foot and ankle kinematics

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Analyzing the effect of Slipper cast and Circumferential wrap molding in the manufacture of insoles on ankle kinematics in patients with flexible flat foot

Analyzing the effect of Slipper cast and Circumferential wrap molding in the manufacture of insoles on ankle kinematics in patients with flexible flat foot

Given the high prevalence of dropped longitudinal arch and its undeniable effect on the mechanism of the lower extremities and its other complications despite numerous studies that foot orthoses and in particular insoles construction methods and different functions on the control of pronation have been made. It seems that the lack of sufficient evidence on current methods of molding of the foot requires more research compared the effect of two different impressions on foot kinematics. On the other hand, many studies based on individual reports to evaluate the success rate of orthotic molded versus non-molded orthotic been made in reducing symptoms (McCourt F., 1990; McCourt et al., 1994; Springett etal., 2007; Stell and Buckley, 1998), but the service inquiry and research of Drug and Health Technology Agency of Canada in 2009 stated that any research or clinical study different methods of casting with plaster bandages, compression molding with foam box or force plate technique has not been and in this context there is a lack of information and resources (Stell and Buckley, 1998). Given the approach, many methods have been used and offered for molding that among these two methods in this study, the method Slipper cast technique and Circumferential wrap are more prevalent and have more credit. Nevertheless the characteristics and biomechanical effects are still not fully understood and the proof of the results of this study about different molding methods, using appropriate molding methods will be helpful to orthopedic society and patients. The importance of this issue and that role can improve the symptoms of flat feet and also have the convenience of users of insoles. The aim of this study was to compare the two molding methods in the molding in the manufacture of insoles on ankle kinematics in patients with flexible flat soles of the feet.
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Characterizing multisegment foot kinematics during gait in diabetic foot patients

Characterizing multisegment foot kinematics during gait in diabetic foot patients

A method for capturing forefoot, midfoot and hindfoot motion during different gait tasks have been proposed. The model includes tibia and fibula, hindfoot, midfoot and forefoot, and allows investigation of 3-dimensional foot and ankle kinematics through stereophotogramme- try. A new model has been generated since available foot protocols were not suitable for this type of analysis [18,19,21,22,26]. One important limitation of the litera- ture was that the 3 planar motion of the midfoot was not evaluated. As the diabetic foot disease accounts for mid- foot structural polymorphism which commonly leads to plantar ulceration [34,35], the authors believe that a suit- able model to describe the diabetic foot biomechanics should perform 3D midfoot kinematic analysis. Further- more, this was confirmed by the results reported in Figure 3 where, the diabetic group has statistically significant dif- ferences in midfoot kinematic parameters over a large part of the gait cycle. Nevertheless the forefoot should be con- sidered entirely and not represented by a single toe as the hallux [36] because it is considered the high risk zone for plantar ulcer formation [4,36]. This was confirmed by the results reported in Figure 3 where, the diabetic group showed statistically significant differences in forefoot kin- ematic parameters over the full gait cycle in the sagittal and coronal planes, and in the 50% of gait cycle in the transversal plane. Furthermore in the literature has been reported that in diabetic patients, changes in weight bear- ing patterns are linked to limited joint mobility that occurs mostly at metatarsophalangeals and subtalar joints. Nevertheless the location of forefoot plantar ulcers in diabetic subjects has been demonstrated to be highly correlated with rearfoot alignment [4]. In addition to the different types of mechanisms of excessive pressure load- ing, abnormal alignment of the foot also affects pressure loading on the foot. Finally patients with an uncompen- sated forefoot varus or forefoot valgus (inverted or everted forefoot) had ulcers located at the first or fifth metatarsal head. Similarly, an inverted heel position has been associ- ated with lateral ulcers, whereas an everted heel position has been associated with medial ulcers [36]. So far the authors believe that a technique for the measurement of rearfoot-forefoot-midfoot structures alignment is needed in understanding the aetiology of diabetic foot ulcers. Finally, the triplanar orientation of the joint axis allows The model anatomical landmarks identified on a skeleton
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The immediate effects of fibular repositioning tape on ankle kinematics and muscle activity

