Journal articles on the topic 'Key words: volleyball, ankle, injury'

Background: The aim of study was to look into the frequency and nature of on-court injuries in female basketball players (FBP) and to determine the most common on-court injuries as well as their anatomical locations. Method: cross sectional descriptive survey study design adopted. The data was gathered through the use of a structured self -administered questionnaire in the form of Google form via social media platforms (WhatsApp, Instagram, Facebook) and e-mail. Using total population sampling design, 40 participants were calculated who filled the form. The collected data were analysed using descriptive analysis. Result: The study found that the commonest injured anatomical area was the ankle (32%) and the commonest nature of injury was joint (22.2%) followed by muscle (20.9%). Conclusion: The study concludes that the lower extremity injuries were the most common. It identified the ankle injuries to be the commonest injuries occurring in female basketball players. Key words: Female basketball players, ankle injuries, basketball, on-court injuries.

Background: The spike is a key action in volleyball, and the landing technique and its asymmetries are commonly associated with an increased risk of injury. Objectives: The aim of this systematic review was to assess how male and female volleyball players land (i.e., unilaterally, or bilaterally) after spike jumps in matches and analytical settings (field or laboratory). Methods: The Preferred Reporting Items for Systematic Reviews and Meta-Analyses 2020 guidelines were followed, with eligibility criteria defined according to participants, interventions, comparators, study design (PICOS): (p) healthy indoor volleyball players of any sex, age group, or competitive level; (i) exposure to landing after spike actions during official matches AND/OR simulated 6 vs. 6 games AND/OR analytical training conditions AND/OR laboratorial experiments; (c) not mandatory; (o) data on landing mechanics after spike actions, including reporting of whether the landing was unilateral or bilateral; (s) no restrictions imposed on study design. Searches were performed in seven electronic databases (Cochrane Library, EBSCO, PubMed, Scielo, Scopus, SPORTDiscus, and Web of Science) on 23 April 2021. Results: Automated searches provided 420 results. Removal of 119 duplicates resulted in 301 records being screened for titles and abstracts. A total of 25 studies were eligible for full-text analysis. Of these, eight studies were deemed eligible for inclusion in the review. Studies showed that (i) attackers landed asymmetrically 68% of the times (61% left leg, 7% right leg); (ii) bilateral asymmetries were observed for the hip, knee, and ankle joints; (iii) bilateral asymmetries were observed even when players were instructed to land evenly on two feet; (iv) landing contact of the leg opposite to the hitting arm preceded the contact of the homolateral leg. One match analysis study showed that men landed more often on the left (31.5%) or right foot (8.5%) than women (23.7% and 1.6%). Conclusions: Studies analyzing spike landing showed a prevalence of unilateral landings (mostly the left leg first, for right-handed players) in men and women but more prevalently in men. Registration INPLASY202140104, DOI: 10.37766/inplasy2021.4.0104.

Reference: Schiftan GS, Ross LA, Hahne AJ. The effectiveness of proprioceptive training in preventing ankle sprains in sporting populations: a systematic review and meta-analysis. J Sci Med Sport. 2015;18(3):238–244. Clinical Question: Does the use of proprioceptive training as a sole intervention decrease the incidence of initial or recurrent ankle sprains in the athletic population? Data Sources: The authors completed a comprehensive literature search of MEDLINE, CINAHL, SPORTDiscus, and Physiotherapy Evidence Database (PEDro) from inception to October 2013. The reference lists of all identified articles were manually screened to obtain additional studies. The following key words were used. Phase 1 population terms were sport*, athlet*, and a combination of the two. Phase 2 intervention terms were propriocept*, balance, neuromusc* adj5 train*, and combinations thereof. Phase 3 condition terms were ankle adj5 sprain*, sprain* adj5 ankle, and combinations thereof. Study Selection: Studies were included according to the following criteria: (1) the design was a moderate- to high-level randomized controlled trial (>4/10 on the PEDro scale), (2) the participants were physically active (regardless of previous ankle injury), (3) the intervention group received proprioceptive training only, compared with a control group that received no proprioceptive training, and (4) the rate of ankle sprains was reported as a main outcome. Search results were limited to the English language. No restrictions were placed on publication dates. Data Extraction: Two authors independently reviewed the studies for eligibility. The quality of the pertinent articles was assessed using the PEDro scale, and data were extracted to calculate the relative risk. Data extracted were number of participants, intervention, frequency, duration, follow-up period, and injury rate. Main Results: Of the initial 345 studies screened, 7 were included in this review for a total of 3726 participants. Three analyses were conducted for proprioceptive training used (1) to prevent ankle sprains regardless of history (n = 3654), (2) to prevent recurrent ankle sprains (n = 1542), or (3) as the primary preventive measure for those without a history of ankle sprain (n = 946). Regardless of a history of ankle sprain, participants had a reduction in ankle-sprain rates (relative risk [RR] = 0.65, 95% confidence interval [CI] = 0.55, 0.77; numbers needed to treat [NNT] = 17, 95% CI = 11, 33). For individuals with a history of ankle sprains, proprioceptive training demonstrated a reduction in repeat ankle sprains (RR = 0.64, 95% CI = 0.51, 0.81; NNT = 13, 95% CI = 7, 100). Proprioceptive training as a primary preventive measure demonstrated significant results (RR = 0.57, 95% CI = 0.34, 0.97; NNT = 33, 95% CI = 16, 1000). Conclusions: Proprioceptive training programs were effective in reducing the incidence rates of ankle sprains in the athletic population, including those with and those without a history of ankle sprains.

