Background/Objectives: The interest in performing Total Ankle Arthroplasty (TAA) to address end-stage ankle osteoarthritis (OA) is continuously growing. Sports activity plays an important role in our world. There is sparse literature regarding return sports activity following TAA. Levels and types of sports in TAA are rarely reported. The purpose of this prospective case series study is to investigate sports activity in ankle osteoarthritis (OA) and TAA in terms of rate, frequency and type as well as clinical outcomes with a minimum 2 years of follow-up after surgery. Methods: 103 patients (105 implants, 52 female, and 51 male), mean age 60.5 years (range, 23-84 years) with end-stage ankle OA were treated using a three-component, uncemented, mobile-bearing VANTAGE Total Ankle System. The mean follow-up was 2.9 years (range, 2-5 years). Visual Analogic Scale Pain Score (VAS, 0-10 points), Ankle Dorsiflexion/Plantarflexion (DF/PF) Range of Motion (ROM; degrees), functional American Orthopedic Foot and Ankle Society (AOFAS) Ankle/Hindfoot Score (0-100 points), Subjective Patients' Satisfaction Score (0-10 points), Sports Activity Rate, Sports Frequency Score, and Sports Type were assessed. Results: Mean preoperative VAS Pain Score was 6.7 points (range, 3-10 points) and postoperative 0.2 points (range, 0-3 points) (p < 0.001). The mean DF/PF ROM was 24.9° (range, 0°-60°) pre-operative and was 52.9° post-operative (range, 15°-85°) (p < 0.001). The mean preoperative functional AOFAS Ankle/Hindfoot Score was 39.5 points (range, 4-57 points) and postoperative 97.8 points (range, 75-100 points) (p < 0.001). Mean postoperative Subjective Patients’ Satisfaction Score was 9.7 points (range, 7-10 points). The preoperative Sports Activity Rate was 31.1%, postoperative 85.4% (p < 0.001). All the groups exhibited substantial Sports Frequency Score increases (p < 0.001). The most practiced sports were hiking, biking, fitness, and swimming. Conclusions: Total Ankle Arthroplasty (TAA) is an effective treatment for end-stage ankle OA. TAA allows a noteworthy increase in sports activity. This research offers important sports insights to patients with ankle OA and TAA.

Purpose: Cardiovascular disease (CVD) is a major risk factor for mortality in patients with osteoarthritis, and comorbidities increase postoperative complications after total knee arthroplasty (TKA). Arteriosclerosis plays a major role in hemodynamic dysfunction and CVD; however, arteriosclerosis has not been preoperatively evaluated before TKA using the cardio–ankle vascular index (CAVI). In this study, we evaluated the degree of preoperative arteriosclerosis using the CAVI in patients undergoing TKA, as well as its correlations with several preoperative patient factors. Methods: Arteriosclerosis was evaluated in 209 consecutive patients (251 knees) with osteoarthritis who underwent TKA at our institution between May 2011 and June 2022. The CAVI was measured in the supine position 1 day before TKA, and the correlations between the CAVI and several clinical factors were analyzed. A p value of <0.05 was considered statistically significant. Results: The CAVI was normal in 62 knees (25%), borderline in 71 knees (28%), and abnormal in 118 knees (47%). Univariate analysis revealed a moderate positive correlation between preoperative CAVI and age (r = 0.451, p < 0.001) and a weak negative correlation between preoperative CAVI and body weight (r = −0.306, p < 0.001) and body mass index (BMI) (r = −0.319, p < 0.001). Multivariate analysis showed that age (β = 0.349, p < 0.001) and BMI (β = −0.235, p < 0.001) were significantly correlated with preoperative CAVI. Conclusion: Arteriosclerosis should be carefully managed intraoperatively and postoperatively in patients with osteoarthritis undergoing TKA, particularly in older patients and patients with a low BMI.

Functional ankle instability (FAI) results from multiple ankle sprains, causing a perceived sense of joint instability due to muscle and ligament imbalances. Neuromuscular training (NMT) is employed to enhance ankle stability in individuals with FAI. The study included 24 male university students with FAI, who underwent ankle NMT on three surfaces. OpenSim musculoskeletal model analyzed the effects on ankle muscle activity, kinetics, and kinematics. Utilizing repeated measures analysis of variance (ANOVA) and one-dimensional statistical non-parametric mapping (SNPM1d) to identify distinctions between training surfaces. NMT on foam cushion (FC) significantly enhanced tibialis anterior (TA) and gastrocnemius medial (GM) activation during walking compared to level-ground (LG) and artificial turf (AT) (p&lt;0.05). However, no differences observed for peroneus longus (PL), gastrocnemius lateral (GL), and peak ankle plantarflexion (PF). During jogging and fast running, post FC training increased TA, PL, GM, GL activation, and peak ankle PF moment (p&lt;0.05). Additionally, post FC training, subtalar mobility was significantly reduced (p&lt;0.05), and ankle joints exhibited greater dorsiflexion (DF) angles during jogging and fast running (p&lt;0.05). Consequently, selecting FC for short-term ankle NMT proves more advantageous in enhancing ankle stability among individuals with FAI, yielding a more positive impact on FAI improvement.

Ankle sprains are exceedingly common injuries in both athletes and general population. They account for 10 to 30% of all sports injuries. Although the vast majority of lateral ankle ligamentous injuries respond successfully to conservative management, the absolute number of those that progress to chronic lateral ankle instability (CLAI) remains considerably important. This condition is characterized by persistent symptoms and may be associated with short-term and long-term complications and functional deficits. There is still a lack of ideal postoperative management of CLAI patients. Furthermore, an evidence-based rehabilitation phasing does not exist and most of the published studies regarding this subject suggest some protocols based on a wide variety of functional assessment scores and other modalities which are not accurate enough. Moreover, the literature that assesses the ability to return to work (RTW) and return to sport (RTS) in general population and athletes operated for CLAI shows most commonly aggregated results with global rates of RTW or RTS without describing a detailed timeline based on the readiness of patients to return to each level of activity. Although stress radiographs and MRI have been assessed as potential tools to improve postoperative management of CLAI patients, the first modality is limited by its low sensitivity to detect laxity and the second one by its static character and its inability to predict the healing process phase nor the mechanical properties of the repaired/reconstructed ligaments. Bioelectrical impedance, mechanical impedance and near-infrared spectroscopy are non-invasive methods of measurement that could be potential assessment tools to help surgeons improve the postoperative management of patients after CLAI surgery.

