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PubMed1975

The genesis of the pulse contours of the distal leg arteries in man.

In order to clarify the genesis of the human pressure and flow pulse contours of the distal leg arteries, in particular the posterior tibial artery, pulse recordings were performed with transcutaneous techniques under normal conditions and in the state of strong vasodilatation (reactive hyperaemia) in the distal parts of the lower legs. From the experimental results it is concluded that the contour of the incident pressure wave arriving in the leg arteries is very similar to the pressure pulse contour of the abdominal aorta, while the resulting contour in the leg arteries is determined by this incident wave and superimposed reflected waves. The latter arise from positive reflection in the periphery of the lower legs. The travel in retrograde direction, are reflected negatively in proximal regions, particularly in the abdominal aorta, and appear again, with opposite sign, in the leg arteries. In addition, retrograde waves reflected positively at the aortic valve and then traveling in antegrade direction also influence the pulse contours. By considering this wave travel, the genesis of the characteristic contours of the pressure and flow pulses of the lower leg arteries is explained in a satisfactory way. This is demonstrated by a simplified graphical pulse construction as well as by the calculation of pulse contours on the basis of a theoretical tube model of the arterial system with the aid of a digital computer. The results of these calculations are discussed with respect to the findings of previous investigators who used analog and digital models of the arterial system.

Adolescent↗

PubMedDate not supplied

Prevalence and aetiology of leg ulcers in Ireland.

BACKGROUND: The prevalence of leg ulcer disease in Ireland has been poorly documented. AIMS: This study aimed to investigate the aetiology and prevalence of leg ulcers in one health district. METHODS: All patients receiving healthcare for an active leg ulcer in the Mid-Western Health Board (MWHB) region of Ireland (population: 317,069) were identified in a defined two-month period. A cross-sectional survey of all healthcare workers providing care to patients with leg ulceration was carried out. Patients with leg ulcers of uncertain cause were invited for follow-up assessment to establish the underlying cause. RESULTS: There were 389 patients with leg ulcers with a mean (standard deviation [SD]) age of 72.3 (11.1) years. The prevalence was 0.12% but it was 1.03% in patients aged 70 years and over. Women were twice as likely to be affected. Venous disease accounted for 81% of ulcers, and arterial disease for 16.3%, while ulceration due to diabetic neuropathy and rheumatoid vasculitis was unusual. CONCLUSION: Leg ulcers are an important source of morbidity in our ageing population. Effective treatment programmes could diminish the impact of this debilitating disease on the health service.

Adult↗

PubMedDate not supplied

One-leg standing balance and functional status in a population of 512 community-living elderly persons.

The objective of this cross-sectional study (whose baseline data were drawn from a longitudinal population study) was to determine if one-leg standing balance might be a useful marker of functional status in elderly persons independently living in an urban community (N = 512, mean age 73 +/- 7.0, 71.4% women). One-leg standing balance (ascertained by the Tinetti test) and functional status were obtained from a baseline gerontological assessment and follow-up questionnaires. Correlations were tested between one-leg balance and physical health and functional measurements. One-leg standing balance (OLSB) was abnormal in 24.7% of the population. At least one incapacity in instrumental activities of daily living (IADL) was found in 60.6% of those with OLSB abnormality, vs 45.5% in those with OLSB "adaptive" (borderline abnormal), and 33.3% in those with normal one-leg standing balance (p < 0.0001). Multivariate analysis showed 3 independent factors related to one-leg balance abnormality: age > 71 years (OR = 5.11, CI = 1.99-13.10); IADL deficit requiring help with transportation (OR = 3.61; CI = 1.15-11.40); and "poor" health status on the Iowa Self-Assessment Inventory (OR = 2.67, CI = 1.35-5.27). We conclude that one-leg standing balance may be a simple, predictive and inexpensive marker helpful in screening for low functional level and frailty in clinical practice.

Activities of Daily Living↗

PubMed2004

[Restless legs syndrome in childhood].