Background: The application of radiofrequency (RF) has been successfully used in the treatment of chronic pain conditions, including facet arthropathy, sacroiliac joint pain, groin pain, radicular pain, cervicogenic headaches, and phantom limb pain. Due to the neurodestructive effect of continuous RF ablation and possible deafferentation sequelae, only pulsed radiofrequency (PRF) has been applied to peripheral sensory nerves. There are no previous reports of successful PRF application to the sural nerve. Objectives: To report on the successful use of PRF to the sural nerve for the treatment of ankle pain. To discuss current theories on the mechanism by which PRF produces pain relief. Methods: The report presented here describes the case of a 39-year old patient who sustained injury to her ankle. The patient was complaining of pain in the distribution of the sural nerve, which was confirmed by electrodiagnostic studies. The pain did not respond to oral and topical analgesics. The patient had short-term relief with a sural block with bupivacaine and triamcinolone. The patient then underwent PRF application to the right sural nerve for 240 seconds at 45 volts. Results: The patient reported complete relief. There was no pain recurrence 5 months after the procedure. Limitations: This report describes a single case report. Conclusions: It is conceivable that PRF may provide long-term pain relief in cases of sural nerve injury. The exact mechanism of the antinociceptive effect is still unknown. Possible mechanisms include changes in molecular structure by the electric field, early gene expression, stimulation of descending inhibitory pathways, and transient inhibition of excitatory transmission. Key words: chronic ankle pain, sural neuropathy, radiofrequency, pulsed radiofrequency application

Objective: The objective of the study was to determine the versatility of reverse sural artery flap in terms of its reliability and efficacy for reconstruction of soft-tissue defects of heel and proximal foot in children. Material and Methods: A total of 30 patients aged 5-13 years with ankle and foot defects admitted to the Plastic Surgery and Burn department at the Sheikh Zayed Hospital, Rahim Yar Khan from January 2018 to July 2020 were studied by designing a retrospective cross-sectional case series study. Results: Out of 30 flaps, 26 (86.7%) healed fully, whereas 4 (13.3%) complicated by partial necrosis requiring a secondary procedure. Nineteen (63.3%) patients had wheel spoke injuries, eight (26.6%) sustained degloving injury after a road traffic accident, and three (0.1%) patients were having a history of electric burn. In 22 patients an interpolated flap was used and in 8 cases an islanded flap. Donor sites were skin grafted in all patients. Two patients developed hypertrophic scarring at donor area. All patients showed good functional results, however flap remained insensate throughout the follow-up period that was minimum for 6 months. Conclusion: The reverse sural artery flap is versatile, reliable and a method of choice in reconstructing soft-tissue defects of the hind foot in children. This flap is easy to dissect, has robust blood supply and does not sacrifice any major blood vessel of the leg. Key Words: Reverse Sural Artery Flap, children, Ankle and Foot, Soft-tissue Defects, Wheel Spook Injury

Effects of contraction history on torque deficits by stretches of active skeletal muscles were examined. After three contractions using maximal and submaximal activation (80 and 20 Hz) at an ankle position of 40° (i.e., long muscle length) and with maximal activation at 120° (i.e., short muscle length), the isometric and stretch torques (15 stretches) of rat plantar flexor muscles (bout 1) were measured. Controls were unconditioned. Stretches (i.e., ankle rotation from 90° to 40°, velocity: 50°•s−1) were imposed on maximal isometric contractions at 90° (i.e. preloaded stretches). All groups performed a second bout following 2 hours of rest after bout 1. After maximal contractions at long muscle length, preload torque at 90° and stretch torque at 40° for stretch 1 of bout 1 were 25% and 18% lower than the other groups. However, for all groups, bout 1 ended and bout 2 began and ended with similar isometric and stretch torques. Stretches early in bout 2, with preloads similar to stretches in bout 1, had greater stretch torques resulting in larger torque deficits. Torque deficits, possibly caused by damage to muscle structures and excitation-contraction uncoupling, were not prevented by a history of isometric contractions. Different contraction histories can result in similar isometric torques but different stretch torques. Key words: injury, warm-up, isometric contractions, prevention, eccentric contractions

Background and Objectives: Gait is an automatic function in healthy individuals that demands minimal or no attention to maintain a steady pattern. Alterations in gait are associated with multiple factors, yet strongest association is seen with lower limb joint arthritis, osteoarthritis of knee being the commonest. Alterations in gait of OA knee individuals are compensatory strategies to reduce medial knee joint loading and pain. Till date, numerous compensatory gait strategies to alter external knee adduction moment have been identified and reported in the literature. The objectives of current narrative review are to report effects of gait modifications on loading of knee and spine in individuals with knee OA. Methods: A literature search for current study was performed in electronic databases of PubMed and Google scholar from 1990 to 2019 with “Gait”, “Biomechanics” and “OA knee” as key words. 584 articles were assessed, articles assessing gait or fall risk in OA knee following ACL/meniscal injury, total knee replacement or any type of knee surgery, medications or any type of therapeutic interventions were eliminated. Findings: Increased hip abduction and lateral trunk leaning during swing phase, contralateral pelvic drop, increased anterior tilting of pelvis, increased hip, knee and ankle flexion angles in sagittal plane, increased step width, increased hip internal rotation, weight transfer to the medial foot are common strategies adopted by OA knee individuals to reduce Knee Adduction Moment (KAM). A few studies have reported adverse loading of spine, hip joints and contralateral knee because of gait adaptations seen in individuals with knee OA. Conclusion: Findings of current review suggests that altered trunk and pelvis kinematics may predispose OA knee individuals to development of degenerative low back pain, which should be given attention while planning rehabilitation strategies for OA knee individuals. Key words: OA knee, Gait, Knee adduction moment, Trunk lean.