The immediate effects of fibular repositioning tape on ankle kinematics and muscle activity

Single leg balance deficits have been found in ankle instability using a variety of parameters and measures. 6-9, 37, 38 Balance can be assessed using both subjective and objective measures. Using the Balance Error Scoring System (BESS) to count errors made during various stance and surface conditions, Docherty et al. 37 found that subjects with functionally unstable ankles committed significantly more errors (had poorer postural stability) than healthy controls. The Star Excursion Balance Test, in which subjects must maintain a single leg stance while reaching for maximal distance in three different directions (anterior, posterior, and medial), has also demonstrated deficits in subjects with FAI, as significantly smaller maximal reach values have been observed compared to healthy subjects. 7 Studies using the more objective measure of force plate kinetic data show similar results. 8, 9, 38 Hertel et al. 8 calculated time to boundary measures in subjects with FAI and controls during single leg stance. Time to boundary was determined by how quickly the center of pressure reached the boundary of the foot. Decreased time to boundaries (worse postural control) was found in subjects with FAI. 8 Using a more dynamic measure of balance, subjects with FAI demonstrated significantly longer time to stabilization measures during a single-leg jump landing. 9
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Foot kinematics in patients with two patterns of pathological plantar hyperkeratosis

Foot kinematics in patients with two patterns of pathological plantar hyperkeratosis

recorded (walking speed was not measured). Local co- ordinate frames (LCF) were defined for each segment. For the tibia anatomical markers on both malleoli, fibula head and tibial tuberosity were used to align the LCF relative to the technical markers on the mid shin [9-11]. For the heel and midfoot the LCF was set parallel to the global system when in relaxed standing. For the first metatarsal and hallux, reflective markers were positioned on the plates to enable the anterior/posterior (x) axis to follow the approximate long axis of the metatarsal and hallux respectively. The medial/lateral axes were 90° to the x-axis and parallel to the supporting surface. Rota- tions between distal and proximal adjacent segments were calculated using Euler rotation sequence z x y. Data were normalised to 0-100% of stance and averaged across ten trials. The reference position (0 degrees) was the foot position when the subject stood upright (figure 2). Other studies have used a subtalar “neutral” position [16-18], which lacks validity (has no proven functional meaning) and has been shown to be more subjective [19-23].
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Reliability, validity and responsiveness of the German self reported foot and ankle score (SEFAS) in patients with foot or ankle surgery

Reliability, validity and responsiveness of the German self reported foot and ankle score (SEFAS) in patients with foot or ankle surgery

From November 2014 to January 2016 a total of 177 pa- tients undergoing surgery of the foot or ankle were con- secutively recruited at a single institution. Eligibility criteria included adult patients undergoing primary foot or/and ankle surgery for osteoarthritis, deformity, rheumatoid arthritis, impingement of the ankle, tendon disorders or bone defect. Patients were asked to complete the German SEFAS, the German Foot and Ankle Outcome Score (FAOS) the German Short-Form 36 Health Survey (SF-36) and a numeric scale for pain and disability (NRS). SEFAS, FAOS, SF-36 and NRS were completed 3–14 days before surgery (t1) and again on the morning before surgery (t2) for reliability testing. 6 months after surgery (t3) all partici- pants were asked to complete SEFAS a last time.
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The effects of powered ankle-foot orthoses on joint kinematics and muscle activation during walking in individuals with incomplete spinal cord injury

The effects of powered ankle-foot orthoses on joint kinematics and muscle activation during walking in individuals with incomplete spinal cord injury

