scholarly journals Relationship Between Recurrent Adductus Deformity of the Forefoot and Achilles Tendon Elongation Following Ponseti Treatment in Children with Idiopathic Clubfoot

2020 ◽  
Author(s):  
Mehmet Demirel ◽  
Fuat BİLGİLİ ◽  
Çiğdem ÖZKARA BİLGİLİ ◽  
Serkan Bayram ◽  
Ömer Naci Ergin ◽  
...  
Keyword(s):  
Muscle Strength ◽  
Achilles Tendon ◽  
Plantar Flexion ◽  
Retrospective Chart Review ◽  
Significant Negative Correlation ◽  
Underlying Mechanism ◽  
Ponseti Method ◽  
Idiopathic Clubfoot ◽  
Tendon Elongation ◽  
Metatarsus Adductus

Background: Many authors have highlighted the role of muscle strength imbalance around the ankle in the development of recurrent clubfoot following Ponseti treatment. Nevertheless, this possible underlying mechanism behind recurrences has not been investigated sufficiently to date. This study aimed to explore whether there is a relationship between Achilles tendon elongation and recurrent metatarsus adductus deformity in children with unilateral clubfeet treated by Ponseti method. Methods: A retrospective chart review was performed on 20 children (14 boys, 6 girls; mean age: 7 years; age range: 5-9) with a recurrent metatarsus adductus deformity treated by the Ponseti method for unilateral idiopathic clubfoot. At the final follow-up, isometric muscle strength was measured using a portable, hand-held dynamometer in reciprocal muscle groups of the ankle. The length of the tendons around the ankle was ultrasonographically measured. Results: The plantar flexion/dorsiflexion ratio was lower on the involved side (p = 0.001). No significant differences in the strength ratio of inversion/eversion were found (p = 0.4). No difference was observed in lengths of tibialis anterior and posterior tendon (p = 0,1), but Achilles tendon was longer on the involved side (p = 0.001; p < 0.01). A significant negative correlation was discovered between involved/uninvolved Achilles tendon length ratios and involved/uninvolved plantar flexion strength ratios (r = −0.524; p = 0.02) Conclusions: Achilles tendon elongation may be a contributor to the muscle imbalance in clubfeet with the relapsed forefoot adduction treated by the Ponseti technique.

scholarly journals Original Algorithm of Rehabilitation Protocol with Use of Ultrasound - Study Based on Achilles Tendon Reconstruction Cases

2014 ◽  
Vol 2 (11_suppl3) ◽  
pp. 2325967114S0016
Author(s):  
Agnieszka Barbara Rosińska ◽  
Beata Ciszkowska-Łysoń ◽  
Robert Śmigielski
Keyword(s):  
Muscle Strength ◽  
Achilles Tendon ◽  
Functional Recovery ◽  
Gastrocnemius Muscle ◽  
Ultrasound Examination ◽  
Fat Body ◽  
Plantar Flexion ◽  
Medical Examination ◽  
Rehabilitation Protocol ◽  
Achilles Tendon Reconstruction

