Abstract Hallux valgus (HV) decreases the forces under the first ray during the propulsive phases of gait and transfers loading to the lesser metatarsals. Biomechanical factors contribute to the development of HV through various mechanisms; however, the flexibility of HV has not been considered to be a major determinant when planning surgery for HV. The aims of this thesis were to develop a clinical test and a new surgical technique for flexible HV, to report the mid-term follow-up results of this new correction method, and to compare the metatarsal load distribution after the new technique to that achieved with distal chevron osteotomy in a matched-pair analysis. The new surgical technique, first tarsometatarsal joint derotational arthrodesis (FTJDA), includes rotational correction of the first metatarsal without surgery to the first metatarsophalangeal joint (I MTPJ). It is indicated for patients who are able to reduce HV with peroneus longus (PL) function (PL activation test). Between 2003 and 2009, a total of 88 flexible HV underwent FTJDA operations. Seventy-six operated feet were re-examined after an average of 5.1 (range 3.0 to 8.3) years of follow-up. Outcome measures included the American Orthopaedic Foot and Ankle Society (AOFAS) score and pre- and postoperative radiological analysis. Gait analysis was used to compare the metatarsal load distribution after the FTJDA with a distal chevron cohort in 30 pairs matched by HV angle and follow-up time. The mean HV and intermetatarsal correction angles between preoperative and six-week follow-up radiographs were 19.8 degrees and 8.9 degrees, respectively. HV and intermetatarsal angle (IMA 1-2) correction were satisfactorily maintained (13.4 degrees [95% CI 11.6 to 15.1] and 4.5 degrees [95% CI 3.7 to 5.2], respectively) at mid-term follow-up. AOFAS score was excellent or good in 72% of the operated feet. In gait analysis, the FTJDA group had 8% higher relative impulses under the first metatarsal head (MTH), whereas chevron group had central loading pattern. In conclusion, FTJDA corrects flexible HV effectively without intervention to the I MTPJ. The correction is satisfactorily maintained at the late follow-up and the clinical results are good. In the gait analysis, the FTJDA produces better postoperative dynamic loading capacity of the first ray in comparison to distal chevron osteotomy. / Tiivistelmä Vaivaisenluu heikentää voimantuottoa ensimmäisen säteen alla kävelyn ponnistusvaiheiden aikana ja kuormitus siirtyy ulommille jalkapöytäluille. Biomekaanisilla tekijöillä arvellaan olevan osuutta vaivaisenluun kehittymiseen. Vaivaisenluun joustavuutta ei ole pidetty ratkaisevana tekijänä kirurgisen hoidon suunnittelussa. Tämän tutkimuksen tavoitteina oli kehittää kliininen testi ja uusi kirurginen korjausmenetelmä joustavalle vaivaisenluuvirheasennolle, raportoida uuden korjausmenetelmän keskipitkän seuranta-ajan tulokset ja verrata jalkapöytäluiden kuormitusjakaumaa uuden korjausmenetelmän jälkeen distaaliseen chevron -osteotomiaan kaltaistettujen parien analyysillä. Uusi kirurginen toimenpide, ensimmäisen tarsometatarsaalinivelen derotaatioartrodeesi (FTJDA), sisältää metatarsaalin rotaatiokorjauksen avaamatta ensimmäisen varpaan tyviniveltä. Menetelmä on tarkoitettu potilaille, joilla vaivaisenluuvirheasento korjaantuu peroneus longuksen toiminnalla (PL-aktivaatiotesti). Vuosina 2003–2009 operoitiin yhteensä 88 joustavaa vaivaisenluuvirheasentoa ensimmäisen tarsometatarsaalinivelen derotaatioartrodeesillä (FTJDA). 76 leikattua jalkaa tutkittiin uudelleen 5,1 vuoden (vaihteluväli 3,0 – 8,3) keskiseuranta-ajan jälkeen. Tulosten arvioinnissa käytettiin AOFAS-pisteytystä ja pre- ja postoperatiivisia radiologisia mittauksia. Kävelyanalyysillä verrattiin jalkapöytäluiden kuormitusta FTJDA- ja distaalisen chevron -osteotomiaryhmän välillä 30 parilla, jotka kaltaistettiin vaivaisenluukulman ja seuranta-ajan suhteen. Keskimääräinen vaivaisenluu- ja intermetatarsaalikulmien korjautuminen oli preoperatiivisten ja kuuden viikon kontrollikuvien välillä 19,8 ja 8,9 astetta. Korjautumistulokset vaivaisenluu- ja intermetatarsaalikulmien osalta säilyivät hyvänä,13,4 astetta (95% luottamusväli 11,6-15,1) ja 4,5 astetta (95% luottamusväli 