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At least 667 records · Page 37Linked to original sources

PubMed1999

Factors predicting lower extremity amputations in patients with type 1 or type 2 diabetes mellitus: a population-based 7-year follow-up study.

OBJECTIVES: The aim of the study was to find factors predicting lower extremity amputation in patients with type 1 or type 2 diabetes mellitus through a 7-year follow-up period. DESIGN: Follow-up study. SUBJECTS: Altogether 733 diabetic patients. aged 10-79 years, were drawn from the national drug reimbursement register. METHODS: At baseline, the patients underwent a podiatric, circulatory and neurophysiological examination. Seven years later a follow-up study was performed based on clinical and register data. Patient data for those who died during the follow-up were collected from hospital records and death certificates. All amputations were recorded. The patients with amputation were compared with the other patients and also, in a case-control manner, by taking three nonamputated patients matched by sex, type of diabetes, and age for each patient with amputation. RESULTS: The number of amputations was 25 in the sample. Compared with all patients without amputation, patients with amputation differed in altogether 24 variables concerning diabetes and its complications. Compared with the matched non-amputated patients, the amputated patients had longer duration of diabetes, lower ankle/brachial pressure index (ABI), more often history of retinopathy, nephropathy, and hypertension, more often visual handicap, elevated serum creatinine level, abnormal neurophysiological indices and electrophysiological findings. In the logistic regression analysis, vibration perception threshold, low ABI, history of retinopathy, visual handicap, and male sex were independently associated with lower extremity amputation. CONCLUSIONS: Lower extremity amputations were strongly associated with retinopathy, nephropathy, and neuropathy. The presence of any of these complications should lead to intensified actions in order to prevent amputations. As far as arterial circulation is concerned, claudication or absent peripheral pulses were not good predictors of amputation, whereas low ABI, despite its known weaknesses, was a reliable indicator of future amputation.

Adolescent↗

PubMed2007

The adverse effects of race, insurance status, and low income on the rate of amputation in patients presenting with lower extremity ischemia.

OBJECTIVES: A consequence of delay in the diagnosis of peripheral vascular disease limb loss. This study was undertaken to determine the correlation of low socioeconomic status and race on the severity of ischemic presentation and the subsequent amputation rate. METHODS: Data from the Nationwide Inpatient Sample (NIS) from 1998 to 2002 on patients from urban hospitals with the diagnosis of lower extremity ischemia were evaluated. The population was divided into two groups: the amputation group (AMP) and lower extremity revascularization group (LER). Comorbidities, age, gender, race, ischemic gangrene at presentation, insurance status (no/noncommercial or commercial), and income status at admission were determined. These variables were compared using multivariate logistic regression analyses of the data for risk adjustment. RESULTS: Of 691,833 patients presenting with lower extremity ischemia, 363,193 underwent revascularization (66.3%) or amputation (33.7%). Univariate analysis correlated a statistically significant (P < .0001) higher rate of amputation and multivariate analysis associated significantly higher odds of amputation with the following variables: nonwhites (1.91, 95% confidence interval [CI], 1.65, 2.20), low-income bracket (1.41, 95% CI, 1.18, 1.60), and Medicare & Medicaid (1.81, 95% CI, 1.66, 1.97). Adjusting for other variables of statistical significance, multivariate regression analysis showed a statistically significant risk for amputation based on the nonteaching status of the institution (odds ratio [OR], 1.17, 95% CI, 1.08, 1.30). CONCLUSIONS: Primary amputation was performed with a higher frequency on patients with lower extremity ischemia who were nonwhite, low income, and without commercial insurance. The observed advanced ischemia among these economically disadvantaged patients suggests a delayed diagnosis of peripheral vascular disease, probably due to lack of access to adequate primary care or vascular surgery providers, or both. Better education of the general population and primary care providers to the symptoms and consequences of PVD may reduce the amputation rate in this group.

Aged↗

PubMed1987

Static measurement of tibia vara. Reliability and effect of lower extremity position.

The purpose of this study was to examine the reliability of tibia vara measurements and to determine the effects of lower extremity position on such measurements. A manual goniometer was used to measure tibia vara in both lower extremities of 20 healthy subjects while they assumed three different positions: double-limb stance (DLS) with subtalar joint position uncontrolled (Condition 1), DLS with subtalar joint positioned in neutral (Condition 2), and single-limb stance with subtalar joint position uncontrolled (Condition 3). Intraclass correlation coefficients (p less than .05) revealed that tibia vara measurements were reliable both within and between raters with mean absolute differences between repeated measures of 2 to 3 degrees. An analysis of variance and a Newman-Keuls post-hoc test (p less than .05) showed that Condition 3 produced the greatest value of tibia vara followed by Conditions 1 and 2, respectively. The results of this study suggest that lower extremity position is an important consideration when measuring tibia vara and determining whether treatment intervention is indicated.

