Objective: The aim of this study is to evaluate muscle changes in stroke patients by assessing muscle diameter and muscle quality using ultrasonography. Materials and Methods: Forty male stroke patients and forty healthy male volunteers who fulfilled the predefined criteria were enrolled in the study. The patient group was evaluated with the Brunnstrom Lower Extremity Motor Evaluation, the Modified Ashworth Scale, the Functional Independence Measure, and the Functional Ambulation Scale. Diameter measurements of the quadriceps femoris muscle, were taken with B-mode ultrasonography, and shear wave elastography (SWE) values were recorded for both groups. Results: Stroke patients' quadriceps femoris muscle diameter was significantly lower than that of controls (p<0.001), while SWE measurements exhibited no significant difference (p>0.05). Subgroup analysis based on stroke duration revealed lower diameter measurements in acutesubacute and chronic stroke patients compared to controls (both p<0.001), with no difference between stroke groups (p>0.05). Similarly, regardless of ambulation status, stroke patients had significantly lower quadriceps femoris muscle diameter than controls (p<0.001), with no disparity between ambulation groups (p>0.05). There was no significant difference in the groups' SWE measurements (p>0.05). Conclusion: These results suggest a decrease in muscle thickness without deterioration in muscle quality. At this point, we believe that simultaneous evaluation with B-mode ultrasonography and elastography during ultrasonographic assessment of muscle changes will provide more objective results. This approach may help us more accurately understand the relationship between the quality and quantity of muscle tissue.

Objective: A scale to evaluate knowledge about lymphedema has not been found in the Turkish literature before. With this study, it was aimed to develop a scale that enables the evaluation of the level of knowledge of healthcare personnel on lymphedema management. Materials and Methods: The permission for this methodological study was obtained from the Ethics Committee of University Faculty of Medicine with protocol 31 number 1453. Application permission was obtained from University Rectorate Practice and Research Hospital Chief Physician. With literature review, the item pool of the Lymphedema Management Knowledge Scale, consisting of 35 45 items including the headings of ”etiology, diagnosis, treatment, and lifestyle”, was organized. For 36 the evaluation of the scale, opinions of 16 faculty members who are experts in the field of Physical Therapy and Rehabilitation were consulted. Results:In our study, lymphedema management was gathered under four main headings and a conceptual framework was created, and it was seen that it was appropriate to evaluate all the questions in one dimension after the construct and reliability validity analyses. The scale is suitable for real life and easy to apply in terms of the questions it contains. Conclusion: With this Lymphedema Management Information Rapid Assessment Scale, which was developed by reviewing the literature and taking expert opinions, the quality of counselling services provided to lymphedema patients will be raised, and the rise in protective measures will increase the quality of life of the patients

OBJECTIVES:Carpal Tunnel Syndrome (CTS) is the most common peripheral nerve compression syndrome. This study aims to evaluate the additive contribution of phonophoresis and low-level laser therapy (LLLT) to tendon and nerve gliding exercises electrophysiologically, ultrasonographically, and clinically in the treatment of moderate CTS. METHODS:The sample consisted of 45 patients with moderate CTS, randomized into three groups. Group 1 received phonophoresis and exercise, Group 2 received LLLT and exercise, and Group 3 received exercise alone. Participants were evaluated electrophysiologically, clinically, and ultrasonographically before treatment and at the 6th and 12th weeks after the treatment. RESULTS:An improvement was observed in clinical parameters (Boston Functional Status Scale, Boston Symptom Severity Scale, visual analog scale at rest, and visual analog scale during activity) for all groups at the 6th and 12th weeks after the treatment (p<0.05). An improvement was also noted in the ultrasonographic parameter (cross-sectional area) for all groups at the 12th week after the treatment (p=0.017). CONCLUSION:Phonophoresis and LLLT do not provide additional effects to exercise therapy. Exercise therapy alone may positively contribute to ultrasonographic and clinical outcomes in the treatment of moderate CTS.

