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Podiatry eUpdate

Autumn - Winter 2016 __________________________________________________________________________________________

1. AKEHI, KAZUMA, LONG, BLAINE C., WARREN, ARIC J. and GOAD, CARLA L. Ankle Joint Angle and Lower Leg Musculotendinous Unit Responses to Cryotherapy J STRENGTH CONDITION RES (LIPPINCOTT WILLIAMS WILKINS) 2016 30 9 2482-2492

2. Bech, Niels H., de Leeuw, Peter A. J. and Haverkamp, Daniel. Posterior Ankle Impingement in Two Athletic Twin Brothers, Could Genetics Play a Role? J. Foot Ankle Surg. 2016 55 5 1021-1023

3. Booth, Sean, Bhosale, Abhijit, Mustafa, Abubakar, Shenoy, Ravi and Pillai, Anand. Triple osteotomy for the correction of severe hallux valgus deformity: Patient reported outcomes and radiological evaluation The Foot 2016 28 30-35 Abstract Background Symptomatic Hallux valgus can be treated with metatarsal osteotomy combined with proximal phalangeal osteotomy, however this might not be sufficient to treat severe HV deformities. Methods Fifteen feet in eleven female patients treated with double first metatarsal and proximal phalanx osteotomies without lateral release were prospectively studied and outcome measures including radiological angles and validated patient reported outcome scores collected. Results Mean radiological follow up was 15 months and PROMs data 17 months. Mean hallux valgus and intermetatarsal angles were corrected from 45 to 24.7 ° and 18.7 to 7.4 ° respectively. There was an eight degree recurrence of hallux valgus angle. There was no wound problems, non-unions or evidence of avascular necrosis. The EQ-5D descriptive index showed a non-statistically significant improvement. All three elements of the MOxFQ score showed a statistically significant improvement: Forefoot pain (59–26.8), Walking and Stability (49.9–29.6) and Social Interaction (56.4–33.1) Conclusion Triple osteotomy, without a lateral soft tissue release, leads to good radiological and functional outcomes in those with severe hallux valgus deformity. Patients need to be warned of the recovery time and potential for future metalwork removal. The risk of early recurrence suggests that a lateral release should be included in order to maintain a long lasting correction.

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4. Brennan, C. Determination of proof of principle of the star excursion balance test as a rehabilitation tool post ankle fracture MANUAL THER 2016 25 e159-e159

5. Brorsson, A., Olsson, N., Nilsson-Helander, K., Karlsson, J., Eriksson, B. I. and Silbernagel, K. G. Recovery of calf muscle endurance 3 months after an Achilles tendon rupture Scand. J. Med. Sci. Sports 2016 26(7):844-853

6. Burrus, M. T., Werner, Brian C., Carr, James B., Perumal, Venkat and Park, Joseph S. Increased Failure Rate of Modified Double Arthrodesis Compared With Triple Arthrodesis for Rigid Pes Planovalgus J. Foot Ankle Surg. 2016 55 1169-1174

7. Cheung,R. T. H., Sze,L. K. Y., Mok,N. W. and Ng,G. Y. F. Intrinsic foot muscle volume in experienced runners with and without chronic plantar fasciitis J. Sci. Med. Sport 2016 19 9 713-715 Objectives: Plantar fasciitis, a common injury in runners, has been speculated to be associated with weakness of the intrinsic foot muscles. A recent study reported that atrophy of the intrinsic forefoot muscles might contribute to plantar fasciitis by destabilizing the medial longitudinal arch. However, intrinsic foot muscle volume difference between individuals with plantar fasciitis and healthy counterparts remains unknown. This study examined the relationship of intrinsic foot muscle volume and incidence of plantar fasciitis.Design: Case-control study.Methods: 20 experienced (=5 years) runners were recruited. Ten of them had bilateral chronic (=2 years) plantar fasciitis while the others were healthy characteristics-matched runners. Intrinsic muscle volumes of the participants' right foot were scanned with a 1.5T magnetic resonance system and segmented using established methods. Body-mass normalized intrinsic foot muscle volumes were compared between runners with and without chronic plantar fasciitis.Results: There was significant greater rearfoot intrinsic muscle volume in healthy runners than runners with chronic plantar fasciitis (Cohen's d=1.13; p=0.023). A similar trend was also observed in the total intrinsic foot muscle volume but it did not reach a statistical significance (Cohen's d=0.92; p=0.056). Forefoot volume was similar between runners with and without plantar fasciitis.Conclusions: These results suggest that atrophy of intrinsic foot muscles may be associated with symptoms of plantar fasciitis in runners. These findings may provide useful information in rehabilitation strategies of chronic plantar fasciitis. Order.

