Effects of 2 ankle destabilization devices on electromyography measures during functional exercises in individuals with chronic ankle instability.

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Donovan, Luke; Hart, Joseph M; Hertel, Jay

2015-03-01

Randomized crossover laboratory study. To determine the effects of ankle destabilization devices on surface electromyography (sEMG) measures of selected lower extremity muscles during functional exercises in participants with chronic ankle instability. Ankle destabilization devices are rehabilitation tools that can be worn as a boot or sandal to increase lower extremity muscle activation during walking in healthy individuals. However, they have not been tested in a population with pathology. Fifteen adults with chronic ankle instability participated. Surface electromyography electrodes were located over the anterior tibialis, fibularis longus, lateral gastrocnemius, rectus femoris, biceps femoris, and gluteus medius. The activity level of these muscles was recorded in a single testing session during unipedal stance with eyes closed, the Star Excursion Balance Test, lateral hops, and treadmill walking. Each task was performed under 3 conditions: shod, ankle destabilization boot, and ankle destabilization sandal. Surface electromyography signal amplitudes were measured for each muscle during each exercise for all 3 conditions. Participants demonstrated a significant increase, with moderate to large effect sizes, in sEMG signal amplitude of the fibularis longus in the ankle destabilization boot and ankle destabilization sandal conditions during the unipedal eyes-closed balance test, the Star Excursion Balance Test in the anterior and posteromedial directions, lateral hops, and walking, when compared to the shod condition. Both devices also resulted in an increase in sEMG signal amplitudes, with large effect sizes of the lateral gastrocnemius, rectus femoris, biceps femoris, and gluteus medius during the unipedal-stance-with-eyes-closed test, compared to the shod condition. Wearing ankle destabilization devices caused greater muscle activation during functional exercises in individuals with chronic ankle instability. Based on the magnitude of the effect, there were

Effects of joint mobilization on chronic ankle instability: a randomized controlled trial.

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Cruz-Díaz, David; Lomas Vega, Rafael; Osuna-Pérez, Maria Catalina; Hita-Contreras, Fidel; Martínez-Amat, Antonio

2015-01-01

To evaluate the effects of joint mobilization, in which movement is applied to the ankle's dorsiflexion range of motion, on dynamic postural control and on the self-reported instability of patients with chronic ankle instability (CAI). A double-blind, placebo-controlled, randomized trial with repeated measures and a follow-up period. Ninety patients with a history of recurrent ankle sprain, self-reported instability, and a limited dorsiflexion range of motion, were randomly assigned to either the intervention group (Joint Mobilizations, 3 weeks, two sessions per week) the placebo group (Sham Mobilizations, same duration as joint mobilization) or the control group, with a 6 months follow-up. Dorsiflexion Range of Motion (DFROM), Star Excursion Balance Test (SEBT) and CAI Tool (CAIT) were outcome measures. A separate 3 × 4 mixed model analysis of variance was performed to examine the effect of treatment conditions and time, and intention-to-treat (ITT) analysis was applied to evaluate the effect of the independent variable. The application of joint mobilization resulted in better scores of DFROM, CAIT, and SEBTs in the intervention group when compared with the placebo or the control groups (p ankle DFROM, postural control, and self-reported instability. These results suggest that joint mobilization could be applied to patients with recurrent ankle sprain to help restore their functional stability. Implications for Rehabilitation Functional instability is a very common sequela in patients with CAI, resulting in reduced quality of living due to the limitations it imposes on daily life activities. The mobilization with movement technique presented by Mulligan, and based on the joint mobilization accompanied by active movement, appears as a valuable tool to be employed by physical therapists to restore ankle function after a recurrent ankle sprain history. ROM restriction, subjective feeling of instability and dynamic postural control are benefiting from the joint

Active ankle motion may result in changes to the talofibular interval in individuals with chronic ankle instability and ankle sprain copers: a preliminary study.

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Croy, Theodore; Cosby, Nicole L; Hertel, Jay

2013-08-01

Alterations in talocrural joint arthrokinematics related to repositioning of the talus or fibula following ankle sprain have been reported in radiological and clinical studies. It is unclear if these changes can result from normal active ankle motion. The study objective was to determine if active movement created changes in the sagittal plane talofibular interval in ankles with a history of lateral ankle sprain and instability. Three subject groups [control (n = 17), ankle sprain copers (n = 20), and chronic ankle instability (n = 20)] underwent ultrasound imaging of the anterolateral ankle gutter to identify the lateral malleolus and talus over three trials. Between trials, subjects actively plantar and dorsiflexed the ankle three times. The sagittal plane talofibular interval was assessed by measuring the anteroposterior distance (mm) between the lateral malleolus and talus from an ultrasound image. Between group and trial differences were analyzed with repeated measures analysis of variance and post-hoc t-tests. Fifty-seven subjects participated. A significant group-by-trial interaction was observed (F4,108 = 3.5; P = 0.009). The talofibular interval was increased in both copers [2.4±3.6 mm; 95% confidence interval (CI): 0.73-4.1; P = 0.007] and chronic ankle instability (4.1±4.6 mm; 95% CI: 1.9-6.2; P = 0.001) at trial 3 while no changes were observed in control ankle talar position (0.06±2.8mm; 95% CI: -1.5-1.4; P = 0.93). The talofibular interval increased only in subjects with a history of lateral ankle sprain with large clinical effect sizes observed. These findings suggest that an alteration in the position of the talus or fibula occurred with non-weight bearing sagittal plane motion. These findings may have diagnostic and therapeutic implications for manual therapists.

Prevalence of chronic ankle instability and associated symptoms in university dance majors: an exploratory study.

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Simon, Janet; Hall, Emily; Docherty, Carrie

2014-01-01

Previous investigations have established that dancers suffer a large number of injuries to the lower leg, foot, and ankle, with a portion of these being significant time loss injuries or in some cases career ending. Lateral ankle sprain is a common injury in dancers and can often lead to recurrent instability and repetitive injuries. Research in other active populations has linked ankle sprains to the development of chronic ankle instability (CAI). Therefore, the purpose of this study was to identify the prevalence of CAI and related symptoms of ankle sprain in a student dance population. Individuals were included if they were currently a modern or ballet dance major at the investigators' university (exclusion criterion: a history of fracture or surgery in the lower extremities). A self-reported demographic questionnaire and the Identification of Functional Ankle Instability survey were used to identify the presence and characteristics of CAI. A total of 83 questionnaires were collected, and after exclusions, 77 participants remained: 43 modern dancers and 34 ballet dancers (10 males and 67 females, mean age 19.61 ± 2.53 years, mean dance experience 13.61 ± 3.16 years). Of all dancers surveyed, 41 (53.2%) had CAI, and of those 24 (58.5%) were modern dancers, and 17 (41.5%) were ballet dancers. When looking only at those dancers who had a previous lateral ankle sprain, 75.9% were identified as having CAI. Chronic Ankle Instability can create long-term problems for anyone but especially female dancers, who place extreme stress on their feet and ankles from being en pointe or demi-pointe. It is important to educate dancers, instructors, and medical staff of the importance of recognizing CAI and seeking medical care for ankle sprains and their residual symptoms.

New arthroscopic assisted technique for ankle instability

International Nuclear Information System (INIS)

Gerstner Garces, Juan Ricardo

2004-01-01

An assisted arthroscopic technique for chronic ankle instability is presented by the author, together with his results for 27 patients treated between January 2000 and February 2004, with a minimum follow-up of six months. Indications for his technique, according to the rehabilitation protocol of the Medical Centre, included patients with chronic subjective and objective ankle instability, anteroposterior instability, associated anteromedical impingement syndromes, non competitive athletes, patients not displaying defects in the alignment of the axis of foot and ankle, or systemic disorders such as diabetes mellitus, collagenisis or hyperelasticity. Patients were evaluated according to the AOFAS scale for the outcome of ankle procedures, and followed up for a minimum period of six months. Positive results confirm an efficient and effective technique, simple and easy to reproduce, that does not hinder future open anatomical or non-anatomical reconstruction, and in which complications are minimal

Chronic instability of the anterior tibiofibular syndesmosis of the ankle. Arthroscopic findings and results of anatomical reconstruction

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Swierstra Bart A

2011-09-01

Full Text Available Abstract Background The arthroscopic findings in patients with chronic anterior syndesmotic instability that need reconstructive surgery have never been described extensively. Methods In 12 patients the clinical suspicion of chronic instability of the syndesmosis was confirmed during arthroscopy of the ankle. All findings during the arthroscopy were scored. Anatomical reconstruction of the anterior tibiofibular syndesmosis was performed in all patients. The AOFAS score was assessed to evaluate the result of the reconstruction. At an average of 43 months after the reconstruction all patients were seen for follow-up. Results The syndesmosis being easily accessible for the 3 mm transverse end of probe which could be rotated around its longitudinal axis in all cases during arthroscopy of the ankle joint, confirmed the diagnosis. Cartilage damage was seen in 8 ankles, of which in 7 patients the damage was situated at the medial side of the ankle joint. The intraarticular part of anterior tibiofibular ligament was visibly damaged in 5 patients. Synovitis was seen in all but one ankle joint. After surgical reconstruction the AOFAS score improved from an average of 72 pre-operatively to 92 post-operatively. Conclusions To confirm the clinical suspicion, the final diagnosis of chronic instability of the anterior syndesmosis can be made during arthroscopy of the ankle. Cartilage damage to the medial side of the tibiotalar joint is often seen and might be the result of syndesmotic instability. Good results are achieved by anatomic reconstruction of the anterior syndesmosis, and all patients in this study would undergo the surgery again if necessary.

Validity of the lower extremity functional movement screen in patients with chronic ankle instability

OpenAIRE

Choi, Ho-Suk; Shin, Won-Seob

2015-01-01

[Purpose] The purpose of this study was to provide evidence of construct validity for the lower extremity functional movement screen (LE-FMS) based on hypothesis testing in patients with chronic ankle instability (CAI). [Subjects] The subjects were 20 healthy subjects and 20 patients with CAI who had a history of ankle sprain with pain for more than 1 day. [Methods] All participants were measured using the Foot and Ankle Disability Index (FADI) and evaluated with the LE-FMS. The screen includ...

Arthroscopic repair of chronic lateral ankle instability.

