Category: Uncategorized

Introducing DonJoy ActyLight®: fit-and-forget ankle support

Posted on | by Matthew Blackwell

Lateral ankle sprains are one of the most common sports-related injuries1; in the United States alone, more than 23,000 people suffer a lateral ankle sprain every day.2 To help address this situation, DonJoy® introduces the new DonJoy ActyLight®, an ankle support so comfortable and easy to fit, you’ll forget you’re even wearing it.

What is an ankle sprain, and why do they happen?

When the ligaments of the ankle are damaged, this is called a sprain. If the foot suddenly rolls inward during activity, the subsequent forceful ankle plantarflexion and inversion can result in stretching and tearing of the ankle ligament fibers. As well as causing swelling and bruising, sprains are usually painful, especially when the person attempts to put weight on the foot.

Ankle sprains are categorized into three grades of severity:

  • Grade I (Mild): This involves minor stretching and tiny tears in the ligament fibers, leading to mild tenderness and swelling around the ankle.
  • Grade II (Moderate): In this grade, there is partial tearing of the ligament, resulting in moderate tenderness and swelling around the ankle. Certain movements can cause some abnormal looseness in the ankle joint.
  • Grade III (Severe): This is the most severe grade, where the ligament is completely torn. It leads to significant tenderness and swelling around the ankle, and certain movements can cause substantial instability in the ankle joint.

What is chronic ankle instability?

Approximately 40% of individuals who suffer an ankle sprain later develop chronic ankle instability (CAI) and report persistent symptoms.3,4 This condition is marked by sensations or instances of the ankle unexpectedly giving way.5

People with CAI commonly experience ongoing symptoms such as persistent swelling, pain, weakness, restricted ankle movement, instability, reduced self-reported functionality, and recurrent ankle sprains.5,6

CAI has been recognized as a precursor to ankle osteoarthritis (OA), with its onset typically happening a decade earlier than knee or hip OA.7

Chronic ankle sprains might necessitate surgical intervention through arthroscopic ligament reconstruction. Individuals with CAI are noted to exhibit both mechanical instability, related to structural changes around the ankle, and functional instability, which is associated with decreased sensorimotor and neuromuscular control.8

Bracing for chronic ankle instability

An ankle brace is worn to support and stabilize the ankle, either as a preventive measure or after an injury has occurred. These braces come in soft or semi-rigid varieties and are intended for one or more of the following purposes:

  • Improve ankle stiffness and thus mechanical stability9
  • Improve neuromuscular control10
  • Improve grounding of the foot10
  • Decrease excessive range of motion (ROM)9
  • Enhance proprioceptive acuity (the body’s ability to sense its own location, movement, and actions)11

Numerous clinical studies have been conducted to assess the effectiveness of ankle bracing in these areas.

In 1998, Vaes et al. discovered that the Aircast® Air-Stirrup® brace significantly reduced talar tilt in unstable ankles during static and dynamic tests, and it slowed down the simulated sprain speed.12

In a study from 2000, Hals et al. demonstrated a significant enhancement in shuttle-run performance among subjects with post-acute, mechanically stable yet functionally unstable ankle sprains when using the Aircast Sport Stirrup® brace.13

A randomized controlled trial conducted by Janssen et al. in 2014, involving 384 athletes who had experienced a lateral ankle sprain, revealed that using an Aircast A60™ brace was more effective than neuromuscular training in reducing the recurrence of ankle sprains.14

Habadi et al. (2014) showed the advantages of soft and semi-rigid ankle orthoses in improving the dynamic balance of individuals with functional ankle instability.15

And a 2020 systematic review by Reyburn and Powden concluded that the current body of research strongly supports the positive impact of ankle braces on the dynamic balance of individuals with CAI.16

Introducing ActyLight by DonJoy®: fit-and-forget ankle support

The convenience and comfort of the DonJoy ActyLight® ankle support means patients will forget they’re even wearing it.

Designed to deliver stability and protection for mild to moderate lateral ankle sprains, thanks to its removable bilateral stays, quick lace-locking mechanism, and step-in design, this modular brace can also be used for the prevention of ankle injuries.

All of this means that patients can rely on ActyLight throughout their journey of activity, from healthy, active use, to support following injury, and to prevention of reinjury in the future.

DonJoy ActyLight ankle support

To find out more about DonJoy ActyLight, go to enovis-medtech.eu.

