Aims. Treatment of Weber B ankle fractures that are stable on weightbearing radiographs but unstable on concomitant stress tests (classified SER4a) is controversial. Recent studies indicate that these fractures should be treated nonoperatively, but no studies have compared alternative nonoperative options. This study aims to evaluate patient-reported outcomes and the safety of fracture treatment using functional orthosis versus cast immobilization. Methods. A total of 110 patients with Weber B/SER4a ankle fractures will be randomized (1:1 ratio) to receive six weeks of functional orthosis treatment or cast immobilization with a two-year follow-up. The primary outcome is patient-reported ankle function and symptoms measured by the Manchester-Oxford Foot and Ankle Questionnaire (MOxFQ); secondary outcomes include Olerud-Molander Ankle Score, radiological evaluation of ankle congruence in weightbearing and gravity stress tests, and rates of treatment-related adverse events. The Regional Committee for Medical and Health Research (approval number 277693) has granted ethical approval, and the study is funded by South-Eastern Norway Regional Health Authority (grant number 2023014). Discussion. Randomized controlled trials are needed to evaluate alternative nonoperative treatment options for Weber B/SER4a ankle fractures, as current clinical guidelines are based on biomechanical reasoning. The findings will be shared through publication in peer-reviewed journals and presentations at conferences. Cite this article: Bone Jt Open 2023;4(9):713–719

Aims. The aim of this study was to compare the longer-term outcomes of operatively and nonoperatively managed patients treated with a removable brace (fixed-angle removable orthosis) or a plaster cast immobilization for an acute ankle fracture. Methods. This is a secondary analysis of a multicentre randomized controlled trial comparing adults with an acute ankle fracture, initially managed either by operative or nonoperative care. Patients were randomly allocated to receive either a cast immobilization or a fixed-angle removable orthosis (removable brace). Data were collected on baseline characteristics, ankle function, quality of life, and complications. The Olerud-Molander Ankle Score (OMAS) was the primary outcome which was used to measure the participant’s ankle function. The primary endpoint was at 16 weeks, with longer-term follow-up at 24 weeks and two years. Results. Overall, 436 patients (65%) completed the final two-year follow-up. The mean difference in OMAS at two years was -0.3 points favouring the plaster cast (95% confidence interval -3.9 to 3.4), indicating no statistically significant difference between the interventions. There was no evidence of differences in patient quality of life (measured using the EuroQol five-dimension five-level questionnaire) or Disability Rating Index. Conclusion. This study demonstrated that patients treated with a removable brace had similar outcomes to those treated with a plaster cast in the first two years after injury. A removable brace is an effective alternative to traditional immobilization in a plaster cast for patients with an ankle fracture. Cite this article: Bone Joint J 2023;105-B(4):382–388

Vacuum orthoses are being applied in the care of patients with foot and lower leg conditions, as ankle fractures or sprains. The lower leg is protected and immobilized, which increases mobility. Due to the design, the orthoses lead to a difference in leg length, i.e. the side with the orthosis becomes longer, which changes the gait kinematics. To prevent or mitigate the unfavourable effects of altered gait kinematics, leg length-evening devices (shoe lifts) are offered that are worn under the shoe on the healthy side. Our aim was to evaluate the effect of such a device on the normality of gait kinematics. Gait analysis was conducted with 63 adult, healthy volunteers having signed an informed consent form that were asked to walk on a treadmill at a speed of 4.5km/h in three different conditions:. barefoot - as reference for establishing the normality score baseline. with a vacuum orthosis (VACOPed, OPED GmbH, Germany) and a sport shoe. with a vacuum orthosis and a shoe lift (EVENup, OPED GmbH, Germany). Data was sampled using the gait analysis system MCU 200 (LaiTronic GmbH, Austria). The positions of the joint markers were exported from the software and evaluated for the joint angles during the gait cycle using custom software (implemented in DIAdem 2017, National Instruments). A normality score using a modification of the Gait Profile Score (GPS) was calculated in every 1%-interval of the gait cycle and evaluated with a Wilcoxon signed rank test. The GPS value was reduced by 0.33° (0.66°) (median and IQR) while wearing the shoe lift. The effect was statistically significant, and very large (W = 1535.00, p < .001; r (rank biserial) = 0.52, 95% CI [0.29, 0.70]). The significant reduction of the GPS value indicates a more normal gait kinematics while using the leg length-evening device on the contralateral shoe. This rather simple and inexpensive device thus might improve patient comfort and balance while using the vacuum orthoses

