scholarly journals Topographic-anatomical characteristics of artery tibialis posterior and its branches in the area of ankle canal

2021 ◽  
Vol 9 (3) ◽  
pp. 493-500
Author(s):  
R.E. Kalinin ◽  
◽  
I.A. Suchkov ◽  
E.A. Klimentova ◽  
I.N. Shanaev ◽  
...  
Keyword(s):  
Lower Limb ◽  
Ultrasound Examination ◽  
Vascular System ◽  
Lower Limbs ◽  
Tibialis Posterior ◽  
Medial Malleolus ◽  
Posterior Edge ◽  
Abductor Hallucis ◽  
Plantar Artery ◽  
Medial Plantar Artery

AIM: To clarify peculiarities of the anatomy and topography of the plantar vessels in the area of the ankle canal, to justify access to the bifurcation of the artery tibialis posterior and ultrasound examination of the plantar arteries. The results of anatomical preparations of 10 amputated lower limbs, and of ultrasound duplex angioscanning (DUS) of 30 healthy volunteers without pathology of the vascular system performed using a linear transducer with frequency of 7–12 MHz, were studied. According to the data of anatomical preparation and ultrasound examination, the bifurcation level of the artery tibialis posterior was 1.7 ± 0.4 cm (min 0.5 cm — max 2 cm) below the level of the posterior edge of the medial ankle and was slightly covered by the musculus abductor hallucis. The average diameter of the artery tibialis posterior above the bifurcation level was 2.56 ± 0.4 mm, of the medial plantar artery 1.4±0.44 mm, and of the lateral plantar artery 1.8 ± 0.5 mm. The lateral plantar artery was 90% larger in diameter than the medial plantar artery. In 7% of cases, the medial plantar artery was larger, and in 3% of cases, the diameters of both arteries were equal. When taking the bifurcation of the posterior tibial artery as the central point, the plantar vessels on the DUS can be traced distally down under the abdomen of the musculus abductor hallucis: the medial vessels lie more anteriorly at 2 o’clock position, and the lateral vessels lie somewhat posteriorly at 1 o’clock. Assessment of blood flow at this level gives an idea of the state of the foot vessels. The level of bifurcation of the artery tibialis posterior is located 1.7 ± 0.4 cm below the posterior edge of the medial malleolus, which makes it possible to identify the location of access to it. The location of the DUS probe from this point at 2 o'clock position corresponds to the projection of the medial plantar artery, at 1 o'clock — to the lateral plantar artery on the right lower limb, on the left lower limb — at 10 and 11 o'clock, respectively.

Effect of Different Placement of Heel Rockers on Lower-Limb Joint Biomechanics in Healthy Individuals

2018 ◽  
Vol 108 (3) ◽  
pp. 231-235 ◽  
Author(s):  
Maedeh Farzadi ◽  
Zahra Safaeepour ◽  
Hoda Nabavi ◽  
Masumeh Bagherzadeh Cham ◽  
Mohammad Ebrahim Mousavi
Keyword(s):  
Range Of Motion ◽  
Lower Limb ◽  
Lower Limbs ◽  
Medial Malleolus ◽  
Initial Contact ◽  
Healthy Individuals ◽  
Peak Knee ◽  
Joint Biomechanics ◽  
Single Limb Support ◽  
Rocker Shoes

Background: Rocker shoes are commonly prescribed to healthy and pathologic populations to decrease stress on the lower limbs. An optimal rocker shoe design must consider both toe and heel rockers. Heel rockers are as effective as toe rockers in relieving foot plantar pressures. However, most studies have focused on the position of toe rockers. The aim of this study was to assess the effect of different heel rocker apex placements on lower-limb kinetics and kinematics. Methods: Eighteen healthy females participated in this study. Three pairs of rocker shoes with rocker apex positions anterior to the medial malleolus (shoe A), at the medial malleolus (shoe B), and posterior to the medial malleolus (shoe C) were fabricated and then compared with a flat shoe (shoe D). Kinetic and kinematic data were collected, and lower-extremity joint ranges of motion and moments were calculated. Results: Ankle range of motion was increased by shoe C (P = .04) during initial contact and by shoe A (P = .02) during single-limb support. Peak knee moment was significantly larger for shoes A and B (P < .05) during single-limb support. Conclusions: Results showed that forward and backward shifting of the heel rocker apex could change the knee moment and ankle joint range of motion in the stance phase of gait. Therefore, placement of the heel rocker in a rocker-bottom shoe can be manipulated to promote the desired lower-limb motion, at least in healthy individuals.