The diagnostic criteria of restless legs syndrome were defined in 1995 by the International Restless Legs Syndrome Study Group (IRLSSG). In light of the latest scientific evidence and increasing clinical experience, the diagnostic criteria were revised in a consensus workshop. Participants of the workshop considered the development of new diagnostic criteria especially important for the following subgroups: (1) for children and (2) for the cognitively impaired elderly. The common characteristic of both groups lies in their difficulty in expressing subjective symptoms adequately. This considerably impedes the diagnosis of restless legs syndrome. In 2002, a proposal for diagnostic criteria of restless legs syndrome in childhood was formulated by members of the study groups "Movement Disorders and Sleep" and "Paediatrics" of the German Sleep Society. The proposal was partially incorporated into the diagnostic criteria for restless legs syndrome in childhood suggested by the IRLSSG. The current criteria are recommendations to enhance further research and must be validated by clinical studies. The following article gives an overview of published studies on restless legs syndrome in childhood, reviews the proposals for diagnostic criteria, and summarizes the peculiarities to be considered in diagnosing restless legs syndrome in children.

Adolescent↗

PubMed2000

[Leg length inequality. Indications for treatment and importance of shortening procedures].

Real leg length discrepancies may be cosmetically disturbing and lead to gait abnormalities, pelvic obliquity with subsequent lumbar scoliosis as well as functional disturbances of hip, knee and ankle joint. During the growth period even discrepancies of more than 1 cm should be treated by simple conservative means in order to prevent a compensatory lumbar scoliosis. In adults, inequalities up to 2 cm are tolerable. As an alternative to cosmetically often unaccepted shoe lifts for discrepancies of 2 to 6 cm, lengthening and shortening procedures should be considered. The latter involve lower costs and fewer complications. However, reduced final height may be an issue. In cases of an open physis, shortening can be achieved by Blount stapling or percutaneous epiphysiodesis. Considering the minimal number of incisions, simple technique and a low complication rate percutaneous epiphysiodesis is the first choice. The key problem, though, is the correct timing of the procedure. Age, anticipated leg length discrepancy at skeletal maturity, calculated loss of length of the longer leg and growth potential of the shorter leg have to be considered. More complex problems require repeated assessment and documentation of the lengths of both legs in order to find out the individual developmental pattern of the leg length discrepancy, which is primarily associated with the underlying pathology. After skeletal maturity, precise shortening may be achieved by osteotomies with resection of up to 6 cm of bone of the femur and up to 3 cm of the tibia. More shortening is limited by muscle insufficiency, as well as relative increase of soft tissues and risk of compartment syndrome in the lower leg.

Adolescent↗

PubMed2004

Revision total knee arthroplasty: a comparison of postoperative leg alignment after computer-assisted implantation versus the conventional technique.

Accurate reconstruction of leg alignment is one important factor for long-term survival in total knee arthroplasty (TKA). Recent developments in computer-assisted surgery focused on systems improving TKA. The aim of the study is to compare the results of computer-assisted revision TKA with the conventional technique. We hypothesize that a significantly better leg alignment and component orientation is achieved when using a navigation system for revision TKA. In a prospective study, two groups of 25 revision TKAs each were operated on using either a CT-free navigation system or the classical surgeon-controlled technique. The postoperative leg alignment was analysed on long-leg coronal and lateral X-rays. The mechanical limb axis was significantly better in the navigation-based group. Twenty-three patients (92%) in the computer-assisted group had a postoperative leg axis between 3 degrees varus/valgus deviation, while 19 patients (76%) in the conventional group had a comparable result (p<0.05). Further, significant differences were seen for the coronal orientation of the femoral component. Computer-assisted revision TKA leads to a superior restoration of leg alignment compared with the conventional technique. Particularly the real-time presentation of the actual leg axis and the flexion and extension gaps is useful in revision TKA. Potential benefits in long-term outcome and functional improvement require additional investigation.

Aged↗

PubMed2005

Reduced hip bone mineral density is related to physical fitness and leg lean mass in ambulatory individuals with chronic stroke.