This paper presents the development and testing of the passive Almaty Ankle Exoskeleton V.2. The device features a new design with three electric linear actuators, and the shin and foot platforms are connected by links with spherical and universal joints. Functional testing demonstrates the prototype's ability to operate effectively within the natural range of ankle joint movements. Preliminary results indicate that the exoskeleton can reduce calf muscle activation in the work limb where the device is applied. In this the passive exoskeleton is designed for dorsiflexion and plantarflexion, whose operation with numerical results is highlighted by focusing on parameters such as angular velocity, linear acceleration, and angles. These measurements provide valuable information about the exoskeleton's performance and efficiency.

Ankle sprains are the most frequently occurring musculoskeletal injuries among recreational athletes. Ankle support through bandages following the initial orthotic treatment might be beneficial for rehabilitation purposes. Since hardly any study has investigated the impact of bandages in the acute phase of ankle sprains, our study examined the immediate effects of wearing an ankle bandage on fine coordination, proprioception, and motor performance in subjects five weeks after an acute ankle injury. In total, 70 subjects with acute unilateral supination trauma were tested. All subjects completed several rating questionnaires and biomechanical investigations, including a fine coordination and proprioception test, single leg stances, the Y-Balance test and gait analysis. All biomechanical investigations were conducted for the subject's injured leg with and without a bandage (MalleoTrain® Bauerfeind AG) and the healthy leg. Subjects reported moderate to strong improvements in ankle stability and pain when wearing the bandage. Wearing the bandage significantly normalized subjects’ single leg stance performance, as well as the stance phase duration, and the vertical ground reaction forces during walking. However, the bandage did not have a clear effect on fine coordination and proprioception. Wearing a bandage in the acute phase of an ankle sprain may immediately improve motor performance, including standing and walking.

Weight-bearing computed tomography (WBCT) enables acquisition of three dimensional bony structure images in a physiological weight-bearing position, which is fundamental in under-standing the pathologic lesions and deformities of the ankle joint. Over the past decade, re-searchers focused on validating and developing WBCT measurements, which has significantly enhanced our knowledge of common foot and ankle disease. Consequently, understanding the application of WBCT in clinical practice is becoming more important to produce improved out-comes in the treatment of disease around the ankle joint. This review will describe an overview of what is currently being evaluated in the foot and ankle surgery using WBCT and where the course of research will be heading in the future.

Ankle joint flexion and extension exercises play an important role in the rehabilitation training of patients who have been injured or bedridden for a long time before and after surgery. Accurately guiding patients to perform ankle flexion and extension exercises can significantly reduce deep vein thromboembolism. Currently, most ankle rehabilitation devices focus on assisting patients with ankle flexion and extension movements, and there is a lack of devices for effectively monitoring these movements. In this study, we designed an ankle joint flexion and extension movement monitoring device based on a pressure sensor. It is composed of an STM32 microcontroller, a pressure sensor, an HX711A/D conversion chip, and an ESP8266 WiFi communication module. The value of force and effective number of ankle joint flexion and extension movements were obtained. An experimental device was designed to verify the accuracy of the system. The results showed that the device can effectively monitor and control ankle flexion and extension movements remotely, ultimately ensuring that the patient can effectively monitor and grasp the active ankle pump movement.

The aims of the study were to analyze the relationship between the Mediterranean diet (MD) and arterial stiffness and metabolic syndrome (MetS) and its components in individuals aged over 65, overall and by sex. Subjects were people over 65 years of age with a full record of all variables analyzed from the EVA, MARK and EVIDENT studies. Data from 1,280 subjects with a mean age of 69.52±3.58 years (57.5% men) were analyzed. MD was recorded with the validated 14-item MEDAS questionnaire used in the PREDIMED study. MetS was defined following the guidelines of the joint scientific statement from the Programa Nacional de Educación sobre el Colesterol III. Arterial stiffness was assessed with the VaSera VS-1500® device by measuring the cardio-ankle vascular index (CAVI) and the brachial-ankle pulse wave velocity (baPWV). Results: The mean MEDAS score was 6.00 ± 1.90, (5.92 ± 1.92 in men, 6.11 ± 1.88 in women; p = 0.036). The mean CAVI value was 9.30 ± 1.11 (9.49 ± 1.05 men, 9.03 ± 1.13 women; p = &lt;0.001). The mean baPWV value was 15.82 ± 2.56 (15.75 ± 2.46 men, 15.92 ± 2.68 women; p = &lt;0.001). MetS was found in 51% (49% men, 54% women; p = 0.036). Subjects with MetS had lower MD adherence and higher arterial stiffness values than subjects without MetS. Overall, we found a negative association of MD score with the number of MetS components (β = -0.168), with glycemia (β = -0.007), triglycerides (β = -0.003), waist circumference (β = -0.018), CAVI (β = -0.196) and baPWV (β = -0.065), and a positive association with HDL cholesterol (β = 0.013). By sex, associations followed the same direction but without reaching statistical significance with blood glucose and triglycerides in women and with HDL cholesterol and waist circumference in men. Conclusion: Results indicate that greater adherence to the Mediterranean diet decreases arterial stiffness and the percentage of subjects with MetS, although results differed in the association with MetS components by sex.

This research focuses on the development of a foot-worn device to assist individuals with limited mobility in walking. The device aims to reduce the risk of accidents by closely moni-toring the wearer's movements and detecting potential hazards. It incorporates sensors, in-cluding the MPU6050 gyro sensor and KY-031 vibration sensor, to track the wearer's walking behavior. In case of abnormalities, such as falls, the device triggers an auditory alert and noti-fies the caregiver via LINE Notify. The system is controlled by the Node MCU ESP8266, enabling seamless integration with the Internet of Things (IoT). The objective of this study is to design an IoT system for medical assistance. The researchers created a prototype of a smart ankle device capable of detecting falls and sending notifications to the user's smartphone. The effectiveness of the notification system was evaluated using the Line Notify application. Re-sults demonstrated a successful detection of falls in 48 out of 50 trials, with two instances of false alarms during normal walking. The overall efficiency of the smart ankle device was 98%. In summary, the proposed smart ankle device demonstrates promising potential for var-ious applications in fall detection and safety alert systems. Further improvements and collab-orations with healthcare experts are recommended to enhance its performance and make it commercially viable. The device's connectivity and responsiveness to IoT systems are vital aspects to be considered. Future research should aim to develop additional features in collab-oration with physiotherapists and healthcare professionals to meet user requirements. The de-vice holds significant benefits in terms of fall detection and safety alerts, and efforts should be made to enhance its durability, robustness, and commercialization prospects.