Aim: To compare footprints of security personnel with age and gender matched individuals. Background: The human foot and ankle are the last segments, the last within the complex kinetic chain of the lower limb as a whole. The foot is one of the most important interaction parts of the body with the ground, especially in the upright posture. During growth, the foot changes not only its dimensions but also its shape. The lower back, leg, ankle and foot are the most commonly affected region causing pain in security personnel during prolonged standing and sitting. This may also lead to change in the arch of the foot and predispose it to the injury. In this study, we aim to analyze footprints with reference to Staheli Index and Chippaux-Smirak Index of security guards and age and gender matched individuals. Methodology: 25 security personnel and 25 age and gender matched individuals were selected as per inclusion criteria. Demographic data like age, gender, height, weight, BMI and any injury in last 6 months were recorded for all study participants. For obtaining foot prints, ink was applied to the feet of the subjects. The subjects were tasked to step on graph paper in standing position, leaving a clear impression of foot’s plantar surface on the paper. The various distances in centimeters were taken using a transparent ruler. The Staheli Index and Chippaux-Smirak Index were also calculated. Result: Statistical analysis showed significant difference in Staheli Index, Chippaux-Smirak Index, Distance E and G between security personnel and age and gender matched individuals. The other values (A, B, C, D, F) were not found to be statistically different. Conclusion: The distance E and distance G is more in age and gender matched individuals as compared to security personnel. Also the Staheli Index and Chippaux-Smirak Index is less in security guards which indicates higher arch as compared to age and gender matched individuals. Key words: footprint, arch of foot, security personnel, Staheli Index, Chippaux-Smirak Index.

Objective: To identify and analyze articles in which the authors examined risk factors for soldiers during military static-line airborne operations. Data Sources: We searched for articles in PubMed, the Defense Technical Information Center, reference lists, and other sources using the key words airborne, parachuting, parachutes, paratrooper, injuries, wounds, trauma, and musculoskeletal. Study Selection: The search identified 17 684 potential studies. Studies were included if they were written in English, involved military static-line parachute operations, recorded injuries directly from events on the landing zone or from safety or medical records, and provided data for quantitative assessment of injury risk factors. A total of 23 studies met the review criteria, and 15 were included in the meta-analysis. Data Extraction: The summary statistic obtained for each risk factor was the risk ratio, which was the ratio of the injury risk in 1 group to that of another (baseline) group. Where data were sufficient, meta-analyses were performed and heterogeneity and publication bias were assessed. Data Synthesis: Risk factors for static-line parachuting injuries included night jumps, jumps with extra equipment, higher wind speeds, higher air temperatures, jumps from fixed-wing aircraft rather than balloons or helicopters, jumps onto certain types of terrain, being a female paratrooper, greater body weight, not using the parachute ankle brace, smaller parachute canopies, simultaneous exits from both sides of an aircraft, higher heat index, winds from the rear of the aircraft on exit entanglements, less experience with a particular parachute system, being an enlisted soldier rather than an officer, and jumps involving a greater number of paratroopers. Conclusions: We analyzed and summarized factors that increased the injury risk for soldiers during military static-line parachute operations. Understanding and considering these factors in risk evaluations may reduce the likelihood of injury during parachuting.

The isolated epidural gas-containing pseudocyst is an uncommon pathogenic factor for severe pain of the lower limb as a result of nerve root compression. After reviewing these rare cases reported in the literature, we found that the name, pathogenesis, and treatment strategy of this pathology remained controversial. The most common treatment is conservative treatment or percutaneous aspiration which might result in poor pain relief and high recurrence rates. Moreover, the patient who received open surgery had good clinical outcome; however, he or she might experience a significant soft tissue injury. In this study, we report the first case of a patient who had a giant epidural gas-containing pseudocyst and received percutaneous endoscopic surgery. This 57-year-old man had been complaining of severe radicular pain in his right ankle for one year. According to computed tomography (CT) and magnetic resonance imaging (MRI) prior to the surgery, the results showed an isolated epidural gas-containing pseudocyst was located in the right lateral recess of S1. At the last follow-up period, postoperative CT scan showed the gas-contained pseudocyst was completely resected and this patient was free from the pain. Due to the great advances in endoscopic techniques and equipment, it is easier to perform lumbar surgery through the endoscope. With this first case of percutaneous endoscopic treatment for the symptomatic epidural gas-containing pseudocyst reported in this study, we believe that this surgical method provides an option to treat this rare condition because it provides sufficient decompression, has a low recurrence rate, and is minimally invasive. Key words: Endoscopic surgery, pseudocyst, epidural gas, intraspinal gas, radiulopathy

Most cases of complex regional pain syndrome (CRPS) occur after some inciting injury. There are a few cases of CRPS after an operation for disc disease. CRPS from a mild herniated intervertebral disc (HIVD) without surgical intervention is even rarer than CRPS after an operation for disc disease. A 22-year-old man was transferred to a pain clinic. He had continuously complained about back and right leg pain. He presented with a skin color change in the right lower leg, intermittent resting tremor, stiffness, and swelling in the right leg. He complained of a pulling sensation and numbness in his right buttock, posterior thigh, lateral calf, and ankle. This symptom was in accordance with L4/5 radiculopathy. Magnetic resonance imaging (MRI) also showed L4/5 HIVD that was central to the bilateral subarticular protrusion. He was diagnosed as having CRPS, which fits the revised International Association for the Study of Pain (IASP) criteria. He fulfilled 4 symptom categories (allodynia, temperature asymmetry and skin color change, sweating changes, decreased range of motion and motor dysfunction) and 3 of 4 sign categories (allodynia, temperature asymmetry and skin color changes, decreased range of motion and motor dysfunction). The bone scan and thermography also revealed CRPS. For the past 2 months, we have performed intensive treatments. But, he never became painfree and walking for 5 minutes led to persistent leg pain. We decided to perform percutaneous nucleoplasty, which can directly decompress a HIVD. On the next day, he achieved dramatic symptom relief. The visual analog scale (VAS) score improved to 3, compared to the VAS score of 9 at the first visit. The skin color change, allodynia, and tremor in the right leg disappeared, and the temperature asymmetry normalized. Motor weakness of the right leg also recovered. We report an unusual case of CRPS that was caused by L4/5 HIVD without a history of trauma or surgery. It has a clear causal relationship between HIVD and CRPS and definitively fits in the newly revised IASP criteria. In conclusion, mild HIVD can cause CRPS without any trauma. And percutaneous nucleoplasty can be considered as a treatment option. Key words: Complex regional pain syndrome, diagnosis, herniated intervertebral disc, nucleoplasty, radiculopathy, sign, symptom, treatment

