IAOM-US Media Gallery

 

Welcome to the IAOM-US media gallery. You may find our videos below:

What we know about minimum toe clearance (MTC)…
- MTC: distance between the ground and the toe when the foot is at the lowest point during swing phase. 
- cognitive dual-task walking, aging and neurological diseases decrease the average value and increase the variability in MTC (leading to a higher risk of falls!).
- reduction in both the joint mobility in lower extremities and the afferent feedback from the soles of the feet alter rhythmic gait pattern and lower limb muscles activity, altering the overall balance.

We can treat MTC variability…

The science behind it:
- non-noxious stimulation to innervate or directly stimulate mechanoreceptors at the soles can modulate lower limb muscle reflexes and fine tune the motor control system during walking.
- proper cutaneous stimulation increases the inflow of sensory input to the CNS to better localize joint position and movement.
- decreased MTC variability may also be related with enhanced gait automaticity.

1. Range of Motion:
- the largest proportion of MTC variance is explained by changes in the sagittal plane angle (at ankle and hip joints).
- ensure that the structure is ready for the function! 

2. Avoid walking barefoot: 
- research has shown that walking with (at least) minimalist shoes, as compared to walking barefoot, is associated with better gait performance - explained by improvements on stability and MTC variability.

3. Vibration:
- supra-threshold vibration (determined in a sitting position) reduces the variability of three-dimensional joint angles at hip, knee, and ankle.
- use vibrating shoes insoles with vibrating stimuli directly applied to the heel and metatarsal heads.

4. Taping: 
- elastic tapes applied to the Achilles and Tibialis Anterior tendons significantly reduce MTC variability by mainly modifying joint angles during automatic gait. 
- applied the tape to the (A) tibialis anterior (Front) and (B) Achilles tendons (Rear) with the ankle positioned at an angle of 90◦. 

Use different sensory stimuli to decrease the MTC variability and to promote a more stable gait pattern.
 
Pathak P, Moon J, Roh SG, Roh C, Shim Y, Ahn J. Application of vibration to the soles reduces minimum toe clearance variability during walking. PLoS One. 2022 Jan 4;17(1):e0261732. 
Pathak P, Ahn J. Taping-induced cutaneous stimulation to the ankle tendons reduces minimum toe clearance variability. Heliyon. 2023 Jan 6;9(1):e12682. 
Petersen E, Zech A, Hamacher D. Walking barefoot vs. with minimalist footwear - influence on gait in younger and older adults. BMC Geriatr. 2020 Mar 4;20(1):88. 
Carter SC, Batavia MZ, Gutierrez GM, Capezuti EA. Joint movements associated with minimum toe clearance variability in older adults during level overground walking. Gait Posture. 2020 Jan;75:14-21. 
Hamacher D, Hamacher D, Müller R, Schega L, Zech A. The Effect of a Cognitive Dual Task on the Control of Minimum Toe Clearance While Walking. Motor Control. 2019 Jul 1;23(3):344-353. 
Illustrations/Pictures: open access articles under the CC BY license (http://creativecommons.org/licenses/by/4.0/).

What we know about minimum toe clearance (MTC)…
- MTC: distance between the ground and the toe when the foot is at the lowest point during swing phase.
- cognitive dual-task walking, aging and neurological diseases decrease the average value and increase the variability in MTC (leading to a higher risk of falls!).
- reduction in both the joint mobility in lower extremities and the afferent feedback from the soles of the feet alter rhythmic gait pattern and lower limb muscles activity, altering the overall balance.

We can treat MTC variability…

The science behind it:
- non-noxious stimulation to innervate or directly stimulate mechanoreceptors at the soles can modulate lower limb muscle reflexes and fine tune the motor control system during walking.
- proper cutaneous stimulation increases the inflow of sensory input to the CNS to better localize joint position and movement.
- decreased MTC variability may also be related with enhanced gait automaticity.

1. Range of Motion:
- the largest proportion of MTC variance is explained by changes in the sagittal plane angle (at ankle and hip joints).
- ensure that the structure is ready for the function!

2. Avoid walking barefoot:
- research has shown that walking with (at least) minimalist shoes, as compared to walking barefoot, is associated with better gait performance - explained by improvements on stability and MTC variability.

3. Vibration:
- supra-threshold vibration (determined in a sitting position) reduces the variability of three-dimensional joint angles at hip, knee, and ankle.
- use vibrating shoes insoles with vibrating stimuli directly applied to the heel and metatarsal heads.

4. Taping:
- elastic tapes applied to the Achilles and Tibialis Anterior tendons significantly reduce MTC variability by mainly modifying joint angles during automatic gait.
- applied the tape to the (A) tibialis anterior (Front) and (B) Achilles tendons (Rear) with the ankle positioned at an angle of 90◦.

Use different sensory stimuli to decrease the MTC variability and to promote a more stable gait pattern.

