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Musculoskeletal Effects of Pregnancy on the Lower Extremity
A Literature Review
Pregnant women are often burdened with musculoskeletal symptoms of the lower extremity due to the physical, hormonal, and anatomical changes that occur throughout pregnancy. These symptoms are associated with musculoskeletal dysfunctions, modified gait, joint laxity, muscle imbalance, and increased body mass. This article reviews the literature involving the lower-extremity changes experienced by women during pregnancy and their respective pathophysiologic causes.
Background:
To date, there is conflicting evidence that high-end “motion control” running shoes can correct and control rearfoot pronation. Many methods have been used to evaluate the efficacy of motion control footwear in reducing hindfoot pronation during gait, including stop-motion photography, three-dimensional camera kinematic analysis, and three-dimensional bone modeling using computed tomography. Until now, there have been no radiographic studies that examined the effect of motion control running shoes on the static posture of the foot. Murley et al devised a reliable system that correlated noninvasive clinical examinations to radiographic values that correspond to foot pronation. The aim of this prospective investigation was to determine whether motion control running shoes are able to produce a significant difference in pronation through a radiographic study, using the angular relationships as described by Murley et al, in two different shoe conditions as compared to the barefoot condition in female subjects.
Methods:
This prospective study screened 28 female subjects ranging in age from 22 to 27 years on the basis of arch height index. The 24 subjects with a standing arch height index less than 0.370 were invited to participate in the study. Unilateral weightbearing dorsoplantar and lateral foot radiographs were taken in barefoot, neutral shoe, and motion control shoe conditions. Calcaneal inclination angle, calcaneal–first metatarsal (CFMA) angle, talonavicular coverage angle (TNCA), and talus–second metatarsal angle were measured in each condition by two independent observers using the Opal-Ortho PACS software package and then averaged. Angles were compared to barefoot baseline values using paired t tests.
Results:
The motion control running shoe produced average decreases of 2.64% in CFMA, 12.62% in TNCA, 5.3% in talus–second metatarsal angle and an average increase of 1.3% in calcaneal inclination angle. Statistically significant (P > .05) improvements in CFMA were noted in both the motion control (P < .000) and neutral shoe conditions (P < .000) when compared to barefoot, whereas TNCA improved only in the motion control shoe condition as compared to barefoot (P = .003).
Conclusions:
This investigation found evidence that the particular models of motion control running shoes studied could correct foot pronation in the transverse and sagittal planes in stance. Motion control running shoes improved CFMA and TNCA from the barefoot condition and were more effective in correcting pronation compared with neutral running shoes in this radiographic study simulating static foot posture in stance.
INTRODUCTION AND OBJECTIVES: The benefits of using amniotic tissue in skin regeneration are well documented. Today, cryopreservation technology allows for better availability and maintenance of mesenchymal stem cells. This is of particular interest in treating the diabetic foot ulcer as this population has fewer mesenchymal stem cells. The objective of this case series investigation was to compare the efficacy of cryopreserved human amniotic stem cells in treating foot wounds of different etiologies. We will present data and case photos for a diabetic foot ulcer, venous leg ulcer, arterial ankle ulcer, and a pyoderma gangrenosum ulcer
METHODS: Cryopreserved human amniotic stem cell grafts were applied to patients with chronic ulcers of different etiologies that had been subjected to at least 4 weeks of standard wound care and did not show adequate clinical progress. Wound area was recorded and photographed on weekly basis. Area reduction was charted over time and the results of each individual case were compared to one another.
RESULTS: All ulcers displayed results that well exceeded the established parameters of weekly healing rates for effective wound treatment modalities.
• Pyoderma gangrenosum displayed the poorest response to treatment. However, it is worth noting that the patient was not compliant in the prescribed adjunctive treatment regimen but managed to achieve 64% wound reduction.
• All ulcers showed the largest appreciable amount of healing in both total area reduction and week-to- week closure percentage after the first application.
CONCLUSIONS: Cryopreserved human amniotic stem cell grafts can aid in the decreasing the time to closure of various types of lower extremity ulcerations. The therapy is a clinically viable option for physicians to consider when formulating a treatment plan for a patient with an ulcer.
