Dynamic Patterns of Forces and Loading Rate in Runners with Unilateral Plantar Fasciitis: A Cross-Sectional Study

Aim/Hypothesis

The etiology of plantar fasciitis (PF) has been related to several risk factors, but the magnitude of the plantar load is the most commonly described factor. Although PF is the third most-common injury in runners, only two studies have investigated this factor in runners, and their results are still inconclusive regarding the injury stage.

Objective

Analyze and compare the plantar loads and vertical loading rate during running of runners in the acute stage of PF to those in the chronic stage of the injury in relation to healthy runners.

Methods

Forty-five runners with unilateral PF (30 acute and 15 chronic) and 30 healthy control runners were evaluated while running at 12 km/h for 40 meters wearing standardized running shoes and Pedar-X insoles. The contact area and time, maximum force, and force-time integral over the rearfoot, midfoot, and forefoot were recorded and the loading rate (20–80% of the first vertical peak) was calculated. Groups were compared by ANOVAs (p<0.05).

Results

Maximum force and force-time integral over the rearfoot and the loading rate was higher in runners with PF (acute and chronic) compared with controls (p<0.01). Runners with PF in the acute stage showed lower loading rate and maximum force over the rearfoot compared to runners in the chronic stage (p<0.01).

Conclusion

Runners with PF showed different dynamic patterns of plantar loads during running over the rearfoot area depending on the injury stage (acute or chronic). In the acute stage of PF, runners presented lower loading rate and forces over the rearfoot, possibly due to dynamic mechanisms related to pain protection of the calcaneal area.     

The influence of footwear on foot motion during walking and running

There are evidences to suggest that wearing footwear constrains the natural barefoot motion during locomotion. Unlike prior studies that deduced foot motions from shoe sole displacement parameters, the aim of this study was to examine the effect of footwear motion on forefoot to rearfoot relative motion during walking and running. The use of a multi-segment foot model allowed accurate both shoe sole and foot motions (barefoot and shod) to be quantified. Two pairs of identical sandals with different midsole hardness were used. Ten healthy male subjects walked and ran in each of the shod condition.The results showed that for barefoot locomotion there was more eversion of the forefoot and it occurred faster than for shod locomotion. In this later condition, the range of eversion was reduced by 20% and the rate of eversion in late stance by 60% in comparison to the barefoot condition. The sole constrained both the torsional (eversion/inversion) and adduction range of motion of the foot. Interestingly, during the push-off phase of barefoot locomotion the rate and direction of forefoot torsion varied between individuals. However, most subjects displayed a forefoot inversion direction of motion while shod. Therefore, this experiment showed that the shoes not only restricted the natural motion of the barefoot but also appeared to impose a specific foot motion pattern on individuals during the push-off phase. These findings have implications for the matching of footwear design characteristics to individual natural foot function.     

Ultrasound elastographic assessment of plantar fascia in runners using rearfoot strike and forefoot strike

Forefoot strike is increasingly being adopted by runners because it can better attenuate impact than rearfoot strike. However, forefoot strike may overload the plantar fascia and alter the plantar fascia elasticity. This study aimed to use ultrasound elastography to investigate and compare shear wave elasticity of the plantar fascia between rearfoot strikers and forefoot strikers. A total of 35 participants (21 rearfoot strikers and 14 forefoot strikers), who were free of lower limb injuries and diseases, were recruited from a local running club. Individual foot strike patterns were identified through the measured plantar pressure during treadmill running. The B-Mode ultrasound images and shear wave elastographic images of the plantar fascia were collected from each runner. Two independent investigators reviewed the images and examined the plantar fascia qualitatively and quantitatively. The results demonstrated an overall good agreement between the investigators in the image review outcomes (ICC:0.96–0.98, κ: 0.89). There were no significant differences in the fascial thickness (p = 0.50) and hypoechogenicity on the gray-scale images (p = 0.54) between the two groups. Shear wave elastography showed that forefoot strikers exhibited reduced plantar fascia elasticity compared to rearfoot strikers (p = 0.01, Cohen’s d = 0.91). A less elastic fascial tissue was more easily strained under loading. Tissue overstrain is frequently related to the incidence of plantar fasciitis. While further study is needed for firm conclusions, runners using forefoot strike were encouraged to enhance their foot strength for better protection of the plantar fascia.     

