Ayoola Ibifubara Aiyegbusi

Predictive factors for flatfoot: The role of age and footwear in children in urban and rural communities in South West Nigeria

BACKGROUND Flatfoot is common in children and its prevalence influenced by several factors. This study investigated the role of age and type of foot wear as predictors of flatfoot in school age children in urban and rural areas in south-western Nigeria. METHODS 560 children between 6 and 12 years, divided into two groups; rural and urban were studied. Each subjects static footprint was taken on a white duplicating paper after which the instep was measured for classification into high arch, normal, flat or severe flat. The BMI of each subject was calculated from the anthropometric data. The type of footwear with which the subjects were shod was also recorded. Data analysis was by Epi Info statistical package version 3.5.1 (2008). RESULTS Chi-square showed a significant (p<0.05) association between the presence of flatfoot, age and type of footwear. Comparison of the prevalence of flatfoot by age group indicated a significant difference at age 10 years. Simple logistic regressions, however, showed that age was a significant (p<0.05) predictor for flat foot while the type of footwear was not. CONCLUSION In this study, age is the primary predictor for flatfoot while the type of footwear is not.

Bromelain in the early phase of healing in acute crush Achilles tendon injury.

Bromelain, an enzyme extracted from the stem of the pineapple plant has been proposed as a treatment for reducing pain and swelling following acute muscle injuries but studies are yet to be done on its effect on tendon healing. This study therefore investigated the effects of bromelain on tenocyte proliferation and the tendon malondialdehyde (MDA) level in the early stage of healing in a crush injury to the Achilles tendon of Sprague‐Dawley rats.

A Comparative Study of the Effects of Bromelain and Fresh Pineapple Juice on the Early Phase of Healing in Acute Crush Achilles Tendon Injury

Bromelain, an enzyme extracted from the stem of the pineapple plant, has been reported to reduce pain and swelling in acute soft tissue injuries, but no study has been done to compare its effect with that of fresh pineapple juice on the healing of acute tendon injuries. This study compared the effects of commercial bromelain and fresh pineapple juice on tenocyte proliferation and the malondialdehyde (MDA) level in the early stage of healing in a crush injury to the Achilles tendon of Sprague-Dawley rats. Twenty-four male rats were divided randomly into three groups of eight rats each; all the rats had induced crush injury to the Achilles tendon: Group 1 (control), no treatment; Group 2, oral bromelain treatment at a dosage of 7 mg/kg of body weight daily; and Group 3, fresh diluted pineapple juice at a dosage of 30 mg/kg of body weight. Treatment was given over the first 14 days post-injury. On day 15 post-injury, the animals were sacrificed, and the tendons were excised and processed for histological study and MDA assay. Results show a significant difference in the tenocyte population between the bromelain group and the control (P < .05), whereas pineapple juice also increased the tenocyte population, although not significantly (P = .36). Pineapple juice, however, significantly lowered the MDA level compared with both the control and bromelain-treated groups. Based on this study, 600 GDU bromelain given at a dosage of 7 mg/kg had a better effect on tenocyte proliferation than fresh pineapple juice given once daily in acute tendon injury.

The morphology of the healing tendon: a comparison of the effects of intrasound therapy and therapeutic pulsed ultrasound.

Background and Purpose: This study investigated the effects of low- and high-intensity intrasound therapy (LITR and HITR) and low-intensity pulsed ultrasound (LIPUS) on the morphology of the healing tendon. Methods: Forty-five male Sprague–Dawley albino rats, randomized into five groups, were further subdivided into groups A and B except Group 1. Groups 2–5 underwent an induced crush injury to the Achilles tendon. The groups were allocated to serve as controls (Group 1), received no treatment (Group 2), LIPUS once daily (Group 3), LITR twice daily (Group 4), and HITR twice daily (Group 5). Treatment commenced 24 hr post-injury over the first 14 days. Subgroup A animals were killed on day 15 and those in subgroup B were killed on day 31. The tendons were excised and processed for histological studies. Results: LITR and HITR given twice daily caused a significant (p < 0.05) proliferation of tenoblasts in the proliferative phase and enhanced their terminal differentiation to tenocytes in the remodeling phase compared with the untreated and LIPUS-treated groups. LITR and HITR also resulted in a significant increase in the volume fraction of collagen fibers compared with LIPUS. Conclusion: Intrasound therapy has a better morphological effect on the healing tendon than LIPUS and may be an option to consider in the treatment of acute tendon injuries.

Prevalence of Achilles Tendinopathy and Its Association with Physical Characteristics in Recreational Sport Participants in Lagos, Nigeria.

Background: Achilles tendinopathy (AT) is the most frequently reported injury related to the ankle and foot in different sports activities. Much attention has been paid to elite athletes in competitive sports, but there is paucity of data on its prevalence in recreational sports. Aims: This study investigated the prevalence of AT and its association with selected physical characteristics in a population of recreational sports participants in Lagos, Nigeria. Settings and Design: Cross-sectional analytical study. Materials and Methods: This study involved 302 recreational sports participants in various sports centers in Lagos State. The Royal London test was used to assess for the presence of AT, while the Victorian Institute of Sports Assessment - Achilles questionnaire was used to evaluate the severity of AT among the participants. Statistical Analysis: Data collected were summarized using descriptive statistics and analyzed using Pearson Chi-square. The level of significance was set at P ≤ 0.05. Results: Our findings show that 21% of the participants had AT. Gender, height, and weight showed no significant association with AT; however, the age of the participants showed a significant association with AT. Conclusion: AT is common among recreational sports individuals in Lagos, Nigeria, age being a contributing factor while other physical characteristics had no impact.

