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At least 883 records · Page 49Linked to original sources

PubMed1993

Effect of a lateral step-up exercise protocol on quadriceps and lower extremity performance.

Closed kinetic chain exercises have been promoted as more functional and more appropriate than open kinetic chain exercises. Limited research exists demonstrating the effect of closed kinetic chain exercise on quadriceps and lower extremity performance. The purpose of this study was to determine the effect of a lateral step-up exercise protocol on isokinetic quadriceps peak torque and the following lower extremity activities: 1) leg press, 2) maximal step-up repetitions with body weight plus 25%, 3) hop for distance, and 4) 6-m timed hop. Twenty subjects participated in a 4-week training period, and 18 subjects served as controls. For the experimental group, a repeated measure ANOVA comparing pretest and posttest values revealed significant improvements in the leg press (p < or = .05), step-ups (p < or = .05), hop for distance (p < or = .05), and hop for time (p < or = .05) and no significant increase in isokinetic quadriceps peak torque (p > or = .05). Over the course of the training period, weight used for the step-up exercise increased (p < or = .05), repetitions decreased (p < or = .05), and step-up work did not change (p > or = .05). For the control group, no significant change (p > or = .05) occurred in any variable. The inability of the isokinetic dynamometer to detect increases in quadriceps performance is important because the isokinetic values are frequently used as criteria for return to functional activities. We conclude that closed kinetic chain testing and exercise provide additional means to assess and rehabilitate the lower extremity.

Adult↗

PubMedDate not supplied

Interpretations and treatment decisions based on MR angiography versus conventional arteriography in symptomatic lower extremity ischemia.

PURPOSE: To determine the frequency with which treatment plans based on findings at magnetic resonance angiography (MRA) match those based on findings at conventional x-ray arteriography (XRA) in the evaluation of symptomatic lower extremity ischemia. PATIENTS AND METHODS: Two-dimensional time-of-flight (TOF) MRA was performed in 42 patients undergoing XRA for evaluation of symptomatic lower extremity ischemia. The blind interpretations and treatment plans based on MRA findings were compared with those based on XRA findings, with use of XRA as the standard of reference. RESULTS: For identification of hemodynamically significant stenosis or occlusion, the sensitivity and specificity of MRA was 100% and 23% for iliac segments, 100% and 82% for common femoral segments, 89% and 67% for superficial femoral segments, 100% and 88% for popliteal segments, and 92% and 91% for tibioperoneal segments, respectively. The treatment plan based on MRA findings matched that based on XRA findings in 41% of patients. CONCLUSION: For evaluation of symptomatic lower extremity ischemia, two-dimensional TOF MRA cannot be considered a reliable substitute for XRA in patients who lack contraindications to XRA.

Angiography↗

PubMed2001

Preoperative planning for lower extremity osteotomies: an analysis using 4 different methods and 3 different osteotomy techniques.

Lower extremity osteotomy is a common procedure for managing deformity and unicompartmental gonarthrosis. One consideration not typically addressed is how the osteotomy will affect the leg length of the extremity. This article presents a numerical analysis of apparent leg-length change before and after osteotomy surgery. It also compares the differences resulting from the 3 different major types of osteotomies (closing wedge, opening wedge, and dome). Three different preoperative planning methods and a fourth intraoperative technique were studied. Using different methods of preoperative planning with the same osteotomy technique resulted in leg-length changes of 0.5 to 3 mm. Differences > 7 degrees in lower extremity alignment may result depending on the planning method used. When comparing osteotomy techniques, 2 cm in leg-length difference was calculated.

Biomechanical Phenomena↗

PubMed1989

Outcome of treatment of combined orthopedic and arterial trauma to the lower extremity.