Objectives: The study was conducted in order to indicate the usefulness of an ultrasound examination in physiotherapy of patients who underwent Achilles tendon reconstruction. The aim was to eliminate the risk of the procedure’s common complication, i.e.: the formation of adhesions between surrounding tissues and the tendon. Methods: This study analyses 10 cases of anatomical reconstruction of the Achilles tendon. In all cases the surgeon, the physical therapist and the rehabilitation protocol were the same. The algorithm: 1. The weekly protocol included: • the evaluation of: ROM, gliding, tissues swelling, tendon ripple, bursa and fat body movement, possible gaps, and vascularity; • medical examination including: observation, palpation, and ultrasound examination. 2. Every PT session was preluded by an examination including: observation, palpation, and ultrasound evaluation. 3. The US examination was performed to evaluate the functioning of tissues in regard to the tendon’s healing stage. • 2-3 weeks after the surgery: the assessment of gliding during passive plantar flexion, the examination included the use of modified Thompson’s test; • after 3 weeks: the assessment of tendon tension and the isometric plantar flexion strength of the medial gastrocnemius muscle; • 3rd and 6th week: the assessment of swelling, vascularity (before and after the PT session including the cooling of the tendon), Kager’s triangle fat body assessment, and active gliding evaluation, testing the gastrocnemius muscle strength during active movement, • from 6th week until the end of physiotherapy: the evaluation of tendon gliding and gastrocnemius’ strength (body weight bearing); • the final US examination performed by the radiology specialist in the 12th week after the surgery, the assessment of gliding and muscle strength. Results: During the final medical examination performed by the doctor in 12th week after the surgery, there were no tendon adhesions between the tendon and surrounding tissues that would limit the tendon’s gliding within its sheath. The weekly US examination helped while choosing appropriate physical therapy methods that increased the functional recovery of the Achilles tendon. Conclusion: 1. The use of ultrasound device during each PT session enables the therapist to choose appropriate methods in order to optimise the rehabilitation process depending on the current condition of the patient. This approach creates good conditions for the optimal functional recovery. 2. The ultrasound works like a biofeedback.

Relationship of Postoperative Achilles Tendon Elongation With Plantarflexion Strength Following Surgical Repair

2019 ◽  
Vol 41 (2) ◽  
pp. 140-146 ◽  
Author(s):  
Önder Murat Hürmeydan ◽  
Mehmet Demirel ◽  
Natig Valiyev ◽  
Turker Sahinkaya ◽  
Önder İsmet Kılıçoğlu
Keyword(s):  
Achilles Tendon ◽  
Chart Review ◽  
Case Series ◽  
Retrospective Chart Review ◽  
Isokinetic Dynamometer ◽  
Level Of Evidence ◽  
Tendon Elongation ◽  
The Mean ◽  
Relationship Of

Background: Little data exist regarding the adverse effects of Achilles tendon (AT) elongation after rupture repair on plantarflexion strength. This study aimed to investigate the effect of AT elongation measured using AT resting angle (ATRA) on the plantarflexion strength in patients with surgically treated acute AT rupture. Methods: A retrospective chart review was performed on 40 patients (15 female and 25 female) who underwent open operative repair due to an acute AT rupture. At the final follow-up, AT elongation was assessed using ATRA. Plantarflexion strength (peak torques and angle-specific torques) was measured using an isokinetic dynamometer. All variables were obtained from the operated and unoperated contralateral ankles of the patients. Results: The mean ATRA was greater in the operated ankles (mean, 57 degrees; range, 39-71 degrees) compared with the unoperated ones (mean, 52 degrees; range, 36-66 degrees; P = .009). Except the plantarflexion torque at 20 degrees of plantarflexion ( P = .246), all the other angle-specific torques were lower in the operated ankles ( P < .05). Peak flexion torque at 30 degrees/s was lower in the operated ankle ( P = .002). A negative correlation was found between operated/unoperated (O/N) ATRA and O/N plantarflexion torque ratios at 0 degrees ( r = −0.404; P = .01), 10 degrees ( r = −0.399; P= .011), and 20 degrees ( r = −0.387; P = .014). Conclusion: Postoperative AT elongation measured using ATRA may have a deleterious effect on the plantarflexion strength in patients with surgically treated acute AT rupture. Level of Evidence: Level IV, case series.

