Evidence of Autoimmune Involvement in the Pathogenesis of Charcot Neuroarthropathy: A Novel Hypothesis with Preliminary Data.

Charcot neuroarthropathy is a devastating condition that places patients at risk for poor outcomes. Although the condition was first described in 1703, knowledge of the causative agent(s) has yet to be fully understood. Recent advances in genetic research have helped to identify potential mechanisms and pathways for the enigmatic destruction and deformities that are often associated with the condition; however, alternative pathways have been proposed.

Template models for simulation of surface manipulation of musculoskeletal extremities.

Capturing the surface mechanics of musculoskeletal extremities would enhance the realism of life-like mechanics imposed on the limbs within surgical simulations haptics. Other fields that rely on surface manipulation, such as garment or prosthetic design, would also benefit from characterization of tissue surface mechanics. Eight homogeneous tissue models were developed for the upper and lower legs and arms of two donors.

Reference data on in vitro anatomy and indentation response of tissue layers of musculoskeletal extremities.

The skin, fat, and muscle of the musculoskeletal system provide essential support and protection to the human body. The interaction between individual layers and their composite structure dictate the body's response during mechanical loading of extremity surfaces. Quantifying such interactions may improve surgical outcomes by enhancing surgical simulations with lifelike tissue characteristics.

Regional variations of in vivo surface stiffness of soft tissue layers of musculoskeletal extremities.

Surface stiffness of bulk soft tissue in musculoskeletal extremities is important to consider in the design of prosthetics, exoskeletons, and protective gear. This knowledge is also foundational for surgical simulation and clinical interventions leveraging manipulation of the musculoskeletal surfaces. Injuries to musculoskeletal extremities are common and surgical and preventive interventions require interactions between various objects such as surgical tools and support surfaces with tissue boundaries.

Instrumentation of off-the-shelf ultrasound system for measurement of probe forces during freehand imaging.

Ultrasound is a popular and affordable imaging modality, but the nature of freehand ultrasound operation leads to unknown applied loads at non-quantifiable angles. The purpose of this paper was to demonstrate an instrumentation strategy for an ultrasound system to measure probe forces and orientation during freehand imaging to characterize the interaction between the probe and soft-tissue as well as enhance repeatability. The instrumentation included a 6-axis load cell, an inertial measurement unit, and an optional sensor for camera-based motion capture.

Open-label Extension Phase of a Chronic Diabetic Foot Ulcer Multicenter, Controlled, Randomized Clinical Trial Using Cryopreserved Placental Membrane.

Objective: The results of the single-arm, open-label extension phase of the Grafix (cryopreserved placental membrane; CPM; Osiris Therapeutics, Inc, Columbia, MD) multicenter, blinded, randomized, controlled clinical trial for chronic diabetic foot ulcers (DFUs) is reported.

Materials And Methods: Twenty-six patients in the standard wound care (SWC) arm whose DFUs did not close in the blinded phase chose to receive weekly applications of the CPM in an open-label extension phase.

Results: In the extension phase, 17 (65.

Reference data on thickness and mechanics of tissue layers and anthropometry of musculoskeletal extremities.

Musculoskeletal extremities exhibit a multi-layer tissue structure that is composed of skin, fat, and muscle. Body composition and anthropometric measurements have been used to assess health status and build anatomically accurate biomechanical models of the limbs. However, comprehensive datasets inclusive of regional tissue anatomy and response under mechanical manipulation are missing.

Replacement of daily load attenuates but does not prevent changes to the musculoskeletal system during bed rest.

The dose-response effects of exercise in reduced gravity on musculoskeletal health have not been well documented. It is not known whether or not individualized exercise prescriptions can be effective in preventing the substantial loss in bone mineral density and muscle function that have been observed in space flight and in bed rest. In this study, typical daily loads to the lower extremities were quantified in free-living subjects who were then randomly assigned to control or exercise groups.

Evaluating Iatrogenic Complications of the Total-Contact Cast: An 8-Year Retrospective Review at Cleveland Clinic.

Background: Total-contact casting is an effective method to treat various pathologic abnormalities in patients with diabetic neuropathy, but its use is frequently associated with iatrogenic complications.

Methods: The largest retrospective review to date of iatrogenic complications of total-contact casts was conducted over an 8-year period at Cleveland Clinic.

Results: In the past 8 years, 23% of patients developed complications, and the most common complication was a new heel ulcer formation.

The efficacy and safety of Grafix(®) for the treatment of chronic diabetic foot ulcers: results of a multi-centre, controlled, randomised, blinded, clinical trial.

In a randomised, controlled study, we compared the efficacy of Grafix(®) , a human viable wound matrix (hVWM) (N = 50), to standard wound care (n = 47) to heal diabetic foot ulcers (DFUs). The primary endpoint was the proportion of patients with complete wound closure by 12 weeks. Secondary endpoints included the time to wound closure, adverse events and wound closure in the crossover phase.

Clustering and classification of regional peak plantar pressures of diabetic feet.

