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Advances in Foot Posture Assessment and Health Implications

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A special issue of International Journal of Environmental Research and Public Health (ISSN 1660-4601). This special issue belongs to the section "Health Care Sciences & Services".

Deadline for manuscript submissions: closed (30 June 2021) | Viewed by 53618

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Special Issue Editors

Prof. Dr. Alfonso Martínez-Nova

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Guest Editor

Nursing Department, University Center of Plasencia, University of Extremadura, 10600 Plasencia, Spain
Interests: foot and ankle pathology; sports injuries; rheumatic diseases; rheumatic diseases; foot surgery; thermography
Special Issues, Collections and Topics in MDPI journals

Dr. Angela Evans

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Guest Editor

Discipline of Podiatry, School of Allied Health, Human Services and Sport, La Trobe University, Plenty Road, Bundoora, Melbourne, VIC 3086, Australia
Interests: foot posture; gait; child health; ankle biomechanics; evidence in practice
Special Issues, Collections and Topics in MDPI journals

Prof. Dr. Gabriel Gijón-Noguerón

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Guest Editor

Department Nursing and Podiatry, Universidad de Malaga, Malaga, 29100 Spain
Interests: foot and ankle pathology; sports injuries; rheumatic diseases; badminton; pediatric podiatry; application of VR in teaching and clinical practice
Special Issues, Collections and Topics in MDPI journals

Prof. Dr. Kevin Deschamps

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Guest Editor

Faculty of Movement & Rehabilitation Sciences, Katholieke Universiteit Leuven
Interests: Podiatry, gait and motion analysis, foot joint kinetics, plantar pressures, foot orthotics

Special Issue Information

Dear Colleagues,

The evaluation of the foot posture, with several methods (footprints, x-ray goniometry, measurements of anatomical heights, more or less objective palpations and evaluations or using motion analysis technology) has been a recurring topic in the research due to its implications in health. About foot posture we are interested in both, physiological, and altered parameters, in order to know the link with whole health or pain appearance, and diseases or deformities in the foot, lower extremity or low back. Being foot posture assessment so important in the childhood, in the sport performance, the design of foot orthoses and sport and daily shoes this special issue of International Journal of Environmental Research and Public Health (IJERPH) focuses on the current state of knowledge on advances in foot posture, methods, evolution and interventions to analyze foot posture and their link with health or the appearance of injuries or diseases. We will accept manuscripts from different disciplines, as new research papers and reviews. Papers dealing with new approaches to assess foot posture and interventions studies are also welcome. Other manuscript types accepted include methodological papers, brief reports and commentaries. Here are some examples of topics that could be addressed in this special issue:

Link between different methods of assessment of foot posture
Interventions that assess foot posture
Does pediatric flatfoot matter?
Foot posture and sports performance
Foot posture at risk foot
Foot posture across the lifespan
Foot posture and foot pain
Foot posture and disease groups
Biopsychological determinants associated to foot posture
Foot posture measurements and its correlation with dynamic foot measurements
Foot posture and medical imaging

Prof. Dr. Alfonso Martínez-Nova
Dr. Angela M. Evans
Prof. Dr. Gabriel Gijón-Noguerón
Prof. Dr. Kevin Deschamps
Guest Editors

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Keywords

Foot
Posture
Health
Foot Injuries
Foot Diseases
Flatfoot
Foot Orthoses
Diabetic Foot

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Published Papers (13 papers)

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10 pages, 364 KiB

Open AccessArticle

Relationship of Body Mass Index and Footprint Morphology to the Actual Height of the Medial Longitudinal Arch of the Foot

by Carolina Rosende-Bautista, Pedro V. Munuera-Martínez, Teresa Seoane-Pillado, María Reina-Bueno, Francisco Alonso-Tajes, Sergio Pérez-García and Gabriel Domínguez-Maldonado

Int. J. Environ. Res. Public Health 2021, 18(18), 9815; https://doi.org/10.3390/ijerph18189815 - 17 Sep 2021