Quantifying rearfoot-forefoot coordination in human walking

A method is proposed to facilitate the quantification and interpretation of inter-joint/-segment coordination. This technique is illustrated using rearfoot-forefoot kinematic data. We expand existing vector coding techniques and introduce a set of operational terms through which the coordinative patterns between the rearfoot segment and the forefoot segment are summarized: in-phase, anti-phase, rearfoot phase and forefoot phase. The literature on foot mechanics has characterized the stable foot at pushoff by a decreasing medial longitudinal arch angle in the sagittal plane, which is accompanied by forefoot pronation and concurrent rearfoot supination-in other words, anti-phase motion. Nine skin markers were placed on the rearfoot and forefoot segments according to a multi-segment foot model. Three healthy subjects performed standing calibration and walking trials (1.35ms(-1)), while a three-dimensional motion capture system acquired their kinematics. Rearfoot-forefoot joint angles were derived and the arch angle was inferred from the sagittal plane. Coupling angles of rearfoot and forefoot segments were derived and categorized into one of the four coordination patterns. Arch kinematics were consistent with the literature; in stance, the arch angle reached peak dorsiflexion, and then decreased rapidly. However, anti-phase coordination was not the predominant pattern during mid- or late stance. These preliminary data suggest that the coordinative interactions between the rearfoot and the forefoot are more complicated than previously described. The technique offers a new perspective on coordination and may provide insight into deformations of underlying tissues, such as the plantar fascia.     

Foot arch deformation and plantar fascia loading during running with rearfoot strike and forefoot strike: A dynamic finite element analysis

Forefoot strike becomes popular among runners because it facilitates better impact attenuation. However, forefoot strike may overload the plantar fascia and impose risk of plantar fasciitis. This study aimed to examine and compare the foot arch deformation and plantar fascia tension between different foot strike techniques in running using a computational modelling approach. A three-dimensional finite element foot model was reconstructed from the MRI of a healthy runner. The foot model included twenty bones, bulk soft tissue, ligaments, tendons, and plantar fascia. The time-series data of segmental kinematics, foot muscle force, and ankle joint reaction force were derived from a musculoskeletal model of the same participant based on the motion capture analysis and input as the boundary conditions for the finite element analysis. Rearfoot strike and forefoot strike running were simulated using a dynamic explicit solver. The results showed that, compared to rearfoot strike, forefoot strike reduced the foot arch height by 9.12% and increased the medial longitudinal arch angle by 2.06%. Forefoot strike also increased the plantar connective tissues stress by 18.28–200.11% and increased the plantar fascia tensile force by 18.71–109.10%. Although it is currently difficult to estimate the threshold value of stress or force that results in injury, forefoot strike runners appeared to be more vulnerable to plantar fasciitis.     

Orthotic effect of a stabilising mechanism in the surface of gymnastic mats on foot motion during landings.

