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Sample records for lower-extremity swelling mimicking

  1. Bilateral lower extremity swelling: black pearl.

    PubMed

    Smithson, Clinton C; Ham, Jared C; Juergens, Andrew L

    2015-12-01

    Iatrogenic pneumothorax secondary to thoracentesis is relatively uncommon but does present to the emergency department (ED). Iatrogenic pneumothoraces developing tension physiology are rare. We report a case of an elderly female patient presenting to the ED with an isolated chief complaint of bilateral leg swelling, beginning the day after a thoracentesis, which was performed 3 days prior for pleural effusions secondary to lung cancer. Given that the patient was hemodynamically stable, not hypoxic, and had a history of chronic obstructive pulmonary disease and recent history of pleural effusions with diminished lung sounds throughout, this was a radiologic diagnosis. Immediately upon diagnosis, a 10F intrapleural catheter was inserted at the second intercostal space in the midclavicular line with successful resolution of the tension phenomenon. The patient tolerated the procedure well, and the catheter was removed on hospital day 2 without recurrence of the pneumothorax. She experienced resolution of her lower extremity swelling and was discharged from the hospital 2 days later. Isolated inferior vena cava syndrome secondary to a subacute tension pneumothorax was likely the cause of the patient's symptoms. This presentation is very rare and is undocumented in the literature. A high degree of suspicion for acute chest pathology should exist in every patient presenting to the ED with history of recent pleural violation. PMID:26003746

  2. Effectiveness of leg movement in reducing leg swelling and discomfort in lower extremities.

    PubMed

    Lin, Yen-Hui; Chen, Chih-Yong; Cho, Min-Hsien

    2012-11-01

    Various occupations required that workers stand for long periods, causing discomfort and pain. This study considered the effectiveness of three leg movements in relieving discomfort of the lower extremities during long periods of standing at work. Ten paid male subjects with no history of problems of the lower extremities were enrolled in this study. They performed three leg movements on a hard floor while standing for 4 h in a laboratory setting. Each 1 h experimental test had two phases - 50 min of standing, followed by 10 min of rest. During the period of standing, one the following leg movements was made. No movement (no change in posture), ankle movement (twice, for 2 min each time), and hip movement (twice, for 2 min each time). Observations revealed that the three leg movements yielded different degrees of lower limb swelling. The percentage changes in thigh (1.22%) and shank (1.32%) circumferences were largest during prolonged standing without any movement and lowest during prolonged standing with ankle movement (0.61%) and hip movement (0.80%). The relationship between perceived discomfort and standing time was determined. The subjects perceived the most shank discomfort (5.8) during the 4 h test without any movement. Leg movement greatly influenced perceived discomfort of the shank. The results of this study suggested that workers should move their ankles and hips for a short period following prolonged standing for 30 min to reduce lower extremity discomfort. PMID:22472344

  3. Primary cutaneous γδ-T-cell lymphoma (CGD-TCL) with unilateral lower extremity swelling as first-onset symptom: a rare case report.

    PubMed

    Li, Duo; Huang, Lijun; Guo, Bin; Wen, Qiuyuan; Wang, Weiyuan; Luo, Jiadi; Fan, Songqing

    2014-01-01

    Primary cutaneous γδ-T-cell lymphoma (CGD-TCL) is a distinct disease entity which is an extremely rare neoplasm with poor prognosis, characterized by the γ/δ T-cell receptor expression on atypical lymphocytes. We report the case of a 42-year-old man who first presented with a swelling in the extremities and subsequent appeared subcutaneous nodule over the body. In order to clarify the diagnosis, a biopsy of subcutaneous nodule for pathology had been done. CGD-TCL was diagnosed by histopathology, immunophenotype, in situ hybridization and analysis of TCRγ genes rearrangement. The patient was treated with chemotherapeutic regimens-CHOP (cyclophosphamide, doxorubicin, vincristine and prednisolone). After one period of chemotherapy, subcutaneous nodules became small, even disappeared, swelling and ulcer in the left pedal gone away gradually. One month later after first chemotherapy, tumor relapsed with lesions growing back rapidly, also showed disease in double lungs. The patient was just 10-month survival time from the onset. To our knowledge, this case is the first report of CGD-TCL with unilateral lower extremity swelling as the first-onset symptom. If patient is presented the first symptoms such as swelling of extremities, especially when ulceration appears, it is of great significance to be considerate about the possibility of CGD-TCL. PMID:25197420

  4. Lower extremity muscle perforator flaps for lower extremity reconstruction.

    PubMed

    Hallock, Geoffrey G

    2004-10-01

    A true muscle perforator flap is distinguished by the requisite intramuscular dissection of its musculocutaneous perforator to capture the same musculocutaneous territory but with total exclusion of the muscle, and thereby results in minimal functional impairment. Adhering to this definition, several lower extremity donor sites now are available, each with specific attributes especially useful for consideration in the treatment of lower extremity defects. In this author's experience over the past two decades, 20 lower extremity muscle perforator flaps using multiple donor sites proved advantageous for lower extremity coverage problems as either a local pedicled flap or as a microsurgical tissue transfer. Significant complications occurred in 30 percent of flaps (six of 20) in that further intervention was required. Venous insufficiency and bulkiness were found to be the major inherent shortcomings. However, giant flaps, lengthy and large-caliber vascular pedicles, and the possibility for combined flaps were important assets. The choice of a lower extremity muscle perforator flap for lower extremity reconstruction limited the surgical intervention and morbidity to a single body region. PMID:15457022

  5. Muscles of the Lower Extremity

    MedlinePlus

    ... Home » Cancer Registration & Surveillance Modules » Anatomy & Physiology » Muscular System » Muscle Groups » Lower Extremity Cancer Registration & Surveillance Modules Anatomy & Physiology Intro to the Human Body Body Functions & Life Process Anatomical Terminology Review Quiz ...

  6. A case of scrotal swelling mimicking testicular torsion preceding Henoch-Schönlein vasculitis.

    PubMed

    Akgun, C

    2012-01-01

    Henoch-Schönlein purpura, is one of the most common types of multisystemic vasculitis seen in childhood. The major clinical manifestations are cutaneous purpura, arthritis, abdominal pain, gastrointestinal bleeding, and nephritis. Isolated central nervous system vasculitis, seizures, coma and hemorrhage, Guillan--Barré syndrome, ataxia and central and peripheral neuropathy, ocular involvement, orchitis, epididymitis or testicular torsion are medical or surgical complications. In this study, we report a 7-year-old boy with scrotal swelling mimicking testicular torsion with ultrasonographic and clinical findings that the typical clinical features of Henoch-Schönlein purpura including rashes and arthritis were developed after one week of surgery (Ref. 15). PMID:22693978

  7. Swelling

    MedlinePlus

    ... syndrome Poor nutrition Pregnancy Thyroid disease Too little albumin in the blood (hypoalbuminemia) Too much salt or ... the swelling. Tests that may be done include: Albumin blood test Blood electrolyte levels Echocardiography ECG Kidney ...

  8. Computed Tomography Angiography of the Lower Extremities.

    PubMed

    Cook, Tessa Sundaram

    2016-01-01

    CT angiography (CTA) of the lower extremities is an important and versatile, noninvasive tool for diagnosis as well as surgical or endovascular interventional planning. Although lower extremity CTA is most commonly performed in patients with peripheral artery disease or trauma affecting the lower extremities, it also plays a role in the workup of nonischemic etiologies such as vasculitis, aneurysms, and congenital vascular malformations. CT scan protocols should adjust bolus timing and multiphasic imaging to account for the clinical question of interest, and 3-dimensional postprocessing plays an important role in the visualization and interpretation of these high-resolution imaging examinations. PMID:26654395

  9. The MR appearance of volume overload in the lower extremities

    NASA Technical Reports Server (NTRS)

    Meler, J. D.; Solomon, M. A.; Steele, J. R.; Yancy, C. W. Jr; Parkey, R. W.; Fleckenstein, J. L.; Blomqvist, C. G. (Principal Investigator)

    1997-01-01

    PURPOSE: Our goal was to describe the MR findings of volume overload (VO) in the lower extremities. METHOD: Fifteen individuals were studied, including eight healthy controls and seven patients with VO (four cardiac, three renal). MR evaluation included various SE techniques. Edema detection, localization, and symmetry were assessed subjectively. Relaxation time estimates were also made of the subcutaneous tissue, marrow, and three muscles. RESULTS: Subcutaneous tissue was markedly edematous in seven of seven patients and asymmetric in four of seven, whereas marrow was normal in all patients. Muscle edema was mild and asymmetric in six and two of seven patients, respectively. Perifascial fluid collections were identified in six of seven patients. CONCLUSION: Subcutaneous tissue edema is the dominant feature of VO in the lower extremities. Perifascial fluid is common but does not necessarily distribute symmetrically. Muscle edema is relatively mild. These findings should aid in identifying VO as the potential cause of swelling in patients with swollen legs.

  10. Lower-extremity ulcers: diagnosis and management.

    PubMed

    Kirsner, R S; Vivas, A C

    2015-08-01

    Chronic wounds of the lower extremities are occurring with increasing prevalence. They affect millions of individuals annually, representing both a significant health risk and a large economic burden. Chronic wounds are associated with increased mortality and substantial morbidity due to infection, pain, limitation of daily activities, and psychosocial consequences. To manage these wounds effectively, clinicians must be able to diagnose and manage their aetiology. Diagnosis starts with determining whether the wound is one of the four most common chronic wounds: venous leg ulcers, diabetic foot ulcers, pressure ulcers and arterial ulcers. Moreover, despite many recent advances in wound care, the challenge of managing chronic wounds is complicated by the lack of consistently accepted diagnostic methods and wound-care standards. We present a comprehensive yet condensed approach to managing lower-extremity ulcers, from diagnosis to basic management. PMID:26257052

  11. Soccer injury in the lower extremities.

    PubMed

    Wong, P; Hong, Y

    2005-08-01

    Information about soccer injuries is required to develop prevention and rehabilitation programmes. Most soccer injuries occur in the lower extremities. This type of injury is reviewed here. Definitions of injury, injury rate, injury percentage, mechanism of injury, anatomical region of injury, type of injury, and severity of injury are summarised. In each section, a description and summary of the data are provided. Finally, the limitations of the studies and suggestions to improve the investigation of soccer injuries are provided. PMID:16046325

  12. Perioperative lower extremity peripheral nerve traction injuries.

    PubMed

    Plastaras, Christopher T; Chhatre, Akhil; Kotcharian, Ashot S

    2014-01-01

    Peripheral nerve traction injuries may occur after surgical care and can involve any of the lower extremity large peripheral nerves. In this review, the authors discuss injuries after knee or hip surgical intervention. The diagnosis, including electrodiagnostic studies, is time sensitive and also relies on a detailed history and physical examination. Successful prevention and treatment involve familiarity with risk and predisposing factors as well as prophylactic measures. PMID:24267207

  13. Consequences and Costs of Lower Extremity Injuries

    PubMed Central

    Dischinger, PC; Read, KM; Kufera, JA; Kerns, TJ; Burch, CA; Jawed, N; Ho, SM; Burgess, AR

    2004-01-01

    Lower extremity injuries resulting from motor vehicle crashes are common and have become relatively more important as more drivers with newer occupant restraints survive high-energy crashes. CIREN data provide a greater level of clinical detail based on coding guidelines from the Orthopedic Trauma Association. These detailed data, in conjunction with long-term follow-up data obtained from patient interviews, reveal that the most costly and disabling injuries are those involving articular (joint) surfaces, especially those of the ankle/foot. Patients with such injuries exhibit residual physical and psychosocial problems, even at one year post-trauma. PMID:15319134

  14. Lower extremity kinematics of athletics curve sprinting.

    PubMed

    Alt, Tobias; Heinrich, Kai; Funken, Johannes; Potthast, Wolfgang

    2015-01-01

    Curve running requires the generation of centripetal force altering the movement pattern in comparison to the straight path run. The question arises which kinematic modulations emerge while bend sprinting at high velocities. It has been suggested that during curve sprints the legs fulfil different functions. A three-dimensional motion analysis (16 high-speed cameras) was conducted to compare the segmental kinematics of the lower extremity during the stance phases of linear and curve sprints (radius: 36.5 m) of six sprinters of national competitive level. Peak joint angles substantially differed in the frontal and transversal plane whereas sagittal plane kinematics remained unchanged. During the prolonged left stance phase (left: 107.5 ms, right: 95.7 ms, straight: 104.4 ms) the maximum values of ankle eversion (left: 12.7°, right: 2.6°, straight: 6.6°), hip adduction (left: 13.8°, right: 5.5°, straight: 8.8°) and hip external rotation (left: 21.6°, right: 12.9°, straight: 16.7°) were significantly higher. The inside leg seemed to stabilise the movement in the frontal plane (eversion-adduction strategy) whereas the outside leg provided and controlled the motion in the horizontal plane (rotation strategy). These results extend the principal understanding of the effects of curve sprinting on lower extremity kinematics. This helps to increase the understanding of nonlinear human bipedal locomotion, which in turn might lead to improvements in athletic performance and injury prevention. PMID:25495196

  15. Lower extremity corrective reactions to slip events.

    PubMed

    Cham, R; Redfern, M S

    2001-11-01

    A significant number of injuries in the workplace is attributed to slips and falls. Biomechanical responses to actual slip events determine whether the outcome of a slip will be recovery or a fall. The goal of this study was to examine lower extremity joint moments and postural adjustments for experimental evidence of corrective strategies evoked during slipping in an attempt to prevent falling. Sixteen subjects walked onto a possibly oily vinyl tile floor, while ground reaction forces and body motion were recorded at 350 Hz. The onset of corrective reactions by the body in an attempt to recover from slips became evident at about 25% of stance and continued until about 45% into stance, i.e. on average between 190 and 350 ms after heel contact. These reactions included increased flexion moment at the knee and extensor activity at the hip. The ankle, on the other hand, acted as a passive joint (no net moment) during fall trials. Joint kinematics showed increased knee flexion and forward rotation of the shank in an attempt to bring the foot back towards the body. Once again, the ankle kinematics appeared to play a less dominant role (compared to the knee) in recovery attempts. This study indicates that humans generate corrective reactions to slips that are different than previously reported responses to standing perturbations translating the supporting surface. PMID:11672718

  16. Imaging of lower extremity trauma from Boston Marathon bombing.

    PubMed

    Konwinski, Ryan R; Singh, Ajay; Soto, Jorge

    2016-10-01

    The goal of this study is to describe the imaging features of lower extremity blast injuries in patients encountered in the radiology departments from the Boston Marathon bombings. A total of 115 patients presented to four acute care hospitals on April 15, 2013, 43 of whom presented with lower extremity injuries and were included in this study. The imaging findings of primary, secondary, tertiary, and quaternary blast injuries were evaluated. Forty-one of 43 patients sustained secondary blast injuries to the lower extremities with 31 patients (70 %) having retained shrapnel, seven patients (16 %) having soft tissue lacerations without retained shrapnel, and ten patients (23 %) having lower extremity amputation (7 % double amputees). Eight of these patients (20 %) had lower extremity fractures, and five patients (12 %) had vascular injuries. Two of the 43 patients (5 %) had only tertiary injuries, and five of 43 patients (12 %) were noted to have lower extremity burns, consistent with quaternary blast injury. No primary blast injury occurred in the lower extremities. A vast majority of lower extremity injuries were from secondary blast injury, most commonly from retained shrapnel in 70 % of patients and 23 % of patients sustaining lower extremity amputation. Retained shrapnel in the lower extremity was most commonly ball bearings and pressure cooker fragments, and most injuries affected the leg, followed by the thigh and foot. PMID:27272899

  17. Clinical features and risk factor analysis for lower extremity deep venous thrombosis in Chinese neurosurgical patients

    PubMed Central

    Guo, Fuyou; Shashikiran, Tagilapalli; Chen, Xi; Yang, Lei; Liu, Xianzhi; Song, Laijun

    2015-01-01

    Background: Deep venous thrombosis (DVT) contributes significantly to the morbidity and mortality of neurosurgical patients; however, no data regarding lower extremity DVT in postoperative Chinese neurosurgical patients have been reported. Materials and Methods: From January 2012 to December 2013, 196 patients without preoperative DVT who underwent neurosurgical operations were evaluated by color Doppler ultrasonography and D-dimer level measurements on the 3rd, 7th, and 14th days after surgery. Follow-up clinical data were recorded to determine the incidence of lower extremity DVT in postoperative neurosurgical patients and to analyze related clinical features. First, a single factor analysis, Chi-square test, was used to select statistically significant factors. Then, a multivariate analysis, binary logistic regression analysis, was used to determine risk factors for lower extremity DVT in postoperative neurosurgical patients. Results: Lower extremity DVT occurred in 61 patients, and the incidence of DVT was 31.1% in the enrolled Chinese neurosurgical patients. The common symptoms of DVT were limb swelling and lower extremity pain as well as increased soft tissue tension. The common sites of venous involvement were the calf muscle and peroneal and posterior tibial veins. The single factor analysis showed statistically significant differences in DVT risk factors, including age, hypertension, smoking status, operation time, a bedridden or paralyzed state, the presence of a tumor, postoperative dehydration, and glucocorticoid treatment, between the two groups (P < 0.05). The binary logistic regression analysis showed that an age greater than 50 years, hypertension, a bedridden or paralyzed state, the presence of a tumor, and postoperative dehydration were risk factors for lower extremity DVT in postoperative neurosurgical patients. Conclusions: Lower extremity DVT was a common complication following craniotomy in the enrolled Chinese neurosurgical patients. Multiple

  18. Iatrogenic Lower Extremity Subcutaneous Emphysema after Prolonged Robotic-Assisted Hysterectomy

    PubMed Central

    Vetter, Monica Hagan; Mutscheller, Chelsea; Cardenas-Goicoechea, Joel

    2015-01-01

    Subcutaneous emphysema is a known complication of carbon dioxide insufflation, an essential component of laparoscopy. The literature contains reports of hypercarbia, pneumothorax, or pneumomediastinum. However, isolated lower extremity subcutaneous emphysema remains a seldom-reported complication. We report a case of unilateral lower extremity subcutaneous emphysema following robotic-assisted hysterectomy, bilateral salpingooophorectomy, staging, and anterior/posterior colporrhaphy for carcinosarcoma and vaginal prolapse. On postoperative day 1, the patient developed tender crepitus and bruising of her right ankle. Radiography confirmed presence of subcutaneous air. Vital signs and laboratory findings were unremarkable. Her symptoms spontaneously improved over time, and she was discharged in good condition on day 2. In stable patients with postoperative extremity swelling or pain with crepitus on exam, the diagnosis of iatrogenic subcutaneous emphysema must be considered. PMID:26788387

  19. Predictive Neuromuscular Fatigue of the Lower Extremity Utilizing Computer Modeling.

    PubMed

    Samaan, Michael A; Weinhandl, Joshua T; Hans, Steven A; Bawab, Sebastian Y; Ringleb, Stacie I

    2016-01-01

    This paper studies the modeling of lower extremity muscle forces and their correlation to neuromuscular fatigue. Two analytical fatigue models were combined with a musculoskeletal model to estimate the effects of hamstrings fatigue on lower extremity muscle forces during a side step cut. One of the fatigue models (Tang) used subject-specific knee flexor muscle fatigue and recovery data while the second model (Xia) used previously established fatigue and recovery parameters. Both fatigue models were able to predict hamstrings fatigue within 20% of the experimental data, with the semimembranosus and semitendinosus muscles demonstrating the largest (11%) and smallest (1%) differences, respectively. In addition, various hamstrings fatigue levels (10-90%) on lower extremity muscle force production were assessed using one of the analytical fatigue models. As hamstrings fatigue levels increased, the quadriceps muscle forces decreased by 21% (p < 0.01), while gastrocnemius muscle forces increased by 36% (p < 0.01). The results of this study validate the use of two analytical fatigue models in determining the effects of neuromuscular fatigue during a side step cut, and therefore, this model can be used to assess fatigue effects on risk of lower extremity injury during athletic maneuvers. Understanding the effects of fatigue on muscle force production may provide insight on muscle group compensations that may lead to altered lower extremity motion patterns as seen in noncontact anterior cruciate ligament (ACL) injuries. PMID:26611439

  20. Cutaneous Markers of Systemic Disease in the Lower Extremity.

    PubMed

    Vella, Joseph

    2016-07-01

    The skin of the lower extremity can be a helpful diagnostic tool for systemic disease. Diabetes, renal disease, genetic disorders, and even cancer can have cutaneous manifestations in the legs and feet; moreover, proper diagnosis can facilitate earlier treatment of these diseases and not only clear up the skin symptoms but also bring about resolution of the systemic disease causing them. Although not comprehensive, this article discusses many of these disorders presenting with integumentary manifestations in the lower extremities. Where appropriate, it also enumerates the treatments involved, both systemic and localized. PMID:27215161

  1. Scintigraphic demonstration of lower extremity periostitis secondary to venous insufficiency

    SciTech Connect

    Gensburg, R.S.; Kawashima, A.; Sandler, C.M.

    1988-07-01

    The scintigraphic findings on bone imaging in two patients with extensive lower extremity periostitis secondary to venous insufficiency are presented. One of these patients had bilateral disease. The use of (/sup 67/Ga)citrate scanning in an attempt to exclude concurrent osteomyelitis is also addressed.

  2. Staff Radiation Doses to the Lower Extremities in Interventional Radiology

    SciTech Connect

    Shortt, C. P.; Al-Hashimi, H.; Malone, L.; Lee, M. J.

    2007-11-15

    The purpose of this study was to investigate the radiation doses to the lower extremities in interventional radiology suites and evaluate the benefit of installation of protective lead shielding. After an alarmingly increased dose to the lower extremity in a preliminary study, nine interventional radiologists wore thermoluminescent dosimeters (TLDs) just above the ankle, over a 4-week period. Two different interventional suites were used with Siemens undercouch fluoroscopy systems. A range of procedures was carried out including angiography, embolization, venous access, drainages, and biopsies. A second identical 4-week study was then performed after the installation of a 0.25-mm lead curtain on the working side of each interventional table. Equivalent doses for all nine radiologists were calculated. One radiologist exceeded the monthly dose limit for a Category B worker (12.5 mSv) for both lower extremities before lead shield placement but not afterward. The averages of both lower extremities showed a statistically significant dose reduction of 64% (p < 0.004) after shield placement. The left lower extremity received a higher dose than the right, 6.49 vs. 4.57 mSv, an increase by a factor of 1.42. Interventional radiology is here to stay but the benefits of interventional radiology should never distract us from the important issue of radiation protection. All possible measures should be taken to optimize working conditions for staff. This study showed a significant lower limb extremity dose reduction with the use of a protective lead curtain. This curtain should be used routinely on all C-arm interventional radiologic equipment.

  3. Adolescent baseball pitching technique: lower extremity biomechanical analysis.

    PubMed

    Milewski, Matthew D; Õunpuu, Sylvia; Solomito, Matthew; Westwell, Melany; Nissen, Carl W

    2012-11-01

    Documentation of the lower extremity motion patterns of adolescent pitchers is an important part of understanding the pitching motion and the implication of lower extremity technique on upper extremity loads, injury and performance. The purpose of this study was to take the initial step in this process by documenting the biomechanics of the lower extremities during the pitching cycle in adolescent pitchers and to compare these findings with the published data for older pitchers. Three-dimensional motion analysis using a comprehensive lower extremity model was used to evaluate the fast ball pitch technique in adolescent pitchers. Thirty-two pitchers with a mean age of 12.4 years (range 10.5-14.7 years) and at least 2 years of experience were included in this study. The pitchers showed a mean of 49 ± 12° of knee flexion of the lead leg at foot contact. They tended to maintain this position through ball release, and then extended their knee during the follow through phase (ball release to maximal internal glenohumeral rotation). The lead leg hip rapidly progressed into adduction and flexion during the arm cocking phase with a range of motion of 40 ± 10° adduction and 30 ± 13° flexion. The lead hip mean peak adduction velocity was 434 ± 83°/s and flexion velocity was 456 ± 156°/s. Simultaneously, the trailing leg hip rapidly extended approaching to a mean peak extension of -8 ± 5° at 39% of the pitch cycle, which is close to passive range of motion constraints. Peak hip abduction of the trailing leg at foot contact was -31 ± 12°, which also approached passive range of motion constraints. Differences and similarities were also noted between the adolescent lower extremity kinematics and adult pitchers; however, a more comprehensive analysis using similar methods is needed for a complete comparison. PMID:22660979

  4. Computed tomography, anatomy and morphometry of the lower extremity

    SciTech Connect

    Hoogewoud, H.M.; Rager, G.; Burch, H.

    1989-01-01

    This book presents up-to-date information on CT imaging of the lower extremity. It includes an atlas correlating new, high-resolution CT scans with identical thin anatomical slices covering the lower extremity from the crista iliaca to the planta pedis. Additional figures, including CT arthrograms of the hip, knee and ankle, depict the anatomy in detail The technique and clinical relevance of CT measurements especially in orthopedic surgery are also clearly explained. Of special interest is the new method developed by the authors for assessing the coverage of the femoral head. The special morphometry software and a 3D program allowing representation in space make it possible to precisely and accurately measure the coverage with normal CT scans of the hip.

  5. Surgical decompression in lower-extremity diabetic peripheral neuropathy.

    PubMed

    Rader, Andrew J

    2005-01-01

    Peripheral neuropathy can be a devastating complication of diabetes mellitus. This article describes surgical decompression as a means of restoring sensation and relieving painful neuropathy symptoms. A prospective study was performed involving patients diagnosed as having type 1 or type 2 diabetes with lower-extremity peripheral neuropathy. The neuropathy diagnosis was confirmed using quantitative sensory testing. Visual analog scales were used for subjective assessment before and after surgery. Treatment consisted of external and as-needed internal neurolysis of the common peroneal, deep peroneal, tibial, medial plantar, lateral plantar, and calcaneal nerves. Subjective pain perception and objective sensibility were significantly improved in most patients who underwent the described decompression. Surgical decompression of multiple peripheral nerves in the lower extremities is a valid and effective method of providing symptomatic relief of neuropathy pain and restoring sensation. PMID:16166461

  6. Congenital anomalies and vascular birthmarks of the lower extremities.

    PubMed

    Laor, T; Burrows, P E

    1998-08-01

    MR imaging is an invaluable tool for the evaluation of congenital abnormalities and vascular birthmarks of the extremities in children. These abnormalities of the immature musculoskeletal system are often underestimated by radiography. MR imaging is useful for diagnosis, assisting in therapy, showing response to treatment, and determining prognosis. Localized and generalized abnormalities of the lower extremities and issues pertinent to their MR imaging are illustrated in this article. PMID:9654582

  7. Lower extremity finite element model for crash simulation

    SciTech Connect

    Schauer, D.A.; Perfect, S.A.

    1996-03-01

    A lower extremity model has been developed to study occupant injury mechanisms of the major bones and ligamentous soft tissues resulting from vehicle collisions. The model is based on anatomically correct digitized bone surfaces of the pelvis, femur, patella and the tibia. Many muscles, tendons and ligaments were incrementally added to the basic bone model. We have simulated two types of occupant loading that occur in a crash environment using a non-linear large deformation finite element code. The modeling approach assumed that the leg was passive during its response to the excitation, that is, no active muscular contraction and therefore no active change in limb stiffness. The approach recognized that the most important contributions of the muscles to the lower extremity response are their ability to define and modify the impedance of the limb. When nonlinear material behavior in a component of the leg model was deemed important to response, a nonlinear constitutive model was incorporated. The accuracy of these assumptions can be verified only through a review of analysis results and careful comparison with test data. As currently defined, the model meets the objective for which it was created. Much work remains to be done, both from modeling and analysis perspectives, before the model can be considered complete. The model implements a modeling philosophy that can accurately capture both kinematic and kinetic response of the lower limb. We have demonstrated that the lower extremity model is a valuable tool for understanding the injury processes and mechanisms. We are now in a position to extend the computer simulation to investigate the clinical fracture patterns observed in actual crashes. Additional experience with this model will enable us to make a statement on what measures are needed to significantly reduce lower extremity injuries in vehicle crashes. 6 refs.

  8. Multiple Lower Extremity Mononeuropathies by Segmental Schwannomatosis: A Case Report.

    PubMed

    Kwon, Na Yeon; Oh, Hyun-Mi; Ko, Young Jin

    2015-10-01

    Schwannoma is an encapsulated nerve sheath tumor that is distinct from neurofibromatosis. It is defined as the occurrence of multiple schwannomas without any bilateral vestibular schwannomas. A 46-year-old man with multiple schwannomas involving peripheral nerves of the ipsilateral lower extremity presented with neurologic symptoms. Electrodiagnostic studies revealed multiple mononeuropathies involving the left sciatic, common peroneal, tibial, femoral and superior gluteal nerves. Histologic findings confirmed the diagnosis of schwannoma. We reported this rare case of segmental schwannomatosis that presented with neurologic symptoms including motor weakness, which was confirmed as multiple mononeuropathies by electrodiagnostic studies. PMID:26605183

  9. Multiple Lower Extremity Mononeuropathies by Segmental Schwannomatosis: A Case Report

    PubMed Central

    Kwon, Na Yeon; Oh, Hyun-Mi

    2015-01-01

    Schwannoma is an encapsulated nerve sheath tumor that is distinct from neurofibromatosis. It is defined as the occurrence of multiple schwannomas without any bilateral vestibular schwannomas. A 46-year-old man with multiple schwannomas involving peripheral nerves of the ipsilateral lower extremity presented with neurologic symptoms. Electrodiagnostic studies revealed multiple mononeuropathies involving the left sciatic, common peroneal, tibial, femoral and superior gluteal nerves. Histologic findings confirmed the diagnosis of schwannoma. We reported this rare case of segmental schwannomatosis that presented with neurologic symptoms including motor weakness, which was confirmed as multiple mononeuropathies by electrodiagnostic studies. PMID:26605183

  10. Dermatologic Concerns of the Lower Extremity in the Pediatric Patient.

    PubMed

    Vlahovic, Tracey C

    2016-07-01

    As the largest organ in the body, skin can prove the most daunting to diagnose and manage due to the large number of conditions and their uncanny ability to have similar qualities visually. Skin can reflect current trauma or infections or can be a harbinger of an underlying systemic disorder. With knowledge of the most common pediatric skin conditions, it is possible for practitioners to start a child on a basic treatment regimen and then refer to an appropriate specialist for more complex or rare disorders. This article covers the most common skin conditions seen on the lower extremity in the pediatric population. PMID:27215157

  11. Gait variables of patients after lower extremity burn injuries.

    PubMed

    Silverberg, R; Lombardo, G; Gorga, D; Nagler, W; Himel, H; Yurt, R

    2000-01-01

    Functional ambulation is an expected outcome of physical therapy after burn injuries on the lower extremities. The purpose of this study was to document temporal and spatial gait parameters of adult patients with the use of the GAITRite system (CIR Systems Inc, Clifton, NJ) after the patients were burned on their lower extremities and to compare these results with previous data reported for normal subjects. Twenty-five adults with lower extremity burns (19 men and 6 women; mean age, 35.6+/-8.3 years) were evaluated within 5 days of discharge from an acute care facility. The GAITRite system, which consists of an electronic walkway that contains 6 sensor pads encapsulated in a rolled-up carpet, was used to collect temporal and spatial variables. The patients walked at their preferred rate of ambulation and completed 2 passes; the 2 passes were then averaged by the software to determine the patients' gait parameters. A 2-tailed t test was used for comparison of the mean values for the patients and the previously published data. The results indicated that for both men and women, cycle time and base of support were significantly higher (P < or = .01) in the patients with burn injuries than in normal subjects. For men, all of the remaining parameters were significantly lower (P < or = .01) in the patients with burns except stride length, which was not significantly different (P > .05). For women, stance time as a percentage of the gait cycle and cadence, velocity, step length, and stride length, were all significantly lower (P < or = .01) in the patients with burn injuries, whereas double support as a percentage of the gait cycle was not significantly different (P > .05) between the 2 groups. These results indicate that immediately after an acute care hospitalization, patients with lower extremity burns have significantly different gait patterns than gender-and age-matched normal subjects. Future studies are necessary to determine whether these impairments in gait limit

  12. Evidence-based management of common chronic lower extremity ulcers.

    PubMed

    Richmond, Nicholas A; Maderal, Andrea D; Vivas, Alejandra C

    2013-01-01

    Chronic lower extremity ulcers are a significant burden on patients and health care systems worldwide. Although relatively common, these wounds can be difficult to treat and present a challenge to physicians. Treatment has often been based on anecdotal accounts; however, there is a growing emphasis on using evidence-based conclusions to guide clinical decisions. In this review article, the standard of care and adjuvant therapies of venous leg ulcers and diabetic foot ulcers are presented from an evidence-based perspective. PMID:23742279

  13. A 61-Year-Old Man With Shortness of Breath, Ascites, and Lower Extremity Edema.

    PubMed

    Ataya, Ali; Cope, Jessica M; Moguillansky, Diego; Machuca, Tiago N; Alnuaimat, Hassan

    2016-06-01

    A 61-year-old man presented with an 18-month history of progressive shortness of breath on exertion, fatigue, worsening bilateral lower extremity edema, abdominal swelling, and increased assistance with activities of daily living. Pertinent past medical history included right-sided pneumonia secondary to Streptococcus pneumoniae that was complicated by empyema, requiring right-sided video-assisted thoracoscopic surgery with decortication 2 years earlier. He had a negative cardiac history, no recent travel in the last 3 years, and no known exposure to tuberculosis. His medications included aspirin and daily furosemide. His symptoms appeared to be refractory to diuretic therapy. Previous workup 6 months earlier included an echocardiography (ECHO) showing enlarged left and right atria with a normal ejection fraction, and a catheterization of the left side of the heart with reported normal left ventricular function and unobstructed coronary arteries. PMID:27287597

  14. Wound size measurement of lower extremity ulcers using segmentation algorithms

    NASA Astrophysics Data System (ADS)

    Dadkhah, Arash; Pang, Xing; Solis, Elizabeth; Fang, Ruogu; Godavarty, Anuradha

    2016-03-01

    Lower extremity ulcers are one of the most common complications that not only affect many people around the world but also have huge impact on economy since a large amount of resources are spent for treatment and prevention of the diseases. Clinical studies have shown that reduction in the wound size of 40% within 4 weeks is an acceptable progress in the healing process. Quantification of the wound size plays a crucial role in assessing the extent of healing and determining the treatment process. To date, wound healing is visually inspected and the wound size is measured from surface images. The extent of wound healing internally may vary from the surface. A near-infrared (NIR) optical imaging approach has been developed for non-contact imaging of wounds internally and differentiating healing from non-healing wounds. Herein, quantitative wound size measurements from NIR and white light images are estimated using a graph cuts and region growing image segmentation algorithms. The extent of the wound healing from NIR imaging of lower extremity ulcers in diabetic subjects are quantified and compared across NIR and white light images. NIR imaging and wound size measurements can play a significant role in potentially predicting the extent of internal healing, thus allowing better treatment plans when implemented for periodic imaging in future.

  15. Radiographic characteristics of lower-extremity bowing in children.

    PubMed

    Cheema, Jugesh I; Grissom, Leslie E; Harcke, H Theodore

    2003-01-01

    Lower-extremity bowing is common in infants and children and can result from a variety of conditions. At radiography, developmental bowing shows varus angulation centered at the knee, "metaphyseal beaking," thickening of the medial tibial cortices, and tilted ankle joints. Tibia vara (Blount disease) demonstrates genu varum and depression of the proximal tibia medially. Congenital bowing manifests as posteromedial bowing with cortical thickening along the concavity of the curvature and, in some cases, diaphyseal broadening. In rickets, radiographic changes occur primarily at sites of rapid growth and are predominantly metaphyseal, with widening of the zone of provisional calcification. Achondroplasia is characterized by shortening and thickening of the long bones with metaphyseal flaring and cupping. In neurofibromatosis, there may be anterolateral bowing of the tibia, and there is often focal narrowing and intramedullary sclerosis or cystic change at the apex of the angulation. The tibia is typically involved at the junction of the middle and distal thirds. Osteogenesis imperfecta demonstrates bowing from softening due to osteoporosis and multiple fractures and typically involves the entire skeleton. In camptomelic dysplasia, lower-extremity bowing is associated with a short trunk, short limbs, and deficiencies in pelvic bone development. Recognition of these pathologic conditions is important for differentiating those that will resolve spontaneously from those that require surgery or other treatment. PMID:12853662

  16. [Ligament ruptures of the lower extremity in the elderly].

    PubMed

    Herbort, M; Raschke, M J

    2011-08-01

    There is an increasing incidence of ligament ruptures of the lower extremities in older patients. This higher incidence is caused by the typical current demographic changes in the population and the higher level of activity and athletic motivation of the older people in our society. In this review we address the most important ligament ruptures of the lower extremity in the old patient. Quadriceps tendon and Achilles tendon ruptures are mostly the result of degenerative and abrasion changes. The ACL rupture on the other hand occurs spontaneously after adequate trauma and without former degenerative changes especially in highly active patients. For a differentiated treatment of the older patient with tendon ruptures, secondary diseases, an increased risk and complication profile and a potentially decreased compliance during rehabilitation must be taken into consideration before indicating operative or conservative therapy. There are no strict age-related limitations for indication of an operative treatment of tendon ruptures in the older patient. In this patient group a differentiated treatment decision is recommended. PMID:21766204

  17. Lower-extremity amputation with immediate postoperative prosthetic placement.

    PubMed

    Folsom, D; King, T; Rubin, J R

    1992-10-01

    To study the efficacy of an immediate postoperative prosthesis (IPOP) program, a retrospective review of 167 major lower-extremity amputations was performed. Patient enrollment in the IPOP program was based on the individual's potential for rehabilitation and participation in an aggressive postoperative physical therapy regimen, as determined by the surgeon, prosthetist, physical therapist, and social worker. Indications for amputation were intractable infection and/or severe unreconstructable arterial insufficiency. Sixty-five patients underwent 69 amputations with IPOP (59 below knee; 10 above knee). Successful program completion was defined as independent ambulation and occurred in 86% of those patients enrolled. The average interval from amputation to ambulation was 15.2 days for the below-knee amputees and 9.3 days for the above-knee amputees. Failure to complete the program occurred in 14% of patients and was due to noncompliance, stump infection, stump trauma, and death. The results of this review support the use of IPOP after major lower-extremity amputation. PMID:1415937

  18. Overuse injuries of the lower extremity in runners.

    PubMed

    Rolf, C

    1995-08-01

    The purpose of this article is to review the literature on overuse injuries of the lower extremity in runners and to discuss briefly today's knowledge concerning etiology, diagnosis and treatment. Running is a natural entity in many sports and a majority of runners will sustain one or more overuse injuries throughout the career, in most cases affecting the lower extremity. A runner may be regarded as an athlete who regularly runs as the predominant physical activity. From that point, we should subdivide the definition "runner" considering the character of different sports or recreational activities performed. Overuse injuries are often described merely from symptoms, including several different etiological and pathoanatomic correlates covering a variety of ailments. The clinical approach should be focused on a thorough history and physical examination. Analysis of possible injury mechanisms, correction of associated extrinsic and intrinsic factors and advice on alternative training should be given. A knowledge of specific demands from the type of running performed is necessary to evaluate the symptoms presented. Overuse etiology has to be considered multifactorial with a yet unsolved exact pathophysiology needing further research. The definition of a "runner", of "running" and of "overuse injury" should be established and agreed upon. This review attempts to draw attention to the huge multidisciplinary work that has to be done to better understand the mechanisms causing an overuse injury in a runner and to define diagnoses on a scientific base, whether or not excentric or intrinsic factors predispose or trigger. PMID:7552763

  19. Contemporary evaluation and management of lower extremity peripheral artery disease.

    PubMed

    Foley, T Raymond; Armstrong, Ehrin J; Waldo, Stephen W

    2016-09-15

    Peripheral artery disease (PAD) includes atherosclerosis of the aorta and lower extremities. Affecting a large segment of the population, PAD is associated with impaired functional capacity and reduced quality of life as well as an increased risk of stroke, myocardial infarction and cardiovascular death. The evaluation of PAD begins with the physical examination, incorporating non-invasive testing such as ankle-brachial indices to confirm the diagnosis. Therapeutic interventions are aimed at alleviating symptoms while preserving limb integrity and reducing overall cardiovascular risk. With this in mind, risk factor modification with exercise and medical therapy are the mainstays of treatment for many patients with PAD. Persistent symptoms or non-healing wounds should prompt more aggressive therapies with endovascular or surgical revascularisation. The following manuscript provides a comprehensive review on the contemporary evaluation and management of PAD. PMID:27250215

  20. INCORPORATING KETTLEBELLS INTO A LOWER EXTREMITY SPORTS REHABILITATION PROGRAM

    PubMed Central

    En Gilpin, Hui; Brunette, Meredith; Meira, Erik P.

    2010-01-01

    The primary goal of a sports rehabilitation program is to return the injured athlete back to competition as quickly and as safely as possible. Sports physical therapists utilize a variety of exercise equipment to help an athlete restore function after an injury. An injured athlete's therapeutic exercise program frequently includes the prescription of functional strengthening and power exercises during the later stages of rehabilitation. One piece of exercise equipment, the kettlebell, has gained popularity for its ability to allow the user to perform functional power exercises. The unique exercises that can be performed with kettlebells may have utility in sports physical therapy practice. This clinical suggestion outlines the clinical rationale for the inclusion of kettlebell exercises when rehabilitating an athlete with a lower extremity injury. PMID:21655384

  1. Incorporating kettlebells into a lower extremity sports rehabilitation program.

    PubMed

    Brumitt, Jason; En Gilpin, Hui; Brunette, Meredith; Meira, Erik P

    2010-12-01

    The primary goal of a sports rehabilitation program is to return the injured athlete back to competition as quickly and as safely as possible. Sports physical therapists utilize a variety of exercise equipment to help an athlete restore function after an injury. An injured athlete's therapeutic exercise program frequently includes the prescription of functional strengthening and power exercises during the later stages of rehabilitation. One piece of exercise equipment, the kettlebell, has gained popularity for its ability to allow the user to perform functional power exercises. The unique exercises that can be performed with kettlebells may have utility in sports physical therapy practice. This clinical suggestion outlines the clinical rationale for the inclusion of kettlebell exercises when rehabilitating an athlete with a lower extremity injury. PMID:21655384

  2. Stenting for Peripheral Artery Disease of the Lower Extremities

    PubMed Central

    2010-01-01

    Executive Summary Background Objective In January 2010, the Medical Advisory Secretariat received an application from University Health Network to provide an evidentiary platform on stenting as a treatment management for peripheral artery disease. The purpose of this health technology assessment is to examine the effectiveness of primary stenting as a treatment management for peripheral artery disease of the lower extremities. Clinical Need: Condition and Target Population Peripheral artery disease (PAD) is a progressive disease occurring as a result of plaque accumulation (atherosclerosis) in the arterial system that carries blood to the extremities (arms and legs) as well as vital organs. The vessels that are most affected by PAD are the arteries of the lower extremities, the aorta, the visceral arterial branches, the carotid arteries and the arteries of the upper limbs. In the lower extremities, PAD affects three major arterial segments i) aortic-iliac, ii) femoro-popliteal (FP) and iii) infra-popliteal (primarily tibial) arteries. The disease is commonly classified clinically as asymptomatic claudication, rest pain and critical ischemia. Although the prevalence of PAD in Canada is not known, it is estimated that 800,000 Canadians have PAD. The 2007 Trans Atlantic Intersociety Consensus (TASC) II Working Group for the Management of Peripheral Disease estimated that the prevalence of PAD in Europe and North America to be 27 million, of whom 88,000 are hospitalizations involving lower extremities. A higher prevalence of PAD among elderly individuals has been reported to range from 12% to 29%. The National Health and Nutrition Examination Survey (NHANES) estimated that the prevalence of PAD is 14.5% among individuals 70 years of age and over. Modifiable and non-modifiable risk factors associated with PAD include advanced age, male gender, family history, smoking, diabetes, hypertension and hyperlipidemia. PAD is a strong predictor of myocardial infarction (MI

  3. Double crush syndrome in the lower extremity: a case report.

    PubMed

    Borgia, Anthony V; Hruska, Jerome K; Braun, Karina

    2012-01-01

    Upton and McComas first described double crush syndrome in 1973. The theory behind double crush syndrome postulated that a proximal lesion in a nerve would make that same nerve more vulnerable to additional distal lesions. Many of the studies investigating the possibility of the double crush syndrome involve lesions in the upper extremity with very few articles written specifically about double crush syndrome in the lower extremity. We present the case of a 33-year-old massage therapist who uses her feet to provide therapy to clients who presented to our clinic with symptoms consistent with tarsal tunnel syndrome. Her failure to progress in a satisfactory manner after a variety of therapies made us search for additional etiologies for her foot pain. In cases where tarsal tunnel persists after surgical therapy, the treating physician should search for more proximal lesions along the course of the nerve. PMID:22826333

  4. [Surgical treatment of lower extremity peripheral nerve injuries].

    PubMed

    Kaiser, Radek

    2016-01-01

    Peripheral nerve injuries of the lower extremities are not frequent. The most common are traction injury of the peroneal nerve at the knee level or iatrogenic trauma of the pelvic nerves during abdominal surgery. Civil sharp injuries are rare.Indications for surgical revision follow the general rules of nerve surgery. Sharp injury should be treated as soon as possible, ideally within 72 hours. Closed lesions are indicated for surgery if a complete denervation remains unchanged three months after the injury. Best results can be achieved within six months from the injury. Irritations caused by bone fragments or scarring or by iatrogenic injury (clamps, cement, screws, etc.) may be revised later. However, the most important is early clinical examination in a specialized neurosurgical department. PMID:27256143

  5. Predicting Functional Status Following Amputation After Lower Extremity Bypass

    PubMed Central

    Suckow, Bjoern D.; Goodney, Philip P.; Cambria, Robert A.; Bertges, Daniel J.; Eldrup-Jorgensen, Jens; Indes, Jeffrey E.; Schanzer, Andres; Stone, David H.; Kraiss, Larry W.; Cronenwett, Jack L.

    2012-01-01

    Background Some patients who undergo lower extremity bypass (LEB) for critical limb ischemia ultimately require amputation. The functional outcome achieved by these patients after amputation is not well known. Therefore, we sought to characterize the functional outcome of patients who undergo amputation after LEB, and to describe the pre- and perioperative factors associated with independent ambulation at home after lower extremity amputation. Methods Within a cohort of 3,198 patients who underwent an LEB between January, 2003 and December, 2008, we studied 436 patients who subsequently received an above-knee (AK), below-knee (BK), or minor (forefoot or toe) ipsilateral or contralateral amputation. Our main outcome measure consisted of a “good functional outcome,” defined as living at home and ambulating independently. We calculated univariate and multivariate associations among patient characteristics and our main outcome measure, as well as overall survival. Results Of the 436 patients who underwent amputation within the first year following LEB, 224 of 436 (51.4%) had a minor amputation, 105 of 436 (24.1%) had a BK amputation, and 107 of 436 (24.5%) had an AK amputation. The majority of AK (75 of 107, 72.8%) and BK amputations (72 of 105, 70.6%) occurred in the setting of bypass graft thrombosis, whereas nearly all minor amputations (200 of 224, 89.7%) occurred with a patent bypass graft. By life-table analysis at 1 year, we found that the proportion of surviving patients with a good functional outcome varied by the presence and extent of amputation (proportion surviving with good functional outcome = 88% no amputation, 81% minor amputation, 55% BK amputation, and 45% AK amputation, p = 0.001). Among those analyzed at long-term follow-up, survival was slightly lower for those who had a minor amputation when compared with those who did not receive an amputation after LEB (81 vs. 88%, p = 0.02). Survival among major amputation patients did not significantly

  6. Model based control of a rehabilitation robot for lower extremities.

    PubMed

    Xie, Xiao-Liang; Hou, Zeng-Guang; Li, Peng-Feng; Ji, Cheng; Zhang, Feng; Tan, Min; Wang, Hongbo; Hu, Guoqing

    2010-01-01

    This paper mainly focuses on the trajectory tracking control of a lower extremity rehabilitation robot during passive training process of patients. Firstly, a mathematical model of the rehabilitation robot is introduced by using Lagrangian analysis. Then, a model based computed-torque control scheme is designed to control the constrained four-link robot (with patient's foot fixed on robot's end-effector) to track a predefined trajectory. Simulation results are provided to illustrate the effectiveness of the proposed model based computed-torque algorithm. In the simulation, a multi-body dynamics and motion software named ADAMS is used. The combined simulation of ADAMS and MATLAB is able to produce more realistic results of this complex integrated system. PMID:21097222

  7. Dominant spinal muscular atrophy with lower extremity predominance

    PubMed Central

    Harms, M.B.; Allred, P.; Gardner, R.; Fernandes Filho, J.A.; Florence, J.; Pestronk, A.; Al-Lozi, M.; Baloh, R.H.

    2010-01-01

    Objective: Spinal muscular atrophies (SMAs) are hereditary disorders characterized by weakness from degeneration of spinal motor neurons. Although most SMA cases with proximal weakness are recessively inherited, rare families with dominant inheritance have been reported. We aimed to clinically, pathologically, and genetically characterize a large North American family with an autosomal dominant proximal SMA. Methods: Affected family members underwent clinical and electrophysiologic evaluation. Twenty family members were genotyped on high-density genome-wide SNP arrays and linkage analysis was performed. Results: Ten affected individuals (ages 7–58 years) showed prominent quadriceps atrophy, moderate to severe weakness of quadriceps and hip abductors, and milder degrees of weakness in other leg muscles. Upper extremity strength and sensation was normal. Leg weakness was evident from early childhood and was static or very slowly progressive. Electrophysiology and muscle biopsies were consistent with chronic denervation. SNP-based linkage analysis showed a maximum 2-point lod score of 5.10 (θ = 0.00) at rs17679127 on 14q32. A disease-associated haplotype spanning from 114 cM to the 14q telomere was identified. A single recombination narrowed the minimal genomic interval to Chr14: 100,220,765–106,368,585. No segregating copy number variations were found within the disease interval. Conclusions: We describe a family with an early onset, autosomal dominant, proximal SMA with a distinctive phenotype: symptoms are limited to the legs and there is notable selectivity for the quadriceps. We demonstrate linkage to a 6.1-Mb interval on 14q32 and propose calling this disorder spinal muscular atrophy–lower extremity, dominant. GLOSSARY lod = logarithm of the odds; SMA = spinal muscular atrophy; SMA-LED = spinal muscular atrophy–lower extremity, dominant; SNP = single-nucleotide polymorphism. PMID:20697106

  8. Development of HIFU Treatment for Lower Extremity Varicose Veins

    NASA Astrophysics Data System (ADS)

    Senoo, Naohiko; Ushijima, Hiroyuki; Suzuki, Jun; Yoshinaka, Kiyoshi; Deguchi, Juno; Takagi, Shu; Miyata, Tetsuro; Matsumoto, Yoichiro

    2011-09-01

    High-intensity focused ultrasound (HIFU) has recently been developed as a noninvasive therapeutic method. In our study, a novel noninvasive therapy with HIFU was proposed for occlusion of lower extremity varicose veins. The temperature increase caused by HIFU is used to occlude varicose veins. Occluded veins became fibrotic, resulting in complete recovery. Our final goal is the medical application of HIFU treatment for varicose veins. In this study, we attempted to occlude the veins of rabbits. Prior to venous occlusion experiments, the area heated by HIFU was investigated using bovine serum albumin (BSA) gel, which denatures at >70 °C. The results indicate that the size of the heated area mainly depends on intensity at the focal point and the exposure time. A tendency was also seen for the heated area to extend toward the transducer with increasing exposure time. In animal experiments, skin burns during HIFU exposure represented a critical problem. We therefore examined the safe range of HIFU intensities in abdominal exposure experiments before conducting venous occlusion experiments. The ultrasound frequency was 1.7 MHz. Intensity at the focal point was 900 W/cm2, and the exposure time was 20 s. Rabbits underwent chemical depilation and echo gel was applied to the exposed skin to fill the boundary gap. Target veins were compressed during HIFU exposure to avoid thermal dissipation, and hyaluronan water solution was injected between the veins and skin to maintain the distance between the skin and veins at ≥5 mm. Veins were then exposed to HIFU and occluded. The capability of HIFU treatment to occlude lower extremity varicose veins was verified by the present study.

  9. Robot-aided assessment of lower extremity functions: a review.

    PubMed

    Maggioni, Serena; Melendez-Calderon, Alejandro; van Asseldonk, Edwin; Klamroth-Marganska, Verena; Lünenburger, Lars; Riener, Robert; van der Kooij, Herman

    2016-01-01

    The assessment of sensorimotor functions is extremely important to understand the health status of a patient and its change over time. Assessments are necessary to plan and adjust the therapy in order to maximize the chances of individual recovery. Nowadays, however, assessments are seldom used in clinical practice due to administrative constraints or to inadequate validity, reliability and responsiveness. In clinical trials, more sensitive and reliable measurement scales could unmask changes in physiological variables that would not be visible with existing clinical scores.In the last decades robotic devices have become available for neurorehabilitation training in clinical centers. Besides training, robotic devices can overcome some of the limitations in traditional clinical assessments by providing more objective, sensitive, reliable and time-efficient measurements. However, it is necessary to understand the clinical needs to be able to develop novel robot-aided assessment methods that can be integrated in clinical practice.This paper aims at providing researchers and developers in the field of robotic neurorehabilitation with a comprehensive review of assessment methods for the lower extremities. Among the ICF domains, we included those related to lower extremities sensorimotor functions and walking; for each chapter we present and discuss existing assessments used in routine clinical practice and contrast those to state-of-the-art instrumented and robot-aided technologies. Based on the shortcomings of current assessments, on the identified clinical needs and on the opportunities offered by robotic devices, we propose future directions for research in rehabilitation robotics. The review and recommendations provided in this paper aim to guide the design of the next generation of robot-aided functional assessments, their validation and their translation to clinical practice. PMID:27485106

  10. Lower Extremity Muscle Activity During a Women's Overhand Lacrosse Shot.

    PubMed

    Millard, Brianna M; Mercer, John A

    2014-06-28

    The purpose of this study was to describe lower extremity muscle activity during the lacrosse shot. Participants (n=5 females, age 22±2 years, body height 162.6±15.2 cm, body mass 63.7±23.6 kg) were free from injury and had at least one year of lacrosse experience. The lead leg was instrumented with electromyography (EMG) leads to measure muscle activity of the rectus femoris (RF), biceps femoris (BF), tibialis anterior (TA), and medial gastrocnemius (GA). Participants completed five trials of a warm-up speed shot (Slow) and a game speed shot (Fast). Video analysis was used to identify the discrete events defining specific movement phases. Full-wave rectified data were averaged per muscle per phase (Crank Back Minor, Crank Back Major, Stick Acceleration, Stick Deceleration). Average EMG per muscle was analyzed using a 4 (Phase) × 2 (Speed) ANOVA. BF was greater during Fast vs. Slow for all phases (p<0.05), while TA was not influenced by either Phase or Speed (p>0.05). RF and GA were each influenced by the interaction of Phase and Speed (p<0.05) with GA being greater during Fast vs. Slow shots during all phases and RF greater during Crank Back Minor and Major as well as Stick Deceleration (p<0.05) but only tended to be greater during Stick Acceleration (p=0.076) for Fast vs. Slow. The greater muscle activity (BF, RF, GA) during Fast vs. Slow shots may have been related to a faster approach speed and/or need to create a stiff lower extremity to allow for faster upper extremity movements. PMID:25114727

  11. Altered lower extremity fracture characteristics in obese pediatric trauma patients

    PubMed Central

    MacLennan, Paul A.; Backstrom, Ian; Creek, Aaron; Sawyer, Jeffrey

    2014-01-01

    Objective To determine whether there are differences in fracture patterns and femur fracture treatment choices in obese vs. non-obese pediatric trauma patients. Design Prognostic study, retrospective chart review. Setting Two level I pediatric trauma centers. Patients The trauma registries of two pediatric hospitals were queried for patients with lower extremity long bone fractures resulting from blunt trauma. 2858 alerts were examined and 397 patients had lower extremity fractures. 331 patients with a total of 394 femur or tibia fractures met inclusion criteria, and 70 patients (21%) were obese. Main Outcome Measurements Weight for age >95th percentile was defined as obese. Radiographs were reviewed and fractures were classified according the OTA/AO pediatric fracture classification system. Fracture patterns (OTA subsegment), severity, and choice of intervention for femur fractures were primary outcomes. Results Overall, obese patients were twice as likely (RR=2.20, 95% CI 1.25–3.89) to have fractures involving the physis. Physeal fracture risk was greater for femur fractures (RR=3.25, 95% CI 1.35–7.78) than tibia fractures (RR=1.58, 95% CI 0.76–3.26). Severity did not differ between groups. Obese patients with femur fractures were more likely to be treated with locked nails. Conclusion Obese pediatric trauma patients are more likely to sustain fractures involving the physis than non-obese patients. This could be related to intrinsic changes to the physis related to obesity, or altered biomechanical forces. This is consistent with the observed relationships between obesity and other conditions affecting the physis including Blount’s and slipped capital femoral epiphysis. PMID:24740109

  12. Joint swelling

    MedlinePlus

    Swelling of a joint ... Joint swelling may occur along with joint pain . The swelling may cause the joint to appear larger or abnormally shaped. Joint swelling can cause pain or stiffness. After an ...

  13. A rare case of bilateral lower extremity edema due to low dose gabapentin therapy in a young male patient

    PubMed Central

    Kahlon, Arunpreet; Gnanabakthan, Naveen; Dhillon, Amrita; Subedi, Dinesh

    2015-01-01

    46 year old male with past medical history of schizoaffective disorder and chronic lower back pain, was admitted for management of worsening depression and anxiety. He was started on gabapentin, 300mg twice daily for his back pain and anxiety symptoms. His only other medication was hydrocodone. Over next few days, he started developing worsening bilateral lower extremity edema. He did not have any cardiovascular related symptoms. Physical exam was only significant for 3+ pitting edema with all laboratory values and imaging being unremarkable. Gabapentin was discontinued and his lower extremity swelling improved over subsequent days. Incidence of pedal edema with gabapentin use is approximately 7 to 7.5% with all studies being in elderly patients receiving doses above 1200 mg/day. This case illustrates that lower doses of gabapentin can also cause this adverse effect. It is important to recognize this adverse effect because gabapentin is used in conditions like diabetic neuropathy, which is associated with multiple co-morbidities that can give rise to bilateral leg swelling. Presence of gabapentin induced leg swelling can thus confound the clinical picture. PMID:26692738

  14. A rare case of bilateral lower extremity edema due to low dose gabapentin therapy in a young male patient.

    PubMed

    Kahlon, Arunpreet; Gnanabakthan, Naveen; Dhillon, Amrita; Subedi, Dinesh

    2015-09-01

    46 year old male with past medical history of schizoaffective disorder and chronic lower back pain, was admitted for management of worsening depression and anxiety. He was started on gabapentin, 300mg twice daily for his back pain and anxiety symptoms. His only other medication was hydrocodone. Over next few days, he started developing worsening bilateral lower extremity edema. He did not have any cardiovascular related symptoms. Physical exam was only significant for 3+ pitting edema with all laboratory values and imaging being unremarkable. Gabapentin was discontinued and his lower extremity swelling improved over subsequent days. Incidence of pedal edema with gabapentin use is approximately 7 to 7.5% with all studies being in elderly patients receiving doses above 1200 mg/day. This case illustrates that lower doses of gabapentin can also cause this adverse effect. It is important to recognize this adverse effect because gabapentin is used in conditions like diabetic neuropathy, which is associated with multiple co-morbidities that can give rise to bilateral leg swelling. Presence of gabapentin induced leg swelling can thus confound the clinical picture. PMID:26692738

  15. Assessment and management of the lower extremity in myelodysplasia.

    PubMed

    Carroll, N C

    1987-10-01

    The goal in managing the lower extremity in a child with spina bifida is to achieve a pattern of development as near normal as possible. Lower limb deformities are produced by muscle imbalance, weight-bearing, and the postural effects of gravity. At any point in time, the management of the lower extremities will depend on the child's general development. Lower limb paralysis, hydrocephalus, bladder infections, hydromyelia, and Arnold Chiari malformation, all contribute to developmental delay. A child's potential for mobility varies with the severity of the motor and sensory deficit. Surgery is done to correct deformity, provide joint stability, and improve joint mobility. The results of surgery will be compromised if the child is not neurologically stable, or if appropriate therapy and orthotic care are not available. Muscle imbalance produces the problem of deformity and instability of the hip. Deformity must be corrected if the child is to assume an upright posture. Instability is of concern only in those children with a strong quadriceps muscle. Hip surgery for instability should be limited to one procedure, which must achieve a stable concentric reduction and balance the muscle forces about the hip. The common deformities seen at the knee are recurvatum, knee flexion contractures, and genu valgum. Most knee deformities can be corrected by soft tissue procedures. Well-designed orthoses rocker sole shoes, and appropriate gait training help prevent knee deformities. The goal in managing foot deformities is to achieve a plantigrade foot with stable skin. Whenever there is a problem with sensation, concentrated pressure in one area of a deformed foot will lead to skin breakdown. Surgical procedures must completely correct deformity and restore muscle imbalance. After surgery, meticulous orthotic care is required to prevent skin breakdown and avoid loss of correction. The orthopedist has a significant role in helping a child with spina bifida to achieve a pattern of

  16. Lower Extremity Overuse Conditions Affecting Figure Skaters During Daily Training

    PubMed Central

    Campanelli, Valentina; Piscitelli, Francesco; Verardi, Luciano; Maillard, Pauline; Sbarbati, Andrea

    2015-01-01

    Background Most ice figure skaters train and compete with ongoing issues in the lower extremities, which are often overlooked by the skaters and considered injuries only when they prevent the athletes from skating. Although not severe, these conditions impair the quality of daily training and compromise the skaters’ state of mind and performances. Purpose (1) To determine the point prevalence of the ongoing lower extremity overuse conditions in a population of ice figure skaters of all ages and levels and (2) to identify the risk factors contributing to the development of the most common ongoing conditions. Study Design Cross-sectional study; Level of evidence, 3. Methods A total of 95 skaters of all ages and skating levels were evaluated in a single examination in the middle of the competitive season. Data collection consisted of a questionnaire, clinical examination, and measurement of the skaters’ characteristics and the equipment used. Results Retrocalcaneal bursitis was the most common problem, affecting at least 1 foot in 34% of the skaters evaluated, followed by posterior heel skin calluses and superficial calcaneal bursitis, which affected 29% and 28% of skaters, respectively. The prevalence of the majority of these conditions was 10% to 32% higher in elite skaters than in nonelite skaters. Higher boot–foot length difference was associated with greater risk of superficial calcaneal bursitis in the landing foot of elite skaters, while higher body weight and greater in-skate ankle flexibility were associated with the development of retrocalcaneal bursitis in nonelite skaters. Only 30 skaters (32%) wore the appropriate boot size, while 57 skaters (51%) could not dorsiflex their ankles properly while wearing skates. Conclusion The heel represents a major area of concern for the high prevalence of calcaneal bursitis and calluses in proximity of the Achilles tendon, suggesting that improvements on the boot heel cup design should take priority. The

  17. Lower-extremity ground reaction forces in collegiate baseball pitchers.

    PubMed

    Guido, John A; Werner, Sherry L

    2012-07-01

    The purpose of this study was to investigate ground reaction forces (GRF) in collegiate baseball pitchers and their relationship to pitching mechanics. Fourteen healthy collegiate baseball pitchers participated in this study. High-speed video and force plate data were collected for fastballs from each pitcher. The average ball speed was 35 ± 3 m/sec (78 ± 7 mph). Peak GRFs of 245 ± 20% body weight (BW) were generated in an anterior or braking direction to control descent. Horizontal GRFs tended to occur in a laterally directed fashion, reaching a peak of 45 ± 63% BW. The maximum vertical GRF averaged 202 ± 43% BW approximately 45 milliseconds after stride foot contact. A correlation between braking force and ball velocity was evident. Because of the downward inclination and rotation of the pitching motion, in addition to volume, shear forces may occur in the musculoskeletal tissues of the stride limb leading to many of the lower-extremity injuries seen in this athletic population. PMID:22344047

  18. [Multilevel revascularization of the lower extremities using loop endarterectomy].

    PubMed

    Losev, R Z; Burov, Iu A; Mikul'skaia, E G; Eliseev, A A; Bogdanova, N B; Skriabin, V V

    2006-01-01

    Results of 91 reconstructions of the ilio-femoro-popliteal segment in patients with multilevel injuries of the lower extremity arteries were analyzed. In 42 of the operations a method of operations associated with loop endarterectomy was used. The first stage in all the patients consisted of iliac deep femoral reconstructions or semi-closed loop endarterectomy from iliac arteries in order for inclusion in blood flow of the profound femoral artery. In the presence of the volumetric blood flow along the profound femoral artery less than 150 ml/min after the first stage of revascularization the operation volume was extended at the expense of the femoro-distal reconstructions and/or semi-closed loop endarterectomy from the femoral and popliteal arteries. It was found that revascularization of the ilio-femoral segment in combination with desobliteration of the popliteal artery allowed performing two-level reconstructions with little time and material costs followed by primary positive results in 92.9% of cases. PMID:17315682

  19. Ogilvie’s syndrome after lower extremity arthroplasty

    PubMed Central

    ElMaraghy, Amr W.; Schemitsch, Emil H.; Burnstein, Marcus J.; Waddell, James P.

    1999-01-01

    Objective To alert surgeons who perform arthroplasty to the possibility of acute colonic pseudo-obstruction (Ogilvie’s syndrome) after elective orthopedic procedures. To identify possible risk factors and emphasize the need for prompt recognition, careful monitoring and appropriate management so as to reduce morbidity and mortality. Design A case series. Setting A university-affiliated hospital that is a major referral centre for orthopedic surgery. Patients Four patients who had Ogilvie’s syndrome after lower extremity arthroplasty. Of this group, 2 had primary hip arthroplasty, 1 had primary knee arthroplasty and 1 had revision hip arthroplasty. Main outcome measures Morbidity and mortality. Results In all 4 patients Ogilvie’s syndrome was recognized late and required surgical intervention. Two patients died as a result of postoperative complications. Conclusions Our case series identified increasing age, immobility and patient-controlled narcotic analgesia as potential risk factors for Ogilvie’s syndrome in the postoperative orthopedic patient. Prompt recognition and early consultation with frequent clinical and radiographic monitoring are necessary to avoid colonic perforation and its significant associated death rate. PMID:10223075

  20. Rehabilitation for patients with paraplegia and lower extremity amputation

    PubMed Central

    Wang, Fangyong; Hong, Yi

    2015-01-01

    [Purpose] To study the characteristics and treatment strategy for patients with paraplegia and lower extremity amputation. [Subjects] Six cases were selected from among the patients admitted to the China Rehabilitation Research Center from 1991 to 2014. The criteria for the six cases were spinal cord injury with amputation immediately or in a short time (1 week) after the trauma. [Methods] General information, clinical diagnosis, treatment, rehabilitation and other data were analyzed. [Results] All the six cases were injured by high energy or complex energy accidents: two cases by falls after high voltage electric shock, one by an oil pipeline explosion, one by the impact of a falling tower crane and received high energy traffic accident injuries (one was hit by a train, and the other was hit by a truck at high speed). All the six cases had thoracic and lumbar vertebral injuries and complete paraplegia. Amputation stump infection occurred in four cases. After comprehensive rehabilitation treatment, patients’ functional independence measure (FIM) scores improved significantly, but American Spinal Injury Association (ASIA) scores and ASIA Impairment Scale (AIS) grades showed no significant improvement. [Conclusion] When formulating the clinical treatment and rehabilitation for spinal cord injury with amputation patients, simultaneous consideration of the characteristics of the spinal cord injury and amputation is needed to develop an individualized strategy. For spinal cord injury with limb amputation patients, prostheses should allow the improvement of patients’ self-care ability. PMID:26644641

  1. Bilaterally Symmetrical Lower Extremity Compartment Syndrome following Massive Transfusion

    PubMed Central

    Karaoren, Gulsah; Bakan, Nurten; Tomruk, Senay Goksu; Topaç, Zelin; Kurtulmuş, Tuhan; Irkören, Saime

    2016-01-01

    Compartment syndrome is a serious condition characterized by raised intracompartmental pressure, which develops following trauma. Well leg compartment syndrome (WLCS) is a term reserved for compartment syndrome in a nontraumatic setting, usually resulting from prolonged lithotomy position during surgery. In literature, 8 cases have been reported regarding well leg compartment syndrome in a supine position and bilateral symmetrical involvement was observed in only 2 cases. In WLCS etiology, lengthy surgery, lengthy hypotension, and extremity malpositioning have been held responsible but one of the factors with a role in the etiology may have been the tissue oedema and impaired microcirculation formed from the effect of vasoactive mediators expressed into the circulation associated with the massive blood transfusion. The case is presented here regarding symmetrical lower extremity compartment syndrome after surgery in which massive transfusion was made for gross haemorrhage from an abdominal injury. In conclusion, blood transfusion applied at the required time is life-saving but potential risks must always be considered. PMID:26885421

  2. Calf pump activity influencing venous hemodynamics in the lower extremity.

    PubMed

    Recek, Cestmir

    2013-03-01

    Calf muscle pump is the motive force enhancing return of venous blood from the lower extremity to the heart. It causes displacement of venous blood in both vertical and horizontal directions, generates ambulatory pressure gradient between thigh and lower leg veins, and bidirectional streaming within calf perforators. Ambulatory pressure gradient triggers venous reflux in incompetent veins, which induces ambulatory venous hypertension in the lower leg and foot. Bidirectional flow in calf perforators enables quick pressure equalization between deep and superficial veins of the lower leg; the outward (into the superficial veins) oriented component of the bidirectional flow taking place during calf muscle contraction is no pathological reflux but a physiological centripetal flow streaming via great saphenous vein into the femoral vein. Calf perforators are communicating channels between both systems making them conjoined vessels; they are not involved in the generation of pathological hemodynamic situations, nor do they cause ambulatory venous hypertension. The real cause why recurrences develop has not as yet been cleared. Pressure gradient arising during calf pump activity between the femoral vein and the saphenous remnant after abolition of saphenous reflux triggers biophysical and biochemical events, which might induce recurrence. Thus, abolition of saphenous reflux removes the hemodynamic disturbance, but at the same time it generates precondition for reflux recurrence and for the comeback of the previous pathological situation; this chain of events has been called hemodynamic paradox. PMID:24436580

  3. Assessment of dynamic balance via measurement of lower extremities tortuosity.

    PubMed

    Eltoukhy, Moataz; Kuenze, Christopher; Jun, Hyung-Pil; Asfour, Shihab; Travascio, Francesco

    2015-03-01

    Tortuosity describes how twisted or how much curvature is present in an observed movement or path. The purpose of this study was to investigate the differences in segmental tortuosity between Star Excursion Balance Test (SEBT) reach directions. Fifteen healthy participants completed this study. Participants completed the modified three direction (anterior, posteromedial, posterolateral) SEBT with three-dimensional motion analysis using an 8 camera BTS Smart 7000DX motion analysis system. The tortuosity of stance limb retro-reflective markers was then calculated and compared between reach directions using a 1 × 3 ANOVA with repeated measures, while the relationship between SEBT performance and tortuosity was established using Pearson product moment correlations. Anterior superior iliac spine tortuosity was significantly greater (p < 0.001) and lateral knee tortuosity was lesser (p = 0.018) in the anterior direction compared to the posteromedial and posterolateral directions. In addition, second metatarsal tortuosity was greater in the anterior reach direction when compared to posteromedial direction (p = 0.024). Tortuosity is a novel biomechanical measurement technique that provides an assessment of segmental movement during common dynamic tasks such as the SEBT. This enhanced level of detail compared to more global measures of joint kinematic may provide insight into compensatory movement strategies adopted following lower extremity joint injury. PMID:25895607

  4. Transbrachial Thrombolysis, PTA and Stenting in the Lower Extremities

    SciTech Connect

    Ernst, Stefan Fischbach, Roman; Brochhagen, Hans-Georg; Heindel, Walter; Landwehr, Peter

    2003-11-15

    We present an analysis of 37 interventions in the arteries of the lower limbs via a transbrachial arterial approach. Twenty-six patients (42-79 years) underwent 37 interventional procedures in the lower extremities (iliac n = 6, iliac + femoro-popliteal n = 1, femoro-popliteal n = 30) with a vascular approach via the brachial artery (33 left sided, 4 right sided, introducer sheath 4-7 F). The transbrachial approach was chosen to avoid puncture of femoral bypass graft material. Technical success could be achieved in 11/13 thrombolyses, 8/9 PTAs, 7/10 combinations of thrombolysis and percutaneous transluminar angioplasty (PTA) and in the placement of two stents. One patient suffered from periprocedural severe re-thrombosis due to insufficient anticoagulation during fibrinolysis, and twice thrombolysis was incomplete. One puncture-related false aneurysm of the brachial artery had to be corrected surgically. One transient ischemic attack (TIA) and four minor complications occurred. Transbrachial vascular approach for arterial interventions in iliac and femoro-popliteal pathologies is a reasonable alternative to the transaxillary access if transfemoral puncture has to be avoided. The technical success rate is comparable with the results of the transaxillary and transfemoral approach. To minimize, at least theoretically, the risk of cerebral complications, the left- sided approach should be preferred and intravenous heparin should be administered routinely.

  5. Amputee Locomotion: lower extremity loading using running-specific prostheses

    PubMed Central

    Hobara, Hiroaki; Baum, Brian S; Kwon, Hyun-Joon; Linberg, Alison; Wolf, Erik J; Miller, Ross H; Shim, Jae Kun

    2013-01-01

    Carbon fiber running-specific prostheses (RSPs) have allowed individuals with lower extremity amputation (ILEA) to actively participate in sporting activities including competitive sports. In spite of this positive trait, the RSPs have not been thoroughly evaluated regarding potential injury risks due to abnormal loading during running. Vertical impact peak (VIP) and average loading rate (VALR) of the vertical ground reaction force (vGRF) have been associated with running injuries in able-bodied runners but not for ILEA. The purpose of this study was to investigate vGRF loading in ILEA runners using RSPs across a range of running speeds. Eight ILEA with unilateral transtibial amputations and eight control subjects performed overground running at three speeds (2.5, 3.0, and 3.5 m/s). From vGRF, we determined VIP and VALR, which was defined as the change in force divided by the time of the interval between 20 and 80% of the VIP.We observed that VIP and VALR increased in both ILEA and control limbs with an increase in running speed. Further, the VIP and VALR in ILEA intact limbs were significantly greater than ILEA prosthetic limbs and control subject limbs for this range of running speeds. These results suggest that 1) loading variables increase with running speed not only in able-bodied runners, but also in ILEA using RSPs, and 2) the intact limb in ILEA may be exposed to a greater risk of running related injury than the prosthetic limb or able-bodied limbs. PMID:24035367

  6. Combined Lymphedema and Capillary Malformation of the Lower Extremity

    PubMed Central

    Maclellan, Reid A.; Chaudry, Gulraiz

    2016-01-01

    Background: Primary lymphedema and capillary malformation are independent vascular malformations that can cause overgrowth of the lower extremity. We report a series of patients who had both types of malformations affecting the same leg. The condition is unique but may be confused with other types of vascular malformation overgrowth conditions (eg, Klippel–Trenaunay and Parkes Weber). Methods: Our Vascular Anomalies Center and Lymphedema Program databases were searched for patients with both capillary malformation and lymphedema. Diagnosis of lymphedema–capillary malformation was made by history, physical examination, and imaging studies. Because lymphedema–capillary malformation has phenotypical overlap with other conditions, only patients who had imaging confirming their diagnosis were included in the analysis. Clinical and radiological features, morbidity, and treatment were recorded. Results: Eight patients (4 females and 4 males) had confirmed lymphedema–capillary malformation. Referring diagnosis was Klippel–Trenaunay syndrome (n = 4), diffuse capillary malformation with overgrowth (n = 3), or lymphatic malformation (n = 1). The condition was unilateral (n = 6) or bilateral (n = 2). Morbidity included infection (n = 6), difficulty fitting clothes (n = 6), bleeding or leaking vesicles (n = 5), leg length discrepancy (n = 4), and difficulty ambulating (n = 3). All patients were managed with compression regimens. Operative management was liposuction (n = 3), treatment of phlebectatic veins (n = 3), staged skin/subcutaneous excision (n = 1), and/or epiphysiodesis (n = 1). Conclusions: Lymphedema and capillary malformation can occur together in the same extremity. Both conditions independently cause limb overgrowth primarily because of subcutaneous adipose deposition. Compression garments and suction-assisted lipectomy can improve the condition. Lymphedema–capillary malformation should not be confused with other vascular malformation overgrowth

  7. Predictive factors for lower extremity amputations in diabetic foot infections.

    PubMed

    Aziz, Zameer; Lin, Wong Keng; Nather, Aziz; Huak, Chan Yiong

    2011-01-01

    The objective of this study was to evaluate the epidemiology of diabetic foot infections (DFIs) and its predictive factors for lower extremity amputations. A prospective study of 100 patients with DFIs treated at the National University Hospital of Singapore were recruited in the study during the period of January 2005-June 2005. A protocol was designed to document patient's demographics, type of DFI, presence of neuropathy and/or vasculopathy and its final outcome. Predictive factors for limb loss were determined using univariate and stepwise logistic regression analysis. The mean age of the study population was 59.8 years with a male to female ratio of about 1:1 and with a mean follow-up duration of about 24 months. All patients had type 2 diabetes mellitus. Common DFIs included abscess (32%), wet gangrene (29%), infected ulcers (19%), osteomyelitis (13%), necrotizing fasciitis (4%) and cellulitis (3%). Thirteen patients were treated conservatively, while surgical debridement or distal amputation was performed in 59 patients. Twenty-eight patients had major amputations (below or above knee) performed. Forty-eight percent had monomicrobial infections compared with 52% with polymicrobial infections. The most common pathogens found in all infections (both monomicrobial and polymicrobial) were Staphylococcus aureus (39.7%), Bacteroides fragilis (30.3%), Pseudomonas aeruginosa (26.0%) and Streptococcus agalactiae (21.0%). Significant univariate predictive factors for limb loss included age above 60 years, gangrene, ankle-brachial index (ABI) <0.8, monomicrobial infections, white blood cell (WBC) count ≥ 15.0×10(9)/L, erythrocyte sedimentation rate ≥100 mm/hr, C-reactive protein ≥15.0 mg/dL, hemoglobin (Hb) ≤10.0g/dL and creatinine ≥150 µmol/L. Upon stepwise logistic regression, only gangrene, ABI <0.8, WBC ≥ 15.0×10(9)/L and Hb ≤10.0g/dL were significant. PMID:22396824

  8. Lower extremity muscular strength, sedentary behavior, and mortality.

    PubMed

    Loprinzi, Paul D

    2016-04-01

    To examine whether lower extremity strength (LES) is predictive of all-cause mortality, independent of physical activity and among those with vary levels of sedentary behavior. Data from the 1999-2002 National Health and Nutrition Examination Survey was used (N = 2768; 50-85 years). Peak isokinetic knee extensor strength was objectively measured, sedentary behavior and physical activity were self-reported, and mortality was assessed via the National Death Index, with follow-up through 2011. Participants were followed for up to 12.6 years with the weighted average follow-up period lasting 9.9 years (standard error, 1.13). In the sample, 321,996 person-months occurred with a mortality rate of 2.1 deaths per 1000 person-months. After adjustments (including physical activity), for every 15 N increase in LES, participants had a 7 % reduced risk of all-cause mortality (HR = 0.93; 95 % CI 0.91-0.95; P < 0.001). When adding a three-level sedentary behavior variable (< 2, 2-4, 5+ h/day) as a covariate in this model, results were unchanged (HR = 0.93; 95 % CI 0.92-0.96; P < 0.001). Similarly, when sedentary behavior was included as a continuous covariate in the model, results regarding the relationship between LES and mortality were unchanged (HR = 0.94; 95 % CI 0.91-0.96; P < 0.001). There was no evidence of statistical interaction between LES and sedentary behavior on all-cause mortality (HRinteraction = 1.01; 95 % CI 0.92-1.10; P = 0.88). LES was inversely associated with all-cause mortality, and this association was unchanged when considering the participant's sedentary behavior. PMID:26931822

  9. Pediatric Obesity and Traumatic Lower Extremity Long Bone Fracture Outcomes

    PubMed Central

    Backstrom, Ian C.; MacLennan, Paul A.; Sawyer, Jeffrey R.; Creek, Aaron T.; Rue, Loring W.; Gilbert, Shawn R.

