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Context: The Y-Balance Test Lower Quarter (YBT-LQ) is a widely utilized tool for evaluating dynamic postural control, requiring a combination of mobility and strength. This study aimed to investigate the combined relationship between isometric thigh muscle strength and joint kinematics on YBT-LQ performance. Design: Cross-sectional laboratory study. Methods: Isometric quadriceps and hamstrings strength were measured before the YBT-LQ in 39 healthy participants (27 females and 12 males). The test was performed under 3-dimensional markerless motion capture, where joint kinematics were extracted from the maximum reach position from each direction. Three multivariable linear regression models were then used to determine the strongest combination of predictors for YBT-LQ performance. Results: Greater hamstrings strength and increased knee flexion, ankle dorsiflexion, and trunk ipsilateral-flexion joint angles explained 56.8% (P <.001) of the variance in anterior reach. Hip flexion, knee flexion, and ankle dorsiflexion angles were the strongest predictors for posteromedial reach distance, explaining 73.0% of the variance (P <.001). Last, 43.3% (P <.001) of the variance in posterolateral reach distance was predicted by hamstring strength and knee-flexion angle. Conclusions: These results emphasize the importance of hamstring strength in YBT-LQ performance across different reach directions. Additionally, the kinematics illustrate a potential movement strategy for maximizing reach distance on the YBT-LQ in healthy individuals. Clinicians can utilize this information to guide interventions aimed at improving dynamic postural control, particularly by focusing on increasing hamstring strength and testing for impairments in specific movement patterns. [ABSTRACT FROM AUTHOR]

Background: Local high-frequency percussive (HFP) massage has recently found widespread application in physical therapy. Although HFP massage reportedly improves range of motion (ROM), the mechanism underlying its action has not yet been proven. This study aimed to clarify whether a 5-minute percussive massage regimen affects muscular or connective tissues, such as the deep fascia and deep intermuscular fascia and the change in joint ROM. Method: The study sample was calculated using G*Power analysis program, and this study enrolled 15 healthy men who underwent 5-minute HFP massage to the medial gastrocnemius muscle. Shear-wave elastography was used to measure tissue stiffness in the deep fascia, muscle, and deep intermuscular fascia through shear-wave velocity as well as the ROM of the volunteers' ankle joint dorsiflexion before and after the HFP massage. A value of P < .05 was used to declare statistical significance, and post hoc was used to calculate the effect size using G*Power. Results: Shear-wave velocity revealed a significant change in the deep fascia (P = .003; shear-wave velocity: -0.7 m/s) and significant increase in ROM of ankle dorsiflexion (P = .002; increase in ROM: 3.0°) after 5 minutes of HFP massage. However, the muscle and deep intermuscular fascia did not exhibit any significant changes. Conclusions: HFP massage for 5 minutes modified the stiffness of the deep fascia and concurrently improved the ankle joint-dorsiflexion ROM. This method can be used as an intervention to decrease stiffness of the deep fascia and increase the ROM efficiently. [ABSTRACT FROM AUTHOR]

Postpartum mothers are susceptible to lumbopelvic pain which may be exacerbated by loading, like carrying their infant in arms and with baby carriers. Nulliparous women carrying infant mannequins may biomechanically mimic mother–infant dyad, but this has not been studied. The purpose of our study was to investigate biomechanical differences of 10 mothers carrying their infants and 10 nulliparous women carrying infant mannequins under 3 gait conditions: carrying nothing, carrying in arms, and carrying in a baby carrier (babywearing). Spatiotemporal gait parameters, peak ground reaction forces and impulses, and lower extremity and trunk kinematics were collected using motion capture and force plates and compared using a mixed 2 × 3 (parity × condition) analysis of variance (α ≤.05). The largest differences occurred between carrying conditions: carrying in arms or babywearing increased vertical and anteroposterior ground reaction forces, trunk extension, ankle dorsiflexion, and hip and knee flexion. Kinematic differences were identified between arms and babywearing conditions. Together this suggests alterations in joint loading for both groups. Our study also contributes a novel understanding of postpartum health by demonstrating alterations in step time, anterior forces, and ankle and knee mechanics, suggesting that during gait, mothers carrying their own infants choose different propulsive strategies than nulliparous women carrying mannequins. [ABSTRACT FROM AUTHOR]

Purpose: Optimal ankle dorsiflexion range of motion plays a vital role in attaining the essential crouched posture necessary for excelling in speed skating. The purpose of this study was to determine how the ankle dorsiflexion angle evolves throughout a day of training and to identify the factors that influence this angle. Methods: Thirty short-track speed skaters, from 2 teams, participated in this study. The maximum ankle dorsiflexion angle was obtained in a lunge position facing a wall, using a digital inclinometer. All measures were obtained 3 times per side, 6 times per day, on 2 training days separated by at least a week. We conducted multiple tests to study the impact of repetition, day, side, team level, sex, and moment on the ankle dorsiflexion angle. Results: The 3 times repeated measures and the 2 days of training did not have a significant influence on the results. There was a statistically significant difference between the first time point of the day and the 5 other time points for both ankles. Moreover, the influence of sex and team level was not statistically significant. Conclusions: The results indicate that there are significant changes in ankle dorsiflexion range of motion but only after the first warm-up of the day. Such findings could enable team staff to enhance athletes' precompetition preparation and tailor ankle mobility training regimens more effectively. [ABSTRACT FROM AUTHOR]

Prior studies have explored the relationship between knee valgus and musculoskeletal variables to formulate injury prevention programs, primarily for females. Nonetheless, there is insufficient evidence pertaining to professional male soccer players. Here, the aim was to test the correlation of lateral trunk inclination, hip adduction, hip internal rotation, ankle dorsiflexion range of motion, and hip isometric strength with knee valgus during the single-leg vertical jump test. Twenty-four professional male soccer players performed a single-leg vertical hop test, hip strength assessments, and an ankle dorsiflexion range of motion test. A motion analysis system was employed for kinematic analysis. Maximal isometric hip strength and ankle dorsiflexion range of motion were tested using a handheld dynamometer and a digital inclinometer, respectively. The correlation of peak knee valgus with peak lateral trunk inclination was.43 during the landing phase (P =.04) and with peak hip internal rotation was −.68 (P <.001). For knee valgus angular displacement, only peak lateral trunk inclination presented a moderate positive correlation (r =.40, P =.05). This study showed that trunk and hip kinematics are associated with knee valgus, which could consequently lead to increased knee overload in male professional soccer players following a unilateral vertical landing test. [ABSTRACT FROM AUTHOR]

Context: Decreased muscle strength and balance in patients with functional ankle instability (FAI) can be effectively improved by ankle strength training. Low-load blood flow restriction (LL-BFR) training increases muscle size and strength, but there is limited evidence from studies on muscle strength and balance in FAI patients. Objective: To study the effects of LL-BFR training versus high-load training (HLT) on muscle strength and balance in FAI patients. Design: Randomized controlled trial. Participants: Forty-six young adults with a history of FAI. Interventions: Participants in the LL-BFR and HLT groups performed 4 sets (30 x 15 x 15 x 15) of ankle training at 20% to 40% of the one-repetition maximum and 70% to 85% one-repetition maximum, respectively, twice a week for 6 weeks. Main Outcome Measure(s): Plantar flexion, dorsiflexion, inversion, and eversion muscle strength, and the Y-balance test scores were assessed at baseline and after 3 and 6 weeks; the thickness of the tibialis anterior, triceps surae, and peroneus longus muscles were assessed at baseline and after 6 weeks. Results: Inversion, eversion, dorsiflexion, and plantar flexion muscle strength; tibialis anterior, triceps surae, and peroneus longus thickness; and Y-balance test scores were significantly increased in the LL-BFR group after 3 and 6 weeks compared with baseline (P < .05), with no significant difference between the LL-BFR and HLT groups after 6 weeks (P > .05). However, at the end of 3 weeks, eversion muscle strength and Y-balance test scores were significantly higher in the LL-BFR group than in the HLT group (P < .05). Conclusions: Over 6 weeks, LL-BFR training was as effective as HLT in improving ankle muscle strength, muscle thickness, and balance in FAI patients, but LL-BFR training improved the ankle eversion muscle strength and dynamic balance more than HLT did in the early stages of the intervention. This finding will provide a new intervention strategy for the clinical rehabilitation of FAI patients. [ABSTRACT FROM AUTHOR]

Objective: To compare the haemodynamic effects of different ankle movements combined ankle and toe movements on the femoral vein of the lower extremity. Methods: 28 healthy volunteers participated in the study. Doppler ultrasound was used to measure peak systolic velocity and time-averaged mean velocity of the common femoral vein during ankle dorsiflexion, ankle dorsiflexion with simultaneous toe extension, ankle plantarflexion, and ankle plantarflexion with simultaneous toe flexion. Results: In comparison to the resting state, both ankle alone or ankle combined with toe movement showed statistically significant differences (p <.01). However, there were no significant difference in the velocity of the common femoral vein between ankle alone and ankle combined with toe movement (p >.05). It is noteworthy that dorsiflexion of the ankle resulted in the highest peak velocity of blood flow. Conclusion: The impact of ankle movement, with or without toe movement, the velocity of the common femoral vein is not significantly correlated. [ABSTRACT FROM AUTHOR]

