Long-Term Effects of Whole-Body Vibration on Human Gait: A Systematic Review and Meta-Analysis

Background: Whole-body vibration is commonly used in physical medicine and neuro-rehabilitation as a clinical prevention and rehabilitation tool. The goal of this systematic review is to assess the long-term effects of whole-body vibration training on gait in different populations of patients.Methods: We conducted a literature search in PubMed, Science Direct, Springer, Sage and in study references for articles published prior to 7 December 2018. We used the keywords “vibration,” “gait” and “walk” in combination with their Medical Subject Headings (MeSH) terms. The Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) methodology was used. Only randomized controlled trials (RCT) published in English peer-reviewed journals were included. All patient categories were selected. The duration of Whole-Body Vibration (WBV) training had to be at least 4 weeks. The outcomes accepted could be clinical or biomechanical analysis. The selection procedure was conducted by two rehabilitation experts and disagreements were resolved by a third expert. Descriptive data regarding subjects, interventions, types of vibration, training parameters and main results on gait variables were collected and summarized in a descriptive table. The quality of selected studies was assessed using the PEDro scale. Statistical analysis was conducted to evaluate intergroup differences and changes after the WBV intervention compared to the pre-intervention status. The level of evidence was determined based on the results of meta-analysis (effect size), statistical heterogeneity (I2) and methodological quality (PEDro scale).Results: A total of 859 studies were initially identified through databases with 46 articles meeting all of the inclusion criteria and thus selected for qualitative assessment. Twenty-five studies were included in meta-analysis for quantitative synthesis. In elderly subjects, small but significant improvements in the TUG test (SMD = −0.18; 95% CI: −0.32, −0.04) and the 10MWT (SMD = −0.28; 95% CI: −0.56, −0.01) were found in the WBV groups with a strong level of evidence (I2 = 7%, p = 0.38 and I2 = 22%, p = 0.28, respectively; PEDro scores ≥5/10). However, WBV failed to improve the 6MWT (SMD = 0.37; 95% CI: −0.03, 0.78) and the Tinetti gait scores (SMD = 0.04; 95% CI: −0.23, 0.31) in older adults. In stroke patients, significant improvement in the 6MWT (SMD = 0.33; 95% CI: 0.06, 0.59) was found after WBV interventions, with a strong level of evidence (I2 = 0%, p = 0.58; PEDro score ≥5/10). On the other hand, there was no significant change in the TUG test despite a tendency toward improvement (SMD = −0.29; 95% CI: −0.60, 0.01). Results were inconsistent in COPD patients (I2 = 66%, p = 0.03), leading to a conflicting level of evidence despite a significant improvement with a large effect size (SMD = 0.92; 95% CI: 0.32, 1.51) after WBV treatment. Similarly, the heterogeneous results in the TUG test (I2 = 97%, p < 0.00001) in patients with knee osteoarthrosis make it impossible to draw a conclusion. Still, adding WBV treatment was effective in significantly improving the 6 MWT (SMD = 1.28; 95% CI: 0.57, 1.99), with a strong level of evidence (I2 = 64%, p = 0.06; PEDro score ≥5/10). As in stroke, WBV failed to improve the results of the TUG test in multiple sclerosis patients (SMD = −0.11; 95% CI: −0.64, 0.43). Other outcomes presented moderate or even limited levels of evidence due to the lack of data in some studies or because only one RCT was identified in the review.Conclusions: WBV training can be effective for improving balance and gait speed in the elderly. The intervention is also effective in improving walking performance following stroke and in patients with knee osteoarthrosis. However, no effect was found on gait quality in the elderly or on balance in stroke and multiple sclerosis patients. The results are too heterogenous in COPD to conclude on the effect of the treatment. The results must be taken with caution due to the lack of data in some studies and the methodological heterogeneity in the interventions. Further research is needed to explore the possibility of establishing a standardized protocol targeting gait ability in a wide range of populations

Orthèses plantaires : types et validités

Depuis de nombreuses années, les orthèses plantaires ont démontré leur utilité dans le traitement des différentes pathologies du pied. Depuis une dizaine d’années, le coût des orthèses plantaires a excédé les 4 billions de dollars [19]. Les récentes définitions des orthèses plantaires qu’on retrouve dans la littérature [1], [2] font référence au contrôle des mouvements anormaux du pied et à la décharge des zones d’hyperpressions plantaires, l’efficacité des orthèses plantaires semble donc connaître un franc succès clinique. Cependant, il y a peu de références en termes de validité scientifique, ce qui rend la pratique incertaine en matière de prescription d’orthèses plantaires ! Récemment, le souhait a été émis, dans quelques études, d’avoir une standardisation dans leur mode de conception et de fabrication, mais la réalité n’est toujours pas là

Feasibility and applications of the Deschamps multi-segment foot model in 3D gait analysis to evaluate foot kinetics in ankle and foot pathologies

