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Test Paper 6
Published in Teck Yew Chin, Susan Cheng Shelmerdine, Akash Ganguly, Chinedum Anosike, Get Through, 2017
Teck Yew Chin, Susan Cheng Shelmerdine, Akash Ganguly, Chinedum Anosike
A 20-year-old man was seen in the A&E department after an injury to his foot during a football game. On examination, there was tenderness on palpation in the forefoot. A plain film performed showed a step in the alignment of the medial aspect of the second metatarsal bone and middle cuneiform bone. The second to fourth metatarsal had moved laterally. Normal alignment was noted at the articulation between the first metatarsal and medial cuneiform bone. Which type of fracture is demonstrated on the plain film? March fractureJones fractureLover’s fractureHomolateral Lisfranc fracture dislocationDivergent Lisfranc fracture dislocation
Development and anatomy of the venous system
Published in Peter Gloviczki, Michael C. Dalsing, Bo Eklöf, Fedor Lurie, Thomas W. Wakefield, Monika L. Gloviczki, Handbook of Venous and Lymphatic Disorders, 2017
There are more than 150 PVs in the lower extremities; however, the medial PVs are most significant and have been the center of debate for decades.34–42 Their role in the development of chronic venous insufficiency and venous ulcers is still not well defined. Significant variation exists in the location of leg perforators; however, the distribution of clusters of PVs follows a predictable pattern (Table 2.2). Dorsal, plantar, medial, and lateral foot perforators are the main groups of PVs in the foot. A large PV runs between the first and second metatarsal bones and connects the superficial dorsal venous arch to the pedal vein. The clusters of PVs at the ankle are the anterior, medial, and lateral ankle perforators. The medial calf perforators exist in two groups: posterior tibial and paratibial PVs. Three groups (lower, middle, and upper) posterior tibial PVs (Cockett I–III perforators) connect the posterior accessory GSV to the posterior tibial veins (Figure 2.10). The paratibial perforators drain the GSV into the posterior tibial veins. Other perforators of the leg below the knee are the anterior, lateral, medial, and lateral gastrocnemius, intergemellar, and Achillean PVs. Infra- and supra-patellar and popliteal fossa PVs are located around the knee. Perforators of the femoral canal connect tributaries of the GSV to the femoral vein (Figure 2.8). Inguinal perforators drain into the femoral vein in the proximal thigh.
Biomechanical modelling and simulation of foot and ankle
Published in Youlian Hong, Roger Bartlett, Routledge Handbook of Biomechanics and Human Movement Science, 2008
In 1997, Lemmon et al.32 developed a 2D model of the second metatarsal bone and encapsulated soft tissue to investigate the metatarsal head pressure as a function of six insole thicknesses and two tissue thicknesses. The plantar soft tissue, polyurethane insole, and cloud crepe foamed midsole were defined as hyperelastic. Frictional contact between the foot and support was considered and a vertical load was applied at the metatarsal bone to simulate push-off. Orthosis with relatively soft material was found to reduce peak plantar pressure, which also decreased with an increase in insole thickness. The pressure reduction for a given increase of insole thickness was greater when plantar tissue layer was thinner. Using the same model, Erdemir et al.17 investigated 36 plug designs of a Microcell Puff midsole including a combination of three materials (Microcell Puff Lite, Plastazote medium, Poron), six geometries (straight or tapered with different sizes), and two locations of placement. Plugs that were placed according to the most pressurized area were more effective in plantar pressure reduction than those positioned based on the bony prominences. Large plugs (40 mm width) made of Microcell Puff Lite or Plastazote Medium, placed at peak pressure sites, provided the largest peak pressure reductions of up to 28 per cent.
How does a systematic tuning protocol for ankle foot orthosis–footwear combinations affect gait in children in cerebral palsy?