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Corte-Real, Nuno M; Moreira, Rodrigo M

2009-03-01

The current "gold standard'' for treatment of chronic lateral ankle instability is the Broström-Gould procedure. Most authors recommend this type of operation even after an arthroscopic inspection of the joint. We review our results with an arthroscopic method of lateral ankle ligament repair. A method of arthroscopic lateral ligament repair with an anchor placed in the fibula is described. We used this technique on 31 consecutive patients (28 were available for followup). Twenty-one patients had work or traffic accidents, four suffered casual falls. and three had sport-related lesions. The patients were evaluated after 24.5 month average followup. The average postoperative AOFAS score was 85.3 (82.3 in the workers-compensation group and 94.4 in the others) and average satisfaction was 3.8 (3.5 to workers-compensation and 4.6 for the others). Complications occurred in nine patients (29%), but only three cases had ongoing problems. We had two recurrences (another sprain without instability on the stress radiograph). Three patients had some wound healing problems and three had injuries of the superficial peroneal nerve, one of which is persistent. One patient developed a deep venous thrombosis postoperatively. With this method, we achieved good clinical results. We had several complications but most of them were minor. It was a simple procedure with less morbidity to most patients. We believe it produced an anatomical repair of the lateral ligament with clinical and functional results similar to other techniques.

慢性踝关节不稳的研究进展%Research Progress of Chronic Ankle Instability

Institute of Scientific and Technical Information of China (English)

刘欣; 黄真

2015-01-01

Ankle sprain is the most common injury of lower limbs. Without proper treatment,it is likely to develop chronic ankle instability. This paper summarized possible pathogenesis of chronic ankle instability, illustrated from the perspectives of proprioceptive disorder,dysfunction of neuromuscular and postural control and weakness of muscles around ankle joint,pointed out the rehabilitation programs which were often used,and provided suggestions for the clinical rehabilitation training of chronic ankle instability.%踝关节扭伤是下肢最常见的损伤，如未得到合理的处理很容易发展成为慢性踝关节不稳。本文归纳了慢性踝关节不稳可能的发病机制，从本体感觉障碍、神经肌肉控制不全、姿势控制功能不全及周围肌群肌力减退等方面进行了阐述，指出了目前常采用的康复训练方法及效果，为慢性踝关节不稳的临床康复训练提供建议。

Selection criteria for patients with chronic ankle instability in controlled research: a position statement of the International Ankle Consortium

NARCIS (Netherlands)

Gribble, P.A.; Delahunt, E.; Bleakley, C.M.; Caulfield, B.; Docherty, C.L.; Fong, D.T.; Fourchet, F.; Hertel, J.; Hiller, C.E.; Kaminski, T.W.; McKeon, P.O.; Refshauge, K.M.; Wees, P.J. van der; Vicenzino, W.; Wikstrom, E.A.

2014-01-01

While research on chronic ankle instability (CAI) and awareness of its impact on society and health care systems has grown substantially in the last 2 decades, the inconsistency in participant or patient selection criteria across studies presents a potential obstacle to addressing the problem

Selection criteria for patients with chronic ankle instability in controlled research: a position statement of the International Ankle Consortium

NARCIS (Netherlands)

Gribble, P.A.; Delahunt, E.; Bleakley, C.; Caulfield, B.; Docherty, C.; Fourchet, F.; Fong, D.T.; Hertel, J.; Hiller, C.; Kaminski, T.; McKeon, P.; Refshauge, K.; Wees, P.J. van der; Vincenzino, B.; Wikstrom, E.

2014-01-01

While research on chronic ankle instability (CAI) and awareness of its impact on society and health care systems has grown substantially in the last 2 decades, the inconsistency in participant/patient selection criteria across studies presents a potential obstacle to addressing the problem properly.

Value of stress ultrasound for the diagnosis of chronic ankle instability compared to manual anterior drawer test, stress radiography, magnetic resonance imaging, and arthroscopy.

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Cho, Jae Ho; Lee, Doo Hyung; Song, Hyung Keun; Bang, Joon Young; Lee, Kyung Tai; Park, Young Uk

2016-04-01

Clinicians frequently diagnose chronic ankle instability using the manual anterior drawer test and stress radiography. However, both examinations can yield incorrect results and do not reveal the extent of ankle instability. Stress ultrasound has been reported to be a new diagnostic tool for the diagnosis of chronic ankle instability. The purpose of this study was to assess the diagnostic value of stress ultrasound for chronic ankle instability compared to the manual anterior drawer test, stress radiography, magnetic resonance imaging (MRI), and arthroscopy. Twenty-eight consecutive patients who underwent ankle arthroscopy and subsequent modified Broström repair for treatment of chronic ankle instability were included. The arthroscopic findings were used as the reference standard. A standardized physical examination (manual anterior drawer test), stress radiography, MRI, and stress ultrasound were performed to assess the anterior talofibular ligament (ATFL) prior to operation. Ultrasound images were taken in the resting position and the maximal anterior drawer position. Grade 3 lateral instability was verified arthroscopically in all 28 cases with a clinical diagnosis (100%). Twenty-two cases showed grade III instability on the manual anterior drawer test (78.6%). Twenty-four cases displayed anterior translation exceeding 5 mm on stress radiography (86%), and talar tilt angle exceeded 15° in three cases (11 %). Nineteen cases displayed a partial chronic tear (change in thickness or signal intensity), and nine cases displayed complete tear on MRI (100%). Lax and wavy ATFL was evident on stress ultrasound in all cases (100 %). The mean value of the ATFL length was 2.8 ± 0.3 cm for the stressed condition and 2.1 ± 0.2 cm for the resting condition (p radiography. III.

Differences in lateral ankle laxity measured via stress ultrasonography in individuals with chronic ankle instability, ankle sprain copers, and healthy individuals.

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Croy, Theodore; Saliba, Susan A; Saliba, Ethan; Anderson, Mark W; Hertel, Jay

2012-07-01

Cross-sectional. To use stress ultrasonography to measure the change in anterior talofibular ligament length during the simulated anterior drawer and ankle inversion stress tests. In approximately 30% of individuals, ankle sprains may eventually develop into chronic ankle instability (CAI) with recurrent symptoms. Individuals with CAI and those who have a history of ankle sprain (greater than 1 year prior) without chronic instability (copers) may or may not have mechanical laxity. Sixty subjects (n=60 ankles) were divided into 3 groups: 1) Control subjects without ankle injury history (n=20; mean ± SD age; 24.8 ± 4.8 years; height, 173.7 ± 9.4 cm; weight, 77.2 ± 19.5 kg), ankle sprain copers (n=20; 22.3 ± 2.9 years; 172.8 ± 11.3 cm; 72.4 ± 14.3 kg), and subjects with CAI (n=20; 23.5 ± 4.2 years; 174.6 ± 9.6 cm; 74.8 ± 17.3 kg). Ligament length change with the anterior drawer and end range ankle inversion was calculated from ultrasound images. The Foot and Ankle Ability Measure (FAAM) was used to quantify self-reported function on activities-of-daily living (ADL) and sports. The anterior drawer test resulted in length changes that were greater (F₂,₅₇=6.2, P=.004) in the CAI (mean ± SD length change, 15.6 ± 15.1%, P=.006) and the coper groups (14.0 ± 15.9%, P=.016) compared to the control group (1.3 ± 10.7%); however the length change for the CAI and coper groups were not different (P=.93). Ankle inversion similarly resulted in greater ligament length change (F₂,₅₇=6.5, P=.003) in the CAI (25.3 ± 15.5%, P=.003) and coper groups (20.2 ± 19.6%, P=.039) compared to the control group (7.4 ± 12.9%); with no difference in length change between the copers and CAI groups (P=.59). The CAI group had a lower score on the FAAM-ADL (87.4 ± 13.4%) and FAAM-Sports (74.2 ± 17.8%) when compared to the control (98.8 ± 2.9% and 98.9 ± 3.1%, P<.0001) and coper groups (99.4 ± 1.8% and 94.6 ± 8.8%, P<.0001). Stress ultrasonography identified greater

Minor or occult ankle instability as a cause of anterolateral pain after ankle sprain.

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Vega, Jordi; Peña, Fernando; Golanó, Pau

2016-04-01

The aim of this study was to determine which intra-articular injuries are associated with chronic anterolateral pain and functional instability after an ankle sprain. From 2008 to 2010, records of all patients who underwent ankle joint arthroscopy with anterolateral pain and functional instability after an ankle sprain were reviewed. A systematic arthroscopic examination of the intra-articular structures of the ankle joint was performed. Location and characteristics of the injuries were identified and recorded. A total of 36 ankle arthroscopic procedures were reviewed. A soft-tissue occupying mass over the lateral recess was present in 18 patients (50%). A partial injury of the anterior talofibular ligament (ATFL) was observed in 24 patients (66.6%). Cartilage abrasion due to the distal fascicle of the anteroinferior tibiofibular ligament coming into contact with the talus was seen in 21 patients (58.3%), but no thickening of the ligament was observed. Injury to the intra-articular posterior structures, including the transverse ligament in 19 patients (52.7%) and the posterior surface of the distal tibia in 21 patients (58.3%), was observed. Intra-articular pathological findings have been observed in patients affected by anterolateral pain after an ankle sprain. Despite no demonstrable abnormal lateral laxity, morphologic ATFL abnormality has been observed on arthroscopic evaluation. An injury of the ATFL is present in patients with chronic anterolateral pain and functional instability after an ankle sprain. A degree of microinstability due to a deficiency of the ATFL could explain the intra-articular pathological findings and the patients' complaints. IV.

Mechanical instability destabilises the ankle joint directly in the ankle-sprain mechanism.

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Gehring, Dominic; Faschian, Katrin; Lauber, Benedikt; Lohrer, Heinz; Nauck, Tanja; Gollhofer, Albert

2014-03-01

Despite massive research efforts, it remains unclear how mechanical ankle instability (MAI) and functional ankle instability (FAI) affect joint control in the situation of ankle sprain. Thus, the purpose of this study was to evaluate whether individuals with MAI have deficits in stabilising their ankle joint in a close-to-injury situation compared with those with FAI and healthy controls. Ankle-joint control was assessed by means of three-dimensional motion analysis and electromyography in participants with FAI and MAI (n=19), in participants with pure FAI (n=9) and in healthy controls (n=18). Close-to-injury situations were simulated during standing, walking and jumping by means of a custom-made tilt platform. Individuals with FAI and MAI displayed significantly greater maximum ankle inversion angles (+5°) and inversion velocities (+50°/s) in the walking and jumping conditions compared to those with pure FAI and controls. Furthermore, individuals in the FAI and MAI group showed a significantly decreased pre-activation of the peroneus longus muscle during jumping compared to those with FAI. No differences between groups were found for plantar flexion and internal rotation, or for muscle activities following tilting of the platform. The present study demonstrates that MAI is characterised by impairments of ankle-joint control in close-to-injury situations. This could make these individuals more prone to recurrent ankle sprains, and suggests the need for additional mechanical support such as braces or even surgery. In addition, the study highlights the fact that dynamic experimental test conditions in the acting participant are needed to further unravel the mystery of chronic ankle instability.

