ASICS FOOTWEAR REVIEW: CHARCOT FOOT GT-4000 2

Charcot Foot GT-4000 2

Thanks to Asics for this latest footwear review from Anthony Ng.

Charcot foot is a significant foot complication of Diabetes which involves a direct inflammatory response affecting bones, soft tissues and joints of the foot and ankle. The pathophysiology is unknown however, Charcot’s tends to develop from trauma, increased weight bearing along with neuropathy.

of a gross foot deformity, resulting in vast valgus malalignment, notably arch collapse with a rocker bottom appearance. This often results in increased stiffening of the foot, along with associated ligament changes altering the natural forces of gait which will lead to further lower limb complications.

The best strategy is to avoid this condition from occurring and diagnose early for prophylaxis. If Charcot’s foot has already occurred and settled, the deformity of the foot structures will need to be continually supported. If you have any suspicion of a patient whom you deem will develop this condition, the treatment is more therapeutic to stop, prevent or preserve the foot from deteriorating. Surgical intervention is recommended for the most serve foot disfigurements where all other non-surgical options are exhausted.

As the deformity mainly occurs at the Lisfranc joints, STJ and MTJ there will be the tendency for the foot to move medially. ASICS has engineered the new GT-4000 version 2, which provides the stiffening strength required at the rear and midportion of the shoe to help support those foot structures during the forces of plantar loading.

The GT-4000 uppers and correct midsole shore densities helps correct alignment and influences the pressure distribution to prevent subsequent disorganization of the foot from further deformity and provide those at risk with supportive footwear before this condition can eventuate. The strong midfoot truss offers reduced torsional twisting to increase stabilization and strength occurring around the mid tarsal region. This will provide the desirable control and help support those associated with a rocker bottom deformity.

This condition is associated with a lack of absorbency. Shock attenuation is required to provide comfort for those interlocking joints and bones throughout the gait cycle. The chosen foam offers durability and effective energy return providing comfort.

Charcot foot is a significant foot complication of Diabetes which involves a direct inflammatory response affecting bones, soft tissues and joints of the foot and ankle. The pathophysiology is unknown however, Charcot’s tends to develop from trauma, increased weight bearing along with neuropathy.

If healthcare professionals are unable to identify the condition at the acute phase to prevent the foot changes, it will result in significant deformation primarily occurring at the Lisfranc joints, STJ or mid tarsal region of the foot. The damage to the foot skeletal shape can be

The ideal pitch profile will not create additional trans ferred forces as the unstable foot moves through gait. The 2E width fit adds extra depth and girth to accom modate structural changes that may have occurred or provide the space for any accommodative custom fabricated devices.

Finding the correct footwear can be difficult, the GT-4000 provides some of the ideal requirements for this condition. GT-4000: Solid rigid constructed rear, with a durable dual-density midsole offers the desirable support thought out the medial and lateral longitudinal arch which extends through to the propulsive phase. Other conditions that this shoe may be benefit include:

Amputation to hallux: is associated with the structures of the midfoot to move medially. Altered pressure distribution occurs during the initial phase of propulsion causing the foot to move in a valgus direction, ultimately affect the timing of the gait cycle. The GT-4000 encompasses a strong extended midfoot component which improves sagittal alignment.

Flexible flatfoot with hallux Valgus: Notable weakening of foot muscles, causes ineffective transfer of energy which alters the timing of the foot during dynamic gait; this often makes normal push-off impossible. Ineffective sagittal plane motion causes increase foot deformity resulting in Hallux Valgus (HAV). Support required from distal midfoot to proximal forefoot. Posterior Tibial Dysfunction: Normally related to adults with an acquired flat foot deformity. resulting in tendon degeneration/ elongation changes. The presentation of a valgus deformity will require a supportive constructive shoe to improve foot alignment in providing a more positive ergonomic ride.

Pronation: Able to effectively control kinematics of pronation and reducing tibial rotation. Capable of replacing the need for orthotic therapy.

STJ Ligament Injury : Usually associated with a major traumatic sprain. Irritation occurs over the anterior ankle, with loss of strength in dorsiflexion. Supportive footwear to regain ankle hold and control.