Cited by 8 | Viewed by 3142

Abstract

The medial longitudinal arch height of the foot is linked to individual characteristics such as sex and body mass index, and these characteristics have been shown to be associated with conditions such as flat feet. In this cross-sectional descriptive study, we examined the medial longitudinal arch morphology in an adult population to determine if there are differences related to sex and body mass index, and values were obtained for the foot posture index. Normalized anthropometric measurements and arch indices were calculated from footprints. Groups, defined by sex and body mass index, were compared, and the correlations between body mass index and the variables were determined. In the population studied (266 women and 177 men), significant differences between men and women for the foot posture index and normalized arch measurements were found. Analysis of the variables related to body mass index indicated there were significant differences in arch indices. Significant differences and positive correlations were also found between the arch index and body mass index for the left and right feet among the men and women studied. The results obtained allow us to reflect on and analyze whether the medial longitudinal arch morphology classification methods used in the clinical and research setting are adequate or whether the influence of factors such as body mass index can generate confusion. Full article

(This article belongs to the Special Issue Advances in Foot Posture Assessment and Health Implications)

10 pages, 575 KiB

Open AccessArticle

Relationship between Connective Tissue Morphology and Lower-Limb Stiffness in Endurance Runners. A Prospective Study

by Alberto Rubio-Peirotén, Felipe García-Pinillos, Diego Jaén-Carrillo, Antonio Cartón-Llorente, Ferrán Abat and Luis E. Roche-Seruendo

Int. J. Environ. Res. Public Health 2021, 18(16), 8453; https://doi.org/10.3390/ijerph18168453 - 10 Aug 2021

Cited by 5 | Viewed by 2404

Abstract

Background: The lower limb behaves like a spring compressing and decompressing during running, where lower-limb stiffness is one of the most influential factors. This prospective observational study is aimed at examining the relationship between the connective tissue morphology and lower-limb stiffness and investigating whether the barefoot/shod condition influences on such relationship. Methods: 14 male amateur runners (10-km time trial <50′) were included. Data were recorded over one session, where participants ran 2 trials (i.e., barefoot and shod conditions) of 3 minutes at 12 km/h, where running spatiotemporal parameters and vertical (Kvert) and leg stiffness (Kleg) were obtained. Prior to testing trials, thickness and cross-sectional area (CSA) were recorded for Achilles (AT) and patellar tendons (PT) and plantar fascia (PF) with ultrasound. Results: Under barefoot condition, a positive correlation was found between Kleg and AT-thickness and CSA and PF-thickness; and between Kvert and AT-thickness and PF thickness. Under shod condition, a positive correlation was found between Kleg and PT-CSA and PT-thickness, and between Kvert and PT-CSA and PT-thickness. Conclusions: The results reveal a specificity of the relationship between the lower-limb stiffness and the morphology of the connective tissue. Greater tendon shows higher lower-limb stiffness when that tendon is specially demanded by the function. Full article

(This article belongs to the Special Issue Advances in Foot Posture Assessment and Health Implications)

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9 pages, 1267 KiB

Open AccessArticle

Effectiveness of a Central Discharge Element Sock for Plantar Temperature Reduction and Improving Comfort

by Alfonso Martínez-Nova, Víctor Manuel Jiménez-Cano, Juan Miguel Caracuel-López, Beatriz Gómez-Martín, Elena Escamilla-Martínez and Raquel Sánchez-Rodríguez

Int. J. Environ. Res. Public Health 2021, 18(11), 6011; https://doi.org/10.3390/ijerph18116011 - 3 Jun 2021