Effects of focal ankle joint cooling on unipedal static balance in individuals with and without chronic ankle instability.

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Kim, Kyung-Min; Hart, Joseph M; Saliba, Susan A; Hertel, Jay

2015-01-01

Application of cryotherapy over an injured joint has been shown to improve muscle function, yet it is unknown how ankle cryotherapy affects postural control. Our purpose was to determine the effects of a 20-min focal ankle joint cooling on unipedal static stance in individuals with and without chronic ankle instability (CAI). Fifteen young subjects with CAI (9 males, 6 females) and 15 healthy gender-matched controls participated. All subjects underwent two intervention sessions on different days in which they had a 1.5L plastic bag filled with either crushed ice (active treatment) or candy corn (sham) applied to the ankle. Unipedal stance with eyes closed for 10s were assessed with a forceplate before and after each intervention. Center of pressure (COP) data were used to compute 10 specific dependent measures including velocity, area, standard deviation (SD), and percent range of COP excursions, and mean and SD of time-to-boundary (TTB) minima in the anterior-posterior (AP) and mediolateral directions. For each measure a three-way (Group-Intervention-Time) repeated ANOVAs found no significant interactions and main effects involving intervention (all Ps > 0.05). There were group main effects found for mean velocity (F(1,28) = 6.46, P = .017), area (F(1,28) = 12.83, P = .001), and mean of TTB minima in the AP direction (F(1,28) = 5.19, P = .031) indicating that the CAI group demonstrated greater postural instability compared to the healthy group. Postural control of unipedal stance was not significantly altered following focal ankle joint cooling in groups both with and without CAI. Ankle joint cryotherapy was neither beneficial nor harmful to single leg balance. Copyright © 2014 Elsevier B.V. All rights reserved.

Effect of kinesiotaping, non-elastic taping and bracing on segmental foot kinematics during drop landing in healthy subjects and subjects with chronic ankle instability.

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Kuni, B; Mussler, J; Kalkum, E; Schmitt, H; Wolf, S I

2016-09-01

To evaluate the effects of kinesiotape, non-elastic tape, and soft brace on segmental foot kinematics during drop landing in subjects with chronic ankle instability and healthy subjects. Controlled study with repeated measurements. Three-dimensional motion analysis laboratory. Twenty participants with chronic ankle instability and 20 healthy subjects. The subjects performed drop landings with 17 retroreflective markers on the foot and lower leg in four conditions: barefoot, with kinesiotape, with non-elastic tape and with a soft brace. Ranges of motion of foot segments using a foot measurement method. In participants with chronic ankle instability, midfoot movement in the frontal plane (inclination of the medial arch) was reduced significantly by non-elastic taping, but kinesiotaping and bracing had no effect. In healthy subjects, both non-elastic taping and bracing reduced that movement. In both groups, non-elastic taping and bracing reduced rearfoot excursion in inversion/eversion significantly, which indicates a stabilisation effect. No such effect was found with kinesiotaping. All three methods reduced maximum plantar flexion significantly. Non-elastic taping stabilised the midfoot best in patients with chronic ankle instability, while kinesiotaping did not influence foot kinematics other than to stabilise the rearfoot in the sagittal plane. ClinicalTrials.gov NCT01810471. Copyright © 2015 Chartered Society of Physiotherapy. Published by Elsevier Ltd. All rights reserved.

Chronic Ankle Instability

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... top of the talus is dome-shaped and... Softball Injuries to the Foot and Ankle Your feet ... ankles take a beating when you are playing softball. Softball players should be aware of the following ...

Peroneal electromechanical delay and fatigue in patients with chronic ankle instability.

Science.gov (United States)

Flevas, Dimitrios A; Bernard, Manfred; Ristanis, Stavros; Moraiti, Constantina; Georgoulis, Anastasios D; Pappas, Evangelos

2017-06-01

The purpose of this study was to investigate the effect of chronic ankle instability (CAI) on electromechanical delay times (EMD) before and after fatigue. Understanding the mechanisms that contribute to CAI is essential for the development of effective rehabilitation programmes. It was hypothesized that patients with CAI will demonstrate prolonged EMD times compared to healthy subjects and that fatigue will cause greater increases in EMD times in the CAI group. Twenty-one male volunteers participated in the study providing data on 16 ankles with CAI and 26 with no history of ankle injury. EMD was measured on an isokinetic dynamometer. Measurements were taken with the ankle in neutral (0°) and at 30° of inversion. All subjects followed an isokinetic fatigue protocol until eversion torque fell below 50 % of initial torque for three consecutive repetitions. A 2 × 2 × 2 ANOVA was used to calculate the effect of ankle status (CAI vs. healthy), fatigue, angle (0° vs. 30°) and their interactions on EMD. Fatigue caused a significant increase on EMD [non-fatigued: 122(29)ms vs. fatigue 155(54)ms; p ankle status and angle was found (p = 0.026) with CAI ankles demonstrating longer EMD [CAI: 156(45)ms vs. healthy: 133(40)ms] in neutral but not at 30° of inversion [CAI: 133(46)ms vs. 132(33)ms]. Patients with CAI had longer EMD times in neutral, but not when the ankle was placed in inversion. This suggests that rehabilitation programmes may be more effective when retraining occurs with the ankle in neutral position. It is likely that low EMD times prevent ankle acceleration at the beginning of the mechanism of injury, but they are less important when the ankle has already inverted at 30°. Both CAI and healthy subjects demonstrated longer EMD after fatigue, emphasizing the importance of proper conditioning in the prevention of delayed peroneal response and subsequent ankle injury. Improving resistance to fatigue of the peroneals may prove to be an effective

The effect of two mobilization techniques on dorsiflexion in people with chronic ankle instability.

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Marrón-Gómez, David; Rodríguez-Fernández, Ángel L; Martín-Urrialde, José A

2015-02-01

To compare the effect of two manual therapy techniques, mobilization with movement (WB-MWM) and talocrural manipulation (HVLA), for the improvement of ankle dorsiflexion in people with chronic ankle instability (CAI) over 48 h. Randomized controlled clinical trial. University research laboratory. Fifty-two participants (mean ± SD age, 20.7 ± 3.4 years) with CAI were randomized to WB-MWM (n = 18), HVLA (n = 19) or placebo group (n = 15). Weight-bearing ankle dorsiflexion measured with the weight-bearing lunge. Measurements were obtained prior to intervention, immediately after intervention, and 10 min, 24 h and 48 h post-intervention. There was a significant effect × time (F4,192 = 20.65; P ankle dorsiflexion in both WB-MWM and HVLA groups with respect to the placebo group with no differences between both active treatment groups. A single application of WB-MWM or HVLA manual technique improves ankle dorsiflexion in people with CAI, and the effects persist for at least two days. Both techniques have similar effectiveness for improving ankle dorsiflexion although WB-MWM demonstrated greater effect sizes. Copyright © 2014 Elsevier Ltd. All rights reserved.

Chronic ankle instability: evaluation with stress radiography, CT and CT arthrography

International Nuclear Information System (INIS)

Faure, Ch.; Deplus, F.; Bochu, M.; Besse, J.L.; Moyen, B.

1997-01-01

We retrospectively evaluated the anterior talo-fibular ligament and the tarsal sinus of 17 patients who had complained of chronic ankle external instability. This study based on both surgery and CT-arthrography findings shows the pathologic or normal aspects of the talo-fibular anterior ligament (normal, lax, fibrosis residue, ruptured). It confirms the good anatomic analysis of the tarsal sinus, i particular the anterior talo-calcaneal interosseous ligament and the search for fibrosis. We underline that capsular distension due to subtalar laxity is not detected with medical imaging. Compared with surgery (all patients), CT arthrography demonstrated the different aspects of the anterior talo fibular ligament injuries (normal, lax, discontinuous). (authors)

[ADVANCES IN ANATOMICAL REPAIR OF CHRONIC LATERAL ANKLE INSTABILITY].

Science.gov (United States)

Zhang, Yan; Liang, Xiaojun

2016-12-08

To summarize the current status and progress of the treatment of chronic lateral ankle instability (CLAI). The literature about the anatomical repair of CLAI at home and abroad was reviewed and summarized. Broström and its modified operations are the most common surgical treatment of CLAI. The operations showed satisfactory clinical outcomes in the short-, medium-, and long-term follow-up and low complication rate. Suture anchor technique and arthroscopic techniques are gradually used in Broström and its modified operations with satisfactory short-term effectiveness, but long-term effectiveness needs further observation because of the limitation of the short clinical application time. Broström and its modified operations are effective, convenient, and safe to treat CLAI. Based on the researches of biomechanics and dynamic anatomy, the more personalized design of the rehabilitation program is the further research direction.

Effects of visual feedback balance training on the balance and ankle instability in adult men with functional ankle instability.

Science.gov (United States)

Nam, Seung-Min; Kim, Kyoung; Lee, Do Youn

2018-01-01

[Purpose] This study examined the effects of visual feedback balance training on the balance and ankle instability in adult men with functional ankle instability. [Subjects and Methods] Twenty eight adults with functional ankle instability, divided randomly into an experimental group, which performed visual feedback balance training for 20 minutes and ankle joint exercises for 10 minutes, and a control group, which performed ankle joint exercise for 30 minutes. Exercises were completed three times a week for 8 weeks. Bio rescue was used for balance ability. It measured limit of stability at one minute. For ankle instability was measured using Cumberland ankle instability tool (CAIT). This measure was performed before and after the experiments in each group. [Results] The experimental group had significant increase in the Limit of Stability and CAIT score. The control group had significant increase in CAIT score. While the Limit of Stability increased without significance. [Conclusion] In conclusion, visual feedback balance training can be recommended as a treatment method for patients with functional ankle instability.