Intrasound Therapy is an Effective Adjunct in the Management of Osteoarthritis of the Knee: A Randomized Control Trial

Intrasound therapy (IST) has been found to improve healing in acute injuries in animal models but no clinical study has been conducted on chronic degenerative conditions in human subjects. The purpose of this study was to investigate and compare the effects of IST and transcutaneous electrical nerve stimulation (TENS) in the management of knee osteoarthritis. Twenty-four patients were randomly assigned into three groups: IST, TENS, and the control group. Subjects in Group 1 had low-intensity IST for 10 minutes and closed-chain exercises, Group 2 subjects had TENS at a frequency of 100 Hz, a pulse width of 150 µs, continuous mode for 15 minutes and closed-chain exercises, while the control group patients had only closed-chain exercises. Treatment was given for eight weeks, twice weekly. Western Ontario and McMaster Universities Arthritis Index (WOMAC) scores, the distance covered in the 6-minute walk test, and knee range of motion were evaluated before and after the treatment. Data were analyzed using paired t-test and analysis of variance. Level of significance was set at P < 0.05. The clinical outcome measures improved significantly in the posttreatment of the three groups. Subjects in the three groups had significant differences in the mean change in the outcome variables for the WOMAC score (TENS = 29.13 ± 3.83; IST = 28.0 ± 1.72; and control = 13.71 ± 2.52). The post hoc analysis between IST and TENS showed no significant differences but IST had better clinical outcome than TENS. The results of this study suggest that IST may be an alternative to TENS as an adjunct therapy in the management of osteoarthritis of the knee.

3 Intrasound Therapy Reverses The Effects Of Alcohol Consumption On The Healing Tendon And Augments Healing

Functional abnormalities in wound structure has been identified as a potential complication if a patient consumes alcohol prior to injury and studies suggest that even a single incidence of acute ethanol exposure can perturb the tissue response to trauma significantly. Ethanol ingestion has been shown to result in delayed and abnormal tendon healing 3 weeks after injury. This study investigated the effects of low intensity intrasound therapy (LITR) given twice daily on the morphology and antioxidant parameters in the healing tendon following an acute injury in rats exposed to prior ethanol consumption. Fifteen male rats, randomised into three groups all underwent induced crush injury to the Achilles tendon. Groups 2 and 3 had prior administration of 30% ethanol for six days. The three groups were allocated to: serve as controls (Group 1), received no treatment (Group 2), LITR twice daily (Group 3). LITR was commenced immediately post-injury and was given twice daily over the first 6 days. The animals were sacrificed on day 20 post-injury and the tendons were excised, and processed for histology and anti-oxidant and MDA assay. The tendons in group 2 showed disordered and haphazard collagen formation with neutrophilic infiltrates and high tenoblast population at 20 days post-injury while the LITR treated tendon had dense, well-ordered, parallel collagen deposits with fewer tenoblasts. LITR also significantly improved the antioxidant parameters and lowered the MDA compared with the alcohol-exposed untreated tendon (p < 0.05). LIRT thus reverses the deleterious effect of ethanol on the healing tendon and resulted in near-normal morphology of the healing tendon 20 days post-injury. Abstract 3 Figure 1 L/S of tendon of rat. A: control, B: alcohol fed with no treatment and C: alcohol fed and treated with LITR. (H&E) X200. A shows moderately aligned collagen fibres (C), B shows disorganized collagen fibres (C) with neutrophilic infiltrates (N) while C shows orderly and parallel collagen deposits (C) and elongated tenocytes (T) Abstract 3 Table 1 Correlation of antioxidants with MDA Spearman’s Correlation (r) Groups SOD Catalase GRP 1 -0.63 -0.63 GRP 2 0.37 0.37 GRP 3 -0.98 -0.97 Group 1: Control (Nil alcohol, nil treatment) Group 2: Alcohol, nil treatment Group 3: Alcohol, LITR twice daily Abstract 3 Table 2 Population of tendon cells Total number of cells (N)/Unit Area Groups TB TC Ratio of TB to TC p-value X ± SD X ± SD GRP 1 710 ± 353 334 ± 120 2 : 1 0.12 GRP 2 693 ± 206 210 ± 52 3 : 1 0.02* GRP 3 572 ± 385 445 ± 76 1: 1 0.59 TB: Tenoblasts; TC: Tenocytes Group 1: Control (Nil alcohol, nil treatment) Group 2: Alcohol, nil treatment Group 3: Alcohol, LITR twice daily * Significant at p < 0.05 References Aiyegbusi et al . Connective Tissue Research. 2012;53(6):478–484 Novasonic. www.novasonicwest.com/novasonic. 2007 Molina et al. Alcohol Clin Exp Res. 2002;26(1):120–8 Sommers MS. Crit Care Nurse. 1994;14:82–86, 88–93