Hintergrund: Material und Methoden: Ergebnisse: Schlussfolgerung: Background: Material and Methods: Results: Conclusion:

BACKGROUND:Therapeutic climbing had been used successfully as an intervention in orthopedic-traumatologic, neurologic, psychomotoric and congenital or chronic diseases. The aim of this abstract is to give an overview of the existing literature on this new form of therapy. This could also aid in assessing the methodology and work out future research directions.MATERIAL AND METHODS:National and international databases within the medical field (Evidence Based Medicine Reviews, PubMed …) have been searched for German and English articles that dealt with climbing in a therapeutic context.RESULTS:Only a limited amount of scientific investigations regarding the effects of therapeutic climbing were found. Evidence for the effectiveness of this form of climbing was only found in the field of orthopedics. Other published results were field reports or individual case studies which did not make any reliable statements/conclusions.CONCLUSION:Based on the current review, therapeutic climbing cannot be wholly recommended as an interventional method. However, this should not be interpreted as a refusal to use therapeutic climbing as an intervention. The use of systematic analysis in studying the general effects of climbing movements as well as comparisons to classical interventional methods is necessary. Further approaches to this research study will be given.

INTRODUCTIONExcessive loading of the plantar surface of the foot has been considered as a possible cause for overuse injuries in soccer. The question arises whether this excessive loading may be reduced by the use of cushioning insoles in a soccer shoe.AIMTo evaluate the influence of a controlled aging process on the loading pattern of the foot inside a soccer shoe.MATERIALS AND METHODS11 experienced soccer players wore a soccer shoe for one year on a regular basis during training sessions and games. After this period, three different aging conditions (old shoe with old insole, old shoe with new insole and new shoe with new insole) were tested during different soccer specific movements regarding plantar loading characteristics using an insole pressure distribution system (Pedar, Novel GmbH, Munich).RESULTSThe comparison between the three different aging conditions showed no consistent results for the parameters peak pressures and relative loads for 10 different foot areas. A trend towards slightly reduced peak pressures was found for characteristic loading zones during side-cutting and kicking. On the other hand, slightly increased peak pressures were found during running and sprinting after using a new insole or a new shoe. No consistent results were found for the relative loads between conditions.DISCUSSIONThe hypothesis of a load reduction after introducing a new insole or a new shoe could not be confirmed. The aging process appears to be influenced by different factors like material properties, form changes or individual adaptation processes.

Background: If conservative therapy fails, the standard treatment for chronic ankle instability is surgical reconstruction of the lateral ligaments. For the last seventy years, the tenodesis principles have been used for reconstruction. Recently however, surgical reconstructions-respecting the intact joint anatomy-have been developed, thus called “anatomical reconstruction principles”. Methods: This study focused on the investigation of the range of motion of the ankle and the subtalar joint following anatomical reconstruction surgery. Three different types of anatomical reconstruction procedures were compared: Direct ligament repair, tendon graft and carbon-fiber implant. Results: All procedures restored the original range of motion of the subtalar joint, except for the plantarflexed/dorsiflexed positions. As for the talocrural joint, the tendon graft and the carbon fiber implant left a small laxity for movements of inversion/eversion and internal/external rotation. The direct repair procedure achieved a more accurate result and restored the physiologic kinematics almost completely. During each procedure the insertion points and the direction of the original ligaments were maintained. However, the different results for the procedure of direct ligament repair compared to the other two anatomical reconstruction procedures showed that this condition alone is not sufficient to perfectly restore the kinematics of the talocrural and subtalar joints. It is important to note that none of the procedures caused a restriction of the range of motion. Conclusions: The maintenance of the range of hindfoot motion decreases the risk of osteoarthritis as well as chronic pain or problems for the patient to walk on uneven surface. Therefore, we believe that standard therapy for chronic instability of the ankle should include direct surgical reconstruction of the ligaments. If this direct procedure cannot be performed because of poor quality of the ligaments an alternative anatomical reconstruction procedure should be considered.

The aim of this study was to investigate the influence of reduced plantar sensation on gait patterns during walking in 20 healthy subjects (25.9±1.2 years, 61.6±11.5 kg, 178±9.5 cm) with no history of sensory disorders. Force plate measurements, electromyography (EMG) measurements and a three-dimensional movement analysis were performed simultaneously during barefoot walking before and after reduction of plantar sensation using an ice immersion technique. The results show that reduced plantar sensation leads to significant changes in gait patterns that are present at the ankle, knee and hip joint and indicate a more cautious ground contact and push-off with modified EMG and motion patterns.

Background Stress fractures are common overuse injuries in runners and appear most frequently in the metatarsals. Purpose To investigate fatigue-related changes in surface electromyographic activity patterns and plantar pressure patterns during treadmill running as potential causative factors for metatarsal stress fractures. Study Design Prospective cohort study with repeated measurements. Methods Thirty experienced runners volunteered to participate in a maximally exhaustive run above the anaerobic threshold. Surface electromyographic activity was monitored for 14 muscles, and plantar pressures were measured using an in-shoe monitoring system. Fatigue was documented with blood lactate measurements. Results The results demonstrated an increased maximal force (5%, P < .01), peak pressure (12%, P < .001), and impulse (9%, P < .01) under the second and third metatarsal head and under the medial midfoot (force = 7%, P < .05; pressure = 6%, P < .05; impulse = 17%, P < .01) toward the end of the fatiguing run. Contact area and contact time were only slightly affected. The mean electromyographic activity was significantly reduced in the medial gastrocnemius (-9%, P < .01), lateral gastrocnemius (-12%, P < .01), and soleus (-9%, P < .001) muscles. Conclusion The demonstrated alteration of the rollover process with an increased forefoot loading may help to explain the incidence of stress fractures of the metatarsals under fatiguing loading conditions.

