One major way that running style varies between individuals is how their foot strikes the ground (forefoot strike or rearfoot strike). Running generates a torque about the ankle that depends on the individual’s foot strike pattern, length of their plantar flexor moment arm, and force generated from the plantar flexor muscles. The foot strike pattern during running, gastrocnemii muscle thickness, and heel length (used as an approximation for plantar flexor moment arm) were determined in 41 runners. Forefoot and rearfoot strike runners had the same thickness of the gastrocnemii muscles. However, in comparison with sedentary walkers, the runners had thicker calf muscles. These results imply a “peak” muscle thickness seems to be attained by running. Runners with longer heels were more likely to use a forefoot strike running style, possibly due to a mechanical advantage in the generation of torque.

No description available.

BACKGROUND: Missed foot fractures are a known problem in the care of the traumatized patient. They do not usually have an influence on the survival, but on the long-term result and the quality of the patient's life. The aim of this study is to find out how many of these fractures are overlooked in a Level I trauma center and what the consequences for the patients are hypothesing that patients with a delayed diagnosis will have worse clinical results. METHODS: Forty-seven patients (7.3%) with foot fractures could be identified in 642 polytrauma patients, retrospectively. All patients were divided into two groups: early diagnosed fractures and delayed diagnosed fractures, the latter defined as diagnosed after Secondary Survey. Patients were evaluated according to the Hannover Outcome Score, the Short Form-36 Health Survey, the AOFAS Score and the Hannover Scoring System. The average follow-up was 5 years and 8 months. Reasons for overlooking a foot fracture were analyzed. RESULTS: The foot fracture was early diagnosed in 26 (55.3%) patients, but delayed in 21 (44.7%). There were no significant differences in the mean stay in the hospital or in the ICU. The fractures that were most often missed were those of the cuboid or the metarsalia. The highest risk factor for a delayed diagnosis was a fracture already diagnosed on the same foot. In 52.4% of the delayed diagosed fractures, an operative therapy was necessary. There were no significant differences between the two groups in the clinical results. CONCLUSIONS: In summary, the results of this study show that foot injuries can be a safety problem for the patient and the examination of the feet in the trauma room has to be a compulsory part of the algorithm. Although the majority of delayed diagnosed foot fractures demonstrated comparable results to the immediately diagnosed fractures, approximately 10% might have benefited from an earlier diagnosis. Even if there were no significant differences in the clinical results, we have to be aware that missing a fracture in the foot can lead to worse results in the complete polytrauma care.

Objectives: The objectives of the research were to determine which intravenous (IV) antibiotics were cost-effective in Diabetic Foot Infections (DFIs) and to assess the impact of MRSA prevalence on clinical outcome. Methods: A Cost-effectiveness analysis (CEA) was performed on IV antibiotics used to treat moderate to severe DFIs in hospitalized patients. MRSA prevalence was taken into account by calculating an ‘Adjusted cure rate’ and re-analysing the CEA. Results: In the original CEA, imipenem/cilastatin was the cost-effective agent. When MRSA prevalence was taken into account imipenem/cilastatin, moxifloxacin, cefoxitin and ertapenem were cost-effective antibiotics. Conclusion: MRSA prevalence adjustments changed the results of the CEA and included classes of IV antibiotics that are seen being using in practice, such as fluoroquinolones and cephalosporins. These methods could potentially have an impact on the evaluation of clinical cure rates and resistance when evaluating the literature.

Objectives: The objectives of the research were to determine which intravenous (IV) antibiotics were cost-effective in Diabetic Foot Infections (DFIs) and to assess the impact of MRSA prevalence on clinical outcome. Methods: A Cost-effectiveness analysis (CEA) was performed on IV antibiotics used to treat moderate to severe DFIs in hospitalized patients. MRSA prevalence was taken into account by calculating an ‘Adjusted cure rate’ and re-analysing the CEA. Results: In the original CEA, imipenem/cilastatin was the cost-effective agent. When MRSA prevalence was taken into account imipenem/cilastatin, moxifloxacin, cefoxitin and ertapenem were cost-effective antibiotics. Conclusion: MRSA prevalence adjustments changed the results of the CEA and included classes of IV antibiotics that are seen being using in practice, such as fluoroquinolones and cephalosporins. These methods could potentially have an impact on the evaluation of clinical cure rates and resistance when evaluating the literature.