    2013-01-01

    Background Pediatric obesity is associated with lower extremity injuries and poor outcomes after blunt trauma. Our aim was to determine if obese pediatric patients with femur and tibia fractures have more severe injury patterns and worse outcomes compared to non-obese patients. Methods We performed a retrospective cohort study of obese and non-obese pediatric patients with femur or tibia fractures treated at two Level-1 trauma centers from 2004-2010. Patients weighing ≥ 95th percentile for age and gender were classified as obese. Patients were compared regarding demographics, Injury Severity Score (ISS), intra-abdominal, and orthopedic injuries. Outcomes included fracture treatment, orthopedic complications, ICU and hospital length of stay, ventilator days, and mortality. Results Of the 356 patients included in the study, 78 (21.9%) were obese and 278 (78.1%) were non-obese. Obese patients were older (9.9±3.7 vs. 8.8±3.9 years; p=0.0162), had a higher ISS (20.8±13.4 vs. 14.5±10.8; p=0.0002), and sustained more intra-abdominal solid organ (24.4% vs.13.5%; p=0.0200) and hollow viscus (3.9% vs. 0.0%; p=0.0105) injuries. They had more pelvic fractures (15.4% vs. 6.9%; p=0.0196), bilateral tibia fractures (8.0% vs. 0.0%; p=0.0332), and operatively-treated femur fractures (89.9% vs. 79.1%; p=0.0484). Adjusting for age, obese patients were more likely to be admitted to the ICU [relative risk (RR), 1.68; 95% confidence interval (CI), 1.10-2.55] and die in the hospital (RR, 3.45; 95% CI, 1.14-10.41). Adjusting for ISS, these associations were non-significant. Conclusions Obese patients with femur and tibia fractures have more severe injuries which may predispose them to greater inpatient morbidity and mortality than non-obese patients. PMID:22902734

  10. Erythema nodosum of non-lower extremity sites - a histopathologic reappraisal.

    PubMed

    Perez-Chua, T; Miller, D D; Mahalingam, M

    2014-11-19

    We recently saw a 51 year--old female with a tender, erythematous nodule on the left elbow and histopathology consistent with Erythema nodosum (EN). A subsequent literature review of EN in non--lower extremity (LE) sites identified only three reports, with minimal histopathology, prompting the current study. We identified nine EN cases on non--LE sites over a 14--year period. Histopathology typical of EN observed included septal panniculitis, fibrosis and edema, a mixed septal inflammatory infiltrate with and spillover into adjacent lobules and Miescher's radial granulomas. Atypical features observed included a mixed (septal and lobular) panniculitis, leukocytoclastic vasculitis, changes in septal small vessels (lymphocytic cuffing of septal venules, endothelial swelling), lipomembranous cystic change and asteroid bodies. To the best of our knowledge, this is the first study to detail the histopathologic findings of EN on non--LE sites. Similar to that noted in classical EN in the LE, findings from the current study indicate that EN in non--LE sites display typical as well as atypical features. Limitations include retrospective design and the unspecified duration of biopsied lesions relative to clinical presentation. PMID:25407105

  11. Changes in Lower Extremity Biomechanics Due to a Short-Term Fatigue Protocol

    PubMed Central

    Cortes, Nelson; Greska, Eric; Kollock, Roger; Ambegaonkar, Jatin; Onate, James A.

    2013-01-01

    Context: Noncontact anterior cruciate ligament injury has been reported to occur during the later stages of a game when fatigue is most likely present. Few researchers have focused on progressive changes in lower extremity biomechanics that occur throughout fatiguing. Objective: To evaluate the effects of a sequential fatigue protocol on lower extremity biomechanics during a sidestep-cutting task (SS). Design: Controlled laboratory study. Setting: Laboratory. Patients or Other Participants: Eighteen uninjured female collegiate soccer players (age = 19.2 ± 0.9 years, height = 1.66 ± 0.5 m, mass = 61.6 ± 5.1 kg) volunteered. Intervention(s): The independent variable was fatigue level, with 3 levels (prefatigue, 50% fatigue, and 100% fatigue). Using 3-dimensional motion capture, we assessed lower extremity biomechanics during the SS. Participants alternated between a fatigue protocol that solicited different muscle groups and mimicked actual sport situations and unanticipated SS trials. The process was repeated until fatigue was attained. Main Outcome Measure(s): Dependent variables were hip- and knee-flexion and abduction angles and internal moments measured at initial contact and peak stance and defined as measures obtained between 0% and 50% of stance phase. Results: Knee-flexion angle decreased from prefatigue (−17° ± 5°) to 50% fatigue (−16° ± 6°) and to 100% fatigue (−14° ± 4°) (F2,34 = 5.112, P = .004). Knee flexion at peak stance increased from prefatigue (−52.9° ± 5.6°) to 50% fatigue (−56.1° ± 7.2°) but decreased from 50% to 100% fatigue (−50.5° ± 7.1°) (F2,34 = 8.282, P = 001). Knee-adduction moment at peak stance increased from prefatigue (0.49 ± 0.23 Nm/kgm) to 50% fatigue (0.55 ± 0.25 Nm/kgm) but decreased from 50% to 100% fatigue (0.37 ± 0.24) (F2,34 = 3.755, P = 03). Hip-flexion angle increased from prefatigue (45.4° ± 10.9°) to 50% fatigue (46.2° ± 11.2°) but decreased from 50% to 100% fatigue (40.9° ± 11.3

  12. Outcomes of lower extremity injuries sustained during Operation Iraqi Freedom and Operation Enduring Freedom.

    PubMed

    Spear, Marcia

    2009-01-01

    Lower extremity war injuries are complex because of changes in weaponry and ballistics. Outcomes of a functional lower extremity depend on early transport, early debridement and washout, and advanced surgical techniques such as microvascular procedures. The purpose of this article is to present evidence on the outcomes of lower extremity complex injuries and provide evidence-based factors that contribute to these outcomes. PMID:19752681

  13. Lower Extremity Fracture Reduction: Tips, Tricks, and Techniques So That You Leave the Operating Room Satisfied.

    PubMed

    Mir, Hassan R; Boulton, Christina L; Russell, George V; Archdeacon, Michael

    2016-01-01

    It can be challenging for surgeons to obtain proper alignment and to create stable constructs for the maintenance of many lower extremity fractures until union is achieved. Whether lower extremity fractures are treated with plates and screws or intramedullary nails, there are numerous pearls that may help surgeons deal with these difficult injuries. Various intraoperative techniques can be used for lower extremity fracture reduction and stabilization. The use of several reduction tools, tips, and tricks may facilitate the care of lower extremity fractures and, subsequently, improve patient outcomes. PMID:27049180

  14. The Effects of Load Carriage and Muscle Fatigue on Lower-Extremity Joint Mechanics

    ERIC Educational Resources Information Center

    Wang, He; Frame, Jeff; Ozimek, Elicia; Leib, Daniel; Dugan, Eric L.

    2013-01-01

    Military personnel are commonly afflicted by lower-extremity overuse injuries. Load carriage and muscular fatigue are major stressors during military basic training. Purpose: To examine effects of load carriage and muscular fatigue on lower-extremity joint mechanics during walking. Method: Eighteen men performed the following tasks: unloaded…

  15. Upper and Lower Extremity Midline Crossing Effects upon Adults with Mild to Moderate Mental Retardation.

    ERIC Educational Resources Information Center

    Woodard, Rebecca J.; Surburg, Paul R.; Lewis, Colleen A.

    1998-01-01

    This study examined whether midline crossing inhibition (MCI) was present in 13 adults with mild to moderate mental retardation when crossing the midline of the body with both the upper and lower extremities. Results indicated that participants exhibited MCI with both the upper and lower extremities. (Author/CR)

  16. Pathology Image Of the Month: Rapidly Progressive Hemorrhagic Cellulitis of Bilateral Lower Extremities with Subsequent Septic Shock and Death.

    PubMed

    Connor, Ellen E; Jackson, Nicole R; McGoey, Robin R

    2016-01-01

    A 51-year-old man presented to a community based emergency department with bilateral lower extremity swelling that began four days prior and that had evolved into recent blister formation on the left lower extremity. Medical history was significant only for hypertension and a recent self-described episode of "food poisoning" five days earlier characterized by diarrhea, nausea, and vomiting that quickly resolved. Physical exam revealed marked bilateral lower extremity edema and an ecchymotic rash below the knee. In addition to the rash, there were large flaccid bullae on the left leg, mostly intact but some notable for draining of scanty serosanguinous fluid. The patient was tachycardic with a rate of 114 bpm and initial labs showed thrombocytopenia (platelets 56 x 103/uL [140-440 x 103/uL]), hypoglycemia (15mg/dl [70-105mg/dl]), an elevated creatinine (2.7mg/dL [0.7- 1.25mg/dL]), and aspartate aminotransferase (AST 156U/L [5- 34U/L]). Two sets of blood cultures were drawn, broad spectrum antibiotics including doxycycline were empirically initiated and then he was subsequently transported to a tertiary care hospital for escalation of care. Within hours of presentation to the tertiary care facility, the rash appeared progressively hemorrhagic and bullous, lactic acidosis and coagulopathy developed and hemodynamic instability and septic shock necessitated endotracheal intubation and vasopressors. He was taken to the operating room for skin debridement but was emergently converted to bilateral above the knee lower extremity amputations due to the extent of the soft tissue necrosis. The patient remained intubated and in critical condition following surgery and the ecchymotic rash reappeared at the amputation sites. A newly developed ecchymotic rash with bullae formation was noted on the right upper extremity forearm. At that time, the clinicians were notified that four out of four blood culture bottles from admission were rapidly growing a microorganism. The family

  17. Prevalence and risk factor analysis of lower extremity abnormal alignment characteristics among rice farmers

    PubMed Central

    Karukunchit, Usa; Puntumetakul, Rungthip; Swangnetr, Manida; Boucaut, Rose

    2015-01-01

    Background Rice farming activities involve prolonged manual work and human–machine interaction. Prolonged farming risk-exposure may result in lower limb malalignment. This malalignment may increase the risk of lower extremity injury and physical disabilities. However, the prevalence and factors associated with lower extremity malalignment have not yet been reported. This study aimed to investigate the prevalence and risk factors of lower extremity malalignment among rice farmers. Methods A cross-sectional survey was conducted with 249 rice farmers. Lower extremity alignment assessment included: pelvic tilt angle, limb length equality, femoral torsion, quadriceps (Q) angle, tibiofemoral angle, genu recurvatum, rearfoot angle, and medial longitudinal arch angle. Descriptive statistics were used to analyze participant characteristics and prevalence of lower extremity malalignment. Logistic regression analysis was used to identify risk factors. Results The highest prevalence of lower extremity malalignment was foot pronation (36.14%), followed by the abnormal Q angle (34.94%), tibiofemoral angle (31.73%), pelvic tilt angle (30.52%), femoral antetorsion (28.11%), limb length inequality (22.49%), tibial torsion (21.29%), and genu recurvatum (11.24%). In females, the risk factors were abnormal Q angle, tibiofemoral angle, and genu recurvatum. Being overweight was a risk factor for abnormal pelvic tilt angle, Q angle, and tibiofemoral angle. Age was a risk factor for limb length inequality. Years of farming were a major risk factor for abnormal Q angle, tibiofemoral angle, and foot malalignment. Conclusion Prevalence of lower extremity malalignment was reported in this study. Female sex, being overweight, and years of farming were major risk factors for lower extremity malalignment. Lower extremity screening should assist in the identification of foot and knee malalignment in rice farmers. This may then lead to early prevention of musculoskeletal disorders arising from

  18. [Phlebography in chronic venous insufficiency of the lower extremities. Technic and value of different tests].

    PubMed

    Genevois, A; Bolot, J E; Michel, C

    1988-01-01

    Remainder of the various phlebographic procedures in chronic venous insufficiency of the lower extremities: peripheral phlebography, popliteal phlebography, femoral phlebography, varicography. The techniques and the informations they provide are presented for each one of these examinations. PMID:3043478

  19. The causes of lower-extremity deep venous thrombosis in the children with cranial diseases

    PubMed Central

    Wang, Yan; Liu, Wei; Jia, Ge; Li, Na; Jia, Yulong

    2015-01-01

    In order to investigate the prevalence of lower-extremity deep venous thrombosis (DVT) and to explore its possible reasons in children patients who received neurosurgery operation. Clinical data of 4958 cases children patients with lower-extremity DVT and without the thrombosis after the neurosurgery operation from 2010 January to 2014 December in department of neurosurgery of Tian Tan hospital were collected and analyzed. 18 cases children were diagnosed with lower-extremity DVT. All of them had invasive operation of lower-extremity deep venous catheterization. The mainly primary diseases of thrombosis children were craniopharyngioma. They have longer operation time compared with those without thrombosis (P<0.05). Therefore, the causes of DVT in neurosurgical children involve not only deep venous catheter-related but also neurological primary disease and operation time. PMID:26885175

  20. Autologous staged fat tissue transfer in post-traumatic lower extremity reconstruction.

    PubMed

    Benjamin, Martin A; Schwarzman, Garrett; Eivazi, Mariet; Zachary, Lawrence

    2015-01-01

    Autologous fat tissue transfer for aesthetic reconstruction has been described in the literature for soft tissue damage as early as 1893. One area that has yet to be described is the role of fat grafting in post-traumatic lower extremity injuries. In this case report, we present a patient who had significant injury to her right lower extremity and presented for reconstruction. The patient is a 52-year-old female who presented to clinic after a right lower extremity traumatic injury that required multiple re-operations, which lead to dense scarring and volume loss along the extremity inferior to the knee joint. The patient received two staged autologous fat injections and reported positive outcomes. Our case report demonstrates the utility of fat transfer in reconstruction of the lower extremity in staged fashion. Further research in the refinement of this technique and patient follow-up will lead to better graft survival and reconstructive outcomes. PMID:26572154

  1. Autologous staged fat tissue transfer in post-traumatic lower extremity reconstruction

    PubMed Central

    Benjamin, Martin A.; Schwarzman, Garrett; Eivazi, Mariet; Zachary, Lawrence

    2015-01-01

    Autologous fat tissue transfer for aesthetic reconstruction has been described in the literature for soft tissue damage as early as 1893. One area that has yet to be described is the role of fat grafting in post-traumatic lower extremity injuries. In this case report, we present a patient who had significant injury to her right lower extremity and presented for reconstruction. The patient is a 52-year-old female who presented to clinic after a right lower extremity traumatic injury that required multiple re-operations, which lead to dense scarring and volume loss along the extremity inferior to the knee joint. The patient received two staged autologous fat injections and reported positive outcomes. Our case report demonstrates the utility of fat transfer in reconstruction of the lower extremity in staged fashion. Further research in the refinement of this technique and patient follow-up will lead to better graft survival and reconstructive outcomes. PMID:26572154

  2. Decoding movement intent of patient with multiple sclerosis for the powered lower extremity exoskeleton.

    PubMed

    Zhang, Fan; Huang, He

    2013-01-01

    This study aims to recognize movement intent of patients with multiple sclerosis (MS) by decoding neuromuscular control signals fused with mechanical measurements as a method of powered lower extremity exoskeleton control. Surface electromyographic (EMG) signals recorded from the lower extremity muscles, ground reaction forces measured from beneath both feet, and kinematics from both thigh segments of a single MS patient were used to identify three activities (level-ground walking, sitting, and standing). Our study showed that during activity performance clear modulation of muscle activity in the lower extremities was observed for the MS patient, whose Kurtzke Expanded Disability Status Scale (EDSS) was 6. The designed intent recognition algorithm can accurately classify the subject's intended movements with 98.73% accuracy in static states and correctly predict the activity transitions about 100 to 130 ms before the actual transitions were made. These promising results indicate the potential of designed intent recognition interface for volitional control of powered lower extremity exoskeletons. PMID:24110847

  3. Management of Lower Extremity and Pelvic Tumors Using Computer Assisted Modeling (CAM) A Case Series.

    PubMed

    Haskoor, John; Sinno, Sammy; Blank, Alan; Saadeh, Pierre; Rapp, Timothy

    2016-06-01

    Computer assisted modeling (CAM) has become an important tool in surgical oncology and reconstructive surgery. The preservation of the limb is an important consideration when approaching the treatment of lower extremity and pelvic tumors. The use of cutting guides allows for optimal conservation of disease-free bone and maintenance of function. We present a small case series that illustrates the use of CAM in patients with lower extremity and pelvic bone tumors. PMID:27281326

  4. An update around the evidence base for the lower extremity ultrasound regional block technique

    PubMed Central

    Fanelli, Andrea; Ghisi, Daniela; Melotti, Rita Maria

    2016-01-01

    Ultrasound guidance currently represents the gold standard for regional anesthesia. In particular for lower extremity blocks, despite the heterogeneity and the lack of large randomized controlled trials, current literature shows a modest improvement in block onset and quality compared with other localization techniques. This review aims to present the most recent findings on the application of ultrasound guidance for each single lower extremity approach. PMID:26918177

  5. Measurements of HIFU-induced Lesions in BSA Gel Phantoms for HIFU Treatment of Varicose Veins of Lower Extremity

    NASA Astrophysics Data System (ADS)

    Ushijima, Hiroyuki; Senoo, Naohiko; Suzuki, Jun; Ichiyanagi, Mitsuhisa; Yoshinaka, Kiyoshi; Deguchi, Juno; Takagi, Shu; Miyata, Tetsuro; Matsumoto, Yoichiro

    2011-09-01

    HIFU treatment has been developed for various diseases because of its minimal invasiveness, and we are now developing a HIFU treatment for varicose veins of the lower extremity. Previous studies have succeeded in occluding rabbit's veins with HIFU, but the success rate was low (about 10%). Failures were mainly caused by skin burns. When the heating lesion comes close to skin, the absorbed ultrasound energy may cause skin burns. Therefore, it is necessary to study the relationships between HIFU lesions and skin burns to improve the success rate. To visualize heating lesions from HIFU, we used tissue-mimicking BSA gel phantoms. We tried various concentrations of BSA in gels, and determined 14% BSA as the most suitable for phantoms for experiments. The attenuation coefficient of the gel was 0.73 dB/cm, and the denaturation temperature was 70 °C. We put the BSA gel phantom in a water tank in which the temperature was kept at 39 °C, and used HIFU exposures at various intensities and irradiation times. After irradiation, we measured the sizes and positions of HIFU-induced lesions, and the results indicate that the sizes of lesion become larger when the intensitiy rises or irradiation time becomes longer. Furthermore, when the intensity rises and irradiation time becomes longer, the heating lesions move closer to upper surface of the gel, which means skin easily gets burned. Thus we have investigated relationships between HIFU parameters and heated lesions that can be used for further research into HIFU treatment of varicose veins of the lower extremity.

  6. Associations of Foot Posture and Function to Lower Extremity Pain: The Framingham Foot Study

    PubMed Central

    Riskowski, JL; Dufour, AB; Hagedorn, TJ; Hillstrom, Howard; Casey, VA; Hannan, MT

    2014-01-01

    Objective Studies have implicated foot posture and foot function as risk factors for lower extremity pain. Empirical population-based evidence for this assertion is lacking; therefore, the purpose of this study was to evaluate cross-sectional associations of foot posture and foot function to lower extremity joint pain in a population-based study of adults. Methods Participants were members of the Framingham Foot Study. lower extremity joint pain was determined by the response to the NHANES-type question, “On most days do you have pain, aching or stiffness in your [hips, knees, ankles, or feet]?” Modified Arch Index (MAI) classified participants as having planus, rectus (referent) or cavus foot posture. Center of Pressure Excursion Index (CPEI) classified participants as having over-pronated, normal (referent) or over-supinated foot function. Crude and adjusted (age, gender, BMI) logistic regression determined associations of foot posture and function to lower extremity pain. Results Participants with planus structure had higher odds of knee (1.57, 95% CI: 1.24– 1.99) or ankle (1.47, 95% CI: 1.05–2.06) pain, whereas those with a cavus foot structure had increased odds of ankle pain only (7.56, 95% CI: 1.99–28.8) and pain at one lower extremity site (1.37, 95% CI: 1.04–1.80). Associations between foot function and lower extremity joint pain were not statistically significant, except for a reduced risk of hip pain in those with an over-supinated foot function (0.69, 95% CI: 0.51–0.93). Conclusions These findings offer a link between foot posture and lower extremity pain, highlighting the need for longitudinal or intervention studies. PMID:24591410

  7. Lower extremity work is associated with club head velocity during the golf swing in experienced golfers.

    PubMed

    McNally, M P; Yontz, N; Chaudhari, A M

    2014-08-01

    While the golf swing is a complex whole body movement requiring coordination of all joints to achieve maximum ball velocity, the kinetic contribution of the lower extremities to club head velocity has not been quantified, despite the perception that the legs are a primary source of power during the swing. Mechanical power at the hips, knees, and ankles was estimated during the downswing phase of a full swing with a driver using a passive optical motion capture system and 2 force plates for adult males across a range of age and self-reported skill levels. Total work by the lower extremities was calculated by integrating the powers of all 6 joints over the downswing. Regression analyses showed that total lower extremity work was a strong predictor of club head velocity (R=0.63). Secondary analyses showed different relationships to club head velocity in lead and trail leg lower extremity joints, but none of these were as predictive of club head velocity as the total work performed by the lower extremities. These results provide quantitative evidence that the lower body's kinetic contribution may be an important factor in achieving greater club head velocity, contributing to greater driving distance and overall golf performance. PMID:24577856

  8. Prevalence of lower extremity arterial disease among elderly people in the community.

    PubMed Central

    Coni, N; Tennison, B; Troup, M

    1992-01-01

    To estimate the prevalence of lower extremity arterial disease, all patients aged over 65 years registered with a rural general practice near Cambridge were invited to attend for examination of the circulation to the lower extremities; 265 subjects (80%) accepted. Three methods were used to investigate the presence of lower extremity arterial disease - enquiring about symptoms of intermittent claudication; clinical examination (and particularly the detection of arterial bruits); and pressure index calculations from measurements of the ankle and brachial systolic blood pressure using a Doppler ultrasound probe. When examining the legs, the presence of a bruit was taken as stronger evidence of disease than inability to palpate the pulses which may be difficult or impossible to detect for a number of reasons. Forty seven of the 264 patients examined (18%) showed evidence of lower extremity arterial disease. Seven patients showed unequivocal evidence of lower extremity arterial disease as demonstrated by all three criteria, 12 by two criteria and 28 patients on one criterion alone. While the pressure index followed a normal distribution curve, there was a tendency for it to decline with age. Other risk factors which showed a correlation with evidence of disease including current, but not previous, cigarette smoking, and a history of stroke. The significance of the findings is discussed in the context of some degree of arterial pathology in many British subjects in this age group. PMID:1586550

  9. [Comparison of phantom limb pain or phantom extremity sensation of upper and lower extremity amputations].

    PubMed

    Uğur, Fatih; Akin, Aynur; Esmaoğlu, Aliye; Doğru, Kudret; Ors, Sevgi; Aydoğan, Harun; Gülcü, Nebahat; Boyaci, Adem

    2007-01-01

    The aim of this retrospective study is to evaluate the upper and the lower extremity amputations with regard to phantom pain, phantom sensation and stump pain. A questionnaire consisting of 23 questions was send to the patients who underwent upper or lower extremity amputation surgery between 1996- 2005. The patients were questioned for the presence of phantom pain and sensations and if they existed for the frequency, intensity, cause of amputation, pre-amputation pain, stump pain, usage of artificial limb. Totally 147 patients were included and the response rate was 70 %. The incidence of phantom pain in Upper Extremity Group was 60 % and 65.8% in Lower Extremity Group. The incidence of phantom sensations was 70.7% in Upper Extremity Group and 75.6% in Lower Extremity Group. There was no significant difference between two groups considering in phantom pain and phantom sensations. The phantom pain was significantly higher in patients who lost dominant hand, experienced pre amputation pain and suffered stump pain. There were no significant differences in regard to phantom pain and sensation between upper and lower extremity amputations. However the presence of preamputation pain, stump pain and amputation of dominant hand were found as risk factors for the development of phantom pain. PMID:17457707

  10. Medical devices; physical medicine devices; classification of the powered lower extremity exoskeleton; republication. Final order; republication.

    PubMed

    2015-05-01

    The Food and Drug Administration (FDA or the Agency) is republishing in its entirety a final order entitled ``Medical Devices; Physical Medicine Devices; Classification of the Powered Lower Extremity Exoskeleton'' that published in the Federal Register on February 24, 2015. FDA is republishing to correct an inadvertent omission of information. FDA is classifying the powered lower extremity exoskeleton into class II (special controls). The special controls that will apply to the device are identified in this order and will be part of the codified language for the powered lower extremity exoskeleton's classification. The Agency is classifying the device into class II (special controls) in order to provide a reasonable assurance of safety and effectiveness of the device. PMID:25985478

  11. Effect of Lower Extremity Stretching Exercises on Balance in Geriatric Population

    PubMed Central

    Reddy, Ravi Shankar; Alahmari, Khalid A

    2016-01-01

    Background and Objective The purpose of this study was to find “Effect of lower extremity stretching exercises on balance in the geriatric population. Method 60 subjects (30 male and 30 female) participated in the study. The subjects underwent 10 weeks of lower limb stretching exercise program. Pre and post 10 weeks stretching exercise program, the subjects were assessed for balance, using single limb stance time in seconds and berg balance score. These outcome measures were analyzed. Results Pre and post lower extremity stretching on balance was analyzed using paired t test. Of 60 subjects 50 subjects completed the stretching exercise program. Paired sample t test analysis showed a significant improvement in single limb stance time (eyes open and eyes closed) (p<0.001) and berg balance score (p<0.001). Conclusion Lower extremity stretching exercises enhances balance in the geriatric population and thereby reduction in the number of falls. PMID:27610062

  12. Effects of different sitting positions on skin temperature of the lower extremity

    PubMed Central

    Namkoong, Seung; Shim, JeMyung; Kim, SungJoong; Shim, JungMyo

    2015-01-01

    [Purpose] The purpose of this study was to identify the effect of different sitting positions on the skin temperature of the lower extremity. [Subjects] The subjects of this study were 23 healthy university students (8 males, 15 females). [Methods] Normal sitting (NS), upper leg cross (ULC) and ankle on knee (AOK) positions were conducted to measure the changes in skin temperature using digital infrared thermographic imaging (DITI). [Results] ULC upper ankle, NS upper shin, ULC upper shin and NS lower shin showed significant declines in temperature with time. [Conclusion] These finding suggest that the ULC and NS sitting positions cause decline of blood flow volume to the lower extremity resulting in decrease of temperature of the lower extremity. Especially, sitting with the legs crossed interferes with the circulation of blood flowing volume much more than just sitting in a chair. PMID:26355265

  13. Evaluation and Treatment of Patients With Lower Extremity Peripheral Artery Disease

    PubMed Central

    Patel, Manesh R.; Conte, Michael S.; Cutlip, Donald E.; Dib, Nabil; Geraghty, Patrick; Gray, William; Hiatt, William R.; Ho, Mami; Ikeda, Koji; Ikeno, Fumiaki; Jaff, Michael R.; Jones, W. Schuyler; Kawahara, Masayuki; Lookstein, Robert A.; Mehran, Roxana; Misra, Sanjay; Norgren, Lars; Olin, Jeffrey W.; Povsic, Thomas J.; Rosenfield, Kenneth; Rundback, John; Shamoun, Fadi; Tcheng, James; Tsai, Thomas T.; Suzuki, Yuka; Vranckx, Pascal; Wiechmann, Bret N.; White, Christopher J.; Yokoi, Hiroyoshi; Krucoff, Mitchell W.

    2016-01-01

    The lack of consistent definitions and nomenclature across clinical trials of novel devices, drugs, or biologics poses a significant barrier to accrual of knowledge in and across peripheral artery disease therapies and technologies. Recognizing this problem, the Peripheral Academic Research Consortium, together with the U.S. Food and Drug Administration and the Japanese Pharmaceuticals and Medical Devices Agency, has developed a series of pragmatic consensus definitions for patients being treated for peripheral artery disease affecting the lower extremities. These consensus definitions include the clinical presentation, anatomic depiction, interventional outcomes, surrogate imaging and physiological follow-up, and clinical outcomes of patients with lower-extremity peripheral artery disease. Consistent application of these definitions in clinical trials evaluating novel revascularization technologies should result in more efficient regulatory evaluation and best practice guidelines to inform clinical decisions in patients with lower extremity peripheral artery disease. PMID:25744011

  14. Lower extremity control and dynamics during backward angular impulse generation in forward translating tasks.

    PubMed

    Mathiyakom, W; McNitt-Gray, J L; Wilcox, R

    2006-01-01

    Observation of complex whole body movements suggests that the nervous system coordinates multiple operational subsystems using some type of hierarchical control. When comparing two forward translating tasks performed with and without backward angular impulse, we have learned that both trunk-leg coordination and reaction force-time characteristics are significantly different between tasks. This led us to hypothesize that differences in trunk-leg coordination and reaction force generation would induce between-task differences in the control of the lower extremity joints during impulse generation phase of the tasks. Eight highly skilled performers executed a series of forward jumps with and without backward rotation (reverse somersault and reverse timer, respectively). Sagittal plane kinematics, reaction forces, and electromyograms of lower extremity muscles were acquired during the take-off phase of both tasks. Lower extremity joint kinetics were calculated using inverse dynamics. The results demonstrated between-task differences in the relative angles between the lower extremity segments and the net joint forces/reaction force and the joint angular velocity profiles. Significantly less knee extensor net joint moments and net joint moment work and greater hip extensor net joint moments and net joint moment work were observed during the push interval of the reverse somersault as compared to the reverse timer. Between-task differences in lower extremity joint kinetics were regulated by selectively activating the bi-articular muscles crossing the knee and hip. These results indicate that between-task differences in the control of the center of mass relative to the reaction force alters control and dynamics of the multijoint lower extremity subsystem. PMID:15878165

  15. High-resolution Sonographic Measurements of Lower Extremity Bursae in Chinese Healthy Young Men

    PubMed Central

    Gao, Yong-Yan; Wu, Chi-Qiu; Liu, Wei-Xing; Zhang, Lei; Li, Chun-Ling

    2016-01-01

    Background: Lower extremity bursae are very vulnerable to injury during strenuous physical exercises. Understanding the imaging characteristics of normal bursae is essential for early diagnosis of morphological abnormalities. Therefore, we evaluated the normal range of lower extremity bursae in healthy young men using high-resolution ultrasound (HR-US) imaging. Methods: Bursae in the lower extremities were examined by HR-US in 290 Chinese healthy young men with a median age of 18 years (range, 18–23 years). The bilateral suprapatellar bursa (SPB), deep infrapatellar bursa (DIPB), popliteal bursa (PB), and retrocalcaneal bursa (RCB) were imaged and measured for analysis. Results: The HR-US identification rates of the SPB, DIPB, PB, and RCB were 89.0% (517/580), 55.0% (319/580), 29.4% (171/580), and 49.5% (287/580), respectively. With the assumption that the bursae were normal in 95% of the study participants, the length and width values at the maximal cross-section of the SPB, DIPB, PB, and RCB were ≤18.00 and 6.09 mm, 8.10 and 2.11 mm, 7.67 and 3.93 mm, and 7.82 and 2.04 mm, respectively. Conclusions: Using HR-US imaging, we were able to analyze lower extremity bursae with high detection rates in healthy young men. The normal ranges of lower extremity bursa dimensions in healthy young men measured by HR-US in this study could be used as reference values for evaluation of bursa abnormalities in the lower extremity. PMID:26831233

  16. Lower Extremity Fatigue, Sex, and Landing Performance in a Population With Recurrent Low Back Pain

    PubMed Central

    Haddas, Ram; James, C. Roger; Hooper, Troy L.

    2015-01-01

    Context: Low back pain and lower extremity injuries affect athletes of all ages. Previous authors have linked a history of low back pain with lower extremity injuries. Fatigue is a risk factor for lower extremity injuries, some of which are known to affect female athletes more often than their male counterparts. Objective: To determine the effects of lower extremity fatigue and sex on knee mechanics, neuromuscular control, and ground reaction force during landing in people with recurrent low back pain (LBP). Design: Cross-sectional study. Setting: A clinical biomechanics laboratory. Patients or Other Participants: Thirty-three young adults with recurrent LBP but without current symptoms. Intervention(s): Fatigue was induced using a submaximal free-weight squat protocol with 15% body weight until task failure was achieved. Main Outcome Measure(s): Three-dimensional knee motion, knee and ankle moments, ground reaction force, and trunk and lower extremity muscle-activity measurements were collected during 0.30-m drop vertical-jump landings. Results: Fatigue altered landing mechanics, with differences in landing performance between sexes. Women tended to have greater knee-flexion angle at initial contact, greater maximum knee internal-rotation angle, greater maximum knee-flexion moment, smaller knee-adduction moment, smaller ankle-inversion moment, smaller ground reaction force impact, and earlier multifidus activation. In men and women, fatigue produced a smaller knee-abduction angle at initial contact, greater maximum knee-flexion moment, and delays in semitendinosus, multifidus, gluteus maximus, and rectus femoris activation. Conclusions: Our results provide evidence that during a fatigued 0.30-m landing sequence, women who suffered from recurrent LBP landed differently than did men with recurrent LBP, which may increase women's exposure to biomechanical factors that can contribute to lower extremity injury. PMID:25322344

  17. Soccer-Specific Warm-Up and Lower Extremity Injury Rates in Collegiate Male Soccer Players

    PubMed Central

    Grooms, Dustin R.; Palmer, Thomas; Onate, James A.; Myer, Gregory D.; Grindstaff, Terry

    2013-01-01

    Context: A number of comprehensive injury-prevention programs have demonstrated injury risk-reduction effects but have had limited adoption across athletic settings. This may be due to program noncompliance, minimal exercise supervision, lack of exercise progression, and sport specificity. A soccer-specific program described as the F-MARC 11+ was developed by an expert group in association with the Federation Internationale de Football Association (FIFA) Medical Assessment and Research Centre (F-MARC) to require minimal equipment and implementation as part of regular soccer training. The F-MARC 11+ has been shown to reduce injury risk in youth female soccer players but has not been evaluated in an American male collegiate population. Objective: To investigate the effects of a soccer-specific warm-up program (F-MARC 11+) on lower extremity injury incidence in male collegiate soccer players. Design: Cohort study. Setting: One American collegiate soccer team followed for 2 seasons. Patients or Other Participants: Forty-one male collegiate athletes aged 18–25 years. Intervention(s): The F-MARC 11+ program is a comprehensive warm-up program targeting muscular strength, body kinesthetic awareness, and neuromuscular control during static and dynamic movements. Training sessions and program progression were monitored by a certified athletic trainer. Main Outcome Measure(s): Lower extremity injury risk and time lost to lower extremity injury. Results: The injury rate in the referent season was 8.1 injuries per 1000 exposures with 291 days lost and 2.2 injuries per 1000 exposures and 52 days lost in the intervention season. The intervention season had reductions in the relative risk (RR) of lower extremity injury of 72% (RR = 0.28, 95% confidence interval = 0.09, 0.85) and time lost to lower extremity injury (P < .01). Conclusions: This F-MARC 11+ program reduced overall risk and severity of lower extremity injury compared with controls in collegiate-aged male soccer

  18. A new case of lower extremity glomus tumor Up-to date review and case report

    PubMed Central

    Frumuseanu, B; Balanescu, R; Ulici, A; Golumbeanu, M; Barbu, M; Orita, V; Topor, L

    2012-01-01

    Glomus tumor (glomus cell tumor) is a rare, hamartomatous, usually benign neoplasm, whose cells resemble the modified smooth muscle cells of the normal glomus body. The diagnosis of a lower extremity is often delayed, due to the lack of awareness and low level of suspicion, by the treating physician. The glomus tumor (GT) often involves the nail beds. The unusual location of the lower extremity often leads to missed or delayed diagnosis and management. There is a paucy of information about GT in general, especially among orthopedic surgeons. The aim of this article is to make the surgical community more aware of this disease PMID:22802895

  19. Lateral Approach to the Popliteal Artery for Free Tissue Transfer to the Lower Extremity

    PubMed Central

    Sinkin, Jeremy C.; Rudolph, Megan; Akbari, Cameron

    2016-01-01

    Summary: Free tissue transfer to the proximal leg and knee requires appropriate recipient vessel selection. The popliteal vessels have historically been unpopular choices, due to their remote location often necessitating vein grafts, and need for prone positioning. In this report, we describe a lateral approach to the above-knee popliteal vessels, which was utilized for 2 cases of free tissue transfer to the lower extremity. Neither prone positioning nor vein grafts were needed. The lateral approach to the above-knee popliteal vessels and their branches is a viable option for the otherwise recipient vessel-depleted lower extremity. PMID:27200237

  20. Current endovascular therapy for lower extremity peripheral arterial disease: indications, outcomes and modalities

    PubMed Central

    Yan, B P; Kiernan, T J; Lam, Y-Y; Yu, C-M

    2009-01-01

    Atherosclerosis of the lower extremities frequently leads to lifestyle-restricting claudication and can cause critical limb ischaemia (rest pain, non-healing ulcer, or gangrene). The prevalence of peripheral arterial disease (PAD) is rising in line with an ageing population. In the USA, PAD affects 8–10 million people (approximately 12% of the adult population). There is a strong association with concomitant coronary artery and cerebral vascular disease in these patients, which represents a significant cause of mortality and morbidity in patients with PAD. Disease affecting the lower extremity peripheral vessels is most aggressive in smokers and diabetics.

  1. Assessment of lower extremity muscle power in functionally-limited elders

    Technology Transfer Automated Retrieval System (TEKTRAN)

    The purpose of this study was to assess the reliability and concurrent validity of a new methodology to evaluate lower extremity muscle power in older, functionally limited men and women. A cross sectional evaluation was performed on 58 older men (n=27) and women (n=31) (74.2 + 0.9 years). Knee and ...

  2. Lower Extremity Power Training in Elderly Subjects with Mobility Limitations: A Randomized Controlled Trial

    Technology Transfer Automated Retrieval System (TEKTRAN)

    Background and Aims This study investigated whether high-velocity high-power training (POW) improved lower extremity muscle power and quality in functionally-limited elders greater than traditional slow-velocity progressive resistance training (STR). Methods Fifty-seven community-dwelling older adul...

  3. The effects of a lateral in-flight perturbation on lower extremity biomechanics during drop landings.

    PubMed

    Yom, Jae P; Simpson, Kathy J; Arnett, Scott W; Brown, Cathleen N

    2014-10-01

    One potential ACL injury situation is due to contact with another person or object during the flight phase, thereby causing the person to land improperly. Conversely, athletes often have flight-phase collisions but do land safely. Therefore, to better understand ACL injury causation and methods by which people typically land safely, the purpose of this study was to determine the effects of an in-flight perturbation on the lower extremity biomechanics displayed by females during typical drop landings. Seventeen collegiate female recreational athletes performed baseline landings, followed by either unexpected laterally-directed perturbation or sham (nonperturbation) drop landings. We compared baseline and perturbation trials using paired-samples t tests (P < .05) and 95% confidence intervals for lower-extremity joint kinematics and kinetics and GRF. The results demonstrated that perturbation landings compared with baseline landings exhibited more extended joint positions of the lower extremity at initial contact; and, during landing, greater magnitudes for knee abduction and hip adduction displacements; peak magnitudes of vertical and medial GRF; and maximum moments of ankle extensors, knee extensors, and adductor and hip adductors. We conclude that a lateral in-flight perturbation leads to abnormal GRF and angular motions and joint moments of the lower extremity. PMID:25010630

  4. Lower extremity injury criteria for evaluating military vehicle occupant injury in underbelly blast events.

    PubMed

    McKay, Brian J; Bir, Cynthia A

    2009-11-01

    Anti-vehicular (AV) landmines and improvised explosive devices (IED) have accounted for more than half of the United States military hostile casualties and wounded in Operation Iraqi Freedom (OIF) (Department of Defense Personnel & Procurement Statistics, 2009). The lower extremity is the predominantly injured body region following an AV mine or IED blast accounting for 26 percent of all combat injuries in OIF (Owens et al., 2007). Detonations occurring under the vehicle transmit high amplitude and short duration axial loads onto the foot-ankle-tibia region of the occupant causing injuries to the lower leg. The current effort was initiated to develop lower extremity injury criteria for occupants involved in underbelly blast impacts. Eighteen lower extremity post mortem human specimens (PMHS) were instrumented with an implantable load cell and strain gages and impacted at one of three incrementally severe AV axial loading conditions. Twelve of the 18 PMHS specimens sustained fractures of the calcaneus, talus, fibula and/or tibia. The initiation of skeletal injury was precisely detected by strain gages and corresponded with local peak axial tibia force. Survival analysis identified peak axial tibia force and impactor velocity as the two best predictors of incapacitating injury. A tibia axial force of 5,931 N and impactor velocity of 10.8 m/s corresponds with a 50 percent risk of an incapacitating injury. The criteria may be utilized to predict the probability of lower extremity incapacitating injury in underbelly blast impacts. PMID:20058557

  5. Lower extremity power training in elderly subjects with moderate mobility limitations: A randomized controlled trial

    Technology Transfer Automated Retrieval System (TEKTRAN)

    Fifty-seven community-dwelling older adults were randomized to either high-velocity high-power training (POW), slow-velocity progressive resistance training (STR) or a control group of lower extremity stretching (CON). Training was performed three times per week for 12 weeks and subjects completed t...

  6. Effects of aquatic PNF lower extremity patterns on balance and ADL of stroke patients

    PubMed Central

    Kim, Eun-Kyung; Lee, Dong-Kyu; Kim, Young-Mi

    2015-01-01

    [Purpose] This study investigated the effect of aquatic proprioceptive neuromuscular facilitation (PNF) patterns in the lower extremity on balance and activities of daily living (ADL) in stroke patients. [Subjects] Twenty poststroke participants were randomly assigned to an experimental group (n = 10) or a control group (n = 10). The experimental group performed lower extremity patterns in an aquatic environment, and the control group performed lower extremity patterns on the ground. Both exercises were conducted for 30 minutes/day, 5 days/week for 6 weeks. Balance was measured with the Berg Balance Scale (BBS), Timed Up and Go Test (TUGT), Functional Reach Test (FRT), and One Leg Stand Test (OLST). Activities of daily living were measured with the Functional Independence Measure (FIM). A paired t-test was used to measure pre- and post-experiment differences, and an independent t-test was used to measure between-group differences. [Results] The experimental and control groups showed significant differences for all pre- and post-experiment variables. In the between-group comparison, the experimental group was significantly difference from the control group. [Conclusion] These results indicate that performing aquatic proprioceptive neuromuscular facilitation patterns in the lower extremity enhances balance and ADL in stroke patients. PMID:25642076

  7. Effects of prosthetic limb prescription on 3-year mortality among lower extremity veteran amputees

    PubMed Central

    Kurichi, Jibby E.; Kwong, Pui; Vogel, W. Bruce; Xie, Dawei; Ripley, Diane Cowper; Bates, Barbara E.

    2015-01-01

    Our objective was to determine the relationship between receipt of a prescription for a prosthetic limb and three-year mortality post-surgery among veterans with lower extremity amputation. We conducted a retrospective observational study that included 4,578 veterans hospitalized for lower extremity amputation and discharged in Fiscal Years 2003 and 2004. The outcome was time to all-cause mortality from the amputation surgical date up to the 3-year anniversary of the surgical date. There were 1,300 (28.4%) veterans with lower extremity amputations who received a prescription for a prosthetic limb within a year after the surgical amputation. About 46% (n=2086) died within three-years of the surgical anniversary. Among those who received a prescription for a prosthetic limb, only 25.2% died within 3 years of the surgical anniversary. After adjustment, veterans who received a prescription for a prosthetic limb were less likely to die after the surgery than veterans without a prescription with a hazard ratio of 0.68 (95% CI, 0.60-0.77). Findings demonstrated that veterans with lower extremity amputations who received a prescription for a prosthetic limb within a year after the surgical amputation were less likely to die within three years of the surgical amputation after controlling for patient-, treatment-, and facility-level characteristics. PMID:26348602

  8. [VARICOSE DISEASE OF THE LOWER EXTREMITIES: CAUSES, COMPLICATIONS, CHOICE OF METHODS FOR TREATMENT AND PROPHYLAXIS].

    PubMed

    Korzhyk, N P

    2016-02-01

    Abstract The results of 1142 patients treatment for varicose disease of the lower extremities in 2006-2014 yrs were adduced. The patients were divided on 3 groups, depending on the clinical signs severity and method of treatment. There were operated 59 patients, in 65--the proposed scheme of treatment was applied. PMID:27244921

  9. Lower Extremity Muscle Mass Predicts Functional Performance in Mobility-Limited Elders

    Technology Transfer Automated Retrieval System (TEKTRAN)

    Objectives This study examined the influence of lower extremity body composition and muscle strength on the severity of mobility-disability in community-dwelling older adults. Methods Fifty-seven older males and females (age 74.2 +/- 7 yrs; BMI 28.9 +/- 6 kg/m2) underwent an objective assessment ...

  10. LOWER EXTREMITY PEAK POWER TRAINING IN ELDERLY SUBJECTS WITH MODERATE MOBILITY LIMITATIONS: A RANDOMIZED CONTROLLED TRIAL

    Technology Transfer Automated Retrieval System (TEKTRAN)

    To examine the effects of a lower extremity high-velocity high-power exercise training intervention in older adults with moderate mobility impairments, and to investigate whether peak power training results in greater increases of peak muscle power output compared to traditional progressive resistan...

  11. Lower extremity control and dynamics during backward angular impulse generation in backward translating tasks.

    PubMed

    Mathiyakom, W; McNitt-Gray, J L; Wilcox, R

    2006-03-01

    Observation of complex whole-body movements suggests that the nervous system coordinates multiple operational subsystems using some type of hierarchical control. When comparing two backward translating tasks performed with and without backward angular impulse, we have learned that task-specific modifications in trunk-leg coordination contribute to the regulation of total-body center of mass (CoM) position relative to the reaction force (RF). In this study, we hypothesized that task-specific differences in trunk-leg coordination would affect the control of the lower extremity joints during the impulse-generation phase of the tasks. Eight highly skilled performers executed a series of backward translating jumps with and without backward rotation (back somersault and back timer, respectively). Sagittal plane kinematics, RFs and electromyograms of lower extremity muscles were acquired during the take-off phase of both tasks. Lower extremity joint kinetics was calculated using inverse dynamics. The results indicate that between-task differences in the relative angles between the lower extremity segments and the net joint forces/RF contributed to significant reductions in knee-extensor net joint moments and increases in hip-extensor net joint moments during the push interval of the back somersault as compared to the back timer. Between-task differences in backward trunk angular velocity also contributed to the re-distribution of work done by the lower extremity net joint moments. Between-task differences in lower extremity joint kinetics were associated with synergistic activation of the bi-articular muscles crossing the knee and hip. These results indicated that task-specific control of CoM relative to the RF in order to regulate the backward angular-impulse-involved modification in the control and dynamics of the knee and hip joints. These results indicate that between-task differences in the control objectives at the total-body level (position of CoM relative to the

  12. Classifying Lower Extremity Muscle Fatigue during Walking using Machine Learning and Inertial Sensors

    PubMed Central

    Zhang, Jian; Lockhart, Thurmon E.; Soangra, Rahul

    2013-01-01

    Fatigue in lower extremity musculature is associated with decline in postural stability, motor performance and alters normal walking patterns in human subjects. Automated recognition of lower extremity muscle fatigue condition may be advantageous in early detection of fall and injury risks. Supervised machine learning methods such as Support Vector Machines (SVM) have been previously used for classifying healthy and pathological gait patterns and also for separating old and young gait patterns. In this study we explore the classification potential of SVM in recognition of gait patterns utilizing an inertial measurement unit associated with lower extremity muscular fatigue. Both kinematic and kinetic gait patterns of 17 participants (29±11 years) were recorded and analyzed in normal and fatigued state of walking. Lower extremities were fatigued by performance of a squatting exercise until the participants reached 60% of their baseline maximal voluntary exertion level. Feature selection methods were used to classify fatigue and no-fatigue conditions based on temporal and frequency information of the signals. Additionally, influences of three different kernel schemes (i.e., linear, polynomial, and radial basis function) were investigated for SVM classification. The results indicated that lower extremity muscle fatigue condition influenced gait and loading responses. In terms of the SVM classification results, an accuracy of 96% was reached in distinguishing the two gait patterns (fatigue and no-fatigue) within the same subject using the kinematic, time and frequency domain features. It is also found that linear kernel and RBF kernel were equally good to identify intra-individual fatigue characteristics. These results suggest that intra-subject fatigue classification using gait patterns from an inertial sensor holds considerable potential in identifying “at-risk” gait due to muscle fatigue. PMID:24081829

  13. Microsurgical Lower Extremity Reconstruction in the Subacute Period: A Safe Alternative

    PubMed Central

    Peric, Mirna; Chowdry, Farshad; Nguyen, Joanna T.; Schooler, Wesley; Sherman, Randolph; Carey, Joseph N.

    2015-01-01

    Background: Microsurgical reconstruction of the lower extremity is an integral part of the limb salvage algorithm. Success is defined by a pain-free functional extremity, with a healed fracture and sufficient durable soft tissue coverage. Although early flap coverage of lower extremity fractures is an important goal, it is not always feasible because of multiple factors. Between the years 2000 and 2010, approximately 50% of patients at Los Angeles County and University of Southern California Medical Center requiring microsurgical reconstruction did not receive soft tissue coverage until more than 15 days postinjury secondary to primary trauma, physiologic instability, patient comorbidities, or orthopedic and plastic surgery operative backlog. The objective of our study was to evaluate outcomes in patients who underwent microsurgical reconstruction of the lower extremity, in relation to the timing of reconstruction. Methods: A retrospective chart review was performed for patients requiring immediate lower extremity reconstruction from January 2000 to December 2009 at LAC + USC. Results: Fifty-one patients were identified in this study. The most common mechanisms of injury were motorcycle, motor vehicle, and fall accidents. Eighty-six percent of injuries were open and 74% were comminuted. The distal 1/3 of the tibia, including the tibial pilon, was the most common location of injury. When comparing patients reconstructed in less than 15 days versus greater than or equal to 15 days, there was no significant difference in rates of flap failure, osteomyelitis, bony union, or ambulation. Conclusion: Microsurgical reconstruction of the lower extremity in the subacute period is a safe alternative. PMID:26301138

  14. Alignment control exercise changes lower extremity movement during stop movements in female basketball players.

    PubMed

    Kato, Shigeyuki; Urabe, Yukio; Kawamura, Kenji

    2008-08-01

    This study was intended to evaluate a short-term intervention designed to improve the lower extremity alignment with neutral position during stop movements of female basketball players when performing a quick-stop jump shot. In this study, 20 healthy female college basketball players (mean age 20.5 years) participated. The authors monitored two groups for 4 weeks: one which trained (n=10) and one which did not train (n=10). The exercise program emphasized the neutral position of lower extremities for dynamic alignment control; the players avoided the valgus position with their knees. Kinematics analysis with a lower extremity angle in the stop action was performed using three digital video cameras and analyzed using software. Following the intervention exercise program, each subject was re-evaluated at two and four weeks to determine changes in movement patterns during the "sink shot" task. Two-way analysis of variance models were used to determine differences at pre-intervention, at mid-term, and post-intervention. After the 2-week intervention, the trained athletes group made basketball shots with greater change of the lower extremity motion pattern during the stop action than did non-trained athletes (p<0.05). However, no significant differences were found between other data of the 2-week and 4-week intervention groups. Results of this study show that two weeks of training can improve the dynamic alignment control of the lower extremities, as measured using the alignment angle of the coronal plane and the torsion angle of horizontal plane during a stop action. PMID:18524598

  15. A Canadian population-based description of the indications for lower-extremity amputations and outcomes

    PubMed Central

    Kayssi, Ahmed; de Mestral, Charles; Forbes, Thomas L.; Roche-Nagle, Graham

    2016-01-01

    Background To our knowledge, there have been no previously published reports characterizing lower-extremity amputations in Canada. The objective of this study was to describe the indications and outcomes of lower-extremity amputations in the Canadian population. Methods We performed a retrospective cohort study of all adult patients who underwent lower-extremity amputation in Canada between 2006 and 2009. Patients were identified from the Canadian Institute for Health Information’s Discharge Abstract Database, which includes all hospital admissions across Canada with the exception of the province of Quebec. Pediatric, trauma, and outpatients were excluded. Results During the study period, 5342 patients underwent lower-extremity amputations in 207 Canadian hospitals. The mean age was 67 ± 13 years, and 68% were men. Amputations were most frequently indicated after admission for diabetic complications (81%), cardiovascular disease (6%), or cancer (3%). In total, 65% of patients were discharged to another inpatient or long-term care facility, and 26% were discharged home with or without extra support. Most patients were diabetic (96%) and most (65%) required a below-knee amputation. Predictors of prolonged (> 7 d) hospital stay included amputation performed by a general surgeon; cardiovascular risk factors, such as diabetes, hypertension, ischemic heart disease, congestive heart failure, or hyperlipidemia; and undergoing the amputation in the provinces of Newfoundland and Labrador, New Brunswick, or British Columbia. Conclusion There is variability in the delivery of lower-extremity amputations and postoperative hospital discharges among surgical specialists and regions across Canada. Future work is needed to investigate the reasons for this variability and to develop initiatives to shorten postoperative hospital stays. PMID:27007090

  16. Effectiveness of Autologous Stem Cell Therapy for the Treatment of Lower Extremity Ulcers

    PubMed Central

    Jiang, Xupin; Zhang, Hengshu; Teng, Miao

    2016-01-01

    Abstract Primary studies in animal models and humans have suggested the therapeutic potential of autologous stem cell for treating chronic lower extremity ulcers. However, the results of pilot randomized controlled trials (RCTs) in humans have been inconsistent. A meta-analysis of RCTs was performed to evaluate the role of autologous stem cell-based therapy for lower extremity ulcers. Studies were identified during a systematic search of Medline, Embase, Cochrane's library, and references cited in related reviews and studies. Studies were included if they were RCTs published in English, recruited patients with lower extremity ulcers who were assigned to either a group for the topical therapy with autologous stem cells, and reported data regarding the healing of the ulcers. Relative risks (RRs) for healing rate and standardized mean differences (SMDs) for the changes in the mean sizes of ulcers were evaluated with a random-effects model. Overall, autologous stem cell-based therapy was associated with better healing of lower extremity ulcers (12 comparisons, 290 patients, RR for partial healing = 3.07, 95% confidence interval [CI] = 1.14–8.24, P = 0.03; RR for complete healing = 2.26, 95% CI = 1.48–3.16, P < 0.001) with little heterogeneity (I2 = 0%). Moreover, autologous stem cell-based therapy was associated with a greater reduction in mean ulcer size (SMD = −0.63, 95% CI = −1.03 to −0.22, P = 0.002). Subgroup analyses indicated that stem cells from peripheral blood and bone marrow seemed to exert similar beneficial effects on the healing of ulcers. Stem cell therapy was not associated with any increased risks for adverse events. The optimized sources, amounts, and delivery methods of stem cell -based therapy for patients with chronic lower extremity ulcers need to be determined, and the long-term effects of stem cell-based therapy on clinical outcomes need further exploration. Autologous stem cell-based therapy is

  17. Reliability of the mangled extremity severity score in combat-related upper and lower extremity injuries

    PubMed Central

    Ege, Tolga; Unlu, Aytekin; Tas, Huseyin; Bek, Dogan; Turkan, Selim; Cetinkaya, Aytac

    2015-01-01

    Background: Decision of limb salvage or amputation is generally aided with several trauma scoring systems such as the mangled extremity severity score (MESS). However, the reliability of the injury scores in the settling of open fractures due to explosives and missiles is challenging. Mortality and morbidity of the extremity trauma due to firearms are generally associated with time delay in revascularization, injury mechanism, anatomy of the injured site, associated injuries, age and the environmental circumstance. The purpose of the retrospective study was to evaluate the extent of extremity injuries due to ballistic missiles and to detect the reliability of mangled extremity severity score (MESS) in both upper and lower extremities. Materials and Methods: Between 2004 and 2014, 139 Gustillo Anderson Type III open fractures of both the upper and lower extremities were enrolled in the study. Data for patient age, fire arm type, transporting time from the field to the hospital (and the method), injury severity scores, MESS scores, fracture types, amputation levels, bone fixation methods and postoperative infections and complications retrieved from the two level-2 trauma center's data base. Sensitivity, specificity, positive and negative predictive values of the MESS were calculated to detect the ability in deciding amputation in the mangled limb. Results: Amputation was performed in 39 extremities and limb salvage attempted in 100 extremities. The mean followup time was 14.6 months (range 6–32 months). In the amputated group, the mean MESS scores for upper and lower extremity were 8.8 (range 6–11) and 9.24 (range 6–11), respectively. In the limb salvage group, the mean MESS scores for upper and lower extremities were 5.29 (range 4–7) and 5.19 (range 3–8), respectively. Sensitivity of MESS in upper and lower extremities were calculated as 80% and 79.4% and positive predictive values detected as 55.55% and 83.3%, respectively. Specificity of MESS score for

  18. Prevalence of exclusive lower extremity metastases at 18F-NaF PET/CT*

    PubMed Central

    Ordones, Monique Beraldo; Valadares, Agnes Araujo; Duarte, Paulo Schiavom; Sado, Heitor Naoki; Lima, Marcos Santos; Carvalho, Giovanna; Sapienza, Marcelo Tatit; Buchpiguel, Carlos Alberto

    2015-01-01

    Objective To evaluate the prevalence of exclusive lower extremity metastases, specifically in the femur and below the knee, observed at 18F-NaF PET/CT. Materials and Methods One thousand consecutive PET/CT studies were retrospectively evaluated for the presence of exclusive uptake in lower extremities suggesting metastatic involvement. The presumptive diagnoses based on such uptakes were subsequently obtained by evaluation of other imaging studies. Results No exclusive uptake suggestive of metastasis below the femur was observed in the present series. Exclusive uptake was observed in the proximal femur with a presumptive diagnosis of metastasis in two patients. Conclusion The prevalence of exclusive metastasis below the femur is low and scanning from head to knees is appropriate in most cases. PMID:26185339

  19. Endovascular Interventions for Acute and Chronic Lower Extremity Deep Venous Disease: State of the Art

    PubMed Central

    Sista, Akhilesh K.; Vedantham, Suresh; Kaufman, John A.

    2015-01-01

    The societal and individual burden caused by acute and chronic lower extremity venous disease is considerable. In the past several decades, minimally invasive endovascular interventions have been developed to reduce thrombus burden in the setting of acute deep venous thrombosis to prevent both short- and long-term morbidity and to recanalize chronically occluded or stenosed postthrombotic or nonthrombotic veins in symptomatic patients. This state-of-the-art review provides an overview of the techniques and challenges, rationale, patient selection criteria, complications, postinterventional care, and outcomes data for endovascular intervention in the setting of acute and chronic lower extremity deep venous disease. Online supplemental material is available for this article. © RSNA, 2015 PMID:26101920

  20. The Effects of Shoe Traction and Obstacle Height on Lower Extremity Coordination Dynamics during Walking

    PubMed Central

    Decker, Leslie; Houser, Jeremy J.; Noble, John M.; Karst, Gregory M.; Stergiou, Nicholas

    2009-01-01

    This study aims to investigate the effects of shoe traction and obstacle height on lower extremity relative phase dynamics (analysis of intralimb coordination) during walking to better understand the mechanisms employed to avoid slippage following obstacle clearance. Ten participants walked at a self-selected pace during eight conditions: four obstacle heights (0%, 10%, 20%, and 40% of limb length) while wearing two pairs of shoes (low and high traction). A coordination analysis was used and phasing relationships between lower extremity segments were examined. The results demonstrated that significant behavioral changes were elicited under varied obstacle heights and frictional conditions. Both decreasing shoe traction and increasing obstacle height resulted in a more in-phase relationship between the interacting lower limb segments. The higher the obstacle and the lower the shoe traction, the more unstable the system became. These changes in phasing relationship and variability are indicators of alterations in coordinative behavior, which if pushed further may have lead to falling. PMID:19187929

  1. Diagnosis, treatment, and rehabilitation of stress fractures in the lower extremity in runners

    PubMed Central

    Kahanov, Leamor; Eberman, Lindsey E; Games, Kenneth E; Wasik, Mitch

    2015-01-01

    Stress fractures account for between 1% and 20% of athletic injuries, with 80% of stress fractures in the lower extremity. Stress fractures of the lower extremity are common injuries among individuals who participate in endurance, high load-bearing activities such as running, military and aerobic exercise and therefore require practitioner expertise in diagnosis and management. Accurate diagnosis for stress fractures is dependent on the anatomical area. Anatomical regions such as the pelvis, sacrum, and metatarsals offer challenges due to difficulty differentiating pathologies with common symptoms. Special tests and treatment regimes, however, are similar among most stress fractures with resolution between 4 weeks to a year. The most difficult aspect of stress fracture treatment entails mitigating internal and external risk factors. Practitioners should address ongoing risk factors to minimize recurrence. PMID:25848327

  2. What's new in lower-extremity arterial disease? WOCN's 2008 clinical practice guideline.

    PubMed

    Bonham, Phyllis A; Flemister, Bonny G; Goldberg, Margaret; Crawford, Penny E; Johnson, Jan J; Varnado, Myra F

    2009-01-01

    Lower-extremity arterial disease (LEAD) affects 8 to 10 million people in the United States, resulting in pain, tissue loss, infection, limb loss, and an impaired quality of life. LEAD is underdiagnosed, undertreated, and often unrecognized. The purpose of this article is to provide a summary of the recommendations from the 2008 evidence-based, clinical practice guideline, Guideline for the Management of Patients With Lower-Extremity Arterial Disease, recently released from the Wound, Ostomy and Continence Nurses Society. This article presents an overview of the process used to develop the guideline, a discussion of risks for LEAD, and specific recommendations for assessment, interventions, patient education, and risk-reduction strategies. PMID:19155822

  3. Exercise testing and training in patients with peripheral vascular disease and lower extremity amputation.

    PubMed

    Priebe, M; Davidoff, G; Lampman, R M

    1991-05-01

    Patients with peripheral vascular disease have a high risk of coronary artery disease. The risk is even greater when the peripheral vascular disease leads to lower extremity amputation. Exercise testing using lower extremity exercise has been the "gold standard" for screening for coronary artery disease, but many patients with peripheral vascular disease and those with amputations have difficulty doing this type of exercise. Arm exercise ergometry has been shown to be a safe and effective alternative for the detection of coronary artery disease in patients who cannot do leg exercise. This test has also been used to determine safe exercise levels and may be able to predict the ultimate level of prosthetic use in amputees. Exercise training with arm ergometry also improves cardiovascular efficiency and upper body strength in poorly conditioned patients. Studies are needed to appreciate fully the role of exercise testing and training in the recovery of these patients after amputation. PMID:1866958

  4. Lower Extremity Radicular Pain Caused by Entrapped Sigmoid Colon Between L5 and S1 Vertebrae

    PubMed Central

    Ko, Sanghyung; Park, Noh Kyoung; Cho, Kyoung Jin; Baek, Jung Hyun; Lim, Jeong-Wook; Choi, Dongjin

    2015-01-01

    Intestinal entrapment between two vertebral bodies is very rare. In all previous cases, it occurred by major trauma. However, the bowel entrapment between two vertebral bodies without trauma has never been reported, not to mention as the cause of lower extremity radicular pain. We describe the case of an 82-year-old female patient with right lower extremity radicular pain without recent trauma history. The patient was diagnosed sigmoid colon entrapment between the L5 and S1 vertebrae by lumbar spinal computerized tomography and magnetic resonance imaging, and showed improvement in radicular pain after manual reduction of interpositioned colon during surgery. Intestinal entrapment between two vertebrae without trauma is caused by degenerative and vacuum changes of the intervertebral disc combined with the anterior longitudinal ligament injury. PMID:26619145

  5. Pelvic and lower extremity injuries in Homer's Iliad: a review of the literature.

    PubMed

    Galanakos, Spyridon P; Bot, Arjan G J; Macheras, George A

    2015-01-01

    The Iliad, composed approximately in the middle of the eighth century bc, constitutes the leading and oldest known example of heroic epic. The Homeric epic presents the conflicts that took place during the last year of the 10-year lasting Trojan War, offering a realistic description of battle wounds. We studied the text of The Iliad in ancient Greek and in the translations in modern Greek and English and searched for all recorded injuries to the pelvis and lower extremities. A total of 16 traumatic injuries of pelvis and lower extremities were described, including 7 fatal wounds, while in 9 cases, the outcome was unknown.The Iliad remains the oldest record of Greek medicine and a unique source of surgical history. To study the vividly reported events is a great experience, particularly for a surgeon. PMID:25539224

  6. Measurement of Paretic–Lower-Extremity Loading and Weight Transfer After Stroke

    PubMed Central

    Mercer, Vicki Stemmons; Freburger, Janet Kues; Chang, Shuo-Hsiu; Purser, Jama L.

    2009-01-01

    Background: Weight bearing through, or “loading” of, the paretic lower extremity and transfer of weight from one lower extremity to the other are important impairment-level goals of stroke rehabilitation. Improvements in these limb-loading and weight-transfer abilities have been shown to relate to improved performance of many functional activities. Unfortunately, valid and practical clinical measures of paretic–lower-extremity loading and weight transfer have not been identified. Objective: The purpose of this study was to assess convergent validity of the Step Test (ST) and the knee extension component of the Upright Motor Control Test (UMCe) as measures of paretic-limb loading and of the Repetitive Reach Test (RR) as a measure of weight transfer in the first 6 months after stroke. Design: This was a prospective cohort study of 33 adults with lower-extremity motor impairment following unilateral, noncerebellar stroke. Participants were tested one time per month from 1 to 6 months poststroke. Results: Scores on the ST (performed with the nonparetic leg as the stepping leg) and UMCe were positively correlated with peak vertical ground reaction forces (GRFs) beneath the paretic limb during functional tasks (R2=.35–.76 for the ST, pseudo R2=.21–.34 for the UMCe). Scores on the RR were positively correlated with change in vertical GRF beneath the paretic limb during the diagonal reach task (R2=.45) and with weight-transfer time during stepping with the nonparetic limb (R2=.15). Conclusions: The ST, performed with the nonparetic leg as the stepping leg, is a valid measure of paretic-limb loading during stroke recovery. Of the clinical measures tested, the ST correlated most strongly with the force platform measures. PMID:19465370

  7. Measurement Properties of the Lower Extremity Functional Scale: A Systematic Review.

    PubMed

    Mehta, Saurabh P; Fulton, Allison; Quach, Cedric; Thistle, Megan; Toledo, Cesar; Evans, Neil A

    2016-03-01

    Study Design Systematic review of measurement properties. Background Many primary studies have examined the measurement properties, such as reliability, validity, and sensitivity to change, of the Lower Extremity Functional Scale (LEFS) in different clinical populations. A systematic review summarizing these properties for the LEFS may provide an important resource. Objective To locate and synthesize evidence on the measurement properties of the LEFS and to discuss the clinical implications of the evidence. Methods A literature search was conducted in 4 databases (PubMed, MEDLINE, Embase, and CINAHL), using predefined search terms. Two reviewers performed a critical appraisal of the included studies using a standardized assessment form. Results A total of 27 studies were included in the review, of which 18 achieved a very good to excellent methodological quality level. The LEFS scores demonstrated excellent test-retest reliability (intraclass correlation coefficients ranging between 0.85 and 0.99) and demonstrated the expected relationships with measures assessing similar constructs (Pearson correlation coefficient values of greater than 0.7). The responsiveness of the LEFS scores was excellent, as suggested by consistently high effect sizes (greater than 0.8) in patients with different lower extremity conditions. Minimal detectable change at the 90% confidence level (MDC90) for the LEFS scores varied between 8.1 and 15.3 across different reassessment intervals in a wide range of patient populations. The pooled estimate of the MDC90 was 6 points and the minimal clinically important difference was 9 points in patients with lower extremity musculoskeletal conditions, which are indicative of true change and clinically meaningful change, respectively. Conclusion The results of this review support the reliability, validity, and responsiveness of the LEFS scores for assessing functional impairment in a wide array of patient groups with lower extremity musculoskeletal

  8. The Incidence of Upper and Lower Extremity Surgery for Rheumatoid Arthritis Among Medicare Beneficiaries

    PubMed Central

    Waljee, Jennifer; Zhong, Lin; Baser, Onur; Yuce, Huseyin; Fox, David A.; Chung, Kevin C.

    2015-01-01

    Background: For elderly patients with rheumatoid arthritis, aggressive immunosuppression can be difficult to tolerate, and surgery remains an important treatment option for joint pain and deformity. We sought to examine the epidemiology of surgical reconstruction for rheumatoid arthritis among older individuals who were newly diagnosed with the disorder. Methods: We identified a 5% random sample of Medicare beneficiaries (sixty-six years of age and older) newly diagnosed with rheumatoid arthritis from 2000 to 2005, and followed these patients longitudinally for a mean of 4.6 years. We used univariate analysis to compare the time from the diagnosis of rheumatoid arthritis to the first operation among the 360 patients who underwent surgery during the study period. Results: In our study cohort, 589 procedures were performed among 360 patients, and 132 patients (37%) underwent multiple procedures. The rate of upper extremity reconstruction was 0.9%, the rate of lower extremity reconstruction was 1.2%, and knee arthroplasty was the most common procedure performed initially (31%) and overall (29%). Upper extremity procedures were performed sooner than lower extremity procedures (fourteen versus twenty-five months; p = 0.02). In multivariable analysis, surgery rates declined with age for upper and lower extremity procedures (p < 0.001). Conclusions: Knee replacement remains the most common initial procedure among patients with rheumatoid arthritis. However, upper extremity procedures are performed earlier than lower extremity procedures. Understanding the patient and provider factors that underlie variation in procedure rates can inform future strategies to improve the delivery of care to patients with rheumatoid arthritis. Level of Evidence: Prognostic Level III. See Instructions for Authors for a complete description of levels of evidence. PMID:25740031

  9. THE RELATIONSHIP BETWEEN LOWER EXTREMITY CLOSED KINETIC CHAIN STRENGTH & SAGITTAL PLANE LANDING KINEMATICS IN FEMALE ATHLETES

    PubMed Central

    Kivlan, Ben; Scibek, Jason S.

    2011-01-01

    Background: Female athletes continue to injure their anterior cruciate ligaments at a greater rate than males in comparable sports. During landing activities, females exhibit several different kinematic and kinetic traits when compared to their male counterparts including decreased knee flexion angles as well as decreased lower extremity (LE) strength. While open kinetic chain strength measures have not been related to landing kinematics, given the closer replication of movement patterns that occur during closed kinetic chain (CKC) activity, it is possible that lower extremity strength if measured in this fashion will be related to landing kinematics. Purpose: To determine if unilateral isometric CKC lower extremity (LE) strength was related to sagittal plane tibiofemoral kinematics during a single leg landing task in competitive female athletes. We hypothesized females who demonstrated lesser CKC LE strength would exhibit decreased sagittal plane angles during landing. Methods: 20 competitive female athletes (age = 16.0 ± 1.8 yrs; height = 166.5 ± 8.3 cm; weight = 59.7 ± 10.2 kg) completed CKC LE strength testing followed by 5 unilateral drop landings on the dominant LE during one test session at an outpatient physical therapy clinic. Closed kinetic chain LE strength was measured on a computerized leg press with an integrated load cell while sagittal plane tibiofemoral kinematics were quantified with an electrogoniometer. Results: No significant relationships between absolute or normalized isometric CKC strength and sagittal plane landing kinematics were identified. Conclusions: Closed kinetic chain lower extremity isometric strength tested at 25 degrees of knee flexion is not related to sagittal plane landing kinematics in adolescent competitive female athletes. Levels of Evidence: Analytic, Observational PMID:21655453

  10. Determination of three-dimensional joint loading within the lower extremities in snowboarding.

    PubMed

    Krüger, Andreas; McAlpine, Paul; Borrani, Fabio; Edelmann-Nusser, Jürgen

    2012-02-01

    In the biomechanical literature only a few studies are available focusing on the determination of joint loading within the lower extremities in snowboarding. These studies are limited to analysis in a restricted capture volume due to the use of optical video-based systems. To overcome this restriction the aim of the present study was to develop a method to determine net joint moments within the lower extremities in snowboarding for complete measurement runs. An experienced snowboarder performed several runs equipped with two custom-made force plates as well as a full-body inertial measurement system. A rigid, multi-segment model was developed to describe the motion and loads within the lower extremities. This model is based on an existing lower-body model and designed to be run by the OpenSim software package. Measured kinetic and kinematic data were imported into the OpenSim program and inverse dynamic calculations were performed. The results illustrate the potential of the developed method for the determination of joint loadings within the lower extremities for complete measurement runs in a real snowboarding environment. The calculated net joint moments of force are reasonable in comparison to the data presented in the literature. A good reliability of the method seems to be indicated by the low data variation between different turns. Due to the unknown accuracy of this method the application for inter-individual studies as well as studies of injury mechanisms may be limited. For intra-individual studies comparing different snowboarding techniques as well as different snowboard equipment the method seems to be beneficial. The validity of the method needs to be studied further. PMID:22468468

  11. Kinematic analysis of flailing injuries of lower extremities in side impacts.

    PubMed

    Yoganandan, Narayan; Humm, John R; Rinaldi, James; Pintar, Frank A; Maiman, Dennis J

    2012-01-01

    The objective of the study was to determine the biomechanics of post mortem human subjects (PMHS) in lateral impact with a focus on lower extremity trauma and aviation safety for side-facing seat applications. Four male three-point belted intact PMHS were seated upright with the Frankfurt plane horizontal on a custom seat, covered with aircraft cushion. The seat had an armrest. The change in velocity from the Federal Aviation FAR25.562 standards was input to two specimens, and a lower energy input was used in the other two specimens. Pre-test and posttest x-rays were obtained, and autopsies were conducted. Sled and pelvic acceleration signals were digitally gathered and processed according to the Society of Automotive Engineers specifications. A high-speed digital video camera was used to track the frontal plane kinematics with targets placed at appropriate lower extremity landmarks. Fractures of the left distal femur-knee complex in one and proximal sub-capital femur in the other specimen occurred in tests using the simulated FAR pulse. Tests at the lower energy input in the other specimens did not result in trauma. Coronal motions in PMHS occurred from initial flailing of the lower leg-knee-upper leg complex initiating after the onset of the side-impact pulse with the armrest acting as a limiting/boundary condition for the left femur-pelvis-region. These motions were attributed to be a causal agent for the observed lower extremity injuries. Although from a limited sample size, the present findings indicate that lower extremities may sustain trauma, and side-facing seats in aviation environments may need to be evaluated for occupant safety in the lateral mode. PMID:22846325

  12. Bilateral lower extremity hyperkeratotic plaques: a case report of ichthyosis vulgaris

    PubMed Central

    Leight, Hayley; Zinn, Zachary; Jalali, Omid

    2015-01-01

    Here, we report a case of a middle-aged woman presenting with severe, long-standing, hyperkeratotic plaques of the lower extremities unrelieved by over-the-counter medications. Initial history and clinical findings were suggestive of an inherited ichthyosis. Ichthyoses are genetic disorders characterized by dry scaly skin and altered skin-barrier function. A diagnosis of ichthyosis vulgaris was confirmed by histopathology. Etiology, prevalence, and treatment options are discussed. PMID:26396540

  13. Whole Body Vibration Immediately Decreases Lower Extremity Loading During the Drop Jump.

    PubMed

    Chen, Zong-Rong; Peng, Hsien-Te; Siao, Sheng-Wun; Hou, Yan-Ting; Wang, Li-I

    2016-09-01

    Chen, Z-R, Peng, H-T, Siao, S-W, Hou, Y-T, and Wang, L-I. Whole body vibration immediately decreases lower extremity loading during the drop jump. J Strength Cond Res 30(9): 2476-2481, 2016-The purpose of this study was to evaluate the acute effect of whole body vibration (WBV) on lower extremity loading during the drop jump (DJ). Fifteen male collegiate physical education students randomly completed 3 experimental sessions on 3 separate days with 4 days interval between sessions (performing 3 trials of DJ from 30-, 40-, and 50-cm drop heights before WBV and 4 minutes after WBV). Eight cameras and 2 force platforms were used to record kinematic and kinetic data, respectively. Peak impact force and loading rate significantly decreased after WBV during DJ from 40 and 50 cm. Knee angular displacements significantly increased after WBV during DJ from 30, 40, and 50 cm. Whole body vibration may help immediately reduce lower extremity loading. PMID:26849793

  14. Pedicled-perforator (propeller) flaps in lower extremity defects: a systematic review.

    PubMed

    Gir, Phanette; Cheng, Angela; Oni, Georgette; Mojallal, Ali; Saint-Cyr, Michel

    2012-11-01

    Pedicled-perforator (propeller) flaps for lower extremity reconstruction have gained popularity due to minimal donor site morbidity, relatively simple surgical technique, and replacement of tissue using "like-by-like" principles. We reviewed and analyzed the clinical use of these flaps in regards to patient age and gender, etiology and location of the defect, size and type of flap, arc of rotation, and complications to determine the reliability of this technique. A systematic review of the PubMed database using search terms to include perforator, pedicled, and propeller flaps in the lower extremity. Data from 15 case series provided 186 cases of pedicled-perforator (propeller) flaps for analysis using Chi-square tests. The Peroneal Artery Perforator (PAP) flaps and Posterior Tibial Artery Perforator (PTAP) flaps were the most frequently used flaps. The overall complication rate was 25.8% and the failure rate was 1.1%. No significant differences were found in complication rate related to age, gender, etiology or location of the defect, type or size of the flap. The most common complications were partial flap loss and venous congestion (11.3 and 8.1%). Pedicled-perforator flaps appear to be a reliable and safe procedure for the coverage soft tissue defects of the lower extremity based on favorable results reported in the literature. PMID:22715046

  15. LOWER EXTREMITY MANIFESTATIONS OF PERIPHERAL ARTERY DISEASE: THE PATHOPHYSIOLOGIC AND FUNCTIONAL IMPLICATIONS OF LEG ISCHEMIA

    PubMed Central

    McDermott, Mary McGrae

    2015-01-01

    Lower extremity peripheral artery disease (PAD) is frequently under-diagnosed, in part because of the wide variety of leg symptoms manifested by patients with PAD and in part because of the high prevalence of asymptomatic PAD. In primary care medical practices, 30% to 60% of PAD patients report no exertional leg symptoms and approximately 45–50% report exertional leg symptoms that are not consistent with classic intermittent claudication. The prevalence and extent of functional impairment and functional decline in PAD may also be underappreciated. Functional impairment and functional decline is common in PAD, even among those who are asymptomatic. Lower extremity ischemia is also associated with pathophysiologic changes in calf skeletal muscle including smaller calf muscle area, increased calf muscle fat content, impaired leg strength, and impaired metabolic function. People with severe PAD have poorer peroneal nerve conduction velocity compared to people with mild PAD or no PAD. The degree of ischemia-related pathophysiologic changes in lower extremity muscles and peripheral nerves of people with PAD are associated with the degree of functional impairment. New interventions are needed to improve functional performance and prevent mobility loss in the large number of PAD patients, including in those who are asymptomatic or who have exertional leg symptoms other than claudication. PMID:25908727

  16. Effect of in-hospital physical activity on cardiovascular prognosis in lower extremity bypass for claudication

    PubMed Central

    Matsuo, Tomohiro; Sakaguchi, Taichi; Ishida, Atsuhisa; Yuguchi, Satoshi; Saito, Kazuya; Nakajima, Masaharu; Ujikawa, Takuya; Morisawa, Tomoyuki; Chikazawa, Genta; Takahashi, Tetsuya

    2015-01-01

    [Purpose] This study aimed to evaluate the effect of in-hospital physical activity on patient prognosis after lower extremity bypass surgery for peripheral arterial disease. [Subjects and Methods] A total of 13 patients (16 limbs; 11 males and 2 females; mean age [standard deviation], 72.8 [5.9] years) who underwent lower extremity bypass surgery for Fontaine stage 2 peripheral arterial disease were included in this study and assigned to either an active group (n = 6) to perform increased physical activity after surgery or an inactive group (n = 7) to perform decreased physical activity after surgery. Daily in-hospital physical activity levels were measured continuously with a triaxial accelerometer. The occurrence of adverse cardiovascular events within a 2 year follow-up period was compared between groups. [Results] At discharge, the patients in the active group were able to walk more steps daily than those in the inactive group. The incidence of adverse events was 16.7% in the active group and 71.4% in the inactive group. [Conclusion] A higher in-hospital physical activity level was associated with a better long-term prognosis after lower extremity bypass surgery in patients with peripheral arterial disease. PMID:26180335

  17. Complications of Lower-Extremity Outpatient Arteriography via Low Brachial Artery

    SciTech Connect

    Chatziioannou, A.; Ladopoulos, C.; Mourikis, D.; Katsenis, K.; Spanomihos, G.; Vlachos, L.