Following a stroke, the reduced level of physical activity and functional use of the paretic leg may lead to bone loss and muscle atrophy. These factors and the high incidence of falls may contribute to hip fractures in the stroke population. This study was the first to examine total proximal femur bone mineral content (BMC) and bone mineral density (BMD) and their relationship to stroke-specific impairments in ambulatory individuals with chronic stroke (onset >1 year). We utilized dual-energy X-ray absorptiometry (DXA) to acquire proximal femur and total body scans on 58 (23 women) community-dwelling individuals with chronic stroke. We reported total proximal femur BMC (g) and BMD (g/cm2) derived from the proximal femur scans, and lean mass (g) and fat mass (g) for each leg derived from the total body scans. Each subject was evaluated for ambulatory capacity (Six-Minute Walk Test), knee extension strength (hand-held dynamometry), physical fitness [maximal oxygen uptake (VO2max)] and spasticity (Modified Ashworth Scale). Results showed that the paretic leg had significantly lower proximal femur BMD, lean mass and percent lean mass, but higher fat mass than the non-paretic leg for both men and women. Proximal femur BMD of the paretic leg was significantly related to ambulatory capacity (r=0.33, P=0.011), muscle strength (r=0.39, P=0.002), physical fitness (r=0.57, P<0.001), but not related to spasticity (r=-0.23, P=0.080). Multiple regression analysis showed that lean mass in the paretic leg was a major predictor (r2=0.371, P<0.001) of the paretic proximal femur BMD. VO2max was a significant predictor of both paretic proximal femur BMD (r2=0.325, P<0.001) and lean mass in the paretic leg (r2=0.700, P<0.001). Further study is required to determine whether increasing physical fitness and lean mass are important to improve hip bone health in chronic stroke.

Absorptiometry, Photon↗

PubMed2004

Preoperative leg-length inequality and hip osteoarthrosis: a radiographic study of 100 consecutive arthroplasty patients.

OBJECTIVE: To assess the leg-length inequality in patients with hip osteoarthrosis (OA) and to evaluate a possible association between the length disparity and side of OA. DESIGN AND PATIENTS: Weight-bearing radiographs of 100 consecutive patients undergoing arthroplasty for primary OA were examined and measured for inequality of leg length, pelvic tilt and severity of OA. RESULTS: The radiographic results showed that preoperatively OA occurred more frequently in the hip of the longer (84%) than the shorter (16%) leg. However, the development of OA did not show a linear relationship with the magnitude of leg-length inequality. CONCLUSION: As hip OA occurred more frequently in the longer leg the authors speculate whether leg-length inequality might predispose to OA in the hip of the longer leg.

Adult↗

PubMedDate not supplied

Aesthetic analysis of the ideal female leg.

The aesthetics of the attractive leg are dependent on three principle factors: length, circumference, and shape. Advances in surgical techniques and instrumentation have the ability to predict an aesthetic result in contouring the leg. However, because of patient variability and differing opinions of the surgeon, the leg aesthetics criteria and thus surgical goals have not been clearly defined. We performed an evaluation of Taiwan Chinese female leg aesthetics by using two study groups. Popular fashion models were evaluated and compared with our attractive female population. We noticed subjectively that there are similar leg shapes in both groups. Criteria that contribute to the aesthetics of the attractive legs can be used as guides for doctors and patients to achieve a more aesthetic and predictable leg contour.

Esthetics↗

PubMed2004

Human leg design: optimal axial alignment under constraints.

Alignment of joints with respect to the leg axis reduces the moment arm of external forces and therefore joint torques. Moreover, it affects the gearing of muscle forces and displacements. Thus, it influences tissue stress, cost of support and locomotion, and stability. Assuming that alignment is of general advantage we propose a mathematical criterion quantifying the axial alignment using the static torque equilibrium of a three-segment leg. Using this criterion derived from joint torque minimisation we asked for optimal leg designs (segment lengths and joint angles) at varied leg lengths. The trivial "straight is best" solution is excluded and the configuration space is restricted by geometrical constraints such as the ground contact. For different total leg lengths we could identify different optimal segment length combinations and appropriately adjusted joint angles. The extended human leg configuration characterised by a short foot and a combination of unequal ankle and knee angles emerges as a global optimum from our analysis. For crouched configurations allowing for larger leg extensions an angle symmetrical 1:1:1 segment length combination is best. The plantigrade optimum is enforced by the requirement of the distal segment (foot) being shorter than the opposite outer segment (thigh), as well as by the ground contact constraint. Different (e.g. digitigrade) geometries might be of advantage in different biological contexts with different constraints. The fact that small mammals use a crouched equal segment design implies that other locomotor requirements such as stability, strain rates, and acceleration distance per step might dominate.

