p = 0.00). Emergency braking resulted in a significantly higher maximum plantarflexion as well as plantarflexion/dorsiflexion range when compared to other maneuvers.ConclusionThis study describes the range of ankle motion identified to drive a car with a manual transmission and a left-sided steering wheel. The right and left ankle exhibit different arcs of motion during driving. This knowledge may assist when evaluating a patient’s driving capability. Further studies are needed to investigate whether movement restrictions impair driving.Level of evidenceBasic science study.     

Is there a learning curve in foot and ankle surgery?

BackgroundPrevious studies of orthopaedic learning curves have largely described the introduction of new techniques to experienced consultants. End points have usually involved technical considerations. A paucity of evidence surrounds foot and ankle surgery. This study investigates the learning curve during a foot and ankle surgeon's first year, defined by functional outcome.Methods150 patients underwent elective foot or ankle surgery during the whole period. Preoperative and 6 month postoperative functional scores were compared between the first and second 6 month groups.ResultsFunctional improvement was greater, approaching significance, in the second group (p = 0.0605). There was no difference for forefoot cases (p = 0.345). Functional improvement was significantly greater in the second group with forefoot cases removed (p = 0.0333).ConclusionsA learning curve exists in the first year of practice of foot and ankle surgery, demonstrated by functional outcome. This is confined to ankle, hindfoot and midfoot, but not forefoot surgery.     

Severity of pronation and classification of first metatarsophalangeal joint dorsiflexion increases the validity of the Hubscher Manoeuvre for the diagnosis of functional hallux limitus

BackgroundFunctional hallux limitus (FHL) is diagnosed with a static test known as the Hubscher Manoeuvre, the validity of which has been previously questioned.ObjectivesTo investigate the validity of this Manoeuvre and whether introducing severity of pronation as a second concurrent test would increase this validity.Method30 participants with a hallux dorsiflexion <12° were divided into 2 equal groups, depending on their severity of pronation according to the Foot Posture Index. A single video camera, placed perpendicular to the plane of motion of the 1st MPJ, captured its movement, from which the angle of maximum dorsiflexion of this joint was measured.Results10 males and 20 females, aged 18–56 years (mean 28 yrs, SD ±12.1 yrs) participated. There was no significant relationship between non-weight bearing and dynamic maximum dorsiflexion (p = 0.160), and between weight bearing and dynamic maximum dorsiflexion (p = 0.865). A significant relationship between 1st MPJ dynamic maximum dorsiflexion and severity of pronation (p = 0.004) was found.ConclusionsNone of the participants exhibited a complete lack of hallux dorsiflexion. A positive Hubscher Manoeuvre test, on its own, is not a good indicator of limited 1st MPJ dorsiflexion during dynamic motion. However, as pronation increases, 1st MPJ maximum dorsiflexion during gait decreases.     

Reliability of the intelligent stretching device for ankle stiffness measurements in healthy individuals

BackgroundA number of devices have been developed to measure joint stiffness. This study investigated the reliability of the Intelligent (Intel) stretch device to measure bilateral ankle joint stiffness during passive range of motion (ROM).MethodsThe reliability of the device was investigated based on torque and angle by establishing the consistency of measurements between examiners on different testing days. In addition, demographic variables were analyzed to investigate the degree of stiffness. Forty-six gender-matched subjects completed the test.ResultsThe reliability ICC_2,1 coefficient of ankle stiffness between-day for both examiners was 0.77 for the right ankle and 0.76 for the left ankle with a 0.05 standard error of measurement (SEM) for ankle stiffness for the right side and 0.04 for the left side. The ICC values of the two examiners were also high based on Chronbach's alpha (0.87 and 0.86). Among the demographic variables, gender (F = 35.25, p = 0.001) and body weight (F = 23.55, p = 0.001) were the most important factors in determining ankle joint stiffness.DiscussionThe results of this study indicated that dorsiflexion and plantarflexion measurements obtained by the Intel stretch device are reproducible and consistent. In addition, ankle stiffness was significantly different based on gender and body weight to develop and/or maintain ankle function. These results may help to identify ankle stiffness factors that will lead to more efficient rehabilitation programs and injury prevention strategies.     