Anthony Ng

B.Sc (Pod), B.Ed, Dip Tch

Complications After Anterior Cruciate Ligament Reconstruction and Their Relation to the Type of Graft A Prospective Study of 958 Cases

Romain Rousseau, MD, Charlotte Labruyere, MD, Charles Kajetanek, MD, Olivia Deschamps, MD, Konstantinos G. Makridis, MD, MSc, PhD, and Patrick Djian, MD

The American Journal of Sports Medicine 2019;47(11):2543-2549 DOI:10.1177/0363546519867913 By Pip Sail

Complications and adverse effects after Anterior Cruciate Ligament (ACL) reconstruction are well known. The purpose of this cohort study is to analyse them in relation to the type of graft.

After an isolated rupture of the ACL similar functional outcomes are obtained with the use of hamstring tendon, patella tendon, quadriceps and iliotibial band (ITB) grafts.1,36,38 90% of patients have normal knee function restored, 80% return to sports and 55% return to competitive sports. Despite this, there are several associated complications including surgical revision, that have the potential to create major effects on functional status and patient quality of life. This prospective study included 958 patients over a 2 year period with isolated rupture of the ACL with or without associated meniscal lesions. The type of graft chosen by the surgeon was based on the age of the patient and the type of sport they played. Partial weight bearing was allowed for the first 6 weeks progressing to full weight bearing as tolerated. Bicycling and jogging started 3 months after surgery in combination with muscle strength exercises. Pivot non-contact sports were allowed at 6 months and contact sport at 8-9 months. The patients were reviewed at 6 weeks and 3,6,12 and 24 months by an independent surgeon. Adverse events and complications included anterior knee pain, joint stiffness, secondary meniscal lesions, pain attributed to hardware, ACL re-rupture, bone complications, thromboembolic complications, haematomas and infection. The total rate of complications and adverse events was 39%. The total surgical revision was 28%. The surgical revision rate was significantly higher in the STG group than in the PT group.

DISCUSSION

Complications after ACL have been recorded in

several studies.1,9,11,12,14,23,25,30 Anterior knee pain is the most frequent complication effecting up to 50% of patients most likely due to the harvesting of PT grafts although also present in some STG patients. Mohtadi et al30 studied 330 patients and found no significant difference between PT and STG graft groups likely due to type of fixation used. Other authors demonstrated that anterior knee pain resolved within 2 years post ACL reconstruction.8.14,15,17,39 The decease in pain over time must be thoroughly explained to patients to reduce concern. Arthrofibrosis is also a common complication post ACL reconstruction, causing significant functional deficit11,27,32 and an increased rate of surgical revision. However the prognosis after surgical debridement was good at the 2 year follow-up. There was no difference between the PF and STG groups

in the extension deficit however there were more cases of Cyclops nodule in the STG group. Secondary meniscal lesions usually occur as a result of new trauma. In this study the majority happened early after the ACL reconstruction and seemed to occur in patients who already had an antecedent meniscal lesion and were independent of the graft type and likely to be due to the lack of scar formation in the pre-existing lesion and the subtle instability putting more stress on the lesion. Patients are exposed to the risk of re-rupture on return to sports activities. Participation in pivot and pivot/contact sports particularly at a high level , is one of the most important predictive factors of new ACL rupture3,26,35 and more recently it has been shown that meniscal deficiency is another predictor of graft failure in single bundle anatomic ACL reconstruction33 Time to return to sport and compliance with the specific rehabilitation protocol may also contribute to the graft re-rupture. In this study the STG group had more re-rupture cases although their activity was less competitive than the PT group. Patella fracture occurs in patients with the PT graft in less than 0.5%. This complication may effect rehabilitation and functional outcomes causing chronic anterior knee pain and stiffness.28

CONCLUSION

The total rate of complications after ACL reconstruction was 39% and surgical revision was 28% within a 2 year period. Problems with hardware material were more common in the STG group, leading to an increased rate of surgical revision. Anterior knee pain was initially higher in the PT group but not significantly different after 2 years. The re-rupture rate was statistically higher in the STG group. Rupture of the contralateral ACL was higher in the PT group possibly due to the return to a higher level of sport. The rate of adverse events is high and prolonged rehabilitation and follow-up is justified to diagnose and treat these events early.

A full set of references is available on request