The most numerous and most complex group of diseases which result in impairment of human function of support and walking are neuro-muscular diseases and traumas of a spine and a spinal cord. Impairments which rise as a consequence of such diseases, require effective orthotic management which will allow the patient to compensate the lost functions necessary at stable walking. For the last 15 years in Ukraine, as well as in the world, a great many of various constructions of orthoses on different levels of the lower extremity, which cover all existing pathologies, has appeared. But as practical experience of global and domestic orthotic management indicates, a significant amount of adult patients who have serious impairments of function of the lower extremities, and first of all new patients, do not use orthoses manufactured for them. The principal causes are: – Absence of comprehension by the patient, whether orthoses are necessary for him, whether he and his family can create conditions at home for his training; – Complexity of choice of an orthosis with correct functionality, made by the doctor and the orthotist. Recently in medical practice for the decision of this problem therapeutical – training orthoses or test-orthoses start to play the increasing role. More often test-orthoses are used before manufacturing of expensive orthoses, for example, knee-ankle-foot orthoses with a knee joint with electronic control. Use of such test-orthoses considerably reduces the time of orthotic management, but, unfortunately, they are not used for persons with serious pathology of lower extremities and cannot be used for determination of functional abilities of patients, especially in new ones. Therefore development of a new construction and a technique of application of test-orthoses (modular orthopedic systems) becomes an important stage in rehabilitation process of persons with serious pathological condition of a locomotor system. Purpose – to present and analyze the experience of application of new constructions of knee-ankle-foot test-orthoses for persons with impairments of functions of support and walking at the final stage of accomplishment of rehabilitation measures, namely provision with individual orthoses in hospital environment. Materials and methods. During realization of the research in the clinic of Ukrainian Research Institute for Prosthetics and Rehabilitation 28 patients (8 women and 20 men) from 21 to 50 years of age were examined, passed a course of rehabilitation treatment and were provided with new constructions of test-orthoses. 25 patients had consequences of traumatic injury of a spine (10 persons with injury at cervical level of a spine, 15 persons – at thoracic and lumbar levels of a spine), 2 persons – with consequences of a cerebral stroke, 1 – with consequences of a spinal stroke. All of them could not stand and walk independently. Rehabilitation measures directed on increasing of general physical status, elimination or decreasing of neurotrophic disorders have been earlier carried out for a significant amount (85.0%) of the examined persons; 72.0% of patients had experience of verticalization in a knee support device. Depending on a seriousness of a lesion the patients were divided into two groups: I group – patients with a lesion of the upper and lower extremities (12 persons); ІІ group – patients with a lesion of the lower extremities (16 persons). For each group the individual technique of application of test-orthoses and modes of their mastering have been developed. Test-orthoses, on the average, were used for one hour per day, within 8–11 days, for mastering of independent walking according to the developed techniques under supervision of the instructor. Service properties of testorthoses and their reliability were evaluated. Clinical, biomechanical diagnostic study of patients and manual testing of affected lower extremities of patients on residual muscle power were carried out, namely: muscle power on was evaluated five-scored Janda scale. Results. In Ukrainian Research Institute for Prosthetics and Rehabilitation within the framework of research work a new construction of a knee-anklefoot test-orthosis and a technique of its application for 2 groups of persons with serious lesions of a locomotor system have been developed. The feature of new constructions of test-orthoses is the possibility of their quick assembly and adjustment (within 2–3 hours) in view of the individual sizes of the patient, due to a modular approach of selection and connection of components. All patients of the group I could stand independently in orthoses in high walkers. Seven patients could move independently in walkers on the distance up to 30 meters, five moved on distance of 10 meters with the help of the instructor. After a 10-day course of mastering of verticalization and walking with test-orthoses a decision was made concerning the design of individual orthoses. Six patients have refused orthotic management for the lack of conditions for training at home. In their case test-orthoses were used as a trainer for verticalization and exercises in a standing position on a designed technique. Patients of the group II moved in bars and in low walkers on a distance from 100 to 300 meters. After mastering walking within 8–10 days with test-orthoses a decision was made concerning the design of individual orthoses. Knee-ankle-foot orthoses with locking knee joints were manufactured to seven patients, inarticulated knee joints and pneumocylinders – to four patients, an inarticulated floor reaction ankle-foot orthosis – to one patient. One patient with consequences of a spinal stroke used test-orthoses at home within 3.5 months. As a result of regular training the muscle power of her left leg and in part of her right leg was restored. In her case test-orthoses helped to avoid expenses on manufacturing of two individual knee-ankle-foot orthoses. The orthosis on her right leg was manufactured which has allowed her to save function of muscles of the leg during walking due to installation of the pneumatic cylinder in the field of the knee joint, that compensated weakness of the quadriceps muscle of the hip in the stance phase. Conclusions. Application of standard test-orthoses allows to estimate physical abilities of patients, to learn them to use orthoses on the lower extremities, to determine for everyone an optimal construction of individual orthoses that enables to refuse long and expensive process of manufacturing of a non-effective and not comfortable individual orthosis beforehand. The further research is necessary for expansion of possibilities of use of testorthoses for children with serious lesions of functions of support and walking. The research was carried out in accordance with the principles of the Helsinki declaration. The study protocol was approved by the Local ethics committee of the participating institution. The informed consent of the patient was obtained for conducting the studies. No conflict of interest was declared by the authors. Key words: locomotor functions impairment; constructions of test-orthoses; efficiency of orthotic management; knee joint; ankle joint.

