Responsiveness of two methods for measuring foot and ankle volume

Establishing regions of interest of the lower leg and ankle for perioperative volumetric assessment with a portable 3D scanner in orthopedic and trauma surgery - a pilot study

BACKGROUND

Soft tissue swelling assessment benefits from a reproducible and easy to use measurement method. Monitoring of the injured lower extremity is of clinical import during staged soft tissue management. Portable 3D scanners offer a novel and precise option to quantify and contrast the shapes and volumes of the injured and contralateral uninjured limbs. This study determined three regions of interest (ROI) within the lower extremity (lower leg, ankle and foot), that can be used to evaluate 3D volumetric assessment for staged soft tissue management in orthopedic and trauma surgery.

METHODS

Twelve healthy volunteers (24 legs) were included in this cohort study. Scans of all three ROI were recorded with a portable 3D scanner (Artec, 3D scanner EVA) and compared between the right and left leg using the software Artec Studio (Arctec Group, Luxemburg).

RESULTS

Mean volume of the right leg was 1926.64 ± 308.84 ml (mean ± SD). ROI: lower leg: 931.86 ± 236.15 ml; ankle: 201.56 ± 27.88 ml; foot: 793.21 ± 112.28 ml. Mean volume of the left leg was 1937.73 ± 329.51 ml. ROI: lower leg: 933.59 ± 251.12 ml; ankle: 201.53 ± 25.54 ml; foot: 802.62 ± 124.83 ml. There was no significant difference of the overall volume between right and left leg (p > 0.05; overall volume: △ difference: 29.5 ± 7.29 ml, p = 0.8; lower leg: △ difference: 21.5 ± 6.39 ml, p = 0.8; ankle: △ difference: 5.3 ± 2.11 ml, p = 0.4; △ difference: 16.33 ± 4.45 ml, p = 0.8.

CONCLUSION

This pilot study defines three regions of interest of the lower leg and demonstrates no difference between the right and left side. Based on these ROI, further studies are needed to evaluate the clinical applicability of the scanner.

Assessment of the Efficiency of Measuring Foot and Ankle Edema with a 3D Portable Scanner

Background: To prospectively evaluate the reliability of a portable optical scanner compared to the water displacement technique for volumetric measurements of the foot and ankle and to compare the acquisition time associated with these two methods. Methods: Foot volume was measured in 29 healthy volunteers (58 feet, 24 females and 5 males) by a 3D scanner (UPOD-S 3D Laser Full-Foot Scanner®) and by water displacement volumetry. Measurements were performed on both feet, up to a height of 10 cm above the ground. The acquisition time for each method was evaluated. The Kolmogorov-Smirnov test, Lin's Concordance Correlation Coefficient, and a Student's t-test were performed. Results: Mean foot volume was 869.7 +/- 165.1 cm³ (3D scanner) versus 867.9 +/- 155.4 cm³ (water-displacement volumetry) (p < 10^-5). The concordance of measurements was 0.93, indicative of a high correlation between the two techniques. Volumes were 47.8 cm³ lower when using the 3D scanner versus water volumetry. After statistically correcting this underestimation, the concordance was improved (0.98, residual bias = -0.03 +/- 35.1 cm³). The mean examination time was 4.2 +/- 1.7 min (3D optical scanner) versus 11.1 +/- 2.9 min (water volumeter) (p < 10^-4). Conclusions: Ankle/foot volumetric measurements performed using this portable 3D scanner are reliable and fast and can be used in clinical practice and research.

Value of closed suction drainage in arthroscopic and minimally invasive surgery of the ankle joint: a prospective randomised study

INTRODUCTION

Closed suction drainage is an established procedure in arthroscopic surgery. It is intended to reduce the retention of wound and irrigation fluids, which form the basis for postoperative swelling, pain, and infection. However, currently, there is no scientific review of the actual benefit of this procedure.

METHODS

Between 2020 and 2021, 84 patients (53 males, 31 females; mean age: 42 years) were prospectively randomised into this study. The patients underwent arthroscopic surgery of the ankle joint with (group A) or without (group B) insertion of a closed suction drain (42 patients per group). Assessments included upper ankle swelling using the figure-of-eight-20 method, pain preoperatively and 48 h postoperatively, and unexpected events within 6 weeks postoperatively.

RESULTS

The measurements performed 48 h postoperatively showed a mean circumferential increase of 1.38 cm (1.48 and 1.28 cm in groups A and B, respectively; p > 0.05) in all patients. The mean pain at rest, assessed using the visual analogue scale (maximum 10 points), was 2.7 and 2.4 in groups A and B, respectively (p > 0.05). Overall, two minor complications occurred: residual swelling in group A and persistent limitation of movement in group B. The average length of hospital stay was 2.4 days (p > 0.05).