Background: While a high incidence of pickleball-related falls is reported, little is known regarding factors differentiating persons with and without a fall history during play. Purpose: This study aimed to determine differences between recreational pickleball players who fell while playing and those who did not. Additional aims were to determine reasons for falling and to investigate associations among assessed factors. Study design: Cross-sectional study. Methods: Participants completed a survey reporting age, fall history, and reasons for falling during play. Hip abduction strength, single leg squat form, ankle dorsiflexion, and change of direction time using a modified T-test on a pickleball court (i.e. pickleball T-test) were assessed. Results: Among the 92 individuals participating in the study, 42% reported a fall while playing and 30% reported falling more than once. Leading reasons for reported falls were lunging and moving backward. Participants who reported falling were significantly older (z = -2.60, p = 0.009) and slower on the pickleball T-test (z = -2.10, p = 0.036) than those who did not report falling. Hip abduction strength was not associated with fall history but was associated with faster time on the pickleball T-test (left rs = -.41, p < 0.001, right rs = -.48, p < 0.001). Single leg squat form and dorsiflexion were not related to fall history. Conclusion: Falls are common among recreational pickleball players, particularly older players. Fall prevention programs for pickleball players should be considered including multi-directional lunging, lower extremity strength and power development, and change of direction training that includes moving backward. Level of evidence: 2 [ABSTRACT FROM AUTHOR]

ObjectivesMethodsResultsDiscussion/ConclusionWe aimed to determine the effect duration of a talocrural mobilization on individuals with restricted dorsiflexion during a static weight bearing lunge test (WBLT) and dynamic 3D motion capture-based peak ankle dorsiflexion during a forward step down (FSD) task. Secondarily, we aimed to correlate any immediate changes in ankle mobility with concurrent changes in proximal joint kinematics during the FSD post-mobilization.Seventy-six individuals were screened for dorsiflexion restriction, of which 26 (15 females, 22.3 ± 2.2 years old, body mass index 25.2 ± 2.9 kg/m2) qualified with a WBLT of ≤ 35° on at least one limb. A baseline WBLT measure and 3D motion capture of 5 consecutive FSD repetitions on a 6-inch box were obtained. Participants then viewed an instructional video of a talocrural joint self-mobilization using a resistance band. WBLT and FSD were collected again immediately post-mobilization and at 5-min intervals for 60 min or until the WBLT returned to baseline for 2 consecutive measures.WBLT dorsiflexion showed a mean increase of 6.5 degrees (p < 0.001) post-mobilization. The effect faded over time and no longer differed from baseline 25 min post-mobilization (p = 0.964). Dynamic peak ankle dorsiflexion did not change post-mobilization at any time point (p ≥ 0.546). No 3D kinematic time-course changes were observed at the hip or knee. However, immediate raw alterations in dorsiflexion correlated with alterations for hip and knee flexion.A talocrural joint mobilization increased static dorsiflexion per the WBLT for a 20–25-min period with regression to baseline. However, increased dynamic ankle dorsiflexion was not observed during the FSD task. Improved mobility alone does not appear to change movement patterns. Clinicians should be aware of both effect duration and the potential need for task-specific training to better facilitate dynamic utilization of increased mobility. [ABSTRACT FROM AUTHOR]

Objectives: Although numerous surgical techniques and fixation methods have been described for the treatment of hallux rigidus (HR) with arthrodesis, consensus on the gold standard treatment has not been reached. The aim of this study is to retrospectively compare the clinical and radiological outcomes of compression screw fixation and plate fixation in the treatment of HR with arthrodesis. Methods: Patients who underwent arthrodesis surgery due to HR between January 2021 and December 2023 at a single center were retrospectively reviewed. Patients who met the inclusion criteria were divided into two groups: those who underwent arthrodesis with plate fixation (PLATE) and those who underwent arthrodesis with compression screw fixation (SCREW). Demographic data including age, gender, affected side, operative time, hallux valgus angle (HVA), dorsiflexion angle, AOFAS scores, and implant irritation data were compared among patients with at least 3 months of follow-up. Results: It was observed that all patients included in the study had successful bone union without any complications. There were no significant differences between the two groups in terms of age, gender, affected side, preoperative HVA, and preoperative AOFAS scores (P= 0.970, P= 0.426, P= 0.694, P= 0.216, and P= 0.905, respectively). The mean operation time and postoperative AOFAS score were lower in the PLATE group compared to the SCREW group (P=0.006 and P=0.004, respectively). However, in the SCREW group, the dorsiflexion angle and the rate of implant irritation were lower compared to the PLATE group (P=0.016 and P=0.01, respectively). Conclusions: In the surgical treatment of HR, both plate fixation arthrodesis and compression screw arthrodesis are reliable surgical techniques. While plate fixation arthrodesis is a faster and more practical method, arthrodesis with a compression screw results in fewer complaints related to the implant and provides a more functional recovery. [ABSTRACT FROM AUTHOR]

Background: The aim of this study was to identify the most responsive foot position for detection of isolated unstable syndesmotic injury. Methods: Fourteen paired human cadaveric lower legs were positioned in a pressure-controlled radiolucent frame and loaded under 700 N. Computed tomography scans were performed in neutral position, 15° internal / external rotation, and 20° dorsal / plantar flexion of the foot before and after cutting all syndesmotic ligaments. For each position, generated 3D models of the intact and injured distal tibiofibular joints were matched and analyzed by calculating three parameters: diastasis, anteroposterior displacement, and shortening of the fibula. Results: Transection of syndesmotic ligaments resulted in significant posterior translation of the fibula (4.34°, SD 1.63°, p < 0.01) compared to uninjured state for external rotation, significant anterior translation (-2.08°, SD 1.65°, p < 0.01) for internal rotation, and significant posterior translation (1.32°, SD 1.16°, p = 0.01) for dorsiflexion. Furthermore, the syndesmotic injury led to significantly increased clear space (0.46 mm, SD 0.46 mm, p = 0.03) in external rotation of the foot. Conclusion: External rotation of the foot under loading seems to be the most responsive position for detection of isolated syndesmotic instability. Under external rotational stress, anteroposterior instability and increased clear space resulting from a complete isolated unstable syndesmotic lesion were most evident. [ABSTRACT FROM AUTHOR]

Unaccustomed eccentric exercise (EE) is protective against muscle damage following a subsequent bout of similar exercise. One hypothesis suggests the existence of an alteration in motor unit (MU) behaviour during the second bout, which might contribute to the adaptive response. Accordingly, the present study investigated MU changes during repeated bouts of EE. During two bouts of exercise where maximal lengthening dorsiflexion (10 repetitions × 10 sets) was performed 3 weeks apart, maximal voluntary isometric torque (MVIC) and MU behaviour (quantified using high‐density electromyography; HDsEMG) were measured at baseline, during (after set 5), and post‐EE. The HDsEMG signals were decomposed into individual MU discharge timings, and a subset were tracked across each time point. MVIC was reduced similarly in both bouts post‐EE (Δ27 vs. 23%, P = 0.144), with a comparable amount of total work performed (∼1,300 J; P = 0.905). In total, 1,754 MUs were identified and the decline in MVIC was accompanied by a stepwise increase in discharge rate (∼13%; P < 0.001). A decrease in relative recruitment was found immediately after EE in Bout 1 versus baseline (∼16%; P < 0.01), along with reductions in derecruitment thresholds immediately after EE in Bout 2. The coefficient of variation of inter‐spike intervals was lower in Bout 2 (∼15%; P < 0.001). Our data provide new information regarding a change in MU behaviour during the performance of a repeated bout of EE. Importantly, such changes in MU behaviour might contribute, at least in part, to the repeated bout phenomenon. What is the central question of this study?Is motor unit (MU) behaviour altered during the performance of an initial and repeated bout of eccentric exercise (EE)?What is the main finding and its importance?During the repeated bout of exercise, we observed a greater contribution from lower threshold MUs to force generation along with reduced firing rate variability. Results suggest an adaptation occurs during the performance of an initial bout of exercise and contributes to the accelerated recovery that occurs following the performance of a repeated bout of EE. Importantly, our data suggest that changes in MU behaviour contribute, partly, to the repeated bout phenomenon immediately upon performing a repeated bout of eccentric activity. [ABSTRACT FROM AUTHOR]

Objectives: According to the conventional postoperative procedure after total ankle arthroplasty (TAA), mobilization and weight-bearing is currently started after completion of wound healing. Recently, early mobilization for dorsiflexion after TAA with modified antero-lateral approach was reported to be feasible and safe. To investigate the further possibility of expediting rehabilitation, this study evaluated the feasibility and safety of early full weight-bearing and gait exercise after cemented TAA. Materials and Methods: This retrospective, observational study investigated 23 consecutive ankles (OA: 14 ankles, RA: 9 ankles) that had received cemented TAA with a modified antero-lateral approach. These ankles were divided into three groups 1. conventional postoperative protocol, 2. early dorsiflexion protocol, 3. early dorsiflexion+full weight-bearing protocol. Postoperative wound complications were observed and recorded. Number of days for hospitalization was also evaluated. Results: No postoperative complications related to wound healing were observed even after early full weight-bearing and gait exercise. Days for hospitalization was significantly shortened in early full weight-bearing and gait exercise group (group 3) from 35-38 days to 24 days. Conclusions: Within this small number of cases, early full weight-bearing and gait exercise from 7 days after cemented TAA was feasible and safe with the modified antero-lateral approach. Combination of early dorsiflexion mobilization and weight-bearing/gait exercise contributed to shortening the hospitalization day. Innovations in postoperative procedures for rehabilitation after TAA can be expected. [ABSTRACT FROM AUTHOR]