18ème congrès de la SOFAMEA, GRENOBLE, FRANCE, 23-/01/2019 - 25/01/2019In daily practice, methods of assessment in patients suffering from foot and pathologies are observation, anamnesis, clinical assessment, medical imaging and in rare cases 3D gait analysis (3DGA). 3DGA is the state of the art for measuring lower limb joint kinematics and kinetics. However, assessing kinetics for the foot joints remains challenging and few studies integrate kinetic pressure map's measurement. The aim of this study was to demonstrate the feasibility of patient kinetics evaluation using 3DGA with a multi-segment foot model

The translating Weil osteotomy in the treatment of an overriding second toe: A report of 25 cases

We present a retrospective study of 25 feet operated for an overriding second toe deformity, whether or not associated with hallux valgus deformity and metatarsalgia. The surgical technique of a medial sliding and decompressive Weil osteotomy is described. All patients, operated between January 2002 and December 2007 for this condition in our institution, were reviewed clinically and radiologically. The mean AOFAS score improved with 47.6 points from 45.9 to 93.5. The theoretical advantages of such a translation Weil osteotomy are discussed trying to clarify the previously described pathologic anatomy of this condition

Analyse comparative des arthrodèses de l’arrière-pied associées à deux types de greffes : « Allogreffe- Demineralized Bone Matrix (DBM) -Ponction de moelle » versus « Autogreffe-DBM »Etude rétrospective sur 115 arthrodèses.

Introduction La pseudarthrose est une complication fréquente ( ̴15%) des arthrodèses de l’arrière-pied et de la cheville. L’utilisation d’autogreffe permet d’améliorer la fusion grâce à ses propriétés d’ostéoconduction, d’ostéoinduction et d’ostéogénicité. Cependant, le prélèvement des autogreffes est source d’iatrogénie. Une alternative est le traitement combiné « allogreffe-Demineralized Bone Matrix (DBM)-ponction de moelle iliaque ». Par cette association, l’allogreffe se rapproche des propriétés biologiques de l’os sain. Employée seule, l’allogreffe présente des propriétés ostéoconductrices et parfois structurales. L’ajout de DBM permet d’apporter des propriétés d’ostéoinduction et d’améliorer l’ostéoconductivité. La ponction de moelle y amène la cellularité et donc des propriétés d’ostéogénicité. Hypothèse Au vu de ses propriétés intrinsèques, l’allogreffe-DBM-ponction serait aussi efficace que le traitement par greffe autologue, tout en simplifiant la pratique clinique. Matériel et méthodes 115 arthrodèses ont été étudiées chez 82 patients. Les patients ont été répartis en deux groupes: autogreffe-DBM vs allogreffe-DBM-ponction de moelle. L’efficacité des traitements a été évaluée selon des critères cliniques (temps et taux de fusion) et radiologiques (pont trabéculaire osseux, disparition de l’interligne). Un scanner a été réalisé lorsque les critères radio-cliniques n’ont pas pu confirmer la consolidation (60% des cas). Résultats Il n’y a pas de différence significative entre les deux groupes lorsque l’on compare le taux de fusion, le temps de fusion, le nombre d’ossifications hétérotopiques, le taux de révision et la quantité de DBM utilisée. Le taux de pseudarthroses était de 18% (groupe autogreffe) vs 13% (groupe allogreffe) et le taux d’infection de 11% vs 4%. Discussion L’utilisation d’allogreffe-DBM-ponction de moelle donne des résultats comparables à l’utilisation d’autogreffe-DBM. De plus, le taux de complications était moins élevé dans le groupe allogreffe. Cependant, le choix pour ce type de traitement chez les patients diabétiques, opérés pour nécrose ou reprise chirurgicale, doit faire l’objet d’une attention toute particulière. Niveau de preuve Etude III: rétrospectiv

Technique and early experience with posterior arthroscopic tibiotalocalcaneal arthrodesis.

Tibiotalocalcaneal arthrodesis is indicated for pain relief in patients with combined arthritis of the ankle and subtalar joint. An arthroscopic posterior approach was designed to improve upon traditional methods by using a minimally invasive technique. The technique involves prone positioning of the patient, one anterolateral and two posterolateral portals, and arthroscopic debridement of both the tibiotalar and posterior talocalcaneal joint. Stabilisation is obtained with a retrograde intramedullary nail, with static interlocking. This article presents illustrative cases and discusses some of the technical advantages and disadvantages over conventional open surgery. For surgeons familiar with posterior ankle or subtalar arthroscopy, this minimally invasive debridement and nailing appears to offer superior exposure, high patient satisfaction and lower postoperative morbidity than traditional methods; fusion is encouraged by preserving the medullary reaming material at the site of the fusion

Technique et expérience initiale de l'arthrodèse tibio-talocalcanéenne postérieure par arthroscopie