Biomechanical Phenomena↗

PubMed2004

Kinetics of oxygen uptake during arm cranking with the legs inactive or exercising at moderate intensities.

The purpose of this study was to compare the kinetics of oxygen uptake (VO(2)) during arm cranking with the legs inactive or exercising. Each subject (n = 8) performed three exercise protocols: 6-min arm cranking at an intensity of 60% of peak oxygen uptake (VO(2peak), AC(60)) and 6-min combined arm cranking and leg cycling in which AC(60) was added to on-going leg cycling at an intensity of 20% or 40% of VO(2peak) (LC(20) and LC(40): AC(60)LC(20) and AC(60)LC(40), respectively). After the onset of arm cranking, VO(2) tended to increase until the end of arm cranking in all of the three exercise modes. The amplitudes of this increase in VO(2) were 0.98 (0.18), 0.93 (0.16) and 0.84 (0.12) l.min(-1) during AC(60), AC(60)LC(20) and AC(60)LC(40), respectively, and there were significant differences between values for each exercise. The data are presented as means and standard deviations. There were no significant differences in the effective VO(2) time constant, partial O(2) deficit, and the difference between the values of VO(2) measured at 3 and 6 min in the three exercise modes. The present results indicate that the amplitude of the increase in VO(2) is reduced during arm cranking with the legs exercising, that this reduction becomes greater with increases in the intensity of leg cycling, and that the rate of increase in VO(2) is not affected by the additional muscle mass of the legs exercising below moderate intensities. The decrease in the amplitude of increase in VO(2) might be caused by reduction in oxygen supply to the exercising arms due to large muscle mass and/or overlaps of activity of stabilizing muscles during combined arm and leg exercise.

Adult↗

PubMed1999

Relative contribution of arms and legs in humans to propulsion in 25-m sprint front-crawl swimming.

Eight male subjects were asked to swim 25 m at maximal velocity while the use of the arm(s) and legs was alternately restricted. Four situations were examined using one arm (1A), two arms (2A), one arm and two legs (1A2L) and both arms and legs (2A2L, normal swim) for propulsion. A significant mean increase of 10% on maximal velocity was obtained in 1A2L and 2A2L compared to 1A and 2A. A non-significant 4% effect was obtained in 1A. This study focused on the actual contribution of leg kick in the 10% gain in maximal velocity. It was clear that the underwater trajectory of the wrist was modified by the action of the legs (most comparisons P < 0.001). Therefore it was thought that the legs enhanced the generated propulsive force by improving the propulsive action of the arm. The arm action was quantified by selecting typical phases from the filmed trajectory of the wrist, namely forward (F), downwards (D) and backwards (B). Although there was a tendency for individual changes in kinematic parameters (F, D and B) to occur with individual changes in velocity when 2A was compared to 2A2L, no relationship was found between the relative changes in F, D and B and relative changes in velocity. This was illustrated by describing the responses of three individuals who could represent three patterns of contribution by legs and arms to propulsion in high speed swimming.

Arm↗

PubMed2001

Correction of length discrepancies and angular deformities of the leg by Blount's epiphyseal stapling.

UNLABELLED: The management of leg length difference (LLD) and angular deformities of the leg remains controversial. Numerous treatment options have been proposed over the past years depending on the patient's general condition, skeletal age, function, and degree and configuration of the deformity. Our retrospective study consisted of 48 patients with 58 legs treated between 1970 and 1991 by Blount's epiphyseal stapling to equalise length or correct angular deformity. After an average follow-up of 16.5 years, all patients with idiopathic bow-legs or knock-knees (n=12) and 71% of LLD caused by overgrowth (e.g. Klippel-Trenaunay syndrome) showed good and excellent results at skeletal maturity, whereas the results of the treatment of LLD with undergrowth of the leg and angular deformities due to trauma, infection or general dysplasia and malformation were fair to poor because of the difficulty in prediction of growth development and growth potential, allowing only for partial correction of the deformity. Besides the restriction of the stapling procedure due to the aetiology of the deformity, the age of the patients at the time of surgery is important, as it determines the complication rate of this technique (loosening or dislocation of staples). Thus Blount's epiphyseodesis should not be performed before the age of 9 years in girls and 11 years in boys. CONCLUSION: Blount's epiphyseal stapling can be recommended as a safe procedure with predictably good results in idiopathic angular deformities of the leg and leg length difference caused by overgrowth.