Total ankle arthroplasty (TAA) improves gait symmetry in patients with unilateral end‐stage ankle arthritis but has not been studied in patients undergoing bilateral TAA (B‐TAA), and few studies compare TAA patients to control subjects. The purpose of this study was to compare gait symmetry in U‐TAA and B‐TAA patients and healthy controls. Using prospective databases, 19 unilateral and 19 bilateral ankle arthritis patients undergoing TAA were matched to 19 control subjects by age, sex, and BMI. The Normalized Symmetry Index (NSI) was determined for joint mechanics and ground reaction forces (GRF) during walking trials at a single visit for controls and preoperatively and 1 to 2 years postoperatively for TAA patients. Data was analyzed using linear mixed‐effects models to determine differences among time points and cohorts at a significance of α = 0.05. Following surgery, B‐TAA and U‐TAA experienced improved peak plantarflexion moment symmetry (p = 0.017) but remained less symmetric than controls. B‐TAA patients had more symmetry than U‐TAA patients during peak weight acceptance GRF (p = 0.002), while U‐TAA patients had greater peak dorsiflexion symmetry than B‐TAA patients. TAA patients demonstrated more asymmetry compared to control subjects for all outcome measures. There was no significant impact of TAA on gait symmetry for GRF or peak ankle angles, and neither U‐TAA nor B‐TAA was consistently associated with higher gait symmetry. These results indicate that TAA improves symmetry during peak plantarflexion moment, and that significant gait asymmetry persists for B‐TAA and U‐TAA patients compared to healthy participants. [ABSTRACT FROM AUTHOR]

Background Reduced dorsiflexion range of motion (DFROM) which is commonly seen following lateral ankle sprain (LAS) has the potential to influence lower extremity biomechanics which have been linked to increased injury risk in the female athlete. Current research on the effect of sex and LAS history on DFROM is limited. Hypothesis/Purpose This study had three aims 1) to determine the effect of sex, leg dominance and LAS history on DFROM, 2) to determine the effect of sex and LAS history on magnitude of DFROM symmetry and 3) to examine the association of sex on direction (whether dominant or non-dominant limb had the higher DFROM) of symmetry. Study Design Cross-Sectional Study Methods DFROM was measured bilaterally in 105 recreational athletes all participating in multidirectional sports using the tape measurement method during the weight bearing lunge test (WBLT). A mean of three measurements was used for analysis. A 3-way mixed ANOVA was carried out to determine the interaction between sex, LAS history and leg dominance on DFROM and a 2-way ANOVA for the effect of sex and LAS history on asymmetry. A chi-square test was used to determine the association of sex and direction of asymmetry. Results The results indicate no significant effect of sex, LAS history, and leg dominance on DFROM (p=0.65). Main effects were significant for sex and LAS on DFROM. The mean asymmetry for all participants was reported as 12.25±14.76cm. No significant effect of sex and LAS history on magnitude of asymmetry was reported. There was a significant association of sex and direction of asymmetry (χ²(1) = 11.26, p = 0.00). Sixty-five-point two percent of males were shown to have higher DFROM of their non-dominant limb compared to 75% of females who were higher in their dominant limb. Conclusion Findings from this study suggest that DFROM is affected by sex and LAS history. While females have increased DFROM compared to males, those with LAS history are more likely to have a decreased DFROM on the involved side. The results also indicate that interlimb asymmetries in DFROM are present in athletes, therefore practitioners should exercise caution when using bilateral comparisons in injury and return to play assessments. Level of Evidence 2b. [ABSTRACT FROM AUTHOR]

BACKGROUND: Trolley bags have gained popularity among students, but there is limited research comparing them to backpack-style school bags. OBJECTIVE: This study aimed to compare how carrying a backpack versus a trolley bag affects the activity of trunk and lower limb muscles in secondary school students. METHODS: Electromyographic activity was measured in 25 students (13.4±1.1 years) as they walked on level ground and up/down stairs while carrying both types of bags. The activity of the gastrocnemius, tibialis anterior, semitendinosus, rectus femoris, lumbar erector spinae, and rectus abdominis muscles was assessed on both the dominant and non-dominant sides. RESULTS: The study found significantly reduced muscle activation in most of the targeted muscles when walking on level ground with the trolley bag and when going up/down stairs with the backpack. CONCLUSIONS: Lifting a trolley bag depends on the slope of the walking surface and is more efficient on level ground, while carrying a backpack is more efficient when going up and down stairs. Since it is not practical to switch bags when encountering stairs in schools, a bag with a mixed model design incorporating features of both trolley and backpack may be more beneficial and practical for students to use. Students, parents, and teachers should be aware of the injury risks associated with carrying different types of bags. [ABSTRACT FROM AUTHOR]

Background: Functional correlates of spastic myopathy, the muscle disorder of spastic paresis, are unknown. Objective: To explore reciprocal relationships between clinical and structural parameters of plantar flexors with i) ambulation speed, ii) dorsiflexion and plantarflexion torques in chronic hemiparesis. Methods: Cross-sectional trial in chronic stroke-induced hemiparesis (>6 months). Plantar flexors were quantified through i) the Five Step Assessment: maximal extensibility (XV1), active range of dorsiflexion (XA); ii) ultrasonography: fascicle length (Lf) and thickness (Th) of medial gastrocnemius (GAS) and soleus (SOL), knee extended in an isokinetic ergometer, ankle at 80% XV1-GAS. Maximal isometric torques in plantar flexion (PF) and dorsiflexion (DF) and maximal barefoot 10-meter ambulation speed were collected. Relationships between structural, biomechanical, clinical and functional parameters were explored using non-parametric testing (Spearman). Results: Twenty-one subjects (age 58.0±8.4, mean±SD, time since lesion 7.8±5.7 years) were recruited, with the following characteristics: ambulation speed, 0.77±0.37m/sec; XV1-SOL 92.7±10.3°; XV1-GAS 91.3±9.6°; XA-SOL 86.9±10.0°; XA-GAS 7676±14.2°; LfGAS, 58.2±18.3mm; ThGAS, 17.1±3.6 mm; LfSOL, 36.0±9.6 mm; ThSOL, 13.8±3.3mm; PF peak-torque 46.5±34.1Nm, DF peak-torque, 20.1±19.1Nm. XA-SOL and XA-GAS strongly correlated with XV1-SOL and XV1-GAS respectively (ρ = 0.74, p = 4E-04; resp ρ = 0.60, p = 0.0052). Ambulation speed moderately correlated with LfGAS (ρ = 0.51, p = 0.054), ThGAS (ρ = 0.58, p = 0.02) and LfSOL (ρ = 0.63, p = 0.009). DF and PF peak-torques both correlated with LfGAS (ρ = 0.53, p = 0.04) a; resp. ρ = 0.71, p = 0.0015). Conclusion: In chronic hemiparesis, active dorsiflexion is mostly determined by plantar flexor extensibility. Plantar flexor fascicle shortening is associated with reduced ambulation speed and ankle torques. Attempts to restore plantar flexor extensibility might be important objectives for gait rehabilitation in chronic hemiparesis. [ABSTRACT FROM AUTHOR]

BackgroundMethodResultsConclusionForce steadiness can be impaired under dual-task conditions in older adults. Since this impairment is attributed to their limited attentional resources, we hypothesized that the degree of cortical activity involved in muscle contraction would affect force steadiness under dual-task conditions. To test this hypothesis, based on the premise that dorsiflexion requires more cortical resources than plantarflexion, we compared the effects of additional motor and cognitive task demands on force steadiness between dorsiflexion and plantarflexion contractions in young and older adults.Eighteen young and eighteen older adults performed a force tracking task by applying either isometric dorsiflexion or plantarflexion force concurrently with and without (control) secondary upper-limb motor or cognitive task.Force steadiness was impaired by both secondary upper-limb motor and cognitive tasks for the dorsiflexors and plantarflexors in older adults. While force steadiness was impaired similarly by additional task demands regardless of the secondary task type for the dorsiflexors, the impairment effect was larger in the secondary cognitive than motor task for the plantarflexors.The effects of dual-task demand on force steadiness could depend on the degree of cortical activity involved in muscle contraction in older adults. [ABSTRACT FROM AUTHOR]

Diabetes-related foot ulcers are a leading cause of morbidity and mortality globally, in which the most significant contributing factor is peripheral neuropathy. The purpose of this research was to evaluate the influence of diabetic peripheral neuropathy and ulceration on lower limb and foot joint kinematics during gait. Are there any significant alterations lower limb and foot joint kinematics during gait in the presence of active and history of diabetic neuropathic ulceration? A prospective, cross-sectional study was conducted, recruiting eighty adult participants who were equally divided into four groups, namely, the diabetes (DM), diabetic peripheral neuropathy (DPN), active diabetic neuropathic ulceration (DNU) and history of diabetic neuropathic ulceration (DHNU) groups. Three-dimensional gait analysis was performed, and participants were instructed to walk barefoot over a 10-m walkway at self-selected speed. The acquired pelvic, hip, knee, ankle and foot joint segmental kinematic data was compared between individuals with and without active neuropathic ulceration. Mean scores between the four independent groups was performed using the Kruskal-Wallis test. Participants within the DNU and DHNU groups demonstrated significantly reduced knee flexion, ankle dorsiflexion and first metatarsal dorsiflexion kinematics with resultant increased anterior pelvic tilt, hip flexion and midtarsal kinematics (all values p<0.01) when compared to participants within the DM and DPN groups. Through the integration of a more individualised, biomechanical approach, the findings in this study may provide improved preventative and management strategies of ulceration amongst the diabetic population. • Joint kinematic related to active and history of neuropathic ulceration. • Proximal lower limb kinematics were significantly altered as foot joint segments. • Including a detailed biomechanical evaluation during diabetic assessment is advised. [ABSTRACT FROM AUTHOR]