Ultrasound prevalence of wrist,hand, ankle and foot synovitis and tenosynovitis in systemic sclerosis,and relationship with disease features and hand disability

IntroductionIn systemic sclerosis, few studies have shown that hand and wrist ultrasound is more sensitive than clinical examination in the detection of synovitis and tenosynovitis. Even fewer studies have investigated ankle and foot involvement with ultrasound. Our objectives were to investigate ultrasound prevalence of wrist, hand, ankle and foot synovitis and tenosynovitis in patients with systemic sclerosis classified with ACR/EULAR 2013 criteria, and to study their relationship with disease features and hand disability.MethodsConsecutive patients with systemic sclerosis, classified with ACR/EULAR 2013 criteria, were included in a monocentric cross-sectional study. They underwent standardized musculoskeletal clinical examination and hand, wrist, ankle and foot ultrasound. Clinical, biological and imaging data were also collected.ResultsFifty-five patients were included. Ultrasound was more sensitive than clinical examination to detect at least one synovitis (respectively 52% versus 25%, P = 0.025) and at least one tenosynovitis (respectively 16% versus 4%, P = 0.009); 18% of patients had ankle tenosynovitis and 29% had ankle and/or foot synovitis, mostly located at metatarsophalangeal joints (25.5%). Having at least one ultrasound hand synovitis was associated with higher Cochin hand functional disability scale (mean 25 ± 3 versus 12 ± 2, P = 0.003) and diffuse cutaneous subset (P = 0.038).ConclusionOur study shows that ultrasound is more sensitive than clinical examination to detect synovitis and tenosynovitis in systemic sclerosis. The foot involvement is less frequent than hand involvement, mainly localized at metatarsophalangeal joint. Finally, having at least one synovitis of the hand is associated with diffuse cutaneous subset and higher hand disability.     

There is a difference in functional ankle stability between different types of footwear in male athletes: A cross-sectional study

ContextLateral ankle sprains (LAS) are among the most common injuries in sports, with a poor long – term prognosis due to high chronicity and recurrence rates. Chronic ankle instability (CAI) results up to 40% of people that endured a first – time LAS.ObjectiveThe aim of this study was to compare ankle stability between groups characterised by the use of different types of footwear during their sport activities.DesignCross-sectional study.SettingFirm training surface, local sport clubs.ParticipantsFifty - one male subjects were recruited, distributed in four groups based on the type of footwear they use during their sport activities.Main outcome measuresAll subjects performed four clinical ankle stability tests, and completed the Dutch version of the Cumberland Ankle Instability Tool (CAIT) and Profile of Mood States (POMS). All clinical ankle stability tests were performed barefoot.ResultsSubjects performing their sport activities barefoot scored better than subjects performing their sport with shoes at the multiple hop test (p = .002 to .047) and executed the figure–of–8 hop test significantly faster than subjects with submalleolar ankle support (AS) (p = .019). Subjects with submalleolar AS and studs showed significantly better results than subjects with supramalleolar AS on the CAIT– score (p = .024, p = .030) and the side– hop test (p = .050, p = .045). They also scored significantly better than subjects with submalleolar AS for the side – hop test (p = .032), foot – lift test (p = .019) and figure–of 8 hop test (p = .011).ConclusionBarefoot sports performing subjects appear to have better ankle stability compared to subjects performing their sports with shoe support. Subjects performing sports with high AS appear to have worst ankle stability.Level of evidence: Level III, Cross–sectional study.     

Progressive rehabilitation of the sprained ankle: A novel treatment method

ObjectivesThis randomised, single blinded cohort study was designed to assess the immediate effect of manual fascial manipulation on walking pain and the range of ankle dorsiflexion within the first 4 days after ankle trauma.MethodsMeasurements were taken from 19 subjects, 5 female and 14 male, who presented with grade I–III ankle sprains. Ankle dorsiflexion was photographed in a standardised position and calculated by means of the Dartfish® Advanced Video Analysis Software and SPSS® (version 17) was used to compare the pre- and post-treatment data.ResultsAfter one treatment session 13 of the 19 subjects were walking pain free and 3 of the 19 where walking with only little pain. The highly significant (p < 0.001) mean improvement of ankle dorsiflexion was 7.9° (±5.8°). All, apart from one subject, whom were walking pain free after treatment showed a minimum of 4° increased dorsiflexion.ConclusionEarly fascia work around the injured ankle improves ankle dorsiflexion and reduces walking pain. It may reduce the delay of tissue healing and, thus, optimise further rehabilitation of the sprained ankle which may also reduce socio-economic costs.     