The powered orthoses were not as effective at increasing ankle push-off angle at higher walking speeds. For both healthy and subjects with spinal cord injury, ankle push- off angle increase as walking speed increases [31,45]. When our subjects walked without orthoses and with pas- sive-orthoses, maximum ankle angle at push-off increased with speed as expected (Figure 3, Table 2). In contrast, there was a decrease in ankle angle at push-off with increasing speed when subjects walked with the powered orthoses. Two possible explanations are pneumatic actua- tor limitations and pushbutton control limitations. It is unlikely that the actuators caused the decline in ankle range of motion at faster speeds. A previous study using the powered orthoses on healthy subjects demonstrated ample force production and range of motion at faster walking speeds [40]. That study used footswitch control- lers to activate the pneumatic actuators automatically dur- ing stance rather than handheld pushbuttons. It is possible that faster walking speeds required more precise timing of the pushbuttons to activate the artificial mus- cles. In the current study, the stance phase duration decreased from 1.26 seconds to 0.74 seconds as walking speed increased from 0.36 m/s to 0.89 m/s. Shorter stance duration results in a smaller time period to activate the orthoses assistance. Small absolute errors in timing may become significant at fast speeds because of increased rel- ative error with respect to the stride cycle. To reduce the possibility for errors in timing future designs could auto- matically trigger assistance during the stride with a foots- witch.
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Evaluation of multi-segmental kinematic modelling in the paediatric foot using three concurrent foot models

Evaluation of multi-segmental kinematic modelling in the paediatric foot using three concurrent foot models

A limitation of the protocol adopted was the com- promise of marker placement on the forefoot segment. The 3DFoot model required a marker on the second metatarsal head, the OFM required a marker between the second and third metatarsal head and Kinfoot re- quired a marker on the third metatarsal head. These lo- cations were in too close proximity for three separate 9 mm markers to be attached to the skin. Therefore, the centre location, in-line with OFM, was chosen as a com- promise. This may have induced errors in the orienta- tion of 3DFoot and Kinfoot’s forefoot segments due to differences between the technical and anatomical co- ordinate systems. However, the compromised marker position did not appear to generate greater errors in the forefoot compared to other foot segments. Indeed, the amount of error in 3Dfoot and Kinfoot’s forefoot seg- ments was consistent with previous findings [7,18]. It is possible that the compromised marker position was within the variability of marker placement found in the current study. Della Croce [25] found within-rater root mean squared differences of 9.0 mm when identifying the second metatarsal head which is the width of a marker used in the current study. Future work should consider examining the repeatability of these foot models in isolation as the close proximity of markers from three foot models may have reduced repeatability in the current study.
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Journal of Foot and Ankle Research: the first ten years

Journal of Foot and Ankle Research: the first ten years

Journal of Foot and Ankle Research (JFAR) was launched in July 2008 as the official research publication of the Society of Chiropodists and Podiatrists (UK) and the Australasian Podiatry Council, replacing both the British Journal of Podiatry and the Australasian Journal of Podi- atric Medicine [1]. JFAR was developed to meet the growing need for an international platform for the publi- cation of research within the podiatry profession [2 – 6], and the timing of its launch coincided with the rise of open access publishing – an innovative publication model which enables free full-text access to anyone with an inter- net connection [7]. Since its inception, JFAR has been published by BioMed Central (now BMC), one of the pio- neers of scholarly open access. This editorial celebrates the journal ’ s 10-year anniversary by summarising the key achievements of the journal between 2008 and 2018.
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Patient perceptions of foot disability in Juvenile Idiopathic Arthritis: a comparison of the juvenile arthritis foot disability index and the Oxford ankle foot questionnaire for children

Patient perceptions of foot disability in Juvenile Idiopathic Arthritis: a comparison of the juvenile arthritis foot disability index and the Oxford ankle foot questionnaire for children

relating to similar activities, no significant difference in domain scores were seen. This was shown for the JAFI participation domain and OxAFQ-C school domain. The author had expected to find some agreement as the JAFI was used in the development of the OxAFQ-C. However there is limited usefulness in comparing across the do- mains between the questionnaires as there are clear dif- ferences in the themes being probed by the statements. For example, the OxAFQ-C has emotional-themed ques- tions in the emotional domain that considers areas such as being “bothered” by the way the individual walked or how their foot / ankle looked. Such areas are not ad- dressed in the JAFI in a comparable domain as the two emotional-themed statements (being worried or sad about foot problems) are included in the activity limita- tion domain alongside 11 activity-based questions. Thus the QxAFQ-C emotional domain was not analysed against a JAFI domain in this study. The JAFI activity domain and the OxAFQ-C physical domain were also compared and a significant difference in the median re- sults was found suggesting that the questions asked in each domain were investigating different areas impacting on well-being.
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The effect of high-top and low-top shoes on ankle inversion kinematics and muscle activation in landing on a tilted surface