Adolescent↗

PubMed1986

Comparison of determinants of myocardial oxygen consumption during arm and leg exercise in normal persons.

Arm exercise assumes an increasingly important role in clinical cardiology as it is used in both exercise testing and training of patients with coronary artery disease. The effects of arm exercise on myocardial oxygen consumption are not well understood; they may differ from the effects of leg exercise. Previous studies have shown that the ischemic threshold is higher in patients performing arm exercise and leg exercise at the same heart rate-blood pressure product. The contribution of other determinants of myocardial oxygen consumption--left ventricular (LV) peak meridional systolic wall stress and contractility--to these observed differences were studied. Thirty healthy subjects exercised to the same peak rate-pressure product during dynamic upper- and lower-extremity exercise. Peak workload was lower during arm exercise (100 +/- 16 W) than during leg exercise (170 +/- 21 W, p less than 0.001). LV wall stress did not differ during either form of exercise (197 +/- 44 vs 204 +/- 33 dynes/cm2 X 10(3), arm vs leg, respectively). This was also true of contractility as assessed by the velocity of circumferential fiber shortening (2.8 +/- 0.6 vs 2.5 +/- 0.4 circ/s, arm vs leg, respectively) and the preejection period/LV ejection time ratio (0.33 +/- 0.11 vs 0.31 +/- 0.07, arm vs leg, respectively). Normal subjects exercising to a similar rate-pressure product showed the same levels of LV wall stress and contractility for arm and leg exercise despite the lower workload performed with arm exercise.

Adult↗

PubMed1992

Movement features and H-reflex modulation. II. Passive rotation, movement velocity and single leg movement.

Modulation of soleus H-reflex magnitudes during pedalling, and their approximation when seated with appropriate joint positions and contractile activity was demonstrated in the previous paper. The present study investigated the modulation of H-reflexes during (A) pedalling movement in the absence of contractile activity, (B) different movement velocities and (C) movement of a single limb. Using a customized tandem cycle ergometer, seated subjects with trunk supported relaxed their leg muscles and allowed their legs to be rotated. Their feet were supported on the pedals with the ankle braced. Reflexes were collected at four phases in the movement cycle (with some at 13 phases) and with speeds of 5-60 revolutions per min (cycle times from 12 to 1 s). The results showed that (i) reflex magnitude substantially decreased with limb rotation (P less than 0.05). The degree of inhibition was dependent on the phase position. (ii) Increasing speed of passive rotation increased the inhibition at all positions, but was most pronounced near the fullest flexion of hip and knee. When subjects actively pedalled, the relationship between speed and inhibition remained. (iii) When the contralateral leg was moved and the target leg was stationary, crossed projection of reflex inhibition was clear. (iv) The reflex gain measured during active pedalling of one leg was similar to that observed during two legged pedalling. Again, a crossed effect from the contralateral leg could be observed. We conclude that the net influence of discharge from movement-elicited afference is inhibitory on this reflex path and that the reflex modulation during pedalling arises from overlaid sources.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗

PubMed1995

The relationship between the kinematics of passive movement, the stretch of extensor muscles of the leg and the change induced in the gain of the soleus H reflex in humans.

The gain of the H reflex attenuates during passive stepping and pedalling movements of the leg. We hypothesized that the kinematics of the movement indirectly reflect the receptor origin of this attenuation. In the first experiment, H reflexes were evoked in soleus at 26 points in the cycle of slow, passive pedalling movement of the leg and at 13 points with the leg static (the ankle was always immobilized). Maximum inhibition occurred as the leg moved through its most flexed position (P < 0.05). Inhibition observed in the static leg was also strongest at this position (P < 0.05). The increase in inhibition was gradual during flexion movement, with rapid reversal of this increase during extension. In the second experiment, the length of stretch of the vasti muscles was modelled. Variable pedal crank lengths and revolutions per minute (rpm) altered leg joint displacements and angular velocities. Equivalent rates of stretch of the vasti, achieved through different combinations of joint displacements and velocities, elicited equivalent attenuations of mean reflex magnitudes in the flexed leg. Reflex gain exponentially related to rate of stretch (R2 = 0.98 P < 0.01). The results imply that gain attenuation of this spinal sensorimotor path arises from spindle discharge in heteronymous extensor muscles of knee and/or hip, concomitant with movement.

