RESUMO
INTRODUCTION: Chronic venous disease (CVD) is a highly prevalent disease that presents a wide spectrum of clinical expressions due to abnormalities in the venous system. Patients often have major functional changes that can limit daily activities. However, the functional factors associated with the severity of the disease remain poorly understood. OBJECTIVE: To identify the functional factors associated with CVD severity. METHODS: Seventy-five patients with CVD (92.0% females, 49.6 ± 13.3 years) were evaluated through clinical examination, lower limb perimetry, ankle range of motion (AROM), and lower limb muscle strength by the Heel Rise test, and Sit-to-stand test. Patients were stratified according to the disease severity as mild (telangiectasia, varicose veins, or edema in the lower limbs) or severe CVD (trophic changes or venous ulcer). RESULTS: Patients with severe CVD (n = 13) were older (p = 0.002), predominantly male (p = 0.007), with reduced AROM in dorsiflexion (p = 0.028) and inversion (p = 0.009), reduced lower limb strength by the Heel Rise test (p = 0.040), and greater circumference of the calf (p = 0.020), ankle (p = 0.003), and plantar arch (p = 0.041) when compared to mild CVD (n = 62). Advanced age, male sex, lower ankle range of motion in dorsiflexion, and greater ankle and plantar arch circumferences were associated with CVD severity. However, the ankle circumference (OR 1.258, 95% CI: 1.008-1.570; p = 0.042), together with advanced age and male sex, was the only functional variable that remained independently associated with CVD severity. CONCLUSION: The increased ankle circumference was a determinant of the CVD severity and may assist in risk stratification and guide treatment goals in this population.
Assuntos
Extremidade Inferior , Força Muscular , Amplitude de Movimento Articular , Índice de Gravidade de Doença , Varizes , Humanos , Masculino , Feminino , Pessoa de Meia-Idade , Adulto , Amplitude de Movimento Articular/fisiologia , Doença Crônica , Força Muscular/fisiologia , Extremidade Inferior/fisiopatologia , Varizes/fisiopatologia , Articulação do Tornozelo/fisiopatologia , Fatores Sexuais , Fatores Etários , Idoso , Insuficiência Venosa/fisiopatologia , Estudos TransversaisRESUMO
BACKGROUND: Peripheral neuropathy due to chemotherapeutic drugs causes alterations in ankle movement during gait. This study aimed to describe the spatiotemporal parameters and ankle kinematics during gait in schoolchildren with acute lymphoblastic leukemia with clinically suspected peripheral neuropathy. METHODS: In children with acute lymphoblastic leukemia in the maintenance phase, we calculated spatiotemporal and kinematic parameters of the ankle during gait using Kinovea® software. Furthermore, we identified alterations in the parameters obtained considering the values of the normality data from a stereophotogrammetry system as the reference values. Finally, we represented the kinematic parameters of the ankles calculated with Kinovea® compared to the normality values of the stereophotogrammetry. FINDINGS: We evaluated 25 schoolchildren; 13 were male (52.0%) with a median age of 88.0months and a median of 60.0 weeks in the maintenance phase, and 54.8% were classified as standard risk. Spatiotemporal parameters: cadence (steps/min), bilateral step length (m), and average gait speed (m/s) in ALL children were significantly lower than reference values (p < 0.001). Except for right mid-stance and bilateral foot strike, initial swing showed that both ankles maintained plantar flexion values during gait, significantly lower in ALL patients (p < 0.05). INTERPRETATION: We identified spatiotemporal and kinematics alterations in schoolchildren with acute lymphoblastic leukemia during all phases of the gait suggestive of alteration in ankle muscles during movement, probably due to peripheral neuropathy; nevertheless, our results should be taken with caution until the accuracy and reliability of Kinovea® software as a diagnostic test compared to the stereophotogrammetric system in children with ALL and healthy peers is proven.