Published in Disability and Rehabilitation, 2022
Laura M. Oudenhoven, Yvette L. Kerkum, Annemieke I. Buizer, Marjolein M. van der Krogt
3D motion capture was used to collect passive marker data (Vicon, Oxford, UK, sample frequency 100 Hz). First, 26 reflective passive markers were placed on anatomical landmarks according to the updated version of the human body model (HBM) [24–26]. Since palpation of bony landmarks was not possible for foot markers when wearing AFOs, a standardised protocol was developed for marker placement. A goniometer was used to ensure alignment of markers perpendicular to the segments. Foot markers (calcaneus and second metatarsal bone) were placed on equal height from the shoe sole without wedges, aligned to the longitudinal axis of the foot. Medial and lateral malleolus markers were placed with the proximal goniometer-arm aligned to the shank and the distal arm aligned to the foot markers. Markers remained attached in-between all AFO walking trials. Marker placement was always performed by the same experienced operator.
Effects of range of motion exercise of the metatarsophalangeal joint from 2-weeks after joint-preserving rheumatoid forefoot surgery
Published in Modern Rheumatology, 2020
Makoto Hirao, Hideki Tsuboi, Naotaka Tazaki, Kohei Kushimoto, Kosuke Ebina, Hideki Yoshikawa, Jun Hashimoto
The subjects walked on a 10-m walkway with 5 1.4-cm-diameter reflective markers placed at specific landmarks of the foot (1. medial malleolus, 2. lateral malleolus, 3. 3 cm proximal of the insertion of the Achilles tendon, 4. second metatarsal head, and 5. second distal phalanx) (Figure 2(a1–3)). Gait motion was recorded in three dimensions using a 12-Raptor camera infrared motion analysis system (MAC 3D system, Motion Analysis, Corp., Rohnert Park, CA, USA) at a sampling frequency of 500 Hz. The captured data were analyzed using a toolkit: Software for Interactive Musculoskeletal Modeling (SIMM, Motion Analysis, Corp.). In the analysis of gait motion, the extension angle of the second MTP joint at the terminal stance phase (when the heel was most elevated) was measured (Figure 2(a-3,b-1.2)). The difference between the terminal stance phase and the standing still phase in the angle created by the longitudinal axis of the second metatarsal bone and the basal phalanx bone was defined as the extension angle of the second MTP joint at the terminal stance phase (Figure 2(b-2)). As healthy controls, the analysis was also performed in healthy subjects (N = 5, age: 26–35 years, no rheumatoid arthritis, no disorder of the lower extremities including the feet and ankles) (Table 2).
Voluntary ambulation using voluntary upper limb muscle activity and Hybrid Assistive Limb® (HAL®) in a patient with complete paraplegia due to chronic spinal cord injury: A case report
Published in The Journal of Spinal Cord Medicine, 2019
Yukiyo Shimizu, Hideki Kadone, Shigeki Kubota, Kenji Suzuki, Kousaku Saotome, Tomoyuki Ueno, Tetsuya Abe, Aiki Marushima, Hiroki Watanabe, Ayumu Endo, Kazue Tsurumi, Ryu Ishimoto, Akira Matsushita, Masao Koda, Akira Matsumura, Yoshiyuki Sankai, Yasushi Hada, Masashi Yamazaki
Assessments were performed before and after each HAL® session. A surface EMG System was used to evaluate muscle activity of the tensor fasciae lata (TFL) for hip flexion, femoral quadriceps (Quad) for knee extension, medial hamstrings (Ham) for knee flexion, and gluteus maximum (Gmax) for hip extension on both sides. Each muscle activity was evaluated using EMG, collected at 2000Hz, and filtered with a 30–400-Hz bandwidth passing filter using scripts on MATLAB 8.2 (Mathworks, Natick, MA, USA). Motion capture (Vicon MX with 16 T20S cameras, Vicon, Oxford, UK) was used to evaluate foot motion in synchronization with EMG. Following the Vicon plug-in gait marker set, auto-reflective markers were placed on the feet, head of the second metatarsal bone for the toe, lateral malleolus for the ankle, and posterior peak for the calcaneus of the heel. The swing phase and stance phase within a gait cycle were extracted according to the movement trajectory of the markers. Heel strikes were detected as the lower peaks of the height of the heel markers, and toe lifts were detected at the lower peaks of the toe markers. The swing phase started with a toe lift and ended with the succeeding heel strike on the same side. The stance phase started with a heel strike and ended with the succeeding toe lift.