3,7-5,2), keskipitkänajan seurannassa. AOFAS pisteytys antoi erinomaisen tai hyvän tuloksen 72%:lle leikatuista jaloista. Kävelyanalyysissä FTJDA -ryhmän relatiivinen impulssi oli 8% korkeampi ensimmäisen jalkapöytäluun pään alla, kun taas chevron -ryhmällä todettiin päkiän keskiosan kohonnut kuormitusjakauma. Yhteenvetona voidaan todeta, että FTJDA korjaa joustavan vaivaisenluun tehokkaasti ilman I-varpaan tyvinivelen toimenpiteitä. Korjautumistulos säilyy pitkäaikaisseurannassa ja kliiniset tulokset ovat hyviä. Kävelyanalyysissä FTJDA tuottaa paremman postoperatiivisen, ensimmäisen säteen dynaamisen kuormituskapasiteetin, distaaliseen chevron -osteotomiaan verrattuna.

Objective: To examine the influence of a 6-week training program on the electromechanical delay (EMD) and reaction time of the peroneus longus muscle. Design and Setting: The study was guided by a 2 x 2 factorial design with repeated measures on the time factor. The independent variables for this study were group (training and control) and time (pre- and post-training). Dependent variables for this study were muscle reaction time and electromechanical delay of the peroneus longus muscle. Subjects: Thirty-six healthy, physically active, college-age (21.8 ± 2.3 yr) male and female (M = 14, F = 28, height = 173.7 ± 11.2 cm, weight = 69.1 ± 18.4 kg) subjects were recruited for this study. Subjects had experienced no more than one ankle sprain to either ankle in their life, and had not sprained either ankle in the last year. Subjects were not currently experiencing any lower extremity pathology and had no history of serious injury to either lower extremity. Measurements: The EMD of the peroneus longus was determined by the onset of force contribution after a percutaneous electrical stimulation was administered, as measured by EMG and force plate data. Reaction time was measured after a perturbation during walking. Data was analyzed using two 2 X 2 X 2 ANOVAs. Group (treatment and control) and gender were between treatments factors, and time was a within treatments factor. Results: Upon initial examination, there was a trend in the EMD measurements to show an increase in EMD in the treatment group. However, this lacked statistical significance (F = 2.96, p = 0.0983). Reaction time demonstrated a trend towards a decrease in reaction time in the treatment group, but again, this lacked statistical significance (F = 2.88, p = 0.1025). Effect size for this reaction time was 1.2. Conclusions: The 6-week training program used in this study did not have a significant effect on the reaction time and electromechanical delay of the peroneus longus muscle.

An estimated 23,000 ankle injuries occur every day in the U.S. Ankle sprains account for 85% of all ankle injuries and inversion ankle sprains account for 85% of all ankle sprains. There is growing evidence that suggests gender and fatigue may increase the risk for inversion ankle sprains. Investigating the effects of fatigue and gender on peroneal reflex response after ankle inversion may help explain the differences in sprain rates with fatigue and gender. Therefore, the purpose of this study was to investigate the effects of fatigue and gender on peroneus brevis and peroneus longus reflexes after ankle inversion. A "trap-door" platform was used to elicit peroneal reflexes from sixteen males and fifteen females by suddenly inverting the ankle to 20°. Five unfatigued peroneal reflex measurements were performed before and after a fatigue protocol that attempted to fatigue the ankle evertors over 12 minutes to 75% of the unfatigued MVC torque. Results showed that reflex delay was not affected by fatigue, gender, or their interaction. PL reflex amplitude was not affected by fatigue or gender but was affected by their interaction. Results showed that PL reflex amplitude decreased by 11.3% in males and increased 22.1% in females with fatigue. A secondary analysis attempted to rule out extraneous factors that could have contributed to the differences in reflex response, but no experimental explanations were found. The differences in PL reflex amplitude were attributed to biomechanical, physiological, and anatomical differences between males and females. / Master of Science