Objectives:The purpose of the study was to contribute further to this debated topic by investigating the correlation of magnetic resonance imaging (MRI) findings with the clinical picture in lumbar spondylosis patients. Patients and methods:This multicenter retrospective study (as part of the epidemiological project of the TLAR-OASG [Turkish League Against Rheumatism-Osteoarthritis Study Group]) included 514 patients (101 males, 413 females; mean age: 63.6±10.8 years; range, 40 to 85 years) who were diagnosed as lumbar spondylosis by clinical examination and direct X-ray between December 2016 and June 2018. Demographic characteristics of patients, Visual Analog Scale for pain, presence of radiating pain, Roland-Morris disability questionnaire, straight leg raise test, deep tendon reflexes, neurogenic intermittent claudication symptoms, any decrease of muscle strength, and abnormality of sensation were recorded. Lumbar MRI findings of the patients were recorded as positive or negative in terms of disc herniation, intervertebral disc degeneration, root compression, osteophytes, spinal stenosis. Statistical analysis was done to assess the correlation between the clinical symptoms, physical examination, and MRI findings. Results:Correlation analysis of the MRI results and the clinical findings showed a significant correlation between straight leg raise test and root compression (p<0.001, r=0.328) and a significant correlation between neurogenic intermittent claudication and spinal stenosis (p<0.001, r=0.376). Roland-Morris disability questionnaire had a significant correlation with all MRI findings (p<0.05, r<0.200). Conclusion:The results of this study corroborate the notion that diligent patient history and physical examination are more valuable than MRI findings, even though a higher incidence of abnormal MRI findings have been obtained in patients with disability and dermatomal radiating pain.

To determine the relationship between plantar pressure values of patients with ankylosing spondylitis (AS) and clinical and radiological parameters used in the follow-up of the disease. This study was conducted with 75 patients diagnosed with AS. The Ankylosing Spondylitis Quality of Life Questionnaire (ASQoL), the Bath Ankylosing Spondylitis Metrology Index (BASMI), the Bath Ankylosing Spondylitis Functional Index (BASFI], Bath Ankylosing Spondylitis Disease Activity Index (BASDAI), Maastricht AS Enthesitis Score (MASES), Mander Enthesitis Index (MEI), and the thoracic kyphosis angle were recorded. Static and dynamic plantar pressures were recorded in the pedobarographic examinations. Static evaluations in the group with increased kyphosis angle, left forefoot medial pressure, bilateral forefoot midsection pressure, percentages of the total load falling on the forefoot in the feet, and left medial and lateral pressures of the heel were found to be higher than in the normal kyphosis angle group. There was no statistical difference in the dynamic evaluation. Increased BASDAI, BASMI, and BASFI scores were associated with decreased forefoot pressure values and increased hindfoot load. Plantar pressure values were associated with clinical and radiological parameters in patients with AS. Pedobarography seems to be an appropriate tool for evaluating the effect and clinical course of the disease on the foot in patients with AS. Trial registration number NCT05731635/02.07.2023 retrospectively registered.

Aim: Patients with plantar fasciitis modify their gait patterns due to the heel pain. We aimed to investigate whether there was a significant difference in the plantar pressure distribution after pain relief due to successful treatment response in plantar fasciitis. Methods: 49 patients diagnosed with chronic unilateral plantar fasciitis received a 3-week physical therapy intervention and home exercises. Visual analog scale, plantar pressure measurement by pedobarographic assessment and magnetic resonance imaging were performed before and 1 month after the intervention. At the 1-month follow up, participants were divided into 2 groups according to successful or poor response to treatment. The treatment's success criteria was defined as a percentage decrease in heel pain exceeding 60% compared to the baseline, assessed one month after the initiation of treatment. Results: A total of 44 subjects successfully completed the study. In group 1, characterized by successful responders, there were 24 subjects, while group 2, comprising poor responders, included 20 subjects. After treatment in group 1, the dynamic plantar pressure on the medial forefoot showed a significant increase (p = 0.015). However, there was no significant change in plantar pressure in the poor responders. Plantar fascia thickness correlated positively with thumb dynamic pressures (coronal p = 0.03 r = 0.434, sagittal r = 0.451 p = 0.02). Conclusion: The results suggest that fascial thickness and dynamic forefoot plantar pressures may be related. Medial forefoot plantar pressures increased as a result of gait restoration with significant pain reduction in adults.

