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Alexander Y Shin - One of the best experts on this subject based on the ideXlab platform.
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Partial Tibial Nerve Transfer to the Tibialis Anterior Motor Branch to Treat Peroneal Nerve Injury After Knee Trauma
Clinical Orthopaedics and Related Research®, 2012Co-Authors: Jennifer L Giuffre, Allen T Bishop, Bruce A. Levy, Richard J Spinner, Alexander Y ShinAbstract:BackgroundInjuries to the deep peroneal nerve result in tibialis anterior muscle paralysis and associated loss of ankle Dorsiflexion. Nerve grafting of peroneal nerve injuries has led to poor function; therefore, tendon transfers and ankle-foot orthotics have been the standard treatment for foot drop.Questions/purposesWe (1) describe an alternative surgical technique to obtain ankle Dorsiflexion by partial tibial nerve transfer to the motor branch of the tibialis anterior muscle; (2) evaluate ankle Dorsiflexion strength using British Medical Research Council grading after nerve transfer; and (3) qualitatively determine factors that influence functional success of surgery.MethodsWe retrospectively reviewed 11 patients treated with partial tibial nerve transfers after peroneal nerve injury. Pre- and postoperative motor strength was measured. Patients completed questionnaires regarding pre- and postoperative gait and disability.ResultsOne patient regained Grade 4 ankle Dorsiflexion, three patients regained Grade 3, one patient regained Grade 2, and two patients regained Grade 1 ankle Dorsiflexion. Four patients did not regain any muscle activity. Clinically apparent motor recovery occurred an average 7.6 months postoperatively. A majority of patients (nine) could walk and participate in activities. Seven patients did not wear ankle-foot orthotics and four patients did not limp. The donor deficits included weak toe flexion (two patients) and reduced calf circumference (seven patients).ConclusionOur observations suggest nerve transfers to the deep peroneal nerve provide inconsistent ankle Dorsiflexion strength, possibly related to the mechanism of peroneal nerve injury or delays in surgery. Despite variable strength, four patients achieved M3 or greater motor recovery, which enabled them to walk without assistive devices.Level of Evidence Level IV, therapeutic study. See Guidelines for Authors for a complete description of levels of evidence.
Jennifer L Giuffre - One of the best experts on this subject based on the ideXlab platform.
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Partial Tibial Nerve Transfer to the Tibialis Anterior Motor Branch to Treat Peroneal Nerve Injury After Knee Trauma
Clinical Orthopaedics and Related Research®, 2012Co-Authors: Jennifer L Giuffre, Allen T Bishop, Bruce A. Levy, Richard J Spinner, Alexander Y ShinAbstract:BackgroundInjuries to the deep peroneal nerve result in tibialis anterior muscle paralysis and associated loss of ankle Dorsiflexion. Nerve grafting of peroneal nerve injuries has led to poor function; therefore, tendon transfers and ankle-foot orthotics have been the standard treatment for foot drop.Questions/purposesWe (1) describe an alternative surgical technique to obtain ankle Dorsiflexion by partial tibial nerve transfer to the motor branch of the tibialis anterior muscle; (2) evaluate ankle Dorsiflexion strength using British Medical Research Council grading after nerve transfer; and (3) qualitatively determine factors that influence functional success of surgery.MethodsWe retrospectively reviewed 11 patients treated with partial tibial nerve transfers after peroneal nerve injury. Pre- and postoperative motor strength was measured. Patients completed questionnaires regarding pre- and postoperative gait and disability.ResultsOne patient regained Grade 4 ankle Dorsiflexion, three patients regained Grade 3, one patient regained Grade 2, and two patients regained Grade 1 ankle Dorsiflexion. Four patients did not regain any muscle activity. Clinically apparent motor recovery occurred an average 7.6 months postoperatively. A majority of patients (nine) could walk and participate in activities. Seven patients did not wear ankle-foot orthotics and four patients did not limp. The donor deficits included weak toe flexion (two patients) and reduced calf circumference (seven patients).ConclusionOur observations suggest nerve transfers to the deep peroneal nerve provide inconsistent ankle Dorsiflexion strength, possibly related to the mechanism of peroneal nerve injury or delays in surgery. Despite variable strength, four patients achieved M3 or greater motor recovery, which enabled them to walk without assistive devices.Level of Evidence Level IV, therapeutic study. See Guidelines for Authors for a complete description of levels of evidence.
Anil Dhal - One of the best experts on this subject based on the ideXlab platform.