Objectives: Proximal 5th metatarsal fractures in athletes are common and have been studied in NCAA athletics as well as professional basketball (NBA), football (NFL), and European soccer (UEFA). Given that Jones fractures have not been studied in Major League Soccer (MLS), we sought to: (1) quantify the burden of fractures, (2) compare outcomes, re-fracture rates, and complication rates with other professional sports, (3) analyze factors for treatment failure, and (4) report return to play characteristics. Methods: A HealtheAthlete (Cerner Corporation, North Kansas City, MO) database was used to catalog all MLS injuries including and after the 2012 season. We extracted all possible Jones fracture injuries from these data from the 2013 to 2017 seasons (January 1, 2013 through December 31, 2017) using key words “toe,” “Jones,” “metatarsal,” “fracture,” and “fifth.” Over 12,000 unique injuries were cataloged; 141 were initially further investigated. Eighty-four were deemed benign, leaving 57 injuries; 12 were reported twice and 3 had 2 different dates of injury, leaving 42 injuries. We then contacted each team chief medical officer for more information including: demographics, date and mechanism of injury, injury classification (zone), prior or contralateral injury, limb dominance, imaging, operative vs. non-operative treatment, details regarding operative treatment if relevant, time to radiographic healing, time to return to sport, and complications including known re-fracture. Twenty-one injuries were further excluded, leaving 21 operatively treated Jones fractures in 18 players. Results: We analyzed 21 operatively treated Jones fractures in 18 players over the five-year study period. Fracture incidence was 0.37 ± 0.08 fractures per 1000 game exposure hours, or 0.063 ± 0.014 fractures per 1000 total exposure hours. Average age, weight, height, and BMI of players at time of fracture was 25.0 ± 3.7 years, 171.3 ± 17.2 lbs, 70.6 ± 3.2 inches, and 24.2 ± 1.9, respectively. 73.7% of players were right foot dominant, and 52.4% of players had right-sided injuries; 1 player reported bilateral injuries. Player position was reported as predominantly defense, midfield, or forward 44.4%, 16.7%, and 28.9%, respectively. 38.1% of injuries occurred in pre-season, with 38.1% associated with chronic, worsening pain, 23.8% with a rolled ankle/foot, 23.8% with a traumatic event, and 14.3% with a quick cut or pivot. One player reported concomitant medial sesamoiditis, otherwise there were no reported associated injuries. Five (24%) reported a prior contralateral fracture. Two (10%) reported a prior ipsilateral non-operatively treated stress fracture. Zone 2 injuries represented 81% of fractures, with the rest classified as zone 3. Average time into MLS career was 2.6 seasons; 8 (38%) occurred in the rookie season. Re-fracture rate was 4/18 players (22.2%), with 1 player’s initial fracture outside the study period; 2 players re-fracture occurred within the study period; and 1 player sustained a re-fracture while on loan (primary fracture included in the study). Average time to re-fracture was 390 days. Treatment for primary fractures (n = 18) included solid screw fixation in 11, cannulated screw fixation in 3, headless cannulated screw fixation in 3, and plate fixation with bone autograft in 1. Treatment for re-fractures (n = 3) included screw exchange with BMAC for 1, screw exchange and bone scaffold with PDGF in 1, and BMAC injection alone with bone stimulator for 1. Average time to radiographic union was 8.3 weeks. Average time to return to play was 10.4 weeks with one outlier removed. Complications include 4 re-fractures, 1 player with screw irritation who required exchange to headless screw with BMAC at 4 months post-op before return to play, 1 mild soft tissue irritation, and 1 mild persistent drainage that resolved with antibiotics. Overall, 20/21 (95%) of players returned to play. Currently, 5 players are retired, 7 remain in MLS, and 6 play in other worldwide professional leagues. Retired players averaged 2.8 years of play after injury. Player return to play characteristics were examined, including games played, games started, full games played, and minutes played; no statistical differences were found. Conclusion: Incidence of Jones fractures appears to be about 1.7x higher than previously reported in European professional soccer (UEFA) (Ekstrand and van Dijk Br J Sports Med 2013). However, articles examining Jones fractures incidence in NFL have shown increased prevalence in the NFL combine over the past few decades (Low et al J Surg Orth Adv 2004, Tu et al FAI 2018, Spang et al OJSM 2018). A significant number of injuries occur in pre-season (38%) and in players’ rookie seasons (38%), with the majority playing non-midfield positions. Return to play of 95% and re-fracture rate of 22% are comparable to rates in other professional sports. There does not appear to be any detrimental effect on players’ ability to perform after Jones fracture fixation.