INTRODUCTION: We aimed to investigate the effects of inhaled corticosteroids (CS) on bone mineral density (BMD), bone formation-resorption markers, and quality of life in premenopausal asthmatic women. METHODS: Premenopausal women diagnosed with asthma and using regular inhaled CS for at least 3 months were included in our cross-sectional study. As the control group, premenopausal women without a diagnosis of asthma and who had not used steroid before were included in the study. Serum bone-specific alkaline phosphatase (BAP), osteocalcin, and β crosslapse levels were evaluated as bone formation-resorption markers. BMD, T and Z scores of lumbar vertebra L2-L4 anterior, left femoral neck, and total hip were measured. The Short Form 36 (SF-36) quality of life scale was used to assess the quality of life. RESULTS: Twenty-two asthmatic patients and 22 non-asthmatic individuals as a control group were included in the study. There was no statistically significant difference between L2-L4 anterior, femoral neck and total hip BMD, T and Z scores, and serum osteocalcin, β crosslaps, and BAP levels between both groups (p>0.05). No statistically significant correlation was found between the duration of inhaled CS use, cumulative inhaled CS dose, and BMD in asthmatic patients (p>0.05). SF-36 quality of life scale pain score was found to be statistically significantly higher in patients with asthma compared to the control group (p<0.05). No significant difference was found in the other subscales of the SF-36 quality of life scale (p>0.05). DISCUSSION AND CONCLUSION: In our study, we did not find the effect of inhaled CS on BMD and bone formation and resorption markers. We did not find any difference between the asthmatic patients and the control group in the sub-parameters of the SF-36 quality of life scale, except for pain. This suggests that inhaled CS may have a positive effect on quality of life in patients with asthma.

Objectives This study aims to evaluate the clinical, functional, and radiological features of hand osteoarthritis (OA) and to examine their relationships in different geographic samples of the Turkish population. Patients and methods Between April 2017 and January 2019, a total of 520 patients (49 males, 471 females; mean age: 63.6±9.8 years) with hand OA were included in the study from 26 centers across Turkey by the Turkish League Against Rheumatism (TLAR). The demographic characteristics, grip strengths with Jamar dynamometer, duration of hand pain (month), the severity of hand pain (Visual Analog Scale [VAS]), and morning stiffness were evaluated. The functional disability was evaluated with Duruöz Hand Index (DHI). The Kellgren-Lawrence (KL) OA scoring system was used to assess the radiological stage of hand OA. Results The DHI had significant correlations with VAS-pain (r=0.367, p<0.001), duration of pain (r=0.143, p=0.001) and bilateral handgrip strengths (r=-0.228, p=0.001; r=-0.303, p<0.001). Although DHI scores were similar between the groups in terms of the presence of hand deformity (p=0.125) or Heberden's nodes (p=0.640), the mean DHI scores were significantly higher in patients with Bouchard's nodes (p=0.015). The total number of nodes had no significant correlations with the VAS-pain and DHI score (p>0.05). The differences between the groups of radiological hand OA grades in terms of age (p=0.007), VAS-pain (p<0.001), duration of pain (p<0.001), and DHI (p<0.001) were significant. There were no significant differences between radiological hand OA grades according to the duration of the stiffness, grip strength, and BMI (p>0.05 for all). Conclusion In our population, the patients with hand OA had pain, functional disability, and weak grip strength. The functional impairment was significantly correlated with the severity of the pain, and the functional status was worse in high radiological hand OA grades.