8. Choi, Seung-Myung, Cho, Byung-Ki and Park, Kyoung-Jin. Percutaneous Deltoid Ligament Augmentation Using Suture Tape for Medial Ankle Instability J. Foot Ankle Surg. 2016 55 6 1307-1311

9. Dehghan, Niloofar, McKee, Michael D., Jenkinson, Richard J., et al. Early Weightbearing and Range of Motion Versus Non-Weightbearing and Immobilization After Open Reduction and Internal Fixation of Unstable Ankle Fractures: A Randomized Controlled Trial J. Orthop. Trauma 2016 30 7 345-352 Objectives: The aim of this study was to compare early weightbearing and range of motion (ROM) to nonweightbearing and immobilization in a cast after surgical fixation of unstable ankle fractures.Design: Multicentre randomized controlled trial.Setting: Two-level one trauma centers.Patients: One hundred ten patients who underwent open reduction and internal fixation of an unstable ankle fracture were recruited and

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randomized.Intervention: One of 2 rehabilitation protocols: (1) Early weightbearing (weightbearing and ROM at 2 weeks, Early WB) or (2) Late weightbearing (nonweightbearing and cast immobilization for 6 weeks, Late WB).Main Outcome Measurements: The primary outcome measure was time to return to work (RTW). Secondary outcome measures included: ankle ROM, SF-36 heath outcome scores, Olerud/Molander ankle function score, and rates of complications.Results: There was no difference in RTW. At 6 weeks postoperatively, patients in the Early WB group had significantly improved ankle ROM (41 vs. 29, P < 0.0001); Olerud/Molander ankle function scores (45 vs. 32, P = 0.0007), and SF-36 scores on both the physical (51 vs. 42, P = 0.008) and mental (66 vs. 54, P = 0.0008) components. There were no differences with regard to wound complications or infections and no cases of fixation failure or loss of reduction. Patients in the Late WB group had higher rates of planned/performed hardware removal due to plate irritation (19% vs. 2%, P = 0.005).Conclusions: Given the convenience for the patient, early improved functional outcome, and the lack of an increased complication rate, we recommend early postoperative weightbearing and ROM in patients with surgically treated ankle fractures. Level Of Evidence: Therapeutic Level I. See Instructions for Authors for a complete description of levels of evidence.

10. Deschamps, Kevin, Dingenen, Bart, Pans, Femke, Van Bavel, Isabelle, Matricali, Giovanni Arnoldo and Staes, Filip. Effect of taping on foot kinematics in persons with chronic ankle instability J. Sci. Med. Sport 2016 19 541-546 Objectives: To investigate differences in rigid-foot and multi-segmental foot kinematics between healthy (control) and chronic ankle instability (CAI) participants during running and to evaluate the effect of low-Dye (LD) and high-Dye (HD) taping on foot kinematics of CAI subjects.Design: Cross-sectional, comparative study.Methods: Kinematic data of 12 controls and 15 CAI participants were collected by a 3D motion analysis system during running. CAI participants performed barefoot (CAI_BF) running trials as well as trials with taping. A rigid Plug-in gait Model and the Rizzoli 3D Multi-Segment Foot Model were used. Groups were compared using one-dimensional statistical parametric mapping.Results: An increased inversion, a decreased dorsiflexion between the foot and tibia and a decreased external foot progression angle were found during terminal swing and early stance in the CAI_BF group. With respect to the taped conditions, post-hoc SPM{t} calculations highlighted a more dorsiflexed rearfoot (38-46% running cycle) in the CAI_HD compared to the CAI_LD, and a more inverted Mid-Met angle (6-24% running cycle) in the CAI_LD compared to the CAI_BF condition.Conclusions: This study revealed significant differences in rigid foot and multi-segmental foot kinematics between all groups. As high-dye taping embraces shank-rearfoot and forefoot, it seems to have better therapeutic features with respect to low-dye taping as the latter created a more inverted forefoot which may not be recommended in this population. Order.