Assuntos
Marcha , Leucemia-Linfoma Linfoblástico de Células Precursoras , Humanos , Leucemia-Linfoma Linfoblástico de Células Precursoras/fisiopatologia , Leucemia-Linfoma Linfoblástico de Células Precursoras/complicações , Masculino , Criança , Feminino , Estudos Transversais , Doenças do Sistema Nervoso Periférico/fisiopatologia , Fenômenos Biomecânicos , Tornozelo/fisiopatologia , Articulação do Tornozelo/fisiopatologia , Movimento , AdolescenteRESUMO
BACKGROUND: Some children and adolescents can develop persistent pain and instability following inversion injuries of the ankle. In these cases, imaging exams could reveal small bone fragments distal to the lateral malleolus. For these patients, regular conservative treatment may not be successful, requiring additional management, which can include surgical treatment. This study aimed to present the short-to-midterm functional and clinical outcomes of a series of 12 pediatric and adolescent patients who underwent ligament repair surgery due to chronic instability associated with the presence of osseous components in the lateral ligaments. METHODS: A review of 12 patients treated with surgical ligament reconstruction of the ankle was evaluated. Clinical and functional evaluations were based on comparing the Visual Analogue Scale (VAS), AOFAS ankle-hindfoot score, and residual symptoms before and after the surgical intervention. RESULTS: Before the reconstructive approach, the mean VAS was 2.41 and the mean AOFAS score was 74.16. After the procedure, the standard VAS declined to zero, and the AOFAS score was 100 in all patients. The mean follow-up was 6.33 months. CONCLUSION: The surgical approach in children and adolescents with symptomatic ankle instability due to the presence of osseous fragments after an initial inversion trauma provided adequate clinical and functional results at short-to-midterm follow-up. LEVEL OF EVIDENCE: Level IV, retrospective case series.
Assuntos
Fratura Avulsão , Instabilidade Articular , Humanos , Adolescente , Instabilidade Articular/cirurgia , Instabilidade Articular/etiologia , Instabilidade Articular/fisiopatologia , Criança , Masculino , Feminino , Estudos Retrospectivos , Fratura Avulsão/cirurgia , Fratura Avulsão/diagnóstico por imagem , Ligamentos Laterais do Tornozelo/lesões , Ligamentos Laterais do Tornozelo/cirurgia , Resultado do Tratamento , Fraturas do Tornozelo/cirurgia , Fraturas do Tornozelo/diagnóstico por imagem , Ligamentos Articulares/lesões , Ligamentos Articulares/cirurgia , Traumatismos do Tornozelo/cirurgia , Articulação do Tornozelo/cirurgia , Articulação do Tornozelo/fisiopatologiaRESUMO
INTRODUCTION: After an ankle sprain, up to 20% of patients may develop chronic lateral ankle instability (CLAI) requiring surgical treatment. The objective of this study was to investigate the functional outcomes and rates of return to sport activities in a cohort of non-athlete patients with chronic lateral ankle instability (CLAI) who underwent the opened Brostrom-Gould technique (BGT). MATERIALS AND METHODS: Seventy-nine patients (seventy-nine feet) from three different centers undergoing BGT were reviewed. For clinical and functional analysis, the AOFAS ankle-hindfoot scale was applied and rates of return to sport activities were assessed. Correlation of Δ-AOFAS and rates of return to sport activities with all variables analyzed was performed. RESULTS: Mean AOFAS score improved from 64.6 to 97.2 (p < 0.001). Sixty-one (77.2%) returned to preinjury activities and 18 (22.8%) changed to a lower-level modality. Symptoms of instability were related to Δ-AOFAS (p = 0.020). Change in the sport activity was related to pain and symptoms of instability (p = 0.41 and p < 0.001). CONCLUSION: Recreational athlete patients who underwent the BGT demonstrated excellent functional outcomes after a mean follow-up of 7 years. Residual pain and symptoms of instability after surgery were the main complaints associated with limitations in physical activities.
