Association between obesity and the aggravation of limited range of ankle mobility in chronic venous disease

Aim The aim of the present study was to show that an increase in weight leads to the aggravation of limited joint mobility. Method One hundred sixteen patients with varicose veins of the lower limbs and body mass index (BMI) higher than 30 kg/m2 were evaluated at the Belczak Clinic in Maringá, Brazil. All patients were evaluated by the same physician, and the goniometric readings were performed on all patients by a physiotherapist. The participants were then divided into three groups based on BMI: Group I—BMI between 30 and 40. Group II—BMI between 40 and 50, and Group III—BMI > 50. Results There is a significant difference between the groups detected. Conclusion The present findings show that an increased BMI in obese individuals with chronic venous disease is associated with a progressive limitation of ankle mobility.

Atypical presentation of complex regional pain syndrome: neuropathic itching - A case report -

Background: In some patients with neuropathic pain (NP), such as complex regional pain syndrome (CRPS), itching rather than pain is the main symptom making diagnosis and treatment difficult.Case: We report a case of a 23-year-old man with a history of hypoxic brain damage who presented with pruritus of the left foot and ankle. His left foot was fractured, and he underwent surgery 6 months previously. After the operation and cast application, he developed uncontrolled pruritus, swelling, sweating, and flushing of the left foot skin with limping. On examination, he showed well-known features of CRPS without pain. He was diagnosed with an atypical CRPS with neuropathic itching (NI). With treatment modalities used for NP and CRPS, his pruritus subsided gradually, and the his ankle mobility improved.Conclusions: Unexplained itching can be the main symptom in some CRPS patients. Treatment according to NP can improve symptoms of NI in CRPS patients.

Multicomponent compression system use in patients with chronic venous insufficiency: a real-life prospective study

Objective: Compression therapy is the cornerstone of therapeutic management of patients with chronic venous insufficiency (CVI). This study aimed to evaluate the efficacy and safety of a multicomponent compression system in an unselected population of patients with CVI problems under real-life conditions. Method: A prospective, multicentre, observational study with a multicomponent two-bandage compression system (UrgoK2, Laboratoires Urgo, France) was conducted in 103 centres in Germany. Main outcomes included wound healing rate, wound healing progression, assessment of oedema and ankle mobility, local tolerability and acceptance of the compression therapy. Results: A total of 702 patients with venous leg ulcers (VLU) and/or with lower limb oedema due to CVI were treated with the evaluated system for a mean (±standard deviation) duration of 27±17 days. By the last visit, 30.9% of wounds had healed and 61.8% had improved. Limb oedema was resolved in 66.7% of patients and an improvement of ankle mobility was reported in 44.2% of patients. The skin condition under the compression therapy was also considered as improved in 73.9% of patients and a substantial reduction of pain was achieved, both in number of patients reporting pain and in pain intensity. Compression therapy with the evaluated system was ‘very well’ or ‘well’ tolerated and ‘very well’ or ‘well’ accepted by >95% of patients. These positive outcomes were in line with the general opinion of physicians on the evaluated compression bandages, which were judged ‘very useful’ or ‘useful’ for >96.6% of patients. Similar results were reported regardless of the treated condition, VLU and/or limb oedema. Conclusion: Real-life data documented in this large observational study of non-selected patients receiving compression therapy in daily practice confirm the benefits and safety profile of the evaluated compression system. This study also confirms the high-level of performance and acceptability of the system, regardless of the characteristics of the wounds or patients at initiation of the treatment. The data support the use of this multicomponent compression system as one first-line intervention in patients with symptoms caused by CVI.

Impact of hip abductor and adductor strength on dynamic balance and ankle biomechanics in young elite female basketball players.

Muscles weakness can affect to injury risk, in lower limb hip abductor (ABD) and adductor (AD) muscles have not been elucidated how affect in female basketball players, such as balance and ankle mobility. This study aimed to investigate hip ABD and AD strength and their relation in balance and ankle dorsiflexion mobility in young elite female basketball players. Observational study in a total of 60 trainee-level elite female basketball players (13–17 years old) were included. Hip ABD and AD isometric strength values were collected. The correlation study showed that hip ABD strength had a low-moderate correlation with balance and ankle mobility in the homolateral and contralateral leg, while there was a low-moderate correlation between hip AD strength and balance and ankle mobility only in the homolateral leg. On the other hand, the ABD-AD ratio was not found to correlate with balance or mobility scores, nor the degree of muscle imbalance between legs. Hip ABD and AD strength affects balance and ankle mobility in trainee level female basketball players. These findings should thus be taken into consideration when designing strategies aimed at reducing the risk of limb injury, which has a high prevalence in women's basketball.

