The act of raising the heel up is an essential portion of the gait cycle in humans, comprising the third rocker in the gait cycle. This act further demands specific motions from the hindfoot, and the surrounding structures. These motions have been previously studied and are reasonably well understood. End-stage osteoarthritis of the ankle (or ESOA) has been theorized to affect not only the ankle joint, but the same joints required for heel rise. (i.e. - hindfoot, lower leg, and foot) In the present research, the powerful effect that ESOA has on the lower leg, hindfoot and forefoot biomechanical relationship was demonstrated as significantly different from that of healthy age and sex-matched controls. This has implications not only for further research, but potentially treatment as well.

The act of raising the heel up is an essential portion of the gait cycle in humans, comprising the third rocker in the gait cycle. This act further demands specific motions from the hindfoot, and the surrounding structures. These motions have been previously studied and are reasonably well understood. End-stage osteoarthritis of the ankle (or ESOA) has been theorized to affect not only the ankle joint, but the same joints required for heel rise. (i.e. - hindfoot, lower leg, and foot) In the present research, the powerful effect that ESOA has on the lower leg, hindfoot and forefoot biomechanical relationship was demonstrated as significantly different from that of healthy age and sex-matched controls. This has implications not only for further research, but potentially treatment as well.

Computational modeling of joints and their function, a developing field, is becoming a significant health and wellness tool of our modern age. Due to familiarity of prior research focused on the lower extremity, a foot and ankle 3D computational model was created to explore the potential for these computational methods. The method of isolating CT scanned tissue and rendering a patient specific anatomy in the digital domain was accomplished by the use of MIMICS™ , SolidWorks™, and COSMOSMotion™ – all available in the commercial domain. The kinematics of the joints are driven solely by anatomically modeled soft tissue applied to articulating joint geometry. Soft tissues are based on highly realistic measurements of anatomical dimension and behavior. By restricting all model constraints to true to life anatomical approximations and recreating their behavior, this model uses inverse kinematics to predict the motion of the foot under various loading conditions. Extensive validation of the function of the model was performed. This includes stability of the arch (due to ligament deficiency) and joint behavior (due to disease and repair). These simulations were compared to a multitude of studies, which confirmed the accuracy of soft tissue strain, joint alignment, joint contact force and plantar load distribution. This demonstrated the capability of the simulation technique to both qualitatively recreate trends seen experimentally and clinically, as well as quantitatively predict a variety of tissue and joint measures. The modeling technique has further strength by combining measurements that are typically done separate (experimental vs. clinical) to build a more holistic model of foot behavior. This has the potential to allow additional conclusions to be drawn about complications associated with repair techniques. This model was built with the intent to provide an example of how patient specific bony geometry can be used as either a research or surgical tool when considering a disease state or repair technique. The technique also allows for the repeated use of anatomy, which is not possible experimentally or clinically. These qualities, along with the accuracy demonstrated in validation, prove the integrity of the technique along with demonstrating its strengths.

No description available.

Several surgically corrective procedures are considered to treat Adult Acquired Flatfoot Deformity (AAFD) patients, relieve pain, and restore function. Procedure selection is based on best practices and surgeon preference. Recent research created patient specific models of Adult Acquired Flatfoot Deformity (AAFD) to explore their predictive capabilities and examine effectiveness of the surgical procedure used to treat the deformity. The models’ behavior was governed solely by patient bodyweight, soft tissue constraints, and joint contact without the assumption of idealized joints. The current work expanded those models to determine if an alternate procedure would be more effective for the individual. These procedures included one hindfoot procedure, the Medializing Calcaneal Osteotomy (MCO), and one of three lateral column procedures: Evans osteotomy, Calcaneocuboid Distraction Arthrodesis (CCDA), Z osteotomy and the combination procedures MCO & Evans osteotomy, MCO & CCDA, and MCO & Z osteotomy all used in combination with a tendon transfer. The combination MCO & Evans and MCO & Z procedures were shown to provide the greatest amount of correction for both forefoot abduction and hindfoot valgus. However, these two procedures significantly increased the joint contact force, specifically at the calcaneocuboid joint, and ground reaction force along the lateral column. With exception to the lateral bands of the plantar fascia and middle spring ligament, the strain present in the plantar fascia, spring, and deltoid ligaments decreased after all procedures. The use of patient specific computational models provided the ability to investigate effects of alternate surgical corrections on restoring biomechanical function in flatfoot patients.

