Kinematic and neuromuscular relationships between lower extremity clinical movement assessments.

PubMed

Mauntel, Timothy C; Cram, Tyler R; Frank, Barnett S; Begalle, Rebecca L; Norcross, Marc F; Blackburn, J Troy; Padua, Darin A

2018-06-01

Lower extremity injuries have immediate and long-term consequences. Lower extremity movement assessments can assist with identifying individuals at greater injury risk and guide injury prevention interventions. Movement assessments identify similar movement characteristics and evidence suggests large magnitude kinematic relationships exist between movement patterns observed across assessments; however, the magnitude of the relationships for electromyographic (EMG) measures across movement assessments remains largely unknown. This study examined relationships between lower extremity kinematic and EMG measures during jump landings and single leg squats. Lower extremity three-dimensional kinematic and EMG data were sampled from healthy adults (males = 20, females = 20) during the movement assessments. Pearson correlations examined the relationships of the kinematic and EMG measures and paired samples t-tests compared mean kinematic and EMG measures between the assessments. Overall, significant moderate correlations were observed for lower extremity kinematic (r avg  = 0.41, r range  = 0.10-0.61) and EMG (r avg  = 0.47, r range  = 0.32-0.80) measures across assessments. Kinematic and EMG measures were greater during the jump landings. Jump landings and single leg squats place different demands on the body and necessitate different kinematic and EMG patterns, such that these measures are not highly correlated between assessments. Clinicians should, therefore, use multiple assessments to identify aberrant movement and neuromuscular control patterns so that comprehensive interventions can be implemented.

Sexuality in persons with lower extremity amputations.

PubMed

Bodenheimer, C; Kerrigan, A J; Garber, S L; Monga, T N

2000-06-15

There is a paucity of information regarding sexual functioning in persons with lower extremity amputations. The purpose of this study was to describe sexual and psychological functioning and health status in persons with lower extremity amputation. Self-report surveys assessed sexual functioning (Derogatis Inventory), depression (Beck Depression Inventory, anxiety (State-Trait Anxiety Inventory), and health status (Health Status Questionnaire) in a convenience sample of 30 men with lower extremity amputations. Mean age of the participants was 57 years (range 32-79). Mean duration since amputation was 23 months (range 3-634 months). Twenty one subjects (70%) had trans-tibial and seven subjects (23%) had trans-femoral amputations. A majority of subjects were experiencing problems in several domains of sexual functioning. Fifty three percent (n = 16) of the subjects were engaged in sexual intercourse or oral sex at least once a month. Twenty seven percent (n = 8) were masturbating at least once a month. Nineteen subjects (63%) reported orgasmic problems and 67% were experiencing erectile difficulties. Despite these problems, interest in sex was high in over 90% of the subjects. There was no evidence of increased prevalence of depression or anxiety in these subjects when compared to other outpatient adult populations. Sexual problems were common in the subjects studied. Despite these problems, interest in sex remained high. Few investigations have been directed toward identifying the psychological and social factors that may contribute to these problems and more research with a larger population is needed in this area.

Footwear traction and lower extremity noncontact injury.

PubMed

Wannop, John W; Luo, Geng; Stefanyshyn, Darren J

2013-11-01

Football is the most popular high school sport; however, it has the highest rate of injury. Speculation has been prevalent that foot fixation due to high footwear traction contributes to injury risk. Therefore, the purpose of the study was to determine whether a relationship exists between the athlete's specific footwear traction (measured with their own shoes on the field of play) and lower extremity noncontact injury in high school football. For 3 yr, 555 high school football athletes had their footwear traction measured on the actual field of play at the start of the season, and any injury the athletes suffered during a game was recorded. Lower extremity noncontact injury rates, grouped based on the athlete's specific footwear traction (both translational and rotational), were compared. For translational traction, injury rate reached a peak of 23.3 injuries/1000 game exposures within the midrange of translational traction, before decreasing to 5.0 injuries/1000 game exposures in the high range of traction. For rotational traction, there was a steady increase in injury rate as footwear traction increased, starting at 4.2 injuries/1000 game exposures at low traction and reaching 19.2 injuries/1000 game exposures at high traction. A relationship exists between footwear traction and noncontact lower extremity injury, with increases in rotational traction leading to a greater injury rate and increases in translational traction leading to a decrease in injury. It is recommended that athletes consider selecting footwear with the lowest rotational traction values for which no detriment in performance results.

Novel application of lower body positive-pressure in the rehabilitation of an individual with multiple lower extremity fractures.

PubMed

Takacs, Judit; Leiter, Jeff R S; Peeler, Jason D

2011-06-01

Lower extremity fractures, if not treated appropriately, can increase the risk of morbidity. Partial weight-bearing after surgical repair is recommended; however, current methods of partial weight-bearing may cause excessive loads through the lower extremity. A new rehabilitation tool that uses lower body positive-pressure is described, that may allow partial weight-bearing while preventing excessive loads, thereby improving functional outcomes. A patient with multiple lower extremity fractures underwent a 6-month rehabilitation programme using bodyweight support technology 3 times per week, post-surgery. The patient experienced a reduction in pain and an improvement in ankle range of motion (p=0.002), walking speed (p>0.05) and physical function (p=0.004), as assessed by the Foot and Ankle Module of the American Academy of Orthopaedic Surgeons Lower Limb Outcomes Assessment Instrument. Training did not appear to affect fracture healing, as was evident on radiograph. The effect of lower body positive-pressure on effusion, which has not previously been reported in the literature, was also investigated. No significant difference in effusion of the foot and ankle when using lower body positive-pressure was found. Initial results suggest that this new technology may be a useful rehabilitation tool that allows partial weight-bearing during the treatment of lower extremity injuries.

Role of interventional radiologists in the management of lower extremity venous insufficiency.

PubMed

Hardman, Rulon L; Rochon, Paul J

2013-12-01

Lower extremity venous insufficiency affects over half of all women. Interventional radiologists should be aware of the clinical evaluation of women with venous insufficiency and classification of disease. Endovascular therapies available for treatment of lower extremity venous insufficiency include: endovenous laser ablation, radiofrequency endovascular ablation, and sclerotherapy. The interventional radiologist should be versed on which therapy to select in each clinical presentation and the procedural techniques. The authors review the role of the interventional radiologist in managing this lower extremity venous disorder.

Lymphoscintigraphic findings in chylous reflux in a lower extremity.

PubMed

Berenji, Gholam R; Iker, Emily; Glass, Edwin C

2007-09-01

Lymphoscintigraphy is a useful and safe tool for the diagnostic evaluation of a swollen extremity. Unilateral leg swelling with cutaneous chylous vesicles is a common manifestation of chylous reflux. The authors present a case of chylous reflux in an 11-year-old boy who presented with swelling and skin lesions of the left lower extremity.

Computational Failure Modeling of Lower Extremities

DTIC Science & Technology

2012-01-01

bone fracture, ligament tear, and muscle rupture . While these injuries may seem well-defined through medical imaging, the process of injury and the...to vehicles from improvised explosives cause severe injuries to the lower extremities, in- cluding bone fracture, ligament tear, and muscle rupture ...modeling offers a powerful tool to explore the insult-to-injury process with high-resolution. When studying a complex dynamic process such as this, it is

Outcomes of lower extremity bypass performed for acute limb ischemia

PubMed Central

Baril, Donald T.; Patel, Virendra I.; Judelson, Dejah R.; Goodney, Philip P.; McPhee, James T.; Hevelone, Nathanael D.; Cronenwett, Jack L.; Schanzer, Andres

2013-01-01

Objective Acute limb ischemia remains one of the most challenging emergencies in vascular surgery. Historically, outcomes following interventions for acute limb ischemia have been associated with high rates of morbidity and mortality. The purpose of this study was to determine contemporary outcomes following lower extremity bypass performed for acute limb ischemia. Methods All patients undergoing infrainguinal lower extremity bypass between 2003 and 2011 within hospitals comprising the Vascular Study Group of New England were identified. Patients were stratified according to whether or not the indication for lower extremity bypass was acute limb ischemia. Primary end points included bypass graft occlusion, major amputation, and mortality at 1 year postoperatively as determined by Kaplan-Meier life table analysis. Multivariable Cox proportional hazards models were constructed to evaluate independent predictors of mortality and major amputation at 1 year. Results Of 5712 lower extremity bypass procedures, 323 (5.7%) were performed for acute limb ischemia. Patients undergoing lower extremity bypass for acute limb ischemia were similar in age (66 vs 67; P = .084) and sex (68% male vs 69% male; P = .617) compared with chronic ischemia patients, but were less likely to be on aspirin (63% vs 75%; P < .0001) or a statin (55% vs 68%; P < .0001). Patients with acute limb ischemia were more likely to be current smokers (49% vs 39%; P < .0001), to have had a prior ipsilateral bypass (33% vs 24%; P = .004) or a prior ipsilateral percutaneous intervention (41% vs 29%; P = .001). Bypasses performed for acute limb ischemia were longer in duration (270 vs 244 minutes; P = .007), had greater blood loss (363 vs 272 mL; P < .0001), and more commonly utilized prosthetic conduits (41% vs 33%; P = .003). Acute limb ischemia patients experienced increased in-hospital major adverse events (20% vs 12%; P < .0001) including myocardial infarction, congestive heart failure exacerbation

Outcomes of lower extremity bypass performed for acute limb ischemia.

PubMed

Baril, Donald T; Patel, Virendra I; Judelson, Dejah R; Goodney, Philip P; McPhee, James T; Hevelone, Nathanael D; Cronenwett, Jack L; Schanzer, Andres

2013-10-01

Acute limb ischemia remains one of the most challenging emergencies in vascular surgery. Historically, outcomes following interventions for acute limb ischemia have been associated with high rates of morbidity and mortality. The purpose of this study was to determine contemporary outcomes following lower extremity bypass performed for acute limb ischemia. All patients undergoing infrainguinal lower extremity bypass between 2003 and 2011 within hospitals comprising the Vascular Study Group of New England were identified. Patients were stratified according to whether or not the indication for lower extremity bypass was acute limb ischemia. Primary end points included bypass graft occlusion, major amputation, and mortality at 1 year postoperatively as determined by Kaplan-Meier life table analysis. Multivariable Cox proportional hazards models were constructed to evaluate independent predictors of mortality and major amputation at 1 year. Of 5712 lower extremity bypass procedures, 323 (5.7%) were performed for acute limb ischemia. Patients undergoing lower extremity bypass for acute limb ischemia were similar in age (66 vs 67; P = .084) and sex (68% male vs 69% male; P = .617) compared with chronic ischemia patients, but were less likely to be on aspirin (63% vs 75%; P < .0001) or a statin (55% vs 68%; P < .0001). Patients with acute limb ischemia were more likely to be current smokers (49% vs 39%; P < .0001), to have had a prior ipsilateral bypass (33% vs 24%; P = .004) or a prior ipsilateral percutaneous intervention (41% vs 29%; P = .001). Bypasses performed for acute limb ischemia were longer in duration (270 vs 244 minutes; P = .007), had greater blood loss (363 vs 272 mL; P < .0001), and more commonly utilized prosthetic conduits (41% vs 33%; P = .003). Acute limb ischemia patients experienced increased in-hospital major adverse events (20% vs 12%; P < .0001) including myocardial infarction, congestive heart failure exacerbation, deterioration in renal function

Interjoint coordination of the lower extremities in short-track speed skating.

PubMed

Khuyagbaatar, Batbayar; Purevsuren, Tserenchimed; Park, Won Man; Kim, Kyungsoo; Kim, Yoon Hyuk

2017-10-01

In short-track speed skating, the three-dimensional kinematics of the lower extremities during the whole skating cycle have not been studied. Kinematic parameters of the lower extremities during skating are presented as joint angles versus time. However, the angle-time presentation is not sufficient to describe the relationship between multi-joint movement patterns. Thus, angle-angle presentations were developed and used to describe interjoint coordination in sport activities. In this study, 15 professional male skaters' full body motion data were recorded using a wearable motion capture system during short-track speed skating. We investigated the three-dimensional kinematics of the lower extremities and then established the interjoint coordination between hip-knee and knee-ankle for both legs during the whole skating cycle. The results demonstrate the relationship between multi-joint movements during different phases of short-track speed skating. This study provides fundamentals of the movement mechanism of the lower extremities that can be integrated with physiotherapy to improve skating posture and prevent injuries from repetitive stress since physiological characteristics play an important role in skating performance.

Cervical Myelopathy in a Patient Referred for Lower Extremity Symptoms.

PubMed

Jackson, Steven M

2017-07-01

The patient was a 38-year-old male referred to physical therapy with complaints of right lower extremity radicular pain and left lower extremity weakness. Following physical therapy examination, the primary care physician referred the patient to a neurologist, who performed electromyography and nerve conduction studies and ordered a magnetic resonance image. Cervical spine imaging revealed a C5-6 disc extrusion with myelopathy. J Orthop Sports Phys Ther 2017;47(7):510. doi:10.2519/jospt.2017.5071.

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

PubMed

Reddy, Ravi Shankar; Alahmari, Khalid A

2016-07-01

The purpose of this study was to find "Effect of lower extremity stretching exercises on balance in the geriatric population. 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. 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). Lower extremity stretching exercises enhances balance in the geriatric population and thereby reduction in the number of falls.

A functional agility short-term fatigue protocol changes lower extremity mechanics

PubMed Central

Cortes, Nelson; Quammen, David; Lucci, Shawn; Greska, Eric; Onate, James

2012-01-01

The purpose of this study was to evaluate the effects of a functional agility fatigue protocol on lower extremity biomechanics between two unanticipated tasks (stop-jump and sidestep). The subjects consisted of fifteen female collegiate soccer athletes (19 ± 0.7 years, 1.67 ± 0.1 m, 61.7 ± 8 kg) free of lower extremity injury. Participants performed five trials of stop-jump and sidestep tasks. A functional short-term agility protocol was performed, and immediately following participants repeated the unanticipated running tasks. Lower extremity kinematic and kinetic values were obtained pre and post fatigue. Repeated measures analyses of variance were conducted for each dependent variable with an alpha level set at 0.05. Knee position post-fatigue had increased knee internal rotation (11.4 ± 7.5° vs. 7.9 ± 6.5° p = 0.011) than pre-fatigue, and a decreased knee flexion angle (−36.6 ± 6.2° vs.−40.0 ± 6.3°, p = 0.003), as well as hip position post-fatigue had decreased hip flexion angle (35.5 ± 8.7° vs. 43.2 ± 9.5°, p = 0.002). A quick functional fatigue protocol altered lower extremity mechanics of Division I collegiate soccer athletes during landing tasks. Proper mechanics should be emphasized from the beginning of practice/game to aid in potentially minimizing the effects of fatigue in lower extremity mechanics. PMID:22424559

Distal Lower-Extremity Pain and Work Postures in the Quebec Population

PubMed Central

Messing, Karen; Tissot, France; Stock, Susan

2008-01-01

Objectives. Standing at work has been associated with discomfort and cardiovascular symptoms. Because standing postures vary in duration, mobility, and constraint, we explored associations between specific postures and pain in the lower extremities. Methods. We used multiple logistic regression to analyze associations between work factors and pain in the lower extremities during the previous 12 months that interfered with usual activities. We used data from among 7757 workers who were interviewed in the 1998 Quebec Health and Social Survey. Results. Among all respondents, 9.4% reported significant ankle or foot pain, and 6.4% had lower-leg or calf pain. Significantly more women than men had pain at both sites. Both leg or calf and ankle or foot pain were strongly associated with standing postures, whole-body vibration, psychological distress, female gender, and being aged 50 years or older. Constrained standing postures were associated with increased ankle or foot pain for both men and women and with leg or calf pain for women, compared with standing with freedom to sit at will. Conclusions. Freedom to sit at work may prevent lower-extremity pain. The effects of specific sitting and standing postures on cartilage, muscle, and the cardiovascular system may help explain discomfort in the lower extremities. PMID:17761561

When are CT angiograms indicated for patients with lower extremity fractures? A review of 275 extremities.

PubMed

Monazzam, Shafagh; Goodell, Parker B; Salcedo, Edgardo S; Nelson, Sandahl H; Wolinsky, Philip R

2017-01-01

Computed tomography angiogram (CTA) is frequently utilized to detect vascular injuries even without examination findings indicating a vascular injury. We had the following hypotheses: (1) a CTA for lower extremity fractures with no clinical signs of a vascular injury is not indicated, and (2) fracture location and pattern would correlate with the risk of a vascular injury. A retrospective review was conducted on patients who had an acute lower extremity fracture(s) and a CTA. Their charts were reviewed for multiple factors including the presence or absence of hard or soft signs of a vascular injury, soft tissue status, and fracture location/pattern. Every CTA radiology report was reviewed and any vascular intervention or amputation resulting from a vascular injury was recorded. Statistical analysis was performed. Of the 275 CTAs of fractured extremities reviewed, 80 (29%) had a positive CTA finding and 16 (6%) required treatment. A total of 109 (40%) of the extremities had no hard or soft signs; all had normal CTAs. Having at least one hard or soft sign was a significant risk factor for having a positive CTA. An open fracture, isolated proximal third fibula fracture, distal and shaft tibia fractures, and the presence of multiple fractures in one extremity were also associated with an increased risk for having a positive CTA. We found no evidence to support the routine use of CTAs to evaluate lower extremity fractures unless at least one hard or soft sign is present. The presence of an open fracture, distal tibia or tibial shaft fractures, multiple fractures in one extremity, and/or an isolated proximal third fibula fracture increases the risk of having a finding consistent with a vascular injury on a CTA. Only 6% of the cases required treatment, and all of them had diminished or absent distal pulses on presentation. Diagnostic test, level III.

Risk factors for lower extremity injuries in elite female soccer players.

PubMed

Nilstad, Agnethe; Andersen, Thor Einar; Bahr, Roald; Holme, Ingar; Steffen, Kathrin

2014-04-01

The incidence of lower extremity injuries in female soccer players is high, but the risk factors for injuries are unknown. To investigate risk factors for lower extremity injuries in elite female soccer players. Cohort study; Level of evidence, 3. Players in the Norwegian elite female soccer league (N = 12 teams) participated in baseline screening tests before the 2009 competitive soccer season. The screening included tests assessing maximal lower extremity strength, dynamic balance, knee valgus angles in a drop-jump landing, knee joint laxity, generalized joint laxity, and foot pronation. Also included was a questionnaire to collect information on demographic data, elite-level experience, and injury history. Time-loss injuries and exposure in training and matches were recorded prospectively in the subsequent soccer season using weekly text messaging. Players reporting an injury were contacted to collect data regarding injury circumstances. Univariate and multivariate regression analyses were used to calculate odds ratios (ORs) and 95% confidence intervals (CIs) for ±1 standard deviation of change. In total, 173 players underwent complete screening tests and registration of injuries and exposure throughout the season. A total of 171 injuries in 107 players (62%) were recorded; ligament and muscle injuries were the most frequent. Multivariate analyses showed that a greater body mass index (BMI) (OR, 1.51; 95% CI, 1.21-1.90; P = .001) was the only factor significantly associated with new lower extremity injuries. A greater BMI was associated with new thigh injuries (OR, 1.51; 95% CI, 1.08-2.11; P = .01), a lower knee valgus angle in a drop-jump landing was associated with new ankle injuries (OR, 0.64; 95% CI, 0.41-1.00; P = .04), and a previous knee injury was associated with new lower leg and foot injuries (OR, 3.57; 95% CI, 1.27-9.99; P = .02), whereas none of the factors investigated influenced the risk of new knee injuries. A greater BMI was associated with

Anticipatory Effects on Lower Extremity Neuromechanics During a Cutting Task.

PubMed

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

2015-09-01

Continued research into the mechanism of noncontact anterior cruciate ligament injury helps to improve clinical interventions and injury-prevention strategies. A better understanding of the effects of anticipation on landing neuromechanics may benefit training interventions. To determine the effects of anticipation on lower extremity neuromechanics during a single-legged land-and-cut task. Controlled laboratory study. University biomechanics laboratory. Eighteen female National Collegiate Athletic Association Division I collegiate soccer players (age = 19.7 ± 0.8 years, height = 167.3 ± 6.0 cm, mass = 66.1 ± 2.1 kg). Participants performed a single-legged land-and-cut task under anticipated and unanticipated conditions. Three-dimensional initial contact angles, peak joint angles, and peak internal joint moments and peak vertical ground reaction forces and sagittal-plane energy absorption of the 3 lower extremity joints; muscle activation of selected hip- and knee-joint muscles. Unanticipated cuts resulted in less knee flexion at initial contact and greater ankle toe-in displacement. Unanticipated cuts were also characterized by greater internal hip-abductor and external-rotator moments and smaller internal knee-extensor and external-rotator moments. Muscle-activation profiles during unanticipated cuts were associated with greater activation of the gluteus maximus during the precontact and landing phases. Performing a cutting task under unanticipated conditions changed lower extremity neuromechanics compared with anticipated conditions. Most of the observed changes in lower extremity neuromechanics indicated the adoption of a hip-focused strategy during the unanticipated condition.

Transcranial Doppler and Lower Extremity Function in Older Adults: Einstein Aging Study.

PubMed

Ezzati, Ali; Rundek, Tatjana; Verghese, Joe; Derby, Carol A

2017-12-01

To determine whether transcranial Doppler ultrasound (TCD) measures of mean blood flow velocity (MBFV) in the major cerebral arteries are associated with measures of lower extremity function in community-dwelling older adults. Cross-sectional study. Community sample. Individuals aged 70 and older (mean 79.5, 54% female) without dementia participating in the Einstein Aging Study (N = 200). All participants underwent TCD assessments and tests of lower extremity function at an annual clinic visit. Average MBFV for anterior (left and right anterior and middle cerebral arteries (MCAs)) and posterior (vertebral (VA) and basilar (BA) artery) circulation was measured using a standardized TCD protocol. Lower extremity function was characterized according to gait speed (cm/s) measured using an instrumented walkway, balance according to unipedal stance time (UPST, seconds), and lower extremity strength according to timed repeated chair rise (seconds). Multiple regression models adjusted for age, sex, race, education, and medical comorbidities showed that lower MBFV in the MCA was associated with slower gait speed and chair rise time but not with UPST. Ordinal regression models showed that lower MBFV in the VA and BA is associated with shorter UPST. Low MBFV in the anterior and posterior cerebral circulation was associated with worse lower extremity function and balance in older adults. This might be indicative of the importance of age-related changes in cerebral hemodynamics in the function of brain regions involved in specific aspects of physical performance. © 2017, Copyright the Authors Journal compilation © 2017, The American Geriatrics Society.

Risk factors for lower extremity injury: a review of the literature

PubMed Central

Murphy, D; Connolly, D; Beynnon, B

2003-01-01

Prospective studies on risk factors for lower extremity injury are reviewed. Many intrinsic and extrinsic risk factors have been implicated; however, there is little agreement with respect to the findings. Future prospective studies are needed using sufficient sample sizes of males and females, including collection of exposure data, and using established methods for identifying and classifying injury severity to conclusively determine addtional risk factors for lower extremity injury. PMID:12547739

Amputation: Not a failure for severe lower extremity combat injury.

PubMed

van Dongen, Thijs T C F; Huizinga, Eelco P; de Kruijff, Loes G M; van der Krans, Arie C; Hoogendoorn, Jochem M; Leenen, Luke P H; Hoencamp, Rigo

2017-02-01

The use of improvised explosive devices is a frequent method of insurgents to inflict harm on deployed military personnel. Consequently, lower extremity injuries make up the majority of combat related trauma. The wounding pattern of an explosion is not often encountered in a civilian population and can lead to substantial disability. It is therefore important to study the impact of these lower extremity injuries and their treatment (limb salvage versus amputation) on functional outcome and quality of life. All Dutch repatriated service members receiving treatment for wounds on the lower extremity sustained in the Afghan theater between august 2005 and August 2014, were invited to participate in this observational cohort study. We conducted a survey regarding their physical and mental health using the Short Form health survey 36, EuroQoL 6 dimensions and Lower Extremity Functional Scale questionnaires. Results were collated in a specifically designed electronic database combined with epidemiology and hospital statistics gathered from the archive of the Central Military Hospital. Statistical analyses were performed to identify differences between combat and non-combat related injuries and between limb salvage treatment and amputation. In comparison with non-battle injury patients, battle casualties were significantly younger of age, sustained more severe injuries, needed more frequent operations and clinical rehabilitation. Their long-term outcome scores in areas concerning well-being, social and cognitive functioning, were significantly lower. Regarding treatment, amputees experienced higher physical well-being and less pain compared to those treated with limb salvage surgery. Sustaining a combat injury to the lower extremity can lead to partial or permanent dysfunction. However, wounded service members, amputees included, are able to achieve high levels of activity and participation in society, proving a remarkable resilience. These long-term results demonstrate

Necrotizing Fasciitis of the Lower Extremity Caused by Serratia marcescens A Case Report.

PubMed

Heigh, Evelyn G; Maletta-Bailey, April; Haight, John; Landis, Gregg S

2016-03-01

Necrotizing fasciitis is a rare and potentially fatal infection, with mortality of up to 30%. This case report describes a patient recovering from a laryngectomy for laryngeal squamous cell cancer who developed nosocomial necrotizing fasciitis of the lower extremity due to Serratia marcescens . Only eight cases of necrotizing fasciitis exclusive to the lower extremity due to S marcescens have been previously reported. Patients with S marcescens necrotizing fasciitis of the lower extremity often have multiple comorbidities, are frequently immunosuppressed, and have a strikingly high mortality rate.

Lower Extremity Stiffness Changes after Concussion in Collegiate Football Players.

PubMed

Dubose, Dominique F; Herman, Daniel C; Jones, Deborah L; Tillman, Susan M; Clugston, James R; Pass, Anthony; Hernandez, Jorge A; Vasilopoulos, Terrie; Horodyski, Marybeth; Chmielewski, Terese L

2017-01-01

Recent research indicates that a concussion increases the risk of musculoskeletal injury. Neuromuscular changes after concussion might contribute to the increased risk of injury. Many studies have examined gait postconcussion, but few studies have examined more demanding tasks. This study compared changes in stiffness across the lower extremity, a measure of neuromuscular function, during a jump-landing task in athletes with a concussion (CONC) to uninjured athletes (UNINJ). Division I football players (13 CONC and 26 UNINJ) were tested pre- and postseason. A motion capture system recorded subjects jumping on one limb from a 25.4-cm step onto a force plate. Hip, knee, and ankle joint stiffness were calculated from initial contact to peak joint flexion using the regression line slopes of the joint moment versus the joint angle plots. Leg stiffness was (peak vertical ground reaction force [PVGRF]/lower extremity vertical displacement) from initial contact to peak vertical ground reaction force. All stiffness values were normalized to body weight. Values from both limbs were averaged. General linear models compared group (CONC, UNINJ) differences in the changes of pre- and postseason stiffness values. Average time from concussion to postseason testing was 49.9 d. The CONC group showed an increase in hip stiffness (P = 0.03), a decrease in knee (P = 0.03) and leg stiffness (P = 0.03), but no change in ankle stiffness (P = 0.65) from pre- to postseason. Lower extremity stiffness is altered after concussion, which could contribute to an increased risk of lower extremity injury. These data provide further evidence of altered neuromuscular function after concussion.

Computed tomography, anatomy and morphometry of the lower extremity

DOE Office of Scientific and Technical Information (OSTI.GOV)

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 inmore » space make it possible to precisely and accurately measure the coverage with normal CT scans of the hip.« less

New Surgical Drapes for Observation of the Lower Extremities during Abdominal Aortic Repair.

PubMed

Obitsu, Yukio; Shigematsu, Hiroshi; Satou, Kazuhiro; Watanabe, Yoshiko; Saiki, Naozumi; Koizumii, Nobusato

2010-01-01

For the early diagnosis and therapy of peripheral thromboembolism (TE) as a complication of abdominal aortic repair (AAR), we developed and evaluated the usefulness of surgical drapes that permit observation of the lower extremities during AAR. Between January 2007 and June 2009, the handling, durability, and usefulness of new surgical drapes were evaluated during AAR in 157 patients with abdominal aortic aneurysms and 9 patients with peripheral arterial disease. The drapes are manufactured by Hogy Medical Co. Ltd. and made of a water-repellent, spun lace, non-woven fabric, including a transparent polyethylene film that covers the patients' legs. This transparent film enables inspection and palpation of the lower extremities during surgery for early diagnosis and therapy of peripheral TE. As a peripheral complication, 1 patient had right lower extremity TE. This was diagnosed immediately after anastomosis, thrombectomy was performed, and the remaining clinical course was uneventful. In all patients, the drapes permitted observation of the lower extremities , and the dorsal arteries were palpable. There were no problems with durability. New surgical drapes permit observation of the lower extremities during AAR for early diagnosis and treatment of peripheral TE.

Does trampoline or hard surface jumping influence lower extremity alignment?

PubMed

Akasaka, Kiyokazu; Tamura, Akihiro; Katsuta, Aoi; Sagawa, Ayako; Otsudo, Takahiro; Okubo, Yu; Sawada, Yutaka; Hall, Toby

2017-12-01

[Purpose] To determine whether repetitive trampoline or hard surface jumping affects lower extremity alignment on jump landing. [Subjects and Methods] Twenty healthy females participated in this study. All subjects performed a drop vertical jump before and after repeated maximum effort trampoline or hard surface jumping. A three-dimensional motion analysis system and two force plates were used to record lower extremity angles, moments, and vertical ground reaction force during drop vertical jumps. [Results] Knee extensor moment after trampoline jumping was greater than that after hard surface jumping. There were no significant differences between trials in vertical ground reaction force and lower extremity joint angles following each form of exercise. Repeated jumping on a trampoline increased peak vertical ground reaction force, hip extensor, knee extensor moments, and hip adduction angle, while decreasing hip flexion angle during drop vertical jumps. In contrast, repeated jumping on a hard surface increased peak vertical ground reaction force, ankle dorsiflexion angle, and hip extensor moment during drop vertical jumps. [Conclusion] Repeated jumping on the trampoline compared to jumping on a hard surface has different effects on lower limb kinetics and kinematics. Knowledge of these effects may be useful in designing exercise programs for different clinical presentations.

Does trampoline or hard surface jumping influence lower extremity alignment?

PubMed Central

Akasaka, Kiyokazu; Tamura, Akihiro; Katsuta, Aoi; Sagawa, Ayako; Otsudo, Takahiro; Okubo, Yu; Sawada, Yutaka; Hall, Toby

2017-01-01

[Purpose] To determine whether repetitive trampoline or hard surface jumping affects lower extremity alignment on jump landing. [Subjects and Methods] Twenty healthy females participated in this study. All subjects performed a drop vertical jump before and after repeated maximum effort trampoline or hard surface jumping. A three-dimensional motion analysis system and two force plates were used to record lower extremity angles, moments, and vertical ground reaction force during drop vertical jumps. [Results] Knee extensor moment after trampoline jumping was greater than that after hard surface jumping. There were no significant differences between trials in vertical ground reaction force and lower extremity joint angles following each form of exercise. Repeated jumping on a trampoline increased peak vertical ground reaction force, hip extensor, knee extensor moments, and hip adduction angle, while decreasing hip flexion angle during drop vertical jumps. In contrast, repeated jumping on a hard surface increased peak vertical ground reaction force, ankle dorsiflexion angle, and hip extensor moment during drop vertical jumps. [Conclusion] Repeated jumping on the trampoline compared to jumping on a hard surface has different effects on lower limb kinetics and kinematics. Knowledge of these effects may be useful in designing exercise programs for different clinical presentations. PMID:29643592

Free flap lower extremity reconstruction in the obese population: does weight matter?

PubMed

Cleveland, Emily C; Fischer, John P; Nelson, Jonas A; Wink, Jason D; Levin, L Scott; Kovach, Stephen J

2014-05-01

The obesity epidemic continues to grow, and we have observed greater numbers of obese individuals among patients seeking lower extremity reconstruction at our institution. These patients may present a greater reconstructive challenge, thus we sought to identify risk factors and differences in outcomes among patients undergoing lower extremity reconstruction.In this study we have performed a retrospective cohort analysis of patients undergoing lower extremity reconstruction with free tissue transfer at our institution from 2005 to 2012. Patients were classified using the World Health Organization criteria for obesity. Records were reviewed for patient characteristics, mechanism of injury, indications for reconstruction, and surgical technique, with a focus on intraoperative and early postoperative complications and outcomes.A total of 43 out of the 119 patients undergoing lower extremity reconstruction were obese (body mass index ≥ 30). Mechanism of injury, wound location, and the indications for reconstruction were similar in both cohorts. No significant differences were found in operative characteristics and techniques, including the type of flap utilized, operative time, or thrombotic events. No significant differences were seen in complication rates overall, however, obese patients more frequently needed second flaps (11.6 vs. 0%, p=0.005).This study concludes that successful lower extremity reconstruction can be performed in the obese population, with few differences in complication rates and outcomes relative to healthy weight patients. Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.

Comparison of the Effects of Walking with and without Nordic Pole on Upper Extremity and Lower Extremity Muscle Activation.

PubMed

Shim, Je-Myung; Kwon, Hae-Yeon; Kim, Ha-Roo; Kim, Bo-In; Jung, Ju-Hyeon

2013-12-01

[Purpose] The aim of this study was to assess the effect of Nordic pole walking on the electromyographic activities of upper extremity and lower extremity muscles. [Subjects and Methods] The subjects were randomly divided into two groups as follows: without Nordic pole walking group (n=13) and with Nordic pole walking group (n=13). The EMG data were collected by measurement while the subjects walking on a treadmill for 30 minutes by measuring from one heel strike to the next. [Results] Both the average values and maximum values of the muscle activity of the upper extremity increased in both the group that used Nordic poles and the group that did not use Nordic poles, and the values showed statistically significant differences. There was an increase in the average value for muscle activity of the latissimus dorsi, but the difference was not statistically significant, although there was a statistically significant increase in its maximum value. The average and maximum values for muscle activity of the lower extremity did not show large differences in either group, and the values did not show any statistically significant differences. [Conclusion] The use of Nordic poles by increased muscle activity of the upper extremity compared with regular walking but did not affect the lower extremity.

Comparison of the Effects of Walking with and without Nordic Pole on Upper Extremity and Lower Extremity Muscle Activation

PubMed Central

Shim, Je-myung; Kwon, Hae-yeon; Kim, Ha-roo; Kim, Bo-in; Jung, Ju-hyeon

2014-01-01

[Purpose] The aim of this study was to assess the effect of Nordic pole walking on the electromyographic activities of upper extremity and lower extremity muscles. [Subjects and Methods] The subjects were randomly divided into two groups as follows: without Nordic pole walking group (n=13) and with Nordic pole walking group (n=13). The EMG data were collected by measurement while the subjects walking on a treadmill for 30 minutes by measuring from one heel strike to the next. [Results] Both the average values and maximum values of the muscle activity of the upper extremity increased in both the group that used Nordic poles and the group that did not use Nordic poles, and the values showed statistically significant differences. There was an increase in the average value for muscle activity of the latissimus dorsi, but the difference was not statistically significant, although there was a statistically significant increase in its maximum value. The average and maximum values for muscle activity of the lower extremity did not show large differences in either group, and the values did not show any statistically significant differences. [Conclusion] The use of Nordic poles by increased muscle activity of the upper extremity compared with regular walking but did not affect the lower extremity. PMID:24409018

The effects of load carriage and muscle fatigue on lower-extremity joint mechanics.

PubMed

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

2013-09-01

Military personnel are commonly afflicted by lower-extremity overuse injuries. Load carriage and muscular fatigue are major stressors during military basic training. To examine effects of load carriage and muscular fatigue on lower-extremity joint mechanics during walking. Eighteen men performed the following tasks: unloaded walking, walking with a 32-kg load, fatigued walking with a 32-kg load, and fatigued walking. After the second walking task, muscle fatigue was elicited through a fatiguing protocol consisting of metered step-ups and heel raises with a 16-kg load. Each walking task was performed at 1.67 m x s(-1) for 5 min. Walking movement was tracked by a VICON motion capture system at 120 Hz. Ground reaction forces were collected by a tandem force instrumented treadmill (AMTI) at 2,400 Hz. Lower-extremity joint mechanics were calculated in Visual 3D. There was no interaction between load carriage and fatigue on lower-extremity joint mechanics (p > .05). Both load carriage and fatigue led to pronounced alterations of lower-extremity joint mechanics (p < .05). Load carriage resulted in increases of pelvis anterior tilt, hip and knee flexion at heel contact, and increases of hip, knee, and ankle joint moments and powers during weight acceptance. Muscle fatigue led to decreases of ankle dorsiflexion at heel contact, dorsiflexor moment, and joint power at weight acceptance. In addition, muscle fatigue increased demand for hip extensor moment and power at weight acceptance. Statistically significant changes in lower-extremity joint mechanics during loaded and fatigued walking may expose military personnel to increased risk for overuse injuries.

Uncontacted tire explosion causing trauma to bilateral lower extremities: A case report.

PubMed

Yu, Ming-Yang; Su, Yun; Meng, Xiang-Jun; Luan, Bo-Wu; Gu, Gui-Shan; Sun, Qiang; Zhao, De-Wei

2017-06-01

It is uncommon for tire explosion related injuries on the lower extremity. The bilateral lower extremities were injured by tire explosion when the patient was seated in a bus. She sustained an open fracture with partial bone loss in the right calcaneus (a comminuted fracture in the right ankle joint) and a closed comminuted fracture in the left tibia and fibula. This damage was caused by uncontacted tire explosion, thanks to a thick floor between the exploded tire and the patient's feet. This type of injury on lower extremity caused by uncontacted tire explosion was uncommon. Copyright © 2017 Daping Hospital and the Research Institute of Surgery of the Third Military Medical University. Production and hosting by Elsevier B.V. All rights reserved.

Lower Extremity Stiffness Changes following Concussion in Collegiate Football Players

PubMed Central

DuBose, Dominique F.; Herman, Daniel C.; Jones, Debi L.; Tillman, Susan M.; Clugston, James R.; Pass, Anthony; Hernandez, Jorge A.; Vasilopoulos, Terrie; Horodyski, MaryBeth; Chmielewski, Terese L.

2016-01-01

Purpose Recent research indicates that a concussion increases risk of musculoskeletal injury. Neuromuscular changes following concussion might contribute to the increased risk of injury. Many studies have examined gait post-concussion, but few studies have examined more demanding tasks. This study compared changes in stiffness across the lower extremity, a measure of neuromuscular function, during a jump-landing task in athletes with a concussion (CONC) to uninjured athletes (UNINJ). Methods Division I football players (13 CONC, 26 UNINJ) were tested pre- and post-season. A motion-capture system recorded subjects jumping on one limb from a 25.4 cm step onto a force plate. Hip, knee, and ankle joint stiffness were calculated from initial contact to peak joint flexion using the regression line slopes of the joint moment versus joint angle plots. Leg stiffness was (peak vertical ground reaction force (PVGRF)/lower extremity vertical displacement) from initial contact to PVGRF. All stiffness values were normalized to bodyweight. Values from both limbs were averaged. General linear models compared group (CONC, UNINJ) differences in the changes of pre- and post-season stiffness values. Results Average time from concussion to post-season testing was 49.9 days. The CONC group showed an increase in hip stiffness (p=0.03), a decrease in knee (p=0.03) and leg stiffness (p=0.03), but no change in ankle stiffness (p=0.65) from pre- to post-season. Conclusion Lower extremity stiffness is altered following concussion, which could contribute to an increased risk of lower extremity injury. These data provide further evidence of altered neuromuscular function after concussion. PMID:27501359

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…

Inpatient Rehabilitation Volume and Functional Outcomes in Stroke, Lower Extremity Fracture, and Lower Extremity Joint Replacement

PubMed Central

Graham, James E.; Deutsch, Anne; O’Connell, Ann A.; Karmarkar, Amol M.; Granger, Carl V.; Ottenbacher, Kenneth J.

2013-01-01

Background It is unclear if volume-outcome relationships exist in inpatient rehabilitation. Objectives Assess associations between facility volumes and two patient-centered outcomes in the three most common diagnostic groups in inpatient rehabilitation. Research Design We used hierarchical linear and generalized linear models to analyze administrative assessment data from patients receiving inpatient rehabilitation services for stroke (n=202,423), lower extremity fracture (n=132,194), or lower extremity joint replacement (n=148,068) between 2006 and 2008 in 717 rehabilitation facilities across the U.S. Facilities were assigned to quintiles based on average annual diagnosis-specific patient volumes. Measures Discharge functional status (FIM instrument) and probability of home discharge. Results Facility-level factors accounted for 6–15% of the variance in discharge FIM total scores and 3–5% of the variance in home discharge probability across the 3 diagnostic groups. We used the middle volume quintile (Q3) as the reference group for all analyses and detected small, but statistically significant (p < .01) associations with discharge functional status in all three diagnosis groups. Only the highest volume quintile (Q5) reached statistical significance, displaying higher functional status ratings than Q3 each time. The largest effect was observed in FIM total scores among fracture patients, with only a 3.6-point difference in Q5 and Q3 group means. Volume was not independently related to home discharge. Conclusions Outcome-specific volume effects ranged from small (functional status) to none (home discharge) in all three diagnostic groups. Patients with these conditions can be treated locally rather than at higher-volume regional centers. Further regionalization of inpatient rehabilitation services is not needed for these conditions. PMID:23579350

Inpatient rehabilitation volume and functional outcomes in stroke, lower extremity fracture, and lower extremity joint replacement.

PubMed

Graham, James E; Deutsch, Anne; O'Connell, Ann A; Karmarkar, Amol M; Granger, Carl V; Ottenbacher, Kenneth J

2013-05-01

It is unclear if volume-outcome relationships exist in inpatient rehabilitation. Assess associations between facility volumes and 2 patient-centered outcomes in the 3 most common diagnostic groups in inpatient rehabilitation. We used hierarchical linear and generalized linear models to analyze administrative assessment data from patients receiving inpatient rehabilitation services for stroke (n=202,423), lower extremity fracture (n=132,194), or lower extremity joint replacement (n=148,068) between 2006 and 2008 in 717 rehabilitation facilities across the United States. Facilities were assigned to quintiles based on average annual diagnosis-specific patient volumes. Discharge functional status (FIM instrument) and probability of home discharge. Facility-level factors accounted for 6%-15% of the variance in discharge FIM total scores and 3%-5% of the variance in home discharge probability across the 3 diagnostic groups. We used the middle volume quintile (Q3) as the reference group for all analyses and detected small, but statistically significant (P<0.01) associations with discharge functional status in all 3 diagnosis groups. Only the highest volume quintile (Q5) reached statistical significance, displaying higher functional status ratings than Q3 each time. The largest effect was observed in FIM total scores among fracture patients, with only a 3.6-point difference in Q5 and Q3 group means. Volume was not independently related to home discharge. Outcome-specific volume effects ranged from small (functional status) to none (home discharge) in all 3 diagnostic groups. Patients with these conditions can be treated locally rather than at higher volume regional centers. Further regionalization of inpatient rehabilitation services is not needed for these conditions.

Evaluation of the Plastic Surgery In-Service Training Exam: Lower Extremity Questions.

PubMed

Silvestre, Jason; Basta, Marten N; Serletti, Joseph M; Chang, Benjamin

2015-01-01

To facilitate the training of plastic surgery residents, we analyzed a knowledge-based curriculum for plastic and reconstructive surgery of the lower extremity. The Plastic Surgery In-Service Training Exam (PSITE) is a commonly used tool to assess medical knowledge in plastic surgery. We reviewed the lower extremity content on 6 consecutive score keys (2008-2013). Questions were classified by taxonomy, anatomy, and subject. Answer references were quantified by source and relative year of publication. Totally, 107 questions related to the lower extremity (9.1% of all questions) and 14 questions had an associated image (13.1%). Questions required decision making (49%) over interpretation (36%) and direct recall (15%) skills (p < 0.001). Conditions of the leg (42.1%) and thigh (24.3%) constituted most of the questions. Subject matter focused on flap reconstruction (38.3%), nerve injury (8.4%), and congenital deformity (6.5%). Analysis of 263 citations to 66 unique journals showed that Plastic and Reconstructive Surgery (54.9%) was the highest yield primary source. The median year of publication relative to PSITE administration was 6 (range: 1-58) with a mode of 2 years. Plastic Surgery by Mathes et al. was the most referenced textbook (21.9%). These data establish a benchmark for lower extremity training during plastic surgery residency. Study efforts focused on the most common topics and references will enhance trainee preparation for lower extremity PSITE questions. Copyright © 2015 Association of Program Directors in Surgery. Published by Elsevier Inc. All rights reserved.

Effect of mirror use on lower extremity muscle strength of patients with chronic stroke.

PubMed

Kim, Myoung-Kwon; Choe, Yu-Won; Shin, Young-Jun; Peng, Cheng; Choi, Eun-Hong

2018-02-01

[Purpose] This study examines the effect on muscle strength of lower extremity muscle strength exercise while using a mirror on the non-paretic side in patients with chronic stroke. [Subjects and Methods] Subjects were randomly assigned to a non-mirror lower extremity exercise group (n=10), a mirror lower extremity exercise group (n=10), or a mirror lower extremity muscle strength exercise group (n=10). Subjects were asked to do the exercise assigned to their group (5 sets 30 times a day, 5 times weekly for 4 weeks) with general physical therapy in the hospital. Muscle strength in the knee extensor and flexor of paretic and non-paretic side were measured using electrical muscle testing device before and after the intervention. [Results] Muscle strength significantly increased within each group after intervention. No significant differences were found among the three groups. [Conclusion] This study showed that the lower extremity muscle strength exercise of the non-paretic side using a mirror has a positive effect on muscle strength in patient with chronic stroke.

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.

Restraint use and lower extremity fractures in frontal motor vehicle collisions.

PubMed

Estrada, Lance S; Alonso, Jorge E; McGwin, Gerald; Metzger, Jesse; Rue, Loring W

2004-08-01

Seat belts and air bags have been shown to significantly reduce morbidity and mortality following MVCs. Research suggests that restraint use does not protect against lower extremity fracture; however, no population-based studies of this association exist. The purpose of this study is to compare the effectiveness of combined seat belt and airbag restraint systems with airbag alone, seat belt alone, and no restraints with respect to incidence and location of lower extremity fractures. A retrospective analysis of front seat occupants involved in police-reported, tow-away frontal MVCs was conducted using data from the 1995 through 2000 National Automotive Sampling System (NASS). Incidence and relative risk (RR) of fracture to specific bony regions were measured according to seat belt use and airbag deployment. Compared with unrestrained occupants, occupants restrained with airbag only had significantly higher risk for all types of lower extremity fractures whereas those occupants restrained with either seat belt only or seat belt and airbag had lower risk of fracture. The greatest difference was seen with tibia/fibula fractures in airbag only (RR, 2.14) but this trend continued to be significant with femur and pelvic fractures (RR, 1.13 and 1.23, respectively). While airbags may reduce the risk of death when used alone or in combination with seat belts, the results of this study demonstrate that air bags increase the risk of lower extremity fractures when used as the sole method of passenger protection. Also, they may do so differentially according to skeletal region. This data strongly support the consideration of developing accessory knee bolster airbags to prevent the "submarining" or sliding under the airbag that may be responsible for this finding.

Risk factors for lower extremity injuries among male marathon runners.

PubMed

Van Middelkoop, M; Kolkman, J; Van Ochten, J; Bierma-Zeinstra, S M A; Koes, B W

2008-12-01

The aim of this study is to identify risk factors for lower extremity injuries in male marathon runners. A random sample of 1500 recreational male marathon runners was drawn. Possible risk factors were obtained from a baseline questionnaire 1 month before the start of the marathon. Information on injuries sustained shortly before or during the marathon was obtained using a post-race questionnaire. Of the 694 male runners who responded to the baseline and post-race questionnaire, 28% suffered a self-reported running injury on the lower extremities in the month before or during the marathon run. More than six times race participation in the previous 12 months [odds ratio (OR) 1.66; confidence interval (CI) 1.08-2.56], a history of running injuries (OR 2.62; CI 1.82-3.78), high education level (OR 0.73; CI 0.51-1.04) and daily smoking (OR 0.23; CI 0.05-1.01) were associated with the occurrence of lower extremity injuries. Among the modifiable risk factor studies, a training distance <40 km a week is a strong protective factor of future calf injuries, and regular interval training is a strong protective factor for knee injuries. Other training characteristics appear to have little or no effect on future injuries.

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. © 2014 American Society for Bone and

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

The incidences of and consultation rate for lower extremity complaints in general practice

PubMed Central

van der Waal, J M; Bot, S D M; Terwee, C B; van der Windt, D A W M; Schellevis, F G; Bouter, L M; Dekker, J

2006-01-01

Objective To estimate the incidence and consultation rate of lower extremity complaints in general practice. Methods Data were obtained from the Second Dutch National Survey of General Practice, in which 195 general practitioners (GPs) in 104 practices recorded all contacts with patients during 12 consecutive months in computerised patient records. GPs classified the symptoms and diagnosis for each patient at each consultation according to the International Classification of Primary Care (ICPC). Incidence densities and consultation rates for different complaints were calculated. Results During the registration period 63.2 GP consultations per 1000 person‐years were attributable to a new complaint of the lower extremities. Highest incidence densities were seen for knee complaints: 21.4 per 1000 person‐years for women and 22.8 per 1000 person‐years for men. The incidence of most lower extremity complaints was higher for women than for men and higher in older age. Conclusions Both incidences of and consultation rates for lower extremity complaints are substantial in general practice. This implies a considerable impact on the workload of the GP. PMID:16269430

The Use of Bovine Collagen-glycosaminoglycan Matrix for Atypical Lower Extremity Ulcers.

PubMed

Garwood, Caitlin S; Kim, Paul J; Matai, Vinay; Steinberg, John S; Evans, Karen K; Mitnick, Carol Deane B; Attinger, Christopher E

2016-09-01

The primary purpose of this study was to evaluate the use of bovine collagen-glycosaminoglycan matrix on atypical lower extremity ulcers. A retrospective chart review was performed on patients who underwent application of bovine collagen matrix to a lower extremity ulcer with an atypical etiology including autoimmune disease, sickle cell anemia, radiation therapy, connective tissue disease, vasculitis, or coagulopathy from January 2009 to October 2014. The following outcomes were evaluated: rate of ulcer healing and closure, number of ulcers that received a split-thickness skin graft, improvement in pain, and complications related to the ulcer. Thirty-eight patients with 71 lower extremity ulcers were analyzed. The most common ulcer etiolo- gies included rheumatoid arthritis, sickle cell anemia, and coagulopa- thy. After application of the bovine collagen matrix, 30 (42.3%) ulcers healed at a mean of 220.9 days. Of the 71 ulcers, 26 (36.6%) re- ceived a split-thickness skin graft after application of the matrix and 17 (65.4%) of those went on to complete healing. Ten patients had a local infection noted during follow-up, and 5 patients had dehiscence or dissociation of the matrix. Atypical lower extremity ulcers, such as those caused by autoimmune diseases and sickle cell anemia, proved difficult to heal. This case series shows that bovine collagen matrix can be a successful adjunctive therapy for the treatment of these challenging ulcers.

[Ultrasonic monitoring foam sclerotherapy for serious varicosis of lower extremity].

PubMed

Yin, Heng-hui; Pan, Fu-shun; Huang, Xue-ling; Chang, Guang-qi; Wang, Shen-ming

2013-11-19

To evaluate the efficacy and safety of foam sclerotherapy for lower extremity varicosis in C4 to C6 patients. A total of 32 patients (32 limbs) with serious lower extremity varicosis classified as C4 to C6 were enrolled. Ultrasonic monitoring of foam sclerotherapy was performed after subfascial endoscopic perforator suture and saphenous vein ligation. They were followed up monthly at outpatient department. Duplex Doppler scan was performed during each interview. All patients were treated successfully. An average of 3.2 perforators were ligated per leg (1-5 perforators). The average volume of foam sclerosing agent was 27.5 ml per leg. Mild chest tightness was observed in one patient but computed tomography (CT) scan excluded pulmonary embolism. Obvious local inflammatory reaction was observed in 4 patients. Residual vein mass without blood signal was seen in 3 patients. No such serious complication as cerebral ischemia was observed. The average follow-up period was 4.8 (1-10) months. Obvious varicose veins and clinical symptoms disappeared at 1 month. And venous ulcers in patients classified as C5 healed within 3 months. Ultrasonic monitoring of foam sclerotherapy, incorporation with saphenous vein ligation and subfascial endoscopic perforator suture, is both safe and effective in the treatment of serious lower extremity varicosis classified as C4 to C6.

Trends and Cost-Analysis of Lower Extremity Nerve Injury Using the National Inpatient Sample.

PubMed

Foster, Chase H; Karsy, Michael; Jensen, Michael R; Guan, Jian; Eli, Ilyas; Mahan, Mark A

2018-06-08

Peripheral nerve injuries (PNIs) of the lower extremities have been assessed in small cohort studies; however, the actual incidence, national trends, comorbidities, and cost of care in lower extremity PNI are not defined. Lack of sufficient data limits discussion on national policies, payors, and other aspects fundamental to the delivery of care in the US. To establish estimates of lower extremity PNIs incidence, associated diagnoses, and cost in the US using a comprehensive database with a minimum of a decade of data. The National Inpatient Sample was utilized to evaluate International Classification of Disease codes for specific lower extremity PNIs (9560-9568) between 2001 and 2013. Lower extremity PNIs occurred with a mean incidence of 13.3 cases per million population annually, which declined minimally from 2001 to 2013. The mean ± SEM age was 41.6 ± 0.1 yr; 61.1% of patients were males. Most were admitted via the emergency department (56.0%). PNIs occurred to the sciatic (16.6%), femoral (10.7%), tibial (6.0%), peroneal (33.4%), multiple nerves (1.3%), and other (32.0%). Associated diagnoses included lower extremity fracture (13.4%), complications of care (11.2%), open wounds (10.3%), crush injury (9.7%), and other (7.2%). Associated procedures included tibial fixation (23.3%), closure of skin (20.1%), debridement of open fractures (15.4%), fixation of other bones (13.5%), and wound debridement (14.5%). The mean annual unadjusted compounded growth rate of charges was 8.8%. The mean ± SEM annual charge over the time period was $64 031.20 ± $421.10, which was associated with the number of procedure codes (β = 0.2), length of stay (β = 0.6), and year (β = 0.1) in a multivariable analysis (P = .0001). These data describe associations in the treatment of lower extremity PNIs, which are important for considering national policies, costs, research and the delivery of care.

Hip abductor function and lower extremity landing kinematics: sex differences.

PubMed

Jacobs, Cale A; Uhl, Timothy L; Mattacola, Carl G; Shapiro, Robert; Rayens, William S

2007-01-01

Rapid deceleration during sporting activities, such as landing from a jump, has been identified as a common mechanism of acute knee injury. Research into the role of potential sex differences in hip abductor function with lower extremity kinematics when landing from a jump is limited. To evaluate sex differences in hip abductor function in relation to lower extremity landing kinematics. 2 x 2 mixed-model factorial design using a between-subjects factor (sex) and a repeated factor (test). University laboratory. A sample of convenience consisting of 30 healthy adults (15 women, 15 men) with no history of lower extremity surgery and no lower extremity injuries within 6 months of testing. Landing kinematics were assessed as subjects performed 3 pre-exercise landing trials that required them to hop from 2 legs and land on a single leg. Isometric peak torque (PT) of the hip abductors was measured, followed by an endurance test during which subjects maintained 50% of their PT to the limits of endurance. After a 15-minute rest period, subjects completed a 30-second bout of isometric hip abduction, from which we calculated the percentage of endurance capacity (%E). Immediately after exercise, subjects completed 3 postexercise landing trials. PT, %E, and peak joint displacement (PJD) of the hip and knee in all 3 planes of motion. Women demonstrated lower PT values (5.8 +/- 1.2% normalized to body weight and height) than did their male counterparts (7.2 +/- 1.5% normalized to body weight and height, P = .009). However, no sex differences were seen in %E. Women also demonstrated larger knee valgus PJD (7.26 degrees +/- 6.61 degrees) than did men (3.29 degrees +/- 3.54 degrees, P = .04). Women's PT was moderately correlated with hip flexion, adduction, and knee valgus PJD; however, PT did not significantly correlate with men's landing kinematics. Regardless of sex, hip flexion (P = .002) and hip adduction (P = .001) were significantly increased following the 30-second bout of

Anthropometric and computerized tomographic measurements of lower extremity lean body mass.

PubMed

Buckley, D C; Kudsk, K A; Rose, B S; Fatzinger, P; Koetting, C A; Schlatter, M

1987-02-01

The loss of lean muscle mass is one of the hallmarks of protein-calorie malnutrition. Anthropometry is a standardized technique used to assess the response of muscle mass to nutrition therapy by quantifying the muscle and fat compartments. That technique does not accurately reflect actual limb composition, whereas computerized tomography does. Twenty lower extremities on randomly chosen men and women patients were evaluated by anthropometry and computerized tomography. Total area, muscle plus bone area, total volume, and muscle plus bone volume were correlated, using Heymsfield's equation and computerized tomography-generated areas. Anthropometrics overestimated total and muscle plus bone cross-sectional areas at almost every level. Anthropometry overestimated total area and total volume by 5% to 10% but overestimated muscle plus bone area and muscle plus bone volume by as much as 40%. Anthropometry, while easily performed and useful in large population groups for epidemiological studies, offers a poor assessment of lower extremity composition. On the other hand, computerized tomography is also easily performed and, while impractical for large population groups, does offer an accurate assessment of the lower extremity tissue compartments and is an instrument that might be used in research on lean muscle mass.

Effect of walking speed on lower extremity joint loading in graded ramp walking.

PubMed

Schwameder, Hermann; Lindenhofer, Elke; Müller, Erich

2005-07-01

Lower extremity joint loading during walking is strongly affected by the steepness of the slope and might cause pain and injuries in lower extremity joint structures. One feasible measure to reduce joint loading is the reduction of walking speed. Positive effects have been shown for level walking, but not for graded walking or hiking conditions. The aim of the study was to quantify the effect of walking speed (separated into the two components, step length and cadence) on the joint power of the hip, knee and ankle and to determine the knee joint forces in uphill and downhill walking. Ten participants walked up and down a ramp with step lengths of 0.46, 0.575 and 0.69 m and cadences of 80, 100 and 120 steps per minute. The ramp was equipped with a force platform and the locomotion was filmed with a 60 Hz video camera. Loading of the lower extremity joints was determined using inverse dynamics. A two-dimensional knee model was used to calculate forces in the knee structures during the stance phase. Walking speed affected lower extremity joint loading substantially and significantly. Change of step length caused much greater loading changes for all joints compared with change of cadence; the effects were more distinct in downhill than in uphill walking. The results indicate that lower extremity joint loading can be effectively controlled by varying step length and cadence during graded uphill and downhill walking. Hikers can avoid or reduce pain and injuries by reducing walking speed, particularly in downhill walking.