Elastic properties of human Achilles tendon are correlated to muscle strength

2005 ◽  
Vol 99 (2) ◽  
pp. 665-669 ◽  
Author(s):  
Tetsuro Muraoka ◽  
Tadashi Muramatsu ◽  
Tetsuo Fukunaga ◽  
Hiroaki Kanehisa
Keyword(s):  
Mechanical Properties ◽  
Muscle Strength ◽  
Achilles Tendon ◽  
Elastic Energy ◽  
Plantar Flexion ◽  
Triceps Surae ◽  
Medial Gastrocnemius ◽  
Myotendinous Junction ◽  
Men And Women ◽  
The Difference

The purpose of this study was to investigate whether the mechanical properties of the Achilles tendon were correlated to muscle strength in the triceps surae in humans. Twenty-four men and twelve women exerted maximal voluntary isometric plantar flexion (MVIP) torque. The elongation (ΔX) and strain of the Achilles tendon (ε), the proximal part of which is the composite of the gastrocnemius tendon and the soleus aponeurosis, at MVIP were determined from the displacement of the distal myotendinous junction of the medial gastrocnemius using ultrasonography. The Achilles tendon force at MVIP (F) was calculated from the MVIP torque and the Achilles tendon moment arm. There were no significant differences in either the F-ΔX or F-ε relationships between men and women. ΔX and ε were 9.8 ± 2.6 mm and 5.3 ± 1.6%, respectively, and were positively correlated to F ( r = 0.39, P < 0.05; r = 0.39, P < 0.05), which meant that subjects with greater muscle strength could store more elastic energy in the tendon. The regression y-intercepts for the F-ΔX ( P < 0.01) and F-ε ( P < 0.05) relationship were significantly positive. These results might indicate that the Achilles tendon was stiffer in subjects with greater muscle strength, which may play a role in reducing the probability of tendon strain injuries. It was suggested that the Achilles tendon of subjects with greater muscle strength did not impair the potential for storing elastic energy in tendons and may be able to deliver the greater force supplied from a stronger muscle more efficiently. Furthermore, the difference in the Achilles tendon mechanical properties between men and women seemed to be correlated to the difference in muscle strength rather than gender.

scholarly journals Outcomes of the Ponseti method for the treatment of children diagnosed with congenital clubfoot in population under five years at Fundación Ruth Paz in San Pedro Sula, Honduras

2018 ◽  
Vol 3 (4) ◽  
Author(s):  
Sandy Lizeth Guerrero Sorto ◽  
Gustavo A. Vásquez García ◽  
Nolvia Sarahí Díaz Cruz ◽  
Paola Estela Figueroa Avilez ◽  
Gabriela Alejandra Contreras
Keyword(s):  
Achilles Tendon ◽  
Plaster Cast ◽  
Ponseti Method ◽  
Abnormal Development ◽  
Idiopathic Clubfoot ◽  
Congenital Clubfoot ◽  
Children Under Five ◽  
Under Five ◽  
San Pedro ◽  
San Pedro Sula

Background: Congenital clubfoot is a common deformity characterized by an abnormal development of the foot. The etiology is multifactorial and genetic causes have been related. The Ponseti method is a conservative treatment for the clubfoot, mostly used in idiopathic cases. This method involves serial plaster cast changes, tenotomy of the Achilles tendon and use of braces to prevent relapses. This study was designed to identify the characteristics of the patients diagnosed with congenital clubfoot who were treated with the Ponseti method and the main outcomes of this treatment in children under five years.Method: A retrospective study was conducted in Fundación Ruth Paz in San Pedro Sula, Honduras, since June 1st 2015 to May 31th 2017. This study included patients under five years who were diagnosed with congenital clubfoot and treated with Ponseti method. The data were collected from the clinical files of the identified cases.Results: Congenital clubfoot was more common among males (66.3%) and the localization of the deformity was more commonly bilateral (51.8%). The cases of idiopathic clubfoot represent 91.6% of all the cases. The tenotomy of the Achilles tendon was performed in 51.8% of the patients.  Complete treatment was identified in 90.4% of the cases and relapses were reported in 12% of the children who completed treatment.Conclusions: Ponseti method was effective for treat children under five years diagnosed with clubfoot (idiopathic and non-idiopathic) and a significant decrease of the Pirani scoring after treatment was identified in all the cases. A correct use of braces is necessary to avoid relapses.

scholarly journals Zdravljenje idiopatskega in kompleksnega prirojenega talipes ekvinovarusa z metodo po Ponsetiju