To ascertain morbidity and disability associated with vigorous attempts at limb salvage after lower extremity combined orthopedic and arterial injuries we reviewed more than 10,000 trauma admissions. Twenty-two patients (0.2%) suffered 14 blunt and eight penetrating lower extremity orthoarterial injuries. In all, more than 90 extremity operations were performed within 30 days of admission. The mechanism of injury, ISS, sequence of orthopedic and vascular procedures, use of temporary arterial shunts, the nature of the arterial reconstruction, length of ischemic time, and the presence of open fractures did not affect limb salvage or outcome. The presence of neurosensory/motor impairment and/or serious soft-tissue loss and injuries at or distal to the popliteal artery were associated with a high frequency of disability and amputation. Tremendous effort was expended to achieve limb salvage in the patients of this review. Patients who underwent amputation had the more uneventful hospitalizations and the lower rates of disability. The notion that limb salvage need to be obtained in all patients at all costs may often lead to the triumph of technique and technology over reason.

Adult↗

PubMed1999

[Staging-syndrome differentiation in treating diabetic foot disorder and its effect on hemodynamic changes of lower extremities with arterial ultrasonic Doppler diagnostic apparatus].

OBJECTIVE: To observe the therapeutic effect of staging-Syndrome Differentiation of TCM in treating the diabetic foot disorder and the corresponding hemodynamic changes in lower extremities. METHODS: Chromatic ultrasonic Doppler diagnostic apparatus (ATL-ULTRAMARK 9 HDI, made in USA) was used to determine the arterial hemodynamic changes and clinical effect on the treatment of diabetic foot disorder in 60 non-insulin dependent diabetes mellitus (NIDDM) patients, among them 30 were treated by staging-Syndrome Differentiation of TCM, and the other 30 as control group treated with 654-2, and the 30 cases of nondiabetic foot disorder as normal control group in comparison. RESULTS: Compared to the normal control, the intravascular diameter, blood flow of both treated groups reduced, maximal and minimal speed of blood flow, and the mean speed were accelerated. Values in dorsal pedis artery had present the most sensitive one. In the comparison between before and after treatment, both treated groups were hemodynamic improvement in the lower extremities' artery, more obviously the dorsal pedis artery, while the comparison between these two groups showed that TCM staging-Syndrome Differentiation had a superior effect on lower extremities' hemodynamics to that of 654-2 group. The comprehensive assessment revealed that the treated groups was also significant different in comparing to that of normal control group (P < 0.05). CONCLUSION: The comprehensive TCM treatment of staging-Syndrome Differentiation as the main therapeutic component was prominently better than that of 654-2 application in the treatment.

Adult↗

PubMed2005

Improvement of a questionnaire measuring activity limitations in rising and sitting down in patients with lower-extremity disorders living at home.

OBJECTIVE: To improve a self-administered questionnaire that includes 42 dichotomous items and measures activity limitations in rising and sitting down (R&S) in patients with lower-extremity disorders who live at home. DESIGN: Cross-sectional study. SETTING: Outpatient clinics of secondary and tertiary care centers. PARTICIPANTS: Patients (N=759; 47% men; mean age +/- standard deviation, 60.7+/-15.2y) living at home, with lower-extremity disorders resulting from stroke, poliomyelitis, osteoarthritis, amputation, and complex regional pain syndrome type I. INTERVENTIONS: Not applicable. MAIN OUTCOME MEASURES: (1) Unidimensionality, indicating that items assess only a single construct; (2) fit with the one-parameter logistic model (OPLM), yielding information about patient and item location parameters; (3) intratest reliability, indicating consistency of patients' item scores; and (4) content validity, indicating completeness with which the items cover the important aspects of the construct that they are attempting to represent. RESULTS: Thirty-nine of 42 items: (1) loaded on 1 component (variance explained, 59%; item component loadings, >or=.51), (2) showed good fit with the OPLM (P=.15), (3) had a good intratest reliability (Cronbach alpha=.96), and (4) had a good content validity (all important aspects represented). CONCLUSIONS: A unidimensional scale that fits with the OPLM has been developed for measuring activity limitations in R&S in patients with lower-extremity disorders who live at home.

Activities of Daily Living↗

PubMed1992

Force- and moment-generating capacity of lower-extremity muscles before and after tendon lengthening.