Preventing lower extremity injury in elite orienteerers: study protocol for a randomised controlled trial

PubMed Central

Halvarsson, Bodil

2018-01-01

Background The high physical load associated with running through uneven terrain contributes toorienteerers being exposed to high injury risk, where the majority of injuries are located in the lower extremities. Specific training programmes have been effective at reducing injury risk in sports. Yet no trial has been conducted in elite orienteering. The aim of this study is to investigate the effectiveness of a specific training programme in preventing lower extremity injury in adult elite orienteerers. Study design Randomised controlled trial (RCT). Methods Seventy-two Swedish elite orienteerers, aged 18–40 years, are allocated to an intervention or control group. The intervention group performs four specific exercises, with three difficult levels intensified every second week over the first 4 weeks, targeting strength, flexibility and coordination of the lower extremity. The exercises are completed four times a week (10 min per session) in conjunction with normal training over 14 weeks. Injury data are collected every second week using a valid injury questionnaire distributed by text messages over 14 weeks. The primary outcome is number of substantial injuries in the lower extremity. The secondary outcomes are incidence of ankle sprains and the average substantial injury prevalence across 14 weeks. Discussion Due to high injury risk and lack of injury prevention trials in orienteering, an RCT investigating the effect of a specific exercise programme in preventing lower extremity injury is warranted. The results of this trial will be beneficial to orienteerers, clubs and federations, and increase our understanding on how lower extremity injuries can be prevented in a physically challenging sport. Trial registration number NCT03408925. PMID:29707231

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.

Cycling injuries of the lower extremity.

PubMed

Wanich, Tony; Hodgkins, Christopher; Columbier, Jean-Allain; Muraski, Erika; Kennedy, John G

2007-12-01

Cycling is an increasingly popular recreational and competitive activity, and cycling-related injuries are becoming more common. Many common cycling injuries of the lower extremity are preventable. These include knee pain, patellar quadriceps tendinitis, iliotibial band syndrome, hip pain, medial tibial stress syndrome, stress fracture, compartment syndrome, numbness of the foot, and metatarsalgia. Injury is caused by a combination of inadequate preparation, inappropriate equipment, poor technique, and overuse. Nonsurgical management may include rest, nonsteroidal anti-inflammatory drugs, corticosteroid injection, ice, a reduction in training intensity, orthotics, night splints, and physical therapy. Injury prevention should be the focus, with particular attention to bicycle fit and alignment, appropriate equipment, proper rider position and pedaling mechanics, and appropriate training.

Reliability and validity of the Persian lower extremity functional scale (LEFS) in a heterogeneous sample of outpatients with lower limb musculoskeletal disorders.

PubMed

Negahban, Hossein; Hessam, Masumeh; Tabatabaei, Saeid; Salehi, Reza; Sohani, Soheil Mansour; Mehravar, Mohammad

2014-01-01

The aim was to culturally translate and validate the Persian lower extremity functional scale (LEFS) in a heterogeneous sample of outpatients with lower extremity musculoskeletal disorders (n = 304). This is a prospective methodological study. After a standard forward-backward translation, psychometric properties were assessed in terms of test-retest reliability, internal consistency, construct validity, dimensionality, and ceiling or floor effects. The acceptable level of intraclass correlation coefficient >0.70 and Cronbach's alpha coefficient >0.70 was obtained for the Persian LEFS. Correlations between Persian LEFS and Short-Form 36 Health Survey (SF-36) subscales of Physical Health component (rs range = 0.38-0.78) were higher than correlations between Persian LEFS and SF-36 subscales of Mental Health component (rs range = 0.15-0.39). A corrected item--total correlation of >0.40 (Spearman's rho) was obtained for all items of the Persian LEFS. Horn's parallel analysis detected a total of two factors. No ceiling or floor effects were detected for the Persian LEFS. The Persian version of the LEFS is a reliable and valid instrument that can be used to measure functional status in Persian-speaking patients with different musculoskeletal disorders of the lower extremity. Implications for Rehabilitation The Persian lower extremity functional scale (LEFS) is a reliable, internally consistent and valid instrument, with no ceiling or floor effects, to determine functional status of heterogeneous patients with musculoskeletal disorders of the lower extremity. The Persian version of the LEFS can be used in clinical and research settings to measure function in Iranian patients with different musculoskeletal disorders of the lower extremity.

Relative incidence of phlebitis associated with peripheral intravenous catheters in the lower versus upper extremities.

PubMed

Benaya, A; Schwartz, Y; Kory, R; Yinnon, A M; Ben-Chetrit, E

2015-05-01

Peripheral venous access in elderly, hospitalized patients is often challenging. The usual alternative is insertion of a central venous catheter, with associated risk for complications. The purpose of this investigation was to determine the relative incidence of phlebitis secondary to lower as compared to upper extremity intravenous catheters (IVCs) and associated risk factors. A non-randomized, observational, cohort-controlled study was carried out. Consecutive patients receiving a lower extremity IVC were enrolled and compared with patients receiving an upper extremity IVC. Patients were followed from insertion until removal of the IVC. The major endpoint was phlebitis. The incidence of phlebitis secondary to upper extremity IVCs was 3/50 (6 %) compared to 5/53 (9.4 %) in lower extremity IVCs (χ(2) Yates = 0.08, p = 0.776). Age, gender, obesity, diabetes mellitus, site (arm versus leg, left versus right), and size of needle were not found to be risk factors for phlebitis according to univariate analysis. None of the patients developed bloodstream infection. In elderly patients with poor venous access, lower extremity IVCs are a reasonable and low-risk alternative to central venous catheters.

Relationship between lower extremity isometric muscle strength and standing balance in patients with multiple sclerosis.

PubMed

Citaker, Seyit; Guclu-Gunduz, Arzu; Yazici, Gokhan; Bayraktar, Deniz; Nazliel, Bijen; Irkec, Ceyla

2013-01-01

Muscle strength and standing balance decrease in patients with Multiple Sclerosis (MS). The aim of the present study was to investigate the relationship between the lower extremity isometric muscle strength and standing balance in patients with MS. Forty-seven patients with MS and 10 healthy volunteers were included. Neurological disability level was assessed using Expanded Disability Status Scale (EDSS). Isometric strength of seven lower extremity muscles (hip flexor-extensor-abductor-adductor, knee flexor-extensor, and ankle dorsal flexor) was assessed using hand-held dynamometer. Duration of static one-leg standing balance was measured using digital chronometer. Hip flexor-extensor-abductor-adductor, knee flexor-extensor, and ankle dorsal flexor isometric muscle strength, and duration of one-leg standing balance were decreased in patients with MS when compared with controls (p < 0.05). All assessed lower extremity isometric muscle strength and EDSS level was related duration of one-leg standing balance in patients with MS. All assessed lower extremity isometric muscle strength (except ankle dorsal flexor) was related with EDSS. Hip flexor-extensor-abductor-adductor, knee flexor-extensor, and ankle dorsal flexor isometric muscle strength decreases in ambulatory MS patients. Lower extremity muscle weakness and neurological disability level are related with imbalance in MS population. Hip and knee region muscles weakness increases the neurological disability level. For the better balance and decrease neurological disability level whole lower extremity muscle strengthening should be included in rehabilitation programs.

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.

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

Systematic review of measurement properties. 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. To locate and synthesize evidence on the measurement properties of the LEFS and to discuss the clinical implications of the evidence. 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. 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. 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 conditions.

Intra-arterial Ultra-low-Dose CT Angiography of Lower Extremity in Diabetic Patients

DOE Office of Scientific and Technical Information (OSTI.GOV)

Özgen, Ali, E-mail: draliozgen@hotmail.com; Sanioğlu, Soner; Bingöl, Uğur Anıl

2016-08-15

PurposeTo image lower extremity arteries by CT angiography using a very low-dose intra-arterial contrast medium in patients with high risk of developing contrast-induced nephropathy (CIN).Materials and MethodsThree cases with long-standing diabetes mellitus and signs of lower extremity atherosclerotic disease were evaluated by CT angiography using 0.1 ml/kg of the body weight of contrast medium given via 10-cm-long 4F introducer by puncturing the CFA. Images were evaluated by an interventional radiologist and a cardiovascular surgeon. Density values of the lower extremity arteries were also calculated. Findings in two cases were compared with digital subtraction angiography images performed for percutaneous revascularization. Blood creatininemore » levels were followed for possible CIN.ResultsIntra-arterial CT angiography images were considered diagnostic in all patients and optimal in one patient. No patient developed CIN after intra-arterial CT angiography, while one patient developed CIN after percutaneous intervention.ConclusionIntra-arterial CT angiography of lower extremity might be performed in selected patients with high risk of developing CIN. Our limited experience suggests that as low as of 0.1 ml/kg of the body weight of contrast medium may result in adequate diagnostic imaging.« less

Early Ambulation After Microsurgical Reconstruction of the Lower Extremity.

PubMed

Orseck, Michael J; Smith, Christopher Robert; Kirby, Sean; Trujillo, Manuel

2018-06-01

Successful outcomes after microsurgical reconstruction of the lower extremity include timely return to ambulation. Some combination of physical examination, ViOptix tissue oxygen saturation monitoring, and the implantable venous Doppler have shown promise in increasing sensitivity of current flap monitoring. We have incorporated this system into our postoperative monitoring protocol in an effort to initiate earlier dependency protocols. A prospective analysis of 36 anterolateral thigh free flap and radial forearm flaps for lower extremity reconstruction was performed. Indications for reconstruction were acute and chronic wounds, as well as oncologic resection. Twenty-three patients were able to ambulate and 3 were able to dangle their leg on the first postoperative day. One flap showed early mottling that improved immediately after elevation. After reelevation and return to baseline, the dependency protocol was successfully implemented on postoperative day 3. All flaps went on to successful healing. Physical examination, implantable venous Doppler, and ViOptix can be used reliably as an adjunct to increase the sensitivity of detecting poorly performing flaps during the postoperative progression of dependency.

Assessing functional mobility in survivors of lower-extremity sarcoma: reliability and validity of a new assessment tool.

PubMed

Marchese, Victoria G; Rai, Shesh N; Carlson, Claire A; Hinds, Pamela S; Spearing, Elena M; Zhang, Lijun; Callaway, Lulie; Neel, Michael D; Rao, Bhaskar N; Ginsberg, Jill P

2007-08-01

Reliability and validity of a new tool, Functional Mobility Assessment (FMA), were examined in patients with lower-extremity sarcoma. FMA requires the patients to physically perform the functional mobility measures, unlike patient self-report or clinician administered measures. A sample of 114 subjects participated, 20 healthy volunteers and 94 patients with lower-extremity sarcoma after amputation, limb-sparing, or rotationplasty surgery. Reliability of the FMA was examined by three raters testing 20 healthy volunteers and 23 subjects with lower-extremity sarcoma. Concurrent validity was examined using data from 94 subjects with lower-extremity sarcoma who completed the FMA, Musculoskeletal Tumor Society (MSTS), Short-Form 36 (SF-36v2), and Toronto Extremity Salvage Scale (TESS) scores. Construct validity was measured by the ability of the FMA to discriminate between subjects with and without functional mobility deficits. FMA demonstrated excellent reliability (ICC [2,1] >or=0.97). Moderate correlations were found between FMA and SF-36v2 (r = 0.60, P < 0.01), FMA and MSTS (r = 0.68, P < 0.01), and FMA and TESS (r = 0.62, P < 0.01). The patients with lower-extremity sarcoma scored lower on the FMA as compared to healthy controls (P < 0.01). The FMA is a reliable and valid functional outcome measure for patients with lower-extremity sarcoma. This study supports the ability of the FMA to discriminate between patients with varying functional abilities and supports the need to include measures of objective functional mobility in examination of patients with lower-extremity sarcoma.

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

[Risk factors for lower extremity amputation in patients with diabetic foot].

PubMed

Xu, B; Yang, C Z; Wu, S B; Zhang, D; Wang, L N; Xiao, L; Chen, Y; Wang, C R; Tong, A; Zhou, X F; Li, X H; Guan, X H

2017-01-01

Objective: To explore the risk factors for lower extremity amputation in patients with diabetic foot. Methods: The clinical data of 1 771 patients with diabetic foot at the Air Force General Hospital of PLA from November 2001 to April 2015 were retrospectively analyzed. The patients were divided into the non-amputation and amputation groups. Within the amputation group, subjects were further divided into the minor and major amputation subgroups. Binary logistic regression analyses were used to assess the association between risk factors and lower extremity amputation. Results: Among 1 771 patients with diabetic foot, 323 of them (18.24%) were in the amputation group (major amputation: 41; minor amputation: 282) and 1 448 (81.76%) in the non-amputation group. Compared with non-amputation patients, those in the amputation group had a longer hospital stay and higher estimated glomerular filtration rate(eGFR)levels. Fasting plasma glucose (FPG), glycosylated hemoglobin (HbA1c), C-reaction protein (CRP), ESR, ferritin, fibrinogen and WBC levels of the amputation group were higher, while hemoglobin albumin, transferrin, TC, TG, HDL-C and LDL-C were lower than those of the non-amputation group (all P <0.05). The proportion of hypertension(52.48% vs 59.98%), peripheral vascular disease (PAD)(68.11% vs 25.04%), and coronary heart disease(21.33% vs 28.71%)were different between the amputation and non-amputation groups (all P <0.05). Multivariable logistic regression analyses showed that Wagner's grade, PAD and CRP were the independent risk factors associated with lower extremity amputation in hospitalized patients with diabetic foot. Conclusion: Wagner's grade, ischemia of lower limbs and infection are closely associated with amputation of diabetic foot patients.

Morbidity and mortality after emergency lower extremity embolectomy.

PubMed

Casillas-Berumen, Sergio; Sadri, Lili; Farber, Alik; Eslami, Mohammad H; Kalish, Jeffrey A; Rybin, Denis; Doros, Gheorghe; Siracuse, Jeffrey J

2017-03-01

Emergency lower extremity embolectomy is a common vascular surgical procedure that has poorly defined outcomes. Our goal was to define the perioperative morbidity for emergency embolectomy and develop a risk prediction model for perioperative mortality. The American College of Surgeons National Surgical Quality Improvement database was queried to identify patients undergoing emergency unilateral and lower extremity embolectomy. Patients with previous critical limb ischemia, bilateral embolectomy, nonemergency indication, and those undergoing concurrent bypass were excluded. Patient characteristics and postoperative morbidity and mortality were analyzed. Multivariate analysis for predictors of mortality was performed, and from this, a risk prediction model was developed to identify preoperative predictors of mortality. There were 1749 patients (47.9% male) who met the inclusion criteria. The average age was 68.2 ± 14.8 years. Iliofemoral-popliteal embolectomy was performed in 1231 patients (70.4%), popliteal-tibioperoneal embolectomy in 303 (17.3%), and at both levels in 215 (12.3%). Fasciotomies were performed concurrently with embolectomy in 308 patients (17.6%). The 30-day postoperative mortality was 13.9%. Postoperative complications included myocardial infarction or cardiac arrest (4.7%), pulmonary complications (16.0%), and wound complications (8.2%). The rate of return to the operating room ≤30 days was 25.7%. Hospital length of stay was 9.8 ± 11.5 days, and the 30-day readmission rate was 16.3%. A perioperative mortality risk prediction model based on factors identified in multivariate analysis included age >70 years, male gender, functional dependence, history of chronic obstructive pulmonary disease, congestive heart failure, recent myocardial infarction/angina, chronic renal insufficiency, and steroid use. The model showed good discrimination (C = 0.769; 95% confidence interval, 0733-0.806) and calibrated well. Emergency lower extremity

The quality of visual information about the lower extremities influences visuomotor coordination during virtual obstacle negotiation.

PubMed

Kim, Aram; Kretch, Kari S; Zhou, Zixuan; Finley, James M

2018-05-09

Successful negotiation of obstacles during walking relies on the integration of visual information about the environment with ongoing locomotor commands. When information about the body and environment are removed through occlusion of the lower visual field, individuals increase downward head pitch angle, reduce foot placement precision, and increase safety margins during crossing. However, whether these effects are mediated by loss of visual information about the lower extremities, the obstacle, or both remains to be seen. Here, we used a fully immersive, virtual obstacle negotiation task to investigate how visual information about the lower extremities is integrated with information about the environment to facilitate skillful obstacle negotiation. Participants stepped over virtual obstacles while walking on a treadmill with one of three types of visual feedback about the lower extremities: no feedback, end-point feedback, or a link-segment model. We found that absence of visual information about the lower extremities led to an increase in the variability of leading foot placement after crossing. The presence of a visual representation of the lower extremities promoted greater downward head pitch angle during the approach to and subsequent crossing of an obstacle. In addition, having greater downward head pitch was associated with closer placement of the trailing foot to the obstacle, further placement of the leading foot after the obstacle, and higher trailing foot clearance. These results demonstrate that the fidelity of visual information about the lower extremities influences both feed-forward and feedback aspects of visuomotor coordination during obstacle negotiation.

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

PubMed

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.

Diabetic Driving Studies-Part 1: Brake Response Time in Diabetic Drivers With Lower Extremity Neuropathy.

PubMed

Meyr, Andrew J; Spiess, Kerianne E

Although the effect of lower extremity pathology and surgical intervention on automobile driving function has been a topic of contemporary interest, we are unaware of any analysis of the effect of lower extremity diabetic sensorimotor neuropathy on driving performance. The objective of the present case-control investigation was to assess the mean brake response time in diabetic drivers with lower extremity neuropathy compared with that of a control group and a brake response safety threshold. The driving performances of participants were evaluated using a computerized driving simulator with specific measurement of the mean brake response time and frequency of abnormally delayed brake responses. We analyzed a control group of 25 active drivers with neither diabetes nor lower extremity neuropathy and an experimental group of 25 active drivers with type 2 diabetes and lower extremity neuropathy. The experimental group demonstrated a 37.89% slower mean brake response time (0.757 ± 0.180 versus 0.549 ± 0.076 second; p < .001), with abnormally delayed responses occurring at a greater frequency (57.5% versus 3.5%; p < .001). Independent of a comparative statistical analysis, the observed mean brake response time in the experimental group was slower than the reported safety brake response threshold of 0.70 second. The results of the present investigation provide original data with respect to abnormally delayed brake responses in diabetic patients with lower extremity neuropathy and might raise the potential for impaired driving function in this population. Copyright © 2017 American College of Foot and Ankle Surgeons. Published by Elsevier Inc. All rights reserved.

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

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.

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. © Georg Thieme Verlag KG Stuttgart · New York.

Vision in relation to lower extremity deficit in older women: cross-sectional and longitudinal study.

PubMed

Kulmala, Jenni; Sipilä, Sarianna; Tiainen, Kristina; Pärssinen, Olavi; Koskenvuo, Markku; Kaprio, Jaakko; Rantanen, Taina

2012-10-01

Vision problems are common experiences within the older population. This study aimed to examine the association between vision and lower extremity impairment. 434 women aged 63-75 participated in visual acuity (VA) measurements at baseline and 313 persons at three-year follow-up. Measurements of lower extremity function included maximal isometric knee extension strength, leg extension power, maximal walking speed and standing balance. At baseline, knee extension strength was lower among participants with visual impairment (VI) (273.2±6.4 N) compared to those with good vision (306.5±5.9 N, p<0.001) as well as leg extension power (95.2±2.7 W vs 104.2±2.6 W, p=0.009) and maximal walking speed (1.6±0.02 m/s vs 1.8±0.03 m/s, p<0.001). Higher velocity moment among persons with VI (53.5±2.7 mm²/s vs 42.7±1.4 mm²/s, p<0.001) indicated that persons with VI had poorer balance compared to persons with good vision. Decreased isometric knee extension strength (OR 1.26, 95% CI 1.09-1.45), poorer standing balance (OR 1.16, 95% CI 1.00-1.35) as well as lower maximal walking speed (OR 1.34, 95% CI 1.13-1.59) were associated with VI in the logistic regression models. Additionally, the association between poorer leg extension power and VI (OR 1.14, 95% CI 0.99-1.31) was of borderline statistical significance. In longitudinal analyses, VI did not predict decline in lower extremity function. Lower extremity impairment was associated with VI among relatively healthy older women. However, change in lower extremity function was quite similar between the vision groups. It is possible that decreased VA may be a marker of underlying systemic factors or the aging process, which lead to poorer functional capacity, or there may be shared background factors, which lead to decreased vision and lower extremity impairment.

Chronic ergot toxicity presenting with bilateral external iliac artery dissection and lower extremity rest pain.

PubMed

Molkara, Afshin M; Abou-Zamzam, Ahmed M; Teruya, Theodore H; Bianchi, Christian; Killeen, J David

2006-11-01

Chronic use of ergot alkaloids has been recognized as a rare cause of lower extremity ischemia. Most patients with ergot toxicity present with symptoms of lower extremity claudication. Herein we present a woman with bilateral lower extremity rest pain and a history of chronic ergot use for migraine headaches. Arteriography demonstrated extensive pruning of the distal arterial tree along with bilateral external iliac artery dissections - a finding that is not often associated with young, normotensive patients with chronic ergot toxicity. This patient was treated with endovascular stenting of the dissections along with cessation of ergot. Her symptoms improved markedly, and follow-up arteriography 6 weeks later demonstrated resolution of the iliac dissections along with restoration of nearly normal lower extremity runoff vessels. Discontinuation of ergot-containing products and cessation of tobacco and caffeine use is the cornerstone of therapy in chronic ergot toxicity. The association of ergot toxicity and iliac dissection has not been previously described. Endovascular or surgical interventions may be considered in patients with ergot toxicity for specific indications or those whose symptoms progress despite conservative management.

[Topical problems of the diagnosis and rehabilitative treatment of lymphedema of the lower extremities].

PubMed

Badtieva, V A; Kniazeva, T A; Apkhanova, T V

2010-01-01

The present review of the literature data highlights modern approaches to and major trends in diagnostics and conservative treatment of lymphedema of the lower extremities based on the generalized world experience. Patients with lymphedema of the lower extremities comprise a "difficult to manage" group because the disease is characterized by steady progression and marked refractoriness to various conservative therapeutic modalities creating problems for both the patient and the attending physician. Modern methods for the diagnosis of lymphedema are discussed with special reference to noninvasive and minimally invasive techniques (such as lymphoscintiography, computed tomography, MRT, laser Doppler flowmetry, etc.). During the last 20 years, combined conservative therapy has been considered as the method of choice for the management of different stages and forms of lymphedema of the lower extremities in foreign clinics. The basis of conservative therapy is constituted by manual lymph drainage (MLD), compression bandages using short-stretch materials, physical exercises, and skin care (using the method of M. Foldi). Also reviewed are the main physiobalneotherapeutic methods traditionally widely applied for the treatment of lymphedema of the lower extremities in this country. Original methods for the same purpose developed by the authors are described including modifications of cryotherapy, pulsed matrix laserotherapy, hydro- and balneotherapy. Mechanisms of their therapeutic action on the main pathogenetic factors responsible for the development of lymphedema (with special reference to lymph transport and formation) are discussed. The principles of combined application of physiotherapeutic methods for the rehabilitative treatment of patients presenting with lymphedema of the lower extremities are briefly substantiated. Special emphasis is laid on their influence on major components of the pathological process.

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

Factors affecting perioperative mortality and wound-related complications following major lower extremity amputations.

PubMed

Stone, Patrick A; Flaherty, Sarah K; Aburahma, Ali F; Hass, Stephen M; Jackson, J Michelle; Hayes, J David; Hofeldt, Matthew J; Hager, Casey S; Elmore, Michael S

2006-03-01

Major lower extremity amputations continue to be associated with significant morbidity and mortality, yet few recent large series have evaluated factors associated with perioperative mortality and wound complications. The purpose of this study was to examine factors affecting perioperative mortality and wound-related complications following major lower extremity amputation. A retrospective review was conducted of all adult patients who underwent nontraumatic major lower extremity amputations over a 5-year period at a single tertiary-care center in southern West Virginia. Demographic and clinical data, perioperative data, and outcomes were collected and analyzed to identify any relationship with perioperative mortality, as well as wound complications and early revisions (within 90 days) to a more proximal level. Variables were examined using chi-squared, two-tailed t-tests, and logistic regression. Three hundred eighty patients (61% male) underwent 412 major lower extremity amputations during 1999-2003. The initial level of amputation included 230 below-knee (BKA), 149 above-knee (AKA), and one hip disarticulation. Perioperative mortality was 15.5% (n = 59). From a regression model, age, albumin level, AKA, and lack of a previous coronary artery bypass graft (CABG) were independently related to mortality. Patients who did not have a previous CABG were nearly three times more likely to die than those who did (p = 0.038). Overall early wound complications were noted in 13.4% (n = 51). Four factors were independently related to experiencing a 90-day wound complication: BKA, community (rather than care facility) living, type of anesthesia, and preoperative hematocrit >30%. Major lower extremity amputation in patients with peripheral vascular disease continues to be associated with considerable perioperative morbidity and mortality. Even though the surgical procedure itself may not be challenging from a technical standpoint, underlying medical conditions put this group

Postoperative complications after lower extremity arterial bypass increase the risk of new deep venous thrombosis.

PubMed

Aziz, Faisal; Lehman, Erik; Blebea, John; Lurie, Fedor

2017-01-01

Background Deep venous thrombosis after any surgical operations is considered a preventable complication. Lower extremity bypass surgery is a commonly performed operation to improve blood flow to lower extremities in patients with severe peripheral arterial disease. Despite advances in endovascular surgery, lower extremity arterial bypass remains the gold standard treatment for severe, symptomatic peripheral arterial disease. The purpose of this study is to identify the clinical risk factors associated with development of deep venous thrombosis after lower extremity bypass surgery. Methods The American College of Surgeons' NSQIP database was utilized and all lower extremity bypass procedures performed in 2013 were examined. Patient and procedural characteristics were evaluated. Univariate and multivariate logistic regression analysis was used to determine independent risk factors for the development of postoperative deep venous thrombosis. Results A total of 2646 patients (65% males and 35% females) underwent lower extremity open revascularization during the year 2013. The following factors were found to be significantly associated with postoperative deep venous thrombosis: transfusion >4 units of packed red blood cells (odds ratio (OR) = 5.21, confidence interval (CI) = 1.29-22.81, p = 0.03), postoperative urinary tract infection (OR = 12.59, CI = 4.12-38.48, p < 0.01), length of hospital stay >28 days (OR = 9.30, CI = 2.79-30.92, p < 0.01), bleeding (OR = 2.93, CI = 1.27-6.73, p = 0.01), deep wound infection (OR = 3.21, CI = 1.37-7.56, p < 0.01), and unplanned reoperation (OR = 4.57, CI = 2.03-10.26, p < 0.01). Of these, multivariable analysis identified the factors independently associated with development of deep venous thrombosis after lower extremity bypass surgery to be unplanned reoperation (OR = 3.57, CI = 1.54-8.30, p < 0.01), reintubation (OR = 8.93, CI = 2

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.

Real-time visual biofeedback during weight bearing improves therapy compliance in patients following lower extremity fractures.

PubMed

Raaben, Marco; Holtslag, Herman R; Leenen, Luke P H; Augustine, Robin; Blokhuis, Taco J

2018-01-01

Individuals with lower extremity fractures are often instructed on how much weight to bear on the affected extremity. Previous studies have shown limited therapy compliance in weight bearing during rehabilitation. In this study we investigated the effect of real-time visual biofeedback on weight bearing in individuals with lower extremity fractures in two conditions: full weight bearing and touch-down weight bearing. 11 participants with full weight bearing and 12 participants with touch-down weight bearing after lower extremity fractures have been measured with an ambulatory biofeedback system. The participants first walked 15m and the biofeedback system was only used to register the weight bearing. The same protocol was then repeated with real-time visual feedback during weight bearing. The participants could thereby adapt their loading to the desired level and improve therapy compliance. In participants with full weight bearing, real-time visual biofeedback resulted in a significant increase in loading from 50.9±7.51% bodyweight (BW) without feedback to 63.2±6.74%BW with feedback (P=0.0016). In participants with touch-down weight bearing, the exerted lower extremity load decreased from 16.7±9.77kg without feedback to 10.27±4.56kg with feedback (P=0.0718). More important, the variance between individual steps significantly decreased after feedback (P=0.018). Ambulatory monitoring weight bearing after lower extremity fractures showed that therapy compliance is low, both in full and touch-down weight bearing. Real-time visual biofeedback resulted in significantly higher peak loads in full weight bearing and increased accuracy of individual steps in touch-down weight bearing. Real-time visual biofeedback therefore results in improved therapy compliance after lower extremity fractures. Copyright © 2017 Elsevier B.V. All rights reserved.

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

2016-08-02

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.

A theoretical framework for understanding neuromuscular response to lower extremity joint injury.

PubMed

Pietrosimone, Brian G; McLeod, Michelle M; Lepley, Adam S

2012-01-01

Neuromuscular alterations are common following lower extremity joint injury and often lead to decreased function and disability. These neuromuscular alterations manifest in inhibition or abnormal facilitation of the uninjured musculature surrounding an injured joint. Unfortunately, these neural alterations are poorly understood, which may affect clinical recognition and treatment of these injuries. Understanding how these neural alterations affect physical function may be important for proper clinical management of lower extremity joint injuries. Pertinent articles focusing on neuromuscular consequences and treatment of knee and ankle injuries were collected from peer-reviewed sources available on the Web of Science and Medline databases from 1975 through 2010. A theoretical model to illustrate potential relationships between neural alterations and clinical impairments was constructed from the current literature. Lower extremity joint injury affects upstream cortical and spinal reflexive excitability pathways as well as downstream muscle function and overall physical performance. Treatment targeting the central nervous system provides an alternate means of treating joint injury that may be effective for patients with neuromuscular alterations. Disability is common following joint injury. There is mounting evidence that alterations in the central nervous system may relate to clinical changes in biomechanics that may predispose patients to further injury, and novel clinical interventions that target neural alterations may improve therapeutic outcomes.

Analysis and evaluation of functional status of lower extremity amputee-appliance systems: an integrated approach.

PubMed

Ganguli, S

1976-11-01

This paper introduces an integrated, objective and biomechanically sound approach for the analysis and evaluation of the functional status of lower extremity amputee-appliance systems. The method is demonstrated here in its application to the unilateral lower extremity amputee-axillary crutches system and the unilateral below-knee amputee-PTB prosthesis system, both of which are commonly encountered in day-to-day rehabilitation practice.

Epidemiology and Impact on Performance of Lower Extremity Stress Injuries in Professional Basketball Players.

PubMed

Khan, Moin; Madden, Kim; Burrus, M Tyrrell; Rogowski, Joseph P; Stotts, Jeff; Samani, Marisa J; Sikka, Robby; Bedi, Asheesh

Professional basketball players in the National Basketball Association (NBA) subject their lower extremities to significant repetitive loading during both regular-season and off-season training. Little is known about the incidence of lower extremity bony stress injuries and their impact on return to play and performance in these athletes. Stress injuries of the lower extremity will have significant impact on performance. Case series. Level 4. All bony stress injuries from 2005 to 2015 were identified from the NBA. Number of games missed due to injury and performance statistics were collected from 2 years prior to injury to 2 years after the injury. A linear regression analysis was performed to determine the impact of injury for players who returned to sport. A total of 76 lower extremity bony stress injuries involving 75 NBA players (mean age, 25.4 ± 4.1 years) were identified. Fifty-five percent (42/76) involved the foot, and most injuries occurred during the regular season (82.9%, 63/76), with half occurring within the first 6 weeks. Among players who sustained a fifth metatarsal stress fracture, 42.9% were unable to return to professional play. Players who sustained stress injuries had reduced play performance, specifically related to number of games played ( P = 0.014) and number of steals per game ( P = 0.004). Players who had surgery had significantly better performance at 2 years than those who were managed nonoperatively, independent of the type of injury (β = 4.561; 95% CI, 1.255-7.868). Lower extremity bony stress injuries may significantly affect both short- and long-term player performance and career length. Stress injuries result in decreased player performance, and surgical intervention results in improved performance metrics compared with those treated using conservative methods. Stress injuries result in decreased player performance, and surgical intervention results in improved performance metrics.

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

Local dynamic stability of lower extremity joints in lower limb amputees during slope walking.

PubMed

Chen, Jin-Ling; Gu, Dong-Yun

2013-01-01

Lower limb amputees have a higher fall risk during slope walking compared with non-amputees. However, studies on amputees' slope walking were not well addressed. The aim of this study was to identify the difference of slope walking between amputees and non-amputees. Lyapunov exponents λS was used to estimate the local dynamic stability of 7 transtibial amputees' and 7 controls' lower extremity joint kinematics during uphill and downhill walking. Compared with the controls, amputees exhibited significantly lower λS in hip (P=0.04) and ankle (P=0.01) joints of the sound limb, and hip joints (P=0.01) of the prosthetic limb during uphill walking, while they exhibited significantly lower λS in knee (P=0.02) and ankle (P=0.03) joints of the sound limb, and hip joints (P=0.03) of the prosthetic limb during downhill walking. Compared with amputees level walking, they exhibited significantly lower λS in ankle joints of the sound limb during both uphill (P=0.01) and downhill walking (P=0.01). We hypothesized that the better local dynamic stability of amputees was caused by compensation strategy during slope walking.

Outcomes of Soft Tissue Reconstruction for Traumatic Lower Extremity Fractures with Compromised Vascularity.

PubMed

Badash, Ido; Burtt, Karen E; Leland, Hyuma A; Gould, Daniel J; Rounds, Alexis D; Azadgoli, Beina; Patel, Ketan M; Carey, Joseph N

2017-10-01

Traumatic lower extremity fractures with compromised arterial flow are limb-threatening injuries. A retrospective review of 158 lower extremities with traumatic fractures, including 26 extremities with arterial injuries, was performed to determine the effects of vascular compromise on flap survival, successful limb salvage and complication rates. Patients with arterial injuries had a larger average flap surface area (255.1 vs 144.6 cm2, P = 0.02) and a greater number of operations (4.7 vs 3.8, P = 0.01) than patients without vascular compromise. Patients presenting with vascular injury were also more likely to require fasciotomy [odds ratio (OR): 6.5, confidence interval (CI): 2.3-18.2] and to have a nerve deficit (OR: 16.6, CI: 3.9-70.0), fracture of the distal third of the leg (OR: 2.9, CI: 1.15-7.1) and intracranial hemorrhage (OR: 3.84, CI: 1.1-12.9). After soft tissue reconstruction, patients with arterial injuries had a higher rate of amputation (OR: 8.5, CI: 1.3-53.6) and flap failure requiring a return to the operating room (OR: 4.5, CI: 1.5-13.2). Arterial injury did not correlate with infection or overall complication rate. In conclusion, arterial injuries resulted in significant complications for patients with lower extremity fractures requiring flap coverage, although limb salvage was still effective in most cases.

Associations of foot posture and function to lower extremity pain: results from a population-based foot study.

PubMed

Riskowski, Jody L; Dufour, Alyssa B; Hagedorn, Thomas J; Hillstrom, Howard J; Casey, Virginia A; Hannan, Marian T

2013-11-01

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. Participants were members of the Framingham Foot Study. Lower extremity joint pain was determined by the response to the National Health and Nutrition Examination Survey-type question, "On most days do you have pain, aching or stiffness in your (hips, knees, ankles, or feet)?" The Modified Arch Index classified participants as having planus, rectus (referent), or cavus foot posture. The Center of Pressure Excursion Index classified participants as having overpronated, normal (referent), or oversupinated foot function. Crude and adjusted (age, sex, and body mass index) logistic regression determined associations of foot posture and function to lower extremity pain. Participants with planus structure had higher odds of knee (odds ratio [OR] 1.57, 95% confidence interval [95% CI] 1.24-1.99) or ankle (OR 1.47, 95% CI 1.05-2.06) pain, whereas those with a cavus foot structure had increased odds of ankle pain only (OR 7.56, 95% CI 1.99-28.8) and pain at 1 lower extremity site (OR 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 oversupinated foot function (OR 0.69, 95% CI 0.51-0.93). These findings offer a link between foot posture and lower extremity pain, highlighting the need for longitudinal or intervention studies. Copyright © 2013 by the American College of Rheumatology.

Test-retest and interrater reliability of the functional lower extremity evaluation.

PubMed

Haitz, Karyn; Shultz, Rebecca; Hodgins, Melissa; Matheson, Gordon O

2014-12-01

Repeated-measures clinical measurement reliability study. To establish the reliability and face validity of the Functional Lower Extremity Evaluation (FLEE). The FLEE is a 45-minute battery of 8 standardized functional performance tests that measures 3 components of lower extremity function: control, power, and endurance. The reliability and normative values for the FLEE in healthy athletes are unknown. A face validity survey for the FLEE was sent to sports medicine personnel to evaluate the level of importance and frequency of clinical usage of each test included in the FLEE. The FLEE was then administered and rated for 40 uninjured athletes. To assess test-retest reliability, each athlete was tested twice, 1 week apart, by the same rater. To assess interrater reliability, 3 raters scored each athlete during 1 of the testing sessions. Intraclass correlation coefficients were used to assess the test-retest and interrater reliability of each of the FLEE tests. In the face validity survey, the FLEE tests were rated as highly important by 58% to 71% of respondents but frequently used by only 26% to 45% of respondents. Interrater reliability intraclass correlation coefficients ranged from 0.83 to 1.00, and test-retest reliability ranged from 0.71 to 0.95. The FLEE tests are considered clinically important for assessing lower extremity function by sports medicine personnel but are underused. The FLEE also is a reliable assessment tool. Future studies are required to determine if use of the FLEE to make return-to-play decisions may reduce reinjury rates.

Quantitative Sensory Testing and Current Perception Threshold Testing in Patients With Chronic Pain Following Lower Extremity Fracture.

PubMed

Griffioen, Mari A; Greenspan, Joel D; Johantgen, Meg; Von Rueden, Kathryn; O'Toole, Robert V; Dorsey, Susan G; Renn, Cynthia L

2018-01-01

Chronic pain is a significant problem for patients with lower extremity injuries. While pain hypersensitivity has been identified in many chronic pain conditions, it is not known whether patients with chronic pain following lower extremity fracture report pain hypersensitivity in the injured leg. To quantify and compare peripheral somatosensory function and sensory nerve activation thresholds in persons with chronic pain following lower extremity fractures with a cohort of persons with no history of lower extremity fractures. This was a cross-sectional study where quantitative sensory testing and current perception threshold testing were conducted on the injured and noninjured legs of cases and both legs of controls. A total of 14 cases and 28 controls participated in the study. Mean time since injury at the time of testing for cases was 22.3 (standard deviation = 12.1) months. The warmth detection threshold ( p = .024) and nerve activation thresholds at 2,000 Hz ( p < .001) and 250 Hz ( p = .002), respectively, were significantly higher in cases compared to controls. This study suggests that patients with chronic pain following lower extremity fractures may experience hypoesthesia in the injured leg, which contrasts with the finding of hyperesthesia previously observed in other chronic pain conditions but is in accord with patients with nerve injuries and surgeries. This is the first study to examine peripheral sensory nerve function at the site of injury in patients with chronic pain following lower extremity fractures using quantitative sensory testing and current perception threshold testing.

Acute lower extremity paralysis after lower extremity endovascular intervention.

PubMed

Öztürk, Semi; Kalyoncuoğlu, Muhsin; Durmuş, Gündüz; Topçu, Adem; Can, Mehmet

2017-04-01

A 61-year-old man underwent successful percutaneous revascularization of both lower limbs with multiple stent implantations. Paralysis of right lower limb was noticed after completion of procedure when transferring the patient from angiography table. Since hematoma compressing lumbosacral neural plexus could be a fatal complication, computed tomography (CT) image was taken. CT showed bulge of distended bladder compressing stent struts. Following placement of Foley catheter, condition improved and he was subsequently discharged uneventfully.

The Influence of Lower Extremity Lean Mass on Landing Biomechanics During Prolonged Exercise.

PubMed

Montgomery, Melissa M; Tritsch, Amanda J; Cone, John R; Schmitz, Randy J; Henson, Robert A; Shultz, Sandra J

2017-08-01

  The extent to which lower extremity lean mass (LELM) relative to total body mass influences one's ability to maintain safe landing biomechanics during prolonged exercise when injury incidence increases is unknown.   To examine the influence of LELM on (1) pre-exercise lower extremity biomechanics and (2) changes in biomechanics during an intermittent exercise protocol (IEP) and (3) determine whether these relationships differ by sex. We hypothesized that less LELM would predict higher-risk baseline biomechanics and greater changes toward higher-risk biomechanics during the IEP.   Cohort study.   Controlled laboratory.   A total of 59 athletes (30 men: age = 20.3 ± 2.0 years, height = 1.79 ± 0.05 m, mass = 75.2 ± 7.2 kg; 29 women: age = 20.6 ± 2.3 years, height = 1.67 ± 0.08 m, mass = 61.8 ± 9.0 kg) participated.   Before completing an individualized 90-minute IEP designed to mimic a soccer match, participants underwent dual-energy x-ray absorptiometry testing for LELM.   Three-dimensional lower extremity biomechanics were measured during drop-jump landings before the IEP and every 15 minutes thereafter. A previously reported principal components analysis reduced 40 biomechanical variables to 11 factors. Hierarchical linear modeling analysis then determined the extent to which sex and LELM predicted the baseline score and the change in each factor over time.   Lower extremity lean mass did not influence baseline biomechanics or the changes over time. Sex influenced the biomechanical factor representing knee loading at baseline (P = .04) and the changes in the anterior cruciate ligament-loading factor over time (P = .03). The LELM had an additional influence only on women who possessed less LELM (P = .03 and .02, respectively).   Lower extremity lean mass influenced knee loading during landing in women but not in men. The effect appeared to be stronger in women with less LELM. Continually decreasing knee loading over time may reflect a

A Theoretical Framework for Understanding Neuromuscular Response to Lower Extremity Joint Injury

PubMed Central

Pietrosimone, Brian G.; McLeod, Michelle M.; Lepley, Adam S.

2012-01-01

Background: Neuromuscular alterations are common following lower extremity joint injury and often lead to decreased function and disability. These neuromuscular alterations manifest in inhibition or abnormal facilitation of the uninjured musculature surrounding an injured joint. Unfortunately, these neural alterations are poorly understood, which may affect clinical recognition and treatment of these injuries. Understanding how these neural alterations affect physical function may be important for proper clinical management of lower extremity joint injuries. Methods: Pertinent articles focusing on neuromuscular consequences and treatment of knee and ankle injuries were collected from peer-reviewed sources available on the Web of Science and Medline databases from 1975 through 2010. A theoretical model to illustrate potential relationships between neural alterations and clinical impairments was constructed from the current literature. Results: Lower extremity joint injury affects upstream cortical and spinal reflexive excitability pathways as well as downstream muscle function and overall physical performance. Treatment targeting the central nervous system provides an alternate means of treating joint injury that may be effective for patients with neuromuscular alterations. Conclusions: Disability is common following joint injury. There is mounting evidence that alterations in the central nervous system may relate to clinical changes in biomechanics that may predispose patients to further injury, and novel clinical interventions that target neural alterations may improve therapeutic outcomes. PMID:23016066

Preservation of lower extremity amputation length using muscle perforator free flaps.

PubMed

Hallock, G G

2008-06-01

Coverage of any lower extremity amputation stump must be durable to resist external forces, well contoured, and thin enough for proper shoewear or prothesis fitting. Preservation of bone length to maximise the ability to ambulate is also of paramount importance. If local soft tissues are inadequate to fulfil these prerequisites, consideration of a microsurgical tissue transfer is a reasonable option, especially to cover bone or save a major joint. Muscle perforator free flaps, as shown in this series of eight patients using four different donor sites, are a versatile alternative for the necessary soft tissue augmentation. Multiple choices are available and often even from the involved lower extremity to minimise further morbidity. The vascular pedicles of this genré of flaps are relatively exceedingly long and of respectable calibre to facilitate reaching an appropriate recipient site. They can be sensate if desired. Of course, muscle function is by definition preserved. Complications are minimal and usually related to the reason for the amputation in the first place.

Anterolateral thigh flap harvested from paralytic lower extremity in a patient with late polio sequel.

PubMed

Valentini, Valentino; Terenzi, Valentina; Cassoni, Andrea; Battisti, Andrea; Della Monaca, Marco; Malavasi, Roberto

2012-01-01

Free flap reconstruction is the treatment of choice after extensive head and neck tumour resection. When treating a patient with a previous disability, such as lower extremity paralysis secondary to poliomyelitis, it is important to offer the best reconstruction whilst preserving healthy extremities. We report the case of a 51-year-old man with a squamous cell carcinoma (SCC) of the right tongue and a left lower extremity paralysis secondary to an acute poliomyelitis during childhood in which reconstruction was successfully achieved with a left anterolateral thigh (ALT) free flap. Copyright © 2011 European Association for Cranio-Maxillo-Facial Surgery. Published by Elsevier Ltd. All rights reserved.

Risk Factor, Job Stress and Quality of Life in Workers With Lower Extremity Pain Who Use Video Display Terminals

PubMed Central

2018-01-01

Objective To investigate the general characteristics of video display terminal (VDT) workers with lower extremity pain, to identify the risk factors of work-related lower extremity pain, and to examine the relationship between work stress and health-related quality of life. Methods A questionnaire about the general characteristics of the survey group and the musculoskeletal symptom was used. A questionnaire about job stress used the Korean Occupational Stress Scale and medical outcome study 36-item Short Form Health Survey (SF-36) to assess health-related quality of life. Results There were 1,711 subjects in the lower extremity group and 2,208 subjects in the control group. Age, sex, hobbies, and feeling of loading affected lower extremity pain as determined in a crossover analysis of all variables with and without lower extremity pain. There were no statistically significant difference between the two groups in terms of job stress and SF-36 values of the pain and control groups. Conclusion Job stress in VDT workers was higher than average, and the quality of life decreased as the stress increased. Factors such as younger age, women, hobbies other than exercise, and feeling of loading influenced lower extremity pain of workers. Further long-term follow-up and supplementary studies are needed to identify risk factors for future lower extremity pain, taking into account ergonomic factors such as worker's posture. PMID:29560330

Risk Factor, Job Stress and Quality of Life in Workers With Lower Extremity Pain Who Use Video Display Terminals.

PubMed

Choi, Sehoon; Jang, Seong Ho; Lee, Kyu Hoon; Kim, Mi Jung; Park, Si-Bog; Han, Seung Hoon

2018-02-01

To investigate the general characteristics of video display terminal (VDT) workers with lower extremity pain, to identify the risk factors of work-related lower extremity pain, and to examine the relationship between work stress and health-related quality of life. A questionnaire about the general characteristics of the survey group and the musculoskeletal symptom was used. A questionnaire about job stress used the Korean Occupational Stress Scale and medical outcome study 36-item Short Form Health Survey (SF-36) to assess health-related quality of life. There were 1,711 subjects in the lower extremity group and 2,208 subjects in the control group. Age, sex, hobbies, and feeling of loading affected lower extremity pain as determined in a crossover analysis of all variables with and without lower extremity pain. There were no statistically significant difference between the two groups in terms of job stress and SF-36 values of the pain and control groups. Job stress in VDT workers was higher than average, and the quality of life decreased as the stress increased. Factors such as younger age, women, hobbies other than exercise, and feeling of loading influenced lower extremity pain of workers. Further long-term follow-up and supplementary studies are needed to identify risk factors for future lower extremity pain, taking into account ergonomic factors such as worker's posture.

Do Associations Between Perceived Environmental and Individual Characteristics and Walking Limitations Depend on Lower Extremity Performance Level?

PubMed

Sakari, Ritva; Rantakokko, Merja; Portegijs, Erja; Iwarsson, Susanne; Sipilä, Sarianna; Viljanen, Anne; Rantanen, Taina

2017-06-01

The aim of this study was to analyze whether the associations between perceived environmental and individual characteristics and perceived walking limitations in older people differ between those with intact and those with poorer lower extremity performance. Persons aged 75 to 90 ( N = 834) participated in interviews and performance tests in their homes. Standard questionnaires were used to obtain walking difficulties; environmental barriers to and, facilitators of, mobility; and perceived individual hindrances to outdoor mobility. Lower extremity performance was tested using Short Physical Performance Battery (SPPB). Among those with poorer lower extremity performance, the likelihood for advanced walking limitations was, in particular, related to perceived poor safety in the environment, and among those with intact performance to perceived social issues, such as lack of company, as well as to long distances. The environmental correlates of walking limitations seem to depend on the level of lower extremity performance.

Core strength and lower extremity alignment during single leg squats.

PubMed

Willson, John D; Ireland, Mary Lloyd; Davis, Irene

2006-05-01

Muscles of the trunk, hip, and knee influence the orientation of the lower extremity during weight bearing activities. The purpose of this study was threefold: first, to compare the orientation of the lower extremity during a single leg (SL) squat among male and female athletes; second, to compare the strength of muscle groups in the trunk, hips, and knees between these individuals; and third, to evaluate the association between trunk, hip, and knee strength and the orientation of the knee joint during this activity. Twenty-four male and 22 female athletes participated in this study. Peak isometric torque was determined for the following muscle actions: trunk flexion, extension, and lateral flexion, hip abduction and external rotation, and knee flexion and extension. The frontal plane projection angle (FPPA) of the knee during a 45 degrees SL squat was determined using photo editing software. Males and females moved in opposite directions during the SL squat test (F(1,42) = 5.05, P = 0.03). Females typically moved toward more extreme FPPA during SL squats (P = 0.056), while males tended to move toward more neutral alignment (P = 0.066). Females also generated less torque in all muscle groups, with the exception of trunk extension. The projection angle of the knee during the SL squat test was most closely associated with hip external rotation strength. Using instruments suitable for a clinical setting, females were found to have greater FPPA and generally decreased trunk, hip, and knee isometric torque. Hip external rotation strength was most closely associated with the frontal plane projection angle.

Patients with inferior vena cava thrombosis frequently present with lower back pain and bilateral lower-extremity deep vein thrombosis.

PubMed

Kraft, Christiane; Hecking, Carola; Schwonberg, Jan; Schindewolf, Marc; Lindhoff-Last, Edelgard; Linnemann, Birgit

2013-07-01

Inferior vena cava (IVC) thrombosis is rare, and data about the clinical presentation of patients are scarce. Therefore, we reviewed all cases of IVC thrombosis consecutively registered in the MAISTHRO (MAin-ISar-THROmbosis) database and described patients’ characteristics in terms of their clinical presentations in the acute setting of IVC thrombosis. From the MAISTHRO registry, which enrolled 1470 consecutive patients with documented histories of venous thromboembolism, we identified 60 patients (0,4 %; females 60 %) with IVC thrombosis and 888 patients (60.4 %; females 55 %) with isolated lower-extremity deep vein thrombosis (LE-DVT). The median age at the time of IVC thrombosis manifestation was 36.5 years (9 to 83). IVC thrombosis was the initial VTE event in 47 patients (78 %). In the majority of cases, IVC thrombosis extended to the lower-extremity veins, and both lower extremities were affected in 17 cases (28 %). The initial clinical symptom of IVC thrombosis was lower back or abdominal pain which preceded typical symptoms of LE-DVT in 29 (48 %) patients. Symptomatic pulmonary embolism was more frequently observed in IVC thrombosis patients when compared to a sex- and age-matched subgroup of LE-DVT patients, although the difference was not significant (27 % vs. 12 %; p = 0.064). Malignant disease was the only established VTE risk factor with a higher prevalence among IVC thrombosis patients than patients with isolated LE-DVT (27 % vs. 9 %; p = 0.015). Congenital IVC anomalies were identified in another eight IVC thrombosis patients (13 %). IVC thrombosis should be considered a differential diagnosis for inexplicable lower back or abdominal pain especially in young patients. Malignant disease and congenital IVC anomalies seem to be predisposing factors for thrombosis involving the inferior vena cava.

Results of a prospective randomized controlled trial of early ambulation for patients with lower extremity autografts.

PubMed

Lorello, David John; Peck, Michael; Albrecht, Marlene; Richey, Karen J; Pressman, Melissa A

2014-01-01

It is common practice to keep those patients with lower extremity autografts immobile until post-operative day (POD) 5. There is however inherent risks associated with even short periods of immobility. As of now there are no randomized controlled trials looking at early ambulation of patients with lower extremity autografts in the burn community.The objective of this study was to show that patients who begin ambulation within 24 hours of lower extremity autografting will have no increased risk of graft failure than those patients who remain immobile until POD 5. Thirty-one subjects who received autografts to the lower extremity were randomized after surgery into either the early ambulation group (EAG;17 subjects) or the standard treatment group (STG;14 subjects). Those subjects randomized to the EAG began ambulating with physical therapy on POD 1. Subjects in the STG maintained bed rest until POD 5. There was no difference in the number of patients with graft loss in either the EAG or STG on POD 5, and during any of the follow-up visits. No subjects required regrafting. There was a significant difference in the mean minutes of ambulation, with the EAG ambulating longer than the STG (EAG 23.4 minutes [SD 12.03], STG 14.1 [SD 9.00], P=.0235) on POD 5. Burn patients with lower extremity autografts can safely ambulate on POD 1 without fear of graft failure compared with those patients that remain on bed rest for 5 days.

MRI of lower extremity impingement and friction syndromes in children

PubMed Central

Aydıngöz, Üstün; Özdemir, Zeynep Maraş; Güneş, Altan; Ergen, Fatma Bilge

2016-01-01

Although generally more common in adults, lower extremity impingement and friction syndromes are also observed in the pediatric age group. Encompassing femoroacetabular impingement, iliopsoas impingement, subspine impingement, and ischiofemoral impingement around the hip; patellar tendon–lateral femoral condyle friction syndrome; iliotibial band friction syndrome; and medial synovial plica syndrome in the knee as well as talocalcaneal impingement on the hindfoot, these syndromes frequently cause pain and may mimic other, and occasionally more ominous, conditions in children. Magnetic resonance imaging (MRI) plays a key role in the diagnosis of musculoskeletal impingement and friction syndromes. Iliopsoas, subspine, and ischiofemoral impingements have been recently described, while some features of femoroacetabular and talocalcaneal impingements have recently gained increased relevance in the pediatric population. Fellowship-trained pediatric radiologists and radiologists with imaging workloads of exclusively or overwhelmingly pediatric patients (particularly those without a structured musculoskeletal imaging program as part of their imaging training) specifically need to be aware of these rare syndromes that mostly have quite characteristic imaging findings. This review highlights MRI features of lower extremity impingement and friction syndromes in children and provides updated pertinent pathophysiologic and clinical data. PMID:27538047

Haptic biofeedback for improving compliance with lower-extremity partial weight bearing.

PubMed

Fu, Michael C; DeLuke, Levi; Buerba, Rafael A; Fan, Richard E; Zheng, Ying Jean; Leslie, Michael P; Baumgaertner, Michael R; Grauer, Jonathan N

2014-11-01

After lower-extremity orthopedic trauma and surgery, patients are often advised to restrict weight bearing on the affected limb. Conventional training methods are not effective at enabling patients to comply with recommendations for partial weight bearing. The current study assessed a novel method of using real-time haptic (vibratory/vibrotactile) biofeedback to improve compliance with instructions for partial weight bearing. Thirty healthy, asymptomatic participants were randomized into 1 of 3 groups: verbal instruction, bathroom scale training, and haptic biofeedback. Participants were instructed to restrict lower-extremity weight bearing in a walking boot with crutches to 25 lb, with an acceptable range of 15 to 35 lb. A custom weight bearing sensor and biofeedback system was attached to all participants, but only those in the haptic biofeedback group were given a vibrotactile signal if they exceeded the acceptable range. Weight bearing in all groups was measured with a separate validated commercial system. The verbal instruction group bore an average of 60.3±30.5 lb (mean±standard deviation). The bathroom scale group averaged 43.8±17.2 lb, whereas the haptic biofeedback group averaged 22.4±9.1 lb (P<.05). As a percentage of body weight, the verbal instruction group averaged 40.2±19.3%, the bathroom scale group averaged 32.5±16.9%, and the haptic biofeedback group averaged 14.5±6.3% (P<.05). In this initial evaluation of the use of haptic biofeedback to improve compliance with lower-extremity partial weight bearing, haptic biofeedback was superior to conventional physical therapy methods. Further studies in patients with clinical orthopedic trauma are warranted. Copyright 2014, SLACK Incorporated.

Influence of trunk posture on lower extremity energetics during running.

PubMed

Teng, Hsiang-Ling; Powers, Christopher M

2015-03-01

This study aimed to examine the influence of sagittal plane trunk posture on lower extremity energetics during running. Forty asymptomatic recreational runners (20 males and 20 females) ran overground at a speed of 3.4 m·s(-1). Sagittal plane trunk kinematics and lower extremity kinematics and energetics during the stance phase of running were computed. Subjects were dichotomized into high flexion (HF) and low flexion (LF) groups on the basis of the mean trunk flexion angle. The mean (±SD) trunk flexion angles of the HF and LF groups were 10.8° ± 2.2° and 3.6° ± 2.8°, respectively. When compared with the LF group, the HF group demonstrated significantly higher hip extensor energy generation (0.12 ± 0.06 vs 0.05 ± 0.04 J·kg(-1), P < 0.001) and lower knee extensor energy absorption (0.60 ± 0.14 vs 0.74 ± 0.09 J·kg(-1), P = 0.001) and generation (0.30 ± 0.05 vs 0.34 ± 0.06 J·kg(-1), P = 0.02). There was no significant group difference for the ankle plantarflexor energy absorption or generation (P > 0.05). Sagittal plane trunk flexion has a significant influence on hip and knee energetics during running. Increasing forward trunk lean during running may be used as a strategy to reduce knee loading without increasing the biomechanical demand at the ankle plantarflexors.

Diagnostic accuracy of ultrasound in upper and lower extremity long bone fractures of emergency department trauma patients

PubMed Central

Frouzan, Arash; Masoumi, Kambiz; Delirroyfard, Ali; Mazdaie, Behnaz; Bagherzadegan, Elnaz

2017-01-01

Background Long bone fractures are common injuries caused by trauma. Some studies have demonstrated that ultrasound has a high sensitivity and specificity in the diagnosis of upper and lower extremity long bone fractures. Objective The aim of this study was to determine the accuracy of ultrasound compared with plain radiography in diagnosis of upper and lower extremity long bone fractures in traumatic patients. Methods This cross-sectional study assessed 100 patients admitted to the emergency department of Imam Khomeini Hospital, Ahvaz, Iran with trauma to the upper and lower extremities, from September 2014 through October 2015. In all patients, first ultrasound and then standard plain radiography for the upper and lower limb was performed. Data were analyzed by SPSS version 21 to determine the specificity and sensitivity. Results The mean age of patients with upper and lower limb trauma were 31.43±12.32 years and 29.63±5.89 years, respectively. Radius fracture was the most frequent compared to other fractures (27%). Sensitivity, specificity, positive predicted value, and negative predicted value of ultrasound compared with plain radiography in the diagnosis of upper extremity long bones were 95.3%, 87.7%, 87.2% and 96.2%, respectively, and the highest accuracy was observed in left arm fractures (100%). Tibia and fibula fractures were the most frequent types compared to other fractures (89.2%). Sensitivity, specificity, PPV and NPV of ultrasound compared with plain radiography in the diagnosis of upper extremity long bone fractures were 98.6%, 83%, 65.4% and 87.1%, respectively, and the highest accuracy was observed in men, lower ages and femoral fractures. Conclusion The results of this study showed that ultrasound compared with plain radiography has a high accuracy in the diagnosis of upper and lower extremity long bone fractures. PMID:28979747

Diagnostic accuracy of ultrasound in upper and lower extremity long bone fractures of emergency department trauma patients.

