Ankle Motion and Offloading in Short Leg Cast and Low and High Fracture Boots

Nahm, Nickolas J.; Bey, Michael J.; Liu, Serena; Guthrie, S. Trent

doi:10.1177/1071100719868721

Cited by 7 publications

(2 citation statements)

References 30 publications

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“…The smaller ankle excursion observed in the walking boot (13°) may limit or reduce muscle activity and possibly contribute to muscle atrophy in the gastrocnemius, soleus, and peroneal muscles (25–28). Nahm et al (41) observed that participants experienced between 3° and 8° of sagittal tibiotalar motion while wearing the different walking boot conditions compared with a regular shoe. Zhang et al (42) observed between 5° and 7° of sagittal ankle excursion in individuals wearing short-leg walking boots during walking.…”

Section: Discussionmentioning

confidence: 99%

A Dynamic Ankle Orthosis Reduces Tibial Compressive Force and Increases Ankle Motion Compared With a Walking Boot

Johnson

Paquette

DiAngelo

2023

Medicine &Amp; Science in Sports &Amp; Exercise

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Purpose: Tibial bone stress injuries are a common overuse injury among runners and military cadets. Current treatment involves wearing an orthopedic walking boot for 3 to 12 wk, which limits ankle motion and leads to lower limb muscle atrophy. A dynamic ankle orthosis (DAO) was designed to provide a distractive force that offloads in-shoe vertical force and retains sagittal ankle motion during walking. It remains unclear how tibial compressive force is altered by the DAO. This study compared tibial compressive force and ankle motion during walking between the DAO and an orthopedic walking boot. Methods: Twenty young adults walked on an instrumented treadmill at 1.0 m•s −1 in two brace conditions: DAO and walking boot. Three-dimensional kinematic, ground reaction forces, and in-shoe vertical force data were collected to calculate peak tibial compressive force. Paired t-tests and Cohen's d effect sizes were used to assess mean differences between conditions. Results: Peak tibial compressive force (P = 0.023; d = 0.5) and Achilles tendon force (P = 0.017; d = 0.5) were moderately lower in the DAO compared with the walking boot. Sagittal ankle excursion was 54.9% greater in the DAO compared with the walking boot (P = 0.05; d = 3.1). Conclusions: The findings from this study indicated that the DAO moderately reduced tibial compressive force and Achilles tendon force and allowed more sagittal ankle excursion during treadmill walking compared with an orthopedic walking boot.

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Section: Discussionmentioning

confidence: 99%

A Dynamic Ankle Orthosis Reduces Tibial Compressive Force and Increases Ankle Motion Compared With a Walking Boot

Johnson

Paquette

DiAngelo

2023

Medicine &Amp; Science in Sports &Amp; Exercise

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“…Previous reviews in the area have found that NRKHDs reduce more PP than other offloading treatments by incorporating more key mechanical features, such as customized insoles/foot-device interfaces, rocker-bottom soles, controlled ankle motion, and higher cast walls/struts preferably extending up to the knee. 20 These features typically also reduce foot and ankle joint movements [21][22][23] and subsequent horizontal shear forces by using the contact surfaces as loadbearing surfaces. 24 In addition, restricted ankle movement will necessitate strategies of reducing mobility and/or increasing requirements on the contralateral limb.…”

Section: Reduction Of Pp and Shear Stress At The Dfumentioning

confidence: 99%

Personalized Offloading Treatments for Healing Plantar Diabetic Foot Ulcers

Jarl

Rusaw

Terrill

et al. 2022

J Diabetes Sci Technol

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Background: Non-removable knee-high devices are the gold-standard offloading treatments to heal plantar diabetic foot ulcers (DFUs). These devices are underused in practice for a variety of reasons. Recommending these devices for all patients, regardless of their circumstances and preferences influencing their ability to tolerate the devices, does not seem a fruitful approach. Purpose: The aim of this article is to explore the potential implications of a more personalized approach to offloading DFUs and suggest avenues for future research and development. Methods: Non-removable knee-high devices effectively heal plantar DFUs by reducing plantar pressure and shear at the DFU, reducing weight-bearing activity and enforcing high adherence. We propose that future offloading devices should be developed that aim to optimize these mechanisms according to each individual’s needs. We suggest three different approaches may be developed to achieve such personalized offloading treatment. First, we suggest modular devices, where different mechanical features (rocker-bottom sole, knee-high cast walls/struts, etc.) can be added or removed from the device to accommodate different patients’ needs and the evolving needs of the patient throughout the treatment period. Second, advanced manufacturing techniques and novel materials could be used to personalize the design of their devices, thereby improving common hindrances to their use, such as devices being heavy, bulky, and hot. Third, sensors could be used to provide real-time feedback to patients and clinicians on plantar pressures, shear, weight-bearing activity, and adherence. Conclusions: By the use of these approaches, we could provide patients with personalized devices to optimize plantar tissue stress, thereby improving clinical outcomes.

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Biomechanical effectiveness of controlled ankle motion boots: A systematic review and narrative synthesis

Stolycia,

Lunn,

Stanier

et al. 2024

Journal of Foot and Ankle Research

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IntroductionControlled ankle motion (CAM) boots are a below‐knee orthotic device prescribed for the management of foot and ankle injuries to reduce ankle range of motion (RoM) and offload the foot and ankle whilst allowing continued ambulation during recovery. There is a lack of clarity within the current literature surrounding the biomechanical understanding and effectiveness of CAM boots.AimsTo summarise the biomechanical effects of CAM boot wear as an orthotic for restricting ankle RoM and offloading the foot.MethodsA systematic literature review was conducted in accordance with the PRISMA 2020 guidelines. All papers were independently screened by two authors for inclusion. Methodological quality was appraised using Joanna Briggs Critical Appraisal checklists. A narrative synthesis of all eligible papers was produced.ResultsThirteen studies involving 197 participants (113 male and 84 female) were included. All studies were quasi‐randomised and employed a within‐study design, of which 12 studies included a control group and a range of CAM boots were investigated. CAM boots can be seen to restrict ankle RoM, however, neighboring joints such as the knee and hip do have kinetic and kinematic compensatory alterations. Plantar pressure of the forefoot is effectively redistributed to the hindfoot by CAM boots.ConclusionThe compensatory mechanisms at the hip and knee joint during CAM boot wear could explain the secondary site pain often reported in patients, specifically at the ipsilateral knee and contralateral hip. Although CAM boots can be used to restrict ankle motion, this review has highlighted a lack of in‐boot kinematic analyses during CAM boot use, where tracking markers are placed on the anatomical structure rather than on the boot, or through video fluoroscopy, urging the need for a more robust methodological approach to achieve this. There is a need for studies to assess the biomechanical alterations caused by CAM boots in populations living with foot and ankle pathologies. Future research, adopting a longitudinal study design, is required to fully understand the effectiveness of CAM boots for rehabilitation.

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Ankle Motion and Offloading in Short Leg Cast and Low and High Fracture Boots

Cited by 7 publications

References 30 publications

A Dynamic Ankle Orthosis Reduces Tibial Compressive Force and Increases Ankle Motion Compared With a Walking Boot

A Dynamic Ankle Orthosis Reduces Tibial Compressive Force and Increases Ankle Motion Compared With a Walking Boot

Personalized Offloading Treatments for Healing Plantar Diabetic Foot Ulcers

Biomechanical effectiveness of controlled ankle motion boots: A systematic review and narrative synthesis

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