Introduction: Achilles tendinopathy can be a chronic disabling condition. Sclerosing injections under ultrasonographic guidance is one method to treat Achilles tendinopathy. Initially good results have later been questioned. Surgery is another treatment option that has been questioned because of varying reported success rate. Aim: We aimed to assess patient- reported outcome in patients suffering from Achilles tendinopathy, treated with sclerosing injections and/or surgery during a 6 ½ year- period. Method: After review of patient records, the Self-reported foot and ankle score (SEFAS) together with an in-house satisfaction questionnaire were mailed to the patients. A SEFAS score of 48 represents normal foot/ankle function. Results: 97 patients (53 women, 44 men, 104 tendons) were included. 69 patients (41 women, 28 men, 75 tendons) returned the questionnaires. The SEFAS values (median and range) were 37.5 (13-48) in patients treated with sclerosing therapy, 42 (15-48) in patients treated surgically and 47 (19-48) in patients that received both treatments. A greater proportion of surgically treated patients were satisfied (90% vs 50%), experienced symptom improvement and were able to return to the previous level of activity. Complications following surgery were wound infections (n=3) and deep vein thrombosis (n=3), two with pulmonary embolism. Following sclerosing injection, there was one complete Achilles tendon rupture. Conclusion: Sclerosing injections seems to be a safe treatment and a positive outcome in 50% of patients might be sufficient to use this therapy in selected patients with Achilles tendinopathy. However, surgical treatments seem more effective but are associated with more severe complications.

No description available.

Background: Open and closed fractures can be associated with posttraumatic or postoperative soft tissue defects caused by initial trauma, operative procedures, or infections. This study evaluated the postoperative outcomes in patients with open or closed lower leg fractures, related soft tissue defects, and subsequent flap coverage. Methods: We performed a retrospective single-center cohort study in a level 1 trauma center. We analyzed the patients treated from January 2012 through December 2017 and recorded demographics, treatment, and outcome data. The outcome data were measured via patient-reported Foot and Ankle Outcomes Scores (FAOS) and EQ-5D-5L scores. Results: We included 22 patients with complicated fractures (11 open and 11 closed) and subsequent soft tissue defects and flap coverages. The mean follow-up time was 41.2 months. Twenty-one patients developed infections, and necrosis at the site of surgery manifested in all closed fractures. Therefore, all patients needed soft tissue reconstructions. Preoperatively, 16 patients underwent arterial examinations via angiography and six underwent ultrasound examinations of the venous system. Ten patients had complications involving the flaps due to ischemia and consequent necrosis. The mean EQ-5D index was 0.62 ± 0.27, and EQ-5D VAS score was 57.7 ± 20.2. The mean FAOS was 60.7 ± 22.2; in particular, quality of life was 32.3 ± 28.8. The rate of returning to work in our patient group was 37.5% after 1 year. Conclusions: Distal tibial fractures often require revisions and soft tissue reconstruction. The evaluated patient population had poor outcomes in terms of function, quality of life, and return to work. Furthermore, patients suffering from flap ischemia have worse outcomes than those without flap ischemia.

No description available.

