The Effects of Wedged Footwear on Lower Limb Frontal-Plane Biomechanics During Running

Lewinson, Ryan T. BSc; Fukuchi, Claudiane A. BSc, PT; Worobets, Jay T. PhD; Stefanyshyn, Darren J. PhD, PEng

Clinical Journal of Sport Medicine:

POST AUTHOR CORRECTIONS, 25 October 2012

doi: 10.1097/JSM.0b013e31826b7c83

Original Research: PDF Only

Objective: Patellofemoral pain syndrome (PFPS), the most common running injury, has been associated with increased internal knee abduction angular impulses (KAAI). Wedged footwear can reduce these impulses during walking, but their effects during running are not well understood. The purpose of this study was to identify the effects of wedged footwear on KAAIs and describe the mechanism by which wedged footwear alters KAAIs during running.

Design: Controlled Laboratory Study.

Setting: Motion analysis laboratory.

Participants: Nine healthy male subjects.

Interventions: Participants ran at a speed of 4 m/s with 7 different footwear conditions (3-, 6-, and 9-mm lateral wedges; 3-, 6-, and 9-mm medial wedges; neutral).

Main Outcome Measures: Knee abduction angular impulses and 8 predictor variables were measured and compared by 1-way repeated-measures analysis of variance ([alpha] = 0.05) with Bonferroni-adjusted 2-tailed paired t tests for post hoc analysis ([alpha] = 0.002). Correlation ([alpha] = 0.05) was used to determine the relationship between the mediolateral center-of-pressure to ankle joint center (COP-AJC) lever arm length and KAAIs.

Results: Laterally wedged conditions produced significantly lower KAAIs (P = 0.001) than medial wedge conditions. Peak knee abduction moments decreased (P = 0.001), whereas ankle inversion moments (P = 0.041) and the COP-AJC lever arms increased (P < 0.001) as wedges progressed from medial to lateral. KAAIs were negatively correlated with COP-AJC lever arm length (r = -0.50, P < 0.001).

Conclusions: KAAIs are reduced with laterally wedged footwear because of lateral shifts in the center-of-pressure beneath the foot, which then increases ankle inversion moments and decreases peak knee abduction moments. Laterally wedged footwear may therefore offer greater relief to runners with PFPS than medially wedged footwear by reducing KAAIs.

Source: http://journals.lww.com/cjsportsmed/Abstract/publishahead/The_Effects_of_Wedged_Footwear_on_Lower_Limb.99855.aspx

Cheaper prosthetic finger prototype could be a blessing to many

10,000 miles will not stop Richard Van As of South Africa and Ivan Owen of Washington State from building an inexpensive prosthetic finger prototype that could one day help millions of amputees. Richard lost his arm last year in an accident. In spite of his condition, he did not lose hope and decided to search for prosthetics online that could help him. After a seemingly futile search, he eventually found one of Ivan's mechanical hand prop videos on YouTube.

Ivan, who has a keen interest in mechanical systems, started working on his prop as a personal project. Richard immediately sent Ivan an email and since then, both men have been trying to build a mechanical digit that could replace what finger amputees lost. Richard created a plastic replica of his hand for Ivan to use as a reference. Ivan went on to work on a prosthetic finger made up of a lever arm, a fingertip  a set of pulleys, and a grip pad. The current prototype that Richard is now using acts like a glove and is held by a hand mount.

Unlike other high-tech prosthetic fingers in the market, Richard and Ivan claims that their prototype is cheaper and is easier to build. Richard and Ivan will be giving away the design for free so that other people will also benefit from their work. You can check out the project here. "My vision for the future will be to take this knowledge and carry it as far and as fast as possible. Get the design and parts out there to as many people as possible so that we can do as much as we can to help fill this need," said Ivan Owen.

Source: http://www.ubergizmo.com/2012/10/cheaper-prosthetic-finger-prototype-could-be-a-blessing-to-many/

Consultation on ensuring fair and transparent pricing for NHS services

A  consultation to help ensure fair and transparent pricing for NHS services is opened today by the Department of Health.

