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To critically assess the literature focused on strength training of the intrinsic foot muscles (IFMs) and resulting improvements in foot function. A search of electronic databases (PubMed, CINAHL, Scopus, and SPORTDiscus) was completed between January 2000 and March 2022. Randomized control trials with an outcome of interest and at least 2 weeks of IFM exercise intervention were included. Outcomes of interest were broadly divided into 5 categories of foot posture (navicular drop and Foot Posture Index), namely: balance, strength, patient-reported outcomes, sensory function, and motor performance. The PEDro scale was used to assess the methodologic quality of the included studies with 2 independent reviewers rating each study. Studies with a PEDro score greater than 4/10 were included. Data extracted by 2 independent reviewers were design, participant characteristics, inclusion and exclusion criteria, type of intervention, outcomes, and primary results. We performed a random-effects meta-analysis to analyze the difference between intervention and control groups for each outcome when at least 2 studies were available. Standardized mean differences (SMDs) describe effect sizes with 95% CIs (SMD ranges). When the CI crossed zero, the effect was not significant. Thirteen studies were included, and IFM exercise interventions were associated with decreasing navicular drop (SMD range = 0.37, 1.83) and Foot Posture Index (SMD range = 1.03, 1.69) and improving balance (SMD range = 0.18, 1.86), strength (SMD range = 0.06, 1.52), and patient-reported outcomes for disability (SMD range = 0.12, 1.00), with pooled effect sizes favoring the IFM intervention over the control. The IFM exercises were not superior (SMD range = -0.15, 0.66) for reducing pain. We could not perform a meta-analysis for sensory function and motor performance, as only 1 study was available for each outcome; however, these results supported the use of IFM strength training. Strength training of the IFMs was helpful for patients in improving foot and ankle outcomes.

The intrinsic foot muscles (IFM), or foot core, provides stability to the foot skeleton. IFM dysfunction has been linked to foot and ankle injuries; however, the functional assessment of IFM in lower extremity conditions remains a clinical conundrum. We undertook a large study to understand the differences in muscle size and quality of IFM across a spectrum of conditions including Chronic Ankle Instability (CAI), Patellofemoral Pain (PFP), 1.sup.st Metatarsophalangeal Joint (1.sup.st MTPJ) arthrodesis and in patients with diabetes. This study compares IFM morphology and tissue quality in patients across these conditions and healthy control group individuals. This study included 119 participants: 35 PFP, 29 CAI, 8 with 1.sup.st MTPJ arthrodesis, 9 with Diabetes, and 38 healthy controls. Ultrasound imaging (USI) assessed cross-sectional area (CSA) for muscle size and echogenicity for muscle quality in the Abductor Hallucis (AbH) and Flexor Digitorum Brevis (FDB). All size measures were normalized to body mass. Analysis of Coavariance (ANCOVA) was performed between groups, controlling for age and sex, to identify differences. Significant differences (P < 0.05) in the CSA of the AbH were found between all pathology groups and healthy control group, except for the 1.sup.st MTPJ group. CSA of FDB showed significant differences (P < 0.01) in all groups except the PFP and 1.sup.st MTPJ groups. For echogenicity, significant differences (P < 0.05) were found between groups for both AbH and FDB, while CAI, 1st MTPJ, and PFP groups showed higher FDB echogenicity. Large effect sizes were found for CSA and echogenicity in all groups except PFP. This is the first study to our knowledge to collectively analyze multiple clinical groups with suspected IFM weakness in functional position for both muscle size and quality. Significant changes in muscle size and quality were observed, suggesting that clinicians should assess and target IFM rehabilitation to improve foot and ankle function in these populations.

The intrinsic foot muscles (IFM), or foot core, provides stability to the foot skeleton. IFM dysfunction has been linked to foot and ankle injuries; however, the functional assessment of IFM in lower extremity conditions remains a clinical conundrum. We undertook a large study to understand the differences in muscle size and quality of IFM across a spectrum of conditions including Chronic Ankle Instability (CAI), Patellofemoral Pain (PFP), 1st Metatarsophalangeal Joint (1st MTPJ)  arthrodesis and in patients with diabetes. This study compares IFM morphology and tissue quality in patients across these conditions and healthy control group individuals. This study included 119 participants: 35 PFP, 29 CAI, 8 with 1st MTPJ arthrodesis, 9 with Diabetes, and 38 healthy controls. Ultrasound imaging (USI) assessed cross-sectional area (CSA) for muscle size and echogenicity for muscle quality in the Abductor Hallucis (AbH) and Flexor Digitorum Brevis (FDB). All size measures were normalized to body mass. Analysis of Coavariance (ANCOVA) was performed between groups, controlling for age and sex, to identify differences. Significant differences (P < 0.05) in the CSA of the AbH were found between all pathology groups and healthy control group, except for the 1st MTPJ group. CSA of FDB showed significant differences (P < 0.01) in all groups except the PFP and 1st MTPJ groups. For echogenicity, significant differences (P < 0.05) were found between groups for both AbH and FDB, while CAI, 1st MTPJ, and PFP groups showed higher FDB echogenicity. Large effect sizes were found for CSA and echogenicity in all groups except PFP. This is the first study to our knowledge to collectively analyze multiple clinical groups with suspected IFM weakness in functional position for both muscle size and quality. Significant changes in muscle size and quality were observed, suggesting that clinicians should assess and target IFM rehabilitation to improve foot and ankle function in these populations.