A computer model of the human lower extremity was developed to study how surgical lengthening of tendon affects the force- and moment-generating capacity of the muscles. This model computes the maximum isometric force and the resulting joint moments that each muscle-tendon complex can develop at any body position. Tendon lengthenings were simulated by increasing the tendon length of each muscle-tendon complex and computing the change in the maximum isometric muscle force and joint moments at a specific body position. These simulations showed that the forces and moments developed by the ankle plantarflexors are extremely sensitive to changes in tendon length. For example, at a body position corresponding to the midstance phase of gait, the maximum isometric moment generated by soleus decreased 30% with a 1-cm increase in tendon length, and 85% with a 2-cm increase in tendon length. In contrast, 1- and 2-cm increases in iliopsoas tendon length decreased its hip flexion moment by only 4% and 9%, respectively. This article quantifies the sensitivity of muscle force and joint moments to changes in tendon length for the most commonly lengthened lower-extremity tendons. These results indicate how much each of these tendons should be lengthened to achieve an incremental decrease in muscle force or joint moment.

Ankle Joint↗

PubMed1984

Lower extremity hemorrhage in spinal cord injured patients receiving therapeutic anticoagulation.

Six episodes of lower extremity hemorrhage occurred in five spinal cord injured patients receiving therapeutic anticoagulation. Factors contributing to hemorrhage included excessive anticoagulation in two episodes and soft tissue trauma during vigorous range of motion (ROM) exercises in three. The three episodes without clinical evidence of trauma were initially misdiagnosed as recurrent deep venous thrombosis. Ecchymoses developed in three episodes, but were delayed in appearance in two. Noninvasive vascular tests yielded false positive results in two out of three cases. Venograms performed in four episodes were negative for thrombosis. Based on this experience, the initial investigation of lower extremity swelling in this setting should include: a search for evidence of trauma, analysis of medications for coagulation-related interactions, leg x-rays, and early determination of hemoglobin, prothrombin or partial thromboplastin time, and platelet count. If there is any question of acute thrombosis, a venogram, rather than noninvasive vascular studies, must be performed. All persons involved in the care of these patients should be aware of the increased risk of bleeding and should perform ROM exercises of weak or paralyzed extremities with caution.

Adolescent↗

PubMed2002

Separation of arteries and veins using flow-induced phase effects in contrast-enhanced MRA of the lower extremities.

In 3-D contrast-enhanced magnetic resonance (MR) angiography of the lower extremities the goal is most often to enhance arterial structures while keeping veins and surrounding tissue unenhanced. Imaging during steady-state concentration of a blood pool agent or during poor timing of an extra-cellular contrast medium may result in simultaneous venous enhancement, making interpretation of the angiogram difficult. The aim of this study was to develop a post-processing method to separate the arteries from the veins in standard contrast-enhanced MR angiograms. The method was based on the different accumulation of flow-induced phase in the arteries and veins of the lower extremities. The method was tested in both phantom experiments and volunteers undergoing 3-D contrast-enhanced MR angiography using both an extra-cellular contrast medium and a blood pool agent. In the phantom studies, opposite directional flow was successfully separated at mean flow velocities as low as 9 cm/s. In the volunteer studies, the larger veins were successfully extinguished while the larger arteries were left unaffected. In smaller vessels with low flow velocities the separation was less successful. This was most apparent in vessels not oriented superior-inferior. The method developed here is promising for separating arteries from veins in contrast-enhanced MR angiography although the results could be further improved by either a different pulse sequence design or combining this method with other segmentation methods.

Arteries↗

PubMed1989

Compartment syndrome in combined arterial and venous injuries of the lower extremity.

In 9 of 45 patients treated for dual vascular injuries of the lower extremity, concomitant fasciotomies were performed at the time of initial surgery for associated soft tissue injury, fracture, or prolonged ischemia. Eight other patients developed compartment syndrome requiring delayed fasciotomy. In seven of them, vein was either ligated or the repaired vein became occluded. In the eighth patient, peripheral venous hypertension was caused by massive swelling of the thigh. In the laboratory, compartment pressure was monitored by wick catheter in 24 hind limbs of 12 dogs subjected to experimental conditions simulating vascular injuries and their management. There was a significant increase in compartment pressure in a group that simulated arterial and venous injuries managed by arterial repair and venous outflow obstruction. Based on our study, we suggest that obstruction to venous drainage and venous hypertension are major factors in the development of compartment syndrome in dual vascular injuries of the lower extremity.