Pathak P, Moon J, Roh SG, Roh C, Shim Y, Ahn J. Application of vibration to the soles reduces minimum toe clearance variability during walking. PLoS One. 2022 Jan 4;17(1):e0261732.
Pathak P, Ahn J. Taping-induced cutaneous stimulation to the ankle tendons reduces minimum toe clearance variability. Heliyon. 2023 Jan 6;9(1):e12682.
Petersen E, Zech A, Hamacher D. Walking barefoot vs. with minimalist footwear - influence on gait in younger and older adults. BMC Geriatr. 2020 Mar 4;20(1):88.
Carter SC, Batavia MZ, Gutierrez GM, Capezuti EA. Joint movements associated with minimum toe clearance variability in older adults during level overground walking. Gait Posture. 2020 Jan;75:14-21.
Hamacher D, Hamacher D, Müller R, Schega L, Zech A. The Effect of a Cognitive Dual Task on the Control of Minimum Toe Clearance While Walking. Motor Control. 2019 Jul 1;23(3):344-353.
Illustrations/Pictures: open access articles under the CC BY license (http://creativecommons.org/licenses/by/4.0/).

5 0

YouTube Video VVUtcE94MG11T3d2UUlMY0ppTVQtanVnLlVjUG1SVUlqaVBj

Minimum Toe Clearance - Taping technique

What we know about bone marrow edema …
- it is now called Bone Marrow Lesion (BML)
- well-known by provoking disabling pain and for representing a negative prognostic factor of progression of knee osteoarthritis with increased structural deterioration, cartilage damage, and reduced function.

What we know about the anterolateral ligament (ALL) …
- it contributes to rotational stability.
- injury always occurs at the tibial insertion (between the Gerdy tubercle and the fibular head).

The TESTS…

1. Painful palpation of the ALL
- manual palpation of both ALL insertions.
- positive if palpation of the injured knee elicits pain but palpation of the contralateral knee does not. 
- excellent diagnostic accuracy: sensitivity and specificity are significantly higher than 80%.
o pain on clinical palpation of the ALL tibial insertion correlates with ultrasonographic findings of an ALL injury.

2. “Percussion Test” (PT) 
- manual percussion (performed with two fingers) of the bony prominence (medial and lateral femoral condyle, and medial and lateral tibial plateau)
- positive if there is asymmetry of the pain perceived between the painful knee (more painful or pronounced) and the healthy one. 
- good diagnostic accuracy: specificity (85–96%), sensitivity (60–79%)


These 2 simple screening tests should be included in every assessment of acute knee injuries

Murgier J, Thomas P, Reina N, Sylvie R, Bérard E, Cavaignac E. Painful Palpation of the Tibial Insertion of the Anterolateral Ligament Is Concordant With Acute Anterolateral Ligament Injury. Orthop J Sports Med. 2020 Jun 26;8(6):2325967120930200. 
Sansone V, Galluzzo A, Maiorano E, Polatti MB, Pascale V. Percussion test: description and diagnostic accuracy of a new manual test for bone marrow edema of the knee. BMC Musculoskelet Disord. 2022 Jan 18;23(1):68.

What we know about bone marrow edema …
- it is now called Bone Marrow Lesion (BML)
- well-known by provoking disabling pain and for representing a negative prognostic factor of progression of knee osteoarthritis with increased structural deterioration, cartilage damage, and reduced function.

What we know about the anterolateral ligament (ALL) …
- it contributes to rotational stability.
- injury always occurs at the tibial insertion (between the Gerdy tubercle and the fibular head).

The TESTS…

1. Painful palpation of the ALL
- manual palpation of both ALL insertions.
- positive if palpation of the injured knee elicits pain but palpation of the contralateral knee does not.
- excellent diagnostic accuracy: sensitivity and specificity are significantly higher than 80%.
o pain on clinical palpation of the ALL tibial insertion correlates with ultrasonographic findings of an ALL injury.

2. “Percussion Test” (PT)
- manual percussion (performed with two fingers) of the bony prominence (medial and lateral femoral condyle, and medial and lateral tibial plateau)
- positive if there is asymmetry of the pain perceived between the painful knee (more painful or pronounced) and the healthy one.
- good diagnostic accuracy: specificity (85–96%), sensitivity (60–79%)


These 2 simple screening tests should be included in every assessment of acute knee injuries

Murgier J, Thomas P, Reina N, Sylvie R, Bérard E, Cavaignac E. Painful Palpation of the Tibial Insertion of the Anterolateral Ligament Is Concordant With Acute Anterolateral Ligament Injury. Orthop J Sports Med. 2020 Jun 26;8(6):2325967120930200.
Sansone V, Galluzzo A, Maiorano E, Polatti MB, Pascale V. Percussion test: description and diagnostic accuracy of a new manual test for bone marrow edema of the knee. BMC Musculoskelet Disord. 2022 Jan 18;23(1):68.

6 1

YouTube Video VVUtcE94MG11T3d2UUlMY0ppTVQtanVnLmpwakJ1WXF0R1kw

Anterior (acute) knee pain - screening tests