Cited by 10 | Viewed by 2484

Abstract

U-shaped plantar cushions could help reduce stress affecting the central forefoot without the need for an orthosis, but they are yet to be integrated as an element in socks. The objective of this study was to verify the effectiveness of a sock with a central discharge element in terms of plantar temperature and comfort. The sample comprised 38 subjects (13 men and 25 women). Their plantar temperatures were measured with a thermographic camera in a basal situation and after each of two 10-minute walks around an indoor circuit during which they wore either control or experimental socks at random (the same design, weight, and fiber, but with the plantar cushioning element added). After the walks, each subject responded to a comfort questionnaire (five-point Likert scale), blindly scoring the two socks. The highest temperatures (28.3 ± 2.7 °C) were recorded in the zone of the second and third metatarsal heads. With the experimental socks, the observed temperature increase in the central forefoot zone was significantly less than with the control socks (31.6 vs. 30.6 °C, p = 0.001). The subjects found the experimental socks to be more comfortable than the controls (4.63 ± 0.5 vs. 4.03 ± 0.5, p < 0.001). The discharge element included in the experimental socks was effective since it reduced the contact zones and excess friction with the ground, thereby lessening overheating by more than 1 °C. Furthermore, the experimental socks were perceived as being more comfortable by the subjects who had mild and occasional foot discomfort. Full article

(This article belongs to the Special Issue Advances in Foot Posture Assessment and Health Implications)

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11 pages, 947 KiB

Open AccessArticle

Foot Pain and Morphofunctional Foot Disorders in Patients with Rheumatoid Arthritis: A Multicenter Cross-Sectional Study

by María Reina-Bueno, Pedro V. Munuera-Martínez, Sergio Pérez-García, María del Carmen Vázquez-Bautista, Gabriel Domínguez-Maldonado and Inmaculada C. Palomo-Toucedo

Int. J. Environ. Res. Public Health 2021, 18(9), 5042; https://doi.org/10.3390/ijerph18095042 - 10 May 2021

Cited by 19 | Viewed by 5438

Abstract

Foot problems are highly prevalent in people with rheumatoid arthritis. This study aims to explore the foot morphology, pain and function in rheumatoid arthritis patients and the relation with the time of disease debut. A cross-sectional study was designed. Footprint, the Foot Posture Index, the hallux valgus prevalence, foot pain and function in 66 rheumatoid arthritis patients and the association with time since diagnosis, were recorded. The Foot Function Index, the Manchester Foot Pain and Disability Index, the Visual Analogic Scale, and the Manchester Scale for hallux valgus were administered and analyzed in two groups, with less and more than 10 years of diagnosis of the disease. A high prevalence of pronated (right 36.8% and left 38.6%) and highly pronated (right 15.8% and left 15.8%) feet was observed, as well as an elevated percentage of low arched footprints (right 68.4 and left 66.7%) and hallux valgus (right 59.6% and left 54.4%). Hallux valgus prevalence, toe deformities and Foot Function Index (Functional limitation) factors were significantly associated with the time since RA diagnosed adjusted for the other factors. The adjusted odds ratio of Hallux valgus prevalence was 4.9 (1.2–19.7). In addition, the foot function was diminished, and foot pain was present in most participants. In conclusion, rheumatoid arthritis patients’ feet showed altered morphology and function, and with longer rheumatoid arthritis history, metatarsophalangical stability and foot function, but not pain and global foot posture, were likely to deteriorate. Full article

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9 pages, 1048 KiB

Open AccessArticle

Symmetry Criterion for Patients with Rheumatoid Arthritis of the Foot: A Cross-Sectional Study

by Jose Alberto Sanchez-Castillo, Andres Reinoso-Cobo, Gabriel Gijon-Nogueron, Rafael Caliz-Caliz, Manuela Exposito-Ruiz, Laura Ramos-Petersen and Ana Belen Ortega-Avila

Int. J. Environ. Res. Public Health 2021, 18(7), 3619; https://doi.org/10.3390/ijerph18073619 - 31 Mar 2021