References

  1. Fong, D.T.P., Hong, Y., Chan, L.K., Yung, P.S.H. and Chan, K.M., (2007). A systematic review on ankle injury and ankle sprain in sports. Sports medicine, 37(1), pp.73-94.
  2. Hubbard, T.J. and Wikstrom, E.A., (2010). Ankle sprain: pathophysiology, predisposing factors, and management strategies. Open Access Journal of Sports Medicine, 1, p.115.
  3. Anandacoomarasamy, A. & Barnsley, L. (2005). Long term outcomes of inversion ankle injuries. Br J Sports Med, 39(3): e14; discussion e14.
  4. Konradsen L., Bech L., Ehrenbjerg M. & Nickelsen T. (2002). Seven years follow-up after ankle inversion trauma. Scand J Med Sci Sports, 12(3): 129-135.
  5. Hertel, J. & Corbett, R.O. (2019). An updated model of chronic ankle instability. Journal of athletic training, 54(6): 572-588.
  6. Ahn, C. S., Kim, H. S., & Kim, M. C. (2011). The Effect of the EMG Activity of the Lower Leg with Dynamic Balance of the Recreational Athletes. The Journal of Physical Therapy Science. 579–583.
  7. Saltzman, C.L., Zimmerman, M.B., O’Rourke, M., Brown, T.D., Buckwalter, J.A. & Johnston, R. (2006). Impact of comorbidities on the measurement of health in patients with ankle osteoarthritis. J Bone Joint Surg Am., 88(11): 2366-2372.
  8. Hertel, J., (2002). Functional anatomy, pathomechanics, and pathophysiology of lateral ankle instability. Journal of athletic training, 37(4): 364.
  9. Zinder, S.M., Granata, K.P., Shultz, S.J. & Gansneder, B.M. (2009). Ankle bracing and the neuromuscular factors influencing joint stiffness. Journal of Athletic Training, 44(4): 363-369.
  10. Kobayashi, T., Saka, M., Suzuki, E., Yamazaki, N., Suzukawa, M., Akaike, A., Shimizu, K. & Gamada, K. (2014). The effects of a semi-rigid brace or taping on talocrural and subtalar kinematics in chronic ankle instability. Foot & Ankle Specialist, 7(6): 471-477.
  11. Raymond, J., Nicholson, L.L., Hiller, C.E. & Refshauge, K.M. (2012). The effect of ankle taping or bracing on proprioception in functional ankle instability: a systematic review and meta-analysis. Journal of Science and Medicine in Sport, 15(5): 386-392.
  12. Vaes, P. H., Duquet, W., Casteleyn, P. P., Handelberg, F., & Opdecam, P. (1998). Static and dynamic roentgenographic analysis of ankle stability in braced and nonbraced stable and functionally unstable ankles. The American journal of sports medicine, 26(5): 692–702.
  13. Hals, T. M., Sitler, M. R., & Mattacola, C. G. (2000). Effect of a semi-rigid ankle stabilizer on performance in persons with functional ankle instability. The Journal of orthopaedic and sports physical therapy, 30(9), 552–556.
  14. Janssen, K. W., van Mechelen, W., & Verhagen, E. A. (2014). Bracing superior to neuromuscular training for the prevention of self-reported recurrent ankle sprains: a three-arm randomised controlled trial. British journal of sports medicine, 48(16): 1235–1239.
  15. Hadadi, M., Mousavi, M. E., Fardipour, S., Vameghi, R., & Mazaheri, M. (2014). Effect of soft and semirigid ankle orthoses on Star Excursion Balance Test performance in patients with functional ankle instability. Journal of science and medicine in sport, 17(4): 430–433.
  16. Reyburn, R. J., & Powden, C. J. (2020). Dynamic Balance Measures in Healthy and Chronic Ankle Instability Participants While Wearing Ankle Braces: Systematic Review With Meta-Analysis. Journal of sport rehabilitation, 30(4): 660–667.

The link between COVID-19 and heel pain

Posted on | by Matthew Blackwell

Since the COVID-19 pandemic began in 2020, the number of patients reporting heel pain has risen. The condition is now so common it has come to be known as “pandemic foot”. Is there really a link between COVID-19 and heel pain, and if so, what treatment options are available?

What is plantar fasciitis?

While “pandemic foot” might be a catchy name, the correct medical term is plantar heel pain, or plantar fasciitis. This condition presents as pain felt on the bottom of the foot around the heel and arch. It is an overuse condition often associated with runners, especially those over the age of 40.

Excessive pressure on the foot, along with a tight calf or Achilles tendon, can cause inflammation of the plantar fascia, the thick band of tissue on the bottom of the foot connecting the heel to the toes.

The pain is commonly felt during the first step, as well as during weight-bearing tasks, particularly after periods of rest.1 Patients often report the pain at its worst as they take their first steps of the day after getting out of bed. It typically decreases as the calf and Achilles tendon become looser during activity, only to return the following day after things have tightened up again during the night.

Does COVID-19 cause plantar fasciitis?

There is no current evidence to suggest there is a direct link between COVID-19 and heel pain. Instead, the rise in plantar fasciitis is more likely to be due to the changes in our daily lives the pandemic has brought about.