PubMed

Frouzan, Arash; Masoumi, Kambiz; Delirroyfard, Ali; Mazdaie, Behnaz; Bagherzadegan, Elnaz

2017-08-01

Long bone fractures are common injuries caused by trauma. Some studies have demonstrated that ultrasound has a high sensitivity and specificity in the diagnosis of upper and lower extremity long bone fractures. The aim of this study was to determine the accuracy of ultrasound compared with plain radiography in diagnosis of upper and lower extremity long bone fractures in traumatic patients. This cross-sectional study assessed 100 patients admitted to the emergency department of Imam Khomeini Hospital, Ahvaz, Iran with trauma to the upper and lower extremities, from September 2014 through October 2015. In all patients, first ultrasound and then standard plain radiography for the upper and lower limb was performed. Data were analyzed by SPSS version 21 to determine the specificity and sensitivity. The mean age of patients with upper and lower limb trauma were 31.43±12.32 years and 29.63±5.89 years, respectively. Radius fracture was the most frequent compared to other fractures (27%). Sensitivity, specificity, positive predicted value, and negative predicted value of ultrasound compared with plain radiography in the diagnosis of upper extremity long bones were 95.3%, 87.7%, 87.2% and 96.2%, respectively, and the highest accuracy was observed in left arm fractures (100%). Tibia and fibula fractures were the most frequent types compared to other fractures (89.2%). Sensitivity, specificity, PPV and NPV of ultrasound compared with plain radiography in the diagnosis of upper extremity long bone fractures were 98.6%, 83%, 65.4% and 87.1%, respectively, and the highest accuracy was observed in men, lower ages and femoral fractures. The results of this study showed that ultrasound compared with plain radiography has a high accuracy in the diagnosis of upper and lower extremity long bone fractures.

Striving for Normalcy after Lower Extremity Reconstruction with Free Tissue: The Role of Secondary Esthetic Refinements.

PubMed

Nelson, Jonas A; Fischer, John P; Haddock, Nicholas T; Mackay, Duncan; Wink, Jason D; Newman, Andrew S; Levin, L Scott; Kovach, Stephen J

2016-02-01

Many patients with successful lower extremity salvage have postoperative functional and esthetic concerns. Such concerns range from contour irregularity preventing proper shoe-fitting to esthetic concerns involving color, contour, and texture match. The purpose of this study is to determine the overall incidence as well as factors associated with an increased likelihood of undergoing secondary, esthetic refinements of lower extremity free flaps and to review current revision techniques. All patients undergoing lower extremity soft tissue coverage for limb salvage procedures between January 2007 and June 2013 at a single institution were included in the analysis. Patients who underwent secondary refinements for lower extremity free flaps were compared with patients not undergoing secondary procedures. During the study period, 152 patients underwent reconstruction and were eligible for inclusion. Of these, 32 (21.1%) patients underwent secondary, esthetic revisions. Few differences in patient or case characteristics were noted, although revision patients trended toward being younger, having lower body mass index, with defects secondary to acute trauma located below the ankle. The most common revision was complex soft tissue rearrangement or surgical flap debulking/direct excision (87.5% of patients), followed by scar revision (12.5%), suction-assisted lipectomy (3.1%), laser scar revision (3.1%), and tissue expansion with local tissue rearrangement (3.1%). A significant portion of patients desire secondary revisions following the initial procedure. This is especially true of younger patients with below ankle reconstruction. In many patients, an esthetic consideration should not be of secondary concern, but should be part of the ultimate reconstructive algorithm for lower extremity limb salvage. Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.

Physical Exam Risk Factors for Lower Extremity Injury in High School Athletes: A Systematic Review

PubMed Central

Onate, James A.; Everhart, Joshua S.; Clifton, Daniel R.; Best, Thomas M.; Borchers, James R.; Chaudhari, Ajit M.W.

2016-01-01

Objective A stated goal of the preparticipation physical evaluation (PPE) is to reduce musculoskeletal injury, yet the musculoskeletal portion of the PPE is reportedly of questionable use in assessing lower extremity injury risk in high school-aged athletes. The objectives of this study are: (1) identify clinical assessment tools demonstrated to effectively determine lower extremity injury risk in a prospective setting, and (2) critically assess the methodological quality of prospective lower extremity risk assessment studies that use these tools. Data Sources A systematic search was performed in PubMed, CINAHL, UptoDate, Google Scholar, Cochrane Reviews, and SportDiscus. Inclusion criteria were prospective injury risk assessment studies involving athletes primarily ages 13 to 19 that used screening methods that did not require highly specialized equipment. Methodological quality was evaluated with a modified physiotherapy evidence database (PEDro) scale. Main Results Nine studies were included. The mean modified PEDro score was 6.0/10 (SD, 1.5). Multidirectional balance (odds ratio [OR], 3.0; CI, 1.5–6.1; P < 0.05) and physical maturation status (P < 0.05) were predictive of overall injury risk, knee hyperextension was predictive of anterior cruciate ligament injury (OR, 5.0; CI, 1.2–18.4; P < 0.05), hip external: internal rotator strength ratio of patellofemoral pain syndrome (P = 0.02), and foot posture index of ankle sprain (r = −0.339, P = 0.008). Conclusions Minimal prospective evidence supports or refutes the use of the functional musculoskeletal exam portion of the current PPE to assess lower extremity injury risk in high school athletes. Limited evidence does support inclusion of multidirectional balance assessment and physical maturation status in a musculoskeletal exam as both are generalizable risk factors for lower extremity injury. PMID:26978166

Repeatability of Non–Contrast-Enhanced Lower-Extremity Angiography Using the Flow-Spoiled Fresh Blood Imaging

PubMed Central

Zhang, Yuyang; Xing, Zhen; She, Dejun; Huang, Nan; Cao, Dairong

2018-01-01

Purpose The aim of this study was to prospectively evaluate the repeatability of non–contrast-enhanced lower-extremity magnetic resonance angiography using the flow-spoiled fresh blood imaging (FS-FBI). Methods Forty-three healthy volunteers and 15 patients with lower-extremity arterial stenosis were recruited in this study and were examined by FS-FBI. Digital subtraction angiography was performed within a week after the FS-FBI in the patient group. Repeatability was assessed by the following parameters: grading of image quality, diameter and area of major arteries, and grading of stenosis of lower-extremity arteries. Two experienced radiologists blinded for patient data independently evaluated the FS-FBI and digital subtraction angiography images. Intraclass correlation coefficients (ICCs), sensitivity, and specificity were used for statistical analysis. Results The grading of image quality of most data was satisfactory. The ICCs for the first and second measures were 0.792 and 0.884 in the femoral segment and 0.803 and 0.796 in the tibiofibular segment for healthy volunteer group, 0.873 and 1.000 in the femoral segment, and 0.737 and 0.737 in the tibiofibular segment for the patient group. Intraobserver and interobserver agreements on diameter and area of arteries were excellent, with ICCs mostly greater than 0.75 in the volunteer group. For stenosis grading analysis, intraobserver ICCs range from 0.784 to 0.862 and from 0.778 to 0.854, respectively. Flow-spoiled fresh blood imaging yielded a mean sensitivity and specificity to detect arterial stenosis or occlusion of 90% and 80% for femoral segment and 86.7% and 93.3% for tibiofibular segment at least. Conclusions Lower-extremity angiography with FS-FBI is a reliable and reproducible screening tool for lower-extremity atherosclerotic disease, especially for patients with impaired renal function. PMID:28787351

Repeatability of Non-Contrast-Enhanced Lower-Extremity Angiography Using the Flow-Spoiled Fresh Blood Imaging.

PubMed

Zhang, Yuyang; Xing, Zhen; She, Dejun; Huang, Nan; Cao, Dairong

The aim of this study was to prospectively evaluate the repeatability of non-contrast-enhanced lower-extremity magnetic resonance angiography using the flow-spoiled fresh blood imaging (FS-FBI). Forty-three healthy volunteers and 15 patients with lower-extremity arterial stenosis were recruited in this study and were examined by FS-FBI. Digital subtraction angiography was performed within a week after the FS-FBI in the patient group. Repeatability was assessed by the following parameters: grading of image quality, diameter and area of major arteries, and grading of stenosis of lower-extremity arteries. Two experienced radiologists blinded for patient data independently evaluated the FS-FBI and digital subtraction angiography images. Intraclass correlation coefficients (ICCs), sensitivity, and specificity were used for statistical analysis. The grading of image quality of most data was satisfactory. The ICCs for the first and second measures were 0.792 and 0.884 in the femoral segment and 0.803 and 0.796 in the tibiofibular segment for healthy volunteer group, 0.873 and 1.000 in the femoral segment, and 0.737 and 0.737 in the tibiofibular segment for the patient group. Intraobserver and interobserver agreements on diameter and area of arteries were excellent, with ICCs mostly greater than 0.75 in the volunteer group. For stenosis grading analysis, intraobserver ICCs range from 0.784 to 0.862 and from 0.778 to 0.854, respectively. Flow-spoiled fresh blood imaging yielded a mean sensitivity and specificity to detect arterial stenosis or occlusion of 90% and 80% for femoral segment and 86.7% and 93.3% for tibiofibular segment at least. Lower-extremity angiography with FS-FBI is a reliable and reproducible screening tool for lower-extremity atherosclerotic disease, especially for patients with impaired renal function.

Fatigue influences lower extremity angular velocities during a single-leg drop vertical jump.

PubMed

Tamura, Akihiro; Akasaka, Kiyokazu; Otsudo, Takahiro; Shiozawa, Junya; Toda, Yuka; Yamada, Kaori

2017-03-01

[Purpose] Fatigue alters lower extremity landing strategies and decreases the ability to attenuate impact during landing. The purpose of this study was to reveal the influence of fatigue on dynamic alignment and joint angular velocities in the lower extremities during a single leg landing. [Subjects and Methods] The 34 female college students were randomly assigned to either the fatigue or control group. The fatigue group performed single-leg drop vertical jumps before, and after, the fatigue protocol, which was performed using a bike ergometer. Lower extremity kinematic data were acquired using a three-dimensional motion analysis system. The ratio of each variable (%), for the pre-fatigue to post-fatigue protocols, were calculated to compare differences between each group. [Results] Peak hip and knee flexion angular velocities increased significantly in the fatigue group compared with the control group. Furthermore, hip flexion angular velocity increased significantly between each group at 40 milliseconds after initial ground contact. [Conclusion] Fatigue reduced the ability to attenuate impact by increasing angular velocities in the direction of hip and knee flexion during landings. These findings indicate a requirement to evaluate movement quality over time by measuring hip and knee flexion angular velocities in landings during fatigue conditions.

Training Shoes do not Decrease the Negative Work of the Lower Extremity Joints.

PubMed

Hashizume, Satoru; Murai, Akihiko; Hobara, Hiroaki; Kobayashi, Yoshiyuki; Tada, Mitsunori; Mochimaru, Masaaki

2017-11-01

Different types of running shoes may have different influence on the negative work of each lower extremity joint. Clarifying this influence can reduce the potential risk of muscle injury. The present study examined the difference in the negative work and associated kinetic and kinematic parameters of the lower extremity joints between training shoes and racing flats during the contact phase of running. Participants were asked to run on a runway at a speed of 3.0 m·s -1 for both training shoes and racing flats. The negative work and associated kinetic and kinematic parameters of each lower extremity joint were calculated. No difference was found in the negative work of the hip and ankle joints between the two types of running shoes. Meanwhile, the negative work of the knee joint was significantly greater for training shoes than for racing flats. This aspect was related to a longer duration of the negative power of the knee joint with the invariant amplitude of the negative power, moment, and angular velocity. These results suggest a higher potential risk of muscle injury around the knee joint for training shoes than for racing flats. © Georg Thieme Verlag KG Stuttgart · New York.

Lower extremity functional tests and risk of injury in division iii collegiate athletes.

PubMed

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

2013-06-01

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. 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. 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. 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. The single-leg hop for distance and the lower extremity functional test, when administered to Division III

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.

Thiazide use is associated with reduced risk for incident lower extremity fractures in men with spinal cord injury.

PubMed

Carbone, Laura D; Chin, Amy S; Lee, Todd A; Burns, Stephen P; Svircev, Jelena N; Hoenig, Helen M; Bailey, Lauren; Weaver, Frances M

2014-06-01

To determine the association between thiazide use and lower extremity fractures in patients who are men with a spinal cord injury (SCI). Cohort study from fiscal years 2002 to 2007. Medical centers. Men (N=6969) with an SCI from the Veterans Affairs (VA) Spinal Cord Dysfunction (SCD) Registry, including 1433 users of thiazides and 5536 nonusers of thiazides. Thiazide use versus nonuse. Incident lower extremity fractures. Among the men, 21% in the VA SCD Registry (fiscal years 2002-2007) included in these analyses used thiazide diuretics. There were 832 incident lower extremity fractures over the time period of this study: 110 fractures (7.7%) in 1433 thiazide users and 722 fractures (13%) in 5536 nonusers of thiazides. In unadjusted and adjusted models alike, thiazide use was associated with at least a one-quarter risk reduction in lower extremity fracture at any given point in time (unadjusted: hazard ratio (HR)=.75; 95% confidence interval (CI), .59-.94; adjusted: HR=.74; 95% CI, .58-.95). Thiazide use is common in men with SCI and is associated with a decreased likelihood for lower extremity fractures. Copyright © 2014 American Congress of Rehabilitation Medicine. Published by Elsevier Inc. All rights reserved.

Intrarater reliability of hand held dynamometry in measuring lower extremity isometric strength using a portable stabilization device.

PubMed

Jackson, Steven M; Cheng, M Samuel; Smith, A Russell; Kolber, Morey J

2017-02-01

Hand held dynamometry (HHD) is a more objective way to quantify muscle force production (MP) compared to traditional manual muscle testing. HHD reliability can be negatively impacted by both the strength of the tester and the subject particularly in the lower extremities due to larger muscle groups. The primary aim of this investigation was to assess intrarater reliability of HHD with use of a portable stabilization device for lower extremity MP in an athletic population. Isometric lower extremity strength was measured for bilateral lower extremities including hip abductors, external rotators, adductors, knee extensors, and ankle plantar flexors was measured in a sample of healthy recreational runners (8 male, 7 females, = 30 limbs) training for a marathon. These measurements were assessed using an intrasession intrarater reliability design. Intraclass correlation coefficients (ICC) were calculated using 3,1 model based on the single rater design. The standard error of measurement (SEM) for each muscle group was also calculated. ICC were excellent ranging from ICC (3,1) = 0.93-0.98 with standard error of measurements ranging from 0.58 to 17.2 N. This study establishes the use of a HHD with a portable stabilization device as demonstrating good reliability within testers for measuring lower extremity muscle performance in an active healthy population. Copyright © 2016 Elsevier Ltd. All rights reserved.

Neuro-musculoskeletal and performance adaptations to lower-extremity plyometric training.

PubMed

Markovic, Goran; Mikulic, Pavle

2010-10-01

Plyometric training (PLY) is a very popular form of physical conditioning of healthy individuals that has been extensively studied over the last 3 decades. In this article, we critically review the available literature related to lower-body PLY and its effects on human neural and musculoskeletal systems, athletic performance and injury prevention. We also considered studies that combined lower-body PLY with other popular training modalities, as well as studies that applied PLY on non-rigid surfaces. The available evidence suggests that PLY, either alone or in combination with other typical training modalities, elicits numerous positive changes in the neural and musculoskeletal systems, muscle function and athletic performance of healthy individuals. Specifically, the studies have shown that long-term PLY (i.e. 3-5 sessions a week for 5-12 months) represents an effective training method for enhancing bone mass in prepubertal/early pubertal children, young women and premenopausal women. Furthermore, short-term PLY (i.e. 2-3 sessions a week for 6-15 weeks) can change the stiffness of various elastic components of the muscle-tendon complex of plantar flexors in both athletes and non-athletes. Short-term PLY also improves the lower-extremity strength, power and stretch-shortening cycle (SSC) muscle function in healthy individuals. These adaptive changes in neuromuscular function are likely the result of (i) an increased neural drive to the agonist muscles; (ii) changes in the muscle activation strategies (i.e. improved intermuscular coordination); (iii) changes in the mechanical characteristics of the muscle-tendon complex of plantar flexors; (iv) changes in muscle size and/or architecture; and (v) changes in single-fibre mechanics. Our results also show that PLY, either alone or in combination with other training modalities, has the potential to (i) enhance a wide range of athletic performance (i.e. jumping, sprinting, agility and endurance performance) in children and

Lower extremity soft tissue reconstruction with free flap based on subscapular artery.

PubMed

Karşıdağ, Semra; Akçal, Arzu; Turgut, Gürsel; Uğurlu, Kemal; Baş, Lütfü

2011-01-01

The purpose of our study was to evaluate the results of the reconstruction of the lower extremity defects with free flaps based on the subscapular artery. Between January, 1998 and December, 2008, 51 patients (mean age 26 years; 16 female and 35 male) presenting with a lower extremity defect underwent a reconstructive surgery with flaps based on the subscapular vascular system. Thirty-seven percent of the defects were located in the crus, 19% in the sole, 16% in the heel, and 14% in the dorsum of the foot. Eighty and a half percent of the patients had traffic-accident-related and 13.5% had burn-related tissue defects. Fifty-three percent of the patients presenting with lower extremity defects underwent reconstruction with latissimus dorsi muscle flaps, 21% with free serratus muscle and/or fascia flaps, 14% with free parascapular fasciocutaneous flaps, and 12% with free combined latissimus muscle and serratus muscle and/or fascia flaps. Anastomoses of 80% of the patients were performed on their posterior tibial artery and accompanying veins and/or foot dorsal veins. End-to-end anastomosis was performed on 14 patients, while 35 patients received end-to-side anastomosis. Six patients were treated with cross free flaps, of which 4 received cross latissimus, 1 cross serratus, and 1 cross combined serratus and latissimus flaps. End-to-side anastomoses were performed on these patients on the cross-leg tibialis posterior artery. The cross-leg anastomosis was freed 4 weeks later. In the early period, venous occlusion was observed in 4 patients and arterial and venous occlusion was present in 1 patient. New anastomoses were performed in these patients. Partial necrosis was observed in 2 patients. The average follow-up period was 61 months. Pressure-related late ulcerative lesions developed in 4 patients. The lesions of these patients were repaired by debridement and primary suturing or partial thickness skin grafts. The subscapular vascular system based flaps have an optimal

Gas gangrene without wound: both lower extremities affected simultaneously.

PubMed

Lu, Jun; Wu, Xiao-Tao; Kong, Xiang-Fei; Tang, Wen-Hao; Cheng, Jian-Ming; Wang, Hai-Liang

2008-10-01

Gas gangrene is a necrotizing soft tissue infection characterized by muscular necrosis and gas formation. It develops quickly and can cause septic shock and death. In adults, gas gangrene used to be a well-known complication of war wounds. Recently, cases of spontaneous or nontraumatic gas gangrene have been reported in both adults and children. We report a case of nontraumatic gas gangrene involving both the lower extremities simultaneously. Pathogenesis of this fatal soft tissue infection is discussed.We also review the diagnosis and treatment aspects of this entity.

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.

Analysis of muscle activation in lower extremity for static balance.

PubMed

Chakravarty, Kingshuk; Chatterjee, Debatri; Das, Rajat Kumar; Tripathy, Soumya Ranjan; Sinha, Aniruddha

2017-07-01

Balance plays an important role for human bipedal locomotion. Degeneration of balance control is prominent in stroke patients, elderly adults and even for majority of obese people. Design of personalized balance training program, in order to strengthen muscles, requires the analysis of muscle activation during an activity. In this paper we have proposed an affordable and portable approach to analyze the relationship between the static balance strategy and activation of various lower extremity muscles. To do that we have considered Microsoft Kinect XBox 360 as a motion sensing device and Wii balance board for measuring external force information. For analyzing the muscle activation pattern related to static balance, participants are asked to do the single limb stance (SLS) exercise on the balance board and in front of the Kinect. Static optimization to minimize the overall muscle activation pattern is carried out using OpenSim, which is an open-source musculoskeletal simulation software. The study is done on ten normal and ten obese people, grouped according to body mass index (BMI). Results suggest that the lower extremity muscles like biceps femoris, psoas major, sartorius, iliacus play the major role for both maintaining the balance using one limb as well as maintaining the flexion of the other limb during SLS. Further investigations reveal that the higher muscle activations of the flexed leg for normal group demonstrate higher strength. Moreover, the lower muscle activation of the standing leg for normal group demonstrate more headroom for the biceps femoris-short-head and psoas major to withstand the load and hence have better static balance control.

Total and Lower Extremity Lean Mass Percentage Positively Correlates With Jump Performance.

PubMed

Stephenson, Mitchell L; Smith, Derek T; Heinbaugh, Erika M; Moynes, Rebecca C; Rockey, Shawn S; Thomas, Joi J; Dai, Boyi

2015-08-01

Strength and power have been identified as valuable components in both athletic performance and daily function. A major component of strength and power is the muscle mass, which can be assessed with dual-energy x-ray absorptiometry (DXA). The primary purpose of this study was to quantify the relationship between total body lean mass percentage (TBLM%) and lower extremity lean mass percentage (LELM%) and lower extremity force/power production during a countermovement jump (CMJ) in a general population. Researchers performed a DXA analysis on 40 younger participants aged 18-35 years, 28 middle-aged participants aged 36-55 years, and 34 older participants aged 56-75 years. Participants performed 3 CMJ on force platforms. Correlations revealed significant and strong relationships between TBLM% and LELM% compared with CMJ normalized peak vertical ground reaction force (p < 0.001, r = 0.59), normalized peak vertical power (p < 0.001, r = 0.73), and jump height (p < 0.001, r = 0.74) for the combined age groups. Most relationships were also strong within each age group, with some relationships being relatively weaker in the middle-aged and older groups. Minimal difference was found between correlation coefficients of TBLM% and LELM%. Coefficients of determination were all below 0.6 for the combined group, indicating that between-participant variability in CMJ measures cannot be completely explained by lean mass percentages. The findings have implications in including DXA-assessed lean mass percentage as a component for evaluating lower extremity strength and power. A paired DXA analysis and CMJ jump test may be useful for identifying neuromuscular deficits that limit performance.

Is Knee Separation During a Drop Jump Associated With Lower Extremity Injury in Adolescent Female Soccer Players?

PubMed

O'Kane, John W; Tencer, Allan; Neradilek, Moni; Polissar, Nayak; Sabado, Lori; Schiff, Melissa A

2016-02-01

Knee injuries are common in older adolescent and adult female soccer players, and abnormal valgus knee appearance characterized by low normalized knee separation (NKS) is a proposed injury risk factor. What constitutes normal NKS in younger adolescents and whether low NKS is an injury risk factor are unknown. To determine the normal range of NKS using a drop-jump test in female perimenarchal youth soccer players and whether low NKS contributes to lower extremity injuries or knee injuries. Cohort study; Level of evidence, 2. From 2008 to 2012, a total of 351 female elite youth soccer players (age range, 11-14 years) were followed for 1 season, with complete follow-up on 92.3% of players. Baseline drop-jump testing was performed preseason. Lower extremity injuries during the season were identified using a validated, Internet-based injury surveillance system with weekly email reporting. Normalized knee separation at prelanding, landing, and takeoff was categorized 2 ways: as ≤10th percentile (most extreme valgus appearance) compared with >10th percentile and as a continuous measure of 1 SD. Poisson regression modeling with adjustment for clustering by team estimated the relative risk (RR) and 95% confidence interval (CI) of the association between the NKS and the risk of lower extremity and knee injury, stratified by menarche. Of the study participants, 134 players experienced 173 lower extremity injuries, with 43 (24.9%) knee injuries. For postmenarchal players (n = 210), those with NKS ≤10th percentile were at 92% increased risk of lower extremity injury (RR, 1.92; 95% CI, 1.17-3.15) and a 3.62-fold increased risk of knee injury (RR, 3.62; 95% CI, 1.18-11.09) compared with NKS >10th percentile at prelanding and landing, respectively. Among postmenarchal players, there was an 80% increased risk of knee injury (RR, 1.80; 95% CI, 1.01-3.23) with a decrease of 1 SD in landing NKS and a 66% increased risk of knee injury (RR, 1.66; 95% CI, 1.04-2.64) with a decrease

Physiotherapist agreement when visually rating movement quality during lower extremity functional screening tests.

PubMed

Whatman, Chris; Hing, Wayne; Hume, Patria

2012-05-01

To investigate physiotherapist agreement in rating movement quality during lower extremity functional tests using two visual rating methods and physiotherapists with differing clinical experience. Clinical measurement. Six healthy individuals were rated by 44 physiotherapists. These raters were in three groups (inexperienced, novice, experienced). Video recordings of all six individuals performing four lower extremity functional tests were visually rated (dichotomous or ordinal scale) using two rating methods (overall or segment) on two occasions separated by 3-4 weeks. Intra and inter-rater agreement for physiotherapists was determined using overall percentage agreement (OPA) and the first order agreement coefficient (AC1). Intra-rater agreement for overall and segment methods ranged from slight to almost perfect (OPA: 29-96%, AC1: 0.01 to 0.96). AC1 agreement was better in the experienced group (84-99% likelihood) and for dichotomous rating (97-100% likelihood). Inter-rater agreement ranged from fair to good (OPA: 45-79%; AC1: 0.22-0.71). AC1 agreement was not influenced by clinical experience but was again better using dichotomous rating. Physiotherapists' visual rating of movement quality during lower extremity functional tests resulted in slight to almost perfect intra-rater agreement and fair to good inter-rater agreement. Agreement improved with increased level of clinical experience and use of dichotomous rating. Copyright © 2011 Elsevier Ltd. All rights reserved.

Lower extremity EMG-driven modeling of walking with automated adjustment of musculoskeletal geometry

PubMed Central

Meyer, Andrew J.; Patten, Carolynn

2017-01-01

Neuromusculoskeletal disorders affecting walking ability are often difficult to manage, in part due to limited understanding of how a patient’s lower extremity muscle excitations contribute to the patient’s lower extremity joint moments. To assist in the study of these disorders, researchers have developed electromyography (EMG) driven neuromusculoskeletal models utilizing scaled generic musculoskeletal geometry. While these models can predict individual muscle contributions to lower extremity joint moments during walking, the accuracy of the predictions can be hindered by errors in the scaled geometry. This study presents a novel EMG-driven modeling method that automatically adjusts surrogate representations of the patient’s musculoskeletal geometry to improve prediction of lower extremity joint moments during walking. In addition to commonly adjusted neuromusculoskeletal model parameters, the proposed method adjusts model parameters defining muscle-tendon lengths, velocities, and moment arms. We evaluated our EMG-driven modeling method using data collected from a high-functioning hemiparetic subject walking on an instrumented treadmill at speeds ranging from 0.4 to 0.8 m/s. EMG-driven model parameter values were calibrated to match inverse dynamic moments for five degrees of freedom in each leg while keeping musculoskeletal geometry close to that of an initial scaled musculoskeletal model. We found that our EMG-driven modeling method incorporating automated adjustment of musculoskeletal geometry predicted net joint moments during walking more accurately than did the same method without geometric adjustments. Geometric adjustments improved moment prediction errors by 25% on average and up to 52%, with the largest improvements occurring at the hip. Predicted adjustments to musculoskeletal geometry were comparable to errors reported in the literature between scaled generic geometric models and measurements made from imaging data. Our results demonstrate that

Do small changes in rotation affect measurements of lower extremity limb alignment?

PubMed

Jamali, Amir A; Meehan, John P; Moroski, Nathan M; Anderson, Matthew J; Lamba, Ramit; Parise, Carol

2017-05-22

The alignment of the lower extremity has important implications in the development of knee arthritis. The effect of incremental rotations of the limb on common parameters of alignment has not been studied. The purpose of the study was to (1) determine the standardized neutral position measurements of alignment and (2) determine the effect of rotation on commonly used measurements of alignment. Eighty-seven full length CT angiography studies (49 males and 38 females, average age 66 years old) were included. Three-dimensional models were created using a rendering software program and placed on a virtual plane. An image of the extremity was obtained. Thirty scans were randomly selected, and those models were rotated in 3° intervals around the longitudinal axis and additional images were obtained. In the neutral position, the mechanical lateral distal femoral articular angle (mLDFA) was 85.6 ± 2.3°, medial proximal tibial angle (MPTA) was 86.1 ± 2.8°, and mechanical tibiofemoral angle (mTFA) was -0.7 ± 3.1°. Females had a more valgus alignment with a mTFA of 0.5 ± 2.9° while males had a more varus alignment with a mTFA of -1.7 ± 2.9°. The anatomic tibiofemoral angle (aTFA) was 4.8 ± 2.6°, the anatomic lateral distal femoral angle (aLDFA) measured 80.2 ± 2.2°, and the anatomical-mechanical angle (AMA) was 5.4 ± 0.7°. The prevalence of constitutional varus was 18%. The effect of rotation on the rotated scans led to statistically significant differences relative to the 0° measurement for all measurements. These effects may be small, and their clinical importance is unknown. This study provides new information on standardized measures of lower extremity alignment and the relationship between discreet axial rotations of the entire lower extremity and these parameters.

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

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.

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

Lower-extremity function in cognitively healthy aging, mild cognitive impairment, and Alzheimer's disease.

PubMed

Eggermont, Laura H; Gavett, Brandon E; Volkers, Karin M; Blankevoort, Christiaan G; Scherder, Erik J; Jefferson, Angela L; Steinberg, Eric; Nair, Anil; Green, Robert C; Stern, Robert A

2010-04-01

To examine differences in lower-extremity function in cognitive healthy older persons, older persons with mild cognitive impairment (MCI), and older persons with Alzheimer's disease (AD). Descriptive study. University Alzheimer's disease clinical and research program. Older persons (N=66) were studied (mean age, 76.7y); 22 were cognitively normal, 22 were diagnosed with probable MCI, 22 were diagnosed with probable AD. Not applicable. Lower-extremity function was assessed by the four-meter walk test (4MWT), Timed Up & Go (TUG) test, and sit-to-stand (STS) test. Analysis of variance, adjusting for covariates, revealed that performance on the 4MWT was significantly lower in the MCI and AD groups as compared with controls. TUG test performance was worse in the AD group compared with controls. No significant group differences were found for STS performance. These results suggest an association between cognitive impairment and lower-limb function in older persons. Walking speed could be evaluated for its possible utility in screening older persons at risk for cognitive impairment and falls. Copyright 2010 American Congress of Rehabilitation Medicine. Published by Elsevier Inc. All rights reserved.

Diagnosis and Treatment of Lower Extremity Deep Vein Thrombosis: Korean Practice Guidelines

PubMed Central

Min, Seung-Kee; Kim, Young Hwan; Joh, Jin Hyun; Kang, Jin Mo; Park, Ui Jun; Kim, Hyung-Kee; Chang, Jeong-Hwan; Park, Sang Jun; Kim, Jang Yong; Bae, Jae Ik; Choi, Sun Young; Kim, Chang Won; Park, Sung Il; Yim, Nam Yeol; Jeon, Yong Sun; Yoon, Hyun-Ki; Park, Ki Hyuk

2016-01-01

Lower extremity deep vein thrombosis is a serious medical condition that can result in death or major disability due to pulmonary embolism or post-thrombotic syndrome. Appropriate diagnosis and treatment are required to improve symptoms and salvage the affected limb. Early thrombus clearance rapidly resolves symptoms related to venous obstruction, restores valve function and reduces the incidence of post-thrombotic syndrome. Recently, endovascular treatment has been established as a standard method for early thrombus removal. However, there are a variety of views regarding the indications and procedures among medical institutions and operators. Therefore, we intend to provide evidence-based guidelines for diagnosis and treatment of lower extremity deep vein thrombosis by multidisciplinary consensus. These guidelines are the result of a close collaboration between interventional radiologists and vascular surgeons. The goals of these guidelines are to improve treatment, to serve as a guide to the clinician, and consequently to contribute to public health care. PMID:27699156

Risk Factors for Lower Extremity Tendinopathies in Military Personnel

PubMed Central

Owens, Brett D.; Wolf, Jennifer Moriatis; Seelig, Amber D.; Jacobson, Isabel G.; Boyko, Edward J.; Smith, Besa; Ryan, Margaret A.K.; Gackstetter, Gary D.; Smith, Tyler C.; Bagnell, Melissa

2013-01-01

Background: Overuse injuries have a significant impact on United States military service members, but research to date has been limited in its ability to assess occupational and behavioral risk factors. Hypothesis/Purpose: To prospectively identify risk factors for the development of lower extremity tendinopathy and plantar fasciitis in United States military personnel. Study Design: Descriptive epidemiology study. Methods: Baseline data from the Millennium Cohort Study, a long-term observational cohort of military personnel, were utilized. Service members were enrolled in the cohort in 2001, 2004, and 2007. A total of 80,106 active-duty personnel were followed over 1 year for the development of patellar tendinopathy, Achilles tendinopathy, and plantar fasciitis. Regression analyses were used to estimate significant associations between each tendinopathy, plantar fasciitis, and demographic, behavioral, and occupational characteristics. Results: Using medical records, 450 cases of Achilles tendinitis, 584 cases of patellar tendinopathy, and 1228 cases of plantar fasciitis were identified. Recent deployment was associated with an increased risk for developing plantar fasciitis (adjusted odds ratio [AOR], 1.27; 95% confidence interval [CI], 1.04-1.56). Moderate weekly alcohol consumption was marginally associated with an increased risk for Achilles tendinopathy (AOR, 1.33; 95% CI, 1.00-1.76). Overweight or obese individuals were more likely to develop Achilles tendinopathy and plantar fasciitis. Conclusion: Lower extremity tendinopathies and plantar fasciitis are common among military service members, and this study identified several modifiable risk factors for their occurrence. These potential risk factors could serve as the focus for future preventive and intervention studies. PMID:26535232

Sensory Feedback for Lower Extremity Prostheses Incorporating Targeted Muscle Reinnervation (TMR)

DTIC Science & Technology

2017-10-01

hour per response, including the time for reviewing instructions, searching existing data sources, gathering and maintaining the data needed, and...map and characterize the sensory capabilities of lower extremity Targeted Reinnervation (TR) sites under tactile stimulation , and (2) Measure the...descent machine; developed new tactile stimulators that we expect to use in later stages of this project; and completed baseline studies to calibrate

Comparison of tensiomyographic neuromuscular characteristics between muscles of the dominant and non-dominant lower extremity in male soccer players.

PubMed

Alvarez-Diaz, Pedro; Alentorn-Geli, Eduard; Ramon, Silvia; Marin, Miguel; Steinbacher, Gilbert; Rius, Marta; Seijas, Roberto; Ballester, Jordi; Cugat, Ramon

2016-07-01

Tensiomyography (TMG) has been used to assess neuromuscular characteristics of muscles of the lower extremity in soccer players. However, the effects of lower extremity dominance on TMG characteristics in this population have not been reported to date. The purpose of this study was to compare the TMG neuromuscular characteristics between the dominant and non-dominant lower extremity in male soccer players. Thirty-eight consecutive healthy male soccer players underwent resting TMG assessment of vastus medialis (VM), vastus lateralis (VL), rectus femoris (RF), semitendinosus (ST), biceps femoris (BF), gastrocnemius medialis (GM), and gastrocnemius lateralis (GL) in both lower extremities. The maximal displacement, delay time, contraction time, sustained time, and half-relaxation time were obtained and compared between both sides. There were no significant differences in the vast majority of the TMG parameters between both lower extremities. The dominant side demonstrated higher VM contraction time (p = 0.008), RF sustained time (p = 0.009), RF half-relaxation time (p = 0.01), and BF sustained time (p = 0.04), but lower VL contraction time (p = 0.03) and VL delay time (p = 0.02) compared to the non-dominant side. In general, TMG-assessed neuromuscular characteristics of the VM, VL, RF, ST, BF, GM, and GL were not affected by lower extremity dominance in male soccer players. Therefore, there is no need to assess both sides when using TMG to monitor the response to training or muscles at risk of injury in soccer players unless there is a specific reason. Prognostic study, Level II.

A comprehensive scoring system to evaluate patient-centred risk factors regarding lower extremity amputation.

PubMed

Miller, M S; Newgent, E W; O'Connell, S M; Broadus, C

2017-10-01

Care of the patient with a presumed life- or limb-threatening lower extremity wound poses many challenges. The mindset regarding potential outcomes of such conditions is mostly driven by the experiences and expertise of those providing the care. This mindset generally appears as two primary actions presented to the afflicted patient: attempted resolution of the problem via medical, surgical or combination treatment, with the hope of low recurrence risk, or exacerbation and amputation-amputations at a level sufficient to, at least in the mind of the surgeon, eliminate the problem. Achieving the former outcome is dependent on a number of factors associated with both patient and caregiver. If healing is achieved, the secondary goal of prevention of recurrence may be no less arduous, with failure most likely resulting in amputation. Clearly, these considerations appear to be based more on the health professionals perception, of the patient's physical and medical status rather than on patient-centred considerations. This article will review considerations and recommendations for lower extremity amputation, and the short- and long-term implications. Based on our research, there is clear need for a set of criteria against which to weigh not just the medical issues, but also definitive patient-centred issues when considering a lower extremity amputation. We offer a set of patient-centred, easily verified and recognised criteria that we believe addresses this need. The goal of the Miller-Newgent Amputation Scale (MENACE) is to provide a decision base from which to consider and evaluate all factors in determining the need for a lower extremity amputation. This involves identification of patient-centred issues, which are likely to produce satisfactory short- and long-term physical and quality-of-life outcomes if the amputation does proceed.

Multistep Approach for Improved Aesthetic and Functional Outcomes for Lower Extremity Wound Closure After Mohs Micrographic Surgery.

PubMed

Kiwanuka, Elizabeth; Cruz, Antonio P

2017-05-01

Lower extremity wounds present a major clinical challenge. This paper introduces a new multistep approach for improved aesthetic and functional outcome for lower extremity wound closure after Mohs micrographic surgery. In this prospective case series, 12 consecutive patients undergoing Mohs micrographic surgery for cutaneous malignancies of the lower extremities underwent closure assisted by elastic bandages, proper positioning with 45° flexion of the knee, buried vertical mattress sutures, and careful eversion, using a premium angled stapler. Assessment of cosmetic outcome was performed by 2 blinded observers, using the Hollander Wound Evaluation Scale. The mean age was 73 ± 9 years with most patients having at least one comorbidity. Six patients (50%) underwent resection of a basal cell carcinoma and 5 patients (42%) underwent resection of a squamous cell carcinoma and 1 patient (8%) underwent resection of a keratoacanthomatous carcinoma. There were no wound complications, and at the 3- to 6-month follow-up, 11 of the 12 wounds (92%) had an optimal Hollander Wound Evaluation Scale score of 6. This new approach to lower extremity wounds provides excellent cosmetic outcome with no reported complications.

Crash analysis of lower extremity injuries in children restrained in forward-facing car seats during front and rear impacts.

PubMed

Bennett, Tellen D; Kaufman, Robert; Schiff, Melissa; Mock, Charles; Quan, Linda

2006-09-01

The mechanism, crash characteristics, and spectrum of lower extremity injuries in children restrained in forward-facing car seats during front and rear impacts have not been described. We identified in two databases children who sustained lower extremity injuries while restrained in forward-facing car seats. To identify the mechanism, we analyzed crash reconstructions from three frontal-impact cases from the Crash Injury Research and Engineering Network. To further describe the crash and injury characteristics we evaluated children between 1 and 4 years of age with lower extremity injuries from front or rear impacts in the National Automotive Sampling System (NASS) Crashworthiness Data System (CDS) database. Crash reconstruction data demonstrated that the likely mechanism of lower extremity injury was contact between the legs and the front seatbacks. In the CDS database, we identified 15 children with lower extremity injuries in a forward-facing child seat, usually (13 out of 15) placed in the rear seat, incurred in frontal impacts (11 out of 15). Several (5 out of 15) children were in unbelted or improperly secured forward-facing car seats. Injury Severity Scores varied widely (5-50). Children in forward-facing car seats involved in severe front or rear crashes may incur a range of lower extremity injury from impact with the car interior component in front of them. Crash scene photography can provide useful information about anatomic sites at risk for injury and alert emergency department providers to possible subtle injury.

Male and female gluteal muscle activity and lower extremity kinematics during running.

PubMed

Willson, John D; Petrowitz, Isaac; Butler, Robert J; Kernozek, Thomas W

2012-12-01

Patellofemoral pain is one of the most common lower extremity overuse injuries in runners and is significantly more common in females. This study evaluated differences in the timing and magnitude of gluteal muscle activity as well as hip and knee joint frontal and transverse plane kinematics between male and female runners in the context of this gender bias. Twenty healthy male and 20 healthy female runners were participants. Three-dimensional lower extremity kinematics, and gluteus medius and gluteus maximus muscle activation were recorded using motion analysis and electromyography as subjects ran at 3.7 m/s (+/-5%). Comparisons of hip and knee joint kinematic and gluteus muscle activation data were made using independent t-tests (α=0.05). Females ran with 40% greater peak gluteus maximus activation level (P=0.028, effect size=0.79) and 53% greater average activation level (P=0.013, effect size=0.93) than males. Female runners also displayed greater hip adduction (P=.001, effect size=1.20) and knee abduction (P=0.011, effect size=0.87) angles at initial contact, greater hip adduction at peak vertical ground reaction force (P<0.001, effect size=1.31), and less knee internal rotation excursion than males (P=0.035, effect size=0.71). Greater gluteus maximus activation levels during running may predispose females to earlier gluteus maximus fatigue, promoting altered lower extremity running kinematics thought to be associated with the etiology of patellofemoral pain. Gender differences in transverse and frontal plane hip and knee kinematics observed in this study may also contribute to the gender bias for patellofemoral pain among females. Copyright © 2012 Elsevier Ltd. All rights reserved.

Lower extremity kinetics in tap dance.

PubMed

Mayers, Lester; Bronner, Shaw; Agraharasamakulam, Sujani; Ojofeitimi, Sheyi

2010-01-01

Tap dance is a unique performing art utilizing the lower extremities as percussion instruments. In a previous study these authors reported decreased injury prevalence among tap dancers compared to other dance and sports participants. No biomechanical analyses of tap dance exist to explain this finding. The purpose of the current pilot study was to provide a preliminary overview of normative peak kinetic and kinematic data, based on the hypothesis that tap dance generates relatively low ground reaction forces and joint forces and moments. Six professional tap dancers performed four common tap dance sequences that produced data captured by the use of a force platform and a five-camera motion analysis system. The mean vertical ground reaction force for all sequences was found to be 2.06+/-0.55 BW. Mean peak sagittal, frontal, and transverse plane joint moments (hip, knee, and ankle) ranged from 0.07 to 2.62 N.m/kg. These small ground reaction forces and joint forces and moments support our hypothesis, and may explain the relatively low injury incidence in tap dancers. Nevertheless, the analysis is highly complex, and other factors remain to be studied and clarified.

Are maturation, growth and lower extremity alignment associated with overuse injury in elite adolescent ballet dancers?

PubMed

Bowerman, Erin; Whatman, Chris; Harris, Nigel; Bradshaw, Elizabeth; Karin, Janet

2014-11-01

To identify growth, maturation and biomechanical risk factors for overuse injury in elite adolescent ballet dancers. Maturation (Tanner scale), growth (foot length change) and age at onset of menarche were recorded in elite adolescent ballet dancers. A modified knee valgus angle and lateral tilt of the pelvis were measured using 2D video during two dance movements (fondu, temps levé) to quantify lower extremity alignment. Overuse dance injuries were recorded by a physiotherapist. The injury rate ratio (RR) associated with each variable was estimated using over-dispersed Poisson regression modelling. Changes in right foot length (RR = 1.41, CI = 0.93-2.13), right knee angles during the fondu (RR = 0.68, CI = 0.45-1.03) and temps levé (RR = 0.72, CI = 0.53-0.98), and pelvic angles during the temps levé on the left (RR = 0.52, CI = 0.30-0.90) and fondu on the right (RR = 1.28, CI = 0.91-1.80) were associated with substantial changes in injury risk. Rate of growth in elite adolescent ballet dancers is likely associated with an increase in risk of lower extremity overuse injury and better right lower extremity alignment is likely associated with a reduction in risk of right lower extremity overuse injury. Copyright © 2014 Elsevier Ltd. All rights reserved.

Comparison of three-dimensional lower extremity running kinematics of young adult and elderly runners.

PubMed

Fukuchi, Reginaldo K; Duarte, Marcos

2008-11-01

The objective of this study was to compare the three-dimensional lower extremity running kinematics of young adult runners and elderly runners. Seventeen elderly adults (age 67-73 years) and 17 young adults (age 26-36 years) ran at 3.1 m x s(-1) on a treadmill while the movements of the lower extremity during the stance phase were recorded at 120 Hz using three-dimensional video. The three-dimensional kinematics of the lower limb segments and of the ankle and knee joints were determined, and selected variables were calculated to describe the movement. Our results suggest that elderly runners have a different movement pattern of the lower extremity from that of young adults during the stance phase of running. Compared with the young adults, the elderly runners had a substantial decrease in stride length (1.97 vs. 2.23 m; P = 0.01), an increase in stride frequency (1.58 vs. 1.37 Hz; P = 0.002), less knee flexion/extension range of motion (26 vs. 33 degrees ; P = 0.002), less tibial internal/external rotation range of motion (9 vs. 12 degrees ; P < 0.001), larger external rotation angle of the foot segment (toe-out angle) at the heel strike (-5.8 vs. -1.0 degrees ; P = 0.009), and greater asynchronies between the ankle and knee movements during running. These results may help to explain why elderly individuals could be more susceptible to running-related injuries.

[Rehabilitation of the patients following the endoprosthetic replacement of the joints of the lower extremities].

PubMed

Rud, I M; Melnikova, E A; Rassulova, M A; Razumov, A N; Gorelikov, A E

2017-12-28

The present article is the analytical review of the literature pertaining to the problem of rehabilitation of the patients following the endoprosthetic replacement of joints of the lower extremities. The relevance of the problem of interest for medical rehabilitation is beyond any doubt. The traditional methods for the rehabilitation of the patients do not always lead to the desired results. The authors discuss in detail the need for and the contemporary approaches to the rehabilitation of the patients who had undergone reconstructive surgery and arthroplasty of the joints of the lower extremities. The pathogenetically-based three-stage algorithm for medical rehabilitation is proposed.

Lower extremity mechanics during landing after a volleyball block as a risk factor for anterior cruciate ligament injury.

PubMed

Zahradnik, David; Jandacka, Daniel; Uchytil, Jaroslav; Farana, Roman; Hamill, Joseph

2015-02-01

To compare lower extremity mechanics and energy absorption during two types of landing after a successful or unsuccessful block in volleyball and assess the risks of anterior cruciate ligament (ACL) injury. Cohort study. Fourteen elite male volleyball players (aged 24.5 ± 4.6 years; height 1.94 ± 0.06 m; mass 86.6 ± 7.6 kg). Subjects were required to land on force platforms using stick landing or step-back landing (with the right lower extremity stepping back away from the net) techniques after performing a standing block jump movement. Vertical ground reaction force (body weight); knee flexion (degrees); knee moments (Nm/kg); and hip, knee and ankle energy absorption (J/kg). The right lower extremity showed a greater first peak of vertical ground reaction force, a greater valgus moment, lower energy absorption by the knee, and higher energy absorption by the hip and ankle joints during step-back landing. The lower extremity may be exposed to a greater risk of ACL injury when stepping back from the net during the initial impact phase after a step-back landing. Copyright © 2014 Elsevier Ltd. All rights reserved.

Association between foot type and lower extremity injuries: systematic literature review with meta-analysis.

PubMed

Tong, Jasper W K; Kong, Pui W

2013-10-01

Systematic literature review with meta-analysis. To investigate the association between nonneutral foot types (high arch and flatfoot) and lower extremity and low back injuries, and to identify the most appropriate methods to use for foot classification. A search of 5 electronic databases (PubMed, Embase, CINAHL, SPORTDiscus, and ProQuest Dissertations and Theses), Google Scholar, and the reference lists of included studies was conducted to identify relevant articles. The review included comparative cross-sectional, case-control, and prospective studies that reported qualitative/quantitative associations between foot types and lower extremity and back injuries. Quality of the selected studies was evaluated, and data synthesis for the level of association between foot types and injuries was conducted. A random-effects model was used to pool odds ratio (OR) and standardized mean difference (SMD) results for meta-analysis. Twenty-nine studies were included for meta-analysis. A significant association between nonneutral foot types and lower extremity injuries was determined (OR = 1.23; 95% confidence interval [CI]: 1.11, 1.37; P<.001). Foot posture index (OR = 2.58; 95% CI: 1.33, 5.02; P<.01) and visual/physical examination (OR = 1.17; 95% CI: 1.06, 1.28; P<.01) were 2 assessment methods using distinct foot-type categories that showed a significant association with lower extremity injuries. For foot-assessment methods using a continuous scale, measurements of lateral calcaneal pitch angle (SMD, 1.92; 95% CI: 1.44, 2.39; P<.00001), lateral talocalcaneal angle (SMD, 1.36; 95% CI: 0.93, 1.80; P<.00001), and navicular height (SMD, 0.34; 95% CI: 0.16, 0.52; P<.001) showed significant effect sizes in identifying high-arch foot, whereas the navicular drop test (SMD, 0.45; 95% CI: 0.03, 0.87; P<.05) and relaxed calcaneal stance position (SMD, 0.49; 95% CI: 0.01, 0.97; P<.05) displayed significant effect sizes in identifying flatfoot. Subgroup analyses revealed no significant

Comparison of imaging value for diabetic lower extremity arterial disease between FBI and CE-MRA.

PubMed

Yi, C-Y; Zhou, D-X; Li, H-H; Wang, Y; Chen, K; Chen, J; Huang, B-C; Xu, X-L

2016-07-01

This study adopted self-control study method to assess the efficacy of fresh blood imaging (FBI) and contrast-enhanced MR angiography (CE-MRA) for patients with diabetic lower extremity arterial disease (DLEAD) (Fontaine stage I to IV), and to evaluate the imaging of lower extremity peripheral arterial disease (PAD) in different stages of diabetes mellitus (DM). 1. This study recruited 44 diabetic patients with suspected lower extremity PAD to take both FBI and CE-MRA. 2. Two experienced cardiovascular radiologists assessed the image quality, the detection of lower extremity arterial branches, and tissue contamination (veins, arteries, and soft tissues) of FBI and CE-MRA, as well as the presence and severity of stenotic lesions. 3. Statistical differences of the quality of FBI and CE-MRA were determined using paired t-test. 4. Correlation analysis was adopted for determining the direction and strength of the relationship between the changes of the indexes of FBI and the different Fontaine stages. 1. The quality evaluation results of the image of lower extremity arteries from the 44 diabetic patients indicated no statistically significant difference between FBI and CE-MRA in the patients with Fontaine stage I-III (p >0.05). However, a statistically significant difference was observed in the patients with Fontaine stage IV (p <0.05), and the quality of FBI was slightly worse. 2. Arterial branches that observed from FBI and CE-MRA were 885 and 904, respectively. There was no statistically significant difference for the arterial branches between FBI and CE-MRA in the patients with Fontaine stage I-III (p >0.05). However, a statistically significant difference was observed in the patients with Fontaine stage IV (p <0.05), and CE-MRA indicated more artery branches than FBI. 3. There was a statistically significant difference for the evaluation of venous contamination between FBI and CE-MRA (p <0.05), and there was less venous contamination using FBI. 4. The study results

Hereditary sensory ataxic neuropathy associated with proximal muscle weakness in the lower extremities.

PubMed

Murakami, Tatsufumi; Fukai, Yuta; Rikimaru, Mitsue; Henmi, Shoji; Ohsawa, Yutaka; Sunada, Yoshihide

2010-04-15

We describe three patients from the same family with hereditary sensory ataxic neuropathy followed by proximal muscle weakness in the lower extremities. Sensory ataxic gait began as an initial symptom when patients were in their 50s. Mild proximal weakness in the lower extremities appeared several years later. Serum creatine kinase was mildly elevated. Nerve conduction studies revealed sensory dominant axonal neuropathy, and short sensory evoked potentials showed involvement of the sensory nerve axon, dorsal root ganglia and posterior funiculus of the spinal cord. Needle electromyography showed fibrillation, positive sharp waves, and multiple giant motor unit potentials, suggesting the involvement of anterior horn motor neurons or the anterior root. Autosomal recessive inheritance was considered, because of consanguinity. The disorder described here may be a new clinical entity with unique clinical manifestations. Copyright 2009 Elsevier B.V. All rights reserved.

Vitamin D-deficiency and post-fracture changes in lower extremity function and falls in women with hip fractures

PubMed Central

Hawkes, W. G.; Glowacki, J.; Yu-Yahiro, J.; Hurwitz, S.; Magaziner, J.

2008-01-01

Summary We determined the prevalence of vitamin D deficiency and lower extremity function in women with hip fractures. Women with extremely low vitamin D levels had reduced lower extremity muscle function and increased falls 1 year later. Ensuring vitamin D sufficiency after a hip fracture may improve function and reduce falls. Introduction Hip fractures are the most devastating of fractures, commonly leading to loss of independent ambulation and living. In this retrospective analysis we determined the prevalence of vitamin D deficiency in women with hip fractures and the association between 25-hydroxyvitamin D [25(OH)D] levels and functional impairment one year later. Methods One hundred ten community-dwelling women with hip fractures were recruited from Boston, MA (n= 30) and Baltimore, MD (n=80) before 1998 and 25(OH)D levels were measured by radioimmunoassay. In a subset of women from Baltimore, a performance measure of the lower extremities using the lower extremity gain scale (LEGS) was measured at 2, 6, and 12 months. Falls, grip strength, chair rise time, walking speed, and balance were also determined. Results Vitamin D insufficiency defined as a 25(OH)D ≤32 ng/mL was present in 96% of the women with hip fractures and 38% had extremely low levels ≤9 ng/mL. At 1 year post-fracture, compared to women with a 25(OH) D >9 ng/mL, those with 25(OH)D ≤9 ng/mL had poorer LEGS performance (p<0.0001) and higher fall rates, without group differences in grip strength or balance. Conclusion Vitamin D sufficiency may have important effects on lower extremity function following hip fractures, without excessive healthcare costs. PMID:18373057

An Examination of Lower Extremity Function and its Correlates in Older African American and White Men.

PubMed

Clay, Olivio J; Thorpe, Roland J; Wilkinson, Larrell L; Plaisance, Eric P; Crowe, Michael; Sawyer, Patricia; Brown, Cynthia J

2015-08-07

Maintaining functional status and reducing/eliminating health disparities in late life are key priorities. Older African Americans have been found to have worse lower extremity functioning than Whites, but little is known about potential differences in correlates between African American and White men. The goal of this investigation was to examine measures that could explain this racial difference and to identify race-specific correlates of lower extremity function. Data were analyzed for a sample of community-dwelling men. Linear regression models examined demographics, medical conditions, health behaviors, and perceived discrimination and mental health as correlates of an objective measure of lower extremity function, the Short Physical Performance Battery (SPPB). Scores on the SPPB have a potential range of 0 to 12 with higher scores corresponding to better functioning. The mean age of all men was 74.9 years (SD=6.5), and the sample was 50% African American and 53% rural. African American men had scores on the SPPB that were significantly lower than White men after adjusting for age, rural residence, marital status, education, and income difficulty (P<.01). Racial differences in cognitive functioning accounted for approximately 41% of the race effect on physical function. Additional models stratified by race revealed a pattern of similar correlates of the SPPB among African American and White men. The results of this investigation can be helpful for researchers and clinicians to aid in identifying older men who are at-risk for poor lower extremity function and in planning targeted interventions to help reduce disparities.

Prophylactic Bracing Has No Effect on Lower Extremity Alignment or Functional Performance.

PubMed

Hueber, Garrett A; Hall, Emily A; Sage, Brad W; Docherty, Carrie L

2017-07-01

Prophylactic ankle bracing is commonly used during physical activity. Understanding how bracing affects body mechanics is critically important when discussing both injury prevention and sport performance. The purpose is to determine if ankle bracing affects lower extremity mechanics during the Landing Error Scoring System test (LESS) and Sage Sway Index (SSI). Thirty physically active participants volunteered for this study. Participants completed the LESS and SSI in both a braced and unsupported conditions. Total errors were recorded for the LESS. Total errors and time (seconds) were recorded for the SSI. The Wilcoxon signed-rank test was utilized to evaluate any differences between the brace conditions for each dependent variable. A priori alpha level was set at p<0.05. The Wilcoxon signed-rank test yielded no significant difference between the braced and unsupported conditions for the LESS (Z=-0.35, p=0.72), SSI time (Z=-0.36, p=0.72), or SSI Errors (Z=-0.37, p=0.71). Ankle braces had no effect on subjective clinical assessments of lower extremity alignment or postural stability. Utilization of a prophylactic support at the ankle did not substantially alter the proximal components of the lower kinetic chain. © Georg Thieme Verlag KG Stuttgart · New York.

[Differential diagnosis of skin changes on the lower extremities in chronic venous insufficiency].

PubMed

Binder, Barbara

2016-06-01

Varicous veins and postthrombotic syndrome can make typical reversible or irreversible skin changes on the lower extremities if no treatment is initiated. The typical clinical signs should be recognised in an early stage and possible differential diagnoses have to be excluded.

PROSPECTIVE FUNCTIONAL PERFORMANCE TESTING AND RELATIONSHIP TO LOWER EXTREMITY INJURY INCIDENCE IN ADOLESCENT SPORTS PARTICIPANTS

PubMed Central

DePhillipo, Nick; Kimura, Iris; Kocher, Morgan; Hetzler, Ronald

2017-01-01

Background Due to the high number of adolescent athletes and subsequent lower extremity injuries, improvements of injury prevention strategies with emphasis on clinic-based and practical assessments are warranted. Purpose The purpose of this study was to prospectively investigate if a battery of functional performance tests (FPT) could be used as a preseason-screening tool to identify adolescent athletes at risk for sports-related acute lower extremity injury via comparison of injured and uninjured subjects. Methods One hundred adolescent volleyball, basketball and soccer athletes (female, n=62; male, n=38; mean age = 14.4 ± 1.6) participated. The FPT assessment included: triple hop for distance, star excursion balance test, double leg lowering maneuver, drop jump video test, and multi-stage fitness test. Composite scores were calculated using a derived equation. Subjects were monitored throughout their designated sport season(s), which consisted of a six-month surveillance period. The schools certified athletic trainer (ATC) recorded all injuries. Subjects were categorized into groups according to sex and injury incidence (acute lower extremity injury vs. uninjured) for analysis. Results Mean FPT composite scores were significantly lower for the injured compared to the uninjured groups in both sexes (males: 19.06 ± 3.59 vs. 21.90 ± 2.44; females: 19.48 ± 3.35 vs. 22.10 ± 3.06 injured and uninjured, respectively)(p < .05). The receiver-operator characteristic analysis determined the cut-off score at ≤ 20 for both genders (sensitivity=.71, specificity=.81, for males; sensitivity=.67, specificity=.69, for females)(p<.05) for acute noncontact lower extremity injuries. Significant positive correlations were found between the FPT composite score and the multi-stage fitness test in male subjects (r=.474, p=.003), suggesting a relationship between functional performance, aerobic capacity, and potential injury risk. Conclusion A

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

Compression ultrasonography of the lower extremity with portable vascular ultrasonography can accurately detect deep venous thrombosis in the emergency department.