CONCLUSIONS

Based on the available data, the routine insertion of a closed suction drainage at the upper ankle does not offer any objective benefit and must be considered obsolete. From both a medical and an economic point of view, the decision to conduct this procedure should be justified on an individual basis.

LEVEL OF EVIDENCE

Level I, prospective randomised trial.

Effectiveness of Mobilization of the Talus and Distal Fibula in the Management of Acute Lateral Ankle Sprain

OBJECTIVE

Distal fibular mobilization with movement (MWM), with and without a posterior gliding fibular tape, and anteroposterior mobilization of the talus (MOB) are widely used to treat acute lateral ankle sprains. The purpose of this study was to investigate the short-term and long-term relative effectiveness of these techniques.

METHODS

In this double-blind randomized controlled trial, 45 amateur soccer players with acute (<72 hours) lateral ankle sprain were randomly allocated to 6 sessions (3/wk within the first 2 weeks) of either MWM, MWM with tape (MWMtape), or MOB. All participants also received general advice, transcutaneous electrical nerve stimulation, edema draining massage, and a program of proprioception exercises. Participant ratings of function on the Foot and Ankle Ability Measure and Patient Global Impression of Improvement Scale were the primary outcomes measured over 52 weeks. Secondary outcomes were ankle pain, pressure pain threshold, range of motion, volume, and strength.

RESULTS

MWM and MWMtape were equally effective and participants demonstrated greater function on the Foot and Ankle Ability Measure at 12 and 52 weeks when compared with those receiving MOB; however, the latter demonstrated superior function at 2 weeks. No differences between groups were observed for Patient Global Impression of Improvement Scale or any of the secondary outcomes.

CONCLUSION

There are limited differences in the short term among techniques, with the exception of better sport function with MOB. Over the longer term, the distal fibular MWM is most effective to achieve activities of daily living and sport function when added to usual physical therapy care. The addition of a posterior gliding fibular tape provides no additional benefit.

IMPACT

Distal fibular mobilization with movement may be the most appropriate choice of treatment for acute lateral ankle sprain to achieve long-term activities of daily living and sport function. In the short term, anteroposterior mobilization of the talus offers greater improvement in sport function. The use of fibular tape provides no added benefit as an adjunct to a treatment that includes distal fibular mobilization with movement.

Physiological changes during prolonged standing and walking considering age, gender and standing work experience

Occupational standing is associated with musculoskeletal and venous disorders. The aim was to investigate whether lower leg oedema and muscle fatigue development differ between standing and walking and whether age, gender and standing work habituation are factors to consider. Sixty participants (15 young females, 15 young males, 15 older males, and 15 young males habituated to standing work) were included and required to stand/walk for 4.5 hours in three periods with two seated breaks. Waterplethysmography/bioelectrical impedance, muscle twitch force and surface electromyography were used to assess lower leg swelling (LLS) and muscle fatigue as well as gastrocnemius muscle activity, respectively. While standing led to LLS and muscle fatigue, walking did not. Low-level medial gastrocnemius activity was not continuous during standing. No significant influence of age, gender and standing habituation was observed. Walking can be an effective prevention measure to counteract the detrimental effects of quasi-static standing.Practitioner summary: Prolonged standing leads to lower leg oedema and muscle fatigue while walking does not. The primary cause of fatigue may be in other muscles than the medial gastrocnemius. Walking may be an effective prevention measure for health risks of occupational standing when included intermittently.Abbreviation: BI: bioelectrical impedance; LLS: lower leg swelling; SEMG: surface electromyography; MTF: muscle twitch force; WP: waterplethysmography; Bsl: Baseline; L: Lunch; E: Evening; MTM: method times measurement; EA: electrical activity; IQR: interquartile range; p: percentile; M: mean; SE: standard error; Adj: adjusted.

Does Neuromuscular Electrical Stimulation Improve Recovery Following Acute Ankle Sprain? A Pilot Randomised Controlled Trial

Aim:

Following soft tissue ankle injury, patients are often referred for out-patient physiotherapy and present symptoms including pain, reduced range of movement and function, and oedema. In this study, we assess the use of a neuromuscular electrical stimulation (NMES) device as an adjunctive therapy to reduce oedema in patients recovering from grade I and II ankle sprains.

Methods:

This was a single-centre, pilot randomised controlled study, recruiting patients referred to physiotherapy following an ankle sprain. Participants presenting with oedema were randomised to one of two treatment groups: (1) the current standard of care and (2) the current standard of care plus NMES use. Participants were identified in an emergency department and referred to a physiotherapy department for treatment 1 to 5 days following the injury and returned to clinic 7 days later.