Adult↗

PubMed1996

A prospective evaluation of atherosclerotic risk factors and hypercoagulability in young adults with premature lower extremity atherosclerosis.

PURPOSE: Fifty-one consecutive patients with premature lower extremity atherosclerosis were prospectively evaluated for atherogenic risk factors and primary or acquired hypercoagulability, which might contribute to early ischemia and revascularization failure. METHODS: Laboratory tests included plasma assays of (1) natural anticoagulants (NAC), lipoprotein (a) (Lp[a]), and anticardiolipin antibodies, and (2) fibrinolytic activators and inhibitors at baseline and stimulated after 20 minutes of upper extremity venous occlusion. RESULTS: Forty-six (90%) of these 51 patients had laboratory abnormalities. One or more NAC deficiencies were found in 15 (30%) patients and included antithrombin III (n = 5), protein C (n = 8), protein S (n = 4), and heparin cofactor II (n = 2). Hypofibrinolysis was identified as a deficiency of stimulated tissue plasminogen activator in 22 (45%) patients and elevated plasminogen activator inhibitor-1 (PAI-1) in 29 (59%). Elevated Lp(a) was found in 43 (86%) patients. Five (10%) patients had anticardiolipin antibodies. Ten patients had combined NAC deficiency and hypofibrinolysis. Five (10%) patients had no abnormality. NAC deficiencies, especially protein C deficiency, were associated with acute ischemia (p < 0.01), prior vascular intervention (p < 0.01), an increasing number of total vascular procedures (p < 0.01), and major amputation (p < 0.01). PAI-1 was associated with a history of heart disease (p < 0.05) and prior vascular procedures (p < 0.05). Elevated Lp(a) was associated with elevated PAI-1 (p < 0.05). Retesting in 20 patients suggested that 80% of NAC deficiencies were acquired, but abnormalities persisted in 66% of patients with elevated PAI-1 and in 93% of those with elevated Lp(a). CONCLUSIONS: These data strongly support the hypothesis that the convergence of atherogenic risk factors and hypercoagulability play an important role in early ischemia and poor results reported for lower extremity vascular procedures in young adults.

Adult↗

PubMed1998

Mathematical model of the lower extremity joint reaction forces using Kane's method of dynamics.

This report describes a new mathematical model for defining the joint reaction forces of the lower extremity using Kane's method of dynamics. Our model utilized average lower extremity joint motion and force/plate data from one healthy female patient during gait. From a cadaver specimen, the anatomical mass centers of the pelvis, femur, tibia, and foot were determined. Joint angular motion during the normal gait cycle was computed using Cardan angles for each distal segment relative to the proximal segment. Fluoroscopy of four normal knees determined average femorotibial and patellofemoral contact positions throughout flexion. A three-dimensional model of the lower extremity was defined in weight-bearing motion by 30 differential equations. During normal walking, the joint reaction forces for the subject tested ranged from 1.9 to 2.6 times body weight at the hip joint and 1.7-2.3 times body weight at the knee joint, depending primarily on gait speed. The method correlates well with known in vivo telemetrically measured forces at the hip joint.

Arthrography↗

PubMed1995

Measurement of muscle strength of the trunk and the lower extremities in subjects with history of low back pain.

STUDY DESIGN: Isokinetically measured muscle strength of the trunk and lower extremities was analyzed. OBJECTIVES: The causes of the weak trunk muscle strength of subjects with low back pain were studied. SUMMARY OF BACKGROUND DATA: Although it is a commonly accepted conclusion that subjects with low back pain have weaker trunk muscles than the normal population, there are no reports concerning muscle strength of the lower extremities in subjects with low back pain. METHODS: Ninety-eight male volunteers were divided into control groups and groups with low back pain. The total trunk strength and total knee strength were defined as the sum of the peak torques of trunk extension, flexion and rotation, and of bilateral knee extension and flexion, respectively. RESULTS: The total trunk and knee strength in the group with low back pain (281 +/- 170 and 301 +/- 132 Nm) were significantly lower than in the control group (543 +/- 124 and 441 +/- 123 Nm). The total trunk and knee strength were linearly correlated in both groups (r = 0.67 and 0.79). CONCLUSIONS: In the group with low back pain, the muscles of the trunk and the lower extremities were similarly affected; this can be attributed to generalized muscular weakness or psychologic factors, such as fear of injury.