The effect of high-top and low-top shoes on ankle inversion kinematics and muscle activation in landing on a tilted surface

Despite the fact that the effect of high-top shoes on ankle evertor muscle function has not been systematic- ally investigated previously, there is evidence that shoe characteristics can substantially affect muscle contrac- tion following sudden inversion of the foot [15,17]. Ramanathan et al. [17] found the peroneus longus responded earlier in the shod condition compared to barefoot during unanticipated foot inversion. More im- portantly, among all the shod conditions (standard train- ing shoe, shoe with sole flare, and laced boot), the muscle responded later with the laced boot. These results par- tially support our findings which also showed a signifi- cant later onset time of the TA and PL muscles before contact when wearing high-top shoes. On the other hand, studies focusing on the EMG amplitude found that shod conditions evoked significantly greater muscle contrac- tion following sudden inversion of the foot compared to the barefoot condition [15,17]. It was then speculated that the shoes may have a facilitatory effect and can en- hance muscle function [15]. However, in our study, we adopted a landing on an inverted platform rather than using a tilting platform to induce sudden ankle inversion. The aEMG pre of the TA, PL, and PB in participants wear-
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The clinimetric qualities of patient assessed instruments for measuring chronic ankle instability: A systematic review

The clinimetric qualities of patient assessed instruments for measuring chronic ankle instability: A systematic review

Floor and ceiling effects were only calculated for the FAOS. According to the quality list used in our study, with the cut-off point set at 15%, all subscales of the FAOS demonstrated ceiling effects. The choice of cut-off point remains arbitrary. For instance, Barber-Westin et al (1999) [47] studied the presence of floor- or ceiling effects of the Cincinatti knee rating system using a cut-off point set at 33%. The observation of ceiling effects may also be spe- cific for the patient population being studied [18]. The patients that were studied had undergone an anatomical reconstruction of the lateral ankle ligaments on average 12 years prior to the study (Roos et al [30]). It is probable that many of them no longer had ankle problems, which may explain the observation of ceiling effects. Moreover, 34% of the same patients also obtained the best possible Karlsson Score. The high percentage of ceiling effects in the FAOS "pain" subscale and FAOS "activities of daily liv- ing" subscale may compromise the validity of these sub- scales.
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Diabetic foot ulcer classification system for research purposes: a progress report on criteria for including patients in research studies

Diabetic foot ulcer classification system for research purposes: a progress report on criteria for including patients in research studies

For each category, a grading system is provided, and this grading system should describe the severity within each category. As the system has been developed for primarily clinical research, the criteria for each category are based upon objective techniques that can be part of the up-to-date management of patients with a foot ulcer, as described in The International Consensus on the Diabetic Foot [8]. How each category is graded depends upon the characteristics of that category and the current evidence base. A system that for instance has three grades, such as none, a little, a lot, seems very attractive. Moreover, if all categories are graded identically, it could render the system more easy to use. However, at present the disadvantages of such a symmetrical system seem greater than the advantages. The evidence base (and consensus) to subdivide all categories in three strict grades is lacking. For instance, in the current system there is no grading for size, it is reported in square centimetres and sensation is defined as loss or no loss of protective sensation. The system does not include a grade 0 because, in many instances, it will be impossible to exclude subclinical abnormalities, for example, in neuropathy or PAD.
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Ankle and Foot Associates of Northern Michigan PC

Ankle and Foot Associates of Northern Michigan PC

Dismissal: We have the right to “dismiss” you from the practice. If you are dismissed from the practice then you can no longer make appointments nor get prescriptions. We will send you a letter of dismissal, and you will need to find another podiatrist for your foot care. Common reasons for dismissal are, but not limited to: noncompliance of physician instructions, failure to keep appointments, abusive to staff or other patients, failure to pay bill.