11. Dolphin, Philippa, Bainbridge, Kelly, Mackenney, Paul and Dixon, John. Functional dynamic bracing and functional rehabilitation for Achilles tendon ruptures: A case series P HYSIOTHER PRACT RES 2016 37 2 119-125 Order.

12. Donovan, Luke, Hart, Joseph M., Saliba, Susan, et al. Effects of ankle destabilization devices and rehabilitation on gait biomechanics in chronic ankle instability patients: A randomized controlled trial PHYS THER SPORT 2016 21 46-56

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13. EUN-KYUNG,K. I. M. and JIN SEOP,K. I. M. The effects of short foot exercises and arch support insoles on improvement in the medial longitudinal arch and dynamic balance of flexible flatfoot patients J PHYS THER SCI 2016 28 3136-3139

14. Farmani, Farzad, Mohseni-Bandpei, Mohammad, Bahramizadeh, Mahmood, Aminian, Gholamreza, Abdoli, Ali and Sadeghi-Goghari, Mohammad. The Influence of Rocker Bar Ankle Foot Orthosis on Gait in Patients with Chronic Hemiplegia J STROKE CEREBROVASC DIS 2016 25 8 2078-2082 Background: This study aimed to evaluate the effect of rocker bar ankle foot orthosis (RAFO) on the spatiotemporal characteristics of gait in chronic hemiplegic patients compared with the effect of solid ankle foot orthosis (SAFO).Methods: Following ethical approval, 18 patients with chronic hemiplegia, at least 6 months post stroke, were investigated in barefoot condition, with SAFO and RAFO in random sequences. Their spatiotemporal characteristics were examined by 2 force platforms and a Vicon motion analysis system.Results: There were significant changes in spatiotemporal outcome measures between barefoot condition and using SAFO and RAFO (P  .05). Furthermore, RAFO led to significant increases in hip extension and knee flexion at toe-off, whereas SAFO did not change these parameters (P < .05).Conclusion: Findings of the present study showed that RAFO further improves gait abilities in chronic hemiplegic patients compared with SAFO, which could be due to the positive effect of added rocker bar on push-off function during the late stance phase of gait.

15. Feger,Mark A. and Hertel,Jay. Surface electromyography and plantar pressure changes with novel gait training device in participants with chronic ankle instability Clin. Biomech. 2016 37 117-124

16.Fernando, Malindu Eranga, Crowther, Robert G., Lazzarini, Peter A., Sangla, Kunwarjit S., Buttner, Petra and Golledge, Jonathan. Gait parameters of people with diabetes-related neuropathic plantar foot ulcers Clin. Biomech. 2016 37 98-107

17. Gocke,Thomas V. Recognizing and managing common foot injuries JAAPA J AM ACAD PHYSICIAN ASSIST (LIPPINCOTT WILLIAMS & WILKINS)201609918-26

18. Gogna, Paritosh, Gaba, Sahil, Mukhopadhyay, Reetadyuti, Gupta, Rakesh, Rohilla, Rajesh and Yadav, Lakhpat. Plantar fasciitis: A randomized comparative study of platelet rich plasma and low dose radiation in sportspersons The Foot 2016 28 16-19 Abstract Background Plantar Fasciitis makes up about 15% of patients requiring professional care due to foot symptoms. The treatment methods are numerous with none proving to be clearly superior to others. We aimed to compare two common treatment methods in search of the best treatment. Method All consecutive sportspersons presenting to our OPD with clinical diagnosis of plantar fasciitis underwent treatment consisting of stretching exercises, activity modification, and NSAID’s for 6 months. First 40 patients who did not respond to the treatment were divided randomly into two groups of 20 patients each, Group A (Platelet rich plasma − PRP) and Group B (low dose radiation − LDR). At the time of final follow-up (6 months) the mean improvement in the pain score (Visual-Analogue-Scale), American Orthopaedic Foot and Ankle Score (AOFAS) and Plantar fascia thickness

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on ultrasound were compared. Result Significant improvement in all 3 parameters was noted at the time of final follow up within both groups. When compared to each other, the difference in outcome of both these Groups on the given 3 parameters came out to be insignificant (p > 0.05). Conclusion PRP is as good as LDR in patients with chronic recalcitrant plantar fasciitis not responding to physical therapy.