Middle-aged adults represent the transition between younger and older adults, where some of the characteristic gait differences due to aging begins to surface. However, the gait characteristics of middle-aged adults across the whole gait cycle remains an understudied topic. As speed is a sensitive indicator of health, characterizing the effects of speed on the gait of middle-aged adults and differentiating it from the response of young adults will provide insights into the effects of aging on gait speed modulation mechanisms. What are the mechanisms of gait speed changes that are employed by middle-aged adults, and how are they different from younger adults? A cohort of healthy young and middle-aged adults completed 60 second trials at three different speeds. Joint kinematics, kinetics, and surface electromyography data were analyzed and compared between the speed levels and age groups. Statistical Parametric Mapping along with a nonlinear curve registration algorithm was used to simultaneously assess the changes in both magnitude and timing of different metrics. When compared to the younger cohort, the middle-aged cohort had significantly lower ankle range of motion, dorsiflexion moment during loading response and plantarflexion moment during push-off. At the knee joint, the middle-aged adults had significantly lower knee flexion moment during stance. At the hip joint, the middle-aged adults had lower extension moment during terminal stance. Time-continuous analysis showed that primary differences due to age were related to decreased joint range of motion and joint moment production capability in the middle-aged adults. Faster walking appears a safe method for middle-aged adults to increase joint range of motion and joint moment expression. However, targeted interventions that focus on improving capability are likely also needed. Suggested targets being improving ankle and knee joint moment capability, and increased range of motion at all joints. • Timing and magnitude changes in gait parameters appear as early as middle age. • Primary differences due to age were related to reduced range of motion. • Middle-aged adults had decreased joint moment production capacity at all joints. • Faster speed generally helped match profile magnitudes between groups. [ABSTRACT FROM AUTHOR]

Lateral ankle sprain (LAS) usually occurs during landing from heights among people with chronic ankle instability (CAI). Although the kinematics when landing on the flat surface has been reported, no studies have explored the effect of different heights on the landing strategies using a trapdoor device among people with CAI. Do people with CAI adopt different landing strategies when drop-landing on the trapdoor device from three heights? Thirty-one participants with CAI (24 males and 7 females, age=21.1±1.8 years, height=176.9±7.4 cm, body mass=71.9±9.2 kg, injured side=18 R&13 L) were recruited. They dropped from three different heights (low height (16 cm), medium height (23 cm), high height (30 cm)) with their affected foot landing on a movable surface of a trapdoor device, which was tilted 24° inward and 15° forward to simulate LAS. Kinematic data was collected using a twelve-camera motion capture system. One-way analysis of variance with repeated measures was used to compare the differences between the three heights. Significant height effects were detected in the peak ankle inversion angle (p=0.009, η2 p =0.280) and angular velocity (p<0.001, η2 p =0.444), and the peak ankle plantarflexion (p=0.002, η2 p =0.360), knee flexion (p<0.001, η2 p =0.555), and hip flexion (p=0.030, η2 p =0.215) angles at the time of peak ankle inversion. Post-hoc tests showed that all the angles and velocities were higher at a low height than at medium (p: 0.001–0.045, d : 0.14–0.44) and high heights (p: 0.001–0.023, d : 0.28–0.66), except for the ankle plantarflexion angle, which was lower at a low height than at medium (p<0.001, d =0.44) and high (p=0.021, d =0.38) heights. People with CAI adopt a protective strategy during drop-landing at medium and high heights compared to a low height. This strategy involves increased ankle dorsiflexion angle as well as knee and hip flexion angles. • People with CAI adopt a different landing strategy when landing from 16 cm than 23–30 cm. • People with CAI use protective strategies when landing from 23 to 30 cm. • People with CAI dorsiflex ankle and flex knee and hip joints when landing from 23 to 30 cm. [ABSTRACT FROM AUTHOR]

Background and Purpose: Warm‐up (WU) is a commonly practiced technique aimed at preparing athletes for physical activity. Although coaches and athletes consider WU essential, there is still an ongoing debate about its effectiveness. This might be due to the fact that WU procedures often rely on experiences rather than scientific research. During WU, athletes may pursue intermediate goals such as ensuring proper ranges of motion in joints, which seem crucial particularly for runners' ankle joints. Hence, the aim of this study was to evaluate influence of whole‐body vibration (WBV), drop jump (DJ), and a combination of both (WBV + DJ) in terms of ankle dorsiflexion and running parameters among recreational runners. Methods: Sixteen runners performed as a WU: five sets of 30 s calf raises without WBV (CTRL), five sets of 30 s calf raises during WBV, five sets of six DJ, five sets of 30 s calf raises during WBV followed by 6 DJ. Range of motion (ROM) of the ankle joint was measured in a prone position using an inclinometer for the soleus and gastrocnemius muscles, separately. Measurements were conducted before and after WU, and after a 3000 m run. Results: There was no interaction for time and WU for left (p = 0.926) and right (p = 0.738) soleus muscle as well as for left (p = 0.748) and right (p = 0.197) gastrocnemius muscles. No difference (p = 0.914) for the running time was found. Discussion: WBV, drop jumps, or a combination of both did not affect ankle dorsiflexion and running time. [ABSTRACT FROM AUTHOR]

Purpose: Our objective was to evaluate the syndesmotic and fracture instability using conventional ankle computed tomography (CT) with stress maneuvers. Methods: A consecutive sample of 123 individuals with an ankle sprain was assessed for eligibility. In total, 33 patients met the inclusion criteria. All patients underwent a magnetic resonance imaging (MRI) and CT scan with stress maneuvers (CTSM). The patterns of ligament tears f were classified using West Point grades I, IIA, IIB, III. Mann–Whitney test was used to test the differences in the numerical variables between injured and uninjured syndesmoses. The Spearman correlation tested the strength of the association between the tibial joint surface involved in posterior malleolus fracture and syndesmotic instability. Results: In MRI, two patterns of syndesmotic ligament injury predominated. A completely torn anterior inferior tibiofibular (AITFL) and interosseous tibiofibular ligaments (ITFL) and a completely torn AITFL were combined with a partially torn ITFL. In the neutral phase CTSM and during the stress phase the median difference of the narrowest tibiofibular distance between injured and uninjured syndesmoses was 0.2 mm (P = 0.057) and 2.3 mm (P < 0.0001), respectively. There was no association between the percentage of involvement of the posterior tibial joint surface in the posterior malleolar fracture and syndesmotic instability as measured with CTSM. Conclusion: The conventional computed tomography with external rotation and dorsiflexion represents a reproducible and accurate diagnostic option for detecting syndesmosis instability and fracture instability in acute isolated non-displaced posterior malleolar fractures Bartoníček and Rammelt type II. Level of Evidence: Prospective study among consecutive patients (Diagnosis); Level of evidence, 2. [ABSTRACT FROM AUTHOR]

Background: It is important to highlight the advantages of ultrasound in assessing muscular and tendinous behavior due to its non-invasive nature and capacity for dynamic studies. However, evaluating tendons via ultrasound can be challenging given the complexity of anisotropic phenomena related to collagen fiber arrangement. This study aims to validate the reliability of fixed ultrasound compared to manual acquisition in measuring Achilles tendon thickness. Method: Twenty participants, six men and fourteen women, were recruited. Ultrasound was used to measure the Achilles tendon's thickness at two specific points (4 and 6 cm from the calcaneal insertion of the Achilles tendon). The measurements were conducted by two examiners, one with previous experience and another without. Results: The measurements at 6 cm from the calcaneal insertion showed α = 0.996, α = 0.998 for measurements at 4 cm using manual acquisition, and α = 0.997 for measurements with fixed ultrasound at rest. For the weight-bearing and ankle dorsiflexion measurements, the reliability was excellent (α = 0.999 and α = 1.000). Conclusions: The findings demonstrated excellent reliability in the ultrasound measurements of the Achilles tendon's thickness, even when performed by different evaluators and under load-bearing conditions. This study suggests the clinical utility of assessing anatomical structures under load, enhancing ultrasound's applicability beyond the examination table. It is concluded that fixed ultrasound acquisition exhibits excellent reliability in measuring the Achilles tendon's thickness, offering potential benefits for precise diagnosis of pathologies, planning surgical interventions, and reducing possible errors related to operator variability. [ABSTRACT FROM AUTHOR]

Evaluating and understanding the release parameters is crucial in the throwing events of athletics, however, calculating the release parameters is time-consuming for data collection and can be expensive. The present study aimed to investigate a method for detecting the release instant from data collected using a single inertia measurement unit (IMU) in shot put. Two male shot putters participated in the study. Each participant performed six competitive throws with a 9-axis IMU (100 Hz) attached to the back of the participant’s throwing hand. Three different methods were examined from IMU data: threshold values of resultant acceleration, waveform of resultant acceleration, and waveform of the angular velocity around the radio-ulnar axis of the hand. The release instant as a true value was obtained from the video recorded in sync with the IMU, and the error of the release instant detected from the IMU was calculated. The final number of trials analysed was four for participant A and six for participant B. As results, there were various cases where the threshold value of acceleration did not exceed the value depending on the participant and trial, and the release instant could not be detected. The release instant detected from the moment the acceleration decreased based on the acceleration waveform had a large error (4.00 ± 2.26 frames). The release instant, which was detected from the moment when the angular velocity became negative based on the angular velocity waveform, was detected in all trials for both participants, and the error was low (1.20 ± 0.92 frame).It was found that utilizing the detection of dorsiflexion timing of the wrist joint, with the angular velocity around the rotational axis parallel to the radio-ulnar axis of the hand as a cue, proved to be a highly accurate approach for determining the release instant. [ABSTRACT FROM AUTHOR]