The relevance of the topic is dictated by the high frequency of osteopenia and osteoporosis in children with cerebral palsy (CP) with IV and V levels according to the GMFCS and the corresponding number of cases of osteoporotic fractures in such patients. During the treatment of such children there are a number of significant problems: reduced mechanical properties and osteoporotic changes in bone tissue, there are pronounced contractures of adjacent joints, inability to move independently, increased risk of bedsores, concomitant neurological pathology and more. This issue is covered in a number of foreign publications and the search for solutions continues. Purpose – sharpen the attention of doctors, staff of rehabilitation centers, parents at increased risk of osteoporotic fractures in patients with CP. To determine the strategy of treatment of such fractures and features of further management of patients of this category. Materials and methods. During the period from 2014 to 2021, 11 patients with CP with osteoporotic fractures of the femur (12 fractures, 1 child with bilateral injuries) were treated in the Chernihiv Regional Children’s Hospital. Rehabilitation and rehabilitation therapy was conducted at the Regional Center for Comprehensive Rehabilitation of Children with Disabilities «Renaissance». Age distribution: from 3 years to 17 years, with the exception of 1 adult patient 40 years (body weight 30 kg). By form of CP: spastic paresis in 9, flaccid paresis in 2 patients. By type of CP: tetraparesis in 9, diplegia in 2 patients. According to the level of GMFCS: III level – 2, IV level – 6, V level – 3 patients. Radiography was performed in 2 projections according to standard methods during fracture diagnosis, intraoperatively, and in the process of consolidation control. Results. All patients had neurological disorders, moved with support or in a wheelchair, had contractures of adjacent joints, according to the pattern, type and form of cerebral palsy, had difficulty with proper nutrition, most had comorbidities. Fractures of the femur occurred from a minor injury (falling from a minor height), or the application of minor force (in the process of exercise, massage or development of movements). Traumagenesis: during the care and development of movements by parents – 3, fall in the home – 2, during an epileptic seizure – 2, during exercise therapy in medical institutions – 4. It should be emphasized that in the case of spastic subluxation and hip dislocation, as well as the available history of reconstructive interventions on the hip joint dramatically increase the possibility of osteoporotic fractures. Clinical manifestations are often obscured: in most cases, children are non-contact (mental retardation of various degrees causes a negative psychological reaction – «white coat» syndrome), have altered pain threshold, traumatic tissue edema and hematomas are not expressed, pre-existing spastic contractures and deformities injured limb. Treated conservatively (plaster fixation) – 6 patients, surgical treatment was performed in 5 children. In the case of conservative treatment, plaster fixation was performed according to the general principles, but taking into account the contractures of the joints that were before the traumatic injury. For example, an oppressive bandage was applied with flexion in the knee joint (in the case of flexion contracture) and/or flexion in the ankle joint (in the presence of an equinus foot installation). Preference was given to polymeric materials, which improved the possibility of hygienic care, air permeability, significantly reduced the weight of the immobilization bandage. In the case of surgical treatment, minimally invasive methods were preferred: ESIN, which allowed to stabilize the fracture, and to avoid long-term fixation in a plaster cast. We draw the attention of orthopedic traumatologists to possible technical difficulties during surgery, which are associated with reduced density and strength of bone tissue! According to the indications (pronounced flexion-drive contractures of the thighs), tenomyotomies of the thigh adductors and partial tenotomy of the illiopsoas muscle were performed. In all cases, consolidation of femoral fractures was achieved in standard time. Conclusions. Patients with CP who are unable to move independently have an increased risk of fractures of the femur in connection with which there is a need for preventive antiosteoporotic measures (verticalization of such patients in special devices, medical treatment (calcium and vitamin D), use vibration, etc.). It is necessary to sharpen the attention of parents, staff of rehabilitation centers, doctors on this issue and use non-aggressive methods in the process of rehabilitation. Orthopedic traumatologists should apply a special strategy for the treatment and management of children with CP with osteoporotic fractures of the femur. The research was carried out in accordance with the principles of the Helsinki declaration. The study protocol was approved by the Local ethics committee of all participating institutions. The informed consent of the patient was obtained for conducting the studies. No conflict of interest was declared by the author. Key words: children, fractures of the femur, spastic paresis, cerebral palsy, GMFCS, osteoporos in children.

Ankle sprains are a very common injury, suffered by approximately 25,000 patients per year, and affect all age groups, including children, athletes, and the elderly. The recognition of the type of ankle sprain (medial, lateral, syndesmotic) affects early and late management of ankle sprains. Also discussed are the acute diagnosis and treatment of ankle sprains, as well as the consequences of chronic ankle instability, which may include serious conditions such as complex regional pain syndrome and chronic ankle instability. Surgical and nonsurgical treatment, evaluation, prognosis, and prevention are also discussed. Key words: ankle pain, ankle sprain, chronic ankle instability, complex regional pain syndrome, cryoneuroablation, high ankle sprain, lateral ankle sprain, medial ankle sprain,