Correlation between the course of the medial plantar artery and the morphology of the abductor hallucis muscle

2005 ◽  
Vol 18 (8) ◽  
pp. 580-588 ◽  
Author(s):  
Veronica Macchi ◽  
Cesare Tiengo ◽  
Andrea Porzionato ◽  
Carla Stecco ◽  
Anna Parenti ◽  
...  
Keyword(s):  
Abductor Hallucis ◽  
Plantar Artery ◽  
Abductor Hallucis Muscle ◽  
Medial Plantar Artery

Objective Assessment of Skin Changes in Lower Limb Venous Disease Using a Tissue Tonometer

2002 ◽  
Vol 17 (3-4) ◽  
pp. 108-114 ◽  
Author(s):  
J. Farrah ◽  
M. Saharay ◽  
P. D. Coleridge Smith
Keyword(s):  
Lower Limb ◽  
Objective Assessment ◽  
Lower Limbs ◽  
Chronic Venous Disease ◽  
Western World ◽  
Medial Malleolus ◽  
Venous Disease ◽  
Skin Changes ◽  
Control Subjects ◽  
Normal Controls

Background: Chronic venous disease (CVD) of the lower limbs is a major problem in the western world with 1% of the adult population estimated to be affected at any one time. No objective method is currently available to assess the skin changes of chronic venous disease. We have devised a tissue tonometer to compare skin compliance in patients with venous disease with that in control subjects. Method: Eighty-six limbs of 69 patients (34 men, 35 women; mean age 62 years, range 28-90 years) with venous disease confirmed by duplex ultrasonography and 42 limbs of 37 normal controls (23 men, 14 women; mean age 42 years, range 20-90 years) were studied. Patients were assigned to one of three clinical groups based on the Clinical, (a) Etiological, Anatomical and Pathophysiological (CEAP) method of classification and grading of chronic venous disease in the lower limbs: C3, oedema; C4a, pigmentation alone; C4b, lipodermato-sclerosis (LDS). Normal controls were assigned C0. A 4 mm diameter plunger loaded with a 30 g weight was applied to the skin 5 cm proximal to the medial malleolus or over the most severe region of skin change. The movement of the plunger was measured for 5 min using a linear variable differential transformer position detector. The initial displacement of the plunger (within 1 s) reflects the compliance of the skin. Results: In C4b patients with LDS, skin compliance is substantially reduced (median plunger displacement in 1 s = 0.81 mm, interquartile range (IQR) 0.67–1.18) compared with C0 control subjects (2.85 mm, IQR 2.39–3.22) (p<0.0005, Mann-Whitney), C4a patients with pigmentation alone without LDS (2.35 mm, IQR 2.04–2.91) (p<0.0005, Mann-Whitney) or C3 patients with venous disease (2.49 mm, IQR 1.58–3.13) (p<0.0005, Mann-Whitney). There were no statistically significant differences between the C0, C3 and C4a groups. Conclusion: Tissue tonometry provides an objective means of assessing skin changes in patients with lower limb chronic venous disease. This may be a useful method of measuring skin compliance as a research tool but will have limited clinical application.

scholarly journals “Like For Like” Reconstruction of Heel Pad with Medial Plantar Artery Flap—Functional and Aesthetic Outcomes in A Series of 19 Cases

2021 ◽  
Vol 54 (03) ◽  
pp. 358-361
Author(s):  
Narayanamurthy Sundaramurthy ◽  
Surya Rao Venkata Mahipathi ◽  
Alagar Raja Durairaj ◽  
Anand Prasath Jayachandiran ◽  
Shalini Ranipet Selvaa
Keyword(s):  
Weight Bearing ◽  
Abductor Hallucis ◽  
Fasciocutaneous Flaps ◽  
Diabetic Ulcer ◽  
Patients Satisfaction ◽  
Heel Pad ◽  
Plantar Artery ◽  
Functional Scores ◽  
Abductor Hallucis Muscle ◽  
Medial Plantar Artery

AbstractHeel pad loss can cause serious problems in weight-bearing and locomotion. The medial plantar artery (MPA) flap is a suitable “like for like” replacement. Nineteen patients whose heels were reconstructed with MPA flap between July 2015 and February 2020 were studied. All patients were assessed based on flap survival, functionality, and patient satisfaction. Loss of heel pad was due to diabetic ulcer (11), trauma (6), tumor (1), and unstable scar (1). The largest flap measured 9 × 7 cm. Sixteen flaps were done as fasciocutaneous flaps and three in combination with abductor hallucis muscle (AbdH). All the flaps survived. The average functional scores at 6, 12, 18, and 24 months were 86.86, 89.62, 89.38 and 97.33 based on AOSAS-AH score. Average patients' satisfaction was 8.7/10. To conclude, the MPA system is a versatile vascular axis providing “like for like” tissue for heel pad reconstruction which is reliable and durable.