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Efficacy of different techniques of AFO construction for hemiplegia patients: A systematic review

Efficacy of different techniques of AFO construction for hemiplegia patients: A systematic review

Some studies in this review clearly reported that AFO was used to resist the ankle foot unwanted movement, depending on structure and mechanical properties such as trim line position and material properties. Vast majority of material properties used in fabrication of the AFOs may also influence the flexibility of these devices and the mo- bility of the ankle and metatarsophalangeal joints (38). Despite suitable examples (21, 24, 35, 41, 42), detailed technical points in AFO design were missed in some studies (43, 44,47,49). Using newly designed method for measuring AFOs stiffness with approved reliability and clinical applicability (48, 50) has recently been described. To enhance AFO intervention results, they must be more accurately assessed regarding the design. Further work should be done on the movements prevented, assist- ed and permitted by the AFO design like mechanical ar- ticulation or special trim line, toe plate form and length and flexibility (21, 24, 35, 41, 42), materials and method of fabrication, AFO ankle angling combination with SVA angle with shoes, type of shoes worn and details of any modifying in AFOs.
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Taping in sports: A brief update

Taping in sports: A brief update

Bandyopadhyay A, Mahapatra D. Taping in sports: a brief update. J. Hum. Sport Exerc. Vol. 7, No. 2, pp. 544-552, 2012. Athletic taping is an adjunct mechanism adopted as a preventive measure of injuries or post-injury rehabilitation and prophylaxis. The tape is chosen properly so that it could be able to properly strap the body parts, e.g., ankle, wrist, finger, etc. There are certain principles, guidelines, rules and regulations based on which taping has to be done. Besides injury prevention, taping is also used in sports as conservative management of pain, biomechanical effects, effects on balance, posture and neuromuscular system, rehabilitation. Taping has been found to be effective in cases of ankle, foot, hand and wrist injuries as well as appeared to be more valuable in rehabilitation than in prevention of knee and ankle injury. A modern and new approach of taping is kinesiology tape which provides athletes with a solution for working through minor injuries and recovering faster from major injuries and has also been found to be an ideal modality for use in chiropractice settings. It also helps in enhancement of endurance capacity and even performance level in certain cases. Contradictory opinions exist among scientists regarding the advantages and disadvantages of application of taping in sports. Nonetheless Athletic Taping is recommended with certain precautions for the benefit of the sportspersons and athletic performance. Key words: KINESIOTAPING, INJURY, CHIROPRACTICE, ATHLETES, SPORT PERFORMANCE
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The gym ball as a chair for the back pain patient: a two case report

The gym ball as a chair for the back pain patient: a two case report

tempted to pivot and push off medially to avoid being tackled. At the time of injury he was wearing grass cleats, although he was practicing on artificial turf. He denied hearing a pop or snap, but did relate that while as- suming his three-point stance and sprinting the pain in his ankle was recreated. Non-weight bearing and immo- bility eliminated the pain. When asked to characterize and localize his symptoms he pointed to the dorsum of the foot (approximately the level of the talar dome) and described the pain, when present, as sharp in nature hav- ing an intensity of 7 out of 10. He has experienced nu- merous sprains of the same ankle, and reported that it is “weak.” These previous occurrences have been treated with courses of passive physiotherapy modalities, active strengthening and proprioceptive drills. His systems re- view was unremarkable.
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The American Academy of Foot & Ankle Osteosynthesis. presents

The American Academy of Foot & Ankle Osteosynthesis. presents

This activity has been planned and implemented in accordance with the standards, requirements, and guidelines for approval of sponsors of continuing education in podiatric medicine through an affiliation of The Podiatry Institute and the American Academy of Foot and Ankle Osteosynthesis. The Podiatry Institute is approved by the Council on Podiatric Medical Education as a sponsor of continuing education in podiatric medicine. The Podiatry Institute has approved this activity for a maximum of 27 continuing education contact hours.