Adolescent↗

PubMed1998

[Genetic analysis of varicose vein of lower extremities].

OBJECTIVE: To make a hereditary analysis of varicose vein of lower extremities(VVLE), including hereditary pattern, sex ratio and the transmitted expression male and female of varicose vein of lower extremities. METHODS: The ascertainment probability was estimated according to Weinberg's proband method. The value of segregation ratio P and proportion of sporadic cases X were estimated by the maximum likelihood score method. The calculations were performed using computer program of segregation analysis. The VVLE cases were random samples from inpatients and outpatients of the authors' hospital from 1991 to 1996. RESULTS: There were 68 pedigrees including 80 nuclear families in 3 different mating types:UAU, UAA and AAA. UAU, UAA and AAA were analysed together. UAA and UAU (multiplex families) were analysed respectively. All the values were compatible with autosomal dominant inheritance of incomplete penetrance; the penetrance frequencies were 91.94%, 78.14% and 69. 92% respectively. The proportion of X was 24.32%. The UAU was compatible with autosomal recessive inheritance; the proportion of sporadic cases was 36.75%. CONCLUSION: VVLE is compatible with autosomal dominant and recessive inheritance. The sex ratio of male:female is 2.39:1. The transmission is possible from male and female to male and female both.

Female↗

PubMed2006

Risk factors for recurrent lower extremity cellulitis in a U.S. Veterans Medical Center population.

BACKGROUND: Despite the frequency of recurrent acute cellulitis of the lower extremities, factors associated with this infection have not been previously assessed in a case-control study among patients admitted to U.S. hospitals. METHODS: We compared the clinical characteristics of 47 patients with those of 94 age- and sex-matched control subjects admitted to the Miami Veterans Affairs Medical Center. RESULTS: In a multivariate analysis, two physical factors, lower extremity edema and body mass index, one behavioral factor, smoking, and one demographic factor, homelessness, were significantly and independently associated with recurrent cellulitis. The latter two factors have not previously been reported to be independently associated with cellulitis. CONCLUSIONS: Our results suggest that increased emphasis on weight loss, smoking cessation, and improved foot hygiene in the homeless might decrease recurrences of lower extremity cellulitis.

Body Mass Index↗

PubMed1990

A method for determining lower extremity muscle-tendon lengths during flexion/extension movements.

A study was conducted to examine the relationship between muscle-tendon lengths of 16 lower extremity muscles and the flexion angle(s) of the joint(s) they cross. Anthropometric data from six subjects were obtained. Various lower extremity joint flexion angle combinations were simulated for each subject using computer software. For each simulated lower extremity position, muscle origin and insertion locations were determined based on averaged cadaveric origin/insertion information and individual anthropometric parameters. Corresponding muscle-tendon lengths were computed and normalized to segment lengths. Regression equations were derived which allow normalized muscle-tendon lengths to be estimated from known joint flexion angles. The regression equations obtained for biarticular muscles fit the data quite well giving correlation coefficients greater than 0.92. The correlation coefficients for the equations describing normalized single joint muscle-tendon lengths range from 0.77 to 0.97. The equations were then validated by comparing predicted lengths to those reported by previous investigations. Confirming the utility of the equations, the comparisons were excellent for both uniarticular and biarticular muscles. Used in conjunction with velocity data (obtained by differentiating the length data) and electromyogram recordings, these equations enable a detailed analysis of muscle function.

Adult↗

PubMed1989

Perception of unilateral lower extremity weightbearing during bilateral upright stance.

The primary purpose of this study was to describe the error in 61 healthy subjects' perceptions of weight-bearing at three target levels during bilateral upright stance. The secondary purpose was to describe the effects of age, sex, lower extremity dominance and target weightbearing level on the error in perceptions of weightbearing. Weightbearing was determined while subjects stood on digital scales. They adjusted their weight in an attempt to bear 25, 50, and 75% of their weight through a designated lower extremity. Three trials were allowed at each weightbearing target, and the results were averaged. Each subject's error in perception of weightbearing at each target level was determined by taking the absolute value of the target percent weightbearing minus the mean actual percent weightbearing. The mean errors at the 25, 50, and 75% targets were 7.3, 3.3, and 7.7%, respectively. The magnitude of the error was unrelated to age. An analysis of variance showed that error was not dependent on sex or whether the dominant lower extremity was used for making judgements. The error did differ between target levels. Clinicians cannot assume, based on the findings of this study, that individuals can accurately judge the percent weightbearing they are placing through one of their lower extremities during bilateral upright stance.