Background: Anterior ankle bony impingement, which can cause pain and dysfunction of the ankle, is commonly seen in sports injuries. Its primary cause is repeated injury due to chronic ankle instability. An excellent clinical result has been reported by surgically removing osteophytes and ankle stabilization. However, reports of complex anterior impingement combined with lateral ankle instability are rare, which remains challenging in clinical practice. Purpose/Hypothesis: The purpose of this study was to evaluate the clinical outcomes of anterior ankle bony impingement combined with lateral ankle instability with surgical dissection of osteophytes and stabilization. It was hypothesized that complex ankle osteophytes with instability would achieve optimal clinical outcomes through surgical management. Study Design: Case series; Level of evidence, 4. Methods: A total of 57 patients with complex ankle bony impingement combined with lateral instability treated with surgical dissection of complex osteophytes between September 2013 and January 2019 were enrolled in the study. The clinical outcomes were evaluated by visual analog scale (VAS) for pain score, American Orthopedic Foot and Ankle Society (AOFAS) score, Karlsson score, and radiographic examination with a mean follow-up time of 39.6 months. Postoperative ankle function and complications were compared using the t test and post hoc Tukey significant difference test. Results: The mean AOFAS score significantly increased at the 3-month, 1-year, and 2-year follow-ups compared with the preoperative condition (t = 10.57, P =.0001). The mean Karlsson score after surgery also significantly improved at each follow-up time compared with the preoperative score (t = 12.93, P =.0001). The preoperative VAS score significantly decreased at 3 months, 1 year, and 2 years postoperatively (t = 8.73, P =.001). A significant improvement of mean dorsiflexion difference was observed at 3 months and 1 year compared with the preoperative condition, but it seemed to have regressed at the 2-year follow-up (t = 2.11, P =.01). Tibial side recurrence was found in 9 cases, including 7 Scranton type 1 and 2 Scranton type 2. Talar side recurrence was also found in 3 of those cases. Conclusion: Our retrospective study demonstrated that complex ankle bony impingement combined with lateral instability can yield good clinical results when treated surgically with both ankle stabilization and osteophyte removal. [ABSTRACT FROM AUTHOR]

Background: Low-intensity resistance exercise therapy (LIRET) based on myofascial chains, applied to both affected and nonlocal joints, is an effective method for knee osteoarthritis (OA) rehabilitation. This study applied LIRET in a comparison of prevalues and postvalues of lower-limb tension in female patients with knee OA and asymptomatic participants. Methods: Twenty-four female participants with knee OA and 20 asymptomatic women took part in a 3-month long application of LIRET. Participants' ankle passive torque and ankle range of motion in the sagittal plane were assessed with an isokinetic dynamometer. The collected values were used to estimate the sagittal-plane lower-limb tension. Results: Compared with the asymptomatic group, participants with knee OA presented decreased maximum ankle dorsiflexion (P <.001), decreased ankle plantar flexion range (P =.023), ankle resting position more inclined to dorsiflexion (P =.017), increased ankle dorsiflexion stiffness (P =.005), and lower ankle plantar flexion stiffness (P =.034). After exercise intervention, the knee OA group self-reported less knee pain (P <.001), improved physical function (P <.001), increased maximum dorsiflexion (P =.021), and increased plantar flexion range (P <.001). While plantar flexion stiffness increased (P =.037), dorsiflexion stiffness decreased (P =.015) and ankle resting position moved toward dorsiflexion (P =.002). Results suggest possible decreased anterior leg tension and possible increased posterior leg tension in patients with knee OA. Conclusions: The results supported that knee OA patients present imbalanced myofascial tension of lower limbs. LIRET based on myofascial chains appears to decrease pain, and stiffness, and improve physical function of patients with knee OA and change their lower-limb tension. [ABSTRACT FROM AUTHOR]

Context: Posterior shoulder tightness evaluated as limited glenohumeral internal rotation and horizontal adduction is a risk factor for throwing-related shoulder and elbow injuries. Given that the throwing motion uses the entire body kinematics, limited lower-limb flexibility might be associated with posterior shoulder tightness. Therefore, we aimed to investigate the relationships between posterior shoulder tightness and lower-limb flexibility in college baseball players. Design: Cross-sectional study. Setting: University laboratory. Participants: Twenty-two college baseball players (20 right-handed and 2 left-handed). Methods: To investigate the relationships between glenohumeral range of motion and lower-limb flexibility using simple linear regression analysis, we measured passive range of motion of glenohumeral internal rotation and horizontal adduction, hip internal/external rotation in the prone/sitting position, ankle dorsiflexion, and quadriceps and hamstrings flexibility from both shoulders and legs. Results: Our analysis indicated that decreases in the lead leg hip external rotation in the prone position were moderately associated with limitations in glenohumeral internal rotation (R2 =.250, β [95% confidence interval, CI] = 0.500 [0.149 to 1.392], P =.018) and horizontal adduction (R2 =.200, β [95% CI] = 0.447 [0.051 to 1.499], P =.019) on the throwing shoulder. Furthermore, there were significant moderate relationships between decreases in glenohumeral internal rotation and limited lead leg quadriceps flexibility (R2 =.189, β [95% CI] = 0.435 [0.019 to 1.137], P =.022), and between decreases in glenohumeral horizontal adduction and limited stance leg ankle dorsiflexion (R2 =.243, β [95% CI] = 0.493 [0.139 to 1.438], P =.010). Conclusion: College baseball players with limited lower-limb flexibilities including the lead leg hip external rotation in the prone position, the lead leg quadriceps flexibility, and the stance leg ankle dorsiflexion showed excessive posterior shoulder tightness. The current results support the hypothesis that lower-limb flexibility is associated with posterior shoulder tightness in college baseball players. [ABSTRACT FROM AUTHOR]

A systematic search was performed of online databases for any anterior cruciate ligament (ACL) injuries within the NBA. Video was obtained of injuries occurring during competition and downloaded for 2-dimensional video analysis. Thirty-five in-game videos were obtained for analysis. Of the reviewed cases, 19% were noncontact ACL injuries where there was no player-to-player contact from an opposing player. Three injury mechanism categories were found based on the events at the point of initial ground contact of the foot of the injured limb: single-leg casting (mean dorsiflexion angle 18.9° (14.4°); mean knee flexion angle 15.6° (7.8°); and mean trunk lateral flexion 18.2° (8.4°)); bilateral hop (mean dorsiflexion angle 18.2° (15.2°), mean knee flexion angle 21° (14.5°), mean trunk extension angle 6.9° (11.4°), and landing angle from the athlete's center of mass 47.9° (10.1°)); and single-leg landing after contact (mean abduction angle of the swing leg 105.4° (18.1°), mean knee flexion angle of the injured limb 34.2° (8.0°), and mean trunk ipsilateral flexion angle 22.2° (7.0°)). [ABSTRACT FROM AUTHOR]

Mobility declines in older adults can be determined through monitoring longitudinal changes in gait speed. We examined longitudinal changes [in] ankle proprioception among those with and without baseline lower extremity numbness to develop a better understanding of mobility declines in healthy older adults. Participants included 568 adults (52.8% women) aged 60–98 years from the Baltimore Longitudinal Study of Aging. Larger ankle proprioception decreases during plantar flexion were found in the participants with lower extremity numbness compared with those without numbness (p =.034). Among participants with lower extremity numbness, slower baseline speeds from both usual and fast pace gait were associated with performance decline in ankle proprioception measured during ankle dorsiflexion (p =.039 and p =.004, respectively). Assisting older adults, especially those with lower extremity numbness, to maintain and improve ankle proprioception may help prevent mobility declines that have previously been considered age related. [ABSTRACT FROM AUTHOR]

Objective: To ascertain the immediate changes in stroke patients' temporal and spatial parameters of gait and the joint angles of stroke patients throughout the entire gait cycle following the application of lower extremity elastic strap binding technique. Methods: Twenty-nine stroke patients were invited as the study participants. The patient seated, flexed the hip and knee, utilized a 5 cm-wide elastic strap, positioning its midpoint beneath the affected foot and crossing it anterior to the ankle joint. Upon standing, the strap encircled the posterior aspect of the lower leg, proceeded around the back of the knee, and ascended the thigh on the affected side. Crossing anteriorly over the thigh, it then encircled the back of the waist before being secured in place. Using Qualisys motion capture system to collect kinematic data of the lower extremities during walking while wearing shoes only or strapping. A paired sample t-test was used to analyze the effects of the technique on gait spatiotemporal parameters and joint angles in stroke patients. Results: The patients' step length decreased (P = 0.024), and step width increased (P = 0.008) during the gait cycle after the strapping. In the gait cycle between 0% and 2%, 7%-77%, and 95%-100%, the hip flexion angle on the affected side was significantly larger after the strapping (P < 0.05). In the gait cycle between 0% to 69% and 94%-100%, the knee flexion angle on the affected side was significantly larger after the strapping (P < 0.05). In the gait cycle between 0% to 57% and 67%-100%, the ankle dorsiflexion angle on the affected side was significantly smaller after the strapping (P < 0.05), and in the gait cycle between 0% to 35% and 68%-100%, the ankle inversion angle on the affected side was significantly smaller after the strapping (P < 0.05). Conclusion: The lower extremity elastic strap binding technique can decrease the hip flexion and knee flexion limitations in stroke patients during walking, and reduce the ankle plantar flexion and ankle inversion angle of stroke patients. The lower extremity elastic strap binding technique enabled stroke patients to adopt a more stable gait pattern. [ABSTRACT FROM AUTHOR]

Purpose: To evaluate the effectiveness of radial extracorporeal shock wave therapy (r ESWT) as an additional treatment modality for spastic equinus deformity in chronic hemiplegic patients. Methods: 100 eligible stroke patients with calf muscles spasticity were randomized into 2 groups. Group I: 50 patients exposed to rESWT 1.500 pulses, 0.10 mJ to 0.3mJ/mm2, with a frequency 4 Hz once weekly for one month. Group II: 50 patients exposed to Sham rESWT once weekly for one month. Clinical, electrophysiological & musculoskeletal ultrasound assessments were done for all patients. Results: After controlling baseline as covariate, the trend for modified Ashworth scale (MAS), Passive ankle dorsiflexion motion (PADFM), 10 meters walk test (10-MWT), and Ratio of maximum H reflex to maximum M response (H/M ratio) after one & two months was significantly different between the two groups, with improvement of all clinical and electrophysiological parameters in group I. Conclusion: ESWT represents a useful non-invasive, additional modality for the reduction of foot spasticity and equinus deformity in stroke patients. Implications for Rehabilitation: Extracorporeal shock wave therapy represents a useful non-invasive, additional modality for reduction of foot spasticity and equinus deformity in chronic stroke patients. The application of such a modality improves limb posture, range of motion, and muscle extensibility. Early extracorporeal shock wave rehabilitative intervention in stroke patients reduces fat infiltration and fibrosis replacement of spastic muscle. [ABSTRACT FROM AUTHOR]

