The Experts below are selected from a list of 267 Experts worldwide ranked by ideXlab platform
Andrea Santamato - One of the best experts on this subject based on the ideXlab platform.
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ultrasonographic evaluation of botulinum toxin injection site for the medial approach to Tibialis Posterior Muscle in chronic stroke patients with spastic equinovarus foot an observational study
Toxins, 2017Co-Authors: Alessandro Picelli, Alessio Baricich, Elena Chemello, Nicola Smania, Carlo Cisari, Marialuisa Gandolfi, Nicoletta Cinone, Maurizio Ranieri, Andrea SantamatoAbstract:The Tibialis Posterior Muscle is a frequent target for injection of botulinum toxin during the management of spastic equinovarus foot in adults with post-stroke spasticity. Although it is deep-seated, the needle insertion into the Tibialis Posterior Muscle is usually performed using anatomical landmarks and safety information obtained from healthy subjects and cadavers. Our aim was to evaluate the botulinum toxin injection site for the medial approach to the Tibialis Posterior Muscle in chronic stroke patients with spastic equinovarus foot. Forty-six patients were evaluated at the affected middle lower leg medial surface with ultrasonography according to the following parameters: Tibialis Posterior Muscle depth, thickness, and echo intensity. As to the spastic Tibialis Posterior, we found a mean Muscle depth of 26.5 mm and a mean Muscle thickness of 10.1 mm. Furthermore we observed a median Tibialis Posterior Muscle echo intensity of 3.00 on the Heckmatt scale. The Tibialis Posterior Muscle thickness was found to be inversely associated with its depth (p < 0.001) and echo intensity (p = 0.006). Furthermore, Tibialis Posterior Muscle depth was found to be directly associated with its echo intensity (p = 0.004). Our findings may usefully inform manual needle placement into the Tibialis Posterior for the botulinum toxin treatment of spastic equinovarus foot in chronic stroke patients.
Vincent Tiffreau - One of the best experts on this subject based on the ideXlab platform.
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Botulinum toxin to prevent foot varus deformity in Charcot-Marie-Tooth disease: Effects on gait parameters, a case report
Annals of Physical and Rehabilitation Medicine, 2013Co-Authors: Etienne Allart, C Dangleterre, Nicolas Boutry, Vincent TiffreauAbstract:Introduction.- Charcot-Marie-Tooth disease (CMTD) leads to progressive feet deformities due to the unbalance between agonists and antagonists Muscles. These deformities have a major impact on standing posture and gait. Their prevention is a key goal for patients. Case.- We present the case of an 11-year-old girl suffering from a type 2 CMTD, presenting on left side a static pes cavo varus during standing and a dynamic varus with forefoot adduction during gait. This deformity causes an early attrition of her orthopedic shoes, pain of the lateral side of the foot and discomfort in wearing nocturnal orthotics. Baropodometric assessment during gait (Zebris FDM, Zebris Inc.) confirmed a major lateral foot overload at the base of the 5th metatarsal. Clinical examination showed that the varus was partially reducible; the Tibialis Posterior Muscle strength was normal whereas fibular Muscles were very weak (2/5). We performed an intramuscular echo guided injection of 50 units of Botulinum toxin (Botox (registered trademark)) in the left Tibialis Posterior Muscle. After the injection (assessments were made after 15 days and 3 months), resistance to passive correction of the varus was clinically less important. The varus deformity was slightly improved during gait (2D video analysis), as was the lateral foot overload (-35% at j15, -46% at M3). According to kinetics data, weakening of the Tibialis Posterior Muscle, which is an accessory plantarflexor, did not decrease left propulsion force and did not modify gait spatio-temporal parameters (Gaitrite). Discussion.- By minimizing unbalance between the Tibialis Posterior and weak fibular Muscles, botulinum toxin improved the varus deformity, plantar pressures and pain during gait. A complementary study seems to be necessary, particularly to evaluate its long-term preventive role.
Michael Skipper Andersen - One of the best experts on this subject based on the ideXlab platform.
