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PubMed1996

Limb movement adaptations in horses with experimentally induced fore- or hindlimb lameness.

The kinematic patterns of all limbs of 11 clinically nonlame Dutch Warmblood horses were studied during induced supporting limb lameness to gain insight into the compensation mechanisms horses use to manage lameness and to test kinematic limb variables for their significance as lameness indicators. Using the locomotion analysis system CODA-3, the kinematics of the horses were recorded while walking (1.6 m/s) and trotting (3.5 m/s) on a treadmill. A transient lameness model, evoking pressure on the hoof sole, was used to induce 3 degrees of fore- and hindlimb lameness. Joint angle patterns and hoof movements were analysed using joint angle/time diagrams and the hoof trajectories in the sagittal plane. Quantitative analysis of 13 selected variables in each limb was done using a 2-way analysis of variance. Hyperextension of the fetlock joint and flexion of the coffin joint during the stance phase decreased significantly (P < 0.05) in the lame limb, both in fore- and hindlimb lameness, at both gaits. In the contralateral nonlame limbs both variables increased compensatorily. Flexion increased with increasing lameness in the proximal joints, i.e. the shoulder joint and even more the tarsal joint of the lame limb. The retraction of both forelimbs decreased during forelimb lameness at the walk, while in the lame hindlimb the protraction decreased. The hoof arcs were lower in the lame limb than in the nonlame limb, due to an increased hoof height in the nonlame limb during forelimb lameness and to a decreased height in the lame limb during hindlimb lameness. It was concluded that patterns of the distal joints reflect the different loadings of the limbs during lameness. Proximal joints acted as load dampers to reduce peak forces in the lame limb. Hyperextension of the fetlock and flexion of the coffin joint proved to be the most sensitive indicators for fore- and hindlimb lameness.

Adaptation, Physiological↗
PubMed1985

Reconstructive foot surgery.

In rheumatoid arthritis (RA) we find a high rate of foot involvements, especially in progressive cases when we see patients submitted for hospital treatment. In about 50% of these patients the ankle joints are involved (25), in juvenile RA even in two thirds of all cases. More than half of all progressive cases show also joint affections of the forefoot. Mainly the metatarsophalangeal joints are involved, especially the first MTP joint. We also can find a high involvement rate of the interphalangeal joint of the big toe. In RA the peripheral toe joints II-V are less frequently involved. Changes in these joints are very much likely to be caused by other inflammatory rheumatic diseases. Even more often than in the ankle joints we can find changes in the tarsal joints, as well as in the tarsometatarsal joints. As we know, in RA the incidence of surgery does not refer to the affection rate. The indication for surgery depends mainly on the amount of functional disability, pain, and the efficacy of conservative treatment. The need of these therapies can differ very much in various countries. E.g. in the Rheumatism Foundation Hospital, Heinola more than one third of all operations were foot surgery, whereas in our clinic, organised in a very similar way to Heinola, we have "only" 20%. Apart from tenosynovectomies and synovectomies at the ankle joint, the operations are nearly exclusively of reconstructive character.

Ankle Joint↗
PubMedDate not supplied

Talonavicular arthrodesis for isolated arthrosis: 9.5-year results and gait analysis.

Eleven patients who were treated for talonavicular arthrosis with a talonavicular arthrodesis between 1961 and 1979 at the Mayo Clinic have been reviewed. Follow-up from surgery ranged from 2.5 to 21 years with a mean of 9.5 years. Clinical, radiographic, and gait analyses were obtained. All patients had satisfactory pain relief, but all noted difficulty in ambulating on irregular ground. Three patients had roentgenographic evidence of arthrosis affecting other tarsal joints that had not been involved before arthrodesis. Gait analysis revealed decreased terminal stance-phase plantarflexion and pronounced reduction of subtalar motion. Talonavicular arthrodesis does give predictable union and patient satisfaction but results in limitation of subtalar motion and loss of stance-phase plantarflexion.

Adult↗
PubMedDate not supplied

Bleomycin-induced arthritis and dermatitis in rats.

