Background: Flat feet change lower extremity alignment, and it may change the load distribution on Achilles tendon during exercise. The purpose of the present study was to investigate the immediate effect of cumulative transverse strain via resistive ankle plantarflexion exercise on the Achilles tendon in individuals with flat feet.
Methods: Fourteen individuals with flat feet and 14 age-matched individuals with normal foot posture were enrolled in the present study. Achilles tendon thickness was measured by an ultrasonography device with a linear probe at 3 points: 1 cm (AT-1), 2 cm (AT-2), and 3 cm (AT-3) proximal to the superior aspect of the calcaneus. Ultrasonography measurements were performed before and after participants completed 90 repetitions of double-leg calf raise exercises which included moving the foot from full ankle dorsiflexion to full ankle plantarflexion.
Results: Achilles tendon thickness at all points measured was thinner in the flat feet group at both pre- and post-exercise conditions compared with that of the control group (p<0.05). Achilles tendon thickness at AT-1, AT-2, and AT-3 decreased after the exercise in both groups (p<0.001). The differences in Achilles tendon thickness at all points measured between pre- and post-exercise conditions were lower in individuals with flat feet than those of the control group (p<0.05).
Conclusion: There was a significant decrease in Achilles tendon thickness after exercise in both groups; however, the tendon thickness markedly diminished in individuals with normal foot posture. The results are thought to result from changes in tendon structure and in load distribution on the Achilles tendon.
Background: To present prospective short-term results of a limited patient series treated with two innovative partial ankle arthroplasties: talar dome resurfacing for mild-to-moderate ankle osteoarthritis (OA) and talar shoulder hemiarthroplasty for chronic medial osteochondral lesions of the talus (OLT).
Methods: Eleven subjects underwent talus resurfacing, and six subjects were enrolled for talar hemiarthroplasty. The outcome was followed by patient-reported measures and by pursuing serious adverse events or implant failures over a 2-year period. Progression of ankle osteoarthritis, peri-implant bone changes, and implant migration were followed radiographically.
Results: Active dorsiflexion increased from 3° to 10° in resurfacing and from 15° to 22° in hemiarthroplasty. Patient-reported ankle function, quality of life, and activity level tended to improve only slightly after resurfacing (FAOS cumulative = 41 to 42; FAAM-ADL = 43 to 46; EQ-5D 3L = 0.38 to 0.39, Tegner activity scale = 1.6 to 2.0), but moderately after hemiarthroplasty (FAOS cumulative = 58 to 68, FAAM-ADL = 37 to 71, EQ-5D 3L = 0.53 to 0.72, Tegner activity scale = 3.1 to 3.1). No implant-related radiographic changes, implant failures, or implant-related revision surgeries were recorded.
Conclusions: Based on a small and heterogeneous prospective case series, both partial ankle implants investigated were safe and stable over a 2-year follow-up period, without any radiographic OA progression of the remaining joint. However, patient-reported ankle function, quality of life, and activity level showed a tendency of only minor improvement after resurfacing but a moderate increase after hemiarthroplasty.
Background: It was aimed to investigate the intra-observer and inter-observer validity of the Hepple classification used in talus osteochondral lesions.
Methods: This study included 32 patients with osteochondral lesions in the talus after exclusion criteria. A PowerPoint presentation was prepared from the MRI views of the patients. Six observers, divided into two groups according to their experience, were asked to categorize the cases according to Hepple classification. The slides were shuffled and the observers were asked to reevaluate after 6 weeks. Fleiss kappa (κ) coefficient was used for the inter-observer validity and Cohen’s kappa (κ) coefficient for the intra-observer validity.
Results: In the overall inter-observer reliability was at a moderate level of agreement (set one κ=0.511, set two κ=0.406). In the intra-observer evaluation, one observer from the experienced group showed almost perfect agreement (κ=0.809), one observer from the less experienced group had moderate agreement (κ=0.556), and all other observers had substantial agreement (κ=0.556 – 0.730). When all observers were examined, it was seen that there was a substantial agreement in the mean intra-observer evaluation (κ=0.661).
Conclusions: While the intra-observer results showed substantial agreement, the inter-observer results showed moderate agreement. Although the Hepple classification system is frequently used, the need for a more reliable classification system for osteochondral lesions of the talus remains.
Background: In this study, our purpose is to evaluate patients who were followed by acute developing single-sided foot drop and improving with conservative management or spontaneously.
