Current clinical practice focuses on discovering injuries and then formulating treatment plans. But some injuries have nothing to do with symptoms, including pain, let alone those situations where there is no injury. The ankle, especially the subtalar joint, has a high rate of variation, so the subtle activities of subtalar joint are exactly important in patients who have biomechanical issues, especially in the condition that all check-ups are normal. This paper presented a case report of a 16-yearold teenager who was a professional basketball player in local senior high school. The pain appeared in both of his soles and ankles as long as he played basketball and disappeared immediately after the exercise since his childhood. All the routine tests involving MRI and ultrasound were normal. No impingement condition was found. 3D dynamic reconstruction combined with 3D continuum model was performed. The specific plain subtalar articular surfaces were revealed. The treatment involving dynamic fixation via rigid tape and training lasted for 4 weeks. Before the treatment, the right talus was more stable than the left one (∆(norm)=0.5126), and the calcaneus was the other way around (∆(norm)=0.6280). The differences of degrees of freedom between two sides decreased significantly (∆(norm)=0.0833, 0.000) after treatment. Besides, the steep and tone of both sides of talus and calcaneus revealed relative rotation and translation which indicated that the movement of subtalar joint trended to the balance of stability and mobility. This patient improved his athletic ability and got pain free immediately after the first treatment. Moreover, the pain didn't appear during the 12-month follow-up. Therefore, we conclude that based on our treatment which focused on the reduction of the subtle activities of subtalar joint, we support that the subtle activities of variable subtalar joint may influence the athletic abilities and cause some symptoms. Therefore, the importance of bone shape which is the chief culprit of abnormal mobility shall be taken seriously. Moreover, in the case calculation based on the mathematical model, stable calcaneus and flexible talus make the better balance of stability and mobility and are necessary for available exercises.
OBJECTIVE: The aim of the study was to identify the efficacy of dynamic fixation using rigid tape (RT) in rehabilitation after surgery of terrible triad injury of the elbow (TTIE). METHODS: Sixty patients who underwent surgery of TTIE were equally randomly divided into RT group and hinged external fixation brace (HEFB) group. Dynamic fixations were applied for 8 weeks. General rehabilitation programs were performed for 3 months, 5 times a week. Follow-up (FU) was at six months. Main outcomes included pain (Visual Analogue Scale, VAS), muscle strength, range of motion (ROM), Elbow Function (Mayo Elbow Performance Index, MEPI), Quality of Life (QOL) (Short Form 36 Questionnaire, SF-36). RESULTS: There were significant time x group interactions for pain, ROM, MEPI, SF-36 (all p= 0.000), which demonstrated positive efficacy of both the two interventions. Difference at each time-point (except for baseline) of pain and ROM between the two groups was statistically significant (all p< 0.05). Some differences between the two groups were not statistically significant which at 14d on MEPI (p= 0.108) and at 21d (p= 0.259) and FU (p= 0.402) on QOL. Moreover, the increased muscle strength at each time-point had no statistically significant difference between the two groups (all p> 0.05). CONCLUSIONS: Both RT and HEFB could significantly improve the postoperative functional outcomes of the TTIE. However, early rehabilitation intervention could increase pain, which affected the corresponding function (MEPI) and QOL. Note that this kind of impact was short-term and reversible. The muscle strength and ROM were not affected by the increased severe pain, maintaining a trend of improvement. In addition, the subjects in the RT group improved faster and more efficiently and had better results with pain, ROM, MEPI, and QOL compared to the subjects in the HEFB group.
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