We investigated the effect of the antitumor drug bleomycin (BLM) on synovial membrane and periarticular deep dermis in 10-wk-old young adult rats. BLM was found to induce edema, mononuclear cell infiltration and necrosis of the synovial membrane in the knee and tarsal joint, and inflammation in the deep dermis of the plantar hindfoot and digital pulvini in these rats after subcutaneous administration of 20 mg/kg for 3 days. After a 4-wk recovery period, foci of degenerative collagen bundles were observed in the deep dermis of the plantar hindfoot in spite of complete recovery of the lesions in the other dermal and synovial membrane sites. The synovitis was determined to begin with vesiculation of the macrophage-type lining cells, followed by edema and cell infiltration, especially near ligament insertion sites in the knee joint. The early dermal lesion consisted of dissociation of endothelial and subendothelial cells in small blood vessels thought to be postcapillary venules, edema, and monocyte infiltration. The severity of arthritis was greater in young adults than juvenile rats. From these results, BLM was shown to have a toxic effect on synovial lining cells and to induce inflammation in the synovial membrane and periarticular dermis.

Aging↗
PubMed1984

Structural components of the arch of the foot analyzed by radiogrammetric and multivariate statistical methods.

The structural component of the arches of the human foot were analyzed by a radiogrammetric method and multivariate statistical procedures. The right feet of 101 male university students were radiographed in the standing position from a lateromedial direction. 6 joint heights were measured directly on the radiographs. Factor analysis with varimax rotation showed 3 basic underlying factors for arch heights: (1) calcaneonavicular joint, cuneonavicular joint and first tarsometatarsal joint; (2) calcaneocuboidal joint and 5th tarsometatarsal joint and (3) subtalar joint. The first factor represented the medial longitudinal arch height, the second was associated with the lateral longitudinal arch height. No transverse factor indicating tarsometatarsal or transverse tarsal joints was found. Cluster analysis showed a similar configuration to that in factor analysis. Analysis suggested a key role of the subtalar joint which integrated both the medial and lateral longitudinal arch heights.

Adult↗
PubMed1993

Salvage, with arthrodesis, in intractable diabetic neuropathic arthropathy of the foot and ankle.

Twenty-nine patients who had diabetic neuropathic arthropathy of the foot and ankle were managed with open reduction and arthrodesis of various joints. Rigid internal fixation was used in all but four patients, who had external fixation. All patients had severe instability or a fixed deformity that precluded successful treatment with bracing. The sites of the fracture-dislocations or the neuropathic dislocations were the ankle in twenty-one patients, the subtalar joint in six, and the transverse tarsal joint in two. The ankle-brachial Doppler indices of these patients averaged 0.86 (range, 0.55 to 1.14). The involved extremities were graded at the initial evaluations according to the Wagner classification system for neuropathic ulceration. The grade was 0 in fourteen patients, I in seven, II in two, and III in six. A tibiocalcaneal arthrodesis was performed after a talectomy in eleven patients; a tibiotalar arthrodesis, in eight; a triple arthrodesis, in six; a pantalar arthrodesis, in two; and a tibiotalocalcaneal arthrodesis, in two. Postoperatively, all patients remained non-weight-bearing and wore a below-the-knee plaster cast for two months. Weight-bearing was then begun with the leg in a total-contact plaster cast, and use of the cast was continued for a mean of five months (range, four to fourteen months). Thereafter, a polypropylene ankle-foot orthosis was used permanently. The most recent evaluation of the patients was performed at an average of forty-two months (range, fourteen to sixty-eight months) after the arthrodesis. There were twenty complications in nineteen of the twenty-nine patients, and there were nine pseudarthroses (six tibiocalcaneal, one tibiotalar, and two talonavicular). However, seven of the pseudarthroses were clinically stable. In these patients, the arthrodesis was performed as an alternative to amputation, and salvage was successful in twenty-seven (93 per cent) of the twenty-nine patients.

Adult↗
PubMed2000

Evidence supporting an increased presence of reactive oxygen species in the diseased equine joint.