Gym attendances have declined since the beginning of the pandemic, with outdoor running and walking becoming more popular instead. More running and walking mean more stress on the plantar fascia, which, due to an increase in flexible working, can be exacerbated by more time spent walking around at home in bare feet, slippers, or flip-flops.

Without the additional support that a heeled shoe can provide, like those typically worn in office environments, the foot spends more time in a flat position, which, for extended periods, can put additional strain on the fascia. Add to this stiff muscles and tendons from running, and you have a recipe for plantar fasciitis. This is the indirect link between COVID-19 and heel pain.

How can heel pain be treated?

There are a number of conservative treatment options for plantar fasciitis. They range from relatively simple orthotics to more advanced rehabilitation devices.

Taping for heel pain

Physio tape (also known as kinesiology tape) like Chatt-Tape is elastic adhesive tape that can be applied to parts of the body to aid healing and recuperation of the soft tissue.2

Tape can be applied to the heel, ankle, and underside of the foot to release tension in the plantar fascia as well as stabilize it. A study by Tezel et al. (2020) showed that kinesiology tape provided pain relief and improved quality of life for patients with plantar fasciitis, as well as improved functionality.3

Chatt-Tape plantar fasciitis
Aircast AirHeel and Dorsal Night Splint

Bracing for heel pain

Plantar fasciitis can be relieved by wearing an orthotic during the night to help reduce the tightening of the calf muscles and Achilles tendon.4 One such device is Aircast’s Dorsal Night Splint; this product is worn while the patient sleeps, to maintain the position of the foot at 90°, thereby helping to stretch the calf and Achilles tendon.

Another type of foot orthosis for plantar fasciitis is a pneumatic ankle brace. Also from Aircast, the AirHeel is designed to treat plantar fasciitis, Achilles tendonitis, and heel pain. Using two interconnected aircells located under the foot arch and in the back of the heel, the brace applies pulsating compression with every step to help reduce swelling and discomfort and enhance circulation.

Kavros’s 2005 study showed that patients with higher plantar fasciitis pain experience faster relief with the Airheel than with a shoe insert.5

Shock wave therapy for heel pain

Shock wave therapy is an electronic modality that uses acoustic waves to stimulate the body on a cellular level for healing purposes. Generally divided into focused shock wave (F-SW) and radial pressure wave (RPW) therapy, shock wave therapy has been shown to be a clinically proven treatment option for plantar fasciitis, especially when treatments like taping have not been successful.1

In a 2022 study by Wheeler et al., RPW treatment provided significant improvement of pain and function in patients with chronic plantar fasciopathy.6

Intelect 2 RPW
LightForce laser therapy

High power laser therapy for heel pain

High power laser therapy, like that offered by LightForce, uses the energy of focused light to trigger the body’s natural healing processes, thereby speeding recovery.

Ordahan et al.’s 2018 study demonstrated that high power laser therapy provided improvement of pain and function in patients with plantar fasciitis.7

Combining laser therapy with shock wave therapy has shown to be even more effective.8

To learn more about products for heel pain, visit enovis-medtech.eu

References

  1. Morrissey, D., Cotchett, M., Said J’Bari, A., Prior, T., Griffiths, I. B., Rathleff, M. S., Gulle, H., Vicenzino, B., & Barton, C. J. (2021). Management of plantar heel pain: a best practice guide informed by a systematic review, expert clinical reasoning and patient values. British journal of sports medicine, 55(19), 1106–1118.
  2. Homayouni, K., et al. (2013). Comparison between kinesio taping and physiotherapy in the treatment of de Quervain’s disease. J. Musculoskelet. Res. 16(4).
  3. Tezel, N., Umay, E., Bulut, M., Cakci, A (2020). Short-Term Efficacy of Kinesiotaping versus Extracorporeal Shockwave Therapy for Plantar Fasciitis: A Randomized Study. Saudi J Med Med Sci. Sep-Dec;8(3):181-187.
  4. Powell, M., Post, W. R., Keener, J., & Wearden, S. (1998). Effective treatment of chronic plantar fasciitis with dorsiflexion night splints: a crossover prospective randomized outcome study. Foot & ankle international, 19(1), 10–18.
  5. Kavros, S. J. (2005). The efficacy of a pneumatic compression device in the treatment of plantar fasciitis. Journal of applied biomechanics, 21(4), 404–413.
  6. Wheeler, P. C., Dudson, C., & Calver, R. (2022). Radial Extracorporeal Shockwave Therapy (rESWT) is not superior to “minimal-dose” rESWT for patients with chronic plantar fasciopathy; a double-blinded randomised controlled trial. Foot and ankle surgery : official journal of the European Society of Foot and Ankle Surgeons, 28(8), 1356–1365.
  7. Ordahan, B., Karahan, A. Y., & Kaydok, E. (2018). The effect of high-intensity versus low-level laser therapy in the management of plantar fasciitis: a randomized clinical trial. Lasers in medical science, 33(6), 1363–1369.
  8. Takla, M. K. N., & Rezk, S. S. R. (2019). Clinical effectiveness of multi-wavelength photobiomodulation therapy as an adjunct to extracorporeal shock wave therapy in the management of plantar fasciitis: a randomized controlled trial. Lasers in medical science, 34(3), 583–593.