Abstract. Objectives. This study aims to evaluate the functional outcomes of early weight-bearing in a functional orthosis for conservatively managed, complete AT ruptures. Also we tried to evaluate the patient reported outcome with this form of treatment. Design. In this prospective study, we have analysed data from 41 patients with ultrasound diagnosed compete AT ruptures, with a gap of less than 5 cm. Every patient was treated in a functional weight-bearing orthosis (VACOped®) for 8 weeks with early weight-bearing following a specific treatment protocol, followed by rehabilitation with a trained physiotherapist. Methods. Patients were followed up with foot and ankle trained physiotherapist for at least 1 year post-injury. At final follow up, the followings were measured: calf girth, single-leg heel raise height and repetitions. Furthermore, ATRS score and a patient feedback were taken on this final visit. Result. The mean ATRS score was 82.1, with a re-rupture rate of only 2% as compared to 5% in normal orthosis. The average calf bulk difference was 1.6 cm, the average heel raise height difference was 1.8cm and a heel raise repetition difference of 6. There was a statistically significant correlation between ATRS score and calf muscle girth (p=0.02). However, there was no significant correlation between ATRS and heel raise height or heel raise repetitions. Conclusion. Early weight-bearing in a functional orthosis provides excellent functional outcomes for conservatively managed, complete AT ruptures, and is associated with very low re-rupture rates. A multidisciplinary approach with a guided rehabilitation programme is essential for optimising functional outcome

Myriad protocols exist for isolated Weber B lateral malleolus fractures with a congruent tibiotalar joint on initial radiographs. Stress and weight-bearing radiographs, all at various timepoints, may be employed to identify those injuries that develop significant talar shift but consensus is elusive. This study outlines a safe and reproducible protocol for such injuries, utilising a removable orthosis, immediate weight bearing and standard supine radiographs. A retrospective analysis of a prospective trauma database was analysed to identify patients with an isolated Weber B ankle fracture with adequate presentation radiographs demonstrating a congruent mortise. Patient records and radiographs were evaluated a minimum of 5 years after initial presentation to determine ankle stability, complications, and the burden on outpatient services. Between 2014 and 2016, 657 patients were referred to the specialist trauma clinic from the emergency department. Of the 657, 52 patients had inadequate ED radiographs to determine ankle congruity. At the two-week assessment, 11 of the 52 demonstrated talar shift and required intervention. Therefore 646 patients demonstrated ankle congruity at two weeks after weight bearing. No patient demonstrated talar shift at the six-week assessment. Average number of follow up appointments was 2.4 with 3.5 radiographs. Our new treatment protocol advocates discharge after a single orthopaedic assessment after two weeks of weight bearing. This study supports immediate weight-bearing of Weber B ankle fractures with a congruent mortise in an orthosis. Follow up beyond two weeks is unnecessary and our protocol offers a safe means of significantly reducing the outpatient burden