scholarly journals Finite Element Analysis Of Large Deformation Of Articular Cartilage In Upper Ankle Joint Of Occupant In Military Vehicles During Explosion

2015 ◽  
Vol 60 (3) ◽  
pp. 2115-2121 ◽  
Author(s):  
T. Klekiel ◽  
R. Będziński
Keyword(s):  
Articular Cartilage ◽  
Ankle Joint ◽  
Lower Limb ◽  
Lower Limbs ◽  
Medial Malleolus ◽  
Element Analysis ◽  
Military Vehicles ◽  
Upper Ankle Joint ◽  
Foot Injury ◽  
Upper Ankle

AbstractThe paper presents the analysis of the load of lower limbs of occupants in the armoured military vehicle, which has been destroyed by detonation of the Improvised Explosive Device (IED) charge under the vehicle. A simplified model of the human lower limb focused on upper ankle joint was developed in order to determine the reaction forces in joints and load in particular segments during the blast load. The model of upper ankle joint, include a tibia and an ankle bone with corresponding articular cartilage, has been developed. An analysis of the stress distribution under the influence of forces applied at different angles to the biomechanical axis of a limb has been performed. We analyzed the case of the lower limb of a sitting man leaning his feet on the floor. It has been shown that during a foot pronation induced by a knee outward deviation, the axial load on the foot causes significantly greater tension in the tibia. At the same time it has been shown that within the medial malleolus, tensile stresses occur on the surface of the bone which may lead to fracture of the medial malleolus. It is a common case of injuries caused by loads on foot of passengers in armored vehicles during a mine or IED load under the vehicle. It was shown that the outward deviation of the knee increases the risk of the foot injury within the ankle joint.

Design of a Human Knee Reeducation Mechanism

2019 ◽  
Vol 11 (1) ◽  
pp. 42-53
Author(s):  
Allaoua Brahmia ◽  
Ridha Kelaiaia
Keyword(s):  
Lower Limb ◽  
Mechanical Design ◽  
Kinematic Chain ◽  
Lower Limbs ◽  
Kinematic Structure ◽  
Robotic Device ◽  
Human Knee ◽  
Kinematic Study ◽  
Rehabilitation Exercise ◽  
New Machine

Abstract To establish an exercise in open muscular chain rehabilitation (OMC), it is necessary to choose the type of kinematic chain of the mechanical / biomechanical system that constitutes the lower limbs in interaction with the robotic device. Indeed, it’s accepted in biomechanics that a rehabilitation exercise in OMC of the lower limb is performed with a fixed hip and a free foot. Based on these findings, a kinematic structure of a new machine, named Reeduc-Knee, is proposed, and a mechanical design is carried out. The contribution of this work is not limited to the mechanical design of the Reeduc-Knee system. Indeed, to define the minimum parameterizing defining the configuration of the device relative to an absolute reference, a geometric and kinematic study is presented.

Foot core strengthening: relevance in injury prevention and rehabilitation for runners

2016 ◽  
Vol 64 (1) ◽  
Keyword(s):  
Injury Prevention ◽  
Lower Limb ◽  
Neuromuscular Electrical Stimulation ◽  
Plantar Fascia ◽  
Core Stability ◽  
Tibialis Posterior ◽  
Lower Limb Injury ◽  
Limb Injury ◽  
Plantar Fasciopathy ◽  
Intrinsic Foot Muscles

The human foot is a flexible structure characterized by a pronounced medial longitudinal arch (MLA) that compresses and recoils during running. That process is actively driven by the intrinsic foot muscles and requires a proper stability of the MLA. This introduces the concept of foot core stability. Because the intrinsic foot muscles are often neglected by clinicians and researchers, the purpose of this article is to provide some guidelines for incorporating foot core training in prevention or rehabilitation programmes for runners. The intrinsic foot muscles play a key role in postural control and maintain balance during single leg stance by controlling the height of the MLA and the foot pronation. During running, these muscles lengthen eccentrically during the absorption phase and subsequently shorten as the arch recoils during the propulsive phase, functioning in parallel to the plantar fascia. As a consequence, the dysfunction or weakness of the MLA active support may lead to injuries (e.g. plantar fasciopathy, Achilles or Tibialis posterior tendinopathy, metatarsalgia or medial tibial stress syndrome), due to numerous biomechanical cascades and mechanisms. In order to counteract or prevent these impairments, there are two ways for enhancing the foot core stability. Firstly in terms of volitional control of the intrinsic foot muscles, the “short foot exercise” must be practiced. Secondly strengthening sessions using neuromuscular electrical stimulation of these muscles seem to be a promising strategy in order to support the MLA and control the pronation during running. Practically, the foot core strengthening protocol may beneficiate not only the runners affected by excessive pronation related injuries but also those who sustained a long term lower limb injury and may be affected by a detraining process. In addition we warmly recommend integrating this protocol in any lower limb injury prevention programme or strength and conditioning plan for runners.