Cited by 5 | Viewed by 2469

Abstract

Objective: The aim of the study was to analyze the feet of rheumatoid arthritis (RA) patients, to determine the degree to which both feet were affected, primarily analyzing the severity of RA in both feet looking at structure and morphology, and secondly looking at the symmetry in terms of the anthropometrics and posture. Method: This cross-sectional study was conducted from January to December 2018. The data from 229 patients with RA and with foot pain and no RA recruited (Granada, Spain) were analyzed. Two researchers independently interviewed the patients to obtain the study data. The clinical data were obtained using specific foot health and quality of life questionnaires and a validated platform for foot measurement. Anthropometric measurements were obtained by means of a foot measurement platform and the Foot Posture Index (FPI). The bivariate analysis was performed with the Student’s t test and the non-parametric Wilcoxon test. The level of significance was established at p < 0.05. Results: In the RA group, anthropometric measurements revealed significant differences between the left and right feet in 13 of the 23 parameters considered, as follows: (non-load-bearing) foot length, length of the first metatarsophalangeal joint, maximum height of the internal longitudinal arch, and width of the midfoot (p < 0.001, p = 0.038, p < 0.001, and p = 0.037 respectively); and Foot Posture Index (p = 0.001). Conclusions: In patients with RA, statistically significant differences were found in the Foot Posture Index and in several parameters related to foot structure and morphology. From this, we conclude that from a morphological, structural, and postural standpoint, a pattern of symmetric joint involvement should not be viewed as a specific criterion for RA in the foot. Full article

(This article belongs to the Special Issue Advances in Foot Posture Assessment and Health Implications)

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9 pages, 465 KiB

Open AccessArticle

Posture and Health: Are the Biomechanical Postural Evaluation and the Postural Evaluation Questionnaire Comparable to and Predictive of the Digitized Biometrics Examination?

by Giovanni Barassi, Edoardo Di Simone, Piero Galasso, Salvatore Cristiani, Marco Supplizi, Leonidas Kontochristos, Simona Colarusso, Christian Pasquale Visciano, Pietro Marano, Di Iulio Antonella and Orazio Giancola

Int. J. Environ. Res. Public Health 2021, 18(7), 3507; https://doi.org/10.3390/ijerph18073507 - 28 Mar 2021

Cited by 8 | Viewed by 2940

Abstract

Background: Postural tone alterations are expressions of myofascial and, therefore, of structural, visceral, and emotional disorders. To prevent these disorders, this study proposes a quantitative investigation method which administers a postural evaluation questionnaire and a postural biomechanical evaluation to 100 healthy subjects. Methods: The reliability of the method is studied by comparing both assessments with digitized biometrics. In addition, 50 subjects undergo the biomechanical evaluation form twice, by four different operators, to study the intraoperative repeatability. Results: The results show a satisfactory overlap between the results obtained with the postural evaluation questionnaire and the postural biomechanical evaluation compared to computerized biometrics. Furthermore, intraoperative repeatability in the use of the biomechanical evaluation form is demonstrated thanks to a minimal margin of error. Conclusions: This experience suggests the importance of undertaking this path in both the curative and the preventive sphere on a large scale and on different types of people who easily, and even unknowingly, may face dysfunctional syndromes, not only structural and myofascial but also consequently of the entire body’s homeostasis. Full article

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9 pages, 1461 KiB

Open AccessArticle

Morphological and Postural Changes in the Foot during Pregnancy and Puerperium: A Longitudinal Study

by Monserrat Alcahuz-Griñan, Pilar Nieto-Gil, Pedro Perez-Soriano and Gabriel Gijon-Nogueron

Int. J. Environ. Res. Public Health 2021, 18(5), 2423; https://doi.org/10.3390/ijerph18052423 - 2 Mar 2021