    2004-01-15

    We retrospectively evaluated low brachial artery puncture for arteriography and its complications as an alternative approach route for bilateral lower extremity run-off. Using the Seldinger technique and catheterization with a sheathless 4-F multiple side-hole pigtail catheter, we performed 2250 low brachial artery punctures in outpatients.The right brachial artery (RBA) was successfully punctured in 2039 patients; the left brachial artery (LBA) in 200. The transfemoral approach was used in 11 patients when catheterizing either of brachial arteries failed. Ten major or moderate complications (2 pseudoaneurysms, 2 thrombosis, 1 dissection and 5 hematomas) were encountered. Surgical intervention was necessary in three cases. There were no transient ischemic attacks. Twenty-one patients suffered temporary loss of radial pulse which returned spontaneously in less than 1 hour. One patient demonstrated prolonged loss of pulse which required heparin. Low brachial artery puncture and catheterization at the antecubital fossa is a very safe and cost-effective alternative to the femoral artery approach for lower extremity intra-arterial arteriography in the hands of experienced operators. The success rate in catheterizing one of the brachial arteries was 99.52% with a low significant complications rate of 0.44%. The transbrachial approach should be used as a standard method for lower extremity IA - DSA in an outpatient setting.

  18. A Flowable Placental Tissue Matrix Allograft in Lower Extremity Injuries: A Pilot Study.

    PubMed

    Lullove, Eric

    2015-06-01

    Damaged connective tissue commonly leads to lower extremity injuries. These injuries can result in inflammation, reduced mobility, and chronic pain. Conservative treatment may include orthotics, offloading the injury, physical therapy, and/or NSAIDs. If conservative treatment fails, surgical intervention may be required. Even after successful surgery, these procedures often result in reduced joint mobility and tendon or ligament strength. A novel flowable tissue matrix allograft, derived from human placental connective tissue, has recently been made available for minimally invasive treatment of damaged or inadequate tissue  (PX50®, Human Regenerative Technologies LLC, Redondo Beach, CA). Based on the universal role of connective tissue in the body, and its reported antimicrobial, anti-adhesive, and anti-inflammatory properties, we assessed the effects of using this placental tissue matrix in the treatment of a series of lower extremity injuries. In this pilot study, 9 of 10 patients reported pain levels of 2 or less by week four using the VAS pain scale. This short-term pilot study effectively shows that injectable, flowable amniotic allografts can be used for orthopedic sports injuries of the lower extremities. PMID:26180699

  19. Somatotype of the individuals with lower extremity amputation and its association with cardiovascular risk.

    PubMed

    Mozumdar, Arupendra; Roy, Subrata K

    2008-03-01

    Anthropometric somatotyping is one of the methods to describe the shape of the human body, which shows some associations with an individual's health and disease condition, especially with cardiovascular diseases (CVD). Individuals with lower extremity amputation (LEA) are known to be more vulnerable to the cardiovascular risk. The objectives of the present study are to report the somatotype of the individuals having lower extremity amputation, to study the possible variation in somatotype between two groups of amputated individuals, and to study the association between cardiovascular disease risk factor and somatotype components among individuals with locomotor disability. 102 adult male individuals with unilateral lower-extremity amputation residing in Calcutta and adjoining areas were investigated. The anthropometric data for somatotyping and data on cardiovascular risk traits (such as body mass index, blood pressure measurements, blood lipids) have been collected. The somatotyping technique of Carter & Heath (1990) has been followed. The result shows high mean values of endomorphy and mesomorphy components and a low mean value of the ectomorphy component among the amputated individuals having cardiovascular risks. The results of both discriminant analysis and logistic regression analysis show a significant relationship between somatotype components and CVD risk among the individuals with LEA. The findings of the present study support the findings of similar studies conducted on the normal population. Diagnosis of CVD risk condition through somatotyping can be utilized in prevention/treatment management for the individuals with LEA. PMID:18435209

  20. Mortality after lower extremity fractures in men with spinal cord injury.

    PubMed

    Carbone, Laura D; Chin, Amy S; Burns, Stephen P; Svircev, Jelena N; Hoenig, Helen; Heggeness, Michael; Bailey, Lauren; Weaver, Frances

    2014-02-01

    In the United States, there are over 200,000 men with spinal cord injuries (SCIs) who are at risk for lower limb fractures. The risk of mortality after fractures in SCI is unknown. This was a population-based, cohort study of all male veterans (mean age 54.1; range, 20.3-100.5 years) with a traumatic SCI of at least 2 years' duration enrolled in the Veterans Affairs (VA) Spinal Cord Dysfunction Registry from FY2002 to FY2010 to determine the association between lower extremity fractures and mortality. Mortality for up to 5 years was determined. The lower extremity fracture rate was 2.14 per 100 patient-years at risk for at least one fracture. In unadjusted models and in models adjusted for demographic, SCI-related factors, healthcare use, and comorbidities, there was a significant association between incident lower extremity fracture and increased mortality (hazard ratio [HR], 1.38; 95% confidence interval [CI], 1.17-1.63; HR, 1.36; 95% CI, 1.15-1.61, respectively). In complete SCI, the hazard of death after lower extremity fracture was also increased (unadjusted model: HR, 1.46; 95% CI, 1.13-1.89; adjusted model: HR, 1.32; 95% CI, 1.02-1.71). In fully-adjusted models, the association of incident lower extremity fracture with increased mortality was substantially greater in older men (age ≥50 years) for the entire cohort (HR, 3.42; 95% CI, 2.75-4.25) and for those with complete SCI (HR, 3.13; 95% CI, 2.19-4.45), compared to younger men (age <50 years) (entire cohort: HR, 1.42; 95% CI, 0.94-2.14; complete SCI: HR, 1.71; 95% CI, 0.98-3.01). Every additional point in the Charlson comorbidity index was associated with a 10% increase in the hazard of death in models involving the entire cohort (HR, 1.11; 95% CI, 1.09-1.13) and also in models limited to men with complete SCI (HR, 1.10; 95% CI, 1.06-1.15). These data support the concept that both the fracture itself and underlying comorbidities are drivers of death in men with SCI. PMID:23873733

  1. LOWER EXTREMITY FUNCTIONAL TESTS AND RISK OF INJURY IN DIVISION III COLLEGIATE ATHLETES

    PubMed Central

    Heiderscheit, Bryan C.; Manske, Robert C.; Niemuth, Paul E.; Rauh, Mitchell J.

    2013-01-01

    Purpose/Background: Functional tests have been used primarily to assess an athlete's fitness or readiness to return to sport. The purpose of this prospective cohort study was to determine the ability of the standing long jump (SLJ) test, the single‐leg hop (SLH) for distance test, and the lower extremity functional test (LEFT) as preseason screening tools to identify collegiate athletes who may be at increased risk for a time‐loss sports‐related low back or lower extremity injury. Methods: A total of 193 Division III athletes from 15 university teams (110 females, age 19.1 ± 1.1 y; 83 males, age 19.5 ± 1.3 y) were tested prior to their sports seasons. Athletes performed the functional tests in the following sequence: SLJ, SLH, LEFT. The athletes were then prospectively followed during their sports season for occurrence of low back or LE injury. Results: Female athletes who completed the LEFT in $118 s were 6 times more likely (OR=6.4, 95% CI: 1.3, 31.7) to sustain a thigh or knee injury. Male athletes who completed the LEFT in #100 s were more likely to experience a time‐loss injury to the low back or LE (OR=3.2, 95% CI: 1.1, 9.5) or a foot or ankle injury (OR=6.7, 95% CI: 1.5, 29.7) than male athletes who completed the LEFT in 101 s or more. Female athletes with a greater than 10% side‐to‐side asymmetry between SLH distances had a 4‐fold increase in foot or ankle injury (cut point: >10%; OR=4.4, 95% CI: 1.2, 15.4). Male athletes with SLH distances (either leg) at least 75% of their height had at least a 3‐fold increase (OR=3.6, 95% CI: 1.2, 11.2 for the right LE; OR=3.6, 95% CI: 1.2, 11.2 for left LE) in low back or LE injury. Conclusions: The LEFT and the SLH tests appear useful in identifying Division III athletes at risk for a low back or lower extremity sports injury. Thus, these tests warrant further consideration as preparticipatory screening examination tools for sport injury in this population. Clinical Relevance: The single‐leg hop for

  2. A review of the risk factors for lower extremity overuse injuries in young elite female ballet dancers.

    PubMed

    Bowerman, Erin Anne; Whatman, Chris; Harris, Nigel; Bradshaw, Elizabeth

    2015-06-01

    The objective of this study was to review the evidence for selected risk factors of lower extremity overuse injuries in young elite female ballet dancers. An electronic search of key databases from 1969 to July 2013 was conducted using the keywords dancers, ballet dancers, athletes, adolescent, adolescence, young, injury, injuries, risk, overuse, lower limb, lower extremity, lower extremities, growth, maturation, menarche, alignment, and biomechanics. Thirteen published studies were retained for review. Results indicated that there is a high incidence of lower extremity overuse injuries in the target population. Primary risk factors identified included maturation, growth, and poor lower extremity alignment. Strong evidence from well-designed studies indicates that young elite female ballet dancers suffer from delayed onset of growth, maturation, menarche, and menstrual irregularities. However, there is little evidence that this deficit increases the risk of overuse injury, with the exception of stress fractures. Similarly, there is minimal evidence linking poor lower extremity alignment to increased risk of overuse injury. It is concluded that further prospective, longitudinal studies are required to clarify the relationship between growth, maturation, menarche, and lower extremity alignment, and the risk of lower extremity overuse injury in young elite female ballet dancers. PMID:26045395

  3. Safety and Efficacy of Mild Compression (18–25 mm Hg) Therapy in Patients with Diabetes and Lower Extremity Edema

    PubMed Central

    Wu, Stephanie C; Crews, Ryan T; Najafi, Bijan; Slone-Rivera, Nancy; Minder, Jessica L; Andersen, Charles A

    2012-01-01

    Background Patients with diabetes often present with lower extremity (LE) edema; however, because of concomitant peripheral arterial disease, compression therapy is generally avoided by providers in fear of compromising arterial circulation. This pilot study sought to assess whether diabetic socks with mild compression (18–25 mm Hg) can reduce LE edema in patients with diabetes without negatively impacting vascularity. Methods Eighteen subjects (9 males, 9 females) aged 61 ± 11 years with diabetes, LE edema, and a mean ankle–brachial index (ABI) of 1.10 ± 0.21 successfully completed this uncontrolled study. At baseline, subjects were fitted and instructed to wear the socks during all waking hours. Follow-up visits occurred weekly for four consecutive weeks. Edema was quantified through midfoot, ankle, and calf circumferences and cutaneous fluid measurements. Vascular status was tracked via ABI. Results Repeated measures analysis of variance and least significant difference post hoc analyses were used for data analyses. Calf circumferences showed a statistically significant (p < .05) decrease of 1.3 ± 0.28 cm after just one week and remained significantly smaller than baseline throughout the study. Foot circumferences were significantly reduced at week 2 (−0.98 ± 0.35 cm) and remained significantly below baseline for the remainder of the study. The ankle also demonstrated a trend of circumference reduction but was not statistically significant. Cutaneous edema significantly reduced by week 3 (−3.1 ± 1.3 U) and remained so at week 4. Ankle–brachial index significantly increased (0.14 ± 0.049) at week 2 but was not significantly higher at weeks 3 or 4. No adverse events occurred during the study. Conclusions Mild compression therapy (18–25 mm Hg) decreased swelling in diabetes patients with LE edema without compromising vascularity. PMID:22768895

  4. The relationship between vitamin D status and idiopathic lower-extremity deep vein thrombosis

    PubMed Central

    Khademvatani, Kamal; Seyyed-Mohammadzad, Mir Hossein; Akbari, Mohammad; Rezaei, Yousef; Eskandari, Ramin; Rostamzadeh, Alireza

    2014-01-01

    Background Vitamin D has been shown to have an anticoagulant effect. A decrease in 25-hydroxyvitamin D [25(OH)D] concentration has also been associated with an increased risk of venous thromboembolism. Hence, we sought to determine the relationship between 25(OH) D levels and idiopathic lower-extremity deep vein thrombosis (DVT). Methods In a case control study, a total of 82 participants with idiopathic lower-extremity DVT were enrolled along with 85 sex- and age-matched healthy participants as controls. The plasma 25(OH)D levels were measured in all the studied samples. Results The participants’ mean age was 47.1±12.3 years. Baseline characteristics were not significantly different between the groups. The concentration of 25(OH)D was significantly lower in the DVT group compared to that of the control group (17.9±10.3 versus 23.1±12.5 ng/mL, P=0.004). The prevalence of participants with deficient 25(OH)D levels was significantly higher in the both DVT and control groups than those with sufficient 25(OH)D levels (68.3% versus 13.4%, and 49.4% versus 28.2%, respectively, P=0.027). In a multivariate analysis, 25(OH)D levels and sex were found to be the only independent predictors of DVT (odds ratio [OR] 1.05, 95% confidence interval [CI] 1.02–1.08, P=0.001 and OR 0.51, 95% CI 0.26–1.00, P=0.049, respectively). Conclusion Low levels of 25(OH)D are associated with idiopathic lower-extremity DVT. Further investigation is needed to establish determinants and probable causative role of 25(OH)D. PMID:24971035

  5. Lower Extremity Strength Is Correlated with Walking Function After Incomplete SCI

    PubMed Central

    DiPiro, Nicole D.; Holthaus, Katy D.; Morgan, Patrick J.; Embry, Aaron E.; Perry, Lindsay A.; Bowden, Mark G.

    2015-01-01

    Background: Lower extremity strength has been reported to relate to walking ability, however, the relationship between voluntary lower extremity muscle function as measured by isokinetic dynamometry and walking have not been thoroughly examined in individuals with incomplete spinal cord injury (iSCI). Objective: To determine the extent to which measures of maximal voluntary isometric contraction (MVIC) and rate of torque development (RTD) in the knee extensor (KE) and plantar flexor (PF) muscle groups correlate with self-selected overground walking speed and spatiotemporal characteristics of walking. Methods: Twenty-two subjects with chronic (>6 months) iSCI participated in a cross-sectional study. Values for MVIC and RTD in the KE and PF muscle groups were determined by isokinetic dynamometry. Walking speed and spatiotemporal characteristics of walking were measured during overground walking. Results: MVIC in the KE and PF muscle groups correlated significantly with walking speed. RTD was significantly correlated with walking speed in both muscle groups, the more-involved PF muscle group showing the strongest correlation with walking speed (r = 0.728). RTD in the KE and PF muscle groups of the more-involved limb was significantly correlated with single support time of the more-involved limb. Conclusion: These data demonstrate that lower extremity strength is associated with walking ability after iSCI. Correlations for the muscle groups of the move-involved side were stronger compared to the less-involved limb. In addition, PF function is highlighted as a potential limiting factor to walking speed along with the importance of RTD. PMID:26364282

  6. CHANGES IN LOWER EXTREMITY MOVEMENT AND POWER ABSORPTION DURING FOREFOOT STRIKING AND BAREFOOT RUNNING

    PubMed Central

    Green, Douglas H.; Wurzinger, Brian

    2012-01-01

    Purpose/Background: Both forefoot strike shod (FFS) and barefoot (BF) running styles result in different mechanics when compared to rearfoot strike (RFS) shod running. Additionally, running mechanics of FFS and BF running are similar to one another. Comparing the mechanical changes occurring in each of these patterns is necessary to understand potential benefits and risks of these running styles. The authors hypothesized that FFS and BF conditions would result in increased sagittal plane joint angles at initial contact and that FFS and BF conditions would demonstrate a shift in sagittal plane joint power from the knee to the ankle when compared to the RFS condition. Finally, total lower extremity power absorption will be least in BF and greatest in the RFS shod condition. Methods: The study included 10 male and 10 female RFS runners who completed 3‐dimensional running analysis in 3 conditions: shod with RFS, shod with FFS, and BF. Variables were the angles of plantarflexion, knee flexion, and hip flexion at initial contact and peak sagittal plane joint power at the hip, knee, and ankle during stance phase. Results: Running with a FFS pattern and BF resulted in significantly greater plantarflexion and significantly less negative knee power (absorption) when compared to shod RFS condition. FFS condition runners landed in the most plantarflexion and demonstrated the most peak ankle power absorption and lowest knee power absorption between the 3 conditions. BF and FFS conditions demonstrated decreased total lower extremity power absorption compared to the shod RFS condition but did not differ from one another. Conclusions: BF and FFS running result in reduced total lower extremity power, hip power and knee power and a shift of power absorption from the knee to the ankle. Clinical Relevance: Alterations associated with BF running patterns are present in a FFS pattern when wearing shoes. Additionally, both patterns result in increased demand at the foot and ankle as

  7. Whole-body heating decreases skin vascular response to low orthostatic stress in the lower extremities.

    PubMed

    Yamazaki, Fumio; Nakayama, Yoshiro; Sone, Ryoko

    2006-04-01

    To elucidate the influence of heat stress on cutaneous vascular response in the lower extremities during orthostatic stress, a head-up tilt (HUT) test at angles of 15 degrees, 30 degrees, 45 degrees, and 60 degrees for 4 min each was conducted under normothermic control conditions followed by whole-body heat stress produced by a hot water-perfused suit in healthy volunteers. Skin blood flows (SkBF) in the forearm, thigh, and calf were monitored using laser-Doppler flowmetry throughout the experiment. Furthermore, to elucidate the effects of increased core and local skin temperatures on the local vascular response in calf skin under increasing orthostatic stress, the thigh was occluded at 20, 30, 50, 70, and 80 mmHg with a cuff in both the normothermic condition and the whole-body or local heating condition. Significant decreases in forearm SkBF during HUT were observed at an angle of 60 degrees during normothermia and at 30 degrees or more during heating. SkBF in the thigh and calf was decreased significantly by HUT at 15 degrees and above during normothermia, and there was no significant reduction of SkBF in these sites during HUT at the lower angles (15 degrees -45 degrees ) during whole-body heating. Significant decreases of calf SkBF were observed at cuff pressures of 20 mmHg and above during normothermia and of 30 mmHg and above during whole-body and local heating, respectively. These results suggest that SkBF in the lower extremities shows a marked reduction compared with the upper extremities during low orthostatic stress in normothermia, and the enhanced skin vasoconstrictor response in the lower extremities is diminished by both whole-body and local heat stress. PMID:16839449

  8. Autologous Fat Grafting in Severe Lower Extremity Asymmetries: Report of Four Cases

    PubMed Central

    2015-01-01

    Background: Lower extremity asymmetries are challenging problems in plastic and aesthetic surgery practice. Regardless of their origin, atrophies and asymmetries can be extremely varied and difficult to solve with simple techniques. Objectives:  The author reports his experience in the treatment of four patients suffering from severe lower extremity atrophy and asymmetry of different etiologies with autologous fat grafting. Methods: A total of four cases are presented. Patient selection was based on the severity of atrophy and asymmetry. Two patients were treated with two sessions of simple fat grafting and two patients with one session of cell-enriched fat grafting. The end point in each session was determined by tension/blanching of soft tissues. All patients were followed up for at least 12 months after the last session. During the postoperative follow-up, variables, such as objective volume improvement, objective girth loss, return to daily activities, and patient satisfaction, were analyzed. Results: The initial analysis of postoperative results showed a good patient satisfaction rate with no relevant complications and an early return to daily activities. Estimated mean volume improvement for simple fat grafting cases was estimated as 44% after two treatments. Mean volume improvement in cell-enriched fat grafting cases was estimated as 25% after only one treatment. Conclusions: Autologous fat grafting is a safe, effective, and reliable technique to perform aesthetic and reconstructive reshaping of a lower extremity in cases of atrophy or severe asymmetry. Depending on the preoperative soft tissue compliance, cell-assisted fat grafting will play an important role in reducing the number of sessions to perform. PMID:26824005

  9. Lower Extremity Flap Salvage in Thrombophilic Patients: Managing Expectations in the Setting of Microvascular Thrombosis.

    PubMed

    DeFazio, Michael V; Hung, Rex W Y; Han, Kevin D; Bunting, Haley A; Evans, Karen K

    2016-07-01

    Background Undiagnosed thrombophilia is a risk factor for flap failure; however, its prevalence in patients undergoing microsurgical reconstruction is unknown. We present our experience with free tissue transfer (FTT) in a high-risk population of lower extremity patients with documented thrombophilia, identified through preoperative screening. Methods Between January 2012 and April 2014, 41 patients underwent 43 free flaps for nontraumatic, lower extremity reconstruction by a single surgeon. Patients were preoperatively screened for thrombophilia using historical information and standardized laboratory testing. Demographic data, perioperative management, outcomes, and salvage rates for thrombophilic and nonthrombophilic cohorts were compared. Results Routine preoperative screening identified 52 thrombophilic traits among 25 patients in this series (61%). The most common traits were the plasminogen activator inhibitor-1 4G/5G variant (n = 12) and the methylenetetrahydrofolate reductase A1298C (n = 10) and C677T (n = 9) polymorphisms. While success rates were similar between thrombophilic and nonthrombophilic patients (84 vs. 94%; p = 0.15), thrombotic complications (25 vs. 14%; p = 0.09) and flap failure following postoperative thrombosis (100 vs. 33%; p = 0.05) appeared to be more common in patients with thrombophilia. On average, microvascular complications manifested later in the setting of thrombophilia (mean 4.8 days vs. 18 hours; p = 0.20) and were associated with a worse overall prognosis (salvage rate, 0 vs. 67%; p = 0.05). Conclusions Despite high success rates, thrombophilia appears to increase the risk of nonsalvageability following lower extremity FTT. This information should be used to help counsel patients regarding the risks and benefits of microsurgical reconstruction, as salvage rates following postoperative thrombotic events approach 0% in the presence of thrombophilia. PMID:26789005

  10. Actions of Two Bi-Articular Muscles of the Lower Extremity: A Review

    PubMed Central

    Landin, Dennis; Thompson, Melissa; Reid, Meghan

    2016-01-01

    The extremities of the human body contain several bi-articular muscles. The actions produced by muscles at the joints they cross are greatly influenced by joint moment arms and muscle length. These factors are dynamic and subject to change as joint angles are altered. Therefore, to more completely understand the actions of such muscles, the angles of both joints must be manipulated. This report reviews investigations, which have explored the actions of two bi-articular muscles of the lower extremities (gastrocnemius and rectus femoris) as the joints they cross are moved into various combinations of angles. The findings have both clinical and physical performance ramifications. PMID:27298656

  11. Sports nuclear medicine. Bone imaging for lower extremity pain in athletes

    SciTech Connect

    Brill, D.R.

    1983-03-01

    Increased participation in sports by the general public has led to an increase in sports-induced injuries, including stress fractures, shin splints, arthritis, and a host of musculotendinous maladies. Bone scintigraphy with Tc-99m MDP has been used with increasing frequency in detecting stress fractures, but this study can miss certain important conditions and detect other lesions of lesser clinical significance. This paper demonstrates the spectrum of findings on bone scanning in nonacute sports trauma and offers suggestions for the optimal use of Tc-99m MDP for detecting the causes of lower extremity pain in athletes.

  12. Actions of Two Bi-Articular Muscles of the Lower Extremity: A Review.

    PubMed

    Landin, Dennis; Thompson, Melissa; Reid, Meghan

    2016-07-01

    The extremities of the human body contain several bi-articular muscles. The actions produced by muscles at the joints they cross are greatly influenced by joint moment arms and muscle length. These factors are dynamic and subject to change as joint angles are altered. Therefore, to more completely understand the actions of such muscles, the angles of both joints must be manipulated. This report reviews investigations, which have explored the actions of two bi-articular muscles of the lower extremities (gastrocnemius and rectus femoris) as the joints they cross are moved into various combinations of angles. The findings have both clinical and physical performance ramifications. PMID:27298656

  13. The role of the Doppler in the differential diagnosis of lower extremity claudication syndromes.

    PubMed

    Terenzi, T J

    1990-05-01

    Certain doppler procedures can be used as screening methods, and may be helpful in detecting and locating arterial occlusive disease in the patient with vertebrogenic sciatica or claudication syndromes of the lower extremities. The doppler has become popular in the office setting because it is quick, noninvasive and inexpensive. The procedures can be performed even with the simple stethoscope doppler. A review of the basic types of equipment as well as pertinent data interpretation are covered in this article. The methods applied are multisegmental pressures and audible doppler flow signals. PMID:2191068

  14. Embolosclerotherapy by the Transvenous Approach for Lower Extremity Arteriovenous Malformation in Cowden Syndrome: A Case Report

    PubMed Central

    Kishino, Mitsuhiro; Nakadate, Masashi; Kudo, Toshifumi; Inoue, Yoshinori; Tateishi, Ukihide

    2016-01-01

    A 69-year-old female with Cowden syndrome presented with pain at rest in the right leg. Arteriovenous malformations (AVMs) of the right lower extremity were detected by computed tomography and magnetic resonance imaging. Angiography indicated arteriolovenous fistulae, which were initially treated using a transarterial approach with minimal therapeutic effect. In contrast, excellent outcomes were achieved with a transvenous approach using coil embolization and liquid sclerotherapy for the venous component of the nidus. At 15 months after embolosclerotherapy, no angiographic evidence of AVM recurrence was noted. Embolosclerotherapy by the transvenous approach for AVM in Cowden syndrome was a useful therapeutic strategy for arteriolovenous fistulae. PMID:27087878

  15. The clinical evaluation of Pterocarpus santalinus Linn. Ointment on lower extremity wounds--a preliminary report.

    PubMed

    Biswas, Tuhin Kanti; Maity, Lakshmi Narayan; Mukherjee, Biswapati

    2004-12-01

    Pterocarpus santalinus is described in the Ayurveda for its wide spectrum of medicinal properties including wound healing. Previously the authors reported animal studies that demonstrated that an ointment made from the bark of this tree was effective without any toxic effects. They used the same ointment in 6 cases of lower extremity wounds. Healing was observed in all wounds. The study was not controlled, the findings are presented here as case studies. Further studies are planned to develop a wound healing ointment from a locally available and inexpensive plant. PMID:15866819

  16. Importance of an early tissue transfer in the treatment of complicated injuries of lower extremities.

    PubMed

    Nejedlý, A; Tvrdek, M; Kletenský, J; Pros, Z

    1994-01-01

    3rd degree fractures with extensive defects of soft tissues represent a major therapeutical problem. The technique of free tissue transfer makes it possible to adopt an active access to primary treatment to this injuries. Radical necrectomies may be performed without respect to the extent of the defect that will arise. The authors present their experience regarding an early coverage of the defect of the lower extremity by means of a free flap. The time period between the accident and tissue transfer as well as a suitable flap type are taken in consideration. PMID:7618393

  17. Nonprescription, padded, lightweight support socks in treatment of mild to moderate lower extremity venous insufficiency.

    PubMed

    Brown, J R; Brown, A M

    1995-03-01

    Currently, strength greater than 20 mm Hg of compression is considered necessary for support hose used to treat symptomatic venous insufficiency in lower extremities. This strength is frequently uncomfortable, which reduces compliance and therefore clinical effectiveness. Whether more comfortable, nonprescription, light-compression support hose is effective in the treatment of mild to moderate venous insufficiency was investigated in 36 men with subjective complaints and objective signs (per Doppler ultrasound) of lower extremity venous insufficiency. All participants wore padded, light-compression (6 mm Hg), crew-height socks for 1 month. Then, participants were assigned to one of two groups on the basis of initial Doppler results. The half with the worst results wore stronger-compression (12 mm Hg) over-the-calf support socks, on the assumption that patients with worse venous insufficiency would require more support; those with the better Doppler results continued to wear the light-compression socks. Participants were retested at monthly intervals for 3 months. In each group, data indicated that the venous insufficiency for all patients improved objectively and subjectively. Many of the objective venous values improved with either statistical or highly statistical significance--specifically deep venous valve function, superficial venous valve functions, and venous capacity--without statistically altering arterial function. Improvement occurred in the first month of the trial and continued throughout the study. The use of light-compression support socks is effective and should be considered as a first line of therapy in treatment of mild to moderate venous insufficiency. PMID:7751167

  18. Effects of shoe type on lower extremity muscle activity during treadmill walking

    PubMed Central

    Kim, Mi-Kyoung; Kim, Young-Hwan; Yoo, Kyung-Tae

    2015-01-01

    [Purpose] The purpose of this study was to analyze the effects of different shoe types on lower extremity muscle activity in healthy young women by using electromyography. [Subjects and Methods] Fifteen healthy young women in their 20s were included in this single-group repeated measures study. The subjects were divided into three groups: Converse sneakers, rain boots, and combat boots. The subjects walked on a treadmill at 4 km/h for 30 min, during which six muscles were examined using electromyography: the rectus femoris, vastus medialis, semimembranosus, tibialis anterior, peroneus longus, and medial head of the gastrocnemius. Between switching shoe types, a 24-h rest period was instated to prevent the fatigue effect from treadmill walking. [Results] One-way analysis of variance used to compare electromyography results among the three groups showed that the main effect of group differed significantly for the vastus medialis. Vastus medialis activity was higher in the rain boots group than the Converse sneakers group, and it was higher in the combat boots group than rain boots group. [Conclusion] Shoe type affects lower extremity muscle activity. Our findings may help individuals choose the ideal shoes for daily walking. PMID:26834363

  19. Lower extremity joint loading during level walking with Masai barefoot technology shoes in overweight males.

    PubMed

    Buchecker, M; Wagner, H; Pfusterschmied, J; Stöggl, T L; Müller, E

    2012-06-01

    The purpose of this study was to evaluate the effects of Masai barefoot technology (MBT) shoes on lower extremity joint loading in overweight males during level walking. Therefore, lower extremity kinematics, kinetics, and muscle electromyographic signals of the vastus lateralis (VL), biceps femoris (BF), and gastrocnemius medialis (GM) were recorded in 10 overweight males at a self-chosen walking speed with MBT shoes and conventional shoes. Selected peak joint moments, maximal joint force loading rates, mean muscle intensities, and co-activation indices of the VL/BF, as well as of the VL/GM were analyzed and compared for the two shoe conditions using paired Student's t-tests (α=0.05). Results showed that walking with MBT shoes reduced first peak knee adduction moments in overweight subjects. During midstance and terminal stance, increases in VL/GM co-activation, accompanied by increases in VL and GM (only terminal stance) intensities were found for the MBT situation. Kinetic variables analyzed to assess ankle and hip joint loading did not exhibit any statistical differences. These results suggest that using MBT shoes diminishes medial compartment loads at the knee without overloading hip or ankle joints in overweight males. However, the additional muscle loading should not be overlooked, and warrants further investigation. PMID:20807383

  20. Shoe midsole hardness, sex and age effects on lower extremity kinematics during running.

    PubMed

    Nigg, Benno M; Baltich, Jennifer; Maurer, Christian; Federolf, Peter

    2012-06-01

    Previous studies investigating the effects of shoe midsole hardness on running kinematics have often used male subjects from within a narrow age range. It is unknown whether shoe midsole hardness has the same kinematic effect on male and female runners as well as runners from different age categories. As sex and age have an effect on running kinematics, it is important to understand if shoe midsole hardness affects the kinematics of these groups in a similar fashion. However, current literature on the effects of sex and age on running kinematics are also limited to a narrow age range distribution in their study population. Therefore, this study tested the influence of three different midsole hardness conditions, sex and age on the lower extremity kinematics during heel-toe running. A comprehensive analysis approach was used to analyze the lower-extremity kinematic gait variables for 93 runners (male and female) aged 16-75 years. Participants ran at 3.33±0.15 m/s on a 30 m-long runway with soft, medium and hard midsoles. A principal component analysis combined with a support vector machine showed that running kinematics based on shoe midsole hardness, sex, and age were separable and classifiable. Shoe midsole hardness demonstrated a subject-independent effect on the kinematics of running. Additionally, it was found that age differences affected the more dominant movement components of running compared to differences due to the sex of a runner. PMID:22507350

  1. Immediate effects of kinematic taping on lower extremity muscle tone and stiffness in flexible flat feet

    PubMed Central

    Wang, Joong-San; Um, Gi-Mai; Choi, Jung-Hyun

    2016-01-01

    [Purpose] This study aimed to examine the immediate effects of kinematic taping on the tone and stiffness in the leg muscles of subjects with flexible flat feet. [Subjects and Methods] A total of 30 subjects, 15 in the kinematic taping and 15 in the sham taping group, were administered respective taping interventions. Subsequently, the foot pressure and the tone and stiffness in the tibialis anterior, rectus femoris, medial gastrocnemius, and the long head of the biceps femoris muscles of both the lower extremities were measured. [Results] The foot pressure of the dominant leg significantly decreased in the kinematic taping group. The muscle tone and stiffness in the rectus femoris muscle of the dominant and non-dominant leg, tibialis anterior muscle of the dominant leg, medial gastrocnemius muscle of the non-dominant leg, and the stiffness in the dominant leg significantly decreased. The muscle tone and stiffness generally increased in the sham taping group. However, no significant difference was observed between the 2 groups. [Conclusion] This study demonstrated that kinematic taping on flexible flat feet had positive effects of immediately reducing the abnormally increased foot pressure and the tone and stiffness in the lower extremity muscles. PMID:27190479

  2. Morphological and functional relationships with ultrasound measured muscle thickness of the lower extremity: a brief review.

    PubMed

    Abe, Takashi; Loenneke, Jeremy P; Thiebaud, Robert S

    2015-08-01

    Ultrasound is a potential method for assessing muscle size of the extremity and trunk. In a large muscle, however, a single image from portable ultrasound measures only muscle thickness (MT), not anatomical muscle cross-sectional area (CSA) or muscle volume (MV). Thus, it is important to know whether MT is related to anatomical CSA and MV in an individual muscle of the extremity and trunk. In this review, we summarize previously published articles in the lower extremity demonstrating the relationships between ultrasound MT and muscle CSA or MV as measured by magnetic resonance imaging and computed tomography scans. The relationship between MT and isometric and isokinetic joint performance is also reviewed. A linear relationship is observed between MT and muscle CSA or MV in the quadriceps, adductor, tibialis anterior, and triceps surae muscles. Intrarater correlation coefficients range from 0.90 to 0.99, except for one study. It would appear that anterior upper-thigh MT, mid-thigh MT and posterior thigh MT are the best predictors for evaluating adductor, quadriceps, and hamstrings muscle size, respectively. Despite a limited number of studies, anterior as well as posterior lower leg MT appear to reflect muscle CSA and MV of the lower leg muscles. Based on previous studies, ultrasound measured anterior thigh MT may be a valuable predictor of knee extension strength. Nevertheless, more studies are needed to clarify the relationship between lower extremity function and MT. PMID:27433253

  3. Post Mortem Human Surrogate Injury Response of the Pelvis and Lower Extremities to Simulated Underbody Blast.

    PubMed

    Bailey, Ann M; Christopher, John J; Brozoski, Frederick; Salzar, Robert S

    2015-08-01

    Military vehicle underbody blast (UBB) is the cause of many serious injuries in theatre today; however, the effects of these chaotic events on the human body are not well understood. The purpose of this research was to replicate both UBB loading conditions and investigate occupant response in a controlled laboratory setting. In addition to better understanding the response of the human to high rate vertical loading, this test series also aimed to identify high rate injury thresholds. Ten whole body post mortem human surrogate (PMHS) tests were completed using the University of Virginia's ODYSSEY simulated blast rig under a range of loading conditions. Seat pan accelerations ranged from 291 to 738 g's over 3 ms of positive phase duration, and foot pan accelerations from 234 to 858 g's over 3 ms of positive phase duration. Post-test computed tomography (CT) scans and necropsies were performed to determine injuries, and revealed a combination of pelvic, lumbar, thoracic, and lower extremity injuries. The research in this paper discusses pelvis and lower extremity injuries under high rate vertical loads. PMID:25503737

  4. Effects of physical characteristics and residence style on alignment of lower extremity

    PubMed Central

    Lee, Jangwon; Park, Hye-Sang

    2016-01-01

    This research was performed to identify the incidence of deformity of lower extremity and to identify the relationship of the incidence between the deformities. Once the incidences and relationship are found, next purpose was to find the effects of physical characteristics and residence styles on the development of lower extremity deformities. One hundred fifteen males and 108 females participated in this study. Data collecting was performed by questionnaire and visual postural evaluation. The incidence of genu varus was significantly high in standing-up life style compared to sitting-on life style (chi-square=8.28; P=0.004). However, the incidences of heel varus (chi-square=13.223; P=0.004) and femoral torsion (chi-square=19.347; P<0.0001) were significantly high in sitting-on life style than standing-up life style. The incidences of genu varus (chi-square=24.18; P<0.0001), heel varus (chi-square= 15.412; P<0.0001), and tibial torsion (chi-square=6.285; P<0.012) were significantly high in sitting-on life style compared to standing-up life style (P<0.05). The odd ratio result for sitting-on life style against standing-up life style showed 6.6 times significantly high relationship in femoral torsion (95% confidence range, 1.64–26.47) in men. PMID:27162772

  5. Near-infrared spectroscopy provides continuous monitoring of compromised lower extremity perfusion during cardiac surgery.

    PubMed

    Prkic, Ivana; Stuth, Eckehard A E

    2016-06-01

    Near-infrared spectroscopy (NIRS) is more frequently used to monitor regional oxygenation/perfusion of the cerebral and somatorenal vascular bed during congenital heart surgery. However, NIRS probes can be placed elsewhere to assess regional perfusion. We report the intraoperative use of NIRS probes on both calves of an infant to continuously monitor changes in the regional oxygenation/perfusion of a lower extremity whose perfusion was compromised after femoral arterial line placement. The NIRS trend of the compromised limb was compared with the contralateral limb throughout congenital heart surgery including the period on cardiopulmonary bypass (CPB). Our case report illustrates that NIRS technology can be used to monitor ongoing lower extremity vascular compromise during congenital heart surgery when it is not practical to directly access and continuously assess the limb. Transient vascular compromise after invasive femoral arterial line or sheath placement for cardiac catheterization in small infants is not infrequent. NIRS technology in such circumstances may help to decide whether watchful waiting is acceptable or immediate interventions are indicated. Continuous NIRS monitoring showed that limb regional oxygenation remained depressed during CPB but dramatically increased in the post-CPB period. PMID:27185674

  6. Clinical and morphological features of patients who underwent endovascular interventions for lower extremity arterial occlusive diseases

    PubMed Central

    Arslan, Sakir; Yuksel, Isa Oner; Koklu, Erkan; Cagirci, Goksel; Ureyen, Cagin Mustafa; Bayar, Nermin; Kus, Gorkem

    2015-01-01

    Introduction Patients with peripheral arterial disease (PAD) are at increased risk for all-cause mortality and cardiovascular mortality. Aim To present anatomical and morphological characteristics of patients who underwent endovascular stenting with laboratory and our mid-term results. Material and methods One hundred fifty-three patients (mean age: 62.8, 86% male) who underwent percutaneous intervention of lower extremity arteries were included in the study. Demographic characteristics, medical history, physical examination and laboratory findings of patients were analyzed. Patients’ lesions were classified according to the TransAtlantic Inter-Society Consensus (TASC). Clinical outcomes included complications and mortality, 6-minute walking distance, functional class (NYHA) and patency rates. Results Seventy percent of patients had hypertension, 42% were smokers, 78% had coronary artery disease, 20% had coronary artery bypass grafting, 55% had diabetes mellitus and 71% had dyslipidemia. Six patients with diabetes mellitus and poor wound healing despite medical therapy were treated with stenting leading to alleviation of pain and avoidance of amputation. The initial technical success rate of revascularization was 95.6% (153/160). Our mid-term results show that percutaneous procedures in lower extremity arterial diseases can be performed with low complication and high success rates. Patients’ 6-minute walk distance, ankle/brachial index values, functional class and the status of foot ulcers were evaluated. Conclusions Especially in patients with distal vascular disease, poor wound healing and no chance of surgical revascularization, percutaneous endovascular revascularization may provide good blood flow and prevent amputation. PMID:26161103

  7. [Limb salvage or amputation after severe trauma to the lower extremities : Evidence from the LEAP Study].

    PubMed

    Müller, C W; Krettek, C; Decker, S; Hankemeier, S; Hawi, N

    2016-05-01

    Deciding between reconstruction and primary amputation after severe high-energy trauma to the lower extremities is difficult and consequential. The Lower Extremity Assessment Project (LEAP) prospectively included and investigated patients with severe, limb-threatening injuries below the femur, with third-grade open fractures, defined soft-tissue damage and amputation wounds. This paper aims to review the key results of the LEAP study, which were published in several parts, in due consideration of the newer relevant literature, and to deduce the consequences for clinical practice. The main results are as follows: No score is sufficiently reliable to predict the success of reconstruction. Loss of muscle seems to be more momentous than loss of bone. Any accompanying injuries that should be taken into account in the individual treatment concepts are crucial to the results, in addition to comorbidities and other individual patient-related factors, such as alcoholism, smoking, insurance, and social background. Psychological impairment is frequent after these injuries and should therefore be addressed regularly with regard to rehabilitation. PMID:27169849

  8. Genomic and Proteomic Determinants of Lower Extremity Revascularization Failure: Rationale and Study Design

    PubMed Central

    Nelson, Peter R.; O'Malley, Kerri A.; Feezor, Robert J.; Moldawer, Lyle L.; Seeger, James M.

    2007-01-01

    This translational research program applies a working model of advanced functional genomics/proteomics and bioinformatics to human peripheral arterial occlusive disease (PAOD). It is a multidisciplinary collaborative effort of clinicians, scientists, and statisticians with an advisory panel comprised of experts in inflammation biology, vascular biology, molecular genetics, bioinformatics, clinical trial design, and epidemiology. The proposed human initiative is designed to study 300 symptomatic patients with PAOD undergoing medical management with or without vascular intervention by either lower extremity angioplasty/stenting or vein graft bypass. The study aims to test the hypothesis that the systemic inflammatory response following vascular intervention influences the local milieu responsible for vascular repair and adaptation. The expectation is that this response is not uniform in all patients, but rather, is modulated by either preoperative genetic predisposition or post-procedure differential regulation of the innate immune response to injury that promotes a maladaptive phenotype leading to intervention failure. Therefore, some of these differences may be present and detectable pre-intervention amenable to class prediction and prospective treatment strategies, while others may be detectable in the early post-procedure period, prior to the onset of clinical failure, permitting interventions to prevent an adverse outcome. The combination of genomic/proteomic data together with functional and quality of life outcome measures to define a critical model for class prediction and analysis should lead to new knowledge about failure mechanisms of vascular intervention and new strategies to improve existing approaches to lower extremity revascularization. PMID:17544028

  9. The effect of the weight of equipment on muscle activity of the lower extremity in soldiers.

    PubMed

    Lindner, Tobias; Schulze, Christoph; Woitge, Sandra; Finze, Susanne; Mittelmeier, Wolfram; Bader, Rainer

    2012-01-01

    Due to their profession and the tasks it entails, soldiers are exposed to high levels of physical activity and strain. This can result in overexertion and pain in the locomotor system, partly caused by carrying items of equipment. The aim of this study was to analyse the extent of muscle activity in the lower extremities caused by carrying specific items of equipment. For this purpose, the activity of selected groups of muscles caused by different items of equipment (helmet, carrying strap, backpack, and rifle) in the upper and lower leg was measured by recording dynamic surface electromyograms. Electrogoniometers were also used to measure the angle of the knee over the entire gait cycle. In addition to measuring muscle activity, the study also aimed to determine out what influence increasing weight load has on the range of motion (ROM) of the knee joint during walking. The activity of recorded muscles of the lower extremity, that is, the tibialis anterior, peroneus longus, gastrocnemius lateralis, gastrocnemius medialis, rectus femoris, and biceps femoris, was found to depend on the weight of the items of equipment. There was no evidence, however, that items of equipment weighing a maximum of 34% of their carrier's body weight had an effect on the ROM of the knee joint. PMID:22973179

  10. Lymphoedema of the lower extremities after surgery and radiotherapy for cancer of the cervix.

    PubMed

    Werngren-Elgström, M; Lidman, D

    1994-12-01

    Fifty-four women were examined to find out the incidence of lymphoedema after treatment of cancer of the uterine cervix. The women had all had total hysterectomy and excision of the pelvic lymph nodes and 53 had also received radiotherapy. The character and severity of problems experienced by the patients in their daily living were assessed by an interview. Twenty-two of the patients (41%) had a unilateral increase in volume of 5% or more in one leg compared with 15 healthy controls in whom the difference between limbs did not exceed 4%. Of the 54 patients 15 (28%) had a slight swelling (> 5% volume increase); 3 (6%) had moderate swelling (> 10% volume increase); and 4 (7%) had severe swelling (> 15% volume increase), which was interpreted as treatment-induced lymphoedema. Twelve (22%) of the patients had lymphoedema that was severe enough to cause symptoms. PMID:7899840

  11. Role for Lower Extremity Interstitial Fluid Volume Changes in the Development of Orthostasis after Simulated Microgravity

    NASA Technical Reports Server (NTRS)

    Platts, Steven H.; Summers, Richard L.; Martin, David S.; Meck, Janice V.; Coleman, Thomas G.

    2007-01-01

    Reentry orthostasis after exposure to the conditions of spaceflight is a persistent problem among astronauts. In a previous study, a computer model systems analysis was used to examine the physiologic mechanisms involved in this phenomenon. In this analysis, it was determined that an augmented capacitance of lower extremity veins due to a fluid volume contracture of the surrounding interstitial spaces during spaceflight results in an increase in sequestered blood volume upon standing and appears to be the initiating mechanism responsible for reentry orthostasis. In this study, we attempt to validate the central premise of this hypothesis using a ground-based spaceflight analog. 10 healthy subjects were placed at bed rest in a 6 head down tilt position for 60 days of bed rest. The impact of adaptations in interstitial fluid volume and venous capacitance in the lower extremities were then observed during a standard tilt test protocol performed before and after the confinement period. The interstitial thickness superficial to the calcaneous immediately below the lateral malleolus was measured using ultrasound with a 17-5 MHz linear array transducer. Measurements of the changes in anterior tibial vein diameter during tilt were obtained by similar methods. The measurements were taken while the subjects were supine and then during upright tilt (80') for thirty minutes, or until the subject had signs of presyncope. Additional measurements of the superficial left tibia interstitial thickness and stroke volume by standard echocardiographic methods were also recorded. In addition, calf compliance was measured over a pressure range of 10-60 mmHg, using plethysmography, in a subset of these subjects (n = 5). There was a average of 6% diminution in the size of the lower extremity interstitial space as compared to measurements acquired prior to bed rest. This contracture of the interstitial space coincided with a subsequent relative increase in the percentage change in tibial

  12. Influence of Lower Extremity Muscle Size and Quality on Stair-Climb Performance in Career Firefighters.

    PubMed

    Kleinberg, Craig R; Ryan, Eric D; Tweedell, Andrew J; Barnette, Timothy J; Wagoner, Chad W

    2016-06-01

    Kleinberg, CR, Ryan, ED, Tweedell, AJ, Barnette, TJ, and Wagoner, CW. Influence of lower extremity muscle size and quality on stair-climb performance in career firefighters. J Strength Cond Res 30(6): 1613-1618, 2016-The purpose of this study was to examine the influence of lower extremity muscular size and quality on stair-climb performance (SCP) in career firefighters. Forty-six male career firefighters (age = 37.0 ± 7.2 years; stature = 180.2 ± 6.9 cm; body mass = 108.0 ± 19.8 kg) volunteered for this study. Panoramic ultrasound images of the vastus lateralis and rectus femoris were obtained to determine cross-sectional area (CSA) and echo intensity (EI) of each muscle. The CSA of each muscle was then summed together and normalized to body mass (CSA/BM [QCSA]). Additionally, EI was averaged across both muscles (QEI). Participants then performed a timed and weighted SCP assessment where they ascended and descended 26 stairs 4 times as quickly as possible while wearing a weighted vest (22.73 kg) to simulate the weight of their self-contained breathing apparatus and turnout gear. Bivariate correlations and stepwise regression analyses were used to examine the relationships among variables and the relative contributions of QCSA and QEI to SCP. Partial correlations were used to examine the relationship between QCSA and SCP and QEI and SCP while controlling for age and body mass index (BMI). The results indicated that QCSA and QEI were significantly related to SCP before (r = -0.492, p = 0.001; r = 0.363, p = 0.013, respectively) and after accounting for age and BMI (r = -0.324, p = 0.032; r = 0.413, p = 0.005, respectively). Both QCSA and QEI contributed significantly to the prediction of SCP (r = 0.560, p < 0.001). These findings indicate that lower extremity muscle size and quality are important contributors to critical firefighting tasks, which have been shown to be improved with resistance training. PMID:26605810

  13. Creation of a neo-aortoiliac system from lower extremity deep and superficial veins.

    PubMed Central

    Clagett, G P; Bowers, B L; Lopez-Viego, M A; Rossi, M B; Valentine, R J; Myers, S I; Chervu, A

    1993-01-01

    OBJECTIVE: This study evaluated the morbidity, mortality, and intermediate term follow-up of patients undergoing replacement of their aortoiliac-femoral systems with lower extremity deep and superficial veins. SUMMARY BACKGROUND DATA: The most commonly used treatment for aortic prosthetic infection is ectopic bypass and removal of the prosthesis. The overall mortality rate with this approach is approximately 20%, with an amputation rate of 10% to 14%. Other limitations include thrombosis of the ectopic bypass leading to limb loss, reinfection of the ectopic bypass, and aortic stump blowout. Dissatisfaction with this approach has led the authors to develop the following. METHODS: A neo-aortoiliac system (NAIS) was fashioned from lower extremity deep veins (DV), greater saphenous veins (GSV), or both in patients with infected aortobifemoral prosthesis (n = 17) and other complex aortic problems (n = 3). Removal of infected prosthetic material, harvest of vein, and creation of NAIS was performed as a single-staged procedure. RESULTS: The in-hospital mortality and amputation rates were 10% each. The mean (+/- standard deviation [SD]) operative time was 6.5 +/- 1.8 hours and the blood transfusion requirement was 4 +/- 3 units. Four patients experienced postoperative gastrointestinal complications with peritonitis and sepsis; NAIS vein graft resisted infection and remained intact. The mean follow-up time was 22.5 +/- 16 months. NAISs constructed from GSVs were prone to the development of focal stenoses requiring intervention or diffuse neointimal hyperplasia leading to occlusion. In contrast, all NAISs from larger caliber DVs have remained widely patent. The failure rate of GSV NAISs was 64%, compared to 0% for DV NAISs (p = 0.006). Despite the high failure rate in patients with GSV NAISs, none has required amputation. In patients who had DVs harvested for NAIS reconstruction, limb edema and other signs of venous hypertension have been minimal. CONCLUSION: NAIS

  14. Sagittal alignment of the spine-pelvis-lower extremity axis in patients with severe knee osteoarthritis

    PubMed Central

    Wang, W. J.; Liu, F.; Zhu, Y.W.; Sun, M.H.; Qiu, Y.

    2016-01-01

    Objectives Normal sagittal spine-pelvis-lower extremity alignment is crucial in humans for maintaining an ergonomic upright standing posture, and pathogenesis in any segment leads to poor balance. The present study aimed to investigate how this sagittal alignment can be affected by severe knee osteoarthritis (KOA), and whether associated changes corresponded with symptoms of lower back pain (LBP) in this patient population. Methods Lateral radiograph films in an upright standing position were obtained from 59 patients with severe KOA and 58 asymptomatic controls free from KOA. Sagittal alignment of the spine, pelvis, hip and proximal femur was quantified by measuring several radiographic parameters. Global balance was accessed according to the relative position of the C7 plumb line to the sacrum and femoral heads. The presence of chronic LBP was documented. Comparisons between the two groups were carried by independent samples t-tests or chi-squared test. Results Patients with severe KOA showed significant backward femoral inclination (FI), hip flexion, forward spinal inclination, and higher prevalence of global imbalance (27.1% versus 3.4%, p < 0.001) compared with controls. In addition, patients with FI of 10° (n = 23) showed reduced lumbar lordosis and significant forward spinal inclination compared with controls, whereas those with FI > 10° (n = 36) presented with significant pelvic anteversion and hip flexion. A total of 39 patients with KOA (66.1%) suffered from LBP. There was no significant difference in sagittal alignment between KOA patients with and without LBP. Conclusions The sagittal alignment of spine-pelvis-lower extremity axis was significantly influenced by severe KOA. The lumbar spine served as the primary source of compensation, while hip flexion and pelvic anteversion increased for further compensation. Changes in sagittal alignment may not be involved in the pathogenesis of LBP in this patient population. Cite this article: W. J. Wang, F. Liu

  15. Postural Stability During Single-Leg Stance: A Preliminary Evaluation of Noncontact Lower Extremity Injury Risk.

    PubMed

    Dingenen, Bart; Malfait, Bart; Nijs, Stefaan; Peers, Koen H E; Vereecken, Styn; Verschueren, Sabine M P; Janssens, Luc; Staes, Filip F

    2016-08-01

    Study Design Controlled laboratory study with a prospective cohort design. Background Postural stability deficits during single-leg stance have been reported in persons with anterior cruciate ligament (ACL) injury, ACL reconstruction, and chronic ankle instability. It remains unclear whether impaired postural stability is a consequence or cause of these injuries. Objectives To prospectively investigate whether postural stability deficits during single-leg stance predict noncontact lower extremity injuries. Methods Fifty injury-free female athletes performed a transition task from double-leg stance to single-leg stance with eyes closed. Center-of-pressure displacement, the main outcome variable, was measured during the first 3 seconds after the time to a new stability point was reached during single-leg stance. Noncontact lower extremity injuries were recorded at a 1-year follow-up. Results Six participants sustained a noncontact ACL injury or ankle sprain. Center-of-pressure displacement during the first 3 seconds after the time to a new stability point was significantly increased in the injured (P = .030) and noninjured legs (P = .009) of the injured group compared to the respective matched legs of the noninjured group. The area under the receiver operating characteristic curve (AUC) analysis revealed significant discriminative accuracy between groups for the center-of-pressure displacement during the first 3 seconds after the time to a new stability point of the injured (AUC = 0.814, P = .015) and noninjured legs (AUC = 0.897, P = .004) of the injured group compared to the matched legs of the noninjured group. Conclusion This preliminary study suggests that postural stability measurements during the single-leg stance phase of the double- to single-leg stance transition task may be a useful predictor of increased risk of noncontact lower extremity injury. Further research is indicated. Level of Evidence Prognosis, level 4. J Orthop Sports PhysTher 2016

  16. Clinical and Ultrasonographic Evaluation of Lower-extremity Vein Thrombosis in Behcet Syndrome

    PubMed Central

    Seyahi, Emire; Cakmak, Osman Serdal; Tutar, Burcin; Arslan, Caner; Dikici, Atilla Suleyman; Sut, Necdet; Kantarci, Fatih; Tuzun, Hasan; Melikoglu, Melike; Yazici, Hasan

    2015-01-01

    Abstract Vascular involvement can be seen in up to 40% of patients with Behcet syndrome (BS), the lower-extremity vein thrombosis (LEVT) being the most common type. The aim of the current study was to compare venous Doppler findings and clinical features between BS patients with LEVT and control patients diagnosed as having LEVT due to other causes. All consecutive 78 patients (71 men, 7 women; mean age 38.6 ± 10.3 years) with LEVT due to BS and 50 control patients (29 men, 21 women; mean age 42.0 ± 12.5 years) who had LEVT due to other causes, or idiopathic, were studied with the help of a Doppler ultrasonography after a detailed clinical examination. Patterns of venous disease were identified by cluster analyses. Clinical features of chronic venous disease were assessed using 2 classification systems. Venous claudication was also assessed. Patients with BS were more likely to be men, had significantly earlier age of onset of thrombosis, and were treated mainly with immunosuppressives and less frequently with anticoagulants. Furthermore, they had significantly more bilateral involvement, less complete recanalization, and more frequent collateral formation. While control patients had a disorganized pattern of venous involvement, BS patients had a contiguous and symmetric pattern, involving all deep and superficial veins of the lower extremities, with less affinity for crural veins. Clinical assessment, as measured by the 2 classification systems, also indicated a more severe disease among the BS patients. In line, 51% of the BS patients suffered from severe post-thrombotic syndrome (PTS) and 32% from venous claudication, whereas these were present in 8% and 12%, respectively, among the controls. Among BS patients, a longer duration of thrombosis, bilateral femoral vein involvement, and using no anticoagulation along with immunosuppressive treatment when first diagnosed were found to be associated independently with severe PTS. Lower-extremity vein

  17. Ankle Dorsiflexion Among Healthy Men With Different Qualities of Lower Extremity Movement

    PubMed Central

    Rabin, Alon; Kozol, Zvi; Spitzer, Elad; Finestone, Aharon

    2014-01-01

    Context: Lower extremity movement patterns have been implicated as a risk factor for various knee disorders. Ankle-dorsiflexion (DF) range of motion (ROM) has previously been associated with a faulty movement pattern among healthy female participants. Objective: To determine the association between ankle DF ROM and the quality of lower extremity movement during the lateral step-down test among healthy male participants. Design: Cross-sectional study. Setting: Training facility of the Israel Defense Forces. Patients or Other Participants: Fifty-five healthy male Israeli military recruits (age = 19.7 ± 1.1 years, height = 175.4 ± 6.4 cm, mass = 72.0 ± 7.6 kg). Intervention(s): Dorsiflexion ROM was measured in weight-bearing and non–weight-bearing conditions using a fluid-filled inclinometer and a universal goniometer, respectively. Lower extremity movement pattern was assessed visually using the lateral step-down test and classified categorically as good or moderate. All measurements were performed bilaterally. Main Outcome Measure(s): Weight-bearing and non–weight-bearing DF ROM were more limited among participants with moderate quality of movement than in those with good quality of movement on the dominant side (P = .01 and P = .02 for weight-bearing and non–weight-bearing DF, respectively). Non–weight-bearing DF demonstrated a trend toward a decreased range among participants with moderate compared with participants with good quality of movement on the nondominant side (P = .03 [adjusted P = .025]). Weight-bearing DF was not different between participants with good and moderate movement patterns on the nondominant side (P = .10). Weight-bearing and non–weight-bearing ankle DF ROM correlated significantly with the quality of movement on both sides (P < .01 and P < .05 on the dominant and nondominant side, respectively). Conclusions: Ankle DF ROM was associated with quality of movement among healthy male participants. The association seemed weaker in

  18. The efficacy of intermittent pneumatic compression in the prevention of lower extremity deep venous thrombosis.

    PubMed

    Sadaghianloo, Nirvana; Dardik, Alan

    2016-04-01

    Intermittent pneumatic compression (IPC) has been used to prevent lower extremity deep venous thrombosis for more than 30 years and is a popular choice for prophylaxis among both physicians and patients because of its efficacy and reduced risk of bleeding compared with pharmacologic prophylaxis. However, the efficacy of IPC may depend on the clinical situation as well as on several variables associated with the devices. To determine the efficacy of IPC, recent guidelines and literature were reviewed. IPC is efficacious as a sole prophylactic agent in low- or moderate-risk surgical patients and in patients with high risk of bleeding with pharmacologic prophylaxis. In high-risk surgical and medical patients, IPC is recommended as a synergistic tool in combination with pharmacologic agents, if pharmacologic agents are not contraindicated. No specific compression modality proved its superiority, although newer portable battery-powered devices seem to allow better patient compliance and satisfaction. PMID:26993875

  19. Effective management of major lower extremity wounds using an acellular regenerative tissue matrix: a pilot study.

    PubMed

    Brigido, Stephen A; Boc, Steven F; Lopez, Ramon C

    2004-01-01

    Wound healing is a significant problem in orthopedics. Graftjacket tissue matrix (Wright Medical Technology, Inc, Arlington, Tenn), a novel acellular regenerative tissue matrix, has been designed to aid wound closure. A prospective, randomized study was initiated to determine the efficacy of this tissue product in wound repair compared with conventional treatment. Lower extremity wounds are refractile to healing in patients with diabetes mellitus. Therefore, researchers used diabetic foot ulcers to evaluate the efficacy of GraftJacket tissue matrix in wound repair. Only a single administration of the tissue matrix was required. After 1 month of treatment, preliminary results demonstrate that this novel tissue matrix promotes faster healing at a statistically significant rate over conventional treatment. Because wounds in this series of patients are deep and circulation around the wound is poor, the preliminary results suggest that this tissue matrix will be applicable to other types of orthopedic wounds. PMID:14763548

  20. Articulating external fixation to overcome nerve gaps in lower extremity trauma.

    PubMed

    Ruch, David S; Smith, Adam M

    2003-04-01

    This report describes the use of articulating external fixation in patients with lower extremity trauma with segmental nerve defects. Four patients who would otherwise require nerve grafting underwent application of an articulated external fixator, allowing optimal positioning for end-to-end, tension-free nerve repair followed by gradual lengthening. After three weeks of immobilization, the fixator was gradually advanced through the arc of the hinge. At an average follow-up of 44 months, motor function testing revealed gastroc-soleus function in all cases with a median motor grade of M4. Sensory function testing with Semmes-Weinstein monofilaments demonstrated protective plantar sensation in all cases with a median monofilament size of 3.84 on the injured limb compared with 3.22 on the contralateral side. This series of patients demonstrates that joint positioning through external fixation may be used safely and effectively to facilitate primary neurorrhaphy and subsequent limb salvage. PMID:12679690

  1. Effects of bridging plus exercises with heel lift on lower extremity muscles

    PubMed Central

    Yoo, Won-gyu

    2016-01-01

    [Purpose] This study investigated the effects of the bridging plus exercise with heel lift on lower extremity muscles. [Subjects and Methods] Nine healthy males participated. The subjects performed bridging exercises under two conditions. Surface electromyography was used to measure the electrical activities of the medial hamstring (MH) and the gluteus maximus (GM) muscles. [Results] Activation of the MH muscle during bridging with heel lift decreased, and activation of the GM muscle during bridging with heel lift increased compared to those with the bridging exercise. [Conclusion] This result showed that bridging plus exercises with heel lift could be an effective exercise for patients with compensatory mechanisms during bridging exercises, such as weak GM with hamstring tightness. PMID:27313376

  2. Effect of Foot Orthoses on Children With Lower Extremity Growing Pains

    PubMed Central

    Lee, Hong-Jae; Lim, Kil-Byung; Yoo, JeeHyun; Jeong, Tae-Ho

    2015-01-01

    Objective To evaluate the effect of custom molded foot orthoses on children with growing pains of the lower extremities. Methods Children with growing pains were recruited during a clinic visit. None had any bony deformities, inflammatory joint disease or depression. Resting calcaneal stance position (RCSP) and calcaneal pitch angle were measured, and individual custom molded rigid foot orthoses were prescribed using the inverted orthotic technique to control for foot overpronation using the RCSP angle. Pain sites, degree and frequency of pain, and balance ability were evaluated using Balance Master computerized posturography prior to foot orthosis fitting, and 1 and 3 months later. Results Twenty children completed the study. Seventeen (75%) had overpronated feet. Significant improvements were noted after 1 and 3 months in pain degree and frequency, and after 3 months in balancing ability. Conclusion The use of custom molded foot orthoses is a good method for treating children with multiple musculoskeletal pains in the leg. PMID:25932426

  3. The role of atherectomy in the treatment of lower extremity peripheral artery disease

    PubMed Central

    2012-01-01

    Background The incidence of lower extremity peripheral artery disease (LE-PAD) continues to increase and associated morbidity remains high. Despite the significant development of percutaneous revascularization strategies, over the past decade, LE-PAD still represents a unique challenge for interventional cardiologists and vascular surgeons. Method Typical features of atherosclerosis that affects peripheral vascular bed (diffuse nature, poor distal runoff, critical limb ischemia, chronic total occlusion) contribute to the disappointing results of traditional percutaneous transluminal angioplasty (PTA). New technologies have been developed in attempt to improve the safety and effectiveness of percutaneous revascularization. Among these, atherectomy, debulking and removing atherosclerotic plaque, offers the potential advantage of eliminating stretch on arterial walls and reducing rates of restenosis. Conclusions This review summarizes the features and the current applications of new debulking devices. PMID:23173800

  4. Impact of an absorbent silver-eluting dressing system on lower extremity revascularization wound complications.

    PubMed

    Childress, Beverly B; Berceli, Scott A; Nelson, Peter R; Lee, W Anthony; Ozaki, C Keith

    2007-09-01

    Surgical wounds for lower extremity revascularization are prone to infection and dehiscence. Acticoat Absorbent, an antimicrobial dressing, offers sustained release of ionic silver. We hypothesized that immediate application of Acticoat as a postoperative dressing would reduce wound complications in patients undergoing leg revascularization. All infrainguinal revascularization cases involving leg incisions at a single Veterans Administration Medical Center were identified from July 1, 2002, to September 30, 2005. The control group received conventional dressings, while the treatment group received an Acticoat dressing. Wound complication rates were captured via National Surgical Quality Improvement Program data. Patient characteristics and procedure distributions were similar between groups. The wound complication rate fell 64% with utilization of the Acticoat-based dressing (control 14% [17/118], treatment 5% [7/130]; P = 0.016). An Acticoat-based dressing system offers a potentially useful, cost-effective adjunct to reduce open surgical leg revascularization wound complications. PMID:17521872

  5. Progressive bone and joint abnormalities of the spine and lower extremities in cerebral palsy.

    PubMed

    Morrell, David S; Pearson, J Michael; Sauser, Donald D

    2002-01-01

    Bone and joint changes in cerebral palsy result from muscle spasticity and contracture. The spine and the joints of the lower extremity are most commonly affected. Scoliosis may progress rapidly and may continue after skeletal maturity. Increased thoracic kyphosis and lumbar lordosis, spondylolisthesis, spondylolysis, and pelvic obliquity may accompany the scoliosis. Progressive hip flexion and adduction lead to windswept deformity, increased femoral anteversion, apparent coxa valga, subluxation, deformity of the femoral head, hip dislocation, and formation of a pseudoacetabulum. In the knee, flexion contracture, patella alta, and patellar fragmentation are the most commonly seen abnormalities. Recurvatum deformity can also develop in the knee secondary to contracture of the rectus femoris muscle. Progressive equinovalgus and equinovarus of the foot and ankle are associated with rocker-bottom deformity and subluxation of the talonavicular joint. Early recognition of progressive deformity in patients with cerebral palsy allows timely treatment and prevention of irreversible change. PMID:11896216

  6. [A MIDDLE-TERM RESULTS OF ENDOVENOUS LASER ABLATION FOR VARICOSE DISEASE OF THE LOWER EXTREMITIES].

    PubMed

    Osmanov, R R

    2016-02-01

    Abstract The results of endovascular laser ablation (EVLA) under ultrasonographic control in treatment of the lower extremities varicose disease (LEVD) in 189 patients (214 extremities) were analyzed. There was established, that for the trustworthy information obtaining the ultrasonographic duplex angioscanning conduction is necessary. The fibrous involution of a big subcutaneous vein trunk was achieved in (97.7 ± 1.0)% observations, in (1.9 ± 0.9)%--while the clinical signs absence--there were revealed the echo-signs of a reflux recurrence--the "ultrasonographic recurrence", and in one observation--a clinical recurrence of LEVD. In (5.1 ± 1.5)% observations in fibrous involution of the segments treated the signs of venous insufficiency in earlier competent parts were revealed--the disease progress registered. The recurrence rate and the pain syndrome severity did not depend on the treated veins diameter. High security of EVLA was established while the complications analyzing. PMID:27244920

  7. Recommended standards for reports dealing with lower extremity ischemia: revised version.

    PubMed

    Rutherford, R B; Baker, J D; Ernst, C; Johnston, K W; Porter, J M; Ahn, S; Jones, D N

    1997-09-01

    Recommended standards for analyzing and reporting on lower extremity ischemia were first published by the Journal of Vascular Surgery in 1986 after approval by the Joint Council of The Society for Vascular Surgery and the North American Chapter of the International Society for Cardiovascular Surgery. Many of these standards have been accepted and are used in the current literature on peripheral arterial occlusive disease. With the passage of time, some oversights, aspects that require clarification, and better modifications have been recognized. This report attempts to correct these shortcomings while reinforcing those recommendations that have proven satisfactory. Explanatory comments are added to facilitate understanding and application. This version is intended to replace the original version. PMID:9308598

  8. Indocyanine Green Lymphographic Signs of Lymphatic Collateral Formation in Lower Extremity Lymphedema After Cancer Resection.

    PubMed

    Tashiro, Kensuke; Shibata, Takashi; Mito, Daisuke; Ishiura, Ryohei; Kato, Motoi; Yamashita, Shuji; Narushima, Mitsunaga; Iida, Takuya; Koshima, Isao

    2016-08-01

    Indocyanine green lymphography has recently been used to assess lymphatic vessel function in lymphedema patients. Postoperative collateral lymphatic vessels toward ipsilateral axillary lymph nodes are rarely seen above the umbilical level in lower lymphedema patients. Between January 2012 and December 2014, we performed indocyanine green lymphography of 192 limbs in 96 lower extremity lymphedema cases. As a result, dermal back flow appeared in 95 cases, with 38 in the lower abdominal area and 31 in the genital area. We confirmed 3 cases of superficial lymphatic collateral ways extending above the umbilical level to the axillary lymph nodes. All 3 cases had similarity in lower abdominal edema, so excessive lymphatic fluid in the lower abdomen was assumed to be the cause. Lymphatic collateral ways from abdomen to axillary lymph nodes in this study was likely to be designed to prevent the progress of lymphedema. PMID:26418772

  9. Acute Osteochondral Fractures in the Lower Extremities - Approach to Identification and Treatment

    PubMed Central

    Pedersen, M.E; DaCambra, M.P; Jibri, Z; Dhillon, S; Jen, H; Jomha, N.M

    2015-01-01

    Chondral and osteochondral fractures of the lower extremities are important injuries because they can cause pain and dysfunction and often lead to osteoarthritis. These injuries can be misdiagnosed initially which may impact on the healing potential and result in poor long-term outcome. This comprehensive review focuses on current pitfalls in diagnosing acute osteochondral lesions, potential investigative techniques to minimize diagnostic errors as well as surgical treatment options. Acute osteochondral fractures are frequently missed and can be identified more accurately with specific imaging techniques. A number of different methods can be used to fix these fractures but attention to early diagnosis is required to limit progression to osteoarthritis. These fractures are common with joint injuries and early diagnosis and treatment should lead to improved long term outcomes. PMID:26587063

  10. Bilateral lower-extremity numbness and ataxia in a young female runner

    PubMed Central

    Casagranda, Bethany; Srivastava, Udayan; Heller, Matthew T.

    2015-01-01

    Inferior vena cava (IVC) absence is thought to have either embryologic or developmental etiologies, depending on the degree of absence. Entire absence of the IVC is thought to be due to embryologic insult, whereas recent studies propose that infrarenal IVC absence is developmental, secondary to perinatal thrombosis. Here we report on an adolescent woman with infrarenal absence of IVC and common iliac veins. Clinically, she presented with bilateral lower-extremity numbness and ataxia following strenuous exercise (running > 1 mile). Symptoms resolved with 30 seconds of rest. Radiographically, MRI revealed extensive collateral vasculature that had developed within the paravertebral soft tissues and epidural space of the spinal canal; these collaterals coursed through the neural foramina and caused moderate stenosis at L4/5 and L5/S1.

  11. The Effect of Manipulating Subject Mass on Lower Extremity Torque Patterns During Locomotion

    NASA Technical Reports Server (NTRS)

    DeWitt, John K.; Cromwell, Ronita L.; Hagan, R. Donald

    2007-01-01

    During locomotion, humans adapt their motor patterns to maintain coordination despite changing conditions (Reisman et al., 2005). Bernstein (1967) proposed that in addition to the present state of a given joint, other factors, including limb inertia and velocity, must be taken into account to allow proper motion to occur. During locomotion with added mass counterbalanced using vertical suspension to maintain body weight, vertical ground reaction forces (GRF's) increase during walking but decrease during running, suggesting that adaptation may be velocity-specific (De Witt et al., 2006). It is not known, however, how lower extremity joint torques adapt to changes in inertial forces. The purpose of this investigation was to examine the effects of increasing body mass while maintaining body weight upon lower-limb joint torque during walking and running. We hypothesized that adaptations in joint torque patterns would occur with the addition of body mass.

  12. Lower Extremity Muscle Activation and Kinematics of Catchers When Throwing Using Various Squatting and Throwing Postures

    PubMed Central

    Peng, Yi-Chien; Lo, Kuo-Cheng; Wang, Lin-Hwa

    2015-01-01

    This study investigated the differences in joint motions and muscle activities of the lower extremities involved in various squatting postures. The motion capture system with thirty-one reflective markers attached on participants was used for motion data collection. The electromyography system was applied over the quadriceps, biceps femoris, tibialis anterior, and gastrocnemius muscles of the pivot and stride leg. The joint extension and flexion in wide squatting are greater than in general squatting (p = 0.005). Knee joint extension and flexion in general squatting are significantly greater than in wide squatting (p = 0.001). The adduction and abduction of the hip joint in stride passing are significantly greater than in step squatting (p = 0.000). Furthermore, the adduction and abduction of the knee joint in stride passing are also significantly greater than in step squatting (p = 0.000). When stride passing is performed, the muscle activation of the hamstring of the pivot foot in general squatting is significantly greater than in wide squatting (p < 0.05), and this difference continues to the stride period. Most catchers use a general or wide squatting width, exclusive of a narrow one. Therefore, the training design for strengthening the lower extremity muscles should consider the appropriateness of the common squat width to enhance squat-up performance. For lower limb muscle activation, wide squatting requires more active gastrocnemius and tibialis anterior muscles. Baseball players should extend the knee angle of the pivot foot before catching the ball. Key points Common squatting width can enhance squat-up performance through strengthening lower body muscle. Wide squatting width might improve lower body muscle activation, leading to more effective communication between the brain and the muscle group. The benefit might be improved coordination of lower body muscle. Common and wide squatting width might be cycled through training to enhance the strengthen and

  13. Lower Extremity Muscle Activation and Kinematics of Catchers When Throwing Using Various Squatting and Throwing Postures.

    PubMed

    Peng, Yi-Chien; Lo, Kuo-Cheng; Wang, Lin-Hwa

    2015-09-01

    This study investigated the differences in joint motions and muscle activities of the lower extremities involved in various squatting postures. The motion capture system with thirty-one reflective markers attached on participants was used for motion data collection. The electromyography system was applied over the quadriceps, biceps femoris, tibialis anterior, and gastrocnemius muscles of the pivot and stride leg. The joint extension and flexion in wide squatting are greater than in general squatting (p = 0.005). Knee joint extension and flexion in general squatting are significantly greater than in wide squatting (p = 0.001). The adduction and abduction of the hip joint in stride passing are significantly greater than in step squatting (p = 0.000). Furthermore, the adduction and abduction of the knee joint in stride passing are also significantly greater than in step squatting (p = 0.000). When stride passing is performed, the muscle activation of the hamstring of the pivot foot in general squatting is significantly greater than in wide squatting (p < 0.05), and this difference continues to the stride period. Most catchers use a general or wide squatting width, exclusive of a narrow one. Therefore, the training design for strengthening the lower extremity muscles should consider the appropriateness of the common squat width to enhance squat-up performance. For lower limb muscle activation, wide squatting requires more active gastrocnemius and tibialis anterior muscles. Baseball players should extend the knee angle of the pivot foot before catching the ball. Key pointsCommon squatting width can enhance squat-up performance through strengthening lower body muscle.Wide squatting width might improve lower body muscle activation, leading to more effective communication between the brain and the muscle group. The benefit might be improved coordination of lower body muscle.Common and wide squatting width might be cycled through training to enhance the strengthen and

  14. Lower Extremity Muscle Activity During a Women’s Overhand Lacrosse Shot

    PubMed Central

    Millard, Brianna M.; Mercer, John A.

    2014-01-01

    The purpose of this study was to describe lower extremity muscle activity during the lacrosse shot. Participants (n=5 females, age 22±2 years, body height 162.6±15.2 cm, body mass 63.7±23.6 kg) were free from injury and had at least one year of lacrosse experience. The lead leg was instrumented with electromyography (EMG) leads to measure muscle activity of the rectus femoris (RF), biceps femoris (BF), tibialis anterior (TA), and medial gastrocnemius (GA). Participants completed five trials of a warm-up speed shot (Slow) and a game speed shot (Fast). Video analysis was used to identify the discrete events defining specific movement phases. Full-wave rectified data were averaged per muscle per phase (Crank Back Minor, Crank Back Major, Stick Acceleration, Stick Deceleration). Average EMG per muscle was analyzed using a 4 (Phase) × 2 (Speed) ANOVA. BF was greater during Fast vs. Slow for all phases (p<0.05), while TA was not influenced by either Phase or Speed (p>0.05). RF and GA were each influenced by the interaction of Phase and Speed (p<0.05) with GA being greater during Fast vs. Slow shots during all phases and RF greater during Crank Back Minor and Major as well as Stick Deceleration (p<0.05) but only tended to be greater during Stick Acceleration (p=0.076) for Fast vs. Slow. The greater muscle activity (BF, RF, GA) during Fast vs. Slow shots may have been related to a faster approach speed and/or need to create a stiff lower extremity to allow for faster upper extremity movements. PMID:25114727

  15. Trunk and Lower Extremity Kinematics During Stair Descent in Women With or Without Patellofemoral Pain

    PubMed Central

    Schwane, Brandi G.; Goerger, Benjamin M.; Goto, Shiho; Blackburn, J. Troy; Aguilar, Alain J.; Padua, Darin A.