Reactive oxygen species (ROS) are capable of degrading many components of the joint in the presence of insufficient antioxidant defences, and as a result have been implicated in the pathogenesis of joint disease in horses. However, to our knowledge, evidence of ROS occurring in diseased joints of horses has not been reported. The objective of this experiment was to compare differences in synovial fluid protein carbonyl content (as a marker of oxidative modification of synovial fluid proteins by ROS) and the antioxidant status of synovial fluid between clinically normal and diseased equine joints. Synovial fluid was collected from the metacarpophalangeal, metatarsophalangeal, carpal and tarsal joints of 4 horses, age 2-5 years, as controls, and from diseased joints (metacarpophalangeal, metatarsophalangeal, carpal, tarsal and/or femoropatellar) of 61 horses, age 2-5 years. Synovial fluid protein carbonyl content was higher (P<0.01) in diseased joints as compared to controls. Antioxidant status of synovial fluid from diseased joints was higher, but not significantly, than that of controls (P = 0.0595). These findings require further study to determine their contribution to the overall disease process.

Animals↗
PubMed1999

Management of a proximal pelvic limb skin laceration in a dog using a skin flap and an external fixator.

A nine-year-old, spayed female crossbred dog sustained a traumatic skin lesion to the right proximal pelvic limb, extending to the extensor surface of the stifle. Surgical management of the wound included primary closure using a body skin flap fashioned from the right caudolateral abdominal wall. To achieve closure and prevent tension on the wound, the coxofemoral and stifle joints on the affected side needed to be immobilised in flexion. Flexion immobilisation of the stifle was achieved using the anatomical principle of muscle reciprocation. The ipsilateral tarsal joint was immobilised in flexion using a uniplanar-bilateral (type II) transarticular external skeletal fixator and this resulted in the automatic flexion of the stifle. The fixator was removed six weeks postoperatively when the wound had healed. There were no apparent complications associated with the fixator either during its use or in the longer term following its removal.

Animals↗
PubMed1979

Tarsal hypermobility after ankle fusion--fact or fiction?

Thirty-seven patients have been reviewed after arthrodesis of the ankle in order to determine the reduction of dorsiflexion and plantarflexion of the foot, the incidence of tarsal hypermobility and its relevance to the clinical results of this procedure. Radiological methods of measuring movements in the foot and tarsus are described and applied to patients who had a normal foot on the opposite side which could be used as a control. Our findings suggest that tarsal hypermobility is not as common as has hitherto been supposed and that a stiff foot with minor radiological degenerative changes in the tarsal joints is quite compatible with an excellent result.

Ankle Joint↗
PubMed1998

Radiographic and clinical classification of acquired midtarsus deformities.

To develop a classification of midtarsus deformities, clinical examination and weightbearing radiographs were used to evaluate 131 feet in 109 patients (average age, 59+/-11 years) with those deformities. Patients were classified into four types based on anatomic location of the maximum deformity. Type I (N=43) showed deformity at the metatarsocuneiform joints medially and the fourth and fifth metatarsocuboid joints laterally, with plantarmedial and/or medial prominence. Type II (N= 60) had deformity at the naviculocuneiform joint medially and the fourth and fifth metatarsocuboid joints laterally; plantarlateral prominence was characteristic, although one-third had isolated or additional medial prominences. Type III (N=17) had major deformity in the perinavicular region, with a prominence plantarcentrally or plantarlaterally. Type IV (N=11) had deformity at the transverse tarsal joints with variable prominences. Each type was further subdivided into stages A, B, and C based on the severity of the deformity. In stage B, the midtarsus was coplanar with the metatarsocalcaneal plane. In stage A, the midtarsus was above this plane. In stage C, the midtarsus was below this plane. We concluded that midtarsus deformities can be classified as one of four types and one of three stages. Additional study is warranted to correlate this system with prognosis and treatment for this pathologic process.

Adult↗
PubMed1989

Occult fracture-subluxation of the midtarsal joint.

In four women with occult fracture-subluxation of the midtarsal joint incurred in trivial accidents, the correct diagnosis was made promptly, assisted in one case by bone scintigraphy. Treatment was conservative, consisting of cast immobilization for six to eight weeks and a weight-bearing restriction. At the minimum follow-up time of 24 months, the functional results were rated good in three patients and fair in one. In the patient with a fair result, a compression fracture of the posterior facet of the calcaneus was diagnosed retrospectively. An occult fracture-subluxation of the mid-tarsal joint can be treated effectively by conservative means.

Adult↗
PubMed1998

Histopathology of murine ankylosing enthesopathy.