19. Hartley, Emily M., Hoch, Matthew C. and McKeon, Patrick O. Reliability and responsiveness of gait initiation profiles in those with chronic ankle instability Gait Posture 2016 49 86-89 Individuals with chronic ankle instability (CAI) have demonstrated deviations in gait initiation (GI) compared to healthy individuals. However, the intersession reliability of GI measures remains unknown in this population. The objective of this study was to determine the reliability and responsiveness of GI measures between two testing days in those with CAI. Twelve individuals with CAI volunteered. Participants performed barefoot GI on a force plate which captured center of pressure (COP). Data was collected on two separate occasions separated by one week. The GI profile was separated into three phases (S1, S2, and S3). S1 began from the deviation of normal balanced standing to the most posterolateral displacement under the stepping limb. S2 began from the end of S1 to the maximum medial position under the stance foot. S3 began at the end of S2 and continued until the vertical ground reaction force dropped below 100N. COP displacement (cm) was calculated as the sum of resultant vectors of the medial-lateral and anterior-posterior excursions for adjacent COP data points within each phase. The averages of 5 trials were used for analyses. Intraclass correlation coefficients (ICC(2,5)), standard error of measurement, and minimum detectable change (MDC) were calculated to determine reliability and responsiveness. S1, S2, and S3 displacement values were highly reliable between days (ICC(2,5) ≥0.76) with the exception of anterior-posterior S1 and medial-lateral S3. MDC values were relatively small (0.6-2.2cm). GI can be reliably assessed in those with CAI which is important for identifying interventions to alter GI profiles in these individuals.

20. Henricson, Anders, Kamrad, Ilka, Rosengren, Björn and Carlsson, Åke. Bilateral Arthrodesis of the Ankle Joint: Self-Reported Outcomes in 35 Patients From the Swedish Ankle Registry J. Foot Ankle Surg. 2016 55 6 1195-1198

21. Hogan, Kathleen K., Powden, Cameron J. and Hoch, Matthew C. The influence of foot posture on dorsiflexion range of motion and postural control in those with chronic ankle instability Clin. Biomech. 2016 38 63-67

22. HUPPIN, LAWRENCE. A New Look at Orthotics for Diabetics PODIATRY MANAGE 2016 35 7 147-152

23. Imai, Kan, Ikoma, Kazuya, Kido, Masamitsu, et al. Nonosseous Tarsal Coalition of the Lateral Cuneocuboid Joint: A Case Report J Foot Ankle Surg.2016 55 5 1072-1075

24. Jain, Nitin B., Kuhn, John E., Murrell, William D. and Archer, Kristin R. What's New in Orthopaedic Rehabilitation J BONE JOINT SURG (AM) 2016 98 22 1937-1942 The article focuses on several researches on orthopaedic rehabilitation published from March 2015 to February 2016 in several periodicals related to orthopaedics. Topics discussed include administration of hyaluronic acid is a

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pharmacological approach to the management of knee osteoarthritis, randomized controlled trial compared surgery with physical therapy for carpal tunnel syndrome and plyometric exercises during rehabilitation after Anterior Cruciate Ligament (ACL) reconstruction.