Assuntos
Traumatismos do Tornozelo , Instabilidade Articular , Volta ao Esporte , Humanos , Volta ao Esporte/estatística & dados numéricos , Masculino , Feminino , Adulto , Instabilidade Articular/cirurgia , Instabilidade Articular/fisiopatologia , Instabilidade Articular/etiologia , Seguimentos , Traumatismos do Tornozelo/cirurgia , Traumatismos do Tornozelo/fisiopatologia , Adulto Jovem , Resultado do Tratamento , Recuperação de Função Fisiológica , Pessoa de Meia-Idade , Estudos Retrospectivos , Adolescente , Articulação do Tornozelo/cirurgia , Articulação do Tornozelo/fisiopatologia , Procedimentos Ortopédicos/métodosRESUMO
Abstract Ankle osteoarthritis (AOA) is associated with pain and variable functional limitation, demanding clinical treatment and possible surgical indication when conservative measures are ineffective - arthrodesis has been the procedure of choice, because it reduces pain, restores joint alignment and makes the segment stable, preserving gait. The present study reports 3 cases (3 ankles) of male patients between 49 and 63 years old, with secondary AOA, preoperative American Orthopaedic Foot and Ankle Society Ankle-Hindfoot Scale (AOFAS AHS) of 27 to 39 points, treated by minimally invasive tibiotalocalcaneal arthrodesis using blocked retrograde intramedullary nail. Hospital stay was of 1 day, and the patients were authorized for immediate loading with removable ambulation orthotics, as tolerated. The physical therapy treatment, introduced since hospitalization, was maintained, prioritizing gait training, strength gain, and proprioception. Clinical and radiographic follow-up was performed at weeks 1, 2, 6, 12 and 24. After evidence of consolidation (between the 6th and 10th weeks), the orthotics were removed. One patient complained of pain in the immediate postoperative period and, at the end of the 1st year, only one patient presented pain during rehabilitation, which was completely resolved with analgesics. Currently, the patients do not present complaints, returning to activities without restrictions - one of them, to the practice of soccer and rappelling. The postoperative AOFAS AHS was from 68 to 86 points.
Resumo A osteoartrite do tornozelo (OAT) está associada a quadro álgico e limitação funcional variável, demandando tratamento clínico e eventual indicação cirúrgica quando as medidas conservadoras são inefetivas - a artrodese tem sido o procedimento de escolha, por reduzir a dor, restaurar o alinhamento articular e tornar o segmento estável, preservando a marcha. O presente estudo relata 3 casos (3 tornozelos) de pacientes do sexo masculino, com entre 49 e 63 anos de idade, portadores de OAT secundária, American Orthopaedic Foot and Ankle Society Ankle-Hindfoot Scale (AOFAS AHS, na sigla em inglês) pré-operatória de 27 a 39 pontos, tratados mediante artrodese tibiotalocalcaneana minimamente invasiva utilizando haste intramedular retrógrada bloqueada. A permanência hospitalar foi de 1 dia, e os pacientes foram autorizados para carga imediata com órteses removíveis para deambulação, conforme tolerado. O tratamento fisioterápico, introduzido desde o internamento, foi mantido, priorizando-se treino de marcha, ganho de força e propriocepção. Foi realizado acompanhamento clínico e radiográfico nas semanas 1, 2, 6, 12 e 24. Após evidências de consolidação (entre a 6ª e a 10ª semanas), as órteses foram retiradas. Um paciente queixou-se de dor no pós-operatório imediato e, ao final do 1° ano, apenas 1 paciente apresentou dor durante a reabilitação, resolvida completamente com analgésicos. Atualmente, os pacientes não apresentam queixas, retornando às atividades sem restrições - um deles, à prática de futebol e rapel. A AOFAS AHS pós-operatória foi de 68 a 86 pontos.
Assuntos
Humanos , Masculino , Adulto , Osteoartrite/cirurgia , Artrodese/reabilitação , Procedimentos Cirúrgicos Minimamente Invasivos , Articulação do Tornozelo/fisiopatologiaRESUMO
OBJECTIVE: To investigate whether Kinesio taping technique, applied to ankles of healthy people as a preventive intervention and people with ankle injuries, is superior to sham or alternative interventions on ankle function. DATA SOURCES: Medline, Embase, Amed, CINAHL, SPORTDiscus, Cochrane Library and Web of Science, from inception to August 2020. REVIEW METHODS: The terms "ankle" and "kinesio taping" were used in the search strategy. Included studies were randomized controlled trials (including crossover design) investigating Kinesio taping effects on ankle functional performance compared to any alternative or control/sham technique. RESULTS: From 5,572 studies, 84 met the eligibility criteria which evaluated 2,684 people. Fifty-eight meta-analyses from 44 studies were performed (participants in meta-analyses ranging from 27 to 179). Fifty-one meta-analyses reported ineffectiveness of Kinesio taping: moderate evidence for star excursion balance test (anterior direction), jump distance, dorsiflexion range of motion, and plantar flexion torque for healthy people (effect size = 0.08-0.13); low to very-low evidence for balance, jump performance, range of motion, proprioception, muscle capacity and EMG for healthy people; balance for older people; and balance and jump performance for people with chronic instability. Seven meta-analyses reported results favoring Kinesio taping (effect size[95% CI]): low to very-low evidence for balance (stabilometry, ranging from 0.42[0.07-0.77] to 0.65[0.29-1.02]) and ankle inversion (0.84[0.28-1.40]) for healthy people; balance for older people (COP velocity, 0.90[0.01-1.78]); and balance for people with chronic instability (errors, 0.55[0.06-1.04]). CONCLUSIONS: Current evidence does not support or encourage the use of Kinesio taping applied to the ankle for improvements in functional performance, regardless the population.