Adolescent↗

PubMed2000

Lower extremity deformities associated with thrombocytopenia and absent radius syndrome.

The cases of 11 patients with the syndrome of thrombocytopenia and absent radius (TAR syndrome) who presented at two institutions between 1970 and 1996 were reviewed. Knee deformities have been well documented in thrombocytopenia and absent radius syndrome, but an inordinate frequency of other lower extremity problems needing orthopaedic attention was seen. Five of the 11 patients with thrombocytopenia and absent radius syndrome studied had knee deformities, but seven of the 11 had 11 other lower extremity deformities. This article documents all of the lower extremity problems seen in the seven patients with thrombocytopenia and absent radius syndrome with anomalies other than those of the knee.

Child, Preschool↗

PubMed2006

Rotational profile of the lower extremity in achondroplasia: computed tomographic examination of 25 patients.

PURPOSE: To evaluate lower-extremity rotational abnormalities in subjects with achondroplasia using computed tomography (CT) scans. MATERIALS AND METHODS: CT scans were performed in 25 subjects with achondroplasia (13 skeletally immature, mean age 8.7 years; 12 skeletally mature, mean age 17.6 years). In a total of 50 bilateral limbs, CT images were used to measure the angles of acetabular anteversion, femoral anteversion, and tibial external torsion. Measurement was performed by three examiners and then repeated by one examiner. Inter- and intraobserver agreements were analyzed, and results were compared with previously reported normal values. RESULTS: Mean values for skeletally immature and skeletally mature subjects were 13.6+/-7.5 degrees and 21.5+/-6.4 degrees respectively for acetabular anteversion, 27.1+/-20.8 degrees and 30.5+/-20.1 degrees for femoral torsion, and 21.6+/-10.6 degrees and 22.5+/-10.8 degrees for tibial torsion. Intra- and interobserver agreements were good to excellent. Acetabular anteversion and femoral anteversion in skeletally mature subjects were greater than normal values in previous studies. Both skeletally immature and mature subjects with achondroplasia had decreased tibial torsion compared to normal skeletally immature and mature subjects. CONCLUSION: Lower-extremity rotational abnormalities in subjects with achondroplasia include decreased tibial external torsion in both skeletally immature and mature subjects, as well as increased femoral and acetabular anteversion in skeletally mature subjects.

Achondroplasia↗

PubMed2000

Effectiveness of a comprehensive diabetes lower-extremity amputation prevention program in a predominantly low-income African-American population.

OBJECTIVE: To compare patient outcomes 1 year before and 1 year after enrollment in a comprehensive diabetes lower-extremity amputation prevention program. RESEARCH DESIGN AND METHODS: Outcome data were obtained on 197 patients enrolled in the Louisiana State University Health Sciences Center Diabetes Foot Program, which provides foot care to a predominantly low-income African-American population in Louisiana. Data were obtained using a structured interview administered by a registered nurse. Recordings were made of number of days with an open foot ulcer, number of times hospitalized for a foot problem, number of days spent in the hospital for a foot problem, number of visits to the emergency room for a foot problem, number of times an antibiotic was prescribed for a foot problem, number of all foot operations, number of lower-extremity amputations, and number of missed workdays for a foot problem. Data were obtained on all patients at the initial visit and at the 1-year follow-up. RESULTS: Analysis of data showed a reduction in foot-related ulcer days (-49%), hospitalizations, (-89%), hospital days (-90%), emergency room visits (-81%), antibiotic prescriptions, (-57%), foot operations (-87%), lower-extremity amputations (-79%), and missed workdays (-70%) after 1 year of comprehensive foot care compared with the 1-year period before treatment. CONCLUSIONS: This single cohort outcome study showed a large reduction in foot-related complications after the first year of comprehensive preventive foot care.

Black or African American↗

PubMedDate not supplied

Use of fibula-free tissue transfer with preoperative 2-vessel runoff to the lower extremity.