BACKGROUND:Reducing lymphedema-associated burden and disability in the pediatric setting requires improved awareness and understanding clinical properties of the lymphedema. The aim of this study was to evaluate the clinical and demographic characteristics of patients with pediatric lymphedema presented to different lymphedema centers in Turkey. METHODS:The socio-demographic and clinical characteristics of the children including age, gender, presence of genetic syndromes, duration of edema, site and stage of lymphedema and the received therapies were determined. Parental and children education on self-management techniques were recorded. RESULTS:A total of 122 children (female: 66, male: 56) with a mean age of 120.7 ± 71.2 months were included from 7 centers. Of them; 92% had primary, 8% had secondary lymphedema mostly due to infection and trauma. Lymphedema was part of a syndrome in 18% of the children. The most common site of involvement was the lower extremity, followed by upper extremity and genital involvement. Lymphedema was complicated in 17 % of children, mainly with a clinical picture of cellulitis, infection, and pain. The median duration of lymphedema was 41 (5-216) months. Although most of the children had stage 2 lymphedema, only 40% of them received treatment. The most commonly received treatment was compression therapy. No family or child was educated for self- care management before. DISCUSSION:In conclusion, pediatric lymphedema has a comparable gender distribution and usually involves the lower extremities. Although most of the children had advanced disease, more than half of the patients did not receive any treatment indicating the unmet need for management of lymphedema. The education of patients and/or children about self-management methods were lacking. We suggest educational activities for both families of children with lymphedema and health care providers, in order to facilitate early reference to lymphedema units and to receive prompt preventive and therapeutic approaches for this suffering condition.

BACKGROUND: Foot and ankle are some of the most frequently injured places in football players' bodies. Overuse injuries have an insidious onset and can restrain athletes from sports temporary or even permanently. This study aimed to investigate the relationship between the clinical evaluation of the foot and ankle and findings obtained from foot plantar pressure measurements with the development of overuse injury, during the one-year follow-up. METHODS: One hundred licensed football players were included in the study. Presence of joint hypermobility, foot posture assessment, ankle and first metatarsophalangeal joint range of motion measurements, pedobarographic plantar pressure assessment of foot was carried out. Then, the footballers were followed for 12 months for the development of new foot and ankle overuse injuries, and the clinical and pedobarographic data of the footballers with at least one injury were compared with the group without injury. RESULTS: We found asymmetric pressure distribution between the preferred and non-preferred foot in the group who had an injury in the pedobarographic static foot plantar pressure measurements (P=0.040). A statistically significant limitation was found in the ankle eversion, first metatarsophalangeal joint dorsiflexion and ankle plantar flexion degrees in the injured group compared to the uninjured group (P=0.029, P=0.023, P=0.044, respectively). CONCLUSIONS: These findings suggest that impairments in foot plantar pressure distribution and limitations in ankle and foot joint range of motion may be risk factors for the development of foot and ankle overuse injury. (Cite this article as: Sahillioglu A, Cerrahoglu L. The relationship of the foot and ankle structure with overuse injuries in licensed footballers: a prospective cohort study. J Sports Med Phys Fitness 2021;61:1499-508. DOI: 10.23736/S0022-4707.20.11780-8)

Femoroacetabular impingement (FAI) is an abnormal contact of the acetabulum with the femur, particularly during flexion and hip rotation, caused by anatomical abnormalities in the femur head and acetabulum, and may result in labral and cartilage damage in the hips.According to the graphical features of the pelvis AP, three types of FAI were defined: cam, pincer and, mix type.Moreover, the mix is the most common type, where typically patients complain of pain in the hip and groin.With symptomatic treatment in the initial phase, the patient's complaints are relieved.However, if the severity of the impingement progresses, the patient may be referred for surgery.Arthroscopic or open surgery corrects the deformity of the femur head and acetabulum.