Adult↗

PubMed1995

The influence of race on the use of surgical procedures for treatment of peripheral vascular disease of the lower extremities.

OBJECTIVE: To assess whether rates of amputation and leg-sparing surgery for peripheral vascular disease of the lower extremities differ between African-American and white patients. DESIGN: Retrospective cohort study using Medicare claims data for 1989 and 1990. SETTING: A total of 3313 hospitals in the United States. PATIENTS: Random sample of 19,236 Medicare Part A enrollees who underwent amputation and/or leg-sparing surgery for peripheral vascular disease. MAIN OUTCOME MEASURES: Adjusted odds of toe and/or foot amputation, below-knee amputation, above-knee amputation, lower extremity arterial vascularization, and percutaneous transluminal angioplasty for African American relative to whites, controlling for case-mix, region, and hospital characteristics. RESULTS: African-American patients were significantly more likely than white patients to undergo above-knee, below-knee, and toe and/or foot amputation and significantly less likely to undergo lower-extremity arterial revascularization and percutaneous transluminal angioplasty. These associations occurred for diabetic patients and nondiabetic patients but were more pronounced among patients who did not have diabetes. CONCLUSIONS: Potential explanations include unmeasured factors such as severity of disease and the technical expertise available at hospitals or other factors such as lack of compliance with medical treatment and race-specific treatment decisions by providers. Whatever the cause, interventions aimed toward reducing the number of amputations among African Americans are needed. Further work is required to determine where such interventions should be targeted.

Black or African American↗

PubMed1991

Lower extremity torsional deformities in children: a prospective comparison of two treatment modalities.

A prospective randomized analysis was conducted on children with lower extremity torsional deformities. Its purpose was to define the natural history of these anomalies and to determine the efficacy of treatment with a Denis-Browne splint. The natural history of pediatric lower extremity torsional deformities is to correct toward the mean of the population. The Denis-Browne splint did not alter the natural history of lower extremity torsional deformities as defined by the foot progression angle.

Bone Diseases, Developmental↗

PubMedDate not supplied

Comparison of the use of enoxaparin versus unfractionated heparin in patients undergoing lower extremity revascularization.

Present available studies suggest that heparin prevents early vessel thrombosis in the immediate postoperative (POP) period after lower extremity bypass. Long-term anticoagulation with warfarin has also been used in these patients, based on its beneficial effect in preventing long-term graft failure. To compare the effectiveness between unfractionated heparin (UH) and low-molecular-weight heparin (enoxaparin) when used as transitional therapeutic POP anticoagulant therapy, a prospective study was performed. Seventy consecutive patients undergoing lower extremity bypass were studied. The initial 35 patients were started on a drip of UH 6 hours POP. The next 35 consecutive patients were treated with enoxaparin, the first dose starting 6 hours POP. All patients underwent subsequent anticoagulation with oral warfarin. There were no statistically significant differences between the two groups with regard to demographics, percentage of above/below the knee bypasses, type of conduit used, emergency operations, and overall complications. There was a significant difference in the length of stay (p = 0.05) in favor of the enoxaparin group, which also reflected a decreased overall cost in this group. In conclusion, POP anticoagulation with enoxaparin is as safe end effective as UH in patients undergoing lower extremity revascularization. Enoxaparin was associated with a decreased overall length of stay and hospital costs.

Aged↗

PubMedDate not supplied

Complications of lower-extremity outpatient arteriography via low brachial artery.

We retrospectively evaluated low brachial artery puncture for arteriography and its complications as an alternative approach route for bilateral lower extremity run-off. Using the Seldinger technique and catheterization with a sheathless 4-F multiple side-hole pigtail catheter, we performed 2250 low brachial artery punctures in outpatients. The right brachial artery (RBA) was successfully punctured in 2039 patients; the left brachial artery (LBA) in 200. The transfemoral approach was used in 11 patients when catheterizing either of brachial arteries failed. Ten major or moderate complications (2 pseudoaneurysms, 2 thrombosis, 1 dissection and 5 hematomas) were encountered. Surgical intervention was necessary in three cases. There were no transient ischemic attacks. Twenty-one patients suffered temporary loss of radial pulse which returned spontaneously in less than 1 hour. One patient demonstrated prolonged loss of pulse which required heparin. Low brachial artery puncture and catheterization at the antecubital fossa is a very safe and cost-effective alternative to the femoral artery approach for lower extremity intra-arterial arteriography in the hands of experienced operators. The success rate in catheterizing one of the brachial arteries was 99.52% with a low significant complications rate of 0.44%. The transbrachial approach should be used as a standard method for lower extremity IA-DSA in an outpatient setting.