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Tibialis Posterior Muscle pain effects on hip knee and ankle gait mechanics
Human Movement Science, 2019Co-Authors: Morten Bilde Simonsen, Aysun Yurtsever, Ketill Naesborgandersen, Peter Derek Christian Leutscher, Kim Horslevpetersen, Michael Skipper Andersen, Rogerio Pessoto HirataAbstract:Abstract Background Tibialis Posterior (TP) dysfunction is a common painful complication in patients with rheumatoid arthritis (RA), which can lead to the collapse of the medial longitudinal arch. Different theories have been developed to explain the causality of Tibialis Posterior dysfunction. In all these theories, pain is a central factor, and yet, it is uncertain to what extent pain causes the observed biomechanical alterations in the patients. The aim of this study was to investigate the effect of experimental Tibialis Posterior Muscle pain on gait mechanics in healthy subjects. Methods Twelve healthy subjects were recruited for this randomized crossover study. Experimental pain was induced by ultrasound-guided injection of 1 mL hypertonic saline into the upper part of the right Tibialis Posterior Muscle with the use of isotonic saline as non-pain-inducing control. Subsequently, kinematic data during three self-paced over ground walking for each condition were collected. Ground reaction forces and external moments were measured from force plates installed in the floor. Painful areas were evaluated using body charts and pain intensity scoring via a verbal numerical rating scale. Findings Decreased hip internal rotation was observed during the pain condition at the end of the stance phase. There were no changes in gait velocity and duration of stand phase between the pain and no pain conditions. Reduced external joint moment was found for external knee rotation and for external hip rotation. Interpretation The study has demonstrated that induced pain in the TP Muscle evokes kinematic alteration in the hip and the knee joints, but not in the ankle, which suggest an underlying early stage joint compensatory mechanism. These findings suggest the need to include those joints in current physical evaluations of Tibialis Posterior dysfunction.
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a parametric study of effect of experimental Tibialis Posterior Muscle pain on joint loading and Muscle forces implications for patients with rheumatoid arthritis
Gait & Posture, 2019Co-Authors: Morten Bilde Simonsen, Aysun Yurtsever, Ketill Naesborgandersen, Peter Derek Christian Leutscher, Kim Horslevpetersen, Rogerio Pessoto Hirata, Michael Skipper AndersenAbstract:Abstract Background Foot pain and deformities are commonly encountered in patients with rheumatoid arthritis (RA). Likewise, Posterior tibial tendon dysfunction (PTTD) is commonly involved in development of foot and ankle abnormalities and has been reported with a prevalence in two-thirds of the RA patients. Research question Redundancy in the physiological function between different Muscles provides the central nervous system multiple options to perform the same movement but which Muscles compensate for the impairment of the Tibialis Posterior (TP) Muscle? And how does these changes affect ankle joint loading? Methods Experimental and computational disciplines were applied to investigate changes in Muscle forces as result of induced pain in the right TP Muscle. Twelve healthy subjects were enrolled in the study. Experimental pain was induced in the TP by a single ultrasound graphically guided injection of 1 mL hypertonic saline (5.0% Sodium Chloride). The participants' gait was assessed by skin marker-based motion capture and force plates. Musculoskeletal models were used to investigate compensation mechanisms systematically in the lower under extremity when TP Muscle was recruited less as a consequence of the induced pain. Results Experimental TP Muscle pain and simulated reduced strength caused altered Muscle recruitment and made the flexor digitorum longus and flexor hallucis longus Muscles compensated for the impairment of the TP Muscle. Further, the resultant ankle joint force was increased as the strength of the TP Muscle was reduced. Significance The compensation mechanism observed in the present study indicate that alterations in Muscle recruitment and Muscle force distribution as a result of the underlying disease inflammation itself may contribute to development of chronic foot pain and deformities in patients with RA. Further studies are required to understand the role of PTTD in occurrence of those late adverse musculoskeletal manifestations aiming at search for early preventive strategies.
Morten Bilde Simonsen - One of the best experts on this subject based on the ideXlab platform.
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Tibialis Posterior Muscle pain effects on hip knee and ankle gait mechanics
Human Movement Science, 2019Co-Authors: Morten Bilde Simonsen, Aysun Yurtsever, Ketill Naesborgandersen, Peter Derek Christian Leutscher, Kim Horslevpetersen, Michael Skipper Andersen, Rogerio Pessoto HirataAbstract:Abstract Background Tibialis Posterior (TP) dysfunction is a common painful complication in patients with rheumatoid arthritis (RA), which can lead to the collapse of the medial longitudinal arch. Different theories have been developed to explain the causality of Tibialis Posterior dysfunction. In all these theories, pain is a central factor, and yet, it is uncertain to what extent pain causes the observed biomechanical alterations in the patients. The aim of this study was to investigate the effect of experimental Tibialis Posterior Muscle pain on gait mechanics in healthy subjects. Methods Twelve healthy subjects were recruited for this randomized crossover study. Experimental pain was induced by ultrasound-guided injection of 1 mL hypertonic saline into the upper part of the right Tibialis Posterior Muscle with the use of isotonic saline as non-pain-inducing control. Subsequently, kinematic data during three self-paced over ground walking for each condition were collected. Ground reaction forces and external moments were measured from force plates installed in the floor. Painful areas were evaluated using body charts and pain intensity scoring via a verbal numerical rating scale. Findings Decreased hip internal rotation was observed during the pain condition at the end of the stance phase. There were no changes in gait velocity and duration of stand phase between the pain and no pain conditions. Reduced external joint moment was found for external knee rotation and for external hip rotation. Interpretation The study has demonstrated that induced pain in the TP Muscle evokes kinematic alteration in the hip and the knee joints, but not in the ankle, which suggest an underlying early stage joint compensatory mechanism. These findings suggest the need to include those joints in current physical evaluations of Tibialis Posterior dysfunction.