25. Jielile, Jiasharete, Badalihan ,Ayinazi, Qianman, Bayixiati, et al. Clinical outcome of exercise therapy and early post-operative rehabilitation for treatment of neglected Achilles tendon rupture: a randomized study Knee Surg. Sports Traumatol. Arthrosc. 2016 24 2148-2155 Purpose: Treatment of neglected Achilles tendon rupture is very challenging. This randomized study aimed to compare the clinical outcome of early post-operative rehabilitation (EPR) with post-operative cast immobilization (PCI).Methods: Fifty-seven patients with neglected Achilles tendon rupture were randomized to receive EPR (n = 26) or PCI (n = 31) management following surgery. Clinical outcome was monitored by follow-up at weeks 8, 12, 18 and 26 and year 2. The significance of intergroup differences from the Leppilahti scoring system (LSS), ultrasonography, multislice spiral computerized tomography (MSCT) and electromyography was assessed.Results: Ultrasonography and MSCT revealed no occurrence of tendon elongation or adhesion. Four patients could perform sustained single-leg heel-raise exercise for 60 s at post-operative day 40. The PCI group also showed increased post-operative LSS score, but recovery was slower. Post-operative complications, such as ankle joint ankylosis and osteoporosis, only occurred in the PCI group.Conclusions: Compared with cast immobilization, early post-operative rehabilitation results in better clinical outcome and faster overall tendon regeneration of neglected Achilles tendon rupture.Level Of Evidence: II.

26. Kalirathinam, Deivendran, Saha, Soumendra, Singh, Taran, et al. Effect of Neuromuscular Training in the Rehabilitation of Ankle Lateral Ligament Injuries - A Review HEALTH SCI J 2016 10 3 1-10

27. Karaaslan, Fatih, Mermerkaya, Musa Ugur, Çirakli, Alper, Karaoglu, Sinan and Duygulu, Fuat. Surgical versus conservative treatment following acute rupture of the Achilles tendon: is there a pedobarographic difference? THER CLIN RISK MANAGE 2016 12 1311-1315 Introduction: Controversy remains regarding the optimal treatment method and postoperative rehabilitation of acute Achilles tendon ruptures. In this study, pedobarographic assessments of surgical and conservative treatments were compared.Material and Methods: A prospective assessment was made of 16 patients (eight surgical, eight conservative) and eight healthy controls using a plantar pressure measurement system. Biomechanical gait parameters were obtained using the Footscan dynamic gait analysis system. Kruskal-Wallis and Mann-Whitney U-tests were used for the evaluation of data.Results: Nineteen males and five females were assessed, with an average age of 42.0±11.9 years. Follow-up was completed in 16 patients. No statistically significant difference was determined between the two treatment groups with regard to the gait analysis, but a difference was observed with the control group (P<0.001). All patients were able to resume their prior activities after 6 months and regained normal ranges of motion, with a high rate of satisfaction. Most of the patients (75%) were able to return to their pre-injury level of activities.Conclusion: Satisfactory results were obtained through conservative treatment of acute ruptures of the Achilles tendon. No significant differences or complications were observed in the group managed conservatively

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versus the group treated surgically. Further studies including 3D gait analyses and tendon biomechanical research are required to further investigate this issue.

28. Kirby, Jessica L., Houston, Megan N., Gabriner, Michael L. and Hoch, Matthew C. Relationships between mechanical joint stability and somatosensory function in individuals with chronic ankle instability The Foot 2016 28 1-6 Abstract Background Individuals with chronic ankle instability (CAI) have demonstrated alterations in ankle mechanics and deficits in sensory function. However, relationships between mechanical stability and somatosensory function have not been examined, nor have those between somatosensory function and injury history characteristics. Therefore, the objective of this study was to examine relationships between (1) somatosensory function and mechanical stability and (2) somatosensory function and injury history characteristics. Methods Forty adults with CAI volunteered to participate. In a single testing session, participants completed mechanical and sensory assessments in a counterbalanced order. Dependent variables included anterior/posterior displacement (mm), inversion/eversion rotation (°), SWM index values, JPS absolute error (°), number of previous ankle sprains, and number of “giving way” episodes in the previous 3 months. Spearman's Rho correlations examined the relationships between somatosensory function and (1) mechanical stability and (2) injury history characteristics (p 0.11), and all r-values were considered weak. Conclusions These results revealed somatosensory function was not significantly correlated to mechanical stability or injury history characteristics. This indicates peripheral sensory impairments associated with CAI are likely caused by factors other than mechanical stability and injury history characteristics.