    2015-01-01

    Context There is limited evidence indicating the contribution of trunk kinematics to patellofemoral pain (PFP). A better understanding of the interaction between trunk and lower extremity kinematics in this population may provide new avenues for interventions to treat PFP. Objective To compare trunk and lower extremity kinematics between participants with PFP and healthy controls during a stair-descent task. Design Cross-sectional study. Setting Research laboratory. Patients or Other Participants Twenty women with PFP (age = 22.2 ± 3.1 years, height = 164.5 ± 9.2 cm, mass = 63.5 ± 13.6 kg) and 20 healthy women (age = 21.0 ± 2.6 years, height = 164.5 ± 7.1 cm, mass = 63.8 ± 12.7 kg). Intervention(s) Kinematics were recorded as participants performed stair descent at a controlled velocity. Main Outcome Measure(s) Three-dimensional joint displacement of the trunk, hip, and knee during the stance phase of stair descent for the affected leg was measured using a 7-camera infrared optical motion-capture system. Pretest and posttest pain were assessed using a visual analogue scale. Kinematic differences between groups were determined using independent-samples t tests. A 2 × 2 mixed-model analysis of variance (group = PFP, control; time = pretest, posttest) was used to compare knee pain. Results We observed greater knee internal-rotation displacement for the PFP group (12.8° ± 7.2°) as compared with the control group (8.9° ± 4.4°). No other between-groups differences were observed for the trunk, hip, or other knee variables. Conclusions We observed no difference in trunk kinematics between groups but did note differences in knee internal-rotation displacement. These findings contribute to the current knowledge of altered movement in those with PFP and provide direction for exercise interventions. PMID:25898109

  16. Predictors and biomarkers of treatment gains in a clinical stroke trial targeting the lower extremity

    PubMed Central

    Burke, Erin; Dobkin, Bruce H.; Noser, Elizabeth A.; Enney, Lori A.; Cramer, Steven C.

    2014-01-01

    Background and Purpose Behavioral measures are often used to distinguish subgroups of stroke patients, e.g., to predict treatment gains, stratify clinical trial enrollees, or select rehabilitation therapy. In studies of the upper extremity, measures of brain function using fMRI have also been found useful, but this approach has not been examined for the lower extremity. The current study hypothesized that an fMRI-based measure of cortical function would significantly improve prediction of treatment-induced lower extremity behavioral gains. Biomarkers of treatment gains were also explored. Methods Patients with hemiparesis 1-12 months post-stroke were enrolled in a double-blind, placebo-controlled, randomized clinical trial of ropinirole+physical therapy vs. placebo+physical therapy, results of which have previously been reported (NCT00221390). Primary endpoint was change in gait velocity. Enrollees underwent baseline multimodal assessment that included 19 measures spanning five assessment categories (medical history, impairment, disability, brain injury, and brain function), and also underwent reassessment three weeks after end of therapy. Results In bivariate analysis, eight baseline measures belonging to four categories (medical history, impairment, disability, and brain function) significantly predicted change in gait velocity. Prediction was strongest, however, using a multivariate model containing two measures (leg Fugl-Meyer score and fMRI activation volume within ipsilesional foot sensorimotor cortex). Increased activation volume within bilateral foot primary sensorimotor cortex correlated positively with treatment-induced leg motor gains. Conclusions A multimodal model incorporating behavioral and fMRI measures best predicted treatment-induced changes in gait velocity in a clinical trial setting. Results also suggest potential utility of fMRI measures as biomarkers of treatment gains. PMID:25070961

  17. Active Ankle Movements Prevent Formation of Lower-Extremity Deep Venous Thrombosis After Orthopedic Surgery.

    PubMed

    Li, Ye; Guan, Xiang-Hong; Wang, Rui; Li, Bin; Ning, Bo; Su, Wei; Sun, Tao; Li, Hong-Yan

    2016-01-01

    BACKGROUND The aim of this study was to assess the preventive value of active ankle movements in the formation of lower-extremity deep venous thrombosis (DVT), attempting to develop a new method for rehabilitation nursing after orthopedic surgery. MATERIAL AND METHODS We randomly assigned 193 patients undergoing orthopedic surgery in the lower limbs into a case group (n=96) and a control group (n=97). The control group received routine nursing while the case group performed active ankle movements in addition to receiving routine nursing. Maximum venous outflow (MVO), maximum venous capacity (MVC), and blood rheology were measured and the incidence of DVT was recorded. RESULTS On the 11th and 14th days of the experiment, the case group had significantly higher MVO and MVC than the control group (all P<0.05). The whole-blood viscosity at high shear rate and the plasma viscosity were significantly lower in the case group than in the control group on the 14th day (both P<0.05). During the experiment, a significantly higher overall DVT incidence was recorded in the control group (8 with asymptomatic DVT) compared with the case group (1 with asymptomatic DVT) (P=0.034). During follow-up, the case group presented a significantly lower DVT incidence (1 with symptomatic DVT and 4 with asymptomatic DVT) than in the control group (5 with symptomatic DVT and 10 with asymptomatic DVT) (P=0.031). CONCLUSIONS Through increasing MVO and MVC and reducing blood rheology, active ankle movements may prevent the formation of lower-extremity DVT after orthopedic surgery. PMID:27600467

  18. Revision Rate and Risk Factors After Lower Extremity Amputation in Diabetic or Dysvascular Patients.

    PubMed

    Wanivenhaus, Florian; Mauler, Flavien; Stelzer, Teresa; Tschopp, Alois; Böni, Thomas; Berli, Martin C

    2016-01-01

    This article reports the revision rate and possible risk factors for lower extremity amputations in patients with diabetes mellitus or peripheral arterial disease (PAD). Data were collected from 421 patients with diabetes mellitus or PAD who underwent amputations of the lower extremity at the authors' institution from 2002 to 2012. There was a 25.2% overall revision rate. Mean time from amputation to revision was 244 days (range, 2-2590 days). Patients with diabetes mellitus had a significantly higher rate of revision to a more proximal level compared with patients without diabetes mellitus (type 1: odds ratio [OR]=3.73; 95% confidence interval [CI], 1.21-11.52; P=.022; and type 2: OR=2.3; 95% CI, 1.07-4.95; P=.033). A significant increase in revision rates was observed from Fontaine stage 0 to IV (stage 0: 17.9%; stage IV, 34.7%; P=.03). Risk factors for revision were diabetic nephropathy (OR=2.26; 95% CI, 1.4-3.63; P=.001) and polyneuropathy (OR=1.68; 95% CI, 1.03-2.73; P=.037). Patients who underwent revision amputation had a significantly younger mean age than patients who did not undergo revision amputation (65.23 years [range, 40-92 years] vs 68.52 years [range, 32-96 years]; P=.013). Anticipated amputation in this patient population requires a multidisciplinary approach with optimization of the patient's health. In the authors' clinical practice, the determination of the appropriate amputation level is performed individually for each patient, considering the risk factors identified in this study and the patient's expected mobilization potential, social background, and acceptance of a more proximal primary amputation level. PMID:26726973

  19. Effect of Reduced Stiffness Dance Flooring on Lower Extremity Joint Angular Trajectories During a Ballet Jump.

    PubMed

    Hackney, James; Brummel, Sara; Newman, Mary; Scott, Shannon; Reinagel, Matthew; Smith, Jennifer

    2015-09-01

    We carried out a study to investigate how low stiffness flooring may help prevent overuse injuries of the lower extremity in dancers. It was hypothesized that performing a ballet jump (sauté) on a reduced stiffness dance floor would decrease maximum joint flexion angles and negative angular velocities at the hips, knees, or ankles compared to performing the same jump on a harder floor. The participants were 15 young adult female dancers (age range 18 to 28, mean = 20.89 ± 2.93 years) with at least 5 years of continuous ballet experience and without history of serious lower body injury, surgery, or recent pain. They performed sautés on a (low stiffness) Harlequin ® WoodSpring Floor and on a vinyl-covered hardwood on concrete floor. Maximum joint flexion angles and negative velocities at bilateral hips, knees, and ankles were measured with the "Ariel Performance Analysis System" (APAS). Paired one-tailed t-tests yielded significant decreases in maximum knee angle (average decrease = 3.4° ± 4.2°, p = 0.026) and angular negative velocity of the ankles (average decrease = 18.7°/sec ± 27.9°/sec, p = 0.009) with low stiffness flooring. If the knee angle is less acute, then the length of the external knee flexion moment arm will also be shorter and result in a smaller external knee flexion moment, given an equal landing force. Also, high velocities of eccentric muscle contraction, which are necessary to control negative angular velocity of the ankle joint, are associated with higher risk of musculotendinous injury. Hence, our findings indicate that reduced floor stiffness may indeed help decrease the likelihood of lower extremity injuries. PMID:26349504

  20. Behçet's ulcerations in the lower extremity: A case report.

    PubMed

    Clark, Seth N; Hronek, Anna L; Hodge, Nan E; Soloman, Nehad; Vaughn, Teri L

    2015-09-01

    Behçet's Disease is a syndrome characterized by recurrent, painful oral aphthous ulcers, in conjunction with 2 or more systemic manifestations - a common systemic manifestation of the disease being cutaneous lesions, which often present as papules that ulcerate to form ulcerations which exhibit the same pathergy phenomenon as pyoderma gangrenosum and are thus difficult to heal. We present a case of a type 2 diabetic male with previously undiagnosed Behçet's Disease who presented to clinic with an atypical lower extremity wound. Due to the atypical nature of the patient's wound, combined with information from the patient regarding the history of the wound and other illnesses he had, the wound was biopsied and the results from the biopsy combined with clinical suspicion yielded a diagnosis of Behçet's Disease. After understanding the nature of the wound, management of the ulceration was adjusted appropriately so as to properly treat the patient with both local wound care and medical management for the disease. Patient was referred to rheumatology for further workup and long-term management of Behçet's Disease. Correct identification and treatment of the systemic disease, as well as the lower extremity ulcerations, in patients with Behçet's Disease are critical to avoid organ and limb-threatening complications. Had the diagnosis of Behçet's not been made in this case, the patient's wound would have been at increased risk of disease-related complications - ranging from non-healing ulceration leading to amputation to renal failure to loss of eyesight. PMID:25802130

  1. An evidence-based review of hip-focused neuromuscular exercise interventions to address dynamic lower extremity valgus.

    PubMed

    Ford, Kevin R; Nguyen, Anh-Dung; Dischiavi, Steven L; Hegedus, Eric J; Zuk, Emma F; Taylor, Jeffrey B

    2015-01-01

    Deficits in proximal hip strength or neuromuscular control may lead to dynamic lower extremity valgus. Measures of dynamic lower extremity valgus have been previously shown to relate to increased risk of several knee pathologies, specifically anterior cruciate ligament ruptures and patellofemoral pain. Therefore, hip-focused interventions have gained considerable attention and been successful in addressing these knee pathologies. The purpose of the review was to identify and discuss hip-focused exercise interventions that aim to address dynamic lower extremity valgus. Previous electromyography, kinematics, and kinetics research support the use of targeted hip exercises with non-weight-bearing, controlled weight-bearing, functional exercise, and, to a lesser extent, dynamic exercises in reducing dynamic lower extremity valgus. Further studies should be developed to identify and understand the mechanistic relationship between optimized biomechanics during sports and hip-focused neuromuscular exercise interventions. PMID:26346471

  2. An evidence-based review of hip-focused neuromuscular exercise interventions to address dynamic lower extremity valgus

    PubMed Central

    Ford, Kevin R; Nguyen, Anh-Dung; Dischiavi, Steven L; Hegedus, Eric J; Zuk, Emma F; Taylor, Jeffrey B

    2015-01-01

    Deficits in proximal hip strength or neuromuscular control may lead to dynamic lower extremity valgus. Measures of dynamic lower extremity valgus have been previously shown to relate to increased risk of several knee pathologies, specifically anterior cruciate ligament ruptures and patellofemoral pain. Therefore, hip-focused interventions have gained considerable attention and been successful in addressing these knee pathologies. The purpose of the review was to identify and discuss hip-focused exercise interventions that aim to address dynamic lower extremity valgus. Previous electromyography, kinematics, and kinetics research support the use of targeted hip exercises with non-weight-bearing, controlled weight-bearing, functional exercise, and, to a lesser extent, dynamic exercises in reducing dynamic lower extremity valgus. Further studies should be developed to identify and understand the mechanistic relationship between optimized biomechanics during sports and hip-focused neuromuscular exercise interventions. PMID:26346471

  3. The effect of virtual reality-based eccentric training on lower extremity muscle activation and balance in stroke patients.

    PubMed

    Park, Seung Kyu; Yang, Dae Jung; Uhm, Yo Han; Heo, Jae Won; Kim, Je Ho

    2016-07-01

    [Purpose] The purpose of this study was to examine the effect of virtual reality-based eccentric training on lower extremity muscle activity and balance in stroke patients. [Subjects and Methods] Thirty stroke patients participated, with 15 patients allotted to each of two eccentric training groups: one using a slow velocity (group I) and one using a fast velocity (group II). The virtual reality-based eccentric training was performed by the patients for 30 minutes once a day, 5 days a week, for 8 weeks using an Eccentron system. Surface electromyography was used to measure the lower extremity muscle activity, while a BioRescue was used to measure balancing ability. [Results] A significant difference in lower extremity muscle activation and balance ability was observed in group I compared with group II. [Conclusion] This study showed that virtual reality-based eccentric training using a slow velocity is effective for improving lower extremity muscle activity and balance in stroke patients. PMID:27512263

  4. The effect of virtual reality-based eccentric training on lower extremity muscle activation and balance in stroke patients

    PubMed Central

    Park, Seung Kyu; Yang, Dae Jung; Uhm, Yo Han; Heo, Jae Won; Kim, Je Ho

    2016-01-01

    [Purpose] The purpose of this study was to examine the effect of virtual reality-based eccentric training on lower extremity muscle activity and balance in stroke patients. [Subjects and Methods] Thirty stroke patients participated, with 15 patients allotted to each of two eccentric training groups: one using a slow velocity (group I) and one using a fast velocity (group II). The virtual reality-based eccentric training was performed by the patients for 30 minutes once a day, 5 days a week, for 8 weeks using an Eccentron system. Surface electromyography was used to measure the lower extremity muscle activity, while a BioRescue was used to measure balancing ability. [Results] A significant difference in lower extremity muscle activation and balance ability was observed in group I compared with group II. [Conclusion] This study showed that virtual reality-based eccentric training using a slow velocity is effective for improving lower extremity muscle activity and balance in stroke patients. PMID:27512263

  5. Correlation between diabetic lower-extremity arterial disease and diabetic neuropathy in patients with type II diabetes: an exploratory study.

    PubMed

    Sun, Peng; Guo, Jianchao; Xu, Na

    2015-01-01

    The lower-extremity vascular injuries and neuropathy are the most salient complications of diabetes which could lead to the poor prognosis, especially for the type II diabetes. The lower extremity vascular injuries and neuropathy usually coexist, yet their correlation in the pathogenesis of lower extremity lesions has received little attention in previous studies. To investigate the correlation between the degree of lower-extremity arterial injuries and lower-extremity neurological functional status in patients with type II diabetes, 32 patients with type II diabetes were examined for the mean flow velocity of the femoral artery and popliteal artery of lower extremeties, while the motor nerve conduction velocity (MCV) and sensory nerve conduction velocity (SCV) of the bilateral common peroneal nerve, sural nerve and posterior tibial nerve were simultaneously examined. Results showed that there was moderate correlation between the mean flow velocity of lower-extremity arteries and MCV/SCV. In particular, the MCV of the right tibial nerve was strongly correlated with the average velocity of the right popliteal artery (P < 0.05). PMID:25785144

  6. Stiffness and ultimate load of osseointegrated prosthesis fixations in the upper and lower extremity

    PubMed Central

    2013-01-01

    Background Techniques for the skeletal attachment of amputation-prostheses have been developed over recent decades. This type of attachment has only been performed on a small number of patients. It poses various potential advantages compared to conventional treatment with a socket, but is also associated with an increased risk of bone or implant-bone interface fracture in the case of a fall. We therefore investigated the bending stiffness and ultimate bending moment of such devices implanted in human and synthetic bones. Methods Eight human specimens and 16 synthetic models of the proximal femora were implanted with lower extremity prostheses and eight human specimens and six synthetic humeri were implanted with upper extremity prostheses. They were dissected according to typical amputation levels and underwent loading in a material testing machine in a four-point bending setup. Bending stiffness, ultimate bending moment and fracture modes were determined in a load to failure experiment. Additionally, axial pull-out was performed on eight synthetic specimens of the lower extremity. Results Maximum bending moment of the synthetic femora was 160.6±27.5 Nm, the flexural rigidity of the synthetic femora was 189.0±22.6 Nm2. Maximum bending moment of the human femora was 100.4±38.5 Nm, and the flexural rigidity was 137.8±29.4 Nm2. The maximum bending moment of the six synthetic humeri was 104.9±19.0 Nm, and the flexural rigidity was 63.7±3.6 Nm2. For the human humeri the maximum bending moment was 36.7±11.0 Nm, and the flexural rigidity at was 43.7±10.5 Nm2. The maximum pull-out force for the eight synthetic femora was 3571±919 N. Conclusion Significant differences were found between human and synthetic specimens of the lower and upper extremity regarding maximum bending moment, bending displacement and flexural rigidity. The results of this study are relevant with respect to previous finding regarding the load at the interfaces of osseointegrated prosthesis

  7. Lower Extremity Microembolism in Open vs. Endovascular Abdominal Aortic Aneurysm Repair

    PubMed Central

    Toursavadkohi, Shahab; Kakkos, Stavros K.; Rubinfeld, Ilan; Shepard, Alexander

    2016-01-01

    Although previous studies have documented the occurrence of microembolization during abdominal aortic aneurysm (AAA) repair by both open and endovascular approaches, no study has compared the downstream effects of these two repair techniques on lower extremity hemodynamics. In this prospective cohort study, 20 patients were treated with endovascular aneurysm repair (EVAR) (11 Zenith, 8 Excluder, and 1 Medtronic) and 18 patients with open repair (OR) (16 bifurcated grafts, 2 tube grafts). Pre- and postoperative ankle-brachial indices (ABIs) and toe-brachial indices (TBIs) were measured preoperatively and on postoperative day (POD) 1 and 5. Demographics and preoperative ABIs/TBIs were identical in EVAR (0.97/0.63) and OR (0.96/0.63) patients (p = 0.21). There was a significant decrease in ABIs/TBIs following both EVAR (0.83/0.52, p = 0.01) and OR (0.73/0.39, p = 0.003) on POD #1, although this decrease was greater following OR than EVAR (p = 0.002). This difference largely resolved by POD #5 (p = 0.41). In the OR group, TBIs in the limb in which flow was restored first was significantly reduced compared to the contralateral limb (0.50 vs. 0.61, p = 0.03). In the EVAR group, there was also a difference in TBIs between the main body insertion side and the contralateral side (0.50 vs. 0.59, p = 0.02). Deterioration of lower extremity perfusion pressures occurs commonly after AAA repair regardless of repair technique. Toe perfusion is worse in the limb opened first during OR and on the main body insertion side following EVAR, suggesting that microembolization plays a major role in this deterioration. The derangement following OR is more profound than after EVAR on POD #1, but recovers rapidly. This finding suggests that microembolizarion may be worse with OR or alternatively that other factors associated with OR (e.g., the hemodynamic response to surgery with redistribution of flow to vital organs peri-operatively) may play a role. PMID

  8. Differences in Lower Extremity and Trunk Kinematics between Single Leg Squat and Step Down Tasks.

    PubMed

    Lewis, Cara L; Foch, Eric; Luko, Marc M; Loverro, Kari L; Khuu, Anne

    2015-01-01

    The single leg squat and single leg step down are two commonly used functional tasks to assess movement patterns. It is unknown how kinematics compare between these tasks. The purpose of this study was to identify kinematic differences in the lower extremity, pelvis and trunk between the single leg squat and the step down. Fourteen healthy individuals participated in this research and performed the functional tasks while kinematic data were collected for the trunk, pelvis, and lower extremities using a motion capture system. For the single leg squat task, the participant was instructed to squat as low as possible. For the step down task, the participant was instructed to stand on top of a box, slowly lower him/herself until the non-stance heel touched the ground, and return to standing. This was done from two different heights (16 cm and 24 cm). The kinematics were evaluated at peak knee flexion as well as at 60° of knee flexion. Pearson correlation coefficients (r) between the angles at those two time points were also calculated to better understand the relationship between each task. The tasks resulted in kinematics differences at the knee, hip, pelvis, and trunk at both time points. The single leg squat was performed with less hip adduction (p ≤ 0.003), but more hip external rotation and knee abduction (p ≤ 0.030), than the step down tasks at 60° of knee flexion. These differences were maintained at peak knee flexion except hip external rotation was only significant in the 24 cm step down task (p ≤ 0.029). While there were multiple differences between the two step heights at peak knee flexion, the only difference at 60° of knee flexion was in trunk flexion (p < 0.001). Angles at the knee and hip had a moderate to excellent correlation (r = 0.51-0.98), but less consistently so at the pelvis and trunk (r = 0.21-0.96). The differences in movement patterns between the single leg squat and the step down should be considered when selecting a single leg task

  9. Differences in Lower Extremity and Trunk Kinematics between Single Leg Squat and Step Down Tasks

    PubMed Central

    Lewis, Cara L.; Foch, Eric; Luko, Marc M.; Loverro, Kari L.; Khuu, Anne

    2015-01-01

    The single leg squat and single leg step down are two commonly used functional tasks to assess movement patterns. It is unknown how kinematics compare between these tasks. The purpose of this study was to identify kinematic differences in the lower extremity, pelvis and trunk between the single leg squat and the step down. Fourteen healthy individuals participated in this research and performed the functional tasks while kinematic data were collected for the trunk, pelvis, and lower extremities using a motion capture system. For the single leg squat task, the participant was instructed to squat as low as possible. For the step down task, the participant was instructed to stand on top of a box, slowly lower him/herself until the non-stance heel touched the ground, and return to standing. This was done from two different heights (16cm and 24cm). The kinematics were evaluated at peak knee flexion as well as at 60° of knee flexion. Pearson correlation coefficients (r) between the angles at those two time points were also calculated to better understand the relationship between each task. The tasks resulted in kinematics differences at the knee, hip, pelvis, and trunk at both time points. The single leg squat was performed with less hip adduction (p ≤ 0.003), but more hip external rotation and knee abduction (p ≤ 0.030), than the step down tasks at 60° of knee flexion. These differences were maintained at peak knee flexion except hip external rotation was only significant in the 24cm step down task (p ≤ 0.029). While there were multiple differences between the two step heights at peak knee flexion, the only difference at 60° of knee flexion was in trunk flexion (p < 0.001). Angles at the knee and hip had a moderate to excellent correlation (r = 0.51–0.98), but less consistently so at the pelvis and trunk (r = 0.21–0.96). The differences in movement patterns between the single leg squat and the step down should be considered when selecting a single leg task

  10. Lower Extremity Microembolism in Open vs. Endovascular Abdominal Aortic Aneurysm Repair.

    PubMed

    Toursavadkohi, Shahab; Kakkos, Stavros K; Rubinfeld, Ilan; Shepard, Alexander

    2016-01-01

    Although previous studies have documented the occurrence of microembolization during abdominal aortic aneurysm (AAA) repair by both open and endovascular approaches, no study has compared the downstream effects of these two repair techniques on lower extremity hemodynamics. In this prospective cohort study, 20 patients were treated with endovascular aneurysm repair (EVAR) (11 Zenith, 8 Excluder, and 1 Medtronic) and 18 patients with open repair (OR) (16 bifurcated grafts, 2 tube grafts). Pre- and postoperative ankle-brachial indices (ABIs) and toe-brachial indices (TBIs) were measured preoperatively and on postoperative day (POD) 1 and 5. Demographics and preoperative ABIs/TBIs were identical in EVAR (0.97/0.63) and OR (0.96/0.63) patients (p = 0.21). There was a significant decrease in ABIs/TBIs following both EVAR (0.83/0.52, p = 0.01) and OR (0.73/0.39, p = 0.003) on POD #1, although this decrease was greater following OR than EVAR (p = 0.002). This difference largely resolved by POD #5 (p = 0.41). In the OR group, TBIs in the limb in which flow was restored first was significantly reduced compared to the contralateral limb (0.50 vs. 0.61, p = 0.03). In the EVAR group, there was also a difference in TBIs between the main body insertion side and the contralateral side (0.50 vs. 0.59, p = 0.02). Deterioration of lower extremity perfusion pressures occurs commonly after AAA repair regardless of repair technique. Toe perfusion is worse in the limb opened first during OR and on the main body insertion side following EVAR, suggesting that microembolization plays a major role in this deterioration. The derangement following OR is more profound than after EVAR on POD #1, but recovers rapidly. This finding suggests that microembolizarion may be worse with OR or alternatively that other factors associated with OR (e.g., the hemodynamic response to surgery with redistribution of flow to vital organs peri-operatively) may play a role. PMID

  11. Lower-extremity amputation in people with diabetes. Epidemiology and prevention.

    PubMed

    Bild, D E; Selby, J V; Sinnock, P; Browner, W S; Braveman, P; Showstack, J A

    1989-01-01

    The age-adjusted rate of lower-extremity amputation (LEA) in the diabetic population is approximately 15 times that of the nondiabetic population. Over 50,000 LEAs were performed on individuals with diabetes in the United States in 1985. Among individuals with diabetes, peripheral neuropathy and peripheral vascular disease (PVD) are major predisposing factors for LEA. Lack of adequate foot care and infection are additional risk factors. Several large clinical centers have experienced a 44-85% reduction in the rate of amputations among individuals with diabetes after the implementation of improved foot-care programs. Programs to reduce amputations among people with diabetes in primary-care settings should identify those at high risk; clinically evaluate individuals to determine specific risk status; ensure appropriate preventive therapy, treatment for foot problems, and follow-up; provide patient education; and, when necessary, refer patients to specialists, including health-care professionals for diagnostic and therapeutic interventions and shoe fitters for proper footwear. Programs should monitor and evaluate their activities and outcomes. Many issues related to the etiology and prevention of LEAs require further research. PMID:2714164

  12. Effect of sprung (suspended) floor on lower extremity stiffness during a force-returning ballet jump.

    PubMed

    Hackney, James; Brummel, Sara; Becker, Dana; Selbo, Aubrey; Koons, Sandra; Stewart, Meredith

    2011-12-01

    Our objective in this study was to compare stiffness of bilateral lower extremities (LEs) in ballet dancers performing sauté on a low-stiffness "sprung floor" to that during the same movement on a high-stiffness floor (wood on concrete). LE stiffness was calculated as the ratio of vertical ground reaction force (in kN) to compression of the lower limb (in meters). Seven female dancers were measured for five repetitions each at the point of maximum leg compression while performing sauté on both of the surfaces, such that 43 ms of data were represented for each trial. The stiffness of bilateral LEs at the point of maximum compression was higher by a mean difference score of 2.48 ± 2.20 kN/m on the low-stiffness floor compared to a high-stiffness floor. Paired t-test analysis of the difference scores yielded a one-tailed probability of 0.012. This effect was seen in six out of seven participants (one participant showed no difference between floor conditions). The finding of increased stiffness of the LEs in the sprung floor condition suggests that some of the force of landing the jump was absorbed by the surface, and therefore did not need to be absorbed by the participants' LEs themselves. This in turn implies that a sprung dance floor may help to prevent dance-related injuries. PMID:22211195

  13. Effects of cold water immersion on lower extremity joint biomechanics during running.

    PubMed

    Fukuchi, Claudiane Arakaki; da Rocha, Emmanuel Souza; Stefanyshyn, Darren John

    2015-01-01

    The purpose of this study was to identify the influence of cryotherapy on lower extremity running biomechanics. Twenty-six healthy male volunteers were randomised into two intervention groups: cold water (cold water at ~11°C) or tepid water (tepid water at ~26°C). They were required to run at 4.0 ± 0.2 m · s(-1) before and after they underwent water immersion for 20 min. Differences between pre- and post-intervention were used to compare the influence of water intervention during running. Peak joint angles, peak joint moments, peak ground reaction forces (GRF) and contact time (CT) were calculated using three-dimensional gait analysis. Independent t-tests were applied with a significant alpha level set at 0.05. Decreased peak propulsive and vertical GRF, decreased plantarflexion moments, increased hip flexion angle and longer CT were observed following cold water immersion. Although cold water immersion (cryotherapy) affected the running movement, none of the alterations have been related to running biomechanical patterns associated with injuries. Therefore, our results indicated that cold water immersion appears safe prior to running activities. PMID:25259552

  14. Effects of combined exercise on changes of lower extremity muscle activation during walking in older women.

    PubMed

    Park, Jaehyun; Lee, Joongsook; Yang, Jeongok; Lee, Bomjin; Han, Dongwook

    2015-05-01

    [Purpose] The purpose of this study was to demonstrate the effects of combined exercise for a period of 12 weeks on the changes in lower extremity muscle activation during walking in older women. [Subjects] The subjects of this study were 22 elderly women who were 65 years of age or older and living in B-City. The subjects had no nervous system or muscular system diseases that might affect walking in the previous two years. [Methods] Muscle activation was measured by using surface EMG (QEMG-8, Laxtha, Daejeon, Republic of Korea). The subjects were asked to walk on an 8 m of footpath at a natural speed. In order to minimize the noise from the cable connecting the EMG measuring instrument to the electrodes, tape was used to affix the electrodes so that they would not fall off the subjects. The EMG data were analyzed by using the RMS. [Results] Muscle activation of the rectus femoris, biceps femoris, tibialis anterior, and gastrocnemius was increased significantly after combined exercise for 12 weeks. However, no increase was observed in the left biceps femoris. [Conclusion] It was demonstrated that our exercise program, which includes aerobic walking exercises, senior-robics, and muscle strengthening exercises using elastic bands, is very effective for reorganizing the normal gait pattern in the cerebral cortex and improving muscle strength. PMID:26157253

  15. Lower extremity muscle function after strength or power training in older adults.

    PubMed

    Marsh, Anthony P; Miller, Michael E; Rejeski, W Jack; Hutton, Stacy L; Kritchevsky, Stephen B

    2009-10-01

    It is unclear whether strength training (ST) or power training (PT) is the more effective intervention at improving muscle strength and power and physical function in older adults. The authors compared the effects of lower extremity PT with those of ST on muscle strength and power in 45 older adults (74.8 +/- 5.7 yr) with self-reported difficulty in common daily activities. Participants were randomized to 1 of 3 treatment groups: PT, ST, or wait-list control. PT and ST trained 3 times/wk for 12 wk using knee-extension (KE) and leg-press (LP) machines at approximately 70% of 1-repetition maximum (1RM). For PT, the concentric phase of the KE and LP was completed "as fast as possible," whereas for ST the concentric phase was 2-3 s. Both PT and ST paused briefly at the midpoint of the movement and completed the eccentric phase of the movement in 2-3 s. PT and ST groups showed significant improvements in KE and LP 1RM compared with the control group. Maximum KE and LP power increased approximately twofold in PT compared with ST. At 12 wk, compared with control, maximum KE and LP power were significantly increased for the PT group but not for the ST group. In older adults with compromised function, PT leads to similar increases in strength and larger increases in power than ST. PMID:19940322

  16. Constraints imposed by the lower extremity extensor synergy in chronic hemiparetic stroke: Preliminary findings.

    PubMed

    Sanchez, Natalia; Dewald, Julius P A

    2014-01-01

    In the present manuscript we implemented the MultiLEIT, a lower extremity isometric torque measurement device to quantify spontaneous joint torque coupling during maximal torque generation in the paretic leg of in chronic hemiparetic stroke. We quantified extension/adduction coupling (coincident with the clinical extension synergy) during the generation of hip extension and ankle plantarflexion maximum voluntary torques. Subjects were then instructed to generate torques outside the synergy by combining hip extension+ hip abduction or ankle plantarflexion + hip abduction. During the hip dual task, the paretic hip torques were significantly different from those measured in the non-paretic and control leg (F = 22.9719, p = 0) and resulted in the inability to generate torques outside the extensor synergy patters. During the dual ankle/ hip task, the paretic extremity generated significantly smaller hip abduction torques compared to controls and to the non-paretic extremity (F = 15.861, p = 0). During this task the paretic extremity was capable of neutralizing the spontaneous adduction torque and generate a net albeit small abduction torque. Results may indicate an increased descending drive from brain stem pathways, particularly during hip extension, responsible for constraints in generating hip abduction torques after stroke. PMID:25571315

  17. New equations to calculate 3D joint centres in the lower extremities.

    PubMed

    Sandau, Martin; Heimbürger, Rikke V; Villa, Chiara; Jensen, Karl E; Moeslund, Thomas B; Aanæs, Henrik; Alkjær, Tine; Simonsen, Erik B

    2015-10-01

    Biomechanical movement analysis in 3D requires estimation of joint centres in the lower extremities and this estimation is based on extrapolation from markers placed on anatomical landmarks. The purpose of the present study was to quantify the accuracy of three established set of equations and provide new improved equations to predict the joint centre locations. The 'true' joint centres of the knee and ankle joint were obtained in vivo by MRI scans on 10 male subjects whereas the 'true' hip joint centre was obtained in 10 male and 10 female cadavers by CT scans. For the hip joint the errors ranged from 26.7 (8.9) to 29.6 (7.5) mm, for the knee joint 5.8 (3.1) to 22.6 (3.3) mm and for the ankle joint 14.4 (2.2) to 27.0 (4.6) mm. This differed significantly from the improved equations by which the error for the hip joint ranged from 8.2 (3.6) to 11.6 (5.6) mm, for the knee joint from 2.9 (2.1) to 4.7 (2.5) mm and for the ankle joint from 3.4 (1.3) to 4.1 (2.0) mm. The coefficients in the new hip joint equations differed significantly between sexes. This difference depends on anatomical differences of the male and female pelvis. PMID:26320760

  18. Special needle over cannula for postoperative analgesia in geriatric lower extremity joint arthroplasty

    PubMed Central

    Yu, Bin; Zou, Tianxiao; He, Miao; Xie, Shuqi; Zhang, Yuwen; Jin, Guangyu; Ruan, Lei; Zhang, Xiaoqing

    2015-01-01

    Objective: To investigate superiorities of a special needle-over-cannula adopting different location methods for continuous femoral nerve block (CFNB) for geriatric lower extremity joint arthroplasty. Methods: 60 elderly patients intending to receive scheduled knee or hip replacement surgery were recruited and divided into 3 groups randomly. Group 1 (n=20) adopted fascial pop for continuous femoral nerve block and postoperative analgesia with indwelling cannula. Group 2 (n=20) adopted location guided by B ultrasound, and Group 3 (n=20) adopted fascial pop combined with B ultrasound. Results: There was significant difference in the performing time of cannula indwelling on average between each two groups (P<0.01). There was no significant difference among three groups about visual analogue scale (VAS) score, Ramsay sedation score (RSS), incidence of nausea and vomit, or patient’s satisfaction at 6, 12, 24 and 48 h. Infection at the puncture site, toxic reaction of local anesthetics and respiratory depression were absent during the cannula indwelling. All the patients did not receive any other analgesic, and the indwelling time of external cannula was 45.3 hours on average. There was only one patient in group 2 who felt mild pains in front of the thigh after removing the indwelling cannula. No stolidity or other abnormal symptom was found among the remaining patients. Conclusions: Shorter indwelling cannula time and higher success rate of single attempt placement suggest that fascial pop combined ultrasound guidance is worth for clinical recommendation. PMID:26064292

  19. A case report of sudden-onset upper and lower extremity weakness.

    PubMed

    Haddad, Heba; Rotblatt, Michael

    2015-02-01

    Thyrotoxic hypokalemic periodic paralysis is characterized by acute attacks of muscle paralysis, hypokalemia, and thyrotoxicosis. It is a medical emergency, as fatal and life-threatening ventricular arrhythmia associated with hypokalemia has been reported. A 24-year-old man presented with severe lower extremity weakness, which progressed to his trunk and arms. He denied any associated symptoms and had no history of a similar episode or predisposing condition. The physical examination was significant for bilateral extremity weakness, more severe in the lower as compared to the upper extremities. The rest of the neurologic exam was normal. A small, smooth, nontender goiter was palpated. Laboratory data was significant for a potassium level of 2.0 mEq/L. Final lab data revealed a thyroid panel consistent with hyperthyroidism. Once the patient's potassium level normalized after repletion, he recovered his strength and was able to walk again. He was diagnosed with thyrotoxic hypokalemic periodic paralysis, a potentially lethal complication of hyperthyroidism. Because it is reversible with treatment of hyperthyroidism, it is imperative that this condition be considered, recognized and managed appropriately. PMID:25556330

  20. Blast effect on the lower extremities and its mitigation: a computational study.

    PubMed

    Dong, Liqiang; Zhu, Feng; Jin, Xin; Suresh, Mahi; Jiang, Binhui; Sevagan, Gopinath; Cai, Yun; Li, Guangyao; Yang, King H

    2013-12-01

    A series of computational studies were performed to investigate the response of the lower extremities of mounted soldiers under landmine detonation. A numerical human body model newly developed at Wayne State University was used to simulate two types of experimental studies and the model predictions were validated against test data in terms of the tibia axial force as well as bone fracture pattern. Based on the validated model, the minimum axial force causing tibia facture was found. Then a series of parametric studies was conducted to determine the critical velocity (peak velocity of the floor plate) causing tibia fracture at different upper/lower leg angles. In addition, to limit the load transmission through the vehicular floor, two types of energy absorbing materials, namely IMPAXX(®) foam and aluminum alloy honeycomb, were selected for floor matting. Their performances in terms of blast effect mitigation were compared using the validated numerical model, and it has been found that honeycomb is a more efficient material for blast injury prevention under the loading conditions studied. PMID:23973770

  1. Development and control of a lower extremity assistive device (LEAD) for gait rehabilitation.

    PubMed

    Shen, Bingquan; Li, Jinfu; Bai, Fengjun; Chew, Chee-Meng

    2013-06-01

    This research developed a wearable lower extremity assistive device intended to aid stroke patient during rehabilitation. The device specifically aims to assist the patient in sit-to-stand, stand-to-sit, and level-walking tasks in order to promote active gait rehabilitation exercises. The device adopts an anthropomorphic structure with hip and knee joint actuated in sagittal plane. A finite state machine strategy was proposed to control the device. At different states, appropriate assist torque is added to each joint. EMG signals are used to assess the assist performance. Tests on an able-bodied subject show that the device could successfully detect and transit between states. In sit-to-stand tasks, the integrated EMG (iEMG) of the Vastus Medialis for standing up with 11 Nm of assistance torque were found to be significantly less (P = 0.00187) than the iEMG of without assistance for standing up which indicate reduced muscle effort with the device assistance. Results show the device could potentially assist stroke patient in similar tasks. PMID:24187186

  2. Alcohol consumption and lower extremity arterial disease among older adults: the cardiovascular health study.

    PubMed

    Mukamal, Kenneth J; Kennedy, Margaret; Cushman, Mary; Kuller, Lewis H; Newman, Anne B; Polak, Joseph; Criqui, Michael H; Siscovick, David S

    2008-01-01

    Few studies of the relation of alcohol intake to lower-extremity arterial disease (LEAD) have included clinical events and objective measurements repeated longitudinally. As part of the Cardiovascular Health Study, a study of older adults from four US communities, 5,635 participants reported their use of beer, wine, and spirits yearly. Incident LEAD was identified by hospitalization surveillance. Technicians measured ankle-brachial index 6 years apart in 2,298 participants. A total of 172 cases of LEAD were documented during a mean of 7.5 years of follow-up between 1989 and 1999. Compared with abstention, the multivariable-adjusted hazard ratios were 1.10 (95% confidence interval (CI): 0.71, 1.71) for <1 alcoholic drink per week, 0.56 (95% CI: 0.33, 0.95) for 1-13 drinks per week, and 1.02 (95% CI: 0.53, 1.97) for > or =14 drinks per week (p for quadratic trend = 0.04). These relations were consistent within strata of sex, age, and apolipoprotein E genotype, and neither lipids nor inflammatory markers appeared to be important intermediates. Change in ankle-brachial index showed a similar relation (p for quadratic trend = 0.01). Alcohol consumption of 1-13 drinks per week in older adults may be associated with lower risk of LEAD, but heavier drinking is not associated with lower risk. PMID:17971339

  3. Imaging features of soft tissue epithelioid angiosarcoma in the lower extremity: A case report

    PubMed Central

    LV, LULU; XU, PENG; SHI, YIBING; HAO, JINGMING; HU, CHUNAI; ZHAO, BAOZHONG

    2016-01-01

    Epithelioid angiosarcomas are extremely rare malignant tumors formed from endothelial cells. The majority of studies reporting these tumors have been concerned with the clinical and pathological aspects, with limited reporting of radiological diagnosis. The aim of the present study was to provide a reference to improve understanding of diagnosis, treatment choice and prognosis assessment of epithelioid angiosarcoma. The current study reports the case of a 44-year-old woman with epithelioid angiosarcoma located in the deep soft tissue of the lower extremities. Physical examination of the right thigh revealed a palpable hard mass and movement was clearly restricted and painful. X-ray, computed tomography (CT) scans and magnetic resonance imaging (MRI) were used to evaluate the imaging features of the tumor. Using X-ray and CT scanning, an inhomogenous tumor with osteolytic osseous destruction was observed. MRI revealed that the bordering skeletal muscles were infiltrated. The patient was treated with palliative surgery and chemotherapy, but succumbed to disease 1 year later. PMID:27123135

  4. Differences in lower-extremity muscular activation during walking between healthy older and young adults

    PubMed Central

    Schmitz, Anne; Silder, Amy; Heiderscheit, Bryan; Mahoney, Jane; Thelen, Darryl G.

    2013-01-01

    Previous studies have identified differences in gait kinetics between healthy older and young adults. However, the underlying factors that cause these changes are not well understood. The objective of this study was to assess the effects of age and speed on the activation of lower-extremity muscles during human walking. We recorded electromyography (EMG) signals of the soleus, gastrocnemius, biceps femoris, medial hamstrings, tibialis anterior, vastus lateralis, and rectus femoris as healthy young and older adults walked over ground at slow, preferred and fast walking speeds. Nineteen healthy older adults (age, 73 ± 5 years) and 18 healthy young adults (age, 26 ± 3 years) participated. Rectified EMG signals were normalized to mean activities over a gait cycle at the preferred speed, allowing for an assessment of how the activity was distributed over the gait cycle and modulated with speed. Compared to the young adults, the older adults exhibited greater activation of the tibialis anterior and soleus during mid-stance at all walking speeds and greater activation of the vastus lateralis and medial hamstrings during loading and mid-stance at the fast walking speed, suggesting increased coactivation across the ankle and knee. In addition, older adults depend less on soleus muscle activation to push off at faster walking speeds. We conclude that age-related changes in neuromuscular activity reflect a strategy of stiffening the limb during single support and likely contribute to reduced push off power at fast walking speeds. PMID:19081734

  5. Poor Lower Extremity Function Was Associated with Pre-Diabetes and Diabetes in Older Chinese People

    PubMed Central

    Wang, Wei; Zhou, Chunling; Xu, Limin; Qiu, Jiahe; Wang, Jiaqi; Meng, Xiangxue; Liang, Yixiong; Niu, Kaijun; Guo, Qi

    2014-01-01

    Objective To determine whether a relationship exists between performance-based physical assessments and pre-diabetes/diabetes in an older Chinese population. Methods Our study population comprised 976 subjects (mean ± SD age: 67.6±6.0 years; 44.5% men) from the Hangu area of Tianjin, China. Diabetes was defined by self-reporting of a physician's diagnosis, or a fasting plasma glucose level ≥126 mg/dL; and pre-diabetes was defined as a fasting plasma glucose level ≥100 mg/dL and <126 mg/dL. Results When all other variables were adjusted for, men needing longer to finish a Timed Up and Go Test and a decreased usual walking speed had higher odds of pre-diabetes (P for trend = 0.007 and 0.008, respectively) and diabetes (P for trend = 0.012 and 0.014, respectively). However, women needing longer to finish the test and a decreased usual walking speed had a higher odds of diabetes (P for trend = 0.020 and 0.034, respectively) but not of pre-diabetes. There was no apparent association between grip strength and pre-diabetes/diabetes in both sexes. Conclusions In this study, poor lower extremity function was associated with pre-diabetes/diabetes in older people. PMID:25531769

  6. The influence of occupation and age on maximal and rapid lower extremity strength.

    PubMed

    Thompson, Brennan J; Ryan, Eric D; Sobolewski, Eric J

    2015-09-01

    The aims of this study were to 1) examine the influence of age and occupation on maximal and rapid strength of the lower-extremity muscles and 2) examine the relationship between maximal and rapid strength and physical workload (work index (WI)) in the blue-collar (BC) cohort. Peak torque (PT) and peak rate of torque development (peakRTD) of the leg extensors (LE), leg flexors (LF), and plantar flexors (PF) were assessed in 47 young (age = 24.1 ± 2.4 years) and 41 middle-aged (52.4 ± 5.2 years) white-collar (WC) and BC men. Middle-aged workers exhibited lower PT for all muscles, and peakRTD for the LF and PF muscles. A positive relationship (r = 0.59; P < 0.01) was observed between WI and peakRTD for the PF in the young BC workers, however, this relationship was negative (r = -0.45; P = 0.053) for the LF of the middle-aged BC workers. Lowering physical work demands and/or incorporating effective health-related practices for employees may be appealing strategies to enhance aging workers' productivity and longevity in the workforce. PMID:25959319

  7. Influences of trunk flexion on mechanical energy flow in the lower extremities during gait

    PubMed Central

    Takeda, Takuya; Anan, Masaya; Takahashi, Makoto; Ogata, Yuta; Tanimoto, Kenji; Shinkoda, Koichi

    2016-01-01

    [Purpose] The time-series waveforms of mechanical energy generation, absorption, and transfer through the joints indicate how movements are produced and controlled. Previous studies have used these waveforms to evaluate and describe the efficiency of human movements. The purpose of this study was to examine the influence of trunk flexion on mechanical energy flow in the lower extremities during gait. [Subjects and Methods] The subjects were 8 healthy young males (mean age, 21.8 ± 1.3 years, mean height, 170.5 ± 6.8 cm, and mean weight, 60.2 ± 6.8 kg). Subjects walked at a self-selected gait speed under 2 conditions: normal gait (condition N), and gait with trunk flexion formed with a brace to simulate spinal curvature (condition TF). The data collected from initial contact to the mid-stance of gait was analyzed. [Results] There were no significant differences between the 2 conditions in the mechanical energy flow in the knee joint and negative mechanical work in the knee joint. However, the positive mechanical work of the knee joint under condition TF was significantly less than that under condition N. [Conclusion] Trunk flexion led to knee flexion in a standing posture. Thus, a strategy of moving of center of mass upward by knee extension using less mechanical energy was selected during gait in the trunk flexed posture. PMID:27313351

  8. Precision and accuracy of 3D lower extremity residua measurement systems

    NASA Astrophysics Data System (ADS)

    Commean, Paul K.; Smith, Kirk E.; Vannier, Michael W.; Hildebolt, Charles F.; Pilgram, Thomas K.

    1996-04-01

    Accurate and reproducible geometric measurement of lower extremity residua is required for custom prosthetic socket design. We compared spiral x-ray computed tomography (SXCT) and 3D optical surface scanning (OSS) with caliper measurements and evaluated the precision and accuracy of each system. Spiral volumetric CT scanned surface and subsurface information was used to make external and internal measurements, and finite element models (FEMs). SXCT and OSS were used to measure lower limb residuum geometry of 13 below knee (BK) adult amputees. Six markers were placed on each subject's BK residuum and corresponding plaster casts and distance measurements were taken to determine precision and accuracy for each system. Solid models were created from spiral CT scan data sets with the prosthesis in situ under different loads using p-version finite element analysis (FEA). Tissue properties of the residuum were estimated iteratively and compared with values taken from the biomechanics literature. The OSS and SXCT measurements were precise within 1% in vivo and 0.5% on plaster casts, and accuracy was within 3.5% in vivo and 1% on plaster casts compared with caliper measures. Three-dimensional optical surface and SXCT imaging systems are feasible for capturing the comprehensive 3D surface geometry of BK residua, and provide distance measurements statistically equivalent to calipers. In addition, SXCT can readily distinguish internal soft tissue and bony structure of the residuum. FEM can be applied to determine tissue material properties interactively using inverse methods.

  9. Lower Extremity Joint Angle Tracking with Wireless Ultrasonic Sensors during a Squat Exercise

    PubMed Central

    Qi, Yongbin; Soh, Cheong Boon; Gunawan, Erry; Low, Kay-Soon; Thomas, Rijil

    2015-01-01

    This paper presents an unrestrained measurement system based on a wearable wireless ultrasonic sensor network to track the lower extremity joint and trunk kinematics during a squat exercise with only one ultrasonic sensor attached to the trunk. The system consists of an ultrasound transmitter (mobile) and multiple receivers (anchors) whose positions are known. The proposed system measures the horizontal and vertical displacement, together with known joint constraints, to estimate joint flexion/extension angles using an inverse kinematic model based on the damped least-squares technique. The performance of the proposed ultrasonic measurement system was validated against a camera-based tracking system on eight healthy subjects performing a planar squat exercise. Joint angles estimated from the ultrasonic system showed a root mean square error (RMSE) of 2.85° ± 0.57° with the reference system. Statistical analysis indicated great agreements between these two systems with a Pearson's correlation coefficient (PCC) value larger than 0.99 for all joint angles' estimation. These results show that the proposed ultrasonic measurement system is useful for applications, such as rehabilitation and sports. PMID:25915589

  10. Mechanical thromboprophylaxis is sufficient to prevent the lower extremity deep vein thrombosis after kidney transplantation

    PubMed Central

    Jun, Kang-Woong; Park, Keun-Myoung; Kim, Mi-Hyeong; Hwang, Jeong-Kye; Park, Soon-Chul; Moon, In-Sung; Chung, Byung-Ha; Choi, Bum-Soon; Yang, Chul-Woo; Kim, Yong-Soo

    2014-01-01

    Purpose Deep vein thrombosis (DVT) is a severe and common complication that occurs after the major operation. Despite the commonality of DVT there is limited data on the incidence of DVT after kidney transplantation (KT). Furthermore, most studies have been retrospective in design and were conducted in western countries. The aim of this study was to evaluate the incidence of lower extremity DVT with mechanical thromboprophylaxis within 1 month of KT in Korea. Methods A total of 187 consecutive patients who underwent KT were included in this study. Patients used a graduated elastic stocking (n = 93) or an intermittent pneumatic compression device (n = 94) to prevent DVT. The frequency of DVT during the first month after KT was evaluated using serial color duplex ultrasound on postoperative days 7 ± 2, 14 ± 2, and 28 ± 3. All patients were tested for eight thrombophilic factors before KT. Results DVT occurred in four patients (2.1%) during the first month after KT. All DVT developed in the graduated elastic stocking group. Interestingly, none of the patients had the factor V Leiden mutation or the prothrombin gene 20210A mutation. Conclusion The incidence of DVT in this study was relatively lower than that of western populations. We did not encounter a factor V Leiden mutation or a prothrombin gene 20210A mutation in our study population. These findings suggest that inherited thrombophilic risk factors may be partially responsible for the difference in DVT incidence rates between different nationalities and/or ethnicities. PMID:25025024

  11. Gender-based analysis of perioperative outcomes associated with lower extremity bypass.

    PubMed

    Jain, Ashish K; Velazquez-Ramirez, Gabriela; Goodney, Philip P; Edwards, Matthew S; Corriere, Matthew A

    2011-07-01

    We analyzed gender-based differences in preoperative factors, procedural characteristics, and 30-day outcomes after lower extremity bypass (LEB). LEB procedures were identified from the American College of Surgeons National Surgical Quality Improvement Program Participant User File. Groupwise comparisons of preoperative and procedural variables were made using chi square, t tests, and nonparametric methods; gender influences on mortality, systemic, and surgical site complications were evaluated using logistic regression. Women (4,107 of 11,011 [37.3%]) were older and had greater prevalence of hypertension, diabetes, chronic obstructive pulmonary disease, rest pain, dialysis, previous stroke, open/infected wound, and dependent functional status (P < 0.01 for all comparisons). Women more commonly underwent emergent and extra-anatomic procedures but had lower rates of venous conduit or tibial level outflow use. Univariable associations between female gender and risk of 30-day mortality, systemic, and surgical site complications were identified; only the association with surgical site complications remained significant in multivariable modeling (OR, 1.8; 95% CI, 1.6 to 2.1; P < 0.0001). Gender-based differences in demographic, comorbidity, and procedural factors may contribute to disparities in perioperative outcomes associated with LEB. Female gender may be associated with increased risk for surgical site complications, but 30-day mortality and systemic complication rates in women may reflect effects of confounding factors rather than gender-specific influence. PMID:21944345

  12. Validity of the lower extremity functional movement screen in patients with chronic ankle instability

    PubMed Central

    Choi, Ho-Suk; Shin, Won-Seob

    2015-01-01

    [Purpose] The purpose of this study was to provide evidence of construct validity for the lower extremity functional movement screen (LE-FMS) based on hypothesis testing in patients with chronic ankle instability (CAI). [Subjects] The subjects were 20 healthy subjects and 20 patients with CAI who had a history of ankle sprain with pain for more than 1 day. [Methods] All participants were measured using the Foot and Ankle Disability Index (FADI) and evaluated with the LE-FMS. The screen included the deep squat, the hurdle step (HS) and the in-line lunge (ILL). The symmetry ratios (RS) were accurately measured during the deep squat trial. [Results] Between the two groups, there were significant differences in scores on the LE-FMS, HS, ILL, RS, FADI, and FADI-sport. The FADI was strongly correlated with both LE-FMS score (r=0.807) and ILL score (r=0.896). There was a strong relationship (r=0.818) between LE-FMS score and FADI-sport. [Conclusion] These results suggest that the LE-FMS may be used to detect deficits related to CAI. Additionally, this instrument is reliable in detecting functional limitations in patients with CAI. PMID:26180349

  13. The effect of backpack heaviness on trunk-lower extremity muscle activities and trunk posture.

    PubMed

    Al-Khabbaz, Yusuf S S M; Shimada, Tomoaki; Hasegawa, Masashi

    2008-08-01

    The purpose of the present study is to analyze trunk-lower extremity muscle activities and trunk postural changes during the carriage of different backpacks. Nineteen male university students (21+/-3 years) participated in the experiment's four standing modes: (1) unloaded standing, (2) 10% body weight (BW) load (in the form of a backpack), (3) 15% BW load and (4) 20% BW load. Bilateral rectus abdominis, erector spinae, vastus medialis and biceps femoris muscle activities were recorded using surface electromyography (SEMG), while trunk inclination, side flexion and rotation were measured by using VICON 250 during all standing modes. The results showed that rectus abdominis muscle activities increased progressively and disproportionably as the backpack load increased. As for the trunk posture, almost the same backward inclination was adapted even with increasing backpack heaviness. Twenty percent BW backpack causes the most significant muscular and postural changes so it should be avoided. However, it is recommended to study other backpack factors such as frequency of usage, usage time, type of the backpack and age to come up with a complete usage recommendation. PMID:18329270

  14. The effect of increase in baggage weight on elderly women's lower extremity muscle activation during gait.

    PubMed

    Kim, Seong-Gil; Nam, Chan-Woo; Yong, Min-Sik

    2014-01-01

    The aim of the present study was to examine the effect of increased baggage weight on the muscle activation of elderly women's lower extremities during gait. A total of 24 elderly women who were residing in communities in Daegu, South Korea aged 79.6±6.2, 149.7±7.0cm in height, and 53.5±7.2kg in weight participated in this study. The muscle activation of each muscle was measured three times at 2kg, 3kg, and 4kg of baggage weight while the subjects were conducting treadmill walking wearing backpacks. Electrodes were placed on four muscles: the quadriceps muscle (rectus femoris), the hamstring muscle (semitendinosus), the tibialis anterior muscle, and the soleus muscle. The results show that the rates of increase in muscle activation in the tibialis anterior and soleus muscles according to baggage weight increase were higher than those in the quadriceps and hamstring muscles (<0.05). These results indicate that the heavier weight loads increase the activation of muscles that control the ankle joints causing muscle fatigue. Moreover, a decrease in balance ability through muscle fatigue can be a risk factor for falls. Thus, elderly people should be instructed not to carry heavy objects. PMID:25179442

  15. Lower extremity thrust and non-thrust joint mobilization for patellofemoral pain syndrome: a case report

    PubMed Central

    Simpson, Brad G; Simon, Corey B

    2014-01-01

    A 40-year old female presented to physical therapy with a one-year history of insidious right anteromedial and anterolateral knee pain. Additionally, the patient had a history of multiple lateral ankle sprains bilaterally, the last sprain occurring on the right ankle 1 year prior to the onset of knee pain. The patient was evaluated and given a physical therapy diagnosis of patellofemoral pain syndrome (PFPS), with associated talocrural and tibiofemoral joint hypomobility limiting ankle dorsiflexion and knee extension, respectively. Treatment included a high-velocity low amplitude thrust manipulation to the talocrural joint, which helped restore normal ankle dorsiflexion range of motion. The patient also received tibiofemoral joint non-thrust manual therapy to regain normal knee extension mobility prior to implementing further functional progression exercises to her home program (HEP). This case report highlights the importance of a detailed evaluation of knee and ankle joint mobility in patients presenting with anterior knee pain. Further, manual physical therapy to the lower extremity was found to be successful in restoring normal movement patterns and pain-free function in a patient with chronic anterior knee pain. PMID:24976753

  16. Lower extremity static and dynamic relationships with rearfoot motion in gait.

    PubMed

    Knutzen, K M; Price, A

    1994-04-01

    Twenty nonsymptomatic subjects were assessed while walking at a photoelectronically monitored place (2 +/- 0.1 m.s-1) using high speed cinematography (200 Hz) to record the rearfoot motion in the frontal plane, and electrogoniometry (100 Hz) to measure joint kinematics in the lower extremity. The foot type of the subjects was determined statically by using a podiascope and digitization techniques. The results demonstrated that no foot type variables contributed significantly to the variance in either rearfoot angle at foot strike or maximum rearfoot angle (p > 0.05). Regression equations were developed using kinematic variables: rearfoot angle at foot strike = 3.81 + (0.06*time to hip internal rotation) - (0.46*tibia internal rotation) + (0.14*plantarflexion); (R = 0.87, SE = 1.23 degrees); maximum rearfoot angle = 4.02 + (0.52*hip internal rotation) - (0.11*time to hip internal rotation); (R = 0.66, SE = 2.07 degrees). This study identifies hip joint movements as being the most significant contributors to prediction of rearfoot angles produced during walking. PMID:8201551

  17. Non traumatic lower extremity amputations in younger patients: an 11-year retrospective study.

    PubMed

    Chin, Jessica W S; Teague, Laura; McLaren, Ann-Marie; Mahoney, James L

    2013-02-01

    The purpose of this study was to assess morbidity and mortality in patients undergoing non traumatic lower extremity amputations ≤65 years to identify the specific needs of these younger patients. A retrospective study was conducted to determine the demographics, comorbidity and mortality with below-knee amputations and above-knee amputations from 1998 to 2008. A total of 203 amputations were performed on 176 patients who were ≤65 years. Major comorbidities and associated physical findings were peripheral vascular disease, diabetes, pain, gangrene, hypertension, ulcer, local wound infection and hypercholesterolemia. Compared to patients who were not deceased post-amputation, those deceased had a higher prevalence of diabetes, renal failure, coronary artery disease (CAD) and sepsis. Significant predictors of mortality were renal failure (hazard ratio [HR] = 4·19; 95% CI 1·96-8·93), CAD (HR = 3·33; 95% CI 1·42-7·81) and amputation site (above-knee) (HR = 3·26; 95% CI 1·51-7·04). This study showed that younger patients may benefit from an interdisciplinary approach in treating local foot ulcers aggressively and optimising their cardiovascular, renal and diabetic risk factors. PMID:22329536

  18. Kinematic characteristics of the lower extremity during a simulated skiing exercise in healthy participants

    PubMed Central

    Lee, Hyo Taek; Roh, Hyo Lyun; Kim, Yoon Sang

    2016-01-01

    [Purpose] Currently, various simulators are produced and used for athlete’s exercise, rehabilitation, and training. In this study, we analyzed the kinematic factors of sectional and total movements in healthy participants by providing group-dependent information during simulated exercise. [Subjects and Methods] Participants in this study included 26 male adults (non-experts and experts); experts held a certificate issued by the Korea Ski Instructors Association. The elapsed times in each phase, the difference in the lower extremity angles, and muscle activity were computed through analysis of kinematic factors. [Results] We observed that motions in the experts took shorter time to perform than that in non-experts, and showed larger variation of lower limb joint angle in most events during simulated skiing. There were also significant group-dependent differences in the peak and mean EMG values during simulated skiing. [Conclusion] A non-expert’s posture leads to enhanced muscle activity to keep the lower body in balance. We suggest the following training guideline: initially, non-experts should maintain appropriate range of motion with lower-intensity exercise to improve muscle endurance. It can be useful in providing preliminary data for future training and rehabilitation studies, as well as improvements in muscle strength and balance. PMID:27065554

  19. Histopathologic features of multiple cutaneous squamous cell carcinomas of the lower extremity.

    PubMed

    Munday, William R; Leffell, David J; McNiff, Jennifer M; Ko, Christine J

    2016-09-01

    Recent studies suggest cutaneous squamous cell carcinomas (SCCs) of the leg, particularly those occurring multiply in sun exposed skin of nonimmunosuppressed women, are a distinct clinical subtype. There are few reports of the histopathologic features of this subtype. A retrospective chart review of 4 patients with multiple SCCs on the leg was performed and a total of 35 biopsies from the legs examined. Histopathologically, the tumors lacked adjacent actinic keratosis (AK) and often had adjacent basaloid retiform proliferations. Most lesions (all but one) were well differentiated and about 40% could be classified histopathologically as keratoacanthoma. Perineural invasion was absent in all but one case. Using the American Joint Committee on Cancer (AJCC) staging criteria for SCC, 21 tumors were Stage I, and 9 Stage II. During 7-10 years of follow-up, no recurrence or metastasis occurred. Patients with multiple SCCs on the lower extremities can have a range of histopathologic features, from keratoacanthoma-like to well-differentiated SCC. PMID:27220356

  20. Use of the spider limb positioner in oncologic lower extremity surgery.

    PubMed

    Henderson, Eric R; Prioreschi, Brandon; Mata-Fink, Ana; Bell, John-Erik

    2014-11-01

    Orthopedic extremity surgery presents a unique set of restraints and difficulties relative to other surgical specialties. Among these is the positioning of heavy limbs in sometimes awkward positions for long periods of time. Ideal positioning of an extremity allows accurate and precise surgery to occur at otherwise difficult to access joints and proximal bones and soft tissues. Numerous solutions to this problem have been proposed, one such solution is the Smith and Nephew Spider Limb Positioning System. The table-mounted pneumatic arm features three fully articulating joints and a simple repositioning mechanism. Classic uses of the Spider Limb Positioner System include shoulder and elbow surgery, total knee replacement and ankle procedures. In our institution, the Spider Limb Positioner is used primarily for shoulder arthroscopy and total shoulder arthroplasty. In addition, we have had success using the system for orthopedic oncology cases. This manuscript addresses the conventional as well as unconventional uses implemented at our institution. Limb positioning in orthopedics provides a unique challenge for prepping, draping and surgery. The use of positioning aids can improve exposure, decrease contamination and reduce the risk of surgeon strain. Our institution has developed a solution to positioning of heavy lower limbs for hip disarticulation via the Smith and Nephew 'Spider'. This pneumatic, full articulating device used primarily for shoulder surgery can be modified to allow lower extremity use in the setting of hip disarticulation. This paper describes the standard and novel use of this device. PMID:25160588

  1. Kinematic characteristics of the lower extremity during a simulated skiing exercise in healthy participants.

    PubMed

    Lee, Hyo Taek; Roh, Hyo Lyun; Kim, Yoon Sang

    2016-01-01

    [Purpose] Currently, various simulators are produced and used for athlete's exercise, rehabilitation, and training. In this study, we analyzed the kinematic factors of sectional and total movements in healthy participants by providing group-dependent information during simulated exercise. [Subjects and Methods] Participants in this study included 26 male adults (non-experts and experts); experts held a certificate issued by the Korea Ski Instructors Association. The elapsed times in each phase, the difference in the lower extremity angles, and muscle activity were computed through analysis of kinematic factors. [Results] We observed that motions in the experts took shorter time to perform than that in non-experts, and showed larger variation of lower limb joint angle in most events during simulated skiing. There were also significant group-dependent differences in the peak and mean EMG values during simulated skiing. [Conclusion] A non-expert's posture leads to enhanced muscle activity to keep the lower body in balance. We suggest the following training guideline: initially, non-experts should maintain appropriate range of motion with lower-intensity exercise to improve muscle endurance. It can be useful in providing preliminary data for future training and rehabilitation studies, as well as improvements in muscle strength and balance. PMID:27065554

  2. Tissue mass ratios and the reporting of distal lower extremity injuries in varsity athletes at a Canadian University.

    PubMed

    Burkhart, Timothy A; Schinkel-Ivy, Alison; Andrews, David M

    2013-01-01

    The purpose of this preliminary investigation was to determine the relative role of the distal lower extremity tissue masses of varsity athletes in predicting distal lower extremity injury sustained during a competitive season. One hundred male and female varsity athletes (basketball, volleyball, soccer, cross country) completed a questionnaire on general health, physiological, and psychosocial variables, during each sport's respective training camp. A series of anthropometric measurements were used as inputs to distal lower extremity tissue mass prediction equations to calculate lean mass, fat mass, bone mineral content and wobbling mass (lean mass + fat mass) and tissue mass ratios. Athletes were monitored throughout their respective seasons and were instructed to report any distal lower extremity injuries to a certified athletic therapist who was responsible for assessing and confirming the reports. Logistic regression analyses were performed to determine which variables significantly predicted distal lower extremity injury. Mean leg fat mass:bone mass (OR = 1.6, CI = 1.0 - 2.5), and competition surface (rubber OR = 8.5, CI = 1.5 - 47.7; artificial turf OR = 4.0, CI = 0.77 - 22.9) were identified as significant predictors of injury. Overall, tibia bone injuries were significantly associated with the ratio of fat mass:bone mineral content and the surface on which the athletes compete. PMID:23215824

  3. Driving evaluation methods for able-bodied persons and individuals with lower extremity disabilities: a review of assessment modalities

    PubMed Central

    Greve, Julia Maria D'Andréa; Santos, Luciana; Alonso, Angelica Castilho; Tate, Denise G

    2015-01-01

    Assessing the driving abilities of individuals with disabilities is often a very challenging task because each medical condition is accompanied by physical impairments and because relative individual functional performance may vary depending on personal characteristics. We identified existing driving evaluation modalities for able-bodied and lower extremity-impaired subjects (spinal cord injury patients and amputees) and evaluated the potential relationships between driving performance and the motor component of driving. An extensive scoping review of the literature was conducted to identify driving assessment tools that are currently used for able-bodied individuals and for those with spinal cord injury or lower extremity amputation. The literature search focused on the assessment of the motor component of driving. References were electronically obtained via Medline from the PubMed, Ovid, Web of Science and Google Scholar databases. This article compares the current assessments of driving performance for those with lower extremity impairments with the assessments used for able-bodied persons. Very few articles were found concerning “Lower Extremity Disabilities,” thus confirming the need for further studies that can provide evidence and guidance for such assessments in the future. Little is known about the motor component of driving and its association with the other driving domains, such as vision and cognition. The available research demonstrates the need for a more evidenced-based understanding of how to best evaluate persons with lower extremity impairment. PMID:26375567

  4. Variation and Trends in Lower Extremity Amputation Rates in Los Angeles County Hospitals 2000-2010.

    PubMed

    Jindeel, Ayad; Gessert, Charles; Johnson, Brian P

    2016-09-01

    Lower extremity amputation (LEA) is a preventable complication of diabetes and peripheral vascular disease. Hospital-related factors associated with higher LEA are low hospital LEA revascularization volume, rural setting, and nonteaching status. In this study, we describe LEA rates in health care systems and hospitals in Los Angeles County from 2000 to 2010. Data on hospital discharges in Los Angeles County from 2000 to 2010 were obtained from the California Office of Statewide Health Planning and Development. LEA rates were adjusted for clinical and demographic variables including age, sex, race, source of health care payment, diabetes, and peripheral vascular disease. Adjusted LEA rates over the study period were analyzed by category of hospital (municipal, nonprofit/non-Kaiser, Kaiser, and private), and for changes in rates in each hospital over the study period. Over the 11-year study period the LEA rates increased for municipal hospitals, while decreasing for the other 3 categories of hospitals. Among the 84 hospitals included in the final analysis, 41 hospitals had higher than average relative risk for LEA in 2007-2010. Among these hospitals 12 had higher than average decline in LEA rate between 2000-2003 and 2007-2010. The other 29 hospitals had not lowered the LEA rate as much as the whole County over the study period. After adjusting for demographic and clinical variables, the relative risk for LEA among hospitals varied by 7.5-fold. Significant variability was found both within each of the 4 types of hospitals, and between the 4 types. Hospitals also varied in the degree that they lowered their LEA rates. This study demonstrated that health care systems and hospitals are associated with significant disparity in LEA rates among socioeconomic groups and geographical regions. PMID:27335119

  5. Trends in diabetes-related lower extremities amputations in Romania-A five year nationwide evaluation.

    PubMed

    Veresiu, Ioan Andrei; Iancu, Silvia Stefania; Bondor, Cosmina

    2015-08-01

    The aim of the study was to perform a nationwide evaluation of the frequency, incidence and trends of diabetes-related LEA (lower extremities amputations) in Romania. We have retrospectively analysed DRG data (ICD 10 AM codes) from all hospitals in the country, over a 5 year period (2006-2010). Knowing the shortcomings of this approach, we have assumed that our study can serve as a platform for future comparisons. The total number of non-traumatic diabetes related LEA procedures was 24,312, they were performed in 16,873 patients with diabetes, 22.55% with type 1 diabetes, 70.26 with type 2 diabetes and 7.19% with non-specified diabetes at discharge. The total number of hospital admissions for these patients was 46,985. During the five years of the study there was an increase in the absolute number of major amputations (above the ankle), as well as of minor amputations. The rate of amputations decreased in type 1 diabetes, from baseline (2006): -8.15% in 2007, -25.83% in 2008, -23.43% in 2009, -27.71% in 2010, whereas it increased in type 2 diabetes in the respective years: 16.96%, 60.75%, 66.91%, and 104.64%, due to an increase in minor amputations and mainly in elderly people. Male: female amputations rate was 2:1 in type 1 diabetes patients and 2.4:1 in type 2 diabetes patients. This study, the first of its kind in the Romanian population, offers a starting point for future comparisons and identifies a target for preventive measures. PMID:26044611

  6. Kinematic analysis of the lower extremities of subjects with flat feet at different gait speeds.

    PubMed

    Kim, Myoung-Kwon; Lee, Yun-Seop

    2013-05-01

    [Purpose] This study determined the difference between flat feet and normal feet of humans at different gait velocities using electromyography (EMG) and foot pressure analysis. [Subjects] This study was conducted on 30 adults having normal feet (N = 15) and flat feet (N = 15), all of whom were 21 to 30 years old and had no neurological history or gait problems. [Methods] A treadmill (AC5000M, SCIFIT, UK) was used to analyze kinematic features during gait. These features were analyzed at slow, normal, and fast gait velocities. A surface electromyogram (TeleMyo 2400T, Noraxon Co., USA) and a foot pressure analyzer (FSA, Vista Medical, Canada) were used to measure muscle activity changes and foot pressure, respectively. [Results] The activities of most muscles of the flat feet, except that of the rectus femoris, were significantly different from the muscle activities of the normal feet at different gait velocities. For example, there was a significant difference in the vastus medialis and abductor hallucis muscle. Likewise, flat feet and normal feet showed significant differences in pressures on the forefoot, midfoot, and medial area of the hindfoot at different gait velocities. Finally, comparison showed there were significant differences in pressures on the 2nd-3rd metatarsal area. [Conclusion] Because muscle activation has a tendency to increase with an increase in gait velocity, we hypothesized that the lower extremity with a flat foot requires more work to move due to the lack of a medial longitudinal arch, and consequently pressure was focused on the 2nd-3rd metatarsal area during the stance phase. PMID:24259795

  7. Kinematic Analysis of the Lower Extremities of Subjects with Flat Feet at Different Gait Speeds

    PubMed Central

    Kim, Myoung-Kwon; Lee, Yun-Seop

    2013-01-01

    [Purpose] This study determined the difference between flat feet and normal feet of humans at different gait velocities using electromyography (EMG) and foot pressure analysis. [Subjects] This study was conducted on 30 adults having normal feet (N = 15) and flat feet (N = 15), all of whom were 21 to 30 years old and had no neurological history or gait problems. [Methods] A treadmill (AC5000M, SCIFIT, UK) was used to analyze kinematic features during gait. These features were analyzed at slow, normal, and fast gait velocities. A surface electromyogram (TeleMyo 2400T, Noraxon Co., USA) and a foot pressure analyzer (FSA, Vista Medical, Canada) were used to measure muscle activity changes and foot pressure, respectively. [Results] The activities of most muscles of the flat feet, except that of the rectus femoris, were significantly different from the muscle activities of the normal feet at different gait velocities. For example, there was a significant difference in the vastus medialis and abductor hallucis muscle. Likewise, flat feet and normal feet showed significant differences in pressures on the forefoot, midfoot, and medial area of the hindfoot at different gait velocities. Finally, comparison showed there were significant differences in pressures on the 2nd–3rd metatarsal area. [Conclusion] Because muscle activation has a tendency to increase with an increase in gait velocity, we hypothesized that the lower extremity with a flat foot requires more work to move due to the lack of a medial longitudinal arch, and consequently pressure was focused on the 2nd–3rd metatarsal area during the stance phase. PMID:24259795

  8. Combined Direct and Indirect CT Venography (Combined CTV) in Detecting Lower Extremity Deep Vein Thrombosis

    PubMed Central

    Shi, Wan-Yin; Wang, Li-Wei; Wang, Shao-Juan; Yin, Xin-Dao; Gu, Jian-Ping

    2016-01-01

    Abstract This study aimed to evaluate the diagnostic accuracy of combined direct and indirect CT venography (combined CTV) in the detection of lower extremity deep vein thrombosis (LEDVT). The institutional review board approved the study protocol, and patients or qualifying family members provided informed consent. A total of 96 consecutive patients undergoing combined CTV were prospectively enrolled. A combined examination with digital subtraction angiography (DSA) plus duplex ultrasonography (US) was used as the criterion standard. Three observers were blinded to clinical, DSA, and US results, and they independently analyzed all combined CTV datasets. Interobserver agreement was expressed in terms of the Cohen k value for categorical variables. Accuracy, sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) of combined CTV in the detection of LEDVT were determined by using patient- and location-based evaluations. Of the 96 patients, DSA plus US revealed LEDVT in 125 segmental veins in 63 patients. Patient-based evaluation with combined CTV yielded an accuracy of 96.9% to 97.9%, a sensitivity of 95.2% to 96.8%, a specificity of 100% to 100%, a PPV of 100% to 100%, and an NPV of 91.7% to 94.3% in the detection of LEDVT. Location-based evaluation yielded similar results. Through combined direct and indirect CTV, patients obtained a combined CT angiogram on the diseased limb and an indirect CT angiogram on the opposite side. The image quality of combined CTV was superior to an indirect venogram. Combined CTV shows promising diagnostic accuracy in the detection of LEDVT with 3-dimensional modeling of the lower limb venous system. PMID:26986113

  9. Combined Direct and Indirect CT Venography (Combined CTV) in Detecting Lower Extremity Deep Vein Thrombosis.

    PubMed

    Shi, Wan-Yin; Wang, Li-Wei; Wang, Shao-Juan; Yin, Xin-Dao; Gu, Jian-Ping

    2016-03-01

    This study aimed to evaluate the diagnostic accuracy of combined direct and indirect CT venography (combined CTV) in the detection of lower extremity deep vein thrombosis (LEDVT). The institutional review board approved the study protocol, and patients or qualifying family members provided informed consent. A total of 96 consecutive patients undergoing combined CTV were prospectively enrolled. A combined examination with digital subtraction angiography (DSA) plus duplex ultrasonography (US) was used as the criterion standard. Three observers were blinded to clinical, DSA, and US results, and they independently analyzed all combined CTV datasets. Interobserver agreement was expressed in terms of the Cohen k value for categorical variables. Accuracy, sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) of combined CTV in the detection of LEDVT were determined by using patient- and location-based evaluations. Of the 96 patients, DSA plus US revealed LEDVT in 125 segmental veins in 63 patients. Patient-based evaluation with combined CTV yielded an accuracy of 96.9% to 97.9%, a sensitivity of 95.2% to 96.8%, a specificity of 100% to 100%, a PPV of 100% to 100%, and an NPV of 91.7% to 94.3% in the detection of LEDVT. Location-based evaluation yielded similar results. Through combined direct and indirect CTV, patients obtained a combined CT angiogram on the diseased limb and an indirect CT angiogram on the opposite side. The image quality of combined CTV was superior to an indirect venogram. Combined CTV shows promising diagnostic accuracy in the detection of LEDVT with 3-dimensional modeling of the lower limb venous system. PMID:26986113

  10. The impact of diabetes on postoperative outcomes following lower-extremity bypass surgery

    PubMed Central

    Wallaert, Jessica B.; Nolan, Brian W.; Adams, Julie; Stanley, Andrew C.; Eldrup-Jorgensen, Jens; Cronenwett, Jack L.; Goodney, Philip P.

    2013-01-01

    Objective The effect of diabetes type (noninsulin dependent vs insulin dependent) on outcomes after lower-extremity bypass (LEB) has not been clearly defined. Therefore, we analyzed associations between diabetes type and outcomes after LEB in patients with critical limb ischemia. Methods We performed a retrospective analysis of 1977 infrainguinal LEB operations done for critical limb ischemia between 2003 and 2010 within the Vascular Study Group of New England. Patients were categorized as nondiabetic (ND), noninsulin-dependent diabetic (NIDD), or insulin-dependent diabetic (IDD) based on their preoperative medication regimen. Our main outcome measures were in-hospital mortality and major adverse events (MAEs) – a composite outcome, including myocardial infarction, dysrhythmia, congestive heart failure, wound infection, renal insufficiency, and major amputation. We compared crude and adjusted rates of mortality and MAEs using logistic regression across diabetes categories. Results Overall, 41% of patients were ND, 28% were NIDD, and 31% were IDD. Crude rates of in-hospital mortality were similar across these groups (1.7% vs 3.1% vs 2.1%; P = .211). Adjusted analyses accounting for differences in patient characteristics showed that diabetes is not associated with increased risk of in-hospital mortality. However, type of diabetes was associated with a higher risk of MAEs in both crude (15.1% for ND; 21.1% for NIDD; and 25.2% for IDD; P <.001) and adjusted analyses (odds ratio for NIDD, 1.41; 95% confidence interval, 1.2–1.7; odds ratio for IDD, 1.53; 95% confidence interval, 1.3–1.8). Conclusions Diabetes is a significant contributor to the risk of postoperative complications after LEB surgery, and insulin dependence is associated with higher risk. Quality measures aimed at limiting complications after LEB may have the most impact if these initiatives are focused on patients who are IDD. PMID:22819754

  11. Temperature Changes in Deep Muscles of Humans During Upper and Lower Extremity Exercise

    PubMed Central

    Wirth, Valerie J.; Van Lunen, Bonnie L.; Mistry, Dilaawar; Saliba, Ethan; McCue, Frank C.