The study presents the conceptual development and simulation of a robotic exoskeleton for ankle rehabilitation. The device is designed for ankle rehabilitation in patients with musculoskeletal disorders, injuries, or neurological diseases. The exoskeleton is equipped with three linear electric actuators that provide precise control of joint movements in multiple planes, allowing dorsiflexion and plantar flexion, inversion, and eversion. By utilizing a screw drive, the exoskeleton provides smooth and controlled movements, significantly reducing the risk of re-injury and improving rehabilitation. Simulation of the device and simulation results showed its high compatibility with the biomechanical features of the ankle joint. Virtual testing confirmed that the exoskeleton provides the smooth, controlled movements necessary for effective rehabilitation. Due to its ability to adapt to the individual physical capabilities of the patient, the device can be used in both active and passive forms of movement support. The results of the study demonstrate the potential of the exoskeleton in clinical applications, including its use in rehabilitation centers and at home. Its cost-effectiveness, ease of use, and high accuracy of movement control make this device a promising solution for restoring the functions of the lower extremities in patients with various musculoskeletal disorders.

This study aimed to clarify the relationship between the joint and ligament structures of the subtalar joint and degeneration of the subtalar articular facet. We examined 50 feet from 25 Japanese cadavers. The number of articular facets, joint congruence, and intersecting angle were measured for the joint structure of the subtalar joint, and the footprint areas of the ligament attachments of the cervical ligament, interosseous talocalcaneal ligament (ITCL), and anterior capsular ligament were measured for the ligament structure. Also, subtalar joint facets were classified into Degeneration (+) and (-) groups according to degeneration of the talus and calcaneus. No significant relationship was identified between the joint structure of the subtalar joint and degeneration of the subtalar articular facet. In contrast, footprint area of the ITCL was significantly higher in the Degeneration (+) group than in the Degeneration (-) group for the subtalar joint facet. These results suggest that the joint structure of the subtalar joint may not affect degeneration of the subtalar articular facet. Degeneration of the subtalar articular facet may be related to the size of the ITCL.

Whereas there is an increasing number of scientific publications investigating the optimal anti-biotic treatment for diabetic foot infections, we are lacking corresponding data in the adult non-diabetic (postsurgical) foot infection population. We therefore established one of the largest single-center databases on this topic and retrospectively investigate failures of a combined sur-gical and antibiotic therapy for surgical site foot infections. Overall, 17.4% of the episodes expe-rienced any therapeutic failures; especially among the infected ankle prostheses. In contrast, neither the age, the biological sex, pathogens, the duration of post-debridement antibiotic treatment, the number of surgical debridement, or the use of negative-pressure wound care could alter the failure risk. In multivariate logistic regression analyses, the duration of postsur-gical antibiotic use was completely indifferent (as a continuous variable with odds ratio 1.0, 95% confidence interval 0.96-1.03), or when stratified into inter-tertiary groups. Our results poten-tially enable shorter applications of systemic antibiotics in favor of a better stewardship in the non-diabetic adult population. Consecutive prospective-randomized trials are under way to identify eligible patient populations for a potentially shorter durations in surgical site infections after elective foot and ankle surgery.

Interviews from strength and conditioning coaches across all levels of athletic competition identified their two biggest concerns with the current state of wearable technology: (a) the lack of solutions that accurately capture data "from the ground up" and (b) the lack of trust due to inconsistent measurements. The purpose of this research is to investigate the use of liquid metal sensors, specifically Liquid Wire sensors, as a potential solution for accurately capturing ankle complex movements such as plantar flexion, dorsiflexion, inversion, and eversion. Sensor stretch linearity was validated using a Micro-Ohm Meter and a Wheatstone bridge circuit. Sensors made from different substrates were also tested and discovered to be linear at multiple temperatures. An ankle complex model and computing unit for measuring resistance values were developed to determine sensor output based on simulated plantar flexion movement. The sensors were found to have a significant relationship between the positional change and the resistance values for plantar flexion movement. The results of the study ultimately confirm the researchers' hypothesis that liquid metal sensors, and Liquid Wire sensors specifically, can serve as a mitigating substitute for inertial measurement unit (IMU) based solutions that attempt to capture specific joint angles and movements.

This paper presents a study on developing of a new exoskeleton for ankle joint rehabilitation with three degrees of freedom (3 DOFs). The primary attention is paid to the process of designing and modelling the device aimed at restoring the lost functions of joint mobility. The authors carried out a complex analysis of the functional requirements of the exoskeleton based on the research of potential user’s needs, which allowed them to develop a conceptual model of the proposed de-vice. In this study, a prototype of the exoskeleton is designed using modern additive technolo-gies. A prototype of the proposed device underwent virtual testing in conditions maximally close to the real one, which confirmed its effectiveness and comfort of use. The main results of the work indicate the promising potential of the proposed solution for application in rehabilitation practice, especially for patients with ankle joint injuries and diseases.

Background: Ankle fractures, comprising about 10% of musculoskeletal injuries, pose a significant healthcare burden with an increasing incidence, particularly among an aging population. This study focuses on isolated Danis-Weber type B fractures. Recent trends lean towards surgical intervention for anatomical restoration, quicker recovery, albeit with associated complications. This report aims to assess the safety and efficacy of NewClip narrow locking plate system with early weight bearing in treating isolated fibular fractures. Methods: The study includes patients with Danis-Weber type B fractures surgically treated with NewClip narrow locking plate system. Exclusions involved nondisplaced fractures, open fractures, or those requiring additional fixation.Results: Fifteen patients were enrolled in this study. Minor complications, including wound swelling, were observed in two cases. The Visual Analogue Scale (VAS) for pain exhibited a steady decline postoperatively, with almost complete resolution by the third month. At three months, the FAOS demonstrated excellent results, and final follow-up at twelve months revealed complete osseous healing without complications.Conclusions: The use of this type of plates in treating isolated fibular fractures with early weight bearing shows promising results in terms of fracture healing, pain resolution, and functional outcomes warranting further investigation with larger cohorts.

A position sensing glove, called SmartScan, that creates a 3D virtual model of a real object is presented. The data from the glove is processed by a volume minimization algorithm to validate the position sensor data. This allows only data from the object’s surface to be retained. The data validation algorithm allows the user to progressively improve an image by repeatedly moving their hand over the object. In addition, the user can choose their own balance between feature resolution and invalid data rejection. The SmartScan glove is tested on a foot model and is shown to be robust against motion artifacts, and has a mean accuracy of 2.9 mm (compared to a 3D model generated from optical imaging) without calibration.