The aim of the present investigation was to evaluate the stabilizing effect of 10 different ankle braces during simulated inversion on a tilting platform. Twenty-five subjects participated in the study (23 +/- 3 yrs, 71 +/- 12 kg, 177 +/- 9 cm). Ten commercially available ankle braces and a trapdoor in combination with a goniometer system that measured hindfoot inversion inside the shoe were used. Inversion was subdivided into a free fall and a maximum inversion phase. Results showed that all braces restricted inversion significantly between 51% and 15% compared to the no-brace condition but distinct differences between models were found. Maximum inversion angle and inversion velocity were lower for those braces that restricted inversion most effectively during the free fall phase. Reaction times of the peroneus longus did not appear to influence the degree of inversion. Relatively constant differences between free fall and maximum inversion angles for all models (between 6 degrees and 10 degrees) and a high correlation between these two parameters suggests that the main function of ankle braces is to restrict inversion during the free fall phase and not at the extremes of motion.

The aim of the present study was to investigate the influence of reduced plantar sensation on pressure distribution patterns during gait of 40 healthy subjects (25.3±3.3yr, 70.8±10.6kg and 176.5±7.8cm) with no history of sensory disorders. Plantar sensation in the subjects was reduced by using an ice immersion approach, and reduced sensitivity was tested with Semmes–Weinstein monofilaments. All subjects performed six trials of barefoot walking over a pressure distribution platform under normal as well as iced conditions. Plantar cutaneous sensation was significantly reduced after the cooling procedure (p<0.0001). Pressure distribution analysis showed substantially modified plantar pressure distribution patterns during the roll-over process (ROP) under iced conditions. Analysis of peak pressures revealed significant reductions under the toes and under the heel (p<0.001). The contact time and the relative impulse for the whole foot did not change significantly between the two conditions. For the different areas, a significant load shift from the heel and toes towards the central and lateral forefoot and the lateral midfoot was observed. The results indicate the strong influence of reduced afferent information of the sole of the foot on the ROP in walking.

In order to assess the changes in talocrural joint contact stress after rotationplasty, 10 lower-leg cadaver specimens were axially loaded with 600 N and investigated in two loading situations: (1) Normal loading with a plantigrade foot; (2) in an equinus position of a simulated rotationplasty. Joint contact stress in the talar facet of the talocrural joint was determined with Fuji Prescale film cut to size and analyzed with digital image analysis for joint contact area, mean and peak pressure, contact force, and location of the load application on the trochlea tali. The results demonstrate a significant transfer on the loading zone to the posterior part of the talus (p = 0.005), a significant reduction of the contact area (p = 0.005) and force (p = 0.005), and a significant increase of the mean (p = 0.022) and maximum pressures (p = 0.013). These results indicate that the rotationplasty causes pronounced changes in joint loading characteristics.

Objective. The aim of the present investigation was to test the stability of 10 different ankle braces under passive and rapidly induced loading conditions in a population suffering from chronic ankle instability in order to provide objective information to choose or recommend an appropriate model for specific needs. In addition, the relationship between passive and rapidly induced testing of the stabilizing effect against inversion was evaluated to identify if passive Support characteristics of braces are reflected under rapidly induced conditions.Design. An experimental in vivo study with a repeated-measures design was used.Background. Ankle braces are commonly used for treatment, rehabilitation, and prevention of ankle injuries. A variety of products exists but there is few information available to assist clinicians, physiotherapists and coaches as well as consumers in choosing a brace on a basis of objective information. Furthermore, there is a lack of studies that provide data for both passively and rapidly induced movement of the ankle joint when using different ankle braces.Methods. Twenty-four subjects with chronic ankle instability participated in the project. Passive ankle range of motion measurements were performed in a custom-built fixture and simulated inversion sprains were elicited on a tilting platform.Results. The tested braces restrict range of motion significantly compared to the no-brace condition for both the passively and rapidly induced inversion and marked differences between braces were revealed. A close relationship between passive and rapidly induced test results for inversion was found.Conclusions. Passive as well as rapidly induced stability tests provide a basis of objective information to describe the characteristics of different ankle braces. Combined results of passive and rapidly induced inversion as well as correlation between results demonstrate that passive support characteristics of braces are reflected under rapidly induced conditions but the amount of restriction is reduced. Therefore, caution should be taken when recommending braces for applications under dynamic circumstances only on the basis of passive support characteristics.

PURPOSE:The aim of the present study was to investigate the effects of a 6-wk multi-station proprioceptive exercise program that is easy to integrate in normal training programs.METHODS:Patients with chronic ankle instability were used, and results of three testing procedures before and afterward were compared: joint position sense, postural sway, and muscle reaction times to sudden inversion events on a tilting platform. A total of 30 subjects with 48 unstable feet were evaluated (exercise group: N = 31; control group: N = 17).RESULTS:In the exercise group, the results showed a significant improvement in joint position sense and postural sway as well as significant changes in muscle reaction times.CONCLUSION:Based on the present results, a multi-station proprioceptive exercise program can be recommended for prevention and rehabilitation of recurrent ankle inversion injuries.

Plantar pressure distribution in Inline skating on straights was measured with a flexible insole in 13 experienced subjects at a speed of 18 and 24 km/h. The results showed three areas that were exposed to high pressures, i.e. the heel with 258 and 265 kPa, the first metatarsal head with 265 and 281 kPa, the hallux with 319 and 324 kPa at 18 and 24 km/h, respectively. All other areas showed peak pressures that were less than half of these values. Lowest values were found in the midfoot area. Changing speed from 18 to 24 km/h led to a small increase of peak pressures in all areas. Peak pressures were comparable to walking but showed the trend to be lower than in running.