Effect of fibular repositioning taping in adult basketball players with chronic ankle instability: a randomized, placebo-controlled, crossover trial.

Science.gov (United States)

Alves, Yanina; Ribeiro, Fernando; Silva, Anabela G

2017-07-05

Chronic ankle instability presents a high incidence and prevalence in basketbal players. It's important to develop strategies to reduce the functional and mechanical limitations resulting from this condition. To compare the effect of Mulligan ́s fibular repositioning taping with a placebo taping immediatly after application and after a running test (Yo-Yo IRT). 16 adult basketball players (10 male, 6 female) with chronic ankle instability and mean age 21.50 ± 2.76 years old. Assessment of static postural control (15 seconds of unipedal stance test with eyes closed in a force platform), functional performance (figure 8 hop test and lateral hop test) and neuromuscular control (peroneus longus latency time in sudden inversion) in two conditions: Mulligan and Placebo. No significant effect was found for the intervantion factor in both hop tests (p>0.170), but there was a significant effect for the time factor (p<0.03). For the peroneus longus latency time, there was a significant interaction between factors (p=0.028) and also for time (p=0.042). No significant effect was found for any of the static postural control variables (area, speed and total displacement) (p≥0.10). There was no differences between Mulligan's fibular repositioning taping and Placebo taping in postural control and functional performance in basketball players with chronic ankle instability. However, Mulligan's taping appears to reduce peroneus longus latency time after a running when compared with a placebo taping.

Single-leg drop landing movement strategies in participants with chronic ankle instability compared with lateral ankle sprain 'copers'.

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Doherty, Cailbhe; Bleakley, Chris; Hertel, Jay; Caulfield, Brian; Ryan, John; Delahunt, Eamonn

2016-04-01

To compare the movement patterns and underlying energetics of individuals with chronic ankle instability (CAI) to ankle sprain 'copers' during a landing task. Twenty-eight (age 23.2 ± 4.9 years; body mass 75.5 ± 13.9 kg; height 1.7 ± 0.1 m) participants with CAI and 42 (age 22.7 ± 1.7 years; body mass 73.4 ± 11.3 kg; height 1.7 ± 0.1 m) ankle sprain 'copers' were evaluated 1 year after incurring a first-time lateral ankle sprain injury. Kinematics and kinetics of the hip, knee and ankle joints from 200 ms pre-initial contact (IC) to 200 ms post-IC, in addition to the vertical component of the landing ground reaction force, were acquired during performance of a drop land task. The CAI group adopted a position of increased hip flexion during the landing descent on their involved limb. This coincided with a reduced post-IC flexor pattern at the hip and increased overall hip joint stiffness compared to copers (-0.01 ± 0.05 vs. 0.02 ± 0.05°/Nm kg(-1), p = 0.03). Individuals with CAI display alterations in hip joint kinematics and energetics during a unipodal landing task compared to LAS 'copers'. These alterations may be responsible for the increased risk of injury experienced by individuals with CAI during landing manoeuvres. Thus, clinicians must recognise the potential for joints proximal to the affected ankle to contribute to impaired function following an acute lateral ankle sprain injury and to develop rehabilitation protocols accordingly. Level III.

Cross-cultural adaptation, reliability, and validation of the Korean version of the identification functional ankle instability (IdFAI).

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Ko, Jupil; Rosen, Adam B; Brown, Cathleen N

2017-09-12

To cross-culturally adapt the Identification Functional Ankle Instability for use with Korean-speaking participants. The English version of the IdFAI was cross-culturally adapted into Korean based on the guidelines. The psychometric properties in the Korean version of the IdFAI were measured for test-retest reliability, internal consistency, criterion-related validity, discriminative validity, and measurement error 181 native Korean-speakers. Intra-class correlation coefficients (ICC 2,1 ) between the English and Korean versions of the IdFAI for test-retest reliability was 0.98 (standard error of measurement = 1.41). The Cronbach's alpha coefficient was 0.89 for the Korean versions of IdFAI. The Korean versions of the IdFAI had a strong correlation with the SF-36 (r s  = -0.69, p 10 was the optimal cutoff score to distinguish between the group memberships. The minimally detectable change of the Korean versions of the IdFAI score was 3.91. The Korean versions of the IdFAI have shown to be an excellent, reliable, and valid instrument. The Korean versions of the IdFAI can be utilized to assess the presence of Chronic Ankle Instability by researchers and clinicians working among Korean-speaking populations. Implications for rehabilitation The high recurrence rate of sprains may result into Chronic Ankle Instability (CAI). The Identification of Functional Ankle Instability Tool (IdFAI) has been validated and recommended to identify patients with Chronic Ankle Instability (CAI). The Korean version of the Identification of Functional Ankle Instability Tool (IdFAI) may be also recommend to researchers and clinicians for assessing the presence of Chronic Ankle Instability (CAI) in Korean-speaking population.

Feedback and Feedforward Control During Walking in Individuals With Chronic Ankle Instability.

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Yen, Sheng-Che; Corkery, Marie B; Donohoe, Amy; Grogan, Maddison; Wu, Yi-Ning

2016-09-01

Study Design Controlled laboratory study. Background Recurrent ankle sprains associated with chronic ankle instability (CAI) occur not only in challenging sports but also in daily walking. Understanding whether and how CAI alters feedback and feedforward controls during walking may be important for developing interventions for CAI prevention or treatment. Objective To understand whether CAI is associated with changes in feedback and feedforward control when individuals with CAI are subjected to experimental perturbation during walking. Methods Twelve subjects with CAI and 12 control subjects walked on a treadmill while adapting to external loading that generated inversion perturbation at the ankle joint. Ankle kinematics around heel contact during and after the adaptation were compared between the 2 groups. Results Both healthy and CAI groups showed an increase in eversion around heel contact in early adaptation to the external loading. However, the CAI group adapted back toward the baseline, while the healthy controls showed further increase in eversion in late adaptation. When the external loading was removed in the postadaptation period, healthy controls showed an aftereffect consisting of an increase in eversion around heel contact, but the CAI group showed no aftereffect. Conclusion The results provide preliminary evidence that CAI may alter individuals' feedback and feedforward control during walking. J Orthop Sports Phys Ther 2016;46(9):775-783. Epub 5 Aug 2016. doi:10.2519/jospt.2016.6403.

Neuromuscular control and ankle instability.

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Gutierrez, Gregory M; Kaminski, Thomas W; Douex, Al T

2009-04-01

Lateral ankle sprains (LAS) are common injuries in athletics and daily activity. Although most are resolved with conservative treatment, others develop chronic ankle instability (AI)-a condition associated with persistent pain, weakness, and instability-both mechanical (such as ligamentous laxity) and functional (neuromuscular impairment with or without mechanical laxity). The predominant theory in AI is one of articular deafferentation from the injury, affecting closed-loop (feedback/reflexive) neuromuscular control, but recent research has called that theory into question. A considerable amount of attention has been directed toward understanding the underlying causes of this pathology; however, little is known concerning the neuromuscular mechanisms behind the development of AI. The purpose of this review is to summarize the available literature on neuromuscular control in uninjured individuals and individuals with AI. Based on available research and reasonable speculation, it seems that open-loop (feedforward/anticipatory) neuromuscular control may be more important for the maintenance of dynamic joint stability than closed-loop control systems that rely primarily on proprioception. Therefore, incorporating perturbation activities into patient rehabilitation schemes may be of some benefit in enhancing these open-loop control mechanisms. Despite the amount of research conducted in this area, analysis of individuals with AI during dynamic conditions is limited. Future work should aim to evaluate dynamic perturbations in individuals with AI, as well as subjects who have a history of at least one LAS and never experienced recurrent symptoms. These potential findings may help elucidate some compensatory mechanisms, or more appropriate neuromuscular control strategies after an LAS event, thus laying the groundwork for future intervention studies that can attempt to reduce the incidence and severity of acute and chronic lateral ankle injury.

Six Sessions of Anterior-to-Posterior Ankle Joint Mobilizations Improve Patient-Reported Outcomes in Chronic Ankle Instability Patients: A Critically Appraised Topic.

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Wikstrom, Erik A; Bagherian, Sajad; Cordero, Nicole B; Song, Kyeongtak

2018-01-24

Clinical Scenario: Chronic ankle instability (CAI) is a complex musculoskeletal condition that results in sensorimotor and mechanical alterations. Manual therapies, such as ankle joint mobilizations are known to improve clinician-oriented outcomes like dorsiflexion range of motion but their impact of patient-reported outcomes remains less clear. Focused Clinical Question: Do anterior-to-posterior ankle joint mobilizations improve patient reported outcomes in patients with CAI? Summary of Key Findings: Three studies (2 RCT, 1 Prospective cohort) quantified the effect of at least 2-weeks of anterior-to-posterior ankle joint mobilizations on improving patient reported outcomes immediately after the intervention and at a follow-up assessment. All three studies demonstrated significant improvements in at least one patient-reported outcome immediately after the intervention and at the follow-up assessment. Clinical Bottom Line: At least 2-weeks of ankle joint mobilization improves patient-reported outcomes in patients with CAI and these benefits are retained for at least a week following the termination of the intervention. Strength of Recommendation: Strength of recommendation is an A due to consistent good-quality patient-oriented evidence.

Comparison of bone tunnel and suture anchor techniques in the modified Broström procedure for chronic lateral ankle instability.