What we wear signals our membership within groups, be theyorganised by gender, class, ethnicity or religion. Simultaneously our clothing signifies hierarchies and power relations that sustain dominant power structures. How we dress is an expression of our identity. For Veblen, how we dress expresses wealth and social stratification. In imitating the fashion of the wealthy, claims Simmel, we seek social equality. For Barthes, clothing is embedded with systems of meaning. For Hebdige, clothing has modalities of meaning depending on the wearer, as do clothes for gender (Davis) and for the body (Entwistle). For Maynard, “dress is a significant material practice we use to signal our cultural boundaries, social separations, continuities and, for the present purposes, political dissidences” (103). Clothing has played a central role in historical and contemporary forms of political dissent. During the French Revolution dress signified political allegiance. The “mandated costumes, the gold-braided coat, white silk stockings, lace stock, plumed hat and sword of the nobility and the sober black suit and stockings” were rejected as part of the revolutionary struggle (Fairchilds 423). After the storming of the Bastille the government of Paris introduced the wearing of the tricolour cockade, a round emblem made of red, blue and white ribbons, which was a potent icon of the revolution, and a central motif in building France’s “revolutionary community”. But in the aftermath of the revolution divided loyalties sparked power struggles in the new Republic (Heuer 29). In 1793 for example anyone not wearing the cockade was arrested. Specific laws were introduced for women not wearing the cockade or for wearing it in a profane manner, resulting in six years in jail. This triggered a major struggle over women’s abilities to exercise their political rights (Heuer 31).Clothing was also central to women’s political struggles in America. In the mid-nineteenth century, women began wearing the “reform dress”—pants with shortened, lightweight skirts in place of burdensome and restrictive dresses (Mas 35). The wearing of pants, or bloomers, challenged gender norms and demonstrated women’s agency. Women’s clothes of the period were an "identity kit" (Ladd Nelson 22), which reinforced “society's distinctions between men and women by symbolizing their natures, roles, and responsibilities” (Ladd Nelson 22, Roberts 555). Men were positioned in society as “serious, active, strong and aggressive”. They wore dark clothing that “allowed movement, emphasized broad chests and shoulders and presented sharp, definite lines” (Ladd Nelson 22). Conversely, women, regarded as “frivolous, inactive, delicate and submissive, dressed in decorative, light pastel coloured clothing which inhibited movement, accentuated tiny waists and sloping shoulders and presented an indefinite silhouette” (Ladd Nelson 22, Roberts 555). Women who challenged these dress codes by wearing pants were “unnatural, and a perversion of the “true” woman” (Ladd Nelson 22). For Crane, the adoption of men’s clothing by women challenged dominant values and norms, changing how women were seen in public and how they saw themselves. The wearing of pants came to “symbolize the movement for women's rights” (Ladd Nelson 24) and as with women in France, Victorian society was forced to consider “women's rights, including their right to choose their own style of dress” (Ladd Nelson 23). As Yangzom (623) puts it, clothing allows groups to negotiate boundaries. How the “embodiment of dress itself alters political space and civic discourse is imperative to understanding how resistance is performed in creating social change” (Yangzom 623). Fig. 1: 1850s fashion bloomersIn a different turn is presented in Mahatma Gandhi’s Khadi movement. Khadi is a term used for fabrics made on a spinning wheel (or charkha) or hand-spun and handwoven, usually from cotton fibre. Khadi is considered the “fabric of Indian independence” (Jain). Gandhi recognised the potential of the fabric to a self-reliant, independent India. Gandhi made the struggle for independence synonymous with khadi. He promoted the materials “simplicity as a social equalizer and made it the nation’s fabric” (Sinha). As Jain notes, clothing and in this case fabric, is a “potent sign of resistance and change”. The material also reflects consciousness and agency. Khadi was Gandhi’s “own sartorial choices of transformation from that of an Englishman to that of one representing India” (Jain). For Jain the “key to Khadi becoming a successful tool for the freedom struggle” was that it was a “material embodiment of an ideal” that “represented freedom from colonialism on the one hand and a feeling of self-reliance and economic self-sufficiency on the other”. Fig. 2: Gandhi on charkha The reappropriating of Khadi as a fabric of political dissent echoes the wearing of blue denim by the Student Nonviolent Coordinating Committee (SNCC) at the 1963 National Mall Washington march where 250,000 people gather to hear Martin Luther King speak. The SNCC formed in 1960 and from then until the 1963 March on Washington they developed a “style aesthetic that celebrated the clothing of African American sharecroppers” (Ford 626). A critical aspect civil rights activism by African America women who were members of the SNCC was the “performance of respectability”. With the moral character of African American women under attack (as a way of delegitimising their political activities), the female activists “emphasized the outward display of their respectability in order to withstand attacks against their characters”. Their modest, neat “as if you were going to church” (Chappell 96) clothing choices helped them perform respectability and this “played an important performative role in the black freedom struggle” (Ford 626). By 1963 however African American female civil rights activists “abandoned their respectable clothes and processed hairstyles in order to adopt jeans, denim skirts, bib-and-brace overalls”. The adoption of bib-and-brace overalls reflected the sharecropper's blue denim overalls of America’s slave past.For Komar the blue denim overalls “dramatize[d] how little had been accomplished since Reconstruction” and the overalls were practical to fix from attack dog tears and high-pressure police hoses. The blue denim overalls, according to Komar, were also considered to be ‘Negro clothes’ purchased by “slave owners bought denim for their enslaved workers, partly because the material was sturdy, and partly because it helped contrast them against the linen suits and lace parasols of plantation families”. The clothing choice was both practical and symbolic. While the ‘sharecropper’ narrative is problematic as ‘traditional’ clothing (something not evident in the case of Ghandi’s Khandi Movement, there is an emotion associated with the clothing. As Barthes (6-7) has shown, what makes ‘traditional clothing,’ traditional is that it is part of a normative system where not only does clothing have its historical place, but it is governed by its rules and regimentation. Therefore, there is a dialectical exchange between the normative system and the act of dressing where as a link between the two, clothing becomes the conveyer of its meanings (7). Barthes calls this system, langue and the act of dressing parole (8). As Ford does, a reading of African American women wearing what she calls a “SNCC Skin” “the uniform [acts] consciously to transgress a black middle-class worldview that marginalised certain types of women and particular displays of blackness and black culture”. Hence, the SNCC women’s clothing represented an “ideological metamorphosis articulated through the embrace and projection of real and imagined southern, working-class, and African American cultures. Central to this was the wearing of the blue denim overalls. The clothing did more than protect, cover or adorn the body it was a conscious “cultural and political tool” deployed to maintain a movement and build solidarity with the aim of “inversing the hegemonic norms” via “collective representations of sartorial embodiment” (Yangzom 622).Fig. 3: Mississippi SNCC March Coordinator Joyce Ladner during the March on Washington for Jobs and Freedom political rally in Washington, DC, on 28 Aug. 1963Clothing in each of these historical examples performs an ideological function that can bridge, that is bring diverse members of society together for a cause, or community cohesion or clothing can act as a fence to keep identities separate (Barnard). This use of clothing is evident in two indigenous examples. For Maynard (110) the clothes worn at the 1988 Aboriginal ‘Long March of Freedom, Justice and Hope’ held in Australia signalled a “visible strength denoted by coherence in dress” (Maynard 