Results:

Twenty-two participants completed the study and had full data sets for analysis (11 in each group). Mean volumetric displacement was reduced in the intervention group in comparison to the standard care group (P = .011); however, there were no between-group differences in figure of eight measurements, function or pain scores. The device was well tolerated, with no device-related adverse events recorded.

Conclusions:

In this pilot, randomised controlled trial, NMES was well tolerated by patients following ankle sprain and demonstrated statistically significant improvements in oedema reduction as measured by fluid displacement. No other changes were observed. Further work will need to confirm the clinical significance and effect on longer term recovery post-ankle sprain.

Eureka! A reliable, home-made water volumetry device

Background

Water displacement is considered to be the gold standard for measuring foot volume; however, it is time-consuming and infrequently used in clinical practice. The objectives of this study were to determine whether a home-made water displacement device is a reliable and time-efficient method for determining foot volume.

Methods

Thirty participants with no foot pathologies were enrolled and had their foot volume measured in two home-made water volumetry devices (Preski and PreskiLite). The participants' foot volumes were measured on two occasions on each of two different days.

Results

All measurements were achieved in less than 90 seconds. Within-day reliability was high (intraclass correlation [ICC]=0.997–0.999) with the minimal detectable change (MDC) at the 90% confidence level (MDC90) of less than 25 ml for both devices. Mean differences in volume displaced between days were small (range 0.6– -5.4 mls). For between-day measures on the same leg, the mean coefficient of variation ranged from 0.65–1 with associated ICCs of 0.989–0.997. The MDC90 for between-day measures was 46 ml for the PreskiLite and 23 ml for the Preski. The difference in volume displaced between right and left legs was less than the MDC90 for both devices.

Conclusions

A novel, home-made water volumetry device provides reliable measures of foot volume both within and between days. Measurements taken on the contralateral leg provide an adequate control. These portable devices provide rapid measurements and only one measurement is needed per day.

Ankle manual therapy for individuals with post-acute ankle sprains: description of a randomized, placebo-controlled clinical trial

BACKGROUND

Ankle sprains are common within the general population and can result in prolonged disablement. Limited talocrural dorsiflexion range of motion (DF ROM) is a common consequence of ankle sprain. Limited talocrural DF ROM may contribute to persistent symptoms, disability, and an elevated risk for re-injury. As a result, many health care practitioners use hands-on passive procedures with the intention of improving talocrural joint DF ROM in individuals following ankle sprains. Dosage of passive hands-on procedures involves a continuum of treatment speeds. Recent evidence suggests both slow- and fast-speed treatments may be effective to address disablement following ankle sprains. However, these interventions have yet to be longitudinally compared against a placebo study condition.

METHODS/DESIGN

We developed a randomized, placebo-controlled clinical trial designed to test the hypotheses that hands-on treatment procedures administered to individuals following ankle sprains during the post-acute injury period can improve short-, intermediate-, and long-term disablement, as well as reduce the risk for re-injury.

DISCUSSION

This study is designed to measure the clinical effects of hands-on passive stretching treatment procedures directed to the talocrural joint that vary in treatment speed during the post-acute injury period, compared to hands-on placebo control intervention.

TRIAL REGISTRATION

http://www.clinicaltrials.gov identifier NCT00888498.

Water displacement leg volumetry in clinical studies--a discussion of error sources

Background

Water displacement leg volumetry is a highly reproducible method, allowing the confirmation of efficacy of vasoactive substances. Nevertheless errors of its execution and the selection of unsuitable patients are likely to negatively affect the outcome of clinical studies in chronic venous insufficiency (CVI).

Discussion

Placebo controlled double-blind drug studies in CVI were searched (Cochrane Review 2005, MedLine Search until December 2007) and assessed with regard to efficacy (volume reduction of the leg), patient characteristics, and potential methodological error sources. Almost every second study reported only small drug effects (≤ 30 mL volume reduction). As the most relevant error source the conduct of volumetry was identified. Because the practical use of available equipment varies, volume differences of more than 300 mL - which is a multifold of a potential treatment effect - have been reported between consecutive measurements. Other potential error sources were insufficient patient guidance or difficulties with the transition from the Widmer CVI classification to the CEAP (Clinical Etiological Anatomical Pathophysiological) grading.

Summary

Patients should be properly diagnosed with CVI and selected for stable oedema and further clinical symptoms relevant for the specific study. Centres require a thorough training on the use of the volumeter and on patient guidance. Volumetry should be performed under constant conditions. The reproducibility of short term repeat measurements has to be ensured.