PubMed

Crisp, Jonathan G; Lovato, Luis M; Jang, Timothy B

2010-12-01

Compression ultrasonography of the lower extremity is an established method of detecting proximal lower extremity deep venous thrombosis when performed by a certified operator in a vascular laboratory. Our objective is to determine the sensitivity and specificity of bedside 2-point compression ultrasonography performed in the emergency department (ED) with portable vascular ultrasonography for the detection of proximal lower extremity deep venous thrombosis. We did this by directly comparing emergency physician-performed ultrasonography to lower extremity duplex ultrasonography performed by the Department of Radiology. This was a prospective, cross-sectional study and diagnostic test assessment of a convenience sample of ED patients with a suspected lower extremity deep venous thrombosis, conducted at a single-center, urban, academic ED. All physicians had a 10-minute training session before enrolling patients. ED compression ultrasonography occurred before Department of Radiology ultrasonography and involved identification of 2 specific points: the common femoral and popliteal vessels, with subsequent compression of the common femoral and popliteal veins. The study result was considered positive for proximal lower extremity deep venous thrombosis if either vein was incompressible or a thrombus was visualized. Sensitivity and specificity were calculated with the final radiologist interpretation of the Department of Radiology ultrasonography as the criterion standard. A total of 47 physicians performed 199 2-point compression ultrasonographic examinations in the ED. Median number of examinations per physician was 2 (range 1 to 29 examinations; interquartile range 1 to 5 examinations). There were 45 proximal lower extremity deep venous thromboses observed on Department of Radiology evaluation, all correctly identified by ED 2-point compression ultrasonography. The 153 patients without proximal lower extremity deep venous thrombosis all had a negative ED compression

Simulator study of young driver's instinctive response of lower extremity to a collision.

PubMed

Gao, Zhenhai; Li, Chuzhao; Hu, Hongyu; Zhao, Hui; Chen, Chaoyang; Yu, Huili

2016-05-18

A driver's instinctive response of the lower extremity in braking movement consists of two parts, including reaction time and braking reaction behavior. It is critical to consider these two components when conducting studies concerning driver's brake movement intention and injury analysis. The purposes of this study were to investigate the driver reaction time to an oncoming collision and muscle activation of lower extremity muscles at the collision moment. The ultimate goal is to provide data that aid in both the optimization of intervention time of an active safety system and the improvement of precise protection performance of a passive safety system. A simulated collision scene was constructed in a driving simulator, and 40 young volunteers (20 male and 20 female) were recruited for tests. Vehicle control parameters and electromyography characteristics of eight muscles of the lower extremity were recorded. The driver reaction time was divided into pre-motor time (PMT) and muscle activation time (MAT). Muscle activation level (ACOL) at the collision moment was calculated and analysed. PMT was shortest for the tibialis anterior (TA) muscle (243∼317 ms for male and 278∼438 ms for female). Average MAT of the TA ranged from 28-55 ms. ACOL was large (5∼31% for male and 5∼23% for female) at 50 km/h, but small (<12%) at 100 km/h. ACOL of the gluteus maximus was smallest (<3%) in the 25 and 100 km/h tests. ACOL of RF of men was significantly smaller than that of women at different speeds. Ankle dorsiflexion is firstly activated at the beginning of the emergency brake motion. Males showed stronger reaction ability than females, as suggested by male's shorter PMT. The detection of driver's brake intention is upwards of 55ms sooner after introducing the electromyography. Muscle activation of the lower extremity is an important factor for 50 km/h collision injury analysis. For higher speed collisions, this might not be a major factor. The activations of certain

Comparison of Hand-Sewn versus Coupled Venous Anastomoses in Traumatic Lower Extremity Reconstruction.

PubMed

Stranix, John T; Rifkin, William J; Lee, Z-Hye; Anzai, Lavinia; Jacoby, Adam; Ceradini, Daniel J; Thanik, Vishal; Saadeh, Pierre B; Levine, Jamie P

2018-06-15

 Microvascular reconstruction of the lower extremity has the highest reported complication and flap failure rates of any anatomical region. Despite widespread adoption of the mechanical anastomotic venous coupler and encouraging results in other anatomical regions, there are limited reports examining its use in the lower extremity. This study compares outcomes between coupled and hand-sewn venous anastomoses in traumatic lower extremity reconstruction.  Retrospective review of our institutional flap registry from 1979 to 2016 identified soft tissue free flaps performed for the reconstruction of Gustilo type IIIB/IIIC open tibial fractures. Patient demographics, flap characteristics, use of a venous anastomotic coupler, and perioperative outcomes were examined. Analysis was performed using chi-square and Student's t -tests.  A total of 361 patients received a microvascular free flap for coverage of a Gustilo type IIIB or IIIC tibial fracture following traumatic injury. After excluding cases that lacked adequate information on coupler use, 358 free flaps were included in the study. There were 72 (20%) free flaps performed using a venous coupler and 286 (80%) performed with hand-sewn venous anastomoses. There were comparable rates of major complications (22.2 vs. 26.1%; p  = 0.522), total flap failure (6.5%, vs. 10.2%; p  = 0.362), and partial flap failure (9.7 vs. 12.2%; p  = 0.579) between venous coupler and hand-sewn anastomoses, respectively. Furthermore, use of the venous coupler was not associated with increased rates of operative take backs (22.8 vs. 23.0%; p  = 0.974). However, reconstructions performed using a venous coupler were significantly more likely to have a second venous anastomosis performed (37.5 vs. 21.3%; p  = 0.004).  Complication and flap failure rates were similar between reconstructions performed with a venous coupler and those performed with hand-sewn venous anastomoses. These findings suggest that use of the

Catheter-Directed Thrombolysis of Acute Deep Vein Thrombosis in the Lower Extremity of a Child with Interrupted Inferior Vena Cava

DOE Office of Scientific and Technical Information (OSTI.GOV)

Oguzkurt, Levent, E-mail: loguzkurt@yahoo.com; Ozkan, Ugur; Tercan, Fahri

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. Ourmore » 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.« less

Biomechanical compensations of the trunk and lower extremities during stepping tasks after unilateral transtibial amputation.

PubMed

Murray, Amanda M; Gaffney, Brecca M; Davidson, Bradley S; Christiansen, Cory L

2017-11-01

Lower extremity movement compensations following transtibial amputation are well-documented and are likely influenced by trunk posture and movement. However, the biomechanical compensations of the trunk and lower extremities, especially during high-demand tasks such as step ascent and descent, remain unclear. Kinematic and kinetic data were collected during step ascent and descent tasks for three groups of individuals: diabetic/transtibial amputation, diabetic, and healthy. An ANCOVA was used to compare peak trunk, hip and knee joint angles and moments in the sagittal and frontal planes between groups. Paired t-tests were used to compare peak joint angles and moments between amputated and intact limbs of the diabetic/transtibial amputation group. During step ascent and descent, the transtibial amputation group exhibited greater trunk forward flexion and lateral flexion compared to the other two groups (P<0.016), which resulted in greater low back moments and asymmetric loading patterns in the lower extremity joints. The diabetic group exhibited similar knee joint loading patterns compared to the amputation group (P<0.016), during step descent. This study highlights the biomechanical compensations of the trunk and lower extremities in individuals with dysvascular transtibial amputation, by identifying low back, hip, and knee joint moment patterns unique to transtibial amputation during stepping tasks. In addition, the results suggest that some movement compensations may be confounded by the presence of diabetes and precede limb amputation. The increased and asymmetrical loading patterns identified may predispose individuals with transtibial amputation to the development of secondary pain conditions, such as low back pain or osteoarthritis. Copyright © 2017 Elsevier Ltd. All rights reserved.

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

Ventilation Increases with Lower Extremity Venous Occlusion in Young Adults

PubMed Central

Keller-Ross, Manda L.; Cowl, Andrielle L.; Cross, Troy; Johnson, Bruce D.; Olson, Thomas P.

2015-01-01

Introduction Venous distention via sub-systolic occlusion of the lower limbs may augment ventilation via stimulation of group III/IV afferent neurons. Purpose The purpose of this study was to examine the ventilatory response to graded lower extremity venous occlusion during exercise in healthy adults. Methods Nineteen adults (9 men, 25±5 yr) completed two visits. Visit 1: a maximal cycle ergometry exercise test. Visit 2 included a 30% peak workload cycle exercise with randomized inflations of bilateral thigh pressure tourniquets to 20, 40, 60, 80, 100 mmHg for 2 min each, separated by 2 min of deflation. Three min of cycling occurred prior to cuffing (CTL). Expired minute ventilation (VE), whole body gas exchange, rating of perceived exertion and dyspnea were measured during each session. Results VE increased significantly from the control condition (exercise only, control, CTL) to each occlusion pressure (p<0.05) with the greatest increase at 100 mmHg (CTL to 100 mmHg: 31.5±6.6 to 40.1±10.7 L/min). Respiratory rate (RR) increased as well (CTL to 100 mmHg: 24.8±6.0 to 30.9±11.5 breaths/min, p<0.05, condition effect) with no change in tidal volume (p>0.05). Tidal volume to inspiratory time (VT/TI) increased significantly from the CTL condition to each occlusion pressure (CTL to 100 mmHg: 1.5±0.3 to 1.8±0.4 L/min, p<0.05, all pressures). Dyspnea and RPE increased with all occlusion pressures from CTL exercise (p<0.05, all pressures). Conclusion Our findings suggest that mild-to-moderate venous occlusion of the lower extremity evokes a tachypneic breathing pattern which, in turn, augments VE and perceived breathing effort during exercise. PMID:26484951

Shoe and field surface risk factors for acute lower extremity injuries among female youth soccer players

PubMed Central

O'Kane, John W.; Gray, Kristen E.; Levy, Marni R.; Neradilek, Moni; Tencer, Allan F.; Polissar, Nayak L.; Schiff, Melissa A.

2015-01-01

Objective Describe acute lower extremity injuries and evaluate extrinsic risk factors in female youth soccer Design Nested case-control study Setting Youth soccer clubs in Washington State, USA. Participants Female soccer players (N= 351) ages 11 to 15 years randomly selected from 4 soccer clubs from which 83% of their players were enrolled with complete follow-up for 92% of players. Interventions Injured players were interviewed regarding injury, field surface, shoe type, and position. Uninjured controls, matched on game or practice session, were also interviewed. Main Outcome Measures The association between risk factors and acute lower extremity injury using logistic regression to estimate odds ratios (OR) and 95% confidence intervals (CI). Results One hundred seventy-three acute lower extremity injuries occurred involving primarily the ankle (39.3%), knee (24.9%), and thigh (11.0%). Over half (52.9%) recovered within 1 week, while 30.2% lasted beyond 2 weeks. During practices, those injured were approximately 3-fold ( OR 2.83, 95% CI 1.49-5.31) more likely to play on grass than artificial turf and 2.4-fold (95% CI 1.03-5.96) more likely to wear cleats on grass than other shoe and surface combinations. During games injured players were 89% (95% CI 1.03-4.17) more likely to play defender compared to forward. Conclusions Half of the acute lower extremity injuries affected the ankle or knee. Grass surface and wearing cleats on grass increased training injuries. PMID:26327288

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

PubMed

Azarmi, Somayeh; Farsi, Zahra

2015-10-01

Any defect in 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 promoting the adaptation of veterans with lower extremities amputation. 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. 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. 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 intervention is advised based on Roy's adaptation model for improving the

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

PubMed

Sista, Akhilesh K; Vedantham, Suresh; Kaufman, John A; Madoff, David C

2015-07-01

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.

Percutaneous and Endoscopic Adhesiolysis in Managing Low Back and Lower Extremity Pain: A Systematic Review and Meta-analysis.

PubMed

Helm, Standiford; Racz, Gabor B; Gerdesmeyer, Ludger; Justiz, Rafael; Hayek, Salim M; Kaplan, Eugene D; El Terany, Mohamed Ahamed; Knezevic, Nebojsa Nick

2016-02-01

Chronic refractory low back and lower extremity pain is frustrating to treat. Percutaneous adhesiolysis and spinal endoscopy are techniques which can treat chronic refractory low back and lower extremity pain.Percutaneous adhesiolysis is performed by placing the catheter into the tissue plane at the ventrolateral aspect of the foramen so that medications can be injected. Adhesiolysis is used both for pain caused by scarring which is not resistant to catheter placement and other sources of pain, including inflammation in the absence of scarring.Mechanical lysis of scars with a catheter may or may not be necessary for percutaneous adhesiolysis to be effective. Spinal endoscopy allows direct visualization of the epidural space and has the possibility to use laser energy to treat pathology. A systematic review of the effectiveness of percutaneous adhesiolysis and spinal endoscopic adhesiolysis to treat chronic refractory low back and lower extremity pain. To evaluate and update the effectiveness of percutaneous adhesiolysis and spinal endoscopic adhesiolysis to treat chronic refractory low back and lower extremity pain. The available literature on percutaneous adhesiolysis and spinal endoscopic adhesiolysis in treating persistent low back and leg pain was reviewed. The quality of each article used in this analysis was assessed. The level of evidence was classified on a 5-point scale from strong, based upon multiple randomized controlled trials to weak, based upon consensus, as developed by the U.S. Preventive Services Task Force (USPSTF) and modified by ASIPP. Data sources included relevant literature identified through searches of PubMed and EMBASE from 1966 to September 2015, and manual searches of the bibliographies of known primary and review articles. Pain relief of at least 50% and functional improvement of at least 40% were the primary outcome measures. Short-term efficacy was defined as improvement of 6 months or less; whereas, long-term efficacy was defined

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

CHILDREN HOSPITALIZED WITH LOWER EXTREMITY FRACTURES IN THE UNITED STATES IN 2006: A POPULATION-BASED APPROACH

PubMed Central

Gao, Yubo

2011-01-01

OBJECTIVE The purpose of this study was to examine the demographic and hospitalization characteristics of children hospitalized with lower extremity fractures in the United States in 2006. METHODS Children aged 0 to 20 years with a diagnosis of lower extremity fracture in the 2006 Healthcare Cost and Utilization Project Kids’ Inpatient Database (KID) were included. Lower extremity fractures were defined by International Classification of Diseases, 9th Revision, Clinical Modification codes 820-829 under “Injury and Poisoning (800-999).” Patient demographic and hospitalization-related data were analyzed by chi-square testing and unbalanced analysis of variance. RESULTS There were more boys than girls with lower extremity fractures and 53% had private insurance as their primary payer. About one half of the children were between the ages of 13 and 20 years, but all ages were represented from age 0 to 20. White children accounted for 56%. Urban hospitalizations accounted for 93% of cases and 66 percent of admissions were to teaching hospitals. All patients had an average length of stay (LOS) 4.04 days, and infant patients had the longest average LOS of 5.46 days. The average number of diagnoses per patient was 3.07, and the average number of procedures per patient was 2.21. The average charge per discharge was $35,236, and the oldest patients had the largest average charge of $41,907. The average number of comorbidities increased with increasing patient age. There was a 55.6% greater mortality risk in non-teaching hospitals than in teaching hospitals and there was at least ten times the mortality risk in rural hospitals than in urban hospitals. CONCLUSIONS This study provides an understanding of the demographic and hospitalization characteristics of children with lower extremity fractures in the United States in 2006. This information may be useful in implementing measures to help prevent similar injuries in the future. Further research is required to determine

Children hospitalized with lower extremity fractures in the United States in 2006: a population-based approach.

PubMed

Gao, Yubo

2011-01-01

The purpose of this study was to examine the demographic and hospitalization characteristics of children hospitalized with lower extremity fractures in the United States in 2006. Children aged 0 to 20 years with a diagnosis of lower extremity fracture in the 2006 Healthcare Cost and Utilization Project Kids' Inpatient Database (KID) were included. Lower extremity fractures were defined by International Classification of Diseases, 9th Revision, Clinical Modification codes 820-829 under "Injury and Poisoning (800-999)." Patient demographic and hospitalization-related data were analyzed by chi-square testing and unbalanced analysis of variance. There were more boys than girls with lower extremity fractures and 53% had private insurance as their primary payer. About one half of the children were between the ages of 13 and 20 years, but all ages were represented from age 0 to 20. White children accounted for 56%. Urban hospitalizations accounted for 93% of cases and 66 percent of admissions were to teaching hospitals. All patients had an average length of stay (LOS) 4.04 days, and infant patients had the longest average LOS of 5.46 days. The average number of diagnoses per patient was 3.07, and the average number of procedures per patient was 2.21. The average charge per discharge was $35,236, and the oldest patients had the largest average charge of $41,907. The average number of comorbidities increased with increasing patient age. There was a 55.6% greater mortality risk in non-teaching hospitals than in teaching hospitals and there was at least ten times the mortality risk in rural hospitals than in urban hospitals. This study provides an understanding of the demographic and hospitalization characteristics of children with lower extremity fractures in the United States in 2006. This information may be useful in implementing measures to help prevent similar injuries in the future. Further research is required to determine causality of the associations found including

Risk of Lower Extremity Injury in a Military Cadet Population After a Supervised Injury-Prevention Program.

PubMed

Carow, Scott D; Haniuk, Eric M; Cameron, Kenneth L; Padua, Darin A; Marshall, Stephen W; DiStefano, Lindsay J; de la Motte, Sarah J; Beutler, Anthony I; Gerber, John P

2016-11-01

 Specific movement patterns have been identified as possible risk factors for noncontact lower extremity injuries. The Dynamic Integrated Movement Enhancement (DIME) was developed to modify these movement patterns to decrease injury risk.  To determine if the DIME is effective for preventing lower extremity injuries in US Military Academy (USMA) cadets.  Cluster-randomized controlled trial.  Cadet Basic Training at USMA.  Participants were 1313 cadets (1070 men, 243 women).  Participants were cluster randomized to 3 groups. The active warm-up (AWU) group performed standard Army warm-up exercises. The DIME groups were assigned to a DIME cadre-supervised (DCS) group or a DIME expert-supervised (DES) group; the former consisted of cadet supervision and the latter combined cadet and health professional supervision. Groups performed exercises 3 times weekly for 6 weeks.  Cumulative risk of lower extremity injury was the primary outcome. We gathered data during Cadet Basic Training and for 9 months during the subsequent academic year. Risk ratios and 95% confidence intervals (CIs) were calculated to compare groups.  No differences were seen between the AWU and the combined DIME (DCS and DES) groups during Cadet Basic Training or the academic year. During the academic year, lower extremity injury risk in the DES group decreased 41% (relative risk [RR] = 0.59; 95% CI = 0.38, 0.93; P = .02) compared with the DCS group; a nonsignificant 25% (RR = 0.75; 95% CI = 0.49, 1.14; P = .18) decrease occurred in the DES group compared with the AWU group. Finally, there was a nonsignificant 27% (RR = 1.27; 95% CI = 0.90, 1.78; P = .17) increase in injury risk during the academic year in the DCS group compared with the AWU group.  We observed no differences in lower extremity injury risk between the AWU and combined DIME groups. However, the magnitude and direction of the risk ratios in the DES group compared with the AWU group, although not statistically significant

Trunk position influences the kinematics, kinetics, and muscle activity of the lead lower extremity during the forward lunge exercise.

PubMed

Farrokhi, Shawn; Pollard, Christine D; Souza, Richard B; Chen, Yu-Jen; Reischl, Stephen; Powers, Christopher M

2008-07-01

Experimental laboratory study. To examine how a change in trunk position influences the kinematics, kinetics, and muscle activity of the lead lower extremity during the forward lunge exercise. Altering the position of the trunk during the forward lunge exercise is thought to affect the muscular actions of the lead lower extremity. However, no studies have compared the biomechanical differences between the traditional forward lunge and its variations. Ten healthy adults (5 males, 5 females; mean age +/- SD, 26.7 +/- 3.2 years) participated. Lower extremity kinematics, kinetics, and surface electromyographic (EMG) data were obtained while subjects performed 3 lunge exercises: normal lunge with the trunk erect (NL), lunge with the trunk forward (LTF), and lunge with trunk extension (LTE). A 1-way analysis of variance with repeated measures was used to compare lower extremity kinematics, joint impulse (area under the moment-time curve), and normalized EMG (highest 1-second window of activity for selected lower extremity muscles) among the 3 lunge conditions. During the LTF condition, significant increases were noted in peak hip flexion angle, hip extensor and ankle plantar flexor impulse, as well as gluteus maximus and biceps femoris EMG (P<.015) when compared to the NL condition. During the LTE condition, a significant increase was noted in peak ankle dorsiflexion and a significant decrease was noted in peak hip flexion angle (P<.015) compared to the NL condition. Performing a lunge with the trunk forward increased the hip extensor impulse and the recruitment of the hip extensors. In contrast, performing a forward lunge with the trunk extended did not alter joint impulse or activation of the lower extremity musculature. Therapy, level 5.

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.

LOWER EXTREMITY KINEMATICS OF ACL-REPAIRED AND NON-INJURED FEMALES WHEN USING KNEE SAVERS®.

PubMed

Stone, Whitley J; Arnett, Scott W; Hoover, Donald L

2017-10-01

Knee Savers® (KS) are an ergonomic aid purported to lessen the risk of injuries linked to deep squats. While widely used in sports such as baseball and softball, KS have not been tested to determine their effect upon lower extremity kinematics in any population. The purpose of the study was to determine if KS influenced the lower extremity kinematics when females with previous anterior cruciate ligament (ACL)-reconstruction and healthy participants completed an end-range squat. A repeated measures, counter-balanced laboratory study design was used. Twenty female participants (mean (SD) - age: 21.65 (2.06) yrs, height: 175.26 (9.29) cm, weight: 64.66 (7.72) kg) with a history of ACL-repair (n=10) or non-injury (n=10) completed this study. Participants completed a standardized trial of three deep squats with and without KS. Movement was analyzed using 2D video analysis methods increasingly available in clinical environments. During the ascending phases of a squatting motion, there was significantly greater medial ( p  = .009) and lateral ( p  = .005) motion of the patella in the frontal plane for non-injured participants, when compared to the ACL-repaired group. No significant differences were found in sagittal plane lower extremity kinematics when squatting with and without KS. Ascending angular velocity was slower in ACL-repaired than non-injured females ( p  = .008) and slower with the KS than without KS for non-injured females ( p  = .007). When squatting with and without KS, the non-injured group experienced more frontal plane motion at the knee, compared to the ACL-repaired group. However, while KS are purported to influence lower extremity joint positions during the bottom phase of a deep squat, the data from the current study did not support this claim. Additionally, KS appear to slow ascending velocity for those without a history of ACL-repair. These findings may have clinically meaningful implications for athletes who use KS during sport

Lower extremity sagittal joint moment production during split-belt treadmill walking

PubMed Central

Roemmich, Ryan T.; Stegemöller, Elizabeth L.; Hass, Chris J.

2012-01-01

The split-belt treadmill (SBT) has recently been used to rehabilitate locomotor asymmetries in clinical populations. However, the joint mechanics produced while walking on a SBT are not well-understood. The purpose of this study was to investigate the lower extremity sagittal joint moments produced by each limb during SBT walking and provide insight as to how these joint moment patterns may be useful in rehabilitating unilateral gait deficits. Thirteen healthy young volunteers walked on the SBT with the belts tied and in a “SPLIT” session in which one belt moved twice as fast as the other. Sagittal lower extremity joint moment and ground reaction force impulses were then calculated over the braking and propulsive phases of the gait cycle. Paired t-tests were performed to analyze magnitude differences between conditions (i.e. the fast and slow limbs during SPLIT vs. the same limb during tied-belt walking) and between the fast and slow limbs during SPLIT. During the SPLIT session, the fast limb produced higher ground reaction force and ankle moment impulses during the propulsive and braking phases, and lower knee moment impulses during the propulsive phase when compared to the slow limb. The knee moment impulse was also significantly higher during braking in the slow limb than in the fast limb. The mechanics of each limb during the SPLIT session also differed from the mechanics observed when the belt speeds were tied. Based on these findings, we suggest that each belt may have intrinsic value in rehabilitating specific unilateral locomotor deficits. PMID:22985473

Resistance training is accompanied by increases in hip strength and changes in lower extremity biomechanics during running.

PubMed

Snyder, Kelli R; Earl, Jennifer E; O'Connor, Kristian M; Ebersole, Kyle T

2009-01-01

Movement and muscle activity of the hip have been shown to affect movement of the lower extremity, and been related to injury. The purpose of this study was to determine if increased hip strength affects lower extremity mechanics during running. Within subject, repeated measures design. Fifteen healthy women volunteered. Hip abduction and external rotation strength were measured using a hand-held dynamometer. Three-dimensional biomechanical data of the lower extremity were collected during running using a high-speed motion capture system. Measurements were made before, at the mid-point, and after a 6-week strengthening program using closed-chain hip rotation exercises. Joint range of motion (rearfoot eversion, knee abduction, hip adduction, and internal rotation), eversion velocity, eversion angle at heel strike, and peak joint moments (rearfoot inversion, knee abduction, hip abduction, and external rotation) were analyzed using repeated measures analysis of variance (P lower extremity joint loading which may reduce injury risk. These exercises could be used in the rehabilitation, or prevention, of lower extremity injuries.

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.

Side-to-side differences in lower extremity biomechanics during multi-directional jump landing in volleyball athletes.

PubMed

Sinsurin, Komsak; Srisangboriboon, Sarun; Vachalathiti, Roongtiwa

2017-07-01

Side-to-side differences of lower extremities may influence the likelihood of injury. Moreover, adding the complexity of jump-landing direction would help to explain lower extremity control during sport activities. The aim was to determine the effects of limb dominance and jump-landing direction on lower extremity biomechanics. Nineteen female volleyball athletes participated. Both dominant limbs (DLs) and non-dominant limbs (NLs) were examined in single-leg jump-landing tests in four directions, including forward (0°), diagonal (30° and 60°), and lateral (90°) directions. Kinematic marker trajectories and ground reaction forces were collected using a 10 camera Vicon system and an AMTI force plate. Repeated measures ANOVA (2 × 4, limb × direction) was used to analyse. The finding showed that, at peak vertical GRF, a significant interaction of limb dominance and direction effects was found in the hip flexion angle and lower extremity joint kinetics (p < .05). NLs and DLs exhibited significantly different strategies while landing in various directions. Significantly higher increase of ankle dorsiflexion angle was observed in lateral direction compared to other directions for both DLs and NLs (p < .05). Increasingly using ankle dorsiflexion was observed from the forward to the lateral direction for both DLs and NLs. However, NLs and DLs preferentially used different strategies of joint moment organization to respond to similar VGRFs in various directions. The response pattern of DLs might not be effective and may expose DLs to a higher injury risk, especially with regard to landing with awkward posture compared with NLs.

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

Sensitivity to change of mobility measures in musculoskeletal conditions on lower extremities in outpatient rehabilitation settings.

PubMed

Navarro-Pujalte, Esther; Gacto-Sánchez, Mariano; Montilla-Herrador, Joaquina; Escolar-Reina, Pilar; Ángeles Franco-Sierra, María; Medina-Mirapeix, Francesc

2018-01-12

Prospective longitudinal study. To examine the sensitivity of the Mobility Activities Measure for lower extremities and to compare it to the sensitivity of the Physical Functioning Scale (PF-10) and the Patient-Specific Functional Scale (PSFS) at week 4 and week 8 post-hospitalization in outpatient rehabilitation settings. Mobility Activities Measure is a set of short mobility measures to track outpatient rehabilitation progress: its scales have shown good properties but its sensitivity to change has not been reported. Patients with musculoskeletal conditions were recruited at admission in three outpatient rehabilitation settings in Spain. Data were collected at admission, week 4 and week 8 from an initial sample of 236 patients (mean age ± SD = 36.7 ± 11.1). Mobility Activities Measure scales for lower extremity; PF-10; and PSFS. All the Mobility Activities Measure scales were sensitive to both positive and negative changes (the Standardized Response Means (SRMs) ranged between 1.05 and 1.53 at week 4, and between 0.63 and 1.47 at week 8). The summary measure encompassing the three Mobility Activities Measure scales detected a higher proportion of participants who had improved beyond the minimal detectable change (MDC) than detected by the PSFS and the PF-10 both at week 4 (86.64% vs. 69.81% and 42.23%, respectively) and week 8 (71.14% vs. 55.65% and 60.81%, respectively). The three Mobility Activities Measure scales assessing the lower extremity can be used across outpatient rehabilitation settings to provide consistent and sensitive measures of changes in patients' mobility. Implications for rehabilitation All the scales of the Mobility Activities Measure for the lower extremity were sensitive to both positive and negative change across the follow-up periods. Overall, the summary measure encompassing the three Mobility Activities Measure scales for the lower extremity appeared more sensitive to positive changes than the Physical Functioning Scale

Effects of Arm Ergometry Exercise on the Reaction, Movement and Response Times of the Lower Extremities.

ERIC Educational Resources Information Center

Israel, Richard G.

A study determined the effects of fatigue produced in the upper extremities on the reaction time, movement time, and response time of the lower extremities in 30 male subjects, 19-25 years old. Each subject participated in a 10 trial practice session one day prior to the experiment and immediately preceding the pre-test. The pre-test consisted of…

Effect of Footwear on Joint Pain and Function in Older Adults With Lower Extremity Osteoarthritis.

PubMed

Wagner, Amy; Luna, Sarah

Lower extremity osteoarthritis (OA) is a common condition among older adults; given the risks of surgical and pharmaceutical interventions, conservative, lower-cost management options such as footwear warrant further investigation. This systematic review investigated the effects of footwear, including shoe inserts, in reducing lower extremity joint pain and improving gait, mobility, and quality of life in older adults with OA. The CINAHL, SPORTDiscus, PubMed, RECAL, and Web of Knowledge databases were searched for publications from January 1990 to September 2014, using the terms "footwear," "shoes," "gait," "pain," and "older adult." Participants who were 50 years or older and those who had OA in at least one lower extremity joint narrowed the results. Outcomes of interest included measures of pain, comfort, function, gait, or quality of life. Exclusion criteria applied to participants with rheumatoid arthritis, amputation, diabetes, multiple sclerosis, use of modified footwear or custom orthotics, purely biomechanical studies, and outcomes of balance or falls only. Single-case studies, qualitative narrative descriptions, and expert opinions were also excluded. The initial search resulted in a total of 417 citations. Eleven articles met inclusion criteria. Two randomized controlled trials and 3 quasiexperimental studies reported lateral wedge insoles may have at least some pain-relieving effects and improved functional mobility in older adults at 4 weeks to 2 years' follow-up, particularly when used with subtalar and ankle strapping. Three randomized controlled trials with large sample sizes reported that lateral wedges provided no knee pain relief compared with flat insoles. Hardness of shoe soles did not significantly affect joint comfort in the foot in a quasiexperimental study. A quasiexperimental designed study investigating shock-absorbing insoles showed reduction in knee joint pain with 1 month of wear. Finally, a cross-sectional prognostic study indicated

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.

Digital Filtering of Three-Dimensional Lower Extremity Kinematics: an Assessment

PubMed Central

Sinclair, Jonathan; Taylor, Paul John; Hobbs, Sarah Jane

2013-01-01

Errors in kinematic data are referred to as noise and are an undesirable portion of any waveform. Noise is typically removed using a low-pass filter which removes the high frequency components of the signal. The selection of an optimal frequency cut-off is very important when processing kinematic information and a number of techniques exists for the determination of an optimal frequency cut-off. Despite the importance of cut-off frequency to the efficacy of kinematic analyses there is currently a paucity of research examining the influence of different cut-off frequencies on the resultant 3-D kinematic waveforms and discrete parameters. Twenty participants ran at 4.0 m•s−1 as lower extremity kinematics in the sagittal, coronal and transverse planes were measured using an eight camera motion analysis system. The data were filtered at a range of cut-off frequencies and the discrete kinematic parameters were examined using repeated measures ANOVA’s. The similarity between the raw and filtered waveforms were examined using intra-class correlations. The results show that the cut-off frequency has a significant influence on the discrete kinematic measure across displacement and derivative information in all three planes of rotation. Furthermore, it was also revealed that as the cut-off frequency decreased the attenuation of the kinematic waveforms became more pronounced, particularly in the coronal and transverse planes at the second derivative. In conclusion, this investigation provides new information regarding the influence of digital filtering on lower extremity kinematics and re-emphasizes the importance of selecting the correct cut-off frequency. PMID:24511338

Relationship between age and lower extremity fractures in frontal motor vehicle collisions.

PubMed

Moran, Stephan G; McGwin, Gerald; Metzger, Jesse S; Alonso, Jorge E; Rue, Loring W

2003-02-01

Older adults (aged > or = 65 years) represent the single fastest growing segment of the United States population and will comprise one in five Americans during the third decade of this century. As this population segment rapidly expands, lower extremity fractures (LE Fx) and their associated disability will become a greater public health concern. The purpose of this study was to quantify the risk for LE Fx from motor vehicle collisions (MVCs) according to age. The 1995 to 2000 National Automotive Sampling System data files were used. Study entry was limited to front-seat occupants involved in frontal MVCs. Risk ratios for LE Fx and age were adjusted for gender, driver versus passenger, seat belt use, airbag deployment, delta-V, intrusion, and vehicle type. Beginning in the fourth decade, there was a trend of higher relative risk for LE Fx with age that reached statistical significance in the seventh decade of life. This study documented an increased risk of LE Fx in older MVC occupants. Efforts to prevent these disabling injuries and to better protect occupants' lower extremities in MVCs should include improved vehicle design and reevaluation of the existing federal motor vehicle safety standards.

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

Association between frontal plane knee control and lower extremity injuries: a prospective study on young team sport athletes

PubMed Central

Pasanen, Kati; Krosshaug, Tron; Vasankari, Tommi; Kannus, Pekka; Heinonen, Ari; Kujala, Urho M; Avela, Janne; Perttunen, Jarmo; Parkkari, Jari

2018-01-01

Background/aim Poor frontal plane knee control can manifest as increased dynamic knee valgus during athletic tasks. The purpose of this study was to investigate the association between frontal plane knee control and the risk of acute lower extremity injuries. In addition, we wanted to study if the single-leg squat (SLS) test can be used as a screening tool to identify athletes with an increased injury risk. Methods A total of 306 basketball and floorball players participated in the baseline SLS test and a 12-month injury registration follow-up. Acute lower extremity time-loss injuries were registered. Frontal plane knee projection angles (FPKPA) during the SLS were calculated using a two-dimensional video analysis. Results Athletes displaying a high FPKPA were 2.7 times more likely to sustain a lower extremity injury (adjusted OR 2.67, 95% CI 1.23 to 5.83) and 2.4 times more likely to sustain an ankle injury (OR 2.37, 95% CI 1.13 to 4.98). There was no statistically significant association between FPKPA and knee injury (OR 1.49, 95% CI 0.56 to 3.98). The receiver operating characteristic curve analyses indicated poor combined sensitivity and specificity when FPKPA was used as a screening test for lower extremity injuries (area under the curve of 0.59) and ankle injuries (area under the curve of 0.58). Conclusions Athletes displaying a large FPKPA in the SLS test had an elevated risk of acute lower extremity and ankle injuries. However, the SLS test is not sensitive and specific enough to be used as a screening tool for future injury risk. PMID:29387448

The collision forces and lower-extremity inter-joint coordination during running.

PubMed

Wang, Li-I; Gu, Chin-Yi; Wang, I-Lin; Siao, Sheng-Wun; Chen, Szu-Ting

2018-06-01

The purpose of this study was to compare the lower extremity inter-joint coordination of different collision forces runners during running braking phase. A dynamical system approach was used to analyse the inter-joint coordination parameters. Data were collected with six infra-red cameras and two force plates. According to the impact peak of the vertical ground reaction force, twenty habitually rearfoot-strike runners were categorised into three groups: high collision forces runners (HF group, n = 8), medium collision forces runners (MF group, n = 5), and low collision forces runners (LF group, n = 7). There were no significant differences among the three groups in the ankle and knee joint angle upon landing and in the running velocity (p > 0.05). The HF group produced significantly smaller deviation phase (DP) of the hip flexion/extension-knee flexion/extension during the braking phase compared with the MF and LF groups (p < 0.05). The DP of the hip flexion/extension-knee flexion/extension during the braking phase correlated negatively with the collision force (p < 0.05). The disparities regarding the flexibility of lower extremity inter-joint coordination were found in high collision forces runners. The efforts of the inter-joint coordination and the risk of running injuries need to be clarified further.

The Effect of Social Integration on Outcomes after Major Lower Extremity Amputation

PubMed Central

Hawkins, Alexander T.; Pallangyo, Anthony J.; Herman, Ayesiga M.; Schaumeier, Maria J.; Smith, Ann D.; Hevelone, Nathanael D.; Crandell, David M.; Nguyen, Louis

2016-01-01

Objective Major lower extremity amputation is a common procedure that results in a profound change in a patient's life. We sought to determine the association between social support and outcomes after amputation. We hypothesized that patients with greater social support will have better post amputation outcomes. Methods From November 2011 to May 2013, we conducted a cross-sectional, observational, multicenter study. Social integration was measured by the social integration subset of the Short Form (Craig Handicap Assessment and Reporting Technique (CHART). Systemic social support was assessed by comparing a US and Tanzanian population. Walking function was measured using the 6MWT and quality of life (QoL) was measured using the EQ-5D. Results 102 major lower extremity amputees were recruited. 63 patients were enrolled in the US with a mean age of 58.0. Forty-two (67%) were male. Patients with low social integration were more likely to be unable to ambulate (no walk 39% vs. slow walk 23% vs. fast walk 10%; P=.01) and those with high social integration were more likely to be fast walkers (no walk 10% vs. slow walk 59% vs. fast walk 74%; P=.01). This relationship persisted in a multivariable analysis. Increasing social integration scores were also positively associated with increasing quality of life scores in a multivariable analysis (β .002; SE .0008; P = .02). In comparing the US population with the Tanzanian cohort (39 subjects), there were no significant differences between functional or quality of life outcomes in the systemic social support analysis. Conclusions In the US population, increased social integration is associated with both improved function and quality of life outcomes among major lower extremity amputees. Systemic social support, as measured by comparing the US population with a Tanzanian population, was not associated with improved function or quality of life outcomes. In the US, steps should be taken to identify and aid amputees with poor

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

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.

Risk of Lower Extremity Injury in a Military Cadet Population After a Supervised Injury-Prevention Program

PubMed Central

Carow, Scott D.; Haniuk, Eric M.; Cameron, Kenneth L.; Padua, Darin A.; Marshall, Stephen W.; DiStefano, Lindsay J.; de la Motte, Sarah J.; Beutler, Anthony I.; Gerber, John P.

2016-01-01

Context: Specific movement patterns have been identified as possible risk factors for noncontact lower extremity injuries. The Dynamic Integrated Movement Enhancement (DIME) was developed to modify these movement patterns to decrease injury risk. Objective: To determine if the DIME is effective for preventing lower extremity injuries in US Military Academy (USMA) cadets. Design: Cluster-randomized controlled trial. Setting: Cadet Basic Training at USMA. Patients or Other Participants: Participants were 1313 cadets (1070 men, 243 women). Intervention(s): Participants were cluster randomized to 3 groups. The active warm-up (AWU) group performed standard Army warm-up exercises. The DIME groups were assigned to a DIME cadre-supervised (DCS) group or a DIME expert-supervised (DES) group; the former consisted of cadet supervision and the latter combined cadet and health professional supervision. Groups performed exercises 3 times weekly for 6 weeks. Main Outcome Measure(s): Cumulative risk of lower extremity injury was the primary outcome. We gathered data during Cadet Basic Training and for 9 months during the subsequent academic year. Risk ratios and 95% confidence intervals (CIs) were calculated to compare groups. Results: No differences were seen between the AWU and the combined DIME (DCS and DES) groups during Cadet Basic Training or the academic year. During the academic year, lower extremity injury risk in the DES group decreased 41% (relative risk [RR] = 0.59; 95% CI = 0.38, 0.93; P = .02) compared with the DCS group; a nonsignificant 25% (RR = 0.75; 95% CI = 0.49, 1.14; P = .18) decrease occurred in the DES group compared with the AWU group. Finally, there was a nonsignificant 27% (RR = 1.27; 95% CI = 0.90, 1.78; P = .17) increase in injury risk during the academic year in the DCS group compared with the AWU group. Conclusions: We observed no differences in lower extremity injury risk between the AWU and combined DIME groups. However, the magnitude and direction

Arterial imaging in patients with lower extremity ischemia and diabetes mellitus.

PubMed

Pomposelli, Frank

2010-09-01

Precise, comprehensive imaging of the arterial circulation is the cornerstone of successful revascularization of the ischemic extremity in patients with diabetes mellitus. Arterial imaging is challenging in these patients because the disease is often multisegmental with a predilection for the distal tibial and peroneal arteries. Occlusive lesions and the arterial wall itself are often calcified and patients presenting with ischemic complications frequently have underlying renal insufficiency. Intra-arterial digital subtraction angiography (DSA), contrast enhanced magnetic resonance angiography (MRA), and more recently, computerized tomographic angiography (CTA) have been used as imaging modalities in lower extremity ischemia. Each has specific advantages and shortcomings in this patient population, which will be summarized and contrasted in this review. DSA is an invasive technique most often performed from a femoral arterial puncture and requires the injection of arterial contrast, which can occasionally cause allergic reactions. In patients with pre-existing renal insufficiency, contrast infusion can result in worsening renal failure; although usually self-limited, it may occasionally require hemodialysis, especially in patients with diabetes. However, DSA provides the highest degree of spatial resolution and image quality. It is also the only modality in which the diagnosis and treatment of arterial disease can be performed simultaneously. MRA is noninvasive, and when enhanced with gadolinium contrast injection provides arterial images of comparable quality to DSA and in some circumstances may uncover distal arterial targets not visualized on DSA. However, spatial resolution is inferior to DSA and erroneous interpretations due to acquisition artifacts are common. Specialized equipment and imaging techniques are necessary to minimize their occurrence in the distal lower extremity. In addition, due to the risk of inducing nephrogenic systemic fibrosis, gadolinium

Complicated Outcomes After Emergent Lower Extremity Surgery in Patients With Solid Organ Transplants.

PubMed

Reid, Alexander T; Perdue, Aaron; Goulet, James A; Robbins, Christopher B; Pour, Aidin Eslam

2016-11-01

The complications of emergent or urgent surgery in solid organ transplant recipients are unclear. The goal of this nonrandomized retrospective case study, conducted at a large public university teaching hospital, was to determine the following: (1) 90-day postsurgical complications in solid organ transplant recipients who undergo fracture surgery of the lower extremities; (2) 90-day and 1-year mortality rates for this cohort; (3) correlation of particular postsurgical complications with the 90-day or 1-year mortality rate; and (4) correlation of body mass index with the 90-day or 1-year mortality rate. Subjects included 36 solid organ transplant recipients who underwent surgical treatment for 37 emergent or urgent lower extremity fractures within 72 hours of presentation to the emergency department. Patients were followed for all medical and surgical complications for 90 days and for all-cause mortality for 1 year. Within 90 days of surgery, patients had complications that included acute renal failure (15, 40.5%), deep venous thrombosis (3, 8.1%), pulmonary embolus (2, 5.4%), pneumonia (7, 18.9%), superficial surgical site infection (3, 8.1%), and nonorthopedic sepsis (4, 10.8%). In addition, 3 (8.1%) and 5 (13.9%) patients died within 90 days and 1 year, respectively. Hospital readmission correlated with a higher 1-year mortality rate (odds ratio, 14.000; P=.016). Higher body mass index correlated with higher 90-day (odds ratio, 1.425; P=.035) and 1-year (odds ratio, 1.334; P=.033) mortality rates. Solid organ transplant recipients with lower extremity fracture have high 90-day and 1-year mortality rates and may have multiple complications within 90 days of treatment. [Orthopedics. 2016; 39(6):e1063-e1069.]. Copyright 2016, SLACK Incorporated.

Cerebral Small Vessel Disease Burden Is Associated with Motor Performance of Lower and Upper Extremities in Community-Dwelling Populations

PubMed Central

Su, Ning; Zhai, Fei-Fei; Zhou, Li-Xin; Ni, Jun; Yao, Ming; Li, Ming-Li; Jin, Zheng-Yu; Gong, Gao-Lang; Zhang, Shu-Yang; Cui, Li-Ying; Tian, Feng; Zhu, Yi-Cheng

2017-01-01

Objective: To investigate the correlation between cerebral small vessel disease (CSVD) burden and motor performance of lower and upper extremities in community-dwelling populations. Methods: We performed a cross-sectional analysis on 770 participants enrolled in the Shunyi study, which is a population-based cohort study. CSVD burden, including white matter hyperintensities (WMH), lacunes, cerebral microbleeds (CMBs), perivascular spaces (PVS), and brain atrophy were measured using 3T magnetic resonance imaging. All participants underwent quantitative motor assessment of lower and upper extremities, which included 3-m walking speed, 5-repeat chair-stand time, 10-repeat pronation–supination time, and 10-repeat finger-tapping time. Data on demographic characteristics, vascular risk factors, and cognitive functions were collected. General linear model analysis was performed to identify potential correlations between motor performance measures and imaging markers of CSVD after controlling for confounding factors. Results: For motor performance of the lower extremities, WMH was negatively associated with gait speed (standardized β = -0.092, p = 0.022) and positively associated with chair-stand time (standardized β = 0.153, p < 0.0001, surviving FDR correction). For motor performance of the upper extremities, pronation–supination time was positively associated with WMH (standardized β = 0.155, p < 0.0001, surviving FDR correction) and negatively with brain parenchymal fraction (BPF; standardized β = -0.125, p = 0.011, surviving FDR correction). Only BPF was found to be negatively associated with finger-tapping time (standardized β = -0.123, p = 0.012). However, lacunes, CMBs, or PVS were not found to be associated with motor performance of lower or upper extremities in multivariable analysis. Conclusion: Our findings suggest that cerebral microstructural changes related to CSVD may affect motor performance of both lower and upper extremities. WMH and brain

Cerebral Small Vessel Disease Burden Is Associated with Motor Performance of Lower and Upper Extremities in Community-Dwelling Populations.

PubMed

Su, Ning; Zhai, Fei-Fei; Zhou, Li-Xin; Ni, Jun; Yao, Ming; Li, Ming-Li; Jin, Zheng-Yu; Gong, Gao-Lang; Zhang, Shu-Yang; Cui, Li-Ying; Tian, Feng; Zhu, Yi-Cheng

2017-01-01

Objective: To investigate the correlation between cerebral small vessel disease (CSVD) burden and motor performance of lower and upper extremities in community-dwelling populations. Methods: We performed a cross-sectional analysis on 770 participants enrolled in the Shunyi study, which is a population-based cohort study. CSVD burden, including white matter hyperintensities (WMH), lacunes, cerebral microbleeds (CMBs), perivascular spaces (PVS), and brain atrophy were measured using 3T magnetic resonance imaging. All participants underwent quantitative motor assessment of lower and upper extremities, which included 3-m walking speed, 5-repeat chair-stand time, 10-repeat pronation-supination time, and 10-repeat finger-tapping time. Data on demographic characteristics, vascular risk factors, and cognitive functions were collected. General linear model analysis was performed to identify potential correlations between motor performance measures and imaging markers of CSVD after controlling for confounding factors. Results: For motor performance of the lower extremities, WMH was negatively associated with gait speed (standardized β = -0.092, p = 0.022) and positively associated with chair-stand time (standardized β = 0.153, p < 0.0001, surviving FDR correction). For motor performance of the upper extremities, pronation-supination time was positively associated with WMH (standardized β = 0.155, p < 0.0001, surviving FDR correction) and negatively with brain parenchymal fraction (BPF; standardized β = -0.125, p = 0.011, surviving FDR correction). Only BPF was found to be negatively associated with finger-tapping time (standardized β = -0.123, p = 0.012). However, lacunes, CMBs, or PVS were not found to be associated with motor performance of lower or upper extremities in multivariable analysis. Conclusion: Our findings suggest that cerebral microstructural changes related to CSVD may affect motor performance of both lower and upper extremities. WMH and brain atrophy

The relationship between lower extremity alignment and Medial Tibial Stress Syndrome among non-professional athletes

PubMed Central

Raissi, Golam Reza D; Cherati, Afsaneh D Safar; Mansoori, Kourosh D; Razi, Mohammad D

2009-01-01

Objective To determine the relationship between lower extremity alignment and MTSS amongst non-professional athletes Design In a prospective Study, sixty six subjects were evaluated. Bilateral navicular drop test, Q angle, Achilles angle, tibial angle, intermalleolar and intercondylar distance were measured. In addition, runner's height, body mass, history of previous running injury, running experience was recorded. Runners were followed for 17 weeks to determine occurrence of MTSS. Results The overall injury rate for MTSS was 19.7%. The MTSS injury rate in girls (22%) was not significantly different from the rate in boys (14.3%). Most MTSS injuries were induced after 60 hours of exercise, which did not differ between boys and girls. There was a significant difference in right and left navicular drop (ND) in athletes with MTSS. MTSS had no significant correlation with other variables including Quadriceps, Tibia and Achilles angles, intercondylar and intermaleolar lengths and lower extremity lengths. Limitation All measurements performed in this study were uniplanar and static. The small sample size deemed our main limitation. The accurate assessment of participants with previous history of anterior leg pain for MTSS was another limitation. Conclusion Although a significant relationship between navicular drop and MTSS was found in this study; there was not any significant relationship between lower extremity alignment and MTSS in our sample study. PMID:19519909

The efficacy of electrical stimulation in lower extremity cutaneous wound healing: A systematic review.

PubMed

Ashrafi, Mohammed; Alonso-Rasgado, Teresa; Baguneid, Mohamed; Bayat, Ardeshir

2017-02-01

Current gold standard lower extremity cutaneous wound management is not always effective. Cutaneous wounds generate a "current of injury" which is directly involved in wound healing processes. Application of exogenous electrical stimulation has been hypothesised to imitate the natural electric current that occurs in cutaneous wounds. The aim of this extensive review was to provide a detailed update on the variety of electrical stimulation modalities used in the management of lower extremity wounds. Several different waveforms and delivery methods of electrical stimulation have been used. Pulsed current appears superior to other electrical modalities available. The majority of studies support the beneficial effects of pulsed current over conservative management of lower extremity cutaneous wounds. Although it appears to have no benefit over causal surgical intervention, it is a treatment option which could be utilised in those patients unsuitable for surgery. Other waveforms and modalities appear promising; however, they still lack large trial data to recommend a firm conclusion with regards to their use. Current studies also vary in quantity, quality and protocol across the different modalities. The ideal electrical stimulation device needs to be non-invasive, portable and cost-effective and provides minimal interference with patients' daily life. Further studies are necessary to establish the ideal electrical stimulation modality, parameters, method of delivery and duration of treatment. The development and implementation of newer devices in the management of acute and chronic wounds provides an exciting direction in the field of electrotherapy. © 2016 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.

Effect of a lateral step-up exercise protocol on quadriceps and lower extremity performance.

PubMed

Worrell, T W; Borchert, B; Erner, K; Fritz, J; Leerar, P

1993-12-01

Closed kinetic chain exercises have been promoted as more functional and more appropriate than open kinetic chain exercises. Limited research exists demonstrating the effect of closed kinetic chain exercise on quadriceps and lower extremity performance. The purpose of this study was to determine the effect of a lateral step-up exercise protocol on isokinetic quadriceps peak torque and the following lower extremity activities: 1) leg press, 2) maximal step-up repetitions with body weight plus 25%, 3) hop for distance, and 4) 6-m timed hop. Twenty subjects participated in a 4-week training period, and 18 subjects served as controls. For the experimental group, a repeated measure ANOVA comparing pretest and posttest values revealed significant improvements in the leg press (p < or = .05), step-ups (p < or = .05), hop for distance (p < or = .05), and hop for time (p < or = .05) and no significant increase in isokinetic quadriceps peak torque (p > or = .05). Over the course of the training period, weight used for the step-up exercise increased (p < or = .05), repetitions decreased (p < or = .05), and step-up work did not change (p > or = .05). For the control group, no significant change (p > or = .05) occurred in any variable. The inability of the isokinetic dynamometer to detect increases in quadriceps performance is important because the isokinetic values are frequently used as criteria for return to functional activities. We conclude that closed kinetic chain testing and exercise provide additional means to assess and rehabilitate the lower extremity.

The influence of a foot orthotic on lower extremity transverse plane kinematics in collegiate female athletes with pes planus.

PubMed

Christopher, R Carcia; Drouin, Joshua M; Houglum, Peggy A

2006-01-01

Non-contact anterior cruciate ligament (ACL) injuries in female athletes remain prevalent. Athletes with excessive foot pronation have been identified to be at greater risk for non-contact ACL injury. Excessive foot pronation has been linked to increased medial tibial rotation. Increased medial tibial rotation heightens ACL strain and has been observed at or near the time of ACL injury. Foot orthotics have been shown to decrease medial tibial rotation during walking and running tasks. The effect of a foot orthotic on activities that simulate a non-contact ACL injury mechanism (i.e. landing) however is unknown. Therefore, the objective of this study was to determine whether a foot orthotic was capable of altering transverse plane lower extremity kinematics in female athletes during landing. Twenty uninjured collegiate female athletes participating in the sports of basketball, soccer or volleyball with pes planus volunteered. Utilizing a repeated measures counterbalanced design, subjects completed two landing tasks with and without a foot orthotic using standardized footwear. The prefabricated orthotic had a rigid shell and a 6 extrinsic rear-foot varus post. Dependent measures included initial contact angle, peak angle, excursion and time to peak angle for both the tibia and femur. Statistical analysis suggested that the selected foot orthosis had little influence over lower extremity transverse plane kinematics. Several factors including: the limitation of a static measure to predict dynamic movement, inter-subject variability and the physical characteristics of the orthotic device likely account for the results. Future research should examine the influence of different types of foot orthotics not only on lower extremity kinematics but also tibiofemoral kinetics. Key PointsLower extremity transverse plane kinematics in female athletes during a landing task exhibit substantial variability.A rigid prefabricated foot orthotic does not significantly alter transverse

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.

[Necrotizing fasciitis of the upper and lower extremities].

PubMed

Kückelhaus, M; Hirsch, T; Lehnhardt, M; Daigeler, A

2017-04-01

Necrotizing fasciitis is a potentially fatal soft tissue infection that may affect the upper and lower extremities, scrotum, perineum and abdominal wall. Typically, the infection demonstrates rapid spreading along the fascial planes leading to sepsis with mortality rates of 15-46%. Without adequate treatment, the mortality rate increases to close to 100%. There are four groups of pathogens that can lead to necrotizing fasciitis, namely beta-hemolytic group A streptococci, mixed infections with obligate and facultative anaerobes, clostridium species and fungal infections. Clinical signs may include erythema, edema and pain out of proportion in the early stages and soft tissue necrosis with bullae during the subsequent course. In some cases, only a deterioration of the general condition is evident and the aforementioned clinical symptoms are initially missing. The decision for treatment is based on the clinical diagnosis and surgical debridement is the cornerstone of treatment, accompanied by broad spectrum i.v. antibiotic treatment, e. g. with penicillin, ciprofloxacin and clindamycin.

Mechanical Prophylaxis after Lower Extremity Total Joint Arthroplasty: A Review.

PubMed

Chughtai, Morad; Newman, Jared M; Solow, Max; Davidson, Iyooh U; Sodhi, Nipun; Gaal, Benjamin; Khlopas, Anton; Sultan, Assem A; Mont, Michael A

2017-12-22

Venous thromboembolism (VTE) is a serious complication that can occur after total hip and knee arthroplasty, and can potentially lead to significant morbidity and even mortality. While various modalities have been used to prevent VTE development, the medications can be associated with a number of adverse events. Therefore, mechanical prophylaxis with pumps and compressive devices has been used more frequently alone, or in combination, with medications. Therefore, the purpose of this study was to review the current literature on mechanical prophylaxis for VTEs after lower extremity total joint arthroplasty. Specifically, we reviewed mechanical prophylaxis after: 1) total hip arthroplasty and 2) total knee arthroplasty.

Lower-extremity peripheral nerve blocks in the perioperative pain management of orthopaedic patients: AAOS exhibit selection.

PubMed

Stein, Benjamin E; Srikumaran, Umasuthan; Tan, Eric W; Freehill, Michael T; Wilckens, John H

2012-11-21

The utilization of peripheral nerve blocks in orthopaedic surgery has paralleled the rise in the number of ambulatory surgical procedures performed. Optimization of pain control in the perioperative orthopaedic patient contributes to improved patient satisfaction, early mobilization, decreased length of hospitalization, and decreased associated hospital and patient costs. Our purpose was to provide a concise, pertinent review of the use of peripheral nerve blocks in various orthopaedic procedures of the lower extremity, with specific focus on procedural anatomy, indications, patient outcome measures, and complications. We reviewed the literature and reference textbooks on commonly performed lower-extremity peripheral nerve block procedures in orthopaedic surgery, focusing on those most commonly used. The use of lower-extremity peripheral nerve blocks is a safe and effective approach to perioperative pain management. Different techniques and timing can have an important impact on patient satisfaction, and each technique has specific indications and complications. For major hip surgery, one of the most commonly used is the lumbar plexus block, which can result in early mobilization, reduced postoperative pain, and decreased opioid-associated adverse events. Associated complications include epidural spread of anesthesia, retroperitoneal hematoma formation, and postoperative falls. For arthroscopic and open knee procedures, the femoral nerve block is frequently used adjunctively. It provides improved early postoperative pain control, early mobilization with therapy, and increased patient satisfaction compared with intra-articular or intravenous opioids alone; it also provides cost savings. However, some studies have shown no significant difference in outcome measures compared with intra-articular opioids alone for arthroscopic anterior cruciate ligament reconstruction. Associated complications include nerve injury, intravascular injection, and postoperative falls. The

Shoe and Field Surface Risk Factors for Acute Lower Extremity Injuries Among Female Youth Soccer Players.

PubMed

OʼKane, John W; Gray, Kristen E; Levy, Marni R; Neradilek, Moni; Tencer, Allan F; Polissar, Nayak L; Schiff, Melissa A

2016-05-01

To describe acute lower extremity injuries and evaluate extrinsic risk factors in female youth soccer. Nested case-control study. Youth soccer clubs in Seattle, WA. Female soccer players (n = 351) ages 11 to 15 years randomly selected from 4 soccer clubs from which 83% of their players were enrolled with complete follow-up for 92% of players. Injured players were interviewed regarding injury, field surface, shoe type, and position. Uninjured controls, matched on game or practice session, were also interviewed. The association between risk factors and acute lower extremity injury using logistic regression to estimate odds ratios (OR) and 95% confidence intervals (CI). One hundred seventy-three acute lower extremity injuries occurred involving primarily the ankle (39.3%), knee (24.9%), and thigh (11.0%). Over half (52.9%) recovered within 1 week, whereas 30.2% lasted beyond 2 weeks. During practices, those injured were approximately 3-fold (OR, 2.83; 95% CI, 1.49-5.31) more likely to play on grass than artificial turf and 2.4-fold (95% CI, 1.03-5.96) more likely to wear cleats on grass than other shoe and surface combinations. During games, injured players were 89% (95% CI, 1.03-4.17) more likely to play defender compared with forward. Half of the acute lower extremity injuries affected the ankle or knee. Grass surface and wearing cleats on grass increased training injuries. The majority, 64%, of female youth soccer players' acute injuries involve the ankle and knee and injury prevention strategies in this age group should target these areas. When considering playing surfaces for training, communities and soccer organizations should consider the third-generation artificial turf a safe alternative to grass.