    1998-01-01

    Objective: To examine the effect of 15 minutes of upper and lower extremity exercise on raising intramuscular temperature in the triceps surae to 39 ° C to 45 ° C (the therapeutic range). Design and Setting: Intramuscular temperature was measured 5 cm deep in the triceps surae using a 23-gauge thermistor needle microprobe connected to a monitor. Each subject was tested under 3 conditions: 15 minutes of rest, 15 minutes of jogging on a treadmill, and 15 minutes of handpedaling an upper-body ergometer. Exercise bouts were performed at 70% of each subject's maximum heart rate. Subjects: Six males, either sedentary or recreational athletes (age = 21.3 ± 2.9 years; ht = 176.8 ± 6.0 cm; wt = 72.7 ± 11.6 kg; resting heart rate = 57.8 ± 6.74 bpm; target heart rate = 156.5 ± 3.0 bpm), volunteered to participate in this experiment. Measurements: Intramuscular temperature was measured at a depth of 5 cm before and after each test condition. Results: Data analyses consisted of analyses of variance with repeated measures and a Tukey post hoc test (P < .05). The results showed a significant temperature increase over baseline after exercise on the treadmill (2.2 ° C ± 0.63 ° C); however, it did not yield temperature increases ≥ 39 ° C. No significant temperature change occurred after exercise on the upper-body ergometer (-0.45 ° C ± 0.80 ° C). Conclusions: Active exercise increased intramuscular temperature in working muscles but did not affect intramuscular temperature in nonworking muscles. In addition, 15 minutes of jogging on a treadmill at 70% of maximum heart rate was not sufficient to raise intramuscular temperature to 39 ° C to 45 ° C. ImagesFigure 1.Figure 2. PMID:16558512

  12. Spectral Clustering for Unsupervised Segmentation of Lower Extremity Wound Beds Using Optical Images.

    PubMed

    Dhane, Dhiraj Manohar; Krishna, Vishal; Achar, Arun; Bar, Chittaranjan; Sanyal, Kunal; Chakraborty, Chandan

    2016-09-01

    Chronic lower extremity wound is a complicated disease condition of localized injury to skin and its tissues which have plagued many elders worldwide. The ulcer assessment and management is expensive and is burden on health establishment. Currently accurate wound evaluation remains a tedious task as it rely on visual inspection. This paper propose a new method for wound-area detection, using images digitally captured by a hand-held, optical camera. The strategy proposed involves spectral approach for clustering, based on the affinity matrix. The spectral clustering (SC) involves construction of similarity matrix of Laplacian based on Ng-Jorden-Weiss algorithm. Starting with a quadratic method, wound photographs were pre-processed for color homogenization. The first-order statistics filter was then applied to extract spurious regions. The filter was selected based on the performance, evaluated on four quality metrics. Then, the spectral method was used on the filtered images for effective segmentation. The segmented regions were post-processed using morphological operators. The performance of spectral segmentation was confirmed by ground-truth pictures labeled by dermatologists. The SC results were additionally compared with the results of k-means and Fuzzy C-Means (FCM) clustering algorithms. The SC approach on a set of 105 images, effectively delineated targeted wound beds yielding a segmentation accuracy of 86.73 %, positive predictive values of 91.80 %, and a sensitivity of 89.54 %. This approach shows the robustness of tool for ulcer perimeter measurement and healing progression. The article elucidates its potential to be incorporated in patient facing medical systems targeting a rapid clinical assistance. PMID:27520612

  13. Lower Extremity Strength and Power Are Associated With 400-Meter Walk Time in Older Adults: The InCHIANTI Study

    PubMed Central

    Marsh, Anthony P.; Miller, Michael E.; Saikin, Aaron M.; Rejeski, W. Jack; Hu, Nan; Lauretani, Fulvio; Bandinelli, Stefania; Guralnik, Jack M.; Ferrucci, Luigi

    2009-01-01

    Background It has been suggested that lower extremity muscle power is more important for physical function in older adults compared to strength, and that there is a nonlinear relationship between power or strength and physical function that might be indicative of a threshold above which the association between muscle function and physical function is no longer evident. This study examined the association between lower extremity strength or power with the time to complete a 400-meter walk, and attempted to identify thresholds within the relationship. Methods A cross-sectional analysis of a sample of 384 females and 336 males aged ≥ 65 years from the InCHIANTI study (“Invecchiare in Chianti,” i.e., Aging in the Chianti Area) was conducted. Measures included 400-meter walk time, lower extremity strength and power, comorbidities, and sociodemographic variables (age, gender, height, education, cognitive function, depression). Results Linear regression models showed that both lower extremity strength and power were significant predictors of 400-meter walk time, although power explained marginally more of the variance in 400-meter walk time. Quadratic models of lower extremity strength and power fit the data slightly better than the linear models. Regardless of gender, comorbidities, or normalization scheme for strength and power, the curvilinear form of the relationship between strength or power and 400-meter walk time remained the same. Conclusions Lower extremity muscle strength and power are both important predictors of the 400-meter walk time. Although curvilinear relationships existed between muscle strength and power and the 400-meter walk time, the data do not indicate a clear threshold for either strength or power above which the performance in the 400-meter walk test plateaus. PMID:17167161

  14. Late Lower Extremity Ischemia due to Thrombi in an Occluded Graft after Axillary-Femoral Artery Bypass

    PubMed Central

    Nishizaki, Kazuhiko; Yasukawa, Motoaki; Seki, Toshio

    2013-01-01

    We experienced a rare case of acute ischemia of the lower extremity due to embolism caused by an occluded prosthetic graft late after axillary-femoral artery bypass. A 67-year-old woman developed acute right lower extremity ischemia 7 years after axillary-femoral artery bypass, which had been performed for lower limb ischemia as a complication of acute aortic dissection (Stanford B). The graft was occluded, and the native vessel had re-canalized by the time of the present admission. She was successfully treated by disconnection of the graft followed by revascularization. PMID:23641293

  15. The Role of Limb Torque, Muscle Action and Proprioception During Closed Kinetic Chain Rehabilitation of The Lower Extremity

    PubMed Central

    Bunton, Edwin E.; Pitney, William A.; Cappaert, Thomas A.; Kane, Alexander W.

    1993-01-01

    This paper defines the differences between open and closed kinetic chain exercise and explains the role of limb torque, muscle action, and proprioception during rehabilitation of the lower extremity. Closed kinetic chain rehabilitation is shown to decrease shear forces, increase proprioception, and increase muscle group coordination through examples of progressive exercises. The authors conclude that closed kinetic chain rehabilitation is an economical, efficient, and effective means of rehabilitation, with the ultimate goal of enhancing proprioception, thus gaining lower extremity joint stability. ImagesFig 9a-b.Fig 1.Fig 2.Fig 3a-b.Fig 4a-b.Fig 5.Fig 6.Fig 7.Fig 8. PMID:16558197

  16. Foot, leg, and ankle swelling

    MedlinePlus

    Swelling of the ankles - feet - legs; Ankle swelling; Foot swelling; Leg swelling; Edema - peripheral; Peripheral edema ... Foot, leg, and ankle swelling is common when the person also: Is overweight Has a blood clot in the leg Is older Has ...

  17. Predictors of Patient Reported Pain After Lower Extremity Nonunion Surgery: The Nicotine Effect

    PubMed Central

    Christiano, Anthony V.; Pean, Christian A.; Konda, Sanjit R.; Egol, Kenneth A.

    2016-01-01

    (p=0.004) postoperatively. Conclusion Healed patients have improved pain levels after lower extremity nonunion surgery. Orthopedic surgeons should stress smoking cessation programs and minimize delay to nonunion surgery, in order to maximize pain relief in this patient cohort. PMID:27528836

  18. Lower Extremity Biomechanical Relationships with Different Speeds in Traditional, Minimalist, and Barefoot Footwear

    PubMed Central

    Fredericks, William; Swank, Seth; Teisberg, Madeline; Hampton, Bethany; Ridpath, Lance; Hanna, Jandy B.

    2015-01-01

    Minimalist running footwear has grown increasingly popular. Prior studies that have compared lower extremity biomechanics in minimalist running to traditional running conditions are largely limited to a single running velocity. This study compares the effects of running at various speeds on foot strike pattern, stride length, knee angles and ankle angles in traditional, barefoot, and minimalist running conditions. Twenty-six recreational runners (19-46 years of age) ran on a treadmill at a range of speeds (2.5-4.0 m·sec-1). Subjects ran with four different footwear conditions: personal, standard, and minimalist shoes and barefoot. 3D coordinates from video data were collected. The relationships between speed, knee and ankle angles at foot strike and toe-off, relative step length, and footwear conditions were evaluated by ANCOVA, with speed as the co-variate. Distribution of non-rearfoot strike was compared across shod conditions with paired t-tests. Non-rearfoot strike distribution was not significantly affected by speed, but was different between shod conditions (p < 0.05). Footwear condition and speed significantly affected ankle angle at touchdown, independent of one another (F [3,71] = 10.28, p < 0.001), with barefoot and minimalist running exhibiting greater plantarflexion at foot strike. When controlling for foot strike style, barefoot and minimalist runners exhibited greater plantarflexion than other conditions (p < 0.05). Ankle angle at lift-off and relative step length exhibited a significant interaction between speed and shod condition. Knee angles had a significant relationship with speed, but not with footwear. There is a clear influence of footwear, but not speed, on foot strike pattern. Additionally, speed and footwear predict ankle angles (greater plantarflexion at foot strike) and may have implications for minimalist runners and their risk of injury. Long-term studies utilizing various speeds and habituation times are needed. Key points Foot strike

  19. Lower extremity vascular injuries: Increased mortality for minorities and the uninsured?

    PubMed Central

    Crandall, Marie; Sharp, Douglas; Brasel, Karen; Carnethon, Mercedes; Haider, Adil; Esposito, Thomas

    2012-01-01

    Background There is increasing evidence to suggest that racial disparities exist in outcomes for trauma. Minorities and the uninsured have been found to have higher mortality rates for blunt and penetrating trauma. However, mechanisms for these disparities are incompletely understood. Limiting the inquiry to a homogenous group, those with lower extremity vascular injuries (LEVIs), may clarify these disparities. Methods The National Trauma Data Bank (NTDB; version 7.0, American College of Surgeons) was used for this study. LEVIs were identified using codes from the International Classification of Diseases, 9th revision. Univariate and multivariate analyses were performed using Stata software (version 11; StataCorp, LP, College Station, TX). Results Records were reviewed for 4,928 LEVI patients. The mechanism of injury was blunt in 2,452 (49.8%), penetrating in 2,452 (49.8%), and unknown in 24 cases (0.5%). Mortality was similar by mechanism (7.6% overall). Regression analysis using mechanism as a covariate revealed a significantly worse mortality for people of color (POC; odds ratio [OR], 1.45; 95% confidence interval [CI], 1.03-2.02; P = .03) and the uninsured (UN; OR, 1.62; 95% CI, 1.15-2.23; P = .006). However, when separate analyses were performed stratifying by mechanism, no significant mortality disparities were found for blunt trauma (POC OR, 1.28; 95% CI, 0.85-1.96; P = .23; UN OR, 1.33; 95% CI, 0.78-2.22; P = .29), but disparities remained for penetrating trauma (POC OR, 1.81; 95% CI, 0.93-3.57; P = .08; UN OR, 1.85; 95% CI, 1.18-2.94; P = .009). Conclusion For patients with LEVI, mortality disparities based on race or insurance status were only observed for penetrating trauma. It is possible that injury heterogeneity or patient cohort differences may partly explain mortality disparities that have been observed between racial and socioeconomic groups. (Surgery 2011;150:656-64.) PMID:22000177

  20. A Refined Prediction Model for Core and Lower Extremity Sprains and Strains Among Collegiate Football Players

    PubMed Central

    Wilkerson, Gary B.; Colston, Marisa A.

    2015-01-01

    Context Researchers have identified high exposure to game conditions, low back dysfunction, and poor endurance of the core musculature as strong predictors for the occurrence of sprains and strains among collegiate football players. Objective To refine a previously developed injury-prediction model through analysis of 3 consecutive seasons of data. Design Cohort study. Setting National Collegiate Athletic Association Division I Football Championship Subdivision football program. Patients or Other Participants For 3 consecutive years, all 152 team members (age = 19.7 ± 1.5 years, height = 1.84 ± 0.08 m, mass = 101.08 ± 19.28 kg) presented for a mandatory physical examination on the day before initiation of preseason practice sessions. Main Outcome Measure(s) Associations between preseason measurements and the subsequent occurrence of a core or lower extremity sprain or strain were established for 256 player-seasons of data. We used receiver operating characteristic analysis to identify optimal cut points for dichotomous categorizations of cases as high risk or low risk. Both logistic regression and Cox regression analyses were used to identify a multivariable injury-prediction model with optimal discriminatory power. Results Exceptionally good discrimination between injured and uninjured cases was found for a 3-factor prediction model that included equal to or greater than 1 game as a starter, Oswestry Disability Index score equal to or greater than 4, and poor wall-sit–hold performance. The existence of at least 2 of the 3 risk factors demonstrated 56% sensitivity, 80% specificity, an odds ratio of 5.28 (90% confidence interval = 3.31, 8.44), and a hazard ratio of 2.97 (90% confidence interval = 2.14, 4.12). Conclusions High exposure to game conditions was the dominant injury risk factor for collegiate football players, but a surprisingly mild degree of low back dysfunction and poor core-muscle endurance appeared to be important modifiable risk factors that

  1. Use of acellular dermal replacement in reconstruction of nonhealing lower extremity wounds.

    PubMed

    Kahn, Steven Alexander; Beers, Ryan J; Lentz, Christopher W

    2011-01-01

    Dermal templates are well established in the treatment of burn wounds and acute nonburn wounds. However, the literature regarding their use for reconstruction of chronic, nonhealing wounds is limited. This study describes a series of patients with chronic wounds reconstructed with a commercially available bilayer, acellular dermal replacement (ADR) containing a collagen-glycosaminoglycan dermal template and a silicone outer layer. A retrospective review was performed of 10 patients treated for chronic wounds with ADR and negative pressure dressing followed by split-thickness skin graft between July 2006 and January 2009. Data collected included age, gender, comorbidities, medications, wound type or location, wound size, the number of applications of ADR, the amount of ADR applied (in square centimeter), the amount of time between ADR placement and grafting, complications, need for reoperation, and percentage of graft take after 5 and 14 days. The mean age of study subjects was 44 years. All patients in the study had comorbidities that interfere with wound healing and were treated for lower extremity wounds (four to legs, five to ankles, and one to foot). The wounds had a variety of causative factors including venostasis ulcers (6, 60%), trauma in diabetic patients (2, 20%), brown recluse bite (1, 10%), and a wound caused from purpura fulminans (1, 10%). The average wound size and amount of ADR applied was 162±182 cm². Each patient required only one application of ADR. The average time between ADR placement and skin grafting was 36.5 days. The mean percentage of graft take at 5 days was 89.55%, 14 days was 90%, and 21 days was 87.3%. Only two patients required regrafting, and one of these grafts was lost because of patient noncompliance. ADR can be used successfully in the treatment of chronic wounds. ADR provides direct wound coverage and can conform to a variety of anatomical sites. This study demonstrates that the use of ADR in treating chronic wounds results

  2. Lower extremity biomechanical relationships with different speeds in traditional, minimalist, and barefoot footwear.

    PubMed

    Fredericks, William; Swank, Seth; Teisberg, Madeline; Hampton, Bethany; Ridpath, Lance; Hanna, Jandy B

    2015-06-01

    Minimalist running footwear has grown increasingly popular. Prior studies that have compared lower extremity biomechanics in minimalist running to traditional running conditions are largely limited to a single running velocity. This study compares the effects of running at various speeds on foot strike pattern, stride length, knee angles and ankle angles in traditional, barefoot, and minimalist running conditions. Twenty-six recreational runners (19-46 years of age) ran on a treadmill at a range of speeds (2.5-4.0 m·sec(-1)). Subjects ran with four different footwear conditions: personal, standard, and minimalist shoes and barefoot. 3D coordinates from video data were collected. The relationships between speed, knee and ankle angles at foot strike and toe-off, relative step length, and footwear conditions were evaluated by ANCOVA, with speed as the co-variate. Distribution of non-rearfoot strike was compared across shod conditions with paired t-tests. Non-rearfoot strike distribution was not significantly affected by speed, but was different between shod conditions (p < 0.05). Footwear condition and speed significantly affected ankle angle at touchdown, independent of one another (F [3,71] = 10.28, p < 0.001), with barefoot and minimalist running exhibiting greater plantarflexion at foot strike. When controlling for foot strike style, barefoot and minimalist runners exhibited greater plantarflexion than other conditions (p < 0.05). Ankle angle at lift-off and relative step length exhibited a significant interaction between speed and shod condition. Knee angles had a significant relationship with speed, but not with footwear. There is a clear influence of footwear, but not speed, on foot strike pattern. Additionally, speed and footwear predict ankle angles (greater plantarflexion at foot strike) and may have implications for minimalist runners and their risk of injury. Long-term studies utilizing various speeds and habituation times are needed. Key points

  3. [Efficacy of oral drug Thrombovasim® in therapy of lower extremity deep vein thromboses].

    PubMed

    Mishenina, S V; Madonov, P G; Kinsht, D N; Émedova, T A; Zotov, S P; Ufimtsev, M S; Leont'ev, S G

    2016-01-01

    Within the framework of the multicenter randomized placebo-controlled double-blind clinical trial "VETTER-1" the authors carried out assessment of therapeutic efficacy and safety of oral drug Thrombovasim® possessing a thrombolytic effect in comprehensive treatment of lower-extremity deep vein thrombosis (LEDVT). The clinical study comprised a total of 154 patients. All patients received standard therapy accepted in LEDVT. The patients were subdivided into 4 groups. Patients from the three study groups received Thrombovasim® at a daily dose of 1,600, 3,200, and 4,800 IU. The control group patients were given placebo. Efficacy was assessed by the results of ultrasound duplex scanning first performed before treatment commenced and then after it terminated. The relative frequency of positive dynamics according to the findings of instrumental methods of study in patients taking Thrombovasim® amounted to 0.728 and in the group of patients receiving placebo to 0.585, p=0.0031. Comparing the degree of blood flow normalization in the zone of the compromised blood flow revealed a pronounced dose-dependent effect: in patients taking the drug at a daily dose of 1,600 IU, the relative frequency of positive dynamics amounted to 0.707 corresponding to an increase in therapeutic efficacy by 21%, for a dose of 3,200 IU these parameters amounted to 0.0257 and 24% and for 4,800 IU - 0.747 and 28%, respectively. In patients taking Thrombovasim® there were no cases of negative dynamics observed. Of the patients taking Thrombovasim®, none developed undesirable or severe adverse events. Inclusion of Thrombovasim® into the composition of comprehensive therapy for LEDVT increases efficacy of treatment at the expense of a spontaneous thrombolytic effect. The most effective dose amounted to 4,800 IU daily. Thrombovasim® turned out to be an efficient and safe agent in treatment of venous thromboses. PMID:27626255

  4. C1 Esterase Inhibitor Reduces Lower Extremity Ischemia/Reperfusion Injury and Associated Lung Damage

    PubMed Central

    Duehrkop, Claudia; Banz, Yara; Spirig, Rolf; Miescher, Sylvia; Nolte, Marc W.; Spycher, Martin; Smith, Richard A. G.; Sacks, Steven H.; Rieben, Robert

    2013-01-01

    Background Ischemia/reperfusion injury of lower extremities and associated lung damage may result from thrombotic occlusion, embolism, trauma, or surgical intervention with prolonged ischemia and subsequent restoration of blood flow. This clinical entity is characterized by high morbidity and mortality. Deprivation of blood supply leads to molecular and structural changes in the affected tissue. Upon reperfusion inflammatory cascades are activated causing tissue injury. We therefore tested preoperative treatment for prevention of reperfusion injury by using C1 esterase inhibitor (C1 INH). Methods and Findings Wistar rats systemically pretreated with C1 INH (n = 6), APT070 (a membrane-targeted myristoylated peptidyl construct derived from human complement receptor 1, n = 4), vehicle (n = 7), or NaCl (n = 8) were subjected to 3h hind limb ischemia and 24h reperfusion. The femoral artery was clamped and a tourniquet placed under maintenance of a venous return. C1 INH treated rats showed significantly less edema in muscle (P<0.001) and lung and improved muscle viability (P<0.001) compared to controls and APT070. C1 INH prevented up-regulation of bradykinin receptor b1 (P<0.05) and VE-cadherin (P<0.01), reduced apoptosis (P<0.001) and fibrin deposition (P<0.01) and decreased plasma levels of pro-inflammatory cytokines, whereas deposition of complement components was not significantly reduced in the reperfused muscle. Conclusions C1 INH reduced edema formation locally in reperfused muscle as well as in lung, and improved muscle viability. C1 INH did not primarily act via inhibition of the complement system, but via the kinin and coagulation cascade. APT070 did not show beneficial effects in this model, despite potent inhibition of complement activation. Taken together, C1 INH might be a promising therapy to reduce peripheral ischemia/reperfusion injury and distant lung damage in complex and prolonged surgical interventions requiring tourniquet application

  5. Fast gaze reorientations by combined movements of the eye, head, trunk and lower extremities.

    PubMed

    Anastasopoulos, Dimitri; Naushahi, J; Sklavos, Sokratis; Bronstein, Adolfo M

    2015-05-01

    Large reorientations of the line of sight, involving combined rotations of the eyes, head, trunk and lower extremities, are executed either as fast single-step or as slow multiple-step gaze transfers. In order to obtain more insight into the mechanisms of gaze and multisegmental movement control, we have investigated time-optimal gaze shifts (i.e. with the instruction to move as fast as possible) during voluntary whole-body rotations to remembered targets up to 180° eccentricity performed by standing healthy humans in darkness. Fast, accurate, single-step movement patterns occurred in approximately 70 % of trials, i.e. considerably more frequently than in previous studies with the instruction to turn at freely chosen speed (30 %). Head-in-space velocity in these cases was significantly higher than during multiple-step transfers and displayed a conspicuously regular bell-shaped profile, increasing smoothly to a peak and then decreasing slowly until realignment with the target. Head-in-space acceleration was on average not different during reorientations to the different target eccentricities. In contrast, head-in-space velocity increased with target eccentricity due to the longer duration of the acceleration phase implemented during trials to more distant targets. Eye saccade amplitude approached the eye-in-orbit mechanical limit and was unrelated to eye/head velocity, duration or target eccentricity. Overall, the combined movement was stereotyped such that the first two principal components accounted for data variance almost up to gaze shift end, suggesting that the three mechanical degrees of freedom under consideration (eye-in-orbit, head-on-trunk and trunk-in-space) are on average reduced to two kinematic degrees of freedom (i.e. eye, head-in-space). Synchronous EMG activity in the anterior tibial and gastrocnemius muscles preceded the onset of eye rotation. Since the magnitude and timing of peak head-in-space velocity were scaled with target eccentricity and

  6. LOWER EXTREMITY HYPERMOBILITY, BUT NOT CORE MUSCLE ENDURANCE INFLUENCES BALANCE IN FEMALE COLLEGIATE DANCERS

    PubMed Central

    Cortes, Nelson; Caswell, Shane V.; Ambegaonkar, Gautam P.; Wyon, Matthew

    2016-01-01

    Background Dance is a physically demanding activity, with almost 70% of all injuries in dancers occurring in the lower extremity (LE). Prior researchers report that muscle function (e.g. muscle endurance) and anatomical factors (e.g. hypermobility) affect physical performance (e.g. balance) and can subsequently influence LE injury risk. Specifically, lesser core muscle endurance, balance deficits, and greater hypermobility are related to increased LE injury risk. However, the potentials interrelationships among these factors in dancers remain unclear. Purpose The purposes of this study were to examine the relationships among core muscle endurance, balance, and LE hypermobility, and determine the relative contributions of core muscle endurance and LE hypermobility as predictors of balance in female collegiate dancers. Study Design Cross-sectional Methods Core muscle endurance was evaluated using the combined average anterior, left, and right lateral plank test time scores(s). LE hypermobility was measured using the LE-specific Beighton hypermobility measure, defining hypermobility if both legs had greater than 10 ° knee hyperextension. Balance was measured via the composite anterior, posterolateral, and posteromedial Star Excursion Balance Test (SEBT) reach distances (normalized to leg length) in 15 female healthy collegiate dancers (18.3 + 0.5yrs, 165.5 + 6.9cm, 63.7 + 12.1kg). Point-biserial-correlation-coefficients examined relationships and a linear regression examined whether core endurance and hypermobility predicted balance (p<.05). Results LE hypermobility (Yes; n = 3, No; n = 12) and balance (87.2 + 8.3% leg length) were positively correlated r(14)=.67, (p=.01). However, core endurance (103.9 + 50.6 s) and balance were not correlated r(14)=.32, (p=.26). LE hypermobility status predicted 36.9% of the variance in balance scores (p=.01). Conclusion LE hypermobility, but not core muscle endurance may be related to balance in female

  7. Abdominal and lower-extremity compression decreases symptoms of postural tachycardia syndrome in youth during tilt table testing.

    PubMed

    Heyer, Geoffrey L

    2014-08-01

    Little is known about the effectiveness of abdominal and lower-extremity compression in treating postural tachycardia syndrome, particularly in younger patients. This repeated-measures study of 20 young patients with postural tachycardia syndrome demonstrates that compression during head-upright tilt table testing decreases tachycardia (P<.001) and effectively attenuates orthostatic symptoms. PMID:24840763

  8. Outcomes of catheter-directed treatment of lower extremity deep vein thrombosis of patients presenting to a tertiary care hospital

    PubMed Central

    Sundar, Gaurav; Keshava, Shyamkumar N; Moses, Vinu; Chiramel, George K; Ahmed, Munawwar; Mammen, Suraj; Aggarwal, Sunil; Stephen, Edwin

    2016-01-01

    Background: Lower extremity deep vein thrombosis (DVT) is a common illness with an annual incidence of 1 per 1000 adults. The major long-term complication of DVT is post-thrombotic syndrome (PTS) which occurs in up to 60% of patients within 2 years of an episode of DVT. Aims: We aim to evaluate the outcomes of catheter-directed treatment (CDT) for symptomatic acute or subacute lower extremity DVT. Materials and Methods: A retrospective 12-year study was conducted on the outcomes of CDT on 54 consecutive patients who presented with acute or subacute lower extremity DVT to our hospital. Statistical Analysis: Descriptive summary statistics and the Chi-square test were used to measure the outcomes of CDT. Results: Grade 3 thrombolysis was achieved in 25 (46.3%) patients, grade 2 thrombolysis in 25 (46.3%) patients, and grade 1 thrombolysis in 4 (7.4%) patients. Significant recanalization (grade 2 or 3 thrombolysis) was possible in 50 (92.6%) patients. There was no statistically significant difference in the percentage of significant recanalization that could be achieved between patients who underwent CDT before and after 10 days. There was no significant difference between the thrombolysis achieved between urokinase and r-tPA. PTS was seen in 33% of the patients. Major complications were seen in 5.5% of the patients. Conclusion: CDT is a safe and effective therapeutic technique in patients with acute and subacute lower extremity DVT, if appropriate patient selection is made. PMID:27081228

  9. Guideline for the management of wounds in patients with lower-extremity neuropathic disease: an executive summary.

    PubMed

    Crawford, Penny Ellen; Fields-Varnado, Myra

    2013-01-01

    This article summarizes the WOCN Evidence-Based Clinical Practice Guideline for Management of Wounds in Patients with Lower Extremity Neuropathic Disease. It is intended for use by physicians, nurses, therapists, and other health care professionals who work with adults who have or are at risk for, lower-extremity neuropathic disease (LEND), and includes updated scientific literature available from January 2003 through February 2012. The full guideline contains definitions of lower extremity neuropathic disorders and disease, prevalence of the problem, relevance and significance of the disorders, as well as comprehensive information about etiology, the nervous system, pathogenesis, and the overall management goals for patients at risk for developing neuropathic foot ulcers. A detailed assessment section describes how to conduct a full clinical history and physical examination. The guideline also provides two approaches to interventions. The first focuses on prevention strategies to reduce the risk of developing LEND wounds or recurrence, including life-long foot offloading, routine dermal temperature surveillance, use of adjunctive therapies, medication management, and implementing lower extremity amputation prevention measures and patient self-care education. The second approach summarized LEND wound management strategies including wound cleansing, debridement, infection management, maintenance of intact peri-wound skin, nutrition considerations, pain and paresthesia management, edema management, offloading and management of gait and foot deformity, medication management, surgical options, adjunctive therapies, patient education, and health care provider follow-up. A comprehensive reference list, glossary of terms, and several appendices regarding an algorithm to determine wound etiology, pharmacology, Lower Extremity Amputation (LEAP) Program, diabetes foot screening and other information is available at the end of the guideline. PMID:23222969

  10. Acute Motor Weakness of Opposite Lower Extremity after Percutaneous Epidural Neuroplasty

    PubMed Central

    Lim, Yong Seok; Park, Cheon Hee; Wee, Sang Woo; Sin, Sung Sik; Kim, Joon

    2015-01-01

    Recently, percutaneous epidural neuroplasty has become widely used to treat radicular pain caused by spinal stenosis or a herniated intervertebral disc. A 19-year-old female patient suffering from left radicular pain caused by an L4-L5 intervertebral disc herniation underwent percutaneous epidural neuroplasty of the left L5 nerve root using a Racz catheter. After the procedure, the patient complained of acute motor weakness in the right lower leg, on the opposite site to where the neuroplasty was conducted. Emergency surgery was performed, and swelling of the right L5 nerve root was discovered. The patient recovered her motor and sensory functions immediately after the surgery. Theoretically, the injection of a large volume of fluid in a patient with severe spinal stenosis during epidural neuroplasty can increase the pressure on the opposite side of the epidural space, which may cause injury of the opposite nerve by barotrauma from a closed compartment. Practitioners should be aware of this potential complication. PMID:25852837

  11. Swelling during Pregnancy

    MedlinePlus

    ... few months. This can cause slight swelling (called edema), particularly in the legs, feet and ankles, but ... few months. This can cause slight swelling (called edema), particularly in the legs, feet and ankles, but ...

  12. Effectiveness of Autologous Stem Cell Therapy for the Treatment of Lower Extremity Ulcers: A Systematic Review and Meta-Analysis.

    PubMed

    Jiang, Xupin; Zhang, Hengshu; Teng, Miao

    2016-03-01

    Primary studies in animal models and humans have suggested the therapeutic potential of autologous stem cell for treating chronic lower extremity ulcers. However, the results of pilot randomized controlled trials (RCTs) in humans have been inconsistent.A meta-analysis of RCTs was performed to evaluate the role of autologous stem cell-based therapy for lower extremity ulcers.Studies were identified during a systematic search of Medline, Embase, Cochrane's library, and references cited in related reviews and studies.Studies were included if they were RCTs published in English, recruited patients with lower extremity ulcers who were assigned to either a group for the topical therapy with autologous stem cells, and reported data regarding the healing of the ulcers.Relative risks (RRs) for healing rate and standardized mean differences (SMDs) for the changes in the mean sizes of ulcers were evaluated with a random-effects model.Overall, autologous stem cell-based therapy was associated with better healing of lower extremity ulcers (12 comparisons, 290 patients, RR for partial healing = 3.07, 95% confidence interval [CI] = 1.14-8.24, P = 0.03; RR for complete healing = 2.26, 95% CI = 1.48-3.16, P < 0.001) with little heterogeneity (I = 0%). Moreover, autologous stem cell-based therapy was associated with a greater reduction in mean ulcer size (SMD = -0.63, 95% CI = -1.03 to -0.22, P = 0.002). Subgroup analyses indicated that stem cells from peripheral blood and bone marrow seemed to exert similar beneficial effects on the healing of ulcers. Stem cell therapy was not associated with any increased risks for adverse events.The optimized sources, amounts, and delivery methods of stem cell -based therapy for patients with chronic lower extremity ulcers need to be determined, and the long-term effects of stem cell-based therapy on clinical outcomes need further exploration.Autologous stem cell-based therapy is effective and safe for

  13. Software for determining lower extremity muscle-tendon kinematics and moment arm lengths during flexion/extension movements.

    PubMed

    Hawkins, D

    1992-01-01

    A computer program was developed to calculate lower extremity muscle-tendon (MT) kinematics and flexion/extension moment arm (MA) lengths for any subject performing movements constrained to occur in the sagittal plane. The program requires as input subject anthropometric and time series ankle, knee, and hip angle data. Using these data a lower extremity link-segment model is constructed for each time element. Muscle-tendon attachment data and a straight line muscle model are used to calculate MT and flexion/extension moment arm lengths. A finite difference technique is used to determine MT shortening velocity. The utility of this program is demonstrated by calculating MT kinematics and MA lengths for six muscles of a single subject both as a function of joint angles and during gait. PMID:1572164

  14. Validation of a full body finite element model (THUMS) for running-type impacts to the lower extremity.

    PubMed

    Schinkel-Ivy, Alison; Altenhof, William J; Andrews, David M

    2014-01-01

    The purpose of this study was to determine whether modifying an existing, highly biofidelic full body finite element model [total human model for safety (THUMS)] would produce valid amplitude and temporal shock wave characteristics as it travels proximally through the lower extremity. Modifying an existing model may be more feasible than developing a new model, in terms of cost, labour and expertise. The THUMS shoe was modified to more closely simulate the material properties of a heel pad. Relative errors in force and acceleration data from experimental human pendulum impacts and simulated THUMS impacts were 22% and 54%, respectively, across the time history studied. The THUMS peak acceleration was attenuated by 57.5% and took 19.7 ms to travel proximally along the lower extremity. Although refinements may be necessary to improve force and acceleration timing, the modified THUMS represented, to a certain extent, shock wave propagation and attenuation demonstrated by living humans under controlled impact conditions. PMID:22519546

  15. Does dance-based therapy increase gait speed in older adults with chronic lower extremity pain: a feasibility study.

    PubMed

    Krampe, Jean; Wagner, Joanne M; Hawthorne, Kelly; Sanazaro, Deborah; Wong-Anuchit, Choochart; Budhathoki, Chakra; Lorenz, Rebecca A; Raaf, Soren

    2014-01-01

    A decreased gait speed in older adults can lead to dependency when the individuals are no longer able to participate in activities or do things for themselves. Thirty-seven senior apartment residents (31 females; Mean age=80.6 years; SD=8.9) with lower extremity pain/stiffness participated in a feasibility and preliminary efficacy study of 12 weeks (24 sessions). Healthy-Steps dance therapy compared to a wait-list control group. Small improvements in gait speed ([ES]=0.33) were noted for participants completing 19-24 dance sessions. Improvements in gait speed measured by a 10 Meter Walk Test (0.0517 m/s) exceeded 0.05 m/s, a value deemed to be meaningful in community dwelling older adults. These feasibility study findings support the need for additional research using dance-based therapy for older adults with lower extremity pain. PMID:24795258

  16. [The theory of lymphangion and current approaches to the pathogenesis, diagnosis and treatment of lymphedema of the lower extremities].

    PubMed

    Bubnova, N A; Borisova, R P; Borisov, A V

    2003-01-01

    The paper describes the results of examination carried out by the Sankt-Peterburg school of lymphologists, pertaining to the structure, physiological properties and function of lymphangions responsible for active lymph transport. The problems of the pathogenesis, diagnosis and treatment of lymphedema of the lower extremities used in clinical practice are reviewed from the standpoint of the new theory. The data obtained as a result of the clinico-morphofunctional studies allowed to delineate the stages of lymphedema as dependent on the degree of lymphocytic structure and function integrity. Based on the aforesaid the new approaches to the diagnosis and selection of the treatment methods for lymphedema of the lower extremities have been formulated. PMID:12811377

  17. Associations between lower extremity muscle mass and metabolic parameters related to obesity in Japanese obese patients with type 2 diabetes.

    PubMed

    Hamasaki, Hidetaka; Kawashima, Yu; Adachi, Hiroki; Moriyama, Sumie; Katsuyama, Hisayuki; Sako, Akahito; Yanai, Hidekatsu

    2015-01-01

    Background. Age-related loss of muscle mass (sarcopenia) increases the incidence of obesity in the elderly by reducing physical activity. This sarcopenic obesity may become self-perpetuating, increasing the risks for metabolic syndrome, disability, and mortality. We investigated the associations of two sarcopenic indices, the ratio of lower extremity muscle mass to body weight (L/W ratio) and the ratio of lower extremity muscle mass to upper extremity muscle mass (L/U ratio), with metabolic parameters related to obesity in patients with type 2 diabetes and obesity. Methods. Of 148 inpatients with type 2 diabetes treated between October 2013 and April 2014, we recruited 26 with obesity but no physical disability. Daily physical activity was measured by a triaxial accelerometer during a period of hospitalization, and which was also evaluated by our previously reported non-exercise activity thermogenesis questionnaire. We measured body composition by bioelectrical impedance and investigated the correlations of L/W and L/U ratios with body weight, body mass index (BMI), waist circumference (WC), waist-to-hip ratio (WHR), visceral fat area, subcutaneous fat area, serum lipid profile, and daily physical activity. Results. The L/W ratio was significantly and negatively correlated with BMI, WC, WHR, body fat mass, body fat percentage, subcutaneous fat area, and serum free fatty acid concentration, was positively correlated with daily physical activity: the locomotive non-exercise activity thermogenesis score, but was not correlated with visceral fat area. The L/U ratio was significantly and positively correlated with serum high-density lipoprotein cholesterol. Conclusions. High L/W and L/U ratios, indicative of relatively preserved lower extremity muscle mass, were predictive of improved metabolic parameters related to obesity. Preserved muscle fitness in obesity, especially of the lower extremities, may prevent sarcopenic obesity and lower associated risks for metabolic

  18. Hip External Rotator Strength Is Associated With Better Dynamic Control of the Lower Extremity During Landing Tasks.

    PubMed

    Malloy, Philip J; Morgan, Alexander M; Meinerz, Carolyn M; Geiser, Christopher F; Kipp, Kristof

    2016-01-01

    The purpose of this study was to determine the association between hip strength and lower extremity kinematics and kinetics during unanticipated single-leg landing and cutting tasks in collegiate female soccer players. Twenty-three National Collegiate Athletic Association division I female soccer players were recruited for strength testing and biomechanical analysis. Maximal isometric hip abduction and external rotation strength were measured using a hand-held dynamometer and expressed as muscle torque (force × femoral length) and normalized to body weight. Three-dimensional lower extremity kinematics and kinetics were assessed with motion analysis and force plates, and an inverse dynamics approach was used to calculate net internal joint moments that were normalized to body weight. Greater hip external rotator strength was significantly associated with greater peak hip external rotation moments (r = 0.47; p = 0.021), greater peak knee internal rotation moments (r = 0.41; p = 0.048), greater hip frontal plane excursion (r = 0.49; p = 0.017), and less knee transverse plane excursion (r = -0.56; p = 0.004) during unanticipated single-leg landing and cutting tasks. In addition, a statistical trend was detected between hip external rotator strength and peak hip frontal plane moments (r = 0.39; p = 0.06). The results suggest that females with greater hip external rotator strength demonstrate better dynamic control of the lower extremity during unanticipated single-leg landing and cutting tasks and provide further support for the link between hip strength and lower extremity landing mechanics. PMID:26110347

  19. A case of familial amyloid polyneuropathy (FAP ATTR Ile107Val) with proximal muscle weakness in the lower extremities.

    PubMed

    Kuzume, Daisuke; Sajima, Kazuaki; Morimoto, Yuko; Komatsu, Kanako; Yamasaki, Masahiro; Enzan, Hideaki

    2016-04-28

    Proximal dominant muscle weakness is rare in transthyretin (TTR)-related familial amyloid polyneuropathy (FAP). A 69-year-old Japanese man developed numbness and dysesthesia of the first, second and third digits of both hands since 2008. He presented to our hospital with one year history of progressive proximal muscle weakness in the lower extremities since 2013. Neurological examinations revealed predominant proximal muscle weakness and atrophy with areflexia in the lower extremities, decreased superficial sensation in the first, second and third fingers of both hands, and decreased superficial and deep sensation in the lower extremities. Nerve conduction studies revealed an axonal degeneration type of sensorimotor polyneuropathy and bilateral carpal tunnel syndrome. Electromyogram revealed acute and chronic neurogenic changes predominantly in proximal muscles. We performed biopsy of the left quadriceps muscle and observed neurogenic changes in the muscle tissue and an amyloid deposition in the adipose tissue. This amyloid deposition was not seen in endomysium, perimysium and blood vessels. Genetic analysis of the TTR gene revealed the patient was heterozygous for a single nucleotide substitution c.379 A>G, which resulted in the replacement of valine with isoleucine at position 107 of the mature protein. We diagnosed his condition as FAP with Amyloid Transthyretin (ATTR) Ile107Val. PMID:27025994

  20. Relationship between Lower Extremity Tightness and Star Excursion Balance Test Performance in Junior High School Baseball Players.

    PubMed

    Endo, Yasuhiro; Sakamoto, Masaaki

    2014-05-01

    [Purpose] The purpose of this study was to examine the relationship between lower extremity tightness and lower extremity balance, measured by the Star Excursion Balance Test (SEBT), in junior high school baseball players. [Subjects] Thirty-three male students belonging to baseball clubs in 2 junior high schools participated in this study. [Methods] For the SEBT, we chose to examine the anterior (ANT), posterior (POS), lateral (LAT), and medial (MED) directions. Regarding muscle tightness measurement, the angle of each joint of the bilateral iliopsoas, quadriceps, hamstring, gastrocnemius, hip internal rotator, and hip external rotator was measured. [Results] The ANT direction of the SEBT was significantly negatively correlated with gastrocnemius tightness. The MED direction of the SEBT was significantly positively correlated with hip internal rotator tightness and hamstrings tightness and significantly negatively correlated with gastrocnemius tightness. The LAT direction of the SEBT was significantly negatively correlated with iliopsoas tightness and gastrocnemius tightness. [Conclusion] Since the rate of upper extremity injury is high in these subjects and this could be due to tightness and instability of the lower extremity from a kinetic viewpoint, the SEBT could be used as a standard evaluation test when examining upper extremity injuries in young baseball players. PMID:24926127

  1. The Influence of an Unstable Surface on Trunk and Lower Extremity Muscle Activities during Variable Bridging Exercises

    PubMed Central

    Kim, Jung-hyun; Kim, Young; Chung, Yijung

    2014-01-01

    [Purpose] The aim of this study was to investigate the influence of an unstable surface on trunk and lower extremity muscle activities during various types of bridging exercises. [Subjects] Thirty healthy female adults voluntarily participated in this study. [Methods] All subjects were asked to perform 3 different bridging exercises (bridging exercise, single leg lift bridging exercise, single leg cross bridging exercise) with and without an unstable surface. The trunk and lower extremity muscle activities were measured by using surface electromyography during bridging exercise. [Results] During the bridging exercise (BE), single leg lift bridging exercise (LBE), and single leg cross bridging exercise (CBE), the muscle activities of the external oblique muscle (EO), erector spinae (ES), and biceps femoris (BF) were significantly higher on an unstable surface than on a stable surface. The muscle activities of the EO on both sides, contralateral BF, and ipsilateral ES were significantly higher during LBE than during BE and CBE. [Conclusion] Use of an unstable surface increases muscle activity of the trunk and lower extremities, and single leg lift bridging exercise increases the muscle activity of the EO on both sides, ipsilateral ES, and contralateral BF. PMID:24764625

  2. Morphing of geometric composites via residual swelling.

    PubMed

    Pezzulla, Matteo; Shillig, Steven A; Nardinocchi, Paola; Holmes, Douglas P

    2015-08-01

    Understanding and controlling the shape of thin, soft objects has been the focus of significant research efforts among physicists, biologists, and engineers in the last decade. These studies aim to utilize advanced materials in novel, adaptive ways such as fabricating smart actuators or mimicking living tissues. Here, we present the controlled growth-like morphing of 2D sheets into 3D shapes by preparing geometric composite structures that deform by residual swelling. The morphing of these geometric composites is dictated by both swelling and geometry, with diffusion controlling the swelling-induced actuation, and geometric confinement dictating the structure's deformed shape. Building on a simple mechanical analog, we present an analytical model that quantitatively describes how the Gaussian and mean curvatures of a thin disk are affected by the interplay among geometry, mechanics, and swelling. This model is in excellent agreement with our experiments and numerics. We show that the dynamics of residual swelling is dictated by a competition between two characteristic diffusive length scales governed by geometry. Our results provide the first 2D analog of Timoshenko's classical formula for the thermal bending of bimetallic beams - our generalization explains how the Gaussian curvature of a 2D geometric composite is affected by geometry and elasticity. The understanding conferred by these results suggests that the controlled shaping of geometric composites may provide a simple complement to traditional manufacturing techniques. PMID:26076671

  3. Use of a pedicled fillet foot flap for knee preservation in severe lower extremity trauma: A case report and literature review

    PubMed Central

    Jensson, David; Audolfsson, Thorir; Mani, Maria; Rodriguez-Lorenzo, Andres

    2015-01-01

    We report the sequential use of a pedicled fillet foot flap in a clinical case of complex bilateral lower extremity trauma to achieve stable wound closure, maximizing length preservation and gait rehabilitation. In addition, we perform a literature review of the use of fillet foot flaps in lower extremity trauma. PMID:27252976

  4. Immunoscintigraphic detection of venous thrombosis of the lower extremities by means of human antifibrin monoclonal antibodies labeled with sup 111 In

    SciTech Connect

    Lusiani, L.; Zanco, P.; Visona, A.; Breggion, G.; Pagnan, A.; Ferlin, G. )

    1989-07-01

    A new monoclonal antibody specific for the beta-chain of human fibrin (C22A) and labeled with 111In has been obtained and successfully used in rabbits and dogs for the in vivo detection of venous thrombosis. Studies in humans are currently ongoing. In order to assess the diagnostic value of 111In-antifibrin for the detection of venous thrombosis of the lower extremities, the authors investigated 25 consecutive patients. Ten patients had clinical and instrumental (contrast phlebography and duplex scanning) evidence of acute deep venous thrombosis (DVT), 3 had a long-standing DVT with relapsing episodes of swelling and pain, 5 had superficial venous thrombosis, and the remaining 7 had no signs of thrombosis at all. Twenty patients were being treated with heparin. All patients received 111In-antifibrin at the dose of 74 MBq IV and were scanned with a large field of view gamma camera coupled with a high-energy, parallel-hole collimator at 30 minutes and three, six, and twenty-four hours postinjection. Only the persistence of an abnormal uptake at twenty-four hours confirmed by two observers at visual inspection was considered as positive. A positive result was obtained in 9 of 10 DVT patients (90% sensitivity) and in all SVT patients. The single DVT patient with a negative 111In-antifibrin test had the longest interval between scintigraphy and onset of symptoms (fifty-five days). Thus, the age of thrombi represented a substantial limitation for the test. A false-positive result was obtained in a single SVT patient, in whom also a deep involvement, unconfirmed by phlebography, was suspected (91.6% specificity).

  5. The Effects of Tai Chi Chuan Combined with Vibration Training on Balance Control and Lower Extremity Muscle Power

    PubMed Central

    Chung, Pao-Hung; Lin, Guan-Lun; Liu, Chiang; Chuang, Long-Ren; Shiang, Tzyy-Yuang

    2013-01-01

    The aim of this study was to determine whether performing Tai Chi Chuan on a customized vibration platform could enhance balance control and lower extremity muscle power more efficiently than Tai Chi Chuan alone in an untrained young population. Forty-eight healthy young adults were randomly assigned to the following three groups: a Tai Chi Chuan combined with vibration training group (TCV), a Tai Chi Chuan group (TCC) or a control group. The TCV group underwent 30 minutes of a reformed Tai Chi Chuan program on a customized vibration platform (32 Hz, 1 mm) three times a week for eight weeks, whereas the TCC group was trained without vibration stimuli. A force platform was used to measure the moving area of a static single leg stance and the heights of two consecutive countermovement jumps. The activation of the knee extensor and flexor was also measured synchronously by surface electromyography in all tests. The results showed that the moving area in the TCV group was significantly decreased by 15.3%. The second jump height in the TCV group was significantly increased by 8.14%, and the activation of the knee extensor/flexor was significantly decreased in the first jump. In conclusion, Tai Chi Chuan combined with vibration training can more efficiently improve balance control, and the positive training effect on the lower extremity muscle power induced by vibration stimuli still remains significant because there is no cross-interaction between the two different types of training methods. Key points Eight weeks of Tai Chi Chuan combined with vibration training can more efficiently improve balance control for an untrained young population. The positive training effect on the lower extremity muscle power induced by vibration stimuli during Tai Chi Chuan movements still remains significant because of SSC mechanism. Combining Tai Chi Chuan with vibration training is more efficient and does not decrease the overall training effects due to a cross-interaction of each other

  6. Functional Foot Symmetry and Its Relation to Lower Extremity Physical Performance in Older Adults: The Framingham Foot Study

    PubMed Central

    Riskowski, J.L.; Hagedorn, TJ; Dufour, AB; Hannan, MT

    2012-01-01

    Background While many studies use gait symmetry as a marker of healthy gait, the evidence that gait symmetry exists is limited. Because gait symmetry is thought to arise through laterality (i.e., limb preference) and affects gait retraining efforts, it is important to understand if symmetry exists during gait in older adults. Therefore, the purpose of this study was to evaluate foot and gait symmetry in the population-based Framingham Foot Study as well as to determine the effects of vertical force symmetry on physical performance measures. Methods Members of the Framingham Foot Study were included in this analysis (N=1333). Foot function and force data were collected using the Tekscan Matscan during self-selected gait, with symmetry evaluated using the symmetry index. The short physical performance battery (SPPB) measures of balance, chair stands and gait speed assessed lower extremity physical function. Participants were evaluated using quartiles of gait speed and foot symmetry to determine the effects of symmetry on lower extremity physical function. Results Individuals with faster gait speed displayed greater foot function asymmetry; individuals with −3.0% to −9.5% asymmetry in foot function performed better on the short physical performance battery (SPPB). Further, with aging, the degree of asymmetry was reduced. Conclusions While this research suggests that a moderate degree of foot asymmetry is associated with better lower extremity function, the causes of vertical force asymmetry are unknown. Future studies should evaluate the causes of foot asymmetry and should track the changes in symmetry that occur with aging. PMID:22560642

  7. Efficacy of Lower-Extremity Venous Thrombolysis in the Setting of Congenital Absence or Atresia of the Inferior Vena Cava

    SciTech Connect

    Ganguli, Suvranu Kalva, Sanjeeva; Oklu, Rahmi; Walker, T. Gregory; Datta, Neil; Grabowski, Eric F.; Wicky, Stephan

    2012-10-15

    Purpose: A rare but described risk factor for deep venous thrombosis (DVT), predominately in the young, is congenital agenesis or atresia of the inferior vena cava (IVC). The optimal management for DVT in this subset of patients is unknown. We evaluated the efficacy of pharmacomechanical catheter-directed thrombolysis (PCDT) followed by systemic anticoagulation in the treatment of acute lower-extremity DVT in the setting of congenital IVC agenesis or atresia. Materials and Methods: Between November of 2005 and May of 2010, six patients (three women [average age 21 years]) were referred to our department with acute lower-extremity DVT and subsequently found to have IVC agenesis or atresia on magnetic resonance imaging. A standardized technique for PCDT (the Angiojet Rheolytic Thrombectomy System followed by the EKOS Microsonic Accelerated Thrombolysis System) was used for all subjects. Successful thrombolysis was followed by systemic heparinization with transition to Coumadin or low molecular-weight heparin and compression stockings. Subjects were followed-up at 1, 3, and then every 6 months after the procedure with clinical assessment and bilateral lower-extremity venous ultrasound. Results: All PCDT procedures were technically successful. No venous stenting or angioplasty was performed. The average thrombolysis time was 28.6 h (range 12-72). Two patients experienced heparin-induced thrombocytopenia, and one patient developed a self-limited knee hemarthrosis, No patients were lost to follow-up. The average length of follow-up was 25.8 {+-} 20.2 months (range 3.8-54.8). No incidence of recurrent DVT was identified. There were no manifestations of postthrombotic syndrome. Conclusions: PCDT followed by systemic anticoagulation and the use of compression stockings appears to be safe and effective in relatively long-term follow-up treatment of patients who present with acute DVT and IVC agenesis or atresia.

  8. Combined use of negative pressure wound therapy and Integra® to treat complex defects in lower extremities after burns

    PubMed Central

    González Alaña, I.; Torrero López, J.V.; Martín Playá, P.; Gabilondo Zubizarreta, F.J.

    2013-01-01

    Summary Deep and extensive burns of lower extremities present a difficult challenge to healthcare professionals. After debridement, bones, tendons or joints are frequently exposed and cannot be covered by simple autografts. Moreover, in the case of major burns, damage to the surrounding areas of skin and the severity of the patient’s overall condition, often count against using pedicled or microsurgical flaps. In dealing with such complex wounds, which are difficult to treat, several authors have recommended the combined use of Integra® and negative pressure wound therapy (NPWT). They emphasize that NPWT eliminates wound exudate, promotes neovascularisation and cell migration through the Integra® matrix while increasing its stability and adherence to the wound bed, as well as decreasing the time needed for its total integration. The case presented here is of a patient with major third-degree flame burns to the lower extremities. After debridement, the external and internal malleolus bilaterally became exposed as well as the partially debrided tendons (Achilles, extensor digitorum longus, long and short peroneus, anterior and posterior tibialis). After ruling out the use of local or microsurgical flaps due to the patient’s poor general condition and the presence of burns debrided to the fascia over both lower extremities, we elected to manage the patient with a combined treatment using Integra® and NPWT. After three weeks of treatment, the surface layer of the Integra® matrix was replaced with autografts. Due to partial loss of the skin grafts, a second autograft was needed. At present the patient is completely healed; he can walk with full flexion-extension of both ankles. PMID:24133403

  9. A randomized, controlled trial of spinal endoscopic adhesiolysis in chronic refractory low back and lower extremity pain [ISRCTN 16558617

    PubMed Central

    Manchikanti, Laxmaiah; Boswell, Mark V; Rivera, Jose J; Pampati, Vidya Sagar; Damron, Kim S; McManus, Carla D; Brandon, Doris E; Wilson, Sue R

    2005-01-01

    Background Postoperative epidural fibrosis may contribute to between 5% to 60% of the poor surgical outcomes following decompressive surgery. Correlations have been reported between epidural scarring and radicular pain, poor surgical outcomes, and a lack of any form of surgical treatment. The use of spinal endoscopic adhesiolysis in recent years in the management of chronic refractory low back and lower extremity pain has been described. Methods A prospective, randomized, double-blind trial was conducted to determine the outcome of spinal endoscopic adhesiolysis to reduce pain and improve function and psychological status in patients with chronic refractory low back and lower extremity pain. A total of 83 patients were evaluated, with 33 patients in Group I and 50 patients in Group II. Group I served as the control, with endoscopy into the sacral level without adhesiolysis, followed by injection of local anesthetic and steroid. Group II received spinal endoscopic adhesiolysis, followed by injection of local anesthetic and steroid. Results Among the 50 patients in the treatment group receiving spinal endoscopic adhesiolysis, significant improvement without adverse effects was shown in 80% at 3 months, 56% at 6 months, and 48% at 12 months. The control group showed improvement in 33% of the patients at one month and none thereafter. Based on the definition that less than 6 months of relief is considered short-term and longer than 6 months of relief is considered long-term, a significant number of patients obtained long-term relief with improvement in pain, functional status, and psychological status. Conclusion Spinal endoscopic adhesiolysis with targeted delivery of local anesthetic and steroid is an effective treatment in a significant number of patients with chronic low back and lower extremity pain without major adverse effects. PMID:16000173

  10. Roy’s Adaptation Model-Guided Education and Promoting the Adaptation of Veterans With Lower Extremities Amputation

    PubMed Central

    Azarmi, Somayeh; Farsi, Zahra

    2015-01-01

    Background: Any defect in extremities of the body can affect different life aspects. Objectives: The purpose of this study was to investigate the effect of Roy’s adaptation model-guided education on promoting the adaptation of veterans with lower extremities amputation. Patients and Methods: In a randomized clinical trial, 60 veterans with lower extremities amputation referring to Kowsar Orthotics and Prosthetics Center of veterans clinic in Tehran, Iran, were recruited with convenience method and were randomly assigned to intervention and control groups during 2013 - 2014. For data collection, Roy’s adaptation model questionnaire was used. After completing the questionnaires in both groups, maladaptive behaviors were determined in the intervention group and an education program based on Roy’s adaptation model was implemented. After two months, both groups completed the questionnaires again. Data was analyzed with SPSS software. Results: Independent t-test showed statistically significant differences between the two groups in the post-test stage in terms of the total score of adaptation (P = 0.001) as well as physiologic (P = 0.0001) and role function modes (P = 0.004). The total score of adaptation (139.43 ± 5.45 to 127.54 ± 14.55, P = 0.006) as well as the scores of physiologic (60.26 ± 5.45 to 53.73 ± 7.79, P = 0.001) and role function (20.30 ± 2.42 to 18.13 ± 3.18, P = 0.01) modes in the intervention group significantly increased, whereas the scores of self-concept (42.10 ± 4.71 to 39.40 ± 5.67, P = 0.21) and interdependence (16.76 ± 2.22 to 16.30 ± 2.57, P = 0.44) modes in the two stages did not have a significant difference. Conclusions: Findings of this research indicated that the Roy’s adaptation model-guided education promoted the adaptation level of physiologic and role function modes in veterans with lower extremities amputation. However, this intervention could not promote adaptation in self-concept and interdependence modes. More

  11. Fixed-site high-frequency transcutaneous electrical nerve stimulation for treatment of chronic low back and lower extremity pain

    PubMed Central

    Gozani, Shai N

    2016-01-01

    Objective The objective of this study was to determine if fixed-site high-frequency transcutaneous electrical nerve stimulation (FS-TENS) is effective in treating chronic low back and lower extremity pain. Background Transcutaneous electrical nerve stimulation is widely used for treatment of chronic pain. General-purpose transcutaneous electrical nerve stimulation devices are designed for stimulation anywhere on the body and often cannot be used while the user is active or sleeping. FS-TENS devices are designed for placement at a pre-determined location, which enables development of a wearable device for use over extended time periods. Methods Study participants with chronic low back and/or lower extremity pain self-administered an FS-TENS device for 60 days. Baseline, 30-, and 60-day follow-up data were obtained through an online questionnaire. The primary outcome measure was the patient global impression of change. Pain intensity and interference were assessed using the Brief Pain Inventory. Changes in use of concomitant pain medications were evaluated with a single-item global self-rating. Results One hundred and thirty participants were enrolled, with 88 completing the 60-day follow-up questionnaire. Most participants (73.9%) were 50 years of age or older. At baseline, low back pain was identified by 85.3%, lower extremity pain by 71.6%, and upper extremity pain by 62.5%. Participants reported widespread pain, at baseline, with a mean of 3.4 (standard deviation 1.1) pain sites. At the 60-day follow-up, 80.7% of participants reported that their chronic pain had improved and they were classified as responders. Baseline characteristics did not differentiate non-responders from responders. There were numerical trends toward reduced pain interference with walking ability and sleep, and greater pain relief in responders. There was a large difference in use of concomitant pain medications, with 80.3% of responders reporting a reduction compared to 11.8% of non

  12. Use of Intra-Arterial Chemotherapy and Embolization Before Limb Salvage Surgery for Osteosarcoma of the Lower Extremity

    SciTech Connect

    Zhang Huojun Yang Jijin Lu Jianping; Lai Chaojen; Sheng Jin; Li Yuxiao; Hao Qiang; Zhang Shunmin; Gupta, Sanjay

    2009-07-15

    We report our experience with the use of intra-arterial chemotherapy and embolization before limb salvage surgery in patients with osteosarcoma of the lower extremity. We evaluated the effect of this procedure on the degree of tumor necrosis and on the amount of blood loss during surgery. We reviewed the medical records of all patients who received intra-arterial chemotherapy and embolization before undergoing limb salvage surgery for osteosarcoma of the lower extremity at our institution between January 2003 and April 2008. Patient demographic, tumor characteristics, treatment details, postembolization complications, and surgical and pathological findings were recorded for each patient. We evaluated the operative time, estimated blood loss (EBL), and volume of blood transfusion during surgery and in the postoperative period in all patients in the study group. The same parameters were recorded for 65 other patients with lower extremity osteosarcoma who underwent limb salvage operation at our institution without undergoing preoperative intervention. The study included 47 patients (25 males and 22 females). Angiography showed that the tumors were hypervascular. Intra-arterial chemotherapy and embolization were performed successfully, resulting in a substantial reduction or complete disappearance of tumor stain in all patients. No major complications were encountered. At the time of surgery, performed 3-7 days after embolization, a fibrous edematous band around the tumor was observed in 43 of the 47 patients, facilitating surgery. The goal of limb salvage was achieved successfully in all cases. Percentage tumor necrosis induced by treatment ranged from 70.2% to 94.2% (average, 82.9%). EBL during surgery, EBL from drains in the postoperative period, total EBL, and transfusion volumes were significantly lower in the 47 study patients compared to the 65 patients who underwent surgery without preoperative treatment with intra-arterial chemotherapy and embolization. The

  13. Reporting standards of the Society for Vascular Surgery for endovascular treatment of chronic lower extremity peripheral artery disease: Executive summary.

    PubMed

    Stoner, Michael C; Calligaro, Keith D; Chaer, Rabih A; Dietzek, Alan M; Farber, Alik; Guzman, Raul J; Hamdan, Allen D; Landry, Greg J; Yamaguchi, Dean J

    2016-07-01

    Recommended reporting standards for lower extremity ischemia were last published by the Society for Vascular Surgery in 1997. Since that time, there has been a proliferation of endovascular therapies for the treatment of chronic peripheral arterial disease. The purpose of this document is to clarify and update these standards, specifically for reports on endovascular treatment. The document is divided into sections: Claudication Reporting, Critical Limb Ischemia Reporting, Preintervention Assessment and Nonanatomic Treatment, Intervention, Outcome Measures - Procedural, Outcome Measures - Disease Specific, and Complications. PMID:27345507

  14. The necessity of physiological muscle parameters for computing the muscle forces: application to lower extremity loading during pedalling.

    PubMed

    Cadová, Michala; Vilímek, Miloslav

    2009-01-01

    The aim of this study is to determine how the use of physiological parameters of muscles is important. This work is focused on musculoskeletal loading analysis during pedalling adopting two approaches: without (1) and with (2) the use of physiological parameters of muscles. The static-optimization approach together with the inverse dynamics problem makes it possible to obtain forces in individual muscles of the lower extremity. Input kinematics variables were examined in a cycling experiment. The significant difference in the resultant forces in one-joint and two-joint muscles using the two different approaches was observed. PMID:20131752

  15. Free tissue transfer in patients with severe peripheral arterial disease: functional outcome in reconstruction of chronic lower extremity defects.

    PubMed

    Kolbenschlag, Jonas; Hellmich, Susanne; Germann, Günter; Megerle, Kai

    2013-11-01

    Chronic wounds of the lower extremity are difficult to treat, especially in patients with peripheral arterial disease (PAD). This patient population frequently suffers from multiple comorbidities, which further impairs wound healing. Local flaps are often not available, or are insufficient to cover these defects, and limbs are frequently amputated, although they could possibly be salvaged by free tissue transplantation. Although there is a growing evidence that free tissue transfer may be feasible in these patients with otherwise doomed extremities, previous studies have mostly focused on short-term flap survival, but not long-term ambulatory status and independence. Therefore, we investigated the long-term results of limb salvage, ambulatory status, and social independence in patients with PAD who underwent free tissue transfer for chronic wounds of the lower extremities.In this study we retrospectively reviewed 38 patients who underwent free tissue transfer because of nontraumatic, chronic wounds of the lower extremities at our institution. All patients suffered from a nontraumatic occlusion of at least one major lower leg artery verified by angiography. After a mean time period of 34 months we assessed flap survival and limb preservation as well as pre- and postoperative ambulatory status and social independence. A subgroup of 14 patients with a "single-vessel-leg" was evaluated separately.It was observed that anterolateral thigh and latissimus dorsi musculocutaneous flaps were most often used to cover the defects. Overall 29 out of the 38 flaps healed completely (9 flap failures) and 34 extremities were salvaged, including 12 out of 14 single-vessel-legs. One patient had to be amputated despite a vital free flap because of persistent calcaneal osteomyelitis. After failure of free tissue transfer, six extremities could still be salvaged by secondary procedures (two secondary free flaps, two local flaps, and two skin grafts). Total 22 out of 34 patients with

  16. A ten-year review of lower extremity burns in diabetics: small burns that lead to major problems.

    PubMed

    Barsun, Alura; Sen, Soman; Palmieri, Tina L; Greenhalgh, David G

    2013-01-01

    Diabetes mellitus with its resulting neurovascular changes may lead to an increased risk of burns and impaired wound healing. The purpose of this article is to review 10 years of experience with foot and lower leg burns in patients with diabetes at a single adult burn center. Patients with lower extremity burns and diabetes mellitus, between May 1999 and December 2009, were identified in the Trauma Registry of the American College of Surgeons database, and their charts were reviewed for data related to their outcomes. Sixty-eight diabetic patients, 87% male, with a mean age of 54 years, sustained foot or lower extremity burns with 37 having burns resulting from insensate feet. The pathogenesis included walking on a hot or very cold surface (8), soaking feet in hot water (22), warming feet on or near something hot such as a heater (13), or spilling hot water (7). The majority of patients were taking insulin (59.6%) or oral hyperglycemic medications (34.6%). Blood sugar levels were not well controlled (mean glucose, 215.8 mg/dl; mean hemoglobin A1c, 9.08%). Renal disease was common with admission serum blood urea nitrogen (27.5 mg/dl) and creatinine (2.21 mg/dl), and 13 were on dialysis preinjury. Cardiovascular problems were common with 39 (57%) having hypertension or cardiac disease, 3 having peripheral vascular disease, and 9, previous amputations. The mean burn size was 4.2% TBSA (range, 0.5-15%) with 57% being full thickness. Despite the small burn, the mean length of stay was 15.2 days (range, 1-95), with 5.65 days per 1% TBSA. Inability to heal these wounds was evident in 19 patients requiring readmission (one required 10 operative procedures). At least one patient sustained more than one burn. There were 62 complications with 30 episodes of infection (cellulitis, 28; osteomyelitis, 4; deep plantar infections, 2; ruptured Achilles tendon, 1) and 3 deaths. Eleven patients needed amputations (7 below-knee amputations, 4 transmetatarsal amputations, and 20 toe

  17. [Transplantation of adipose tissue multipotent stromal cells in the treatment of chronic ischemia of the lower extremities].

    PubMed

    Saliutin, R V; Palianytsia, S S; Sirman, V M; Panchenko, L A; Komarova, L S

    2014-07-01

    The expediency of the stromal cells application, obtained from adipose tissue, was determined in a frame of preclinical investigations conduction, concerning experimental works on laboratory rats, in whom the extremity ischemia was simulated. Histologic and immunohistochemical changes were studied in muscular tissue after transplantation of multipotent stromal cells of own adipose tissue in patients, suffering ischemia of the lower extremity. Reduction of severity of the myofibrills ischemic damage, rapid activation of the muscles regenerative power, accurate stimulation of the angiogenesis processes in 3 mo after transplantation of the cells were demonstrated. PMID:25252413

  18. Prevalence, incidence and course of lower extremity injuries in runners during a 12-month follow-up period.

    PubMed

    van Poppel, D; Scholten-Peeters, G G M; van Middelkoop, M; Verhagen, A P

    2014-12-01

    To describe the incidence, 12-month prevalence, and course of lower extremity injuries that occurred during and after the Amgen Singelloop Breda in 2009. The design was based on a prospective cohort study with a population-based setting. In total, 3605 registered runners received a web-based baseline questionnaire of which 713 participants completed and returned it. Information about previous injuries, training programs, and demographic data were gathered at baseline. Site and intensity of running injuries and occurrence of new injuries were obtained from five post-race questionnaires. The main outcome measurement was lower extremity injury. The incidence of running injuries during the Amgen Singelloop Breda itself was 7.8%; most of these injuries occurred in the calf muscle, thigh, and knee joint. Three-month incidence of injuries during follow-up varied between 13.5% and 16.3%. During the 12-month follow-up period, 277 new running injuries were reported. Runners who ran more than 10 km are more susceptible to injury in comparison with runners who ran short distances (10 km or less). In total, 69.1% of running injuries resolves within 10 days. Running injuries are very common among recreational runners. Injuries mostly occur in the knee, thigh, and calf muscle. PMID:23957385

  19. Evaluation of Stiffness of the Spastic Lower Extremity Muscles in Early Spinal Cord Injury by Acoustic Radiation Force Impulse Imaging

    PubMed Central

    Cho, Kang Hee

    2015-01-01

    Objective To investigate intrinsic viscoelastic changes using shear wave velocities (SWVs) of spastic lower extremity muscles in patients with early spinal cord injury (SCI) via acoustic radiation force impulse (ARFI) imaging and to evaluate correlation between the SWV values and spasticity. Methods Eighteen patients with SCI within 3 months and 10 healthy adults participated. We applied the ARFI technique to measure SWV of gastrocnemius muscle (GCM) and long head of biceps femoris muscle. Spasticity of ankle and knee joint was assessed by original Ashworth Scale. Results Ten patients with SCI had spasticity. Patients with spasticity had significantly faster SWV for GCM and biceps femoris muscle than those without spasticity (Mann-Whitney U test, p=0.007 and p=0.008) and normal control (p=0.011 and p=0.037, respectively). The SWV values of GCM correlated with the ankle spasticity (Spearman rank teat, p=0.026). There was significant correlation between the SWV values for long head of biceps femoris muscle and knee spasticity (Spearman rank teat, p=0.022). Conclusion ARFI demonstrated a difference in muscle stiffness in the GCM between patients with spastic SCI and those without spasticity. This finding suggested that stiffness of muscles increased in spastic lower extremity of early SCI patients. ARFI imaging is a valuable tool for noninvasive assessment of the stiffness of the spastic muscle and has the potential to identify pathomechanical changes of the tissue associated with SCI. PMID:26161345

  20. Dynamic Frequency Analyses of Lower Extremity Muscles during Sit-To-Stand Motion for the Patients with Knee Osteoarthritis

    PubMed Central

    Suzuki, Kentaro; Yagi, Masahide

    2016-01-01

    Objective Muscle activities during the sit-to-stand motion (STS) are characterized by coordinated movements between hip extensors and knee extensors. However, previous reports regarding the STS and lower extremity muscle activities have focused on some quantitative assessment, but little qualitative research. This study aimed to examine the muscle activities of the lower extremity both quantitatively and qualitatively. Methods Study participants included 13 patients with knee osteoarthritis (knee OA) and 11 age-matched asymptomatic controls. The task was STS from a chair with a height-adjustable seat. EMG activities were acquired using surface electromyogram. The root mean square signals normalized as a percentage of maximum voluntary isometric contraction values (RMS%MVC) and the mean power frequency (MPF) were calculated. Results During STS, knee OA patients had increased RMS%MVC of the vastus medialis and raised MPF of the rectus femoris before buttocks-off. Conclusion These findings suggest that STS of knee OA patients not only increased relative muscle activity of the vastus medialis, but also enlisted the rectus femoris in knee extension to improve muscle contraction force by activating more type II fibers to accomplish buttocks-off. PMID:26807578

  1. Analysis of walking variability through simultaneous evaluation of the head, lumbar, and lower-extremity acceleration in healthy youth

    PubMed Central

    Toda, Haruki; Nagano, Akinori; Luo, Zhiwei

    2016-01-01

    [Purpose] The purpose of this study was to clarify whether walking speed affects acceleration variability of the head, lumbar, and lower extremity by simultaneously evaluating of acceleration. [Subjects and Methods] Twenty young individuals recruited from among the staff at Kurashiki Heisei Hospital participated in this study. Eight accelerometers were used to measure the head, lumbar and lower extremity accelerations. The participants were instructed to walk at five walking speeds prescribed by a metronome. Acceleration variability was assessed by a cross-correlation analysis normalized using z-transform in order to evaluate stride-to-stride variability. [Results] Vertical acceleration variability was the smallest in all body parts, and walking speed effect had laterality. Antero-posterior acceleration variability was significantly associated with walking speed at sites other than the head. Medio-lateral acceleration variability of the bilateral hip alone was smaller than the antero-posterior variability. [Conclusion] The findings of this study suggest that the effect of walking speed changes on the stride-to-stride acceleration variability was individual for each body parts, and differs among directions. PMID:27390419

  2. Gunther Tulip Inferior Vena Cava Filter Placement During Treatment for Deep Venous Thrombosis of the Lower Extremity

    SciTech Connect

    Yamagami, Takuji Kato, Takeharu; Iida, Shigeharu; Hirota, Tatsuya; Nishimura, Tsunehiko

    2005-05-15

    Purpose. To evaluate the efficacy and safety of Gunther tulip retrievable vena cava filter (GTF) implantation to prevent pulmonary embolism during intravenously administered thrombolytic and anticoagulation therapy and interventional radiological therapy for occlusive or nonocclusive deep venous thrombosis (DVT) of the lower extremity. Methods. We evaluated placement of 55 GTFs in 42 patients with lower extremity DVT who had undergone various treatments including those utilizing techniques of interventional radiology. Results. Worsening of pulmonary embolism in patients with existing pulmonary embolism or in those without pulmonary embolism at the time of GTF insertion was avoided in all patients. All attempts at implantation of the GTF were safely accomplished. Perforation and migration experienced by one patient was the only complication. Mean period of treatment for DVT under protection from pulmonary embolism by the GTF was 12.7 {+-} 8.3 days (mean {+-} SD, range 4-37 days). We attempted retrieval of GTFs in 18 patients in whom the venous thrombus had disappeared after therapy, and retrieval in one of these 18 cases failed. GTFs were left in the vena cava in 24 patients for permanent use when the DVT was refractory to treatment. Conclusion. The ability of the GTF to protect against pulmonary embolism during treatment of DVT was demonstrated. Safety in both placement and retrieval was clarified. Because replacement with a permanent filter was not required, use of the GTF was convenient when further protection from complicated pulmonary embolism was necessary.

  3. Association between Femoral Anteversion and Lower Extremity Posture upon Single-leg Landing: Implications for Anterior Cruciate Ligament Injury

    PubMed Central

    Kaneko, Masaaki; Sakuraba, Keishoku

    2013-01-01

    [Purpose] Increased femoral anteversion may occur with hip internal rotation and valgus knee alignment upon landing and is considered a risk factor for anterior cruciate ligament injury. We examined the relationship between femoral anteversion and joint motion and muscle activity of the lower extremity in terms of the risk factors for anterior cruciate ligament injury. [Subjects] Sixteen healthy females were divided on the basis of femoral anteversion into low and high groups. [Methods] Femoral anteversion was assessed using Craig's test. We performed kinematic analysis and measured the electromyography activity of the lower extremity upon left single-leg landing. [Results] The high group had a significantly lower hip flexion angle and higher knee flexion and valgus angles than the low group. The rectus femoris showed significantly greater electromyography activities in the high group than in the low group. [Conclusion] These results suggest that increased femoral anteversion results in lower hip flexion angle, higher knee valgus alignment, and greater rectus femoris muscle activity, leading to anterior tibial displacement upon single-leg landing. Increased femoral anteversion may be a potential risk factor for anterior cruciate ligament injury. PMID:24259760

  4. Negative first-term outcomes associated with lower extremity injury during recruit training among female Marine Corps graduates.

    PubMed

    Trone, Daniel W; Villaseñor, Adriana; Macera, Caroline A

    2007-01-01

    This study assessed the impact of lower extremity injuries and stress fractures during recruit training on first-term outcomes among female Marine Corps graduates. Injury data were collected from women recruits at Parris Island, South Carolina (1995-1999) and negative first-term outcomes were obtained from the Career History Archival Medical and Personnel System. The three negative outcomes included (1) failure to complete first-term of service, (2) failure to achieve rank of corporal, and (3) failure to reenlist. Overall, 22% did not complete their first-term enlistment and 12% of those who did were not promoted to corporal. After adjustment for demographic characteristics, not completing first term and not being promoted to corporal were both associated with injuries or stress fracture during training. Reenlistment was not associated with training injuries. Our findings indicate lower extremity injuries among women undergoing Marine Corps recruit training are associated with poor first-term outcomes even among those who graduate. PMID:17274273

  5. Consequences of lower extremity and trunk muscle fatigue on balance and functional tasks in older people: A systematic literature review

    PubMed Central

    2010-01-01

    Background Muscle fatigue reduces muscle strength and balance control in young people. It is not clear whether fatigue resistance seen in older persons leads to different effects. In order to understand whether muscle fatigue may increase fall risk in older persons, a systematic literature review aimed to summarize knowledge on the effects of lower extremity and trunk muscle fatigue on balance and functional tasks in older people was performed. Methods Studies were identified with searches of the PUBMED and SCOPUS data bases. Papers describing effects of lower extremity or trunk muscle fatigue protocols on balance or functional tasks in older people were included. Studies were compared with regards to study population characteristics, fatigue protocol, and balance and functional task outcomes. Results Seven out of 266 studies met the inclusion criteria. Primary findings were: fatigue via resistance exercises to lower limb and trunk muscles induces postural instability during quiet standing; induced hip, knee and ankle muscle fatigue impairs functional reach, reduces the speed and power of sit-to-stand repetitions, and produces less stable and more variable walking patterns; effects of age on degree of fatigue and rate of recovery from fatigue are inconsistent across studies, with these disparities likely due to differences in the fatigue protocols, study populations and outcome measures. Conclusion Taken together, the findings suggest that balance and functional task performance are impaired with fatigue. Future studies should assess whether fatigue is related to increased risk of falling and whether exercise interventions may decrease fatigue effects. PMID:20716373

  6. Guideline for the management of wounds in patients with lower-extremity venous disease: an executive summary.

    PubMed

    Kelechi, Teresa J; Johnson, Jan J

    2012-01-01

    This article provides an executive summary of the lower extremity venous disease (LEVD) evidence-based guideline produced by the WOCN Wound Guidelines Task Force. The target audience for this guideline is health care professionals who specialize in, direct, or provide wound care for patients at risk for or with lower-extremity venous disease. The full guideline opens with an overview of definitions of LEVD, its prevalence, clinical relevance, etiology, related physiology and pathophysiology, and overall management goals for patients at risk for developing venous leg ulcers. A detailed assessment section describes how to conduct a full clinical history and physical examination. Two approaches to interventions are provided: one addresses prevention strategies to reduce the risk of developing LEVD with ulcers. Methods to prevent ulcer recurrence are summarized including compression therapy, adjunctive therapies, medications, and patient education. A second approach presents treatment interventions including wound cleansing, debridement, infection control, antibiotic use, along with management of the periwound skin, nutrition, pain, and edema. This section also discusses limb elevation, surgical options, adjunctive therapies, patient education, and health care provider follow-up. A comprehensive reference list, glossary of terms, and appendices on cellulitis and venous eczema, types of edema, and compression therapy are available at the end of the guideline. This article provides an executive summary of the essential features of the guideline. PMID:23138493

  7. A Multiple Degree of Freedom Lower Extremity Isometric Device to Simultaneously Quantify Hip, Knee and Ankle Torques

    PubMed Central

    Sánchez, Natalia; Acosta, Ana Maria; Stienen, Arno H.A.