Assuntos
Traumatismos do Tornozelo/terapia , Articulação do Tornozelo/fisiologia , Tornozelo/fisiologia , Fita Atlética , Tornozelo/fisiopatologia , Traumatismos do Tornozelo/fisiopatologia , Articulação do Tornozelo/fisiopatologia , Humanos , Desempenho Físico Funcional , Propriocepção , Amplitude de Movimento ArticularRESUMO
This study aimed to verify whether there are differences in foot type, physical function, and performance between children and adolescents with Charcot-Marie-Tooth disease (CMT) and their healthy counterparts, and whether an interval of 6 months, from the initial assessment, reveals any significant changes on physical performance and other specific physical measures of the lower limbs. Subjects and Methods: Participants between 6 and 17 years of age, with CMT (CMT group n = 40), were compared to healthy participants (Control group, n = 49). Twenty participants with CMT completed the follow-up. We collected anthropometric, goniometric (ankle and knee), and dynamometric (inversion, eversion, plantar flexors, dorsiflexors, knee, hip extensors) measures, agonist/antagonist ratios, feet alignment (Foot Posture Index - FPI), muscle power (Long Jump), Pediatric Balance Scale (PBS), and 10-meter walk test (10MWT). Results: Compared to Control, CMT showed reduced passive range of motion (ROM), weakness in all evaluated muscles, increased agonist/antagonist ratios, predominance of varus and lower performance (PBS and Long Jump). After 6 months, CMT measures did not change. Conclusion: The cross-sectional analysis showed reduced ROM, strength, power, and distal muscle imbalance, as well as secondary limitations (PBS and 10MWT) in children and adolescents with CMT. These biomechanical and functional alterations did not change at the 6-month follow-up.
Assuntos
Articulação do Tornozelo/fisiopatologia , Doença de Charcot-Marie-Tooth/fisiopatologia , Força Muscular/fisiologia , Desempenho Físico Funcional , Adolescente , Criança , Estudos Transversais , Feminino , Humanos , Masculino , Amplitude de Movimento Articular/fisiologia , Teste de CaminhadaRESUMO
OBJECTIVES: To investigate the interaction of ankle-foot complex and hip joint factors with Achilles Tendinopathy (AT) occurrence in recreational runners. DESIGN: Cross-sectional. SETTING: Research Laboratory. PARTICIPANTS: 51 runners, 26 healthy and 25 with AT. MAIN OUTCOMES MEASURES: Shank-forefoot alignment (SFA), weight bearing lunge test (WBLT), passive hip internal rotation (IR) range of motion (ROM), hip external rotators (ER) and ankle plantar flexors (PF) isometric strength. CART analyses were performed to assess interactions that could distinguish those with AT. RESULTS: Passive hip IR ROM, ankle PF torque, SFA, and hip ER isometric torque were associated AT occurrence. The model correctly classified 92% of individuals without AT and 72% of those with AT. The area under the receiver operating characteristic curve was 0.88. Interaction factors revealed in nodes 3 and 10 were statistically significant. In node 3, runners with more than 29.33° of passive hip IR ROM had a 130% increased likelihood (PR = 2.30) of AT. Node 10 showed that individuals with higher PF torque, SFA varus, ER torque, but reduced passive hip IR ROM had an 87% increased likelihood (PR = 1.87) of AT. CONCLUSION: Interactions between hip and foot factors could accurately classify recreational runners with and without AT.