[Osteogenesis imperfecta--operative treatment on lower extremities in children with osteogenesis imperfecta].

PubMed

Sułko, Jerzy; Radło, Wojciech

2005-01-01

The group of 141 children with osteogenesis imperfecta was treated in Orthopaedic Department of the University Children Hospital in Krakow, Poland. In 77 (54.6%) children from this group, we operated on lower extremities. Prophylactic operations, that were intramedullary Rush rodding, we performed in 19 cases (14 femurs and 11 tibias). Sofield-Millar procedures we performed in 58 children. We operated 321 times - there are 4 operations on average in one child. Average follow-up period was 6.7 years. We operated 473 long bones: 234 femurs and 239 tibias. We did 479 osteotomies. First operations were done at the age of 9 years on average (1.5-21 years). Further operations, 3 in each patient on average, we performed in period 37 months from one to another on tibias and 49 months on femurs. In all operated children we achieved full axis correction and their activity after operation improved. In order to assess that, we used the Bleck scale. In general, before operation, 54 (70%) children did not walk, and, in contrast, after operations 53 (69%) started walking. Operative treatment of the lower extremities in children with osteogenesis imperfecta improves their clinical physical abilities, quality of life and allows increase in activities.

Permissive weight bearing in trauma patients with fracture of the lower extremities: prospective multicenter comparative cohort study.

PubMed

Kalmet, Pishtiwan H S; Meys, Guido; V Horn, Yvette Y; Evers, Silvia M A A; Seelen, Henk A M; Hustinx, Paul; Janzing, Heinrich; Vd Veen, Alexander; Jaspars, Coen; Sintenie, Jan Bernard; Blokhuis, Taco J; Poeze, Martijn; Brink, Peter R G

2018-02-02

The standard aftercare treatment in surgically treated trauma patients with fractures around or in a joint, known as (peri)- or intra-articular fractures of the lower extremities, is either non-weight bearing or partial weight bearing. We have developed an early permissive weight bearing post-surgery rehabilitation protocol in surgically treated patients with fractures of the lower extremities. In this proposal we want to compare our early permissive weight bearing protocol to the existing current non-weight bearing guidelines in a prospective comparative cohort study. The study is a prospective multicenter comparative cohort study in which two rehabilitation aftercare treatments will be contrasted, i.e. permissive weight bearing and non-weight bearing according to the AO-guideline. The study population consists of patients with a surgically treated fracture of the pelvis/acetabulum or a surgically treated (peri)- or intra-articular fracture of the lower extremities. The inclusion period is 12 months. The duration of follow up is 6 months, with measurements taken at baseline, 2,6,12 and 26 weeks post-surgery. ADL with Lower Extremity Functional Scale. Outcome variables for compliance, as measured with an insole pressure measurement system, encompass peak load and step duration. This study will investigate the (cost-) effectiveness of a permissive weight bearing aftercare protocol. The results will provide evidence whether a permissive weight bearing protocol is more effective than the current non-weight bearing protocol. The study is registered in the Dutch Trial Register ( NTR6077 ). Date of registration: 01-09-2016.

Thromboembolic Risk of Endovascular Intervention for Lower Extremity Deep Venous Thrombosis.

PubMed

Lindsey, Philip; Echeverria, Angela; Poi, Mun J; Matos, Jesus; Bechara, Carlos F; Cheung, Mathew; Lin, Peter H

2018-05-01

This study evaluated the risk of thromboembolism during endovascular interventions in patients with symptomatic lower extremity deep vein thrombosis (DVT) METHODS: Clinical records of all patients who underwent endovascular interventions for symptomatic lower extremity DVT from 2001 to 2017 were retrospectively analyzed using a prospectively maintained database. Only patients who received an inferior vena cava (IVC) filter were included in the analysis. Trapped intrafilter thrombus was assessed for procedure-related thromboembolism. Clinical outcomes of thrombus management and thromboembolism risk were analyzed. A total 172 patients (mean age 57.4 years, 98 females) who underwent 174 endovascular DVT interventions were included in the analysis. Treatment strategies included thrombolytic therapy (64%), mechanical thrombectomy (n = 86%), pharmacomechanical thrombolysis (51%), balloon angioplasty (98%), and stent placement (28%). Thrombectomy device used included AngioJet (56%), Trellis (19%), and Aspire (11%). Trapped IVC filter thrombus was identified in 58 patients (38%) based on the IVC venogram. No patient developed clinically evident pulmonary embolism (PE). IVC filter retrieval was performed in 98 patients (56%, mean 11.8 months after implantation). Multivariate analysis showed that iliac vein occlusion (P = 0.04) was predictive for procedure-related thromboembolism. Iliac vein thrombotic occlusion is associated with an increased thromboembolic risk in DVT intervention. Retrievable IVC filter should be considered when performing percutaneous thrombectomy in patients with iliac venous occlusion to prevent PE. Copyright © 2017 Elsevier Inc. All rights reserved.

Secondary abdominal compartment syndrome after complicated traumatic lower extremity vascular injuries.

PubMed

Macedo, F I B; Sciarretta, J D; Otero, C A; Ruiz, G; Ebler, D J; Pizano, L R; Namias, N

2016-04-01

Secondary abdominal compartment syndrome (ACS) can occur in trauma patients without abdominal injuries. Surgical management of patients presenting with secondary ACS after isolated traumatic lower extremity vascular injury (LEVI) continues to evolve, and associated outcomes remain unknown. From January 2006 to September 2011, 191 adult trauma patients presented to the Ryder Trauma Center, an urban level I trauma center in Miami, Florida with traumatic LEVIs. Among them 10 (5.2 %) patients were diagnosed with secondary ACS. Variables collected included age, gender, mechanism of injury, and clinical status at presentation. Surgical data included vessel injury, technical aspects of repair, associated complications, and outcomes. Mean age was 37.4 ± 18.0 years (range 16-66 years), and the majority of patients were males (8 patients, 80 %). There were 7 (70 %) penetrating injuries (5 gunshot wounds and 2 stab wounds), and 3 blunt injuries with mean Injury Severity Score (ISS) 21.9 ± 14.3 (range 9-50). Surgical management of LEVIs included ligation (4 patients, 40 %), primary repair (1 patient, 10 %), reverse saphenous vein graft (2 patients, 20 %), and PTFE interposition grafting (3 patients, 30 %). The overall mortality rate in this series was 60 %. The association between secondary ACS and lower extremity vascular injuries carries high morbidity and mortality rates. Further research efforts should focus at identifying parameters to accurately determine resuscitation goals, and therefore, prevent such a devastating condition.

Quantification of lower extremity physical exposures in various combinations of sit/stand time duration associated with sit-stand workstation.

PubMed

Pei, Huining; Yu, Suihuai; Babski-Reeves, Kari; Chu, Jianjie; Qu, Min; Tian, Baozhen; Li, Wenhua

2017-05-16

Sit-stand workstations are available for office work purposes but there is a dearth of quantitative evidence to state benefits for lower limb outcomes while using them. And there are no guidelines on what constitutes appropriate sit/stand time duration. The primary aim of this study has been to compare muscle activity and perceived discomfort in the lower extremity during various combinations of sit/stand time duration associated with a sit-stand workstation separately and to evaluate the effects of the sit-stand workstation on the lower extremity during the text entry task. During the 5 days, all participants completed a 2-h text entry task each day for various sit/stand time duration combinations as follows: 5/25 min, 10/20 min, 15/15 min, 20/10 min, 25/5 min. Lower extremity muscular exposure of 12 male and 13 female participants was collected at 8 sites by surface electromyography and body discomfort was calculated by a questionnaire under those 5 conditions. Results have demonstrated that lower extremity muscle activity has been significantly varied among the 5 sit/stand time duration groups. Perceived level of discomfort (PLD) has not differed significantly for 9 out of 10 body parts. The muscle activity of the thigh region was influenced by sit/stand time duration significantly. Ergonomic exposures of lower extremity when using a sit-stand workstation were increased, particularly during the long time standing posture. Results indicate that body mass index (BMI) and gender were not significant factors in this study. Combination of sit/stand time duration 25/5 min appears to show positive effects on relief of muscle exposure of back of thigh in the shifts of sitting and standing work position. Med Pr 2017;68(3):315-327. This work is available in Open Access model and licensed under a CC BY-NC 3.0 PL license.

Rasch analysis of the Italian Lower Extremity Functional Scale: insights on dimensionality and suggestions for an improved 15-item version.

PubMed

Bravini, Elisabetta; Giordano, Andrea; Sartorio, Francesco; Ferriero, Giorgio; Vercelli, Stefano

2017-04-01

To investigate dimensionality and the measurement properties of the Italian Lower Extremity Functional Scale using both classical test theory and Rasch analysis methods, and to provide insights for an improved version of the questionnaire. Rasch analysis of individual patient data. Rehabilitation centre. A total of 135 patients with musculoskeletal diseases of the lower limb. Patients were assessed with the Lower Extremity Functional Scale before and after the rehabilitation. Rasch analysis showed some problems related to rating scale category functioning, items fit, and items redundancy. After an iterative process, which resulted in the reduction of rating scale categories from 5 to 4, and in the deletion of 5 items, the psychometric properties of the Italian Lower Extremity Functional Scale improved. The retained 15 items with a 4-level response format fitted the Rasch model (internal construct validity), and demonstrated unidimensionality and good reliability indices (person-separation reliability 0.92; Cronbach's alpha 0.94). Then, the analysis showed differential item functioning for six of the retained items. The sensitivity to change of the Italian 15-item Lower Extremity Functional Scale was nearly equal to the one of the original version (effect size: 0.93 and 0.98; standardized response mean: 1.20 and 1.28, respectively for the 15-item and 20-item versions). The Italian Lower Extremity Functional Scale had unsatisfactory measurement properties. However, removing five items and simplifying the scoring from 5 to 4 levels resulted in a more valid measure with good reliability and sensitivity to change.

Normal venous anatomy and physiology of the lower extremity.

PubMed

Notowitz, L B

1993-06-01

Venous disease of the lower extremities is common but is often misunderstood. It seems that the focus is on the exciting world of arterial anatomy and pathology, while the topic of venous anatomy and pathology comes in second place. However, venous diseases such as chronic venous insufficiency, leg ulcers, and varicose veins affect much of the population and may lead to disability and death. Nurses are often required to answer complex questions from the patients and his or her family about the patient's disease. Patients depend on nurses to provide accurate information in terms they can understand. Therefore it is important to have an understanding of the normal venous system of the legs before one can understand the complexities of venous diseases and treatments. This presents an overview of normal venous anatomy and physiology.

In-Hospital Outcomes of Atherectomy During Endovascular Lower Extremity Revascularization.

PubMed

Panaich, Sidakpal S; Arora, Shilpkumar; Patel, Nilay; Patel, Nileshkumar J; Patel, Samir V; Savani, Chirag; Singh, Vikas; Jhamnani, Sunny; Sonani, Rajesh; Lahewala, Sopan; Thakkar, Badal; Patel, Achint; Dave, Abhishek; Shah, Harshil; Bhatt, Parth; Jaiswal, Radhika; Ghatak, Abhijit; Gupta, Vishal; Deshmukh, Abhishek; Kondur, Ashok; Schreiber, Theodore; Grines, Cindy; Badheka, Apurva O

2016-02-15

Contemporary data on clinical outcomes after utilization of atherectomy in lower extremity endovascular revascularization are sparse. The study cohort was derived from Healthcare Cost and Utilization Project nationwide inpatient sample database from the year 2012. Peripheral endovascular interventions including atherectomy were identified using appropriate International Classification of Diseases, Ninth Revision, Clinical Modification diagnostic and procedural codes. The subjects were divided and compared in 2 groups: atherectomy versus no atherectomy. Two-level hierarchical multivariate mixed models were created. The coprimary outcomes were in-hospital mortality and amputation; secondary outcome was a composite of in-hospital mortality and periprocedural complications. Hospitalization costs were also assessed. Atherectomy utilization (odds ratio, 95% CI, p value) was independently predictive of lower in-hospital mortality (0.46, 0.28 to 0.75, 0.002) and lower amputation rates (0.83, 0.71 to 0.97, 0.020). Atherectomy use was also predictive of significantly lower secondary composite outcome of in-hospital mortality and complications (0.79, 0.69 to 0.90, 0.001). In the propensity-matched cohort, atherectomy utilization was again associated with a lower rate of amputation (11.18% vs 12.92%, p = 0.029), in-hospital mortality (0.71% vs 1.53%, p 0.001), and any complication (13.24% vs 16.09%, p 0.001). However, atherectomy use was also associated with higher costs ($24,790 ± 397 vs $22635 ± 251, p <0.001). Atherectomy use in conjunction with angioplasty (with or without stenting) was associated with improved in-hospital outcomes in terms of lower amputation rates, mortality, and postprocedural complications. Copyright © 2016 Elsevier Inc. All rights reserved.

The effect of ankle bracing on lower extremity biomechanics during landing: A systematic review.

PubMed

Mason-Mackay, A R; Whatman, C; Reid, D

2016-07-01

To examine the evidence for effect of ankle bracing on lower-extremity landing biomechanics. Literature review. Systematic search of the literature on EBSCO health databases. Articles critiqued by two reviewers. Ten studies were identified which investigated the effect of ankle bracing on landing biomechanics. Overall results suggest that landing biomechanics are altered with some brace types but studies disagree as to the particular variables affected. There is evidence that ankle bracing may alter lower-extremity landing biomechanics in a manner which predisposes athletes to injury. The focus of studies on specific biomechanical variables rather than biomechanical patterns, analysis of pooled data means in the presence of differing landing styles between participants, variation in landing-tasks investigated in different studies, and lack of studies investigating goal-directed sport-specific landing tasks creates difficulty in interpreting results. These areas require further research. Copyright © 2015 Sports Medicine Australia. Published by Elsevier Ltd. All rights reserved.

The effect of unilateral arm swing motion on lower extremity running mechanics associated with injury risk.

PubMed

Agresta, Cristine; Ward, Christian R; Wright, W Geoffrey; Tucker, Carole A

2018-06-01

Many field sports involve equipment that restricts one or both arms from moving while running. Arm swing during running has been examined from a biomechanical and physiologic perspective but not from an injury perspective. Moreover, only bilateral arm swing suppression has been studied with respect to running. The purpose of this study was to determine the influence of running with one arm restrained on lower extremity mechanics associated with running or sport-related injury. Fifteen healthy participants ran at a self-selected speed with typical arm swing, with one arm restrained and with both arms restrained. Lower extremity kinematics and spatiotemporal measures were analysed for all arm swing conditions. Running with one arm restrained resulted in increased frontal plane knee and hip angles, decreased foot strike angle, and decreased centre of mass vertical displacement compared to typical arm swing or bilateral arm swing restriction. Stride length was decreased and step frequency increased when running with one or both arms restrained. Unilateral arm swing restriction induces changes in lower extremity kinematics that are not similar to running with bilateral arm swing restriction or typical arm swing motion. Running with one arm restrained increases frontal plane mechanics associated with risk of knee injury.

A comparative analysis of functional outcomes in adolescents and young adults with lower-extremity bone sarcoma.

PubMed

Ginsberg, Jill P; Rai, Shesh N; Carlson, Claire A; Meadows, Anna T; Hinds, Pamela S; Spearing, Elena M; Zhang, Lijun; Callaway, Lulie; Neel, Michael D; Rao, Bhaskar N; Marchese, Victoria G

2007-12-01

Comparison of functional mobility and quality of life is performed in patients with lower-extremity bone sarcoma following either amputation, limb-sparing surgery, or rotationplasty with four different types of outcome measures: (1) an objective functional mobility measure that requires patients to physically perform specific tasks, functional mobility assessment (FMA); (2) a clinician administered tool, Musculoskeletal Tumor Society Scale (MSTS); (3) a patient questionnaire, Toronto Extremity Salvage Scale (TESS); and (4) a health-related quality of life (HRQL) measure, Short Form-36 version 2 (SF-36v.2). This is a prospective multi-site study including 91 patients with lower-extremity bone sarcoma following amputation, limb-sparing surgery, or rotationplasty. One of three physical therapists administered the quality of life measure (SF-36v.2) as well as a battery of functional measures (FMA, MSTS, and TESS). Differences between patients who had amputation, limb-sparing surgery, or rotationplasty were consistently demonstrated by the FMA. Patients with limb sparing femur surgery performed better than those patients with an above the knee amputation but similarly to a small number of rotationplasty patients. Several of the more conventional self-report measures were shown to not have the discriminative capabilities of the FMA in these cohorts. In adolescents with lower-extremity bone sarcoma, it may be advantageous to consider the use of a combination of outcome measures, including the FMA, for objective functional mobility assessment along with the TESS for a subjective measure of disability and the SF-36v.2 for a quality-of-life measure. 2007 Wiley-Liss, Inc

Cognitive Demands Influence Lower Extremity Mechanics During a Drop Vertical Jump Task in Female Athletes.

PubMed

Almonroeder, Thomas Gus; Kernozek, Thomas; Cobb, Stephen; Slavens, Brooke; Wang, Jinsung; Huddleston, Wendy

2018-05-01

Study Design Cross-sectional study. Background The drop vertical jump task is commonly used to screen for anterior cruciate ligament injury risk; however, its predictive validity is limited. The limited predictive validity of the drop vertical jump task may be due to not imposing the cognitive demands that reflect sports participation. Objectives To investigate the influence of additional cognitive demands on lower extremity mechanics during execution of the drop vertical jump task. Methods Twenty uninjured women (age range, 18-25 years) were required to perform the standard drop vertical jump task, as well as drop vertical jumps that included additional cognitive demands. The additional cognitive demands were related to attending to an overhead goal (ball suspended overhead) and/or temporal constraints on movement selection (decision making). Three-dimensional ground reaction forces and lower extremity mechanics were compared between conditions. Results The inclusion of the overhead goal resulted in higher peak vertical ground reaction forces and lower peak knee flexion angles in comparison to the standard drop vertical jump task. In addition, participants demonstrated greater peak knee abduction angles when trials incorporated temporal constraints on decision making and/or required participants to attend to an overhead goal, in comparison to the standard drop vertical jump task. Conclusion Imposing additional cognitive demands during execution of the drop vertical jump task influenced lower extremity mechanics in a manner that suggested increased loading of the anterior cruciate ligament. Tasks utilized in anterior cruciate ligament injury risk screening may benefit from more closely reflecting the cognitive demands of the sports environment. J Orthop Sports Phys Ther 2018;48(5):381-387. Epub 10 Jan 2018. doi:10.2519/jospt.2018.7739.

[The application of impulse magnetic therapy for the treatment of the patients presenting with lymphedema of the lower extremities].

PubMed

Kulchitskaya, D B; Gerasimenko, M Yu; Aphanova, T V; Konchugova, T V

The principal objective of the present work was to evaluate the influence of impulse magnetic therapy on the state of the microcirculatory system in the patients presenting with lymphedema of the lower extremities. The study included 59 patients with stage of 1 and 2 lymphedema who were divided into two groups. Those comprising the first group had impulse magnetic therapy applied to their lower extremities while the patients making up the second group served as controls. All the patients were examined with the use of the laser Doppler flowmetry (LDF) that revealed the initially present pathological changes in the microcirculatory system of their lower extremities. The study has demonstrated that the application of impulse magnetic therapy produced a positive effect on all the constituent components of the microcirculatory blood stream of the patients suffering from lymphedema of the lower extremities. Specifically, the initially increased arteriolar tonus was decreased, the blood flow in the capillary vessels was improved, and congestive phenomena in the venular segments of the microcirculation blood stream were markedly reduced. The results of the LDF examination in the control group gave no evidence of significant changes in the patients' microcirculatory system. The results of the LDF examination of the patients of the control group suggested the absence of any appreciable changes in the microcirculatory system. The present study has demonstrated the advisability of the application of impulse magnetic therapy for the treatment of the patients presenting with lymphedema of the lower extremities as a minimally invasive technique for the evaluation of the condition of the microcirculatory system and the objective assessment of the effectiveness of the outcomes of physiotherapy in the patients with vascular pathology.

An analysis of the effect of lower extremity strength on impact severity during a backward fall.

PubMed

Sandler, R; Robinovitch, S

2001-12-01

At least 280 000 hip fractures occur annually in the U.S. at an estimated cost of $9 billion. While over 90 percent of these are caused by falls, only about 2 percent of all falls result in hip fracture. Evidence suggests that the most important determinants of hip fracture risk during a fall are the body's impact velocity and configuration. Accordingly, protective responses for reducing impact velocity and the likelihood for direct impact to the hip, strongly influence fracture risk. One method for reducing the body's impact velocity and kinetic energy during a fall is to absorb energy in the lower extremity muscles during descent, as occurs during sitting and squatting. In the present study, we employed a series of in verted pendulum models to determine: (a) the theoretical effect of this mechanism on impact severity during a backward fall, and (b) the effect on impact severity of age-related declines (or exercise-induced enhancements) in lower extremity strength. Compared to the case of a fall with zero energy absorption in the lower extremity joints, best-case falls (which involved 81 percent activation of ankle and hip muscles, but only 23 percent activation of knees muscles) involved 79 percent attenuation (from 352 J to 74 J) in the body's vertical kinetic energy at impact (KEv), and 48 percent attenuation (from 3.22 to 1.68 m/s) in the downward velocity of the pelvis at impact (v(v)). Among the mechanisms responsible for this were: (1) eccentric contraction of lower extremity muscles during descent, which resulted in up to 150 J of energy absorption; (2) impact with the trunk in an upright configuration, which reduced the change in potential energy associated with the fall by 100 J; and (3) knee extension during the final stage of descent, which "transferred" up to 90 J of impact energy into horizontal (as opposed to vertical) kinetic energy. Declines in joint strength reduced the effectiveness of mechanisms (1) and (3), and thereby increased impact

Concussion May Increase the Risk of Subsequent Lower Extremity Musculoskeletal Injury in Collegiate Athletes

PubMed Central

Herman, Daniel; Jones, Debi; Harrison, Ashley; Moser, Michael; Tillman, Susan; Farmer, Kevin; Pass, Anthony; Clugston, Jay; Hernandez, Jorge; Chmielewski, Terese

2016-01-01

Background Laboratory-based studies on neuromuscular control after concussion and epidemiological studies suggest that concussion may increase the risk of subsequent musculoskeletal injury. Objective The purpose of this study was to determine if athletes have an increased risk of lower extremity musculoskeletal injury after return-to-play from a concussion. Methods Injury data were collected from 2006–2013 for men’s football and women’s basketball, soccer, and lacrosse at a NCAA Division I university. Ninety cases in 73 athletes (52 Male, 21 Female) of in-season concussion with return-to-play at least 30 days prior to the end of the season were identified. A period of up to 90 days of in-season competition following return-to-play was reviewed for time-loss injury. The same period was studied in up to two control athletes who were without a concussion within the prior year and were matched on sport, starting status, and position. Results Lower extremity musculoskeletal injuries occurred at a higher rate in the concussed athletes (45/90 or 50%) compared to the non-concussed athletes (30/148 or 20%) (p < 0.01). The odds of sustaining a musculoskeletal injury were 3.39 times higher in the concussed athletes (95% CI = 1.90, 6.05; p < 0.01). Overall, the number of days lost due to injury was similar between concussed and non-concussed athletes (Median = 9 vs 15, p = 0.41). Conclusions The results of this study demonstrate a relationship between concussion and an increased risk of lower extremity musculoskeletal injury after return to play, and may have implications for current medical practice standards regarding the evaluation and management of concussion injuries. PMID:27544666

An interval kicking progression for return to soccer following lower extremity injury.

PubMed

Arundale, Amelia; Silvers, Holly; Logerstedt, David; Rojas, Jaime; Snyder-Mackler, Lynn

2015-02-01

The majority of all soccer injuries affect the lower extremities. Regardless of whether the injured limb is an athlete's preferred kicking or stance leg, a lower extremity injury may affect their ability to impact the ball. Sport-specific biomechanical progressions to augment loading and gradually reintroduce a player to the demands of sport have been developed for upper extremity sports such as baseball, softball, tennis, and golf. Generalized return to soccer progressions have also been published in order to assist clinicians in safely returning athletes to sport; however, there are no specific progressions for the early stages of kicking designed to introduce stance leg loading and kicking leg impact. Thus, the purpose of this clinical commentary was to review the existing literature elucidating the biomechanics of kicking a soccer ball and propose a progressive kicking program to support clinicians in safely returning their soccer athletes to the demands of sport. The interval kicking program (IKP) describes clinical guidelines for readiness to begin a kicking program as well as possible readiness to return to sport measures. The program is performed on alternate days integrating therapeutic exercise and cardiovascular fitness. The IKP gradually introduces a player to the loading and impact of kicking. The progression increases kicking distance (using the markings of a soccer field as a guide), volume, and intensity and uses proposed soreness rules, effusion guidelines, and player feedback in order to assist clinicians in determining readiness for advancement though the stages. The IKP also recommends utility of specific tests and measures to determine readiness for return to sport. Gradual reintroduction to sport specific demands is essential for a safe return to soccer. This return to sport progression provides a framework integrating injury specific therapeutic exercise, cardiovascular fitness, and the return to kicking progression, to assist clinicians in

Lower extremity joint moments of collegiate soccer players differ between genders during a forward jump.

PubMed

Hart, Joseph M; Garrison, J Craig; Palmieri-Smith, Riann; Kerrigan, D Casey; Ingersoll, Christopher D

2008-05-01

Lower extremity kinetics while performing a single-leg forward jump landing may help explain gender biased risk for noncontact anterior cruciate ligament injury. Gender comparison of lower extremity joint angles and moments. Static groups comparison. Motion analysis laboratory. 8 male and 8 female varsity, collegiate soccer athletes. 5 single-leg landings from a 100cm forward jump. Peak and initial contact external joint moments and joint angles of the ankle, knee, and hip. At initial heel contact, males exhibited a adduction moment whereas females exhibited a abduction moment at the hip. Females also had significantly less peak hip extension moment and significantly less peak hip internal rotation moment than males had. Females exhibited greater knee adduction and hip internal rotation angles than men did. When decelerating from a forward jump, gender differences exist in forces acting at the hip.

The Lower Extremity Biomechanics of Single- and Double-Leg Stop-Jump Tasks

PubMed Central

2011-01-01

The anterior cruciate ligament (ACL) injury is a common occurrence in sports requiring stop-jump tasks. Single- and double-leg stop-jump techniques are frequently executed in sports. The higher risk of ACL injury in single-leg drop landing task compared to a double-leg drop landing task has been identified. However the injury bias between single- and double-leg landing techniques has not been investigated for stop-jump tasks. The purpose of this study was to determine the differences between single- and double-leg stop-jump tasks in knee kinetics that were influenced by the lower extremity kinematics during the landing phase. Ground reaction force, lower extremity kinematics, and knee kinetics data during the landing phase were obtained from 10 subjects performing single- and double-leg stop-jump tasks, using motion-capture system and force palates. Greater peak posterior and vertical ground reaction forces, and peak proximal tibia anterior and lateral shear forces (p < 0.05) during landing phase were observed of single-leg stop-jump. Single-leg stop-jump exhibited smaller hip and knee flexion angle, and knee flexion angular velocity at initial foot contact with the ground (p < 0.05). We found smaller peak hip and knee flexion angles (p < 0.05) during the landing phase of single-leg stop-jump. These results indicate that single-leg landing may have higher ACL injury risk than double-leg landing in stop-jump tasks that may be influenced by the lower extremity kinematics during the landing phase. Key points Non-contact ACL injuries are more likely to occur during the single-leg stop-jump task than during the double-leg stop-jump task. Single-leg stop-jump exhibited greater peak proximal tibia anterior and lateral shear forces, and peak posterior and vertical ground reaction forces during the landing phase than the double-leg stop-jump task. Single-leg stop-jump exhibited smaller hip flexion angle, knee flexion angle, and knee flexion angular velocity at initial foot

Percentage extremity fat, but not percentage trunk fat, is lower in adolescent boys with anorexia nervosa than in healthy adolescents123

PubMed Central

Misra, Madhusmita; Katzman, Debra K; Cord, Jennalee; Manning, Stephanie J; Mickley, Diane; Herzog, David B; Miller, Karen K; Klibanski, Anne

2013-01-01

Background Anorexia nervosa (AN) is a condition of severe undernutrition associated with altered regional fat distribution in females. Although primarily a disease of females, AN is increasingly being recognized in males and is associated with hypogonadism. Testosterone is a major regulator of body composition in males, and testosterone administration in adults decreases visceral fat. However, the effect of low testosterone and other hormonal alterations on body composition in boys with AN is not known. Objective We hypothesized that testosterone deficiency in boys with AN is associated with higher trunk fat, as opposed to extremity fat, compared with control subjects. Design We assessed body composition using dual-energy X-ray absorptiometry and measured fasting testosterone, estradiol, insulin-like growth factor-1, leptin, and active ghrelin concentrations in 15 boys with AN and in 15 control subjects of comparable maturity aged 12–19 y. Results Fat and lean mass in AN boys was 69% and 86% of that in control subjects. Percentage extremity fat and extremity lean mass were lower in boys with AN (P = 0.003 and 0.0008); however, percentage trunk fat and the trunk to extremity fat ratio were higher after weight was adjusted for (P = 0.005 and 0.003). Testosterone concentrations were lower in boys with AN, and, on regression modeling, positively predicted percentage extremity lean mass and inversely predicted percentage trunk fat and trunk to extremity fat ratio. Other independent predictors of regional body composition were bone age and weight. Conclusions In adolescent boys with AN, higher percentage trunk fat, higher trunk to extremity fat ratio, lower percentage extremity fat, and lower extremity lean mass (adjusted for weight) are related to the hypogonadal state. PMID:19064506

Overuse injuries of the lower extremity: shin splints, iliotibial band friction syndrome, and exertional compartment syndromes.

PubMed

Jones, D C; James, S L

1987-04-01

The authors' discussion of overuse injuries of the lower extremity encompasses shin splints, iliotibial band friction syndrome, and exertional compartment syndromes. Etiology, diagnosis, and treatment are considered for each disorder.

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

PubMed Central

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/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

[Biomechanical air-vibration stimulation in the medical rehabilitation of patients with chronic venous insufficiency of the lower extremities].

PubMed

Zhukov, B N; Katorkin, S E

1993-01-01

Biomechanical pneumo-vibration stimulation of lower extremities was used in 146 patients with different forms and stages of chronic venous insufficiency of lower extremities during conservative treatment in preoperative preparation and the following early rehabilitation, in 106 patients with consequences of the trauma and diseases of the spinal cord as well as in 35 healthy people. The biomechanical pneumo-vibration stimulation is thought by the authors to be a promising noninvasive conservative method of medical rehabilitation. It can be recommended for clinical use with due regard for contraindications.

Can custom-made biomechanic shoe orthoses prevent problems in the back and lower extremities? A randomized, controlled intervention trial of 146 military conscripts.

PubMed

Larsen, Kristian; Weidich, Flemming; Leboeuf-Yde, Charlotte

2002-06-01

Shock-absorbing and biomechanic shoe orthoses are frequently used in the prevention and treatment of back and lower extremity problems. One review concludes that the former is clinically effective in relation to prevention, whereas the latter has been tested in only 1 randomized clinical trial, concluding that stress fractures could be prevented. To investigate if biomechanic shoe orthoses can prevent problems in the back and lower extremities and if reducing the number of days off-duty because of back or lower extremity problems is possible. Prospective, randomized, controlled intervention trial. One female and 145 male military conscripts (aged 18 to 24 years), representing 25% of all new conscripts in a Danish regiment. Health data were collected by questionnaires at initiation of the study and 3 months later. Custom-made biomechanic shoe orthoses to be worn in military boots were provided to all in the study group during the 3-month intervention period. No intervention was provided for the control group. Differences between the 2 groups were tested with the chi-square test, and statistical significance was accepted at P <.05. Risk ratio (RR), risk difference (ARR), numbers needed to prevent (NNP), and cost per successfully prevented case were calculated. Outcome variables included self-reported back and/or lower extremity problems; specific problems in the back or knees or shin splints, Achilles tendonitis, sprained ankle, or other problems in the lower extremity; number of subjects with at least 1 day off-duty because of back or lower extremity problems and total number of days off-duty within the first 3 months of military service because of back or lower extremity problems. Results were significantly better in an actual-use analysis in the intervention group for total number of subjects with back or lower extremity problems (RR 0.7, ARR 19%, NNP 5, cost 98 US dollars); number of subjects with shin splints (RR 0.2, ARR 19%, NNP 5, cost 101 US dollars); number

Surgical Management of Complex Lower-Extremity Trauma With a Long Hindfoot Fusion Nail: A Case Report.

PubMed

Jain, Nickul S; Lopez, Gregory D; Bederman, S Samuel; Wirth, Garrett A; Scolaro, John A

2016-08-01

High-energy injuries can result in complete or partial loss of the talus. Ipsilateral fractures to the lower limb increase the complexity of surgical management, and treatment is guided by previous case reports of similar injuries. A case of complex lower-extremity trauma with extruded and missing talar body and ipsilateral type IIIB open tibia fracture is presented. Surgical limb reconstruction and salvage was performed successfully with a single orthopaedic implant in a manner not described previously in the literature. The purpose of this case report is to present the novel use of a single orthopaedic implant for treatment of a complex, open traumatic injury. Previous case reports in the literature have described the management of complete or partial talar loss. We describe the novel use of a long hindfoot fusion nail and staged bone grafting to achieve tibiocalcaneal arthrodesis for the treatment of complex lower-extremity trauma. Therapeutic, Level IV: Case study. © 2015 The Author(s).

Normal axial alignment of the lower extremity and load-bearing distribution at the knee.

PubMed

Hsu, R W; Himeno, S; Coventry, M B; Chao, E Y

1990-06-01

Based on a series of 120 normal subjects of different gender and age, the geometry of the knee joint was analyzed using a full-length weight-bearing roentgenogram of the lower extremity. A special computer program based on the theory of a rigid body spring model was applied to calculate the important anatomic and biomechanical factors of the knee joint. The tibiofemoral mechanical angle was 1.2 degrees varus. Hence, it is difficult to rationalize the 3 degree varus placement of the tibial component in total knee arthroplasty suggested by some authors. The distal femoral anatomic valgus (measured from the lower one-half of the femur) was 4.2 degrees in reference to its mechanical axis. This angle became 4.9 degrees when the full-length femoral anatomic axis was used. When simulating a one-legged weight-bearing stance by shifting the upper-body gravity closer to the knee joint, 75% of the knee joint load passed through the medial tibial plateau. The knee joint-line obliquity was more varus in male subjects. The female subjects had a higher peak joint pressure and a greater patello-tibial Q angle. Age had little effect on the factors relating to axial alignment of the lower extremity and load transmission through the knee joint.

Tibiopedal access for lower extremity arterial intervention: when to use and how to perform.

PubMed

Wiechmann, Bret N

2014-09-01

Tibiopedal artery access is being used with increasing frequency as an alternative access to facilitate procedural success in lower extremity arterial intervention. This technique is usually employed in the setting of critical limb ischemia and tibial artery intervention, but it may offer potential practical advantages for popliteal artery and even superficial femoral artery intervention in unique situations. As in all cases of lower extremity arterial intervention, consideration of access is important not only for initial approach to any obstructing lesion but also for exit strategy. The dorsalis pedis artery and posterior tibial artery can be readily accessed if necessary owing to their relatively superficial position in the foot or the ankle, yet their normal diameter and the presence of significant calcification (a common finding in patients with tibial occlusive disease and critical limb ischemia) can pose difficulties as well. In addition, the peroneal artery in the lower leg can be accessed percutaneously; however, its size and depth may present additional challenges. Meticulous attention to detail is paramount in avoiding complications in what may be the only distal vessel supplying the foot. This article describes common techniques in using tibiopedal artery access as a means of alternative access for successful infrainguinal intervention. Copyright © 2014 Elsevier Inc. All rights reserved.

Gait Training Interventions for Lower Extremity Amputees: A Systematic Literature Review

PubMed Central

Highsmith, M. Jason; Andrews, Casey R.; Millman, Claire; Fuller, Ashley; Kahle, Jason T.; Klenow, Tyler D.; Lewis, Katherine L.; Bradley, Rachel C.; Orriola, John J.

2016-01-01

Lower extremity (LE) amputation patients who use prostheses have gait asymmetries and altered limb loading and movement strategies when ambulating. Subsequent secondary conditions are believed to be associated with gait deviations and lead to long-term complications that impact function and quality of life as a result. The purpose of this study was to systematically review the literature to determine the strength of evidence supporting gait training interventions and to formulate evidence statements to guide practice and research related to therapeutic gait training for lower extremity amputees. A systematic review of three databases was conducted followed by evaluation of evidence and synthesis of empirical evidence statements (EES). Eighteen manuscripts were included in the review, which covered two areas of gait training interventions: 1) overground and 2) treadmill-based. Eight EESs were synthesized. Four addressed overground gait training, one covered treadmill training, and three statements addressed both forms of therapy. Due to the gait asymmetries, altered biomechanics, and related secondary consequences associated with LE amputation, gait training interventions are needed along with study of their efficacy. Overground training with verbal or other auditory, manual, and psychological awareness interventions was found to be effective at improving gait. Similarly, treadmill-based training was found to be effective: 1) as a supplement to overground training; 2) independently when augmented with visual feedback and/or body weight support; or 3) as part of a home exercise plan. Gait training approaches studied improved multiple areas of gait, including sagittal and coronal biomechanics, spatiotemporal measures, and distance walked. PMID:28066520

Gender differences in lower extremity kinematics, kinetics and energy absorption during landing.

PubMed

Decker, Michael J; Torry, Michael R; Wyland, Douglas J; Sterett, William I; Richard Steadman, J

2003-08-01

To determine whether gender differences exist in lower extremity joint motions and energy absorption landing strategies between age and skill matched recreational athletes. Mixed factor, repeated measures design. Compared to males, females execute high demand activities in a more erect posture potentially predisposing the anterior cruciate ligament to greater loads and injury. The preferred energy absorption strategy may provide insight for this performance difference. Inverse dynamic solutions estimated lower extremity joint kinematics, kinetics and energetic profiles for twelve males and nine females performing a 60 cm drop landing. Females demonstrated a more erect landing posture and utilized greater hip and ankle joint range of motions and maximum joint angular velocities compared to males. Females also exhibited greater energy absorption and peak powers from the knee extensors and ankle plantar-flexors compared to the males. Examinations of the energy absorption contributions revealed that the knee was the primary shock absorber for both genders, whereas the ankle plantar-flexors muscles was the second largest contributor to energy absorption for the females and the hip extensors muscles for the males. Females may choose to land in a more erect posture to maximize the energy absorption from the joints most proximal to ground contact. Females may be at a greater risk to anterior cruciate ligament injury during landing due to their energy absorption strategy.

Does pediatric body mass index affect surgical outcomes of lower-extremity external fixation?

PubMed

Fedorak, Graham T; Cuomo, Anna V; Otsuka, Norman Y

2015-06-01

Obese patients are highly prevalent in the pediatric orthopaedic surgeon's practice and obesity is an increasing issue in the United States. Increased body mass index (BMI) has been associated with increased complications in pediatric orthopaedic patients, but no study has looked specifically at external fixation. The purpose of this study was to determine whether obesity is a risk factor for increased complications in lower-extremity procedures requiring external fixation. A retrospective chart review was conducted of pediatric patients who underwent external fixation as definitive operative treatment for any condition at a tertiary care hospital over a 15-year period. Patients were grouped into normal weight, overweight, and obese based on Centers for Disease Control definitions. All orthopaedic complications were recorded. A total of 208 patients with a mean age of 11.2 years were identified. Ninety-four children were obese at the 95th percentile BMI or higher, 22 were overweight and 93 were normal weight. External fixation was applied to the tibia in 82 cases, to the femur in 77 and to both in 49. Mean duration of fixation was 160 days (range, 31 to 570 d) and patients were followed for a mean of 3.9 years (range, 1.0 to 12.0 y). There was no statistically significant difference in the rate of complications between the 3 groups (P=0.61). In the obese group complications occurred in 68.1% versus 66.7% in the overweight group and 61.3% in normal weight. In the setting of external fixator use for lower-extremity pathology in pediatric patients, there is no association between an increase in complications and obesity as defined by BMI. Complication rates are high when external fixation is utilized for the lower extremity, however, patients and families should not be counseled that increased BMI will add to the burden of orthopaedic complications in this situation. Level II-prognostic.

Asymmetries in functional hop tests, lower extremity kinematics, and isokinetic strength persist 6 to 9 months following anterior cruciate ligament reconstruction.

PubMed

Xergia, Sofia A; Pappas, Evangelos; Zampeli, Franceska; Georgiou, Spyros; Georgoulis, Anastasios D

2013-03-01

Within-subject and between-subject cross-sectional study. To investigate symmetry in hop-test performance, strength, and lower extremity kinematics 6 to 9 months following anterior cruciate ligament reconstruction (ACLR). Despite the extensive body of literature involving persons following ACLR, no study has comprehensively evaluated measures of strength, lower extremity kinematics, and functional performance of functional hop tests in this population. The subjects were 22 men (mean ± SD age, 28.8 ± 11.2 years) who had ACLR using a bone-patellar tendon-bone autograft 6 to 9 (7.01 ± 0.93) months previously and 22 healthy male controls (age, 24.8 ± 9.1 years). Participants completed a self-report questionnaire and underwent isokinetic strength testing and functional and kinematic assessment of the single-, triple-, and crossover-hop tests. Two-way analyses of variance were used to test for differences between the ACLR group and the control group, and between the 2 lower extremities of the ACLR group. Compared to the control group, the ACLR group had greater isokinetic knee extension torque deficits at all speeds (P ≤.001) and greater performance asymmetry for all 3 hop tests (P<.001). Compared to the noninvolved lower extremity, the involved lower extremity of the ACLR group exhibited less ankle dorsiflexion and knee flexion in the phases of propulsion (P ≤.014) and landing (P ≤.032). When compared to the control group, the involved lower extremity exhibited less ankle dorsiflexion in the propulsion phase (P<.001) but higher hip flexion in the landing phase (P = .014). Six to 9 months following ACLR, patients continue to demonstrate functional hop and isokinetic knee extension deficits, as well as kinematic differences, during the propulsion and landing phases of the hop tests.

Dynamic balance performance and noncontact lower extremity injury in college football players: an initial study.

PubMed

Butler, Robert J; Lehr, Michael E; Fink, Michael L; Kiesel, Kyle B; Plisky, Phillip J

2013-09-01

Field expedient screening tools that can identify individuals at an elevated risk for injury are needed to minimize time loss in American football players. Previous research has suggested that poor dynamic balance may be associated with an elevated risk for injury in athletes; however, this has yet to be examined in college football players. To determine if dynamic balance deficits are associated with an elevated risk of injury in collegiate football players. It was hypothesized that football players with lower performance and increased asymmetry in dynamic balance would be at an elevated risk for sustaining a noncontact lower extremity injury. Prospective cohort study. Fifty-nine collegiate American football players volunteered for this study. Demographic information, injury history, and dynamic balance testing performance were collected, and noncontact lower extremity injuries were recorded over the course of the season. Receiver operator characteristic curves were calculated based on performance on the Star Excursion Balance Test (SEBT), including composite score and asymmetry, to determine the population-specific risk cut-off point. Relative risk was then calculated based on these variables, as well as previous injury. A cut-off point of 89.6% composite score on the SEBT optimized the sensitivity (100%) and specificity (71.7%). A college football player who scored below 89.6% was 3.5 times more likely to get injured. Poor performance on the SEBT may be related to an increased risk for sustaining a noncontact lower extremity injury over the course of a competitive American football season. College football players should be screened preseason using the SEBT to identify those at an elevated risk for injury based upon dynamic balance performance to implement injury mitigation strategies to this specific subgroup of athletes.

Lower extremity neuromuscular compensations during instrumented single leg hop testing 2-10 years following ACL reconstruction.

PubMed

Nyland, John; Wera, Jeff; Klein, Scott; Caborn, David N M

2014-12-01

This study compared lower extremity EMG activation and sagittal plane kinematics of subjects at a minimum of 2 years post-successful ACL reconstruction and rehabilitation during instrumented single leg hop testing. Comparisons were made based on subject responses to the following question, "compared to prior to your knee injury how capable are you now in performing sports activities"? Group 1=very capable, Group 2=capable, and Group 3=not capable. In addition to EMG (1000 Hz) and kinematic (60 Hz) data, subjective knee function, internal health locus of control, sports activity characteristics (intensity, frequency) pre-knee injury, and at follow-up were also compared. Group 3 had lower perceived knee function, decreased perceived sports intensity, and more subjects with decreased sports activity intensity by two levels compared to pre-injury values. Perceived function scores, anterior laxity measurements and grades were similar between groups. During single leg hop propulsion and landing Group 1 (very capable) had greater involved lower extremity gluteus maximus and medial hamstring activation amplitudes than Group 3 (not capable). Perceived sports capability was related to better subjective knee function, and higher perceived sports activity intensity. Neuromuscular compensations suggesting a hip bias with increased gluteus maximus and medial hamstring activation were identified at the involved lower extremity among most subjects who perceived high perceived sports capability compared to pre-injury status. These compensations may be related to a permanent neurosensory deficit, and its influence on afferent pathway changes that influence CNS sensorimotor re-organization. Copyright © 2014 Elsevier B.V. All rights reserved.

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

DOE Office of Scientific and Technical Information (OSTI.GOV)

Brill, D.R.

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.

Aspirin versus anticoagulation for prevention of venous thromboembolism major lower extremity orthopedic surgery: a systematic review and meta-analysis.

PubMed

Drescher, Frank S; Sirovich, Brenda E; Lee, Alexandra; Morrison, Daniel H; Chiang, Wesley H; Larson, Robin J

2014-09-01

Hip fracture surgery and lower extremity arthroplasty are associated with increased risk of both venous thromboembolism and bleeding. The best pharmacologic strategy for reducing these opposing risks is uncertain. To compare venous thromboembolism (VTE) and bleeding rates in adult patients receiving aspirin versus anticoagulants after major lower extremity orthopedic surgery. Medline, Cumulative Index to Nursing and Allied Health Literature, and the Cochrane Library through June 2013; reference lists, ClinicalTrials.gov, and scientific meeting abstracts. Randomized trials comparing aspirin to anticoagulants for prevention of VTE following major lower extremity orthopedic surgery. Two reviewers independently extracted data on rates of VTE, bleeding, and mortality. Of 298 studies screened, 8 trials including 1408 participants met inclusion criteria; all trials screened participants for deep venous thrombosis (DVT). Overall rates of DVT did not differ statistically between aspirin and anticoagulants (relative risk [RR]: 1.15 [95% confidence interval {CI}: 0.68-1.96]). Subgrouped by type of surgery, there was a nonsignificant trend favoring anticoagulation following hip fracture repair but not knee or hip arthroplasty (hip fracture RR: 1.60 [95% CI: 0.80-3.20], 2 trials; arthroplasty RR: 1.00 [95% CI: 0.49-2.05], 5 trials). The risk of bleeding was lower with aspirin than anticoagulants following hip fracture repair (RR: 0.32 [95% CI: 0.13-0.77], 2 trials), with a nonsignificant trend favoring aspirin after arthroplasty (RR: 0.63 [95% CI: 0.33-1.21], 5 trials). Rates of pulmonary embolism were too low to provide reliable estimates. Compared with anticoagulation, aspirin may be associated with higher risk of DVT following hip fracture repair, although bleeding rates were substantially lower. Aspirin was similarly effective after lower extremity arthroplasty and may be associated with lower bleeding risk. Journal of Hospital Medicine 2014;9:579-585. © 2014 Society of

Changes in lower extremity movement and power absorption during forefoot striking and barefoot running.

PubMed

Williams, D S Blaise; Green, Douglas H; Wurzinger, Brian

2012-10-01

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. 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. 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. 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. 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 compared to the knee.

Concussion May Increase the Risk of Subsequent Lower Extremity Musculoskeletal Injury in Collegiate Athletes.

PubMed

Herman, Daniel C; Jones, Debi; Harrison, Ashley; Moser, Michael; Tillman, Susan; Farmer, Kevin; Pass, Anthony; Clugston, James R; Hernandez, Jorge; Chmielewski, Terese L

2017-05-01

Laboratory-based studies on neuromuscular control after concussion and epidemiological studies suggest that concussion may increase the risk of subsequent musculoskeletal injury. The purpose of this study was to determine if athletes have an increased risk of lower extremity musculoskeletal injury after return to play from a concussion. Injury data were collected from 2006 to 2013 for men's football and for women's basketball, soccer and lacrosse at a National Collegiate Athletic Association Division I university. Ninety cases of in-season concussion in 73 athletes (52 male, 21 female) with return to play at least 30 days prior to the end of the season were identified. A period of up to 90 days of in-season competition following return to play was reviewed for time-loss injury. The same period was studied in up to two control athletes who had no concussion within the prior year and were matched for sport, starting status and position. Lower extremity musculoskeletal injuries occurred at a higher rate in the concussed athletes (45/90 or 50 %) than in the non-concussed athletes (30/148 or 20 %; P < 0.01). The odds of sustaining a musculoskeletal injury were 3.39 times higher in the concussed athletes (95 % confidence interval 1.90-6.05; P < 0.01). Overall, the number of days lost because of injury was similar between concussed and non-concussed athletes (median 9 versus 15; P = 0.41). The results of this study demonstrate a relationship between concussion and an increased risk of lower extremity musculoskeletal injury after return to play, and may have implications for current medical practice standards regarding evaluation and management of concussion injuries.

Reliability of upper and lower extremity anthropometric measurements and the effect on tissue mass predictions.

PubMed

Burkhart, Timothy A; Arthurs, Katherine L; Andrews, David M

2008-01-01

Accurate modeling of soft tissue motion effects relative to bone during impact requires knowledge of the mass of soft and rigid tissues in living people. Holmes et al., [2005. Predicting in vivo soft tissue masses of the lower extremity using segment anthropometric measures and DXA. Journal of Applied Biomechanics, 21, 371-382] developed and validated regression equations to predict the individual tissue masses of lower extremity segments of young healthy adults, based on simple anthropometric measurements. However, the reliability of these measurements and the effect on predicted tissue mass estimates from the equations has yet to be determined. In the current study, two measurers were responsible for collecting two sets of unilateral measurements (25 male and 25 female subjects) for the right upper and lower extremities. These included 6 lengths, 6 circumferences, 8 breadths, and 4 skinfold thicknesses. Significant differences were found between measurers and between sexes, but these differences were relatively small in general (75-80% of between-measurer differences were <1cm). Within-measurer measurement differences were smaller and more consistent than those between measurers in most cases. Good to excellent reliability was demonstrated for all measurement types, with intra-class correlation coefficients of 0.79, 0.86, 0.85 and 0.86 for lengths, circumferences, breadth and skinfolds, respectively. Predicted tissue mass magnitudes were moderately affected by the measurement differences. The maximum mean errors between measurers ranged from 3.2% to 24.2% for bone mineral content and fat mass, for the leg and foot, and the leg segments, respectively.

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

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

PubMed

Welke, Bastian; Hurschler, Christof; Föller, Marie; Schwarze, Michael; Calliess, Tilman

2013-07-11

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. 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. 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. 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 fixation devices and are crucial for the

Kinematic and kinetic synergies of the lower extremities during the pull in olympic weightlifting.

PubMed

Kipp, Kristof; Redden, Josh; Sabick, Michelle; Harris, Chad

2012-07-01

The purpose of this study was to identify multijoint lower extremity kinematic and kinetic synergies in weightlifting and compare these synergies between joints and across different external loads. Subjects completed sets of the clean exercise at loads equal to 65, 75, and 85% of their estimated 1-RM. Functional data analysis was used to extract principal component functions (PCF's) for hip, knee, and ankle joint angles and moments of force during the pull phase of the clean at all loads. The PCF scores were then compared between joints and across loads to determine how much of each PCF was present at each joint and how it differed across loads. The analyses extracted two kinematic and four kinetic PCF's. The statistical comparisons indicated that all kinematic and two of the four kinetic PCF's did not differ across load, but scaled according to joint function. The PCF's captured a set of joint- and load-specific synergies that quantified biomechanical function of the lower extremity during Olympic weightlifting and revealed important technical characteristics that should be considered in sports training and future research.

Neural substrates of lower extremity motor, balance, and gait function after supratentorial stroke using voxel-based lesion symptom mapping.

PubMed

Moon, Hyun Im; Pyun, Sung-Bom; Tae, Woo-Suk; Kwon, Hee Kyu

2016-07-01

Stroke impairs motor, balance, and gait function and influences activities of daily living. Understanding the relationship between brain lesions and deficits can help clinicians set goals during rehabilitation. We sought to elucidate the neural substrates of lower extremity motor, balance, and ambulation function using voxel-based lesion symptom mapping (VLSM) in supratentorial stroke patients. We retrospectively screened patients who met the following criteria: first-ever stroke, supratentorial lesion, and available brain magnetic resonance imaging (MRI) data. MRIs of 133 stroke patients were selected for VLSM analysis. We generated statistical maps of lesions related to lower extremity motor (lower extremity Fugl-Meyer assessment, LEFM), balance (Berg Balance Scale, BBS), and gait (Functional Ambulation Category, FAC) using VLSM. VLSM revealed that lower LEFM scores were associated with damage to the bilateral basal ganglia, insula, internal capsule, and subgyral white matter adjacent to the corona radiata. The lesions were more widely distributed in the left than in the right hemisphere, representing motor and praxis function necessary for performing tasks. However, no associations between lesion maps and balance and gait function were established. Motor impairment of the lower extremities was associated with lesions in the basal ganglia, insula, internal capsule, and white matter adjacent to the corona radiata. However, VLSM revealed no specific lesion locations with regard to balance and gait function. This might be because balance and gait are complex skills that require spatial and temporal integration of sensory input and execution of movement patterns. For more accurate prediction, factors other than lesion location need to be investigated.

Effect of vibration on muscle strength imbalance in lower extremity using multi-control whole body vibration platform.

PubMed

Yu, Chang Ho; Seo, Shin Bae; Kang, Seung Rok; Kim, Kyung; Kwon, Tae Kyu

2015-01-01

This study shows the improvement of muscle activity and muscle strength imbalance in the lower extremities through independent exercise loads in vibration platform. Twenty females of age 20 participated in this study. The subjects were divided into WBV group, with more than 10% of muscle strength imbalance between left and right the lower extremities, and control group, with less than 10% of muscle strength imbalance between left and right the lower extremities. As the prior experiment showed, different exercise postures provide different muscular activities. As a result, the highest muscular activity was found to be in the low squat posture. Therefore, the LS posture was selected for the exercise in this experiment. Vibration intensities were applied to dominant muscle and non-dominant muscle, and the vibration frequency was fixed at 25Hz for the WBV group. The control group was asked to perform the same exercise as the WBV group, without stimulated vibration. This exercise was conducted for a total of 4 weeks. As a result, the WBV group which showed an average deviation of 16% before the experiment, tended to decrease approximately to 5%. In this study, vibration exercise using load deviation is shown to be effective in improving the muscle strength imbalance.

Development and validation of an exercise performance support system for people with lower extremity impairment.

PubMed

Minor, M A; Reid, J C; Griffin, J Z; Pittman, C B; Patrick, T B; Cutts, J H

1998-02-01

To identify innovative strategies to support appropriate, self-directed exercise that increase physical activity levels of people with arthritis. This article reports on one interactive, multimedia exercise performance support system (PSS) for people with lower extremity impairments in strength or flexibility. An interdisciplinary team developed the PSS using self-report of lower extremity musculoskeletal impairments (flexibility and strength) to produce an individualized exercise program with video and print educational materials. Initial evaluation has investigated the validity and reliability of program assessments and recommendations. PSS self-report and professional assessments were similar, with more impairments indicated by self-report. PSS exercise recommendations were similar to those made by 3 expert physical therapists using the same exercise data base. Results of PSS impairment assessments were stable over a 1-week period. PSS exercise recommendations appear to be reliable and a valid reflection of current exercise knowledge in rheumatology. Furthermore, users were able to complete the computer-based program with minimal assistance and reported it to be enjoyable and informative.

Improved lower extremity pedaling mechanics in individuals with stroke under maximal workloads.

PubMed

Linder, Susan M; Rosenfeldt, Anson B; Bazyk, Andrew S; Koop, Mandy Miller; Ozinga, Sarah; Alberts, Jay L

2018-05-01

Background Individuals with stroke present with motor control deficits resulting in the abnormal activation and timing of agonist and antagonist muscles and inefficient movement patterns. The analysis of pedaling biomechanics provides a window into understanding motor control deficits, which vary as a function of workload. Understanding the relationship between workload and motor control is critical when considering exercise prescription during stroke rehabilitation. Objectives To characterize pedaling kinematics and motor control processes under conditions in which workload was systematically increased to an eventual patient-specific maximum. Methods A cohort study was conducted in which 18 individuals with chronic stroke underwent a maximal exertion cardiopulmonary exercise test on a stationary cycle ergometer, during which pedaling torque was continuously recorded. Measures of force production, pedaling symmetry, and pedaling smoothness were obtained. Results Mean Torque increased significantly (p < 0.05) for both legs from initial to terminal workloads. Mean torque Symmetry Index, calculated for down and upstroke portions of the pedaling action, improved from 0.37(0.29) to 0.29(0.35) during downstroke (p = 0.007), and worsened during the upstroke: -0.37(0.38) to -0.62(0.46) (p < 0.001) from initial to terminal workloads. Low Torque Duration improved from initial to terminal workloads, decreasing from 121.1(52.9) to 58.1(39.6) degrees (p < 0.001), respectively. Smoothness of pedaling improved significantly from initial to terminal workloads (p < 0.001). Conclusions Improved pedaling kinematics at terminal workloads indicate that individuals with stroke demonstrate improved motor control with respect to the timing, sequencing, and activation of hemiparetic lower extremity musculature compared to lower workloads. Therapeutic prescription involving higher resistance may be necessary to sufficiently engage and activate the paretic lower extremity.

Pre-Kidney Transplant Lower Extremity Impairment and Post-Kidney Transplant Mortality.

PubMed

Nastasi, A J; McAdams-DeMarco, M A; Schrack, J; Ying, H; Olorundare, I; Warsame, F; Mountford, A; Haugen, C E; González Fernández, M; Norman, S P; Segev, D L

2018-01-01

Prediction models for post-kidney transplantation mortality have had limited success (C-statistics ≤0.70). Adding objective measures of potentially modifiable factors may improve prediction and, consequently, kidney transplant (KT) survival through intervention. The Short Physical Performance Battery (SPPB) is an easily administered objective test of lower extremity function consisting of three parts (balance, walking speed, chair stands), each with scores of 0-4, for a composite score of 0-12, with higher scores indicating better function. SPPB performance and frailty (Fried frailty phenotype) were assessed at admission for KT in a prospective cohort of 719 KT recipients at Johns Hopkins Hospital (8/2009 to 6/2016) and University of Michigan (2/2013 to 12/2016). The independent associations between SPPB impairment (SPPB composite score ≤10) and composite score with post-KT mortality were tested using adjusted competing risks models treating graft failure as a competing risk. The 5-year posttransplantation mortality for impaired recipients was 20.6% compared to 4.5% for unimpaired recipients (p < 0.001). Impaired recipients had a 2.30-fold (adjusted hazard ratio [aHR] 2.30, 95% confidence interval [CI] 1.12-4.74, p = 0.02) increased risk of postkidney transplantation mortality compared to unimpaired recipients. Each one-point decrease in SPPB score was independently associated with a 1.19-fold (95% CI 1.09-1.30, p < 0.001) higher risk of post-KT mortality. SPPB-derived lower extremity function is a potentially highly useful and modifiable objective measure for pre-KT risk prediction. © 2017 The American Society of Transplantation and the American Society of Transplant Surgeons.