The purpose of this quasiexperimental study was to test the effects of wearing the NewGait rehabilitative device on walking abilities in individuals with foot drop. The study involved 16 participants with foot drops caused by stroke (11 participants), multiple sclerosis (one participant), and peripheral neuropathies (four individuals). During a single testing session, participants walked 12 m at their self‐selected speed in four experimental conditions: walking without any orthotic device; walking while wearing a regular plastic posterior leaf ankle foot orthosis (AFO); walking with the NewGait device assisting ankle dorsiflexion only; and walking with the NewGait device assisting the hip, knee, and ankle joint motions. Body motions during walking were recorded using a 3D system for motion analysis and analyzed with a set of spatiotemporal and kinematic parameters and a gait decomposition index. The gait decomposition index indicated sagittal interjoint coordination in the three joint pairs (hip–knee, knee–ankle, and hip–ankle) of the paretic (foot drop) leg during walking and was validated in a previous study. Overall, wearing all three orthotic devices improved the gait velocity, ankle dorsiflexion, and foot clearance compared to gait trials in which no assistive devices were used. However, wearing the AFO significantly restricted the plantarflexion range of motion and decreased interjoint coordination as measured by joint decomposition. In contrast, the NewGait device altered the ankle plantarflexion motions but also increased coordinated movement (reduced the decomposition) in most lower‐extremity joint pairs and conditions. Therefore, the NewGait rehabilitative device can be considered superior to a regular AFO in correcting gait deviations caused by foot drop. [ABSTRACT FROM AUTHOR]

BACKGROUND: After undergoing fibula-free flap harvest, patients may experience complications such as ankle instability. It remains unclear whether these patients have deficits of proprioception, and the recovery process is also uncertain. OBJECTIVE: This study aimed to objectively evaluate proprioception on the donor and normal side of surgical patients during long-term follow-up using the Pro-kin system. METHODS: This study enrolled 36 patients who underwent reconstruction of the head and neck using osseous free flaps harvested from the fibula. Each patient underwent pre-operative evaluations and was subsequently evaluated at postoperative months 1, 3, 6, and 12. The study assessed the proprioceptive evaluation of the lower limbs, muscle function, range of motion of the ankle, and donor side complications. RESULTS: On the donor side, the average trace error (ATE) at postoperative month 1 was significantly higher than pre-operation, postoperative months 6 and 12 (P < 0.05). The test execution time (TTE) at postoperative month 1 was significantly increased by 9.875s compared to the pre-operative levels (P = 0.012, 95% confidence interval [CI] 4: 1.877–17.873) and by 11.583s compared to postoperative month 12 (P = 0.007, 95% CI: 2.858–20.309). The reduction in range of motion of ankle dorsiflexion was most pronounced at postoperative month 1, exhibiting an 11.25∘ decrease compared to pre-operative levels (P < 0.001, 95% CI: 6.304–16.16). Although the range of motion of ankle dorsiflexion gradually improved over time at postoperative months 3, 6, and 12, it remained lower than pre-operative levels (P < 0.05). CONCLUSION: The study revealed that the patients exhibited proprioceptive disturbances in both lower limbs at postoperative month 1. The proprioceptive function gradually improved over time, with a gradual decrease in donor site complications. [ABSTRACT FROM AUTHOR]

This study evaluates the utility of OpenCap (v0.3), a smartphone-based motion capture system, for performing gait analysis in patients with neurological disorders. We compared kinematic and kinetic gait parameters between 10 healthy controls and 10 patients with neurological conditions, including stroke, Parkinson's disease, and cerebral palsy. OpenCap captured 3D movement dynamics using two smartphones, with data processed through musculoskeletal modeling. The key findings indicate that the patient group exhibited significantly slower gait speeds (0.67 m/s vs. 1.10 m/s, p = 0.002), shorter stride lengths (0.81 m vs. 1.29 m, p = 0.001), and greater step length asymmetry (107.43% vs. 91.23%, p = 0.023) compared to the controls. Joint kinematic analysis revealed increased variability in pelvic tilt, hip flexion, knee extension, and ankle dorsiflexion throughout the gait cycle in patients, indicating impaired motor control and compensatory strategies. These results indicate that OpenCap can effectively identify significant gait differences, which may serve as valuable biomarkers for neurological disorders, thereby enhancing its utility in clinical settings where traditional motion capture systems are impractical. OpenCap has the potential to improve access to biomechanical assessments, thereby enabling better monitoring of gait abnormalities and informing therapeutic interventions for individuals with neurological disorders. [ABSTRACT FROM AUTHOR]

Introduction: Ankle‐foot orthoses (AFOs) are commonly prescribed for people with Charcot‐Marie‐Tooth disease (CMT) to improve gait efficiency and reduce the occurrence of tripping and falls. The aim of this study was to systematically review evidence on the effects of AFOs on gait kinematics and kinetics and postural stability/balance in people with CMT. Methods: Studies were identified from electronic databases and screened for inclusion online using Rayyan. Data from all eligible studies were extracted into a standardised Excel spreadsheet. Methodological quality was assessed using the Joanna Briggs Institute Critical Appraisal Checklists. Where available, continuous outcomes were pooled to estimate standardised mean differences in random‐effects meta‐analyses. Results: A total of 15 studies were included with variable methodological quality. Sample sizes ranged from 1 to 32 with significant variability in participant characteristics, AFO designs and testing procedures. Data from eight studies were available for meta‐analysis. Although AFOs impacted walking velocity, stride length, step length, cadence, ankle dorsiflexion, plantarflexion, knee and hip flexion and ankle plantarflexion and dorsiflexion moments, the effect sizes were small‐to‐moderate and non‐significant. There were insufficient data available for pooled analyses of outcomes related to postural stability/balance. Conclusion: Although AFOs positively affect a number of gait and balance parameters, the small participant numbers, variability in participant characteristics, AFO designs and testing procedures adopted by the available studies resulted in the absence of statistically significant effects when data were pooled. The results from this review also highlight the importance of device customisation based on the individual needs of people with CMT and their degree of gait impairment. [ABSTRACT FROM AUTHOR]

Background: Changes in the trunk and lower limbs' sagittal movements may cause patellofemoral pain (PFP) because they influence the forces acting on this joint. Objectives: To compare trunk and lower limb sagittal kinematics between women with and without PFP during functional tests and to verify whether sagittal trunk kinematics are correlated with those of the knees and ankles. Methods: A total of 30 women with PFP and 30 asymptomatic women performed single-leg squat (SLS) and step-down (SD) tests and were filmed by a camera in the sagittal plane. The trunk inclination angle, forward knee displacement, and ankle angle were calculated. Results: The PFP group exhibited less trunk flexion (SLS, p =.006; SD, p =.016) and greater forward knee displacement (SLS, p =.001; SD, p =.004) than the asymptomatic group; there was no significant difference in ankle angle (SLS, p =.074; SD, p =.278). Correlation analysis revealed that decreased trunk flexion was associated with increased forward knee displacement (SLS, r = −0.439, p =.000; SD, r = −0.365, p =.004) and ankle dorsiflexion (SLS, r = −0.339, p =.008; SD, r = −0.356, p =.005). Conclusion: Women with PFP present kinematic alterations of the trunk and knee in the sagittal plane during unipodal activities. Furthermore, the trunk and lower limb sagittal movements were interdependent. [ABSTRACT FROM AUTHOR]

Running exposes the body to physiological and mechanical stresses that generate musculoskeletal injuries, such as low back pain due to large spinal loading. Increasing running cadence may reduce impact forces and spinal shrinkage. This study aimed to determine the relationship between spinal loading and running cadence. This cross-sectional study included 15 runners from the local community (36 ± 11 years; 23 ± 2 kg.m−2, and 8 ± 9 years of running experience) who ran for 30 min (R30) and 60 min (R60) at a constant speed (10 km.h−1). The spinal loading was assessed via fine stature variation measurements before the run (baseline) at R30 and R60. Cadence was monitored via a wristwatch. The cadence ranged from 150 to 180 steps.min−1. A t-test was used to compare stature loss between R30 and R60 (relative to baseline), and a stepwise linear regression equation was used to identify the relationship between cadence and stature variation in each instant. There was a stature loss throughout the race (R30 = 5.27 ± 1.92 mm and R60 =7.51 ± 2.51 mm). A linear regression analysis revealed a negative relationship between stature loss and cadence, indicating that running at a faster cadence produces smaller spinal loading than running at slower cadences after R60 (R2 = 0.38; p<0.05). Increasing running cadence might cause less spinal loading than running with a slower cadence, which may reduce the risk of injury and back disorders in runners. • Spinal loading occurs in response to impact forces after running for 30 and 60 min. • Faster paces produced less pronounced spinal loading than running at slower paces. • Spinal loading may be reduced by adjusting the running cadence. [ABSTRACT FROM AUTHOR]