Ankylosing enthesopathy is a spontaneously occurring progressive stiffening of the ankle and/or tarsal joints in mice of C57Black background. In C57BL/10 mice and mice of the same genetic background that had been made transgenic for HLA-B27, the start of the disease was detected by weekly testing for decreased mobility in the ankle/tarsus region. Ankylosing enthesopathy was found to begin with a short phase of proliferative inflammation of the joints and adjacent tissues, with some fibrinous exsudation, some leucocytic infiltration and slight bone erosion. This inflammation is soon accompanied and followed by proliferation of cartilaginous cells at the bone insertions of joint capsule ligaments (entheses). Ossification of the cartilage proliferations and some desmal ossification lead to large osteophytes that inhibit mobility. Fusion of osteophytes occasionally leads to marginal ankylosis. The histopathology of the successive stages of murine ankylosing enthesopathy and the preponderance in males and HLA-B27 transgenic mice are reminiscent of ankylosing spondylitis in man. The spine, however, was not affected.

Animals↗
PubMed1980

The joints of the evolving foot. Part II. The intrinsic joints.

A description is given of the functional morphology of the intrinsic joints of the foot, with particular reference to the primates, and an attempt is made to define the key human derived features. In the human subtalar joint the compromise axis has become reoriented into a very elevated position and more nearly in line with the functional foot axis than it is in subhuman primates. This provides for torque of the talus, and so the supported body weight, about the axis, during the stance phase of gait. In the subhuman primates the very oblique subtalar axis is important in inverting the foot into a grasping attitude. In subhuman primates the transverse tarsal joint complex plays an important role in supination of the forefoot, which complements inversion at the subtalar joint complex in achieving the ideal grasping position. This movement is only rendered possible by a helical action at the subtalar joint complex. In man the calcaneocuboid joint has been remodelled so as to bring the lamina pedis into a close-packed position during the latter part of the stance phase of gait. The joints between the cuneiforms and the cuboids, and the associated tarsometatarsal joints show significant modifications in man.

Animals↗
PubMed1999

Functional outcome and gait analysis after triple or double arthrodesis.

Thirteen patients who had undergone unilateral triple or double arthrodesis were studied an average of 5.2 years after surgery. Patients with a neuromuscular disorder; inflammatory arthritis; or any other focus of lower extremity arthritis, deformity, or joint dysfunction were excluded from the study. Clinical and radiological assessment of the patients was performed in addition to three-dimensional kinematic and kinetic gait analysis. Objective clinical outcome based on the American Orthopaedic Ankle and Foot Society score was rated as good or excellent for 10 patients, fair for 2, and poor for 1. Two patients developed radiological evidence of arthrosis affecting other tarsal joints that was not apparent on preoperative radiographs. Two other patients had some progression of radiological arthrosis that was identified before the index surgery. The presence of radiological ankle or tarsal arthritis did not correlate with the level of the patient's pain or functional disability. Gait analysis demonstrated a 13% increase in range of flexion of the ipsilateral knee during the third rocker period of stance. At the ankle, range of motion during the same period of stance was reduced by 33%. This was mostly the result of a 6 degrees (53%) loss of plantarflexion at toe-off. Analysis of the ankle kinetic data identified a mean 13% reduction in the peak external ankle dorsiflexion moment and a 45% reduction in mean maximum power generation at the ankle in comparison to the normal side. Unilateral triple or double arthrodesis was shown to predictably result in decreased pain and increased function in otherwise normal individuals.

Adult↗
PubMed2005

Effects of effort and EMG levels on short-latency stretch reflex modulation after varying background muscle contractions.

