The databases of the Picture Archiving and Communication Systems of two hospitals were searched and all children who had a lateral radiograph of the ankle during their attendance at the emergency department were identified. In 227 radiographs, Bohler's and Gissane's angles were measured on two separate occasions and by two separate authors to allow calculation of inter- and intra-observer variation. Intraclass correlation coefficients were used to assess the reliability of the measurements. For Bohler's angle the overall inter-observer reliability, the intraclass correlation coefficient was 0.90 and the intra-observer reliability 0.95, giving excellent agreement. This reliability was maintained across the age groups. For Gissane's angle, inter- and intra-observer reliability was only fair or poor across most age groups. Further analysis of the Bohler's angle showed a significant variation in the mean angle with age. Contrary to published opinion, the angle is not uniformly lower than that of adults but varies with age, peaking towards the end of the first decade before attaining adult values. The age-related radiologic changes presented here may help in the interpretation of injuries to the hindfoot in children.

Congenital clubfoot is a relatively common lower limb deformity that is increasingly managed by non-operative methods of serial manipulation and immobilization. This review looks at aetiology, examination techniques and severity scoring, and provides an overview of operative and non-operative methods of treatment.

Purpose The mechanisms that underpin exercise-induced muscle damage and recovery are believed to be mediated, in part, by immune cells recruited to the site of injury. The aim of this study was to characterise the effects of muscle damage from bench-stepping on circulating cytokine and immune cell populations post-exercise and during recovery. Methods Ten untrained, healthy male volunteers completed 30 min of bench-stepping exercise to induce muscle damage to the eccentrically exercised leg. Muscle function, muscle pain and soreness were measured before, immediately after and 24, 48 and 72 h after exercise. Plasma creatine kinase, cartilage oligomeric matrix protein, cytokines and circulating immune cell phenotyping were also measured at these timepoints. Results Significant decreases occurred in eccentric, isometric and concentric (P = 0.018, 0.047 and 0.003, respectively) muscle function in eccentrically, but not concentrically, exercised quadriceps post-exercise. Plasma monocyte chemoattractant protein (MCP)-1 concentrations significantly increased immediately after exercise (69.0 ± 5.8 to 89.5 ± 10.0 pg/mL), then declined to below pre-exercise concentrations (58.8 ± 6.3 pg/mL) 72 h after exercise. These changes corresponded with the significant decrease of circulating CD45+ CD16− CD14+ monocytes (5.8% ± 1.5% to 1.9% ± 0.5%; Pre-exercise vs. 48 h) and increase of CD45+ CD3+ CD56− T-cells (60.5% ± 2.2% to 66.1% ± 2.1%; Pre-exercise vs. 72 h) during recovery. Conclusion Bench-stepping induced muscle damage to the quadriceps, which mediated systemic changes in MCP-1, monocytes and T-cells immediately post-exercise and during recovery. Further research is needed to clarify how modulations in immune subpopulations facilitate muscle recovery and adaptation following muscle damage.