From April 2014, Monitor and the NHS Commissioning Board will take over responsibility for pricing NHS services from the Department. They will do this through the national tariff. These arrangements will place responsibility for pricing with the bodies best placed in the new system to undertake it.

This consultation seeks views on the Department of Health's proposals for:

• which providers can formally object to Monitor's way of calculating prices
• what level of objections from commissioners and/or providers would require Monitor to: reconsider how it calculates prices, or refer its way of calculating prices to the Competition Commission, who will then decide whether or not it is appropriate.

• Respond to the consultation online
• Read Fair and transparent pricing for NHS services – A consultation on proposals for objecting to proposed pricing methodology
• Download consultation response form
• Read answers to frequently asked questions for this consultation

The closing date for responses is 21 December 2012.

This consultation should be considered alongside current consultations on a new licensing regime for providers of NHS services and procurement regulations for NHS commissioners.

Role of ankle foot orthoses in the outcome of clinical tests of balance, Disability and Rehabilitation: Assistive Technology, Informa Healthcare

Role of ankle foot orthoses in the outcome of clinical tests of balance, Disability and Rehabilitation: Assistive Technology, Informa Healthcare

Nilovana Panwalkar, Alexander S. Aruin

Purpose: The purpose of this study was to investigate the effect of ankle foot orthoses (AFOs) on the outcome of balance assessment. Methods: Ten healthy subjects participated in clinical tests of balance with and without bilateral ankle foot orthoses (AFOs). The following clinical tests were performed: the Modified Clinical Test of Sensory Interaction on Balance (MCTSIB), the Limits of Stability (LOS) and the Functional Reach test. Results: A statistically significant effect of AFOs was seen in the outcomes of the MCTSIB test (p = 0.042), LOS test (p = 0.021) and Reach test (p = 0.003). Conclusions: The results indicate that the use of AFOs may impede the performance of clinical tests of balance. This outcome should be taken into consideration while performing balance evaluations with patient populations in the clinic.

Implications for Rehabilitation

• Ankle foot orthoses (AFOs) are effective means of improving ambulation in patients.
• The use of AFOs may influence the outcome of clinical tests of balance.
• The role of AFOs should be taken into consideration while performing balance evaluations in the clinic.

Source: http://informahealthcare.com/doi/abs/10.3109/17483107.2012.721158

Clustering and classification of regional peak plantar pressures of diabetic feet

• Craig J. Bennetts
, 
• Tammy M. Owings
, 
• Ahmet Erdemir
, 
• Georgeanne Botek
, 
• Peter R. Cavanagh

Journal of Biomechanics

Accepted 7 September 2012. published online 22 October 2012. 
Corrected Proof

Abstract 

High plantar pressures have been associated with foot ulceration in people with diabetes, who can experience loss of protective sensation due to peripheral neuropathy. Therefore, characterization of elevated plantar pressure distributions can provide a means of identifying diabetic patients at potential risk of foot ulceration. Plantar pressure distribution classification can also be used to determine suitable preventive interventions, such as the provision of an appropriately designed insole. In the past, emphasis has primarily been placed on the identification of individual focal areas of elevated pressure. The goal of this study was to utilize k-means clustering analysis to identify typical regional peak plantar pressure distributions in a group of 819 diabetic feet. The number of clusters was varied from 2 to 10 to examine the effect on the differentiation and classification of regional peak plantar pressure distributions. As the number of groups increased, so too did the specificity of their pressure distributions: starting with overall low or overall high peak pressure groups and extending to clusters exhibiting several focal peak pressures in different regions of the foot. However, as the number of clusters increased, the ability to accurately classify a given regional peak plantar pressure distribution decreased. The balance between these opposing constraints can be adjusted when assessing patients with feet that are potentially "at risk" or while prescribing footwear to reduce high regional pressures. This analysis provides an understanding of the variability of the regional peak plantar pressure distributions seen within the diabetic population and serves as a guide for the preemptive assessment and prevention of diabetic foot ulcers.