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Hu, Chang-Yong; Lee, Keun-Bae; Song, Eun-Kyoo; Kim, Myung-Sun; Park, Kyung-Soon

2013-08-01

The modified Broström procedure is frequently used to treat chronic lateral ankle instability. There are 2 common methods of the modified Broström procedure, which are the bone tunnel and suture anchor techniques. To compare the clinical outcomes of the modified Broström procedure using the bone tunnel and suture anchor techniques. Cohort study; Level of evidence, 2. Eighty-one patients (81 ankles) treated with the modified Broström procedure for chronic lateral ankle instability constituted the study cohort. The 81 ankles were divided into 2 groups, namely, a bone tunnel technique (BT group; 40 ankles) and a suture anchor technique (SA group; 41 ankles). The Karlsson score, American Orthopaedic Foot and Ankle Society (AOFAS) ankle-hindfoot score, anterior talar translation, and talar tilt angle were used to evaluate clinical and radiographic outcomes. The BT group consisted of 32 men and 8 women with a mean age of 34.8 years at surgery and a mean follow-up duration of 34.2 months. The SA group consisted of 33 men and 8 women with a mean age of 33.3 years at surgery and a mean follow-up duration of 32.8 months. Mean Karlsson scores improved significantly from 57.0 points preoperatively to 94.9 points at final follow-up in the BT group and from 59.9 points preoperatively to 96.4 points at final follow-up in the SA group. Mean AOFAS scores also improved from 64.2 points preoperatively to 97.8 points at final follow-up in the BT group and from 70.3 points preoperatively to 97.4 points at final follow-up in the SA group. Mean anterior talar translations in the BT group and SA group improved from 9.0 mm and 9.2 mm preoperatively to 6.5 mm and 6.8 mm at final follow-up, respectively. Mean talar tilt angles were 12.0° in the BT group and 12.5° in the SA group preoperatively and 8.8° at final follow-up for both groups. No significant differences were found between the 2 groups in terms of the Karlsson score, AOFAS score, anterior talar translation, and talar tilt

Lower extremity joint coupling variability during gait in young adults with and without chronic ankle instability.

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Lilley, Thomas; Herb, Christopher C; Hart, Joseph; Hertel, Jay

2018-06-01

Chronic ankle instability (CAI) is a condition resulting from a lateral ankle sprain. Shank-rearfoot joint-coupling variability differences have been found in CAI patients; however, joint-coupling variability (VCV) of the ankle and proximal joints has not been explored. Our purpose was to analyse VCV in adults with and without CAI during gait. Four joint-coupling pairs were analysed: knee sagittal-ankle sagittal, knee sagittal-ankle frontal, hip frontal-ankle sagittal and hip frontal-ankle frontal. Twenty-seven adults participated (CAI:n = 13, Control:n = 14). Lower extremity kinematics were collected during walking (4.83 km/h) and jogging (9.66 km/h). Vector-coding was used to assess the stride-to-stride variability of four coupling pairs. During walking, CAI patients exhibited higher VCV than healthy controls for knee sagittal-ankle frontal in latter parts of stance thru mid-swing. When jogging, CAI patients demonstrated lower VCV with specific differences occurring across various intervals of gait. The increased knee sagittal-ankle frontal VCV in CAI patients during walking may indicate an adaptation to deal with the previously identified decrease in variability in transverse plane shank and frontal plane rearfoot coupling during walking; while the decreased ankle-knee and ankle-hip VCV identified in CAI patients during jogging may represent a more rigid, less adaptable sensorimotor system ambulating at a faster speed.

Recovery From a First-Time Lateral Ankle Sprain and the Predictors of Chronic Ankle Instability: A Prospective Cohort Analysis.

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Doherty, Cailbhe; Bleakley, Chris; Hertel, Jay; Caulfield, Brian; Ryan, John; Delahunt, Eamonn

2016-04-01

Impairments in motor control may predicate the paradigm of chronic ankle instability (CAI) that can develop in the year after an acute lateral ankle sprain (LAS) injury. No prospective analysis is currently available identifying the mechanisms by which these impairments develop and contribute to long-term outcome after LAS. To identify the motor control deficits predicating CAI outcome after a first-time LAS injury. Cohort study (diagnosis); Level of evidence, 2. Eighty-two individuals were recruited after sustaining a first-time LAS injury. Several biomechanical analyses were performed for these individuals, who completed 5 movement tasks at 3 time points: (1) 2 weeks, (2) 6 months, and (3) 12 months after LAS occurrence. A logistic regression analysis of several "salient" biomechanical parameters identified from the movement tasks, in addition to scores from the Cumberland Ankle Instability Tool and the Foot and Ankle Ability Measure (FAAM) recorded at the 2-week and 6-month time points, were used as predictors of 12-month outcome. At the 2-week time point, an inability to complete 2 of the movement tasks (a single-leg drop landing and a drop vertical jump) was predictive of CAI outcome and correctly classified 67.6% of cases (sensitivity, 83%; specificity, 55%; P = .004). At the 6-month time point, several deficits exhibited by the CAI group during 1 of the movement tasks (reach distances and sagittal plane joint positions at the hip, knee and ankle during the posterior reach directions of the Star Excursion Balance Test) and their scores on the activities of daily living subscale of the FAAM were predictive of outcome and correctly classified 84.8% of cases (sensitivity, 75%; specificity, 91%; P < .001). An inability to complete jumping and landing tasks within 2 weeks of a first-time LAS and poorer dynamic postural control and lower self-reported function 6 months after a first-time LAS were predictive of eventual CAI outcome. © 2016 The Author(s).

Movement Strategies among Groups of Chronic Ankle Instability, Coper, and Control.

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Son, S Jun; Kim, Hyunsoo; Seeley, Matthew K; Hopkins, J Ty

2017-08-01

Comprehensive evaluation of movement strategies during functional movement is a difficult undertaking. Because of this challenge, studied movements have been oversimplified. Furthermore, evaluating movement strategies at only a discrete time point(s) provide limited insight into how movement strategies may change or adapt in chronic ankle instability (CAI) patients. This study aimed to identify abnormal movement strategies in individuals with a history of ankle sprain injury during a sports maneuver compared with healthy controls. Sixty-six participants, consisting of 22 CAI patients, 22 ankle sprain copers, and 22 healthy controls, participated in this study. Functional profiles of lower extremity kinematics, kinetics, and EMG activation from initial contact (0% of stance) to toe-off (100% of stance) were collected and analyzed during a jump landing/cutting task using a functional data analysis approach. Compared with copers, CAI patients displayed landing positions of less plantarflexion, less inversion, more knee flexion, more hip flexion, and less hip abduction during the first 25% of stance. However, restricted dorsiflexion angle was observed in both CAI patients and copers relative to controls during the midlanding to mid-side-cutting phase when the ankle and knee reached its peak range of motion (e.g., dorsiflexion and knee flexion). Reduced EMG activation of tibialis anterior, peroneus longus, medial gastrocnemius, and gluteus medius may be due to altered kinematics that reduce muscular demands on the involved muscles. CAI patients displayed altered movement strategies, perhaps in an attempt to avoid perceived positions of risk. Although sagittal joint positions seemed to increase the external torque on the knee and hip extensors, frontal joint positions appeared to reduce the muscular demands on evertor and hip abductor muscles.

Kinetic Compensations due to Chronic Ankle Instability during Landing and Jumping.

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Kim, Hyunsoo; Son, S Jun; Seeley, Matthew K; Hopkins, J Ty

2018-02-01

Skeletal muscles absorb and transfer kinetic energy during landing and jumping, which are common requirements of various forms of physical activity. Chronic ankle instability (CAI) is associated with impaired neuromuscular control and dynamic stability of the lower extremity. Little is known regarding an intralimb, lower-extremity joint coordination of kinetics during landing and jumping for CAI patients. We investigated the effect of CAI on lower-extremity joint stiffness and kinetic and energetic patterns across the ground contact phase of landing and jumping. One hundred CAI patients and 100 matched able-bodied controls performed five trials of a landing and jumping task (a maximal vertical forward jump, landing on a force plate with the test leg only, and immediate lateral jump toward the contralateral side). Functional analyses of variance and independent t-tests were used to evaluate between-group differences for lower-extremity net internal joint moment, power, and stiffness throughout the entire ground contact phase of landing and jumping. Relative to the control group, the CAI group revealed (i) reduced plantarflexion and knee extension and increased hip extension moments; (ii) reduced ankle and knee eccentric and concentric power, and increased hip eccentric and concentric power, and (iii) reduced ankle and knee joint stiffness and increased hip joint stiffness during the task. CAI patients seemed to use a hip-dominant strategy by increasing the hip extension moment, stiffness, and eccentric and concentric power during landing and jumping. This apparent compensation may be due to decreased capabilities to produce sufficient joint moment, stiffness, and power at the ankle and knee. These differences might have injury risk and performance implications.

Rehabilitation of the Ankle after Acute Sprain or Chronic Instability.

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Mattacola, Carl G.; Dwyer, Maureen K.

2002-01-01

Outlines rehabilitation concepts applicable to acute and chronic ankle injury, providing evidence for current techniques used in ankle rehabilitation and describing a functional rehabilitation program that progresses from basic to advanced, while taking into account empirical data from the literature and clinical practice. The article notes that…

改良 Brostrom 法联合踝关节镜治疗踝关节扭伤致慢性踝关节不稳的研究%Modified Brostrom precedure combined with ankle arthroscopy for chronic ankle instability derived from ankle sprains

Institute of Scientific and Technical Information of China (English)

陈冬; 姚建华; 黄炎; 伍罕

2015-01-01

目的：探讨改良 Brostrom 法联合踝关节镜治疗踝关节扭伤致慢性踝关节不稳的临床效果。方法选择踝关节扭伤治疗后发展为慢性踝关节不稳的患者共23例，采用改良的 Brostrom 法联合踝关节镜进行治疗，AOFAS 评分评价患者术前、术后3个月、术后1年时的治疗效果。结果踝关节镜检查发现患者均存在不同程度滑膜增生，其中发生软骨损伤18例，Ⅱ~Ⅲ度损伤为主。术后1年患者 AOFAS 分项及总分均显著高于术前。结论采用改良 Brostrom术式结合踝关节镜治疗踝关节扭伤致慢性踝关节不稳可获得较好的治疗效果，术后短期随访踝关节功能恢复较好。%Objective To investigate the therapeutic effect of modified Brostrom procedure combined with ankle arthroscopy for chronic ankle instability derived from ankle sprains. Methods A total of 23 cases of chronic ankle instability derived from ankle sprain were investigated. The modified Brostrom procedure combined with ankle arthroscopy were used for treatment. AOFAS score were respectively evaluated before surger-y and three months and one year after treatment. Results Ankle arthroscopy found varying degrees of synovial hyperplasia in all patients and carti-lage damage in 18 patients(mainly Ⅱ ~ Ⅲ degree). After one year of surgery,AOFAS score was significantly improved. Conclusion Short -term postoperative follow - up indicates the combination of modified Brostrom procedure and ankle arthroscopy exhibits good treatment effect and better recovery of ankle function in chronic ankle instability patients.

Validity of the lower extremity functional movement screen in patients with chronic ankle instability.