2015 ◽  
Vol 84 (10) ◽  
Author(s):  
Lovro Suhodolčan ◽  
Karin Schara ◽  
Janez Brecelj ◽  
Vane Antolič
Keyword(s):  
Healthy Child ◽  
Plantar Flexion ◽  
Ponseti Method ◽  
Idiopathic Clubfoot ◽  
Live Births ◽  
Rigid Deformation ◽  
Tendo Achillis ◽  
Sole Of The Foot

Abstract:Congenital idiopathic clubfoot is a deformity typically occurring in an otherwise healthy child which occurs in 11,4 in 10.000 live births. Approximately one-half of cases present with bilateral deformity and affects boys and girls equally. Clubfoot is characterized by adduction, supination and cavus deformity of the forefoot and midfoot, varus of the heel, and a fixed plantar flexion (equinus) of the ankle. Treatment od idiopathic type of clubfoot consists of corrective manipulation and casting by the Ponseti method, where usually four to six casts are needed. Equinus is corrected with tendo Achillis tenotomy followed by foot abduction brace application.Complex type of clubfoot, which has more severe rigid deformation, is present in 6,5% of all clubfeet and is refractory to the usual corrective manipulation and casting by the Ponsetti method. Clinically, complex clubfoot is characterized  as short, stubby foot,  having rigid equinus, severe adduction and plantar flexion of all metatarsals, a deep crease above the heel and a transverse crease in the sole of the foot. Modified Ponsetti method for treatment of complex clubfoot consists of simultaneus correction of adduction and heel varus and subsequent cavus and rigid equinus correction. After the Achillis tendon tenotomy, modified foot abduction brace is applied, where foot is in 40° outer rotation in contrast to 70° abduction used in less rigid congenital idiopathic clubfoot. Relapse occurs in 14% and is ussually related to problems with shoe fit and patient coplience.

scholarly journals Foot abduction brace noncompliance in children with idiopathic clubfoot: how the deep squatting posture might help

2020 ◽  
Vol 8 (3) ◽  
pp. 241-248
Author(s):  
Pipattra Sailohit ◽  
Noppachart Limpaphayom
Keyword(s):  
Exercise Group ◽  
Ponseti Method ◽  
Idiopathic Clubfoot ◽  
Routine Practice ◽  
Group A ◽  
Metatarsus Adductus ◽  
Noncompliance Rate ◽  
Group B ◽  
Recent Evaluation

Background. Compliance with the foot abduction brace (FAB) is essential for idiopathic clubfoot (ICF) managed by the Ponseti method. The deep squatting posture (DSP) was correlated with favorable outcomes in ICF. Aim. The aims of the study were to identify the noncompliance rate with the FAB, and assess how the routine practice of ankle stretching and Asian-style DSP affected the ICF correction during the Ponseti method. Materials and methods. Of 42 children with ICF, 63 ICF underwent the Ponseti method at an average age of 8.7 12.6 weeks using an average of 5.4 1.7 casts followed by FAB wear. The children practiced the DSP exercise as an adjunct to the FAB protocol. Children noncompliant with the FAB protocol but compliant with the DSP exercise (group A) were compared with children noncompliant with both FAB protocol and DSP exercise (group B). Results. At an average follow-up of 3.5 1.4 years, 8 of 42 children compliant with the FAB protocol. The FAB protocol deviation was documented at an average of 10.3 4.8 months. Children who did not adhere to the practice of the DSP exercise had a higher recurrent rate of any ICF deformity (OR 7.82, 95% CI 1.3553.79, p = 0.003). Of the 34 children (48 feet) noncompliant with FAB, the children in group A (39 feet) had lower recurrence rate (p = 0.02), a better Dimeglio grade (p = 0.005), and a better Pirani score (p 0.001) at the most recent evaluation than children in group B (nine feet). However, recurrent metatarsus adductus was more prevalent in group A. Conclusion. The DSP exercise should be advocated as a supplemental modality but cannot substitute the regular use of FAB.