What is the difference between focused shock wave (FSW) and radial pressure wave (RPW) therapy?

Posted on | by Cliff Eaton

Shock wave therapy is not a new modality; in its modern electronic form it has been around since the early 1980s, where it was first shown to have beneficial effects on treating kidney and biliary stones, and later on bone and wound healing.

However, despite now being an established medical intervention, questions still persist around the specifics of shock wave therapy. This article explains the difference between focused shock wave (F-SW) and radial pressure wave (RPW) therapy.

What are shock waves?

A shock wave is defined as a moving sound source travelling at more than the speed of sound. A stationary sound wave emits acoustic pressure waves that are evenly distributed in all directions. However, when the sound source is moving, the sound waves in front are compressed, and if the source moves faster than the speed of sound, the compressed waves overlap and create a shock wave, which is heard as a sonic boom.

It was noted that shock waves travel much better through water than they do through air, and that they could affect the body on a cellular level, thereby stimulating its intrinsic healing mechanism. This led to efforts to harness this phenomenon for medical applications, and the resulting technology became commonly known as shock wave therapy.

A brief history of shock wave therapy

Shock wave therapy as we know it first came into practical use in the 1980s, in the form of focused shock wave (F-SW). As with the emergence of any new intervention, there was immediately a great deal of interest – and hype – surrounding it.

Researchers began conducting clinical trials, but with no real guidelines on parameters, results were conflicting. At the same time, therapists were treating through trial and error, with outcomes ranging from very good to poor. This led to a drop in interest during the 1990s, with practitioners becoming disillusioned with F-SW, due also in part to the relative high cost of the devices.

However, with the advent of modified modalities, better research, and the technology to study the therapeutic effects on a molecular level, interest in shock wave therapy was rekindled around the end of the 1990s. Manufacturers began building more affordable clinic-based F-SW devices, and therapists became better at incorporating shock wave therapy into their treatments, all of which helped lead to better outcomes for patients.

Then, towards the end of the 1990s, a new technology emerged: radial pressure wave (RPW) therapy. Just as F-SW machines were becoming more affordable, RPW devices turned out to be even cheaper to produce and answered the demand from clinicians for a shock wave technology that could be used to treat on a more superficial level over larger areas.

Now shock wave therapy is an accepted and valued intervention that generates positive outcomes, supported by a wide range of clinical studies, and with far more affordable devices available to practitioners.

The differences between focus shock wave and radial pressure wave therapy

While focused shock wave (F-SW) therapy and radial pressure wave (RPW) therapy are often referred to together as ‘shock wave’, or extracorporeal shock wave therapy, only one is truly worthy of the definition.

F-SW delivers maximum energy at a focal point in the tissue at a depth of between 4-6cm, though some devices can achieve therapeutic energy values down to 12cm. Conversely, RPW delivers maximum energy at the surface of the skin, which then travels radially into the body up to a depth of 5-6cm. If we look at the physical properties of the two interventions, we can see they are completely different (Fig. 1).

Firstly, a focused shock wave will produce a pressure peak in the range of 10-100 Mega-Pascals (MPa), compared to the positive peak pressure of 0.1-1 MPa for a radial pressure wave – 100 times the amount of energy. Furthermore, the time taken for a focused shock wave to reach that peak, as well as its overall pulse duration, is far shorter than that of an RPW.

Therefore, unlike F-SW, a radial pressure wave is not a ‘true’ shock wave.

Additionally, while both technologies involve the conversion of electrical energy into mechanical energy, the ways in which focused shock waves and radial pressure waves are generated and delivered are also different.

F-SW machines generate shock waves using either electrohydraulic, electromagnetic, or piezoelectric technology. The shock waves are generated in water contained in a standoff attached to a handheld applicator. These waves are then focused through a lens and transmitted into the tissue.

Most RPW machines generate radial pressure waves using either oil or air compressors. During use, the compressed air is released via a valve into the barrel of a hand-held applicator which contains a small projectile. As the valve opens and closes very quickly, the projectile is driven by the compressed air into a transmitter at the end of the applicator, where the kinetic energy is converted into acoustic shock waves.

To learn more about the effects and applications of shock wave therapy:

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