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Choi, Ho-Suk; Shin, Won-Seob

2015-06-01

[Purpose] The purpose of this study was to provide evidence of construct validity for the lower extremity functional movement screen (LE-FMS) based on hypothesis testing in patients with chronic ankle instability (CAI). [Subjects] The subjects were 20 healthy subjects and 20 patients with CAI who had a history of ankle sprain with pain for more than 1 day. [Methods] All participants were measured using the Foot and Ankle Disability Index (FADI) and evaluated with the LE-FMS. The screen included the deep squat, the hurdle step (HS) and the in-line lunge (ILL). The symmetry ratios (RS) were accurately measured during the deep squat trial. [Results] Between the two groups, there were significant differences in scores on the LE-FMS, HS, ILL, RS, FADI, and FADI-sport. The FADI was strongly correlated with both LE-FMS score (r=0.807) and ILL score (r=0.896). There was a strong relationship (r=0.818) between LE-FMS score and FADI-sport. [Conclusion] These results suggest that the LE-FMS may be used to detect deficits related to CAI. Additionally, this instrument is reliable in detecting functional limitations in patients with CAI.

Clinical examination results in individuals with functional ankle instability and ankle-sprain copers.

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Wright, Cynthia J; Arnold, Brent L; Ross, Scott E; Ketchum, Jessica; Ericksen, Jeffrey; Pidcoe, Peter

2013-01-01

Why some individuals with ankle sprains develop functional ankle instability and others do not (ie, copers) is unknown. Current understanding of the clinical profile of copers is limited. To contrast individuals with functional ankle instability (FAI), copers, and uninjured individuals on both self-reported variables and clinical examination findings. Cross-sectional study. Sports medicine research laboratory. Participants consisted of 23 individuals with a history of 1 or more ankle sprains and at least 2 episodes of giving way in the past year (FAI: Cumberland Ankle Instability Tool [CAIT] score = 20.52 ± 2.94, episodes of giving way = 5.8 ± 8.4 per month), 23 individuals with a history of a single ankle sprain and no subsequent episodes of instability (copers: CAIT score = 27.74 ± 1.69), and 23 individuals with no history of ankle sprain and no instability (uninjured: CAIT score = 28.78 ± 1.78). Self-reported disability was recorded using the CAIT and Foot and Ankle Ability Measure for Activities of Daily Living and for Sports. On clinical examination, ligamentous laxity and tenderness, range of motion (ROM), and pain at end ROM were recorded. Questionnaire scores for the CAIT, Foot and Ankle Ability Measure for Activities of Daily Living and for Sports, ankle inversion and anterior drawer laxity scores, pain with palpation of the lateral ligaments, ankle ROM, and pain at end ROM. Individuals with FAI had greater self-reported disability for all measures (P < .05). On clinical examination, individuals with FAI were more likely to have greater talar tilt laxity, pain with inversion, and limited sagittal-plane ROM than copers (P < .05). Differences in both self-reported disability and clinical examination variables distinguished individuals with FAI from copers at least 1 year after injury. Whether the deficits could be detected immediately postinjury to prospectively identify potential copers is unknown.

Cross-cultural adaptation, reliability, and validity of the Persian version of the Cumberland Ankle Instability Tool.

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Hadadi, Mohammad; Ebrahimi Takamjani, Ismail; Ebrahim Mosavi, Mohammad; Aminian, Gholamreza; Fardipour, Shima; Abbasi, Faeze

2017-08-01

The purpose of the present study was to translate and to cross-culturally adapt the Cumberland Ankle Instability Tool (CAIT) into Persian language and to evaluate its psychometric properties. The International Quality of Life Assessment process was pursued to translate CAIT into Persian. Two groups of Persian-speaking individuals, 105 participants with a history of ankle sprain and 30 participants with no history of ankle sprain, were asked to fill out Persian version of CAIT (CAIT-P), Foot and Ankle Ability Measure (FAAM), and Visual Analog Scale (VAS). Data obtained from the first administration of CAIT were used to evaluate floor and ceiling effects, internal consistency, dimensionality, and criterion validity. To determine the test-retest reliability, 45 individuals re-filled CAIT 5-7 days after the first session. Cronbach's alpha was over the cutoff point of 0.70 for both ankles and in both groups. The intra-class correlation coefficient was high for right (0.95) and left (0.91) ankles. There was a strong correlation between each item and the total score of the CAIT-P. Although the CAIT-P had strong correlation with VAS, its correlation with both subscales of FAAM was moderate. The CAIT-P has good validity and reliability and it can be used by clinicians and researchers for identification and investigation of functional ankle instability. Implications for Rehabilitation Chronic ankle instability is one of the most common consequences of acute ankle sprain. Cumberland Ankle Instability Tool is an acceptable measure to determine functional ankle instability and its severity. The Persian version of Cumberland Ankle Instability Tool is a valid and reliable tool for clinical and research purpose in Persian-speaking individuals.

Selection criteria for patients with chronic ankle instability in controlled research: a position statement of the International Ankle Consortium.

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Gribble, Phillip A; Delahunt, Eamonn; Bleakley, Chris; Caulfield, Brian; Docherty, Carrie; Fourchet, François; Fong, Daniel Tik-Pui; Hertel, Jay; Hiller, Claire; Kaminski, Thomas; McKeon, Patrick; Refshauge, Kathryn; van der Wees, Philip; Vincenzino, Bill; Wikstrom, Erik

2014-07-01

While research on chronic ankle instability (CAI) and awareness of its impact on society and health care systems has grown substantially in the last 2 decades, the inconsistency in participant/patient selection criteria across studies presents a potential obstacle to addressing the problem properly. This major gap within the literature limits the ability to generalise this evidence to the target patient population. Therefore, there is a need to provide standards for patient/participant selection criteria in research focused on CAI with justifications using the best available evidence. The International Ankle Consortium provides this position paper to present and discuss an endorsed set of selection criteria for patients with CAI based on the best available evidence to be used in future research and study designs. These recommendations will enhance the validity of research conducted in this clinical population with the end goal of bringing the research evidence to the clinician and patient. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://group.bmj.com/group/rights-licensing/permissions.

The Effect of Joint Mobilization on Dynamic Postural Control in Patients With Chronic Ankle Instability: A Critically Appraised Topic.

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Kosik, Kyle B; Gribble, Phillip A

2018-01-01

Clinical Scenario: Dorsiflexion range of motion is an important factor in the performance of the Star Excursion Balance Test (SEBT). While patients with chronic ankle instability (CAI) commonly experience decreased reach distances on the SEBT, ankle joint mobilization has been suggested to be an effective therapeutic intervention for targeting dorsiflexion range of motion. What is the evidence to support ankle joint mobilization for improving performance on the SEBT in patients with CAI? Summary of Key Findings: The literature was searched for articles examining the effects of ankle joint mobilization on scores of the SEBT. A total of 3 peer-reviewed articles were retrieved, 2 prospective individual cohort studies and 1 randomized controlled trial. Only 2 articles demonstrated favorable results following 6 sessions of ankle joint mobilization. Clinical Bottom Line: Despite the mixed results, the majority of the available evidence suggests that ankle joint mobilization improves dynamic postural control. Strength of Recommendation: In accordance with the Centre of Evidence Based Medicine, the inconsistent results and the limited high-quality studies indicate that there is level C evidence to support the use of ankle joint mobilization to improve performance on the SEBT in patients with CAI.

Dynamic ankle control in athletes with ankle instability during sports maneuvers.

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Lin, Cheng-Feng; Chen, Chin-Yang; Lin, Chia-Wei

2011-09-01

Ankle sprain is a common sports injury. While the effects of static constraints in stabilizing the ankle joint are relatively well understood, those of dynamic constraints are less clear and require further investigation. This study was undertaken to evaluate the dynamic stability of the ankle joint during the landing phase of running and stop-jump maneuvers in athletes with and without chronic ankle instability (CAI). Controlled laboratory study. Fifteen athletes with CAI and 15 age-matched athletes without CAI performed running and stop-jump landing tasks. The dynamic ankle joint stiffness, tibialis anterior (TA)/peroneus longus (PL) and TA/gastrocnemius lateralis (GL) co-contraction indices, ankle joint angle, and root-mean-square (RMS) of the TA, PL, and GL electromyographic signals were measured during each task. During running, the CAI group exhibited a greater ankle inversion angle than the control group in the pre-landing phase (P = .012-.042) and a lower dynamic ankle joint stiffness in the post-landing phase (CAI: 0.109 ± 0.039 N·m/deg; control: 0.150 ± 0.068 N·m/deg; P = .048). In the stop-jump landing task, athletes with CAI had a significantly lower TA/PL co-contraction index during the pre-landing phase (CAI: 49.1 ± 19; control: 64.8 ± 16; P = .009). In addition, the CAI group exhibited a greater ankle inversion (P = .049), a lower peak eversion (P = .04), and a smaller RMS of the PL electromyographic signal in the post-landing phase (CAI: 0.73 ± 0.32; control: 0.51 ± 0.22; P = .04). Athletes with CAI had a relatively inverted ankle, reduced muscle co-contraction, and a lower dynamic stiffness in the ankle joint during the landing phase of sports maneuvers and this may jeopardize the stability of the ankle. Sports training or rehabilitation programs should differentiate between the pre-landing and post-landing phases of sports maneuvers, and should educate athletes to land with an appropriate ankle position and muscle recruitment.

The Cumberland Ankle Instability Tool (CAIT) in the Dutch population with and without complaints of ankle instability.

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Vuurberg, Gwendolyn; Kluit, Lana; van Dijk, C Niek

2018-03-01

To develop a translated Dutch version of the Cumberland Ankle Instability Tool (CAIT) and test its psychometric properties in a Dutch population with foot and ankle complaints. The CAIT was translated into the Dutch language using a forward-backward translation design. Of the 130 subsequent patients visiting the outpatient clinic for foot and ankle complaints who were asked to fill out a questionnaire containing the CAIT, the Foot and Ankle Outcome Score (FAOS), and the numeric rating scale (NRS) pain, 98 completed the questionnaire. After a 1-week period, patients were asked to fill out a second questionnaire online containing the CAIT and NRS pain. This second questionnaire was completed by 70 patients. With these data, the construct validity, test-retest reliability, internal consistency, measurement error, and ceiling and floor effects were assessed. Additionally, a cut-off value to discriminate between stable and unstable ankles, in patients with ankle complaints, was calculated. Construct validity showed moderate correlations between the CAIT and FAOS subscales (Spearman's correlation coefficient (SCC) = 0.36-0.43), and the NRS pain (SCC = -0.55). The cut-off value was found at 11.5 points of the total CAIT score (range 0-30). Test-retest reliability showed to be excellent with an intraclass correlation coefficient of 0.94. Internal consistency was high (Cronbach's α = 0.86). No ceiling or floor effects were detected. Based on the results, the Dutch version of the CAIT is a valid and reliable questionnaire to assess ankle instability in the Dutch population and is able to differentiate between a functionally unstable and stable ankle. The tool is the first suitable tool to objectify the severity of ankle instability specific complaints and assess change in the Dutch population. Level of evidence II.