scholarly journals Electromyographic Evidence of Excessive Achilles Tendon Elongation During Isometric Contractions After Achilles Tendon Repair

2019 ◽  
Vol 7 (7_suppl5) ◽  
pp. 2325967119S0032
Author(s):  
Malachy P. McHugh ◽  
Karl F. Orishimo ◽  
Ian J. Kremenic ◽  
Julia Adelman ◽  
Stephen J. Nicholas
Keyword(s):  
Achilles Tendon ◽  
Muscle Fiber ◽  
Fourier Transforms ◽  
Plantar Flexion ◽  
Maximum Voluntary Contraction ◽  
Tendon Repair ◽  
Voluntary Contraction ◽  
Plantar Flexor ◽  
Achilles Tendon Repair ◽  
Tendon Elongation

Objectives: It has been proposed that increased tendon elongation after Achilles tendon repair contributes to selective weakness in end-range plantar flexion (Mullaney et al 2006). Excessive tendon elongation during maximum voluntary contraction (MVC) means greater muscle fiber shortening. Since mean frequency (MF) of the electromyogram (EMG) increases with muscle fiber shortening, it was hypothesized that during isometric plantar flexor MVCs MF would be higher on the involved versus non-involved side. Therefore, the purpose of this study was to examine MF during isometric MVCs in patients with Achilles tendon repairs. Methods: Maximum isometric plantar flexion torque was measured at 20° and 10° dorsiflexion, neutral, and 10° and 20° plantar flexion in 17 patients (mean±SD age, 39±9 years; 15 men, 2 women) 43±24 months after surgery (range, 9 months to 8 years). Surface EMG signals were recorded during strength tests. MF was calculated from Fast Fourier Transforms of medial gastroc (MG) lateral gastroc (LG) and soleus (S) EMG signals. Effect of weakness on MF was assessed using analysis of variance. Based on reported plantar flexor MF values it was estimated that with 17 subjects there would be 80% power to detect a 16% difference in MF between involved and noninvolved legs at P<0.05. Results: Patients had marked weakness in 20° plantar flexion (deficit 28±18%, P<0.01; 14 of 17 deficit >20%) but no significant weakness in 20° dorsiflexion (deficit 8±15%, P=0.20; 4 of 17 deficit >20%). MF increased moving from dorsiflexion to plantar flexion (P<0.001) but overall was not different between involved and noninvolved sides (P=0.22). However, differences in MF between the involved and noninvolved sides were apparent in the patients with marked weakness. At 10° plantar flexion 8 of 17 patients had marked weakness (>20% deficit). MF at 10° plantar flexion was significantly higher on involved versus noninvolved side in patients with weakness but this was not apparent in patients with no weakness (side by group P=0.014; Table 1). MF at 10° plantar flexion average across the 3 muscles was 13% higher on the involved versus noninvolved side in patients with weakness (P=0.012) versus 3% lower in patients with no weakness (P=0.47). Conclusion: Higher MF on the involved versus noninvolved side in patients with significant plantar flexion weakness is consistent with greater muscle fiber shortening. This indicates that weakness was primarily due to excessive lengthening of the repaired Achilles tendon. If weakness were simply due to atrophy, a lower MF would have been be expected and patients would have had weakness throughout the range of motion. Surgical and rehabilitative strategies are needed to prevent excessive tendon elongation and weakness in end-range plantar flexion after Achilles repair. [Table: see text]

scholarly journals Reliability of Bi-Axial Ankle Stiffness Measurement in Older Adults

Sensors ◽  
2021 ◽  
Vol 21 (4) ◽  
pp. 1162
Author(s):  
Hogene Kim ◽  
Sangwoo Cho ◽  
Hwiyoung Lee
Keyword(s):  
Older Adults ◽  
Range Of Motion ◽  
Angular Displacement ◽  
Plantar Flexion ◽  
Significant Negative Correlation ◽  
Talocrural Joint ◽  
Ankle Foot Orthosis ◽  
Ankle Stiffness ◽  
Ankle Movement ◽  
Test Retest Reliability