OBJECTIVE: To present our experience with fibula-free tissue transfer in patients with documented 2-vessel runoff to the lower extremity on preoperative angiography. METHODS: A case series of 16 patients with segmental mandibular defects reconstructed with a fibula-free flap by the senior author with 100% stenosis of the anterior or posterior tibial arteries were retrospectively reviewed for radiographic data and complications. RESULTS: All flaps performed were successful, and there were no donor site complications. Angiography documented flow of contrast to the foot by a patent anterior or posterior tibial artery in all patients. Occlusive arteriosclerotic disease was identified in the anterior tibial artery in 10 patients and in the posterior tibial artery in 6 patients. CONCLUSIONS: Using our specific criteria, we experienced no complications with the use of a fibula-free flap in extremities with 100% obstructive vascular disease in the anterior or posterior tibial artery. Preoperative angiography is indicated to select appropriate candidates for fibula-free tissue transfer with 2-vessel lower extremity runoff to avoid potential donor site ischemic complications.

Angiography↗

PubMed1995

Microvascular steal phenomenon in lower extremity reconstruction.

Macrovascular bypass procedures and microvascular free tissue transfer have resulted in dramatic improvements in lower limb salvage. Although vascular steal is a well-documented phenomenon in the surgical literature, there is a paucity of information on its potential impact in microvascular surgery, particularly in relation to lower extremity reconstruction in the elderly patient with peripheral vascular disease. We report three cases of lower extremity reconstruction using microvascular free tissue transfer in which the free flap survived but the distal extremity suffered progressive ischemic necrosis. A retrospective analysis of these cases defines the conditions in which microvascular steal phenomenon may adversely influence lower limb salvage.

Aged↗

PubMed1999

Evaluation and conservative management of chronic lower extremity arterial disease.

Aging of the population has made atherosclerotic cardiovascular disease one of the most significant health problems in the United States. Primary care providers are often the first contact for persons presenting with symptoms of chronic lower extremity arterial disease. Accurate assessment can prevent erroneous referrals, unnecessary diagnostic studies, and added time and medical expense for patients. Understanding of the natural history and risk factors associated with chronic lower extremity arterial disease provides the foundation for developing a knowledgeable, comprehensive plan of care for patients. Through multidisciplinary collaboration and a strong commitment to patient education and support, care providers can enhance the quality of life for individuals with chronic lower extremity arterial disease.

Arterial Occlusive Diseases↗

PubMed1982

Lower extremity replantation-two and a half-year follow-up.

Successful replantation of the lower extremity at the above-knee level in an 11-year-old girl is reported with a two and a half-year follow-up. The patient has nerve regeneration and protective sensation to her foot. She is fully ambulatory and uses a brace to stabilize her ankle with a 51/2 cm lift on her shoe. Scanograms have revealed a growth of the severed extremity and the initial 10 cm discrepancy between the two legs is now approximately 51/2 cm. Lower extremity replantation is advocated in children and young adults where nerve regeneration is probable. Short ischemia time, probably less than seven hours, is essential for survival.

Amputation, Traumatic↗

PubMed1970

Assessment of a lower extremity training program.

The response to a lower extremity program has been studied in workmen undergoing progressive rehabilitation following injury to the lower leg or ankle region. When first seen, the isometric strength of the injured limb was substantially reduced relative to its counterpart, and aerobic power was also poor, relative to normal standards. Substantial gains of isometric strength occurred over a four- to six-week period of therapy. Measurements above the site of injury suggested a 13% gain of strength, and measurements below the injury indicated a gain of 34%. On the other hand, there were minimal changes of thigh circumference over this period. Soft tissue radiographs taken in the posteroanterior and lateral planes showed a small (1%) increase of muscle tissue and a somewhat larger (5%) loss of subcutaneous fat. Dynamic exercise at a fixed percentage of aerobic power was associated with similar subjective discomfort and a similar accumulation of lactate before and after rehabilitation.It is concluded that the apparent improvement in isometric strength over the period of rehabilitation is due to (1) initial voluntary limitation of effort and (2) increase in skill. The use of soft tissue radiographs may afford a more objective basis for the evaluation of future muscle training programs.

Accidents, Occupational↗