Introduction. Charcot neuroarthropathy (CN) of foot and ankle presents significant challenges to the orthopaedic foot and ankle surgeon. Current treatment focuses on conservative management during the acute CN phase with offloading followed by deformity correction during the chronic phase. However, the deformity can progress in some feet despite optimal offloading resulting ulceration, infection, and limb loss. Our aim was to assess outcomes of primary surgical management with early reconstruction. Methods. Between December 2011 and December 2019, 25 patients underwent operative intervention at our specialist diabetic foot unit for CN with progressive deformity and or instability despite advanced offloading. All had peripheral neuropathy, and the majority due to diabetes. Twenty-six feet were operated on in total - 14 during Eichenholtz stage 1 and 12 during stage 2. Fourteen of these were performed as single stage procedures, whereas 12 as two-stage reconstructions. These included isolated hindfoot reconstructions in seven, midfoot in four and combined in 14 feet. Mean age at the time of operation was 54. Preoperative ulceration was evident in 14 patients. Results. Mean follow up was 45 months (Range 12–98). There was 100% limb salvage. One-year ambulation outcomes demonstrate FWB in bespoke footwear for 17 patients and in an ankle foot orthosis (AFO), Charcot restraint orthopaedic walker (CROW) or bivalve cast for seven. All preoperative ulceration had healed. Union was achieved in 18/21 hindfoot reconstructions and 7/18 midfoot reconstructions. There were nine episodes of return to theatre, of which five were within the first 12 months. There was one episode of new ulceration. Conclusion. Surgical management of acute CN (Eichenholtz one and two) of the foot provides functional limb salvage. In particular, hindfoot reconstruction shows good rates of bony union. It should be considered in ‘foot at risk’ presentations of acute CN foot

Ponseti method has become the most common and validated initial non-operative and/or minimally invasive treatment modality of idiopathic clubfoot regardless of the severity of the deformity worldwide. Despite hundreds of publications in the literature favoring Ponseti method, the data about secondary procedures performed in the follow-up period of clubfoot and their incidence remains sparse and given as small details in the articles. The objective of this study was to analyse our incidence of secondary procedures performed in the midterm followup period of idiopathic clubfoot patients treated with Ponseti method and review of the relevant literature. For this purpose 86 feet of 60 patients with idiopathic clubfoot who were treated with original Ponseti method were enrolled in this retrospective case control study. Unilateral ankle foot orthosis (AFO) was used rather than standart bar-connected foot abduction orthosis varying from 12 months to 25 months in the follow-up period and 74 of 86 (86%) feet required percutaneous achilles tenotomy. The average age of initial cast treatment was 12.64 days (range 1 to 102 days). The mean follow-up time was 71 months (range 19 to 153 months). Thirty seven feet of 24 patients recieved secondary procedures (43%) consisting of; supramalleolary derotational osteotomy (SMDO) (1 patient/2 feet), complete subtalar release (3 patients/5 feet), medial opening lateral closing osteotomy (double osteotomy) (2 patients/3 feet), double osteotomy with transfer of tibialis anterior tendon (TTAT) (2 patients/3 feet), partial subtalar release (PSTR) (3 patients/5 feet), PSTR with SDO (1 patient/1 foot), posterior release (PR) with repeated achillotomy (1 patient/2 feet), TTAT (6 patients/10 feet), TTAT with PR (2 patients/2 feet), TTAT with Vulpius procedure (1 patient/1 foot) and TTAT with SMDO (2 patients/3 feet) respectively. The amount of percutaneous achilles tenotomy (86%) in our study correlated with the literature which ranged from 80 to 90 %. The transfer of tibialis anterior tendon continued to be the most performed secondary procedure both in our study (51%) and in the literature, but the amount of total secondary procedures in our study (43%) was determined to be higher than the literature data varying from 7 to 27 percent which may be due to unilateral AFO application after Ponseti method for idiopathic clubfoot deformity in our study