Source: http://www.jbiomech.com/article/S0021-9290(12)00521-0/abstract

Effects of a knee–ankle–foot orthosis on gait biomechanical characteristics of paretic and non-paretic limbs in hemiplegic patients with genu recurvatum

• J. Boudarham
, 
• R. Zory
, 
• F. Genet
, 
• G. Vigné
, 
• D. Bensmail
, 
• N. Roche
, 
• D. Pradon

Received 1 February 2012; accepted 17 September 2012. published online 16 October 2012. 

Abstract 

Background

A knee–ankle–foot orthosis may be prescribed for the prevention of genu recurvatum during the stance phase of gait. It allows also to limit abnormal plantarflexion during swing phase. The aim is to improve gait in hemiplegic patients and to prevent articular degeneration of the knee. However, the effects of knee–ankle–foot orthosis on both the paretic and non-paretic limbs during gait have not been evaluated. The aim of this study was to quantify biomechanical adaptations induced by wearing a knee–ankle–foot orthosis, on the paretic and non-paretic limbs of hemiplegic patients during gait.

Methods

Eleven hemiplegic patients with genu recurvatum performed two gait analyses (without and with the knee–ankle–foot orthosis). Spatio-temporal, kinematic and kinetic gait parameters of both lower limbs were quantified using an instrumented gait analysis system during the stance and swing phases of the gait cycle.

Findings

The knee–ankle–foot orthosis improved spatio-temporal gait parameters. During stance phase on the paretic side, knee hyperextension was reduced and ankle plantarflexion and hip flexion were increased. During swing phase, ankle dorsiflexion increased in the paretic limb and knee extension increased in the non-paretic limb. The paretic limb knee flexion moment also decreased.

Interpretation

Wearing a knee–ankle–foot orthosis improved gait parameters in hemiplegic patients with genu recurvatum. It increased gait velocity, by improving cadence, stride length and non-paretic step length. These spatiotemporal adaptations seem mainly due to the decrease in knee hyperextension during stance phase and to the increase in paretic limb ankle dorsiflexion during both phases of the gait cycle.

Keywords: Kinematic, Kinetic, Spatiotemporal, Hyperextension, Stance and swing phase

Source: http://www.clinbiomech.com/article/S0268-0033(12)00226-4/abstract

--

Kind regards

Jonathan Bull MBAPO

Vice Chair

 

BAPO Secretariat, Sir James Clark Building,

Abbeymill Business Centre, Paisley PA1 1TJ

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BAPOmag 2012 Issue 3

BAPOmag 2012 Issue 3 Now available and BAPO Members can download the latest issue from the Members section of our website.

www.bapo.com

Bionic limbs

www.bbc.co.uk/news/health-17153052

Anatomical Origin of Forefoot Varus Malalignment

1. Rebecca S. Lufler, PhD*, 
2. T. M. Hoagland, PhD†, 
3. Jingbo Niu, MD, DSc‡and 
4. K. Douglas Gross, PT, DSc‡

Abstract

Background: Forefoot varus malalignment is clinically defined as a nonweightbearing inversion of the metatarsal heads relative to a vertical bisection of the calcaneus in subtalar joint neutral. Although often targeted for treatment with foot orthoses, the etiology of forefoot varus malalignment has been debated and may involve an unalterable bony torsion of the talus.

Methods: Forty-nine feet from 25 cadavers underwent bilateral measurement of forefoot alignment using adapted clinical methods, followed by dissection and measurement of bony talar torsion. The relationship between forefoot alignment and talar torsion was determined using the Pearson correlation coefficient.

Results: Mean ± SD forefoot alignment was −0.9° ± 9.8° (valgus) and bony talar torsion was 32.8° ± 5.3° valgus. There was no association between forefoot alignment and talar torsion (r = 0.18; 95% confidence interval, −0.11 to 0.44; P = .22).

Conclusions: These findings may have implications for the treatment of forefoot varus since they suggest that the source of forefoot varus malalignment may be found in an alterable soft-tissue deformity rather than in an unalterable bony torsion of the talus. (J Am Podiatr Med Assoc 102(5): 390–395, 2012)

Source: http://www.japmaonline.org/content/102/5/390.short

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Final Reminder: Consultation of revised Standards

Final Reminder to have your say on the revised Professional Standards for Prosthetics and Orthotics before the consultation period ends on 30th September 2012.