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catapult splint a foot Dorsiflexion assist splint
Foot and Ankle Surgery, 2011Co-Authors: Vineet Jain, Mayank Agrawal, Anil DhalAbstract:BACKGROUND: Loss of Dorsiflexion is a common problem in cases where an external fixator or Ilizarov assembly is applied. It results in functional impairment of the foot by affecting the swing phase of gait cycle. We devised a simple dynamic Dorsiflexion assist splint for prevention, correction of equinus/cavus deformity and maintenance of normal Dorsiflexion of foot. METHODS: This prospective study used a rubber splint styled in the shape of a catapult, made of discarded car rubber tubes attached to the frame of fixator in 50 patients. RESULTS: In 17 patients there was varying amount of loss of Dorsiflexion at the time of application of splint while in 22 patients it was applied soon after the application of the fixator. In the rest of patients it was applied for cavus deformity. Out of 17 patients 10 had complete recovery of Dorsiflexion. 22 patients in whom it was applied at the outset had normal range of movement at ankle. Correction was achieved in all 6 cases of cavus deformity and prevented its occurrence in the rest of 5 cases. CONCLUSION: Catapult splint is a low cost foot Dorsiflexion assist splint.
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Catapult splint: A foot Dorsiflexion assist splint
Foot and Ankle Surgery, 2011Co-Authors: Vineet Jain, Mayank Agrawal, Anil DhalAbstract:Abstract Background Loss of Dorsiflexion is a common problem in cases where an external fixator or Ilizarov assembly is applied. It results in functional impairment of the foot by affecting the swing phase of gait cycle. We devised a simple dynamic Dorsiflexion assist splint for prevention, correction of equinus/cavus deformity and maintenance of normal Dorsiflexion of foot. Methods This prospective study used a rubber splint styled in the shape of a catapult, made of discarded car rubber tubes attached to the frame of fixator in 50 patients. Results In 17 patients there was varying amount of loss of Dorsiflexion at the time of application of splint while in 22 patients it was applied soon after the application of the fixator. In the rest of patients it was applied for cavus deformity. Out of 17 patients 10 had complete recovery of Dorsiflexion. 22 patients in whom it was applied at the outset had normal range of movement at ankle. Correction was achieved in all 6 cases of cavus deformity and prevented its occurrence in the rest of 5 cases. Conclusion Catapult splint is a low cost foot Dorsiflexion assist splint.
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Catapult splint: A foot Dorsiflexion assist splint
Foot and Ankle Surgery, 2011Co-Authors: Vineet Jain, Mayank Agrawal, Anil DhalAbstract:Background: Loss of Dorsiflexion is a common problem in cases where an external fixator or Ilizarov assembly is applied. It results in functional impairment of the foot by affecting the swing phase of gait cycle. We devised a simple dynamic Dorsiflexion assist splint for prevention, correction of equinus/cavus deformity and maintenance of normal Dorsiflexion of foot. Methods: This prospective study used a rubber splint styled in the shape of a catapult, made of discarded car rubber tubes attached to the frame of fixator in 50 patients. Results: In 17 patients there was varying amount of loss of Dorsiflexion at the time of application of splint while in 22 patients it was applied soon after the application of the fixator. In the rest of patients it was applied for cavus deformity. Out of 17 patients 10 had complete recovery of Dorsiflexion. 22 patients in whom it was applied at the outset had normal range of movement at ankle. Correction was achieved in all 6 cases of cavus deformity and prevented its occurrence in the rest of 5 cases. Conclusion: Catapult splint is a low cost foot Dorsiflexion assist splint. © 2011 European Foot and Ankle Society.
Joshua Burns - One of the best experts on this subject based on the ideXlab platform.
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serial night casting increases ankle Dorsiflexion range in children and young adults with charcot marie tooth disease a randomised trial
Journal of Physiotherapy, 2010Co-Authors: Joshua Burns, Kristy J Rose, Jacqueline Raymond, Kathryn M Refshauge, Kathryn N NorthAbstract:Question Does 4 weeks of serial night casting followed by 4 weeks of stretching of the gastrocnemius and soleus improve ankle Dorsiflexion range and other outcomes compared with no intervention in children and young adults with Charcot-Marie-Tooth disease? Design Randomised trial with concealed allocation, assessor blinding, and intention-to-treat analysis. Participants 30 children and young adults with Charcot-Marie-Tooth disease and restricted ankle Dorsiflexion range. Intervention The experimental group received 4 weeks of serial night casting followed by 4 weeks of weightbearing stretches. The control group received no intervention. Outcome measures Primary outcome was ankle Dorsiflexion range; secondary outcomes included foot deformity, mobility, balance, falls, and self-reported activity limitations. Outcomes were measured at baseline, 4, and 8 weeks. Results By 4 weeks, serial night casting had increased ankle Dorsiflexion range by a mean of 4 deg (95% CI 2 to 6) more in the experimental group than the control group. After a further 4 weeks of weightbearing stretches, the experimental group still had a mean of 3 deg (95% CI 0 to 5) more ankle Dorsiflexion range than the control group. Other than reduced time to walk 10 metres at self-selected pace favouring night casting at 4 weeks, outcomes did not differ between groups at any time point. Two minor adverse events were reported in the experimental group. Conclusion 4 weeks of serial night casting increased ankle Dorsiflexion range compared with no intervention, but at 8 weeks there was no significant difference between groups. Trial registration ACTRN12605000011684.