Cited by 4 | Viewed by 3272

Abstract

The aim of this study is to observe the morphological and postural changes to the foot that take place during pregnancy and the puerperium. Method: In this descriptive, observational, longitudinal study, we analysed 23 pregnant women, with particular attention to morphological and postural aspects of the foot, at three time points during and after pregnancy: in weeks 9–13 of gestation, weeks 32–35 of gestation and weeks 4–6 after delivery. The parameters considered were changes in foot length, the Foot Posture Index (FPI) and the Hernández Corvo Index, which were analysed using a pedigraph and taking into account the Body Mass Index (BMI). The same procedure was conducted in each review. Results: The statistical analyses obtained for each foot did not differ significantly between the three measurement times. A pronator-type footprint was most frequently observed during the third trimester of pregnancy; it was predominantly neutral during the postpartum period. Statistically significant differences between the measurement times were obtained in the right foot for cavus vs. neutral foot type (between the first and third trimesters and also between the first trimester and the puerperium) (in both cases, p < 0.0001). Conclusions: Foot length increases in the third trimester and returns to normal in the puerperium. According to FPI findings, the third trimester of pregnancy is characterised by pronation, while the posture returns to neutrality during the postpartum period. During pregnancy, the plantar arch flattens, and this persists during the puerperium. The incidence of cavus foot increases significantly in the third trimester and in the puerperium. Full article

(This article belongs to the Special Issue Advances in Foot Posture Assessment and Health Implications)

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11 pages, 323 KiB

Open AccessArticle

Preliminary Evidence That Taping Does Not Optimize Joint Coupling of the Foot and Ankle Joints in Patients with Chronic Ankle Instability

by Charles Deltour, Bart Dingenen, Filip Staes, Kevin Deschamps and Giovanni A. Matricali

Int. J. Environ. Res. Public Health 2021, 18(4), 2029; https://doi.org/10.3390/ijerph18042029 - 19 Feb 2021

Cited by 1 | Viewed by 2717

Abstract

Background: Foot–ankle motion is affected by chronic ankle instability (CAI) in terms of altered kinematics. This study focuses on multisegmental foot–ankle motion and joint coupling in barefoot and taped CAI patients during the three subphases of stance at running. Methods: Foot segmental motion data of 12 controls and 15 CAI participants during running with a heel strike pattern were collected through gait analysis. CAI participants performed running trials in three conditions: barefoot running, and running with high-dye and low-dye taping. Dependent variables were the range of motion (RoM) occurring at the different inter-segment angles as well as the cross-correlation coefficients between predetermined segments. Results: There were no significant RoM differences for barefoot running between CAI patients and controls. In taped conditions, the first two subphases only showed RoM changes at the midfoot without apparent RoM reduction compared to the barefoot CAI condition. In the last subphase there was limited RoM reduction at the mid- and rearfoot. Cross-correlation coefficients highlighted a tendency towards weaker joint coupling in the barefoot CAI condition compared to the controls. Joint coupling within the taped CAI conditions did not show optimization compared to the barefoot CAI condition. Conclusions: RoM was not significantly changed for barefoot running between CAI patients and controls. In taped conditions, there was no distinct tendency towards lower mean RoM values due to the mechanical restraints of taping. Joint coupling in CAI patients was not optimized by taping. Full article

(This article belongs to the Special Issue Advances in Foot Posture Assessment and Health Implications)

12 pages, 4526 KiB

Open AccessArticle

A Community Audit of 300 “Drop-Out” Instances in Children Undergoing Ponseti Clubfoot Care in Bangladesh—What Do the Parents Say?

by Angela Margaret Evans, Mamun Chowdhury and Sharif Khan

Int. J. Environ. Res. Public Health 2021, 18(3), 993; https://doi.org/10.3390/ijerph18030993 - 23 Jan 2021

Cited by 12 | Viewed by 9108

Abstract

Introduction: Drop-out before treatment completion is a vexing problem for all clubfoot clinics. We and others have previously identified better engagement with parents as a crucial method of ameliorating incomplete clubfoot treatment, which increases deformity relapse. Materials and methods: The novel use of community facilitators enabled an audit of over 300 families who had dropped-out from a child’s clubfoot treatment. A questionnaire standardized the parent interviews. Parents were encouraged to present for clinical review of their child’s clubfeet. Results: When treatment was discontinued for six months, 309 families were audited. A social profile of families was developed, showing that most lived in tin houses with one working family member, indicating low affluence. Family issues, brace difficulty, travel distances, and insufficient understanding of ongoing bracing and follow-up were the main reasons for discontinuing treatment. Overt deformity relapse was found in 9% of children, while half of the children recommenced brace use after review. Conclusions: Identifying families at risk of dropping out from clubfoot care enables support to be instigated. Our findings encourage clinicians to empathize with parents of children with clubfoot deformity. The parent load indicator, in parallel with the initial clubfoot severity assessment, may help clinicians to better appreciate the demand that treatment will place on parents, the associated risk of drop-out, and the opportunity to enlist support. Full article

