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PubMed1989

Diagnosis, treatment, and rehabilitation of injuries to the lower leg and foot.

The article provides an overview of specific lower-extremity and foot injuries. The areas of concentration are sinus tarsi syndrome, tendon injuries, stress fractures, ankle sprains, and plantar fascitis. Diagnosis, treatment, and rehabilitation techniques have been discussed for each injury. The authors have also included biomechanical treatment modalities using orthotics for rehabilitation of these injuries.

Athletic Injuries↗
PubMed1977

Influence of the burn wound on local and systemic responses to injury.

Total resting leg blood flow, measured by venous occlusion plethysmography; leg oxygen consumption; substrate turnover; and leg surface temperature were determined in 21 nonseptic burn patients and four normals. The patients studied during the second to third week postinjury sustained total body surface injuries averaging 45% (range 12-86%) and leg injuries of 35% total leg surface (0-82.5%). To integrate the peripheral metabolic and circulatory events with the systemic responses to injury, total body oxygen consumption, cardiac output, rectal and mean skin temperatures were also measured. Leg blood flow and leg surface temperature generally increased with total burn size but did not correlate with cardiac output, total body oxygen consumption, or body temperature. However, leg blood flow was closely related to the extent of the leg burn (r(2) = 0.73). To evaluate the metabolic determinants of the wound blood flow, patients were matched for burn size (40.5% total body surface in one group vs. 42%), resulting in similar systemic responses to injury (cardiac index 7.8 +/- 0.7 L/min m(2) vs. 7.5 +/- 0.8, VO(2) 204 +/- 12 ml/min m(2) vs. 241 +/- 22, rectal temperature 38.5 +/- 0.3 degrees vs. 38.3 +/- 0.3 degrees , NS). One group (n = 7) had extensive leg burns (58% of the leg surface), the other (n = 9) minimal leg injuries (9.5%). Leg oxygen consumption was similar in the two groups (0.24 +/- 0.01 ml/100 ml leg min vs. 0.19 +/- 0.04, NS), although leg blood flow was markedly increased in the injured extremities (8.0 +/- 0.5 ml/100 ml leg min vs. 4.2 +/- 0.4, p < 0.001). Glucose uptake and lactate production were enhanced in the burned extremities (glucose 0.34 +/- 0.08 mg/100 ml leg mmn vs. 0.04 +/- 0.03, p < 0.01, lactate 0.30 +/- 0.08 mg/100 ml leg min vs. 0.06 +/- 0.06, p < 0.05) and related in a general manner with size of the leg burn. Increased peripheral blood flow following injury is directed to the wound and unrelated to aerobic metabolic demands of the extremity. The selectively perfused wound consumes glucose and produces lactate. The increased systemic cardiovascular and metabolic responses to thermal injury are essential for the enhanced circulatory and anaerobic demands of the healing wound.

Adolescent↗
PubMed1986

[Therapeutic concepts in neurologic damage following severe soft tissue and bone injuries of the distal lower leg and foot].

In less than 1% of the cases nervous lesions after severe lower leg lesions demand surgical treatment: Neurosurgical Clinic: 28 reconstructive interventions on the lower leg, however, 362 on the forearm in 15 years; Clinic of Accident Surgery: 264 severest lower leg- and foot-injuries, among them only two nervous lesions. The n. peronaeus is more frequently affected than the n. tibialis. Even if continuity of the nerve is maintained, endoneural bleeding and internal ruptures can lead to extensive axonal lesions. The kind of nervous lesion (neurapraxia, axonotmesia, neurotmesia) should be clarified during the first three months, if possible, since it determines the prognosis as well as the kind of operative treatment during the first six months.

Foot Injuries↗
PubMed1976

Modeling of the human leg in ski injuries.

This study establishes that the human lower extremity-ski system has a fundamental frequency of approximately 1 Hz. The fundamental mode dominates the system response when loading times are short compared to the first natural frequency. Consequently, the use of a single degree of freedom approximation and the use of impulse criteria can provide important insights into the problem of skiing injuries. Specifically, the sport of snow skiing develops forces with frequency content in the static, transition, and impulse regions of the leg-ski response spectrum. Therefore, ski release bindings must be designed to safely and effectively couple the leg to the ski throughout this loading environment. An important means of evaluating possible binding designs is by simulating their characteristics in a computer model. The model will apply realistic loading histories to the ski or binding, will evaluate the strain in the bones and ligaments of the lower extremity, and will determine the release point of the binding. The program presented in this discussion is one stage in the development of this total system capability.

Ankle Joint↗
PubMed2007

Complex limb salvage or early amputation for severe lower-limb injury: a meta-analysis of observational studies.

PURPOSE: Leg threatening injuries present patients and clinicians with a difficult decision: whether to pursue primary amputation or limb salvage? The purpose of our study was to review the literature in an effort to inform this management decision. METHODS: We systematically searched and selected observational studies that reported on individuals presenting with leg threatening injuries comparing outcomes of limb salvage versus primary amputation. We searched MEDLINE, CINAHL, and EMBASE. We reported on the following outcomes, and pooled data across trials when possible: length of hospital stay, total rehabilitation time, cost, clinical outcomes, failure rate for limb salvage, function & quality of life, pain, return to work, factors associated with poor outcome, and patient preference. RESULTS: Nine observational studies contributed data to our systematic review. The current evidence suggests that while length of hospital stay is similar for limb salvage and primary amputation, length of rehabilitation and total costs are higher for limb salvage patients. Salvage patients requires greater additional surgery and are significantly more likely to undergo re-hospitalization. Long-term functional outcomes (up to 7 years post injury) are equivalent between limb salvage and primary amputation; both forms of management are associated with high rates of self-reported disability (40%; to 50%;), and functional status continues to worsen over time. Report of pain following limb salvage or primary amputation is similar. Return to work is essentially the same between limb salvage and primary amputation groups, with approximately half of such patients returning to competitive employment at 2 years post injury. Both clinical and psychosocial factors are associated with poorer functional outcomes. At the time of injury patients prefer limb salvage, but the majority of failed salvage patients would opt for early amputation if they could decide again. CONCLUSION AND SIGNIFICANCE: Functional outcome among patients who present with leg-threatening injuries are not significantly different, at least up to 7 years, whether they are managed with limb salvage or primary amputation. Research to optimize triage decisions to avoid failed limb salvage as well as on interventions targeting important psychosocial prognostic variables should be considered a priority.

Amputation, Surgical↗