Technological advances in game-mediated robotics provide an opportunity to engage children with cerebral palsy (CP) and other neuromotor disabilities in more frequent and intensive therapy by making personalized, programmed interventions available 24/7 in children’s homes. Though shown to be clinically effective and feasible to produce, little is known of the subjective factors impacting acceptance of what we term assistive/rehabilitative (A/R) gamebots by their target populations. This research describes the conceptualization phase of an effort to develop a valid and reliable instrument to guide the design of A/R gamebots. We conducted in-depth interviews with 8 children with CP and their families who had trialed an exemplar A/R gamebot, PedBotHome, for 28 days in their homes. The goal was to understand how existing theories and instruments were either appropriate or inappropriate for measuring the subjective experience of A/R gamebots. Key findings were the importance of differentiating the use case of therapy from that of assistance in rehabilitative technology assessment, the need to incorporate the differing perspectives of children with CP and those of their parents into A/R gamebot evaluation, and the potential conflict between the goals of preserving the quality of the experience of game play for the child while also optimizing the intensity and duration of therapy provided during play.

Background: Our objective was to conduct a comprehensive analysis of the reproducibility of foot and ankle anthropometric measurements with a three-dimensional (3D) optical scanner. Methods: We evaluated thirty-nine different anthropometric parameters obtained with 3D Laser UPOD-S Full-Foot Scanner in a healthy population of twenty subjects. We determined the variance of the measurements for each foot/ankle, and the average variance among different subjects. Results: For 40 feet and ankles (15 women and 5 men; mean age 35.62 +/- 9.54 years, range 9-75 years), the average variance was 1.4 ± 2 (range 0,1 to 8). Overall, the mean absolute measurement error was < 1 mm, with a maximum variance percentage of 8.3%. Forefoot and midfoot circumferences had a low variance < 2.5, with variance percentages < 1%. Hindfoot circumferences, malleolar heights, and the length of the first and fifth metatarsal to the ground contact points showed the highest variance (range 1 to 7). Conclusion: This optical scanner achieved a good reproducibility of a large set of foot and ankle anthropometric measurements. It is a valuable tool for clinical and research purposes.

We propose that the high energy Cosmic Ray particles around the spectral turn-down commonly called the {\it knee} and up to the upturn, commonly called the {\it ankle}, mostly come from Blue Super Giant star explosions. At the upturn, i.e. the {\it ankle}, Cosmic Rays probably switch to another source class, most likely extragalactic sources. To show this we recently compiled a set of Radio Supernova data to list the magnetic field, shock speed and radius scale (Biermann et al. 2018) \cite{Biermann18}. Using particle acceleration theory at shocks, those numbers can be transformed into characteristic {\it knee} and {\it ankle} energies. Without adjusting any free parameters both of these observed energies are directly indicated by the supernova data. We now proceed to the next step in the argument, and use the Supernova Remnant data of the starburst galaxy M82. Assuming that they are Blue Supergiant star explosions, the shock will race to their outer edge with a magnetic field that follows ${B (r) \, r \, \sim \, const.}$. We argue that the shock runs through the entire magnetic plasma wind region at full speed all the way out to the wind-shell, which is of order parsec scale. The speed is observed to be $\sim \, 0.1 \, c$ at about ${10^{16} \, {\rm cm}}$ radius in the plasma wind. This demonstrates how Blue Supergiant star explosions can provide the Cosmic Ray particles across the {\it knee} and up to the {\it ankle} energy range. The data from the CREAM (Cosmic Ray Energetics and Mass Experiment) mission will test this cosmic ray concept which is reasonably well grounded in two independent radio supernova data sets. The next step in developing our understanding is to obtain accurate Cosmic Ray data near to the {\it knee}, and use unstable isotopes of Cosmic Ray nuclei at high energy to probe the "piston" driving the explosion. We plan to combine these data with the physics of the budding black hole which is probably forming in each of these stars to learn more.

Genetics plays an integral role in athletic performance and is increasingly becoming recognised as an important risk factor for injury. Ankle and knee injuries are the most common injuries sustained by soccer players. Often these injuries result in players missing training and matches, which can incur significant costs to clubs. This study aimed to identify genotypes associated with ankle and knee injuries in soccer players and how these impacted the number of matches played. 289 soccer players including 46 professional, 98 semi-professional and 145 amateur players were genetically tested. Ankle and knee injuries and the number of matches played were recorded during the 2014/15 season. Four genes were assessed in relation to injury. Genotypes found to be associated with injury included the TT genotype of the GDF5 gene, TT and CT genotypes of AMPD1 gene, TT genotype of COL5A1 and GG genotype of IGF2 gene. These genes were also associated with a decrease in the number of matches played.

Background: Posterior malleolar fractures (PMFs) account for 7-44% of all ankle fractures, and are crucial for ankle stability, associated with poorer functional outcomes and higher rates of traumatic arthritis. Despite the exact mechanism and treatment strategy of this kind of fractures still remain controversial, most orthopaedic surgeons tend to treat PMFs with open reduction internal fixation method. To achieve rigid fixation for the fragment, screws should be inserted across the fracture plane perpendicularly. However, the study on the spatial geometry of the fracture surface of PMFs, especially the trend surface, has not been reported before.Objective: This study aimed to construct the trend surface of PMFs and establish an algorithm to better understand the spatial geometry of the fracture surface, which could guide treatment strategies.Methods: A retrospective analysis of CT images of PMFs from January 2021 to January 2024 was conducted. Cases were grouped according to the Bartoníček classification system. The skeletal ankle models were reconstructed, which were then transformed into CAD models. Fracture surfaces were segmented, and point clouds were output to record coordinate values. The K-Dimensional Tree data structure was built for the efficient indexcality of the Depth-First-Search algorithm to find the matched points in the clouds. The average point was computed for matched points, and subsequently, the fracture trend surface and heat map were generated.Results: Twenty-four cases were included. The posterior malleolar fracture trend surface was composed of two surfaces, each approximated as a plane and intersect an angle about 130.5°. The posterolateral surface extended slightly curvingly from the posterior two-fifths of the fibular notch to the posteromedial one-third of the distal tibia, formed an angle of 10.1° with the tibia axis and 10.1° with the coronal plan of the lower leg. The posteromedial surface extended from the posteromedial one-third of the distal tibia towards the intercollicular groove, formed an angle of 5.2° with the tibia axis and 39.4° with the coronal plan of the lower leg. The heat map revealed that the high-frequency fracture regions presented at 16.0mm away from the posterior malleolar distal edge and 11.2mm medial to the posterior margin of the fibular notch.Conclusion: The study provides a novel perspective on PMFs by describing the spatial geometric morphology of the fracture surface. This can be useful for the treatment strategies. 1. The fracture lines on the bone surface help us generate a stereoscopic model of the fracture surface in our brain, but this model may not be the same as the true fracture surface. 2. In A-P fluoroscopic view, 16.0mm away from the posterior malleolar distal edge and 11.2mm medial to the posterior margin of the fibular notch were the high frequency regions where the fracture surfaces passed through. 3. To firmly hold the posterolateral PMF, 3 key screws should be parallelly inserted into the distal tibia through the fragment, oriented medially 10.4°, cephalad 10°. The insertion points of the screws, in back view, are individually identified at 8.3mm, 16.9mm, 8.3mm superior to the inferior margin of the posterior malleolus, and 6.0mm,10.5mm, 15.1mm posterior to the posterior margin of the fibular notch. The depth of the screws should be no more than 40mm to avoid irritating the anterior tendons, vessels and nerves.