Adolescent↗

PubMed1999

Altered movement strategy increases lower extremity stiffness during stepping down in the aged.

One way the human neuromuscular system negotiates locomotory challenges is by stiffening the muscles and joints of a limb. Because aging reduces joint range of motion and muscle strength, the intrinsic elements of stiffness, we hypothesized that lower extremity stiffness would be greater in elderly than in young subjects during downward stepping. Fourteen elderly (mean age 70.1) and 16 young women (mean age 20.8) stepped down from a platform adjusted to 10% and 20% of body height. Subjects stepped down onto a force plate and were videotaped from the side. The lower extremity was modeled as a simple spring and stiffness was computed as the quotient of stress under the foot and the shortening of the limb. Ankle and knee joint angular position and velocity were also determined during stepping. Compared with young women, elders had 50% greater lower extremity stiffness and 28% less linear shortening of the limb. Elders also performed downward stepping with 92% less dorsiflexion and 28% less knee flexion and 42% less ankle and 57% less knee joint range of motion. Elders executed downward stepping with a more erect lower extremity alignment, resulting in a stiffer leg and an apparently safer movement strategy.

Acceleration↗

PubMed2006

Morphological muscle and joint parameters for musculoskeletal modelling of the lower extremity.

BACKGROUND: To assist in the treatment of gait disorders, an inverse and forward 3D musculoskeletal model of the lower extremity will be useful that allows to evaluate if-then scenarios. Currently available anatomical datasets do not comprise sufficiently accurate and complete information to construct such a model. The aim of this paper is to present a complete and consistent anatomical dataset, containing the orientations of joints (hip, knee, ankle and subtalar joints), muscle parameters (optimum length, physiological cross sectional area), and geometrical parameters (attachment sites, 'via' points). METHODS: One lower extremity, taken from a male embalmed specimen, was studied. Position and geometry were measured with a 3D-digitizer. Optotrak was used for measurement of rotation axes of joints. Sarcomere length was measured by laser diffraction. FINDINGS: A total of 38 muscles were measured. Each muscle was divided in different muscle lines of action based on muscle morphology. 14 Ligaments of the hip, knee and ankle were included. INTERPRETATION: The presented anatomical dataset embraces all necessary data for state of the art musculoskeletal modelling of the lower extremity. Implementation of these data into an (existing) model is likely to significantly improve the estimation of muscle forces and will thus make the use of the model as a clinical tool more feasible.

Aged↗

PubMedDate not supplied

Survey of the effects of aerobic dance on the lower extremity in aerobic instructors.

The rate of aerobic dance injuries has been high for two decades. To determine the types of lower-extremity injuries to aerobic instructors, a questionnaire was sent to 18 fitness centers in the Sydney, Australia, metropolitan area requesting information on the number and types of injuries, frequency of activity levels, footwear worn, and treatments sought. The reported rate of injury was 77%. The leg was the most common site of injury, reported by 52.9% of respondents, followed by the foot and ankle (32.8%), and the knee (20%). These figures are comparable to previous studies. Further investigation is warranted into causes and preventive measures, and information on the kinetics and kinematics of the lower extremity may increase understanding of the incidence of lower-extremity injuries to aerobic instructors and participants.

Australia↗

PubMed2006

[Effects of a tilting training program on lower extremities function, depression, and self-efficacy among stroke inpatients].

PURPOSE: The purpose of this study was to identify effects of a tilting training program on lower extremities function, depression, and self-efficacy among stroke inpatients. METHOD: The subjects were 60 stroke patients hospitalized in an oriental medical hospital; 31 in the experimental group and 29 in the control group. A nonequivalent control group pretest-posttest design was used. The tilting training program consisted of 3 sessions and was implemented for 30 minutes daily during 3 weeks. Data was collected from Feb to July 2003, and analyzed by percentage, Fisher's exact probability, chi2-test, and t-test using the SPSS/Win 10.0 computerized program. RESULT: After treatment with the tilting training program, the experimental group was significantly increased in the mean score for function of lower extremities (t=2.72, p=.009) compared to the control group, especially for keeping standing balance (t=2.78, p=.007) and standing by oneself (t=3.32, p=.002). However, in the mean scores of depression and self-efficacy, there were no significant differences between the two groups. CONCLUSION: The tilting training program was effective for increasing the function of lower extremities and to improve walking ability earlier among stroke inpatients. Therefore, the tilting training program is applicable to increase the balance level in standing and walking ability at the early rehabilitation stage for stroke patients.

Adult↗