The purpose of this study was to examine two hypotheses: (a) mat hardness affects foot motion during landing; (b) the influence of a surface stabilising interface integrated in a mat on foot motion is detectable. Two studies were carried out: In the first one, six female gymnasts performed barefoot landings from different falling heights onto three mats having different hardness. In the second study, a stabilising mechanism was integrated in the surface of three new mats with different hardness. Three high speed video cameras (250Hz) captured the motion of the left leg and foot. These were modelled by means of a four rigid body system. The maximal eversion at the ankle joint was not influenced by the different mats (hard: 4.6 degrees +/-1.9 to 9.3 degrees +/-3.4, medium: 3.1 degrees +/-2.7 to 7.4 degrees +/-3.5, soft: 4.8 degrees +/-2.1 to 8.4 degrees +/-3.5). The soft mat without the stabilised surface showed higher eversion values (p<0.05) between forefoot and rearfoot (medial joint: hard: 5.1 degrees +/-3.2 to 7.3 degrees +/-3.3, medium: 6.9 degrees +/-3.1 to 7.5 degrees +/-2.9, soft: 12.7 degrees +/-4.1 to 13.4 degrees +/-3.3; lateral joint: hard: 8.5 degrees +/-3.1 to 9.7 degrees +/-1.1, medium: 9.5 degrees +/-2.6 to 11.2 degrees +/-3.3, soft: 12.1 degrees +/-2.3 to 15.7 degrees +/-3.3). For the mats with the surface stabilising interface, the different hardness did not cause any significant differences in maximal eversion values at the medial (hard: 1.5 degrees +/-3.3 to 5.5 degrees +/-4.5, medium: 1.3 degrees +/-3.5 to 5.1 degrees +/-3.6, soft: 0.7 degrees +/-4.9 to 5.4 degrees +/-4.2) nor at the lateral (hard: 11.3 degrees +/-4.2 to 17.3 degrees +/-4.2, medium: 12.3 degrees +/-4.8 to 17.1 degrees +/-3.7, soft: 11.5 degrees +/-4.6 to 17.1 degrees +/-4.3) forefoot joints. The structure of the mat and the consequent deformation hollow did not influence the kinematics of the ankle joint during landings, but it influenced the motion at the medial and the lateral forefoot joints. By means of a stabilised surface, it is possible to reduce the influence of mat deformation on the maximal eversion between forefoot and rearfoot.     

Foot joint coupling variability differences between habitual rearfoot and forefoot runners prior to and following an exhaustive run

As joint coupling variability has been associated with running-related lower extremity injury, the purpose of this study was to identify how variability within the foot may be different between forefoot (FFS) and rearfoot strike (RFS) runners. Identifying typical variability in uninjured runners may contribute to understanding of ideal coordination associated with running foot strike patterns.Fifteen FFS and 15 RFS runners performed a maximal-effort 5 km treadmill run. A 7-segment foot model identified 6 functional articulations (rearfoot, medial and lateral midfoot and forefoot, and 1st metatarsophalangeal) for analysis. Beginning and end of the run motion capture data were analyzed. Vector coding was used to calculate 6 joint couples. Standard deviations of the coupling angles were used to identify variability within subphases of stance (loading, mid-stance, terminal, and pre-swing). Mixed between-within subjects ANOVAs compared differences between the foot strikes, pre and post run.Increased variability was identified within medial foot coupling for FFS and within lateral foot coupling for RFS during loading and mid-stance. The exhaustive run increased variability during mid-stance for both groups.Interpretation. Joint coupling variability profiles for FFS and RFS runners suggest different foot regions have varying coordination needs which should be considered when comparing the strike patterns.     

The Relationships between Foot Arch Volumes and Dynamic Plantar Pressure during Midstance of Walking in Preschool Children

Objectives

The purpose of this study was to examine the correlation between the foot arch volume measured from static positions and the plantar pressure distribution during walking.

Methods

A total of 27 children, two to six years of age, were included in this study. Measurements of static foot posture were obtained, including navicular height and foot arch volume in sitting and standing positions. Plantar pressure, force and contact areas under ten different regions of the foot were obtained during walking.

Results

The foot arch index was correlated (r = 0.32) with the pressure difference under the midfoot during the foot flat phase. The navicular heights and foot arch volumes in sitting and standing positions were correlated with the mean forces and pressures under the first (r = −0.296∼−0.355) and second metatarsals (r = −0.335∼−0.504) and midfoot (r = −0.331∼−0.496) during the stance phase of walking. The contact areas under the foot were correlated with the foot arch parameters, except for the area under the midfoot.

Conclusions

The foot arch index measured in a static position could be a functional index to predict the dynamic foot functions when walking. The foot arch is a factor which will influence the pressure distribution under the foot. Children with a lower foot arch demonstrated higher mean pressure and force under the medial forefoot and midfoot, and lower contact areas under the foot, except for the midfoot region. Therefore, children with flatfoot may shift their body weight to a more medial foot position when walking, and could be at a higher risk of soft tissue injury in this area.     