scholarly journals Effects of Dominant and Nondominant Limb Immobilization on Muscle Activation and Physical Demand during Ambulation with Axillary Crutches

2021 ◽  
Vol 6 (1) ◽  
pp. 16
Author(s):  
Kara B. Bellenfant ◽  
Gracie L. Robbins ◽  
Rebecca R. Rogers ◽  
Thomas J. Kopec ◽  
Christopher G. Ballmann
Keyword(s):  
Lower Limb ◽  
Muscle Activation ◽  
Weight Bearing ◽  
Lower Limbs ◽  
Medial Gastrocnemius ◽  
Bipedal Walking ◽  
Lower Limb Muscle ◽  
Limb Muscle ◽  
Physical Demand ◽  
Limb Dominance

The purpose of this study was to investigate the effects of how limb dominance and joint immobilization alter markers of physical demand and muscle activation during ambulation with axillary crutches. In a crossover, counterbalanced study design, physically active females completed ambulation trials with three conditions: (1) bipedal walking (BW), (2) axillary crutch ambulation with their dominant limb (DOM), and (3) axillary crutch ambulation with their nondominant limb (NDOM). During the axillary crutch ambulation conditions, the non-weight-bearing knee joint was immobilized at a 30-degree flexion angle with a postoperative knee stabilizer. For each trial/condition, participants ambulated at 0.6, 0.8, and 1.0 mph for five minutes at each speed. Heart rate (HR) and rate of perceived exertion (RPE) were monitored throughout. Surface electromyography (sEMG) was used to record muscle activation of the medial gastrocnemius (MG), soleus (SOL), and tibialis anterior (TA) unilaterally on the weight-bearing limb. Biceps brachii (BB) and triceps brachii (TB) sEMG were measured bilaterally. sEMG signals for each immobilization condition were normalized to corresponding values for BW.HR (p < 0.001) and RPE (p < 0.001) were significantly higher for both the DOM and NDOM conditions compared to BW but no differences existed between the DOM and NDOM conditions (p > 0.05). No differences in lower limb muscle activation were noted for any muscles between the DOM and NDOM conditions (p > 0.05). Regardless of condition, BB activation ipsilateral to the ambulating limb was significantly lower during 0.6 mph (p = 0.005) and 0.8 mph (p = 0.016) compared to the same speeds for BB on the contralateral side. Contralateral TB activation was significantly higher during 0.6 mph compared to 0.8 mph (p = 0.009) and 1.0 mph (p = 0.029) irrespective of condition. In conclusion, limb dominance appears to not alter lower limb muscle activation and walking intensity while using axillary crutches. However, upper limb muscle activation was asymmetrical during axillary crutch use and largely dependent on speed. These results suggest that functional asymmetry may exist in upper limbs but not lower limbs during assistive device supported ambulation.

scholarly journals COVID-19 era in long-term cardiac rehabilitation programs: how was muscle strenght and lean mass affected in cardiovascular patients?

2021 ◽  
Vol 28 (Supplement_1) ◽  
Author(s):  
M Borges ◽  
M Lemos Pires ◽  
R Pinto ◽  
G De Sa ◽  
I Ricardo ◽  
...  
Keyword(s):  
Muscle Strength ◽  
Cardiac Rehabilitation ◽  
Lean Mass ◽  
Lower Limb ◽  
Lower Limbs ◽  
Phase Iii ◽  
Face To Face ◽  
Home Based ◽  
Lower Limb Strength