112). Most noted was the wearing of colours – black, red and yellow, first thought to be adopted during protest marches organised by the Black Protest Committee during the 1982 Commonwealth Games in Brisbane (Watson 40). Maynard (110) describes the colour and clothing as follows:the daytime protest march was dominated by the colours of the Aboriginal people—red, yellow and black on flags, huge banners and clothing. There were logo-inscribed T-shirts, red, yellow and black hatband around black Akubra’s, as well as red headbands. Some T-shirts were yellow, with images of the Australian continent in red, others had inscriptions like 'White Australia has a Black History' and 'Our Land Our Life'. Still others were inscribed 'Mourn 88'. Participants were also in customary dress with body paint. Older Indigenous people wore head bands inscribed with the words 'Our Land', and tribal elders from the Northern Territory, in loin cloths, carried spears and clapping sticks, their bodies marked with feathers, white clay and red ochres. Without question, at this most significant event for Aboriginal peoples, their dress was a highly visible and cohesive aspect.Similar is the Tibetan Freedom Movement, a nonviolent grassroots movement in Tibet and among Tibet diaspora that emerged in 2008 to protest colonisation of Tibet. It is also known as the ‘White Wednesday Movement’. Every Wednesday, Tibetans wear traditional clothes. They pledge: “I am Tibetan, from today I will wear only Tibetan traditional dress, chuba, every Wednesday”. A chuba is a colourful warm ankle-length robe that is bound around the waist by a long sash. For the Tibetan Freedom Movement clothing “symbolically functions as a nonverbal mechanism of communication” to “materialise consciousness of the movement” and functions to shape its political aims (Yangzom 622). Yet, in both cases – Aboriginal and Tibet protests – the dress may “not speak to single cultural audience”. This is because the clothing is “decoded by those of different political persuasions, and [is] certainly further reinterpreted or reframed by the media” (Maynard 103). Nevertheless, there is “cultural work in creating a coherent narrative” (Yangzom 623). The narratives and discourse embedded in the wearing of a red, blue and white cockade, dark reform dress pants, cotton coloured Khadi fabric or blue denim overalls is likely a key feature of significant periods of political upheaval and dissent with the clothing “indispensable” even if the meaning of the clothing is “implied rather than something to be explicated” (Yangzom 623). On 21 January 2017, 250,000 women marched in Washington and more than two million protesters around the world wearing pink knitted pussy hats in response to the remarks made by President Donald Trump who bragged of grabbing women ‘by the pussy’. The knitted pink hats became the “embodiment of solidarity” (Wrenn 1). For Wrenn (2), protests such as this one in 2017 complete with “protest visuals” which build solidarity while “masking or excluding difference in the process” indicates “a tactical sophistication in the social movement space with its strategic negotiation of politics of difference. In formulating a flexible solidarity, the movement has been able to accommodate a variety of races, classes, genders, sexualities, abilities, and cultural backgrounds” (Wrenn 4). In doing so they presented a “collective bodily presence made publicly visible” to protest racist, sexist, homophobic, Islamophobic, and xenophobic white masculine power (Gokariksel & Smith 631). The 2017 Washington Pussy Hat March was more than an “embodiment tactic” it was an “image event” with its “swarms of women donning adroit posters and pink pussy hats filling the public sphere and impacting visual culture”. It both constructs social issues and forms public opinion hence it is an “argumentative practice” (Wrenn 6). Drawing on wider cultural contexts, as other acts of dissent note here do, in this protest with its social media coverage, the “master frame” of the sea of pink hats and bodies posited to audiences the enormity of the anger felt in the community over attacks on the female body – real or verbal. This reflects Goffman’s theory of framing to describe the ways in which “protestors actively seek to shape meanings such that they spark the public’s support and encourage political openings” (Wrenn 6). The hats served as “visual tropes” (Goodnow 166) to raise social consciousness and demonstrate opposition. Protest “signage” – as the pussy hats can be considered – are a visual representation and validation of shared “invisible thoughts and emotions” (Buck-Coleman 66) affirming Georg Simmel’s ideas about conflict; “it helps individuals define their differences, establish to which group(s) they belong, and determine the degrees to which groups are different from each other” (Buck-Coleman 66). The pink pussy hat helped define and determine membership and solidarity. Further embedding this was the hand-made nature of the hat. The pattern for the hat was available free online at https://www.pussyhatproject.com/knit/. The idea began as one of practicality, as it did for the reform dress movement. This is from the Pussy Hat Project website:Krista was planning to attend the Women’s March in Washington DC that January of 2017 and needed a cap to keep her head warm in the chill winter air. Jayna, due to her injury, would not be able to attend any of the marches, but wanted to find a way to have her voice heard in absentia and somehow physically “be” there. Together, a marcher and a non-marcher, they conceived the idea of creating a sea of pink hats at Women’s Marches everywhere that would make both a bold and powerful visual statement of solidarity, and also allow people who could not participate themselves – whether for medical, financial, or scheduling reasons — a visible way to demonstrate their support for women’s rights. (Pussy Hat Project)In the tradition of “craftivism” – the use of traditional handcrafts such as knitting, assisted by technology (in this case a website with the pattern and how to knit instructions), as a means of community building, skill-sharing and action directed towards “political and social causes” (Buszek & Robertson 197) –, the hand-knitted pink pussy hats avoided the need to purchase clothing to show solidarity resisting the corporatisation of protest clothing as cautioned by Naomi Klein (428). More so by wearing something that could be re-used sustained solidarity. The pink pussy hats provided a counter to the “incoherent montage of mass-produced clothing” often seen at other protests (Maynard 107). Everyday clothing however does have a place in political dissent. In late 2018, French working class and middle-class protestors donned yellow jackets to protest against the government of French President Emmanuel Macron. It began with a Facebook appeal launched by two fed-up truck drivers calling for a “national blockade” of France’s road network in protest against rising fuel prices was followed two weeks later with a post urging motorist to display their hi-vis yellow vests behind their windscreens in solidarity. Four million viewed the post (Henley). Weekly protests continued into 2019. The yellow his-vis vests are compulsorily carried in all motor cars in France. They are “cheap, readily available, easily identifiable and above all representing an obligation imposed by the state”. The yellow high-vis vest has “proved an inspired choice of symbol and has plainly played a big part in the movement’s rapid spread” (Henley). More so, the wearers of the yellow vests in France, with the movement spreading globally, are winning in “the war of cultural representation. Working-class and lower middle-class people are visible again” (Henley). Subcultural clothing has always played a role as heroic resistance (Evans), but the coloured dissent dressing associated with the red, blue and white ribboned cockades, the dark bloomers of early American feminists, the cotton coloured natural fabrics of Ghandi’s embodiment of resistance and independence, the blue denim sharecropper overalls worn by African American women in their struggles for civil rights, the black, red and orange of Aboriginal protestors in Australia and the White Wednesday performances of resistance undertaken by Tibetans against Chinese colonisation, the Washington Pink Pussy Hat marches for gender respect and equality and the donning of every yellow hi-vis vests by French protestors all posit the important role of fabric and colour in protest meaning making and solidarity building. It is in our rage we consciously wear the colours and fabrics of dissent dress. ReferencesBarnard, Malcolm. Fashion as Communication. New York: Routledge, 1996. 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