The causes of persistent muscle weakness after anterior cruciate ligament reconstruction (ACLR) are not well known. Changes in muscle oxygenation have been proposed as a possible mechanism. To investigate changes in quadriceps muscle oxygenation during knee extension in ACLR-involved and ACLR-uninvolved limbs. Case-control study. Laboratory. A total of 20 individuals: 10 patients with primary, unilateral ACLR (7 women, 3 men; age = 22.90 ± 3.45 years, height = 170.81 ± 7.93 cm, mass = 73.7 ± 15.1 kg) and 10 matched control individuals (7 women, 3 men; age = 21.50 ± 2.99 years, height = 170.4 ± 10.7 cm, mass = 68.86 ± 9.51 kg). Each participant completed a single data-collection session consisting of 5-second isometric contractions at 25%, 50%, and 75% of the volitional maximum followed by a 30-second maximal isometric knee-extension contraction. Oxygenated hemoglobin (O2Hb) measures in the reconstructed thigh were continuously recorded (versus the uninvolved contralateral limb as well as the nondominant thigh of healthy control individuals) using 3 wearable, wireless near-infrared spectroscopy units placed superficially to the vastus medialis, vastus lateralis, and rectus femoris muscles. Relative changes in oxygenation were ensemble averaged and plotted for each contraction intensity with associated 90% confidence intervals (CIs). Statistical significance occurred where portions of the exercise trials with confidence intervals on the O2Hb graph did not overlap. Effect sizes (Cohen d, 90% CI) were determined for statistical significance. We observed less relative change in O2Hb in patients with ACLR than in healthy control participants in the rectus femoris at 25% (d = 2.1; 90% CI = 1.5, 2.7), 50% (d = 2.8; 90% CI = 2.6, 2.9), and 75% (d = 2.0; 90% CI = 1.9, 2.2) and for the vastus medialis at 75% (d = 1.5; 90% CI = 1.4, 1.5) and 100% (d = 2.6; 90% CI = 2.5, 2.7). Less relative change in O2Hb was also noted for the vastus medialis in ACLR-involved versus ACLR-uninvolved limbs at 100% (d = 2.62; 90% CI = 2.54, 2.70). Quadriceps muscle oxygenation during exercise differed between patients with ACLR versus healthy control individuals. However, not all portions of the quadriceps were affected uniformly across contraction intensities.

Purpose To investigate the clinical measures of foot posture and morphology, multisegmented joint motion and play, strength, and dynamic balance in recreationally active young adults with and without a history of a lateral ankle sprain (LAS), copers, and chronic ankle instability (CAI). Methods Eighty recreationally active individuals (healthy: n  = 22, coper: n  = 21, LAS: n  = 17, CAI: n  = 20) were included. Foot posture index (FPI), morphologic measures, joint motion (weight-bearing dorsiflexion (WBDF), rearfoot dorsiflexion, plantar flexion, inversion, eversion; forefoot inversion, eversion; hallux flexion, extension), joint play (proximal and distal tibiofibular; talocrural and subtalar, forefoot; 1st tarsometatarsal and metatarsophalangeal), strength (dorsiflexion, plantar flexion, inversion, eversion, hallux flexion, lesser toe flexion), and Star Excursion Balance Test (SEBT) (anterior, posteromedial, posterolateral) were assessed. Results There were no group differences in FPI or morphological measures. LAS and CAI groups had decreased ankle dorsiflexion ( p  = 0.001) and greater frontal plane motion ( p  < 0.001), first MT plantar flexion, and sagittal excursion ( p  < 0.001); increased talocrural glide ( p  = 0.02) and internal rotation ( p  < 0.001) and decreased forefoot inversion joint play ( p  < 0.001); and decreased strength in all measures ( p  < 0.001) except dorsiflexion compared to healthy controls. The LAS group also demonstrated decreased distal tibiofibular ( p  = 0.04) and forefoot general laxity ( p  = 0.05) and SEBT performance (anterior: p  = 0.02; posteromedial: p  < 0.001; posterolateral: p  < 0.001). Conclusion Individuals with LAS or CAI have increased pain, impaired physiologic and accessory joint motion, ligamentous tenderness, and strength in the foot and ankle. Clinicians should assess the multiple segments of the ankle–foot complex when caring for individuals with an LAS or CAI. Level of evidence II.

