Improvement in Knee Loading After Use of Specialized Footwear for Knee Osteoarthritis: Results of a Six‐Month Pilot Investigation

Objective

Biomechanical interventions for knee osteoarthritis (OA) aim to improve pain and retard disease progression by decreasing knee loading. This study was undertaken to evaluate the effects of 6 months of use of flat, flexible footwear (the mobility shoe) on knee loading in OA.

Methods

Subjects with knee OA underwent baseline gait analyses under conditions of walking in their own shoes, walking in mobility shoes, and walking barefoot. Thereafter, subjects wore the mobility shoes at least 6 hours per day for 6 days per week. Gait evaluations were repeated at 6, 12, and 24 weeks. An intent‐to‐treat analysis was performed to assess the longitudinal effects on knee loading with the shoe intervention.

Results

Compared to knee loading at baseline with the participants' own shoes, there was an 18% reduction in the knee adduction moment (KAM) by 24 weeks with the mobility shoes (P < 0.001) and no significant differences in the KAM by 24 weeks between mobility shoe and barefoot walking (P = 0.192). Over the 6 months of followup, participants also experienced an 11% reduction in the KAM when walking in their own shoes (P = 0.002) and a 10% reduction in the KAM when walking barefoot (P = 0.002 for the whole followup), as compared to these values at baseline under the same conditions.

Conclusion

This study suggests that use of flat, flexible footwear results in significant reductions in knee loading in subjects with OA. By 24 weeks, there is evidence of a gait adaptation with sustained load reduction even when the mobility shoes are removed, suggesting that footwear may serve as a biomechanical training device to achieve beneficial alterations in gait mechanics for knee OA.

     

Influence of microtubules on vascular smooth muscle contraction

Microtubules are ubiquitous in eukaryotic cells and play key roles in many cellular activities. The purpose of this study was to investigate the influence of microtubules on vascular smooth muscle contraction. Quantitative immunocytochemical analysis of rat aortic tissue revealed that, relative to the control group, colchicine (15 M, 90 min) and nocodazole (15 M, 90 min) decreased the microtubule density by 40–50% while taxol (10 M, 90 min) increased the microtubule density by 33%. Isometric contraction studies demonstrated that both colchicine and nocodazole caused an upward shift in the phenylephrine (10^–8 to 10^–5 M) dose–response curve while taxol caused no significant change when compared to the control group. Potassium chloride (30 mM) induced 55 ± 5% P ₀ contraction in DMSO treated vessel rings. The active tension increased to 73 ± 5% P ₀ and 71 ± 6% P ₀ after pretreatment of the aortic rings with colchicine or nocodazole, respectively. Taxol did not cause a significant change in the active tension (56 ± 7% P ₀). These results indicate that microtubule depolymerization enhances isometric contraction of vascular smooth muscle and this enhanced contraction is not receptor dependent. Pretreatment of the aortic rings with an inhibitor of nitric oxide synthase (NOS) (N -nitro-L-arginine) did not change the increased contractile response to phenylephrine due to microtubule depolymerization suggesting that this phenomenon is not mediated by endothelium dependent relaxation.     

Long term outcome following mild traumatic brain injury in Moroccan patients

Primary objectives

To describe the symptoms of chronic post-concussion syndrome (PCS) and to investigate the relationship between the persistence of these symptoms and different aspects of social life (return to work, quality of life, sport and leisure activities and family relationships) in Moroccan patients with mild traumatic brain injury (MTBI), one year after the trauma.

Methods

Forty-two adult patients who sustained MTBI were reviewed one year after trauma. We investigated the persistence of PCS by using the “Problem Checklist” questionnaire. We also assessed their quality of life using a visual analogue scale, and noted the changes in employment status, social activities and family relationships. Then, we examined whether there were significant relationships between these different data.

Results

More than half of the patients (n = 23, 54.8%) were found with persistent post-concussion symptoms at one year post-injury. Chronic PCS was significantly more common in married persons (p = 0.008) and significantly related to both non return to work (p ≤ 0.01), and QoL deterioration (p ≤ 0.001).

Conclusion

In this study, a large proportion of persons who sustained a MTBI experienced persistent symptoms up to one year after trauma. MTBI might have significant and lasting impact on the quality of life, which is to be verified by further studies.     

Tabetic arthropathy. A report of 43 cases

Destructive tabetic arthropathy (TA) has become rare in the course of syphilis because of early diagnosis and treatment. TA is difficult to manage because of the severity of the handicap and the absence of a specific treatment. We describe the clinical, biological, and radiological characteristics of TA. In this paper, we performed a retrospective study of 24 patients with TA from 1983 to 2003. Inclusion criteria were typical radiological findings and positive syphilitic serology in blood and/or synovial fluid and/or cerebrospinal fluid. Included in the study were 15 men and 9 women, their mean age was 53.71±12.25 years, and the delay of diagnosis was 36.83±53.03 months. Thirteen patients (54.2%) had a known primary syphilitis. In the studied cases, 43 of the patients’ joints were involved, which concerned knees, hips, the spine, and ankles in 91.66, 8.33, 8.33, and 4.16% of cases, respectively. TA was bilateral in 62.5% and multifocal in 8.3%. The neurological exam found signs suggesting tabes dorsalis in seven cases. The osteoarticular exam showed an abnormal range of mobility (n=25), hydarthrosis, and articular deformation (n=17). Syphilitic serology tests were positive in synovial fluid, cerebrospinal fluid, and blood in 12 (50%), 8 (33.33%), and 24 (100%) cases, respectively. Radiological exam showed atrophic and hypertrophic forms. The frequency and severity of TA in our study may be explained by the frequency of atypical forms of syphilitis and the absence of penicillin in Morocco in the 1950s.     

Walking barefoot decreases loading on the lower extremity joints in knee osteoarthritis

OBJECTIVE: To evaluate the effects that modern shoes have on gait and lower extremity joint loads in osteoarthritis (OA). METHODS: Gait analyses were performed on 75 subjects with knee OA while they were wearing their everyday walking shoes and while they were walking barefoot. The trials involved optoelectronic detection of external markers during ambulation over a multicomponent force plate, and were matched for speed. Comparisons were made of gait parameters and joint loading during trials in which the subjects walked while wearing shoes and while barefoot. RESULTS: Peak joint loads at the hips and knees significantly decreased during barefoot walking, with an 11.9% reduction noted in the knee adduction moment. Stride, cadence, and range of motion at the lower extremity joints also changed significantly, but these changes could not explain the reduction in the peak joint loads. CONCLUSION: Shoes may detrimentally increase loads on the lower extremity joints. Once factors responsible for the differences in loads between with-shoe and barefoot walking are better delineated, modern shoes and walking practices may need to be reevaluated with regard to their effects on the prevalence and progression of OA in our society.