We investigated the biomechanical behaviour of different fixations of the tibial posterior malleolus (TPM), simulating distinct situations of involvement of the tibiotalar articular surface (TTAS) through a finite element model (FEM). A 3D computer-aided design model of the left ankle was obtained. The materials used were divided according to their characteristics into ductile and non-ductile, and all materials were assumed to be linear elastic, isotropic, and homogenous. Three different fracture lines of the TPM were defined, with sagittal angles of 10º, 25º, and 45º. For biomechanical comparison, different constructions using a trans-syndesmotic screw (TSS) only (Group T), a one-third tubular plate only with (Group PT) and without (Group PS) a TSS, and a locked compression plate with (Group LCPT) and without (Group LCPS) a TSS were tested. FEM was used to simulate the boundary conditions of vertical loading. Load application regions were selected in the direction of the 700N Z axis, 90% on the tibia and 10% on the fibula. Data on the displacement and stress in the FEM were collected, including the total principal maximum (MaxT) and total principal minimum (MinT) for non-ductile materials, total displacement (desT), localized displacement at the fragment (desL), localized displacement at syndesmosis (desS), and Von Mises equivalent stress for ductile materials. The data were analyzed using ANOVA and multiple comparison LSD tests were used. For TPM fractures with a sagittal angles 10º and 25º, desL in the PT and LCP groups was significantly lower, as well as Von Mises stress in Group LCPT in 10º, and PT and LCPT groups in 25º. TPM fractures with a sagittal angle of 45º, desL in the LCP group and Von Mises stress in Group LCPS and LCPT was significantly lower. We found that any TPM fracture may indicate instability of the distal tibiofibular syndesmosis, even when the fragment is small. Our study showed that in fragments involving 10% of the TTAS, the use of a TSS is sufficient, but when the involvement is greater than 25% of the TTAS, either non-locked or locked plate must be used to buttress the TPM. In posterior fragments affecting 45% or more of the TTAS, the use of a locking plate is recommended.

Despite limited research on the effects of a combined physical exercises on static and proactive postural control and neuromuscular functions in older adults with sarcopenic obesity (SO), this study addresses the gap by examining the efficacy of a 4-month Total Mobility Plus (TMP) regimen. The study enrolled 40 older adults with SO, split into an intervention group (n=25, mean age = 76.1 ± 3.5 years; mean BMI = 34.4 ± 4.0 kg/m²) and a control group (n=25, mean age = 75.9 ± 5.4 years; mean BMI = 32.9 ± 2.3 kg/m²). Participants in the IG engaged in 60-minute TMP sessions three times a week for four months, while the CG maintained their typical daily activities. Standardized evaluations were performed before and after the intervention, including the Romberg and Timed Up and Go (TUG) tests, Center of pressure (CoP) parameters during different conditions, muscle activation and strength of plantar and dorsal flexors. Post-intervention results revealed significant reduction of the standing time measured in the Romberg (-15.6%, p<0.05), and TUG (-34.6%, p<0.05) tests. Additionally, CoP area and velocity, were notably reduced in various conditions (p<0.05). Postural control improvements were associated with an increase of strength and decrease of ankle muscle activation. These findings validate the TMP program as a safe and effective method for enhancing static and proactive postural control and neuromuscular capabilities in older adults with SO.

Foot drop is a common disability in post-stroke patients and represents a challenge for the clinician. To date, Ankle Foot Orthosis (AFO) combined with conventional rehabilitation is the gold standard of rehabilitation management. AFO has a palliative mechanical action without actively restoring the associated neural function. Functional Electrical Stimulation (FES), consisting in stimulation of the peroneal nerve pathway, represents an alternative approach. By providing a FES device (Bioness L-300, BIONESS, USA) for 6 months to a post-stroke 22-year-old woman with a foot drop, our goal was to quantify its potential benefit on walking capacity. Gait parameters and the temporal evolution of the speed were collected with a specific connected sole device (Feet Me®) during the 10-meter walking, the Time Up and Go, and the 6-minute walking tests with AFO, FES or without any device (NO). As a result, the walking speed changes on 10-meters were clinically significant with an increase from baseline to 6 months in AFO and FES conditions (+0.14m-1 and +0.36m-1), without any changes in NO condition. In addition, speed decreased at about 4-minutes of the 6-minute walking test in NO and AFO conditions, while speed increased in FES conditions at baseline and after 1, 3 and 6 months. Monitoring gait speed in an endurance test after an ecological rehabilitation training program helps to examine walking performance in post-stroke patients and to propose a specific rehabilitation program depending on a fatigue threshold.

In-depth research on the rehabilitation mechanism and motion characteristics of a rehabilitation training robot based on 4-UPUS parallel mechanism. The overall design and the working principle of each key component are explained, and the robot rehabilitation scheme is described. The static analysis and modal analysis of the robot bearing structure are carried out to verify whether the static mechanical characteristics of the mechanism meet the application requirements under working conditions.A simplified mathematical model of the six-bar linkage mechanism is established, and the kinematics of the mechanism is solved by the geometric analysis method. The motion characteristic diagram of each key point is obtained through simulation calculation. Establish the motion model of the parallel mechanism, and discuss the working space and motion performance analysis of the mechanism. The forward solution analysis of the mechanism position is carried out by using the numerical analysis method, and the three-dimensional graphics of the attitude angle and linear displacement of the reachable working space are obtained.Taking the UPUS single branch chain as the analysis object, the single open chain analysis method is used to solve the kinematics image of the corresponding surface in the working space of the mechanism, which verifies the correctness of the kinematics theoretical solution and the feasibility of simulation.The research results show that the 4-UPUS parallel mechanism rehabilitation training robot can cooperate with the ankle joint for rehabilitation training. It makes up for the single movement of the current lower limb rehabilitation robot and the unsatisfactory rehabilitation effect, and provides a reference for the practical application of the subsequent ankle joint rehabilitation robot system.