The aim of this study was to identify factors independently associated with symptomatic venous thromboembolism (VTE) following acute Achilles tendon rupture (ATR), and to suggest a clinical VTE risk assessment tool for patients with ATR. From 2010–2018, 984 consecutive adults (median age 47yrs, 73% male) sustaining an ATR were retrospectively identified. There were 95% managed non-operatively (below-knee cast 52%, n=507/984; walking boot 44%, n=432/984), with 5% (n=45/984) undergoing primary operative repair (<6wks). VTE was diagnosed using medical records and national imaging archives, reviewed at a mean of 5yrs (1–10) post-injury. Regression was performed to identify factors independently associated with VTE. Incidence of VTE within 90 days of ATR was 3.6% (n=35/984; deep vein thrombosis 2.1% [n=21/984], pulmonary embolism 1.9% [n=19/984]). Age ≥50yrs (adjusted OR [aOR] 2.3, p=0.027), personal history of VTE/thrombophilia (aOR 6.1, p=0.009) and family history of VTE (aOR 20.9, p<0.001) were independently associated with VTE. These non-modifiable risk factors were incorporated into a VTE risk assessment tool. 23% of patients developing VTE (n=8/35) had a relevant personal or family history, but incorporating age into the tool identified 69% of patients with VTE (n=24/35). Non weight-bearing ≥2wks after ATR was also independently associated with VTE (aOR 3.2, p=0.026). Age ≥50 years, personal history of VTE/thrombophilia and a positive family history were independently associated with VTE following ATR. Incorporating age into our suggested VTE risk assessment tool enhanced sensitivity in identifying at-risk patients. Early weight-bearing in an appropriate orthosis may be beneficial in VTE risk reduction

A complete design-manufacturing process for delivering customized foot orthoses by means of digital technologies is presented. Moreover, this feasibility study aims to combine a semi-automatic modelling approach with the use of low-cost devices for 3D scanning and 3D printing. In clinical practice, traditional methods for manufacturing customized foot orthoses are completely manual, mainly based on plaster casting plus hand fabrication, and are widely used among practitioners. Therefore, results depend on skills and expertise of individual orthoptists and podiatrists that need considerable training and practice in order to obtain optimal functional devices. On the other side, novel approaches for design and manufacturing customized foot orthoses by means of digital technologies (generally based on 3D scanning, 3D modelling and 3D printing) are recently reported as a valid alternative method to overcome these limitations. This study has been carried out in an interdisciplinary approach between the staff of Design and Methods in Industrial Engineering and the staff of Podology with the aim to assess the feasibility of a novel user-friendly and cost-effective solution for delivering customized functional foot orthoses. More specifically, a Generative Design (GD) workflow has been developed to enable practitioners without enough CAD skills to easily 3D modelling and interactively customize foot orthoses. Additionally, low-cost devices for 3D scanning and 3D printing that have been acquired by the Podology Lab, were also tested and compared with the high-cost ones of the Department of Industrial Engineering. The complete process is divided into three main steps. The first one regards the digitization of the patient's foot by means of 3D laser scanner devices. Then a user-friendly 3D modelling approach, developed for this purpose as GD workflow, allows interactively generating the customized foot orthosis, also adjusting several features and exporting the watertight mesh in STL format. Finally, the last step involves Additive Manufacturing systems to obtain the expected physical item ready to use. First, for what concerns the digitizing step, the acquired data resulting from 3D scanning by means of the low-cost system (Sense 3D scanner) appears accurate enough for the present practical purposes. Then, with respect to the 3D modelling step, the proposed GD workflow in Grasshopper is intuitive and allows easily and interactively customizing the final foot orthosis. Finally, regarding the Additive Manufacturing step, the low cost 3D printer (Wasp Delta 40 70) is capable to provide adequate results for the shell of the foot orthosis. Moreover, this system appears really versatile in reason of the capability to print in a wide range of different filaments. Therefore, since the market of 3D printing filaments is rapidly growing, building sessions with different materials (both flexible and rigid such, for example, PLA, AB and PETG) were completed. This study validated, in terms of feasibility, that the use of a GD modelling approach, in combination with low-cost devices for 3D scanning and 3D printing, is a real alternative to conventional processes for providing customized foot orthosis. Moreover, the interdisciplinary approach allowed the transfer of skills and knowledge to the practitioners involved and, also, the low-cost devices Sense 3D scanner and Wasp Delta 40 70 that have been acquired by the Podology Lab, were demonstrated suitable for this kind of applications