Plantar pressures are higher in cases with diabetic foot ulcers compared to controls despite a longer stance phase duration

Background

Current international guidelines advocate achieving at least a 30 % reduction in maximum plantar pressure to reduce the risk of foot ulcers in people with diabetes. However, whether plantar pressures differ in cases with foot ulcers to controls without ulcers is not clear. The aim of this study was to assess if plantar pressures were higher in patients with active plantar diabetic foot ulcers (cases) compared to patients with diabetes without a foot ulcer history (diabetes controls) and people without diabetes or a foot ulcer history (healthy controls).

Methods

Twenty-one cases with diabetic foot ulcers, 69 diabetes controls and 56 healthy controls were recruited for this case-control study. Plantar pressures at ten sites on both feet and stance phase duration were measured using a pre-established protocol. Primary outcomes were mean peak plantar pressure, pressure-time integral and stance phase duration. Non-parametric analyses were used with Holm’s correction to correct for multiple testing. Binary logistic regression models were used to adjust outcomes for age, sex and body mass index. Median differences with 95 % confidence intervals and Cohen’s d values (standardised mean difference) were reported for all significant outcomes.

Results

The majority of ulcers were located on the plantar surface of the hallux and toes. When adjusted for age, sex and body mass index, the mean peak plantar pressure and pressure-time integral of toes and the mid-foot were significantly higher in cases compared to diabetes and healthy controls (p?<?0.05). The stance phase duration was also significantly higher in cases compared to both control groups (p?<?0.05). The main limitations of the study were the small number of cases studied and the inability to adjust analyses for multiple factors.

Conclusions

This study shows that plantar pressures are higher in cases with active diabetic foot ulcers despite having a longer stance phase duration which would be expected to lower plantar pressure. Whether plantar pressure changes can predict ulcer healing should be the focus of future research. These results highlight the importance of offloading feet during active ulceration in addition to before ulceration.

     

Anatomy and Biomechanical Properties of the Plantar Aponeurosis: A Cadaveric Study

Objectives

To explore the anatomy of the plantar aponeurosis (PA) and its biomechanical effects on the first metatarsophalangeal (MTP) joint and foot arch.

Methods

Anatomic parameters (length, width and thickness of each central PA bundle and the main body of the central part) were measured in 8 cadaveric specimens. The ratios of the length and width of each bundle to the length and width of the central part were used to describe these bundles. Six cadaveric specimens were used to measure the range of motion of the first MTP joint before and after releasing the first bundle of the PA. Another 6 specimens were used to evaluate simulated static weight-bearing. Changes in foot arch height and plantar pressure were measured before and after dividing the first bundle.

Results

The average width and thickness of the origin of the central part at the calcaneal tubercle were 15.45 mm and 2.79 mm respectively. The ratio of the length of each bundle to the length of the central part was (from medial to lateral) 0.29, 0.30, 0.28, 0.25, and 0.27, respectively. Similarly, the ratio of the widths was 0.26, 0.25, 0.23, 0.19 and 0.17. The thickness of each bundle at the bifurcation of the PA into bundles was (from medial to lateral) 1.26 mm, 1.04 mm, 0.91 mm, 0.84 mm and 0.72 mm. The average dorsiflexion of the first MTP joint increased 10.16° after the first bundle was divided. Marked acute changes in the foot arch height and the plantar pressure were not observed after division.

Conclusions

The first PA bundle was not the longest, widest, or the thickest bundle. Releasing the first bundle increased the range of motion of the first MTP joint, but did not acutely change foot arch height or plantar pressure during static load testing.     

Effects of a foot orthosis inspired by the concept of a twisted osteoligamentous plate on the kinematics of foot-ankle complex during walking: A proof of concept