Early functional outcome of a modified Brostrom-Gould surgery using bioabsorbable suture anchor for chronic lateral ankle instability.

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Shahrulazua, A; Ariff Sukimin, M S; Tengku Muzaffar, T M; Yusof, M I

2010-03-01

The purpose of this study was to evaluate the early functional outcome following the use of a bioabsorbable suture anchor to simplify the repair of injured lateral ankle structures as a variation of an established technique known as the Brostrom-Gould procedure. This was a prospective study of 30 ankles with chronic lateral instability that underwent a modified Brostrom-Gould surgery using a bioabsorbable suture anchor, performed by a single surgeon. A total of 29 patients, aged 15 to 52 (mean is 33) years, were enrolled in the study. The follow-up period ranged from three to six (mean is four) months. The function of the patients' ankles was scored using the Kaikkonen Functional Scale, both preoperatively and postoperatively. Preoperatively, all ankles had poor scores (less than 50). Postoperatively, 28 ankles showed excellent scores and two ankles showed good scores, while none obtained a fair or poor score. The difference in the overall means between the postoperative and preoperative scores was statistically significant (p-value is 0.001). Post surgery, 24 ankles had no symptoms, while six had only mild ankle tightness with extreme inversion movement at the last review. All patients were able to walk normally, and 29 ankles regained their normal running capability. There was marked improvement in the ability to descend stairs, to rise on heels and toes, to perform a single-limb stance, and in range of motions of the ankle dorsiflexion as well as in ankle laxity. The modified Brostrom-Gould procedure using a bioabsorbable suture anchor allowed for early ankle rehabilitation and offered a reproducible and excellent early functional outcome with minimal complications.

Spatiotemporal postural control deficits are present in those with chronic ankle instability

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McKeon Patrick O

2008-06-01

Full Text Available Abstract Background Postural control deficits have been purported to be a potential contributing factor in chronic ankle instability (CAI. Summary forceplate measures such as center of pressure velocity and area have not consistently detected postural control deficits associated with CAI. A novel measurement technique derived from the dynamical systems theory of motor control known as Time-to-boundary (TTB has shown promise in detecting deficits in postural control related to chronic ankle instability (CAI. In a previous study, TTB deficits were detected in a sample of females with CAI. The purpose of this study was to examine postural control in sample of males and females with and without CAI using TTB measures. Methods This case-control study was performed in a research laboratory. Thirty-two subjects (18 males, 14 females with self-reported CAI were recruited and matched to healthy controls. All subjects performed three, ten-second trials of single-limb stance on a forceplate with eyes open and eyes closed. Main outcome measures included the TTB absolute minimum (s, mean of TTB minima (s, and standard deviation of TTB minima (s in the anteroposterior and mediolateral directions. A series of group by gender analyses of variance were conducted to evaluate the differences in postural control for all TTB variables separately with eyes open and eyes closed. Results There were no significant group by gender interactions or gender main effects for any of the measures. There, however, significant group main effects for 4 of the 6 measures with eyes closed as the CAI group demonstrated significant deficits in comparison to the control group. There were no significant differences between groups in any of the TTB measures with eyes open. Conclusion TTB deficits were present in the CAI group compared to the control group. These deficits were detected with concurrent removal of visual input. CAI may place significantly greater constraints on the

Clinical Outcomes of the Modified Broström Technique in the Management of Chronic Ankle Instability After Early, Intermediate, and Delayed Presentation.

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Hassan, Sami; Thurston, Daniel; Sian, Tanvir; Shah, Rohi; Aziz, Abdul; Kothari, Paresh

2018-04-11

The modified Broström technique (MBT) is considered the reference standard for surgical management of ankle instability, with good short-term outcomes. However, limited evidence is available regarding outcomes for delayed presentations of instability. We report our outcomes for patients who underwent ligament repair using the MBT, from a single-surgeon retrospective study of consecutive patients. The minimum postoperative follow-up period was 6 months during a 5-year study period. The patients were retrospectively divided into 3 groups according to the delay in presentation: group 1, 6 months to 2 years; group 2, 2 to 4 years; and group 3, >4 years. We collected data on patient demographics, injury pattern, and intraoperative surgeon findings. The American Orthopaedic Foot and Ankle Society (AOFAS) ankle-hindfoot scale (AHS) was used to evaluate patient outcomes and satisfaction with surgery. Twenty-six patients were treated with MBT. The mean follow-up period was 36.9 (range 6-42) months. Twenty-five (96.2%) patients had unilateral injuries, and 1 (3.85%) had bilateral repairs. Of the 26 patients, 21 (80.8%) completed the AOFAS-AHS, with a mean score of 87.4 (range 12 to 100). The mean interval from injury to surgery was 47.9 months. The results were excellent in 15 (71.4%), good in 3 (14.3%), fair in 1 (4.8%), and poor in 2 (9.5%) using the AOFAS-AHS. We found no significant difference in the overall AOFAS-AHS score or postoperative satisfaction among the groups (p > .05). All patients had a stable ankle joint at their final follow-up visit. In conclusion, patients with persistent or chronic ankle instability have good clinical outcomes and satisfaction after the MBT, irrespective of the time from injury to presentation. Copyright © 2017 The American College of Foot and Ankle Surgeons. Published by Elsevier Inc. All rights reserved.

Predicting Manual Therapy Treatment Success in Patients With Chronic Ankle Instability: Improving Self-Reported Function.

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Wikstrom, Erik A; McKeon, Patrick O

2017-04-01

  Therapeutic modalities that stimulate sensory receptors around the foot-ankle complex improve chronic ankle instability (CAI)-associated impairments. However, not all patients have equal responses to these modalities. Identifying predictors of treatment success could improve clinician efficiency when treating patients with CAI.   To conduct a response analysis on existing data to identify predictors of improved self-reported function in patients with CAI.   Secondary analysis of a randomized controlled clinical trial.   Sports medicine research laboratories.   Fifty-nine patients with CAI, which was defined in accordance with the International Ankle Consortium recommendations.   Participants were randomized into 3 treatment groups (plantar massage [PM], ankle-joint mobilization [AJM], or calf stretching [CS]) that received six 5-minute treatments over 2 weeks.   Treatment success, defined as a patient exceeding the minimally clinically important difference of the Foot and Ankle Ability Measure-Sport (FAAM-S).   Patients with ≤5 recurrent sprains and ≤82.73% on the Foot and Ankle Ability Measure had a 98% probability of having a meaningful FAAM-S improvement after AJM. As well, ≥5 balance errors demonstrated 98% probability of meaningful FAAM-S improvements from AJM. Patients <22 years old and with ≤9.9 cm of dorsiflexion had a 99% probability of a meaningful FAAM-S improvement after PM. Also, those who made ≥2 single-limb-stance errors had a 98% probability of a meaningful FAAM-S improvement from PM. Patients with ≤53.1% on the FAAM-S had an 83% probability of a meaningful FAAM-S improvement after CS.   Each sensory-targeted ankle-rehabilitation strategy resulted in a unique combination of predictors of success for patients with CAI. Specific indicators of success with AJM were deficits in self-reported function, single-limb balance, and <5 previous sprains. Age, weight-bearing-dorsiflexion restrictions, and single-limb balance

Assessment of Relationships Between Joint Motion Quality and Postural Control in Patients With Chronic Ankle Joint Instability.

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Bączkowicz, Dawid; Falkowski, Krzysztof; Majorczyk, Edyta

2017-08-01

Study Design Controlled laboratory study, cross-sectional. Background Lateral ankle sprains are among the most common injuries encountered during athletic participation. Following the initial injury, there is an alarmingly high risk of reinjury and development of chronic ankle instability (CAI), which is dependent on a combination of factors, including sensorimotor deficits and changes in the biomechanical environment of the ankle joint. Objective To evaluate CAI-related disturbances in arthrokinematic motion quality and postural control and the relationships between them. Methods Sixty-three male subjects (31 with CAI and 32 healthy controls) were enrolled in the study. For arthrokinematic motion quality analysis, the vibroarthrographic signals were collected during ankle flexion/extension motion using an acceleration sensor and described by variability (variance of mean squares [VMS]), amplitude (mean of 4 maximal and 4 minimal values [R4]), and frequency (vibroarthrographic signal bands of 50 to 250 Hz [P1] and 250 to 450 Hz [P2]) parameters. Using the Biodex Balance System, single-leg dynamic balance was measured by overall, anteroposterior, and mediolateral stability indices. Results Values of vibroarthrographic parameters (VMS, R4, P1 and P2) were significantly higher in the CAI group than those in the control group (Pankle arthrokinematic motion and postural control were present. Therefore, physical therapy interventions focused on improving ankle neuromuscular control and arthrokinematic function are necessary in CAI patient care. J Orthop Sports Phys Ther 2017;47(8):570-577. Epub 4 Nov 2016. doi:10.2519/jospt.2017.6836.

Surgical Reconstruction with the Remnant Ligament Improves Joint Position Sense as well as Functional Ankle Instability: A 1-Year Follow-Up Study

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Kamizato Iwao

2014-01-01

Full Text Available Introduction. Chronic functional instability—characterized by repeated ankle inversion sprains and a subjective sensation of instability—is one of the most common residual disabilities after an inversion sprain. However, whether surgical reconstruction improves sensorimotor control has not been reported to date. The purpose of this study was to assess functional improvement of chronic ankle instability after surgical reconstruction using the remnant ligament. Materials and Methods. We performed 10 cases in the intervention group and 20 healthy individuals as the control group. Before and after surgical reconstruction, we evaluated joint position sense and functional ankle instability by means of a questionnaire. Results and Discussion. There was a statistically significant difference between the control and intervention groups before surgical reconstruction. Three months after surgery in the intervention group, the joint position sense was significantly different from those found preoperatively. Before surgery, the mean score of functional ankle instability in the intervention group was almost twice as low. Three months after surgery, however, the score significantly increased. The results showed that surgical reconstruction using the remnant ligament was effective not only for improving mechanical retensioning but also for ameliorating joint position sense and functional ankle instability.