A key factor delaying rehabilitation after a tendo Achillis (TA) rupture is gait abnormality. We quantified changes in planter pressures after a rupture of the TA in four groups of patients:. 15 controls subjects, mean 40 years, with no history of lower limb abnormality. 14 patients, mean 48 years, treated in a non-weight-bearing plaster cast. 12 patients, mean age 45 years, treated with immediate weight-bearing in a ‘rigid’ orthosis. 14 patients, mean age 51 years, treated with immediate weight-bearing in a ‘flexible’ orthosis. Mean and maximum peak planter pressures within the forefoot and heel were measured using in-shoe pressure pads two weeks after removal of the cast/orthosis; five gait cycles were recorded. The terminal stance and pre-swing phases were also measured as a proportion of the total stance phase of the gait cycle. One-way ANOVA was used to compare the difference in means between the groups. The normal control group had less than 2% difference between the limbs on all of the measured parameters. The patients in the plaster cast and ‘rigid’ orthotic groups had significant deficits (p = 0.04 and < 0.001 compared to control) in mean peak forefoot pressures, implying weakness in the triceps surae. However, the patients in the flexible orthosis group had only an 11% deficit (p = 0.25 compared to control). All of the patients treated for a TA rupture had increased heel pressures but only the ‘rigid’ orthotic group had cadence abnormalities (p = < 0.001). This may be the result of abnormal motor patterns secondary to mobilising in the rigid orthosis. This study highlights the gait abnormalities associated with triceps surae weakness following rupture of the TA. Accelerated rehabilitation using weight-bearing orthotics may alleviate some of these problems, but new designs for flexible orthotics may be required for maximum benefit

Background: Non-operative treatment for plantar fasciitis varies widely and includes the use of night ankle-foot orthoses (AFO’s). Some studies have shown that this is more effective in the initial management of plantar fasciitis than anti-inflammatory therapy. During sleep the foot and ankle tend to assume a plantarflexed position, which results in tightness of the calf muscle group, accounting for the stiffness and pain experienced by patients as they take their first weight bearing steps in the morning. However, when the foot and ankle are kept in a dorsiflexed stretched position at night, stress relaxation occurs and the plantar fascia relaxes. Aim: Compliance with night AFO’s that dorsiflex the foot/ankle has always been a problem. This study compares the effectiveness of a posterior AFO, which dorsiflexes the foot, with an anterior AFO, which maintains the foot in plantigrade, asking whether it is absolutely necessary to dorsiflex the foot and ankle during the night to avoid early morning pain and stiffness, or whether it is it sufficient just to maintain the foot in plantigrade. Methods: 18 participants were recruited on a voluntary basis and at random from among those patients referred to the Orthotics department with plantar fasciitis to be provided with a night orthosis. The inclusion criterion was that the diagnosis was purely plantar fasciitis with no secondary diagnosis, symptoms or complications. Each participant was given a questionnaire to fill in; this evaluated how satisfied the participants were with the orthosis with regards to comfort, ease of use and appearance, and whether the pain in the foot was reduced and at what stage was it reduced. The two types of AFO’s used in this study were:. A posterior AFO that holds the foot in dorsiflexion. The amount of dorsiflexion could be adjusted. An anterior AFO that keeps the ankle and foot in plantigrade, with no adjustment to the amount of dorsiflexion. Results: 67% of the participants confirmed that morning pain and stiffness was less after wearing the AFO; this included 78% of those that wore the anterior AFO and 56% of those that used the posterior orthosis. 56% of all participants reported that the orthoses were uncomfortable and disrupted sleep. The most uncomfortable was the posterior AFO (89%), as opposed to the anterior one (22%). Both types of orthoses were reported to be relatively easy to don and doff (89% anterior AFO and 78% posterior AFO). On a scale of 1 to 10, the participants were asked to grade the pain before starting the orthosis treatment regime, after 6 weeks of wearing the AFO and again 6 weeks later. On average, the anterior AFO reduced the pain from 7 to 2.1, while the posterior orthosis only reduced the pain from 8.1 to 6.7. Conclusion: In general, plantar fasciitis night AFO’s are poorly tolerated orthoses, however, their use can be justified in that the pain levels are reduced. The anterior AFO seems to be more effective in achieving this, without dorsiflexing the foot/ankle beyond plantigrade. Thus, one could argue that there is no need to dorsiflex to achieve the goal. However, further investigation is necessary with a larger patient cohort