It has been suggested that the foot acts as a twisted osteoligamentous plate to control pronation and facilitate supination during walking. The aim of this study was to investigate the effect of an orthosis inspired by the concept of a foot’s twisted osteoligamentous plate on the kinematics of foot-ankle complex. Thirty-five subjects underwent a kinematic assessment of the foot-ankle complex during walking using three different orthoses: (1) Twisted Plate Spring (TPS) orthosis: inspired by the concept of a twisted osteoligamentous plate shape and made with a spring-like material (carbon fiber); (2) Flat orthosis: control orthosis made of a non-elastic material with a non-inclined surface; and (3) Rigid orthosis: control orthosis made of a non-elastic material, with the same shape of the TPS. Repeated measures analyses of variance demonstrated that the TPS reduced the duration and magnitude of rearfoot eversion (p ≤ 0.03), increased rearfoot inversion relative to shank (p < 0.01), increased forefoot eversion relative to rearfoot (p < 0.01), and increased peak of plantar flexion of forefoot relative to rearfoot during the propulsive phase (p = 0.01) compared to Flat orthosis. The effects of the TPS were different from the Rigid orthosis, demonstrating that, alongside shape, material properties were a determinant factor for the obtained results. The findings of this study help clarify the role of a mechanism similar to a twisted osteoligamentous plate on controlling foot pronation and facilitating supination during the stance phase of walking.     

Tendon Achilles lengthening for the treatment of neuropathic ulcers causes a temporary reduction in forefoot pressure associated with changes in plantar flexor power rather than ankle motion during gait

The purposes of this study were to determine the effects of tendon Achilles lengthening (TAL) on ambulatory plantar pressures and ankle range of motion, moment, and power, and to determine whether changes in forefoot pressure after treatment of a neuropathic ulcer are related to changes in ankle dorsiflexion range of motion (DFROM) or plantar flexor (PF) power during gait. Pressure and gait tests were performed before treatment, and at 3 weeks and 8 months after treatment in two randomly assigned groups of subjects with diabetes, equinus deformity, and a neuropathic forefoot ulcer treated with TAL and total contact casting (TAL group, n=14), or total contact casting alone (TCC group, n=14). The TAL group had an initial decrease in forefoot peak pressure (PP) (27%), forefoot pressure-time integral (PTI) (42%), PF moment (53%), and PF power (65%), along with an initial increase in rear foot PP (34%), rear foot PTI (48%), and DFROM (74%). Post-surgical changes in rear foot pressure and DFROM were maintained up to 8 months after treatment with TAL, whereas forefoot pressure and PF moment and power increased significantly. Changes in forefoot pressure after treatment in either group were correlated with changes in PF power (r=0.45-0.60), but not with changes in DFROM during gait (r=-0.02-0.08). Results suggest TAL causes a temporary reduction in forefoot pressure primarily by reducing PF power during gait. The initial decrease in forefoot pressure, followed by progressive reloading of forefoot tissues as PF muscles regain strength after TAL, may help reduce the risk of ulcer recurrence in patients with diabetes.     

Natural Killer Cell Immunoglobulin-like Receptor (KIR) genotypes in Follicular Lymphoma patients: Results of a pilot study

Aims

The Natural Killer Cell Immunoglobulin-like Receptor (KIR) genotype profiling in Follicular Lymphoma has not been reported before in the literature.

Materials and methods

DNA extracted from 20 Follicular Lymphoma patients and 62 healthy controls was analyzed for KIR genotyping using a polymerase chain reaction/sequence specific primers technique (PCR/SSP) for the presence of 16 KIR gene and pseudogene loci.

Results

The AA, AB, and BB genotype frequencies were, respectively, 20%, 60% and 20% with an A:B ratio of 1:1. KIR 2DL4, KIR 3DL2, KIR 3DL3, and KIR 3DP1*003 were presented in all individuals. No significant difference between patients and controls was detected.

Conclusion

KIR genotyping profile does not seem to be associated with Follicular Lymphoma. The results presented in this pilot research represent the first international report about this important clinical entity.     

Classification of Forefoot Plantar Pressure Distribution in Persons with Diabetes: A Novel Perspective for the Mechanical Management of Diabetic Foot?

Background

The aim of this study was to identify groups of subjects with similar patterns of forefoot loading and verify if specific groups of patients with diabetes could be isolated from non-diabetics.

Methodology/Principal Findings

Ninety-seven patients with diabetes and 33 control participants between 45 and 70 years were prospectively recruited in two Belgian Diabetic Foot Clinics. Barefoot plantar pressure measurements were recorded and subsequently analysed using a semi-automatic total mapping technique. Kmeans cluster analysis was applied on relative regional impulses of six forefoot segments in order to pursue a classification for the control group separately, the diabetic group separately and both groups together. Cluster analysis led to identification of three distinct groups when considering only the control group. For the diabetic group, and the computation considering both groups together, four distinct groups were isolated. Compared to the cluster analysis of the control group an additional forefoot loading pattern was identified. This group comprised diabetic feet only. The relevance of the reported clusters was supported by ANOVA statistics indicating significant differences between different regions of interest and different clusters.