Sprint skating is essential for competitive success in hockey. Previous studies have highlighted various measures of lower-body strength and power as key factors influencing sprint performance. However, while these studies have indicated a significant association between the ability to exert greater force and impulse into the ice surface, and the capacity to achieve faster sprint skating speeds, the direct relationship between these factors remains largely inferred. What are the relationships between insole plantar force variables, sprint skating performance, and their association with physical capacity measures, in national-level male hockey athletes? Athletes (n=13) performed 25 m sprint skating trials with insole force sensors and completed: ankle dorsiflexion and hip abduction range-of-motion (ROM), countermovement jump (CMJ), seated single-leg jump, and 10–5 repeated-hop test (RHT) assessments. Relationships were assessed using Kendall's Tau rank correlations (τ), with significant relationships identified between mean relative weight acceptance impulse [WAI] and 0–5 m (τ=0.47) and total distance (τ=0.46) times. Additionally, significant associations were observed between mean relative WAI and: CMJ relative eccentric deceleration impulse (τ=0.44), CMJ eccentric peak velocity (τ=-0.46) and RHT concentric impulse (τ=-0.56). Finally, significant relationships were identified between mean relative PI for all strides and the 10–20 m split, with peak velocity (PV) (τ=-0.58 to −0.73); and between ankle dorsiflexion ROM and PV (τ=-0.57). Athletes with faster initial acceleration and overall sprint performance times demonstrated lower relative WAI during their strides and employed a jump strategy that optimized concentric impulse with a rapid eccentric phase. To attain a high PV the athletes appeared to require a stride that maximized glide and minimized vertical force, with greater ankle dorsiflexion ROM potentially facilitating this. • Insole force variables were significantly related to sprint skating performance. • Lower relative WAI was associated with faster 25 m time and initial acceleration. • Performance in the RHT and CMJ were associated with sprint performance. • Greater ankle dorsiflexion may facilitate a stride with more glide and less drag. [ABSTRACT FROM AUTHOR]

A novel fixation system for a hand‐held dynamometer (HHD) was designed to enable isometric muscle measurements on various muscle groups of strong, healthy individuals in a field setting. The objective of this study was to evaluate the intra‐ and interrater reliability of the system and determine its suitability for use by multiple researchers within large‐scale data collections during field activities. Four researchers tested eight healthy subjects, who each completed eight different maximal isometric muscle strength assessments using the HHD fixation system. Intraclass correlation coefficients (ICC) results were evaluated with a 95% confidence interval. ICC results for interrater reliability demonstrated excellent agreement of all eight measurements tested. ICC results for intrarater reliability demonstrated excellent agreement for six out of eight measurements. This system provides a new opportunity for several different high‐quality maximal muscle strength measurements to be collected by multiple data collectors on large numbers of strong, healthy individuals in a field setting. Highlights: This system is a reliable testing procedure that provides a new opportunity for several different high‐quality maximal muscle strength measurements.The system allows for laboratory quality data to be collected in the field by multiple data collectors on large numbers of strong, healthy individuals. [ABSTRACT FROM AUTHOR]

The aim of this study was to examine associations between patellofemoral pain (PFP) and musculoskeletal features (such as tendon structure and bone properties) in young (pre- and post-pubertal) female dancers. A total of 49 dancers participated in this study (mean age 13.6 ± 2.9; weight 47.0 ± 13.2; height 153.7 ± 12.9 and body mass index (BMI) 19.4 ± 3.1) and were assessed for the following factors: dance background and Tanner stage through interviews; ultrasonography assessments of bone properties and patellar tendon structure through ultrasonographic tissue characterization and quantitative ultrasound, respectively; and anthropometric measurements, muscle strength, range of motion (ROM), hypermobility and PFP through physical examinations. PFP was found in 49% of the participants. Post-pubertal dancers with no-PFP were found to have greater muscle strength, greater radial and tibial properties, and better tendon structure compared to pre-pubertal dancers with PFP and compared to pre-pubertal dancers with no-PFP [F(2, 41) = 18.64, p <.001; F(2, 41) = 20.46, p <.001; F(2, 41) = 33.06, p <.001; and, F(2, 41) = 6.02, p =.007, respectively]. Logistic regression showed that tibial bone properties and range of movement (ROM) in hip external rotation were significantly associated with PFP [odds ratio (OR) =.889 and OR = 2.653, respectively; Cox & Snell R2 =.701]. The study revealed a high prevalence of PFP among young dancers, with low bone properties and hyperjoint ROM emerging as the main factors that are related to PFP. These findings should be addressed by medical teams, athletic trainers, and dance teachers regarding the need for implementing modifications to dance training programmes and injury-prevention strategies in young pre-pubertal dancers. [ABSTRACT FROM AUTHOR]

• TIA1/SQSTM1 myopathy is one of the few digenic myopathies. • All patients carry the TIA1 p.Asn357Ser variant and four different SQSTM1 variants have been reported. • Patients present with asymmetric ankle dorsiflexion and hand finger extensors weakness. • Sensorimotor axonal polyneuropathy may be an additional feature of the disease. • TIA1 p.Asn357Ser is increased in distal myopathy patients and could act as a genetic modifier. TIA1/SQSTM1 myopathy is one of the few digenic myopathies. We describe four new French adult male patients carrying the TIA1 p.Asn357Ser and SQSTM1 p.Pro392Leu variant and review the literature to include 20 additional cases to define the spectrum of the disease. These twenty-four patients (75% males) had late-onset (52,6 ± 10,1 years), mainly asymmetric, distal ankle and hand finger extension weakness (75%), mild CK elevation (82.4%) and myopathic EMG. Two of the four French patients had sensorimotor axonal polyneuropathy and an additional one had neurogenic changes in muscle biopsy. Muscle biopsy showed rimmed vacuoles (44.4%), myofibrillar disorganization (16.7%) or both (38.9%), with P62/TDP43 aggregates. The TIA1 p.Asn357Ser variant was present in all patients and the SQSTM1 p.Pro392Leu was the most frequent (71%) of the four reported SQSTM1 variants. We reviewed the distal myopathy gene panels of Pitié-Salpêtrière's hospital cohort finding a prevalence of 11/414=2.7% of the TIA1 p.Asn357Ser variant, with two patients having an alternative diagnosis (TTN and MYH7) with atypical phenotypes, resembling some of the features seen in TIA1/SQSTM1 myopathy. Overall, TIA1/SQSTM1 myopathy has a homogenous phenotype reinforcing the pathogenicity of its digenic variants. We confirm an increased burden of the TIA1 p.Asn357Ser variant in distal myopathy patients which could act as a genetic modifier. [ABSTRACT FROM AUTHOR]

Motoneuronal persistent inward currents (PICs) are facilitated by neuromodulatory inputs but are highly sensitive to local inhibitory circuits. Estimates of PICs are reduced by group Ia reciprocal inhibition, and increased with the diffuse actions of neuromodulators released during remote muscle contraction. However, it remains unknown how motoneurons function in the presence of simultaneous excitatory and inhibitory commands. To probe this topic, we investigated motor unit discharge patterns and estimated PICs during voluntary co‐contraction of ankle muscles, which simultaneously demands the contraction of agonist–antagonist pairs. Twenty participants performed triangular ramps of both co‐contraction (simultaneous dorsiflexion and plantar flexion) and isometric dorsiflexion to a peak of 30% of their maximum muscle activity from a maximal voluntary contraction. Motor unit spike trains were decomposed from high‐density surface EMG activity recorded from tibialis anterior using blind source separation algorithms. Voluntary co‐contraction altered motor unit discharge rate characteristics. Discharge rate at recruitment and peak discharge rate were modestly reduced (∼6% change; P < 0.001; d = 0.22) and increased (∼2% change; P = 0.001, d = −0.19), respectively, in the entire dataset but no changes were observed when motor units were tracked across conditions. The largest effects during co‐contraction were that estimates of PICs (ΔF) were reduced by ∼20% (4.47 vs. 5.57 pulses per second during isometric dorsiflexion; P < 0.001, d = 0.641). These findings suggest that, during voluntary co‐contraction, the inhibitory input from the antagonist muscle overcomes the additional excitatory and neuromodulatory drive that may occur due to the co‐contraction of the antagonist muscle, which constrains PIC behaviour. Key points: Voluntary co‐contraction is a unique motor behaviour that concurrently provides excitatory and inhibitory synaptic input to motoneurons.Co‐contraction of agonist–antagonist pairs alters agonist motor unit discharge characteristics, consistent with reductions in persistent inward current magnitude. [ABSTRACT FROM AUTHOR]

Purpose: Static stretching (SS) improves flexibility but may impair the accuracy of joint position sense. Therefore, this study aimed to investigate the acute effects and time course of SS on the accuracy of joint position sense, range of motion (ROM), and muscle–tendon unit (MTU) stiffness. Methods: This study randomly assigned 16 healthy, young males to the SS and control conditions. SS intervention in the SS condition was performed on the plantar flexors of the dominant leg for three sets of 60 s. The participants were instructed to sit for 240 s in the control condition. The ankle dorsiflexion (DF) ROM, passive torque at DF ROM, MTU stiffness, and joint position sense on the dominant leg side were measured before (PRE) and immediately (POST) and at 5, 10, and 20 min postintervention. Results: A significant interaction effect was observed in the relative error in the joint position sense, and significant increases were noted in POST compared to PRE in the SS condition. Further, significant interactions were observed in DF ROM, passive torque at DF ROM, and MTU stiffness. The SS condition demonstrated significant increases in DF ROM and passive torque at DF ROM compared to PRE with POST, 5 min, and 10 min, and MTU stiffness significantly decreased in POST compared with PRE. Conclusion: Our results indicated that the accuracy of the joint position sense decreased immediately after SS, but returned to baseline in a very short time. [ABSTRACT FROM AUTHOR]