We are committed to engaging with our members, taking account of their views and input in the way that we carry out our work.

It is the intention of BAPO that these standards will form the baseline of practice for Prosthetists, Orthotists and Assistant Practitioners in the UK by providing more detailed information and guidance for both day to day practice and service planning. As such they sit alongside all other regulatory documents by which the profession is guided.
 
We expect the revised standards to be useful not only for Prosthetists and Orthotists, but for all healthcare commissioners and providers, Service Heads and managers, other healthcare professionals and interested members of the public.
 
When fully approved, the Standards will be freely available to all stakeholders.
 
Please review the draft standards which can be found on the member only section of the BAPO website under Downloads & Documents/Guidelines.

Hospital Directions show: November 21-22, 2012

If you are unable to view this email please click here to view online.

Hospital Directions show: November 21-22 Hospital Directions Show 21-22 November Olympia, London http://www.hospitaldirections.co.uk/ The NHS is going through significant change with high expectations for improved efficiency and savings. NHS Chief Executive David Nicholson set the organisation a massive challenge to deliver savings of £20bn by 2015, at the same time as the government launched the biggest reform of healthcare services since the inception of the NHS. It has left hospitals desperately trying to manage rising demand against the backdrop of a real-terms cut to funding. The new structures in primary care mean that hospitals are forging fresh relationships with commissioners, who are in turn under pressure to deliver more health services in the community and nearer to people's homes. In the past, when such funding challenges have arisen, services have been slashed, waiting lists increased and training and quality compromised. But with an ageing population, increasing levels of obesity, and rising expectations, the NHS can't afford such short sighted solutions. Secondary care will not survive this squeeze and reform unchanged. However, investment in prevention, improvement, information and infrastructure during these tough times could make frontline hospital services more productive in the future. Now the need for strong leadership and efficiency improvement is greater than ever. Offering comprehensive speaker streams on Innovation, Efficiency and Leadership, Hospital Directions will bring senior hospital managers together from the fields of patient services, human resources, information technology, estates management and procurement to listen to – and share – best practice. Experts will speak on service redesign, integration and innovation; improved use of information, evidence and technology; new approaches to leadership, recruitment and performance management; flexible and efficient estates and facilities management; and progressive procurement and use of the private sector. Six speaker streams run over two days, jam-packed with seminars, and supported by an exhibition, and will bring managers together from across the different disciplines and from all around the country. Tickets for Hospital Directions are being offered free up to 10 individuals for their hospitals. Register now at www.hospitaldirections.co.uk/register

BAPO Practical orthotic assessment course

BAPO Practical orthotic assessment and is due to run on 20^th October 2012 and is aimed at developing upon the

required skills for graduate orthotists and is to be held at Peacocks in Newcastle upon Tyne.

Download your application form here

SPINAL IMAGING IN PATIENTS WITH INFANTILE AND JUVENILE IDIOPATHIC SCOLIOSIS: IS ROUTINE MAGNETIC RESONANCE IMAGING INDICATED?

K. O'Shea, H. Mullett, C. Goldberg, D. Moore, E. Fogarty and F. Dowling.

Author Affiliations

Abstract

Surgical correction of spinal deformity in patients with neural axis abnormalities has established risks of causing further neurological injury. It is necessary to identify individuals with a predisposition for such abnormalities before treatment is instituted.

Objective: Examination of the association between idiopathic scoliosis and underlying neural axis abnormalities in the infantile and juvenile age groups.

Design: Retrospective chart and radiographic review.

Subjects: Ninety-four (36 infantile, 58 juvenile) consecutive patients with non-congenital scoliosis under the age of eleven years.

Outcome measures: These consisted of the MRI findings, neurological examination, associated curve morphology and necessity for neurosurgical intervention or surgical curve correction.