Individual didactic sessions or group lectures for teaching the foot and ankle to orthopaedic residents

BackgroundThe relative efficacy of individual didactic sessions or group lectures in teaching the foot and ankle to orthopaedic residents is unknown.MethodTen fourth year (R4) orthopaedic residents received individual didactic teaching sessions during a 1-month foot and ankle rotation, and 12 fifth year (R5) orthopaedic residents who had no foot and ankle rotation received a series of group lectures. Foot and ankle knowledge level was evaluated before and after the teaching programs with multiple choice tests.ResultsThe average test score for all residents was significantly improved from before to after the teaching programs (all residents: pre-test, 51 ± 11%; post-test, 66 ± 8%; P < 0.0001). There was no difference between the R4 and R5 resident groups in average pre-test score or post-test score. The improvement in test scores from the pre-test to the post-test was similar for the R4 and R5 resident groups.ConclusionsIndividual didactic sessions and group lectures were equally effective in encouraging learning and improving knowledge level of the foot and ankle. The key factors in significantly improving knowledge of the foot and ankle were the presence of a formal teaching program to stimulate learning and the availability of an active Foot and Ankle Service with dedicated attending foot and ankle subspecialist surgeons.     

Biomechanical comparison of stability of tibiotalocalcaneal arthrodesis with two different intramedullary retrograde nails

BackgroundThe aim of the study was to compare the initial construct stability of two retrograde intramedullary nail systems for tibiotalocalcaneal arthrodesis (TTCF) (A3, Small Bone Innovations; HAN, Synthes) in a biomechanical cadaver study.MethodsNine pairs of human cadaver bones were instrumented with two different retrograde nail systems. One tibia from each pair was randomized to either rod. The bone mineral density was determined via tomography to ensure the characteristics in each pair of tibiae were similar. All tests were performed in load-control. Displacements and forces were acquired by the sensors of the machine at a rate of 64 Hz. Specimens were tested in a stepwise progression starting with six times ±125N with a frequency of 1 Hz for 250 cycles each step was performed (1500 cycles). The maximum load was then increased to ±250N for another 14 steps or until specimen failure occurred (up to 3500 cycles).ResultsAverage bone mineral density was 67.4 mgHA/ccm and did not differ significantly between groups (t-test, p = .28). Under cyclic loading, the range of motion (dorsiflexion/plantarflexion) at 250N was significantly lower for the HAN-group with 7.2 ± 2.3 mm compared to the A3-group with 11.8 ± 2.9 mm (t-test, p < 0.01). Failure was registered for the HAN after 4571 ± 1134 cycles and after 2344 ± 1195 cycles for the A3 (t-test, p = .031). Bone mineral density significantly correlated with the number of cycles to failure in both groups (Spearman-Rho, r > .69, p < 0.01).ConclusionsThe high specimen age and low bone density simulates an osteoporotic bone situation. The HAN with only lateral distal bend but two calcaneal locking screws showed higher stability (higher number of cycles to failure and lower motion such as dorsiflexion/plantarflexion during cyclic loading) than the A3 with additional distal dorsal bend but only one calcaneal locking screw. Both constructs showed sufficient stability compared with earlier data from a similar test model.Clinical relevanceThe data suggest that both implants allow for sufficient primary stability for TTCF in osteoporotic and consequently also in non-osteoporotic bone.Level of evidenceNot applicable, experimental basic science study.     

Reliability study of the Phillips Biometer™ for the measurement of subtalar joint range of motion

BackgroundReproducible accurate clinical measurements of the subtalar joint are one of the essential components of a biomechanical exam in order to effectively aid in the diagnosis and treatment of foot pathology.ObjectivesThe objective of this study was to evaluate the intra and interrater reliability of the Phillips Biometer™ measuring subtalar joint range of motion.MethodTwelve volunteer subjects (six females, and six males, ages 20–40 years) participated. Two novice testers measured subtalar joint range of motion on the right foot of each subject during two testing sessions. Intrarater and interrater reliability coefficients (ICC) were determined using intraclass correlation coefficients. ICC values ranged from 0 to 1, where 0.0 indicated that there is no agreement and 1.0 indicated perfect agreement. The patterns of interrater reliability were also investigated using a paired t-test and the Bland-Altman technique of assessing agreement. The patterns of intrarater reliability were also investigated using a repeated-measures ANOVA and analysis of coefficient of variation.ResultsInterpreter reliability for all trials averaged 0.99 for inversion and 0.94 for eversion of the subtalar joint. The paired t-test revealed no statistically significant difference between the testers when measuring inversion (t = −1.10, p = 0.30) or eversion (t = 1.62, p = 0.13). The Bland-Altman analysis showed a small bias (−0.53°) for tester-1 relative to tester-2 for eversion. The 95% confidence interval for the measurement was between +1.61° and −2.67°. There was no systematic trend in bias as a function of the size of the measured angle.Intrarater reliability averaged 0.99 for inversion and 0.93 for eversion, indicating a high degree of agreement between trials. The only statistically significant difference on replicate measurements, based on ANOVA, was found on tester-1's measurement of inversion. The coefficient of variation was approximately 5% for inversion and approximately 10% for eversion with no systematic trend as a function of the size of the measured angle.ConclusionThe results indicated a high degree of reliability of the measurements between testers. The study demonstrated that interrater and intrarater reliability were high for both subtalar joint inversion and eversion. This study showed that the Phillips Biometer™ had a high degree of reliability and was a more accurate way to obtain subtalar joint measurements in the biomechanical exam versus the goniometer, the K-square, the gravity angle finder, the digital goniometer, the Polhemus Isotrak II™ tracking system, and a computer-assisted video analysis system.     