29. Kuni,B., Mussler,J., Kalkum,E., Schmitt,H. and Wolf,S. I. Effect of kinesiotaping, non-elastic taping and bracing on segmental foot kinematics during drop landing in healthy subjects and subjects with chronic ankle instability Physiotherapy 2016 102 3 287-293

30. Ledoux,William R., Pai,Shruti, Shofer,Jane B. and Wang,Yak-Nam. The association between mechanical and biochemical/histological characteristics in diabetic and non-diabetic plantar soft tissue J. Biomech. 2016 49 14 3328-3333 Abstract Diabetes, and the subsequent complication of lower limb ulcers leading to potential amputation, remains an important health care problem in United States, even with declining amputation rates. It has been well documented that diabetes can alter the mechanical properties (i.e., increased stiffness) of the plantar soft tissue, although this finding is not universal. Similarly, biochemical, and histological changes have been found in the plantar soft tissue, but, as with the mechanical changes, these findings are not consistent across all studies. Our group׳s work has demonstrated that diabetes increases plantar soft tissue modulus and increases elastic septal thickness. The purpose of the current study was to explore the association between mechanical, biochemical and histological properties. Using previously collected data, a linear mixed effects regression was conducted. The correlations were weak; of the 32 that were tested, only 3 (modulus to septal thickness when location was accounted for, energy loss to total collagen, and energy loss to collagen/elastin ratio) were statistically significant, none with an R2 greater than 0.10. The main differences in the means were increased tissue stiffness and increased septal wall thickness, both trends were supported in the

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literature. However, as the correlations were weak, it is likely that another unexamined biochemical factor (perhaps collagen crosslinking) is associated with the mechanical tissue changes.

31. Li, Hong-Yun and Hua, Ying-Hui. Achilles Tendinopathy: Current Concepts about the Basic Science and Clinical Treatments BIOMED RES INT 2016 1-9

32. Lööf,Elin, Andriesse,Hanneke, André,Marie, Böhm,Stephanie and Broström,Eva,W. Gait in 5-year-old children with idiopathic clubfoot: A cohort study of 59 children, focusing on foot involvement and the contralateral foot ACTA ORTHOP 2016 105 522-528

33. Luc-Harkey, Brittney, Harkey, Matthew S., Stanley, Laura E., Blackburn, J. T., Padua, Darin A. and Pietrosimone, Brian. Sagittal plane kinematics predict kinetics during walking gait in individuals with anterior cruciate ligament reconstruction Clin. Biomech. 2016 39 9-13

34. Mallows, A. J., Debenham, J. and Littlewood, C. Are psychological variables a feature in tendinopathy: a systematic review Physiotherapy 2016 102 e154-e155

35. Mark-Christensen, Troels, Troelsen, Anders, Kallemose, Thomas and Barfod, Kristoffer. Functional rehabilitation of patients with acute Achilles tendon rupture: a meta-analysis of current evidence Knee Surg. Sports Traumatol. Arthrosc. 2016 066 1852-1859 Purpose: The optimal treatment for acute Achilles tendon rupture (ATR) is continuously debated. Recent studies have proposed that the choice of either operative or non-operative treatment may not be as important as rehabilitation, suggesting that functional rehabilitation should be preferred over traditional immobilization. The purpose of this meta-analysis of randomized controlled trials (RCTs) was to compare functional rehabilitation to immobilization in the treatment of ATR.Method: This meta-analysis was conducted using the databases: PubMed, EMBASE, Rehabilitation and Sports Medicine Source, AMED, CINAHL, Cochrane Library and PEDro using the search terms: "Achilles tendon," "rupture," "mobilization" and "immobilization". Seven RCTs involving 427 participants were eligible for inclusion, with a total of 211 participants treated with functional rehabilitation and 216 treated with immobilization.Results: Re-rupture rate, other complications, strength, range of motion, duration of sick leave, return to sport and patient satisfaction were examined. There were no statistically significant differences between groups. A trend favoring functional rehabilitation was seen regarding the examined outcomes.Conclusion: Functional rehabilitation after acute Achilles tendon rupture does not increase the rate of re-rupture or other complications. A trend toward earlier return to work and sport, and increased patient satisfaction was found when functional rehabilitation was used. The present literature is of low-to-average quality, and the basic constructs of the examined treatment and study protocols vary considerably. Larger, randomized controlled trials using validated outcome measures are needed to confirm the findings.Level Of Evidence: II. Order.