Playground slide-related injuries in preschool children: increased risk of lower extremity injuries when riding on laps.

PubMed

Jennissen, Charles A; Koos, Maggie; Denning, Gerene

2018-04-10

The purpose of this study was to better understand the factors associated with playground slide-related injuries in preschool children and to test the hypothesis that riding on laps increases the likelihood of lower extremity injuries. Playground slide-related injuries (product code 1242) in children ≤5 years of age treated in emergency departments from 2002 to 2015 were identified (N = 12,686) using the U.S. Consumer Product Safety Commission's National Electronic Injury Surveillance System (NEISS). Descriptive and comparative analyses, including chi-square testing and binary logistic regression, were performed. Based on NEISS stratified national sampling estimates, over 350,000 children ≤5 years of age were injured on slides from 2002 to 2015. Overall, 59% of the children were male, and 65% were white. Almost 60% of injuries occurred in parks or other public areas. The most frequent diagnosis was a fracture (36%); lacerations were 19% of the injuries. A higher proportion of musculoskeletal injuries were seen in toddlers < 3 years old as compared to those 3-5 years of age (p < 0.001). Injuries to the lower extremities increased in frequency as age decreased, whereas injuries to the upper extremities and head/neck/face were more common in older preschoolers. Children < 3 years of age were 12 times more likely to be identified from narratives as being on another person's lap at the time of injury. Children identified as being on a lap had an increased odds of injury to the lower extremity than to other body parts (OR 43.0, 95% confidence interval (CI) 32.0-58.0), and of lower leg/ankle fracture than fractures elsewhere (OR 49.5, 95% CI 31.7-77.4). Decreasing age was associated with a higher likelihood of being identified as sliding down on another person's lap and a higher likelihood of lower extremity injuries. Healthcare providers should be mindful of the potential for these slide-related injuries as they can result in a toddler's fracture of

Functional Outcomes of Persons Undergoing Dysvascular Lower Extremity Amputations

PubMed Central

Sauter, Carley N.; Pezzin, Liliana E.; Dillingham, Timothy R.

2012-01-01

Objective To examine the effect of post-acute rehabilitation setting on functional outcomes among patients undergoing major lower extremity dysvascular amputations. Design A population-based, prospective cohort study conducted in Maryland and Wisconsin. Data collected from medical records and patient interviews conducted during acute hospitalization following amputation and at six-month following the acute care discharge were analyzed using multivariate models and instrumental variable techniques. Results A total of 297 patients were analyzed based on post-acute care rehabilitation setting: acute inpatient rehabilitation (IRF), skilled nursing facility (SNF) or home. The majority (43.4%) received care in IRF, 32% in SNF, and 24.6% at home. On SF-36 subscales, significantly improved outcomes were observed for patients receiving post-acute care at an IRF relative to those cared for at a SNF in physical function (PF), role physical (RF) and physical component score (PCS). Patients receiving post-acute care in IRFs also experienced better RF and PCS outcomes compared to those discharged directly home. In addition, patients receiving post-acute care at an IRF were significantly more likely to score in the top quartile for general health in IRF compared to SNF or home, and less likely to score in the lowest quartile for PF, RF and PCS in IRF compared to SNF. Lower ADL impairment was observed in IRF compared to SNF. Conclusions Among this large and diverse cohort of patients undergoing major dysvascular lower limb amputations, receipt of interdisciplinary rehabilitation services at an IRF yielded improved functional outcomes six months after amputation relative to care received at SNFs or home. PMID:23291599

Does core strength training influence running kinetics, lower-extremity stability, and 5000-M performance in runners?

PubMed

Sato, Kimitake; Mokha, Monique

2009-01-01

Although strong core muscles are believed to help athletic performance, few scientific studies have been conducted to identify the effectiveness of core strength training (CST) on improving athletic performance. The aim of this study was to determine the effects of 6 weeks of CST on ground reaction forces (GRFs), stability of the lower extremity, and overall running performance in recreational and competitive runners. After a screening process, 28 healthy adults (age, 36.9 +/- 9.4 years; height, 168.4 +/- 9.6 cm; mass, 70.1 +/- 15.3 kg) volunteered and were divided randomly into 2 groups (n = 14 in each group). A test-retest design was used to assess the differences between CST (experimental) and no CST (control) on GRF measures, lower-extremity stability scores, and running performance. The GRF variables were determined by calculating peak impact, active vertical GRFs (vGRFs), and duration of the 2 horizontal GRFs (hGRFs), as measured while running across a force plate. Lower-extremity stability was assessed using the Star Excursion Balance Test. Running performance was determined by 5000-m run time measured on outdoor tracks. Six 2 (pre, post) x 2 (CST, control) mixed-design analyses of variance were used to determine the influence of CST on each dependent variable, p < 0.05. Twenty subjects completed the study (nexp = 12 and ncon = 8). A significant interaction occurred, with the CST group showing faster times in the 5000-m run after 6 weeks. However, CST did not significantly influence GRF variables and lower-leg stability. Core strength training may be an effective training method for improving performance in runners.

Attribution of extreme precipitation in the lower reaches of the Yangtze River during May 2016

NASA Astrophysics Data System (ADS)

Li, Chunxiang; Tian, Qinhua; Yu, Rong; Zhou, Baiquan; Xia, Jiangjiang; Burke, Claire; Dong, Buwen; Tett, Simon F. B.; Freychet, Nicolas; Lott, Fraser; Ciavarella, Andrew

2018-01-01

May 2016 was the third wettest May on record since 1961 over central eastern China based on station observations, with total monthly rainfall 40% more than the climatological mean for 1961-2013. Accompanying disasters such as waterlogging, landslides and debris flow struck part of the lower reaches of the Yangtze River. Causal influence of anthropogenic forcings on this event is investigated using the newly updated Met Office Hadley Centre system for attribution of extreme weather and climate events. Results indicate that there is a significant increase in May 2016 rainfall in model simulations relative to the climatological period, but this increase is largely attributable to natural variability. El Niño years have been found to be correlated with extreme rainfall in the Yangtze River region in previous studies—the strong El Niño of 2015-2016 may account for the extreme precipitation event in 2016. However, on smaller spatial scales we find that anthropogenic forcing has likely played a role in increasing the risk of extreme rainfall to the north of the Yangtze and decreasing it to the south.

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

PubMed

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

2016-01-01

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. We aim to evaluate the outcomes of catheter-directed treatment (CDT) for symptomatic acute or subacute lower extremity DVT. 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. Descriptive summary statistics and the Chi-square test were used to measure the outcomes of CDT. 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. CDT is a safe and effective therapeutic technique in patients with acute and subacute lower extremity DVT, if appropriate patient selection is made.

Manual physical therapy combined with high-intensity functional rehabilitation for severe lower extremity musculoskeletal injuries: a case series*

PubMed Central

Crowell, Michael S.; Deyle, Gail D.; Owens, Johnny; Gill, Norman W.

2016-01-01

Objectives Severe lower extremity trauma accounts for large healthcare costs and often results in elective amputation and poor long-term outcomes. The purpose of this case series is to describe an orthopedic manual physical therapy (OMPT) approach combined with a return to run (RTR) clinical pathway consisting of high-intensity functional rehabilitation with a custom energy-storing orthosis. Methods Three consecutive male patients, aged 21–23 years, with severe lower extremity musculoskeletal injuries were treated with a combined intervention that included a mean (SD) of 12 (2·1) OMPT sessions and 24 (8·7) functional rehabilitation sessions over a mean of 6 weeks (1·0). Additional training with a custom energy-storing orthosis consisted of a mean of 15 (1·2) additional sessions over 4 weeks. Patient self-report outcome measures and a variety of physical performance tests captured change in function. Results Baseline lower extremity functional scale (LEFS) and foot and ankle ability measure activities of daily living subscale (FAAM-ADL) scores indicated severe disability. All patients exceeded the minimal clinically important difference (MCID) in at least one self-report outcome or physical performance test without a brace. Two of three patients exceeded the MCID for at least two physical performance tests after training with and utilizing a custom energy-storing orthosis. Discussion Clinically meaningful changes in self-reported function or physical performance were observed in all patients. A multi-modal approach, including manual therapy and functional exercise, may address the entire spectrum of impairments in patients with severe lower extremity trauma, resulting in improvements in both braced and un-braced function. PMID:27252581

The effect of equalizing landing task demands on sex differences in lower extremity energy absorption.

PubMed

Montgomery, Melissa M; Shultz, Sandra J; Schmitz, Randy J

2014-08-01

Less lean mass and strength may result in greater relative task demands on females compared to males when landing from a standardized height and could explain sex differences in energy absorption strategies. We compared the magnitude of sex differences in energy absorption when task demands were equalized relative to the amount of lower extremity lean mass available to dissipate kinetic energy upon landing. Male-female pairs (n=35) were assessed for lower extremity lean mass with dual-energy X-ray absorptiometry. Relative task demands were calculated when landing from a standardized height. Based on the difference in lower extremity lean mass within each pair, task demands were equalized by increasing the drop height for males. Joint energetics were measured while landing from the two heights. Multivariate repeated measures ANOVAs compared the magnitude of sex differences in joint energetics between conditions. The multivariate test for absolute energy absorption was significant (P<0.01). The magnitude of sex difference in energy absorption was greater at the hip and knee (both P<0.01), but not the ankle (P=0.43) during the equalized condition compared to the standardized and exaggerated conditions (all P<0.01). There was no difference in the magnitude of sex differences between equalized, standardized and exaggerated conditions for relative energy absorption (P=0.18). Equalizing task demands increased the difference in absolute hip and knee energy absorption between sexes, but had no effect on relative joint contributions to total energy absorption. Sex differences in energy absorption are likely influenced by factors other than differences in relative task demands. Copyright © 2014 Elsevier Ltd. All rights reserved.

Perfusion Controlled Mobilization after Lower Extremity Free Flaps-Pushing the Limits of Time and Intensity.

PubMed

Dornseifer, Ulf; Kleeberger, Charlotte; Kargl, Lukas; Schönberger, Markus; Rohde, Daniel; Ninkovic, Milomir; Schilling, Arndt

2017-03-01

Background  The current standard to gradually adapt the fragile perfusion in lower extremity free flaps to an upright posture is the dangling maneuver. This type of flap training neither fits the orthostatic target load of an upright posture, nor does it assist in mobilizing the patients effectively. In this study, we quantitatively analyzed training effects of an early and full mobilization on flap perfusion. Methods  A total of 15 patients with gracilis flaps for distal lower extremity reconstruction were included. Flap training was performed daily by mobilizing the patients on a tilt table into a fully upright posture for 5 minutes between the third and fifth postop days (PODs). Changes in micro- and macrocirculation were analyzed by laser Doppler flowmetry, remission spectroscopy, and an implanted Doppler probe. Results  All flaps healed without complications. Yet, in three patients, the increased orthostatic load required an adjustment of the training duration due to a critical blood flow. The others showed an increasing compensation in the microcirculation. When tilting the patients, blood flow and oxygen saturation dropped significantly less on POD5 than on POD3. Furthermore, a significant increase of the blood flow was noted after an initial decrease during the mobilization on all days. An increasing compensation in the macrocirculation could not be determined. Conclusion  Full mobilization of patients with lower extremity free flaps can be performed safely under perfusion monitoring, already starting on POD3. Additionally, monitoring allows a consideration of the individual orthostatic competence and therefore, exploitation of the maximum mobilization potential. Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.

Better glycemic control is associated with maintenance of lower-extremity function over time in Mexican American and European American older adults with diabetes.

PubMed

Wang, Chen-Pin; Hazuda, Helen P

2011-02-01

Diabetes is a major cause of functional decline among older adults, but the role of glycemic control remains unclear. This article assesses whether better glycemic control is associated with better maintenance of lower-extremity function over time in older adults with diabetes. Participants (n = 119) in the San Antonio Longitudinal Study of Aging, ages 71-85, who met American Diabetes Association diabetes criteria were followed over a 36-month period. Seven measures of A1C (HbA(1c)) were obtained at 6-month intervals; three measures of lower-extremity function were obtained at 18-month intervals using the Short Physical Performance Battery (SPPB). A two-step analytic approach was used, first, to identify distinct glycemic control classes using latent growth mixture modeling and, second, to examine trajectories of lower-extremity function based on these classes using path analysis. Two glycemic control classes were identified: a poorer control class with higher means (all >7%) and higher within-subject variability in HbA(1c) and a better control class with lower means (all <7%) and lower within-subject variability. The short-term and long-term maintenance of lower-extremity function, assessed by the association between the first and second SPPB measures and the first and third SPPB measures, were both greater in the better control class than in the poorer control class. Among older adults with diabetes, better glycemic control may improve both short-term and long-term maintenance of lower-extremity function.

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.

Virtual Reality Training With Three-Dimensional Video Games Improves Postural Balance and Lower Extremity Strength in Community-Dwelling Older Adults.

PubMed

Lee, Yongwoo; Choi, Wonjae; Lee, Kyeongjin; Song, Changho; Lee, Seungwon

2017-10-01

Avatar-based three-dimensional technology is a new approach to improve physical function in older adults. The aim of this study was to use three-dimensional video gaming technology in virtual reality training to improve postural balance and lower extremity strength in a population of community-dwelling older adults. The experimental group participated in the virtual reality training program for 60 min, twice a week, for 6 weeks. Both experimental and control groups were given three times for falls prevention education at the first, third, and fifth weeks. The experimental group showed significant improvements not only in static and dynamic postural balance but also lower extremity strength (p < .05). Furthermore, the experimental group was improved to overall parameters compared with the control group (p < .05). Therefore, three-dimensional video gaming technology might be beneficial for improving postural balance and lower extremity strength in community-dwelling older adults.

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

PubMed

Gozani, Shai N

2016-01-01

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. 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. 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. 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-responders. FS-TENS is a safe and effective

Major lower extremity lawn mower injuries in children.

PubMed

Dormans, J P; Azzoni, M; Davidson, R S; Drummond, D S

1995-01-01

Between 1983 and 1993, 16 children with 18 lower extremity power lawn mower-related injuries were treated at Children's Hospital of Philadelphia. Eleven of 16 patients (69%) were bystanders or nonoperators. The average age at injury was 4 years 9 months. Length of follow-up averaged 3 years 10 months. There was an average of 4.9 procedures per patient. Fourteen of the 18 limbs injured required eventual amputation (78%). We propose a new classification of lawn mower injuries in children. The most common injury (16 of 18 limbs) was a shredding type injury and was either intercalary or distal. The second was a paucilaceration type (two of 18 limbs). Of the four salvaged limbs, there were two shredding type injuries, and on most recent follow-up are considered to have poor results. The two patients with the paucilaceration type injuries and limb salvage are considered to have excellent results. All patients with a shredding type injury ultimately required amputation or had poor results with the salvaged limb. Limb salvage surgery was associated with prolonged hospitalizations, a higher incidence of surgical problems, a longer treatment course, and more complications than early ablative procedures.

A failure of preoperative duplex imaging to diagnose a lower extremity venous aneurysm in a patient with severe chronic venous insufficiency.

PubMed

Jones, Roy Wesley; Parkerson, Godfrey Ross; Ottinger, Mary; Rodriguez, Eduardo; Park, Brian

2017-01-01

We present a case of recurrent bilateral lower extremity venous stasis ulcers in association with a superficial venous aneurysm at the right saphenofemoral junction that was misdiagnosed on preoperative duplex scanning. A 53-year-old female presented to our clinic with 6-year history of bilateral lower extremity venous stasis ulcers. Her past medical history was significant for refractory venous stasis ulcers of the bilateral lower extremities present for 6 years and morbid obesity. Preoperative venous duplex demonstrated severe venous insufficiency of the superficial and deep systems, but a venous aneurysm was not appreciated. During the high ligation of the right saphenofemoral junction, a 3 × 4 × 5 cm aneurysm was encountered. Repair consisted of aneurysm resection, high ligation of the greater saphenous vein, dissociation of the great saphenous and anterior saphenous veins, and stab phlebectomy of large varicose veins of the thigh and lower leg. The patient recovered uneventfully and experienced complete healing of the venous stasis ulcer in several weeks. Superficial venous aneurysms of the lower extremity are rare and can be often missed on preoperative duplex ultrasound imaging. Large diameter measurements of the proximal greater saphenous vein and obesity increase the risk of misdiagnosing venous aneurysms with duplex imaging; therefore, clinical suspicion must remain high. These aneurysms can be associated with significant symptoms for which repair is indicated.

Health related quality of life and return to work after minor extremity injuries: A longitudinal study comparing upper versus lower extremity injuries.

PubMed

Sluys, Kerstin Prignitz; Shults, Justine; Richmond, Therese S

2016-04-01

To investigate the impact on health related quality of life (HRQL) during the first year after minor extremity injury and to determine whether there is a difference in recovery patterns and return to work between upper extremity injuries (UEI) and lower extremity injuries (LEI). A total of 181 adults' age 18 years or older randomly selected from patients admitted to an emergency department with minor injuries were studied. HRQL was measured using the Functional Status Questionnaire (FSQ) at 1-2 weeks, 3, 6, and 12-months post-injury. Pre-injury FSQ scores were measured retrospectively at admission. A quasi-least square (QLS) model was constructed to examine differences of FSQ scores at each measuring point for UEI and LEI. Fractures of the knee/lower leg (25%) were the most frequently injured body area. Slips or falls (57%) and traffic-related events (22%) were the most common injury causes. The mean ISS was 4.2 (SD 0.86). Both groups had significant declines in the FSQ scores physical and social functioning at 1-2 weeks after injury. Patients with UEI made larger improvements in the first 3 months post-injury versus patients with LEI whose improvements extended over the first 6 months. None of the groups reached the pre-injury FSQ scores during the first post-injury year except in the subscale work performance where UEI exceeded the pre-injury scores. At 12 months post-injury, significant lower FSQ scores remained in the LEI group compared to the UEI group in intermediate activities of daily living (p=0.036, d 0.4) and work performance (p=0.004, d 0.7). The return to work at 3 months and 12 months were 76% and 88% for UEI and 58% and 77% for LEI. No significant differences were found between groups in the FSQ scale mental health and social interaction. LEI had the highest impact on HRQL and return to work during the first year which exceeded the consequences of UEI. These findings contribute to the information about the consequences of injury in order to give

Health related quality of life and return to work after minor extremity injuries: A longitudinal study comparing upper versus lower extremity injuries

PubMed Central

Sluys, Kerstin Prignitz; Shults, Justine; Richmond, Therese S.

2016-01-01

Purpose To investigate the impact on health related quality of life (HRQL) during the first year after minor extremity injury and to determine whether there is a difference in recovery patterns and return to work between upper extremity injuries (UEI) and lower extremity injuries (LEI). Method A total of 181 adults’ age 18 years or older randomly selected from patients admitted to an emergency department with minor injuries were studied. HRQL was measured using the Functional Status Questionnaire (FSQ) at 1–2 weeks, 3, 6, and 12-months post-injury. Pre-injury FSQ scores were measured retrospectively at admission. A quasi-least square (QLS) model was constructed to examine differences of FSQ scores at each measuring point for UEI and LEI. Results Fractures of the knee/lower leg (25%) were the most frequently injured body area. Slips or falls (57%) and traffic-related events (22%) were the most common injury causes. The mean ISS was 4.2 (SD 0.86). Both groups had significant declines in the FSQ scores physical and social functioning at 1–2 weeks after injury. Patients with UEI made larger improvements in the first 3 months post-injury versus patients with LEI whose improvements extended over the first 6 months. None of the groups reached the pre-injury FSQ scores during the first post-injury year except in the subscale work performance where UEI exceeded the pre-injury scores. At 12 months post-injury, significant lower FSQ scores remained in the LEI group compared to the UEI group in intermediate activities of daily living (p=0.036, d 0.4) and work performance (p=0.004, d 0.7). The return to work at 3 months and 12 months were 76% and 88% for UEI and 58% and 77% for LEI. No significant differences were found between groups in the FSQ scale mental health and social interaction. Conclusions LEI had the highest impact on HRQL and return to work during the first year which exceeded the consequences of UEI. These findings contribute to the information about the

Manipulating the fidelity of lower extremity visual feedback to identify obstacle negotiation strategies in immersive virtual reality.

PubMed

Kim, Aram; Zhou, Zixuan; Kretch, Kari S; Finley, James M

2017-07-01

The ability to successfully navigate obstacles in our environment requires integration of visual information about the environment with estimates of our body's state. Previous studies have used partial occlusion of the visual field to explore how information about the body and impending obstacles are integrated to mediate a successful clearance strategy. However, because these manipulations often remove information about both the body and obstacle, it remains to be seen how information about the lower extremities alone is utilized during obstacle crossing. Here, we used an immersive virtual reality (VR) interface to explore how visual feedback of the lower extremities influences obstacle crossing performance. Participants wore a head-mounted display while walking on treadmill and were instructed to step over obstacles in a virtual corridor in four different feedback trials. The trials involved: (1) No visual feedback of the lower extremities, (2) an endpoint-only model, (3) a link-segment model, and (4) a volumetric multi-segment model. We found that the volumetric model improved success rate, placed their trailing foot before crossing and leading foot after crossing more consistently, and placed their leading foot closer to the obstacle after crossing compared to no model. This knowledge is critical for the design of obstacle negotiation tasks in immersive virtual environments as it may provide information about the fidelity necessary to reproduce ecologically valid practice environments.

Correlations among pelvic positions and differences in lower extremity joint angles during walking in female university students.

PubMed

Cho, Misuk

2015-06-01

[Purpose] This study aimed to identify correlations among pelvic positions and differences in lower extremity joint angles during walking in female university students. [Subjects] Thirty female university students were enrolled and their pelvic positions and differences in lower extremity joint angles were measured. [Methods] Pelvic position, pelvic torsion, and pelvic rotation were assessed using the BackMapper. In addition, motion analysis was performed to derive differences between left and right flexion, abduction, and external rotation ranges of hip joints; flexion, abduction, and external rotation ranges of knee joints; and dorsiflexion, inversion, and abduction ranges of ankle joints, according to X, Y, and Z-axes. [Results] Pelvic position was found to be positively correlated with differences between left and right hip flexion (r=0.51), hip abduction (r=0.62), knee flexion (r=0.45), knee abduction (r=0.42), and ankle inversion (r=0.38). In addition, the difference between left and right hip abduction showed a positive correlation with difference between left and right ankle dorsiflexion (r=0.64). Moreover, differences between left and right knee flexion exhibited positive correlations with differences between left and right knee abduction (r=0.41) and ankle inversion (r=0.45). [Conclusion] Bilateral pelvic tilt angles are important as they lead to bilateral differences in lower extremity joint angles during walking.

Lower-Extremity Weakness in a Teenager Due to Thyrotoxic Periodic Paralysis.

PubMed

Thornton, Matthew D

2017-04-01

Thyrotoxic hypokalemic paralysis is the hallmark of thyrotoxic periodic paralysis (TPP). TPP is a potentially deadly complication of hyperthyroidism that occurs because of rapid and dramatic intracellular shift of potassium. This transference results in severe hypokalemia and clinically manifests itself as muscle weakness or paralysis. This condition predominantly affects males of Asian descent, and its presentation can range from mild to severe, as seen in our case. We present the case of a 15-year-old Asian-American male who presented to a tertiary-care pediatric emergency department complaining of generalized weakness and flaccid paralysis of his lower extremities. The differential for such a complaint is extremely broad, and the symptoms can result from etiologies arising from the cerebral cortex, the spinal cord, peripheral nerves, the neuromuscular junction, or even the muscles themselves. Our patient was found to have an extremely low serum potassium concentration, as well as an electrocardiogram that revealed a prolonged QT interval and right bundle branch block. The etiology of these abnormalities and the patient's symptoms was found to be undiagnosed and uncontrolled hyperthyroidism from Grave's disease, which resulted in this dramatic presentation of thyrotoxic hypokalemic paralysis. WHY SHOULD AN EMERGENCY PHYSICIAN BE AWARE OF THIS?: This entity is common in Asia but still somewhat rare in the United States and other Western countries. Our case illustrates that careful history taking and a focused diagnostic evaluation, in conjunction with having an awareness of this disease, can help expedite diagnosis and management, as well as avoid unnecessary and potential harmful testing in the emergency department setting. Copyright © 2016 Elsevier Inc. All rights reserved.

Relationship of race and poverty to lower extremity function and decline: findings from the Women's Health and Aging Study.

PubMed

Thorpe, Roland James; Kasper, Judith D; Szanton, Sarah L; Frick, Kevin D; Fried, Linda P; Simonsick, Eleanor M

2008-02-01

Race- and poverty-related disparities in physical function are well documented, though little is known about effects of race and poverty on functional decline and the progression of disability. We examined cross-sectional and longitudinal relationships between race, poverty and lower extremity function using data from moderately to severely disabled women in the U.S. Women's Health and Aging Study. Severity of lower extremity functional limitation was determined from scaled responses of reported difficulty walking (1/4) mile, walking across a room, climbing stairs, and stooping, crouching or kneeling. Usual walking speed assessed over 4m was our objective measure of function. Of the 996 women who described themselves as black or white, 284 (29%) were black and 367 (37%) were living at or below 100% of the federal poverty level. Independent of demographic and health-related factors, among white women, the poor exhibited consistently worse lower extremity function than the non-poor; this association, however, was not observed in black women. Among the non-poor, black women had slower walking speeds, and reported more limitation in lower extremity function than their non-poor white counterparts, even after adjusting for demographic variables and health-related characteristics. After 3 years, accounting for baseline function, demographic and health-related factors, race and poverty status were unrelated to functional decline. Thus, while race and poverty status were associated with functional deficits in old age, they do not appear to impact the rate of functional decline or progression of disability over 3 years.

Two simple leg net devices designed to protect lower-extremity skin grafts and donor sites and prevent decubitus ulcer.

PubMed

Hedman, Travis L; Chapman, Ted T; Dewey, William S; Quick, Charles D; Wolf, Steven E; Holcomb, John B

2007-01-01

Burn therapists routinely are tasked to position the lower extremities of burn patients for pressure ulcer prevention, skin graft protection, donor site ventilation, and edema reduction. We developed two durable and low-maintenance devices that allow effective positioning of the lower extremities. The high-profile and low-profile leg net devices were simple to fabricate and maintain. The frame was assembled using a three-quarter-inch diameter copper pipe and copper fittings (45 degrees, 90 degrees, and tees). A double layer of elasticized tubular netting was pulled over the frame and doubled back for leg support to complete the devices. The devices can be placed on any bed surface. The netting can be exchanged when soiled and the frame can be disinfected between patients using standard techniques. Both devices were used on approximately 250 patients for a total of 1200 treatment days. No incidence of pressure ulcer was observed, and graft take was not adversely affected. The devices have not required repairs or replacement. Medical providers reported they are easy to apply and effectively maintain proper positioning throughout application. Neither device interfered with the application of other positioning devices. Both devices were found to be an effective method of positioning lower extremities to prevent pressure ulcer, minimize graft loss and donor site morbidity, and reduce edema. The devices allowed for proper wound ventilation and protected grafted lower extremities on any bed surface. The devices are simple to fabricate and maintain. Both devices can be effectively used simultaneously with other positioning devices.

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

DOE Office of Scientific and Technical Information (OSTI.GOV)

Zhang Huojun, E-mail: chyyzhj@hotmail.com; Yang Jijin, E-mail: yangjijin@live.com; Lu Jianping

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 evaluatedmore » 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

Better Glycemic Control Is Associated With Maintenance of Lower-Extremity Function Over Time in Mexican American and European American Older Adults With Diabetes

PubMed Central

Wang, Chen-Pin; Hazuda, Helen P.

2011-01-01

OBJECTIVE Diabetes is a major cause of functional decline among older adults, but the role of glycemic control remains unclear. This article assesses whether better glycemic control is associated with better maintenance of lower-extremity function over time in older adults with diabetes. RESEARCH DESIGN AND METHODS Participants (n = 119) in the San Antonio Longitudinal Study of Aging, ages 71–85, who met American Diabetes Association diabetes criteria were followed over a 36-month period. Seven measures of A1C (HbA1c) were obtained at 6-month intervals; three measures of lower-extremity function were obtained at 18-month intervals using the Short Physical Performance Battery (SPPB). A two-step analytic approach was used, first, to identify distinct glycemic control classes using latent growth mixture modeling and, second, to examine trajectories of lower-extremity function based on these classes using path analysis. RESULTS Two glycemic control classes were identified: a poorer control class with higher means (all >7%) and higher within-subject variability in HbA1c and a better control class with lower means (all <7%) and lower within-subject variability. The short-term and long-term maintenance of lower-extremity function, assessed by the association between the first and second SPPB measures and the first and third SPPB measures, were both greater in the better control class than in the poorer control class. CONCLUSIONS Among older adults with diabetes, better glycemic control may improve both short-term and long-term maintenance of lower-extremity function. PMID:21216857

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

Effects of lower extremity injuries on aerobic exercise capacity, anaerobic power, and knee isokinetic muscular function in high school soccer players.

PubMed

Ko, Kwang-Jun; Ha, Gi-Chul; Kim, Dong-Woo; Kang, Seol-Jung

2017-10-01

[Purpose] The study investigated the effects of lower extremity injuries on aerobic exercise capacity, anaerobic power, and knee isokinetic muscular function in high school soccer players. [Subjects and Methods] The study assessed U High School soccer players (n=40) in S area, South Korea, divided into 2 groups: a lower extremity injury group (n=16) comprising those with knee and ankle injuries and a control group (n=24) without injury. Aerobic exercise capacity, anaerobic power, and knee isokinetic muscular function were compared and analyzed. [Results] Regarding the aerobic exercise capacity test, significant differences were observed in maximal oxygen uptake and anaerobic threshold between both groups. For the anaerobic power test, no significant difference was observed in peak power and average power between the groups; however, a significant difference in fatigue index was noted. Regarding the knee isokinetic muscular test, no significant difference was noted in knee flexion, extension, and flexion/extension ratio between both groups. [Conclusion] Lower extremity injury was associated with reduced aerobic exercise capacity and a higher fatigue index with respect to anaerobic exercise capacity. Therefore, it seems necessary to establish post-injury training programs that improve aerobic and anaerobic exercise capacity for soccer players who experience lower extremity injury.

Self-reported dietary intake of omega-3 fatty acids and association with bone and lower extremity function.

PubMed

Rousseau, James H; Kleppinger, Alison; Kenny, Anne M

2009-10-01

To assess the relationship between self-reported omega-3 fatty acid (O3FA) intake and bone mineral density (BMD) and lower extremity function in older adults. Cross-sectional analysis of baseline information from three separate ongoing studies of older adults, pooled for this analysis. Academic health center. Two hundred forty-seven men (n=118) and women (n=129) residing in the community or an assisted living facility. Self-reported dietary intake (O3FA, omega-6 fatty acids (O6FA), protein, and total calorie); BMD of the hip or heel; and lower extremity function including leg strength, chair rise time, walking speed, Timed Up and Go, and frailty. The mean reported intake of O3FA was 1.27 g/day. Correlation coefficients (r) between O3FA and T-scores from total femur (n=167) were 0.210 and 0.147 for combined femur and heel T scores. Similar correlations were found for leg strength (r=0.205) and chair rise time (r=-0.178), but the significance was lost when corrected for protein intake. Subjects with lower reported O3FA intake (<1.27 g/day) had lower BMD than those with higher reported O3FA intake. In a multiple regression analysis with femoral neck BMD as the dependent variable and reported intake of O3FA, O6FA, protein, and vitamin D as independent variables, reported O3FA intake was the only significant variable, accounting for 6% of the variance in BMD. Older adults had low reported intakes of O3FA. There was an association between greater reported O3FA intake and higher BMD. There was no independent association between reported O3FA intake and lower extremity function. Results from this preliminary report are promising and suggest further investigation.

Mid-term outcome of endovascular treatment for acute lower extremity deep venous thrombosis.

PubMed

Jiang, Kun; Li, Xiao-Qiang; Sang, Hong-Fei; Qian, Ai-Min; Rong, Jian-Jie; Li, Cheng-Long

2017-04-01

Purposes of the study To evaluate the benefit of stenting the iliac vein in patients with residual iliac vein stenosis treated with catheter-directed thrombolysis for acute iliofemoral deep venous thrombosis. Procedures In this randomized prospective study, patients with a first-time acute lower extremity deep venous thrombosis that had persisted <14 days were treated with catheter-directed thrombolysis. After catheter-directed thrombolysis, patients with >50% residual iliac vein stenosis were randomly divided into two groups: catheter-directed thrombolysis + Stent Group and catheter-directed thrombolysis Alone Group. Patients received urokinase thrombolysis and low-molecular-weight heparin/oral warfarin during the hospitalization period and were administrated oral warfarin after discharge. Cumulative deep vein patency, the Clinical Etiology Anatomic Pathophysiologic classification system, the Venous Clinical Severity Score and the Chronic Venous Insufficiency Questionnaire score were evaluated. Findings The cumulative deep vein patency rate was 74.07% in the catheter-directed thrombolysis + Stent Group and 46.59% in the catheter-directed thrombolysis Alone Group. The mean postoperative Clinical Etiology Anatomic Pathophysiologic classification and Venous Clinical Severity Score was significantly lower in the catheter-directed thrombolysis + Stent Group than in the catheter-directed thrombolysis Alone Group. The mean postoperative Chronic Venous Insufficiency Questionnaire score was significantly higher in the catheter-directed thrombolysis + Stent Group than the catheter-directed thrombolysis Alone Group. Conclusions Placement of an iliac vein stent in patients with residual iliac vein stenosis after catheter-directed thrombolysis for acute lower extremity deep venous thrombosis increases iliac vein patency and improves clinical symptoms and health-related quality of life at mid-term follow-up compared to patients treated with catheter

Short physical performance battery for middle-aged and older adult cardiovascular disease patients: implication for strength tests and lower extremity morphological evaluation.

PubMed

Yasuda, Tomohiro; Fukumura, Kazuya; Nakajima, Toshiaki

2017-04-01

[Purpose] To examine if the SPPB is higher with healthy subjects than outpatients, which was higher than inpatients and if the SPPB can be validated assessment tool for strength tests and lower extremity morphological evaluation in cardiovascular disease patients. [Subjects and Methods] Twenty-four middle aged and older adults with cardiovascular disease were recruited from inpatient and outpatient facilities and assigned to separate experimental groups. Twelve age-matched healthy volunteers were assigned to a control group. SPPB test was used to assess balance and functional motilities. The test outcomes were compared with level of care (inpatient vs. outpatient), physical characteristics, strength and lower extremity morphology. [Results] Total SPPB scores, strength tests (knee extensor muscle strength), and lower extremity morphological evaluation (muscle thickness of anterior and posterior mid-thigh and posterior lower-leg) were greater in healthy subjects and outpatients groups compared with inpatients. To predict total Short Physical Performance Battery scores, the predicted knee extension and anterior mid-thigh muscle thickness were calculated. [Conclusion] The SPPB is an effective tool as the strength tests and lower extremity morphological evaluation for middle-aged and older adult cardiovascular disease patients. Notably, high knee extensor muscle strength and quadriceps femoris muscle thickness are positively associated with high SPPB scores.

[TRANSOSSEOUS OSTEOSYNTHESIS OF LOWER EXTREMITIES BONES FRACTURES AND QUALITY OF LIFE OF PATIENTS IN THE TREATMENT PERIOD].

PubMed

Dyusupov, A; Dyusupov, A; Manarbekov, E; Bukatov, A; Serikbaev, A

2018-02-01

The aim of the study is a comparative analysis of the quality of life in the treatment of fractures of the bones of the lower extremities of various localizations using transosseous and submerged osteosynthesis. We examined 397 patients with injuries of the lower segment of the lower extremity (patellar fractures - 81, multiple bones fractures of the tibia - 84 and fractures of the ankles, accompanied by a dislocation of the foot - 232). Patients were distributed in the subgroups depending on the treatment. The main group was performed using transosseous osteosynthesis, the comparison group - submerged osteosynthesis. The quality of life was examined using a general questionnaire SF-36 and specialized KOOS (with patella fractures) and FOAS (fractures of the bones of the lower leg and ankles). In patients with all localizations of fractures the quality of life was exceeded in the subgroups of the transosseous osteosynthesis group over the parameters of the comparison group. The most significant differences with the use of specialized questionnaires were revealed 6-9 months after trauma with a tendency to leveling to the end of the study (1 year). A more pronounced excess of the quality of life in the main group was seen in fractures of the shin bones. The study of the quality of life allows us to recommend the use of transosseous osteosynthesis for the treatment of lower segment of the lower limb bone fractures.

TLEM 2.0 - a comprehensive musculoskeletal geometry dataset for subject-specific modeling of lower extremity.

PubMed

Carbone, V; Fluit, R; Pellikaan, P; van der Krogt, M M; Janssen, D; Damsgaard, M; Vigneron, L; Feilkas, T; Koopman, H F J M; Verdonschot, N

2015-03-18

When analyzing complex biomechanical problems such as predicting the effects of orthopedic surgery, subject-specific musculoskeletal models are essential to achieve reliable predictions. The aim of this paper is to present the Twente Lower Extremity Model 2.0, a new comprehensive dataset of the musculoskeletal geometry of the lower extremity, which is based on medical imaging data and dissection performed on the right lower extremity of a fresh male cadaver. Bone, muscle and subcutaneous fat (including skin) volumes were segmented from computed tomography and magnetic resonance images scans. Inertial parameters were estimated from the image-based segmented volumes. A complete cadaver dissection was performed, in which bony landmarks, attachments sites and lines-of-action of 55 muscle actuators and 12 ligaments, bony wrapping surfaces, and joint geometry were measured. The obtained musculoskeletal geometry dataset was finally implemented in the AnyBody Modeling System (AnyBody Technology A/S, Aalborg, Denmark), resulting in a model consisting of 12 segments, 11 joints and 21 degrees of freedom, and including 166 muscle-tendon elements for each leg. The new TLEM 2.0 dataset was purposely built to be easily combined with novel image-based scaling techniques, such as bone surface morphing, muscle volume registration and muscle-tendon path identification, in order to obtain subject-specific musculoskeletal models in a quick and accurate way. The complete dataset, including CT and MRI scans and segmented volume and surfaces, is made available at http://www.utwente.nl/ctw/bw/research/projects/TLEMsafe for the biomechanical community, in order to accelerate the development and adoption of subject-specific models on large scale. TLEM 2.0 is freely shared for non-commercial use only, under acceptance of the TLEMsafe Research License Agreement. Copyright © 2014 Elsevier Ltd. All rights reserved.

High spatial resolution time-resolved magnetic resonance angiography of lower extremity tumors at 3T

PubMed Central

Wu, Gang; Jin, Teng; Li, Ting; Morelli, John; Li, Xiaoming

2016-01-01

Abstract The aim of this study was to compare diagnostic value of high spatial resolution time-resolved magnetic resonance angiography with interleaved stochastic trajectory (TWIST) using Gadobutrol to Computed tomography angiography (CTA) for preoperative evaluation of lower extremity tumors. This prospective study was approved by the institutional review board. Fifty consecutive patients (31 men, 19 women, age range 18–80 years, average age 42.7 years) with lower extremity tumors underwent TWIST magnetic resonance angiography (MRA) and CTA. Digital subtraction angiography was available for 8 patients. Image quality of MRA was compared with CTA by 2 radiologists according to a 4-point Likert scale. Arterial involvement by tumor was compared using kappa test between MRA and CTA. The ability to identify feeding arteries and arterio-venous fistulae (AVF) was compared using Wilcoxon signed rank test and McNemar test, respectively. Image quality of MRA and CTA was rated without a statistically significant difference (3.88 ± 0.37 vs. 3.97 ± 0.16, P = 0.135). Intramodality agreement was high for the identification of arterial invasion (kappa = 0.806 ± 0.073 for Reader 1, kappa = 0.805 ± 0.073 for Reader 2). Readers found AVF in 27 of 50 MRA cases and 14 of 50 CTA cases (P < 0.001). Mean feeding arteries identified with MRA were significantly more than that with CTA (2.08 ± 1.72 vs. 1.62 ± 1.52, P = .02). TWIST MRA is a reliable imaging modality for the assessment of lower extremity tumors. TWIST MRA is comparable to CTA for the identification of AVF and feeding arteries. PMID:27631262

[Free latissimus dorsi flap transfer for reconstruction of soft tissue defects of the lower extremity].

PubMed

Knobloch, K; Herold, C; Vogt, P M

2012-04-01

Sustainable and durable soft tissue coverage at the lower extremity following trauma, tumor resections, sequelae of radiation therapy or osteomyelitis using free latissimus dorsi muscle transfer is provided by a free latissimus dorsi muscle flap. Soft tissue defects at the lower extremity following trauma, tumor resections, and sequelae of radiation therapy or osteomyelitis. Thoracotomy with incision of the latissimus dorsi muscle; a relative contraindication in wheelchair drivers as well as in overhead athletes due to potential diminished strength and shoulder proprioception following latissimus dorsi muscle transplantation. Under general anesthesia the patient is positioned laterally, and a substantial and meticulous debridement of the defect is performed, as is the identification and preparation of the target vessel, which is preferentially the posterior tibial artery at the calf, or more proximally the popliteal or femoral artery from the medial side as well as concomitant veins/the great saphenous vein. A tailored latissimus dorsi musculocutaneous flap is harvested with subsequent microsurgical anastomosis to the target vessel with preferential end-to-side anastomosis of the artery and end-to-end anastomosis of one or two veins. A 24-h intermediate care unit, clinical flap monitoring for at least 5-7 days, dangling of the flap using an elastic bandage for an initial 3  times  5 min starting on POD 7, compression stockings for at least 6 months subsequently. From 2001-2007 75 free latissimus dorsi flaps were performed (53 ± 17 years) for soft tissue coverage at the lower extremity. In 58% the target vessel was the posterior tibial artery, in 11% the femoral artery, in 8% the anterior tibial artery and in 8% the popliteal artery. In 15% an arteriovenous (AV) loop was applied. Overall free flap survival was 95%. We encountered four total flap losses, exclusively in complex reconstructions with AV-loop situations.

Altered lower extremity joint mechanics occur during the star excursion balance test and single leg hop after ACL-reconstruction in a collegiate athlete.

PubMed

Samaan, Michael A; Ringleb, Stacie I; Bawab, Sebastian Y; Greska, Eric K; Weinhandl, Joshua T

2018-03-01

The effects of ACL-reconstruction on lower extremity joint mechanics during performance of the Star Excursion Balance Test (SEBT) and Single Leg Hop (SLH) are limited. The purpose of this study was to determine if altered lower extremity mechanics occur during the SEBT and SLH after ACL-reconstruction. One female Division I collegiate athlete performed the SEBT and SLH tasks, bilaterally, both before ACL injury and 27 months after ACL-reconstruction. Maximal reach, hop distances, lower extremity joint kinematics and moments were compared between both time points. Musculoskeletal simulations were used to assess muscle force production during the SEBT and SLH at both time points. Compared to the pre-injury time point, SEBT reach distances were similar in both limbs after ACL-reconstruction except for the max anterior reach distance in the ipsilateral limb. The athlete demonstrated similar hop distances, bilaterally, after ACL-reconstruction compared to the pre-injury time point. Despite normal functional performance during the SEBT and SLH, the athlete exhibited altered lower extremity joint mechanics during both of these tasks. These results suggest that measuring the maximal reach and hop distances for these tasks, in combination with an analysis of the lower extremity joint mechanics that occur after ACL-reconstruction, may help clinicians and researchers to better understand the effects of ACL-reconstruction on the neuromuscular system during the SEBT and SLH.

Poor outcome of bilateral lower extremity morel-lavallee lesions: a case report.

PubMed

Stanley, Sharon S; Molmenti, Ernesto P; Siskind, Eric; Kasabian, Armen K; Huang, Su-I D

2014-03-01

The Morel-Lavallee lesion is a closed, internal degloving injury that results when a strong, shearing force is applied parallel to the plane of injury, as is common in vehicular trauma. It is an underdiagnosed entity that is often missed during the initial trauma workup as symptoms can be subtle. There are few reports of lesions occurring below the knee. Most cases affect the proximal thigh and trochanter, as these tend to be dependent areas in high velocity trauma. To the best of our knowledge, this is the first literature report of bilateral lower extremity Morel-Lavallee lesions.

The photonic device for integrated evaluation of collateral circulation of lower extremities in patients with local hypertensive-ischemic pain syndrome

NASA Astrophysics Data System (ADS)

Pavlov, Volodymyr S.; Bezsmernyi, Yurii O.; Zlepko, Sergey M.; Bezsmertna, Halyna V.

2017-08-01

The given paper analyzes principles of interaction and analysis of the reflected optical radiation from biotissue in the process of assessment of regional hemodynamics state in patients with local hypertensive- ischemic pain syndrome of amputation stumps of lower extremities, applying the method of photoplethysmography. The purpose is the evaluation of Laser photoplethysmography (LPPG) diagnostic value in examination of patients with chronic ischemia of lower extremities. Photonic device is developed to determine the level of the peripheral blood circulation, which determines the basic parameters of peripheral blood circulation and saturation level. Device consists of two sensors: infrared sensor, which contains the infrared laser radiation source and photodetector, and red sensor, which contains the red radiation source and photodetector. LPPG method allows to determined pulsatility of blood flow in different areas of the foot and lower leg, the degree of compensation and conservation perspectives limb. Surgical treatment of local hypertensive -ischemic pain syndrome of amputation stumps of lower extremities by means of semiclosed fasciotomy in combination with revasculating osteotrepanation enabled to improve considerably regional hemodynamics in the tissues of the stump and decrease pain and hypostatic disorders.

Changes in Lower Extremity Kinematics and Temporal Parameters of Adolescent Baseball Pitchers During an Extended Pitching Bout.

PubMed

Kung, Stacey M; Shultz, Sarah P; Kontaxis, Andreas; Kraszewski, Andrew P; Gibbons, Mandi W; Backus, Sherry I; Fink, Philip W; Fealy, Stephen; Hillstrom, Howard J

2017-04-01

Few studies have investigated detailed 3-dimensional lower extremity kinematics during baseball pitching in adolescent athletes during extended play. Changes in these parameters may affect performance outcomes. To investigate whether adolescent baseball pitchers experience changes in lower extremity kinematics and event timing during a simulated game-length pitching bout. Descriptive laboratory study. Twelve male adolescent pitchers (aged 14-16 years) threw 6 sets of 15 fastball pitches from an artificial pitching mound to a target at regulation distance. Joint angles and angular velocities at the hip, knee, and ankle of both legs were collected throughout the phases of the pitching cycle as well as stride length, pelvis orientation, pitch duration, timing of foot contact and ball release, ball speed, and pitching accuracy. Paired t tests ( P < .05) were used to compare the dependent variables between the last 5 pitches of the second (baseline) and sixth (final) sets. During the stride phase, decreased maximum angular excursions for hip extension (baseline: 14.7° ± 9.8°; final: 11.6° ± 10.3°; P < .05) and ankle plantar flexion (baseline: 30.2° ± 14.5°; final: 24.2° ± 15.3°; P < .05) as well as maximum angular velocity for knee extension (baseline: 144.9 ± 63.3 deg·s -1 ; final: 121.7 ± 62.0 deg·s -1 ; P < .05) were observed between sets in the trailing leg. At foot contact, pitchers had decreased hip flexion (baseline: 69.5° ± 10.1°; final: 66.5° ± 11.8°; P < .05) and increased hip abduction (baseline: 20.7° ± 8.9°; final: 25.4° ± 6.0°; P < .05) in the leading leg in the final set. Compared with the baseline set, ball speed significantly decreased in the final set (29.5 ± 2.5 m·s -1 vs 28.3 ± 2.5 m·s -1 , respectively; P < .05). Kinematic changes and decreased ball speeds observed in the final set suggest that adolescent pitchers are unable to maintain lower extremity kinematics and performance as a result of extended play. The

Evaluation of Spine Health and Spine Mechanics in Servicemembers with Traumatic Lower Extremity Amputation or Injury

DTIC Science & Technology

2015-10-01

of proximal compensations (e.g., hip-hiking) to assist with toe clearance (Michaud et al., 2000), or simply because these individuals feel more...related unilateral lower extremity amputation: a long-term survey in a prosthesis center in Iran. Journal of orthopaedic trauma 23(7), 525-530

The Association of Vitamin D Status in Lower Extremity Muscle Strains and Core Muscle Injuries at the National Football League Combine.

PubMed

Rebolledo, Brian J; Bernard, Johnathan A; Werner, Brian C; Finlay, Andrea K; Nwachukwu, Benedict U; Dare, David M; Warren, Russell F; Rodeo, Scott A

2018-04-01

To evaluate the association between serum vitamin D level and the prevalence of lower extremity muscle strains and core muscle injuries in elite level athletes at the National Football League (NFL) combine. During the 2015 NFL combine, all athletes with available serum vitamin D levels were included for study. Baseline data were collected, including age, race, body mass index, position, injury history specific to lower extremity muscle strain or core muscle injury, and Functional Movement Screen scores. Serum 25-hydroxyvitamin D was collected and defined as normal (≥32 ng/mL), insufficient (20-31 ng/mL), and deficient (<20 ng/mL). Univariate regression analysis was used to examine the association of vitamin D level and injury history. Subsequent multivariate regression analysis was used to examine this relation with adjustment for collected baseline data variables. The study population included 214 athletes, including 78% African American athletes and 51% skilled position players. Inadequate vitamin D was present in 59%, including 10% with deficient levels. Lower extremity muscle strain or core muscle injury was present in 50% of athletes, which was associated with lower vitamin D levels (P = .03). Athletes with a positive injury history also showed significantly lower vitamin D levels as compared with uninjured athletes (P = .03). African American/black race (P < .001) and injury history (P < .001) was associated with lower vitamin D. Vitamin D groups showed no differences in age (P = .9), body mass index (P = .9), or Functional Movement Screen testing (P = .2). Univariate analysis of inadequate vitamin D levels showed a 1.86 higher odds of lower extremity strain or core muscle injury (P = .03), and 3.61 higher odds of hamstring injury (P < .001). Multivariate analysis did not reach an independent association of low vitamin D with injury history (P = .07). Inadequate vitamin D levels are a widespread finding in athletes at the NFL combine. Players

Lower extremity injuries in runners. Advances in prediction.

PubMed

Macera, C A

1992-01-01

Recreational and competitive running is practised by many individuals to improve cardiorespiratory function and general well-being. The major negative aspect of running is the high rate of injuries to the lower extremities. Several well-designed population-based studies have found no major differences in injury rates between men and women; no increasing effect of age on injuries; a declining injury rate with more years of running experience; no substantial effect of weight or height; an uncertain effect of psychological factors; and a strong effect of previous injury on future injuries. Among the modifiable risk factors studied, weekly distance is the strongest predictor of future injuries. Other training characteristics (speed, frequency, surface, timing) have little or no effect on future injuries after accounting for distance run. More studies are needed to address the effects of appropriate stretching practices and abrupt change in training patterns. For recreational runners who have sustained injuries, especially within the past year, a reduction in running to below 32 km per week is recommended. For those about to begin a running programme, moderation is the best advice. For competitive runners, great care should be taken to ensure that prior injuries are sufficiently healed before attempting any racing event, particularly a marathon.

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

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

Reliability and validity of a low load endurance strength test for upper and lower extremities in patients with fibromyalgia.

PubMed

Munguía-Izquierdo, Diego; Legaz-Arrese, Alejandro

2012-11-01

To evaluate the reliability, standard error of the mean (SEM), clinical significant change, and known group validity of 2 assessments of endurance strength to low loads in patients with fibromyalgia syndrome (FS). Cross-sectional reliability and comparative study. University Pablo de Olavide, Seville, Spain. Middle-aged women with FS (n=95) and healthy women (n=64) matched for age, weight, and body mass index (BMI) were recruited for the study. Not applicable. The endurance strength to low loads tests of the upper and lower extremities and anthropometric measures (BMI) were used for the evaluations. The differences between the readings (tests 1 and 2) and the SDs of the differences, intraclass correlation coefficient (ICC) model (2,1), 95% confidence interval for the ICC, coefficient of repeatability, intrapatient SD, SEM, Wilcoxon signed-rank test, and Bland-Altman plots were used to examine reliability. A Mann-Whitney U test was used to analyze the differences in test values between the patient group and the control group. We hypothesized that patients with FS would have an endurance strength to low loads performance in lower and upper extremities at least twice as low as that of the healthy controls. Satisfactory test-retest reliability and SEMs were found for the lower extremity, dominant arm, and nondominant arm tests (ICC=.973-.979; P<.001; SEMs=1.44-1.66 repetitions). The differences in the mean between the test and retest were lower than the SEM for all performed tests, varying from -.10 to .29 repetitions. No significant differences were found between the test and retest (P>.05 for all). The Bland-Altman plots showed 95% limits of agreement for the lower extremity (4.7 to -4.5), dominant arm (3.8 to -4.4), and nondominant arm (3.9 to -4.1) tests. The endurance strength to low loads test scores for the patients with FS were 4-fold lower than for the controls in all performed tests (P<.001 for all). The endurance strength to low loads tests showed good

An investigation of turbulent transport in the extreme lower atmosphere

NASA Technical Reports Server (NTRS)

Koper, C. A., Jr.; Sadeh, W. Z.

1975-01-01

A model in which the Lagrangian autocorrelation is expressed by a domain integral over a set of usual Eulerian autocorrelations acquired concurrently at all points within a turbulence box is proposed along with a method for ascertaining the statistical stationarity of turbulent velocity by creating an equivalent ensemble to investigate the flow in the extreme lower atmosphere. Simultaneous measurements of turbulent velocity on a turbulence line along the wake axis were carried out utilizing a longitudinal array of five hot-wire anemometers remotely operated. The stationarity test revealed that the turbulent velocity is approximated as a realization of a weakly self-stationary random process. Based on the Lagrangian autocorrelation it is found that: (1) large diffusion time predominated; (2) ratios of Lagrangian to Eulerian time and spatial scales were smaller than unity; and, (3) short and long diffusion time scales and diffusion spatial scales were constrained within their Eulerian counterparts.

Lower- extremity biomechanics and maintenance of vertical-jump height during prolonged intermittent exercise.

PubMed

Schmitz, Randy J; Cone, John C; Copple, Timothy J; Henson, Robert A; Shultz, Sandra J

2014-11-01

Potential biomechanical compensations allowing for maintenance of maximal explosive performance during prolonged intermittent exercise, with respect to the corresponding rise in injury rates during the later stages of exercise or competition, are relatively unknown. To identify lower-extremity countermovement-jump (CMJ) biomechanical factors using a principal-components approach and then examine how these factors changed during a 90-min intermittent-exercise protocol (IEP) while maintaining maximal jump height. Mixed-model design. Laboratory. Fifty-nine intermittent-sport athletes (30 male, 29 female) participated in experimental and control conditions. Before and after a dynamic warm-up and every 15 min during the 1st and 2nd halves of an individually prescribed 90-min IEP, participants were assessed on rating of perceived exertion, sprint/cut speed, and 3-dimensional CMJ biomechanics (experimental). On a separate day, the same measures were obtained every 15 min during 90 min of quiet rest (control). Univariate piecewise growth models analyzed progressive changes in CMJ performance and biomechanical factors extracted from a principal-components analysis of the individual biomechanical dependent variables. While CMJ height was maintained during the 1st and 2nd halves, the body descended less and knee kinetic and energetic magnitudes decreased as the IEP progressed. The results indicate that vertical-jump performance is maintained along with progressive biomechanical changes commonly associated with decreased performance. A better understanding of lower-extremity biomechanics during explosive actions in response to IEP allows us to further develop and individualize performance training programs.

The Effect of the Weight of Equipment on Muscle Activity of the Lower Extremity in Soldiers

PubMed Central

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

Sex differences in lower extremity biomechanics during single leg landings.

PubMed

Schmitz, Randy J; Kulas, Anthony S; Perrin, David H; Riemann, Bryan L; Shultz, Sandra J

2007-07-01

Females have an increased incident rate of anterior cruciate ligament tears compared to males. Biomechanical strategies to decelerate the body in the vertical direction have been implicated as a contributing cause. This study determined if females would exhibit single leg landing strategies characterized by decreased amounts of hip, knee, and ankle flexion resulting in greater vertical ground reaction forces and altered energy absorption patterns when compared to males. Recreationally active males (N=14) and females (N=14), completed five single leg landings from a 0.3m height onto a force platform while three-dimensional kinematics and kinetics were simultaneously collected. Compared to males, females exhibited (1) less total hip and knee flexion displacements (40% and 64% of males, respectively, P<0.05) and less time to peak hip and knee flexion (48% and 78% of males, respectively, P<0.05), (2) 9% greater peak vertical ground reaction forces (P<0.05), (3) less total lower body energy absorption (76% of males, P<0.05), and (4) 11% greater relative energy absorption at the ankle (P<0.05). Females in this study appear to adopt a single leg landing style using less hip and knee flexion, absorbing less total lower body energy with more relative energy at the ankle resulting in a landing style that can be described as stiff. This may potentially cause increased demands on non-contractile components of the lower extremity. Preventative training programs designed to prevent knee injury may benefit from the biomechanical description of sex-specific landing methods demonstrated by females in this study by focusing on the promotion of more reliance on using the contractile components to absorb impact energy during landings.

In-shoe plantar pressure distribution and lower extremity muscle activity patterns of backward compared to forward running on a treadmill.

PubMed

Sterzing, Thorsten; Frommhold, Clivia; Rosenbaum, Dieter

2016-05-01

Backward locomotion in humans occurs during leisure, rehabilitation, and competitive sports. Little is known about its general biomechanical characteristics and how it affects lower extremity loading as well as muscle coordination. Thus, the purpose of this research was to analyze in-shoe plantar pressure patterns and lower extremity muscle activity patterns for backward compared to forward running. On a treadmill, nineteen runners performed forward running at their individually preferred speed, followed by backward running at 70% of their self-selected forward speed. In-shoe plantar pressures of nine foot regions and muscular activity of nine lower extremity muscles were recorded simultaneously over a one-minute interval. Backward and forward running variables were averaged over the accumulated steps and compared with Wilcoxon-signed rank tests (p<.05). For backward compared to forward running, in-shoe plantar pressure distribution showed a load increase under metatarsal heads I and II, as well as under the medial midfoot. This was indicated by higher maximum forces and peak pressures, and by longer contact times. Muscle activity showed significantly higher mean amplitudes during backward running in the semitendinosus, rectus femoris, vastus lateralis, and gluteus medius during stance, and in the rectus femoris during swing phase, while significantly lower mean amplitudes were observed in the tibialis anterior during swing phase. Observations indicate plantar foot loading and muscle activity characteristics that are specific for the running direction. Thus, backward running may be used on purpose for certain rehabilitation tasks, aiming to strengthen respective lower extremity muscles. Furthermore, the findings are relevant for sport specific backward locomotion training. Finally, results provide an initial baseline for innovative athletic footwear development aiming to increase comfort and performance during backward running. Copyright © 2016 Elsevier B.V. All

Anterior cruciate ligament injury alters preinjury lower extremity biomechanics in the injured and uninjured leg: the JUMP-ACL study.