Partial foot amputation is becoming a more viable and common surgical intervention for the treatment of advanced diabetes, vascular insufficiency and trauma. Statistics describing the incidence of partial foot amputation are scarce. In Australia, it is not known how many people undergo partial foot amputation annually however in the United States upwards of 10,000 partial foot amputations are performed each year. Many of these procedures are likely to be in preference to below-knee amputation under the pretext of improved function associated with preserving the ankle joint and foot length despite common failings including ulceration and equinus contracture which can lead to more proximal amputation. There is a substantial body of literature, which lends support to the contention that much of clinical practice has not been based on experimental evidence describing the gait of partial foot amputees or the influence of prosthetic and orthotic intervention. This limited scientific underpinning of practice may contribute to the common failures and allow misconceptions, such that preserving foot length and the ankle joint improves function, to perpetuate. The aim of this investigation was to develop accurate mechanical models to analyse the effects of amputation and prosthetic/orthotic intervention on the gait of partial foot amputees. Anthropometric and linked-segment inverse dynamic models were developed to accurately depict the affected lower limb and account for prosthetic/orthotic intervention and footwear. These novel techniques enhance the accuracy of kinetic descriptions, affecting the results obtained for terminal swing phase. These models more accurately portray the requirements of the hamstring and gluteus maximus muscles to decelerate the swinging limb in response to the net increase in mass and inertia of the limb segments due to prosthetic fitting. With an appreciation of the influence these models have on the estimation of kinetic parameters, the gait of partial foot amputees was investigated. Kinematic abnormalities were primarily limited to the ankle and were characterised by poor control of tibial rotation during the mid-stance phase consistent with reduced eccentric work by the triceps surae muscles. The centre of pressure excursion and anterior progression of the trunk outside the reduced base of support was limited until contralateral initial contact; which could reflect triceps surae weakness and an inability to substantially load the prosthetic forefoot. Reductions in power generation across the affected ankle were the result of reductions in the angular excursion of the ankle and reductions in the ankle moment. Reductions in the ankle moment were consistent with the limited excursion of the centre of pressure commensurate with peak ground reaction forces. During early stance, concentric activity of the hip extensor musculature was observed, bilaterally, to advance the body forward. Results from these investigations focus on restoring power generation across the ankle given that the primary reason for preserving the ankle joint and calf musculature would seem to be the ability to use it functionally. Improvements in triceps surae strength may allow individuals to capitalise on improvements in below ankle prosthetic design and affect significant improvements in ankle power generation. In conjunction with improvements in muscle strength, below ankle prosthetic design needs to incorporate a socket and toe lever capable of comfortably distributing forces caused by loading the prosthetic forefoot. In conjunction with improvements in muscle strength, above ankle prosthetic design needs to incorporate an ankle joint. The development of a suitable joint poses significant design challenges for the engineer and prosthetist. This thesis provides new insights into the gait of partial foot amputees and the influence of prosthetic/orthotic design, which challenge common misconceptions underpinning clinical practice, prosthetic prescription and surgery. Aside from advancing the understanding of partial foot amputee gait and the influence of prosthetic/orthotic fitting, these investigations challenge and aim to improve current prosthetic and rehabilitation practice. Thus reducing the incidence of complications, such as ulceration which have been associated with the need for more proximal below knee amputation and allow partial foot amputees to utilise the intact ankle joint complex.

Thesis (Ph.D.) -- University of Western Sydney, 2004. / Bibliography : leaves 130-168.

Thesis (M.S.)--University of Delaware, 2008. / Principal faculty advisor: Irene S. Davis, Dept. of Physical Therapy. Includes bibliographical references.

Thesis (Ph. D.)--University of Washington, 2004. / Vita. Includes bibliographical references (leaves 56-68).

Thesis (MSc (Veterinary Tropical Diseases))--University of Pretoria, 2008. / Includes bibliographical references. Also available in print format.