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Objective Even if properly fitted, the posture and gait of amputee people are disturbed, leading to compensations and over-solicitations of the contralateral limb. The recent commercialization of new generation ankle-foot (NG) prosthesis is not covered by French social security insurance. The evaluation of the service delivered by these medical devices was until now a combination of multidisciplinary evaluations and patient assessments, but needs objective evaluation. Several teams reported a benefit of NG feet, mainly in terms of joint mobility, walking speed and reduction in compensations. But the main subjective improvement is in balance, both in static (more comfortable waiting position) as well as in dynamic (quality and fluidity of walking), which was poorly evaluated in amputees with NG feet. The main objective of this research is to evaluate the relevance of these NG feet in terms of static stability, on both flat and inclined surfaces. Material/patients and methods Six transtibial subjects were included. Three NG feet (Elan®, Propriofoot®, Meridium®) and the patient's usual foot were successively tested. For each foot type, after socket and alignment validation by an expert prosthetist, an acclimatization period of 15 days at home was observed. After this period, clinical, instrumental (static acquisitions of 20 s on two force platforms, eyes open and closed, on flat ground and on 12% inclined slope uphill and downhill) and functional evaluations (Berg Balance Scale and Activity Specific Balance Scale) were performed. Participants observed a wash out period of 3 weeks with the usual foot before testing each NG foot. The static parameters collected were: lower limb joint angles, Center of Pressure (COP) variation, ground reaction forces (GRF), and functional scores. Results In static position, a larger prosthetic ankle dorsiflexion, less compensations of the amputed lower limb, better symmetry of the GRF and increase of CoP parameters (as length of trajectory and range) were found with NG feet, compared to ESR. Discussion, conclusion The absence of postural control leads to asymmetrical posture, leading to osteoarticular complications. Ankle mobility of NG feet may allow a better balance and improve destabilizations adaptations, above all on slope, and may reduce sound limb compensations.

Introduction/Background Since ancient civilizations, health through sports is a fundamental military rule. Bonaparte first integrates by law sports education in military schools. After word war I and II, a collective awareness has emerged, often under the impulse of mutilated warriors. Then, military sport then became a strong tool of peace among nations, and the awareness of this lever led to the creation of the CISM (International Military Sports Council) in 1948. Material and method France has developed a strong link between each steps of military sports management. The aim of this presentation is to sum up the military PMR French departments organisation and missions. Its strong links with the military forces, including Navy and Air forces, has strengthened since the recent conflicts in Afghanistan, Middle East and terrorists attacks. Since the use of Improvised Explosive Devices, major limb injuries and traumatic amputations have emerged. The multidisciplinary approach of Percy Military hospital, is now highlighting a category of high-level expectations young wounded soldiers, whose aim is to go back to duty, and to get back to their former sporty way of life. Results Since 2001, a French multidisciplinary process is improving, including military PMR, psychiatry practitioners, social workers, and headquarters, leading to the creation of wounded aid cells, and reconstruction courses by adapted sports. The global reflection around the recovery of a sport with a residual disability is a fundamental mission of PMR military departments. Thanks to the implementation of financial means, (including possibility of purchasing electronical high technologies prostheses), there is now a high lightening of these wounded soldiers, through local and international events like Invictus games or Ad victoriam. Conclusion Thanks to the multidisciplinary approach of the wounded soldier, and the inclusion of adapted sport has a way of life, the glimpse at these soldiers is changing, in French armed forces but also in French population.