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A pneumatic power harvesting ankle-foot orthosis to prevent foot-drop

A pneumatic power harvesting ankle-foot orthosis to prevent foot-drop

[20].) Following initial contact, the unlocked ankle joint allowed for full sagittal plane range of motion through stance (plantarflexion – dorsiflexion – plantarflexion) as noted by average ankle angle behavior (Fig. 4). Continued plantarflexion is limited at the neutral position during early swing due to the locking mechanism. Excessive dor- siflexion was observed during mid-swing while wearing the PhAFO. This dorsiflexion may have occurred as a con- sequence of the able-bodied test subject's desire to com- pensate for the limited plantarflexion during push-off and unconscious concern to prevent foot-floor contact during swing. This excessive dorsiflexion during swing should not occur with foot-drop patients by virtue of their dorsi- flexor weakness. This excessive fluctuation in dorsiflexion during swing, which ideally should not have occurred due to the locking mechanism design, illustrates a need for additional design refinements to limit excess motion in the dorsiflexion direction. Free dorsiflexion during stance was also confirmed using the footswitches placed under the heel and metatarsals (Fig. 5). These switches confirm that both the heel and forefoot were in contact with the ground throughout stance demonstrating that the PhAFO did not force the subject to begin heel rise prematurely. The capacity of the PhAFO pneumatic circuit to repeatedly harvest fluid power during gait for the operation of the actuated cam-lock mechanism was also validated by the pilot study. During ten minutes of walking, the PhAFO repeatedly pressurized and discharged the pneumatic air circuit, cyclically locking and unlocking the mechanical ankle joint on the orthosis at the desired periods of the gait cycle. The bellow pump consistently generated peak pressures over 150 kPa (Fig. 6), and always exceeded the minimum pressure necessary to activate the linear cylin- der, thus providing consistent actuation performance. A small decay in pressure after the maximum pressure was observed and attributed to the volumetric expansion of the bellow as the foot is unloaded from the floor (Fig. 5). The heel-mounted pressure release-valve was found to have a near instantaneous release of pressure upon heel- strike (Fig. 5). In general, PhAFO gait demonstrates motion patterns and ranges of motion for each joint com- parable to the non-AFO gait, except for the desired con- straint in ankle motion during swing (Fig. 4). Use of the PhAFO resulted in modest timing differences from the control conditions. Peak dorsiflexion was reached later in the gait cycle for the PhAFO trials; however, the general plantar/dorsiflexion behaviors during stance were similar. Stance-swing phase timing was also slightly different. Stance phase tended to be shorter for the side with the Ground reaction force and pneumatic pressure
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Effects of Lace up Brace on the Ankle Muscles Activity in Different Foot Position during Drop Landing with and without Fatigue

Effects of Lace up Brace on the Ankle Muscles Activity in Different Foot Position during Drop Landing with and without Fatigue

prevention of primary injury and recurrence of injury, the use of protective and supportive equipment such as brace and tape highly recommended to athletes by therapists, doctors, and coaches of the teams (Bahr and Krosshaug, 2005). Meanwhile, the use of the ankle brace has expanded because of its availability, ease of use, and cost-effectiveness. Different studies have examined the effectiveness of this tool and different results have been obtained. Kofotolis et al. (2007) reported that the incidence rate of ankle injury was 2.48 times higher among players who did not wear external ankle support (Kofotolis & Kellis, 2007). Pedowitz et al. (2008) conducted a prospective study between 1998 and 2005 whom they found that the use of semi-rigid ankle brace reduced the incidence of ankle injuries (Pedowitz, Reddy, Parekh, Huffman, & Sennett, 2008). On the other hand, the results of review study by Raymond et al. (2012) revealed that the use of ankle brace did not affect the proprioception of participants with a history of recurrent ankle sprain injury or those with functional ankle instability (Raymond, Nicholson, Hiller, & Refshauge, 2012).
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Finite element analysis of ankle foot orthoses

Finite element analysis of ankle foot orthoses

The magnitude of the maximum stress, ankle moment and heel rotation were all found to depend on the distribution of imposed displacement at the foot region simulating rotation about the [r]

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