36. Mason-Mackay, Anna, Whatman, Chris, Reid, Duncan and Lorimer, Anna. The effect of ankle bracing on landing biomechanics in female netballers PHYS THER SPORT 2016 20 13-18

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37. Menger, Björn, Kannenberg, Andreas, Petersen, Wolf, et al. Effects of a novel foot-ankle orthosis in the non-operative treatment of unicompartmental knee osteoarthritis Arch. Orthop. Trauma Surg.2016 136 1281-1287 Introduction: Unloader braces are non-surgical treatment options for patients with unicompartmental knee osteoarthritis (OA). However, many patients do not adhere to brace treatment because of complications related to discomfort and poor fit. An alternative to knee bracing is an ankle-foot orthosis (AFO) with a lever arm that presses the lower leg into valgus or varus. The aim of this study is to evaluate the clinical benefits of this AFO for patients with unicompartmental knee OA.Materials and Methods: Twenty-three patients with knee OA were enrolled in this observational study. The primary clinical outcome measure was the Western Ontario and McMasters Universities Arthritis Index (WOMAC) total score. Secondary outcome measures included WOMAC subscores, visual analogue pain scale, activity restriction and complication rate. Clinical scores were collected at start and 3, 6, 9, and 12 months after enrollment. Statistical evaluation was performed using the Student's t test.Results: Of the patients enrolled, 83 % suffered from medial compartment OA. Most patients had Grade II OA according to the Kellgren and Lawrence classification. WOMAC total score, both subscores and visual analogue pain scale were significantly improved over time. Patients also noted a reduction in restrictions to activities of daily living and sport-related activities while using the AFO. No patients discontinued orthosis use because of adverse effects. Two types of complications were noted: discomfort or light pressure sores around the ankle (7 patients), and wear and tear of the shoe in which the AFO was worn (14 patients).Conclusions: This observational study suggests that this AFO is effective at significantly reducing pain and stiffness as well as improving the physical function of patients with mild to moderate unicompartmental osteoarthritis of the knee.

38. Menz, Hylton B. Chronic foot pain in older people Maturitas 201 91 110-114 Foot pain is a common accompaniment of advancing age, affecting at least one in four older people. However, management of foot pain is a largely undervalued aspect of geriatric health care, resulting in many older people needlessly enduring chronic foot pain and related disability. The aim of this review is to provide an overview of (i) the prevalence and risk factors for foot pain, (ii) the impact of foot pain on mobility and quality of life, and (iii) the conservative management of foot pain. The available evidence indicates that although foot pain is common and disabling in older people, conservative interventions such as routine foot care, footwear advice and foot orthoses are effective at reducing foot pain and may also assist in maintaining mobility and independence in this age group.

39. Sawada,Tomonori, Tokuda,Kazuki, Tanimoto,Kenji, et al. Foot alignments influence the effect of knee adduction moment with lateral wedge insoles during gait Gait Posture 2016 49 451-456 Lateral wedge insoles (LWIs) reduce the peak external knee adduction moment (KAM). However, the efficacy of LWIs is limited in certain individuals for whom they fail to decrease KAM. Possible explanations for a lack of desired LWI response are variations in foot alignments. The purpose of this study was to evaluate whether the immediate biomechanical effects of LWIs depend on individual foot alignments during gait. Fifteen healthy adults participated in this study. Their feet were categorized as normal, pronated, and supinated using the foot posture index. All subjects were subsequently requested to perform a normal gait under barefoot and LWI conditions. A three-

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dimensional motion analysis system was used to record the kinematic and kinetic data, included peak KAM, KAM impulse (KAAI), center of pressure displacement, and knee-ground reaction force lever arm (KLA). Furthermore, lower limb frontal plane kinematic parameters at the rear foot, ankle, knee, and hip were evaluated. Among all feet, there was no significant difference in the peak KAM and KAAI between the conditions. In contrast, the peak KAM was significantly reduced under the LWI condition relative to the barefoot condition in the normal foot group. Reductions in the peak KAM were correlated with a more lateral center of pressure and reduced KLA. In addition, a reduced KLA was correlated with decreased hip adduction. LWIs significantly reduced the peak KAM in normal feet, indicating that biomechanical effects of LWIs vary between individual foot alignments. Our findings suggest that it is helpful to assess individual foot alignment to ensure adequate insole treatment for patients with knee osteoarthritis.