Objective Ultra-endurance events may induce biological changes as a consequence of intense muscle stress and hormonal fluctuations. Two ultra-endurance athletes, one on treadmill, the other on a home trainer pinion, have attempted to break world records for greatest distance covered over 6 days in Paris on January 4–10, 2015 (“six extreme days”). We analyzed the hematological, hormonal and biochemical changes. Materials and methods Hematological, biochemical, hormonologic, metabolic and specific to oxidative stress analysis were conducted on fresh and frozen blood samples collected a week before (D-7), 30 minutes (D6) and 2 days (D8) after the event for both sportsmen. Periods of waking/sleep, cardiovascular data (pulse, saturation) and developed efforts (distance, speed) were monitored throughout the event. Results Hemoglobin, hematocrit and iron parameters (serum iron, ferritin, transferrin saturation coefficient) were found lower on D6, after 2750 km cycling or 713 km running, than on D-7 (hemoglobin decreased from 15.2 g/dl before the event to 13.3 g/dl just after). They start to increase back on D-8. Leukocytes (6.5 to 9.4 G/l between D-7 and D-6), haptoglobin (tripled between D-7 and D-8, from 1 to 3 g/l), liver enzymes, Creatine Phosphokinase, troponin, Brain Natriuretic Peptide and uric acid rose during the event before going back down on D8 without however reaching back initial levels. Discussion The observed transient anemia is multifactorial, inflammatory, iron deficiency but without here any element for hemolysis. Hepatic cytolysis and heart stress are commonly encountered [1] . No study however focuses on oxidative stress enzymes (glutathione, lipid peroxidation products, activation of xanthine oxidase) after such a long effort, for which mobilization of leukocytes and increased uric acid (antioxidant) are indirect markers [2] . Data from this exploration should help enhancing our understanding of the impact of very prolonged effort on the oxidative stress chain, and paves the way for potential improvement in the training methods of athletes.

Objective The perineal pressure ulcer is, from the outset, a serious bedsore as it exposes the patient to the risk of fistula in addition to the regular complications associated with bedsores. Treatments reported in the literature couple recovery by musculocutaneous flap combined either with urethroplasty or urinary diversion [1] , without decision-making criteria. The objective of this study is to analyze the management of perineal pressure ulcers in SCI patients and suggest a suitable therapeutic strategy. Materials and methods Retrospective, observational study of a group of SCI patients picked up at the Garches hospital and in the urology department at the Pitie-Salpetriere, between 2002 and 2014. Results The study includes 20 patients, of which 15 show urethrocutaneous fistula. Following a musculocutaneous flap combined or not with an urethroplasty, but without joint urological care, no patient recovered. None of the two urethral reconstructions have helped to heal the bedsores or enabled the reuse of urethra for self-catheterization. After cystoprostatectomy and Bricker, only 2 out of 15 patients relapsed, given a follow-up period between 1 and 6 years. Discussion Like any pressure ulcer, the treatment of perineal pressure ulcer requires a careful evaluation of the circumstances of occurrence and risk factors (history of ischiectomy, proximal hip removal, prolonged indwelling catheter), and a neuroperineal (bladder balance and voiding mode), skin, nutrition, neuro-orthopedic, seat, and socio-psychological assessment. In the presence of urethrocutaneous fistula, a urinary diversion seems absolutely necessary: usually a non-continent bypass with cystoprostatectomy and Bricker which remains surgically heavy and may negatively affects self-image exceptionally, a continent diversion may be considered with closure of the bladder neck. The urethroplasty by experienced urologists associated with bedsores surgery could have been discussed but was not be performed for technical reasons (surgeries on 2 different hospitals). In the absence of fistula, but the presence of chronic perineal maceration with bad management of bladder, trans-ileal cutaneous ureterostomy with cystoprostatectomy ensures the complete drying of the perineum.

et les radiographies du pied de face et de profil en charge. Plusieurs etudes attestent de la fiabilite et de la reproductibilite des mesures de la plate-forme de marche. Cette fiabilite est accentuee par l’etalonnage de l’appareil avant toute etude et par trois passages successifs et sans hesitation du patient sur la trame barosensible. Le diagnostic de certaines pathologies affectant le pied et l’evaluation des traitements de celles-ci representent les deux principaux champs d’application des mesures dynamiques des pressions plantaires au cours de la marche. Pour en savoir plus Shaw JE et al. An analysis of dynamic forces transmitted through the foot in diabetic neuropathy. Diabetes Care 1998;21:1955–9.