The cavovarus foot
Maneesh Bhatia in Essentials of Foot and Ankle Surgery, 2021
It is a complex three-dimensional structure held in shape by the delicate balance of the intrinsic and extrinsic muscles. In a forefoot driven cavovarus foot, early clinical problems can be from overloading of the first metatarsal head area, resulting in a plantar callosity, sesamoid disease or early hallux rigidus. For balancing purposes, the authors would recommend using equal height blocks under both feet simultaneously. A wide range of potential operations are described in literature which can be daunting. Clawing of the great toe can be rebalanced by the Jones procedure, which involves transfer of EHL to the first metatarsal neck and stabilisation of the interphalangeal joint by fusion in a straight position. Most patients with a pes cavus have a foot drop and a weak tibialis anterior muscle.
Lower Leg Injuries in Sport
Lars Peterson, Per A.F.H. Renstrom in Sports Injuries, 2017
Functional anatomy The musculature of the lower leg is enclosed in four tight, inflexible compartments by fascias of connective tissue, which are anchored to the tibia and fibula. A crosssection through the lower leg about 10 cm (4 in.) below the knee shows that the four compartments are very well defined. In front, between the tibia and the fibula, there is an anterior compartment, which contains the toe extensors, the tibialis anterior muscle and the blood vessels and nerves that supply the anterior aspect of the lower leg and the dorsal aspect of the foot. At the back, the lower leg is divided into two compartments, one deep and one superficial. The posterior deep compartment, which is located between the tibia and the fibula and behind the tight connective tissue band (interosseous membrane) that connects the two, contains the long toe flexors (flexor digitorum longus and flexor hallucis longus) and the tibialis posterior muscle. Nerves and blood vessels pass to the back of the lower leg and the sole of the foot through this deep compartment. The posterior superficial muscle compartment at the back contains the broad, deep calf muscle (the soleus) and the superficial calf muscle (the gastrocnemius). On the lateral aspect of the leg, around the fibula, there is a lateral compartment, which encloses the peroneus longus, the peroneus brevis muscles and the peroneal nerve (Figs. 20.1-20.4).
Effect of Wii-Based Balance Training on Corticomotor Excitability Post Stroke
Published in Journal of Motor Behavior, 2015
Oluwabunmi Omiyale, Charles R. Crowell, Sangeetha Madhavan
The objective was to examine the effectiveness of a 3-week balance training program using the Nintendo Wii Fit gaming system (Nintendo Wii Sports, Nintendo, Redmond, WA) on lower limb corticomotor excitability and other clinical measures in chronic stroke survivors. Ten individuals diagnosed with ischemic stroke with residual hemiparesis received balance training using the Wii Fit for 60 min/day, three times/week, for three weeks. At the end of training, an increase in interhemispheric symmetry of corticomotor excitability of the tibialis anterior muscle representations was noted (n = 9). Participants also showed improvements in reaction time, time to perform the Dual Timed-Up-and-Go test, and balance confidence. The training-induced balance in corticomotor excitability suggests that this Wii-based balance training paradigm has the potential to influence neural plasticity and thereby functional recovery.
Frequency of Anticipatory Trunk Muscle Onsets in Children with and Without Developmental Coordination Disorder
Published in Physical & Occupational Therapy In Pediatrics, 2014
This study used electromyography to compare the frequency of anticipatory postural adjustments for three bilateral trunk muscles and unilateral tibialis anterior muscle between children with and without developmental coordination disorder (DCD; n = 22, ages 7 to 14 years) during three tasks (kicking a ball, stepping onto a step, standing on one foot). Between-group comparisons demonstrated significantly less frequent anticipatory activation of ipsilateral tibialis anterior, ipsilateral transversus abdominis/internal oblique, and bilateral external oblique muscles in children with DCD. Odds ratios indicated that children with DCD utilized anticipatory contractions of these muscles one half to one quarter as often as the typically developing children did, while performing the same tasks. These results suggest that the movement difficulties experienced by children with DCD may be associated with less frequent anticipatory adjustments. For these children, inconsistent preparatory activation may contribute to postural control difficulties, excessive movement variability and poor movement quality.
A theoretical model to study the effects of cellular stiffening on the damage evolution in deep tissue injury
Published in Computer Methods in Biomechanics and Biomedical Engineering, 2009
T. Nagel, S. Loerakker, C.W.J. Oomens
Pressure induced deep tissue injury (DTI) is a severe form of pressure ulcers that is hard to detect in early stages and difficult to prevent and treat. High prevalence figures are partly due to a lack of understanding of pathological pathways involved in DTI. The aim of this study was to investigate, whether changes in material properties of damaged tissue can play a role in DTI aetiology. A numerical model was developed based on muscle microstructure and tissue engineering experiments. A time dependent damage law was proposed and stiffening of dead cells incorporated. The results obtained in the microstructural investigations were used to include the stiffening information in a pre-existing macroscopic model based on animal experiments, which correlated strains to tissue damage measured in the tibialis anterior muscle in rat limbs. With the modelling approach employed in this paper, the damaged area in the rat limb models increased up to 1.65-fold and the rate of damage progression was up to 2.1 times higher in microstructural simulations when stiffening was included.