High plantar pressures have been associated with foot ulceration in people with diabetes, who can experience loss of protective sensation due to peripheral neuropathy. Therefore, characterization of elevated plantar pressure distributions can provide a means of identifying diabetic patients at potential risk of foot ulceration. Plantar pressure distribution classification can also be used to determine suitable preventive interventions, such as the provision of an appropriately designed insole.

Custom therapeutic insoles based on both foot shape and plantar pressure measurement provide enhanced pressure relief.

Objective: The purpose of this study was to determine whether custom insoles tailored to contours of the barefoot pressure distribution and shape of a patient's foot can reduce plantar pressures in the metatarsal head (MTH) region to a greater extent than conventional custom insoles.

Research Design And Methods: Seventy regions of elevated barefoot pressures (mean peak 834 kPa under MTHs) were identified in 20 subjects with diabetes. Foam box impressions of their feet were sent to three different orthotic supply companies for fabrication of custom insoles.

Nonsurgical strategies for healing and preventing recurrence of diabetic foot ulcers.

We have outlined an approach to the nonsurgical treatment of diabetic foot ulcers based on an understanding of their etiology. We have emphasized the importance of off-loading as the crucial element to success in healing foot ulcers and preventing their recurrence in those with diabetes. Computerized design of custom insoles can allow the unloading of elevated plantar pressure while incorporating the shape of the foot, which was formerly the major criterion used insole design.

Lower extremity strength plays only a small role in determining the maximum recoverable lean angle in older adults.

Background: The purpose of this study was to determine the extent to which measures of lower extremity strength and power contribute to the ability of older men and women to restore postural equilibrium using a single-step recovery following a large postural disturbance.

Methods: The postural disturbance, which has been used as a surrogate for forward-directed falls, involved a sudden release from a forward-leaning angle. The ability to recover using a single step was evaluated as the maximum recoverable lean angle for 56 healthy older women and men.

Variability of step kinematics in young and older adults.

Fall-related injuries are the most common and serious medical problems facing older adults. Recent studies of older adults have focused on the variability of step kinematics and the relationship to falling. The accuracy of step variability estimates is proportional to the number of steps that are collected.

Step width variability, but not step length variability or step time variability, discriminates gait of healthy young and older adults during treadmill locomotion.

The variability of spatial and temporal step kinematics have separately been shown to prospectively predict falls by older adults. However, the published literature has not addressed the relative importance of the information related to locomotion control contributed by variability of spatial variables, temporal variables, or both. We conducted a post hoc analysis to determine the extent to which the variability of spatial and temporal step kinematics are independent descriptors of locomotion control in healthy young and older adults.

Influence of ball velocity, attention, and age on response time for a simulated catch.

Purpose: The ability of a baseball infielder to respond to a batted ball may provide the best defense for avoiding injury. This study investigated the response times of young athletes performing a simulated baseball-fielding task to estimate the maximum velocity with which a baseball can leave the bat and allow a player, standing 13.7 m away, to safely respond to the approaching ball.

Measuring step kinematic variability on an instrumented treadmill: how many steps are enough?

Variability of step kinematics has been associated with falls by older adults. However, between-study differences with regard to the number of steps used to compute variability have varied by an order of magnitude. If the number of steps used to compute variability is too low there is the potential for a statistically spurious outcome.

Motor control of the vastus medialis oblique and vastus lateralis muscles is disrupted during eccentric contractions in subjects with patellofemoral pain.

Background: Inappropriate control of the vastus medialis oblique and vastus lateralis muscles by the central nervous system can contribute to maltracking of the patella.

Hypothesis: The activation timing and amplitude of the vastus medialis oblique and vastus lateralis muscles will be different between normal subjects and patients with patellofemoral pain.

Study Design: Controlled laboratory study.

Influence of lower extremity strength of healthy older adults on the outcome of an induced trip.

Objectives: To determine whether decreased lower extremity strength contributes to trip-related falls in older adults.

Design: A cross-sectional sample of older adults were safety-harnessed and tripped while walking using a concealed, mechanical obstacle. Lower extremity strength was compared between trip outcome groups.

Can fall-related hip fractures be prevented by characterizing the biomechanical mechanisms of failed recovery?

Unintentional injuries are the seventh leading cause of death in adults ages 65 and older, and the greatest number of these deaths results from fall-related injuries. In addition to the startling mortality, the morbidity associated with fall-related injuries, particularly hip fractures, has become a research imperative. This article reviews a series of studies that was undertaken to determine the biomechanical reasons that older adults are unable to recover from very large postural perturbations that are applied during locomotion that, if not corrected, can lead to a fall.

Body segment inertial parameter estimation for the general population of older adults.

The practical determination of accurate body segment inertial parameters for the general older adult population remains a problem, especially in estimating these parameters for women and accounting for variations in body type. A method is presented for determining the mass and center of mass location of the body segments of individuals within the general population of older adults. Effects of sex and body type on older adult mass distribution are accounted for using 32 easily obtainable body measurements.