    2015-01-01

    Characterization of the joint torque coupling strategies used in the lower extremity to generate maximal and submaximal levels of torque at either the hip, knee or ankle is lacking. Currently, there are no available isometric devices that quantify all concurrent joint torques in the hip, knee and ankle of a single leg during maximum voluntary torque generation. Thus, joint-torque coupling strategies in the hip, knee and concurrent torques at ankle and/or coupling patterns at the hip and knee driven by the ankle have yet to be quantified. This manuscript describes the design, implementation and validation of a multiple degree of freedom, lower extremity isometric device (the MultiLEIT) that accurately quantifies simultaneous torques at the hip, knee and ankle. The system was mechanically validated and then implemented with two healthy control individuals and two post-stroke individuals to test usability and patient acceptance. Data indicated different joint torque coupling strategies used by both healthy individuals. In contrast, data showed the same torque coupling patterns in both post-stroke individuals, comparable to those described in the clinic. Successful implementation of the MultiLEIT can contribute to the understanding of the underlying mechanisms responsible for abnormal movement patterns and aid in the design of therapeutic interventions. PMID:25163064

  8. Cutaneous lymphoid hyperplasia mimicking cutaneous lymphoma in a hyperthyroid cat

    PubMed Central

    Snead, Elisabeth; Kerr, Moira; MacDonald, Valerie

    2013-01-01

    A 12-year-old neutered male domestic shorthair cat presented for chronic, localized, swelling and crusting of the left upper lip, weight loss, sporadic vomiting, and focal alopecia between the scapulae was diagnosed with hyperthyroidism and regional eosinophilic lymphadenitis. Treatment with methimazole exacerbated an underlying hypersensitivity disorder leading to marked generalized lymphadenopathy that histologically mimicked lymphoma. PMID:24155419

  9. Mimickers of lumbar radiculopathy.

    PubMed

    Grimm, Bennett Douglas; Blessinger, Brian Joseph; Darden, Bruce Vaiden; Brigham, Craig D; Kneisl, Jeffrey S; Laxer, Eric B

    2015-01-01

    Orthopaedic surgeons frequently treat patients who report pain that radiates from the back into the lower extremity. Although the most common etiology is either a herniated disk or spinal stenosis, a myriad of pathologies can mimic the symptoms of radiculopathy, resulting in differences in the clinical presentation and the workup. Therefore, the clinician must be able to distinguish the signs and symptoms of lumbar radiculopathy from pathologies that may have a similar presentation. Being cognizant of these other possible conditions enables the physician to consider a breadth of alternative diagnoses when a patient presents with radiating lower extremity pain. PMID:25538126

  10. Comparison of joint angles and electromyographic activity of the lower extremities during standing with wearing standard and revised high-heeled shoes: A pilot study.

    PubMed

    Bae, Young-Hyeon; Ko, Mansoo; Lee, Suk Min

    2016-04-29

    Revised high-heeled shoes (HHSs) were designed to improve the shortcomings of standard HHSs. This study was conducted to compare revised and standard HHSs with regard to joint angles and electromyographic (EMG) activity of the lower extremities during standing. The participants were five healthy young women. Data regarding joint angles and EMG activity of the lower extremities were obtained under three conditions: barefoot, when wearing revised HHSs, and when wearing standard HHSs. Lower extremity joint angles in the three dimensional plane were confirmed using a VICON motion capture system. EMG activity of the lower extremities was measured using active bipolar surface EMG. Kruskal-Wallis one-way analysis of variance by rank applied to analyze differences during three standing conditions. Compared with the barefoot condition, the standard HHSs condition was more different than the revised HHSs condition with regard to lower extremity joint angles during standing. EMG activity of the lower extremities was different for the revised HHSs condition, but the differences among the three conditions were not significant. Wearing revised HHSs may positively impact joint angles and EMG activity of the lower extremities by improving body alignment while standing. PMID:27163313

  11. Swelling of Olympic Gels

    NASA Astrophysics Data System (ADS)

    Lang, M.; Fischer, J.; Werner, M.; Sommer, J.-U.

    2014-06-01

    The swelling equilibrium of Olympic gels, which are composed of entangled cyclic polymers, is studied by Monte Carlo simulations. In contrast to chemically cross-linked polymer networks, we observe that Olympic gels made of chains with a larger degree of polymerization, N, exhibit a smaller equilibrium swelling degree, Q∝N-0.28ϕ0-0.72, at the same polymer volume fraction ϕ0 at network preparation. This observation is explained by a desinterspersion (reorganization with release of nontrapped entanglements) process of overlapping nonconcatenated rings upon swelling.

  12. The reliability of the modified lower extremity functional scale among adults living with HIV on antiretroviral therapy, in Rwanda, Africa

    PubMed Central

    Tumusiime, D.K.; Stewart, A.; Venter, F.W.D.; Musenge, E.

    2014-01-01

    Abstract Peripheral neuropathy (PN) is common among people living with HIV (PLHIV) on antiretroviral therapy (ART), and affects their daily functional ability and quality of life. Lower extremity functional ability, which is most commonly compromised in patients with PN, has not been clearly evaluated in an African setting, with regard to functional limitations. The lower extremity functional scale (LEFS) was originally developed and validated among elderly people in the USA, where the environment and activities of daily life are very different from those in Rwanda. The purpose of this study was to adapt and establish the reliability of LEFS, among adults living with HIV on ART, in a Rwandan environment. The study translated LEFS from English to Kinyarwanda, the local language spoken in Rwanda, the LEFS was then modified accordingly, and tested for test-retest reliability among 50 adult PLHIV on ART. An average Spearman rank order correlation coefficient, ρ ≥ 0.7, was considered optimal for reliability. Prior to the modification of the LEFS and in the initial testing of the translated LEFS, none of the activities was strongly correlated (ρ ≥ 0.8); most of the activities (90%, 18/20) were moderately correlated (ρ ≥ 0.5) and 10% (2/20) were weakly correlated (ρ ≤ 0.5). The ρ of most of the functional activities improved after modification by an expert group to ρ ≥ 0.7, establishing reliability and validity of LEFS among PLHIV on ART with lower extremity functional limitations, in this environment. In conclusion, this study demonstrated the importance of modifying and establishing test – retest reliability of tools derived from developed world contexts to local conditions in developing countries, such as in Rwanda. The modified LEFS in this study can be used in Rwanda by clinicians, specifically at ART clinics to screen and identify people with functional limitations at an early stage of the limitations, for treatment

  13. Routine use of ultrasound-guided access reduces access-site related complications after lower extremity percutaneous revascularization

    PubMed Central

    Lo, Ruby C.; Fokkema, Margriet T.M.; Curran, Thomas; Darling, Jeremy; Hamdan, Allen D.; Wyers, Mark; Martin, Michelle; Schermerhorn, Marc L.

    2014-01-01

    Objectives We sought to elucidate the risks for access site-related complications (ASC) following percutaneous lower extremity revascularization and to evaluate benefit of routine ultrasound-guided access (RUS) in decreasing ASC. Methods We reviewed all consecutive percutaneous revascularizations (PTA or stent) performed for lower extremity atherosclerosis at our institution from 2002–2012. RUS began September 2007. Primary outcome was any ASC (bleeding, groin or retroperitoneal [RP] hematoma, vessel rupture, or thrombosis). Multivariable logistic regression was used to determine predictors of ASC. Results A total of 1,371 punctures were performed on 877 patients (43% women, median age 69 [IQR 60–78] yrs for claudication (29%), critical limb ischemia (59%), or bypass graft stenosis (12%) using 4–8Fr sheaths. There were 72 ASCs (5%): 52 instances of bleeding or groin hematoma, 9 pseudoaneurysms, 8 retroperitoneal hematomas, 2 artery lacerations, and 1 thrombosis. ASC were less frequent when RUS was used (4% vs. 7%, P=.02). Multivariable predictors of ASC were age >75 years (OR 2.0, 95% CI 1.1–3.7, P=.03), CHF (OR 1.9, 95% CI 1.1–1.3, P=.02), preoperative warfarin use (OR 2.0, 95% CI 1.1–3.5, P=.02), & RUS (OR 0.4, 95% CI 0.2–0.7, P<.01). Vascular closure devices (VCDs) were not associated with lower rates of ASCs (OR 1.1, 95% CI 0.2–0.7, P<.01). RUS lowered ASCs in those >75 years (5% vs. 12%, P<.01) but not those on warfarin preoperatively (10% vs. 13%, P=.47). RUS did not decrease VCD failure (6% vs. 4%, P=.79). Conclusions We were able to decrease the rate of ASCs during lower extremity revascularization with the implementation of RUS. VCDs did not impact ASCs. Particular care should be taken on patients >75 years old, those with CHF, and those on warfarin. PMID:25240244

  14. Lower Extremity Radiography

    MedlinePlus

    ... images of the toes, feet, ankles, lower leg, knee, upper leg or hip. These types of examinations are performed to detect conditions such as fractures, soft tissue damage and arthritis. A physician will ...

  15. Foot, leg, and ankle swelling

    MedlinePlus

    ... feet - legs; Ankle swelling; Foot swelling; Leg swelling; Edema - peripheral; Peripheral edema ... 51. Trayes KP, Studdiford JS, Pickle S, Tully AS. Edema: Diagnosis and management. Am Fam Phys . 2013;88( ...

  16. The effect of limb crossing and limb congruency on multisensory integration in peripersonal space for the upper and lower extremities.

    PubMed

    van Elk, Michiel; Forget, Joachim; Blanke, Olaf

    2013-06-01

    The present study investigated how multisensory integration in peripersonal space is modulated by limb posture (i.e. whether the limbs are crossed or uncrossed) and limb congruency (i.e. whether the observed body part matches the actual position of one's limb). This was done separately for the upper limbs (Experiment 1) and the lower limbs (Experiment 2). The crossmodal congruency task was used to measure peripersonal space integration for the hands and the feet. It was found that the peripersonal space representation for the hands but not for the feet is dynamically updated based on both limb posture and limb congruency. Together these findings show how dynamic cues from vision, proprioception, and touch are integrated in peripersonal limb space and highlight fundamental differences in the way in which peripersonal space is represented for the upper and lower extremity. PMID:23579198

  17. A study of the effects of prolonged simulated microgravity on the musculature of the lower extremities in man - An introduction

    NASA Technical Reports Server (NTRS)

    Buchanan, Paul; Convertino, Victor A.

    1989-01-01

    The experimental approach and the protocol are described for a study designed to investigate the effect of prolonged microgravity (simulated by a continuous exposure of subjects to 30-d-long 6-deg headdown tilt) on the musculature of the lower extremities in humans. The objectives of this study are as follows: (1) to determine changes in the functional characteristics of knee joint flexor and extensor muscle group; (2) to examine changes in the histochemical, biochemical, electron microscopic, and computed tomographic characteristics of skeletal muscle; (3) to determine if functional characteristics of skeletal muscle would be normalized four weeks after the bedrest; and (4) to compare these results to those of spaceflight. Percutaneous muscle biopsy, computed tomography, anthropometry, and in vivo muscle strength measurements are to be used to assess mechanical, structural, and metabolic characteristics of skeletal muscle.

  18. Treatment of lower extremity injuries due to antipersonnel mines: blast resuscitation and victim assistance team experiences in Cambodia.

    PubMed

    Parr, Reagan R; Providence, Bertram C; Burkhalter, William E; Smith, Allan C

    2003-07-01

    The two teams comprising the fiscal year 2001 Blast Resuscitation and Victim Assistance mission had the opportunity to learn from and practice mine injury treatment principles with experienced local and international war surgeons in Cambodia. Treatment principles were modifications of International Committee of the Red Cross recommendations. A total of 14 acute lower extremity mine injuries were treated. Surgery generally consisted of an open amputation or thorough irrigation and debridement using equipment readily available in any U.S. military field hospital. The surgical techniques will be described in detail. Delayed primary closure occurred 5 days later followed by prosthesis fitting (for amputees) in an International Committee of the Red Cross facility 12 weeks later. Other options and techniques will be discussed with an emphasis on applicability to U.S. military field surgery. PMID:12901462

  19. Microbial cellulose wound dressing in the treatment of nonhealing lower extremity ulcers.

    PubMed

    Portal, Orlando; Clark, William A; Levinson, Dennis J

    2009-01-01

    Following standard care, nonhealing lower extremity (LE) ulcers were managed with a bacterial cellulose (BC) wound dressing, Dermafill™, (AMD/Ritmed, Tonawanda, NY), derived from Acetobacter xylinum. The time to 75% reduction in wound size was compared in 11 chronic wounds before and after the application of BC. The mean period of observation before the application of BC was 315 days; (95% CI: 239-392 days). With the application of BC to these chronic wounds, the mean time to 75% epithelization was reduced to 81 days (95% CI: 50-111 days) with a median of 79 days. The rate of wound closure with BC was significantly faster than with standard care (P < 0.001). When applied to nonhealing LE ulcers, a BC wound dressing shortens the time to wound closure over standard care. PMID:25904579

  20. Medial sural artery perforator free flap: legitimate use as a solution for the ipsilateral distal lower extremity defect.

    PubMed

    Hallock, Geoffrey G

    2014-03-01

    The medial sural artery perforator (MSAP) flap captures the cutaneous territory of the medial calf, and can potentially be advantageous as a thin free flap, even in the most obese individual, for coverage of most foot and/or ankle defects where bulk is a liability. The anatomy is fairly constant, as usually at least one reasonably large perforator can always be found emanating from the medial head of the gastrocnemius muscle. As a microsurgical tissue transfer, a long vascular pedicle of large caliber is routinely possible which facilitates any requisite microanastomoses.Over the past decade from our free flap registry, 14 patients with distal lower extremity wounds were covered specifically with a perforator flap based on the ipsilateral medial sural artery; out of which only 2 (14%) were females.In this series using a MSAP free flap, there was only one failure requiring salvage by a different free flap. All but one case was a sequel of trauma, and these involved all zones of the foot and ankle. A skin graft of the donor site was necessary in 5/14 (36%) patients. In no cases did the flap subsequently impede the use of shoes nor hinder ambulation.The study concluded the major disadvantage of the MSAP flap is the nonaesthetic scar left at the donor site which can be quite conspicuous, especially if a skin graft had to be used. Yet even this detriment can be acceptable for ipsilateral distal lower extremity defects where reconstruction of the defect itself may be cosmetically unappealing. This may be the best indication for the MSAP flap to be considered first as the free flap of choice. PMID:24114709

  1. Testing and Modeling the Responses of Hybrid III Crash-Dummy Lower Extremity under High-speed Vertical Loading.

    PubMed

    Zhu, Feng; Dong, Liqiang; Jin, Xin; Jiang, Binhui; Kalra, Anil; Shen, Ming; Yang, King H

    2015-11-01

    Anthropometric test devices (ATDs), such as the Hybrid III crash-test dummy, have been used to simulate lowerextremity responses to military personnel subjected to loading conditions from anti-vehicular (AV) landmine blasts. Numerical simulations [e.g., finite element (FE) analysis] of such high-speed vertical loading on ATD parts require accurate material parameters that are dependent on strain rate. This study presents a combined experimental and computational study to calibrate the rate-dependent properties of three materials on the lower extremities of the Hybrid III dummy. The three materials are heelpad foam, foot skin, and lower-leg flesh, and each has properties that can affect simulation results of forces and moments transferred to the lower extremities. Specifically, the behavior of the heel-pad foam was directly calibrated through standard compression tests, and the properties of the foot skin and lower-leg flesh were calibrated based on an optimization procedure in which the material parameters were adjusted for best fit between the calculated force-deflection responses and least squares of the experimental data. The material models updated with strain-rate effects were then integrated into an ATD full-body FE model (FEM), which was used to simulate vertical impulsive loading responses at different speeds. Results of validations using this model demonstrated basic replication of experimentally obtained response patterns of the tibia. The bending moments matched those calculated from the experimental data 25-40% more accurately than those obtained from the original model, and axial forces were 60-90% more accurate. However, neither the original nor the modified models well captured whole-body response patterns, and further improvements are required. As a generalized approach, the optimization method presented in this paper can be applied to characterize material constants for a wide range of materials. PMID:26660755

  2. Mobility-Related Consequences of Reduced Lower-Extremity Peripheral Nerve Function with Age: A Systematic Review

    PubMed Central

    Ward, Rachel E.; Caserotti, Paolo; Cauley, Jane A.; Boudreau, Robert M.; Goodpaster, Bret H.; Vinik, Aaron I.; Newman, Anne B.; Strotmeyer, Elsa S.

    2016-01-01

    The objective of this study is to systematically review the relationship between lower-extremity peripheral nerve function and mobility in older adults. The National Library of Medicine (PubMed) was searched on March 23, 2015 with no limits on publication dates. One reviewer selected original research studies of older adults (≥65 years) that assessed the relationship between lower-extremity peripheral nerve function and mobility-related outcomes. Participants, study design and methods of assessing peripheral nerve impairment were evaluated and results were reported and synthesized. Eight articles were identified, including 6 cross-sectional and 2 longitudinal studies. These articles investigated 6 elderly cohorts (4 from the U.S. and 2 from Italy): 3 community-dwelling (including 1 with only disabled women and 1 without mobility limitations at baseline), 1 with both community-dwelling and institutionalized residents, 1 from a range of residential locations, and 1 of patients with peripheral arterial disease. Mean ages ranged from 71-82 years. Nerve function was assessed by vibration threshold (n=2); sensory measures and clinical signs and symptoms of neuropathy (n=2); motor nerve conduction (n=1); and a combination of both sensory measures and motor nerve conduction (n=3). Each study found that worse peripheral nerve function was related to poor mobility, although relationships varied based on the nerve function measure and mobility domain assessed. Six studies found that the association between nerve function and mobility persisted despite adjustment for diabetes. Evidence suggests that peripheral nerve function impairment at various levels of severity is related to poor mobility independent of diabetes. Relationships varied depending on peripheral nerve measure, which may be particularly important when investigating specific biological mechanisms. Future research needs to identify risk factors for peripheral nerve decline beyond diabetes, especially those

  3. Effects of the lower extremities muscle activation during muscular strength training on an unstable platform with magneto-rheological dampers

    NASA Astrophysics Data System (ADS)

    Piao, YongJun; Choi, YounJung; Kim, JungJa; Kwan, TaeKyu; Kim, Nam-Gyun

    2009-03-01

    Adequate postural balance depends on the spatial and temporal integration of vestibular, visual, and somatosensory information. Especially, the musculoskeletal function (range of joint, flexibility of spine, muscular strength) is essential in maintaining the postural balance. Muscular strength training methods include the use of commercialized devices and repeatable resistance training tools (rubber band, ball, etc). These training systems cost high price and can't control of intensity. Thus we suggest a new training system which can adjust training intensity and indicate the center of pressure of a subject while the training was passively controlled by applying controlled electric current to the Magneto- Rheological damper. And we performed experimental studies on the muscular activities in the lower extremities during maintaining, moving and pushing exercises on an unstable platform with Magneto rheological dampers. A subject executed the maintaining, moving and pushing exercises which were displayed in a monitor. The electromyographic signals of the eight muscles in lower extremities were recorded and analyzed in the time and frequency domain: the muscles of interest were rectus femoris, biceps femoris, tensor fasciae latae, vastus lateralis, vastus medialis, gastrocnemius, tibialis anterior, and soleus. The experimental results showed the difference of muscular activities at the four moving exercises and the nine maintaining exercises. The rate of the increase in the muscular activities was affected by the condition of the unstable platform with MR dampers for the maintaining and moving exercises. The experimental results suggested the choice of different maintaining and moving exercises could selectively train different muscles with varying intensity. Furthermore, the findings also suggested the training using this system can improve the ability of postural balance.

  4. The association between social participation and lower extremity muscle strength, balance, and gait speed in US adults.

    PubMed

    Warren, Meghan; Ganley, Kathleen J; Pohl, Patricia S

    2016-12-01

    Social participation is associated with healthy aging, and although associations have been reported between social participation and demographics, no published studies have examined a relationship between social participation and measures amenable to intervention. The purpose was to explore the association between self-reported social participation and lower extremity strength, balance, and gait speed. A cross-sectional analysis of US adults (n = 2291; n = 1,031 males; mean ± standard deviation age 63.5 ± 0.3 years) from the 2001-2 National Health and Nutrition Examination Survey was conducted. Two questions about self-reported difficulty with social participation were categorized into limited (yes/no). The independent variables included knee extension strength (n = 1537; classified as tertiles of weak, normal, and strong), balance (n = 1813; 3 tests scored as pass/fail), and gait speed (n = 2025; dichotomized as slow [less than 1.0 m/s] and fast [greater than or equal to 1.0 m/s]). Logistic regression, accounting for the complex survey design and adjusting for age, sex, physical activity, and medical conditions, was used to estimate the odds of limitation in social participation with each independent variable. Alpha was decreased to 0.01 due to multiple tests. Slower gait speed was significantly associated with social participation limitation (odds ratio = 3.1; 99% confidence interval: 1.5-6.2). No significant association was found with social participation and lower extremity strength or balance. The odds of having limitation in social participation were 3 times greater in those with slow gait speed. Prospective studies should examine the effect of improved gait speed on levels of social participation. PMID:27413675

  5. Illustration of Cost Saving Implications of Lower Extremity Nerve Decompression to Prevent Recurrence of Diabetic Foot Ulceration

    PubMed Central

    Rankin, Timothy M.; Miller, John D.; Gruessner, Angelika C.; Nickerson, D. Scott

    2015-01-01

    The US diabetic foot ulcer (DFU) incidence is 3-4% of 22.3 million diagnosed diabetes cases plus 6.3 million undiagnosed, 858 000 cases total. Risk of recurrence after healing is 30% annually. Lower extremity multiple nerve decompression (ND) surgery reduces neuropathic DFU (nDFU) recurrence risk by >80%. Cost effectiveness of hypothetical ND implementation to minimize nDFU recurrence is compared to the current $6.171 billion annual nDFU expense. A literature review identified best estimates of annual incidence, recurrence risk, medical management expense, and noneconomic costs for DFU. Illustrative cost/benefit calculations were performed assuming widespread application of bilateral ND after wound healing to the nDFU problem, using Center for Medicare Services mean expense data of $1143/case for unilateral lower extremity ND. Calculations use conservative, evidence-based cost figures, which are contemporary (2012) or adjusted for inflation. Widespread adoption of ND after nDFU healing could reduce annual DFU occurrences by at least 21% in the third year and 24% by year 5, representing calculated cost savings of $1.296 billion (year 3) to $1.481 billion (year 5). This scenario proffers significant expense reduction and societal benefit, and represents a minimum 1.9× return on the investment cost for surgical treatment. Further large cost savings would require reductions in initial DFU incidence, which ND might achieve by selective application to advanced diabetic sensorimotor polyneuropathy (DSPN). By minimizing the contribution of recurrences to yearly nDFU incidence, ND has potential to reduce by nearly $1 billion the annual cost of DFU treatment in the United States. PMID:26055081

  6. Asymmetry of magnetic motor evoked potentials recorded in calf muscles of the dominant and non-dominant lower extremity.

    PubMed

    Olex-Zarychta, Dorota; Koprowski, Robert; Sobota, Grzegorz; Wróbel, Zygmunt

    2009-08-01

    The aim of the study was to determine the applicability of magnetic stimulation and magnetic motor evoked potentials (MEPs) in motor asymmetry studies by obtaining quantitative and qualitative measures of efferent activity during low intensity magnetic stimulation of the dominant and non-dominant lower extremities. Magnetic stimulation of the tibial nerve in the popliteal fossa was performed in 10 healthy male right-handed and right-footed young adults. Responses were recorded from the lateral head of the gastrocnemius muscles of the right and left lower extremities. Response characteristics (duration, onset latency, amplitude) were analyzed in relation to the functional dominance of the limbs and in relation to the direction of the current in the magnetic coil by use of the Wilcoxon pair sequence test. The CCW direction of coil current was related to reduced amplitudes of recorded MEPs. Greater amplitudes of evoked potentials were recorded in the non-dominant extremity, both in the CW and CCW coil current directions, with the statistical significance of this effect (p=0.005). No differences in duration of response were found in the CW current direction, while in CCW the time of the left-side response was prolonged (p=0.01). In the non-dominant extremity longer onset latencies were recorded in both current directions, but only for the CW direction the side asymmetries showed a statistical significance of p=0.005. In the dominant extremity the stimulation correlated with stronger paresthesias, especially using the CCW direction of coil current. The results indicate that low intensity magnetic stimulation may be useful in quantitative and qualitative research into the motor asymmetry. PMID:19427357

  7. The Effects of Wearing High Heels while Pressing a Car Accelerator Pedal on Lower Extremity Muscle Activation.

    PubMed

    Jung, Jaemin; Lee, Sang-Yeol

    2014-11-01

    [Purpose] The purpose of this study was to determine the effects of wearing high heels while driving on lower extremity muscle activation. [Subjects] The subjects of this experimental study were 14 healthy women in their 20s who normally wear shoes with high heels. [Methods] The subjects were asked to place their shoes on an accelerator pedal with the heel touching the floor and then asked to press the pedal with as much pressure as possible for 3 seconds before removing their feet from the pedal. A total of 3 measurements were taken for each heel height (flat, 5 cm, 7 cm), and the heel height was randomly selected. [Results] The levels of muscle activity, indicated as the percentage of reference voluntary contraction, for gastrocnemius muscle in the flat, 5 cm, and 7 cm shoes were 180.8±61.8%, 285.4±122.3%, and 366.2±193.7%, respectively, and there were significant differences between groups. Those for the soleus muscle were 477.3±209.2%, 718.8±380.5%, and 882.4±509.9%, and there were significant differences between groups. [Conclusion] To summarize the results of this study, it was found that female drivers require greater lower extremity muscle activation when wearing high heels than when wearing low heels. Furthermore, instability and muscle fatigue of the ankle joint, which results from wearing high heels on a daily basis, could also occur while driving. PMID:25435684

  8. Effects of a 10-Week Inspiratory Muscle Training Program on Lower-Extremity Mobility in People with Multiple Sclerosis

    PubMed Central

    Fry, Donna

    2011-01-01

    Pulmonary muscle weakness is common in ambulatory people with multiple sclerosis (MS) and may lead to deficits in mobility function. The purpose of this study was to examine the effect of a 10-week home-based exercise program using an inspiratory muscle threshold trainer (IMT) on the results of four lower-extremity physical performance tests in people with MS. The study design was a two-group (experimental-control), pretest-posttest study. Outcome measures consisted of pulmonary function measures including maximal inspiratory pressure (MIP), maximal expiratory pressure (MEP), and maximal voluntary ventilation (MVV), and the following lower-extremity physical performance measures: the 6-Minute Walk (6MW) distance, gait velocity (GV), the Sit-to-Stand Test (SST), the Functional Stair Test (FST), and a balance test (BAL). A total of 46 ambulatory participants (Expanded Disability Status Scale [EDSS] score, 2.0–6.5) with MS were randomly assigned to an intervention group (mean EDSS score, 4.1) that received 10 weeks of home-based inspiratory muscle training or a nontreatment control group (mean EDSS score, 3.2). Of the original 46 participants, 20 intervention group participants and 19 control group participants completed the study. Compared with the control group, the intervention group made significantly greater gains in inspiratory muscle strength (P = .003) and timed balance scores (P = .008). A nonsignificant improvement in 6MW distance (P = .086) was also noted in the IMT-trained group as compared with the control group. This is the first study directly linking improvement in respiratory function to improvement in physical performance function in people with mild-to-moderate disability due to MS. PMID:24453703

  9. Illustration of Cost Saving Implications of Lower Extremity Nerve Decompression to Prevent Recurrence of Diabetic Foot Ulceration.

    PubMed

    Rankin, Timothy M; Miller, John D; Gruessner, Angelika C; Nickerson, D Scott

    2015-07-01

    The US diabetic foot ulcer (DFU) incidence is 3-4% of 22.3 million diagnosed diabetes cases plus 6.3 million undiagnosed, 858 000 cases total. Risk of recurrence after healing is 30% annually. Lower extremity multiple nerve decompression (ND) surgery reduces neuropathic DFU (nDFU) recurrence risk by >80%. Cost effectiveness of hypothetical ND implementation to minimize nDFU recurrence is compared to the current $6.171 billion annual nDFU expense. A literature review identified best estimates of annual incidence, recurrence risk, medical management expense, and noneconomic costs for DFU. Illustrative cost/benefit calculations were performed assuming widespread application of bilateral ND after wound healing to the nDFU problem, using Center for Medicare Services mean expense data of $1143/case for unilateral lower extremity ND. Calculations use conservative, evidence-based cost figures, which are contemporary (2012) or adjusted for inflation. Widespread adoption of ND after nDFU healing could reduce annual DFU occurrences by at least 21% in the third year and 24% by year 5, representing calculated cost savings of $1.296 billion (year 3) to $1.481 billion (year 5). This scenario proffers significant expense reduction and societal benefit, and represents a minimum 1.9× return on the investment cost for surgical treatment. Further large cost savings would require reductions in initial DFU incidence, which ND might achieve by selective application to advanced diabetic sensorimotor polyneuropathy (DSPN). By minimizing the contribution of recurrences to yearly nDFU incidence, ND has potential to reduce by nearly $1 billion the annual cost of DFU treatment in the United States. PMID:26055081

  10. Transcutaenous electrical nerve stimulation to manage a lower extremity wound complicated by peripheral arterial disease: a case report.

    PubMed

    Yarboro, Douglas D; Smith, Robert

    2014-07-01

    Transcutaneous electrical nerve stimulation (TENS) is used to alleviate muscle pain, and there is some evidence it may affect healing in chronic wounds. An 80-year-old male patient with a chronic left lower extremity wound and a history of peripheral arterial disease, type 2 diabetes, hypertension, chronic obstructive pulmonary disease, and lung cancer presented for treatment. Previous protocols of care, mainly consisting of sharp debridement and daily dressing changes, had not resulted in a decrease in wound size. The patient had right and left iliac artery stenosis - not amenable to surgical intervention - and an ankle brachial index (ABI) of 0.63 on the left and 0.59 on the right lower extremities. On presentation, the wound measured 3.0 cm x 2.0 cm with a depth of 0.3 cm and a 0.5-cm tract at the 5 o'clock position. Treatment was changed to application of an ionic silver-containing Hydrofiber™ dressing and low-frequency TENS. Electrodes were applied 2 cm superior and inferior to the wound margin at a frequency of 2 Hz with a pulse width of 250 microseconds and amplitude of 33 mA. Treatment time was 45 minutes, twice daily, for 3 months, performed at home by the patient and his caregiver. After 4 weeks, wound dimensions decreased by 1.51% per day, and the wound was completely healed (100% epithelialized) after 12 weeks. At that time, the ABI of the left (treated) leg had increased to 0.71. Research is needed to determine the efficacy and effectiveness of low-frequency TENS to help clinicians provide evidenced-based treatment for wounds complicated by decreased blood flow. PMID:25019248

  11. Mobility-Related Consequences of Reduced Lower-Extremity Peripheral Nerve Function with Age: A Systematic Review.

    PubMed

    Ward, Rachel E; Caserotti, Paolo; Cauley, Jane A; Boudreau, Robert M; Goodpaster, Bret H; Vinik, Aaron I; Newman, Anne B; Strotmeyer, Elsa S

    2016-08-01

    The objective of this study is to systematically review the relationship between lower-extremity peripheral nerve function and mobility in older adults. The National Library of Medicine (PubMed) was searched on March 23, 2015 with no limits on publication dates. One reviewer selected original research studies of older adults (≥65 years) that assessed the relationship between lower-extremity peripheral nerve function and mobility-related outcomes. Participants, study design and methods of assessing peripheral nerve impairment were evaluated and results were reported and synthesized. Eight articles were identified, including 6 cross-sectional and 2 longitudinal studies. These articles investigated 6 elderly cohorts (4 from the U.S. and 2 from Italy): 3 community-dwelling (including 1 with only disabled women and 1 without mobility limitations at baseline), 1 with both community-dwelling and institutionalized residents, 1 from a range of residential locations, and 1 of patients with peripheral arterial disease. Mean ages ranged from 71-82 years. Nerve function was assessed by vibration threshold (n=2); sensory measures and clinical signs and symptoms of neuropathy (n=2); motor nerve conduction (n=1); and a combination of both sensory measures and motor nerve conduction (n=3). Each study found that worse peripheral nerve function was related to poor mobility, although relationships varied based on the nerve function measure and mobility domain assessed. Six studies found that the association between nerve function and mobility persisted despite adjustment for diabetes. Evidence suggests that peripheral nerve function impairment at various levels of severity is related to poor mobility independent of diabetes. Relationships varied depending on peripheral nerve measure, which may be particularly important when investigating specific biological mechanisms. Future research needs to identify risk factors for peripheral nerve decline beyond diabetes, especially those

  12. A research on the effects of practicing Baduanjin on the lower extremities by using sEMG

    NASA Astrophysics Data System (ADS)

    Jin, Li; Li, Ran; Chen, Jing; Tian, Ye

    2015-03-01

    The purpose of this study was to evaluate the effects of practicing Baduanjin exercises on the lower extremities of subjects, using electromyography analysis, and values of IEMG were calculated. [Subjects] Forty, healthy adults were randomly assigned as subjects to two groups: SG (Study Group, n=20) who received twelve weeks of Baduanjin training, and CG (Control Group, n=20), who received no training. [Methods] A sixteen-channel sEMG system (ME6000, Mega Electronics Ltd., Kuopio, Finland) was selected to record and measure activity changes in two muscles (vastus medialis and vastus lateralis). [Results] After twelve-week of Baduanjin training, the results of this study showed that the SG group had significant increases in values of IEMG in second, fifth and seventh section of the Baduanjin exercises. In second section, the values of IEMG had increased for 56.95% in vastus lateralis (p < 0.05) and for 40.04% in vastus medialis (p < 0.05). In fifth section, the values of IEMG had increased for 37.61% in vastus lateralis (p < 0.05) and for 33.83% in vastus medialis (p < 0.05). In seventh section, the increasement of IEMG values was 47.19% in vastus lateralis (p < 0.05) and 49.31% in vastus medialis (p < 0.05). [Conclusion] This study indicated that performing twelve-week of Baduanjin training can significantly increase the strength and the physical function of the lower extremities among healthy adults. With no adverse events from exercise were reported during the training procedure, the safety and low intensity of Baduanjin exercise was also proved, it could be widely taken as an appropriate no-risk treatment exercise for healthy adults.

  13. Catheter-Directed Thrombolysis of Acute Deep Vein Thrombosis in the Lower Extremity of a Child with Interrupted Inferior Vena Cava

    SciTech Connect

    Oguzkurt, Levent Ozkan, Ugur; Tercan, Fahri; Koc, Zafer

    2007-04-15

    We present the case of a 14-year-old girl who developed acute deep vein thrombosis (DVT) in her right lower extremity. Laboratory testing revealed protein S deficiency, and the patient's father also had this abnormality with a history of lower extremity DVT. Manual thromboaspiration followed by catheter-directed thrombolysis resulted in total clearance of all thrombi. Computed tomography and later venography revealed an interrupted inferior vena cava. Catheter-directed thrombolysis is an established treatment for adults with acute DVT. To the best of our knowledge, this report is the first to describe catheter-directed thrombolysis in a pediatric patient with lower extremity DVT. Our results suggest that catheter-directed thrombolysis is safe and effective for use in selected older children and adolescents with acute DVT in the lower extremity.

  14. Role of pelvic translation and lower-extremity compensation to maintain gravity line position in spinal deformity.

    PubMed

    Ferrero, Emmanuelle; Liabaud, Barthelemy; Challier, Vincent; Lafage, Renaud; Diebo, Bassel G; Vira, Shaleen; Liu, Shian; Vital, Jean Marc; Ilharreborde, Brice; Protopsaltis, Themistocles S; Errico, Thomas J; Schwab, Frank J; Lafage, Virginie

    2016-03-01

    OBJECT Previous forceplate studies analyzing the impact of sagittal-plane spinal deformity on pelvic parameters have demonstrated the compensatory mechanisms of pelvis translation in addition to rotation. However, the mechanisms recruited for this pelvic rotation were not assessed. This study aims to analyze the relationship between spinopelvic and lower-extremity parameters and clarify the role of pelvic translation. METHODS This is a retrospective study of patients with spinal deformity and full-body EOS images. Patients with only stenosis or low-back pain were excluded. Patients were grouped according to T-1 spinopelvic inclination (T1SPi): sagittal forward (forward, > 0.5°), neutral (-6.3° to 0.5°), or backward (< -6.3°). Pelvic translation was quantified by pelvic shift (sagittal offset between the posterosuperior corner of the sacrum and anterior cortex of the distal tibia), hip extension was measured using the sacrofemoral angle (SFA; the angle formed by the middle of the sacral endplate and the bicoxofemoral axis and the line between the bicoxofemoral axis and the femoral axis), and chin-brow vertical angle (CBVA). Univariate and multivariate analyses were used to compare the parameters and correlation with the Oswestry Disability Index (ODI). RESULTS In total, 336 patients (71% female; mean age 57 years; mean body mass index 27 kg/m(2)) had mean T1SPi values of -8.8°, -3.5°, and 5.9° in the backward, neutral, and forward groups, respectively. There were significant differences in the lower-extremity and spinopelvic parameters between T1SPi groups. The backward group had a normal lumbar lordosis (LL), negative SVA and pelvic shift, and the largest hip extension. Forward patients had a small LL and an increased SVA, with a large pelvic shift creating compensatory knee flexion. Significant correlations existed between lower-limb parameter and pelvic shift, pelvic tilt, T-1 pelvic angle, T1SPi, and sagittal vertical axis (0.3 < r < 0.8; p < 0.001). ODI

  15. A Decade of Progress Using Virtual Reality for Poststroke Lower Extremity Rehabilitation: Systematic Review of the Intervention Methods

    PubMed Central

    Luque-Moreno, Carlos; Ferragut-Garcías, Alejandro; Rodríguez-Blanco, Cleofás; Heredia-Rizo, Alberto Marcos; Oliva-Pascual-Vaca, Jesús; Kiper, Pawel; Oliva-Pascual-Vaca, Ángel

    2015-01-01

    Objective. To develop a systematic review of the literature, to describe the different virtual reality (VR) interventions and interactive videogames applied to the lower extremity (LE) of stroke patients, and to analyse the results according to the most frequently used outcome measures. Material and Methods. An electronic search of randomized trials between January 2004 and January 2014 in different databases (Medline, Cinahl, Web of Science, PEDro, and Cochrane) was carried out. Several terms (virtual reality, feedback, stroke, hemiplegia, brain injury, cerebrovascular accident, lower limb, leg, and gait) were combined, and finally 11 articles were included according to the established inclusion and exclusion criteria. Results. The reviewed trials showed a high heterogeneity in terms of study design and assessment tools, which makes it difficult to compare and analyze the different types of interventions. However, most of them found a significant improvement on gait speed, balance and motor function, due to VR intervention. Conclusions. Although evidence is limited, it suggests that VR intervention (more than 10 sessions) in stroke patients may have a positive impact on balance, and gait recovery. Better results were obtained when a multimodal approach, combining VR and conventional physiotherapy, was used. Flexible software seems to adapt better to patients' requirements, allowing more specific and individual treatments. PMID:26539480

  16. Validation of the Microsoft Kinect® camera system for measurement of lower extremity jump landing and squatting kinematics.

    PubMed

    Eltoukhy, Moataz; Kelly, Adam; Kim, Chang-Young; Jun, Hyung-Pil; Campbell, Richard; Kuenze, Christopher

    2016-01-01

    Cost effective, quantifiable assessment of lower extremity movement represents potential improvement over standard tools for evaluation of injury risk. Ten healthy participants completed three trials of a drop jump, overhead squat, and single leg squat task. Peak hip and knee kinematics were assessed using an 8 camera BTS Smart 7000DX motion analysis system and the Microsoft Kinect® camera system. The agreement and consistency between both uncorrected and correct Kinect kinematic variables and the BTS camera system were assessed using interclass correlations coefficients. Peak sagittal plane kinematics measured using the Microsoft Kinect® camera system explained a significant amount of variance [Range(hip) = 43.5-62.8%; Range(knee) = 67.5-89.6%] in peak kinematics measured using the BTS camera system. Across tasks, peak knee flexion angle and peak hip flexion were found to be consistent and in agreement when the Microsoft Kinect® camera system was directly compared to the BTS camera system but these values were improved following application of a corrective factor. The Microsoft Kinect® may not be an appropriate surrogate for traditional motion analysis technology, but it may have potential applications as a real-time feedback tool in pathological or high injury risk populations. PMID:26835547

  17. Correlation between the selective control assessment of lower extremity and pediatric balance scale scores in children with spastic cerebral palsy

    PubMed Central

    Lim, Hyoungwon

    2015-01-01

    [Purpose] The purpose of this study was to investigate the correlation between the Selective Control Assessment of Lower Extremity (SCALE) and Pediatric Balance Scales (PBS) in children with spastic cerebral palsy and further to test whether the SCALE is a valid tool to predict the PBS. [Subjects and Methods] A cross-sectional study was conducted to evaluate the SCALE and PBS in 23 children (9 females, 14 males, GMFCS level I–III) with spastic cerebral palsy. [Results] Both the SCALE and PBS scores for children with spastic hemiplegia were significantly higher than those for children with spastic diplegia. The scores for SCALE items were low for distal parts. The PBS items that were difficult for the participants to perform were items 8, 9, 10, and 14 with the highest difficulty experienced for item 8 followed by items 9, 10, and 14. The correlation coefficient (0.797) between the SCALE and PBS scores was statistically significant. The correlations between each SCALE item and the PBS scores were also statistically significant. SCALE items were significantly correlated with two PBS dimensions (standing and postural change). [Conclusion] In SCALE assessment, more severe deficits were observed in the distal parts. Standing and postural changes in the PBS method were difficult for the participants to perform. The two tests, that is, the SCALE and PBS, were highly correlated. Therefore, the SCALE is useful to prediction of PBS outcomes and is also applicable as a prognostic indicator for treatment planning. PMID:26834323

  18. RETURN TO PLAY PROGRESSION FOR RUGBY FOLLOWING INJURY TO THE LOWER EXTREMITY: A CLINICAL COMMENTARY AND REVIEW OF THE LITERATURE

    PubMed Central

    Davis, Chelseana C.

    2016-01-01

    Background & Purpose Rugby requires unique demands from its players. Those involved in rehabilitation and care of these athletes must possess an understanding of both the game and various positions. There have been numerous reports focusing on the physiological demands and biomechanical analyses of various components of gameplay, but no specific progression has been developed to assist clinicians assessing the readiness to return of a player after injury. The purpose of this clinical commentary is to outline testing components, general gameplay guidelines, movement progressions, and sport and position-specific progressions related to rugby gameplay following a lower extremity injury. Description of Topic This commentary provides a recommended progression for clinical use for use in a return to rugby program. It includes metabolic considerations, advanced strengthening exercises, agility exercises, and incorporation of drills specific to the sport of rugby that may be performed with the clinician or with assistance from team members. This progression also includes testing parameters for each phase and guidance for clinicians regarding the ability to gauge readiness to return to sport. Discussion It is essential that an athlete returning to the sport of rugby undertake a guided, graduated return to sport progression to ensure safety and to decrease the risk of re-injury. This proposed return to sport progression outlines key parameters for both the sport as a whole and for various specific positions. Level of Evidence Level 5 – Clinical Commentary, Review of Literature PMID:27104062

  19. Effect of forced use of the lower extremity on gait performance and mobility of post-acute stroke patients

    PubMed Central

    Yu, Wen-Hsiu; Liu, Wen-Yu; Wong, Alice May-Kuen; Wang, Tzu-Chi; Li, Yen-Chen; Lien, Hen-Yu

    2015-01-01

    [Purpose] The purpose of this study was to investigate the effects of a forced-use training program on gait, mobility and quality of life of post-acute stroke patients. [Subjects] Twenty-one individuals with unilateral stroke participated in this study. All participants had suffered from first-ever stroke with time since onset of at least 3 months. [Methods] A single-blinded, non-equivalent, pre-post controlled design with 1-month follow-up was adopted. Participants received either a forced-use or a conventional physical therapy program for 2 weeks. The main outcomes assessed were preferred and fastest walking velocities, spatial and temporal symmetry indexes of gait, the timed up and go test, the Rivermead Mobility Index, and the Stroke-Specific Quality of Life Scale (Taiwan version). [Results] Forced-use training induced greater improvements in gait and mobility than conventional physical therapy. In addition, compared to pre-training, patients in the conventional physical therapy group walked faster but more asymmetrically after training. However, neither program effectively improved in-hospital quality of life. [Conclusion] The forced-use approach can be successfully applied to the lower extremities of stroke patients to improve mobility, walking speeds and symmetry of gait. PMID:25729182

  20. A comparative study of the electromyographic activities of lower extremity muscles during level walking and Pedalo riding

    PubMed Central

    Lee, DongGeon; Kim, YouJeong; Yun, JiHyeon; Jung, MiHye; Lee, GyuChang

    2016-01-01

    [Purpose] To analyze the electromyographic (EMG) activities of several lower extremity muscles during ground walking and pedaling using the Pedalo Reha-Bar device. [Subjects and Methods] Fifteen healthy adults aged 20–29 year participated in this study. The subjects’ surface EMG signals while walking and Pedalo Reha-Bar riding were recorded. The subjects performed 20 steps on flat ground and 20 cycles on the Pedalo Reha-Bar. During the tasks, EMG signals of the rectus femoris, biceps femoris, tibialis anterior, soleus, and gastrocnemius within a 20-second period were recorded. The mean EMG signals within the 10 seconds from 6 to 15 seconds were used for the data analysis. [Results] There was a significant increase in the bilateral use of the rectus femoris and a significant decrease in the use of the left tibialis anterior and left soleus in pedaling using the Pedalo Reha-Bar device compared to ground walking. [Conclusion] Level walking and the Pedalo Reha-Bar riding utilize different types of muscles activities. These results suggest that Pedalo Reha-Bar riding may be used for neuromuscular activation, especially of the rectus femoris. PMID:27313354

  1. Catheter-Directed Thrombolysis with Percutaneous Rheolytic Thrombectomy Versus Thrombolysis Alone in Upper and Lower Extremity Deep Vein Thrombosis

    SciTech Connect

    Kim, Hyun S. Patra, Ajanta; Paxton, Ben E.; Khan, Jawad; Streiff, Michael B.

    2006-12-15

    Purpose. To compare the efficacy of catheter-directed thrombolysis (CDT) alone versus CDT with rheolytic percutaneous mechanical thrombectomy (PMT) for upper and lower extremity deep vein thrombosis (DVT). Methods. A retrospective cohort of consecutive patients with acute iliofemoral or brachiosubclavian DVT treated with urokinase CDT was identified, and a chart review was conducted. Demographic characteristics, treatment duration, total lytic dose, clot lysis rates and complications were compared in patients treated with urokinase CDT alone or combined CDT and rheolytic PMT. Results. Forty limbs in 36 patients were treated with urokinase CDT alone. Twenty-seven limbs in 21 patients were treated with urokinase CDT and rheolytic PMT. The mean treatment duration for urokinase CDT alone was 48.0 {+-} 27.1 hr compared with 26.3 {+-} 16.6 hr for urokinase CDT and rheolytic PMT (p = 0.0004). The mean urokinase dose required for CDT alone was 5.6 {+-} 5.3 million units compared with 2.7 {+-} 1.8 million units for urokinase CDT with rheolytic PMT (p = 0.008). Complete clot lysis was achieved in 73% (29/40) of DVT treated with urokinase CDT alone compared with 82% (22/27) treated with urokinase CDT with rheolytic PMT. Conclusion. Percutaneous CDT with rheolytic PMT is as effective as CDT alone for acute proximal extremity DVT but requires significantly shorter treatment duration and lower lytic doses. Randomized studies to confirm the benefits of pharmacomechanical thrombolysis in the treatment of acute proximal extremity DVT are warranted.

  2. Lower Extremity Muscle Thickness During 30-Day 6 degrees Head-Down Bed Rest with Isotonic and Isokinetic Exercise Training

    NASA Technical Reports Server (NTRS)

    Ellis, S.; Kirby, L. C.; Greenleaf, J. E.

    1993-01-01

    Muscle thickness was measured in 19 Bed-Rested (BR) men (32-42 year) subjected to IsoTonic (ITE, cycle orgometer) and IsoKi- netic (IKE, torque orgometer) lower extremity exercise training, and NO Exercise (NOE) training. Thickness was measured with ultrasonography in anterior thigh-Rectus Femoris (RF) and Vastus Intermadius (VI), and combined posterior log-soleus, flexor ballucis longus, and tibialis posterior (S + FHL +TP) - muscles. Compared with ambulatory control values, thickness of the (S + FHL + TP) decreased by 90%-12% (p less than 0.05) In all three test groups. The (RF) thickness was unchanged in the two exercise groups, but decreased by 10% (p less than 0.05) in the NOE. The (VI) thickness was unchanged In the ITE group, but decreased by 12%-l6% (p less than 0.05) in the IKE and NOE groups. Thus, intensive, alternating, isotonic cycle ergometer exercise training is as effective as intensive, intermittent, isokinetic exercise training for maintaining thicknesses of rectus femoris and vastus lntermedius anterior thigh muscles, but not posterior log muscles, during prolonged BR deconditioning.

  3. Analyzing Longitudinal Data with Multilevel Models: An Example with Individuals Living with Lower Extremity Intra-articular Fractures

    PubMed Central

    Kwok, Oi-Man; Underhill, Andrea T.; Berry, Jack W.; Luo, Wen; Elliott, Timothy R.; Yoon, Myeongsun

    2008-01-01

    The use and quality of longitudinal research designs has increased over the past two decades, and new approaches for analyzing longitudinal data, including multi-level modeling (MLM) and latent growth modeling (LGM), have been developed. The purpose of this paper is to demonstrate the use of MLM and its advantages in analyzing longitudinal data. Data from a sample of individuals with intra-articular fractures of the lower extremity from the University of Alabama at Birmingham’s Injury Control Research Center is analyzed using both SAS PROC MIXED and SPSS MIXED. We start our presentation with a discussion of data preparation for MLM analyses. We then provide example analyses of different growth models, including a simple linear growth model and a model with a time-invariant covariate, with interpretation for all the parameters in the models. More complicated growth models with different between- and within-individual covariance structures and nonlinear models are discussed. Finally, information related to MLM analysis such as online resources is provided at the end of the paper. PMID:19649151

  4. The Influence of a Prefabricated Foot Orthosis on Lower Extremity Mechanics During Running in Individuals With Varying Dynamic Foot Motion.

    PubMed

    Almonroeder, Thomas G; Benson, Lauren C; O'Connor, Kristian M

    2016-09-01

    Study Design Controlled laboratory study, cross-sectional. Background Orthotic prescription is often based on the premise that the mechanical effects will be more prominent in individuals with greater calcaneal eversion. Objective To compare the effects of a prefabricated foot orthosis on lower extremity kinematics and kinetics between recreational athletes with high and low calcaneal eversion during running. Methods Thirty-one recreational athletes were included in this study. Three-dimensional kinematic and kinetic data were collected while running with and without a foot orthosis. Participants were grouped based on the degree of calcaneal eversion during the running trials relative to a standing trial (dynamic foot motion). The effects of the orthosis on the frontal and transverse plane angles and moments of the hip and knee were compared between the 10 participants with the greatest and least amount of dynamic foot motion. Results There were no significant interactions (group by orthotic condition) for any of the kinematic or kinetic variables of interest. Conclusion The effects of an orthosis on the mechanics of the hip and knee do not appear to be dependent on an individual's dynamic foot motion. J Orthop Sports Phys Ther 2016;46(9):749-755. Epub 5 Aug 2016. doi:10.2519/jospt.2016.6253. PMID:27494054

  5. Factors Associated With Late Specialized Rehabilitation among Veterans with Lower Extremity Amputation Who Underwent Immediate Postoperative Rehabilitation

    PubMed Central

    Kurichi, Jibby E.; Xie, Dawei; Kwong, Pui L.; Bates, Barbara E.; Vogel, W. Bruce; Stineman, Margaret G.

    2011-01-01

    Objective To determine what patient- and facility-level characteristics drive late specialized rehabilitation among veterans who already received immediate postoperative services. Design Data were obtained from 8 administrative databases for 2,453 patients who underwent lower extremity amputation in Veterans Affairs Medical Centers in 2002-2004. A Cox proportional hazards model was used to determine the hazards ratios and 95% confidence intervals of the factors associated with days to readmission for late services after discharge from the surgical hospitalization. Results There were 2,304 patients who received only immediate postoperative services, while 152 also received late specialized rehabilitation. After adjustment, veterans who were less disabled physically, residing in the South Central compared to the Southeast region, and had their surgeries in CARF accredited facilities were all more likely to receive late services. The hazards ratios for type of immediate postoperative rehabilitation were not constant over time. At hospital discharge, there was no difference in receipt, however, after 3 months, those who received early specialized rehabilitation were significantly less likely to receive late services. Conclusion The factors associated with late specialized rehabilitation were due mainly to facility-level characteristics and care process variables. Knowledge of these factors may help with decision-making policies regarding CARF accredited units. PMID:21389847

  6. Three-Dimensional Lower Extremity Joint Loading in a Carved Ski and Snowboard Turn: A Pilot Study

    PubMed Central

    Müller, Erich

    2014-01-01

    A large number of injuries to the lower extremity occur in skiing and snowboarding. Due to the difficulty of collecting 3D kinematic and kinetic data with high accuracy, a possible relationship between injury statistic and joint loading has not been studied. Therefore, the purpose of the current study was to compare ankle and knee joint loading at the steering leg between carved ski and snowboard turns. Kinetic data were collected using mobile force plates mounted under the toe and heel part of the binding on skies or snowboard (KISTLER). Kinematic data were collected with five synchronized, panning, tilting, and zooming cameras. An extended version of the Yeadon model was applied to calculate inertial properties of the segments. Ankle and knee joint forces and moments were calculated using inverse dynamic analysis. Results showed higher forces along the longitudinal axis in skiing and similar forces for skiing and snowboarding in anterior-posterior and mediolateral direction. Joint moments were consistently greater during a snowboard turn, but more fluctuations were observed in skiing. Hence, when comparing joint loading between carved ski and snowboard turns, one should differentiate between forces and moments, including the direction of forces and moments and the turn phase. PMID:25317202

  7. Factors Associated with Total Inpatient Costs and Length of Stay among Veterans with Lower Extremity Amputation during the Surgical Hospitalization

    PubMed Central

    Kurichi, Jibby E.; Vogel, W. Bruce; Kwong, Pui L.; Xie, Dawei; Bates, Barbara E.; Stineman, Margaret G.

    2013-01-01

    Objective To identify patient- and facility-level factors associated with total inpatient costs and length of stay (LOS) among veterans with lower extremity amputation. Design Patient data for 1,536 veterans were compiled from 9 databases from the Veterans Health Administration between October 1, 2002, and September 30, 2003. Linear mixed models were used to identify factors associated with the natural logarithm of total inpatient costs and LOS. Results Statistically significant factors associated with both higher total inpatient costs and longer LOS included admission by transfer from another hospital, systemic sepsis, arrhythmias, chronic blood loss anemia, fluid and electrolyte disorders, weight loss, specialized inpatient rehabilitation, and larger hospital bed sizes. Device infection, coagulopathy, solid tumor without metastasis, CARF accreditation, and Medicare Wage Index were only associated with higher total inpatient costs. Factors only associated with longer LOS included older age, not being married, previous amputation complication, congestive heart failure, deficiency anemias, and paralysis. Conclusions Most drivers of total inpatient costs were similar to those that increased LOS with a few exceptions. These findings may have implications for projecting future health care costs, and thus could be important in efforts to reducing costs, understanding LOS, and refining payment and budgeting policies. PMID:23117271

  8. Lower extremity function during gait in participants with first time acute lateral ankle sprain compared to controls.

    PubMed

    Doherty, Cailbhe; Bleakley, Chris; Hertel, Jay; Caulfield, Brian; Ryan, John; Delahunt, Eamonn

    2015-02-01

    Laboratory analyses of chronic ankle instability populations during gait have elucidated a number of anomalous movement patterns. No current research exists analysing these movement patterns in a group in the acute phase of lateral ankle sprain (LAS) injury. It is possible that participants with an acute LAS display movement patterns continuous with their chronically impaired counterparts. Sixty eight participants with acute LAS and nineteen non-injured participants completed five gait trials. 3D lower extremity temporal kinematic and kinetic data were collected from 200 ms pre- to 200 ms post-heel strike (period 1) and from 200 ms pre- to 200 ms post-toe off (period 2). During period 1, the LAS group displayed increased knee flexion with increased net extensor pattern at the knee joint, increased ankle inversion with a greater inversion moment, and reduced ankle plantar flexion, compared to the non-injured control group. During period 2, the LAS group displayed decreased hip extension with a decrease in the flexor moment at the hip, and decreased ankle plantar flexion with a decrease in the net plantar flexion moment, compared to the non-injured control group. These results indicate that participants with acute LAS display coordination strategies which may play a role in the onset of chronicity or recovery. PMID:25443172

  9. 2014 Guideline for Management of Wounds in Patients With Lower-Extremity Arterial Disease (LEAD): An Executive Summary.

    PubMed

    Bonham, Phyllis A; Flemister, Bonny G; Droste, Linda R; Johnson, Jan J; Kelechi, Teresa; Ratliff, Catherine R; Varnado, Myra F

    2016-01-01

    The purpose of this article is to provide a summary of the recommendations from the 2014 Guideline for Management of Wounds in Patients With Lower-Extremity Arterial Disease (LEAD), published by the Wound, Ostomy and Continence Nurses Society (WOCN). This article provides an overview of the process used to update and develop the guideline, and specific recommendations from the guideline for assessment, referral for further evaluation, interventions (ie, debridement, dressings, infection, antibiotics, nutrition, pain management, compression issues, medications, surgical options, and adjunctive therapies), and patient education and risk-reduction strategies. The LEAD guideline is a resource for physicians, nurses, therapists, and other healthcare professionals who work with adults who have/or are at risk for wounds due to LEAD. The full text of the published guideline, which includes the available evidence supporting the recommendations and a complete reference list, is available from the WOCN Society, 1120 Rt. 73, Suite 200, Mount Laurel, NJ, 08054; Web site: www.wocn.org. Refer to the Supplemental Digital Content (Supplement Digital Content 1, http://links.lww.com/JWOCN/A31) associated with this article for the complete reference list for the guideline. The guideline has been accepted for publication by the National Guideline Clearinghouse (www.guideline.gov/). PMID:26649551

  10. Age-related differences in muscle control of the lower extremity for support and propulsion during walking

    PubMed Central

    Toda, Haruki; Nagano, Akinori; Luo, Zhiwei

    2016-01-01

    [Purpose] This study examined age-related differences in muscle control for support and propulsion during walking in both males and females in order to develop optimal exercise regimens for muscle control. [Subjects and Methods] Twenty elderly people and 20 young people participated in this study. Coordinates of anatomical landmarks and ground reaction force during walking were obtained using a 3D motion analysis system and force plates. Muscle forces during walking were estimated using OpenSim. Muscle modules were obtained by using non-negative matrix factorization analysis. A two-way analysis of covariance was performed to examine the difference between the elderly and the young in muscle weightings using walking speed as a covariate. The similarities in activation timing profiles between the elderly and the young were analyzed by cross-correlation analysis in males and females. [Results] In the elderly, there was a change in the coordination of muscles around the ankle, and muscles of the lower extremity exhibited co-contraction in late stance. Timing and shape of these modules were similar between elderly and young people. [Conclusion] Our results suggested that age-related alteration of muscle control was associated with support and propulsion during walking. PMID:27134360

  11. Reporting standards of the Society for Vascular Surgery for endovascular treatment of chronic lower extremity peripheral artery disease.

    PubMed

    Stoner, Michael C; Calligaro, Keith D; Chaer, Rabih A; Dietzek, Alan M; Farber, Alik; Guzman, Raul J; Hamdan, Allen D; Landry, Greg J; Yamaguchi, Dean J

    2016-07-01

    Peripheral arterial disease (PAD) represents a spectrum from asymptomatic stenosis to limb-threatening ischemia. The last decade has seen a tremendous increase in the variety of endovascular devices and techniques to treat occlusive disease. Like many evolving technologies, the literature surrounding therapy for endovascular arterial disease consists of mixed-quality manuscripts without clear standardization. Accordingly, critical evaluation of the reported results may be problematic. As such, providers and their patients make treatment decisions without the full benefit of a comparative effectiveness framework. The purpose of this document is to provide a summary for the reporting of endovascular revascularization techniques in the setting of chronic disease. Much of the work in this document is based on prior publications and standards proposed by the Society for Vascular Surgery. We have also made recommendations based on current literature and have attempted to acknowledge shortcomings and areas for future research. The various sections contain summaries of required reporting standards and should serve as a guide for the design of clinical trials and as reference for journal editors and reviewers when considering scientific work pertaining to endovascular therapy for chronic lower extremity arterial disease. An Appendix is provided with commonly used abbreviations in this document. PMID:27345516

  12. Three-dimensional lower extremity joint loading in a carved ski and snowboard turn: a pilot study.

    PubMed

    Klous, Miriam; Müller, Erich; Schwameder, Hermann

    2014-01-01

    A large number of injuries to the lower extremity occur in skiing and snowboarding. Due to the difficulty of collecting 3D kinematic and kinetic data with high accuracy, a possible relationship between injury statistic and joint loading has not been studied. Therefore, the purpose of the current study was to compare ankle and knee joint loading at the steering leg between carved ski and snowboard turns. Kinetic data were collected using mobile force plates mounted under the toe and heel part of the binding on skies or snowboard (KISTLER). Kinematic data were collected with five synchronized, panning, tilting, and zooming cameras. An extended version of the Yeadon model was applied to calculate inertial properties of the segments. Ankle and knee joint forces and moments were calculated using inverse dynamic analysis. Results showed higher forces along the longitudinal axis in skiing and similar forces for skiing and snowboarding in anterior-posterior and mediolateral direction. Joint moments were consistently greater during a snowboard turn, but more fluctuations were observed in skiing. Hence, when comparing joint loading between carved ski and snowboard turns, one should differentiate between forces and moments, including the direction of forces and moments and the turn phase. PMID:25317202

  13. Use of a Dehydrated Amniotic Membrane Allograft on Lower Extremity Ulcers in Patients with Challenging Wounds: A Retrospective Case Series.

    PubMed

    Lintzeris, Dimitrios; Yarrow, Kari; Johnson, Laura; White, Amber; Hampton, Amanda; Strickland, Andy; Albert, Kristy; Cook, Arlene

    2015-10-01

    Lower extremity ulcers in patients with diabetes mellitus may take a long time to heal despite the use of advanced topical therapies. A retrospective review of cases was conducted to assess the use of a dehydrated amniotic membrane allograft (DAMA) in a convenience sample of 9 wounds in 8 patients (5 men, 3 women, average age 62 years [range 31-81 years]) with diabetes mellitus and/or vascular disease. Wound data and patient characteristics were abstracted from medical records. Descriptive statistics were used to summarize the data. In 5 of 9 wounds, DAMA was applied after a failure to demonstrate a 50% reduction in area after 4 weeks of treatment with advanced wound care, offloading, and compression as indicated. In 4 wounds, DAMA was applied 2-4 weeks after presentation because of concerns about existing patient risk factors for nonhealing. Wounds were present for an average of 11 weeks (range 1-35 weeks) before application of DAMA. Mean baseline wound area and volume were 3.11 cm2 (± 3.73) and 0.55 cm3 (± 0.58), respectively. All wounds healed in an average of 5.7 (± 2.9) weeks (range: 1-9 weeks) after a mean of 2.7 applications (± 1.7) (range 1-5 applications). No adverse events occurred. These observations suggest prospective, randomized, controlled clinical studies to compare the use of DAMA to other topical treatment modalities are warranted. PMID:26479124

  14. Age-related differences in muscle control of the lower extremity for support and propulsion during walking.

    PubMed

    Toda, Haruki; Nagano, Akinori; Luo, Zhiwei

    2016-03-01

    [Purpose] This study examined age-related differences in muscle control for support and propulsion during walking in both males and females in order to develop optimal exercise regimens for muscle control. [Subjects and Methods] Twenty elderly people and 20 young people participated in this study. Coordinates of anatomical landmarks and ground reaction force during walking were obtained using a 3D motion analysis system and force plates. Muscle forces during walking were estimated using OpenSim. Muscle modules were obtained by using non-negative matrix factorization analysis. A two-way analysis of covariance was performed to examine the difference between the elderly and the young in muscle weightings using walking speed as a covariate. The similarities in activation timing profiles between the elderly and the young were analyzed by cross-correlation analysis in males and females. [Results] In the elderly, there was a change in the coordination of muscles around the ankle, and muscles of the lower extremity exhibited co-contraction in late stance. Timing and shape of these modules were similar between elderly and young people. [Conclusion] Our results suggested that age-related alteration of muscle control was associated with support and propulsion during walking. PMID:27134360

  15. Reference values for the Y Balance Test and the lower extremity functional scale in young healthy adults

    PubMed Central

    Alnahdi, Ali H; Alderaa, Asma A; Aldali, Ali Z; Alsobayel, Hana

    2015-01-01

    [Purpose] This study aimed to establish gender-specific reference values for the Y Balance Test (YBT) and the Arabic version of the Lower Extremity Functional Scale (LEFS-Ar) in healthy young adults in Saudi Arabia, and to examine gender differences in the YBT and LEFS-Ar values. [Subjects and Methods] Healthy young adults (31 females, 30 males) completed the YBT and LEFS-Ar in 1 test session. Descriptive statistical analysis (mean, standard deviation, 95% confidence interval) was used to compute the YBT and LEFS-Ar reference values. Independent t-tests were used to examine gender differences in the YBT and LEFS-Ar values. [Results] Gender-specific reference values were obtained for the right, left, dominant, and non-dominant leg as well as for the average performance of both the legs. males showed greater YBT normalized reach distances than females did in the anterior, posteromedial, and posterolateral directions; furthermore, males showed higher YBT composite scores than females did. However, the LEFS-Ar values did not differ between males and females. [Conclusion] Gender-specific reference values were obtained for the YBT and LEFS-Ar in healthy young adults in Saudi Arabia. males performed better than females did in the YBT. However, no gender differences were noted in LEFS-Ar. PMID:26834380

  16. Reference values for the Y Balance Test and the lower extremity functional scale in young healthy adults.

    PubMed

    Alnahdi, Ali H; Alderaa, Asma A; Aldali, Ali Z; Alsobayel, Hana

    2015-12-01

    [Purpose] This study aimed to establish gender-specific reference values for the Y Balance Test (YBT) and the Arabic version of the Lower Extremity Functional Scale (LEFS-Ar) in healthy young adults in Saudi Arabia, and to examine gender differences in the YBT and LEFS-Ar values. [Subjects and Methods] Healthy young adults (31 females, 30 males) completed the YBT and LEFS-Ar in 1 test session. Descriptive statistical analysis (mean, standard deviation, 95% confidence interval) was used to compute the YBT and LEFS-Ar reference values. Independent t-tests were used to examine gender differences in the YBT and LEFS-Ar values. [Results] Gender-specific reference values were obtained for the right, left, dominant, and non-dominant leg as well as for the average performance of both the legs. males showed greater YBT normalized reach distances than females did in the anterior, posteromedial, and posterolateral directions; furthermore, males showed higher YBT composite scores than females did. However, the LEFS-Ar values did not differ between males and females. [Conclusion] Gender-specific reference values were obtained for the YBT and LEFS-Ar in healthy young adults in Saudi Arabia. males performed better than females did in the YBT. However, no gender differences were noted in LEFS-Ar. PMID:26834380

  17. The effect of hip abductor exercise on muscle strength and trunk stability after an injury of the lower extremities

    PubMed Central

    Kak, Hwang-Bo; Park, Sun-Ja; Park, Byun-Joon

    2016-01-01

    [Purpose] The gluteus medius, a hip abductor, controls femoral movement and stabilizes the pelvis during lower extremity mobilization. [Subjects] This study enrolled 24 subjects into control and experimental groups. [Methods] This randomized controlled study included patients who underwent arthroscopy after meniscus injury and started a rehabilitative exercise program 8 weeks after surgery. Subjects were divided into the experimental gluteus medius resistance exercise group (n=12) and the control group (n=12). The study investigated muscle strength and balance of the flexors, extensors, and abductors of the knee for 8 weeks. [Results] Strengths of knee extensors in patients who underwent rehabilitative exercise for 8 weeks were measured. Strength of the knee extensors of the experimental and control groups increased by 40% and 31%, respectively; strength of the hip flexors of the experimental and control groups increased by 31% and 18%, respectively. Strength of the hip joint muscles showed a 40% increase in the experimental group and a 14% increase in the control group. However, there was a significant difference (18%) in muscle strength of the hip abductors between the groups. Measurements of trunk lateral flexion showed a difference within a group, but no intergroup difference was found. [Conclusion] This study investigated the effect of hip abductor exercise on muscular strength and trunk stability in patients with a meniscus injury. PMID:27134387

  18. Muscle activation and knee biomechanics during squatting and lunging after lower extremity fatigue in healthy young women.

    PubMed

    Longpré, Heather S; Acker, Stacey M; Maly, Monica R

    2015-02-01

    Muscle activations and knee joint loads were compared during squatting and lunging before and after lower extremity neuromuscular fatigue. Electromyographic activations of the rectus femoris, vastus lateralis and biceps femoris, and the external knee adduction and flexion moments were collected on 25 healthy women (mean age 23.5 years, BMI of 23.7 kg/m(2)) during squatting and lunging. Participants were fatigued through sets of 50 isotonic knee extensions and flexions, with resistance set at 50% of the peak torque achieved during a maximum voluntary isometric contraction. Fatigue was defined as a decrease in peak isometric knee extension or flexion torque ≥25% from baseline. Co-activation indices were calculated between rectus femoris and biceps femoris; and between vastus lateralis and biceps femoris. Fatigue decreased peak isometric extension and flexion torques (p<0.05), mean vastus lateralis activation during squatting and lunging (p<0.05), and knee adduction and flexion moments during lunging (p<0.05). Quadriceps activations were greater during lunging than squatting (p<0.05). Thus, fatigue altered the recruitment strategy of the quadriceps during squatting and lunging. Lunging challenges quadriceps activation more than squatting in healthy, young women. PMID:25258248

  19. Relation of selective voluntary motor control of the lower extremity and extensor strength of the knee joint in children with spastic diplegia.

    PubMed

    Kusumoto, Yasuaki; Takaki, Kenji; Matsuda, Tadamitsu; Nitta, Osamu

    2016-06-01

    [Purpose] The aim of this study was to investigate differences in selective voluntary motor control of the lower extremities by objective assessment and determine the relationship between selective voluntary motor control and knee extensor strength in children with spastic diplegia. [Subjects and Methods] Forty individuals who had spastic cerebral palsy, with Gross Motor Function Classification System levels ranging from I to III, were assessed using the Selective Control Assessment of the Lower Extremity and by testing the maximum knee extensor strength. The unaffected side was defined as the lower limb with the higher score, and the affected side was defined as the lower limb with the lower score. [Results] The Selective Control Assessment of the Lower Extremity score on the affected side had a lower average than that on the unaffected side. The scores showed a significant inverse correlation with the maximum knee extensor strength. [Conclusion] There was bilateral difference in the selective voluntary motor control of the lower extremities in children with spastic diplegia, and the selective voluntary motor control of the lower extremity was related to maximum knee extensor strength. PMID:27390436

  20. Relation of selective voluntary motor control of the lower extremity and extensor strength of the knee joint in children with spastic diplegia

    PubMed Central

    Kusumoto, Yasuaki; Takaki, Kenji; Matsuda, Tadamitsu; Nitta, Osamu

    2016-01-01

    [Purpose] The aim of this study was to investigate differences in selective voluntary motor control of the lower extremities by objective assessment and determine the relationship between selective voluntary motor control and knee extensor strength in children with spastic diplegia. [Subjects and Methods] Forty individuals who had spastic cerebral palsy, with Gross Motor Function Classification System levels ranging from I to III, were assessed using the Selective Control Assessment of the Lower Extremity and by testing the maximum knee extensor strength. The unaffected side was defined as the lower limb with the higher score, and the affected side was defined as the lower limb with the lower score. [Results] The Selective Control Assessment of the Lower Extremity score on the affected side had a lower average than that on the unaffected side. The scores showed a significant inverse correlation with the maximum knee extensor strength. [Conclusion] There was bilateral difference in the selective voluntary motor control of the lower extremities in children with spastic diplegia, and the selective voluntary motor control of the lower extremity was related to maximum knee extensor strength. PMID:27390436

  1. The association between periprocedural factors and the late outcome of percutaneous stenting of lower extremity arteries. A retrospective cohort study

    PubMed Central

    Grzelązka, Paweł; Koza, Klaudia; Trofimiuk, Adrianna; Suppan, Karol; Wasielewski, Marcin; Wiśniewska, Joanna

    2015-01-01

    Introduction About 20–30% of the population have peripheral artery disease. Many of them require intervention, with a percutaneous procedure currently being the first choice. However, the outcomes of these interventions need regular evaluation due to continuous progress in endovascular techniques and the devices used. Aim The aim of this study was to analyze procedural factors influencing the outcome of endovascular intervention in patients stented for the first time due to lower extremity atherosclerosis. Material and methods The medical documentation of 91 patients with at least 1 year of follow-up after stenting of a lower limb artery was retrospectively evaluated. Uni- and multivariate analyses were performed. Results The mean observation time was 544.4 ±502.9 days. The primary patency of a stent after such a follow-up was 68.1%. Cox proportional hazard analysis revealed that the risk of target lesion revascularization was affected by the following (hazard risk, 95% confidence interval): the number of vascular segments with significant lesions (13.14, 2.28–75.8); critical limb ischemia (5.68, 1.23–26.2); localization of the target lesion in an aorto-iliac in comparison with a femoro-popliteal vascular segment (0.37, 0.14–0.7); aorto-iliac lesion class according to the TASC-II consensus (1.96, 1.1–3.8); and claudication distance (1.02, 1.01–1.03). Conclusions The common primary patency of a stent implanted into either an aorto-iliac or a femoro-popliteal vascular segment was similar to that found in other reports. The main factors affecting the outcome of the endovascular procedures performed were mainly related to atherosclerosis severity, not to the type of technique or device used. PMID:26161102

  2. A Comparison of Muscle Activities in the Lower Extremity between Flat and Normal Feet during One-leg Standing

    PubMed Central

    Lee, Ju-Eun; Park, Ga-Hyeon; Lee, Yun-Seop; Kim, Myoung-Kwon

    2013-01-01

    [Purpose] This study examined the differences in muscle activation between flat and normal feet in the one-leg standing position which delivers the greatest load to the lower extremity. [Subjects] This study was conducted with 23 adults, 12 with normal feet and 12 with flat feet, with ages ranging from 21 to 30 years old, who had no neurological history or gait problems. [Methods] The leg used for one leg standing was the dominant leg of the subjects. The experimenter instructed the subjects to raise the non-dominant leg with their eyes open, and the subjects maintained a posture with the non-dominant leg's knee flexed at 90° and the hip joint flexed at 45° for six seconds. In the position of one-leg standing, a horizontal rod was set at the height of the waist line of the subjects who lightly placed two fingers of each hand on the rod to prevent inclination of the trunk to one side. Measurements were taken three times and the maximum value was used. A surface electromyogram (TeleMyo 2400T, Noraxon Co., USA) was used to measure muscle activities. [Results] We compared muscle activities between flat and normal foot, and the results show a significant difference between normal and flat feet in the muscle activity of the abductor hallucis muscle. [Conclusion] The subjects with flat feet had relatively lower activation of the abductor hallucis muscle than those with normal feet during one leg standing. We infer from this that the abductor hallucis muscle of flat foot doesn't work as well as a dynamic stabilizer, compared to a normal foot, during one leg standing. PMID:24259915

  3. Repeated Elevation of the Anterolateral Thigh Flap for Lower Extremity Orthopedic Trauma Does Not Affect Flap Viability.

    PubMed

    Kotick, James D; Mitchell, William; Bayouth, Lilly; Klein, Richard; Lee, Ken

    2016-03-01

    Background The anterolateral thigh (ALT) flap has a key role regarding limb salvage and has facilitated the preservation of function and esthetics in lower extremity reconstruction. The purpose of this study is to review the advantages of the ALT flap when used early in the reconstruction of the trauma patient; specifically, its long-term viability when ALT flap reconstruction is followed by recurrent flap elevation performed to allow a variety of sequential orthopedic operations including washout, antimicrobial disc placement, and reinstrumentation. Methods A retrospective analysis was performed to review all ALT flaps performed by the authors from January 2009 to October 2012 at the Orlando Regional Medical Center. A total of 69 patients with an average age of 38 years were included in the study leading to a total of 69 ALT flaps indicated for traumatic orthopedic wounds. Out of these, 29 flaps were elevated at least once leading to a total of 49 flap elevations. Results The median number of days to flap elevation was 117 with a minimum of 1 day and a maximum of 540 days. A total of 42% flaps were elevated at least once after initial placement for reinstrumentation, washout, or antibiotic disk placement. Overall, 52% of the flaps were lifted once, 34% were lifted twice, and 14% were lifted more than thrice. There is no statistically significant difference in the complication rate between elevating the flap compared with primary ALT placement. Conclusion We conclude, therefore, there is no elevated risk to long-term viability by elevating the ALT flap. This combined with the ease of elevation makes it a safe procedure to be performed as needed for access to the deep tissues. PMID:26382873

  4. An enhanced treatment program with markedly reduced mortality after a transtibial or higher non-traumatic lower extremity amputation.

    PubMed

    Kristensen, Morten T; Holm, Gitte; Krasheninnikoff, Michael; Jensen, Pia S; Gebuhr, Peter

    2016-06-01

    Background and purpose - Historically, high 30-day and 1-year mortality post-amputation rates (> 30% and 50%, respectively) have been reported in patients with a transtibial or higher non-traumatic lower extremity amputation (LEA). We evaluated whether allocating experienced staff and implementing an enhanced, multidisciplinary recovery program would reduce the mortality rates. We also determined factors that influenced mortality rates. Patients and methods - 129 patients with a LEA were consecutively included over a 2-year period, and followed after admission to an acute orthopedic ward. Mortality was compared with historical and concurrent national controls in Denmark. Results - The 30-day and 1-year mortality rates were 16% and 37%, respectively, in the intervention group, as compared to 35% and 59% in the historical control group treated in the same orthopedic ward. Cox proportional harzards models adjusted for age, sex, residential and health status, the disease that caused the amputation, and the index amputation level showed that 30-day and 1-year mortality risk was reduced by 52% (HR =0.48, 95% CI: 0.25-0.91) and by 46% (HR =0.54, 95% CI: 0.35-0.86), respectively, in the intervention group. The risk of death was increased for patients living in a nursing home, for patients with a bilateral LEA, and for patients with low health status. Interpretation - With similarly frail patient groups and instituting an enhanced program for patients after LEA, the risks of death by 30 days and by 1 year after LEA were markedly reduced after allocating staff with expertise. PMID:27088484

  5. Effects of a 2-hour run on metabolic economy and lower extremity strength in men and women.

    PubMed

    Glace, B W; McHugh, M P; Gleim, G W

    1998-03-01

    Changes in running economy, or the oxygen cost of running at a given submaximal speed (ml/m/kg), during prolonged exercise have been well described in men but not in women. Lower extremity strength changes associated with prolonged exercise have never been addressed. We examined changes in running economy and strength following a 2-hour run in eight men and eight women. Knee and hip strength were measured pre- and post-running. Peak oxygen consumption (VO2peak) and oxygen consumption at ventilatory threshold were determined. Subjects then ran for 2 hours at an intensity which elicited ventilatory threshold (68.7% vs. 66.6% of VO2peak for men and women, p = 0.5). Water was ingested at a rate of 0.5% of body weight each half hour. Oxygen uptake (VO2) and respiratory exchange ratio were measured initially and at 1 and 2 hours. Body weight declined in the men (p = 0.001) but not in the women (p = 0.12). Running economy decreased in the men (p < 0.001) but not in the women (p = 0.084). At 2 hours of running, knee flexion and extension strength declined significantly in the men only (effect of gender x time, p < 0.014), but hip flexion, abduction, and adduction strength declined in both genders. Decreased knee extensor/flexor strength was evident in men only, while decreased hip strength was independent of gender. We conclude that 2 hours of running produced changes in knee strength and running economy in men only. PMID:9513864

  6. Investigation of the Saturation Pulse Artifact in Non-Enhanced MR Angiography of the Lower Extremity Arteries at 7 Tesla

    PubMed Central

    Johst, Sören; Maderwald, Stefan; Fischer, Anja; Quick, Harald H.; Ladd, Mark E.; Orzada, Stephan

    2015-01-01

    When performing non-enhanced time-of-flight MR angiography of the lower extremity arteries at 7 T with cardiac triggering, the acquisition time is a crucial consideration. Therefore, in previous studies, saturation RF pulses were applied only every second TR. In the axial source images a slight artifact with an appearance similar to aliasing could be observed. The purpose of this study was to investigate the origin of this artifact. The reason for the artifact is supposed to be related to the two effective TRs during acquisition caused by the sparsely applied saturation RF pulse. Several sequence variants were simulated and implemented within the sequence source code to examine this hypothesis. An adaptation of the excitation flip angles for each TR as well as a correction factor for the k-space data was calculated. Additionally, a different ordering of the k-space data during acquisition was implemented as well as the combination of the latter with the k-space correction factor. The observations from the simulations were verified using both a static and a flow phantom and, finally, in a healthy volunteer using the same measurement setup as in previous volunteer and patient studies. Of all implemented techniques, only the reordering of the k-space was capable of suppressing the artifact almost completely at the cost of creating a ringing artifact. The phantom measurements showed the same results as the simulations and could thus confirm the hypothesis regarding the origin of the artifact. This was additionally verified in the healthy volunteer. The origin of the artifact could be confirmed to be the periodic signal variation caused by two effective TRs during acquisition. PMID:25785837

  7. Do Ergogenic Aids Alter Lower Extremity Joint Alignment During a Functional Movement Lunge Prior to and Following an Exercise Bout?