Die Einrichtungen der Verkehrsunfallforschung Hannover und (ab 1999) Dresden registrierten 736 Beinverletzungen eines Schweregrades AIS ≥ 2 im Zeitraum von 1983 bis März 2007. 174 dieser Verletzungen (23,6 %) waren Frakturen und Luxationen des Fußes und des oberen Sprunggelenkes. Es waren 149 Füße von 141 Frontinsassen (140 PKW) betroffen. Die Insassen untergliederten sich in 117 Fahrer und 24 Beifahrer. Das durchschnittliche Alter der Insassen betrug 38.5 ± 16.8 Jahre. Die häufigste Verletzung war die Fraktur des oberen Sprunggelenkes (n=82; 80 Malleolarfrakturen, 2 Pilonfrakturen). 34 Frakturen und Luxationen betrafen den Rückfuß (5 Talus- und 26 Calcaneusfrakturen, 2 subtalare Luxationen, 1 subtotale Amputation), 16 den Mittfuß (4 Navicularefrakturen, 5 Cuboidfrakturen, 3 Cuneiformefrakturen, 2 Chopart-Gelenksluxationen, 1 subtotale Amputation, 1 schweres Decollement) und 39 den Vorfuß (Metatarsalefrakturen). Offene Frakturen wurden nur in 3 Fällen registriert (2 Malleolarfrakturen, 1 Metatarsalefraktur). In 10 Fällen wurden beide Füße verletzt. 33 Insassen (23,4 %) waren polytraumatisiert, davon starben 17. 81 % der Insassen waren angeschnallt. Die verunfallten PKW wurden in prä- (Baujahr 1997 und älter) und post-EuroNCAP- (Baujahr 1998 und jünger) Fahrzeuge unterteilt. Die meisten Fußverletzungen fanden sich in prä-EuroNCAP-Autos. Die meisten Insassen befanden sich in Fahrzeugen der unteren Mittelklasse (40 Fahrer und 9 Beifahrer) und der Mittelklasse (27 Fahrer und 7 Beifahrer). 49 der 140 Unfälle ereigneten sich auf Landes- bzw. Kreisstraßen, 26 auf Bundesstraßen und 13 auf Autobahnen. Es wurden überwiegend Frontalzusammenstöße beobachtet. Zwischen den verletzten Fußregionen fanden sich keine signifikanten Unterschiede hinsichtlich der Delta v- und EES-Werte, es ergab sich aber ein Trend zu höheren Delta v- und EES-Werten bei neueren PKW (post-EuroNCAP). Die Häufigkeit von Fußverletzungen stieg linear mit steigendem Delta v-Wert, oberhalb eines Delta v-Wertes von 55 km/h kam es nur noch in prä-EuroNCAP-Autos zu einem weiteren linearen Anstieg, während post-EuroNCAP-Fahrzeuge keinen weiteren Anstieg der Verletzungshäufigkeit zeigten. Die Fußraumintrusion zeigte keine signifikanten Unterschiede zwischen den einzelnen Fußregionen, jedoch zeigte sich in post-EuroNCAP-Fahrzeugen ein Trend zu höheren Intrusionswerten. Zwischen den einzelnen Fahrzeugklassen zeigten sich keine Unterschiede in der Fußraumintrusion. Nur 29 der 174 Frakturen und Luxationen des Fußes und des oberen Sprunggelenkes wurden in post-EuroNCAP-Fahrzeugen registiert, die überwiegende Zahl dieser Verletzungen (n=145) ereignete sich in prä-EuroNCAP-Fahrzeugen. Bei Betrachtung des AIS2008-assoziierten FCI (functional capacity index) für die Fußregion zeigte sich eine geringere Wahrscheinlichkeit einer dauerhaften Behinderung in post-EuroNCAP-Fahrzeugen bei gleichem Delta v-Wert.:1. Einleitung zur Unfallforschung in Deutschland 6 2. Fragestellung 10 3. Patientengut und Methodik 13 4. Charakteristische Frakturen und zu Grunde liegende Unfälle 23 5. Auswertung 28 5.1 Erfasste Verletzungen 28 5.2 Charakterisierung der Fahrzeuge 32 5.2.1 Fahrzeugsegment 32 5.2.2 Unfallort 33 5.2.3 Aufprallrichtung 35 5.2.4 Verletzungsverursachendes Fahrzeugteil 36 5.3 Geschwindigkeitsparameter bei den beobachteten Verletzungen 37 5.4 Fußraumintrusion bei den beobachteten Verletzungen 41 5.5 Häufigkeit von Fußverletzungen 53 6. Diskussion 54 7. Zusammenfassung 67 8. Literaturverzeichnis 69 Danksagung 95 Thesen zur Dissertation 96 / The accident research of Hanover and (from 1999 on) Dresden registered 736 leg injuries (AIS ≥ 2) from 1983 to March 2007. 