89 research outputs found
Efficacy of customised foot orthoses in the treatment of achilles tendinopathy : study protocol for a randomised trial
BACKGROUND: Achilles tendinopathy is a common condition that can cause marked pain and disability. Numerous non-surgical treatments have been proposed for the treatment of this condition, but many of these treatments have a poor or non-existent evidence base. The exception to this is eccentric calf muscle exercises, which have become a standard non-surgical intervention for Achilles tendinopathy. Foot orthoses have also been advocated as a treatment for Achilles tendinopathy, but the long-term efficacy of foot orthoses for this condition is unknown. This manuscript describes the design of a randomised trial to evaluate the efficacy of customised foot orthoses to reduce pain and improve function in people with Achilles tendinopathy. METHODS: One hundred and forty community-dwelling men and women aged 18 to 55 years with Achilles tendinopathy (who satisfy inclusion and exclusion criteria) will be recruited. Participants will be randomised, using a computer-generated random number sequence, to either a control group (sham foot orthoses made from compressible ethylene vinyl acetate foam) or an experimental group (customised foot orthoses made from semi-rigid polypropylene). Both groups will be prescribed a calf muscle eccentric exercise program, however, the primary difference between the groups will be that the experimental group receive customised foot orthoses, while the control group receive sham foot orthoses. The participants will be instructed to perform eccentric exercises 2 times per day, 7 days per week, for 12 weeks. The primary outcome measure will be the total score of the Victorian Institute of Sport Assessment - Achilles (VISA-A) questionnaire. The secondary outcome measures will be participant perception of treatment effect, comfort of the foot orthoses, use of co-interventions, frequency and severity of adverse events, level of physical activity and health-related quality of life (assessed using the Short-Form-36 questionnaire - Version two). Data will be collected at baseline, then at 1, 3, 6 and 12 months. Data will be analysed using the intention to treat principle. DISCUSSION: This study is the first randomised trial to evaluate the long-term efficacy of customised foot orthoses for the treatment of Achilles tendinopathy. The study has been pragmatically designed to ensure that the study findings are generalisable to clinical practice. TRIAL REGISTRATION: Australian New Zealand Clinical Trials Registry Number: ACTRN12609000829213
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Quantification Of Trochlea Dysplasia Via Computed Tomography: Assessment Of Morphology Difference Between Control And Chronic Patellofemoral Instability Patients
Objectives: Trochlear dysplasia is an important risk factor for the development of recurrent patella instability. Owing to its complex 3-Dimensional morphology, the need for a true lateral radiograph, and poor inter-observer reliability, the Dejour classification system of dysplasia may not be the most optimal measure for quantification. The purpose of this study is to report a novel technique to define and quantify the trochlea volume and length using an axial computed tomography. This technique was applied to a series of patients surgically treated for recurrent patellofemoral instability and the measurements compared to a control group. Methods: From 2007 to 2013, 99 control patients (136 knees) were identified from trauma CT scans obtained during admission at our Level I trauma hospital. Patients older than 35y/o or with fractures in the distal femur were excluded. Axial cuts at 1.25 mm were used to measure trochlea volume; defined to be from the physeal scar to the final axial image in which the sulcus could be visualized (Figure 1). Trochlear groove distance was measured from a midline sagittal reformatted image perpendicular to the posterior margin of the femoral condyles. The inter-observer reliability was assessed with independent measurements from attending orthopedist, MSK radiologist and two senior residents. Dysplasia patient cohort was a series of 35 patients (70knees) who were surgically treated for recurrent instability, by AAS or CME, from 2007-2013 and a diagnosis of dysplasia based on lateral knee radiograph. CT tracking studies are obtained from bilateral knees as a normal part of our pre-operative assessment. Institutional IRB approval was obtained for data retrieval. Results: Control cohort average age 25 +/- 4 years, 68 M:31F, without documented history of patella instability on chart review. Dysplastic cohort average age 24 +/- 5 years, 2 M:33F, all 35 patients had bilateral knees scanned. Statistically significant differences were noted in comparing the trochlea volume (3.75 +/- 0.97 cm3 vs. 2.0+/- 0.56 cm3) and the trochlea length (34.8 +/- 4.9 mm vs. 31.7 +/- 4.2 mm) between control and dysplastic cohorts respectively. Comparing female only patients demonstrated difference in trochlea volume (2.89 +/- 0.57 cm3 vs. 2.0+/- 0.36 cm3), but not trochlea length (31.7 +/- 2.5 mm vs. 31.7 +/- 2.7 mm). No difference in trochlea volume or length b/w symptomatic knee to asymptomatic contralateral knees in patients with recurrent instability (2.31 cm3 vs. 2.24 cm3) and (30.0 mm vs. 30.5 mm). Inter-observer reliability was assess measuring trochlea volume: ICC for Right Trochlea: 0.98, ICC Left Trochlea: 0.97. Conclusion: This novel technique clearly defines and quantifies the trochlea morphology into volume and length values with high ICC values. Applying this technique demonstrates a significant difference in both trochlea volume and length between a control group and patients treated for recurrent patellofemoral instability
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