Abstract Funding Acknowledgements Type of funding sources: None. Introduction Exercise prescription is one of the main components of phase III Cardiac Rehabilitation (CR) programs due to its documented prognostic benefits. It has been well established that, when added to aerobic training, resistance training (RT) leads to greater improvements in peripheral muscle strength and muscle mass in patients with cardiovascular disease (CVD). With COVID-19, most centre-based CR programs had to be suspended and CR patients had to readjust their RT program to a home-based model where weight training was more difficult to perform. How COVID-19 Era impacted lean mass and muscle strength in trained CVD patients who were attending long-term CR programs has yet to be discussed. Purpose To assess upper and lower limb muscle strength and lean mass in CVD patients who had their centre-based CR program suspended due to COVID-19 and compare it with previous assessments. Methods 87 CVD patients (mean age 62.9 ± 9.1, 82.8% male), before COVID-19, were attending a phase III centre-based CR program 3x/week and were evaluated annually. After 7 months of suspension, 57.5% (n = 50) patients returned to the face-to-face CR program. Despite all constraints caused by COVID-19, body composition and muscle strength of 35 participants (mean age 64.7 ± 7.9, 88.6% male) were assessed. We compared this assessment with previous years and established three assessment time points: M1) one year before COVID-19 (2018); M2) last assessment before COVID-19 (2019); M3) the assessment 7 months after CR program suspension (last trimester of 2020). Upper limbs strength was measured using a JAMAR dynamometer, 30 second chair stand test (number of repetitions – reps) was used to measure lower limbs strength and dual energy x-ray absorptiometry was used to measure upper and lower limbs lean mass. Repeated measures ANOVA were used. Results Intention to treat analysis showed that upper and lower limbs lean mass did not change from M1 to M2 but decreased significantly from M2 to M3 (arms lean mass in M2: 5.68 ± 1.00kg vs M3: 5.52 ± 1.06kg, p = 0.004; legs lean mass in M2: 17.40 ± 2.46kg vs M3: 16.77 ± 2.61kg, p = 0.040). Lower limb strength also decreased significantly from M2 to M3 (M2: 23.31 ± 5.76 reps vs M3: 21.11 ± 5.31 reps, p = 0.014) after remaining stable in the year prior to COVID-19. Upper limb strength improved significantly from M1 to M2 (M1: 39.00 ± 8.64kg vs M2: 40.53 ± 8.77kg, p = 0.034) but did not change significantly from M2 to M3 (M2 vs M3: 41.29 ± 9.13kg, p = 0.517). Conclusion After CR centre-based suspension due to COVID-19, we observed a decrease in upper and lower limbs lean mass and lower limb strength in previously trained CVD patients. These results should emphasize the need to promote all efforts to maintain physical activity and RT through alternative effective home-based CR programs when face-to-face models are not available or possible to be implemented.

Computed tomography angiography and microsurgical flaps for traumatic wounds: What is the added value?

2021 ◽  
pp. 1-9
Author(s):  
Lucas Sousa Macedo ◽  
Renato Polese Rusig ◽  
Gustavo Bersani Silva ◽  
Alvaro Baik Cho ◽  
Teng Hsiang Wei ◽  
...  
Keyword(s):  
Computed Tomography ◽  
Upper Limb ◽  
Computed Tomography Angiography ◽  
Lower Limb ◽  
High Energy ◽  
Lower Limbs ◽  
Added Value ◽  
Vascular Lesions ◽  
Limb Injuries ◽  
Significant Difference

BACKGROUND: Microsurgical flaps are widely used to treat complex traumatic wounds of upper and lower limbs. Few studies have evaluated whether the vascular changes in preoperative computed tomography angiography (CTA) influence the selection of recipient vessel and type of anastomosis and the microsurgical flaps outcomes including complications. OBJECTIVE: The aim of this study was to evaluate if preoperative CTA reduces the occurrence of major complications (revision of the anastomosis, partial or total flap failure, and amputation) of the flaps in upper and lower limb trauma, and to describe and analyze the vascular lesions of the group with CTA and its relationship with complications. METHODS: A retrospective cohort study was undertaken with all 121 consecutive patients submitted to microsurgical flaps for traumatic lower and upper limb, from 2014 to 2020. Patients were divided into two groups: patients with preoperative CTA (CTA+) and patients not submitted to CTA (CTA–). The presence of postoperative complications was assessed and, within CTA+, we also analyzed the number of patent arteries on CTA and described the arterial lesions. RESULTS: Of the 121 flaps evaluated (84 in the lower limb and 37 in the upper limb), 64 patients underwent preoperative CTA. In the CTA+ group, 56% of patients with free flaps for lower limb had complete occlusion of one artery. CTA+ patients had a higher rate of complications (p = 0.031), which may represent a selection bias as the most complex limb injuries and may have CTA indicated more frequently. The highest rate of complications was observed in chronic cases (p = 0.034). There was no statistically significant difference in complications in patients with preoperative vascular injury or the number of patent arteries. CONCLUSIONS: CTA should not be performed routinely, however, CTA may help in surgical planning, especially in complex cases of high-energy and chronic cases, since it provides information on the best recipient artery and the adequate level to perform the microanastomosis, outside the lesion area.

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