Adult↗

PubMed2005

Leg ulceration in Portugal: prevalence and clinical history.

OBJECTIVE: To determine the prevalence and clinical history of leg ulceration in Portugal. DESIGN: Case identification of patients through health professionals providing care for patients with leg ulceration. SETTING: Clinical areas in hospital, community centres and patients' homes. PARTICIPANTS: Patients registered with five health centres within Lisbon suffering from ulceration of the leg receiving care from hospital and community staff. METHODS: Patients identified by health care professionals working in one area of Lisbon were asked to complete a simple proforma on each patient with leg ulceration. Patients were followed up prospectively to determine healing rates during this baseline period of evaluation. RESULTS: In total 263 patients were identified in a population of 186,000 (total prevalence 1.41 (95%CI 1.25-1.59) per 1000 population). The prevalence was similar between men and women (1.3 and 1.46 per 1000, respectively). As expected this was highly age dependent being most common in the patients aged over 80 years (6.5 and 4.9 per 1000, respectively). Median duration of ulceration was 18 months, with 158/240 (66%) present for longer than 1 year, and 40 (17%) for longer than 5 years. The cause of ulceration was unknown to the health professional treating the patient in 86 (33%) patients. Diagnosis of aetiology was usually on the basis of clinical examination alone (145, 56%), with 21 (8%) having undergone ankle to brachial pressure index (ABPI) measurements and a further eight undergoing either echo-Doppler or arteriography. Most care was provided by community services, with 145 (55%) treated in health centres and 77 (29%) treated in the patient's home. CONCLUSIONS: The prevalence of chronic leg ulceration is similar to other reported studies in western Europe, and indicates that approximately 14,000 patients suffer from leg ulceration at any one time in Portugal. Leg ulceration causes a considerable burden on both hospital and community services.

Aged↗

PubMed2000

Postural sway of the affected and nonaffected pelvis and leg in stance of hemiparetic patients.

OBJECTIVES: To study potential differences between sway of the paretic and of the nonparetic pelvis and leg in standing hemiparetic patients by comparing measurements of corresponding bilateral waist and leg sites, and by comparing the results to those of healthy control subjects. DESIGN AND SETTING: Anterior-posterior and mediolateral sway of 15 hemiparetic patients and 13 healthy control subjects was measured with the eyes open and closed during quiet stance. Data were collected via an ultrasonic-based system that continuously monitored the position of four transducers mounted bilaterally on the anterior aspect of the pelvis and on each tibial tuberosity. Sway of each transducer marker was calculated by the standard deviation around its mean position and by its mean speed. Descriptive statistics, analysis of variance, and cross-correlation analysis were used for comparing hemiparetic patients with healthy subjects, as well as for determining the effects of body level, body side, and vision on postural sway. RESULTS: For all four measurement sites and in both the anterior-posterior and mediolateral axes, the hemiparetic patients had larger sways than the control subjects. Patients' sway on the paretic side was larger than on the nonparetic side, whereas no side differences were detected in the control subjects. For both groups, waist sway was larger than legs' sway. Cross-correlation values between sway of the ipsilateral waist and leg on each body side, as well as between the two legs, were substantially lower in the patients than in healthy subjects. CONCLUSIONS: Postural sway of standing hemiparetic patients is characterized by an asymmetrical profile that is expressed both in larger sway values of the paretic than of the nonparetic side, and in low temporal synchronization between sway of the legs and of the pelvis as well as between the two legs. Impairment in the ability to stabilize the distal segments of the lower extremity on the paretic side, rather than in stabilization of the pelvis, appears to underlie the enhanced postural sway of hemiparetic patients during stance.

Aged↗