Background/Objectives: Stroke patients generally have balance and gait dysfunction due to decreased range of motion (ROM) and muscle strength of the ankle joint. A therapist can apply a floss band to enhance ROM, pain control, jumping performance, strength, myofascial release, and recovery from fatigue. This study compared the immediate effects of floss band application on ankle ROM, balance, and gait ability in stroke patients.; Methods: This study randomized 40 chronic stroke patients to either the floss (n = 20) or sham (n = 20) band group. Outcome measures were ankle ROM, weight bearing lunge test (WBLT) performance, standing balance, and gait ability. Outcome measures were assessed at baseline and immediately after applying the floss or placebo band.; Results: There were significant improvements in dorsiflexion (DF), WBLT, static balance, and foot strike in those who used the floss band compared to the sham group (all p &lt; 0.05).; Conclusions: The floss band improved ankle DF, balance, and gait, indicating that it is a feasible therapeutic method for improving ankle DF, balance, and gait in chronic stroke patients.

Background: Good reduction of the articular surface and restoration of the congruent joint space are crucial for promoting positive outcomes in ankle fracture treatment. A good understanding of the mechanism of ankle fractures is indispensable to achieve these goals. Unfortunately, until now, the mechanism has still not been fully elucidated, particularly regarding the posterior malleolar fractures (PMFs). This study aims to provide insight into the mechanism of PMFs, thereby grasping the key to proceeding with PMFs reduction and fixation. Methods: An FE model of a normal ankle in tiptoe posture with 9 collateral ligaments was constructed from CT images. On the model, lateral malleolar fractures were made below, through, and above the syndesmosis; the medial malleolus was broken at its base; and ligaments were suppressed to simulate ligament rupture. A force of 1000 Newtons was applied on the talus head along talus axis. The posterior malleolar fragment (PMF) displacement, whether the talus impacts the posterior malleolus, and the initial mechanism displacing the PMF, were recorded. Results: A total of 15 tests were conducted. The tests, 'all collateral ligaments rupture', 'LMFB', 'LMFC+AITFL rupture', 'ATFL+CFL+PTFL rupture', 'ATTL+PTTL+TCL rupture', 'MMF', and 'MMF+AITFL rupture', presented significant PMF displacement. In tests 'MMF' and 'ATTL+PTTL+TCL rupture', the talus hit the medial edge of the PMF; but in tests 'ATFL+CFL+PTFL rupture' and 'all collateral ligaments rupture', the talus impacted the center part of the PMF. Except tests 'all collateral ligaments rupture' and 'ATFL+CFL+PTFL rupture', where PMF displacement was initially caused by talus impact, the other tests demonstrated PMF displaced following PITFL drag. Conclusions: This research discovered that rotation is the initial and major mechanism causing PMF displacement. The subsequent impact of the talus on the posterior malleolus may be the reason for large/blocky PMF. The talus impacting the posterior malleolus is always combined with talus rotation. Without the medial ankle structure being broken, big/blocky PMF may not occur. These findings suggest that, in clinical practice, reconstructing both the medial and lateral ankle structures is critical for achieving ankle stability, and this procedure even takes precedence over posterior malleolar fracture fixation itself.

This analytical cross-sectional study was designed to evaluate the association between glycemic control and peripheral arterial disease in patients with diabetic foot with more than ten years of evolution of diabetes mellitus who attended the diabetic foot outpatient clinic of the Guillermo Almenara National Hospital between June 2015 and February 2017. Glycosylated hemoglobin (HbA1C) and ankle-brachial index (ABI) were used to diagnose glycemic control and peripheral arterial disease, respectively. A generalized Poisson log-linear regression model was used to calculate the crude (cPR) and adjusted (aPR) prevalence ratios, with 95% confidence intervals, and a significance level of p < 0.05. 226 patients were included in the study, finding 23% (n=52) with good glycemic control, and 44.7% (n=101) with peripheral arterial disease. The adjusted model found statistically significant associations for glycemic control, age, and sedentary lifestyle with peripheral arterial disease. Compared with patients with good glycemic control, those with poor glycemic control had a 34% higher probability of presenting peripheral arterial disease (aPR: 1.34, 95%CI: 1.01-1.79, p=0.045). The prevalence of good glycemic control in the population with diabetic foot is low. Poor glycemic control was found to be independently associated with the presence of peripheral arterial disease.

Introduction: Systemic lupus erythematosus (SLE) is an autoimmune disease associated with an increased risk of cardiovascular diseases (CVD), leading to elevated mortality rates among patients. We aimed to evaluate the levels of cardio-ankle vascular index (CAVI), global longitudinal strain (GLS), ventricular-arterial coupling (VAC) and high-sensitivity cardiac troponin (hsTn), in SLE patients and to explore their relationship with clinical parameters. Methods: This cross-sectional study enrolled 82 SLE patients without evident cardiac or kidney impairment and 41 age- and sex matched healthy controls. We comparatively evaluated CAVI, GLS, VAC, and hsTn between SLE patients and controls, and we assessed their association among SLE patients with disease activity based on the SELENA-SLEDAI Activity Index. Multivariate regression analysis was performed to identify independent predictors of CAVI and hsTn within the SLE cohort. Results: In comparison to healthy controls, SLE patients presented with significantly higher CAVI, GLS and hsTn levels, while VAC was significantly reduced (p&lt;0.001). Further, SLE patients with active disease (SELENA-SLEDAI≥4) exhibited higher levels of CAVI and troponin than those with inactive disease (p&lt;0.001). SLEDAI was an independent predictor of CAVI, while VAC and SLEDAI were independent determinants of hsTn in SLE cohort. Conclusion: SLE patients displayed abnormal levels of CAVI, VAC, GLS, and troponin compared to healthy individuals. Our findings implicate the potential of those CV novel CVD risk factors to refine screening and therapeutic strategies for this specific population.

A warning sign for impending cardio-vascular events is not fully established. In the process to plaque rupture, formation of vulnerable plaque is important, and oxidized cholesterols play important role in its progression. Furthermore, the significance of vasa vasorum penetrating medial smooth muscle layer and rich in atheromatous lesion should be paid attention. Cardio-ankle vascular index (CAVI) is new arterial stiffness index of the arterial tree from the origin of the aorta to the ankle. CAVI reflects functional stiffness in addition to structural stiffness. Rapid rise of CAVI means medial smooth muscle cell contraction, and strangling vasa vasorum. We reported rapid rise of CAVI in peoples after big earthquake, following high frequency of cardiovascular events. And we met several cases who showed rapid rise of CAVI a few weeks or months before suffering cardiovascular events. To explain these sequences of events, we proposed a hypothesis; A rapid rise of CAVI means medial smooth muscle contraction, strangling vasa vasorum, leading ischemia, necrosis of vulnerable plaque, then, the plaque ruptures. In individuals having high CAVI, further rapid rise of CAVI might be a warning sign for impending cardiovascular events. In such case, treatments to decrease CAVI had better to be taken soon.