Background Patellofemoral pain (PFP) is characterized by chronic pain in the anterior aspect of the knee during loading activities. Many studies investigating muscle morphology changes for individuals with PFP focus on the proximal joints, however, few studies have investigated muscles of the foot and ankle complex. This study aimed to explore the differences in peroneal muscle size and activation between individuals with PFP and healthy controls using ultrasound imaging in weight‐bearing. Methods A case‐control study in a university lab setting was conducted. Thirty individuals with PFP (age: 20.23 ± 3.30 years, mass: 74.70 ± 27.63 kgs, height: 161.32 ± 11.72 cm) and 30 healthy individuals (age: 20.33 ± 3.37 years, mass: 64.02 ± 11.00 kgs, height: 169.31 ± 9.30 cm) participated. Cross‐sectional area (CSA) images of the peroneal muscles were taken in non‐weight bearing and weight‐bearing positions. The functional activation ratio from lying to single‐leg standing (SLS) was calculated. Results There was a statistically significant (p = 0.041) group (PFP, healthy) by position (non‐weight‐bearing, weight‐bearing) interaction for the peroneal muscle CSA with a Cohen's d effect size of 0.2 in non‐weight‐bearing position and 0.7 in weight‐bearing position. The functional activation ratio for the healthy group was significantly more (p = 0.01) than the PFP group. Conclusion Peroneal muscles were found to be smaller in size in those with PFP compared to the healthy subjects in the weight‐bearing SLS position. This study found that those with PFP have lower activation of peroneal muscles in functional position.

Lateral ankle sprains (LAS) result in chronic ankle instability (CAI), causing ongoing instability. Although peroneal muscle weakness is documented in CAI, surface electromyography shows similar activation patterns between CAI and healthy individuals, suggesting structural rather than neural deficits. Ultrasound imaging (USI) uniquely enables noninvasive assessment of muscle morphology and quality through cross-sectional area and echogenicity measurements. However, previous USI studies examined peroneals only in nonweight-bearing positions, potentially missing functional deficits. This study examines peroneal muscle characteristics in CAI versus healthy individuals specifically during weight-bearing functional positions using USI. A case-control study was conducted with 58 participants (29 CAI and 29 healthy controls), aged 18-30 years. Cross-sectional area (CSA), echogenicity (grayscale analysis where higher values indicate fatty infiltration/fibrosis), and functional activation ratio (FAR) of the peroneal muscles were assessed using USI in nonweight-bearing (side lying) and weight-bearing (bilateral-leg standing (BLS) and single-leg standing (SLS)) positions. CSA images were averaged from three measurements for each position. The CAI group had significantly smaller CSA in BLS (p < 0.01) and SLS (p < 0.01) but not lying (p = 0.06), higher echogenicity indicating poorer muscle quality (69.7 ± 10.3 vs. 61.3 ± 7.0, p < 0.01), and lower FAR in both BLS (0.99 ± 0.13 vs. 1.13 ± 0.16, p < 0.01) and SLS (1.01 ± 0.17 vs. 1.12 ± 0.22, p = 0.03) compared to healthy controls. Individuals with CAI showed reduced peroneal muscle CSA, lower activation, and poorer muscle quality specifically in weight-bearing positions compared to healthy controls. These findings suggest altered muscle function in CAI especially in functional weight-bearing positions. This demonstrates the need to assess peroneals in functional weight-bearing position compared to resting.

 Researchers are increasingly interested in appraising the impact of their research work, which eventually drives public perception. The overall impact of a study can only be gauged if we consider both traditional and non-traditional dissemination patterns. Hence, we preferred to study the association between the non-traditional reader engagement metrics and traditional dissemination metrics in relation to coronavirus disease 2019 (COVID-19)-related research published in five high-impact peer-reviewed medical journals.  This observational study was conducted using data sourced from Altmetric, including the Altmetric attention score (AAS), an aggregate score of an article's dissemination. New England Journal of Medicine (NEJM), Lancet Infectious Diseases, Clinical Infectious Diseases (CID), Chest Journal (CHEST), and Journal of the American Medical Association (JAMA) were included in the study based on the prevalence of COVID-19-related original research published in each of them. The number of citations was framed as the reference for traditional metrics. To avoid artificial variance, data were collected on the same day, November 13, 2022. Correlational analyses were performed using the Pearson correlation coefficient using Minitab 17 (Minitab Inc., State College, PA). The relationship between the variables was considered very weak if r<0.3, weak if r: 0.3 to 0.5, moderate if r: 0.5 to 0.7, and strong for r>0.7.  We found a very weak correlation between citations and AAS for Clinical Infectious Diseases, Lancet Infectious Diseases, and CHEST, whereas the correlation was moderate for NEJM and JAMA. The correlation between citations and Twitter mentions was very weak for Clinical Infectious Disease, Lancet Infectious Disease, and CHEST, but it improved for NEJM and JAMA. There was a very weak correlation between citations and news mentions for Clinical Infectious Diseases, Lancet Infectious Diseases, and CHEST.  Our study highlights that the traditional indicator, i.e., citation has a very weak to moderate correlation with the AAS and it doesn't capture the entire influence of a research publication. Also, the current method of determining a journal's impact factor doesn't take this disparity into consideration. Hence, there needs to have a more inclusive strategy to define the impact of scientific research on the general population in real-time.