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12 pages, 523 KiB

Open AccessArticle

Backpacks Effect on Foot Posture in Schoolchildren with a Neutral Foot Posture: A Three-Year Prospective Study

by Pilar Alfageme-García, Julián Fernando Calderón-García, Alfonso Martínez-Nova, Sonia Hidalgo-Ruiz, Mariana Martínez-Álvarez and Sergio Rico-Martín

Int. J. Environ. Res. Public Health 2020, 17(19), 7313; https://doi.org/10.3390/ijerph17197313 - 7 Oct 2020

Cited by 8 | Viewed by 2792

Abstract

Background: There is a paucity of data on the relationship between backpack use and foot posture in children. The aim of this study was to assess the effects of a backpack on foot posture in children with neutral foot posture during three years of follow-up. Methods: A prospective longitudinal observational study was conducted in a sample of 627 children with neutral foot. For each participant included in the study, age, sex, weight, height, body mass index, type of schoolbag (backpack or non-backpack), foot shape, metatarsal formula and type of shoes were recorded. Foot posture was described by the mean of the foot posture index (FPI) and reassessed after three years in a follow-up study. Results: The average age of the children was 8.32 ± 1.32 years. A total of 458 used a backpack when going to school. Over the three-year follow-up period, 50 children who had neutral foot developed supinated foot (n = 18) or pronated foot (n = 32). Univariate and multivariate analysis showed that the children using a backpack were at a higher risk of developing pronated foot (adjusted Odds Ratio (aOR) = 2.05, 95% IC: 1.08–3.89, p = 0.028). Backpack use was not associated with the change from neutral foot to supinated foot. Conclusions: We found a positive association between using a backpack and the risk of developing pronated but not supinated foot. Clinical trials should be conducted to analyze the effect of backpack use on the foot among schoolchildren. Full article

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11 pages, 3231 KiB

Open AccessArticle

Randomized Clinical Trial: The Effect of Exercise of the Intrinsic Muscle on Foot Pronation

by Manuel Pabón-Carrasco, Aurora Castro-Méndez, Samuel Vilar-Palomo, Ana María Jiménez-Cebrián, Irene García-Paya and Inmaculada C. Palomo-Toucedo

Int. J. Environ. Res. Public Health 2020, 17(13), 4882; https://doi.org/10.3390/ijerph17134882 - 7 Jul 2020

Cited by 26 | Viewed by 9189

Abstract

Background: There is little scientific evidence regarding the effectiveness of strengthening exercises on the foot’s intrinsic musculature in improving the lower limb on the statics and dynamics in healthy individuals. Method: To evaluate the effect on foot posture with regard to the reinforcement of the short foot exercise (SFE) compared to another without a recognized biomechanical action, which we called the “non-biomechanical function” (NBF) exercise. A randomized clinical trial was carried out with 85 asymptomatic participants with a bilateral Foot Posture Index (FPI) greater than 6 points. An experimental group (n = 42) did SFE training and a control group (n = 43) carried out NBF exercises. The foot posture was evaluated twice via the navicular drop (ND) test, and the FPI was assessed on the day of inclusion in the study (pre-intervention) and after four weeks of training (post-intervention). Results: Statistically significant values were not found in foot posture between the experimental and the control groups when comparing before and after the training. However, the foot posture was modified in both groups with respect to its initial state, and the ND value decreased. Conclusions: SFE could be considered a useful tool to deal with pathologies whose etiology includes excessive pronation of the foot. Full article