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does stretching increase ankle Dorsiflexion range of motion a systematic review
British Journal of Sports Medicine, 2006Co-Authors: Joel A Radford, Joshua Burns, Rachelle Buchbinder, Karl B Landorf, Catherine CookAbstract:Background: Many lower limb disorders are related to calf muscle tightness and reduced Dorsiflexion of the ankle. To treat such disorders, stretches of the calf muscles are commonly prescribed to increase available Dorsiflexion of the ankle joint. Hypothesis: To determine the effect of static calf muscle stretching on ankle joint Dorsiflexion range of motion. Study design: A systematic review with meta-analyses. Methods: A systematic review of randomised trials examining static calf muscle stretches compared with no stretching. Trials were identified by searching Cinahl, Embase, Medline, SportDiscus, and Central and by recursive checking of bibliographies. Data were extracted from trial publications, and meta-analyses performed that calculated a weighted mean difference (WMD) for the continuous outcome of ankle Dorsiflexion. Sensitivity analyses excluded poorer quality trials. Statistical heterogeneity was assessed using the quantity I 2. Results: Five trials met inclusion criteria and reported sufficient data on ankle Dorsiflexion to be included in the meta-analyses. The meta-analyses showed that calf muscle stretching increases ankle Dorsiflexion after stretching for ⩽15 minutes (WMD 2.07°; 95% confidence interval 0.86 to 3.27), >15–30 minutes (WMD 3.03°; 95% confidence interval 0.31 to 5.75), and >30 minutes (WMD 2.49°; 95% confidence interval 0.16 to 4.82). There was a very low to moderate statistical heterogeneity between trials. The meta-analysis results for ⩽15 minutes and >15–30 minutes of stretching were considered robust when compared with sensitivity analyses that excluded lower quality trials. Conclusions: Calf muscle stretching provides a small and statistically significant increase in ankle Dorsiflexion. However, it is unclear whether the change is clinically important.
Bruce A. Levy - One of the best experts on this subject based on the ideXlab platform.
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Partial Tibial Nerve Transfer to the Tibialis Anterior Motor Branch to Treat Peroneal Nerve Injury After Knee Trauma
Clinical Orthopaedics and Related Research®, 2012Co-Authors: Jennifer L Giuffre, Allen T Bishop, Bruce A. Levy, Richard J Spinner, Alexander Y ShinAbstract:BackgroundInjuries to the deep peroneal nerve result in tibialis anterior muscle paralysis and associated loss of ankle Dorsiflexion. Nerve grafting of peroneal nerve injuries has led to poor function; therefore, tendon transfers and ankle-foot orthotics have been the standard treatment for foot drop.Questions/purposesWe (1) describe an alternative surgical technique to obtain ankle Dorsiflexion by partial tibial nerve transfer to the motor branch of the tibialis anterior muscle; (2) evaluate ankle Dorsiflexion strength using British Medical Research Council grading after nerve transfer; and (3) qualitatively determine factors that influence functional success of surgery.MethodsWe retrospectively reviewed 11 patients treated with partial tibial nerve transfers after peroneal nerve injury. Pre- and postoperative motor strength was measured. Patients completed questionnaires regarding pre- and postoperative gait and disability.ResultsOne patient regained Grade 4 ankle Dorsiflexion, three patients regained Grade 3, one patient regained Grade 2, and two patients regained Grade 1 ankle Dorsiflexion. Four patients did not regain any muscle activity. Clinically apparent motor recovery occurred an average 7.6 months postoperatively. A majority of patients (nine) could walk and participate in activities. Seven patients did not wear ankle-foot orthotics and four patients did not limp. The donor deficits included weak toe flexion (two patients) and reduced calf circumference (seven patients).ConclusionOur observations suggest nerve transfers to the deep peroneal nerve provide inconsistent ankle Dorsiflexion strength, possibly related to the mechanism of peroneal nerve injury or delays in surgery. Despite variable strength, four patients achieved M3 or greater motor recovery, which enabled them to walk without assistive devices.Level of Evidence Level IV, therapeutic study. See Guidelines for Authors for a complete description of levels of evidence.