AIMS:Charcot Foot (CF) is a neuropathy-induced condition that can lead to fractures and dislocation, warranting long-time offloading in total contact cast (TCC). It is unknown whether CF or its treatment increases the risk of venous thromboembolism (VTE). This study aims to retrospectively investigate the risk of VTE in people with CF during and after treatment. METHODS:Individuals with diabetes mellitus and active CF treated with TCC at Skåne University Hospital (Lund and Malmö, Sweden) were screened for inclusion in a retrospective cohort study. Baseline characteristics and occurrences of VTE were retrieved using medical records. Causes of death were retrieved from the National Cause of Death Register. RESULTS:209 individuals with 241 CF episodes were included and followed for 6.8 (3.8-11) years. No VTE was diagnosed during TCC treatment. Two individuals (0.96%) developed VTE after uncasting but before discharge (86-157 days after uncasting; while using boot and orthotic walker, respectively), whereas the other eight individuals (3.8%) had VTE diagnosed after end of CF treatment and follow-up. Hemodialysis was associated with increased VTE risk after CF diagnosis (HR 13 [3.25-50], p < 0.001, accounting for all observed VTE occurrences). CONCLUSION:No VTE occurred during TCC treatment, whereas the risk of VTE during the entire CF treatment period was 0.96%.
INTRODUCTION:Children's developing musculoskeletal systems are highly sensitive to mechanical stimuli. This study investigated the effects of running shoe midsole hardness (MH) (soft midsole [SM], medium midsole [MM], and hard midsole [HM]) on lower-limb biomechanics and muscle activation during the running stance phase in children. METHODS:Thirty healthy boys participated. Kinematic, kinetic, electromyographic, and navicular height (NH) data were collected during running. Differences across the three hardness conditions were analyzed using one-way repeated-measures ANOVA. RESULTS:Maximum ankle sagittal angle decreased from 29.12° (SM) to 27.11° (HM) (p = 0.008), and hip sagittal range of motion (ROM) decreased from 43.06° (SM) to 39.66° (HM) (p = 0.047). NH was significantly higher under MM (12.48 mm) and HM (12.93 mm) than under SM (10.92 mm) (both p < 0.001). Vertical average loading rate (VALR) was significantly higher in HM (64.18 BW/s) than SM (53.14 BW/s; p = 0.032). Regarding muscle activation, significant main effects of MH were observed for the relative contributions of the tibialis anterior (TA), lateral gastrocnemius (LG), and semitendinosus (ST) (p = 0.046, p = 0.010, and p = 0.011, respectively). Post hoc comparisons showed that TA and LG contributions were lower under HM than under SM, whereas ST contribution was higher under HM than under SM and MM. Gluteus maximus (GM) activation (0.38) and relative contribution (17.5%) were highest under MM, with a significant main effect of MH (p = 0.002). CONCLUSIONS:Midsole hardness altered selected lower-limb kinematics, navicular height, vertical loading rate, and muscle activation during running in children; however, these acute differences do not indicate functional superiority of any of the tested hardness conditions.
BACKGROUND:Diabetic foot ulcers (DFUs) are a serious complication of diabetes, with a lifetime risk of up to 34%. Despite preventive guidelines, gaps remain in the care chain. This study aimed to identify and prioritise improvements in DFU prevention, care, and self-care in the Region Västra Götaland, Sweden. METHODS:A participatory action research design was used as part of a larger observational co-design study. Patients with diabetes, healthcare professionals, and researchers participated. Data were collected through Concept Mapping to generate and cluster ideas, followed by a workshop to prioritise improvements. The improvements were assessed regarding feasibility and importance ranging from 0 to 7, with exceptions that some participants scored ideas > 7. RESULTS:Thirty-one participants contributed and based on 83 ideas five clusters were generated: (1) Examination of the feet by healthcare professionals, (2) Exchange of knowledge/Exchange of experiences, (3) Access to podiatry, (4) Economy/Equal care, and (5) Other/Support for self-care. In a workshop with 22 participants, the three prioritised ideas were: (1) Having access to podiatry if problems occur, (2) Getting help when problems arise, and (3) Information from the healthcare about the importance of good foot healthcare. These ideas got 80% or more of all votes within each of the five clusters and were scored > 5 for feasibility and of > 7 for importance. Other prioritised ideas involved enhancing individual self-care capabilities and maintaining personalised interactions despite digitalisation. CONCLUSIONS:Timely access to podiatry, increased foot health awareness among healthcare professionals, and rapid intervention when problems arise were identified as key priorities for improving DFU care and patient outcomes.