    PubMed Central

    Mills, Chris; Knight, James; Milligan, Gemma

    2015-01-01

    Ergogenic aids have been used to alter joint kinematics in an attempt to minimise injury risk, yet the effectiveness of these aids may be compromised following a bout of exercise. This preliminary study aimed to measure the effect of compression garments and Kinesio Tape® on lower extremity joint alignment prior to and following an exercise bout. Eight male athletes (age = 24.1 ± 3.0 years, body height = 177.4 ± 5.2 cm, body mass = 72.3 ± 7.2 kg) volunteered to participant in this study. Joint kinematics were recorded whilst all participants performed three rotational lunges, in three conditions (control, compression garment, Kinesio Tape®), prior to and following a 10 minute exercise bout. Frontal plane kinematics (lateral pelvic tilt, knee valgus, ankle inversion/eversion) were used to assess ergogenic aid effectiveness during the lunge. Participants exhibited no significant differences in joint kinematics between ergogenic aid conditions prior to the exercise bout. Following exercise the only significant difference occurred within the Kinesio Tape® condition where maximum knee valgus angle significantly increased from 6.5° prior to exercise, to 7.7° following the exercise bout. The results of this study suggest joint kinematics are not affected by the ergogenic aids in this study prior to an exercise bout. However, there is evidence to suggest that the application of Kinesio Tape® may allow an increase in knee valgus angle following a bout of exercise, yet, compression garments are effective at maintaining joint alignment following a bout of exercise. PMID:25964805

  8. Modeling of the blood flow in the lower extremities for dynamic diffuse optical tomography of peripheral artery disease

    NASA Astrophysics Data System (ADS)

    Marone, A.; Hoi, J. W.; Khalil, M. A.; Kim, H. K.; Shrikhande, G.; Dayal, R.; Hielscher, A. H.

    2015-07-01

    Peripheral Arterial Disease (PAD) is caused by a reduction of the internal diameters of the arteries in the upper or lower extremities mainly due to atherosclerosis. If not treated, its worsening may led to a complete occlusion, causing the death of the cells lacking proper blood supply, followed by gangrene that may require chirurgical amputation. We have recently performed a clinical study in which good sensitivities and specificities were achieved with dynamic diffuse optical tomography. To gain a better understanding of the physiological foundations of many of the observed effects, we started to develop a mathematical model for PAD. The model presented in this work is based on a multi-compartment Windkessel model, where the vasculature in the leg and foot is represented by resistors and capacitors, the blood pressure with a voltage drop, and the blood flow with a current. Unlike existing models, the dynamics induced by a thigh-pressure-cuff inflation and deflation during the measurements are taken into consideration. This is achieved by dynamically varying the resistances of the large veins and arteries. By including the effects of the thigh-pressure cuff, we were able to explain many of the effects observed during our dynamic DOT measurements, including the hemodynamics of oxy- and deoxy-hemoglobin concentration changes. The model was implemented in MATLAB and the simulations were normalized and compared with the blood perfusion obtained from healthy, PAD and diabetic patients. Our preliminary results show that in unhealthy patients the total system resistance is sensibly higher than in healthy patients.

  9. Radiation planning comparison for superficial tissue avoidance in radiotherapy for soft tissue sarcoma of the lower extremity

    SciTech Connect

    Griffin, Anthony M.; Euler, Colleen I.; Sharpe, Michael B.; Ferguson, Peter C.; Wunder, Jay S.; Bell, Robert S.; Chung, Peter W.M.; Catton, Charles N.; O'Sullivan, Brian . E-mail: brian.osullivan@rmp.uhn.on.ca

    2007-03-01

    Purpose: Three types of preoperative radiotherapy (RT) plans for extremity soft tissue sarcoma were compared to determine the amount of dose reduction possible to the planned surgical skin flaps required for tumor resection and wound closure, without compromising target coverage. Methods and Materials: Twenty-four untreated patients with large, deep, lower extremity STS treated with preoperative RT and limb salvage surgery had their original conventional treatment plans re-created. The same clinical target volume was used for all three plans. The future surgical skin flaps were created virtually through contouring by the treating surgeon and regarded as an organ at risk. The original, conformal, and intensity-modulated RT (IMRT) plans were created to deliver 50 Gy in 25 fractions to the clinical target volume. Clinical target volume and organ-at-risk dose-volume histograms were calculated and the plans compared for conformality, target coverage, and dose sparing. Results: The mean dose to the planned skin flaps was 42.62 Gy (range, 30.24-48.65 Gy) for the original plans compared with 40.12 Gy (range, 24.24-47.26 Gy) for the conformal plans and 26.71 Gy (range, 22.31-31.91 Gy) for the IMRT plans (p = 0.0008). An average of 86.4% (range, 53.2-97.4%) of the planned skin flaps received {>=}30 Gy in the original plans compared with 83.4% (range, 36.2-96.2%) in the conformal plans and only 34.0% (range, 22.5-53.3%) in the IMRT plans (p = 0.0001). IMRT improved target conformality compared with the original and conformal plans (1.27, 2.34, and 1.76, respectively, p = 0.0001). Conclusion: In a retrospective review, preoperative IMRT substantially lowered the dose to the future surgical skin flaps, sparing a greater percentage of this structure's volume without compromising target (tumor) coverage.

  10. Long-Term Clinical and Functional Outcomes After Treatment for Localized Ewing's Tumor of the Lower Extremity

    SciTech Connect

    Indelicato, Daniel J.; Keole, Sameer R. Shahlaee, Amir H.; Gibbs, Charles P.; Scarborough, Mark T.; Marcus, Robert B.

    2008-02-01

    Purpose: Retrospective review describing the 35-year University of Florida experience with Ewing's tumors of the lower extremity. Patients and Methods: Fifty-three patients were treated between 1971 and 2006. Thirty patients were treated with radiotherapy (RT) alone and 23 patients were treated with surgery {+-} RT. Larger tumors and tumors of the femur were treated more often with definitive RT. Median potential follow-up was 19.2 years. Functional outcome was assessed using the Toronto Extremity Salvage Score (TESS). Results: Before 1985, 24% of patients were treated with surgery; since then, the rate has increased to 61%. The 15-year actuarial overall survival (OS), cause-specific survival (CSS), freedom from relapse, and limb preservation rates were 68% vs. 47% (p = 0.21), 73% vs. 47% (p = 0.13), 73% vs. 40% (p = 0.03), and 43% vs. 40% (p = 0.52), respectively, for patients treated with surgery {+-} RT vs. RT alone. Excluding 8 patients who underwent amputation or rotationplasty, the 15-year actuarial local control rate was 100% for the surgery {+-} RT group and 68% for the definitive RT group (p = 0.03). The ranges of the TESS for surgery {+-} RT vs. RT alone were 70-100 (mean, 94) and 97-100 (mean, 99), respectively. Twenty-six percent (6/23) of patients had complications related to surgery requiring amputation or reoperation. Conclusions: Overall survival and CSS were not statistically compromised, but we observed an increased risk of relapse and local failure in patients treated with RT alone, thereby justifying a transition toward primary surgical management in suitable patients. However, despite an adverse risk profile, patients treated with RT alone had similar long-term amputation-free survival and demonstrated comparable functional outcomes. Poor results observed in Ewing's of the femur mandate innovative surgical and RT strategies.

  11. An enhanced treatment program with markedly reduced mortality after a transtibial or higher non-traumatic lower extremity amputation

    PubMed Central

    Kristensen, Morten T; Holm, Gitte; Krasheninnikoff, Michael; Jensen, Pia S; Gebuhr, Peter

    2016-01-01

    Background and purpose Historically, high 30-day and 1-year mortality post-amputation rates (> 30% and 50%, respectively) have been reported in patients with a transtibial or higher non-traumatic lower extremity amputation (LEA). We evaluated whether allocating experienced staff and implementing an enhanced, multidisciplinary recovery program would reduce the mortality rates. We also determined factors that influenced mortality rates. Patients and methods 129 patients with a LEA were consecutively included over a 2-year period, and followed after admission to an acute orthopedic ward. Mortality was compared with historical and concurrent national controls in Denmark. Results The 30-day and 1-year mortality rates were 16% and 37%, respectively, in the intervention group, as compared to 35% and 59% in the historical control group treated in the same orthopedic ward. Cox proportional harzards models adjusted for age, sex, residential and health status, the disease that caused the amputation, and the index amputation level showed that 30-day and 1-year mortality risk was reduced by 52% (HR =0.48, 95% CI: 0.25–0.91) and by 46% (HR =0.54, 95% CI: 0.35–0.86), respectively, in the intervention group. The risk of death was increased for patients living in a nursing home, for patients with a bilateral LEA, and for patients with low health status. Interpretation With similarly frail patient groups and instituting an enhanced program for patients after LEA, the risks of death by 30 days and by 1 year after LEA were markedly reduced after allocating staff with expertise. PMID:27088484

  12. Standards of the Polish Ultrasound Society - update. Ultrasound examination of the aorta and arteries of the lower extremities.

    PubMed

    Małek, Grzegorz; Elwertowski, Michał; Nowicki, Andrzej

    2014-06-01

    A Doppler ultrasound examination has an advantage over other vessel imaging methods as it can be carried out by the patient's bedside and allows to make a diagnosis without exposing the patient to the inconveniency of transportation or an X-ray scan. The purpose of testing the lower extremities and the aorta is to objectively confirm a preliminary clinical diagnosis, localize lesions responsible for the symptoms of the disease, determine their severity and nature (e.g., if they are calcifications or soft lesions), and finally evaluate the hemodynamic criteria. In assessment of the aorta attention is paid not only to aortic diameter measurements, but also to the vascular lumen (dissections with the formation of two flow channels, detachments, balloting of atherosclerotic plaques, etc.) and the presence of atherosclerotic plaques with influx into them (PAU - penetrating ulcer in the plaque or lesions surrounding the aorta, such as retroperitoneal fibrosis or mycotic aneurysm). A correct diagnosis of an abdominal aortic aneurysm requires repeated measurements of the abdominal aorta diameter, and in particular its transverse dimension. When assessing the degree of peripheral arterial stenosis on the basis of hemodynamic parameters, degree of morphological stenosis must be taken into consideration. Collateral circulation may reduce the flow through the main vessel, and thus, the achieved systolic velocities are lower and may understate the degree of the assessed stenosis. Calf vessels are difficult to detect, which results both from the thickness of the muscle and the presence of calcifications. This article has been prepared on the basis of Standards of the Polish Ultrasound Society (2011) and updated on the basis of the latest reports from relevant literature. PMID:26673404

  13. Timing of access to secondary healthcare services and lower extremity amputations in patients with diabetes: a case–control study

    PubMed Central

    Buckley, Claire M; Ali, Fauzi; Roberts, Graham A; Kearney, Patricia M; Perry, Ivan J; Bradley, Colin P

    2015-01-01

    Objective To investigate the association between timing of patient access to secondary healthcare services for diabetes management and lower extremity amputation (LEA) among patients with diabetes. Research design and methods A case–control study was conducted in the secondary healthcare system in Ireland. Cases were 116 patients with diabetes who underwent a first major non-traumatic LEA between 2006 and 2012. Controls were 348 patients with diabetes, over 45 years, admitted to the same hospital as an emergency or electively, frequency-matched for gender, type of diabetes, and year. Data were collected for 7 years prior to the event year. ORs for LEA in patients with diabetes comparing early versus late referral from primary to secondary healthcare were calculated. Results Statistically significant risk factors associated with LEA in patients with diabetes included being single, chronic kidney disease, hypertension, and hyperglycemia. Documented retinopathy was a significant protective factor. In unconditional logistic regression analysis adjusted for potential confounders, there was no evidence of a reduced risk of LEA among patients referred earlier to secondary healthcare for diabetes management. Conclusions Specialist referral may need to occur earlier than the 7-year cut-off used to demonstrate an effect on reducing LEA risk. Documented retinopathy was associated with reduced risk of LEA, most likely as a proxy for better self-care. Variation in the management of diabetes in primary care may also be impacting on outcomes. Efforts to develop more integrated care between primary and secondary services may be beneficial, rather than focusing on timing of referral to secondary healthcare. PMID:26336607

  14. Functional MRI determination of a dose-response relationship to lower extremity neuromuscular electrical stimulation in healthy subjects.

    PubMed

    Smith, Gerald V; Alon, Gad; Roys, Steven R; Gullapalli, Rao P

    2003-05-01

    Although empirical evidence supports the use of neuromuscular electrical stimulation (NMES) to treat physical impairments associated with stroke, the mechanisms underlying the efficacy of this modality are poorly understood. Recent studies have employed functional imaging to investigations of brain responses to median nerve stimulation. These studies suggest a dose-response relationship may exist between selected stimulation parameters and hemodynamic responses in sensorimotor regions. However, substantial gaps exist in this literature. The present study was designed to address these deficiencies. Ten healthy subjects participated. In phase one, four stimulus intensity levels were established: (1). sensory threshold [Th], (2). (MM-Th)x0.333+Th [low-intermediate level, LI], (3). (MM-Th)x0.666+Th [high-intermediate level, HI], and (4). maximal motor (MM). In phase two, subjects were scanned using a spiral-echoplanar imaging technique at each stimulus level. Image sets were analyzed to determine hemodynamic responses at the highest Pearson correlation level ( r) ascertained for each of five areas of interest (AOI): (1). primary sensory, (2). primary motor, (3). cingulate gyrus, (4). thalamus, and (5). cerebellum. ANOVA demonstrated significant main effects for BOLD signal amplitude ( p<0.05) changes in all AOI. Similarly, ANOVA showed significant differences in the volume of activation ( p<0.05) with increasing stimulus intensity in four AOI. Secondary analyses of pooled data showed increasing probabilities of activation at higher stimulus intensities within each AOI. Collectively, these data indicate a dose-response relationship exists between lower extremity NMES and brain activation in specific neural regions. The current results, while limited in their generalizability, are foundational for future studies of interventions using NMES. PMID:12698214

  15. Exoskeleton control for lower-extremity assistance based on adaptive frequency oscillators: adaptation of muscle activation and movement frequency.

    PubMed

    Aguirre-Ollinger, Gabriel

    2015-01-01

    In this article, we analyze a novel strategy for assisting the lower extremities based on adaptive frequency oscillators. Our aim is to use the control algorithm presented here as a building block for the control of powered lower-limb exoskeletons. The algorithm assists cyclic movements of the human extremities by synchronizing actuator torques with the estimated net torque exerted by the muscles. Synchronization is produced by a nonlinear dynamical system combining an adaptive frequency oscillator with a form of adaptive Fourier analysis. The system extracts, in real time, the fundamental frequency component of the net muscle torque acting on a specific joint. Said component, nearly sinusoidal in shape, is the basis for the assistive torque waveform delivered by the exoskeleton. The action of the exoskeleton can be interpreted as a virtual reduction in the mechanical impedance of the leg. We studied the ability of human subjects to adapt their muscle activation to the assistive torque. Ten subjects swung their extended leg while coupled to a stationary hip joint exoskeleton. The experiment yielded a significant decrease, with respect to unassisted movement, of the activation levels of an agonist/antagonist pair of muscles controlling the hip joint's motion, which suggests the exoskeleton control has potential for assisting human gait. A moderate increase in swing frequency was observed as well. We theorize that the increase in frequency can be explained by the impedance model of the assisted leg. Per this model, subjects adjust their swing frequency in order to control the amount of reduction in net muscle torque. PMID:25655955

  16. Epidural ropivacaine with dexmedetomidine reduces propofol requirement based on bispectral index in patients undergoing lower extremity and abdominal surgeries

    PubMed Central

    Joy, Renu; Pujari, Vinayak Seenappa; Chadalawada, Mohan V. R.; Cheruvathoor, Ajish Varghese; Bevinguddaiah, Yatish; Sheshagiri, Nirmal

    2016-01-01

    Background and Aim: To assess the amount of propofol required for induction based on bispectral index (BIS) after administering epidural anesthesia with ropivacaine alone and ropivacaine with dexmedetomidine in patients undergoing lower extremities and abdominal surgeries. Subjects and Methods: A double-blinded randomized clinical trial was carried out in 60 patients over a period of 2 years in a tertiary care hospital. American Society of Anaesthesiologists I or II in age group 18–65 years were included in the study. Group R received epidural anesthesia with ropivacaine alone, and Group D received ropivacaine and dexmedetomidine. General anesthesia was induced with propofol under BIS monitoring after 15 min. Onset of sensory and motor block, time for loss of consciousness and total amount of propofol used during induction to achieve the BIS value < 55 were recorded. Student's t-test and Chi-square test were used to find the significance of study parameters. Results: Time of onset of sensory block (Group R 11.30 ± 1.64/Group D 8.27 ± 0.83 min), motor block (Group R 14.16 ± 1.33/Group D 12.63 ± 1.22 min), time for loss of consciousness (Group R 90.57 ± 11.05/Group D 73.67 ± 16.34 s), and total amount of propofol (Group R 129.83 ± 22.38/Group D 92.13 ± 12.93 s) were reduced in Group D which was statistically significant with P < 0.001. Conclusion: Epidural ropivacaine with dexmedetomidine significantly reduces the total propofol dose required for induction of anesthesia. Also, it decreases the onset time of sensory and motor block and provides good hemodynamic stability. PMID:26957689

  17. The effect of lateral banking on the kinematics and kinetics of the lower extremity during lateral cutting movements.

    PubMed

    Wannop, John W; Graf, Eveline S; Stefanyshyn, Darren J

    2014-02-01

    There are many aspects of cutting movements that can limit performance, however, the implementation of lateral banking may reduce some of these limitations. Banking could provide a protective mechanism, placing the foot and ankle in orientations that keep them out of dangerous positions. This study sought to determine the effect of two banking angles on the kinematics and kinetics of the lower extremity during two athletic maneuvers. Kinematic and kinetic data were collected on 10 recreational athletes performing v-cuts and side shuffle movements on different banked surfaces (0°, 10°, 20°). Each sample surface was rigidly attached to the force platform. Joint moments were calculated and compared between conditions using a repeated measures ANOVA. Banking had a pronounced effect on the ankle joint. As banking increased, the amount of joint loading in the transverse and frontal planes decreased likely leading to a reduction in injury risk. Also an increase in knee joint loading in the frontal plane was seen during the 20° bank during the v-cut. Conversely loading in the sagittal plane at the ankle joint increased with banking and coupled with a reorientation of the ground reaction vector may facilitate a performance increase. The current study indicates that the 10° bank may be the optimal bank, in that it decreases ankle joint loading, as well as increases specific performance variables while not increasing frontal plane knee joint loading. If banking could be incorporated in footwear it may be able to provide a protective mechanism for athletes. PMID:24074906

  18. Risk of lower extremity arterial disease in a cohort of workers occupationally exposed to ionizing radiation over a prolonged period.

    PubMed

    Azizova, Tamara V; Bannikova, Maria V; Grigorieva, Evgenia S; Bagaeva, Yaroslava P; Azizova, Elena V

    2016-05-01

    In this study the incidence risk of lower extremity arterial disease (LEAD; international classification of diseases version 9 code 440.2) was assessed in a cohort of workers occupationally exposed to radiation over a prolonged period. The study cohort includes 22,377 workers of the Mayak Production Association (25% of whom are females) first employed at one of the main facilities in 1948-1982 and followed up to the end of 2008. Dose estimates used in the study are provided by Mayak Worker Dosimetry System 2008. The mean total dose from external gamma-rays is 0.54 Gy for males and 0.44 Gy for females. The mean absorbed liver dose from internal alpha-radiation due to incorporated plutonium is 0.23 Gy in males and 0.44 Gy in females. Relative risks and excess relative risks per unit dose (ERR/Gy) are calculated based on maximum likelihood. A total of 943 cases of LEAD are registered in the study cohort during the follow-up of 512,801 person-years. A significant association of LEAD incidence with total dose from external gamma-rays (based on a linear model) was revealed, and the ERR/Gy is 0.27 (95% confidence interval (CI) 0.11; 0.48). It turned out that a linear-exponential model provides a better fit of the data (∆AIC = 9.957). Inclusion of an adjustment for internal alpha-radiation dose resulted in the reduction of the ERR/Gy to 0.19 (95% CI 0.05; 0.39), but the risk remains significant. No association of LEAD incidence with dose from internal alpha-radiation was found in the study worker cohort. It is concluded that this study provides evidence for an association of LEAD incidence with dose from external gamma-rays taking non-radiation factors into account. PMID:26994996

  19. DEVELOPMENT OF A PHYSICAL PERFORMANCE ASSESSMENT CHECKLIST FOR ATHLETES WHO SUSTAINED A LOWER EXTREMITY INJURY IN PREPARATION FOR RETURN TO SPORT: A DELPHI STUDY

    PubMed Central

    Haines, Sara; Baker, Tricia

    2013-01-01

    Purpose/Background: To develop a consensus on the critical constructs necessary to be included in a physical performance assessment checklist (PPAC) to assess an athlete's ability for return to sport following a lower extremity injury. Methods: The study used a 3‐round Delphi method to finalize the PPAI originally developed by a panel of experts. Fourteen Delphi representative sample participants were randomly derived from the authors of peer‐reviewed publications of lower extremity injuries. Nine participants completed all 3 rounds. Results: Throughout the 3 rounds, the 10 initial constructs were modified and revised to produce the finalized PPAC consisting of 12 constructs necessary to consider for an athlete's return to sport after a lower extremity injury. Conclusions: This instrument can be used as a checklist to advocate for prospective batteries of physical performance tests to incorporate the elements identified by this study. Level of Evidence: 5 PMID:23439809

  20. Triaxial modulation of the acceleration induced in the lower extremity during whole-body vibration training: a pilot study.

    PubMed

    Cook, David P; Mileva, Katya N; James, Darren C; Zaidell, Lisa N; Goss, Victor G; Bowtell, Joanna L

    2011-02-01

    The purpose of the present study was to quantify vibration transmissibility through the lower extremity during exercise on a whole-body vibration (WBV) platform. Six healthy adults completed 20 trials of 30-second static squat exercise at 30 or 40 degrees of knee flexion angle on a WBV platform working at combinations of 5 frequencies (VF: 20, 25, 30, 35, 40 Hz) and 2 amplitudes (VA: low, 1.5 mm or high, 3 mm). Accelerations induced by the platform were recorded simultaneously at the shank and the thigh using triaxial accelerometers positioned at the segmental center of mass. Root-mean-square (RMS) acceleration amplitude and transmission ratios between the platform and the leg segments were calculated and compared between the experimental conditions. An alpha level of 0.05 was set to establish significance. Shank vertical acceleration was greatest at the lower VF (p = 0.028), higher VA (p = 0.028), and deeper squat (p = 0.048). Thigh vertical acceleration was not affected by depth of squat (p = 0.25), but it was greatest at higher VA (p = 0.046) and lower VF (p = 0.028). Medial-lateral shank acceleration was greatest at higher VF and deeper squat (both p = 0.046) and at higher VA (p = 0.028). Medial-lateral thigh acceleration was positively related to both VF (p = 0.046) and VA (p = 0.028) but was not affected by knee angle (p = 0.46). Anterior-posterior shank acceleration was higher at deeper squat (p = 0.046) and at lower VF and higher VA (both p = 0.028). Anterior-posterior thigh acceleration was related positively to the VA (p = 0.028), inversely to the VF (p = 0.028), and not dependent on knee angle (p = 0.75). Identification of specific vibration parameters and posture, which underpin WBV training efficacy, will enable coaches and athletes to design WBV training programs to specifically target shank or thigh muscles for enhanced performance. PMID:20040893

  1. High dose botulinum toxin A for the treatment of lower extremity hypertonicity in children with cerebral palsy

    PubMed Central

    Willis, Allison W; Crowner, Beth; Brunstrom, Janice E; Kissel, Abigail; Racette, Brad A

    2011-01-01

    The aim of this study was to determine the safety profile of high dose (15–25 units/kg) of botulinum toxin A (BTX-A) in children with cerebral palsy (CP) and increased lower extremity muscle tone. We performed a retrospective review of 929 patient encounters at the Movement Disorders Center at Washington University. A total of 261 patients (105 females; 156 males) were treated during these visits, ages 6 months to 21 years (mean 8y 4mo [SD 4y 8mo]). Ambulatory ability at the time of BTX-A injection was independent ambulation (36.4%, n=95), ambulation with a walker (27.6%, n=72), and non-ambulatory (31.8%, n=83). A few patients (4.2%, n=11) were able to ambulate with a cane or crutch at the time of injection. Participants were characterized according to BTX-A dose, CP etiology, motor involvement pattern, muscles injected, ambulatory ability, and use of oral tone medications. Follow-up records were searched for reported adverse events (AEs), with a mean time to AE assessment of 6.5 weeks (SD 3.38). The AE occurrence was determined for doses of 0 to 4.9 units/kg, 5 to 9.9 units/kg, 10 to 14.9 units/kg, 15 to 19.9 units/kg, and 20 to 25 units/kg. The overall AE occurrence was 4.2%. Standard doses of BTX-A had side-effect occurrences of 3.9% for 5 to 10 units/kg and 7.6% for 10 to 15 units/kg. Among higher doses (15–20 units/kg and 20–25 units/kg) the AE occurrence was 3.5% and 8.6% respectively. No patient developed botulism. AEs were randomly distributed across dosing groups, CP etiologies, clinical phenotypes, ambulatory status, and treatment duration. All doses were associated with a significant increase in passive range of motion using the Tardieu scale. We conclude that higher dose BTX-A is safe in children with a spectrum of CP phenotypes and are well tolerated over time. PMID:17979859

  2. Risk factors for lower extremity amputation in patients with diabetic foot ulcers: a hospital-based case–control study

    PubMed Central

    Pemayun, Tjokorda Gde Dalem; Naibaho, Ridho M.; Novitasari, Diana; Amin, Nurmilawati; Minuljo, Tania Tedjo

    2015-01-01

    Background Diabetic foot ulcers (DFU) may cause significant morbidity and lower extremity amputation (LEA) due to diabetic foot problems can occur more often compared to the general population. The purpose of the present study was to use an epidemiological design to determine and to quantify the risk factors of subsequent amputation in hospitalized DFU patients. Methods We performed a hospital-based, case–control study of 47 DFU patients with LEA and 47 control DFU patients without LEA. The control subjects were matched to cases in respect to age (±5 years), sex, and nutritional status, with ratio of 1:1. This study was conducted in Dr. Kariadi General Hospital Semarang between January 2012 and December 2014. Patients’ demographical data and all risk factors-related information were collected from clinical records using a short structural chart. Using LEA as the outcome variable, we calculated odds ratios (ORs) and 95% confidence intervals (CIs) by logistic regression. Univariate and stepwise logistic regression analyses were used to assess the independent effect of selected risk factors associated with LEA. The data were analyzed in SPSS version 21. Results There were 47 case–control pairs, all of which were diagnosed with type 2 diabetes mellitus. Seven potential independent variables show a promise of influence, the latter being defined as p≤0.15 upon univariate analysis. Multivariable logistic regression identified levels of HbA1c ≥8% (OR 20.47, 95% CI 3.12–134.31; p=0.002), presence of peripheral arterial disease (PAD) (OR 12.97, 95% CI 3.44–48.88; p<0.001), hypertriglyceridemia (OR 5.58, 95% CI 1.74–17.91; p=0.004), and hypertension (OR 3.67, 95% CI 1.14–11.79; p=0.028) as the independent risk factors associated with subsequent LEA in DFU. Conclusions Several risk factors for LEA were identified. We found that HbA1c ≥8%, PAD, hypertriglyceridemia, and hypertension have been recognized as the predictors of LEA in this study. Good glycemic

  3. COMPARISON OF TRUNK AND LOWER EXTREMITY MUSCLE ACTIVITY AMONG FOUR STATIONARY EQUIPMENT DEVICES: UPRIGHT BIKE, RECUMBENT BIKE, TREADMILL, AND ELLIPTIGO®

    PubMed Central

    Baker, Ryan; Gibson, Chris; Kearney, Andrew; Busemeyer, Tommy

    2016-01-01

    Background Stationary equipment devices are often used to improve fitness. The ElliptiGO® was recently developed that blends the elements of an elliptical trainer and bicycle, allowing reciprocal lower limb pedaling in an upright position. However, it is unknown whether the muscle activity used for the ElliptiGO® is similar to walking or cycling. To date, there is no information comparing muscle activity for exercise on the treadmill, stationary upright and recumbent bikes, and the ElliptiGO®. Purpose/Hypothesis The purpose of this study was to assess trunk and lower extremity muscle activity among treadmill walking, cycling (recumbent and upright) and the ElliptiGO® cycling. It was hypothesized that the ElliptiGO® and treadmill would elicit similar electromyographic muscle activity responses compared to the stationary bike and recumbent bike during an exercise session. Study Design Cohort, repeated measures Methods Twelve recreationally active volunteers participated in the study and were assigned a random order of exercise for each of the four devices (ElliptiGO®, stationary upright cycle ergometer, recumbent ergometer, and a treadmill). Two-dimensional video was used to monitor the start and stop of exercise and surface electromyography (SEMG) were used to assess muscle activity during two minutes of cycling or treadmill walking at 40-50% heart rate reserve (HRR). Eight muscles on the dominant limb were used for analysis: gluteus maximus (Gmax), gluteus medius (Gmed), biceps femoris (BF), lateral head of the gastrocnemius (LG), tibialis anterior (TA), rectus femoris (RF). Two trunk muscles were assessed on the same side; lumbar erector spinae at L3-4 level (LES) and rectus abdominus (RA). Maximal voluntary isometric contractions (MVIC) were determined for each muscle and SEMG data were expressed as %MVIC in order to normalize outputs. Results The %MVIC for RF during ElliptiGO® cycling was higher than recumbent cycling. The LG muscle activity was highest

  4. Psychometric Evaluation of the Lower Extremity Computerized Adaptive Test, the Modified Harris Hip Score, and the Hip Outcome Score

    PubMed Central

    Hung, Man; Hon, Shirley D.; Cheng, Christine; Franklin, Jeremy D.; Aoki, Stephen K.; Anderson, Mike B.; Kapron, Ashley L.; Peters, Christopher L.; Pelt, Christopher E.

    2014-01-01

    Background: The applicability and validity of many patient-reported outcome measures in the high-functioning population are not well understood. Purpose: To compare the psychometric properties of the modified Harris Hip Score (mHHS), the Hip Outcome Score activities of daily living subscale (HOS-ADL) and sports (HOS-sports), and the Lower Extremity Computerized Adaptive Test (LE CAT). The hypotheses was that all instruments would perform well but that the LE CAT would show superiority psychometrically because a combination of CAT and a large item bank allows for a high degree of measurement precision. Study Design: Cohort study (diagnosis); Level of evidence, 2. Methods: Data were collected from 472 advanced-age, active participants from the Huntsman World Senior Games in 2012. Validity evidences were examined through item fit, dimensionality, monotonicity, local independence, differential item functioning, person raw score to measure correlation, and instrument coverage (ie, ceiling and floor effects), and reliability evidences were examined through Cronbach alpha and person separation index. Results: All instruments demonstrated good item fit, unidimensionality, monotonicity, local independence, and person raw score to measure correlations. The HOS-ADL had high ceiling effects of 36.02%, and the mHHS had ceiling effects of 27.54%. The LE CAT had ceiling effects of 8.47%, and the HOS-sports had no ceiling effects. None of the instruments had any floor effects. The mHHS had a very low Cronbach alpha of 0.41 and an extremely low person separation index of 0.08. Reliabilities for the LE CAT were excellent and for the HOS-ADL and HOS-sports were good. Conclusion: The LE CAT showed better psychometric properties overall than the HOS-ADL, HOS-sports, and mHHS for the senior population. The mHHS demonstrated pronounced ceiling effects and poor reliabilities that should be of concern. The high ceiling effects for the HOS-ADL were also of concern. The LE CAT was superior

  5. Ipsilateral lower extremity joint involvement increases the risk of poor pain and function outcomes after hip or knee arthroplasty

    PubMed Central

    2013-01-01

    strongly associated with poor pain and function outcomes. A potential way to improve outcomes is to address ipsilateral lower extremity joint involvement. PMID:23738845

  6. Osteofibrous dysplasia of clavicle clinically mimicking chronic osteomyelitis

    PubMed Central

    Gopinathan, Nirmal Raj; Prakash, Mahesh; Saibaba, Balaji; Das, Ashim

    2016-01-01

    Osteofibrous dysplasia or ossifying fibroma is an uncommon benign fibro-osseous lesion of childhood, commonly described in the maxilla and the mandible. Among long bones, it usually presents in the tibia as a painless swelling or anterior bowing. Ossifying fibroma of clavicle has never been reported in English literature, to the best of our knowledge. Here, we would like to present an unusual case of osteofibrous dysplasia of clavicle clinically mimicking chronic osteomyelitis. PMID:27413281

  7. Osteofibrous dysplasia of clavicle clinically mimicking chronic osteomyelitis.

    PubMed

    Gopinathan, Nirmal Raj; Prakash, Mahesh; Saibaba, Balaji; Das, Ashim

    2016-01-01

    Osteofibrous dysplasia or ossifying fibroma is an uncommon benign fibro-osseous lesion of childhood, commonly described in the maxilla and the mandible. Among long bones, it usually presents in the tibia as a painless swelling or anterior bowing. Ossifying fibroma of clavicle has never been reported in English literature, to the best of our knowledge. Here, we would like to present an unusual case of osteofibrous dysplasia of clavicle clinically mimicking chronic osteomyelitis. PMID:27413281

  8. Melorheostosis mimicking synovial osteochondromatosis.

    PubMed

    Wadhwa, Vibhor; Chhabra, Avneesh; Samet, Jonathan D

    2014-01-01

    Melorheostosis is an uncommon, sporadic, sclerosing bone lesion that may affect the adjacent soft tissues. It has been associated with many entities such as osteopoikilosis, soft tissue vascular malformations, bone and soft tissue tumors, nephrotic syndrome, segmental limb contractures, osteosarcoma, desmoid tumor, and mesenteric fibromatosis. Synovial osteochondromatosis is a benign neoplasia of the hyaline cartilage presenting as nodules in the subsynovial tissue of a joint or tendon sheath. The intra-articular extension of melorheostosis mimicking synovial osteochondromatosis has not been reported before. In this article, the authors describe an unusual case mimicking synovial chondromatosis arising as a result of melorheostosis and their characteristic imaging findings. PMID:25971832

  9. Longitudinal decline of lower extremity muscle power in healthy and mobility-limited older adults: influence of muscle mass, strength, composition, neuromuscular activation and single fiber contractile properties

    Technology Transfer Automated Retrieval System (TEKTRAN)

    This longitudinal study examined the major physiological mechanisms that determine the age related loss of lower extremity muscle power in two distinct groups of older humans. We hypothesized that after ~3 years of follow-up, mobility-limited older adults (mean age: 77.2 +/- 4, n = 22, 12 females) w...

  10. Relationship of lower extremity alignment during the wall squat and single-leg jump: assessment of single-leg landing using three-dimensional motion analysis

    PubMed Central

    Watanabe, Manabu; Matsumoto, Takaaki; Ono, Susumu; Koseki, Hirohisa; Watarai, Koji

    2016-01-01

    [Purpose] The purpose of this study was to evaluate the relationship between malalignment and lower-extremity injury and to determine the optimal dynamic alignment of the lower extremity with wall squats. [Subjects and Methods] Healthy individuals from one therapy school were enrolled and assigned to a wall squat normal or abnormal group based on their forms during wall squats. The abnormal group was found to be more prone to lower-extremity injury on three-dimensional motion analysis. Eight students from each group were randomly chosen for the study. The effects of single-leg landing movements were assessed using three-dimensional motion analysis. [Results] In the sagittal plane, significant flexion of the hip and knee joints occurred 0.02 and 0.04 seconds after initial foot contact with the ground in the normal and abnormal groups, respectively. In the frontal plane, significant adduction of the hip joint occurred at 0.07 seconds in the abnormal group. [Conclusion] The abnormal group tended to display later flexion of the hip and knee joints and narrower hip, knee, and ankle range of motion than the normal group, suggesting that dynamic alignment of the lower extremity in the abnormal group likely made them susceptible to injury. PMID:27390393

  11. Relationship of lower extremity alignment during the wall squat and single-leg jump: assessment of single-leg landing using three-dimensional motion analysis.

    PubMed

    Watanabe, Manabu; Matsumoto, Takaaki; Ono, Susumu; Koseki, Hirohisa; Watarai, Koji

    2016-06-01

    [Purpose] The purpose of this study was to evaluate the relationship between malalignment and lower-extremity injury and to determine the optimal dynamic alignment of the lower extremity with wall squats. [Subjects and Methods] Healthy individuals from one therapy school were enrolled and assigned to a wall squat normal or abnormal group based on their forms during wall squats. The abnormal group was found to be more prone to lower-extremity injury on three-dimensional motion analysis. Eight students from each group were randomly chosen for the study. The effects of single-leg landing movements were assessed using three-dimensional motion analysis. [Results] In the sagittal plane, significant flexion of the hip and knee joints occurred 0.02 and 0.04 seconds after initial foot contact with the ground in the normal and abnormal groups, respectively. In the frontal plane, significant adduction of the hip joint occurred at 0.07 seconds in the abnormal group. [Conclusion] The abnormal group tended to display later flexion of the hip and knee joints and narrower hip, knee, and ankle range of motion than the normal group, suggesting that dynamic alignment of the lower extremity in the abnormal group likely made them susceptible to injury. PMID:27390393

  12. Managing Lower Extremity Muscle Tone and Function in Children with Cerebral Palsy via Eight-Week Repetitive Passive Knee Movement Intervention

    ERIC Educational Resources Information Center

    Cheng, Hsin-Yi Kathy; Ju, Yan-Ying; Chen, Chia-Ling; Chang, Ya-Ju; Wong, Alice May-Kuen

    2013-01-01

    This study used a repeated measures design to assess the effect of an eight-week repetitive passive movement (RPM) intervention on lower extremity muscle tone and function in children with cerebral palsy (CP). Eighteen children (aged 9.5 [plus or minus] 2.1 years) with spastic CP were randomly assigned to a knee RPM intervention condition of 3…

  13. The Society for Vascular Surgery Lower Extremity Threatened Limb Classification System: risk stratification based on wound, ischemia, and foot infection (WIfI).

    PubMed

    Mills, Joseph L; Conte, Michael S; Armstrong, David G; Pomposelli, Frank B; Schanzer, Andres; Sidawy, Anton N; Andros, George

    2014-01-01

    Critical limb ischemia, first defined in 1982, was intended to delineate a subgroup of patients with a threatened lower extremity primarily because of chronic ischemia. It was the intent of the original authors that patients with diabetes be excluded or analyzed separately. The Fontaine and Rutherford Systems have been used to classify risk of amputation and likelihood of benefit from revascularization by subcategorizing patients into two groups: ischemic rest pain and tissue loss. Due to demographic shifts over the last 40 years, especially a dramatic rise in the incidence of diabetes mellitus and rapidly expanding techniques of revascularization, it has become increasingly difficult to perform meaningful outcomes analysis for patients with threatened limbs using these existing classification systems. Particularly in patients with diabetes, limb threat is part of a broad disease spectrum. Perfusion is only one determinant of outcome; wound extent and the presence and severity of infection also greatly impact the threat to a limb. Therefore, the Society for Vascular Surgery Lower Extremity Guidelines Committee undertook the task of creating a new classification of the threatened lower extremity that reflects these important considerations. We term this new framework, the Society for Vascular Surgery Lower Extremity Threatened Limb Classification System. Risk stratification is based on three major factors that impact amputation risk and clinical management: Wound, Ischemia, and foot Infection (WIfI). The implementation of this classification system is intended to permit more meaningful analysis of outcomes for various forms of therapy in this challenging, but heterogeneous population. PMID:24126108

  14. Co-Activity during Maximum Voluntary Contraction: A Study of Four Lower-Extremity Muscles in Children with and without Cerebral Palsy

    ERIC Educational Resources Information Center

    Tedroff, Kristina; Knutson, Loretta M.; Soderberg, Gary L.

    2008-01-01

    This study was designed to determine whether children with cerebral palsy (CP) showed more co-activity than comparison children in non-prime mover muscles with regard to the prime mover during maximum voluntary isometric contraction (MVIC) of four lower-extremity muscles. Fourteen children with spastic diplegic CP (10 males, four females; age…

  15. Prospective multicenter study of quality of life before and after lower extremity vein bypass in 1404 patients with critical limb ischemia

    PubMed Central

    Nguyen, Louis L.; Moneta, Gregory L.; Conte, Michael S.; Bandyk, Dennis F.; Clowes, Alexander W.; Seely, B. Lynn

    2010-01-01

    Background Patients with critical limb ischemia (CLI) have multiple comorbidities and limited life spans. The ability of infrainguinal vein bypass to improve quality of life (QoL) in patients with CLI has therefore been questioned. Prospective preoperative and postoperative QoL data for patients undergoing lower extremity vein bypass for CLI are presented. Methods A validated, disease-specific QoL questionnaire (VascuQoL) with activity, symptom, pain, emotional, and social domains and responses scored 1 (lowest QoL) to 7 (best QoL) was administered before surgery and at 3 and 12 months after lower extremity vein bypass for CLI. Changes in QoL at 3 and 12 months after lower extremity vein bypass and multiple predetermined variables potentially influencing QoL after lower extremity vein bypass were analyzed to determine the effect of lower extremity vein bypass on QoL in CLI patients. Results A total of 1404 patients had lower extremity vein bypass for CLI at 83 centers in the United States and Canada as part of the PREVENT III clinical trial. Surveys were completed in 1296 patients at baseline, 862 patients at 3 months, and 732 patients at 12 months. The global QoL score (mean ± SD) was 2.8 ± 1.1 at baseline and was 4.7 ± 1.4 and 5.1 ± 1.4 at 3 and 12 months, respectively. Mean changes from baseline at 3 and 12 months were statistically significant (P < .0001). Improved QoL scores extended across all domains. Diabetes and the development of graft-related events were associated with decreased improvement in QoL scores, though the mean relative change from baseline remained positive. Conclusions Patients with CLI have a low QoL at baseline that is improved at 3 and 12 months after lower extremity vein bypass. QoL improvements are lower in diabetic patients and those who develop graft-related events. Successful revascularization can be expected to improve QoL in patients with CLI, with benefits that are sustained to at least 1 year. PMID:17098529

  16. Modified superficial circumflex iliac artery perforator flap and supermicrosurgery technique for lower extremity reconstruction: a new approach for moderate-sized defects.

    PubMed

    Hong, Joon Pio; Sun, Sang Hoon; Ben-Nakhi, Muneera

    2013-10-01

    The superficial circumflex iliac artery perforator (SCIP) flap is an evolved form of groin flap. It overcomes the inherent disadvantages of the groin flap by preserving the deep fascia but still requires challenging skills because of short pedicles and small caliber of vessels. The use of SCIP flap was evaluated for lower extremity use.From June of 2009 to August of 2011, a total of 79 cases were performed (age range, 4-80 years) on the lower extremity using supermicrosurgical approach. All flaps were harvested above the deep fat and the pedicles were taken above or just below the deep fascia to reconstruct the defects throughout the lower extremity.Supermicrosurgery technique was used in 71 cases. A total of 75 cases were performed successfully; 1 case underwent revision but failed and 2 cases were lost within 2 days of surgery. Average size of the flap was 75.5 cm, thickness 7 mm, average length of pedicle was 5 cm, and the average caliber of artery was 0.7 mm. Donor sites were all closed primarily but complications were noted with 1 dehiscence and prolong drainage of lymphatics. Flaps provided good functional coverage and appearance. The average follow-up was 12 months.With the modification of elevating the flap on the superficial fascia, we can harvest a thin flap without additional debulking and avoid complications such as lymphorrhea. Furthermore, with the perforator to perforator or perforator to small distal vessel approach, we can apply this flap on all regions of the lower extremity overcoming the difficulties with short pedicle and small vessel caliber. In our hands, the modified SCIP flap is the flap of choice for small to moderate size defects in the lower extremity. PMID:23187712

  17. Novel Adipokines, High Molecular Weight Adiponectin and Resistin, are Associated with Outcomes following Lower Extremity Revascularization with Autogenous Vein

    PubMed Central

    Owens, Christopher D.; Kim, Ji Min; Hevelone, Nathanael; Hamdan, Allen; Raffetto, Joseph D.; Creager, Mark A.; Conte, Michael S.

    2010-01-01

    Objective A significant portion of patients undergoing lower extremity bypass surgery (LEB) for peripheral arterial disease (PAD) will have cardiovascular or graft-related events. It has been previously demonstrated that systemic inflammation is associated with PAD and its clinical outcomes. We hypothesized that serum biomarkers of insulin resistance and inflammation would identify a sub-group at elevated risk for graft failure, limb loss, and mortality. Methods This was a prospective longitudinal study of patients (N=225) undergoing LEB using autogenous vein. Baseline blood samples were obtained prior to surgery in the fasting state. High-sensitivity C-reactive protein (hsCRP) and the adipokines resistin and high-molecular weight adiponectin (HMWA) were measured by ELISA. Median follow-up was 893 days. The major endpoints of primary patency (PP) and amputation free survival (AFS) were examined using multivariable methods. Endpoints were screened against biomarkers and patient characteristics for univariate associations. Promising explanatory variables (P < 0.1) were included in multivariable Cox proportional hazard models. Results The mean age of subjects was 67.6 years; 71.6% were male and 87.1% were Caucasian. One-hundred and thirty-three (59.1%) subjects underwent bypass for critical limb ischemia (CLI) and 73 (32.4%) had tissue loss. Patients with CLI and diabetes demonstrated elevated resistin and hsCRP levels. HMWA levels correlated with CLI and with a measure of insulin resistance (HOMA-IR) but not with clinical diabetes. Baseline biomarkers were higher in those presenting with tissue loss and in patients with post-operative events (mortality, limb loss). After multivariable analysis (including CLI, diabetes, age, estimated glomerular filtration rate (eGFR), adiponectin, resistin, and CRP), resistin (HR 1.75, 95% CI 1.07 to 2.85, P=0.025) and CRP (HR 2.39, 95% CI 1.30 to 4.39, P=0.005) were independently predictive of reduced AFS. However, only resistin

  18. Presentation, treatment, and outcome differences between men and women undergoing revascularization or amputation for lower extremity peripheral arterial disease

    PubMed Central

    Lo, Ruby C.; Bensley, Rodney P.; Dahlberg, Suzanne E.; Matyal, Robina; Hamdan, Allen D.; Wyers, Mark; Chaikof, Elliot L.; Schermerhorn, Marc L.

    2013-01-01

    Objective Prior studies have suggested treatment and outcome disparities between men and women for lower extremity peripheral arterial disease after surgical bypass. Given the recent shift toward endovascular therapy, which has increasingly been used to treat claudication, we sought to analyze sex disparities in presentation, revascularization, amputation, and inpatient mortality. Methods We identified individuals with intermittent claudication and critical limb ischemia (CLI) using International Classification of Diseases, Ninth Revision codes in the Nationwide Inpatient Sample from 1998 to 2009. We compared presentation at time of intervention (intermittent claudication vs CLI), procedure (open surgery vs percutaneous transluminal angioplasty or stenting vs major amputation), and in-hospital mortality for men and women. Regional and ambulatory trends were evaluated by performing a separate analysis of the State Inpatient and Ambulatory Surgery Databases from four geographically diverse states: California, Florida, Maryland, and New Jersey. Results From the Nationwide Inpatient Sample, we identified 1,797,885 patients (56% male) with intermittent claudication (26%) and CLI (74%), who underwent 1,865,999 procedures (41% open surgery, 20% percutaneous transluminal angioplasty or stenting, and 24% amputation). Women were older at the time of intervention by 3.5 years on average and more likely to present with CLI (75.9% vs 72.3%; odds ratio [OR], 1.21; 95% confidence interval [CI], 1.21–1.23; P < .01). Women were more likely to undergo endovascular procedures for both intermittent claudication (47% vs 41%; OR, 1.27; 95% CI, 1.25–1.28; P < .01) and CLI (21% vs 19%; OR, 1.14; 95% CI, 1.13–1.15; P < .01). From 1998 to 2009, major amputations declined from 18 to 11 per 100,000 in men and 16 to 7 per 100,000 in women, predating an increase in total CLI revascularization procedures that was seen starting in 2005 for both men and women. In-hospital mortality was

  19. Urticaria mimickers in children.

    PubMed

    Mathur, Anubhav N; Mathes, Erin F

    2013-01-01

    Acute urticaria is a self-limited cutaneous condition marked by transient, erythematous, and pruritic wheals. It is a hypersensitivity response that is often secondary to infection, medications, or food allergies in children. In contrast, the urticarial "mimickers" described in this review article are often seen in the context of fever and extracutaneous manifestations in pediatric patients. The differential diagnosis ranges from benign and self-limited hypersensitivity responses to multisystem inflammatory diseases. Establishing the correct diagnosis of an urticarial rash in a pediatric patient is necessary to both prevent an unnecessary work up for self-limited conditions and to appropriately recognize and evaluate multisystem inflammatory disorders. Herein, we describe two cases to illustrate the clinical manifestations, laboratory findings, histopathology and differential diagnoses for several mimickers of acute urticaria including: urticaria multiforme, serum sickness like reaction, Henoch-Schönlein purpura, acute hemorrhagic edema of infancy, systemic onset juvenile idiopathic arthritis, cryopyrin associated periodic syndromes, and urticarial vasculitis. PMID:24552410

  20. Technical refinements of composite thoracodorsal system free flaps for 1-stage lower extremity reconstruction resulting in reduced donor-site morbidity.

    PubMed

    Bannasch, Holger; Strohm, Peter C; Al Awadi, Khalid; Stark, G Björn; Momeni, Arash

    2008-04-01

    A multitude of local flaps has been suggested for lower extremity reconstruction. However, the gold standard for defect coverage remains free tissue transfer. In this regard, the scapular vascular axis is a well-established source of expendable skin, fascia, muscle, and bone for use in free flap reconstruction of defects requiring bone and soft tissue in complex 3-dimensional relationships. Composite bone and soft-tissue flaps derived from the subscapular vascular axis include the osteocutaneous scapular flap, the "latissimus/bone flap," and the thoracodorsal artery perforator-scapular osteocutaneous flap.Patient outcome following reconstruction of lower extremity defects with composite free flaps from the thoracodorsal system were analyzed. Here, we demonstrate the execution of technical refinements on free composite flap transfers based on the thoracodorsal vascular axis, thus resulting in a stepwise reduction of donor-site morbidity. PMID:18362565

  1. Efficacy of a New Heparan Sulfate Mimetic Dressing in the Healing of Foot and Lower Extremity Ulcerations in Type 2 Diabetes: A Case Series.

    PubMed

    Papanas, Nikolaos; Demetzos, Costas; Pippa, Natassa; Maltezos, Efstratios; Tentolouris, Nicholas

    2016-03-01

    A novel heparan sulfate glycosaminoglycan mimetic product for local application to promote wound healing (CACIPLIQ) has recently become available. It is a biophysical therapeutic product comprising a polysaccharide as an innovative biomaterial to accomplish mechanical tissue engineering and skin regeneration in the site of ulceration. We present a series of 12 patients with type 2 diabetes (4 men and 8 women; age 53-87 years; diabetes duration 8-25 years) having chronic resistance to therapy for foot and lower extremity ulcerations. CACIPLIQ was locally applied twice per week after careful debridement. Complete ulcer healing was accomplished in all patients after a mean treatment duration of 4.92 months (range = 2-12 months). The product was very well tolerated. In conclusion, these results, although preliminary, are encouraging and suggest adequate efficacy and safety of the new product in difficult-to-heal foot and lower extremity ulcerations in type 2 diabetes. PMID:26933115

  2. Effects of Low-Impact Dance on Blood Biochemistry, Bone Mineral Density, the Joint Range of Motion of Lower Extremities, Knee Extension Torque, and Fall in Females.

    PubMed

    Wu, Hui Ying; Tu, Jui Hung; Hsu, Chin Hsing; Tsao, Te Hung

    2016-01-01

    The effect of low-impact dance on blood metabolites, the joint range of motion (ROM) of the lower extremities, knee extension torque, bone mass density (BMD), the number of falls, and the confidence to perform daily activities (Modified Falls Efficacy Scale [MFES]) was examined in older sedentary women (age: 59 ± 4 years) before and after a 16-week intervention. Results showed that the average score for the MFES, some parameters of blood chemistry, and joint ROM were significantly improved after low-impact intervention. In addition to improvements in blood lipids and body fat percentages, the increases shown in the parameters regarding the lower extremities may contribute to confidence in performing common daily activities in older women, although the number of falls did not significantly differ between the two groups during the 16-week period. PMID:25642949

  3. Effect of Roy’s Adaptation Model-Guided Education on Coping Strategies of the Veterans with Lower Extremities Amputation: A Double-Blind Randomized Controlled Clinical Trial

    PubMed Central

    Farsi, Zahra; Azarmi, Somayeh

    2016-01-01

    Background: Any defect in the extremities of the body can affect different life aspects. The purpose of this study was to investigate the effect of Roy’s adaptation model-guided education on coping strategies of the veterans with lower extremities amputation. Methods: In a double-blind randomized controlled clinical trial, 60 veterans with lower extremities amputation referring to Kowsar Orthotics and Prosthetics Center of Veterans Clinic in Tehran, Iran were recruited using convenience method and randomly assigned to intervention and control groups in 2013-2014. Lazarus and Folkman coping strategies questionnaire was used to collect the data. After completing the questionnaires in both groups, maladaptive behaviours were determined in the intervention group and an education program based on Roy’s adaptation model was implemented. After 2 months, both groups completed the questionnaires again. Data were analyzed using SPSS software. Results: Independent T-test showed that the score of the dimensions of coping strategies did not have a statistically significant difference between the intervention and control groups in the pre-intervention stage (P>0.05). This test showed a statistically significant difference between the two groups in the post-intervention stage in terms of the scores of different dimensions of coping strategies (P>0.05), except in dimensions of social support seeking and positive appraisal (P>0.05). Conclusion: The findings of this research indicated that the Roy’s adaptation model-guided education improved the majority of coping strategies in veterans with lower extremities amputation. It is recommended that further interventions based on Roy’s adaptation model should be performed to improve the coping of the veterans with lower extremities amputation. Trial Registration Number: IRCT2014081118763N1 PMID:27218110

  4. Effects of sensorimotor foot training on the symmetry of weight distribution on the lower extremities of patients in the chronic phase after stroke

    PubMed Central

    Goliwas, Magdalena; Kocur, Piotr; Furmaniuk, Lech; Majchrzycki, Marian; Wiernicka, Marzena; Lewandowski, Jacek

    2015-01-01

    [Purpose] To assess the effects of sensorimotor foot stimulation on the symmetry of weight distribution on the feet of patients in the chronic post-stroke phase. [Subjects and Methods] This study was a prospective, single blind, randomized controlled trial. In the study we examined patients with chronic stroke (post-stroke duration > 1 year). They were randomly allocated to the study group (n=8) or to the control group (n=12). Both groups completed a standard six-week rehabilitation programme. In the study group, the standard rehabilitation programme was supplemented with sensorimotor foot stimulation training. Each patient underwent two assessments of symmetry of weight distribution on the lower extremities with and without visual control, on a treadmill, with stabilometry measurements, and under static conditions. [Results] Only the study group demonstrated a significant increase in the weight placed on the leg directly affected by stroke, and a reduction in asymmetry of weight-bearing on the lower extremities. [Conclusion] Sensorimotor stimulation of the feet enhanced of weight bearing on the foot on the side of the body directly affected by stroke, and a decreased asymmetry of weight distribution on the lower extremities of patients in the chronic post-stroke phase. PMID:26504326

  5. Effect of attending to a ball during a side-cut maneuver on lower extremity biomechanics in male and female athletes.

    PubMed

    Fedie, Rebecca; Carlstedt, Kristen; Willson, John D; Kernozek, Thomas W

    2010-09-01

    Many sports associated with anterior cruciate ligament (ACL) injury require athletes attend to a ball during participation. We investigated effects of attending to a ball on lower extremity mechanics during a side-cut maneuver and if these effects are consistent for males and females. Sagittal and frontal plane hip and knee kinematics and joint moments were measured during side-cut maneuvers in 19 male and 19 female National Collegiate Athletic Association division III basketball players. Participants also experienced two side-cut conditions that required attention to a ball. Our results did not indicate that the effect of attention varies with gender. However, during side-cut conditions while attending to a ball, internal knee adductor moment was 20% greater (p = 0.03) and peak knee flexion angle was 4 degrees larger (p < 0.01). Females demonstrated 5 degrees less hip flexion (p = 0.046), 12 degrees less knee flexion (p < 0.01), and 4 degrees more knee abduction (p = 0.026) at initial contact during all side-cut conditions than males. Attention to a ball may affect lower extremity mechanics relevant to ACL injury. The validity of laboratory studies of lower extremity mechanics for sports that include attention to a ball may be increased if participants are required to attend to a ball during the task. PMID:21162362

  6. Effectiveness of mirror therapy on lower extremity motor recovery, balance and mobility in patients with acute stroke: A randomized sham-controlled pilot trial

    PubMed Central

    Mohan, Uthra; babu, S. Karthik; Kumar, K. Vijay; Suresh, B. V.; Misri, Z. K.; Chakrapani, M.

    2013-01-01

    Objective: To evaluate the effectiveness of mirror therapy on lower extremity motor recovery, balance and mobility in patients with acute stroke. Design: A randomized, sham-controlled, assessor blinded, pilot trial. Setting: Inpatient stroke rehabilitation unit. Subjects: First time onset of stroke with mean post-stroke duration of 6.41 days, able to respond to verbal instructions, and Brunnstrom recovery stage 2 and above were enrolled. Intervention: Mirror therapy group performed 30 minutes of functional synergy movements of non-paretic lower extremity, whereas control group underwent sham therapy with similar duration. In addition, both groups were administered with conventional stroke rehabilitation regime. Altogether 90 minutes therapy session per day, six days a week, for two weeks duration was administered to both groups. Outcome Measures: Lower extremity motor subscale of Fugl Meyer Assessment (FMA), Brunnel Balance Assessment (BBA) and Functional Ambulation Categories (FAC). Results: Amongst the 22 patients included, equal number of patients participated in mirror group (N = 11) and control group (N = 11). Baseline variables were similar in both groups, except for Brunnstrom recovery stage. There was no statistical difference between groups, except for FAC. (FMA: P = 0.894; BBA: P = 0.358; FAC: P = 0.02). Significance was set at P < 0.05. Conclusion: Administration of mirror therapy early after stroke is not superior to conventional treatment in improving lower limb motor recovery and balance, except for improvement in mobility. PMID:24339596

  7. The association of meniscal status, lower extremity alignment, and body mass index with chondrosis at the time of revision Anterior Cruciate Ligament reconstruction

    PubMed Central

    Brophy, Robert H.; Haas, Amanda K.; Huston, Laura J.; Nwosu, Sam K.; Wright, Rick W.

    2015-01-01

    Background Knees undergoing revision ACL reconstruction (rACLR) have a high prevalence of articular cartilage lesions. Hypothesis The purpose of this study was to test the hypothesis that the prevalence of chondrosis at the time of rACLR is associated with meniscus status and lower extremity alignment. Study design Cross sectional study. Methods Data from the prospective Multicenter ACL Revision Study (MARS) cohort was reviewed to identify patients with pre-operative lower extremity alignment films. Lower extremity alignment was defined by the weight bearing line (WBL) as a percentage of the tibial plateau width, while the chondral and meniscal status of each weight bearing compartment was recorded at the time of surgery. Multivariable proportional odds models were constructed and adjusted for relevant factors in order to examine which risk factors were independently associated with the degree of medial and lateral compartment chondrosis. Results The cohort included 246 patients with lower extremity alignment films at the time of rACLR. Average (SD) patient age was 26.9 (9.5) years with a BMI of 26.4 (4.6). The medial compartment had more chondrosis (Grade 2/3: 42%, Grade 4: 6.5%) than the lateral compartment (Grade 2/3: 26%, Grade 4: 6.5%). Disruption of the meniscus was noted in 35% of patients on the medial side and 16% in the lateral side. The average (SD) WBL was measured to be 0.43 (0.13). Medial compartment chondrosis was associated with BMI (p=0.025), alignment (p=0.002), and medial meniscus status (p=0.001). None of the knees with the WBL lateral to 0.625 had Grade 4 chondrosis in the medial compartment. Lateral compartment chondrosis was significantly associated with age (p=0.013) and lateral meniscus status (p<0.001). Subjects with ‘intact’ menisci were found to decrease their odds of having chondrosis by 64–84%. Conclusions The status of articular cartilage in the tibiofemoral compartments at the time of rACLR is related to meniscal status. Lower

  8. The Swelling of Olympic Gels

    NASA Astrophysics Data System (ADS)

    Lang, Michael; Fischer, Jakob; Werner, Marco; Sommer, Jens-Uwe

    2014-03-01

    The swelling equilibrium of Olympic gels is studied by Monte Carlo Simulations. We observe that gels consisting of flexible cyclic molecules of a higher degree of polymerization N show a smaller equilibrium swelling degree Q ~N - 0 . 28φ0- 0 . 72 for the same monomer volume fraction φ0 at network preparation. This observation is explained by a disinterpenetration process of overlapping non-concatenated polymers upon swelling. In the limit of a sufficiently large number of concatenations per cyclic molecule we expect that the equilibrium degree of swelling becomes proportional to φ0- 1 / 2 independent of N. Our results challenge current textbook models for the equilibrium degree of swelling of entangled polymer networks. Now at: Bio Systems Analysis Group, Jena Centre for Bioinformatics (JCB) and Department for Mathematics and Computer Sciences, Friedrich Schiller University of Jena, 07743 Jena, Germany.

  9. Dissolution/swelling behavior of cycloolefin polymers in aqueous base

    NASA Astrophysics Data System (ADS)

    Ito, Hiroshi; Allen, Robert D.; Opitz, Juliann; Wallow, Thomas I.; Truong, Hoa D.; Hofer, Donald C.; Varanasi, Pushkara R.; Jordhamo, George M.; Jayaraman, Saikumar; Vicari, Richard

    2000-06-01

    Polycycloolefins prepared by addition polymerization of norbornene derivatives are quite different from hydroxystyrene-based polymers in terms of their interaction with aqueous base. Their dissolution kinetics monitored on a quartz crystal microbalance is not a smooth function of the ratio of the polar to nonpolar functionalities in polymer but abruptly changes from very fast dissolution to massive swelling within a narrow range of composition. The maximum swelling is a function of thickness and the entire film thickness can swell in a few seconds at > 3,000 angstroms/sec or at immeasurably fast rates. The initial concentration of a pendant carboxylic acid in polymer has to be selected to minimize swelling and the concentration of an acid-labile group to induce fast dissolution in the exposed area. Furthermore, swelling which occurs in the partially- exposed regions must be minimized by incorporating a third monomer unit or by adding a dissolution modifying agent (DMA) such as t-butyl cholate. However, the function of DMA which is also acid-labile is quite complex; depending on the matrix polymer composition and its dissolution/swelling behavior, DMA could function as a swelling suppressor or promoter and a carboxylic acid generated by acidolysis of DMA as a dissolution or swelling promoter. Photochemically generated sulfonic acid could also affect the dissolution/swelling behavior. Base hydrolysis of anhydride during development is controlled by the polarity (carboxylic acid concentration) in polymer film, which has been demonstrated in an unequivocal fashion by IR spectroscopy under the condition strongly mimicking the development process and thus could boost development contrast but could hurt performance as well. Thus, incorporation of carboxylic acid in the form of methacrylic acid, for example, in radical copolymerization of norbornene with maleic anhydride must be handled carefully as it would increase the susceptibility of the anhydride hydrolysis and could

  10. Effect of Nordic Walking and Water Aerobics Training on Body Composition and the Blood Flow in Lower Extremities in Elderly Women

    PubMed Central

    Jasiński, Ryszard; Socha, Małgorzata; Sitko, Ludmiła; Kubicka, Katarzyna; Woźniewski, Marek; Sobiech, Krzysztof A.

    2015-01-01

    Nordic walking and water aerobics are very popular forms of physical activity in the elderly population. The aim of the study was to evaluate the influence of regular health training on the venous blood flow in lower extremities and body composition in women over 50 years old. Twenty-four women of mean age 57.9 (± 3.43) years, randomly divided into three groups (Nordic walking, water aerobics, and non-training), participated in the study. The training lasted 8 weeks, with one-hour sessions twice a week. Dietary habits were not changed. Before and after training vein refilling time and the function of the venous pump of the lower extremities were measured by photoplethysmography. Body composition was determined by bioelectrical impedance. Eight weeks of Nordic walking training improved the venous blood flow in lower extremities and normalized body composition in the direction of reducing chronic venous disorder risk factors. The average values of the refilling time variable (p = 0.04, p = 0.02, respectively) decreased in both the right and the left leg. After training a statistically significant increase in the venous pump function index was found only in the right leg (p = 0.04). A significant increase in fat-free mass, body cell mass and total body water was observed (p = 0.01), whereas body mass, the body mass index, and body fat decreased (p < 0.03). With regard to water aerobic training, no similar changes in the functions of the venous system or body composition were observed. PMID:25964815

  11. Image Quality and Radiation Dose of Lower Extremity CT Angiography Using 70 kVp, High Pitch Acquisition and Sinogram-Affirmed Iterative Reconstruction

    PubMed Central

    Qi, Li; Meinel, Felix G.; Zhou, Chang Sheng; Zhao, Yan E.; Schoepf, U. Joseph; Zhang, Long Jiang; Lu, Guang Ming

    2014-01-01

    Objectives The purpose of this study was to assess image quality and radiation dose of lower extremity CT angiography (CTA) with 70 kVp, high pitch acquisition and sinogram-affirmed iterative reconstruction (SAFIRE). Methods Lower extremity CTAs were performed on 44 patients: 22 patients were examined using protocol A (120 kVp, pitch of 0.85 and 120 ml of contrast agent on a first-generation dual-source CT) (120 kVp group) and 22 patients were evaluated with protocol B (70 kVp, pitch of 2.2 and 80 ml of contrast agent on a second-generation dual-source CT) (70 kVp group). Images from the 120 kVp group were reconstructed with filtered back projection (FBP) and images from the 70 kVp group with SAFIRE. The attenuation, image noise, signal-to-noise ratio (SNR) and contrast-to-noise ratio (CNR) were calculated. Two radiologists subjectively assessed image quality of lower extremity arteries, plantar arterial enhancement and venous contamination of all patients. Radiation dose was compared between the two groups. Results Higher mean intravascular attenuation was obtained in the 70 kVp group (70 vs. 120 kVp group, 555.4±83.4 HU vs. 300.9±81.4 HU, P<0.001), as well as image noise (20.0±2.8 HU vs. 17.5±3.2 HU, P = 0.010), SNR (32.0±7.0 vs. 19.1±6.9, P<0.001) and CNR (28.1±6.6 vs 15.9±6.3, P<0.001). No difference in subjective image quality and plantar arterial enhancement was found between 120 kVp group and 70 kVp group (all P>0.05). The venous contamination score was 1.5±0.8 for 120 kVp group while no venous contamination was found in 70 kVp group. The inter-observer agreement was moderate to good for both groups (0.515∼1, P<0.001). The effective dose was lower in 70 kVp group (0.3±0.1 mSv) than in 120 kVp group (1.6±0.7 mSv)(P<0.001). Conclusions Lower extremity CTA using 70 kVp, high pitch acquisition and SAFIRE, except increasing imaging noise, allows for lower radiation dose and contrast material volume without compromising image quality. PMID

  12. [Features of allele polymorphism of genes involved in homocysteine and folate metabolism in patients with atherosclerosis of the lower extremity arteries].

    PubMed

    Klenkova, N A; Kapustin, S I; Saltykova, N B; Shmeleva, V M; Blinov, M N

    2009-01-01

    Under study were features of allele polymorphism of genes of methylenetetrahydrofolate reductase (MTHFR C677T and A1298C), methionine synthase (MS A 2756G), methionine synthase reductase (MTRR A66G) and methylenetetrahydrofolate dehydrogenase (MTHFD G1958A) in patients with atherosclerosis of the lower extremity arteries (ALEA). Patients with hyperhomocysteinemia (HHcy) had statistically significant increase of allele MTHFR 677T and MTRR 66GG as compared both with the control group and with the group of patients without HHcy. It suggests that polymorphism of genes involved in homocystein and folate metabolism might affect the risk of HHcy in patients with ALEA. PMID:20209990

  13. Myositis ossificans: the mimicker

    PubMed Central

    Govindarajan, Arunkumar; Sarawagi, Radha; Prakash, Manikka Lakshmanan

    2013-01-01

    A 14-year-old boy presented with upper backache and a painful swelling in the right paraspinal region for 7 days. He had no history of trauma. MRI showed a non-specific ill-defined heterogeneous lesion, which showed intense postcontrast enhancement. Ultrasonogram showed a peripheral sheet of calcification around the lesion. A CT scan showed a faint rim of calcification, which increased in thickness over weeks, confirming the diagnosis as myositis ossificans. We present our approach to the case and also review the imaging features of different stages of the disease process and their differentials. PMID:24326436

  14. The use of an acellular dermal regenerative tissue matrix in the treatment of lower extremity wounds: a prospective 16-week pilot study.

    PubMed

    Brigido, Stephen A

    2006-09-01

    A prospective, single-centre, randomized controlled study was performed to evaluate the effectiveness of Graftjacket, a human acellular regenerative tissue matrix as a treatment option for chronic non healing lower extremity wounds. Twenty-eight diabetic patients with full-thickness wounds that had been present for at least 6 weeks were treated with sharp debridement and randomized to a single application of Graftjacket tissue matrix plus mineral oil-soaked fluff compression dressing or to a control treatment of wound gel with gauze dressings. All patients were seen weekly. By week 16, 12 of 14 patients treated with Graftjacket tissue matrix demonstrated complete wound closure compared with 4 of 14 patients in the control group. Patients treated with Graftjacket tissue matrix showed a statistically significant higher percentage of wound healing with respect to wound area, and clinically significant differences in wound depth and wound volume. This comparison is not performed to demonstrate that the application of the Grafjacket is more effective than sharp debridement. This study is done to help assign a role to the use of Graftjacket matrix in lower extremity wound care. PMID:16984575

  15. Remote ischaemic conditioning in the context of type 2 diabetes and neuropathy: the case for repeat application as a novel therapy for lower extremity ulceration.

    PubMed

    Epps, J A; Smart, N A

    2016-01-01

    An emerging treatment modality for reducing damage caused by ischaemia-reperfusion injury is ischaemic conditioning. This technique induces short periods of ischaemia that have been found to protect against a more significant ischaemic insult. Remote ischaemic conditioning (RIC) can be administered more conveniently and safely, by inflation of a pneumatic blood pressure cuff to a suprasystolic pressure on a limb. Protection is then transferred to a remote organ via humoral and neural pathways. The diabetic state is particularly vulnerable to ischaemia-reperfusion injury, and ischaemia is a significant cause of many diabetic complications, including the diabetic foot. Despite this, studies utilising ischaemic conditioning and RIC in type 2 diabetes have often been disappointing. A newer strategy, repeat RIC, involves the repeated application of short periods of limb ischaemia over days or weeks. It has been demonstrated that this improves endothelial function, skin microcirculation, and modulates the systemic inflammatory response. Repeat RIC was recently shown to be beneficial for healing in lower extremity diabetic ulcers. This article summarises the mechanisms of RIC, and the impact that type 2 diabetes may have upon these, with the role of neural mechanisms in the context of diabetic neuropathy a focus. Repeat RIC may show more promise than RIC in type 2 diabetes, and its potential mechanisms and applications will also be explored. Considering the high costs, rates of chronicity and serious complications resulting from diabetic lower extremity ulceration, repeat RIC has the potential to be an effective novel advanced therapy for this condition. PMID:27613524

  16. Assessment of the efficacy and safety of steam vein sclerosis as compared to classic surgery in lower extremity varicose vein management

    PubMed Central

    Mlosek, Robert K.; Ciostek, Piotr

    2015-01-01

    Introduction For the last 10 years, endovenous thermal ablation methods have gradually predominated over the classic Babcock procedure in varicose vein treatment. Steam vein sclerosis is the newest thermal ablation technique. Aim To assess the efficacy and safety of steam vein sclerosis as compared to the Babcock procedure in lower extremity varicose vein treatment. Material and methods One hundred and two adult subjects with varicose veins of clinical grade C2 to C6 according to the CEAP classification, treated with varicose vein surgery between 2010 and 2012, were enrolled in the study. These were subdivided into two groups: the study group of 52 patients treated with endovenous steam vein sclerosis and the control group of 50 patients treated with the Babcock procedure. A single lower extremity with isolated great or small saphenous vein insufficiency was operated on in each subject. The groups were compared for demography, disease severity, involved veins, potential perioperative and postoperative complications, as well as treatment efficacy based on the VCSS score reduction. Results There were no statistically significant differences between the groups in terms of demography, disease severity, involved veins, or perioperative and postoperative complications. The treatment efficacy of both methods, assessed based on the recurrence rate and the quantitative VCSS score reduction, was similar. Clinically significant recanalisation was observed in 1 (1.9%) patient in the study group. Conclusions The efficacy and safety analysis shows that steam vein sclerosis is a safe, simple method which can be recommended as effective varicose vein treatment. PMID:25960788

  17. Feasibility and outcomes of a classical Pilates program on lower extremity strength, posture, balance, gait, and quality of life in someone with impairments due to a stroke.

    PubMed

    Shea, Sarah; Moriello, Gabriele

    2014-07-01

    Pilates is a method that can potentially be used for stroke rehabilitation to address impairments in gait, balance, strength, and posture. The purpose of this case report was to document the feasibility of using Pilates and to describe outcomes of a 9-month program on lower extremity strength, balance, posture, gait, and quality of life in an individual with stroke. The participant was taught Pilates exercises up to two times per week for nine months in addition to traditional rehabilitation in the United States. Outcomes were assessed using the Berg Balance Scale (BBS), Stroke Impact Scale (SIS), GAITRite System(®), 5 repetition sit-to-stand test (STST), and flexicurve. Improvements were found in balance, lower extremity strength, and quality of life. Posture and gait speed remained the same. While these changes cannot be specifically attributed to the intervention, Pilates may have added to his overall rehabilitation program and with some modifications was feasible to use in someone with a stroke. PMID:25042304

  18. Influence of Whole-Body Vibration Training Without Visual Feedback on Balance and Lower-Extremity Muscle Strength of the Elderly: A Randomized Controlled Trial.