Background: Brachial-ankle pulse wave velocity (baPWV) is widely used as a marker of arterial stiffness. It has been suggested as a simple method for detecting arterial loads that can trigger left ventricular hypertrophy in the heart. Increased left ventricular hypertrophy in hypertensive patients is a predictor that will have an impact on increasing morbidity and mortality. Objective: This study aimed to evaluate the correlation between the baPWV and the left ventricular mass index (LVMI) in hypertensive patients. Methods: This cross-sectional study was conducted by collecting secondary data from hypertensive patients at the Heart Outpatient Clinic, with inclusion: aged more than 40 years old, suffering hypertension more than one year, and had baPWV and echocardiography data. Correlation between baPWV and LVMI was evaluated using the Pearson correlation test. Results: A total of 40 hypertensive patients were enrolled in this study. 60% were women. The mean age was 52.92 ± 9.50 years. Mean LVMI was 107.20 + 21.01 gram/m2. LVMI showed a significant association with age and systolic blood pressure (p=0.001 and 0.019, respectively). Mean baPWV was 1832.90 + 336.22 cm/sec. A significant association was found between baPWV and age and systolic blood pressure (p=0.000 and 0.049, respectively). There was a significant positive correlation between baPWV and LVMI (r=0.493, p=0.001); and between baPWV and Relative Wall Thickness (RWT) (r=0.404, p=0.01). Conclusion: This study shows that elevated baPWV is an indicator of increased LVMI in hypertensive patients. Examination of baPWV should be carried out routinely to detect earlier arterial stiffness as a morbidity and mortality prevention strategy in hypertensive patients.

The relationship between arterial stiffness and oxygen uptake (VO2) in patients with acute myocardial infarction (AMI) remains unclear. We aimed to investigate this relationship and factors contributing to VO2 in patients with AMI. The role of arterial stiffness in cardiac-skeletal muscle coupling during exercise was then elucidated. The exercise capacity via cardiopulmonary exercise testing (CPX), cardio-ankle vascular index (CAVI), and body composition of 101 patients with AMI were measured at discharge. Patients were categorized based on their CAVI into three groups: (i) normal (CAVI: ≤7.9), (ii) borderline (CAVI: 8.0–8.9), and (iii) abnormal (CAVI: ≥9.0). Subsequently, VO2 was compared among these groups. The relationship between the CAVI and peak VO2 (VO2 Peak) during CPX and factors contributing to VO2 Peak were investigated. The abnormal CAVI group had a significantly lower VO2 Peak than the normal and borderline groups. The CAVI was associated with VO2 Peak in patients with AMI. Furthermore, the CAVI was found to be a factor contributing to VO2 Peak. These findings suggest that arterial stiffness in tissue blood distribution and blood supply defines systemic exercise limits in patients with AMI. This suggested that arterial stiffness plays a significant role in cardio-vascular-skeletal muscle coupling.

The aim of the study was to examine the long-term prognostic value of changes in cardio-ankle vascular index (CAVI) within a year after coronary artery bypass grafting (CABG). Methods. Patients with coronary artery disease (n = 251) in whom cardio-ankle vascular index (CAVI) was assessed using the VaSera VS-1000 device before and in a year after CABG. Groups with improved CAVI (CAVI decreased from pathological value to normal or the index remained within normal values) or worsened CAVI (persistent pathological index value or an increase in CAVI to pathological values or an increase of 1 unit or more) were identified. The groups were compared for the following events at 10-year follow-up: death from all causes, myocardial infarction, stroke/transient ischemic attack, and the combined endpoint. Results. A year after CABG surgery, 45% of patients showed positive dynamics or stable normal CAVI values. Death from all causes was significantly more common in the group with CAVI progression - 32 (27.6%) than in the group with CAVI improvement - 14 (14.8%; p = 0.029). Patients with CAVI progression were more likely to have MACE (death, MI, stroke/TIA) in 49 (42.2%) cases, compared with patients with CAVI improvement - in 23 (24.5%; p=0.008). Negative dynamics of CAVI (p = 0.024), number of shunts (p = 0.006), and the presence of carotid stenosis more than 30% (p = 0.051) were independent predictors of death from all causes at 10-year follow-up after CABG. The presence of carotid stenosis more than 30% (p = 0.002) and the group with negative dynamics of CAVI after a year (p = 0.008) were independent predictors of the development of the combined endpoint during long-term follow-up. Conclusions. Patients with negative dynamics of CAVI one year after CABG were more likely to experience death from all causes and combined endpoint in the long-term follow-up than patients with normal CAVI. In further studies, it is advisable to evaluate the dynamics of CAVI and, based on this, identify the most effective interventions to improve the prognosis of patients after CABG.

Background and Objectives: This study aimed to evaluate the effects of subtalar joint axis-based balance exercises on the anterior talofibular ligament (ATFL) thickness, ankle strength, and ankle stability after an arthroscopic modified Broström operation (AMBO) for chronic ankle instability (CAI). Materials and Methods: The study included 47 patients diagnosed with CAI who underwent AMBO and were randomly divided into three groups: control (n=11), general balance exercise (n=17), and subtalar joint axis balance exercise (n=19), regardless of the affected area. Participants in the exercise rehabilitation group performed exercises for 60 min twice a week for 6 weeks, starting 6 weeks after AMBO. ATFL thickness, ankle strength, and ankle dynamic stability were measured using musculoskeletal ultrasonography, Biodex, and Y-balance test, respectively, before and after treatment. Results: Compared with the remaining groups, the subtalar joint axis balance exercise group had reduced ATFL thickness (p = 0.000), improved ankle strength for eversion (p = 0.000) and inversion (p = 0.000), and enhanced ankle stability (p = 0.000). Conclusions: The study results suggests that subtalar joint axis-based balance exercises may contribute to the early recovery of the ankle joint after AMBO.