Flat foot and femoral anteversion in children—A prospective study

BackgroundFlat foot in children during the first years of life evokes significant parental concern. Flat foot, intoeing and femoral anteversion may well be differential dimensions of developmental pathodynamics with potential for inter-related developmental correction. While correlation of femoral anteversion with intoeing is documented, its relationship with flat foot remains unclear.ObjectiveThe aim of this prospective study is to investigate the relationship between flat foot and internal rotation of hip, indirectly femoral anteversion.Methods651 Children, 339 boys and 312 girls, aged 3–6 years, were examined and Contact Index II for flat foot as well as internal rotation of hip measured. 82 children with other foot and leg deformities were excluded from further analysis.ResultsOut of 569 children, 95 (16.7%) had flat feet – 56 bilateral, 39 unilateral – with Contact Index II of 0.88 or above. All children with flat feet (and none of the normal 474) had raised internal rotation of hip (mean 69.9°, range 62–80°).ConclusionRegression analysis established an unequivocal and highly significant statistical relationship between flat foot and increased internal rotation of hip (F = 168.1, p < 0.001, r = 0.53) in children between 3 and 6 years.     

The stop screw technique—A simple and reliable method in treating flexible flatfoot in children

PurposeThe purpose of this study was to evaluate the stop screw method inserted with a minimal invasive technique in the treatment of flexible flatfoot in children.Materials and methodsWe evaluated the results in a series of 21 flat feet in the age group ranging from 8 to 14 years between 1999 and 2007. The correction was evaluated clinically by assessment of heel valgus angle, range of motion of the ankle joint, and the photopodographic grading. The radiological assessment was performed by measuring the talonavicular angulation (Meary's line).ResultsAt time of follow-up there was significant improvement in the heel valgus angle during rest and during tiptoe standing, significant improvement in the dorsiflexion from neutral position, and in podographic grading. Radiologically talonavicular angulation improved significantly from 162 ± 8.9° preoperatively to 174 ± 5.8° postoperatively.ConclusionWe can conclude that subtalar arthroereisis is relatively simple, effective, and minimally invasive procedure in treating flexible flatfoot in pediatric age.     

Study on the foot shape characteristics of the elderly in China

BackgroundWith aging, the feet of the elderly above 60 years old in China present degenerative changes, deformities, and diseases, which significantly affect their daily activities.ObjectivesThe authors aimed to study the morphological characteristics of the feet and identify the foot type according to size (length and width) and defect characteristics of elderly feet in China.MethodsA convenient sample of 1000 subjects above 60 years old was recruited mainly in the regions of Shanghai, Shaanxi, Henan, Hebei, and Sichuan in China. Foot images were collected, and 800 (male 398, female 402) valid questionnaires were recovered. A total of 800 elderly subjects as the test group were invited to measure their foot sizes by means of a Footprint Collector (Tong Yuan Tang Health Management Limited, Qingdao in Shandong province). The foot type of the elderly was compared with that of the general adult Chinese population as the control group using the t-test for independent samples.ResultsHallux valgus (46.9%) and flat foot (50.0%) were the most common foot shape deformities. The most frequent foot diseases were foot scaling (91.2%) and calluses (96.3%). The medial width of the first metatarsal-toe joint of the elderly was significantly higher (elderly female, 44.95 ± 4.86 mm; elderly male, 48.55 ± 4.94 mm) than that of the general adult population (adult female, 40.18 ± 3.43 mm; adult male, 43.22 ± 3.20 mm) (p < 0.01).ConclusionThe foot length of the elderly was not significantly different from that of the general adult Chinese population. The width of the first metatarsal-toe joint in the forefoot of the elderly was significantly higher than that of the general adult Chinese population, which was consistent with the result that a high proportion of elderly subjects presented hallux valgus.     