Results: Approximately 25% of patients presenting as idiopathic juvenile scoliosis had underlying neural axis abnormalities. No patient with apparent infantile idiopathic scoliosis had an abnormal spinal MRI scan. Using the Z score for independent proportions, there was a statistically significant difference between infantile and juvenile scoliosis and the presence of an underlying neural axis abnormality (Z score of 2.089, equivalent to p<0.02).

Conclusions: We advocate routine MR spinal imaging in all patients with juvenile idiopathic scoliosis. In infantile idiopathic scoliosis, to avoid unnecessary general anaesthetics, one should image the spinal canal only when clinically indicated.

http://www.bjjprocs.boneandjoint.org.uk/content/84-B/SUPP_III/336.5.abstract

An advanced virtual model of the human foot has been created by researches to drive forward improvements in treating serious injuries and illness.

The 3D model depicts bones, joints, ligaments, muscles and tendons in an unprecedented level of detail.

Continue reading the main story

"Start Quote

The Glasgow/Maastricht foot is a game-changer"

Prof Jim WoodburnGlasgow Caledonian University

It will be used to develop advanced treatments for conditions ranging from foot and ankle problems to amputations.

The 3.7 million euro a-footprint project is being led by Glasgow Caledonian University (GCU).

The human foot is particularly difficult to model because of its complexity.

Researchers worked in partnership with the Maastricht University and Danish biomechanical firm AnyBody Technology on what had been named the Glasgow/Maastricht Foot Model.

It is estimated that 200 million Europeans suffer from disabling foot and ankle conditions and the model should lead to more efficient orthotic devices, cutting recovery times and reducing symptoms.

It will also have aplications in treating flat feet or foot drop - which prevents recovering stroke patients from moving their ankles and toes.

GCU's Professor Jim Woodburn, who is the project co-ordinator, said: "Previous to this development, most computer models of the human body ended in a black rectangle - the foot was simply too complicated to model. The Glasgow/Maastricht foot is a game-changer.

"It opens the door to a huge range of applications, including the manufacture of better and more efficient orthotics, resulting in quicker recovery times, reduced symptoms and improved functional ability for those suffering from conditions which afflict the foot and lower leg."

The simulation can be used to test potential cures as well as developing new orthotic devices, using 3D printing techniques.

Source: http://www.bbc.co.uk/news/uk-scotland-glasgow-west-19660736

Sport prostheses and prosthetic adaptations for the upper and lower limb amputees: an overview of peer reviewed literature

1. Mihai Bragaru, Rienk Dekker, Jan HB Geertzen

Abstract

Background: Sport prostheses are used by both upper- and lower-limb amputees while participating in sports and other physical activities. Although the number of these devices has increased over the past decade, no overview of the peer reviewed literature describing them has been published previously. Such an overview will allow specialists to choose appropriate prostheses based on available scientific evidence rather than on personal experience or preference.

Objective: To provide an overview of the sport prostheses as they are described by the papers published in peer reviewed literature.

Study Design: Literature review.

Methods: Four electronic databases were searched using free text and Medical Subject Headings (MESH) terms. Papers were included if they concerned a prosthesis or a prosthetic adaptation used in sports. Papers were excluded if they did not originate from peer reviewed sources, if they concerned prostheses for body parts other than the upper or lower limbs, if they concerned amputations distal to the wrist or ankle, or if they were written in a language other than English.

Results: Twenty-four papers were included in this study. The vast majority contained descriptive data and consisted of expert opinions and technical notes.

Conclusion: Data concerning the energy efficiency, technical characteristics and special mechanical properties of prostheses or prosthetic adaptations for sports, other than running, are scarce.

Clinical relevance An overview of the peer reviewed literature will enable rehabilitation specialists working with amputees to choose a prosthesis that best suits their patients' expectations on the available scientific evidence. Identifying the information gaps present in the peer reviewed literature will stimulate new research and eventually broaden the base of scientific knowledge.

Source: http://poi.sagepub.com/content/36/3/290.abstract

 

Development of a simple stance-control system for persons with poliomyelitis and an associated gait analysis

Nakanishi, Y. Kato, N. ;  Wada, F. ;  Hachisuka, K. ;  Watanabe, Y. ; Okumura, K. ;  Arai, M. 