Tibiotalocalcaneal arthrodesis is indicated for pain relief in patients with combined arthritis of the ankle and subtalar joint. An arthroscopic posterior approach was designed to improve upon traditional methods by using a minimally invasive technique. The technique involves prone positioning of the patient, one anterolateral and two posterolateral portals, and arthroscopic debridement of both the tibiotalar and posterior talocalcaneal joint. Stabilisation is obtained with a retrograde intramedullary nail, with static interlocking. This article presents illustrative cases and discusses some of the technical advantages and disadvantages over conventional open surgery. For surgeons familiar with posterior ankle or subtalar arthroscopy, this minimally invasive debridement and nailing appears to offer superior exposure, high patient satisfaction and lower postoperative morbidity than traditional methods; fusion is encouraged by preserving the medullary reaming material at the site of the fusion. © 2010 Elsevier Masson SAS

Plantar pressure relief using a forefoot offloading shoe.

AIM: To assess the effectiveness of the Barouk(®) second-generation postoperative forefoot relief shoes during appropriate use of the shoe on healthy subjects. MATERIALS AND METHODS: A convenience sample of 35 volunteer subjects (17 women, 18 men) was recruited to participate in this study. Dynamic foot loading was evaluated with inshoe plantar pressure measurements. Subjects were asked to walk two trials at a self-selected speed: (a) in their mass-produced shoes to assess baseline pressure values, defined as 100% and (b) with the Barouk(®) postoperative shoe on the right foot and their own shoe on the left side. Data analysis was tested for statistical differences with paired Student's t-tests (with p<0.05 as a significance level). RESULTS: The Barouk(®) second-generation postoperative forefoot relief shoes relieved forefoot pressure in all trials. For all 35 volunteers, there was a 79-96% mean peak pressure reduction (p<0.001) of the forefoot except for the fifth metatarsal head during appropriate use of the postoperative shoe. In contrast to the results for the forefoot, a significant increase of the peak pressure values was observed in the heel region. Similar findings were observed for the pressure-time integral values. CONCLUSION: The data of our study provide evidence that the second-generation Barouk(®) shoe relieve pressure of the forefoot with appropriate use

Medium term follow-up of the AES ankle prosthesis: High rate of asymptomatic osteolysis

BACKGROUND: The AES (Ankle Evolutive System) is a cobalt-chromium three-component ankle prosthesis with a hydroxyapatite coating, similar to the Buechel-Pappas ankle prosthesis, but with some modifications. Our objective was to assess its medium term follow-up results as well as its complications. METHODS: 21 patients (mean age of 57.6 years) were operated by a total ankle arthroplasty (TAA), using the AES implant, according to the standard technique. Only 18 patients were included. The other three patients were excluded from the study: two had been revised for avascular talar necrosis and one patient was happy with her outcome but could not present for logistic reasons at the last follow-up. Indications for surgery included posttraumatic osteoarthritis, primary osteoarthritis, hemochromatosis, rheumatic arthritis and osteoarthritis as a sequel of ankle instability. All patients were analyzed clinically and radiologically. Special attention was given to the presence or not of areas of osteolysis around the implants as well on conventional radiography as on CT-scan imaging, according to a specific protocol. RESULTS: The mean follow-up was 39.4 months. Average American Orthopaedic Foot and Ankle Society (AOFAS) ankle-hindfoot score improved from 52.2 preoperatively to 86.6 postoperatively. No intra-operative complications or early complications have been noted. Delayed complications were the following: one valgus malalignment, one recurrent painful anterior heterotrophic bone formation. Above all, we noted on conventional X-ray the presence of osteolysis in 77% (14) of our patients, with a size of 0.5-1cm or greater on conventional X-ray. The most vulnerable area seemed to be the posterior tibial plafond. The four remaining patients did not show any cyst formation on X-ray but did also, just as the other 14 patients, on the CT-scan. CT-scan, on the contrary, found more osteolysis in the body of the talus, underneath the implant, an area masked on conventional X-ray. Only one patient was revised with allograft bone filling of a symptomatic osteolysis, without the need for implant removal. CONCLUSIONS: This retrospective study shows a high frequency of delayed appearance of osteolysis (77%) in 18 AES total ankle arthroplasties. Fortunately at this moment and considering one revision, this considerable amount of asymptomatic osteolysis could not warrant a durable uncomplicated outcome

Modifications of intrinsic foot joint kinetics after total ankle replacement

SB 2022, 47eme Congrès de la Société de Biomécanique, Monastir, Tunisie, 26-/10/2022 - 28/10/2022Therefore, this prospective study aims at comparing the kinematics and kinetics ofthe intrinsic foot joints between pre- and post-operative conditions in TAR patients, as well as between patients and a control group. The main hypothesis is that the kinetics of the considered foot joints during gait will have a more typical profile after TAR