Association ankle function and balance in community-dwelling older adults

Background and purpose Ankle function declines with age. The objective of this study was to investigate the association between ankle function and balance in older adults, with a focus on range of motion (ROM) and strength. Methods This was a cross-sectional study that included 88 healthy community-dwelling older adults. Ankle mobility was measured while bearing weight (lunge test) and not bearing weight. The plantar-flexor muscle strength was assessed using a hand-held dynamometer. Balance was measured in terms of dynamic balance and mobility (timed up and go test), monopodal and bipodal static balance with open and closed eyes (single-leg stand test and platform measures), and margins of stability (functional reach test). Linear correlation and multiple regression analyses were conducted with a 95% CI. Results and discussion Most participants had limited ankle mobility (n = 75, 86%). Weight-bearing ankle dorsiflexion ROM was the strongest predictor of dynamic balance and included general mobility and stability (Radj2 = [0.34]; β = [-0.50]). In contrast, plantar-flexor muscle strength was a significant predictor of static standing balance with open eyes (Radj2 = [0.16–0.2]; β = [0.29–0.34]). Overall, weight-bearing ankle dorsiflexion ROM was a more representative measure of balance and functional performance; however, a non-weight-bearing mobility assessment provides complementary information. Therefore, both measures can be used in clinical practice. Conclusion This study supports the concept that ankle mobility contributes to the performance of dynamic tasks, while the plantar-flexor muscle strength helps to develop a standing static balance. Identification of alterations in ankle function is warranted and may assist in the design of tailored interventions. These interventions can be used in isolation or to augment conventional balance training in order to improve balance performance in community-dwelling older adults.

Assessment of Effectiveness of 15 Weeks of Physical Therapy on Biplanar Ankle Mobility, Gait and Pain Level in Patients Following Operative Repair of the Achilles Tendon

Background. The aim of the study was to assess the effectiveness of 15 weeks of physical therapy on biplanar ankle mobility, gait and pain level in patients following operative repair of the Achilles tendon. Material and methods. The study enrolled two groups of patients; a group of men (n=40) after operative repair of the Achilles tendon, who underwent 15 weeks of postoperative physiotherapy (Group I) and a group of men (n=40) without Achilles tendon injury (Group II). The ranges of motion for supination, pronation, plantar and dorsiflexion of the foot were measured in both groups. The ankle and shin circumferences were also measured. 10-meter unassisted walking, the Thom­son test results and pain according to a VAS scale were assessed. In Group I the tests were carried out after 5 and 20 weeks following open Achilles tendon repair. A test for dependent samples was used to compare within-group statistics and the ANOVA and Tukey’s tests were used for between-group comparison. Results. After 15 weeks of postoperative physical therapy, the patients in Group I had regained the ability to walk unassisted, all measured ranges of motion had improved significantly (from p=0.0001 to p=0.001), the ankle circumference on the operated side had decreased (p=0.002) and no pain was reported. However, the between-group comparison showed persistent, significantly decreased values of supination and plantar flexion on the operated side (p=0.001). Conclusions. 1. 15 weeks of postoperative physical therapy after open Achilles tendon repair restored painless function of the ankle joint and unassisted walking. 2. Despite a significant improvement in the range of motion, supination and plantar flexion of the foot on the operated side were not fully restored.

An Orthotic Joint Design for Enhancing Ankle Mobility With Ankle Foot Orthoses Use

Articulated ankle foot orthoses (AFOs) are prescribed to treat drop-foot, a common neuromuscular weakness observed after a stroke. These assistive devices prevent the toe from dragging during swing (drop-foot) by providing a resistive moment at the ankle. However, existing ankle joint designs for articulated AFOs introduce additional gait pathologies as they also constrain ankle mobility during stance. A novel ankle joint for AFOs to prevent drop-foot during swing and improve ankle mobility during stance was developed, thereby reducing compensatory knee motion during stance. The design intent was to mimic the unconstrained kinematic response of a nonpathologic ankle at initial contact while preventing drop-foot during swing. The design incorporated two modes of operation: locked during swing for support and unlocked during stance for enhanced range of motion. Proof of concept testing with able-bodied subjects was conducted to test walking ability over level ground based on kinetic and kinematic parameters. The comparative tests confirmed the ability of the novel design to prevent drop-foot and its potential for enhanced ankle mobility during stance. Preliminary results indicate that the novel ankle joint should be refined to facilitate smooth and consistent unlocking but can be safely used in its current form with mobility impaired individuals.