ABSTRACT

A simple stance-control system (SSCS) was developed, which is a new device attached to the upper lateral frame of a carbon fiber-reinforced plastic knee-ankle-foot orthosis (carbon KAFO). The SSCS consisted of two pressure sensors beneath the heel and metatarsal phalangeal joints, connecting cables, microcomputer, motor controlling the lever of Swiss-lock knee joint, and battery box. Normally the SSCS is off, and the Swiss-lock knee joint is mechanically fixed in the extended position, whereas the SSCS is on during the swing phase according to the information from the pressure sensors, and the Swiss-lock knee joint is released by pulling up the lever. Therefore, a patient using a carbon KAFO with SSCS can flex his/her knee joint during the swing phase and to maintain it in the extended position during the stance phase. The safety while using the SSCS was confirmed in four healthy men and the gait pattern was measured by using a three-dimensional motion analysis and force plate system. These results revealed that the SSCS attached to a carbon KAFO did not unlock the Swiss-lock knee joint on the five conditions in daily living activities, and enabled a patient to control his/her lower limb during the stance phase and flex it during the swing phase.

Source:  http://ieeexplore.ieee.org/xpl/articleDetails.jsp?arnumber=6275704

On page(s): 169
Conference Location :  Kobe
Print ISBN: 978-1-4673-1617-0
INSPEC Accession Number: 12948666
Digital Object Identifier :  10.1109/ICCME.2012.6275704
Date of Current Version :   23 August 2012
Issue Date :   1-4 July 2012

Functional Gait Analysis Before and After Delayed Military Trauma-Related Amputation A Report of Three Cases

Barri L. Schnall, MPT, LT Scott C. Wagner, MD, Jenna D. Montgomery, BS, Marilynn Wyatt, PT, MA,

and MAJ Benjamin K. Potter, MD

The current conflicts in Iraq and Afghanistan have produced

a large number of service members with severe

combat-related injuries. Eighty-two percent of service

members with combat-related injuries have sustained extremity

trauma, which accounts for 54% of wounds overall1.

Of all the lower-extremity amputations performed at military

treatment facilities, approximately 13% (125 of 975) were the

result of delayed or ''elective'' procedures2. Recent studies have

shown that the outcomes of extensive salvage procedures for

severely injured limbs are not necessarily definitive in a nonmilitary

population3 and that early amputation can be preferable

to limb salvage in many such instances3-12.

Some military and nonmilitary population studies have

considered a delayed amputation as occurring within as little as

twenty-four hours postinjury, while other studies have cited a

range over years4,13,14. Up to 15% of combat-related amputations

have occurred later than twelve weeks postinjury, and the military

medical community has adopted this as a reasonable timeframe

during which initial operative efforts at limb salvage can be attempted

2,14. Given the incidence of trauma-related amputation in

the active duty military population, as well as the likely underreported

frequency of similar scenarios in civilian trauma settings

3,8,15-17, the goal of this report is to provide an analysis of gait in

combat-injured patients before and after delayed amputation.

Our institutional review board approved the retrospective review

of the data presented in this manuscript. The three patients included

in this case series were informed that data would be submitted

for publication, and they all gave consent.

Source: http://caseconnector.jbjs.org/data/Journals/JBJSCC/4401/CC_02_01_00073.pdf

Oscar Pistorius could have run with longer blades at the Paralympics, says prosthetics supplier - Telegraph

Oscar Pistorius could have run with longer blades at the Paralympics, says prosthetics supplier - Telegraph
A clinical prosthetics specialist for the company that supplies both Oscar Pistorius and Alan Oliveira with their running blades says Pistorius would have been perfectly within his rights to experiment with longer blades at the Paralympics to achieve greater speed.

Read more

Posterior tibial tendon dysfunction and flatfoot: Analysis with simulated wa...