PubMed

Goerger, Benjamin M; Marshall, Stephen W; Beutler, Anthony I; Blackburn, J Troy; Wilckens, John H; Padua, Darin A

2015-02-01

Information as to how anterior cruciate ligament (ACL) injury and reconstructive surgery (ACLR) alter lower extremity biomechanics may improve rehabilitation and return to play guidelines, reducing the risk for repeat ACL injury. To compare lower extremity biomechanics before ACL injury and after subsequent ACLR for the injured and uninjured leg. Baseline unilateral lower extremity biomechanics were collected on the dominant leg of participants without ACL injury when they entered the Joint Undertaking to Monitor and Prevent ACL (JUMP-ACL) study. Thirty-one participants with subsequent ACL injury, reconstructive surgery and full return to physical activity completed repeat, follow-up biomechanical testing, as did 39 uninjured, matched controls. Not all injured participants suffered injury to the dominant leg, requiring separation of those with ACL injury into two groups: ACLR-injured leg group (n=12) and ACLR-uninjured leg group (n=19). We compared the landing biomechanics of these three groups (ACLR-injured leg, ACLR-uninjured leg, control) before ACL injury (baseline) with biomechanics after ACL injury, surgery and return to physical activity (follow-up). ACL injury and ACLR altered lower extremity biomechanics, as both ACLR groups demonstrated increases in frontal plane movement (increased hip adduction and knee valgus). The ACLR-injured leg group also exhibited decreased sagittal plane loading (decreased anterior tibial shear force, knee extension moment and hip flexion moment). No high-risk biomechanical changes were observed in control group participants. ACL injury and ACLR caused movement pattern alterations of the injured and uninjured leg that have previously shown to increase the risk for future non-contact ACL injury. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://group.bmj.com/group/rights-licensing/permissions.

Association of lower extremity range of motion and muscle strength with physical performance of community-dwelling older women.

PubMed

Jung, Hungu; Yamasaki, Masahiro

2016-12-08

Reduced lower extremity range of motion (ROM) and muscle strength are related to functional disability in older adults who cannot perform one or more activities of daily living (ADL) independently. The purpose of this study was to determine which factors of seven lower extremity ROMs and two muscle strengths play dominant roles in the physical performance of community-dwelling older women. Ninety-five community-dwelling older women (mean age ± SD, 70.7 ± 4.7 years; age range, 65-83 years) were enrolled in this study. Seven lower extremity ROMs (hip flexion, hip extension, knee flexion, internal and external hip rotation, ankle dorsiflexion, and ankle plantar flexion) and two muscle strengths (knee extension and flexion) were measured. Physical performance tests, including functional reach test (FRT), 5 m gait test, four square step test (FSST), timed up and go test (TUGT), and five times sit-to-stand test (FTSST) were performed. Stepwise regression models for each of the physical performance tests revealed that hip extension ROM and knee flexion strength were important explanatory variables for FRT, FSST, and FTSST. Furthermore, ankle plantar flexion ROM and knee extension strength were significant explanatory variables for the 5 m gait test and TUGT. However, ankle dorsiflexion ROM was a significant explanatory variable for FRT alone. The amount of variance on stepwise multiple regression for the five physical performance tests ranged from 25 (FSST) to 47% (TUGT). Hip extension, ankle dorsiflexion, and ankle plantar flexion ROMs, as well as knee extension and flexion strengths may play primary roles in the physical performance of community-dwelling older women. Further studies should assess whether specific intervention programs targeting older women may achieve improvements in lower extremity ROM and muscle strength, and thereby play an important role in the prevention of dependence on daily activities and loss of physical function, particularly

Clinical and Ultrasonographic Evaluation of Lower-extremity Vein Thrombosis in Behcet Syndrome: An Observational Study.

PubMed

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

2015-11-01

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 thrombosis

Risk Factors for Thirty-Day Readmissions After Lower Extremity Amputation in Patients With Vascular Disease.

PubMed

Vogel, Todd R; Smith, Jamie B; Kruse, Robin L

2018-05-29

Understanding risk factors associated with readmission after lower extremity amputation may indicate targets for reducing readmission. This study evaluated factors associated with all-cause 30-day readmission after lower extremity amputation procedures. Retrospective cohort study. Inpatient. A total of 2480 patients who had lower extremity amputations between 2008 and 2014 were selected from national electronic medical record database, Cerner Health Facts. Univariate analysis of demographics, diagnoses, postoperative medications, and laboratory results were examined. Multivariate logistic regression models were used to identify characteristics independently associated with readmission overall and by amputation location-above the knee (AKA) or below the knee (BKA). Readmission within 30 days of discharge. More than one half of patients (1403, 57%) underwent BKA and 1077 (43%) underwent AKA. Readmission within 30 days was 22% (24.1% BKA versus 19.4% AKA, P = .005). In multivariable logistic regression, factors associated with 30-day readmission after any amputation included BKA (odds ratio [OR] 1.41, 95% confidence interval [CI] 1.15-1.74, P = .001), hypertension (OR 1.70, 95% CI 1.33-2.16), surgical-site infections (OR 1.44, 95% CI 1.02-2.04), heart failure (OR 1.39, 95% CI 1.10-1.75), discharge to a skilled nursing facility (OR 1.88, 95% CI 1.41-2.51), and emergency/urgent procedures (OR 1.32, 95% CI 1.04-1.67). At readmission, 13.3% of patients with a BKA required an AKA revision, and 21.3% had a diagnosis of surgical-site infection. Risk factors for readmission after any amputation included cardiac comorbidities, associated postoperative medications, and discharge to a skilled nursing facility. The finding that acute arterial embolism or thrombosis and a BKA during the index admission was highly associated with readmission, combined with the high rates of 30-day conversion to an AKA when readmitted, suggests these patients more often develop stump complications

Effect of a Lower Extremity Preventive Training Program on Physical Performance Scores in Military Recruits.

PubMed

Peck, Karen Y; DiStefano, Lindsay J; Marshall, Stephen W; Padua, Darin A; Beutler, Anthony I; de la Motte, Sarah J; Frank, Barnett S; Martinez, Jessica C; Cameron, Kenneth L

2017-11-01

Peck, KY, DiStefano, LJ, Marshall, SW, Padua, DA, Beutler, AI, de la Motte, SJ, Frank, BS, Martinez, JC, and Cameron, KL. Effect of a lower extremity preventive training program on physical performance scores in military recruits. J Strength Cond Res 31(11): 3146-3157, 2017-Exercise-based preventive training programs are designed to improve movement patterns associated with lower extremity injury risk; however, the impact of these programs on general physical fitness has not been evaluated. The purpose of this study was to compare fitness scores between participants in a preventive training program and a control group. One thousand sixty-eight freshmen from a U.S. Service Academy were cluster-randomized into either the intervention or control group during 6 weeks of summer training. The intervention group performed a preventive training program, specifically the Dynamic Integrated Movement Enhancement (DIME), which is designed to improve lower extremity movement patterns. The control group performed the Army Preparation Drill (PD), a warm-up designed to prepare soldiers for training. Main outcome measures were the Army Physical Fitness Test (APFT) raw and scaled (for age and sex) scores. Independent t tests were used to assess between-group differences. Multivariable logistic regression models were used to control for the influence of confounding variables. Dynamic Integrated Movement Enhancement group participants completed the APFT 2-mile run 20 seconds faster compared with the PD group (p < 0.001), which corresponded with significantly higher scaled scores (p < 0.001). Army Physical Fitness Test push-up scores were significantly higher in the DIME group (p = 0.041), but there were no significant differences in APFT sit-up scores. The DIME group had significantly higher total APFT scores compared with the PD group (p < 0.001). Similar results were observed in multivariable models after controlling for sex and body mass index (BMI). Committing time to the

Determinants of lower extremity amputations: an institutional experience.

PubMed

Soomro, Nabila; Khan, Mahjabeen; Ahmed, Syed Imran; Minhas, Muhammad Ali

2013-07-01

To determine the determinants of lower extremity amputations in diabetics and non-diabetics in a tertiary care institute. Cross-sectional, analytical study. Outpatients Department of the Institute of Physical Medicine and Rehabilitation, Dow University of Health Sciences, Karachi, from January 2007 to December 2010. All patients with amputations reporting at the study centre for prosthesis fitting were included in the study. Patient`s age, level of amputation, stump complications and associated risk factors of amputation were recorded on a structured proforma. Prosthesis and orthotic assessment were carried out. The frequency and determinants were collected to compare diabetic and non-diabetic amputees. The data was analyzed in SPSS windows version 16. A total of 1091 subjects were provided prosthesis, including 847 males (77.6%). Mean age in diabetic and nondiabetics being 49.6 ± 15.2 and 26.6 ± 17.9 years respectively which is significant at (p < 0.001). Socioeconomic status and educational levels were significantly associated with diabetic status (p < 0.001). Amputation was more common in non-diabetic 858 (78.6%) compared to diabetics 233 (21.4%). This study has identified that most common and significant predictors were gender, low social status and educational levels. Other significant predictors of amputation identified were type of lesion, (infections and ischaemia), initial diagnosis acute/chronic arterial insufficiency and diabetic foot.

Validity and interobserver agreement of lower extremity local tissue water measurements in healthy women using tissue dielectric constant.

PubMed

Jensen, Mads R; Birkballe, Susanne; Nørregaard, Susan; Karlsmark, Tonny

2012-07-01

Tissue dielectric constant (TDC) measurement may become an important tool in the clinical evaluation of chronic lower extremity swelling in women; however, several factors are known to influence TDC measurements, and comparative data on healthy lower extremities are few. Thirty-four healthy women volunteered. Age, BMI, moisturizer use and hair removal were registered. Three blinded investigators performed TDC measurements in a randomized sequence on clearly marked locations on the foot, the ankle and the lower leg. The effective measuring depth was 2.5 mm. The mean TDC was 37.8 ± 5.5 (mean ± SD) on the foot, 29.0 ± 3.1 on the ankle and 30.5 ± 3.9 on the lower leg. TDC was highly dependent on measuring site (P<0.001) but did not vary significantly between investigators (P=0.127). Neither age, BMI, hair removal nor moisturizer use had any significant effect on the lower leg TDC. Intraclass correlation coefficients were 0.77 for the foot, 0.94 for the ankle and 0.94 for the lower leg. The TDC on the foot was significantly higher compared with ankle and lower leg values. Foot measurements should be interpreted cautiously because of questionable interobserver agreement. The interobserver agreement was high on lower leg and ankle measurements. Neither age, BMI, hair removal nor moisturizer use had any significant on effect on the lower leg TDC. TDC values of 35.2 for the ankle and 38.3 for the lower leg are suggested as upper normal reference limits in women. © 2012 The Authors Clinical Physiology and Functional Imaging © 2012 Scandinavian Society of Clinical Physiology and Nuclear Medicine.

Diabetic Driving Studies-Part 2: A Comparison of Brake Response Time Between Drivers With Diabetes With and Without Lower Extremity Sensorimotor Neuropathy.

PubMed

Spiess, Kerianne E; Sansosti, Laura E; Meyr, Andrew J

We have previously demonstrated an abnormally delayed mean brake response time and an increased frequency of abnormally delayed brake responses in a group of neuropathic drivers with diabetes compared with a control group of drivers with neither diabetes nor lower extremity neuropathy. The objective of the present case-control study was to compare the mean brake response time between 2 groups of drivers with diabetes with and without lower extremity sensorimotor neuropathy. The braking performances of the participants were evaluated using a computerized driving simulator with specific measurement of the mean brake response time and the frequency of the abnormally delayed brake responses. We compared a control group of 25 active drivers with type 2 diabetes without lower extremity neuropathy and an experimental group of 25 active drivers with type 2 diabetes and lower extremity neuropathy from an urban U.S. podiatric medical clinic. The experimental group demonstrated an 11.49% slower mean brake response time (0.757 ± 0.180 versus 0.679 ± 0.120 second; p < .001), with abnormally delayed reactions occurring at a greater frequency (57.5% versus 35.0%; p < .001). Independent of a comparative statistical analysis, diabetic drivers with neuropathy demonstrated a mean brake response time slower than a suggested safety threshold of 0.70 second, and diabetic drivers without neuropathy demonstrated a mean brake response time faster than this threshold. The results of the present investigation provide evidence that the specific onset of lower extremity sensorimotor neuropathy associated with diabetes appears to impart a negative effect on automobile brake responses. Copyright © 2017 American College of Foot and Ankle Surgeons. Published by Elsevier Inc. All rights reserved.

Association of Vitamin K Status Combined With Vitamin D Status and Lower-Extremity Function: A Prospective Analysis of Two Knee Osteoarthritis Cohorts.

PubMed

Shea, M Kyla; Loeser, Richard F; McAlindon, Timothy E; Houston, Denise K; Kritchevsky, Stephen B; Booth, Sarah L

2017-10-17

Vitamins K and D are important for the function of vitamin K-dependent proteins in joint tissues. It is unclear whether these nutrients are mutually important to functional outcomes related to knee osteoarthritis (OA). We evaluated the association of vitamin K and D sufficiency with lower-extremity function in the Health, Aging and Body Composition knee OA substudy (Health ABC) and conducted a replication analysis in an independent cohort, the Osteoarthritis Initiative (OAI). In Health ABC (60% female, mean ± SD age 75 ± 3 years) baseline nutrient status was measured using circulating vitamin K and 25-hydroxyvitamin D (25[OH]D). Lower-extremity function was assessed using the Short Physical Performance Battery (SPPB) and usual 20-meter gait speed. In the OAI (58% female, mean ± SD age 61 ± 9 years), baseline nutrient intake was estimated by food frequency questionnaire. Lower-extremity function was assessed using usual 20-meter gait speed and chair stand completion time. Multivariate mixed models were used to evaluate the association of vitamin K and D status and intake with lower-extremity function over 4-5 years. Health ABC participants with sufficient plasma vitamin K (≥1.0 nmoles/liter) and serum 25(OH)D (≥50 nmoles/liter) generally had better SPPB scores and faster usual gait speed over followup (P ≤ 0.002). In the OAI, sufficient vitamin K and vitamin D intake combined was associated with overall faster usual gait speed and chair stand completion time over followup (P ≤ 0.029). Sufficient vitamin K status combined with sufficient vitamin D status was associated with better lower-extremity function in 2 knee OA cohorts. These findings merit confirmation in vitamin K and D co-supplementation trials. © 2017, American College of Rheumatology.

Diabetes, peripheral neuropathy, and lower-extremity function.

PubMed

Chiles, Nancy S; Phillips, Caroline L; Volpato, Stefano; Bandinelli, Stefania; Ferrucci, Luigi; Guralnik, Jack M; Patel, Kushang V

2014-01-01

Diabetes among older adults causes many complications, including decreased lower-extremity function and physical disability. Diabetes can cause peripheral nerve dysfunction, which might be one pathway through which diabetes leads to decreased physical function. The study aims were to determine the following: (1) whether diabetes and impaired fasting glucose are associated with objective measures of physical function in older adults, (2) which peripheral nerve function (PNF) tests are associated with diabetes, and (3) whether PNF mediates the diabetes-physical function relationship. This study included 983 participants, age 65 years and older from the InCHIANTI study. Diabetes was diagnosed by clinical guidelines. Physical performance was assessed using the Short Physical Performance Battery (SPPB), scored from 0 to 12 (higher values, better physical function) and usual walking speed (m/s). PNF was assessed via standard surface electroneurographic study of right peroneal nerve conduction velocity, vibration and touch sensitivity. Clinical cutpoints of PNF tests were used to create a neuropathy score from 0 to 5 (higher values, greater neuropathy). Multiple linear regression models were used to test associations. One hundred twenty-six (12.8%) participants had diabetes. Adjusting for age, sex, education, and other confounders, diabetic participants had decreased SPPB (β=-0.99; p<0.01), decreased walking speed (β=-0.1m/s; p<0.01), decreased nerve conduction velocity (β=-1.7m/s; p<0.01), and increased neuropathy (β=0.25; p<0.01) compared to non-diabetic participants. Adjusting for nerve conduction velocity and neuropathy score decreased the effect of diabetes on SPPB by 20%, suggesting partial mediation through decreased PNF. © 2014.

Diabetes, Peripheral Neuropathy, and Lower Extremity Function

PubMed Central

Chiles, Nancy S.; Phillips, Caroline L.; Volpato, Stefano; Bandinelli, Stefania; Ferrucci, Luigi; Guralnik, Jack M.; Patel, Kushang V.

2014-01-01

Objective Diabetes among older adults causes many complications, including decreased lower extremity function and physical disability. Diabetes can cause peripheral nerve dysfunction, which might be one pathway through which diabetes leads to decreased physical function. The study aims were to determine: (1) whether diabetes and impaired fasting glucose are associated with objective measures of physical function in older adults, (2) which peripheral nerve function (PNF) tests are associated with diabetes, and (3) whether PNF mediates the diabetes-physical function relationship. Research Design and Methods This study included 983 participants, age 65 and older from the InCHIANTI Study. Diabetes was diagnosed by clinical guidelines. Physical performance was assessed using the Short Physical Performance Battery (SPPB), scored from 0-12 (higher values, better physical function) and usual walking speed (m/s). PNF was assessed via standard surface electroneurographic study of right peroneal nerve conduction velocity, vibration and touch sensitivity. Clinical cut-points of PNF tests were used to create a neuropathy score from 0-5 (higher values, greater neuropathy). Multiple linear regression models were used to test associations. Results and Conclusion 12.8% (n=126) of participants had diabetes. Adjusting for age, sex, education, and other confounders, diabetic participants had decreased SPPB (β= −0.99; p< 0.01), decreased walking speed (β= −0.1m/s; p< 0.01), decreased nerve conduction velocity (β= −1.7m/s; p< 0.01), and increased neuropathy (β= 0.25; p< 0.01) compared to non-diabetic participants. Adjusting for nerve conduction velocity and neuropathy score decreased the effect of diabetes on SPPB by 20%, suggesting partial mediation through decreased PNF. PMID:24120281

Effect of ankle braces on lower extremity joint energetics in single-leg landings.

PubMed

Gardner, Jacob K; McCaw, Steven T; Laudner, Kevin G; Smith, Peter J; Stafford, Lindsay N

2012-06-01

Ankle sprains are one of the most common injuries in competitive and recreational athletics. Studies have shown that the use of prophylactic ankle braces effectively reduces the frequency of ankle sprains in athletes. However, although it is generally accepted that the ankle braces are effective at reducing frontal plane motion, some researchers report that the design of the brace may also reduce ankle sagittal plane motion. The purpose of this study was to quantify lower extremity joint contributions to energy absorption during single-legged drop landings in three ankle brace conditions (no brace, boot brace, and hinged brace). Eleven physically active females experienced in landing and free of lower extremity injury (age = 22.3 ± 1.7 yr, height = 1.66 ± 0.04 m, mass = 58.43 ± 5.83 kg) performed 10 single-leg drop landings in three conditions (one unbraced, two braced) from a 0.33-m height. Measurements taken were hip, knee, and ankle joint impulse; hip, knee, ankle, and total work; and hip, knee, and ankle joint relative work. Total energy absorption remained consistent across the braced conditions (P = 0.057). Wearing the boot brace reduced relative ankle work (P = 0.04, Cohen d = 0.43) but did not change relative knee (P = 0.08, Cohen d = 0.32) or hip (P = 0.14, Cohen d = 0.20) work compared with the no-brace condition. In an ankle-braced condition, ankle, knee, and hip energetics may be altered depending on the design of the brace.

Major amputation of lower extremity: prognostic value of positive bone biopsy cultures.

PubMed

Vaznaisiene, D; Beltrand, E; Laiskonis, A P; Yazdanpanah, Y; Migaud, H; Senneville, E

2013-02-01

To assess the correlation between culture results of section's osseous slice biopsy (SOB) and the distal infected site responsible for the amputation performed concomitantly during major amputation of lower extremity. The influence of a positive culture of SOB on the patients' outcome was also evaluated. We conducted a retrospective study of medical charts of patients who underwent SOB during major amputation of lower extremity at our institution from 2000 to 2009. Fifty-seven patients (42 males/15 females, mean age 52.16years) who undergone major limb amputation (47 below knee and ten above knee) were included. The initial medical conditions of the investigated patients were: trauma (n=32), infection (n=13), trophic disorders (n=10) and tumor (n=2). The major cause of amputation was an uncontrolled infection, accouting for 64.9% of the cases (37/57) (foot=5, ankle=8, leg=24), the remaining 20 patients had trophic disorders of lower limb. Twenty-one (36.8%) from 57 biopsies were sterile, 12 (21.1%) doubtful and 24 (42.1%) positive. Thirty-one (54.4%) patients had an antibiotic-free interval before limb amputation. Independently of the bacterial species, 69.6% of the microorganisms identified from SOB were found in the distal infected site. Patients with positive SOB had a significantly longer interval between the decision to amputate the patient and the surgical procedure (200.2 vs. 70.1days; P<0.03) and a shorter total duration of antibiotic therapy before amputation than patients with negative SOB (3.68 vs. 6.08months; P<0.03). The delay for complete healing was significantly higher in patients with a positive SOB compared with those with a negative SOB (3.57 vs. 2.48months; P<0.03). Our results suggest that the infection may extend from the distal site to the level of amputation in a large proportion of cases and that the delay with which the amputation is performed after the decision has been taken may play a role in this event. Study level IV

A preliminary study on effects of increment of loads to lower extremity joints during kettlebell swing activity

NASA Astrophysics Data System (ADS)

Zin, Muhammad Athif Mat; Rambely, Azmin Sham; Ariff, Noratiqah Mohd

2018-04-01

The purpose of the study was to determine the effects of increment of loads to lower extremity joints during the two-hand kettlebell swing (KS) activity with loads of 4 kg, 6 kg and 8 kg. Three male adults participated in this study. Subjects were required to perform a two-hand KS with three different loads which were 4 kg, 6 kg and 8 kg. A Vicon Nexus system (v1.5.2) with three infrared cameras adjusted with 100 Hz speed were used to capture KS motion to produce kinematics data for lower extremity joints which were ankle, knee and hip joints. The results showed that mean maximum flexion angle (MFA) of ankle, knee and hip joints decreased as load increased. Mean MFA of knee joint was the highest while mean MFA of ankle joint was the smallest recorded. Mean MFA of ipsilateral leg was higher than that of contralateral leg for a right-dominant subject.

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.

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

2009-08-07

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.

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. © 2013 Elsevier Ltd. All rights reserved.

Directing clinical care using lower extremity biomechanics in patients with ankle osteoarthritis and ankle arthroplasty.

PubMed

Queen, Robin

2017-11-01

Ankle osteoarthritis is a debilitating disease with approximately 50,000 new cases per year leading to skeletal deformity, severe and recurrent pain, cartilage breakdown, and gait dysfunction limiting patient mobility and well-being. Although many treatments (total ankle arthroplasty [TAA], ankle fusion [arthrodesis], and ankle distraction arthroplasty) relieve pain, it is not clear that these procedures significantly improve patient mobility. The goal of the research presented here is to summarize what is presently known about lower extremity gait mechanics and outcomes and to quantify the impact of ankle osteoarthritis and TAA have on these measures using an explicitly holistic and mechanistic approach. Our recent studies have explored physical performance and energy recovery and revealed unexpected patterns and sequelae to treatment including incomplete restoration of gait function. These studies demonstrated for the first time the extreme levels and range of gait and balance dysfunction present in ankle osteoarthritis patients as well as quantifying the ways in which the affected joint alters movement and loading patterns not just in the painful joint, but throughout both the ipsilateral and contralateral lower extremity. Through this work, we determined that relieving pain alone through TAA is not enough to restore normal walking mechanics and balance due to underlying causes including limited ankle range of motion and balance deficits leading to long-term disability despite treatment. The results indicate the need to consider additional therapeutic interventions aimed at restoring balance, ankle range of motion, and movement symmetry in order to improve long-term health and function. © 2017 Orthopaedic Research Society. Published by Wiley Periodicals, Inc. J Orthop Res 35:2345-2355, 2017. © 2017 Orthopaedic Research Society. Published by Wiley Periodicals, Inc.

High dose-rate brachytherapy for the treatment of lower extremity in-stent restenosis.

PubMed

Ho, Karen J; Devlin, Phillip M; Madenci, Arin L; Semel, Marcus E; Gravereaux, Edwin C; Nguyen, Louis L; Belkin, Michael; Menard, Matthew T

2017-03-01

Historically, edge stenosis and late thrombosis limited the effectiveness of adjunctive endovascular brachytherapy (EVBT) for in-stent restenosis (ISR) after percutaneous transluminal angioplasty (PTA) and stenting. We evaluated an updated protocol of PTA and EVBT for ISR among patients with lower extremity occlusive disease. This is a retrospective, single-center review of patients treated with PTA and EVBT for ISR in the iliac and femoropopliteal segments between 2004 and 2012. A dose of 20 Gy was given at a depth of 0.5 mm beyond the radius of the largest PTA balloon using iridium 192, with at least 2-cm-long margins of radiation coverage proximal and distal to the injured area. Stents were assessed for patency by duplex ultrasound imaging at 1, 3, 6, 9, 12, and 18 months and then yearly. The primary end point was freedom from ≥50% restenosis in the treated segment at 6 months, 1 year, and 2 years. Patency data were estimated using the Kaplan-Meier method. Secondary end points were early and late thrombotic occlusion. Among 42 consecutive cases in 35 patients of EVBT for ISR in common or external iliac (9 [20.8%]) and superficial femoral or popliteal (33 [76.7%]) arteries, or both, 21 patients (50%) had claudication, asymptomatic hemodynamically significant stenoses were identified on duplex ultrasound imaging in 16 (38.1%), and 4 (9.8%) had critical limb ischemia. Mean treated length was 23.5 ± 12.3 cm over a mean duration of 16.1 ± 9.6 minutes. There was one technical failure (2.3%). Median post-EVBT follow-up time was 682 days (range, 1-2262 days). There were two (4.9%) and five (11.9%) cases of early and late thrombotic occlusions, respectively. There was one death, believed to be secondary to acute coronary syndrome. Primary, assisted primary, and secondary patency in the entire cohort was 75.2%, 89.1%, and 89.1%, respectively, at 1 year and 63.7%, 80.6%, and 85.6%, respectively, at 2 years. This contemporary protocol of PTA and adjunctive

Differences in lumbar spine and lower extremity kinematics during a step down functional task in people with and people without low back pain.

PubMed

Hernandez, Alejandra; Gross, Karlie; Gombatto, Sara

2017-08-01

When functional movements are impaired in people with low back pain, they may be a contributing factor to chronicity and recurrence. The purpose of the current study was to examine lumbar spine, pelvis, and lower extremity kinematics during a step down functional task between people with and without a history of low back pain. A 3-dimensional motion capture system was used to analyze kinematics during a step down task. Total excursion of the lumbar spine, pelvis, and lower extremity segments in each plane were calculated from the start to end of the task. Separate analysis of variance tests (α=0.05) were conducted to determine the effect of independent variables of group and plane on lumbar spine, pelvis, and lower extremity kinematics. An exploratory analysis was conducted to examine kinematic differences among movement-based low back pain subgroups. Subjects with low back pain displayed less lumbar spine movement than controls across all three planes of movement (P-values=0.001-0.043). This group difference was most pronounced in the sagittal plane. For the lower extremity, subjects with low back pain displayed more frontal and axial plane knee movement than controls (P-values=0.001). There were no significant differences in kinematics among movement-based low back pain subgroups. People with low back pain displayed less lumbar region movement in the sagittal plane and more off-plane knee movements than the control group during a step down task. Clinicians can use this information when assessing lumbar spine and lower extremity movement during functional tasks, with the goal of developing movement-based interventions. Copyright © 2017 Elsevier Ltd. All rights reserved.

Negative First-Term Outcomes Associated with Lower Extremity Injury During Recruit Training Among Female Marine Corps Graduates

DTIC Science & Technology

2007-01-01

regarding stress fractures and retention, and no sex -specific practices. Current medical practice at MCRD Parris Island is to recommend separation for...2.5 Lower Extremity Injury Stress Fracture IU Reference B Failed to completed H No promotlon# • No reenllst# | Fig. 1. AORs for first- tenn outcome

Complicated Lower Extremity Wound Caused by Immune Thrombocytopenic Purpura Leading to Hypercoagulable State: A Team Approach for Limb Salvage

PubMed Central

Simman, Richard; Haluschak, John; Jackson, Sarah

2010-01-01

This article describes a complicated lower extremity wound due to hypercoagulable state caused by immune thrombocytopenic purpura. A team approach was important to limb salvage. A literature review is included. PMID:24527141

Characterization of Volitional Electromyographic Signals in the Lower Extremity After Motor Complete Spinal Cord Injury.

PubMed

Heald, Elizabeth; Hart, Ronald; Kilgore, Kevin; Peckham, P Hunter

2017-06-01

Previous studies have demonstrated the presence of intact axons across a spinal cord lesion, even in those clinically diagnosed with complete spinal cord injury (SCI). These axons may allow volitional motor signals to be transmitted through the injury, even in the absence of visible muscle contraction. To demonstrate the presence of volitional electromyographic (EMG) activity below the lesion in motor complete SCI and to characterize this activity to determine its value for potential use as a neuroprosthetic command source. Twenty-four subjects with complete (AIS A or B), chronic, cervical SCI were tested for the presence of volitional below-injury EMG activity. Surface electrodes recorded from 8 to 12 locations of each lower limb, while participants were asked to attempt specific movements of the lower extremity in response to visual and audio cues. EMG trials were ranked through visual inspection, and were scored using an amplitude threshold algorithm to identify channels of interest with volitional motor unit activity. Significant below-injury muscle activity was identified through visual inspection in 16 of 24 participants, and visual inspection rankings were well correlated to the algorithm scoring. The surface EMG protocol utilized here is relatively simple and noninvasive, ideal for a clinical screening tool. The majority of subjects tested were able to produce a volitional EMG signal below their injury level, and the algorithm developed allows automatic identification of signals of interest. The presence of this volitional activity in the lower extremity could provide an innovative new command signal source for implanted neuroprostheses or other assistive technology.

Radiographic parameters improve lower extremity prosthetic alignment.

PubMed

Mooney, Ryan; Carry, Patrick; Wylie, Erin; Schultz, Abby; McNair, Bryan; Page, Carol; Biffl, Susan; Heare, Travis

2013-12-01

The goal of prosthetic fitting is to provide comfort and functionality to the patient. It is thought that incorporating the use of standing anterior-posterior long leg radiographs (LLR) into the fitting of lower extremity prostheses will provide an objective guide when making adjustments, and be a better assessment of alignment. This study compares prosthetic alignment before and after radiography-guided adjustments. This retrospective study was performed at a multidisciplinary amputee clinic on patients with congenital and/or acquired limb deficiencies. Their prosthetic alignment was evaluated by LLR and adjusted as needed. Satisfactory alignment was defined as a mechanical axis angular deviation of ≤1° and a leg length discrepancy of ≤10 mm. A total of 45 unique prostheses from 24 subjects (10 female and 14 male) were included. Post-adjustment radiographs were obtained from 29 prostheses. After the initial prosthetic fitting, the probability of a satisfactory fit was 20.0 % (95 % CI 10.9-34.9 %). Following the baseline adjustment, the probability of a satisfactory fit improved to 53.3 % (95 % CI 37.5-70.9 %). After adjustment number 4, the probability of a satisfactory fit further improved to 76.7 % (95 % CI 41.9-98.0 %). There were also significant improvements in distal offset distance (p = 0.0040) and leg length discrepancy (p = 0.0206). The distal offset distance decreased by an average of 10.7 mm (95 % CI 3.6-17.8), and leg length discrepancy decreased by an average of 3.0 mm (95 % CI 00.48-5.5). The addition of LLRs to existing fitting methods significantly improves prosthetic alignment and length.

Quantifying Emergency Department Visits From Sport and Recreation: Focus on the Lower Extremity and Knee, 1997–2009

PubMed Central

Tenan, Matthew S.

2016-01-01

Context:  Few authors have reported nationally representative data on the number of sport and recreation (SR) injuries resulting in emergency department (ED) visitation. The existing studies have only provided 1 or 2 years of data and are not longitudinal in nature. Objective:  To use a novel algorithmic approach to determine if ED visitation is due to SR, resulting in a substantially larger longitudinal dataset. Design:  Descriptive epidemiology study. Setting:  Hospital. Patients or Other Participants:  The National Hospital Ambulatory Medical Care Survey, a stratified random-sample survey of US hospital EDs was combined for years 1997–2009. There were 15 699 unweighted patient visits determined to be from SR. Main Outcome Measure(s):  A custom algorithm classified SR visits based on the International Classification of Diseases, Ninth Revision, Clinical Modification E-code and pattern recognition of narrative text. Sport and recreation visits were assessed by age and categorized according to broad injury classifications. Additional quantification was performed on SR visits for lower extremity and knee-specific injuries. Sample weights were applied to provide national annual estimates. Results:  Annually, 4 243 000 ED visits resulted from SR. The largest classification of injury from SR was sprains and strains (896 000/y). Males had substantially more SR-related ED visits than females (2 929 000/y versus 1 314 000/y). For patients 10–49 years old, 1 093 000 lower extremity and 169 000 knee-specific injury visits annually were from SR. For both injury types, males had a higher rate of ED visitation; however, females had 25% and 39% greater odds of visitation for lower extremity and knee-specific injury, respectively. Conclusions:  The burden on the health system of ED visits from SR was substantial. Males presented in the ED at a higher rate for SR injury, though females had a higher proportion of lower extremity and knee

Lower extremity arthroplasty in patients with inflammatory arthritis: preoperative and perioperative management.

PubMed

Goodman, Susan M; Figgie, Mark

2013-06-01

Spondylarthritis, which includes conditions such as ankylosing spondylitis and psoriatic arthritis, and rheumatoid arthritis are the most common forms of inflammatory arthritis. Joint inflammation and damage may result in the need for arthroplasty, and the surgeon must be aware of the perioperative challenges associated with these systemic diseases. In patients with inflammatory arthritis who have polyarticular disease and spinal involvement at the time of presentation for lower extremity arthroplasty, preoperative evaluation must include careful evaluation of all joints, including the cervical spine. Preoperative assessment and perioperative management must be appropriate to minimize cardiac and pulmonary complications. Finally, the perioperative management of medications used to manage inflammatory arthritis is critical because these medications may increase the risk of infection and compromise wound healing.

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. Copyright © 2014 Elsevier Inc. All rights reserved.

One-shot scleroembolization: a new technique for the treatment of varicose veins disease of lower extremities. Preliminary results.

PubMed

Viani, Marco P; Viani, Giacomo M; Sergenti, Jessica

2014-12-01

The aim of this article is to present a new technique for minimally invasive treatment of varicose veins disease of lower extremities. One-shot scleroembolization is a new technique designed for the treatment of varicose veins of the lower extremities, which associates a mechanical interruption of the sapheno-femoral junction to classic sclerotherapy with no need for surgery or anesthesia. This is achieved with the combined use of a coil positioned in the terminal portion of the great saphenous vein and a foamed sclerosant drug. At three months' follow-up no complications have been observed. The great saphenous vein was still occluded in all patients (nine out of nine). One-shot scleroembolization seems to be an effective technique for the treatment of varicose veins disease in outpatients, with the advantage of causing little distress to the patient. © The Author(s) 2013 Reprints and permissions: sagepub.co.uk/journalsPermissions.nav.

Can new passenger cars reduce pedestrian lower extremity injury? A review of geometrical changes of front-end design before and after regulatory efforts.

PubMed

Nie, Bingbing; Zhou, Qing

2016-10-02

Pedestrian lower extremity represents the most frequently injured body region in car-to-pedestrian accidents. The European Directive concerning pedestrian safety was established in 2003 for evaluating pedestrian protection performance of car models. However, design changes have not been quantified since then. The goal of this study was to investigate front-end profiles of representative passenger car models and the potential influence on pedestrian lower extremity injury risk. The front-end styling of sedans and sport utility vehicles (SUV) released from 2008 to 2011 was characterized by the geometrical parameters related to pedestrian safety and compared to representative car models before 2003. The influence of geometrical design change on the resultant risk of injury to pedestrian lower extremity-that is, knee ligament rupture and long bone fracture-was estimated by a previously developed assessment tool assuming identical structural stiffness. Based on response surface generated from simulation results of a human body model (HBM), the tool provided kinematic and kinetic responses of pedestrian lower extremity resulted from a given car's front-end design. Newer passenger cars exhibited a "flatter" front-end design. The median value of the sedan models provided 87.5 mm less bottom depth, and the SUV models exhibited 94.7 mm less bottom depth. In the lateral impact configuration similar to that in the regulatory test methods, these geometrical changes tend to reduce the injury risk of human knee ligament rupture by 36.6 and 39.6% based on computational approximation. The geometrical changes did not significantly influence the long bone fracture risk. The present study reviewed the geometrical changes in car front-ends along with regulatory concerns regarding pedestrian safety. A preliminary quantitative benefit of the lower extremity injury reduction was estimated based on these geometrical features. Further investigation is recommended on the structural changes

Epidemiology of diabetic foot disease and diabetes-related lower-extremity amputation in Australia: a systematic review protocol.

PubMed

van Netten, Jaap J; Baba, Mendel; Lazzarini, Peter A

2017-05-18

Diabetic foot disease is associated with major morbidity, mortality, costs, and reduction of a person's quality of life. Investigating the epidemiology of diabetic foot disease is the backbone of diabetic foot research and clinical practice, yet the full burden of diabetic foot disease in Australia is unknown. This study aims to describe the protocol for a systematic review of the epidemiology of diabetic foot disease and diabetes-related lower-extremity amputation in Australia. The systematic review will be performed according to the Preferred Reporting Items for Systematic Review and Meta-Analyses guidelines. PubMed and EMBASE will be searched for publications in any language and without restrictions to date. Two independent investigators will screen publications for eligibility, with publications reporting Australian population-based incidence or prevalence of diabetic foot disease or diabetes-related lower-extremity amputation to be included. Additionally, a forward literature search will be performed in Google Scholar, and a grey literature search will be performed to identify government publications. Quality assessment will be performed using customised checklists. The summary statistic used for each study will be an incidence or prevalence proportion of diabetic foot disease or diabetes-related lower-extremity amputation. The standard error for each proportion will be calculated. A meta-analysis will be performed when three or more publications of adequate quality, reporting on similar outcomes and in similar populations, are identified. The results of this systematic review can be used to adequately inform stakeholders in the field of diabetic foot disease on the extent of the problem in incidence and prevalence of diabetic foot disease in Australia, and to help guide appropriate use of resources to reduce the burden of this disease. PROSPERO CRD42016050740.

The effects of extracorporeal shockwave on acute high-energy long bone fractures of the lower extremity.

PubMed

Wang, Ching-Jen; Liu, Hao-Chen; Fu, Te-Hu

2007-02-01

High-energy long bone fractures of the lower extremity are at risk of poor fracture healing and high rate of non-union. Extracorporeal shockwave was shown effective to heal non-union of long bone fracture. However, the effect of shockwave on acute fractures is unknown. The purpose of this study was to investigate the effects of shockwave on acute high-energy fractures of the lower extremity. Between January and October 2004, 56 patients with 59 acute high-energy fractures were enrolled in this study. Patients were randomly divided into two groups with 28 patients with 28 fractures in the study group and 28 patients with 31 fractures in the control group. Both groups showed similar age, gender, type of fracture and follow-up time. Patients in the study group received open reduction and internal fixation and shockwave treatment immediately after surgery on odd-numbered days of the week, whereas, patients in the control group received open reduction and internal fixation without shockwave treatment on even-numbered days of the week. Postoperative managements were similarly performed in both groups including crutch walking with non-weight bearing on the affected limb until fracture healing shown on radiographs. The evaluation parameters included clinical assessments of pain score and weight bearing status of the affected leg and serial radiographs at 3, 6 and 12 months. The primary end-point is the rate of non-union at 12 months, and the secondary end point is the rate of fracture healing at 3, 6 and 12 months. At 12 months, the rate of non-union was 11% for the study group versus 20% for the control group (P < 0.001). Significantly, better rate of fracture healing was noted in the study group than the control group at 3, 6 and 12 months (P < 0.001). Extracorporeal shockwave is effective on promoting fracture healing and decreasing the rate of non-union in acute high-energy fractures of the lower extremity.

Reliability of digital photography for assessing lower extremity alignment in individuals with flatfeet and normal feet types.

PubMed

Ashnagar, Zinat; Hadian, Mohammad Reza; Olyaei, Gholamreza; Talebian Moghadam, Saeed; Rezasoltani, Asghar; Saeedi, Hassan; Yekaninejad, Mir Saeed; Mahmoodi, Rahimeh

2017-07-01

The aim of this study was to investigate the intratester reliability of digital photographic method for quantifying static lower extremity alignment in individuals with flatfeet and normal feet types. Thirteen females with flexible flatfeet and nine females with normal feet types were recruited from university communities. Reflective markers were attached over the participant's body landmarks. Frontal and sagittal plane photographs were taken while the participants were in a standardized standing position. The markers were removed and after 30 min the same procedure was repeated. Pelvic angle, quadriceps angle, tibiofemoral angle, genu recurvatum, femur length and tibia length were measured from photographs using the Image j software. All measured variables demonstrated good to excellent intratester reliability using digital photography in both flatfeet (ICC: 0.79-0.93) and normal feet type (ICC: 0.84-0.97) groups. The findings of the current study indicate that digital photography is a highly reliable method of measurement for assessing lower extremity alignment in both flatfeet and normal feet type groups. Copyright © 2016. Published by Elsevier Ltd.

Medicare Program; Comprehensive Care for Joint Replacement Payment Model for Acute Care Hospitals Furnishing Lower Extremity Joint Replacement Services. Final rule.

PubMed

2015-11-24

This final rule implements a new Medicare Part A and B payment model under section 1115A of the Social Security Act, called the Comprehensive Care for Joint Replacement (CJR) model, in which acute care hospitals in certain selected geographic areas will receive retrospective bundled payments for episodes of care for lower extremity joint replacement (LEJR) or reattachment of a lower extremity. All related care within 90 days of hospital discharge from the joint replacement procedure will be included in the episode of care. We believe this model will further our goals in improving the efficiency and quality of care for Medicare beneficiaries with these common medical procedures.

Lower extremity joint kinetics and lumbar curvature during squat and stoop lifting

PubMed Central

Hwang, Seonhong; Kim, Youngeun; Kim, Youngho

2009-01-01

Background In this study, kinematics and kinetics of the lower extremity joint and the lumbar lordosis during two different symmetrical lifting techniques(squat and stoop) were examined using the three-dimensional motion analysis. Methods Twenty-six young male volunteers were selected for the subjects in this study. While they lifted boxes weighing 5, 10 and 15 kg by both squat and stoop lifting techniques, their motions were captured and analyzed using the 3D motion analysis system which was synchronized with two forceplates and the electromyographic system. Joint kinematics was determined by the forty-three reflective markers which were attached on the anatomical locations based on the VICON Plug-in-Gait marker placement protocol. Joint kinetics was analyzed by using the inverse dynamics. Paired t-test and Kruskal-Wallis test was used to compare the differences of variables between two techniques, and among three different weights. Correlation coefficient was calculated to explain the role of lower limb joint motion in relation to the lumbar lordosis. Results There were not significant differences in maximum lumbar joint moments between two techniques. The hip and ankle contributed the most part of the support moment during squat lifting, and the knee flexion moment played an important role in stoop lifting. The hip, ankle and lumbar joints generated power and only the knee joint absorbed power in the squat lifting. The knee and ankle joints absorbed power, the hip and lumbar joints generated power in the stoop lifting. The bi-articular antagonist muscles' co-contraction around the knee joint during the squat lifting and the eccentric co-contraction of the gastrocnemius and the biceps femoris were found important for maintaining the straight leg during the stoop lifting. At the time of lordotic curvature appearance in the squat lifting, there were significant correlations in all three lower extremity joint moments with the lumbar joint. Differently, only the hip

Lower extremity joint kinetics and lumbar curvature during squat and stoop lifting.

PubMed

Hwang, Seonhong; Kim, Youngeun; Kim, Youngho

2009-02-02

In this study, kinematics and kinetics of the lower extremity joint and the lumbar lordosis during two different symmetrical lifting techniques(squat and stoop) were examined using the three-dimensional motion analysis. Twenty-six young male volunteers were selected for the subjects in this study. While they lifted boxes weighing 5, 10 and 15 kg by both squat and stoop lifting techniques, their motions were captured and analyzed using the 3D motion analysis system which was synchronized with two forceplates and the electromyographic system. Joint kinematics was determined by the forty-three reflective markers which were attached on the anatomical locations based on the VICON Plug-in-Gait marker placement protocol. Joint kinetics was analyzed by using the inverse dynamics. Paired t-test and Kruskal-Wallis test was used to compare the differences of variables between two techniques, and among three different weights. Correlation coefficient was calculated to explain the role of lower limb joint motion in relation to the lumbar lordosis. There were not significant differences in maximum lumbar joint moments between two techniques. The hip and ankle contributed the most part of the support moment during squat lifting, and the knee flexion moment played an important role in stoop lifting. The hip, ankle and lumbar joints generated power and only the knee joint absorbed power in the squat lifting. The knee and ankle joints absorbed power, the hip and lumbar joints generated power in the stoop lifting. The bi-articular antagonist muscles' co-contraction around the knee joint during the squat lifting and the eccentric co-contraction of the gastrocnemius and the biceps femoris were found important for maintaining the straight leg during the stoop lifting. At the time of lordotic curvature appearance in the squat lifting, there were significant correlations in all three lower extremity joint moments with the lumbar joint. Differently, only the hip moment had significant

[CHANGES OF THE HEMOSTASIS SYSTEM IN THE INJURED PERSONS IN FRACTURES OF LONG BONES OF THE LOWER EXTREMITIES].

PubMed

Tarabrin, O O; Grichushenko, I S

2015-09-01

The changes of hemostasis in the injured persons, in the lower extremities long bones fracture were analyzed. Complex dynamic investigation of the hemostasis system was conducted preoperatively in 76 injured persons, in whom long bones of the lower extremities fracture have occurred, and in 31--with injury of meniscus. Instrumental diagnostic method--a low-frequency piezoelectric thromboelastography--was applied for investigation of the blood coagulation system. The shift in a system of hemostasis towards hypercoagulation, fibrinolytic and the thrombine activity inhibition, the thrombocytes spontaneous aggregation intensity, duration of formation of a clot fibrinthrombocytic structure; the blood fibrinthrombocytic constanta enhancement, a summary index of the clot retraction and spontaneous lysis reduction were revealed in a hemostasis system before start of the treatment. The hemostasis system disorders in the injured persons may cause thrombohemorrhagic complications, what trusts a necessity for rational choice of preoperative methods of prophylaxis and intensive therapy in a system of hemostasis.

Lower Quarter Y-Balance Test Scores and Lower Extremity Injury in NCAA Division I Athletes.

PubMed

Lai, Wilson C; Wang, Dean; Chen, James B; Vail, Jeremy; Rugg, Caitlin M; Hame, Sharon L

2017-08-01

Functional movement tests that are predictive of injury risk in National Collegiate Athletic Association (NCAA) athletes are useful tools for sports medicine professionals. The Lower Quarter Y-Balance Test (YBT-LQ) measures single-leg balance and reach distances in 3 directions. To assess whether the YBT-LQ predicts the laterality and risk of sports-related lower extremity (LE) injury in NCAA athletes. Case-control study; Level of evidence, 3. The YBT-LQ was administered to 294 NCAA Division I athletes from 21 sports during preparticipation physical examinations at a single institution. Athletes were followed prospectively over the course of the corresponding season. Correlation analysis was performed between the laterality of reach asymmetry and composite scores (CS) versus the laterality of injury. Receiver operating characteristic (ROC) analysis was used to determine the optimal asymmetry cutoff score for YBT-LQ. A multivariate regression analysis adjusting for sex, sport type, body mass index, and history of prior LE surgery was performed to assess predictors of earlier and higher rates of injury. Neither the laterality of reach asymmetry nor the CS correlated with the laterality of injury. ROC analysis found optimal cutoff scores of 2, 9, and 3 cm for anterior, posteromedial, and posterolateral reach, respectively. All of these potential cutoff scores, along with a cutoff score of 4 cm used in the majority of prior studies, were associated with poor sensitivity and specificity. Furthermore, none of the asymmetric cutoff scores were associated with earlier or increased rate of injury in the multivariate analyses. YBT-LQ scores alone do not predict LE injury in this collegiate athlete population. Sports medicine professionals should be cautioned against using the YBT-LQ alone to screen for injury risk in collegiate athletes.

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. Copyright © 2014 Society for Vascular Surgery. Published by Mosby, Inc. All rights reserved.

Changes in lower extremity biomechanics due to a short-term fatigue protocol.

PubMed

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

2013-01-01

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. To evaluate the effects of a sequential fatigue protocol on lower extremity biomechanics during a sidestep-cutting task (SS). Controlled laboratory study. Laboratory. 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. 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. 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. 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°) (F2,34 = 6.542, P = .004). Hip flexion at peak stance increased from prefatigue (49.8° ± 9.9°) to 50% fatigue (52.9° ± 12.1�

Effect of Ankle Range of Motion (ROM) and Lower-Extremity Muscle Strength on Static Balance Control Ability in Young Adults: A Regression Analysis

PubMed Central

Kim, Seong-Gil

2018-01-01

Background The purpose of this study was to investigate the effect of ankle ROM and lower-extremity muscle strength on static balance control ability in young adults. Material/Methods This study was conducted with 65 young adults, but 10 young adults dropped out during the measurement, so 55 young adults (male: 19, female: 36) completed the study. Postural sway (length and velocity) was measured with eyes open and closed, and ankle ROM (AROM and PROM of dorsiflexion and plantarflexion) and lower-extremity muscle strength (flexor and extensor of hip, knee, and ankle joint) were measured. Pearson correlation coefficient was used to examine the correlation between variables and static balance ability. Simple linear regression analysis and multiple linear regression analysis were used to examine the effect of variables on static balance ability. Results In correlation analysis, plantarflexion ROM (AROM and PROM) and lower-extremity muscle strength (except hip extensor) were significantly correlated with postural sway (p<0.05). In simple correlation analysis, all variables that passed the correlation analysis procedure had significant influence (p<0.05). In multiple linear regression analysis, plantar flexion PROM with eyes open significantly influenced sway length (B=0.681) and sway velocity (B=0.011). Conclusions Lower-extremity muscle strength and ankle plantarflexion ROM influenced static balance control ability, with ankle plantarflexion PROM showing the greatest influence. Therefore, both contractile structures and non-contractile structures should be of interest when considering static balance control ability improvement. PMID:29760375

Effect of Ankle Range of Motion (ROM) and Lower-Extremity Muscle Strength on Static Balance Control Ability in Young Adults: A Regression Analysis.

PubMed

Kim, Seong-Gil; Kim, Wan-Soo

2018-05-15

BACKGROUND The purpose of this study was to investigate the effect of ankle ROM and lower-extremity muscle strength on static balance control ability in young adults. MATERIAL AND METHODS This study was conducted with 65 young adults, but 10 young adults dropped out during the measurement, so 55 young adults (male: 19, female: 36) completed the study. Postural sway (length and velocity) was measured with eyes open and closed, and ankle ROM (AROM and PROM of dorsiflexion and plantarflexion) and lower-extremity muscle strength (flexor and extensor of hip, knee, and ankle joint) were measured. Pearson correlation coefficient was used to examine the correlation between variables and static balance ability. Simple linear regression analysis and multiple linear regression analysis were used to examine the effect of variables on static balance ability. RESULTS In correlation analysis, plantarflexion ROM (AROM and PROM) and lower-extremity muscle strength (except hip extensor) were significantly correlated with postural sway (p<0.05). In simple correlation analysis, all variables that passed the correlation analysis procedure had significant influence (p<0.05). In multiple linear regression analysis, plantar flexion PROM with eyes open significantly influenced sway length (B=0.681) and sway velocity (B=0.011). CONCLUSIONS Lower-extremity muscle strength and ankle plantarflexion ROM influenced static balance control ability, with ankle plantarflexion PROM showing the greatest influence. Therefore, both contractile structures and non-contractile structures should be of interest when considering static balance control ability improvement.

Two cases of painful gynecomastia and lower extremity pain in association with pregabalin therapy.

PubMed

Málaga, Ignacio; Sanmarti, Francesc X

2006-09-01

We report two patients with refractory epilepsy who developed unilateral painful gynecomastia and lower extremity pain (one of them localized and the other one diffuse), shortly after receiving Pregabalin (PGB). Neither of them had previous endocrinologic problems or complaints about pain on their medical history. PGB was stopped in one patient and reduced in the other one, with complete disparition of the symptoms in the following weeks in both patients. This supports the hypothesis that gynecomastia could be a drug-induced and easy to manage secondary effect of PGB, with a higher incidence than observed on previous clinical trials.

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

Repeatability of chemical-shift-encoded water-fat MRI and diffusion-tensor imaging in lower extremity muscles in children.

PubMed

Ponrartana, Skorn; Andrade, Kristine E; Wren, Tishya A L; Ramos-Platt, Leigh; Hu, Houchun H; Bluml, Stefan; Gilsanz, Vicente

2014-06-01

The purpose of this study was to assess the repeatability of water-fat MRI and diffusion-tensor imaging (DTI) as quantitative biomarkers of pediatric lower extremity skeletal muscle. MRI at 3 T of a randomly selected thigh and lower leg of seven healthy children was studied using water-fat separation and DTI techniques. Muscle-fat fraction, apparent diffusion coefficient (ADC), and fractional anisotropy (FA) values were calculated. Test-retest and interrater repeatability were assessed by calculating the Pearson correlation coefficient, intraclass correlation coefficient, and Bland-Altman analysis. Bland-Altman plots show that the mean difference between test-retest and interrater measurements of muscle-fat fraction, ADC, and FA was near 0. The correlation coefficients and intraclass correlation coefficients were all between 0.88 and 0.99 (p < 0.05), suggesting excellent reliability of the measurements. Muscle-fat fraction measurements from water-fat MRI exhibited the highest intraclass correlation coefficient. Interrater agreement was consistently better than test-retest comparisons. Water-fat MRI and DTI measurements in lower extremity skeletal muscles are objective repeatable biomarkers in children. This knowledge should aid in the understanding of the number of participants needed in clinical trials when using these determinations as an outcome measure to noninvasively monitor neuromuscular disease.

Disparity between functional recovery and daily use of the upper and lower extremities during subacute stroke rehabilitation

PubMed Central

Rand, Debbie; Eng, Janice J.

2011-01-01

Background Although inpatient rehabilitation may enhance an individual’s functional ability after stroke, it is not known whether these improvements are accompanied by an increase in daily use of the arms and legs. Objective To determine the change in daily use of the upper and lower extremities of stroke patients during rehabilitation and to compare these values with that of community-dwelling older adults. Methods A total of 60 stroke patients underwent functional assessments and also wore 3 accelerometers for 3 consecutive weekdays on admission to rehabilitation and 3 weeks later prior to hospital discharge. The number of steps and upper-extremity activity counts were measured over the waking hours and during daily use for occupational therapy and physical therapy (PT) sessions. Healthy older adults (n = 40) also wore 3 accelerometers for 5 consecutive days. Results Stroke patients demonstrated a significant increase in mobility function, and this was accompanied by an increase in daily walking over the entire day as well as in PT. However, increases in daily walking were found predominantly in patients who were wheelchair users (and not walkers) at the time of admission. Control walking values (5202 steps) were more than 17 times that of stroke patients. Despite significant improvements in paretic hand function, no increase in daily use of the paretic or nonparetic hand was found over the entire day or in PT. Conclusions. A disparity between functional recovery and increases in daily use of the upper and lower extremities was found during inpatient stroke rehabilitation. PMID:21693771

Management of Lower Extremity Long-bone Fractures in Spinal Cord Injury Patients.

PubMed

Schulte, Leah M; Scully, Ryan D; Kappa, Jason E

2017-09-01

The AO classification system, used as a guide for modern fracture care and fixation, follows a basic philosophy of care that emphasizes early mobility and return to function. Lower extremity long-bone fractures in patients with spinal cord injury often are pathologic injuries that present unique challenges, to which the AO principles may not be entirely applicable. Optimal treatment achieves healing without affecting the functional level of the patient. These injuries often result from low-energy mechanisms in nonambulatory patients with osteopenic bone and a thin, insensate soft-tissue envelope. The complication rate can be high, and the outcomes can be catastrophic without proper care. Satisfactory results can be obtained through various methods of immobilization. Less frequently, internal fixation is applied. In certain cases, after discussion with the patient, amputation may be suitable. Prevention strategies aim to minimize bone loss and muscle atrophy.

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.

Repeatability testing of a new Hybrid III 6-year-old ATD lower extremity.

PubMed

Boucher, Laura C; Ryu, Yeonsu; Kang, Yun-Seok; Bolte, John H

2017-05-29

Vehicle safety is improving, thus decreasing the number of life-threatening injuries and increasing the need for research in other areas of the body. The current child anthropomorphic test device (ATD) does not have the capabilities or instrumentation to measure many of the potential interactions between the lower extremity and the vehicle interior. A prototype Hybrid III 6-year-old ATD lower extremity (ATD-LE) was developed and contains a tibia load cell and a more biofidelic ankle. The repeatability of the device has not yet been assessed; thus, the objective was to evaluate the repeatability of the ATD-LE. Additionally, a dynamic assessment was conducted to quantify injury threshold values. A pneumatic ram impactor was used at 2 velocities to evaluate repeatability. The ATD-LE was fixed to a table and impacted on the plantar aspect of the forefoot. Three repeated trials at 1.3 and 2.3 m/s without shoes and 2.3 m/s with shoes were conducted. The consistency of tibia force (N), bending moment (Nm), ankle range of motion (ROM, °), and stiffness (Nm/°) were quantified. A dynamic assessment using knee bolster airbag (KBA) tests was also conducted. The ATD-LE was positioned to mimic 3 worst-case scenarios: toes touching the mid-dashboard, touching the lower dashboard, and flat on the floor prior to airbag deployment. The impact responses in the femur and tibia were directly collected and compared with published injury threshold values. Ram impact testing indicated primarily excellent repeatability for the variables tested. For all 3 conditions the coefficients of variance (CV) were as follows: tibia force, 1.9-2.7%; tibia moment, 1.0-2.2%; ROM, 1.3-1.4%; ankle stiffness, 4.8-15.6%. The shoe-on condition resulted in a 25% reduction in tibia force and a 56% reduction in tibia bending moment. The KBA tests indicate that the highest injury risk may be when the toes touch the lower dashboard, due to the high bending moments recorded in the tibia at 76.2 Nm, which was

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

Farsi, Zahra; Azarmi, Somayeh

2016-04-01

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. 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. 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). 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. IRCT2014081118763N1.

