T. Horstmann

Foot morphology of normal, underweight and overweight children

Objective:Due to the fact that there is a global increase in obesity, knowledge about the impact of obesity on the development of a childs foot is of great importance for orthopaedic and paediatric physicians with regard to prevention, clinical treatment and management. Therefore, the purpose of this study was to investigate the influence of body mass on the development of a childs foot based on a foot type classification.Methods:The feet of 1450 boys and 1437 girls aged 2–14 years were measured using a three-dimensional (3D) foot scanner (Pedus, Human Solutions Inc., Germany) in a bipedal upright position. Twelve relevant 3D foot measures were recorded, as well as the childrens age, gender, height and mass. Factor analysis of principal components was used to obtain a smaller number of independent and standardized variables. The variables were used for cluster analysis to classify the childrens feet.Results:Five foot types were identified: flat, robust, slender, short and long feet. There were significant differences among foot types with respect to the childrens body mass index. Normal weight children displayed an almost equal distribution of all foot types throughout childhood. Flat and robust feet were more common in overweight children, whereas underweight children showed more slender and long feet.Conclusion:The influence of excess, as well as deficient mass could be verified for the comprehensive foot morphology based on a foot type classification. Subsequently, foot discomfort as a result of various musculoskeletal disorders may develop. In turn, this might keep the children from being active and therefore reinforce the risk of developing obesity. However, there is still a lack of information regarding these relationships, which needs to be determined. This knowledge may help prevent orthopaedic foot problems and injuries.

What are causes and treatment strategies for patellar-tendinopathy in female runners?

Patellar-tendinopathy (PT) is a common overuse injury in long distance runners, especially in women. Until today, no definite combinations of clinical, biomechanical, or training variables, or causative factors in the development of PT have been found. This study focused on assessing the differences in biomechanical characteristics between healthy runners (CO) and runners with PT only. We examined a total of 42 women. 21 CO and 21 PT. 3D kinematics of barefoot running was used in the biomechanical setup. Both groups were matched with respect to height and weight. After determining dropouts due to forefoot running, poor quality of data and lack of matching subjects in CO in terms of body height and weight, the final population comprised 24 subjects (CO=12, PT=12). Biomechanical evaluations indicate eccentric overloading of the quadriceps muscle group (knee extensors), increased pronation velocity as well as a lack of joint coordination as major etiological factors in the development of PT. We assume that eccentric strengthening of the knee extensors, as well as reduction of pronation velocity through orthotics, proper running shoes, and balance training will help treat and possibly prevent PT.

Individuelles isokinetisches Krafttraining bei Patienten mit Gonarthrose

ZusammenfassungProblemstellung: Bislang zielt die Therapie bei Gonarthrose überwiegend ab auf Schmerzbekämpfung und Verhaltensänderung, was meist zu verminderter Aktivität führt. Eine so bedingte Schwächung der Quadrizepsmuskulatur hat eine Zunahme der Instabilität des Gelenks und der Arthrose zur Folge, und die schmerzbedingte reduzierte Kniewinkelgeschwindigkeit wird durch eine verstärkte Belastung anderer Gelenke ausgeglichen. Die Progredienz der Muskelatrophie kovariiert mit dem Schmerzgrad. Das Ziel dieser Studie war es, nachzuweisen, daß 4-wöchiges individuelles isokinetisches Krafttraining bei Gonarthrosepatienten die Arbeitsleistung verbessert und den Schmerz reduziert. Methode: Während eines stationär konservativen Krankenhausaufenthaltes wurde randomisiert bei 19 Patienten mit Gonarthrose eine krankengymnastisch-physikalische Therapie, bei 19 weiteren Patienten zusätzlich ein isokinetisches Krafttraining durchgeführt. In einem identischen Eingangs- und Ausgangstest wurde die „geleistete Arbeit” bei 60°/s und 180°/s erfaßt und ein Schmerzanamnesebogen abgefragt. Ergebnisse: Die geleistete Arbeit (60°/s, 180°/s) in der Versuchsgruppe stieg im Vergleich zur Kontrollgruppe für die Extension statistisch signifikant an. Bei der Schmerzverbesserung nach durchgeführter Therapie war die Versuchsgruppe mit 19 Patienten statistisch signifikant besser als die Kontrollgruppe mit 8 Patienten. Die Schmerzqualität in der Versuchsgruppe verbesserte sich darüberhinaus deutlich. Schlußfolgerungen: Ein Umdenken in der Therapiestrategie unter Einbeziehung kostengünstiger sporttherapeutischer Maßnahmen von Gonarthrosepatienten wird empfohlen, Studien aus dem angloamerikanischen und skandinavischen Raum unterstützen diese Forderung. Durch ein genau und niedrig dosiertes Krafttraining sind Überlastungen und Schmerzen zu vermeiden, deshalb sind objektive und reproduzierbare Messungen an Patienten, die ein individuelles Training möglich machen, erforderlich.SummaryProblem: To date, therapy of osteoarthritis of the knee is aimed at relieving pain and changing behavior patterns, which usually leads to reduced activity. The weakening of the quadricep‘s musculature leads to an increase in both joint instability and arthritis. Walking time is prolonged and the pain-induced reaction of knee angle velocity is onset by increased stress on other joints. The progressive muscle atrophy correlates to the degree of pain. The aim of this study was to demonstrate an improvement in strength and pain based on 4-week isokinetic strength training in gonarthritis patients. Method: During a conservative hospitalization period, isokinetic strength training was performed by 19 randomized patients with gonarthritis in addition to regular physiocaltherapy. Another 19 patients functioned as a control group. The work was examined at 60°/s and 180°/s and rated using a pain questionnaire at the start and end of the investigation. Results: In addition to the expected increase of strength and strength endurance in the test group, the degree of pain could also be statistically significantly decreased compared to the control group. Activities of daily living, such as climbing stairs and standing-up, were also performed more easily. Conclusions: The therapeutic strategy for patients with osteoarthritis of the knee should be reconsidered to include less expensive therapeutic sport measures. Angloamerican and Scandinavian studies support this statement. Overuse and pain can be avoided by precise and low-dose strength training. Objective and reproducible measurements in the patients are essential to make individual training possible.

Comparison of gait data using two different protocols for ankle joint kinematics

Gait analysis is an important instrument in various fields of clinical research and its protocols are intended to make kinematics interpretable for clinicians. Although they use the same nomenclature for joint angles, different protocols produce different results [1]. The purpose of this study was to compare gait events of the ankle joint to determine differences between two protocols.