A semi-quantitative technique to assess excursion of the flexor hallucis longus

BackgroundRecent research indicates that restriction in excursion of flexor hallucis longus (FHL) contributes to hallux rigidus development. As described in the literature, clinical evaluation of FHL excursion has poor interobserver reliability. A simple, inexpensive, easily used FHL relative excursion measurement device was developed and tested.Methods64 subjects were enrolled with shoe size, height, weight, BMI, and age compared. Using a footplate and series of mechanical wedges, maximum ankle dorsiflexion was measured with the great toe in 15°, 30°, and 45° of dorsiflexion.ResultsAnkle dorsiflexion decrease with progressive hallux dorsiflexion increase was statistically significant with a linear correlation (r² = .814 p < .001) and was not statistically related to shoe size, height, weight, BMI, or age.ConclusionsThis technique provides consistent assessment of the limitation to ankle dorsiflexion incurred by decreased FHL excursion, establishing groundwork for future studies to assess the relationship between diminished FHL excursion and FHL pathology.     

The effects of carrying extra weight on ankle stability in adolescent basketball players

PurposeThe purpose of this study was to investigate the effects of weight on ankle stability in adolescent basketball players.Methods20 non-injured subjects (age = 11.05 ± 1.5 years) were included in this study. Each subject performed a 15 min warm-up by running or riding a stationary bike. The Star Excursion Balance Test (SEBT), single-leg balance test (performed with eyes open and eyes closed) and vertical jump test were performed with dominant lower extremity. 1 week later, same tests were performed with a schoolbag. The schoolbag contained weight bars as 20% of the players own body weight.ResultsOnly posteromedial component of SEBT had significant difference between non-weight measurement and weighted measurement (p = 0.004). Single-leg stance test performed with eyes open (p = 0.006) and closed (p = 0.001) had significant difference between non-weight measurement and weighted measurement. Also the vertical jump test had significant difference between non-weight measurement and weighted measurement (p = 0.001).ConclusionsThese findings indicate that 20% weight of their own body weight does not affect dynamic ankle stability and postural limitations, which are magnified by advancing weight. We are confident in our conclusions because of the three-way interaction noted with posterior/medial with weight in SEBT. Furthermore, Star Excursion Balance test is more effective both weight and non-weight in measuring functional stability of the ankle.     

Computer-assisted surgery (CAS) based correction of posttraumatic ankle and hindfoot deformities—Preliminary results

The first clinical experiences with a computer assisted surgery based (CAS) guided correction arthrodeses at ankle, hindfoot and midfoot were evaluated.MethodsTime spent, accuracy, surgeons’ rating (Visual Analogue Scale [VAS], 0–10 points) were analyzed. The accuracy was assessed by ISO-C 3D (Siremobile™, Siemens, Germany).Results10 patients were included (ankle, n = 3; subtalar joint, n = 6; ankle and subtalar joint, n = 2; Lisfranc joint, n = 1). Time needed for preparation was 500 s (400–900). The correction process took 45 s (30–60). All angles/translations were achieved as planned before surgery (≤ ±1°/±1 mm). The ratings of the three involved surgeons were: feasibility, 9.5 (9–10); accuracy 9.8 (9.5–10); clinical benefit 9 (8–10).ConclusionsCAS guided correction of posttraumatic deformities of the ankle and hindfoot region provides very high accuracy and a fast correction process. The significance of the introduced method may be high in those cases, because the improved accuracy may lead to an improved clinical outcome.     

Anti-pronation tape changes foot posture but not plantar ground contact during gait

ObjectivesTo investigate changes in medial longitudinal arch (MLA) posture and dynamic plantar contact area following the application of augmented low-Dye (ALD) tape during walking and running.MethodsEighteen asymptomatic subjects (mean age 27 ± 7.8 years) with a navicular drop greater than 10 mm were studied. MLA height standardised to foot length was measured before and after the application of tape. Subjects then walked and jogged taped and non-taped over an EMED-SF floor mounted force platform. The plantar surface of the foot was divided into six regions with the toes excluded. Contact area (CA) and Lateral-Medial Area Indices (LMAI) were calculated for each region.ResultsCompared to the no-tape control condition, the MLA increased significantly after the application of tape (p = 0.000). Contact area was reduced in the medial and lateral rearfoot during jogging (p = 0.001 and 0.005, respectively) and the medial rearfoot during walking (p = 0.004) following tape. There was no significant mean difference between the taped and control conditions for mean Lateral-Medial Area Indices.ConclusionWhilst the ALD tape changed foot posture by providing an anti-pronation effect, minimal changes were noted in CA or LMAI after tape application. These findings indicate that anti-pronation tape procedures, like the ALD, do not significantly alter plantar contact area.