Clinical Commentary
Robert A. Donatelli
The biomechanics of the foot and ankle are important to the normal function of the lower extremity. The foot is the terminal joint in the lower kinetic chain that opposes external resistance. Proper arthrokinematic movement within the foot and ankle influences the ability of the lower limb to attenuate the forces of weightbearing. It is important for the lower extremity to distribute and dissipate compressive, tensile, shearing, and rotatory forces during the stance phase of gait. Inadequate distribution of these forces could lead to abnormal stress and the eventual breakdown of connective tissue and muscle. The combined effect of muscle, bone, ligaments, and normal foot biomechanics will result in the most efficient force attenuation in the lower limb. This article will look specifically at the normal biomechanics of the foot and ankle.
J Orthop Sports Phys They 1985;7(3):91-95.
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Research Report
Lauren Y. Hughes
Forty-seven subjects were studied to discover predisposing factors for their radiologically diagnosed metatarsal stress fractures. Biomechanics of the foot and ankle were introduced to help explain forefoot varus, abnormal rearfoot valgus, and dorsiflexion as intervening variables in metatarsal stress fracture development. Results concluded that subjects with forefoot varus and decreased dorsiflexion had 8.3: 1 and 4.6: 1, respectively, odds of developing a metatarsal stress fracture. Abnormal rearfoot valgus had no significant effect on predisposing the subjects to develop a stress fracture.
J Orthop Sports Phys Ther 1985;7(3):96-101.
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Research Report
Eric R. Viel, J. J. Desmarets
The purpose of this study was to measure the deflection angle of both peroneal tendons as they turn around the lateral malleolus. A reduction of the angle occurs when the subject stands on tip-toes, in the manner of dancers and sprinters. This reduction of deflection angle leads to higher mechanical efficency. Female subjects were found to be superior to males in their ability to plantarflex the ankle, straightening out their tendons more than do men. The traditional approach to exercising muscles around the ankle ignores the varied mechanical situations which occur during the practice of sports. The data presented should provide guidelines for rehabilitation programs of the injured ankle and lateral border of the foot.
J Orthop Sports Phys Ther 1985;7(3):102-106.
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Research Report
Deborah A. Nawoczenski, Marjorie G. Owen, Malcolm L. Ecker, Barry Altman, Marcia Epler
The purposes of this paper are to describe an objective technique developed to assess the dynamic response of the peroneal muscles to a sudden inversion motion and to report the results obtained from testing injured and noninjured ankles. A platform was constructed to drop the ankle into a controlled degree of inversion while measuring the time to peroneal response and the angular rotation. Thirty volunteers were tested, 15 of whom had experienced a unilateral ankle sprain 3- 10 months prior to testing. Results show a trend toward delayed peroneal response and greater angular displacement at the time of peroneal response in injured ankles but analysis of variance showed no significant difference. The total angular displacement in the injured ankles was significantly greater. This objective technique could be used to evaluate treatment regimens and, by testing ankles soon after injury and serially, to evaluate readiness to return to activity.
J Orthop Sports Phys Ther 1985;7(3):107-109.
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Research Report
Peter Vaes, H. De Boeck, F. Handelberg, P. Opdecam
A comparative radiological study was carried out to test the stabilizing value of ankle strapping and taping on unstable tibiotalar joints. Unstable ankle joints of 51 sportsmen were examined without bandages, with strapping, and with taping before and after an activity program. The use of taping proved to give the greatest decrease of the talar tilt angle. This improvement was still greater, even after activity, than the stabilization obtained by strapping, before any activity.
J Orthop Sports Phys Ther 1985;7(3):110-114.
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Research Report
Karen Elton, Kathleen McDonough, Emily Savinar-Nogue, Gail M. Jensen
The purpose of this pilot study was to identify those clinical exam findings most often seen in patients with a positive chondromalacia patella (CMP) arthroscopic exam. Twenty patients with a clinical diagnosis of CMP or meniscal lesions (M) or both (CMP+M) were evaluated by two physical therapists using the history, physical, and Cybex® II isokinetic testing data. More than 50% of the patients with arthroscopically confirmed CMP complained of peripatellar pain, pain with ascending and descending stairs, and pain with prolonged flexion. At least 50% of these patients also demonstrated pain with a patellar grinding test and crepitus during the active knee extension test. Chi square analysis of the clinical exam data between the arthroscopically diagnosed CMP+M patients and 20 age- and sex-matched normal subjects revealed a significant difference in response to the three history questions analyzed. No significant differences were found on the physical exam, including Cybex II isokinetic testing results. Our findings demonstrate the significant role of the history in diagnosing symptomatic CMP.
J Orthop Sports Phys Ther 1985;7(3):115-123.
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Technical Note
David E. Knoeppel
Equipment "set-up" time must be kept to a minimum. Although equipment is available to rehabilitate the shoulder, often it is not utilized because of the time it takes to prepare. The use of a low stool can expedite set-up time and allow a vigorous workout for the orthopedic andlor sports medicine patient.
J Orthop Sports Phys Ther 1985;7(3):124-126.
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