40. SCHERER, PAUL. The Case for Friction Management PODIATRY MANAGE 2016 35 7 111-116

41. Sheean, Andrew J., Tennent, David J., Owens, Johnny G., Wilken, Jason M., Hsu, Joseph R. and Stinner, Daniel J. Effect of Custom Orthosis and Rehabilitation Program on Outcomes Following Ankle and Subtalar Fusions Foot Ankle Int. 2016 37 11 1205-1210 Order.

42. Singh, Bhupinder, Negatu, Megan G., Francis, Shelby L., Janz ,Kathleen F. and Yack, H. J. Do fitness and fatigue affect gait biomechanics in overweight and obese children? Gait Posture 2016 500 190-195 The purpose of this study was to determine how an overweight or obese child's cardiorespiratory fitness level and a state of fatigue affect gait biomechanics.Methods: Using a three-dimensional motion analysis system, twenty-nine (female and male) overweight and obese children aged 8-11 years walked on force plates before and after being fatigued from the Progressive Aerobic Cardiovascular Endurance Run (PACER) protocol. Joint moments were calculated for the knee and hip in the frontal and sagittal planes.Results: In a non-fatigued state, peak hip and knee adductor moments showed a negative relationship with cardiorespiratory fitness level (R(2)=0.26, 0.26). After the subjects were fatigued, peak hip extensor (p=0.02), peak knee extensor moments (p=0.02) and peak knee adductor moments (p=0.01) showed a significant increase.Conclusion: This trend illustrates that as an overweight or obese individual's fitness improves, the lower limb joint moments in the frontal plane decrease when walking. However, with the introduction of cardiorespiratory fatigue, lower limb joint moments tend to increase in the frontal and sagittal planes. Increased joint stress may have potential implications for obese children performing physical activity, as well as for clinicians who are attempting to intervene in the cycle of obesity.

43. Song, Weidong, Liu, Wenzhou, Chen, Binghao, Anand, Adytia, Cheng, Xiangyu and Yang, Tao. Posteromedial Ankle Impingement Caused by Hypertrophy of Talocalcaneal Coalition: A Report of Five Cases and Introduction of a Novel Index System J. Foot Ankle Surg. 2016 55 6 1312-1317

44. Weerasekara, R. M. I. M., Tennakoon, S. U. B. and Suraweera, H. J. Contrast Therapy and Heat Therapy in Subacute Stage of Grade I and II Lateral Ankle Sprains Foot & Ankle Specialist 2016 Objective. This study was conducted to

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determine the most effective thermal modality; heat or contrast therapy—in reducing pain, reducing swelling, and increasing range of movement (ROM) of the grade I and II lateral ankle sprain in the prechronic stage of the subacute phase. Design. Randomized control trail. Methods. One hundred and fifteen participants of both genders who were diagnosed as having grade I or II lateral ankle sprain were randomly assigned to the study on the fifth day of injury. Pain, volume, and ROM were recorded before and after treatment continuously for 3 days. Results. Effects were evaluated as “Immediately after application” and “3 days after continuous application.” Immediately after application, there was no difference between the 2 modalities on ankle ROM; heat reduced pain over contrast therapy, and both modalities increased swelling. When considering the effects after continuous application for 3 days, no difference was found between the 2 modalities on ROM and the reduction of pain. Contrast therapy reduced swelling while heat caused increased swelling even after 3 days. Conclusion. The use of different thermal modalities during the transition from the acute to chronic phase of injury can be suggested as effective treatment options according to the objectives of injury management: pain reduction, improve ROM, and swelling management.Levels of Evidence: Therapeutic, Level II: Randomized clinical trial

45. Wu, Ziying, Yao, Wei, Chen, Shiyi and Li, Yunxia. Outcome of Extracorporeal Shock Wave Therapy for Insertional Achilles Tendinopathy with and without Haglund’s Deformity BIOMED RES INT 2016 1-6

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