Posterior tibial tendon dysfunction and flatfoot: Analysis with simulated walking - Corrected Proof

via Gait & Posture - Articles in Press by Kota Watanabe, Harold B. Kitaoka, Tadashi Fujii, Xavier Crevoisier, Lawrence J. Berglund, Kristin D. Zhao, Kenton R. Kaufman, Kai-Nan An on 8/31/12

Highlights: ► We examined the flatfoot motion utilizing a dynamic foot-ankle simulator. ► Magnetic tracking system monitored the cadaver foot bone movements 3-dimensionally. ► Kinematics in the intact condition were consistent with normal gait analysis data. ► Kinematics altered in the flatfoot condition in coronal and transverse planes. ► The simulated flatfoot was consistent with patients data with flatfoot.Abstract: Many biomechanical studies investigated pathology of flatfoot and effects of operations on flatfoot. The majority of cadaveric studies are limited to the quasistatic response to static joint loads. This study examined the unconstrained joint motion of the foot and ankle during stance phase utilizing a dynamic foot–ankle simulator in simulated stage 2 posterior tibial tendon dysfunction (PTTD). Muscle forces were applied on the extrinsic tendons of the foot using six servo-pneumatic cylinders to simulate their action. Vertical and fore-aft shear forces were applied and tibial advancement was performed with the servomotors. Three-dimensional movements of multiple bones of the foot were monitored with a magnetic tracking system. Twenty-two fresh-frozen lower extremities were studied in the intact condition, then following sectioning peritalar constraints to create a flatfoot and unloading the posterior tibial muscle force. Kinematics in the intact condition were consistent with gait analysis data for normals. There were altered kinematics in the flatfoot condition, particularly in coronal and transverse planes. Calcaneal eversion relative to the tibia averaged 11.1±2.8° compared to 5.8±2.3° in the normal condition. Calcaneal-tibial external rotation was significantly increased in flatfeet from mean of 2.3±1.7° to 8.1±4.0°. There were also significant changes in metatarsal-tibial eversion and external rotation in the flatfoot condition. The simulated PTTD with flatfoot was consistent with previous data obtained in patients with PTTD. The use of a flatfoot model will enable more detailed study on the flatfoot condition and/or effect of surgical treatment.

AGE OF DIAGNOSIS AND PROGNOSIS OF IDIOPATHIC SCOLIOSIS UNRELATED TO INFORMATION ON HEREDITY

A Grauers a , b , A Danielsson c , MK Karlsson d and P Gerdhem a

Author Affiliations

paul.gerdhem@karolinska.se

Abstract

Purpose To compare information on heredity among patients with idiopathic scoliosis.

Methods 1440 patients with idiopathic scoliosis were recruited. Information on prevalence of scoliosis among relatives was obtained by questionnaire.

Results 1256 (87%) were women and 184 (13%) were men. 204 (14%) of the participants were juvenile (4-9 yrs) at time of diagnosis. 1236 (86%) were adolescents (10-19 yrs) at time of diagnosis.

141 of the 204 patients (69%) with juvenile scoliosis had been treated (73 brace, 68 surgery) and 817 of the 1236 patients (66%) with adolescent scoliosis had been treated (490 brace, 327 surgery).

23% had at least one parent and 13% had at least one grandparent with scoliosis. When comparing female and male patients there was no difference in proportion of parents with scoliosis (p=0.97, Chi-square) or grandparents with scoliosis (p=0.35). 26% of patients with juvenile scoliosis had at least one parent with scoliosis compared to 22% for patients with adolescent scoliosis (p=0.23). 18% of patients with juvenile scoliosis had at least one grandparent with scoliosis compared to 12% for patients with adolescent scoliosis (p=0.04).

When dividing the patients into groups according to treatment (observed, brace, or surgery), there was no difference in proportion of parents with scoliosis (p=0.59) or in proportion of grandparents with scoliosis (p=0.99).

Conclusion It is unlikely that information on heredity is of importance for the prognosis of idiopathic scoliosis. We found no difference in heredity among patients with juvenile and adolescent scoliosis or between males and females.

http://www.bjjprocs.boneandjoint.org.uk/content/94-B/SUPP_XXXI/23.abstract