SEARCH · Search PubMed
Search indexed PubMed citations on genomics, clinical trials, systematic reviews and public health. Explore titles, authors and supplied subject terms, then open the PubMed record.
Quote a phrase for an exact phrase match. Source license links do not imply unrestricted reuse.
Incorrect techniques repeated daily by a dancer can lead to overuse injuries. This article discusses the causes and treatment of foot and ankle injuries in the ballet dancer. The author also addresses skin lesions that are common in dancers who wear pointe shoes.
INTRODUCTION:: Fracture-dislocations of the Chopart or Lisfranc joint line represent rather rare injuries which usually result from high-energy trauma. During the last decade surgical therapy, including open reduction and internal fixation, had been accepted as the best way to achieve an optimum return to function. Repeatedly, it had been stated that anatomical reduction represented the prerequisite for satisfactory results. But nevertheless, despite benign appearances on postoperative radiographs, even disappointing clinical results may occur after this severe type of complex foot injury. In order to get more insight into foot function after Chopart and/or Lisfranc joint trauma and eventually characterize those parameters with most importance for surgical intervention and a non-disturbed gait function, a post-reconstruction study was performed in 25 patients after surgical therapy and definite healing. METHODS:: Twenty five patients were examined clinically according to a standardized protocol 1-8 years after injury and surgical reconstruction and the Maryland Foot Score (100-point rating scale) was calculated from clinical and anamnestic data. Further, standard radiography of the foot was performed. Five patients had suffered from an injury of the midtarsal joints, 11 patients had an isolated injury of the tarsometatarsal joints and 9 patients had a combined injury of both joint complexes. Surgery generally included open reduction and internal fixation employing AO small fragment screws and/or K-wires, sometimes supplemented by an external fixator. Generally, at the time of examination implant removal had been performed, again. Gait function was studied employing an EMED-SF 4 platform integrated into a walkway of 6 m length. Standard parameters were calculated in 9 specific masks employing the Novel-win software. Essentially, an intraindividual comparison with the data from the non-injured extremity was performed. Further, lateral-medial force indices were calculated using Novel-orthopaedics. RESULTS:: Intraindividual comparison of the local impulse distribution pattern correlated considerably well with the total count of the Maryland Foot Score. The mediolateral force index showed that patients with a former lesion of one of the foot columns (medial or lateral) tended to load the non-injured column, mainly. This could also be recognized in patients with apparently good or excellent gait function. The severity of radiographically visible posttraumatic arthrosis obviously did not influence gait function to a major degree, but a loss of length of one of the foot columns following a comminution injury component or a shift of the foot axis either in the horizontal or in the vertical direction demonstrated a substantial influence on gait quality. Due to the limited number of patients, an influence of technical variations of surgical reconstruction could not be demonstrated. CONCLUSION:: As a practical consequence of the presented study it may be concluded that the correct alignment of the foot axes, including a correct length proportion of the medial and lateral foot columns after an injury of the Chopart and/or Lisfranc joints, should represent a major goal of therapy.
The ankle is one of the most frequently injured joints in the course of sports activities. MR imaging has become the modality of choice in the evaluation of most of these lesions, especially in competitive athletes. The purpose of this article is: (1) To illustrate the MR imaging features of a great number of sports-related injuries of the ankle, correlating it with lesional mechanisms and clinical findings, and (2) To review the role of MR imaging in clinical management and surgical planning of these injuries, especially in competitive athletes. In order to a better understanding of these lesions, a classification based on the anatomic origin are outlined. The spectrum of injuries has been classified in: (1) osseous lesions, (2) ligamentous injuries, (3) tendinous lesions, (4) impingement impingement, and (5) plantar fascial lesions.
The complex injury of the foot requires immediate decisions. At first the question of vital danger and amputation should be ruled out. The criteria for the conservation of the extremity will be shown. For the most severely injured, primary amputation is indicated, since all attempts of preservation in this group hardly survived. The two-step amputation is recommended: i.e. "Guillotine"-amputation in the acute phase and muscle plastic stump formation in the regeneration phase. Important principles of treatment are: immediate anatomic reduction and retention of fractures and unstable joints, open wound treatment, delayed closure and reconstructive plastic intervention. A planned "second-look"-operation is obligatory.