The August 2015 Foot & Ankle Roundup. 360 . looks at: Is orthosis more important than physio in tibialis posterior deficiency?; Radiographic evaluation of ankle injury; Sciatic catheter quite enough!; A fresh look at avascular necrosis of the talus; Total ankle and VTE; Outcomes of posterior malleolar fracture; Absorbable sutures in the Achilles tendon; Lisfranc injuries under the spotlight

Introduction: A comparison of the success of the thoracolumbosacral orthosis (TLSO) and the Providence orthosis in the treatment of adolescent idiopathic scoliosis (AIS) using the new Scoliosis Research Society’s (SRS) Committee on Bracing and Nonoperative Management inclusion and assessment criteria for bracing studies. Methods: A retrospective study of brace patients with AIS between 1992 and 2004. We have used a custom TLSO (22 hour/day) and the Providence orthosis (8–10 hour/night) to control progressive curves. A total of 83 patients met the new inclusion criteria: 10 years of age and older at initiation of bracing; initial curve of 25 to 40 degrees; Risser sign 0–2; females, premenarchal or less than one year post menarchal; and no prior treatment. There were 48 patients in the TLSO group and 35 in the Providence group. The new SRS assessment criteria of effectiveness included the percentage of patients who had 5 degrees or less and 6 degrees or more of curve progression at maturity; the percentage of patients whose curve progressed beyond 45 degrees; the percentage of patients who had surgery recommended or undertaken; and a minimum of two years of follow-up beyond maturity in those patients who were felt to have been successfully treated. All patients are analyzed irregardless of compliance (“intent to treat”). Results: There were no significant differences in age at brace initiation, initial primary curve magnitude, gender, or initial Risser sign between the two groups. In the TLSO group, only 7 patients (15%) did not progress (5 degrees or less), while 41 patients progressed 6 degrees or more (85%), including 30 patients that exceeded 45 degrees. Thirty-eight patients (79%) ultimately required surgery. In the Providence group, 11 patients (31%) did not progress, while 24 patients (69%) progressed 6 degrees or more, including 15 patients that exceeded 45 degrees. Twenty-one patients (60%) required surgery. However, when the initial curve at initiation of bracing was 25 to 35 degrees, the results improved. Five of 34 patients (15%) in the TLSO group and 10 of 24 patients (42%) in the Providence group did not progress, while 29 patients (85%) and 14 patients (58%) progressed 6 degrees or more and 26 patients (76%) and 11 patients (46%) required surgery, respectively. Conclusions: Using the new SRS criteria, the Providence orthosis was more effective for avoiding surgery and preventing curve progression than the TLSO when the primary initial curves were 35 degrees or less. However, the overall success in both groups was inferior to previous studies. Our results raises the question of the effectiveness of orthotic management in AIS and supports the need for a multicenter, randomized study utilizing the new SRS inclusion and assessment criteria

