Sarah Ettinger

Funktionelle Elektrostimulation zur Therapie des neurogenen Fallfußes

INTRODUCTION Neurologic paralysis of the foot due to damage to the central nervous system is primarily caused by a cerebral insult. The ankle-foot orthosis (AFO), which is the classical conservative treatment option, is associated with drawbacks, e.g., increased contractures, limited mobilization from the sitting position, and cosmetic aspects. METHODS Functional external electrostimulation (FES) is an suitable treatment method for patients with a central lesion and intact peroneal nerve. Based on this method, the neuroprosthesis is a dynamic therapy option in the form of an implantable nerve stimulator (ActiGait® system, Otto Bock, Duderstadt, Germany) which is placed directly on the motor branch of the peroneus nerve and results in active foot lifting. The aim of the present study is to evaluate the clinical effect of the ActiGait® system with regard to its suitability for everyday use by means of gait tests with an emphasis on time-distance parameters and to compare it with the current literature. RESULTS AND CONCLUSION In this retrospective study, the clinical results after implantation of the ActiGait® system are presented and evaluated. In summary, the implantation of a neuroprosthesis in patients with stroke-related drop foot represents a sensible and promising therapy option.

Ruptur der Musculus-tibialis-anterior-SehneRupture of the tendon of the tibialis anterior muscle

Ruptures of the tendon of the tibialis anterior muscle tend to occur in the context of degenerative impairments. This mainly affects the distal avascular portion of the tendon. Owing to the good compensation through the extensor hallucis longus and extensor digitorum muscles, diagnosis is often delayed. In addition to the clinical examination, magnetic resonance inaging (MRI) diagnostics are of particular importance, although damage or rupture of the tendon can also be demonstrated sonographically. Therapeutic measures include conservative or operative measures, depending on the clinical symptoms. Conservative stabilization of the ankle can be achieved by avoiding plantar flexion using a peroneal orthosis or an ankle-foot orthosis. Subsequent problems, such as metatarsalgia or overloading of the medial foot edge can be addressed by insoles or a corresponding shoe adjustment. An operative procedure is indicated when there is corresponding suffering due to pressure and functional impairment. The direct end-to-end reconstruction of the tendon is only rarely possible in cases of delayed diagnosis due to the degenerative situation and the retraction of the tendon stumps. Depending on the defect size and the tendon quality, various operative techniques, such as rotationplasty, free transplants or tendon transfer can be used.

Ruptur der Musculus-tibialis-anterior-Sehne

Ruptures of the tendon of the tibialis anterior muscle tend to occur in the context of degenerative impairments. This mainly affects the distal avascular portion of the tendon. Owing to the good compensation through the extensor hallucis longus and extensor digitorum muscles, diagnosis is often delayed. In addition to the clinical examination, magnetic resonance inaging (MRI) diagnostics are of particular importance, although damage or rupture of the tendon can also be demonstrated sonographically. Therapeutic measures include conservative or operative measures, depending on the clinical symptoms. Conservative stabilization of the ankle can be achieved by avoiding plantar flexion using a peroneal orthosis or an ankle-foot orthosis. Subsequent problems, such as metatarsalgia or overloading of the medial foot edge can be addressed by insoles or a corresponding shoe adjustment. An operative procedure is indicated when there is corresponding suffering due to pressure and functional impairment. The direct end-to-end reconstruction of the tendon is only rarely possible in cases of delayed diagnosis due to the degenerative situation and the retraction of the tendon stumps. Depending on the defect size and the tendon quality, various operative techniques, such as rotationplasty, free transplants or tendon transfer can be used.

Hip and knee effects after implantation of a drop foot stimulator

BACKGROUND An active ankle dorsiflexion is essential for a proper gait pattern. If there is a failure of the foot lifting, considerable impairments occur. The therapeutic effect of an implantable peroneus nerve stimulator (iPNS) for the ankle dorsiflexion is already approved by recent studies. However, possible affection for knee and hip motion after implantation of an iPNS is not well described. OBJECTIVE The objective of this retrospective study was to examine with a patient cohort whether the use of iPNS induces a lower-extremity flexion withdrawal response in the form of an increased knee and hip flexion during swing phase. METHODS Eighteen subjects (12 m/6 w) treated with an iPNS (ActiGait®, Otto Bock, Duderstadt, Germany) were examined in knee and hip motion by gait analysis with motion capture system (Vicon Motion System Ltd®, Oxford, UK) and Plug-in-Gait model after a mean follow up from 12.5 months. The data were evaluated and compared in activated and deactivated iPNS. RESULTS Only little changes could be documented, as a slight average improvement in peak knee flexion during stand phase from 1.0° to 2.5° and peak hip flexion in stance from 3.1° to 2.1° In contrast, peak knee flexion during swing appeared similar (25.3° to 25.7°) same as peak hip flexion during swing. In comparison with the healthy extremity, a more symmetric course of the knee flexion during stand phase could be shown. CONCLUSIONS No statistical significant improvements or changes in hip and knee joint could be shown in this study. Only a more symmetric knee flexion during stand phase and a less hip flexion during stand phase might be hints for a positive affection of iPNS for knee and hip joint. It seems that the positive effect of iPNS is only based on the improvement in ankle dorsiflexion according to the recent literature.

Outcomes after Lengthening Calcaneal Osteotomy for Flexible Flatfoot Deformity– Evans versus Hintermann Osteotomy

Category: Hindfoot Introduction/Purpose: Evans and Hintermann calcaneal osteotomies are commonly used to correct flexible pes planovalgus deformity. Both methods are well accepted with good clinical results. The aim of this study was to compare the outcomes after Evans or Hintermann osteotomy. Methods: We retrospectively examined 49 patients who were operated for the treatment of flexible flatfoot deformity between October 2007 and March 2014. Sixteen Evans and 36 Hintermann osteotomies were performed. The data was collected using clinical and radiological examination as well as clinical scores (FAOS, SF-36) during regular follow-up. A paired t-test was used for statistical analysis. A one-way anova with the Holm-Sidak’s multiple comparisons test was used to compare non-parametric data. Results: The mean age was 39.6 ± 18.69 years in the Hintermann (H) group and 32.8 ± 17.86 years in the Evans (E) group. The mean follow up was 67.67 ± 20.57 months in the E- and 39.71 ± 12.77 months in the H-group. In both groups FAOS and SF-36 improved significantly (p<0.05). The hindfoot alignment improved significantly in both groups (p<0.05). The mean time to return to work and sports was 14.25 ± 8.92 and 19.0 ± 18.62 weeks in the E-group, 19.36 ± 16.71 and 28.25 ± 20.07 weeks in the H- group. Seven patients of each group needed an implant removal; one patient underwent an arthrodesis of the subtalar joint in the E-group. There were no significant differences between the outcomes of both groups. Conclusion: Both surgical techniques lead to good correction of the flatfoot deformity and show a significant improvement of the clinical outcome scores. Neither of these two surgical techniques can be identified as being superior.