This study involves measurements of bi-axial ankle stiffness in older adults, where the ankle joint is passively moved along the talocrural and subtalar joints using a custom ankle movement trainer. A total of 15 elderly individuals participated in test–retest reliability measurements of bi-axial ankle stiffness at exactly one-week intervals for validation of the angular displacement in the device. The ankle’s range of motion was also compared, along with its stiffness. The kinematic measurements significantly corresponded to results from a marker-based motion capture system (dorsi-/plantar flexion: r = 0.996; inversion/eversion: r = 0.985). Bi-axial ankle stiffness measurements showed significant intra-class correlations (ICCs) between the two visits for all ankle movements at slower (2.14°/s, ICC = 0.712) and faster (9.77°/s, ICC = 0.879) speeds. Stiffness measurements along the talocrural joint were thus shown to have significant negative correlation with active ankle range of motion (r = −0.631, p = 0.012). The ankle movement trainer, based on anatomical characteristics, was thus used to demonstrate valid and reliable bi-axial ankle stiffness measurements for movements along the talocrural and subtalar joint axes. Reliable measurements of ankle stiffness may help clinicians and researchers when designing and fabricating ankle-foot orthosis for people with upper-motor neuron disorders, such as stroke.

scholarly journals Operative Outcome of Side-Locking Loop Suture Technique Accompanied by Autologous Semitendinosus Tendon Grafting for Chronic Rupture of Achilles Tendon

2021 ◽  
Vol 6 (2) ◽  
pp. 247301142110035
Author(s):  
Keisuke Tsukada ◽  
Youichi Yasui ◽  
Maya Kubo ◽  
Shinya Miki ◽  
Kentaro Matsui ◽  
...  
Keyword(s):  
Achilles Tendon ◽  
Scale Score ◽  
Tendon Rupture ◽  
Plantar Flexion ◽  
Achilles Tendon Rupture ◽  
Case Series ◽  
Semitendinosus Tendon ◽  
Level Of Evidence ◽  
Operative Outcomes

Background: The purpose of this retrospective study was to clarify the operative outcomes of the side-locking loop suture (SLLS) technique accompanied by autologous semitendinosus tendon grafting for chronic Achilles tendon rupture. Methods: A chart review was conducted of consecutive patients treated with the SLLS technique at our department from 2012 to 2017. Postoperatively, a below-knee splint was applied for 2 weeks in 20 degrees of plantar flexion and then active range of motion exercise was started. Partial weightbearing exercise was allowed at 4 weeks according to patient tolerance, and full weightbearing without crutches was allowed at 8 weeks. The American Orthopaedic Foot & Ankle Society (AOFAS) ankle-hindfoot scale score and the Achilles tendon rupture score (ATRS) were used to evaluate clinical outcomes preoperatively and at the final follow-up. Results: Ten patients (6 men, 4 women) were included in the analysis. Mean AOFAS ankle-hindfoot scale score increased significantly from 64.2 ± 5.6 points preoperatively to 95.0 ± 5.3 points at the final follow-up ( P < .001). The mean ATRS also increased significantly from 29.8 ± 4.4 points to 86.2 ± 7.7 points, respectively ( P < .001). Mean time between surgery and ability to perform 20 continuous double-leg heel raises of the operated foot was 13.5 ± 3.4 (range 10-18) weeks. One patient complained of postoperative hypoesthesia in the foot, which had spontaneously resolved by 3 months after surgery. Conclusion: The SLLS technique accompanied by autologous semitendinosus tendon grafting provided successful operative outcomes for patients with chronic Achilles tendon rupture regardless of the size of the defect, and thus long-term orthotic use was not needed after surgery. Level of Evidence: Level IV, retrospective case series.

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