174 of these injuries (23.6 %) were fractures or dislocations of foot and ankle. 149 feet of 141 front seat car occupants in 140 cars were affected. Of these 117 were drivers, 24 were front seat passengers. The mean age of occupants was 38.5 ± 16.8 years. Ankle fractures were the most frequent injury (n = 82; 80 malleolar fractures, 2 pilon fractures). 34 fractures and dislocations affected the hindfoot (5 talus and 26 calcaneal fractures, 2 subtalar dislocations and 1 subtotal amputation) , 16 to midfoot (4 navicular fractures, 5 cuboid fractures, 3 fractures of cuneiformia, 2 dislocations of chopart joint, 1 subtotal amputation, and one severe decollement) and 39 the forefoot (metatarsal fractures). Open fractures were seldom seen (2 malleolar fractures, 1 metatarsal fracture). Both feet were injured in 10 cases. 33 occupants (23.4 %) were polytaumatic had a polytrauma, 17 of them died. 81 percent of the occupants were belted. The cars were divided in pre EuroNCAP (year of manufacture 1997 and older) and post EuroNCAP cars (year of manufacture 1998 and newer). Most of the foot injuries were seen in pre EuroNCAP cars. Most of the occupants sat in compact cars (40 drivers and 9 front seat passengers) and large family cars (27 drivers and 7 co-drivers). 49 of 140 accidents occurred on country roads, 26 on main roads and 13 on motorways. The crash direction was mostly frontal. Generally were found no differences of delta v- and EES-level between the injured foot regions, but divided into pre- and post-EuroNCAP cars there was a tendency to higher delta v- and EES-levels in newer cars. The frequency of foot injuries increased linearly with increasing delta v-level; but above delta v-level of 55 km/h the linear increase only was seen in pre-EuroNCAP cars, post-EuroNCAP cars showed no further increase of injuries. The footwell intrusion showed no difference between the injured foot regions but post-EuroNCAP cars had a tendency to higher footwell intrusion. There were no differences in footwell intrusion between the car types. Only 29 of 174 fractures or dislocations of foot and ankle were seen in post-EuroNCAP cars, the predominate number of these injuries (n = 145) were noticed in pre-EuroNCAP cars. A lower probability of long-term impairment was found in post-EuroNCAP cars for equal delta v levels, using the AIS2008 associated Functional Capacity Index (FCI) for the foot region.:1. Einleitung zur Unfallforschung in Deutschland 6 2. Fragestellung 10 3. Patientengut und Methodik 13 4. Charakteristische Frakturen und zu Grunde liegende Unfälle 23 5. Auswertung 28 5.1 Erfasste Verletzungen 28 5.2 Charakterisierung der Fahrzeuge 32 5.2.1 Fahrzeugsegment 32 5.2.2 Unfallort 33 5.2.3 Aufprallrichtung 35 5.2.4 Verletzungsverursachendes Fahrzeugteil 36 5.3 Geschwindigkeitsparameter bei den beobachteten Verletzungen 37 5.4 Fußraumintrusion bei den beobachteten Verletzungen 41 5.5 Häufigkeit von Fußverletzungen 53 6. Diskussion 54 7. Zusammenfassung 67 8. Literaturverzeichnis 69 Danksagung 95 Thesen zur Dissertation 96