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Fractures of the calcaneus are often associated with serious permanent disability, a considerable reduction in quality of life, and high socio-economic cost. Although some studies have already reported changes in plantar pressure distribution after calcaneal fracture, no investigation has yet focused on the patient's strength and postural control.
Method: 60 patients with unilateral, operatively treated, intra-articular calcaneal fractures were clinically and biomechanically evaluated >1 year postoperatively (physical examination, SF-36, AOFAS score, lower leg isokinetic strength, postural control and gait analysis including plantar pressure distribution). Results were correlated to clinical outcome and preoperative radiological findings (Bohler angle, Zwipp and Sanders Score).
Results: Clinical examination revealed a statistically significant reduction in range of motion at the tibiotalar and the subtalar joint on the affected side. Additionally, there was a statistically significant reduction of plantar flexor peak torque of the injured compared to the uninjured limb (p < 0.001) as well as a reduction in postural control that was also more pronounced on the initially injured side (standing duration 4.2 +/- 2.9 s vs. 7.6 +/- 2.1 s, p < 0.05). Plantar pressure measurements revealed a statistically significant pressure reduction at the hindfoot (p = 0.0007) and a pressure increase at the midfoot (p = 0.0001) and beneath the lateral forefoot (p = 0.037) of the injured foot.
There was only a weak correlation between radiological classifications and clinical outcome but a moderate correlation between strength differences and the clinical questionnaires (CC 0.27-0.4) as well as between standing duration and the clinical questionnaires. Although thigh circumference was also reduced on the injured side, there was no important relationship between changes in lower leg circumference and strength suggesting that measurement of leg circumference may not be a valid assessment of maximum strength deficits. Self-selected walking speed was the parameter that showed the best correlation with clinical outcome (AOFAS score).
Conclusion: Calcaneal fractures are associated with a significant reduction in ankle joint ROM, plantar flexion strength and postural control. These impairments seem to be highly relevant to the patients. Restoration of muscular strength and proprioception should therefore be aggressively addressed in the rehabilitation process after these fractures.
Permafrost is a distinct feature of the terrestrial Arctic and is vulnerable to climate warming. Permafrost degrades in different ways, including deepening of a seasonally unfrozen surface and localized but rapid development of deep thaw features. Pleistocene ice-rich permafrost with syngenetic ice-wedges, termed Yedoma deposits, are widespread in Siberia, Alaska, and Yukon, Canada and may be especially prone to rapid-thaw processes. Freeze-locked organic matter in such deposits can be re-mobilized on short time-scales and contribute to a carbon-cycle climate feedback. Here we synthesize the characteristics and vulnerability of Yedoma deposits by synthesizing studies on the Yedoma origin and the associated organic carbon pool. We suggest that Yedoma deposits accumulated under periglacial weathering, transport, and deposition dynamics in non-glaciated regions during the late Pleistocene until the beginning of late glacial warming. The deposits formed due to a combination of aeolian, colluvial, nival, and alluvial deposition and simultaneous ground ice accumulation. We found up to 130 gigatons organic carbon in Yedoma, parts of which are well-preserved and available for fast decomposition after thaw. Based on incubation experiments, up to 10% of the Yedoma carbon is considered especially decomposable and may be released upon thaw. The substantial amount of ground ice in Yedoma makes it highly vulnerable to disturbances such as thermokarst and thermo-erosion processes. Mobilization of permafrost carbon is expected to increase under future climate warming. Our synthesis results underline the need of accounting for Yedoma carbon stocks in next generation Earth-System-Models for a more complete representation of the permafrost-carbon feedback.
Lakes are a ubiquitous landscape feature in northern permafrost regions. They have a strong impact on carbon, energy and water fluxes and can be quite responsive to climate change. The monitoring of lake change in northern high latitudes, at a sufficiently accurate spatial and temporal resolution, is crucial for understanding the underlying processes driving lake change. To date, lake change studies in permafrost regions were based on a variety of different sources, image acquisition periods and single snapshots, and localized analysis, which hinders the comparison of different regions. Here, we present a methodology based on machine-learning based classification of robust trends of multi-spectral indices of Landsat data (TM, ETM+, OLI) and object-based lake detection, to analyze and compare the individual, local and regional lake dynamics of four different study sites (Alaska North Slope, Western Alaska, Central Yakutia, Kolyma Lowland) in the northern permafrost zone from 1999 to 2014. Regional patterns of lake area change on the Alaska North Slope (-0.69%), Western Alaska (-2.82%), and Kolyma Lowland (-0.51%) largely include increases due to thermokarst lake expansion, but more dominant lake area losses due to catastrophic lake drainage events. In contrast, Central Yakutia showed a remarkable increase in lake area of 48.48%, likely resulting from warmer and wetter climate conditions over the latter half of the study period. Within all study regions, variability in lake dynamics was associated with differences in permafrost characteristics, landscape position (i.e., upland vs. lowland), and surface geology. With the global availability of Landsat data and a consistent methodology for processing the input data derived from robust trends of multi-spectral indices, we demonstrate a transferability, scalability and consistency of lake change analysis within the northern permafrost region.