High-pressure injection injuries are reported often in the hand and occasionally in the foot. Injection with water and air causes minimal tissue damage but nevertheless requires irrigation, minimal debridement, administration of antibiotics, and concern for development of compartment syndrome. The outcome for patients injected with water and air should be excellent. Adjunctive hyperbaric oxygen causes immediate resolution of subcutaneous emphysema, edema, and pain for more rapid rehabilitation.
A pooled analysis was conducted of the seven studies on the clinical diagnostic effectiveness of the Ottawa ankle rules when used with adult patients in the emergency department (ED). The seven studies, conducted in university and community hospital EDs, had examined the sensitivity, specificity, and positive and negative predictive values of the Ottawa ankle rules. ED physicians applied the Ottawa ankle rules with adult patients who had blunt ankle injuries. The gold standard was radiography. The combined sensitivity for the seven studies was 97% or higher for ankle/foot, original/refined Ottawa ankle rules and negative predictive value was greater than 99%. These results support the effectiveness of the Ottawa ankle rules for ruling out a fractured ankle or foot. Specificity was lower, ranging from 31% to 63%; positive predictive value was <20%. Thus, the Ottawa ankle rules should not be used for ruling in a fractured ankle or foot. This pooled analysis shows the Ottawa ankle rules to be effective as clinical practice guidelines for acute ankle and foot injuries in the adult ED patient. Patients with negative results when the rules are used are highly unlikely to have a fractured ankle or foot, but the diagnosis for positive patients is much less certain, suggesting the need for radiography.
Explore the source record for details and available documents.
Participation in the sport of figure skating has more than doubled in the past 10 years. The sport has changed with an increased emphasis on free skating, which includes jumps and spins. The actual art of "figure" skating has been eliminated from the sport. With this change, there is an increased volume of foot and ankle injuries in figure skaters. This report outlines common foot and ankle injuries in figure skaters, discusses possible causes, and outlines treatment options.
Explore the source record for details and available documents.
OBJECTIVE: To determine whether foot shape (flat, normal, or cavus feet) affects functioning among military recruits. METHODS: A total of 230 Royal Australian Air Force recruits embarking on a 10-week basic training course took part in a prospective cohort study of foot shape and its effect on functioning. Recruits were divided into three groups based on their foot shape, i.e., flat feet (n = 22), normal feet (n = 139), and cavus feet (n = 44), with the diagnosis being made from the arch index measured from their footprints. The groups were assessed at baseline and week 8. Outcome measures included pain, injury, foot health, and quality of life. RESULTS: There were no significant differences in outcome measures at baseline. At the end of the trial, foot shape was not related to injury. The flat feet group had significantly poorer subjective physical health than did the normal feet group (p = 0.001). CONCLUSION: This study provides high-level evidence that foot shape has little impact on pain, injury, and functioning among military recruits.
Over the years patients with relatively minor compressive injuries seem to have a different morbidity, largely because of a constellation of neurologic findings, including dysesthesia and hyperesthesias. These are usually multifocal, and often extend far beyond the point of impact of the crushing force. Neuroischemia may play a role in the development of chronic pain after crush injuries to the foot, either through direct trauma to the peripheral nerves or by intraneural or extraneural fibrosis. This direct trauma to the nerve may cause chronic neuritis, which then triggers a sympathetically mediated pain syndrome. For the injured worker, these problems seem to be magnified. Early recognition of the extent of injury, the zone of injury, and the need for early soft tissue coverage is essential. With expeditious treatment, wound coverage, treatment of compartment syndromes, and early aggressive rehabilitation, many of the complications of these injuries, including chronic pain syndromes, can be minimized.