To identify if any differences exist in IFM size and quality in single leg weight bearing position between healthy and PFP participants based on foot posture. Cross-sectional, matched case-comparison study University Laboratory Setting 35 PFP (age:20.46 ± 3.79yrs, mass:73.28 ± 26.58 kg, height:170.80 ± 11.91 cm) and 35 healthy (age:20.40 ± 3.16yrs, mass:64.76 ± 11.52 kg, height:169.55 ± 9.10 cm) participants After measuring Foot Posture Index (FPI), ultrasound images (USI) of Abductor Hallucis (AH), Flexor Digitorum Brevis (FDB) and Quadratus Plantae (QP) were taken in a single limb weight bearing position. Cross-sectional area (CSA) and echogenicity were measured on the USI. FPI was not different between groups (PFP:2.34 ± 3.76, Healthy:2.34 ± 3.10, 9 pronated and 26 non-pronated in both groups). AH CSA was smaller in PFP than healthy group (PFP:0.030 ± 0.01 cm2/kg, Healthy:0.042 ± 0.01 cm2/kg, P < 0.001) with a large effect (d = −1.20(-1.71, −0.69). There were no other significant group main effects or group-by-FP interactions in AH/FDB/QP CSA or echogenicity. AH CSA was smaller in PFP than healthy controls, but no difference in CSA or echogenicity of FDB/QP exist, as well as no difference in foot posture between groups. While single limb weight bearing, the PFP group presented with a smaller IFM which provides eccentric control of medial longitudinal arch, which may have implications up the chain during weight bearing functional tasks. •Individuals with PFP have a smaller cross-sectional area of the AH than health.•There are no differences in muscle quality of IFM between PFP and healthy controls.•No differences in cross-sectional area of FDB, QP was found between PFP and healthy.

Patellofemoral pain (PFP) is a common source of knee pain in active individuals, accounting for a large number of knee injuries examined in sports medicine clinics. As a chronic condition, PFP can affect mental health. However, this effect has not yet been studied in individuals with PFP. To determine how subjective physical and mental health measures in individuals with PFP differed from those measures in pain-free individuals. Case-control study. Laboratory. Volunteers for the study were 30 people with PFP (19 women, 11 men; age = 20.23 ± 3.32 years, height = 166.69 ± 6.41 cm, mass = 69.55 ± 13.15 kg) and 30 matched pain-free individuals (19 women, 11 men; age = 20.33 ± 3.37 years, height = 169.31 ± 9.30 cm, mass = 64.02 ± 11.00 kg). Current and worst pain levels in the past 24 hours were determined using a visual analog scale (VAS). The Anterior Knee Pain Scale, Fear Avoidance Belief Questionnaire, and Lower Extremity Functional Scale were administered. Physical and mental health measures were obtained using a modified 12-item Short Form Health Survey. Scores for 2 subscales on the modified Short Form-12 were weighted and calculated: physical component and mental component.Independent t tests were calculated to compare variables between groups. Coefficient correlations were used to measure the associations between the variables. Individuals with PFP reported lower levels of physical (pain free: 56.13 ± 1.63, PFP: 50.54 ± 7.10, P < .001) and mental (pain-free: 53.32 ± 4.71, PFP: 48.64 ± 10.53, P = .03) health. In the PFP group, we found moderate negative correlations between the VAS score for current pain and mental health (r = -0.52, P < .01) and between the VAS score for worst pain in the past 24 hours and mental health (r = -0.46, P = .01) and between activity limitations in individuals with PFP and fear avoidance beliefs (r = -0.61, P < .01). Our results should encourage clinicians, especially musculoskeletal rehabilitation professionals, to acknowledge the importance of a whole-person approach when treating or planning rehabilitation programs for individuals with PFP.