The aim of this study is to evaluate the efficacy of the use of the dynamic hip orthosis in subjects who are affected with degenerative hip diseases, even those who are waiting for a total hip replacement, and in subjects who had undergone a hip replacement because of a proximal femur fracture. For each patient we’ve prepared a card in which we’ve reported personal data, comorbidities, pharmacological and rehabilitative treatments, VAS, WOMAC, Barthel Index, GDS and a evaluation of the compliance. We’ve evaluated those patients periodically. Until now, and considering the follow up is not ended, we can say that the dynamic hip orthosis can be addressed to patients with mild to moderate hip osteoarthritis and in elderly who’ve been undergone surgery for a proximal femur fracture because it reduces pain, it facilitates a safer gait and it accelerates the functional recovery. However it is important the dynamic hip orthosis to become a part of an individualized rehabilitative project

The June 2015 Research Roundup360 looks at: Tranexamic acid: just give it – it’s not important how!; The anterolateral ligament re-examined; Warfarin a poor post-operative agent; Passive exoskeleton the orthosis of the future?; Musculoskeletal medicine: a dark art to UK medical students?; Alendronic acid and bone density post arthroplasty; Apples with oranges? Knee functional scores revisited

Purpose: A retrospective study to determine the causes of failure of the Ponseti technique and treatment for those failed feet. Materials and Methods: Eighty-nine patients with 136 clubfeet were treated by the Ponseti technique and evaluated on the Dimeglio/Bensahel and Catterall/ Pirani scoring systems. Six patients with 9 clubfeet were not corrected and therefore did not enter the dynamic ankle-foot orthosis stage. These 6 patients started treatment after the age of 8 months, except for one patient who was 9 weeks old at the start of treatment. Of these 9 feet, 8 underwent open Achilles tendon releases combined with posterior releases. Three of these feet had percutaneous Achilles tenotomies prior to their failure and 1 foot underwent complete soft tissue clubfoot releases. Eighty-three patients (127 clubfeet) completed the Ponseti technique. Eighteen patients with 28 club-feet were lost to 2-year follow-up (Group A), and 65 patients with 99 clubfeet (78.3%) had a greater than 2-year follow-up (Group B). Results: Nine out of a total of 136 clubfeet failed the Ponseti technique. At 2-year follow-up, one-third (29/99) required additional procedure(s). At application of the dynamic ankle-foot orthosis in Group B, patients’ rating scores were similar. However, after 2-year follow-up, the noncompliant group’s scores (no orthosis) changed significantly for the worse when compared to the compliant group’s scores who used the orthosis for 2 years. After 2-year follow-up, Group B patients in the orthosis-compliant group had better scores than the 2-year failures (29 feet) who underwent further surgery and the initial 9 feet who failed the Pon-seti technique

The MediShoe (Promedics Orthopaedics Ltd, Glasgow) is a specific post-operative foot orthosis used by post-operative foot and ankle patients designed to protect fixations, wounds and maximise comfort. The use of rigid-soled shoes has been said to alter joint loading within the knee and with the popular use of the MediShoe at our centre in post operative foot and ankle surgery patients, it is important to ascertain whether this is also true. An analysis of the knee gait kinetics in healthy subjects wearing the MediShoe was carried out. Ten healthy subjects were investigated in a gait lab both during normal gait (control) and then with one shoe orthosis worn. Force plates and an optoelectronic motion capture system with retroreflective markers were used and placed on the subjects using a standardised referencing system. Three knee gait kinetic parameters were measured:- knee adduction moment; angle of action of the ground reaction force with respect to the ground in the coronal plane as well as the tibiofemoral angle. These were calculated with the Qualisys software package (Gothenburg, Sweden). A two-tailed paired t-test (95% CI) showed no significant difference between the control group and the shoe orthosis-fitted group for the knee adduction moment (p = 0.238) and insignificant changes with respect to the tibiofemoral angle (p = 0.4952) and the acting angle of the ground reaction force (p = 0.059). The MediShoe doesn't significantly alter knee gait kinetics in healthy patients. Further work, however is recommended before justifying its routine use

The June 2013 Children’s orthopaedics Roundup. 360 . looks at: whether reaching a diagnosis is more difficult than previously thought; adolescent and paediatric DDH; the A-frame orthosis and Legg-Calvé-Perthes’ disease; failure of hip surgery in patients with cerebral palsy; adolescent rotator cuff injuries; paediatric peripheral nerve injuries; predicting residual deformity following Ponseti treatment; and the Dunn procedure.