PURPOSE:This study investigated foot muscle and plantar fascia size measurements and their relationship with static balance dysfunction in stroke patients. METHODS:This cross-sectional study included 90 stroke patients (3-12 months post-stroke) and 95 healthy controls. Ultrasound imaging quantified thickness and cross-sectional area (CSA) of intrinsic foot muscles (e.g., flexor hallucis brevis), extrinsic foot muscles (e.g., tibialis anterior, peroneus longus), and plantar fascia segments. Force platform measured center-of-pressure (CoP) parameters during 30-s static standing under eyes-open and eyes-closed conditions. RESULTS:Stroke patients exhibited significantly reduced peroneus longus (d = 1.14, p < 0.001) and tibialis anterior (d = 0.70, p < 0.001) muscle sizes, reduced flexor hallucis brevis muscle thickness (d = 0.76, p < 0.001), and increased plantar fascia thickness in middle and posterior segments (d = 0.74, p < 0.001; d = 0.71, p < 0.001). In healthy controls, foot muscle parameters strongly correlated with balance metrics, with flexor hallucis brevis thickness showing significant correlation with mediolateral displacement under eyes-closed conditions (r = -0.52, p < 0.001). However, no significant correlations between structural parameters and balance metrics were observed in stroke patients after false discovery rate correction, indicating structural-functional dissociation. CONCLUSION:Although stroke patients exhibited mixed size changes in foot-ankle structures, the dissociation between structural changes and balance function suggests that dysfunction is primarily attributable to central nervous system damage rather than to peripheral structural alterations. This implies that rehabilitation should focus on neuromuscular control training rather than on isolated muscle strengthening.
INTRODUCTION:Up to one in two individuals who have a history of an ankle injury will develop chronic ankle instability, which subsequently increases the risk of osteoarthritis development. Although lateral ankle ligament injuries are the most common, recent research shows that concomitant injuries to the deltoid (medial collateral) ligament complex may be more prevalent than previously recognised. However, the anatomy and biomechanics of the deltoid ligament complex are reported inconsistently in the literature. This systematic review will summarise current evidence on the anatomy and biomechanics of the deltoid ligament complex in healthy adult ankles. METHODS:Searches will be conducted in Scopus, MEDLINE, Embase, CINAHL and SPORTDiscus. Our search strategy will cover terms associated with 'deltoid ligament', 'anatomy' and 'biomechanics'. We will only include dissection and imaging studies published in English that report any of the listed clinically relevant properties of the deltoid ligament in healthy adult human ankles. Two reviewers will independently perform screening and assess study quality using the anatomical quality assessment (AQUA) tool. One reviewer will extract relevant data, which will be independently verified by co-authors. Primary outcomes include band prevalence, length, width, cross-sectional area, maximum and/or failure load and elastic modulus. If three or more studies report a primary outcome, we will conduct a meta-analysis and report findings as pooled means with 95% confidence intervals. If a meta-analysis is not feasible, outcomes will be summarised as a narrative analysis. Measures will be taken during data synthesis to address anticipated methodological heterogeneity across included studies, and pooled estimates will be interpreted with caution. DISCUSSION:This protocol details a systematic review that aims to summarise the anatomy and biomechanics of the deltoid ligament complex. Our findings will inform computational modelling, clinical management and biomechanics for ankle pathologies, as well as identifying research gaps and directions for future research. TRIAL REGISTRATION:PROSPERO: CRD420251142867.