Evaluation of Mangled Extremity Severity Score (MESS) as a predictor of lower limb amputation in children with trauma.

PubMed

Behdad, Saba; Rafiei, Mohammad Hadi; Taheri, Hadi; Behdad, Samin; Mohammadzadeh, Mahdi; Kiani, Gelare; Hosseinpour, Mehrdad

2012-12-01

Management of the severely injured lower limb in children remains a challenge despite advances in surgical techniques. Models that predict the risk of lower limb trauma patients are designed to provide an estimation of the probability of limb salvage. In this study, we validate Mangled Extremity Syndrome Index (Mangled Extremity Severity Score [MESS]) by measurement of its discrimination in children. From September 2009 to 2010, we collected the hospital records of all children who presented with lower extremity long bone open fractures. The inclusion criteria were I grade, II B, III C open fractures, severe injury to three of four organ systems, and severe injury to two of four organ systems with minor injury to two of four systems that require surgical interventions. Severity of limb injury was measured using MESS. Patients were followed up for 1 year. The discrimination of MESS model in differentiating of outcome in patients was assessed by calculating the area under the receiver operator characteristic plot. We evaluated 200 children referred consecutively to our center. The mean MESS in the amputation group was 7.5 ± 1.59 versus 6.4 ± 2.02 in the limb salvage group (p = 0.04). Amputation rate was 7.5% (n = 15). Percentages of skeletal/soft-tissue injury was different between groups (p = 0.0001). Children in the amputation group showed more tissue injury compared with limb salvage group. The best clinical discriminator power was calculated as MESS ≥ 6.5 (sensitivity = 73%, specificity = 54%). We assumed that patients with a high risk of amputation can be identified early, and specific measures can be implemented immediately by using MESS with threshold of 6.5. Georg Thieme Verlag KG Stuttgart · New York.

Prevention of lower extremity stress fractures: a controlled trial of a shock absorbent insole.

PubMed Central

Gardner, L I; Dziados, J E; Jones, B H; Brundage, J F; Harris, J M; Sullivan, R; Gill, P

1988-01-01

A prospective controlled trial was carried out to determine the usefulness of a viscoelastic polymer insole in prevention of stress fractures and stress reactions of the lower extremities. The subjects were 3,025 US Marine recruits who were followed for 12 weeks of training at Parris Island, South Carolina. Polymer and standard mesh insoles were systematically distributed in boots that were issued to members of odd and even numbered platoons. The most important finding was that an elastic polymer insole with good shock absorbency properties did not prevent stress reactions of bone during a 12-week period of vigorous physical training. To control for the confounding effects of running in running shoes, which occurred for about one and one-half hours per week for the first five weeks, we also examined the association of age of shoes and cost of shoes with injury incidence. A slight trend of increasing stress injuries by increasing age of shoes was observed. However, this trend did not account for the similarity of rates in the two insole groups. In addition, we observed a strong trend of decreasing stress injury rate by history of increasing physical activity, as well as a higher stress injury rate in White compared to Black recruits. The results of the trial were not altered after controlling for these factors. This prospective study confirms previous clinical reports of the association of stress fractures with physical activity history. The clinical application of a shock absorbing insole as a preventive for lower extremity stress reactions is not supported in these uniformly trained recruits. The findings are relevant to civilian populations. PMID:3056045

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.

Sensory and motor peripheral nerve function and lower-extremity quadriceps strength: the health, aging and body composition study.

PubMed

Strotmeyer, Elsa S; de Rekeneire, Nathalie; Schwartz, Ann V; Resnick, Helaine E; Goodpaster, Bret H; Faulkner, Kimberly A; Shorr, Ronald I; Vinik, Aaron I; Harris, Tamara B; Newman, Anne B

2009-11-01

To determine whether sensory and motor nerve function is associated cross-sectionally with quadriceps or ankle dorsiflexion strength in an older community-based population. Cross-sectional analyses within a longitudinal cohort study. Two U.S. clinical sites. Two thousand fifty-nine Health, Aging and Body Composition Study (Health ABC) participants (49.5% male, 36.7% black, aged 73-82) in 2000/01. Quadriceps and ankle strength were measured using an isokinetic dynamometer. Sensory and motor peripheral nerve function in the legs and feet was assessed using 10-g and 1.4-g monofilaments, vibration threshold, and peroneal motor nerve conduction amplitude and velocity. Monofilament insensitivity, poorest vibration threshold quartile (>60 mu), and poorest motor nerve conduction amplitude quartile (<1.7 mV) were associated with 11%, 7%, and 8% lower quadriceps strength (all P<.01), respectively, than in the best peripheral nerve function categories in adjusted linear regression models. Monofilament insensitivity and lowest amplitude quartile were both associated with 17% lower ankle strength (P<.01). Multivariate analyses were adjusted for demographic characteristics, diabetes mellitus, body composition, lifestyle factors, and chronic health conditions and included all peripheral nerve measures in the same model. Monofilament insensitivity (beta=-7.19), vibration threshold (beta=-0.097), and motor nerve conduction amplitude (beta=2.01) each contributed independently to lower quadriceps strength (all P<.01). Monofilament insensitivity (beta=-5.29) and amplitude (beta=1.17) each contributed independently to lower ankle strength (all P<.01). Neither diabetes mellitus status nor lean mass explained the associations between peripheral nerve function and strength. Reduced sensory and motor peripheral nerve function is related to poorer lower extremity strength in older adults, suggesting a mechanism for the relationship with lower extremity disability.

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�

Severe soft tissue infection of the lower extremity caused by Haemophilus influenzae (serotype f, biotype II) in an adult patient.

PubMed

Hagiya, Hideharu; Murase, Tomoko; Naito, Hiromichi; Hagioka, Shingo; Morimoto, Naoki

2012-01-01

The infection caused by non-b-type Haemophilus influenzae has been increasing in this Hib (H.influenzae serotype b) vaccination era. H.influenzae serotype f (Hif) is considered as one of those emerging pathogens. In general, H.influenzae is a common pathogen of such as pneumonia, otitis media, and meningitis, but is rare in soft tissue infection, especially at the extremity. We report a rare case of severe soft tissue infection caused by Hif which occurred at the lower extremity of immunocompetent adult patient.

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

Sexual function in adolescent and young adult survivors of lower extremity bone tumors.

PubMed

Barrera, Maru; Teall, Tanya; Barr, Ronald; Silva, Mariana; Greenberg, Mark

2010-12-15

Improving survival rates and new surgical options have led to increased interest regarding late effects and quality of life in adolescent and young adult survivors of bone cancers, including their sexual functioning. This study investigated sexual functioning in adolescent and young adult survivors of lower limb bone tumors, in relation to surgical treatments, gender differences, depressive symptoms, global self worth, and physical disability. Twenty-eight participants (age range 18-32 years) completed measures of gender specific sexual function, depressive symptoms, global self worth, and physical disability. For analysis, surgical intervention was grouped into limb sparing surgeries (LS; allograft fusion and endoprosthesis) and amputation or Van Nes rotationplasty (AMP). Male survivors reported significantly higher scores than females on total sexual function scores (P = 0.050), sexual drive (P = 0.002), and frequency of sexual thoughts, fantasies or erotic dreams (P = 0.021). Men also reported significantly better physical functioning scores than women (P = 0.012). LS scored significantly lower on frequency of sexual thoughts, fantasies and erotic dreams (P = 0.048) and frequency of sexual experiences (P = 0.016) compared with AMP. In addition, LS reported significantly more depressive symptoms scores (P = 0.004) and lower self worth scores (P = 0.037), than AMP. These results suggest that male survivors of lower extremity bone tumors experience better sexual functioning than women. Survivors of limb sparing surgeries struggle with sexual function, depressive symptoms, and poor self-perception compared to Van Nes rotationplasty and amputation survivors. Copyright © 2010 Wiley-Liss, Inc.

Effects of an age-specific anterior cruciate ligament injury prevention program on lower extremity biomechanics in children.

PubMed

DiStefano, Lindsay J; Blackburn, J Troy; Marshall, Stephen W; Guskiewicz, Kevin M; Garrett, William E; Padua, Darin A

2011-05-01

Implementing an anterior cruciate ligament injury prevention program to athletes before the age at which the greatest injury risk occurs (15-17 years) is important from a prevention standpoint. However, it is unknown whether standard programs can modify lower extremity biomechanics in pediatric populations or if specialized training is required. To compare the effects of traditional and age-specific pediatric anterior cruciate ligament injury prevention programs on lower extremity biomechanics during a cutting task in youth athletes. The authors hypothesized that the age-specific pediatric program would result in greater sagittal plane motion (ie, hip and knee flexion) and less motion in the transverse and frontal plane (ie, knee valgus, knee and hip rotation) as compared with the traditional program. Randomized controlled trial; Level of evidence, 1. Sixty-five youth soccer athletes (38 boys, 27 girls) volunteered to participate. The mean age of participants was 10 ± 1 years. Teams (n, 7) were cluster randomized to a pediatric injury prevention program, a traditional injury prevention program, or a control group. The pediatric program was modified from the traditional program to include more feedback, progressions, and variety. Teams performed their programs as part of their normal warm-up routine. Three-dimensional lower extremity biomechanics were assessed during a sidestep cutting task before and after completion of the 9-week intervention period. The pediatric program reduced the amount of knee external rotation at initial ground contact during the cutting task, F ((2,62)) = 3.79, P = .03 (change: pediatric, 7.73° ± 10.71°; control, -0.35° ± 7.76°), as compared with the control group after the intervention period. No other changes were observed. The injury prevention program designed for a pediatric population modified only knee rotation during the cutting task, whereas the traditional program did not result in any changes in cutting biomechanics. These

Reliability, validity, and sensitivity to change of the lower extremity functional scale in individuals affected by stroke.

PubMed

Verheijde, Joseph L; White, Fred; Tompkins, James; Dahl, Peder; Hentz, Joseph G; Lebec, Michael T; Cornwall, Mark

2013-12-01

To investigate reliability, validity, and sensitivity to change of the Lower Extremity Functional Scale (LEFS) in individuals affected by stroke. The secondary objective was to test the validity and sensitivity of a single-item linear analog scale (LAS) of function. Prospective cohort reliability and validation study. A single rehabilitation department in an academic medical center. Forty-three individuals receiving neurorehabilitation for lower extremity dysfunction after stroke were studied. Their ages ranged from 32 to 95 years, with a mean of 70 years; 77% were men. Test-retest reliability was assessed by calculating the classical intraclass correlation coefficient, and the Bland-Altman limits of agreement. Validity was assessed by calculating the Pearson correlation coefficient between the instruments. Sensitivity to change was assessed by comparing baseline scores with end of treatment scores. Measurements were taken at baseline, after 1-3 days, and at 4 and 8 weeks. The LEFS, Short-Form-36 Physical Function Scale, Berg Balance Scale, Six-Minute Walk Test, Five-Meter Walk Test, Timed Up-and-Go test, and the LAS of function were used. The test-retest reliability of the LEFS was found to be excellent (ICC = 0.96). Correlated with the 6 other measures of function studied, the validity of the LEFS was found to be moderate to high (r = 0.40-0.71). Regarding the sensitivity to change, the mean LEFS scores from baseline to study end increased 1.2 SD and for LAS 1.1 SD. LEFS exhibits good reliability, validity, and sensitivity to change in patients with lower extremity impairments secondary to stroke. Therefore, the LEFS can be a clinically efficient outcome measure in the rehabilitation of patients with subacute stroke. The LAS is shown to be a time-saving and reasonable option to track changes in a patient's functional status. Copyright © 2013 American Academy of Physical Medicine and Rehabilitation. Published by Elsevier Inc. All rights reserved.

Acute Lower Extremity Deep Venous Thrombosis: The Data, Where We Are, and How It Is Done.

PubMed

Ramaswamy, Raja S; Akinwande, Olaguoke; Giardina, Joseph D; Kavali, Pavan K; Marks, Christina G

2018-06-01

The incidence of venous thromboembolism, including both deep vein thrombosis and pulmonary embolism, is estimated at 300,000-600,000 per year. Although thrombosis may occur anywhere, it is thrombosis of the deep veins of the lower extremities that is of interest as this is where thrombosis occurs most often within the venous system. This article discusses the evaluation and interventions, including endovascular catheter-direct treatments, for patients with acute deep venous thrombosis. Published by Elsevier Inc.

Does morbid obesity negatively affect the hospital course of patients undergoing treatment of closed, lower-extremity diaphyseal long-bone fractures?

PubMed

Baldwin, Keith D; Matuszewski, Paul E; Namdari, Surena; Esterhai, John L; Mehta, Samir

2011-01-03

Obesity is prevalent in the developed world and is associated with significant costs to the health care system. The effect of morbid obesity in patients operatively treated for long-bone fractures of the lower extremity is largely unknown. The National Trauma Data Bank was accessed to determine if morbidly obese patients (body mass index >40) with lower extremity fractures have longer length of hospital stay, higher cost, greater rehabilitation admission rates, and more complications than nonobese patients. We identified patients with operatively treated diaphyseal femur (6920) and tibia (5190) fractures. Polytrauma patients and patients younger than 16 years were excluded. Morbidly obese patients were identified by ICD-9 and database comorbidity designation (femur, 131 morbidly obese; tibia, 75 morbidly obese). Patients meeting these criteria who were not morbidly obese were used as controls. Sensitivity analyses were performed to analyze patients with isolated trauma to the tibia or femur. Morbidly obese patients were more likely to be admitted to a subacute facility. Length of stay trended higher in morbidly obese patients. There was no significant relationship between obesity and inpatient mortality or inpatient complications. These trends held true when considering patients with multiple injuries and patients who had isolated long-bone injuries. Our study showed that morbidly obese patients may have greater rehabilitation needs following long-bone fractures in the lower extremity. Our study showed no difference in mortality or complications, although further studies are needed to confirm these findings. Copyright 2011, SLACK Incorporated.

Bivariate extreme value distributions

NASA Technical Reports Server (NTRS)

Elshamy, M.

1992-01-01

In certain engineering applications, such as those occurring in the analyses of ascent structural loads for the Space Transportation System (STS), some of the load variables have a lower bound of zero. Thus, the need for practical models of bivariate extreme value probability distribution functions with lower limits was identified. We discuss the Gumbel models and present practical forms of bivariate extreme probability distributions of Weibull and Frechet types with two parameters. Bivariate extreme value probability distribution functions can be expressed in terms of the marginal extremel distributions and a 'dependence' function subject to certain analytical conditions. Properties of such bivariate extreme distributions, sums and differences of paired extremals, as well as the corresponding forms of conditional distributions, are discussed. Practical estimation techniques are also given.

Diagnostic performance and radiation dose of lower extremity CT angiography using a 128-slice dual source CT at 80 kVp and high pitch.

PubMed

Kim, Jin Woo; Choo, Ki Seok; Jeon, Ung Bae; Kim, Tae Un; Hwang, Jae Yeon; Yeom, Jeong A; Jeong, Hee Seok; Choi, Yoon Young; Nam, Kyung Jin; Kim, Chang Won; Jeong, Dong Wook; Lim, Soo Jin

2016-07-01

Multi-detector computed tomography (MDCT) angiography is now used for the diagnosing patients with peripheral arterial disease. The dose of radiation is related to variable factors, such as tube current, tube voltage, and helical pitch. To assess the diagnostic performance and radiation dose of lower extremity CT angiography (CTA) using a 128-slice dual source CT at 80 kVp and high pitch in patients with critical limb ischemia (CLI). Twenty-eight patients (mean, 64.1 years; range, 39-80 years) with CLI were enrolled in this retrospective study and underwent CTA using a 128-slice dual source CT at 80 kVp and high pitch and subsequent intra-arterial digital subtraction angiography (DSA), which was used as a reference standard for assessing diagnostic performance. For arterial segments with significant disease (>50% stenosis), overall sensitivity, specificity, and accuracy of lower extremity CTA were 94.8% (95% CI, 91.7-98.0%), 91.5% (95% CI, 87.7-95.2%), and 93.1% (95% CI, 90.6-95.6%), respectively, and its positive and negative predictive values were 91.0% (95% CI, 87.1-95.0%), and 95.1% (95% CI, 92.1-98.1%), respectively. Mean radiation dose delivered to lower extremities was 266.6 mGy.cm. Lower extremity CTA using a 128-slice dual source CT at 80 kVp and high pitch was found to have good diagnostic performance for the assessment of patients with CLI using an extremely low radiation dose. © The Foundation Acta Radiologica 2015.

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.

Lower extremity joint kinetics and energetics during backward running.

PubMed

DeVita, P; Stribling, J

1991-05-01

The purpose of this study was to measure lower extremity joint moments of force and joint muscle powers used to perform backward running. Ten trials of high speed (100 Hz) sagittal plane film records and ground reaction force data (1000 Hz) describing backward running were obtained from each of five male runners. Fifteen trials of forward running data were obtained from one of these subjects. Inverse dynamics were performed on these data to obtain the joint moments and powers, which were normalized to body mass to make between-subject comparisons. Backward running hip moment and power patterns were similar in magnitude and opposite in direction to forward running curves and produced more positive work in stance. Functional roles of knee and ankle muscles were interchanged between backward and forward running. Knee extensors were the primary source of propulsion in backward running owing to greater moment and power output (peak moment = 3.60 N.m.kg-1; peak power = 12.40 W.kg-1) compared with the ankle (peak moment = 1.92 N.m.kg-1; peak power = 7.05 W.kg-1). The ankle plantarflexors were the primary shock absorbers, producing the greatest negative power (peak = -6.77 W.kg-1) during early stance. Forward running had greater ankle moment and power output for propulsion and greater knee negative power for impact attenuation. The large knee moment in backward running supported previous findings indicating that backward running training leads to increased knee extensor torque capabilities.

Evaluation, management and prevention of lower extremity youth ice hockey injuries.

PubMed

Popkin, Charles A; Schulz, Brian M; Park, Caroline N; Bottiglieri, Thomas S; Lynch, T Sean

2016-01-01

Ice hockey is a fast-paced sport played by increasing numbers of children and adolescents in North America and around the world. Requiring a unique blend of skill, finesse, power and teamwork, ice hockey can become a lifelong recreational activity. Despite the rising popularity of the sport, there is ongoing concern about the high frequency of musculoskeletal injury associated with participation in ice hockey. Injury rates in ice hockey are among the highest in all competitive sports. Numerous research studies have been implemented to better understand the risks of injury. As a result, rule changes were adopted by the USA Hockey and Hockey Canada to raise the minimum age at which body checking is permitted to 13-14 years (Bantam level) from 11-12 years (Pee Wee). Continuing the education of coaches, parents and players on rules of safe play, and emphasizing the standards for proper equipment use are other strategies being implemented to make the game safer to play. The objective of this article was to review the evaluation, management and prevention of common lower extremity youth hockey injuries.

Image quality and radiation dose of lower extremity CT angiography at 70 kVp on an integrated circuit detector dual-source computed tomography.

PubMed

Qi, Li; Zhao, Yan'E; Zhou, Chang Sheng; Spearman, James V; Renker, Matthias; Schoepf, U Joseph; Zhang, Long Jiang; Lu, Guang Ming

2015-06-01

Despite the well-established requirement for radiation dose reduction there are few studies examining the potential for lower extremity CT angiography (CTA) at 70 kVp. To compare the image quality and radiation dose of lower extremity CTA at 70 kVp using a dual-source CT system with an integrated circuit detector to similar studies at 120 kVp. A total of 62 patients underwent lower extremity CTA. Thirty-one patients were examined at 70 kVp using a second generation dual-source CT with an integrated circuit detector (70 kVp group) and 31 patients were evaluated at 120 kVp using a first generation dual-source CT (120 kVp group). The attenuation and image noise were measured and signal-to-noise ratio (SNR) and contrast-to-noise ratio (CNR) were calculated. Two radiologists assessed image quality. Radiation dose was compared. The mean attenuation of the 70 kVp group was higher than the 120 kVp group (575 ± 149 Hounsfield units [HU] vs. 258 ± 38 HU, respectively, P < 0.001) as was SNR (44.0 ± 22.0 vs 32.7 ± 13.3, respectively, P = 0.017), CNR (39.7 ± 20.6 vs 26.6 ± 11.7, respectively, P = 0.003) and the mean image quality score (3.7 ± 0.1 vs. 3.2 ± 0.3, respectively, P < 0.001). The inter-observer agreement was good for the 70 kVp group and moderate for the 120 kVp group. The dose-length product was lower in the 70 kVp group (264.5 ± 63.1 mGy × cm vs. 412.4 ± 81.5 mGy × cm, P < 0.001). Lower extremity CTA at 70 kVp allows for lower radiation dose with higher SNR, CNR, and image quality when compared with standard 120 kVp. © The Foundation Acta Radiologica 2014 Reprints and permissions: sagepub.co.uk/journalsPermissions.nav.

Lower-extremity resistance training on unstable surfaces improves proxies of muscle strength, power and balance in healthy older adults: a randomised control trial.

PubMed

Eckardt, Nils

2016-11-24

It is well documented that both balance and resistance training have the potential to mitigate intrinsic fall risk factors in older adults. However, knowledge about the effects of simultaneously executed balance and resistance training (i.e., resistance training conducted on unstable surfaces [URT]) on lower-extremity muscle strength, power and balance in older adults is insufficient. The objective of the present study was to compare the effects of machine-based stable resistance training (M-SRT) and two types of URT, i.e., machine-based (M-URT) and free-weight URT (F-URT), on measures of lower-extremity muscle strength, power and balance in older adults. Seventy-five healthy community-dwelling older adults aged 65-80 years, were assigned to three intervention groups: M-SRT, M-URT and F-URT. Over a period of ten weeks, all participants exercised two times per week with each session lasting ~60 min. Tests included assessment of leg muscle strength (e.g., maximal isometric leg extension strength), power (e.g., chair rise test) and balance (e.g., functional reach test), carried out before and after the training period. Furthermore, maximal training load of the squat-movement was assessed during the last training week. Maximal training load of the squat-movement was significantly lower in F-URT in comparison to M-SRT and M-URT. However, lower-extremity resistance training conducted on even and uneven surfaces meaningfully improved proxies of strength, power and balance in all groups. M-URT produced the greatest improvements in leg extension strength and F-URT in the chair rise test and functional reach test. Aside from two interaction effects, overall improvements in measures of lower-extremity muscle strength, power and balance were similar across training groups. Importantly, F-URT produced similar results with considerably lower training load as compared to M-SRT and M-URT. Concluding, F-URT seems an effective and safe alternative training program to mitigate

Virtual Reality to Assess and Treat Lower Extremity Disorders in Post-stroke Patients.

PubMed

Luque-Moreno, C; Oliva-Pascual-Vaca, A; Kiper, P; Rodríguez-Blanco, C; Agostini, M; Turolla, A

2016-01-01

This article is part of the Focus Theme of Methods of Information in Medicine on "Methodologies, Models and Algorithms for Patients Rehabilitation". To identify support of a virtual reality system in the kinematic assessment and physiotherapy approach to gait disorders in individuals with stroke. We adapt Virtual Reality Rehabilitation System (VRRS), software widely used in the functional recovery of the upper limb, for its use on the lower limb of hemiplegic patients. Clinical scales have been used to relate them with the kinematic assessment provided by the system. A description of the use of reinforced feedback provided by the system on the recovery of deficits in several real cases in the field of physiotherapy is performed. Specific examples of functional tasks have been detailed, to be considered in creating intelligent health technologies to improve post-stroke gait. Both participants improved scores on the clinical scales, the kinematic parameters in leg stance on plegic lower extremity and walking speed > Minimally Clinically Important Difference (MCID). The use of the VRRS software attached to a motion tracking capture system showed their practical utility and safety in enriching physiotherapeutic assessment and treatment in post-stroke gait disorders.

Use of US in the evaluation of patients with symptoms of deep venous thrombosis of the lower extremities.

PubMed

Useche, Juan N; de Castro, Alfredo M Fernández; Galvis, Germán E; Mantilla, Rodolfo A; Ariza, Alvaro

2008-10-01

Deep venous thrombosis (DVT) is a major health problem and is estimated to have an incidence of 600,000 cases per year. Clinical signs and symptoms of DVT are unreliable. If clinical signs alone were used to diagnose DVT, 42% of patients would receive unnecessary anticoagulation therapy. Most patients evaluated with ultrasonography (US) do not have DVT. The key to making a precise diagnosis is recognizing the characteristics of various diseases on US images. The anatomic approach is the most useful strategy for characterizing the spectrum of pathologic conditions seen in patients with symptoms that simulate DVT. The inferior extremity can be divided into four regions-inguinal, thigh, popliteal, and lower leg-with the rough limits defined for each as they are examined at US. The differential diagnoses affecting the lower extremities include infectious, neoplastic, traumatic, inflammatory, vascular, and miscellaneous entities. Some pathologic conditions seen in the inguinal region are adenopathies, lymphangitis, soft-tissue tumors, hematomas, adductor tendonitis, and hernias. In the thigh, cellulitis, myositis, abscess, benign and malignant tumors, and sports-related lesions are seen. In the popliteal region, cellulitis, arthritis, benign and malignant masses, muscle contusions, ruptured popliteal cysts, and thrombophlebitis are seen. And in the lower leg, cellulitis, lipomas, tennis leg, superficial thrombophlebitis, tendonitis, and soft-tissue hydrostatic edema secondary to cardiac and renal failure can simulate DVT. (c) RSNA, 2008.

Safety of catheter-directed thrombolysis for the treatment of acute lower extremity deep vein thrombosis: A systematic review and meta-analysis.

PubMed

Wang, Li; Zhang, Chuanlin; Mu, Shaoyu; Yeh, Chao Hsing; Chen, Liqun; Zhang, Zeju; Wang, Xueqin

2017-09-01

Despite established guidelines, catheter-directed thrombolysis (CDT) for the management of acute lower extremity deep vein thrombosis (DVT) should not be overstated because the risks of CDT are uncertain. We performed a meta-analysis to comprehensively and quantitatively evaluate the safety of CDT for patients with acute lower extremity DVT. Relevant databases, including PubMed, Embase, Cochrane, Ovid MEDLINE, and Scopus, were searched up to January 2017. The inclusion criteria were applied to select patients with acute lower extremity DVT treated by CDT or compared CDT with anticoagulation. In case series studies, the pooled estimates of safety outcomes for complications, pulmonary embolism (PE), and mortality were calculated across studies. In studies comparing CDT with anticoagulation, summary odds ratios (ORs) were calculated. Of the 1696 citations identified, 24 studies (6 comparing CDT with anticoagulation and 18 case series) including 9157 patients met the eligibility criteria. In the case series studies, the pooled risks of major, minor, and total complications were 0.03 (95% confidence interval [CI]: 0.02-0.04), 0.07 (95% CI: 0.05-0.08), and 0.09 (95% CI: 0.08-0.11), respectively; other pooled risk results were 0.00 for PE (95% CI: 0.00-0.01) and 0.07 for mortality (95% CI: 0.03-0.11). Our meta-analysis of 6 studies comparing the risk of complications and PE related to CDT with those related to anticoagulation showed that CDT was associated with an increased risk of complications (OR = 4.36; 95% CI: 2.94-6.47) and PE (OR = 1.57; 95% CI: 1.37-1.79). Acute lower extremity DVT patients receiving CDT are associated with a low risk of complications. However, compared with anticoagulation, CDT is associated with a higher risk of complications and PE. Rare mortality related to thrombolytic therapy was reported. More evidence should be accumulated to prove the safety of CDT.

Cortical reorganization associated lower extremity motor recovery as evidenced by functional MRI and diffusion tensor tractography in a stroke patient.

PubMed

Jang, Sung Ho; You, Sung H; Kwon, Yong-Hyun; Hallett, Mark; Lee, Mi Young; Ahn, Sang Ho

2005-01-01

Recovery mechanisms supporting upper extremity motor recovery following stroke are well established, but cortical mechanism associated with lower extremity motor recovery is unknown. The aim of this study was to assess cortical reorganization associated with lower extremity motor recovery in a hemiparetic patient. Six control subjects and a 17 year-old woman with left intracerebral hemorrhage due to an arterio-venous malformation rupture were evaluated. The motor function of the paretic (left) hip and knee had recovered slowly to the extent of her being able to overcome gravity for 10 months after the onset of stroke. However, her paretic upper extremity showed no significant motor recovery. Blood oxygenation level dependent (BOLD) functional MRI at 1.5 Tesla was used to determine the acutual location of cortical activation in the predefined regions of interest. Concurrently, Diffusion Tensor Imaging (DTI) in combination with a novel 3D-fiber reconstruction algorithm was utilized to investigate the pattern of the corticospinal pathway connectivity between the areas of the motor stream. All subjects' body parts were secured in the scanner and performed a sequential knee flexion-extension with a predetermined angle of 0-60 degrees at 0.5 Hz. Controls showed anticipated activation in the contralateral sensorimotor cortex (SM1) and the descending corticospinal fibers stemming from motor cortex. In contrast to control normal subjects, the stroke patient showed fMRI activation only in the unaffected (right) primary SM1 during either paretic or nonparetic knee movements. DTT fiber tracing data showed that the corticospinal tract fibers were found only in the unaffected hemisphere but not in the affected hemisphere. Our results indicate that an ipsilateral motor pathway from the unaffected (right) motor cortex to the paretic (right) leg was present in this patient. This study raises the potential that the contralesional (ipsilateral) SM1 is involved in cortical

Sex-specific relationships of physical activity, body composition, and muscle quality with lower-extremity physical function in older men and women.

PubMed

Straight, Chad R; Brady, Anne O; Evans, Ellen

2015-03-01

This study aims to determine the sex-specific relationships of physical activity, body composition, and muscle quality with lower-extremity physical function in older men and women. Seventy-nine community-dwelling men (n = 39; mean [SD] age, 76.1 [6.2] y; mean [SD] body mass index, 27.3 [3.8] kg/m(2)) and women (n = 40; mean [SD] age, 75.8 [5.5] y; mean [SD] body mass index, 27.0 [3.8] kg/m(2)) were assessed for physical activity via questionnaire, body composition via dual-energy x-ray absorptiometry scanning, leg extension power using the Nottingham power rig, and muscle quality (W/kg; the ratio of leg extension power [W] to lower-body mineral-free lean mass [kg]). A composite measure of physical function was obtained by summing Z scores from the 6-minute walk, 8-ft up-and-go test, and 30-second chair-stand test. As expected, men had significantly greater levels of physical activity, lower adiposity, greater lean mass, higher leg extension power, and greater muscle quality compared with women (all P < 0.05). In linear regression analyses, muscle quality and physical activity were the strongest predictors of lower-extremity physical function in men and independently explained 42% and 29% of the variance, respectively. In women, muscle quality (16%) and percent body fat (12%) were independent predictors after adjustment for covariates. Muscle quality is the strongest predictor of lower-extremity physical function in men and women, but sex impacts the importance of physical activity and adiposity. These findings suggest that older men and women may benefit from different intervention strategies for preventing physical disability and also highlight the importance of weight management for older women to preserve physical function.

A Systematic Review and Meta-Analysis of Perforator-Pedicled Propeller Flaps in Lower Extremity Defects: Identification of Risk Factors for Complications.

PubMed

Bekara, Farid; Herlin, Christian; Mojallal, Ali; Sinna, Raphael; Ayestaray, Benoit; Letois, Flavie; Chavoin, Jean Pierre; Garrido, Ignacio; Grolleau, Jean Louis; Chaput, Benoit

2016-01-01

Currently, increased interest in the perforator-pedicled propeller flap should not obscure the fact that it is, in reality, a complex procedure requiring experience and monitoring similar to free flaps. Through a meta-analysis, the authors aimed to identify the risk factors of perforator-pedicled propeller flap failure in lower extremity defects. The MEDLINE, PubMed Central, Embase, and Cochrane databases were searched from 1991 to May of 2014 for articles describing perforator-pedicled propeller flaps in the lower extremity. The study selection met the Preferred Reporting Items for Systematic Reviews and Meta-Analyses statement. Fixed-effects models were used. Forty articles complied with the inclusion criteria, representing 428 perforator-pedicled propeller flaps. The most common cause was posttraumatic (55.2 percent). Most of the defects were at the distal third of the lower leg (45.6 percent). The arc of rotation was 180 degrees for 34.3 percent. Complications were found in 25.2 percent, including partial necrosis (10.2 percent) and complete necrosis (3.5 percent). Complete flap survival was found in 84.3 percent. The authors identified three significant risk factors: age older than 60 years (relative risk, 1.61; p = 0.03), diabetes (relative risk, 2.00; p = 0.02), and arteriopathy (relative risk, 3.12; p = 0.01). No significant results were found regarding smoking status other than a tendency (p = 0.06), acute cause (p = 0.59), posttraumatic cause (p = 0.97), distal third of the lower leg (p = 0.66), fascia inclusion (p = 0.70), and pedicle rotation greater than 120 degrees (p = 0.41). Age older than 60 years, diabetes, and arteriopathy are significant risk factors of perforator-pedicled propeller flap complications in the lower extremity. Risk, IV.

Effects of the belt electrode skeletal muscle electrical stimulation system on lower extremity skeletal muscle activity: Evaluation using positron emission tomography.

PubMed

Numata, Hitoaki; Nakase, Junsuke; Inaki, Anri; Mochizuki, Takafumi; Oshima, Takeshi; Takata, Yasushi; Kinuya, Seigo; Tsuchiya, Hiroyuki

2016-01-01

Lower-extremity muscle weakness in athletes after lower limb trauma or surgery can hinder their return to sports, and the associated muscle atrophy may lead to deterioration in performance after returning to sports. Recently, belt electrode skeletal muscle electrical stimulation (B-SES) which can contract all the lower limb skeletal muscles simultaneously was developed. However, no study has evaluated skeletal muscle activity with B-SES. Since only superficial muscles as well as a limited number of muscles can be investigated using electromyography, we investigated whether positron emission tomography (PET) can evaluate the activity of all the skeletal muscles in the body simultaneously. The purpose of this study was to evaluate the effectiveness of the B-SES system using PET. Twelve healthy males (mean age, 24.3 years) were divided into two groups. The subjects in the control group remained in a sitting position for 10 min, and [(18)F] fluorodeoxyglucose (FDG) was intravenously injected. In the exercise group, subjects exercised using the B-SES system for 20 min daily for three consecutive days as a pre-test exercise. On the measurement day, they exercised for 10 min, received an injection of FDG, and exercised for another 10 min. PET-computed tomography images were obtained in each group 60 min after the FDG injection. Regions of interest were drawn in each lower-extremity muscle. We compared each skeletal muscle metabolism using the standardized uptake value. In the exercise group, FDG accumulation in the gluteus maximus, gluteus medius, gluteus minimus, quadriceps femoris, sartorius, and hamstrings was significantly higher than the muscles in the control (P < 0.05). Exercise with B-SES increased the skeletal muscle activity of the gluteal muscles as well as the most lower-extremity muscles simultaneously. Copyright © 2015 The Japanese Orthopaedic Association. Published by Elsevier B.V. All rights reserved.

Lower extremity muscle function of front row rugby union scrummaging.

PubMed

Yaghoubi, Mostafa; Lark, Sally D; Page, Wyatt H; Fink, Philip W; Shultz, Sarah P

2018-05-16

A rugby scrum's front row must act uniformly to transfer maximal horizontal force and improve performance. This study investigated the muscle activation patterns of lower extremity muscles in front row forwards during live and machine scrums at professional and amateur levels. Electromyography was collected bilaterally on vastus lateralis, rectus femoris and gastrocnemius muscles of 75 male rugby prop players during live and machine scrums. ANOVAs compared muscle reaction time, rate of change in muscle amplitude and muscle amplitude between groups and conditions. Cross-correlation analysis explored muscle synchronicity. There were significantly greater rates of change in each muscle amplitude in professional players than amateur players. Additionally, there was significantly quicker muscle reaction time in all muscles, and greater amplitude in vastus lateralis and gastrocnemius, during the live scrum vs. machine condition. The professional props produced more synchronised muscle activation than amateur players and all players produced more synchronised muscle activation against the scrum machine vs. live scrummage. The results indicate a higher skill proficiency and muscle synchronicity in professional players. While scrum machine training is ideally suited for functional muscle strengthening during practice, to truly simulate the requirements of the scrum, training should incorporate the live situation as much as possible.

Hip abductor strength and lower extremity running related injury in distance runners: A systematic review.

PubMed

Mucha, Matthew D; Caldwell, Wade; Schlueter, Emily L; Walters, Carly; Hassen, Amy

2017-04-01

Determine the association between hip abduction strength and lower extremity running related injury in distance runners. Systematic review. Prospective longitudinal and cross sectional studies that quantified hip abduction strength and provided diagnosis of running related injury in distance runners were included and assessed for quality. Effect size was calculated for between group differences in hip abduction strength. Of the 1841 articles returned in the initial search, 11 studies matched all inclusion criteria. Studies were grouped according to injury: iliotibial band syndrome, patellofemoral pain syndrome, medial tibial stress syndrome, tibial stress fracture, and Achilles tendinopathy, and examined for strength differences between injured and non-injured groups. Meaningful differences were found in the studies examining iliotibial band syndrome. Three of five iliotibial band syndrome articles found weakness in runners with iliotibial band syndrome; two were of strong methodological rigor and both of those found a relationship between weakness and injury. Other results did not form associative or predictive relationships between weakness and injury in distance runners. Hip abduction weakness evaluated by hand held dynamometer may be associated with iliotibial band syndrome in distance runners as suggested by several cross sectional studies but is unclear as a significant factor for the development of patellofemoral pain syndrome, medial tibial stress syndrome, tibial stress fracture or Achilles tendinopathy according to the current literature. Future studies are needed with consistent methodology and inclusion of all distance running populations to determine the significance of hip abduction strength in relationship to lower extremity injury. Copyright © 2016 Sports Medicine Australia. Published by Elsevier Ltd. All rights reserved.

Effects of sensorimotor foot training on the symmetry of weight distribution on the lower extremities of patients in the chronic phase after stroke.

PubMed

Goliwas, Magdalena; Kocur, Piotr; Furmaniuk, Lech; Majchrzycki, Marian; Wiernicka, Marzena; Lewandowski, Jacek

2015-09-01

[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.

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

Effects of Functional Electrical Stimulation Lower Extremity Training in Myotonic Dystrophy Type I: A Pilot Controlled Study.

PubMed

Cudia, Paola; Weis, Luca; Baba, Alfonc; Kiper, Pawel; Marcante, Andrea; Rossi, Simonetta; Angelini, Corrado; Piccione, Francesco

2016-11-01

Functional electrical stimulation (FES) is a new rehabilitative approach that combines electrical stimulation with a functional task. This pilot study evaluated the safety and effectiveness of FES lower extremity training in myotonic dystrophy type 1. This is a controlled pilot study that enrolled 20 patients with myotonic dystrophy type 1 over 2 years. Eight patients (age, 39-67 years) fulfilled the inclusion criteria. Four participants performed FES cycling training for 15 days (one daily session of 30 minutes for 5 days a week). A control group, matched for clinical and genetic variables, who had contraindications to electrical stimulation, performed 6 weeks of conventional resistance and aerobic training. The modified Medical Research Council Scale and functional assessments were performed before and after treatment. Cohen d effect size was used for statistical analysis. Functional electrical stimulation induced lower extremity training was well tolerated and resulted in a greater improvement of tibialis anterior muscle strength (d = 1,583), overall muscle strength (d = 1,723), and endurance (d = 0,626) than conventional training. Functional electrical stimulation might be considered a safe and valid tool to improve muscle function, also in muscles severely compromised in which no other restorative options are available. Confirmation of FES efficacy through further clinical trials is strongly advised.

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

Effects of pelvic compression belts on the kinematics and kinetics of the lower extremities during sit-to-stand maneuvers

PubMed Central

Kim, Jong Moon; Je, Hyun Dong; Kim, Hyeong-Dong

2017-01-01

[Purpose] To investigate the effects of a pelvic compression belt (PCB) and chair height on the kinematics and kinetics of the lower extremity during sit-to-stand (STS) maneuvers in healthy people. [Subjects and Methods] Twenty-two people participated in this study. They were required to perform STS maneuvers under four conditions. Hip joint moment and angular displacement of the hip, knee, and ankle were measured. A PCB was also applied below the anterior superior iliac spine. [Results] The angular displacement of the ankle joint increased while performing STS maneuvers from a normal chair with a PCB in phase 1, and decreased during phase 2 when performing STS maneuvers from a high chair. The overall angular displacement in phase 3 was decreased while rising from a chair with a PCB and rising from a high chair. When performed STS maneuvers from a high chair, the angular displacement of the hip, knee, and ankle joint decreased considerably in phase 3. This decreased lower extremity motion in phase 3 indicated that participants required less momentum to complete the maneuver. [Conclusion] The results of this study suggest that a PCB might be appropriate for patients with pelvic girdle pain and lower back pain related to pregnancy. PMID:28878454

Effects of pelvic compression belts on the kinematics and kinetics of the lower extremities during sit-to-stand maneuvers.

PubMed

Kim, Jong Moon; Je, Hyun Dong; Kim, Hyeong-Dong

2017-08-01

[Purpose] To investigate the effects of a pelvic compression belt (PCB) and chair height on the kinematics and kinetics of the lower extremity during sit-to-stand (STS) maneuvers in healthy people. [Subjects and Methods] Twenty-two people participated in this study. They were required to perform STS maneuvers under four conditions. Hip joint moment and angular displacement of the hip, knee, and ankle were measured. A PCB was also applied below the anterior superior iliac spine. [Results] The angular displacement of the ankle joint increased while performing STS maneuvers from a normal chair with a PCB in phase 1, and decreased during phase 2 when performing STS maneuvers from a high chair. The overall angular displacement in phase 3 was decreased while rising from a chair with a PCB and rising from a high chair. When performed STS maneuvers from a high chair, the angular displacement of the hip, knee, and ankle joint decreased considerably in phase 3. This decreased lower extremity motion in phase 3 indicated that participants required less momentum to complete the maneuver. [Conclusion] The results of this study suggest that a PCB might be appropriate for patients with pelvic girdle pain and lower back pain related to pregnancy.

Dynamic knee valgus alignment influences impact attenuation in the lower extremity during the deceleration phase of a single-leg landing.

PubMed

Tamura, Akihiro; Akasaka, Kiyokazu; Otsudo, Takahiro; Shiozawa, Jyunya; Toda, Yuka; Yamada, Kaori

2017-01-01

Dynamic knee valgus during landings is associated with an increased risk of non-contact anterior cruciate ligament (ACL) injury. In addition, the impact on the body during landings must be attenuated in the lower extremity joints. The purpose of this study was to investigate landing biomechanics during landing with dynamic knee valgus by measuring the vertical ground reaction force (vGRF) and angular impulses in the lower extremity during a single-leg landing. The study included 34 female college students, who performed the single-leg drop vertical jump. Lower extremity kinetic and kinematic data were obtained from a 3D motion analysis system. Participants were divided into valgus (N = 19) and varus (N = 15) groups according to the knee angular displacement during landings. The vGRF and angular impulses of the hip, knee, and ankle were calculated by integrating the vGRF-time curve and each joint's moment-time curve. vGRF impulses did not differ between two groups. Hip angular impulse in the valgus group was significantly smaller than that in the varus group (0.019 ± 0.033 vs. 0.067 ± 0.029 Nms/kgm, p<0.01), whereas knee angular impulse was significantly greater (0.093 ± 0.032 vs. 0.045 ± 0.040 Nms/kgm, p<0.01). There was no difference in ankle angular impulse between the groups. Our results indicate that dynamic knee valgus increases the impact the knee joint needs to attenuate during landing; conversely, the knee varus participants were able to absorb more of the landing impact with the hip joint.

Pediatric sports-related lower extremity fractures: hospital length of stay and charges: what is the role of the primary payer?

PubMed

Gao, Yubo; Johnston, Richard C; Karam, Matthew

2010-01-01

The purposes of this study were (a) to evaluate the distribution by primary payer (public vs. private) of U.S. pediatric patients aged 5-18 years who were hospitalized with a sports-related lower extremity fracture and (b) to discern the adjusted mean hospital length of stay and mean charge per day by payer type. Children who were aged 5 to 18 years and had diagnoses of lower extremity fracture and sports-related injury in the 2006 Healthcare Cost and Utilization Project Kids' Inpatient Database were included. Lower extremity fractures are defined as International Classification of Diseases, 9th Revision, Clinical Modification codes 820-829 under Section "Injury and Poisoning (800-999)," while sports-related external cause of injury codes (E-codes) are E886.0, E917.0, and E917.5. Differences in hospital length of stay and cost per day by payer type were assessed via adjusted least square mean analysis. The adjusted mean hospital length of stay was 20% higher for patients with a public payer (2.50 days) versus a private payer (2.08 days). The adjusted mean charge per day differed about 10% by payer type (public, US$7,900; private, US$8,794). Further research is required to identify factors that are associated with different length of stay and mean charge per day by payer type, and explore whether observed differences in hospital length of stay are the result of private payers enhancing patient care, thereby discharging patients in a more efficient manner.

Classification systems for lower extremity amputation prediction in subjects with active diabetic foot ulcer: a systematic review and meta-analysis.

PubMed

Monteiro-Soares, M; Martins-Mendes, D; Vaz-Carneiro, A; Sampaio, S; Dinis-Ribeiro, M

2014-10-01

We systematically review the available systems used to classify diabetic foot ulcers in order to synthesize their methodological qualitative issues and accuracy to predict lower extremity amputation, as this may represent a critical point in these patients' care. Two investigators searched, in EBSCO, ISI, PubMed and SCOPUS databases, and independently selected studies published until May 2013 and reporting prognostic accuracy and/or reliability of specific systems for patients with diabetic foot ulcer in order to predict lower extremity amputation. We included 25 studies reporting a prevalence of lower extremity amputation between 6% and 78%. Eight different diabetic foot ulcer descriptions and seven prognostic stratification classification systems were addressed with a variable (1-9) number of factors included, specially peripheral arterial disease (n = 12) or infection at the ulcer site (n = 10) or ulcer depth (n = 10). The Meggitt-Wagner, S(AD)SAD and Texas University Classification systems were the most extensively validated, whereas ten classifications were derived or validated only once. Reliability was reported in a single study, and accuracy measures were reported in five studies with another eight allowing their calculation. Pooled accuracy ranged from 0.65 (for gangrene) to 0.74 (for infection). There are numerous classification systems for diabetic foot ulcer outcome prediction, but only few studies evaluated their reliability or external validity. Studies rarely validated several systems simultaneously and only a few reported accuracy measures. Further studies assessing reliability and accuracy of the available systems and their composing variables are needed. Copyright © 2014 John Wiley & Sons, Ltd.

Effectiveness of mirror therapy on lower extremity motor recovery, balance and mobility in patients with acute stroke: A randomized sham-controlled pilot trial.

PubMed

Mohan, Uthra; Babu, S Karthik; Kumar, K Vijay; Suresh, B V; Misri, Z K; Chakrapani, M

2013-10-01

To evaluate the effectiveness of mirror therapy on lower extremity motor recovery, balance and mobility in patients with acute stroke. A randomized, sham-controlled, assessor blinded, pilot trial. Inpatient stroke rehabilitation unit. 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. 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. Lower extremity motor subscale of Fugl Meyer Assessment (FMA), Brunnel Balance Assessment (BBA) and Functional Ambulation Categories (FAC). 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. 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.

Lower extremity endovascular interventions: can we improve cost-efficiency?

PubMed

O'Brien-Irr, Monica S; Harris, Linda M; Dosluoglu, Hasan H; Dayton, Merril; Dryjski, Maciej L

2008-05-01

Management of lower extremity arterial disease with endovascular intervention is on the rise. Current practice patterns vary widely across and within specialty practices that perform endovascular intervention. This study evaluated reimbursement and costs of different approaches for offering endovascular intervention and identified strategies to improve cost-efficiency. The medical records of all patients admitted to a university health system during 2005 for an endovascular intervention were retrospectively reviewed. Procedure type, setting, admission status, and financial data were recorded. Groups were compared using analysis of variance, Student t test for independent samples, and chi2. A total of 296 endovascular interventions were completed, and 184 (62%) met inclusion criteria. Atherectomy and stenting were significantly more costly when performed in the operating room than in the radiology suite: atherectomy, dollars 6596 vs dollars 4867 (P = .002); stent, dollars 5884 vs dollars 3292, (P < .001); angioplasty, dollars 2251 vs dollars 1881 (P = .46). Reimbursement was significantly higher for inpatient vs ambulatory admissions (P < .001). Costs were lowest when the endovascular intervention was done in the radiology suite on an ambulatory basis and highest when done as an inpatient in the operating room (dollars 5714 vs dollars 12,278; P < .001). Contribution margins were significantly higher for inpatients. Net profit was appreciated only for interventions done as an inpatient in the radiology suite. Reimbursement, contribution margins, and net profit were significantly lower among private pay patients in both the ambulatory and inpatient setting. The 30-day hospital readmission after ambulatory procedures was seven patients (6%). Practice patterns for endovascular interventions differ considerably. Costs vary by procedure and setting, and reimbursement depends on admission status and accurate documentation; these dynamics affect affordability. Organizing

A startling acoustic stimulus facilitates voluntary lower extremity movements and automatic postural responses in people with chronic stroke.

PubMed

Coppens, Milou J M; Roelofs, Jolanda M B; Donkers, Nicole A J; Nonnekes, Jorik; Geurts, Alexander C H; Weerdesteyn, Vivian

2018-05-14

A startling acoustic stimulus (SAS) involuntary releases prepared movements at accelerated latencies, known as the StartReact effect. Previous work has demonstrated intact StartReact in paretic upper extremity movements in people after stroke, suggesting preserved motor preparation. The question remains whether motor preparation of lower extremity movements is also unaffected after stroke. Here, we investigated StartReact effects on ballistic lower extremity movements and on automatic postural responses (APRs) following perturbations to standing balance. These APRs are particularly interesting as they are critical to prevent a fall following balance perturbations, but show substantial delays and poor muscle coordination after stroke. Twelve chronic stroke patients and 12 healthy controls performed voluntary ankle dorsiflexion movements in response to a visual stimulus, and responded to backward balance perturbations evoking APRs. Twenty-five percent of all trials contained a SAS (120 dB) simultaneously with the visual stimulus or balance perturbation. As expected, in the absence of a SAS muscle and movement onset latencies at the paretic side were delayed compared to the non-paretic leg and to controls. The SAS accelerated ankle dorsiflexion onsets in both the legs of the stroke subjects and in controls. Following perturbations, the SAS accelerated bilateral APR onsets not only in controls, but for the first time, we also demonstrated this effect in people after stroke. Moreover, APR inter- and intra-limb muscle coordination was rather weak in our stroke subjects, but substantially improved when the SAS was applied. These findings show preserved movement preparation, suggesting that there is residual (subcortical) capacity for motor recovery.

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

DOE Office of Scientific and Technical Information (OSTI.GOV)

Ganguli, Suvranu, E-mail: sganguli@partners.org; Kalva, Sanjeeva; Oklu, Rahmi

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 tomore » 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.« less

Effects of Progressive Body Weight Support Treadmill Forward and Backward Walking Training on Stroke Patients' Affected Side Lower Extremity's Walking Ability.

PubMed

Kim, Kyunghoon; Lee, Sukmin; Lee, Kyoungbo

2014-12-01

[Purpose] The purpose of the present study was to examine the effects of progressive body weight supported treadmill forward and backward walking training (PBWSTFBWT), progressive body weight supported treadmill forward walking training (PBWSTFWT), progressive body weight supported treadmill backward walking training (PBWSTBWT), on stroke patients' affected side lower extremity's walking ability. [Subjects and Methods] A total of 36 chronic stroke patients were divided into three groups with 12 subjects in each group. Each of the groups performed one of the progressive body weight supported treadmill training methods for 30 minute, six times per week for three weeks, and then received general physical therapy without any other intervention until the follow-up tests. For the assessment of the affected side lower extremity's walking ability, step length of the affected side, stance phase of the affected side, swing phase of the affected side, single support of the affected side, and step time of the affected side were measured using optogait and the symmetry index. [Results] In the within group comparisons, all the three groups showed significant differences between before and after the intervention and in the comparison of the three groups, the PBWSTFBWT group showed more significant differences in all of the assessed items than the other two groups. [Conclusion] In the present study progressive body weight supported treadmill training was performed in an environment in which the subjects were actually walked, and PBWSTFBWT was more effective at efficiently training stroke patients' affected side lower extremity's walking ability.

Lower extremity balance is improved at time of return to throwing in baseball players after an ulnar collateral ligament reconstruction when compared to pre-operative measurements.

PubMed

Hannon, Joseph; Garrison, J Craig; Conway, John

2014-05-01

/ Lower extremity balance deficits have been shown to lead to altered kinematics and increased injury risk in lower extremity athletes. The purpose of this study was to compare lower extremity balance in baseball players with an ulnar collateral ligament (UCL) tear pre-operatively and post-operatively at the beginning of the pre-return to throwing program stage of rehabilitation (3 months). Thirty-three competitive high school and collegiate male baseball players (18.5 ± 3.2) with a diagnosed UCL tear volunteered for the study. Of the 33 baseball players 29 were pitchers, 1 was a catcher, and 3 were infielders. Participants were seen pre-operatively and at 3 months post operatively. This 3 month point was associated with a follow-up visit to the orthopedic surgeon and subsequent release to begin the pre-return to throwing mark for baseball players following their surgery. Following surgery, each participant followed a standard UCL protocol which included focused lower extremity balance and neuromuscular control exercises. Participants were tested for single leg balance using the Y-Balance Test™ - Lower Quadrant (YBT-LQ) on both their lead and stance limbs. YBT-LQ composite scores were calculated for the stance and lead limbs pre- and post-operatively and compared over time. Paired t-tests were used to calculate differences between time 1 and time 2 (p < 0.05). Baseball players with diagnosed UCL tears demonstrated significant balance deficits on their stance (p < .001) and lead (p = .009) limbs prior to surgery compared to balance measures at the 3-month follow up (Stance Pre-Op = 89.4 ± 7.5%; Stance 3 Month = 94.9 ± 9.5%) (Lead Pre-Op = 90.2 ± 6.7%; Lead 3 Month = 93.6 ± 7.2%). Based on the results of this study, lower extremity balance is altered in baseball players with UCL tears prior to surgery. Statistically significant improvements were seen and balance measures improved at the time of return to throwing. Level 2b.

Effects of dopamine replacement therapy on lower extremity kinetics and kinematics during a rapid force production task in persons with Parkinson disease.

PubMed

Foreman, K Bo; Singer, Madeline L; Addison, Odessa; Marcus, Robin L; LaStayo, Paul C; Dibble, Leland E

2014-01-01

Postural instability appears to be a dopamine resistance motor deficit in persons with Parkinson disease (PD); however, little is known about the effects of dopamine replacement on the relative biomechanical contributions of individual lower extremity joints during postural control tasks. To gain insight, we examined persons with PD using both clinical and laboratory measures. For a clinical measure of motor severity we utilized the Unified Parkinson Disease Rating Scale motor subsection during both OFF and ON medication conditions. For the laboratory measure we utilized data gathered during a rapid lower extremity force production task. Kinematic and kinetic variables at the hip, knee, and ankle were gathered during a counter movement jump during both OFF and ON medication conditions. Sixteen persons with PD with a median Hoehn and Yahr severity of 2.5 completed the study. Medication resulted in significant improvements of angular displacement for the hip, knee, and ankle. Furthermore, significant improvements were revealed only at the hip for peak net moments and average angular velocity compared to the OFF medication condition. These results suggest that dopamine replacement medication result in decreased clinical motor disease severity and have a greater influence on kinetics and kinematics proximally. This proximally focused improvement may be due to active recruitment of muscle force and reductions in passive restraint during lower extremity rapid force production. Copyright © 2013 Elsevier B.V. All rights reserved.

Adaptive statistical iterative reconstruction use for radiation dose reduction in pediatric lower-extremity CT: impact on diagnostic image quality.

PubMed

Shah, Amisha; Rees, Mitchell; Kar, Erica; Bolton, Kimberly; Lee, Vincent; Panigrahy, Ashok

2018-06-01

For the past several years, increased levels of imaging radiation and cumulative radiation to children has been a significant concern. Although several measures have been taken to reduce radiation dose during computed tomography (CT) scan, the newer dose reduction software adaptive statistical iterative reconstruction (ASIR) has been an effective technique in reducing radiation dose. To our knowledge, no studies are published that assess the effect of ASIR on extremity CT scans in children. To compare radiation dose, image noise, and subjective image quality in pediatric lower extremity CT scans acquired with and without ASIR. The study group consisted of 53 patients imaged on a CT scanner equipped with ASIR software. The control group consisted of 37 patients whose CT images were acquired without ASIR. Image noise, Computed Tomography Dose Index (CTDI) and dose length product (DLP) were measured. Two pediatric radiologists rated the studies in subjective categories: image sharpness, noise, diagnostic acceptability, and artifacts. The CTDI (p value = 0.0184) and DLP (p value <0.0002) were significantly decreased with the use of ASIR compared with non-ASIR studies. However, the subjective ratings for sharpness (p < 0.0001) and diagnostic acceptability of the ASIR images (p < 0.0128) were decreased compared with standard, non-ASIR CT studies. Adaptive statistical iterative reconstruction reduces radiation dose for lower extremity CTs in children, but at the expense of diagnostic imaging quality. Further studies are warranted to determine the specific utility of ASIR for pediatric musculoskeletal CT imaging.

Dissemination and Implementation Strategies of Lower Extremity Preventive Training Programs in Youth: A Clinical Review.

PubMed

DiStefano, Lindsay J; Frank, Barnett S; Root, Hayley J; Padua, Darin A

Neuromuscular preventive training programs effectively reduce injury and improve performance in youth athletes. However, program effectiveness is directly linked to program compliance, fidelity, and dosage. Preventive training programs are not widely adopted by youth sport coaches. One way to promote widespread dissemination and compliance is to identify implementation strategies that influence program adoption and maintenance. It is unknown how previously published programs have followed the elements of an implementation framework. The objective of this review was to evaluate how elements of the 7 steps of implementation, developed by Padua et al, have been performed in the evidence of lower extremity preventive training programs. A systematic review of the literature from 1996 through September 2016 was conducted using electronic databases. Investigations that documented implementation of a sport team-based neuromuscular preventive training program in youth athletes and measured lower extremity injury rates were included. Clinical review. Level 4. A total of 12 studies met the inclusion criteria and were reviewed. Information regarding the completion of any of the 7 steps within the implementation framework developed by Padua et al was extracted. None of the 12 articles documented completion of all 7 steps. While each study addressed some of the 7 steps, no study addressed maintenance or an exit strategy for youth athletes. Program implementation appears limited in obtaining administrative support, utilizing an interdisciplinary implementation team, and monitoring or promoting fidelity of the intervention. Despite strong evidence supporting the effectiveness of preventive training programs in youth athletes, there is a gap between short-term improvements and long-term implementation strategies. Future interventions should include all 7 steps of the implementation framework to promote transparent dissemination of preventive training programs.

Evaluation, management and prevention of lower extremity youth ice hockey injuries

PubMed Central