The efficiency of brace treatment for adolescent idiopathic scoliosis is correlated to how the brace has been worn. A smart orthosis was developed to maintain the interface pressure between the brace and the body within the prescribed range during daily activity. Six patients with scoliosis, with Cobb angles of 31 +/− 5 degrees, who were new brace candidates were recruited. They used the system for four weeks: two weeks with monitoring only and two weeks with an automatic feedback activated. The time that the pressure level was in target level range during the study period was increased from 53 +/− 9% to 68 +/− 14% with the feedback activated. This work helps brace candidates wear their braces more effectively and receive the most benefit from the brace treatment. As a result, all subjects who participated in the study maintained their Cobb angles within + two degrees during the study period. Brace correction based upon mechanical action requires appropriate interface pressure between the body and the brace. A smart orthosis was developed to record how much time (quantity) a brace was worn, how well (quality) it was used and how well the interface pressure was maintained to the prescribed level. Six subjects were recruited and they all were fitted with Boston style braces. Each subject wore the brace for 2 weeks without the force maintenance system activated to serve as the control period, and the remaining 2 weeks with the force maintenance system activated. During the automatic feedback mode, the pressure maintenance system was activated only during the daytime hours (8:00–22:00hrs) to avoid disturbing the patients during sleep. The subject could either return the system to us after 1 month or continue to use the system until the next clinic. The time that the pressure level was in the target level range during the study period was increased from 53 +/− 9% to 68 +/− 14% with the feedback activated. The average brace wear time for the study period was 72 +/− 15% (12.6hr/day) of the prescribed time (17.5 +/− 3.8 hours). The curve severity of all subjects on the following clinical visit was the same (within measurement error) as the first visit (32 +/− 5 vs 31 +/− 5 degrees). Compliance was not affected when wearing the monitor. The smart orthosis was able to improve the efficiency of a conventional brace by maintaining the prescribed interface pressure automatically. This project helps brace candidates wear their braces more effectively and gets the most benefit from the brace treatment. As a result, all participating subjects maintained their Cobb angle within +/− 2 degrees during the study period

Aim: To compare the radiological and functional outcomes of compression type thoracolumbar vertebral fractures treated with cloth-type thoracolumbar orthosis fitted with steel plates and bed rest. Methods: This prospective comparative study was done between July 2004 and January 2007. Twenty three patients (17 male, 6 female) with compression type (Magerl A1) thoracolumbar vertebral fractures were included. No patient had associated neurogical findings or additional injury. Eleven patients were treated with cloth-type thoracolumbar orthosis and 12 patients with only bed rest. Bed rest group cases were instructed to stand up and walk around as possible as they tolerated after pain relief just only in the house under the supervision of it’s relates. All cases were evaluated at last follow-up with SF-36 questionaire, clinical and radiological examination. Results: There was no significant difference between two groups with regard to demographic data. Radiological parameters including anterior compression angle, local kyphosis angle, sagittal index and anterior vertebral height were measured and compared on initial admittion, on the third month and at the last visit showing no significant difference (p> 0.05). Clinical evaluation was performed via work and pain criteria described by Denis. We found no significant difference between both groups for functional criteria (p> 0.05). Mental and physical points of SF-36 questionaire were recorded and compared dispaying no difference (pmental=0.15, pphysical=0.44). Conclusion: Magerl type A1 thoracolumbar fractures can be treated via bed rest by allowing controlled ambulation in home without bracing. This functional therapy can prevent complications due to absolute bed rest or related to bracing. However patient’s cooperation is the most important factor while choosing functional therapy