Conclusion/s Significance

There seems to emerge a new era in diabetic foot medicine which embraces the classification of diabetic patients according to their biomechanical profile. Classification of the plantar pressure distribution has the potential to provide a means to determine mechanical interventions for the prevention and/or treatment of the diabetic foot.     

Foot strike pattern,step rate,and trunk posture combined gait modifications to reduce impact loading during running

Elevated impact loading can be detrimental to runners as it has been linked to the increased risk of tibial stress fracture and plantar fasciitis. The objective of this study was to investigate the combined effects of foot strike pattern, step rate, and anterior trunk lean gait modifications on impact loading in runners. Nineteen healthy runners performed 12 separate gait modification trials involving: three foot strike patterns (rearfoot, midfoot, and forefoot strike), two step rates (natural and 10% increased), and two anterior trunk lean postures (natural and 10-degree increased flexion). Overall, forefoot strike combined with increased step rate led to the lowest impact loading rates, and rearfoot strike combined with anterior trunk lean led to the highest impact loading rates. In addition, there were interaction effects between foot strike pattern and step rate on awkwardness and effort, such that it was both more natural and easier to transition to a combined gait modification involving forefoot strike and increased step rate than to an isolated gait modification involving either forefoot strike or increased step rate. These findings could help to inform gait modifications for runners to reduce impact loading and associated injury risks.     

Effect of peak pressure and pressure gradient on subsurface shear stresses in the neuropathic foot

The pressure distribution on the plantar surface of the foot may provide insights into the stresses within the subsurface tissues of patients with diabetes mellitus and peripheral neuropathy (PN) who are at risk for skin breakdown. The purposes of this study were to (1) estimate the stress distribution in the subsurface soft tissue from a measured surface pressure distribution and determine any differences between values in the forefoot and rearfoot, and (2) determine the relationship between maximum shear stress (MSS) (magnitude and depth) and characteristics of the pressure distribution. The measured in-shoe pressure distributions during walking characterized by the peak plantar pressure and maximum pressure gradient on the plantar surface of the feet for 20 subjects with diabetes, PN and history of a mid foot or forefoot plantar ulcer were analyzed. The effects of peak pressure and maximum pressure gradient at the peak pressure location on the stress components in the subsurface soft tissue were studied using a potential function method to estimate the subsurface tissue stress. The calculated MSSs are larger in magnitude and located closer to the surface in the forefoot, where most skin breakdown occurs, compared to the rearfoot. In addition, the MSS (magnitude and depth) is highly correlated with the pressure gradient (r=-0.77 & 0.61) and the peak pressure (r=-0.61 & 0.91). The peak pressure and the maximum pressure gradient obtained from the surface pressure distribution appear to be important variables to identify where MSSs are located in the subsurface tissues on the plantar foot that may lead to skin break down.     

Influence of the posterior tibial tendon on the medial arch of the foot: an in vitro kinetic and kinematic study]