A study on work injuries that occurred over a five-year period was conducted in an iron and steel mill employing over 1000 workers. Of all the 921 injuries which required more than one day's sick leave, over 40% (383 cases) happened during the morning shift (0700-1500 hours), 210 cases occurred in the afternoon shift (1500-2300 hours) and only 150 cases were reported during the night shift. There were two injury peaks throughout the day, one at mid-morning (between 0900 and 1000 hours) and the other towards the mid-afternoon (1400-1500 hours). It was observed that hand injuries were more common during the morning and afternoon shifts and foot injuries normally occurred at night. 'Fall' was one of the main causes of accidents at night, whereas 'struck by' heavy objects and 'burn' were more common during the day. Although there were more accidents during the morning and afternoon shifts, work injuries which occurred at night generally required a longer duration of sick leave. This suggests that accidents which happened at night were more serious. It is believed that the work habits, shift systems and work environment have a substantial influence on these accidents.
Split-thickness skin excision (STSE) was used as an adjunctive modality in the treatment of eight crush injuries of the foot. Compartment syndromes were present in four feet and were treated with fasciotomy. Wound debridement, internal fixation of fractures, and STSE followed. This technique accurately determined the viability of the skin flap, simultaneously providing skin for local wound coverage. All flaps treated in this manner survived and all (100%) of the degloved STSE grafts healed. Additional procedures were performed in four patients (two free flaps and two split-thickness skin grafts) adjacent to the debrided flap for complete coverage. STSE proved to be an effective modality for skin coverage in crush injuries of the foot associated with degloving of skin.
Three hundred fifty male recruits were randomly allocated to either the standard recruit training program (N = 180) or substituted a weighted-march activity for all formal run periods (N = 170) in the physical training program. All injuries were seen at a single medical facility, and the cause, location, and severity of injury were recorded in the medical documents. Lower-limb injuries constituted 79.8% of all Run injuries and 61.1% of all Walk injuries. Foot (18.9%), knee (16.7%), ankle (13.3%), and shoulder (8.9%) were the most common sites of injury in the Walk group. In the Run group, the most common sites were knee (32.1%), ankle (18.3%), foot (11.9%), and shin (7.3%). There were two stress fractures (tibial) in the Run group and none in the Walk group, giving the Run group an incidence of 1.1%. There were 10 medical discharges in the Walk group and 16 in the Run group. Ten (62.5%) of the Run and 2 (20%) of the Walk discharges were due to lower-limb causes. Of these, only 1 (10%) of the Walk and 4 (25%) of the Run injuries were not considered to be pre-existing conditions. Marching (30.0%), physical training (25.5%), and the obstacle course (11.1%) were the most frequent causes of injury in the Walk group. In the Run group, the leading causes were running (36.6%), physical training (19.2%), and the obstacle course (14.6%). Running was the major cause of knee injury in the Run group (17/35), whereas physical training was the major cause of knee injury in the Walk group (5/15). Running was also the major cause of other lower-limb injuries in the Run group (19/58), whereas marching was the major cause in the Walk group (19/50). Lower-limb injuries were more frequent in the Run group, with running cited as the major cause of these injuries.
In a prospective study over the two years 1981-1982, there were 1186 separate sporting injuries treated at a Sports Injury Clinic. Just over 75% of patients were aged between 16 and 25 years old, while 80% were male. Football, Rugby, Running, Squash and Rowing contributed over 70% of these injuries. The commonest injuries were to the lower limb and lumbar region. In 43% of knee injuries there was strain of the collateral ligaments, while another 26% had patello-femoral pain. Short distance running was associated with an increase in shin splints, tibial stress fractures and hamstring injuries. Long distance running was associated with an increase in ankle and foot injuries. Sports Injury Clinics can benefit the injured athlete and there appears to be a need for their development in major hospitals.
Explore the source record for details and available documents.
Classical ballet is a popular but physically demanding activity. Minor injuries become increasingly common as the dancer encounters the greater workload of professional dancing. The doctor must have a basic knowledge of ballet technique and an understanding of the mental approach of dancers to accurately diagnose and effectively treat their injuries. The practice of dancing on the toes, the exaggerated turn out of the feet, and the extreme flexibility of the hips and spine all lead to unusual injuries. With informed conservative treatment, most ballet injuries will heal, but surgery is occasionally required.
The causes, clinical signs and various approaches to treatment of injuries involving the foot and pastern regions are reviewed, and the prognosis for each type of injury is discussed.