Total ankle replacement (TAR) implants are an effective option to restore the range of motion of the ankle joint for arthritic patients. An effective tool for analyzing these implants’ mechanical performance and longevity in-silico is finite element analysis (FEA). ABAQUS FEA was used to statically analyze the von Mises stress and contact pressure on the articulating surface of the bearing component in two newly installed fixed-bearing total ankle replacement implants (the Wright Medical INBONE II and the Exactech Vantage). This ultra-high molecular weight polyethylene (UHMWPE) bearing commonly fails and is the cause for surgeon revisions. Six different FEA models for various gait percentages during stance (10%-60%) were created. They varied in magnitude of the compressive load and the ankle dorsiflexion/plantarflexion angle. The results indicated that the von Mises stress and contact pressure distributions increased as compressive load increased, and the largest magnitudes occurred at high dorsiflexion angles (15-30°). High magnitudes occurred in regions where the thickness of the bearing was the least. Additionally, high contact pressures were examined in areas near the talar component's edge or at the bearing's edges. To the author’s knowledge, this is the first study available to the research community that analyzes the Vantage implant with FEA. This study lays an essential foundation for future researchers in presenting a thorough literature review of TAR and methods for a simple FEA model setup. This study provides valuable information that can be beneficial to medical company designers and orthopedic surgeons in understanding the stress response and contact pressure of TAR implants during use.

The ability to monitor Sprained Ankle Rehabilitation Exercises (SPAREs) in home environments can help therapists to ascertain if exercises have been performed as prescribed. Whilst wearable devices have been shown to provide advantages such as high accuracy and precision during monitoring activities, disadvantages such as limited battery life, users' inability to remember to charge and wear the devices are often the challenges for their usage. Also, video cameras, which are notable for high frame rates and granularity, are not privacy-friendly. This paper, therefore, proposes the use and fusion of unobtrusive and privacy-friendly sensing solutions for data collection and processing during SPAREs in home environments. Two Infrared Thermopile Array (ITA-32) thermal sensors and two Frequency Modulated Continuous Wave (FMCW) Radar sensors were used to simultaneously monitor 15 healthy participants during SPAREs which involved twisting their ankle in 4-fundamental movement patterns namely (i) extension, (ii) flexion, (iii) eversion and (iv) inversion. Experimental results indicated the ability to identify thermal blobs of participants performing the 4 fundamental movement patterns of the human ankle. Cluster-based analysis of data gleaned from the ITA-32 sensors and the FMCW Radar sensors indicated average classification accuracy of 96.9% with K-Nearest Neighbours, Neural Network, AdaBoost, Decision Tree, Stochastic Gradient Descent and Support Vector Machine, amongst others.

Casein hydrolysate improves arterial stiffness, as estimated by brachial ankle pulse wave velocity (baPWV), in untreated hypertensive subjects. Facial pigmentation is a useful biomarker for arterial stiffness. This trial evaluated whether casein hydrolysate improves facial pigmentation in association with changes in arterial stiffness. A randomized, double-blind, placebo-controlled trial was conducted in 80 non-hypertensive Japanese participants randomly assigned to receive either active tablets containing casein hydrolysate or placebo for 48 weeks. Facial pigmentation and baPWV were measured at baseline and at the end of the intervention. Other biochemical atherosclerosis-related parameters were also measured, including advanced glycation end products (AGEs). Changes in facial pigmentation showed a significant difference between the groups. Change in baPWV was significantly better in the active than in the placebo group. In contrast, no significant association was seen between changes in facial pigmentation and those in baPWV. Among other atherosclerosis-related factors, changes in advanced glycation products (AGEs) were significantly decreased in the active compared to the placebo group. Further, changes in facial pigmentation were positively correlated with those in AGEs. Changes in AGEs were independently associated with changes in facial pigmentation. Casein hydrolysate improves facial pigmentation in non-hypertensive participants. Casein hydrolysate may have beneficial effects on glycation stress.

Powered ankle prostheses have been proven to improve the walking economy of people with transtibial amputation. All commercial powered ankle prostheses that are currently available can only perform one-degree-of-freedom motion in a limited range. However, studies have shown that the frontal plane motion during ambulation is associated with balancing. In addition, as more advanced neural interfaces have become available for people with amputation, it is possible to fully recover ankle function by combining neural signals and a robotic ankle. Accordingly, there is a need for a powered ankle prosthesis that can have active control on not only plantarflexion and dorsiflexion but also eversion and inversion. We designed, built, and evaluated a two-degree-of-freedom (2-DoF) powered ankle-foot prosthesis that is untethered and can support level-ground walking. Benchtop tests were conducted to characterize the dynamics of the system. Walking trials were performed with a 77 kg subject that has unilateral transtibial amputation to evaluate system performance under realistic conditions. Benchtop tests demonstrated a step response rise time of less than 50 milliseconds for a torque of 40 N·m on each actuator. The closed-loop torque bandwidth of the actuator is 9.74 Hz. Walking trials demonstrated torque tracking errors (root mean square) of less than 7 N·m. These results suggested that the device can perform adequate torque control and support level-ground walking. This prosthesis can serve as a platform for studying biomechanics related to balance and has the possibility of further recovering the biological function of the ankle-subtalar-foot complex beyond the existing powered ankles.

Addressing non-unions involves stabilizing the affected area through osteosynthesis and improving bone biology using bone grafts. However, there is no consensus on the optimal treatment method. This study aims to compare outcomes of non-union revision using conventional treatment methods (metal hardware ± graft) versus osteosynthesis with the human, allogeneic cortical bone screw (Shark Screw®). Thirty-four patients underwent conventional treatment, while 28 cases received Shark Screws®. Patient demographics, bone healing, time to bone healing, and complications were assessed. Results revealed a healing rate of 96.4% for the Shark Screw® group, compared to 82.3% for the conventionally treated group. The Shark Screw® group exhibited a tendency for faster bone healing (9.4±3.2 vs. 12.9±8.5 weeks, p=0.05061). Hardware irritations led to six metal removals in the conventional group versus two in the Shark Screw® group. The Shark Screw® emerges as a promising option for personalized non-union treatment in the foot, ankle, and select lower leg cases, facilitating effective osteosynthesis and grafting within a single construct, promoting high union rates, low complications, and a rapid healing process.

The human ankle is a complex joint, most commonly represented as talocrural and subtalar axes. It is difficult to locate and take in vivo measurements of the ankle joint. There are no instruments for patients lying on a bed or the floor; that can be used in outdoor or remote sites. We have developed a "Turmell-meter" to address these issues. We started with the study of ankle anatomy and anthropometry, then we used the product of exponentials’ formula to visualize the movements. Furthermore, we built a prototype using human proportions and statistics. For pose estimation, we used a trilateration method by applying tetrahedral geometry. Additionally, we computed the axis direction by fitting 3D circles, plotting the manifold and chart as an ankle joint model. We presented the results of simulations, a prototype comprising 45 parts, specifically designed draw-wire sensors, and electronics. Finally, we tested the device by capturing positions and fitting them into the bi-axial ankle model as a Riemannian manifold. The Turmell-meter is intended to be a hardware platform for human ankle joint axis estimation, it is adjustable and has an easy setup. The proposed model has the properties of a chart in a geometric manifold, we provided the details