OBJECTIVE:Low-level laser therapy (LLLT) and extracorporeal shock wave therapy (ESWT) is applied in the conservative treatment of inflammatory plantar fasciitis, which is also a characteristic feature of spondyloarthritis (SpA) (Gill, 1997 and Roxas, 2005). We determined and compared the effectiveness of LLLT and ESWT using magnetic resonance imaging (MRI).METHODS:This study is a prospective, randomized, comparative, single-blind clinical study. Voluntarily followed 40 patients with the diagnosis of SpA and having pain at the heels at least for 6 months. Patients were divided randomly into two treatment groups. One group undertook 14 sessions of infrared Ga-Al-As LLLT, and the other group undertook 3 sessions ESWT. Feet functions of the patients were evaluated by American Orthopaedic Foot and Ankle Society (AOFAS) and Roles and Maudsley Scoring; VAS was evaluated for foot pain and function. In clinical assessment, disease activity was carried out by applying the BASDAI, the functional assessment was evaluated through the BASFI, and the patient quality of life was evaluated through the ASQoL; enthesitis was scored according to MASES assessment, performed before and at 1 month after treatment. The thickness of the plantar fascia was measured with MRI before and 1 month after treatment.RESULTS:Compared with the pretherapy, progress in the feet function by AOFAS and Roles-Maudsley scoring and decrease in VAS levels were statistically significant in both groups (p < 0.001). Only the VAS exercise score was superior to LLLT (p < 0.05). The thickness of the plantar fascia had decreased significantly on MRI in all two groups.CONCLUSION:The treatment of plantar fasciitis with LLLT and ESWT was more successful in pain improvement and functional outcomes with the dose, frequency, and duration used in our study.

The main purpose of this study was to compare the values determined in the clinical examination of the foot and ankle and the plantar pressure measurements of the foot in athletes who developed an overuse-type disability and in athletes who did not develop overuse-type disability, and was to find factors that might predispose to disability, during the one-year follow-up. 100 licensed football players were included in the study. Presence of joint hypermobility, foot posture assessment, ankle and first metatarsophalangeal (MTP) joint range of motion (ROM) measurements, pedobarographic plantar pressure assessment of foot was carried out. Then, the footballers were followed for 12 months for the development of new foot and ankle overuse injuries and the clinical and pedobarographic data of the footballers with at least one injury were compared with the group without injury. We found asymmetric pressure distribution between the preferred and non-preferred foot in the group who had an injury in the pedobarographic static foot plantar pressure measurements (p = .040) . When we compared the ROM values of footballers who had an injury and footballers who did not have an injury, we found a significant limitation in the group that suffered an injury, in the ankle eversion, first MTP joint dorsiflexion and ankle plantarflexion degrees (p = .029, p = .023, p=.044, respectively) . These findings suggest that impairments in foot plantar pressure distribution and limitations in ankle and foot joint ROM may be risk factors for the development of foot and ankle overuse injury. ### Competing Interest Statement The authors have declared no competing interest. ### Clinical Trial SJMSS-O-853-20 ### Funding Statement The authors declare that this study has received no financial support from any person or organization. ### Author Declarations I confirm all relevant ethical guidelines have been followed, and any necessary IRB and/or ethics committee approvals have been obtained. Yes The details of the IRB/oversight body that provided approval or exemption for the research described are given below: Our work was presented to the ethics committee for approval and accepted with the ethics committee numbered 20478486-369 dated 19.11.2014. All necessary patient/participant consent has been obtained and the appropriate institutional forms have been archived. Yes I understand that all clinical trials and any other prospective interventional studies must be registered with an ICMJE-approved registry, such as ClinicalTrials.gov. I confirm that any such study reported in the manuscript has been registered and the trial registration ID is provided (note: if posting a prospective study registered retrospectively, please provide a statement in the trial ID field explaining why the study was not registered in advance). Yes I have followed all appropriate research reporting guidelines and uploaded the relevant EQUATOR Network research reporting checklist(s) and other pertinent material as supplementary files, if applicable. Yes all data is available

Familial Mediterranean Fever (FMF) is the most common Periodic Fever syndrome characterized by attacks like serositis and fever. FMF is an autosomal recessive disease caused by MEFV gene mutations which located on 16p13.3. Spondyloarthropathy (SpA) is a chronic rheumatic disease characterized by inflammation in axial and peripheral joints with enthesitis and extraartricular involvements. One of the major criteria of SpA is sacroiliitis that can be described rarely in FMF patients. M694V mutation has been frequently seen mutation in FMF patients; also it has been associated with SpA. In this article, we present a case of a patient with heterozygous M694V mutation FMF and SpA combination.