Methods: Between 2019 and 2020, 10 patients were evaluated for a unilateral weakness of the lower extremity in the form of absent dorsiflexion at the ankle joint and were given a diagnosis of foot drop without any etiological cause. Patients were followed for a period of 18 months. All patients were evaluated for acute foot drop of the affected extremity by utilizing the following diagnostic modalities, EMG, MRI lumbar spine, MRI knee, peripheral MRI neurography and non-contrast brain MRI. Each patient was evaluated for a history of Covid-19 infection over the past year. Patients with any identified cause were excluded.
Results: Initial evaluation of muscle strength in all patients revealed 0/5 by the MRC muscle testing grading scale. (1) In 2 patients, the muscle strength was 3/5 at the 6th month, and in the other 8 patients 4/5 at the 6th month. The muscle strength of all patients improved as 5/5 in 1 year. Six of the patients were dispensed an AFO device and nine patient’s performed physical therapy. Evaluation of EMG results identified significant neuropathy at the level of the common peroneal at the fibular head in all patients. In comparison with peroneal nerve stimulation below and above the fibular head in the lateral popliteal fossa; 50% reduction in sensory amplitude, and motor conduction slowing of >10 m/s was present. Evaluation of knee MRI revealed, no masses, edema, or anatomical variations at the level of the fibular head.
Conclusions: In patients diagnosed with unilateral acute foot drop without an etiological cause, one should keep in mind that spontaneous resolution of this condition can occur within one year period.
Background: Distal fibula fractures at the ankle level are common and are usually accompanied by ligament injuries. This study aims to evaluate the effects of ankle ligament ruptures on ankle joints, fracture instability, and plate stress after distal fibula fracture fixed with plate created by finite element analysis (FEA) modeling and loading applied to ligament rupture models that may accompany this fracture.
Methods: A finite element model consisting of 3-D (3D) fibula, tibia, foot bones, and ankle ligaments was designed to investigate the effects of ligament injuries accompanying plate-detected Arbeitsgemeinschaft für Osteosynthesefragen (AO 44B2.1)-type fractures on fracture detection, fixation material, and ankle joints. Then, the results were evaluated by modeling ligament rupture in 6 different ways.
Results: In the modeling where the deltoid and the talofibular ligament are broken together, instability is the highest in the ankle (2.31 mm) and fracture line (0.15 mm). In our study, the rupture of the tibiofibular anterior and posterior ligaments associated with syndesmosis caused less instability in the fracture and ankle than the single rupture models of both the deltoid and the talofibular ligament.
Conclusions: In the finite element modeling of AO 44B2.1-type fractures detected with plate, the importance and potential effects of often overlooked ankle ligaments are pointed out shown. It is important to keep in mind that when treating ankle injuries, the ankle should be treated as a whole, with both bone and soft tissue. In some cases, the fracture may represent the visible tip of the iceberg.
Background: The aim of this study was to create AO 44 A1, B1 and C1 fractures using finite element analysis (FEA), to determine the stability of k-wire, intramedullary screw (IS) and plate-screw (PS) fixation methods in fracture
Methods: Using FEA the post-reduction behaviour of AO 44 A1, B1 and C1 fractures with k-wire, IS and PS fixation methods was analysed and compared in terms of displacement and stress.
Results: The lowest amount of displacement was provided with the IS method in AO 44 A1 and B1. It was observed in the detection of 4 mm k-wire in AO 44 C1. The total displacement of the IS system used for fixation in AO 44 A1, B1 and C1 fractures was lower
Conclusions: According to FEA results, the lowest amount of displacement was obtained with IS in AO 44 A1 and B1, while 4 mm K-wire fixation was achieved in AO 44 C1 fractures.
Background: The aim of this study is to measure the quality of information about ‘flatfoot’ and ‘pes planus’ presented online on the social media site YouTube and to determine the trends of viewers to medical information on YouTube.
Methods: ‘flatfoot and pes planus’ was typed into the YouTube search module. From the search results, videos with 50000 views or more, longer than 45 seconds, containing information about flatfoot and pes planus disease were selected. DISCERN, JAMA scoring, daily average views, number of likes, number of comments were collected from 53 videos that met the criteria. The profession of the sharer was evaluated in terms of the information quality of the sharing and the orientation of the audience.
Results: The mean number of views per day of the examined videos was 2047. Mean video presentation time was 8 minutes 50 seconds. The mean JAMA score was 2/4 and the mean DISCERN score was 38.16/75. According to the DISCERN score according to the professions, the video quality was moderate in doctors (41.44±12.99), moderate in physiotherapists (41.91±9.04), poor in coaches (32.78±7.87), poor in patients (34.50±5.32) and weak in others (34.89±14.00). According to the Spearman correlation between DISCERN score and mean daily viewing significant relationships were found in the doctors group p:0.0102 and the others group p:0.0033, however, no significant relationships were observed in the physiotherapists group p:0.1073, the flatfoot patients group p:0.5363 and the coaches group p:0.9111. There were significant relationships between like and comment counts in all groups (doctors p:0.0088, coaches p:0.0069, physiotherapists p:0.0007, others p:0.0018, patients p:0.0066).