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a parametric study of effect of experimental Tibialis Posterior Muscle pain on joint loading and Muscle forces implications for patients with rheumatoid arthritis
Gait & Posture, 2019Co-Authors: Morten Bilde Simonsen, Aysun Yurtsever, Ketill Naesborgandersen, Peter Derek Christian Leutscher, Kim Horslevpetersen, Rogerio Pessoto Hirata, Michael Skipper AndersenAbstract:Abstract Background Foot pain and deformities are commonly encountered in patients with rheumatoid arthritis (RA). Likewise, Posterior tibial tendon dysfunction (PTTD) is commonly involved in development of foot and ankle abnormalities and has been reported with a prevalence in two-thirds of the RA patients. Research question Redundancy in the physiological function between different Muscles provides the central nervous system multiple options to perform the same movement but which Muscles compensate for the impairment of the Tibialis Posterior (TP) Muscle? And how does these changes affect ankle joint loading? Methods Experimental and computational disciplines were applied to investigate changes in Muscle forces as result of induced pain in the right TP Muscle. Twelve healthy subjects were enrolled in the study. Experimental pain was induced in the TP by a single ultrasound graphically guided injection of 1 mL hypertonic saline (5.0% Sodium Chloride). The participants' gait was assessed by skin marker-based motion capture and force plates. Musculoskeletal models were used to investigate compensation mechanisms systematically in the lower under extremity when TP Muscle was recruited less as a consequence of the induced pain. Results Experimental TP Muscle pain and simulated reduced strength caused altered Muscle recruitment and made the flexor digitorum longus and flexor hallucis longus Muscles compensated for the impairment of the TP Muscle. Further, the resultant ankle joint force was increased as the strength of the TP Muscle was reduced. Significance The compensation mechanism observed in the present study indicate that alterations in Muscle recruitment and Muscle force distribution as a result of the underlying disease inflammation itself may contribute to development of chronic foot pain and deformities in patients with RA. Further studies are required to understand the role of PTTD in occurrence of those late adverse musculoskeletal manifestations aiming at search for early preventive strategies.
Alessandro Picelli - One of the best experts on this subject based on the ideXlab platform.
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ultrasonographic evaluation of botulinum toxin injection site for the medial approach to Tibialis Posterior Muscle in chronic stroke patients with spastic equinovarus foot an observational study
Toxins, 2017Co-Authors: Alessandro Picelli, Alessio Baricich, Elena Chemello, Nicola Smania, Carlo Cisari, Marialuisa Gandolfi, Nicoletta Cinone, Maurizio Ranieri, Andrea SantamatoAbstract:The Tibialis Posterior Muscle is a frequent target for injection of botulinum toxin during the management of spastic equinovarus foot in adults with post-stroke spasticity. Although it is deep-seated, the needle insertion into the Tibialis Posterior Muscle is usually performed using anatomical landmarks and safety information obtained from healthy subjects and cadavers. Our aim was to evaluate the botulinum toxin injection site for the medial approach to the Tibialis Posterior Muscle in chronic stroke patients with spastic equinovarus foot. Forty-six patients were evaluated at the affected middle lower leg medial surface with ultrasonography according to the following parameters: Tibialis Posterior Muscle depth, thickness, and echo intensity. As to the spastic Tibialis Posterior, we found a mean Muscle depth of 26.5 mm and a mean Muscle thickness of 10.1 mm. Furthermore we observed a median Tibialis Posterior Muscle echo intensity of 3.00 on the Heckmatt scale. The Tibialis Posterior Muscle thickness was found to be inversely associated with its depth (p < 0.001) and echo intensity (p = 0.006). Furthermore, Tibialis Posterior Muscle depth was found to be directly associated with its echo intensity (p = 0.004). Our findings may usefully inform manual needle placement into the Tibialis Posterior for the botulinum toxin treatment of spastic equinovarus foot in chronic stroke patients.