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20 pages, 4279 KiB

Open AccessArticle

A Pilot Study of Musculoskeletal Abnormalities in Patients in Recovery from a Unilateral Rupture-Repaired Achilles Tendon

by Dong Sun, Gusztáv Fekete, Julien S. Baker, Qichang Mei, Bíró István, Yan Zhang and Yaodong Gu

Int. J. Environ. Res. Public Health 2020, 17(13), 4642; https://doi.org/10.3390/ijerph17134642 - 28 Jun 2020

Cited by 15 | Viewed by 3144

Abstract

The purpose of this study was to compare the inter-limb joint kinematics, joint moments, muscle forces, and joint reaction forces in patients after an Achilles tendon rupture (ATR) via subject-specific musculoskeletal modeling. Six patients recovering from a surgically repaired unilateral ATR were included in this study. The bilateral Achilles tendon (AT) lengths were evaluated using ultrasound imaging. The three-dimensional marker trajectories, ground reaction forces, and surface electromyography (sEMG) were collected on both sides during self-selected speed during walking, jogging and running. Subject-specific musculoskeletal models were developed to compute joint kinematics, joint moments, muscle forces and joint reaction forces. AT lengths were significantly longer in the involved side. The side-to-side triceps surae muscle strength deficits were combined with decreased plantarflexion angles and moments in the injured leg during walking, jogging and running. However, the increased knee extensor femur muscle forces were associated with greater knee extension degrees and moments in the involved limb during all tasks. Greater knee joint moments and joint reaction forces versus decreased ankle joint moments and joint reaction forces in the involved side indicate elevated knee joint loads compared with reduced ankle joint loads that are present during normal activities after an ATR. In the frontal plane, increased subtalar eversion angles and eversion moments in the involved side were demonstrated only during jogging and running, which were regarded as an indicator for greater medial knee joint loading. It seems after an ATR, the elongated AT accompanied by decreased plantarflexion degrees and calf muscle strength deficits indicates ankle joint function impairment in the injured leg. In addition, increased knee extensor muscle strength and knee joint loads may be a possible compensatory mechanism for decreased ankle function. These data suggest patients after an ATR may suffer from increased knee overuse injury risk. Full article

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7 pages, 1775 KiB

Open AccessCase Report

Clinical and Biomechanical Progression after Ankle Joint Distraction in a Young Adolescent Patient with Haemophilia

by Nicolas Haelewijn, Sebastien Lobet, An Van Damme, Pierre-Louis Docquier, Maarten Eerdekens and Kevin Deschamps

Int. J. Environ. Res. Public Health 2021, 18(21), 11405; https://doi.org/10.3390/ijerph182111405 - 29 Oct 2021

Cited by 1 | Viewed by 2629

Abstract

Ankle joint distraction (AJD) has been described to be a valuable joint-sparing alternative to arthrodesis or arthroplasty; however, clinical endpoints associated to this surgical intervention are lacking. The current case report describes clinical and biomechanical outcome measures of ankle joint distraction in a 14-year-old patient with severe haemophilia A. Because of persistent and incapacitating pain and the poor response to conservative and invasive treatment options, ankle joint distraction was performed in this 14-year-old patient using an external fixator encompassing two Ilizarov full rings in the tibia and a foot ring fixed to the foot by four K-wires. State-of-the-art medical imaging and non-invasive skin marker-based 3D multi-segment foot modelling were performed in a pre- and post-operative stage. From a structural viewpoint, this AJD was a success since it improved and stabilised the osteo-cartilaginous lesions of the ankle. Biomechanical outcome measures associated with the 18-month follow-up were found to be suboptimal, showing an early plantarflexion pattern at the ankle joint during midstance and a tendency towards increased power absorption at the midfoot with peak power absorption being almost two times higher when compared to boys of the same age. From a functional viewpoint, we observed a clear reduction in the patients’ physical activities until one year after AJD. Despite these functional and structural improvements, recurrent painful phenomena, including the development of a complex regional pain syndrome (CRPS) and a stress fracture of the third metatarsal bone, were observed which are probably related with the development of recurrent subchondral oedema. Full article

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