Conclusions: Looking at previous studies, it was observed that the quality of online health information was historically inadequate. Likewise, in our study on YouTube, we found that the quality of flatfoot and pes planus information was poor to moderate.
Background: This study aimed to compare two-point discrimination in feet with ankle sprains and feet without ankle problems, and to determine whether there was a change in the two-point discrimination values in ankle sprains.
Methods: A total of 108 people were included in the study. These subjects were aged between 18 and 40 years and visited the Medical Faculty of Yozgat Bozok University for various reasons in July and September of 2022. These people were divided into two groups: subjects with an ankle sprain and subjects with no ankle problems. Two-point discrimination values measured in mm were recorded for both groups using a caliper (esthesiometer) used in six regions of 216 feet. The two-point discrimination threshold values of the feet were compared statistically according to feet with ankle sprains and feet without ankle problems, as well as in right and left feet.
Results: The study determined that the two-point discrimination threshold values measured at the 1st toe tip, heel, 3rd plantar metatarsal head, medial malleolus, and lateral malleolus in subjects with an ankle sprain was higher than in subjects with no ankle problems. When comparing both feet of the subjects with an ankle sprain, the two-point discrimination threshold value in the heel of the foot with an ankle sprain was higher than in the heel of the foot without ankle problems.
Conclusions: The two-point discrimination threshold value was higher in subjects with an ankle sprain than in subjects with no ankle problems. The data suggest that the two-point discrimination threshold may be higher in people with an ankle sprain. Further studies are needed to better understand the two-point discrimination threshold in ankle sprains.
Background: Online health-related information has become increasingly popular. Social media platforms have great potential to support and change patients’ perspective. Plantar fasciitis (PF) is a common disease which is one of the most frequently researched subjects in foot problems. This study aimed to assess the content, quality and reliability of YouTube videos related to PF and to evaluate if they reflect current PF treatment guidelines.
Methods: The descriptive cross - sectional study analyzed the most viewed 79 YouTube videos retrieved by using the keyword “plantar fasciitis”. The quality, reliability and content of the videos were analyzed using Global Quality Scale (GQS), the modified DISCERN, JAMA and content scoring system by two independent physiotherapist. The analyzed videos were divided into three groups according to their GQS score as high, intermediate and low quality. Also, video parameters were compared between the useful and misleading groups.
Results: Of the analyzed 79 videos, 26 (32.9%) were of low quality, 29 (36.7%) were of intermediate quality and 24 were of (30.3%) high quality. Most of high quality videos were uploaded by allied health professionals (39.4%). View ratio and video power index scores were highest in patients. There were significant differences between useful and misleading videos in terms of DISCERN, GQS and JAMA scores (p =0.000, p=0.000, p=0.020, respectively). Almost all of the evaluated videos contain at least one treatment approach.
Conclusions: This study demonstrates that the vast of majority YouTube videos on PF are useful and comprehensive, also our results may propose that the vast majority of the videos reflect current treatment guidelines. Video-based information about PF may provide valuable insight to patients, especially in the absence of a direct access to healthcare stakeholders.
Background: This cross-sectional retrospective study aimed to present the influence of unilateral and bilateral flatfoot on coronal spinopelvic alignment in asymptomatic young healthy males.
Methods: It was carried out by examining the medical reports of individuals who apply to the National Health Board to work in positions requiring physical fitness between January 2018 and January 2019. Plain radiographies of the feet, pelvis, and spine were analyzed. Calcaneal pitch angle (CPA) for flatfoot, pelvic obliquity (PO), and Cobb angle (CA) for spinal asymmetry was measured. After all analyzes were completed, participants divided into 2 groups as unilateral (UniFF) or bilateral (BiFF) flatfoot, depending on the CPA measurements and compared.
Results: There was no statistically significant difference in age (p= .609). The UniFF group showed higher values in terms of BMI with a statistically significant difference (p= .01). The curve patterns identified as single thoracal, lumbal and double. Post hoc analyses suggests that males without spinal asymmetry were more likely to have unilateral flatfoot (p< .008). There were statistically significant differences between groups in PO and CA (p< .05). The effect size was found small to medium effect for PO and medium to large for CA.
Conclusions: In conclusion, young males with bilaterally increased foot pronation demonstrate more increased pelvic obliquity and spinal curvature.