INTRODUCTION: The respective contributions of the active and passive structures of the foot to the stability of the medical arch were investigated using an in vitro kinetic and kinematic model. The effect of the tibialis posterior tendon on foot and ankle movements, and plantar pressure distribution of the foot were tested in a cadaveric human foot. METHOD: The stance phase from heel-contact to toe-off of normal walking gait and after tibialis posterior tendon rupture was simulated in eight roentenographically normal human feet (age 66 +/- 19 years, males). Ground reaction force and tibial inclination was simulated by means of a tilting angle and force-controlled translation stage. Plantar pressure was measured using a pressure-measuring platform. The force developed by the flexors and extensor muscles of the foot were simulated via cables attached to 7 force-controlled hydraulic cylinders. Tibial rotation was produced by an electric servo-motor, and foot movements measured with an ultrasonic analysis system. RESULTS: The model was verified against the plantar distribution and kinematics of healthy subjects measured during normal gait. Tibialis posterior deficit did not result in any detectable changes in pressure or force-time integral in the medial regions of the foot--a common sign of flat foot (pressure: midfoot 0.2 < or = 0.9; medial forefoot 0.5 < or = p < or = 0.9; hallux 0.5 < or = p < or = 0.9; force-time integral: midfoot p = 0-871; medial forefoot p = 0.632; hallux p = 0.068). Only small tendential changes in the kinematics of the talus and calcaneus were observed in dorsiflexion (0-58 sec; talus 0.1 < or = p < or = 0.6; calcaneus 0.4 < or = p < or = 0.06) and eversion (talus: 0-60 sec. 0.1 < or = p < or = 0.6; calcaneus: 37-60 sec. 0.2 < or = p < or = 0.7). CONCLUSION: The results of this in vitro study show that defective tibialis posterior alone does not produce significant changes in the kinetics or kinematics of the stance phase of normal gait. This suggests that the development of flat foot observed in degeneration of the tibialis posterior tendon occurs only after fatigue of the passive structures of the foot.     

XRCC3 Thr241Met polymorphism and risk of acute myeloid leukemia in a Romanian population

Background

DNA repair systems have a critical role in maintaining the genome integrity and stability. DNA repair gene polymorphisms may influence the capacity to repair DNA damage, and thus lead to an increased cancer susceptibility. X-ray repair cross-complementing groups 3 (XRCC3), a DNA repair gene, may be involved in acute myeloid leukemia susceptibility. The objective of the current study was to investigate the association of Thr241Met polymorphism of XRCC3 gene with the risk of acute myeloid leukemia (AML).

Methods

This study included 78 AML patients and 121 healthy individuals without cancer. We used polymerase chain reaction-restriction fragment length polymorphism assay to determine XRCC3 genotypes.

Results

The XRCC3 variant genotype (Thr/Met+Met/Met) was more frequent in AML patients than in healthy controls (OR = 2.76, 95% CI: 1.52-4.98, P = 0.001). Our study revealed a statistically significant association between variant genotype (Thr/Met+Met/Met) and AML de novo compared to secondary AML (P = 0.007). No significant associations were found between any genotype and age at diagnosis, number of white blood cells and subtype of AML. Overall survival of patients with Thr/Thr genotype was better than those of variant Thr/Met and Met/Met genotypes.

Conclusions

Our findings indicate that the XRCC3 Thr241Met polymorphism may be a genetic risk factor for AML, particularly in male patients with de novo AML from the central part of Romania.     

Screening of longevity-associated genes based on a comparison between dead and surviving populations

Aim

To investigate longevity-associated genes based on a comparison between dead and surviving populations.

Methods

A total of 71 cases of dead individuals were treated as the death group, and healthy volunteers who were matched with the dead individuals based on sex and age were recruited as the survival group. Alleles of 13 CODIS STR loci were determined using the AmpFLSTR Profiler Plus PCR Amplification Kit. The cross-validation was performed based on differences between the two groups in both frequency values and ages.

Results

The frequency value of the D18S51-17 alleles was significantly higher in the dead group than in the survival group (p < 0.05), and the frequency value of the D2S1338-18 allele was statistically lower in the dead group than in the survival group (p < 0.05). The mean age of the subjects with the D2S1338-18 allele was also significantly higher than that of the subjects without D2S1338-18, and no significant difference was observed with respect to the other three alleles.

Conclusions

The results suggest that D2S1338-18 is associated with longevity.     

Foot internal stress distribution during impact in barefoot running as function of the strike pattern

The aim of the present study is to examine the impact absorption mechanism of the foot for different strike patterns (rearfoot, midfoot and forefoot) using a continuum mechanics approach. A three-dimensional finite element model of the foot was employed to estimate the stress distribution in the foot at the moment of impact during barefoot running. The effects of stress attenuating factors such as the landing angle and the surface stiffness were also analyzed. We characterized rear and forefoot plantar sole behavior in an experimental test, which allowed for refined modeling of plantar pressures for the different strike patterns. Modeling results on the internal stress distributions allow predictions of the susceptibility to injury for particular anatomical structures in the foot.