It is known that the short-latency stretch reflex (SLSR) is modulated by the background muscle activity when it is elicited at matched torque levels. This study was designed to examine the effects of muscle contraction types before a stretch perturbation on SLSR in the human soleus muscle (SOL) when SLSR was elicited at the same levels of effort and at matched electromyographic (EMG) activity levels. A mechanical stretch perturbation was applied to the calf muscles when the ankle joint reached a ninety degree tibio-tarsal joint angle after the muscles performed an isometric (pre-ISO), shortening (pre-SHO) and lengthening contraction (pre-LEN). Subjects were seated on an ankle ergometer chair and developed 0%, 10%, 20%, 30%, 40%, 50%, 60% and 70% ankle joint torque (AJT) of maximum voluntary isometric plantar flexion contraction at 80 degrees in pre-SHO, at 90 degrees in pre-ISO and at 100 degrees in pre-LEN. After that, isometric or dynamic contractions started, and the subjects were asked to maintain effort levels as, needed, to maintain the target torque levels until the end of the stretch. They relaxed their muscles fully after the stretch. This chain of processes was consecutively repeated 10 times. EMG signals obtained from SOL were averaged after they were high-pass filtered and full-wave rectified. Some major findings resulted: (1) there were no differences in SLSR area in the active muscle between pre-ISO and pre-SHO, whereas its waveform was steeper in pre-ISO than in pre-SHO. (2) SLSR p-to-p amplitude and waveform were larger and steeper in the active muscle than in the relaxed one in all conditions, whereas they were independent of the effort levels once the muscle was activated. This led to steady SLSR modulation in response to the background muscle contraction in the active muscle regardless of whether the SLSR was elicited at matched AJT or EMG activity levels. These findings suggest that SLSR is closely related to the muscle spindle sensitivity influenced by the following factors: (1) the background muscle contraction type, and (2) gamma motoneuron activity set by CNS based on the effort level.

Adaptation, Physiological↗
PubMedDate not supplied

[Arthrodesis of the ankle. A study of the complications and long term results (author's transl)].

The authors have studied the complications and long term results of 91 cases of tibio-talar arthrodesis and 43 cases of tibio-talar arthrodesis associated with subtalar arthrodesis. Minor complications such as limited skin necrosis were noted in 13 p. 100 of the cases, and no-fusion occurred in 7 p. 100. The results were satisfactory in 75 p. 100 of the cases, fair in 13 p. 100, poor in 12 p. 100. Most of the poor results were related to painfull subtalar joints after isolated tibio-talar arthrodesis. This happened often following conditions : excessive equinus, protrusion of screws in the subtalar joint, preoperative lesions of the subtalar joint. In cases of associated tibio-tarsal and subtalar arthrodesis, the long term study revealed moderate and painless secondary arthrosis of the mid-tarsal joint. It is concluded that associated fusion of the subtalar joint should always be considered when tibio-talar arthrodesis is indicated.

Adolescent↗
PubMed1999

The influence of different exercise regimens on the development of locomotion in the foal.

To study the influence of different exercise regimens on the development of locomotion, 40 Warmblood foals aged 1 week were subdivided into 3 groups: box-rest, training and pasture exercise. The box-rest group remained for 24 h a day in a box stall while the training group was housed similarly, but additionally received a 30 min workout with gallop sprints 6 times a week. The pasture group served as a control group and was kept at pasture for 24 h a day. After 5 months, the locomotion pattern at the trot of every foal was recorded overground with a 2-D MacReflex gait analysis system. A randomly selected group of 19 foals was recorded again at age 11 months after they had been kept in an open loose box with access to a small paddock without any specific training for 6 months duration. At 5 months of age the box-rest group moved with a more protracted forelimb, and more extended shoulder and elbow joints than the pasture group. Carpal and fetlock joint kinematics were rather similar in all groups. In the hindlimb, the box-rest foals were significantly different from the other 2 groups, reflected in a more retracted hindlimb, more hip extension, more flexed stifle and tarsal joints, and a larger maximal flexion of hip, stifle, tarsal and fetlock joints. In the simultaneous video recordings this locomotion pattern was visible as a hypermetric movement. The larger protraction in the forelimb and retraction in the hindlimb, as seen in the box-rest group, is opposite to the interlimb coordination of a superior moving horse. The pastured foals had a smaller range of motion of the shoulder and hip joint and less maximal step height of both fore and hind hooves, while the velocity and step length were similar between the 3 groups. Pastured foals could trot the same distance with less joint motion and therefore had a more efficient intralimb coordination. The training group moved in a way comparable with the box-rest group in the similar velocity box-rest foals trot with an abnormal, hypermetric and therefore inefficient and poorer locomotion pattern. When, superimposed on box-rest, exercise is provided in the form of gallop sprints, this will mainly improve the hindlimb locomotion. These induced differences in locomotion pattern of foals can be reversed when the foals afterwards are subjected to the same exercise regimen again.

Animals↗