Introduction: Wearable exoskeletons are emerging technologies for providing movement assistance and rehabilitation for people with motor disorders. In this study, we focus on the specific gait pathology dropfoot, which is common after a stroke. Dropfoot makes it difficult to achieve foot clearance during swing and heel contact at early stance and often necessitates compensatory movements. Methods: We developed a soft ankle exoskeleton consisting of actuation and transmission systems to assist two degrees of freedom simultaneously: dorsiflexion and eversion, then performed several proof-of-concept experiments on non-disabled persons. The actuation system consists of two motors worn on a waist belt. The transmission system provides assistive force to the medial and lateral sides of the forefoot via Bowden cables. The coupling design enables variable assistance of dorsiflexion and inversion at the same time, and a force-free controller is proposed to compensate for device resistance. We first evaluated the performance of the exoskeleton in three seated movement tests: assisting dorsiflexion and eversion, controlling plantarflexion, and compensating for device resistance, then during walking tests. In all proof-of-concept experiments, dropfoot tendency was simulated by fastening a weight to the shoe over the lateral forefoot. Results: In the first two seated tests, errors between the target and the achieved ankle joint angles in two planes were low; errors of <1.5° were achieved in assisting dorsiflexion and/or controlling plantarflexion and of <1.4° in assisting ankle eversion. The force-free controller in test three significantly compensated for the device resistance during ankle joint plantarflexion. In the gait tests, the exoskeleton was able to normalize ankle joint and foot segment kinematics, specifically foot inclination angle and ankle inversion angle at initial contact and ankle angle and clearance height during swing. Discussion: Our findings support the feasibility of the new ankle exoskeleton design in assisting two degrees of freedomat the ankle simultaneously and show its potential to assist people with dropfoot and excessive inversion. [ABSTRACT FROM AUTHOR]

The addition of highly responsive lightweight foam and a stiff plate in the midsole of long-distance road racing shoes has yielded significant energetic cost savings that have translated to notable improvements in performance. This new foam and stiff plate technology have since been implemented in long-distance track spikes, where performances have also improved. However, the impact of spikes with advanced footwear technology (AFT) on distance running biomechanics has been studied minimally to date. Therefore, the purpose of this study was to compare running biomechanics between two spikes which incorporate AFT (Nike ZoomX Dragonfly, Nike Air Zoom Victory) to a traditional spike (Nike Zoom Matumbo). Seventeen competitive collegiate female runners completed 60 m trials at their 5k race pace in each spike condition while outfitted with IMU sensors and plantar pressure insoles. We observed significantly lower peak ankle dorsiflexion in the Dragonfly and Victory compared to the Matumbo and lower whole foot, forefoot and rearfoot peak and average pressure in the Dragonfly compared to the Matumbo and Victory. The acute biomechanical alterations observed in this study warrant future investigation into the association between running biomechanics and racing performance in track spikes with advanced footwear technology. [ABSTRACT FROM AUTHOR]

Background: In recent decades, early rehabilitation after Achilles tendon rupture (ATR) repair has been proposed. The aim of this prospective cohort study was to compare different immobilisation durations in order to determine the optimal duration after open surgery for ATR repair. Methods: This study included 1088 patients (mean age, 34.9 ± 5.9 years) who underwent open surgery for acute ATR repair. The patients were categorised into four groups (A, B, C, and D) according to postoperative immobilisation durations of 0, 2, 4, and 6 weeks, respectively. All patients received the same suture technique and a similar rehabilitation protocol after brace removal,; they were clinically examined at 2, 4, 6, 8, 10, 12, 14, and 16 weeks postoperatively, with a final follow-up at a mean of 19.0 months. The primary outcome was the recovery time for the one-leg heel-rise height (OHRH). Secondary outcomes included the time required to return to light exercise (LE) and the recovery times for the range of motion (ROM). Data regarding the surgical duration, complications, the visual analogue scale (VAS) score for pain, the Achilles tendon Total Rupture Score (ATRS), and the American Orthopaedic Foot and Ankle Society (AOFAS) Ankle-Hindfoot Scale score were also collected. Results: The recovery times for OHRH, LE, and ROM were significantly shorter in groups A and B than in groups C and D (P < 0.001). The VAS scores decreased over time, reaching 0 in all groups by 10 weeks. The mean scores in groups A and B were higher than those in the other groups at 2 and 4 weeks (P < 0.001), whereas the opposite was true at 8 weeks (P < 0.001). ATRS and the AOFAS Ankle-Hindfoot scale score increased across all groups over time, showing significant between-group differences from weeks 6 to 16 (P < 0.001) and weeks 6 to 12 (P < 0.001). The mean scores were better in groups A and B than in groups C and D. Thirty-eight complications (3.5%) were observed, including 20 re-ruptures and 18 superficial infections. All complications were resolved at the last follow-up, with no significant between-group differences. Conclusions: Immobilisation for 2 weeks after open surgery for ATR repair may be the optimal strategy for early rehabilitation with relatively minimal pain and other complications. Trial registration: ClinicalTrials.gov (NCT04663542). [ABSTRACT FROM AUTHOR]

We report a first case of hallux rigidus successfully treated in an elderly patient by intra-articular infiltration of cross-linked hyaluronic acid (HA) 21 mg/mL with mannitol (Desirial Plus) and review the previous literature on the different compositions of HA infiltrative treatment applied to hallux rigidus. A 77-year-old female patient with moderate unilateral pain of 6 months of evolution and stiffness of the movement of the first metatarsophalangeal joint of the left foot, corresponding to grade 2 of the classification proposed by Coughlin and Shurnas. The objective of the study was to perform a pilot test to (a) evaluate the correct technique of intra-articular infiltration as well as (b) the use of a commercial cross-linked HA 21 mg/mL with mannitol, to a voluntary patient diagnosed with hallux rigidus. A single cross-linked HA infiltration is applied to the first metatarsophalangeal joint with an administered amount of 1 mL. The loaded dorsiflexion, the unloaded dorsiflexion, and the unloaded plantarflexion angles of the first metatarsophalangeal joint improved from 15°, 20°, and 10°, respectively, before injection to 45°, 52°, and 22°, respectively, at 14 days after injection. Moreover, these improvements maintained until the final follow-up (400 days). The intensity of pain, according to the visual analog scale, improved from 7 of 10 before the injection, passing through 4 of 10 at 14 days after the injection, to 1 of 10 at 60 days after the injection. Cross-linked HA 21 mg/mL with mannitol improves symptomatology, joint mobility of the first metatarsophalangeal joint, and quality of life in the patient with stiff hallux submitted to the pilot test. These effects have been maintained for more than 14 months. [ABSTRACT FROM AUTHOR]

Individuals with neuromuscular pathologies are often prescribed an ankle-foot orthosis (AFO) to improve their gait mechanics by decreasing pathological movements of the ankle and lower limb. AFOs can resist or assist excessive or absent muscular forces that lead to tripping, instability, and slow inefficient gait. However, selecting the appropriate AFO with mechanical characteristics, which limit pathological ankle motion in certain phases of the gait cycle while facilitating effective ankle movement during other phases, requires careful clinical decision-making. The aim of this study is to propose an explicit methodology for the adjustment of multi-function articulated AFOs in clinical settings. A secondary aim is to outline the evidence supporting this methodology and to identify gaps in the literature as potential areas for future research. An emerging class of AFO, the multi-function articulated AFO, offers features that permit more comprehensive, iterative, and reversible adjustments of AFO ankle alignment and resistance to ankle motion. However, no standard method exists for the application and optimization of these therapeutic devices in the clinical setting. Here we propose an evidence-guided methodology applicable to the adjustment of multi-function articulated AFOs in the clinical setting. Characteristic load-deflection curves are given to illustrate the idealized yet complex resistance-angle behavior of multi-function articulated AFOs. Research is cited to demonstrate how these mechanical characteristics can help mitigate specific pathologic ankle and knee kinematics and kinetics. Evidence is presented to support the effects of systematic adjustment of high resistance, alignable, articulated AFOs to address many typical pathomechanical patterns observed in individuals with neuromuscular disorders. The published evidence supporting most decision points of the algorithm is presented with identified gaps in the evidence. In addition, two hypothetical case examples are given to illustrate the application of the method in optimizing multi-function articulated AFOs for treating specific gait pathomechanics. This method is proposed as an evidence-guided systematic approach for the adjustment of multi-function articulated AFOs. It utilizes observed gait deviations mapped to specific changes in AFO alignment and resistance settings as a clinical tool in orthotic treatment for individuals with complex neuromuscular gait disorders. [ABSTRACT FROM AUTHOR]

Post-Acute sequelae of SARS-CoV-2 (PASC) is a multisystem disorder causing persistent musculoskeletal deconditioning and reduced lower extremity strength. Electrical stimulation (E-Stim) to the gastrocnemius muscle can enhance strength outcomes by increasing the frequency of muscle fiber activation. We investigated its effect on individuals with PASC. Participants were randomized into intervention (IG) or control (CG) groups. The IG self-administered daily one-hour E-Stim to both their gastrocnemius muscles using a functional device over 4-week, while the CG used a sham device. Primary outcomes were ankle dorsiflexion strength assessed via dynamometry during maximum voluntary contractions, and gastrocnemius voluntary activation (GVA) via surface electromyography. The secondary outcome assessed activities of daily living (ADL), instrumental ADL, and mobility queries. Percentage improvement was calculated. Eighteen patients were analyzed (IG = 10; CG = 8). After 4 week, the IG showed a significantly higher improvement in ankle dorsiflexion strength (222.64%) compared to the CG (51.27%, p = 0.002). Additionally, the IG's ankle dorsiflexion strength improvement significantly correlated with GVA improvement (rho = 0.782) at 4 week. The secondary outcomes did not reveal significant changes in neither group. Self-administered gastrocnemius E-Stim improves ankle dorsiflexion strength in individuals with PASC. However, larger sample sizes and longer interventions are needed to validate these findings. [ABSTRACT FROM AUTHOR]