    PubMed

    Tseng, Shiuan-Yu; Lai, Chung-Liang; Chang, Kai-Ling; Hsu, Pi-Shan; Lee, Meng-Chih; Wang, Chun-Hou

    2016-02-01

    The purpose of this study was to investigate the influence of whole-body vibration (WBV) training without visual feedback on balance and lower-extremity muscle strength in the elderly.Elderly subjects who did not exercise regularly participated in this study. Subjects were randomly divided into a WBV with eyes open group, a visual feedback-deprived plus WBV (VFDWBV) group, and a control group (0 Hz, eyes open). WBV training was provided over a 3-month period, 3 times per week for 5 min each session. Balance performance was measured with the limits of stability test, and muscle strength was measured with an isokinetic dynamometer.A total of 45 elderly subjects with an average age of 69.22  ±  3.97 years, divided into a WBV group (n = 14), a VFDWBV group (n = 17), and a control group (n = 14), completed the trial. Statistically significant differences were found in the balance performance of the 3 groups at different time points (time × group interaction: F = 13.213, P < 0.001), and the VFDWBV group had more improvement in balance than the WBV and control groups. The strength of the knee extensor and flexor muscles had time × group interactions: F = 29.604, P < 0.001 and F = 4.684, P = 0.015, respectively; the VFDWBV group had more improvement on lower-extremity muscle strength than the WBV and control groups. The 6-month follow-up showed that the rates of hospital visits for medical services due to falls were 0% in the WBV group (0/14), 0% in the VFDWBV group (0/17), and 28.57% in the control group (4/14).Results showed that WBV training at 20  Hz without visual feedback can significantly improve the balance performance and lower-extremity muscle strength of the elderly. PMID:26844514

  19. Influence of Whole-Body Vibration Training Without Visual Feedback on Balance and Lower-Extremity Muscle Strength of the Elderly

    PubMed Central

    Tseng, Shiuan-Yu; Lai, Chung-Liang; Chang, Kai-Ling; Hsu, Pi-Shan; Lee, Meng-Chih; Wang, Chun-Hou

    2016-01-01

    Abstract The purpose of this study was to investigate the influence of whole-body vibration (WBV) training without visual feedback on balance and lower-extremity muscle strength in the elderly. Elderly subjects who did not exercise regularly participated in this study. Subjects were randomly divided into a WBV with eyes open group, a visual feedback-deprived plus WBV (VFDWBV) group, and a control group (0 Hz, eyes open). WBV training was provided over a 3-month period, 3 times per week for 5 min each session. Balance performance was measured with the limits of stability test, and muscle strength was measured with an isokinetic dynamometer. A total of 45 elderly subjects with an average age of 69.22 ± 3.97 years, divided into a WBV group (n = 14), a VFDWBV group (n = 17), and a control group (n = 14), completed the trial. Statistically significant differences were found in the balance performance of the 3 groups at different time points (time × group interaction: F = 13.213, P < 0.001), and the VFDWBV group had more improvement in balance than the WBV and control groups. The strength of the knee extensor and flexor muscles had time × group interactions: F = 29.604, P < 0.001 and F = 4.684, P = 0.015, respectively; the VFDWBV group had more improvement on lower-extremity muscle strength than the WBV and control groups. The 6-month follow-up showed that the rates of hospital visits for medical services due to falls were 0% in the WBV group (0/14), 0% in the VFDWBV group (0/17), and 28.57% in the control group (4/14). Results showed that WBV training at 20 Hz without visual feedback can significantly improve the balance performance and lower-extremity muscle strength of the elderly. PMID:26844514

  20. Epidural injection with or without steroid in managing chronic low back and lower extremity pain: ameta-analysis of ten randomized controlled trials

    PubMed Central

    Zhai, Jinshuai; Zhang, Long; Li, Mengya; Tian, Yiren; Zheng, Wang; Chen, Jia; Huang, Teng; Li, Xicheng; Tian, Zhi

    2015-01-01

    Background: Chronic low back and lower extremity pain is mainly caused by lumbar disc herniation (LDH) and radiculitis. Various surgery and nonsurgical modalities, including epidural injections, have been used to treat LDH or radiculitis. Therefore, we conducted this meta-analysis to assess the effects of the two interventions in managing various chronic low and lower extremity pain. Methods: A systematic literature search was conducted to identify randomized controlled trials (RCTs) which compared the effect of local anesthetic with or without steroids. The outcomes included pain relief, functional improvement, opioid intake, and therapeutic procedural characteristics. Pooled estimates were calculated using a random-effects or fixed-effects model, depending on the heterogeneity between the included studies. Results: 10 RCTs (involving 1111 patients) were included in this meta-analysis. The pooled results showed that 41.7% of patients who received local anesthetic with steroid (group 1) and 40.2% of patients who received local anesthetic alone (group 2) had significant improvement in pain relief. And the Numeric Rating Scale pain scales were significantly reduced by 4.09 scores (95% CI: -4.26, -3.91), and 4.12 (95% CI: -4.35, -3.89) scores, respectively. Similarly, 39.8% of patients in group 1 and 40.7% of patients in group 2 achieved significantly improved functional status. The Oswestry Disability Index in the two groups were reduced by 14.5 (95% CI: -15.24, -13.75) and 12.37 (95% CI: -16.13, -8.62), respectively. The average procedures per year in group 1 was 3.68 ± 1.17 and 3.68 ± 1.26 in group 2 with an average total relief per year of 31.67 ± 13.17 weeks and 32.64 ± 13.92 weeks, respectively. The opioid intake decreased from baseline by 8.81 mg (95% CI: -12.24, -5.38) and 16.92 mg (95% CI: -22.71, -11.12) in the two groups, respectively. Conclusion: This meta-analysis confirms that epidural injections of local anesthetic with or without steroids have

  1. Componentry for lower extremity prostheses.

    PubMed

    Friel, Karen

    2005-09-01

    Prosthetic components for both transtibial and transfemoral amputations are available for patients of every level of ambulation. Most current suspension systems, knees, foot/ankle assemblies, and shock absorbers use endoskeletal construction that emphasizes total contact and weight distribution between bony structures and soft tissues. Different components offer varying benefits to energy expenditure, activity level, balance, and proprioception. Less dynamic ambulators may use fixed-cadence knees and non-dynamic response feet; higher functioning walkers benefit from dynamic response feet and variable-cadence knees. In addition, specific considerations must be kept in mind when fitting a patient with peripheral vascular disease or diabetes. PMID:16148358

  2. Effects of fast and slow squat exercises on the muscle activity of the paretic lower extremity in patients with chronic stroke

    PubMed Central

    Choi, Young-Ah; Kim, Jin-Seop; Lee, Dong-Yeop

    2015-01-01

    [Purpose] The purpose of this study was to investigate the effects of the speed of squat exercises on paretic lower extremity muscle activity in patients with hemiplegia following a stroke. [Subjects and Methods] Ten stroke patients performed fast and slow squat exercises for 2 seconds and 8 seconds, respectively. The muscle activities of the paretic and non-paretic sides of the rectus femoris muscle, the biceps femoris muscle, and the tibialis anterior muscle were assessed and compared using surface electromyography. [Results] The paretic side of the rectus femoris muscle showed statistically significant differences in the fast squat exercise group, which demonstrated the highest muscle activity during the rapid return to the upright position. [Conclusion] The rectus femoris muscle showed the highest muscle activity during the return to the upright position during the fast squat exercise, which indicates that the rectus femoris muscle is highly active during the fast squat exercise. PMID:26356385

  3. Soft tissue sarcomas of the distal lower extremities: A single-institutional analysis of the prognostic significance of surgical margins in 120 patients.

    PubMed

    Harati, Kamran; Kirchhoff, Pascal; Behr, Björn; Daigeler, Adrien; Goertz, Ole; Hirsch, Tobias; Lehnhardt, Marcus; Ring, Andrej

    2016-08-01

    Soft tissue sarcomas (STS) arising in the distal lower extremities pose a therapeutic challenge due to concerns of functional morbidity. The impact of surgical margins on local recurrence‑free survival (LRFS) and overall survival (OS) still remains controversial. The aim of this study was to identify prognostic indicators of survival and functional outcome in patients with STS of the distal lower extremities through a long‑term follow‑up. Between 1999 and 2014, 120 patients with STS of the foot, ankle and lower leg were treated surgically at our institution. The median follow‑up was 6.3 years. The results reveal that the 5‑year estimate of the OS rate was 80.0% [95% confidence interval (CI): 69.6‑87.1] for the entire series. Surgical margins attained at the resection of the primary tumor did not influence OS significantly [5‑year OS: R0 80.5% (69.7‑87.9) vs. R1 74.1% (28.9‑93.0); P=0.318]. Within the R0 subgroup, negative surgical margin widths ≤1 and >1 mm led to similar outcomes, as well as ≤5 and >5 mm, respectively. In the multivariate analysis, significant adverse prognostic features included male gender and age >60 years at the time point of primary diagnosis. In conclusion, the data from this study could not underscore the long‑term benefit of negative margins achieved at the resection of the primary tumor. Surgical efforts should aim at function‑sparing resections when feasible with negative margins. Here, close negative margins seem to be adequate. PMID:27278861

  4. The results of bone deformity correction using a spider frame with web-based software for lower extremity long bone deformities

    PubMed Central

    Tekin, Ali Çağrı; Çabuk, Haluk; Dedeoğlu, Süleyman Semih; Saygılı, Mehmet Selçuk; Adaş, Müjdat; Esenyel, Cem Zeki; Büyükkurt, Cem Dinçay; Tonbul, Murat

    2016-01-01

    Aim: To present the functional and radiological results and evaluate the effectiveness of a computer-assisted external fixator (spider frame) in patients with lower extremity shortness and deformity. Materials and methods: The study comprised 17 patients (14 male, 3 female) who were treated for lower extremity long bone deformity and shortness between 2012 and 2015 using a spider frame. The procedure’s level of difficulty was determined preoperatively using the Paley Scale. Postoperatively, the results for the patients who underwent tibial operations were evaluated using the Paley criteria modified by ASAMI, and the results for the patients who underwent femoral operations were evaluated according to the Paley scoring system. The evaluations were made by calculating the External Fixator and Distraction indexes. Results: The mean age of the patients was 24.58 years (range, 5–51 years). The spider frame was applied to the femur in 10 patients and to the tibia in seven. The mean follow-up period was 15 months (range, 6–31 months) from the operation day, and the mean amount of lengthening was 3.0 cm (range, 1–6 cm). The mean duration of fixator application was 202.7 days (range, 104–300 days). The mean External Fixator Index was 98 days/cm (range, 42–265 days/cm). The mean Distraction Index was 10.49 days/cm (range, 10–14 days/cm). Conclusion: The computer-assisted external fixator system (spider frame) achieves single-stage correction in cases of both deformity and shortness. The system can be applied easily, and because of its high-tech software, it offers the possibility of postoperative treatment of the deformity. PMID:27163100

  5. Effects of a 10-week inspiratory muscle training program on lower-extremity mobility in people with multiple sclerosis: a randomized controlled trial.

    PubMed

    Pfalzer, Lucinda; Fry, Donna

    2011-01-01

    Pulmonary muscle weakness is common in ambulatory people with multiple sclerosis (MS) and may lead to deficits in mobility function. The purpose of this study was to examine the effect of a 10-week home-based exercise program using an inspiratory muscle threshold trainer (IMT) on the results of four lower-extremity physical performance tests in people with MS. The study design was a two-group (experimental-control), pretest-posttest study. Outcome measures consisted of pulmonary function measures including maximal inspiratory pressure (MIP), maximal expiratory pressure (MEP), and maximal voluntary ventilation (MVV), and the following lower-extremity physical performance measures: the 6-Minute Walk (6MW) distance, gait velocity (GV), the Sit-to-Stand Test (SST), the Functional Stair Test (FST), and a balance test (BAL). A total of 46 ambulatory participants (Expanded Disability Status Scale [EDSS] score, 2.0-6.5) with MS were randomly assigned to an intervention group (mean EDSS score, 4.1) that received 10 weeks of home-based inspiratory muscle training or a nontreatment control group (mean EDSS score, 3.2). Of the original 46 participants, 20 intervention group participants and 19 control group participants completed the study. Compared with the control group, the intervention group made significantly greater gains in inspiratory muscle strength (P = .003) and timed balance scores (P = .008). A nonsignificant improvement in 6MW distance (P = .086) was also noted in the IMT-trained group as compared with the control group. This is the first study directly linking improvement in respiratory function to improvement in physical performance function in people with mild-to-moderate disability due to MS. PMID:24453703

  6. [The application of the method of kinesio-taping technique for the combined non-pharmacological rehabilitation of the patients presenting with lymphedema of the lower extremities].

    PubMed

    Gerasimenko, M Yu; Knyazeva, T A; Apkhanova, T V; Kul'Chitskaya, D B

    2015-01-01

    Based on the innovative "kinesio-taping" technique proposed by the Japanese researcher Kenzo Kace, we have designed a new physiotherapeutic complex including the well-known physiotherapeutic methods of lymphatic drainage with intermittent pneumatic compression and underwater massage shower. The objective of our study was to evaluate the efficiency of the application of the "kinesio-taping" technique for the non-pharmacological rehabilitative treatment of the patients presenting with stage I-III lymphedema of the lower sextremities. The secondary objective was to evaluate the possibility of correction of endothelial dysfunction in the patients with lymphedema after the application of the "kinesio-taping" technique. The study included 30 patients with stage I-III lymphedema of the lower extremities randomized into two groups. Group 1 was comprised of 15 patients who were consistently treated by a combination of intermittent pneumatic compression, "akinesio-taping", and underwater massage shower. Group 2 contained 15 patients treated with the use of intermittent pneumatic compression and underwater massage shower. The results of study give evidence of positive changes in microcirculation of the patients comprising group 1 that suggest the improvement of endothelial function, vasodilation of precapillaries, enhancement of the blood flow in the microcirculatory system, and reduction of the influence of the ineffective shunting blood flow. The data obtained confirm the effectiveness of the new non-pharmacological rehabilitation complex that includes the innovative lymph-draining method of kinesio-taping, intermittent pneumatic compression and underwater massage shower for the treatment of patients with lymphedema of the lower extremities. The effectiveness of this complex is due to combined stimulation of the lymphatic and venous drainage systems and coupled to the stimulation of blood flow in the microcirculatory bed and the formation of a positive endothelial response

  7. The Efficacy of Femoral Block and Unilateral Spinal Anaesthesia on Analgesia, Haemodynamics and Mobilization in Patients undergoing Endovenous Ablation in the Lower Extremity

    PubMed Central

    Öztürk, Tülün; Çevikkalp, Eralp; Nizamoglu, Funda; Özbakkaloğlu, Alper; Topcu, İsmet

    2016-01-01

    Objective This study aimed to investigate the efficacy of femoral block and unilateral spinal anaesthesia on analgesia, haemodynamics and mobilization during endovenous ablation in patients with lower extremity venous insufficiency. Methods Forty patients of ASA physical status I and II, with ages ranging between 30 and 45 years, and who were scheduled for endovenous laser ablation for varicose veins were prospectively enrolled in this study. Patients were randomized into a unilateral spinal anaesthesia group (group HS, n=20) or a femoral block group (group F, n=20). Group HS received 7.5–10 mg of heavy bupivacaine for unilateral spinal anaesthesia, while group F received 100 mg prilocaine for femoral block with ultrasound guidance. The level of motor blockage (Bromage score), visual pain score, mean heart rate and mean arterial pressures were recorded at postoperative 0, 1, 2, 3d and 6 h, respectively. Results Perioperative visual pain score values in both groups were <4. None of the groups required an additional analgesic agent. Bromage scores were significantly lower in group F than in group HS during the postoperative period (p<0.01). Motor function returned to normal in all patients at 3 h in group F and at 6 h in group HS. Postoperative mean heart rate and arterial pressure did not differ between the groups (p>0.05). Conclusion In patients with lower extremity venous insufficiency who were undergoing endovenous laser ablation, an ultrasound-guided femoral block provided similar analgesia with that of unilateral spinal anaesthesia. In group F, the duration of anaesthesia and mobilization time was shorter. PMID:27366565

  8. Lean Body Mass Associated with Upper Body Strength in Healthy Older Adults While Higher Body Fat Limits Lower Extremity Performance and Endurance.

    PubMed

    Charlton, Karen; Batterham, Marijka; Langford, Kelly; Lateo, Jenna; Brock, Erin; Walton, Karen; Lyons-Wall, Philippa; Eisenhauer, Katie; Green, Nick; McLean, Cameron

    2015-09-01

    Impaired strength adversely influences an older person's ability to perform activities of daily living. A cross-sectional study of 117 independently living men and women (age = 73.4 ± 9.4 year; body mass index (BMI) = 27.6 ± 4.8 kg/m²) aimed to assess the association between body composition and: (1) upper body strength (handgrip strength, HGS); (2) lower extremity performance (timed up and go (TUG) and sit to stand test (STS)); and (3) endurance (6-minute walk (SMWT). Body composition (% fat; lean body mass (LBM)) was assessed using bioelectrical impedance. Habitual physical activity was measured using the Minnesota Leisure Time Physical Activity Questionnaire (MLTPA) and dietary macronutrient intake, assessed using 24 h recalls and 3-day food records. Regression analyses included the covariates, protein intake (g/kg), MLTPA, age and sex. For natural logarithm (Ln) of right HGS, LBM (p < 0.001) and % body fat (p < 0.005) were significant (r² = 46.5%; p < 0.000). For left LnHGS, LBM (p < 0.000), age (p = 0.036), protein intake (p = 0.015) and LnMLTPA (p = 0.015) were significant (r² = 0.535; p < 0.000). For SMW, % body fat, age and LnMLTPA were significant (r² = 0.346; p < 0.000). For STS, % body fat and age were significant (r² = 0.251; p < 0.000). LBM is a strong predictor of upper body strength while higher % body fat and lower physical activity are associated with poorer outcomes on tests of lower extremity performance. PMID:26343709

  9. Longitudinal decline of lower extremity muscle power in healthy and mobility-limited older adults: influence of muscle mass, strength, composition, neuromuscular activation and single fiber contractile properties

    PubMed Central

    Reid, Kieran F.; Pasha, Evan; Doros, Gheorghe; Clark, David J.; Patten, Carolynn; Phillips, Edward M.; Frontera, Walter R.; Fielding, Roger A.

    2013-01-01

    Purpose This longitudinal study examined the major physiological mechanisms that determine the age-related loss of lower extremity muscle power in two distinct groups of older humans. We hypothesized that after ~ 3 years of follow-up, mobility-limited older adults (mean age: 77.2 ± 4, n = 22, 12 females) would have significantly greater reductions in leg extensor muscle power compared to healthy older adults (74.1 ± 4, n = 26, 12 females). Methods Mid-thigh muscle size and composition were assessed using computed tomography. Neuromuscular activation was quantified using surface electromyography and vastus lateralis single muscle fibers were studied to evaluate intrinsic muscle contractile properties. Results At follow-up, the overall magnitude of muscle power loss was similar between groups: mobility-limited: −8.5% vs. healthy older: −8.8%, P > 0.8. Mobility-limited elders had significant reductions in muscle size (−3.8%, P< 0.01) and strength (−5.9%, P< 0.02), however, these parameters were preserved in healthy older (P ≥ 0.7). Neuromuscular activation declined significantly within healthy older but not in mobility-limited participants. Within both groups, the cross sectional areas of type I and type IIA muscle fibers were preserved while substantial increases in single fiber peak force ( > 30%), peak power (> 200%) and unloaded shortening velocity (>50%) were elicited at follow-up. Conclusion Different physiological mechanisms contribute to the loss of lower extremity muscle power in healthy older and mobility-limited older adults. Neuromuscular changes may be the critical early determinant of muscle power deficits with aging. In response to major whole muscle decrements, major compensatory mechanisms occur within the contractile properties of surviving single muscle fibers in an attempt to restore overall muscle power and function with advancing age. PMID:24122149

  10. Outcomes Following Low-Energy Civilian Gunshot Wound Trauma to the Lower Extremities: Results of a Standard Protocol at an Urban Trauma Center

    PubMed Central

    Abghari, Michelle; Monroy, Alexa; Schubl, Sebastian; Davidovitch, Roy; Egol, Kenneth

    2015-01-01

    Background Lower extremity injuries secondary to low-energy gunshot wounds are frequently seen in the civilian populations of urban areas. Although these wounds have fewer complications than high-energy gunshot injuries, the functional and psychological damage is still significant making appropriate timely orthopaedic treatment and follow-up imperative. Purpose The purpose of this study is to present our outcomes in the treatment of low-energy gunshot wounds in a civilian population at an urban, level one trauma center in patients treated by a standard protocol. Methods One hundred and thirty three patients who sustained 148 gunshot wound injuries were treated at our level one trauma center between January 1st, 2009 and October 1st, 2011. Following IRB approval, we extracted information from medical records regarding hospital course, length of stay and type of operative or non-operative treatment. If available, injury and post-operative radiographs were also reviewed. Patients were contacted by telephone to obtain Short Musculoskeletal Function Assessment (SMFA) surveys, pain on a scale of 0–10 and for the determination of any adverse events related to their shooting. Results There were 125 men (94.0%) and 8 women (6.0%) with an average age of 27.1 years (range 15.2–56.3). Seventy-six patients (57.1%) did not have any health insurance upon admission. The average length of stay in the hospital was 4.5 days (range 0.0–88.0). Fifty-one gun shots (34.5%) resulted in fractures of the lower extremities. Patients underwent a total of 95 lower extremity-related procedures during their hospitalization. Twenty-two patients (16.5%) experienced a complication related to their gunshot wounds. 38% of the cohort was available for long-term functional assessment At a mean 23.5 months (range 8–48) of follow up, patients reported mean Functional and Bothersome SMFA scores of 19.6 (SD 15.9) and 10.9 (SD 15.6) suggesting that these patients have poorer function scores than the

  11. Assessment of the risk of falling with the use of timed up and go test in the elderly with lower extremity osteoarthritis

    PubMed Central

    Zasadzka, Ewa; Borowicz, Adrianna Maria; Roszak, Magdalena; Pawlaczyk, Mariola

    2015-01-01

    Background Falling in the elderly results in a significant number of admissions to hospitals and long-term care facilities, especially among patients with lower extremity osteoarthritis (OA). Objective The aim of the study was to assess the risk of falling in adults older than 60 years with OA using timed up and go (TUG) test. Materials and methods A total of 187 patients (aged >60 years) were enrolled in the study. The assessment included: basic activities of daily living (ADLs), lower extremity strength with the use of the 30-second chair stand test (30 CST), and assessment of the risk of falling (TUG test). Pain intensity was evaluated with the numeric rating scale (NRS). Results The TUG test results were significantly better in younger OA patients (aged 60–69 years), as compared with their older peers (aged 70–79 years; P<0.01) and the oldest group (aged >80 years; P<0.001). Also, the 30 CST results were significantly higher in younger OA patients (P<0.05). Subjects older than 80 years had a significantly worse ADL score (P<0.05 and P<0.001). Pain complaints were reported significantly more frequently by women than men (P<0.05). A correlation between age and the TUG test score (r=0.412; P<0.0004) as well as between the TUG test and the 30 CST scores (r=0.7368; P=0.000) was detected. In the group with the TUG test score of <13.5 seconds, the 30 CST (P<0.0001) and ADL (P<0.003) results were significantly better. A comparison of fallers vs nonfallers revealed that the number of falls was significantly higher in the group of subjects who scored ≥13.5 when compared to <13.5 (P=0.003). Fallers significantly more often reported pain (P<0.0001), whereas nonfallers had significantly better 30 CST results (P=0.0003). Conclusion Elderly population with OA is at an elevated risk of falling, which increases with progressing age, pain, and muscle weakness. It seems prudent to identify individuals at a high risk of falling and to propose an adequate treatment for them

  12. Mechanosensitivity during lower extremity neurodynamic testing is diminished in individuals with Type 2 Diabetes Mellitus and peripheral neuropathy: a cross sectional study

    PubMed Central

    2010-01-01

    Background Type 2 Diabetes Mellitus (T2DM) and diabetic symmetrical polyneuropathy (DSP) impact multiple modalities of sensation including light touch, temperature, position sense and vibration perception. No study to date has examined the mechanosensitivity of peripheral nerves during limb movement in this population. The objective was to determine the unique effects T2DM and DSP have on nerve mechanosensitivity in the lower extremity. Methods This cross-sectional study included 43 people with T2DM. Straight leg raise neurodynamic tests were performed with ankle plantar flexion (PF/SLR) and dorsiflexion (DF/SLR). Hip flexion range of motion (ROM), lower extremity muscle activity and symptom profile, intensity and location were measured at rest, first onset of symptoms (P1) and maximally tolerated symptoms (P2). Results The addition of ankle dorsiflexion during SLR testing reduced the hip flexion ROM by 4.3° ± 6.5° at P1 and by 5.4° ± 4.9° at P2. Individuals in the T2DM group with signs of severe DSP (n = 9) had no difference in hip flexion ROM between PF/SLR and DF/SLR at P1 (1.4° ± 4.2°; paired t-test p = 0.34) or P2 (0.9° ± 2.5°; paired t-test p = 0.31). Movement induced muscle activity was absent during SLR with the exception of the tibialis anterior during DF/SLR testing. Increases in symptom intensity during SLR testing were similar for both PF/SLR and DF/SLR. The addition of ankle dorsiflexion induced more frequent posterior leg symptoms when taken to P2. Conclusions Consistent with previous recommendations in the literature, P1 is an appropriate test end point for SLR neurodynamic testing in people with T2DM. However, our findings suggest that people with T2DM and severe DSP have limited responses to SLR neurodynamic testing, and thus may be at risk for harm from nerve overstretch and the information gathered will be of limited clinical value. PMID:20799983

  13. Establishing a Customized Guide Plate for Osteotomy in Total Knee Arthroplasty Using Lower-extremity X-ray and Knee Computed Tomography Images

    PubMed Central

    Zhang, Jin; Tian, Xiao-Bin; Sun, Li; Hu, Ru-Yin; Tian, Jia-Liang; Han, Wei; Zhao, Jin-Min

    2016-01-01

    Background: The conventional method cannot guarantee the precise osteotomies required for a perfect realignment and a better prognosis after total knee arthroplasty (TKA). This study investigated a customized guide plate for osteotomy placement in TKAs with the aid of the statistical shape model technique using weight-bearing lower-extremity X-rays and computed tomography (CT) images of the knee. Methods: From October 2014 to June 2015, 42 patients who underwent a TKA in Guizhou Provincial People's Hospital were divided into a guide plate group (GPG, 21 cases) and a traditional surgery group (TSG, 21 cases) using a random number table method. In the GPG group, a guide plate was designed and printed using preoperative three-dimensional measurements to plan and digitally simulate the operation. TSG cases were treated with the conventional method. Outcomes were obtained from the postoperative image examination and short-term follow-up. Results: Operative time was 49.0 ± 10.5 min for GPG, and 62.0 ± 9.7 min in TSG. The coronal femoral angle, coronal tibial angle, posterior tibial slope, and the angle between the posterior condylar osteotomy surface and the surgical transepicondylar axis were 89.2 ± 1.7°, 89.0 ± 1.1°, 6.6 ± 1.4°, and 0.9 ± 0.3° in GPG, and 86.7 ± 2.9°, 87.6 ± 2.1°, 8.9 ± 2.8°, and 1.7 ± 0.8° in TSG, respectively. The Hospital for Special Surgery scores 3 months after surgery were 83.7 ± 18.4 in GPG and 71.5 ± 15.2 in TSG. Statistically significant differences were found between GPG and TSG in all measurements. Conclusions: A customized guide plate to create an accurate osteotomy in TKAs may be created using lower-extremity X-ray and knee CT images. This allows for shorter operative times and better postoperative alignment than the traditional surgery. Application of the digital guide plate may also result in better short-term outcomes. PMID:26879010

  14. Clinical Characteristics and Risk Factor Analysis for Lower-Extremity Amputations in Diabetic Patients With Foot Ulcer Complicated by Necrotizing Fasciitis

    PubMed Central

    Chen, I-Wen; Yang, Hui-Mei; Chiu, Cheng-Hsun; Yeh, Jiun-Ting; Huang, Chung-Huei; Huang, Yu-Yao

    2015-01-01

    Abstract Patients with diabetes are at a higher risk of having diabetic foot ulcers (DFUs) or necrotizing fasciitis (NF). The present study aims to examine the clinical characteristics and associated risk factors for lower-extremity amputation (LEA) in patients with DFU complicated by NF. We retrospectively reviewed patients treated at a major diabetic foot center in Taiwan between 2009 and 2014. Of the 2265 cases 110 had lower-extremity NF. Limb preservation outcomes were classified as major LEA, minor LEA, or limb-preserved. Clinical characteristics, laboratory data, and bacterial culture results were collected for analysis. Of the 110 patients with NF, 100 had concomitant DFUs (NF with DFU) and the remaining 10 had no DFU (NF without DFU). None of the NF patients without DFU died nor had their leg amputated. Two NF patients with DFU died of complications. The amputation rate in the surviving 98 NF patients with DFU was 72.4% (46.9% minor LEA and 25.5% major LEA). Seventy percent of the NF patients without DFU had monomicrobial infections (60% with Streptococcus species), and 81.4% NF patients with DFU had polymicrobial infections. Anaerobic organisms were identified in 66% of the NF patients with DFU. Multinomial logistic regression analysis revealed an association between high-grade Wagner wound classification (Wagner 4 and Wagner 5) and LEA (adjusted odds ratio [aOR] = 21.856, 95% confidence interval [95% CI] = 1.625–203.947, P = 0.02 and aOR = 20.094, 95% CI = 1.968–205.216, P = 0.01 for major and minor LEA, respectively) for NF patients with DFU. In addition, a lower serum albumin level was associated with major LEA (OR = 0.066, P = 0.002). In summary, once DFUs were complicated by NF, the risk of amputation increased. Empirical treatment for NF patients with DFU should cover polymicrobial infections, including anaerobic organisms. The high-grade wound classification and low serum albumin level were associated with LEA

  15. Dose-Effect Relationships for Femoral Fractures After Multimodality Limb-Sparing Therapy of Soft-Tissue Sarcomas of the Proximal Lower Extremity

    SciTech Connect

    Pak, Daniel; Vineberg, Karen A.; Griffith, Kent A.; Sabolch, Aaron; Chugh, Rashmi; Biermann, Janet Sybil; Feng, Mary

    2012-07-15

    Purpose: We investigated the clinical and dosimetric predictors for radiation-associated femoral fractures in patients with proximal lower extremity soft tissue sarcomas (STS). Methods and Materials: We examined 131 patients with proximal lower extremity STS who received limb-sparing surgery and external-beam radiation therapy between 1985 and 2006. Five (4%) patients sustained pathologic femoral fractures. Dosimetric analysis was limited to 4 fracture patients with full three-dimensional dose information, who were compared with 59 nonfracture patients. The mean doses and volumes of bone (V{sub d}) receiving specified doses ({>=}30 Gy, 45 Gy, 60 Gy) at the femoral body, femoral neck, intertrochanteric region, and subtrochanteric region were compared. Clinical predictive factors were also evaluated. Results: Of 4 fracture patients in our dosimetric series, there were three femoral neck fractures with a mean dose of 57.6 {+-} 8.9 Gy, V30 of 14.5 {+-} 2.3 cc, V45 of 11.8 {+-} 1.1 cc, and V60 of 7.2 {+-} 2.2 cc at the femoral neck compared with 22.9 {+-} 20.8 Gy, 4.8 {+-} 5.6 cc, 2.5 {+-} 3.9 cc, and 0.8 {+-} 2.7 cc, respectively, for nonfracture patients (p < 0.03 for all). The femoral neck fracture rate was higher than at the subtrochanteric region despite lower mean doses at these subregions. All fracture sites received mean doses greater than 40 Gy. Also, with our policy of prophylactic femoral intramedullary nailing for high-risk patients, there was no significant difference in fracture rates between patients with and without periosteal excision. There were no significant differences in age, sex, tumor size, timing of radiation therapy, and use of chemotherapy between fracture and nonfracture patients. Conclusions: These dose-volume toxicity relationships provide RT optimization goals to guide future efforts for reducing pathologic fracture rates. Prophylactic femoral intramedullary nailing may also reduce fracture risk for susceptible patients.

  16. The influence of ACE ID and ACTN3 R577X polymorphisms on lower-extremity function in older women in response to high-speed power training

    PubMed Central

    2013-01-01

    Background We studied the influence of the ACE I/D and ACTN3 R577X polymorphisms (single or combined) on lower-extremity function in older women in response to high-speed power training. Methods One hundred and thirty-nine healthy older Caucasian women participated in this study (age: 65.5 ± 8.2 years, body mass: 67.0 ± 10.0 kg and height: 1.57 ± 0.06 m). Walking speed (S10) performance and functional capacity assessed by the “get-up and go” (GUG) mobility test were measured at baseline (T1) and after a consecutive 12-week period of high-speed power training (40-75% of one repetition maximum in arm and leg extensor exercises; 3 sets 4–12 reps, and two power exercises for upper and lower extremity). Genomic DNA was extracted from blood samples, and genotyping analyses were performed by PCR methods. Genotype distributions between groups were compared by Chi-Square test and the gains in physical performance were analyzed by two-way, repeated-measures ANOVA. Results There were no significant differences between genotype groups in men or women for adjusted baseline phenotypes (P > 0.05). ACE I/D and ACTN3 polymorphisms showed a significant interaction genotype-training only in S10 (P = 0.012 and P = 0.044, respectively) and not in the GUG test (P = 0.311 and P = 0.477, respectively). Analyses of the combined effects between genotypes showed no other significant differences in all phenotypes (P < 0.05) at baseline. However, in response to high-speed power training, a significant interaction on walking speed (P = 0.048) was observed between the “power” (ACTN3 RR + RX & ACE DD) versus “non-power” muscularity-oriented genotypes (ACTN3 XX & ACE II + ID)]. Conclusions Thus, ACE I/D and ACTN3 R577X polymorphisms are likely candidates in the modulation of exercise-related gait speed phenotype in older women but not a significant influence in mobility traits. PMID:24313907

  17. Clinical Characteristics and Risk Factor Analysis for Lower-Extremity Amputations in Diabetic Patients With Foot Ulcer Complicated by Necrotizing Fasciitis.

    PubMed

    Chen, I-Wen; Yang, Hui-Mei; Chiu, Cheng-Hsun; Yeh, Jiun-Ting; Huang, Chung-Huei; Huang, Yu-Yao

    2015-11-01

    Patients with diabetes are at a higher risk of having diabetic foot ulcers (DFUs) or necrotizing fasciitis (NF). The present study aims to examine the clinical characteristics and associated risk factors for lower-extremity amputation (LEA) in patients with DFU complicated by NF.We retrospectively reviewed patients treated at a major diabetic foot center in Taiwan between 2009 and 2014. Of the 2265 cases 110 had lower-extremity NF. Limb preservation outcomes were classified as major LEA, minor LEA, or limb-preserved. Clinical characteristics, laboratory data, and bacterial culture results were collected for analysis.Of the 110 patients with NF, 100 had concomitant DFUs (NF with DFU) and the remaining 10 had no DFU (NF without DFU). None of the NF patients without DFU died nor had their leg amputated. Two NF patients with DFU died of complications. The amputation rate in the surviving 98 NF patients with DFU was 72.4% (46.9% minor LEA and 25.5% major LEA). Seventy percent of the NF patients without DFU had monomicrobial infections (60% with Streptococcus species), and 81.4% NF patients with DFU had polymicrobial infections. Anaerobic organisms were identified in 66% of the NF patients with DFU. Multinomial logistic regression analysis revealed an association between high-grade Wagner wound classification (Wagner 4 and Wagner 5) and LEA (adjusted odds ratio [aOR] = 21.856, 95% confidence interval [95% CI] = 1.625-203.947, P = 0.02 and aOR = 20.094, 95% CI = 1.968-205.216, P = 0.01 for major and minor LEA, respectively) for NF patients with DFU. In addition, a lower serum albumin level was associated with major LEA (OR = 0.066, P = 0.002).In summary, once DFUs were complicated by NF, the risk of amputation increased. Empirical treatment for NF patients with DFU should cover polymicrobial infections, including anaerobic organisms. The high-grade wound classification and low serum albumin level were associated with LEA. PMID:26554804

  18. Swelling

    MedlinePlus

    ... Collier DS, Bryan S, eds. Signs and Symptoms in Family Medicine: A Literature-Based Approach . Philadelphia, PA: Elsevier Mosby; ... Northwest Division of Physician Assistant Studies, Department of Family Medicine, UW Medicine, School of Medicine, University of Washington, ...

  19. The effects of hip external rotator exercises and toe-spread exercises on lower extremity muscle activities during stair-walking in subjects with pronated foot

    PubMed Central

    Goo, Young-Mi; Kim, Da-Yeon; Kim, Tae-Ho

    2016-01-01

    [Purpose] The purpose of the present study was to examine the effects of toe-spread (TS) exercises and hip external rotator strengthening exercises for pronated feet on lower extremity muscle activities during stair-walking. [Subjects and Methods] The participants were 20 healthy adults with no present or previous pain, no past history of surgery on the foot or the ankle, and no foot deformities. Ten subjects performed hip external rotator strengthening exercises and TS exercises and the remaining ten subjects performed only TS exercises five times per week for four weeks. [Results] Less change in navicular drop height occurred in the group that performed hip external rotator exercises than in the group that performed only TS exercises. The group that performed only TS exercises showed increased abductor hallucis muscle activity during both stair-climbing and -descending, and the group that performed hip external rotator exercises showed increased muscle activities of the vastus medialis and abductor hallucis during stair-climbing and increased muscle activity of only the abductor hallucis during stair-descending after exercise. [Conclusion] Stair-walking can be more effectively performed if the hip external rotator muscle is strengthened when TS exercises are performed for the pronated foot. PMID:27134364

  20. Magnetic Resonance Imaging of Phosphocreatine and Determination of BOLD Kinetics in Lower Extremity Muscles using a Dual-Frequency Coil Array.

    PubMed

    Brown, Ryan; Khegai, Oleksandr; Parasoglou, Prodromos

    2016-01-01

    Magnetic resonance imaging (MRI) provides the unique ability to study metabolic and microvasculature functions in skeletal muscle using phosphorus and proton measurements. However, the low sensitivity of these techniques can make it difficult to capture dynamic muscle activity due to the temporal resolution required for kinetic measurements during and after exercise tasks. Here, we report the design of a dual-nuclei coil array that enables proton and phosphorus MRI of the human lower extremities with high spatial and temporal resolution. We developed an array with whole-volume coverage of the calf and a phosphorus signal-to-noise ratio of more than double that of a birdcage coil in the gastrocnemius muscles. This enabled the local assessment of phosphocreatine recovery kinetics following a plantar flexion exercise using an efficient sampling scheme with a 6 s temporal resolution. The integrated proton array demonstrated image quality approximately equal to that of a clinical state-of-the-art knee coil, which enabled fat quantification and dynamic blood oxygen level-dependent measurements that reflect microvasculature function. The developed array and time-efficient pulse sequences were combined to create a localized assessment of calf metabolism using phosphorus measurements and vasculature function using proton measurements, which could provide new insights into muscle function. PMID:27465636

  1. Magnetic Resonance Imaging of Phosphocreatine and Determination of BOLD Kinetics in Lower Extremity Muscles using a Dual-Frequency Coil Array

    PubMed Central

    Brown, Ryan; Khegai, Oleksandr; Parasoglou, Prodromos

    2016-01-01

    Magnetic resonance imaging (MRI) provides the unique ability to study metabolic and microvasculature functions in skeletal muscle using phosphorus and proton measurements. However, the low sensitivity of these techniques can make it difficult to capture dynamic muscle activity due to the temporal resolution required for kinetic measurements during and after exercise tasks. Here, we report the design of a dual-nuclei coil array that enables proton and phosphorus MRI of the human lower extremities with high spatial and temporal resolution. We developed an array with whole-volume coverage of the calf and a phosphorus signal-to-noise ratio of more than double that of a birdcage coil in the gastrocnemius muscles. This enabled the local assessment of phosphocreatine recovery kinetics following a plantar flexion exercise using an efficient sampling scheme with a 6 s temporal resolution. The integrated proton array demonstrated image quality approximately equal to that of a clinical state-of-the-art knee coil, which enabled fat quantification and dynamic blood oxygen level-dependent measurements that reflect microvasculature function. The developed array and time-efficient pulse sequences were combined to create a localized assessment of calf metabolism using phosphorus measurements and vasculature function using proton measurements, which could provide new insights into muscle function. PMID:27465636

  2. [Atherosclerosis of the lower extremities as a linked comorbidity in Patients Admitted for cardiac rehabilitation (THINKPAD): rationale, design, and study group].

    PubMed

    Ambrosetti, Marco; Diaco, Tommaso; Febo, Oreste; Calisi, Pasqualina; Favretto, Giuseppe; Carlon, Roberto; Temporelli, Pier Luigi

    2012-03-01

    Peripheral arterial disease (PAD) is a frequent comorbidity among patients entering cardiac rehabilitation (CR) programmes and an important source of disability and impaired prognosis. The prevalence of PAD across the wide range of conditions for CR is poorly understood, as far as its impact on drug optimization and intervention delivered. The "ATHerosclerosis of the lower extremities as a liNKed comorbidity in Patients Admitted for carDiac rehabilitation" (THINKPAD) study was carried out by the Italian Association for Cardiovascular Prevention, Rehabilitation and Epidemiology (GICR-IACPR) in order to explore PAD both as a comorbidity and a primary indication at the entry of CR. The study was a retrospective case series. In the study period (from May 1, 2012 to June 30, 2012), data on consecutive patients discharged from 17 CR units in Northern Italy were collected. Web-based electronic case report forms (e-CRF), accessible in a dedicated section of the IACPR website (www.iacpr.it), were used for data entry, and data were transferred via web to a central database. The data collection instrument was designed with a multiple choice format, with jump menus or select boxes and obligatory items. A sample size of 1,300 subjects is expected, with first data available by the end of 2012. PMID:22928398

  3. A modeling and computer simulation approach to determine optimal lower extremity joint angular velocities based on a criterion to maximize individual muscle power.

    PubMed

    Hawkins, D

    1994-03-01

    A computer program was developed in conjunction with a musculoskeletal modeling scheme to determine lower extremity joint angular velocity profiles which allow specific muscles, if activated tetanically, to generate their greatest power. As input the program requires subject anthropometric and joint configuration data. Muscle-tendon (MT) attachment location data and a straight line MT model are used to calculate MT lengths for each joint configuration. The shortening velocity which allows an active muscle to generate its greatest power is calculated based on muscle architecture and a relationship between power and shortening velocity. A finite difference technique is used to calculate the time between sequential joint configurations which will produce the optimal muscle shortening velocity. This time is then used to calculate optimal joint angular velocities for each muscle and and for each joint configuration. The utility of this program is demonstrated by calculating optimal joint angular velocities for fifteen muscles and comparing calculated knee extension velocities with experimental results cited in the literature. PMID:8062553

  4. Application of Computational Lower Extremity Model to Investigate Different Muscle Activities and Joint Force Patterns in Knee Osteoarthritis Patients during Walking

    PubMed Central

    Nha, Kyung Wook; Shin, Jun Ho; Kim, Jong In; Kwon, Jae Ho; Kim, Yoon Hyuk

    2013-01-01

    Many experimental and computational studies have reported that osteoarthritis in the knee joint affects knee biomechanics, including joint kinematics, joint contact forces, and muscle activities, due to functional restriction and disability. In this study, differences in muscle activities and joint force patterns between knee osteoarthritis (OA) patients and normal subjects during walking were investigated using the inverse dynamic analysis with a lower extremity musculoskeletal model. Extensor/flexor muscle activations and torque ratios and the joint contact forces were compared between the OA and normal groups. The OA patients had higher extensor muscle forces and lateral component of the knee joint force than normal subjects as well as force and torque ratios of extensor and flexor muscles, while the other parameters had little differences. The results explained that OA patients increased the level of antagonistic cocontraction and the adduction moment on the knee joint. The presented findings and technologies provide insight into biomechanical changes in OA patients and can also be used to evaluate the postoperative functional outcomes of the OA treatments. PMID:24302973

  5. Magnetic Resonance Imaging of Phosphocreatine and Determination of BOLD Kinetics in Lower Extremity Muscles using a Dual-Frequency Coil Array

    NASA Astrophysics Data System (ADS)

    Brown, Ryan; Khegai, Oleksandr; Parasoglou, Prodromos

    2016-07-01

    Magnetic resonance imaging (MRI) provides the unique ability to study metabolic and microvasculature functions in skeletal muscle using phosphorus and proton measurements. However, the low sensitivity of these techniques can make it difficult to capture dynamic muscle activity due to the temporal resolution required for kinetic measurements during and after exercise tasks. Here, we report the design of a dual-nuclei coil array that enables proton and phosphorus MRI of the human lower extremities with high spatial and temporal resolution. We developed an array with whole-volume coverage of the calf and a phosphorus signal-to-noise ratio of more than double that of a birdcage coil in the gastrocnemius muscles. This enabled the local assessment of phosphocreatine recovery kinetics following a plantar flexion exercise using an efficient sampling scheme with a 6 s temporal resolution. The integrated proton array demonstrated image quality approximately equal to that of a clinical state-of-the-art knee coil, which enabled fat quantification and dynamic blood oxygen level-dependent measurements that reflect microvasculature function. The developed array and time-efficient pulse sequences were combined to create a localized assessment of calf metabolism using phosphorus measurements and vasculature function using proton measurements, which could provide new insights into muscle function.

  6. Technetium-99m-RBC venography in the diagnosis of deep venous thrombosis of the lower extremity: a systematic review of the literature.

    PubMed

    Pinson, A G; Becker, D M; Philbrick, J T; Parekh, J S

    1991-12-01

    We systematically reviewed the six articles from the English-language medical literature, since 1979, which compared 99mTc-RBC venography with contrast venography for the diagnosis of deep venous thrombosis (DVT) of the lower extremity. The studies were generally small in size and poorly compliant with methodologic standards for diagnostic test research. There was considerable variation in both how the 99mTc-RBC venograms were performed and how they were interpreted. Sufficient clinical information on the patients was not provided. Although the overall sensitivities and specificities were high with a mean sensitivity of 0.89 and a mean specificity of 0.84, the small numbers of patients resulted in wide 95% confidence intervals. For distal disease, with only a total of 14 patients studied, the 95% confidence intervals were particularly broad. Although 99mTc-RBC venography is a promising technique, future studies with larger numbers of patients and closer adherence to methodologic standards are required. PMID:1836023

  7. Cost-effectiveness of the bird's nest filter for preventing pulmonary embolism among patients with malignant brain tumors and deep venous thrombosis of the lower extremities.

    PubMed

    Chau, Quan; Cantor, Scott B; Caramel, Elenir; Hicks, Marshall; Kurtin, Danna; Grover, Tejpal; Elting, Linda S

    2003-12-01

    Patients with malignant brain tumors and deep venous thrombosis (DVT) of the lower extremities are at high risk of developing pulmonary embolism (PE). We developed a Markov model to compare the cost-effectiveness of two strategies to prevent PE in such patients: intra-vena-caval bird's nest filter (BNF) with anticoagulation versus anticoagulation alone. Using the benchmark of 50,000 US dollars per quality-adjusted life year (QALY), BNF was not cost-effective in this population as it reduced the rate of PE at an incremental cost-effectiveness ratio of 198,852 dollars per QALY gained. However, after adjusting the model to reflect the 5-year mortality rate of hypothetical breast cancer patients, BNF was more effective and less expensive than anticoagulation alone. BNF was effective in reducing the rate of PE but was not cost-effective for patients with brain tumors. BNF could be cost-effective for patients with longer life expectancies. PMID:13680322

  8. Effect of Virtual Reality Exercise Using the Nintendo Wii Fit on Muscle Activities of the Trunk and Lower Extremities of Normal Adults

    PubMed Central

    Park, Jungseo; Lee, Daehee; Lee, Sangyong

    2014-01-01

    [Purpose] The present study aimed to determine the effect of virtual reality exercise using the Nintendo Wii Fit on the muscle activities of the trunk and lower extremities of normal adults. [Subjects] The subjects of the study were 24 normal adults who were divided into a virtual reality exercise group (VREG, n=12) and a stable surface exercise group (SEG, n=12). [Methods] The exercises of the VREG using the Nintendo Wii Fit and the SEG using a stable surface were conducted three times a week for six weeks. Electromyography was used to measure the muscle activities of the tibialis anterior (TA), medial gastrocnemius (MG), erector spinae (ES), and rectus abdominal (RA) muscles. [Results] VREG showed significant within group differences in TA and MG muscle activities, while the SEG showed a significant difference in the muscle activity of the MG. [Conclusion] Virtual reality exercise using the Nintendo Wii Fit was an effective intervention for the muscle activities of the TA and MG of normal adults. PMID:24648647

  9. Influence of bicycle seat tube angle and hand position on lower extremity kinematics and neuromuscular control: implications for triathlon running performance.

    PubMed

    Silder, Amy; Gleason, Kyle; Thelen, Darryl G

    2011-11-01

    We investigated how varying seat tube angle (STA) and hand position affect muscle kinematics and activation patterns during cycling in order to better understand how triathlon-specific bike geometries might mitigate the biomechanical challenges associated with the bike-to-run transition. Whole body motion and lower extremity muscle activities were recorded from 14 triathletes during a series of cycling and treadmill running trials. A total of nine cycling trials were conducted in three hand positions (aero, drops, hoods) and at three STAs (73°, 76°, 79°). Participants also ran on a treadmill at 80, 90, and 100% of their 10-km triathlon race pace. Compared with cycling, running necessitated significantly longer peak musculotendon lengths from the uniarticular hip flexors, knee extensors, ankle plantar flexors and the biarticular hamstrings, rectus femoris, and gastrocnemius muscles. Running also involved significantly longer periods of active muscle lengthening from the quadriceps and ankle plantar flexors. During cycling, increasing the STA alone had no affect on muscle kinematics but did induce significantly greater rectus femoris activity during the upstroke of the crank cycle. Increasing hip extension by varying the hand position induced an increase in hamstring muscle activity, and moved the operating lengths of the uniarticular hip flexor and extensor muscles slightly closer to those seen during running. These combined changes in muscle kinematics and coordination could potentially contribute to the improved running performances that have been previously observed immediately after cycling on a triathlon-specific bicycle. PMID:21896955

  10. Swelling-resistant nuclear fuel

    DOEpatents

    Arsenlis, Athanasios; Satcher, Jr., Joe; Kucheyev, Sergei O.

    2011-12-27

    A nuclear fuel according to one embodiment includes an assembly of nuclear fuel particles; and continuous open channels defined between at least some of the nuclear fuel particles, wherein the channels are characterized as allowing fission gasses produced in an interior of the assembly to escape from the interior of the assembly to an exterior thereof without causing significant swelling of the assembly. Additional embodiments, including methods, are also presented.

  11. Vulval Swelling: A Diagnostic Dilemma

    PubMed Central

    Sapre, Shilpa; Natu, Neeta

    2015-01-01

    Vulval swellings have always caused dilemmas in diagnosis and more so when they are huge in size. Sebaceous cysts are known to occur as a result of blocked pilo-sebaceous gland and duct or as a result of any injury to the skin. Face, neck, chest, back, scalp, and ears are known sites, however, they also occur over private parts. They are mostly asymptomatic but cause intense pain and discomfort if infected. Symptomatic cysts warrant removal. PMID:26538748

  12. Managing Chemotherapy Side Effects: Swelling (Fluid Retention)

    MedlinePlus

    ... ancer I nstitute Managing Chemotherapy Side Effects Swelling (Fluid retention) “My hands and feet were swollen and ... at one time. Managing Chemotherapy Side Effects: Swelling (Fluid retention) Weigh yourself. l Weigh yourself at the ...

  13. Xanthogranulomatous cholecystitis mimicking gallbladder cancer.

    PubMed

    Ewelukwa, Ofor; Ali, Omair; Akram, Salma

    2014-01-01

    Xanthogranulomatous cholecystitis (XGC) is a benign, uncommon variant of chronic cholecystitis characterised by focal or diffuse destructive inflammatory process of the gallbladder (GB). Macroscopically, it appears like yellowish tumour-like masses in the wall of the GB. This article reports on a 74-year-old woman with XGC mimicking GB cancer. PMID:24811556

  14. Xanthogranulomatous cholecystitis mimicking gallbladder cancer

    PubMed Central

    Ewelukwa, Ofor; Ali, Omair; Akram, Salma

    2014-01-01

    Xanthogranulomatous cholecystitis (XGC) is a benign, uncommon variant of chronic cholecystitis characterised by focal or diffuse destructive inflammatory process of the gallbladder (GB). Macroscopically, it appears like yellowish tumour-like masses in the wall of the GB. This article reports on a 74-year-old woman with XGC mimicking GB cancer. PMID:24811556

  15. Atypical Cogan's syndrome mimicking encephalitis.

    PubMed

    Lepur, Dragan; Vranjican, Zoran; Himbele, Josip; Barsić, Bruno; Klinar, Igor

    2004-01-01

    Cogan's syndrome is a rare autoimmune multisystem disease. The main clinical features of typical Cogan's syndrome are vestibuloauditory dysfunction and interstitial keratitis. The authors present a case of atypical Cogan's syndrome with headache, fever, deafness, trigeminal neuralgia and electroencephalographic abnormality which mimicked viral encephalitis. PMID:15307593

  16. Kawasaki Disease Mimicking Retropharyngeal Abscess

    PubMed Central

    Srividhya, Vazhkudai Sridharan; Vasanthi, Thiruvengadam; Shivbalan, Somu

    2010-01-01

    Kawasaki disease is an acute, self-limiting febrile mucocutaneous vasculitis of infants and young children. Retropharyngeal lymphadenopathy is a rare presentation of Kawasaki disease. We present a case of Kawasaki disease mimicking a retropharyngeal abscess, with upper airway obstruction resulting in delayed diagnosis. PMID:20635457

  17. Acute penile pain and swelling in a 4-year-old child with Henoch-Schönlein purpura.

    PubMed

    Tewary, Kishor Kumar; Khodaghalian, Bernadette; Narchi, Hassib

    2015-01-01

    Henoch-Schönlein purpura (HSP) is the most common vasculitis found in children. It usually affects the small vessels of the skin, joints, gastrointestinal tract and, more rarely, kidneys, brain, lungs and genitalia. Apart from classical presentation with purpuric rashes around buttocks and lower extremities, features such as arthralgia, abdominal pain, haematuria and proteinuria as well as scrotal swelling have been described in the literature. Penile involvement is rare and is not commonly described. We describe a child with HSP who developed penile involvement. We review the literature of all the cases reported in detail, in order to highlight useful clinical presentation, management and prognosis of this rare manifestation. PMID:25858918

  18. Treatment of chronic diabetic lower extremity ulcers with advanced therapies: a prospective, randomised, controlled, multi-centre comparative study examining clinical efficacy and cost.

    PubMed

    Zelen, Charles M; Serena, Thomas E; Gould, Lisa; Le, Lam; Carter, Marissa J; Keller, Jennifer; Li, William W

    2016-04-01

    Advanced therapies such as bioengineered skin substitutes (BSS) and dehydrated human amnion/chorion membrane (dHACM) have been shown to promote healing of chronic diabetic ulcers. An interim analysis of data from 60 patients enrolled in a prospective, randomised, controlled, parallel group, multi-centre clinical trial showed that dHACM (EpiFix®, MiMedx Group Inc., Marietta, GA) is superior to standard wound care (SWC) and BSS (Apligraf®, Organogenesis, Inc., Canton, MA) in achieving complete wound closure within 4-6 weeks. Rates and time to closure at a longer time interval and factors influencing outcomes remained unassessed; therefore, the study was continued in order to achieve at least 100 patients. With the larger cohort, we compare clinical outcomes at 12 weeks in 100 patients with chronic lower extremity diabetic ulcers treated with weekly applications of Apligraf (n = 33), EpiFix (n = 32) or SWC (n = 35) with collagen-alginate dressing as controls. A Cox regression was performed to analyse the time to heal within 12 weeks, adjusting for all significant covariates. A Kaplan-Meier analysis was conducted to compare time-to-heal within 12 weeks for the three treatment groups. Clinical characteristics were well matched across study groups. The proportion of wounds achieving complete closure within the 12-week study period were 73% (24/33), 97% (31/32), and 51% (18/35) for Apligraf, EpiFix and SWC, respectively (adjusted P = 0·00019). Subjects treated with EpiFix had a very significant higher probability of their wounds healing [hazard ratio (HR: 5·66; adjusted P: 1·3 x 10(-7) ] compared to SWC alone. No difference in probability of healing was observed for the Apligraf and SWC groups. Patients treated with Apligraf were less likely to heal than those treated with EpiFix [HR: 0·30; 95% confidence interval (CI): 0·17-0·54; unadjusted P: 5·8 x 10(-5) ]. Increased wound size and presence of hypertension were significant factors that influenced healing. Mean

  19. Bone Fractures Following External Beam Radiotherapy and Limb-Preservation Surgery for Lower Extremity Soft Tissue Sarcoma: Relationship to Irradiated Bone Length, Volume, Tumor Location and Dose

    SciTech Connect

    Dickie, Colleen I.; Parent, Amy L.; Griffin, Anthony M.; Fung, Sharon; Chung, Peter W.M.; Catton, Charles N.; Ferguson, Peter C.; Wunder, Jay S.; Bell, Robert S.; Sharpe, Michael B.; O'Sullivan, Brian

    2009-11-15

    Purpose: To examine the relationship between tumor location, bone dose, and irradiated bone length on the development of radiation-induced fractures for lower extremity soft tissue sarcoma (LE-STS) patients treated with limb-sparing surgery and radiotherapy (RT). Methods and Materials: Of 691 LE-STS patients treated from 1989 to 2005, 31 patients developed radiation-induced fractures. Analysis was limited to 21 fracture patients (24 fractures) who were matched based on tumor size and location, age, beam arrangement, and mean total cumulative RT dose to a random sample of 53 nonfracture patients and compared for fracture risk factors. Mean dose to bone, RT field size (FS), maximum dose to a 2-cc volume of bone, and volume of bone irradiated to >=40 Gy (V40) were compared. Fracture site dose was determined by comparing radiographic images and surgical reports to fracture location on the dose distribution. Results: For fracture patients, mean dose to bone was 45 +- 8 Gy (mean dose at fracture site 59 +- 7 Gy), mean FS was 37 +- 8 cm, maximum dose was 64 +- 7 Gy, and V40 was 76 +- 17%, compared with 37 +- 11 Gy, 32 +- 9 cm, 59 +- 8 Gy, and 64 +- 22% for nonfracture patients. Differences in mean, maximum dose, and V40 were statistically significant (p = 0.01, p = 0.02, p = 0.01). Leg fractures were more common above the knee joint. Conclusions: The risk of radiation-induced fracture appears to be reduced if V40 <64%. Fracture incidence was lower when the mean dose to bone was <37 Gy or maximum dose anywhere along the length of bone was <59 Gy. There was a trend toward lower mean FS for nonfracture patients.

  20. The Contemporary Safety and Effectiveness of Lower Extremity Bypass Surgery and Peripheral Endovascular Interventions in the Treatment of Symptomatic Peripheral Arterial Disease

    PubMed Central

    Rehring, Thomas F.; Rogers, R. Kevin; Shetterly, Susan M.; Wagner, Nicole M.; Gupta, Rajan; Jazaeri, Omid; Hedayati, Nasim; Jones, W. Schuyler; Patel, Manesh R.; Ho, P. Michael; Go, Alan S.; Magid, David J.

    2015-01-01

    Background— Treatment for symptomatic peripheral artery disease includes lower extremity bypass surgery (LEB) and peripheral endovascular interventions (PVIs); however, limited comparative effectiveness data exist between the 2 therapies. We assessed the safety and effectiveness of LEB and PVI in patients with symptomatic claudication and critical limb ischemia. Methods and Results— In a community-based clinical registry at 2 large integrated healthcare delivery systems, we compared 883 patients undergoing PVI and 975 patients undergoing LEB between January 1, 2005 and December 31, 2011. Rates of target lesion revascularization were greater for PVI than for LEB in patients presenting with claudication (12.3±2.7% and 19.0±3.5% at 1 and 3 years versus 5.2±2.4% and 8.3±3.1%, log-rank P<0.001) and critical limb ischemia (19.1±4.8% and 31.6±6.3% at 1 and 3 years versus 10.8±2.5% and 16.0±3.2%, log-rank P<0.001). However, in comparison with PVI, LEB was associated with increased rates of complications up to 30 days following the procedure (37.1% versus 11.9%, P<0.001). There were no differences in amputation rates between the 2 groups. Findings remained consistent in sensitivity analyses by using propensity methods to account for treatment selection. Conclusions— In patients with symptomatic peripheral artery disease, in comparison with LEB, PVI was associated with fewer 30-day procedural complications, higher revascularization rates at 1 and 3 years, and no difference in subsequent amputations. PMID:26362632

  1. A Pilot Study Using the Gynecologic Cancer Lymphedema Questionnaire (GCLQ) as a Clinical Care Tool to Identify Lower Extremity Lymphedema in Gynecologic Cancer Survivors

    PubMed Central

    Carter, Jeanne; Raviv, Leigh; Appollo, Kathleen; Baser, Raymond E.; Iasonos, Alexia; Barakat, Richard R.

    2016-01-01

    Objective To determine the feasibility and efficacy of using the Gynecologic Cancer Lymphedema Questionnaire (GCLQ) as a symptom scale for lymphedema of the lower extremity (LLE). Methods Twenty-eight gynecologic cancer survivors with documented LLE and 30 without a history or presence of lymphedema completed the GCLQ and provided feedback about their satisfaction with and feasibility of using the GCLQ at their oncology follow-ups. The study survey took approximately 5–10 minutes to complete, and it was easily understood by the majority of the sample. Results Participants had a mean age of 59.6 years (range, 28–80 years). Twenty-eight women (48%) had LLE and 30 (52%) had no history or presence of LLE (confirmed by limb volume [LV] measurements at assessment). Type of cancer history included: endometrial, 38 (66%); cervical, 13 (22%); and vulvar, 7 (12%). GCLQ scores differed significantly by lymphedema diagnosis; LLE patients had higher scores (P<0.01). The large area under the curve (AUC) of 0.95 (95% CI: 0.90–1.000) suggests that the GCLQ can distinguish between patients with and without LLE. Although all 28 (100%) of the LLE patients were aware of their LLE diagnosis, only 23 (82%) underwent treatment. The GCLQ was easily understood by most (55/58, 95%); and overall, patients showed a high willingness (56/58, 96%) to complete the questionnaire at future appointments. Twenty-five (88%) of the LLE patients found the GCLQ to be helpful in identifying symptoms of lymphedema. Conclusions The GCLQ effectively distinguished between gynecologic cancer survivors with and those without LLE, with good sensitivity and specificity. The patients, particularly those with LLE, showed high confidence in the GCLQ’s ability to detect LLE symptoms. PMID:20163847

  2. Impact of Laser Fiber Design on Outcome of Endovenous Ablation of Lower-Extremity Varicose Veins: Results from a Single Practice

    SciTech Connect

    Prince, Ethan A. Soares, Gregory M.; Silva, MaryLou; Taner, Anil; Ahn, SunHo; Dubel, Gregory J.; Jay, Bryan S.

    2011-06-15

    The design of laser fibers used for endovenous laser ablation (EVLA) in the management of lower-extremity varicose vein disease may affect treatment success. The purpose of this investigation is to report our experience using the gold-tip NeverTouch VenaCure laser fiber (AngioDynamics, Queensbury, NY) and to compare that to our experience with standard bare-tip fibers. A retrospective chart review of 363 consecutive EVLA treatments using the gold-tip laser fiber was performed. Demographic data including patient age, sex, history of previous varicose vein stripping, vein identity, laterality, treatment length, total applied energy in joules (J), use of adjuvant sclerotherapy and ambulatory phlebectomy, treatment-related complications, and treatment failure, which was defined as recanalization of any portion of the treated vein during follow-up as assessed by duplex ultrasound examination-were entered into a spreadsheet. These data were compared with a control group of 471 EVLA treatments performed with a standard bare-tip laser fiber. Data were analyzed using independent-samples Student's t test, chi-square test, and multivariate analysis. Demographic data were similar between the two groups. Treatments with the gold-tip fiber had a failure rate of 11.1%, whereas treatment with a bare-tip fiber had a failure rate of 2.3% during a similar follow-up period. This difference was highly statistically significant (p < 0.0001). Multivariate analysis showed fiber type as the most significant factor associated with treatment failure. We conclude that laser fiber design has a significant effect on treatment success in the performance of EVLA.

  3. A retrospective cohort study evaluating efficacy in high-risk patients with chronic lower extremity ulcers treated with negative pressure wound therapy.

    PubMed

    Yao, Min; Fabbi, Matteo; Hayashi, Hisae; Park, Nanjin; Attala, Khaled; Gu, Gousheng; French, Michael A; Driver, Vickie R

    2014-10-01

    The purpose of this study was to evaluate the efficacy of negative pressure wound therapy (NPWT) compared with standard of care on wound healing in high-risk patients with multiple significant comorbidities and chronic lower extremity ulcers (LEUs) across the continuum of care settings. A retrospective cohort study of 'real-world' high-risk patients was conducted using Boston University Medical Center electronic medical records, along with chart abstraction to capture detailed medical history, comorbidities, healing outcomes and ulcer characteristics. A total of 342 patients, 171 NPWT patients with LEUs were matched with 171 non-NPWT patients with respect to age and gender, were included in this cohort from 2002 to 2010. The hazard ratios (HRs) were estimated by COX proportional hazard models after adjusting for potential confounders. The NPWT patients were 2·63 times (95% CI = 1·87-3·70) more likely to achieve wound closure compared with non-NPWT patients. Moreover, incidence of wound closure in NPWT patients were increased in diabetic ulcers (HR = 3·26, 95% CI = 2·21-4·83), arterial ulcers (HR = 2·27, CI = 1·56-3·78) and venous ulcers (HR = 6·31, 95% CI = 1·49-26·6) compared with non-NPWT patients. In addition, wound healing appeared to be positively affected by the timing of NPWT application. Compared with later NPWT users (1 year or later after ulcer onset), early NPWT users (within 3 months after ulcer onset) and intermediate NPWT users (4-12 months after ulcer onset) were 3·38 and 2·18 times more likely to achieve wound healing, respectively. This study showed that despite the greater significant comorbidities, patients receiving NPWT healed faster. Early use of NPWT demonstrated better healing. The longer the interval before intervention is with NPWT, the higher the correlation is with poor outcome. PMID:23163962

  4. EMG-Driven Forward-Dynamic Estimation of Muscle Force and Joint Moment about Multiple Degrees of Freedom in the Human Lower Extremity

    PubMed Central

    Sartori, Massimo; Reggiani, Monica; Farina, Dario; Lloyd, David G.

    2012-01-01

    This work examined if currently available electromyography (EMG) driven models, that are calibrated to satisfy joint moments about one single degree of freedom (DOF), could provide the same musculotendon unit (MTU) force solution, when driven by the same input data, but calibrated about a different DOF. We then developed a novel and comprehensive EMG-driven model of the human lower extremity that used EMG signals from 16 muscle groups to drive 34 MTUs and satisfy the resulting joint moments simultaneously produced about four DOFs during different motor tasks. This also led to the development of a calibration procedure that allowed identifying a set of subject-specific parameters that ensured physiological behavior for the 34 MTUs. Results showed that currently available single-DOF models did not provide the same unique MTU force solution for the same input data. On the other hand, the MTU force solution predicted by our proposed multi-DOF model satisfied joint moments about multiple DOFs without loss of accuracy compared to single-DOF models corresponding to each of the four DOFs. The predicted MTU force solution was (1) a function of experimentally measured EMGs, (2) the result of physiological MTU excitation, (3) reflected different MTU contraction strategies associated to different motor tasks, (4) coordinated a greater number of MTUs with respect to currently available single-DOF models, and (5) was not specific to an individual DOF dynamics. Therefore, our proposed methodology has the potential of producing a more dynamically consistent and generalizable MTU force solution than was possible using single-DOF EMG-driven models. This will help better address the important scientific questions previously approached using single-DOF EMG-driven modeling. Furthermore, it might have applications in the development of human-machine interfaces for assistive devices. PMID:23300725

  5. Effects of Intermittent Pneumatic Compression on Reduction of Postoperative Lower Extremity Edema and Normalization of Foot Microcirculation Flow in Patients Undergoing Arterial Revascularization

    PubMed Central

    Pawlaczyk, Katarzyna; Gabriel, Marcin; Urbanek, Tomasz; Dzieciuchowicz, Łukasz; Krasiński, Zbigniew; Gabriel, Zofia; Olejniczak-Nowakowska, Małgorzata; Stanisić, Michał

    2015-01-01

    Background In patients with chronic leg ischemia, the beneficial effect of arterial revascularization can be significantly decreased due to postoperative leg swelling. The aim of this study was to assess the effects of intermittent pneumatic compression (IPC) on skin flow normalization in patients undergoing revascularization procedures due to chronic leg ischemia. Material/Methods We evaluated 116 patients with chronic leg ischemia. The patients were divided into groups according to the performed treatment (endovascular or surgical) and implementation of IPC postoperatively. The leg edema assessment and microcirculation flow assessment were performed pre- and postoperatively, using percutaneous O2 pressure (TcpO2), cutaneous blood perfusion (CBP) measurements, and skin flow motion assessment. Results In patients who did not receive IPC, a decrease in CBP value was observed in the 1st postoperative assessment. Among patients receiving IPC, the CBD value increased at the 1st and 2nd postoperative measurements, especially in the surgical group. The lowest TcpO2 values were observed in by-pass surgery group without IPC postoperatively. Conclusions The benefits of the by-pass procedure in patients with leg ischemia can be significantly reduced by postoperative edema. Among patients with postoperative leg edema, local tissue blood perfusion can be improved by the use of IPC, which can result in decreased local leg swelling, as well as improved skin blood perfusion and TcpO2. PMID:26690828

  6. Effects of Intermittent Pneumatic Compression on Reduction of Postoperative Lower Extremity Edema and Normalization of Foot Microcirculation Flow in Patients Undergoing Arterial Revascularization.

    PubMed

    Pawlaczyk, Katarzyna; Gabriel, Marcin; Urbanek, Tomasz; Dzieciuchowicz, Łukasz; Krasiński, Zbigniew; Gabriel, Zofia; Olejniczak-Nowakowska, Małgorzata; Stanisić, Michał

    2015-01-01

    BACKGROUND In patients with chronic leg ischemia, the beneficial effect of arterial revascularization can be significantly decreased due to postoperative leg swelling. The aim of this study was to assess the effects of intermittent pneumatic compression (IPC) on skin flow normalization in patients undergoing revascularization procedures due to chronic leg ischemia. MATERIAL AND METHODS We evaluated 116 patients with chronic leg ischemia. The patients were divided into groups according to the performed treatment (endovascular or surgical) and implementation of IPC postoperatively. The leg edema assessment and microcirculation flow assessment were performed pre- and postoperatively, using percutaneous O2 pressure (TcpO2), cutaneous blood perfusion (CBP) measurements, and skin flow motion assessment. RESULTS In patients who did not receive IPC, a decrease in CBP value was observed in the 1st postoperative assessment. Among patients receiving IPC, the CBD value increased at the 1st and 2nd postoperative measurements, especially in the surgical group. The lowest TcpO2 values were observed in by-pass surgery group without IPC postoperatively. CONCLUSIONS The benefits of the by-pass procedure in patients with leg ischemia can be significantly reduced by postoperative edema. Among patients with postoperative leg edema, local tissue blood perfusion can be improved by the use of IPC, which can result in decreased local leg swelling, as well as improved skin blood perfusion and TcpO2. PMID:26690828

  7. Scrotal Swelling in the Neonate

    PubMed Central

    Basta, Amaya M.; Courtier, Jesse; Phelps, Andrew; Copp, Hillary L.; MacKenzie, John D.

    2016-01-01

    Discovery of scrotal swelling in a neonate can be a source of anxiety for parents, clinicians, and sonologists alike. This pictorial essay provides a focused review of commonly encountered scrotal masses and mimics specific to the neonatal setting. Although malignancy is a concern, it is very uncommon, as most neonatal scrotal masses are benign. Key discriminating features and management options are highlighted to improve the radiologist’s ability to diagnose neonatal scrotal conditions and guide treatment decisions. Neonatal scrotal processes ranging from common to uncommon will be discussed. PMID:25715370

  8. Swell Sleeves for Testing Explosive Devices

    NASA Technical Reports Server (NTRS)

    Hinkel, Todd J.; Dean, Richard J.; Hohmann, Carl W.; Hacker, Scott C.; Harrington, Douglas W.; Bacak, James W.

    2003-01-01

    A method of testing explosive and pyrotechnic devices involves exploding the devices inside swell sleeves. Swell sleeves have been used previously for measuring forces. In the present method, they are used to obtain quantitative indications of the energy released in explosions of the devices under test. A swell sleeve is basically a thick-walled, hollow metal cylinder threaded at one end to accept a threaded surface on a device to be tested (see Figure 1). Once the device has been tightly threaded in place in the swell sleeve, the device-and-swell-sleeve assembly is placed in a test fixture, then the device is detonated. After the explosion, the assembly is removed from the test fixture and placed in a coordinate-measuring machine for measurement of the diameter of the swell sleeve as a function of axial position. For each axial position, the original diameter of the sleeve is subtracted from the diameter of the sleeve as swollen by the explosion to obtain the diametral swelling as a function of axial position (see Figure 2). The amount of swelling is taken as a measure of the energy released in the explosion. The amount of swelling can be compared to a standard amount of swelling to determine whether the pyrotechnic device functioned as specified.

  9. Foot deformities, function in the lower extremities, and plantar pressure in patients with diabetes at high risk to develop foot ulcers

    PubMed Central

    Tang, Ulla Hellstrand; Zügner, Roland; Lisovskaja, Vera; Karlsson, Jon; Hagberg, Kerstin; Tranberg, Roy

    2015-01-01

    Objective Foot deformities, neuropathy, and dysfunction in the lower extremities are known risk factors that increase plantar peak pressure (PP) and, as a result, the risk of developing foot ulcers in patients with diabetes. However, knowledge about the prevalence of these factors is still limited. The aim of the present study was to describe the prevalence of risk factors observed in patients with diabetes without foot ulcers and to explore possible connections between the risk factors and high plantar pressure. Patients and methods Patients diagnosed with type 1 (n=27) or type 2 (n=47) diabetes (mean age 60.0±15.0 years) were included in this cross-sectional study. Assessments included the registration of foot deformities; test of gross function at the hip, knee, and ankle joints; a stratification of the risk of developing foot ulcers according to the Swedish National Diabetes Register; a walking test; and self-reported questionnaires including the SF-36 health survey. In-shoe PP was measured in seven regions of interests on the sole of the foot using F-Scan®. An exploratory analysis of the association of risk factors with PP was performed. Results Neuropathy was present in 28 (38%), and 39 (53%) had callosities in the heel region. Low forefoot arch was present in 57 (77%). Gait-related parameters, such as the ability to walk on the forefoot or heel, were normal in all patients. Eighty percent had normal function at the hip and ankle joints. Gait velocity was 1.2±0.2 m/s. All patients were stratified to risk group 3. Hallux valgus and hallux rigidus were associated with an increase in the PP in the medial forefoot. A higher body mass index (BMI) was found to increase the PP at metatarsal heads 4 and 5. Pes planus was associated with a decrease in PP at metatarsal head 1. Neuropathy did not have a high association with PP. Conclusions This study identified several potential risk factors for the onset of diabetic foot ulcers (DFU). Hallux valgus and hallux

  10. Interaction of the glutathione S-transferase genes and cigarette smoking on risk of lower extremity arterial disease: the Atherosclerosis Risk in Communities (ARIC) study.

    PubMed

    Li, R; Folsom, A R; Sharrett, A R; Couper, D; Bray, M; Tyroler, H A

    2001-02-15

    Glutathione S-transferases M1 or T1 (GSTM1/GSTT1) affect the body's ability either to detoxify or to activate chemicals in cigarette smoke. Cigarette smoking increases the risk of lower extremity arterial disease (LEAD). We conducted a cross-sectional study to evaluate a hypothesized interaction of the genetic polymorphisms of GSTM1 and T1 with cigarette smoking in the risk of LEAD in the ARIC study. A stratified-random sample, including 212 LEAD cases (ankle-brachial index <0.9 in men or <0.85 in women) and 1277 non-cases, was selected from the ARIC cohort of 12041 middle-aged participants free of CHD, transient ischemic attack and stroke at baseline (1987-1989). Overall, the differences in the frequencies of GSTM1-0 and GSTT1-0 (the homozygous deletion genotype) were not statistically significant between cases and non-cases (44 vs. 41% and 28 vs. 18%). However, smoking was more prevalent among LEAD cases than non-cases. The results suggest that the non-deletion genotype GSTM1-1 interacts with smoking to increase the risk of LEAD, but this interaction was not statistically significant. The functional genotype GSTT1-1 was significantly associated with increased risk of LEAD given smoking after adjustment for other risk factors. In individuals with GSTT1-1, the odds ratios (ORs) (95% confidence intervals) of LEAD were 3.6 (1.4, 9.0) for current smoking and 5.0 (1.9, 13.0) for 20+ pack-years. However, in those with GSTT1-0, the ORs were 0.8 (0.2, 2.8) for current smoking and 0.6 (0.1, 2.1) for 20+ pack-years. The interaction was significant (P<0.05) on the additive scale for current smoking and on both the additive and multiplicative scales for 20+ pack-years. Among non-smokers, GSTT1-1 was not associated with LEAD. The results suggest that the GSTT1-1 polymorphism may be a susceptibility factor modifying the risk of LEAD associated with cigarette smoking. PMID:11257276

  11. The development and validation of a novel outcome measure to quantify mobility in the dysvascular lower extremity amputee: the amputee single item mobility measure

    PubMed Central

    Norvell, Daniel C; Williams, Rhonda M; Turner, Aaron P; Czerniecki, Joseph M

    2016-01-01

    Objective: This study describes the development and psychometric evaluation of a novel patient-reported single-item mobility measure. Design: Prospective cohort study. Setting: Four Veteran’s Administration Medical Centers. Subjects: Individuals undergoing their first major unilateral lower extremity amputation; 198 met inclusion criteria; of these, 113 (57%) enrolled. Interventions: None. Main measures: The Amputee Single Item Mobility Measure, a single item measure with scores ranging from 0 to 6, was developed by an expert panel, and concurrently administered with the Locomotor Capabilities Index-5 (LCI-5) and other outcome measures at six weeks, four months, and 12 months post-amputation. Criterion and construct validity, responsiveness, and floor/ceiling effects were evaluated. Responsiveness was assessed using the standardized response mean. Results: The overall mean 12-month Amputee Single Item Mobility Measure score was 3.39 ±1.4. Scores for transmetatarsal, transtibial, and transfemoral amputees were 4.2 (±1.3), 3.2 (±1.5), and 2.9 (±1.1), respectively. Amputee Single Item Mobility Measure scores demonstrated “large” and statistically significant correlations with the LCI-5 scores at six weeks (r = 0.72), four months (r = 0.81), and 12 months (r = 0.86). At four months and 12 months, the correlation between Amputee Single Item Mobility Measure scores and hours of prosthetic use were r = 0.69 and r = 0.66, respectively, and between Amputee Single Item Mobility Measure scores and Trinity Amputation and Prosthesis Experience Scales functional restriction scores were r = 0.45 and r = 0.67, respectively. Amputee Single Item Mobility Measure scores increased significantly from six weeks to 12 months post-amputation. Minimal floor/ceiling effects were demonstrated. Conclusions: In the unilateral dysvascular amputee, the Amputee Single Item Mobility Measure has strong criterion and construct validity, excellent

  12. Female gender and oral anticoagulants are associated with wound complications in lower extremity vein bypass: An analysis of 1404 operations for critical limb ischemia

    PubMed Central

    Nguyen, Louis L.; Brahmanandam, Soma; Bandyk, Dennis F.; Belkin, Michael; Clowes, Alexander W.; Moneta, Gregory L.; Conte, Michael S.

    2010-01-01

    Background Infrainguinal bypass (IB) surgery is an effective means of improving arterial circulation to the lower extremity for patients with critical limb ischemia (CLI). However, wound complications (WC) of the surgical incision following IB can impart significant morbidity. Methods A retrospective analysis of WC from the 1404 patients enrolled in a multicenter clinical trial of vein bypass grafting for CLI was performed. Univariate and multivariable regression models were used to determine WC predictors and associated outcomes, including graft patency, limb salvage, quality of life (QoL), resource utilization (RU), and mortality. Results A total of 543 (39%) patients developed a reported WC within 30 days of surgery, with infections (284, 52%) and hematoma/hemorrhage (121, 22%) being the most common type. Postoperative anticoagulation (odds ratio [OR], 1.554; 95% confidence interval [CI] 1.202 to 2.009; P = .0008) and female gender (OR, 1.376; 95% CI, 1.076 to 1.757; P = .0108) were independent factors associated with WC. Primary, primary-assisted, and secondary graft patency rates were not influenced by the presence of WC; though, patients with WC were at increased risk for limb loss (hazard ratio [HR], 1.511; 95% CI 1.096 to 2.079; P = .0116) and higher mortality (HR, 1.449; 95% CI 1.098 to 1.912; P = .0089). WC was not significantly associated with lower QoL at 3 months (4.67 vs 4.79, P = .1947) and 12 months (5.02 vs 5.13, P = .2806). However, the subset of patients with serious WC (SWC) demonstrated significantly lower QoL at 3 months compared with patients without WC, (4.43 vs 4.79, respectively, P = .0166), though this difference was not seen at 12 months (4.94 vs 5.13, P = .2411). Patients with WC had higher RU than patients who did not have WC. Mean index length of hospital stay (LOS) was 2.3 days longer, mean cumulative 1-year LOS was 8.1 days longer, and mean number of hospitalizations was 0.5 occurrences greater for patients with WC compared with

  13. Disseminated histoplasmosis mimicking secondary syphilis.

    PubMed

    Pastor, Tony A; Holcomb, Maura J; Motaparthi, Kiran; Grekin, Sarah J; Hsu, Sylvia

    2011-01-01

    A 34-year-old, HIV-positive man living in Texas presented with a 2-week history of fever, malaise, myalgias, oral ulcers, and papules on his chest, back, face, and extremities, including the palms. Initially secondary syphilis was suspected. However, RPR was negative. Histopathologic examination revealed a lymphocytic infiltrate with numerous intra-histiocytic fungal organisms. GMS and PAS stains were positive, consistent with the diagnosis of histoplasmosis. We report a case of disseminated histoplasmosis clinically mimicking secondary syphilis. PMID:22136866

  14. Leishmaniasis recidiva cutis of the lips mimicking granulomatous cheilitis.

    PubMed

    Ekiz, Özlem; Rifaioǧlu, Emine Nur; Şen, Bilge Bülbül; Çulha, Gülnaz; Özgür, Tümay; Doǧramaci, Asena Çiǧde