Lower limb joint motion during a cross cutting movement differs in individuals with and without chronic ankle instability.

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Koshino, Yuta; Yamanaka, Masanori; Ezawa, Yuya; Ishida, Tomoya; Kobayashi, Takumi; Samukawa, Mina; Saito, Hiroshi; Takeda, Naoki

2014-11-01

To compare the kinematics of lower limb joints between individuals with and without chronic ankle instability (CAI) during cross-turn and -cutting movements. Cross-sectional study. Motion analysis laboratory. Twelve subjects with CAI and twelve healthy controls. Hip flexion, adduction, and internal rotation, knee flexion, and ankle dorsiflexion and inversion angles were calculated in the 200 ms before initial ground contact and from initial ground contact to toe-off (stance phase) in a cross-turn movement during gait and a cross-cutting movement from a forward jump, and compared across the two groups. In the cross-cutting movement, the CAI group exhibited greater hip and knee flexion than the control group during the stance phase, and more hip abduction during the period before initial contact and the stance phase. In the cross-turn movement the joint kinematics were similar in the two groups. CAI subjects exhibited an altered pattern of the proximal joint kinematics during a cross-cutting movement. It is important for clinicians to assess the function of the hip and knee as well as the ankle, and to incorporate coordination training for the entire lower limb into rehabilitation after lateral ankle sprains. Copyright © 2013 Elsevier Ltd. All rights reserved.

Individuals with chronic ankle instability exhibit dynamic postural stability deficits and altered unilateral landing biomechanics: A systematic review.

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Simpson, Jeffrey D; Stewart, Ethan M; Macias, David M; Chander, Harish; Knight, Adam C

2018-06-13

To evaluate the literature regarding unilateral landing biomechanics and dynamic postural stability in individuals with and without chronic ankle instability (CAI). Four online databases (PubMed, ScienceDirect, Scopus, and SportDiscus) were searched from the earliest records to 31 January 2018, as well as reference sections of related journal articles, to complete the systematic search. Studies investigating the influence of CAI on unilateral landing biomechanics and dynamic postural stability were systematically reviewed and evaluated. Twenty articles met the criteria and were included in the systematic review. Individuals with CAI were found to have deficits in dynamic postural stability on the affected limb with medium to large effect sizes and altered lower extremity kinematics, most notably in the ankle and knee, with medium to large effect sizes. Additionally, greater loading rates and peak ground reaction forces, in addition to reductions in ankle muscle activity were also found in individuals with CAI during unilateral jump-landing tasks. Individuals with CAI demonstrate dynamic postural stability deficits, lower extremity kinematic alterations, and reduced neuromuscular control during unilateral jump-landings. These are likely factors that contribute recurrent lateral ankle sprain injuries during dynamic activity in individuals with CAI. Copyright © 2018 Elsevier Ltd. All rights reserved.

Whole-Body-Vibration Training and Balance in Recreational Athletes With Chronic Ankle Instability.

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Sierra-Guzmán, Rafael; Jiménez-Diaz, Fernando; Ramírez, Carlos; Esteban, Paula; Abián-Vicén, Javier

2018-04-01

  Deficits in the propioceptive system of the ankle contribute to chronic ankle instability (CAI). Recently, whole-body-vibration (WBV) training has been introduced as a preventive and rehabilitative tool.   To evaluate how a 6-week WBV training program on an unstable surface affected balance and body composition in recreational athletes with CAI.   Randomized controlled clinical trial.   Research laboratory.   Fifty recreational athletes with self-reported CAI were randomly assigned to a vibration (VIB), nonvibration (NVIB), or control group.   The VIB and NVIB groups performed unilateral balance training on a BOSU 3 times weekly for 6 weeks. The VIB group trained on a vibration platform, and the NVIB group trained on the floor.   We assessed balance using the Biodex Balance System and the Star Excursion Balance Test (SEBT). Body composition was measured by dual-energy x-ray absorptiometry.   After 6 weeks of training, improvements on the Biodex Balance System occurred only on the Overall Stability Index ( P = .01) and Anterior-Posterior Stability Index ( P = .03) in the VIB group. We observed better performance in the medial ( P = .008) and posterolateral ( P = .04) directions and composite score of the SEBT in the VIB group ( P = .01) and in the medial ( P Balance System, whereas the VIB and NVIB groups displayed better performance on the SEBT.

The Effect of 2 Forms of Talocrural Joint Traction on Dorsiflexion Range of Motion and Postural Control in Those With Chronic Ankle Instability.

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Powden, Cameron J; Hogan, Kathleen K; Wikstrom, Erik A; Hoch, Matthew C

2017-05-01

Talocrural joint mobilizations are commonly used to address deficits associated with chronic ankle instability (CAI). Examine the immediate effects of talocrural joint traction in those with CAI. Blinded, crossover. Laboratory. Twenty adults (14 females; age = 23.80 ± 4.02 y; height = 169.55 ± 12.38 cm; weight = 78.34 ± 16.32 kg) with self-reported CAI participated. Inclusion criteria consisted of a history of ≥1 ankle sprain, ≥2 episodes of giving way in the previous 3 mo, answering "yes" to ≥4 questions on the Ankle Instability Instrument, and ≤24 on the Cumberland Ankle Instability Tool. Subjects participated in 3 sessions in which they received a single treatment session of sustained traction (ST), oscillatory traction (OT), or a sham condition in a randomized order. Interventions consisted of four 30-s sets of traction with 1 min of rest between sets. During ST and OT, the talus was distracted distally from the ankle mortise to the end-range of accessory motion. ST consisted of continuous distraction and OT involved 1-s oscillations between the mid and end-range of accessory motion. The sham condition consisted of physical contact without force application. Preintervention and postintervention measurements of weight-bearing dorsiflexion, dynamic balance, and static single-limb balance were collected. The independent variable was treatment (ST, OT, sham). The dependent variables included pre-to-posttreatment change scores for the WBLT (cm), normalized SEBTAR (%), and time-to-boundary (TTB) variables(s). Separate 1-way ANOVAs examined differences between treatments for each dependent variable. Alpha was set a priori at P manual therapies.

Difference in postural control between patients with functional and mechanical ankle instability.

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Chen, Henry; Li, Hong-Yun; Zhang, Jian; Hua, Ying-Hui; Chen, Shi-Yi

2014-10-01

Lateral ankle sprain is one of the most common injuries. Since the structural and pathological differences in mechanical ankle instability (MAI) and functional ankle instability (FAI) may not be the same, it may be better to treat these as separate groups. The purpose of this study was to compare the difference in postural sway between MAI and FAI in patients with chronic ankle instability (CAI). Twenty-six patients with CAI and 14 healthy control participants were included in the study. The CAI patients were subdivided into MAI (15 patients) and FAI (11 patients) groups. Patients who were diagnosed with lateral ankle ligaments rupture by magnetic resonance imaging and ultrasonography were assigned to the MAI group. All participants performed single-limb postural sway tests 3 times on each leg with eyes closed and open. The average distances from the mean center of pressure position in the mediolateral and anteroposterior directions were recorded and compared among the 3 groups. The unstable ankles in the MAI group showed significantly greater postural sway in the anterior, posterior, and medial directions compared with those in the control group with eyes closed. With eyes open, significantly greater postural sway was found in the anterior direction. In the FAI group, no difference was found in postural sway compared with those in the control group. The MAI group showed significantly greater postural sway in the anterior direction compared with the FAI group with eyes closed and open. No significant difference in postural sway was found between the unstable and stable ankles in the MAI or FAI groups, with or without vision. Patients with MAI have deficits in postural control, especially in anterior-posterior directions. However, no difference was found in postural sway in patients with FAI compared with healthy people. As MAI patients suffer from deficits in postural control, balance training should be applied in those patients. In addition, special training

Allograft tendon reconstruction of the anterior talofibular ligament and calcaneofibular Ligament in the treatment of chronic ankle instability.

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Wang, Weikai; Xu, Guo Hong

2017-04-08

The purpose was retrospectively to investigate functional and clinical outcomes after anterior talofibular ligament (ATFL) and calcaneofibular ligament (CFL) reconstruction using a single allograft. Patients with severe chronic lateral instability of the ankle underwent surgery after conservative treatment failed. Ultrasounds of the ankle were performed, and if the AFTL and CFL were completely torn without enough soft tissue for repair, the ligaments were reconstructed using allograft tendon. Outcomes were assessed by clinical examination, stress radiography, ultrasound, the American Orthopaedic Foot and Ankle Society score (AOFAS), and Karlsson Ankle Functional score (KAFS) before surgery and at final follow-up. Nineteen patients, ten men and nine women with mean age of 27.9 years (range, 19-41 years), underwent reconstruction. Mean follow-up was 30 months (range, 24-40 months). At final follow-up, all patients had returned to activity without instability, pain, or limited range of motion. On stress radiography, mean talar tilt angle decreased from 17.32° ± 3.58° before surgery to 4.16° ± 1.12° at follow-up (p surgery to 3.97 ± 0.99 mm at follow-up (p < 0.05). Mean AOFAS improved from 64.00 ± 18.43 to 90.32 ± 5.17 points (p < 0.001), and mean KAFS improved from 50.84 ± 16.73 to 90.89 ± 5.08 points (p < 0.001). Ultrasound showed the reconstructed ligaments maintained good continuity and excellent tension. No case of infection and immunological rejection was reported. This novel reconstruction technique takes into account the anatomical specialty of AFTL and CFL. This case series showed increased stability of the ankle in clinical and functional outcomes. The trial registration number (TRN) and date of registration: ChiCTR-ORC-17010796 , Mar 6th 2017. Retrospectively registered.

Ankle ligament injuries

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Per A.F.H. Renström

1998-06-01

Full Text Available Acute ankle ligament sprains are common injuries. The majority of these occur during athletic participation in the 15 to 35 year age range. Despite the frequency of the injury, diagnostic and treatment protocols have varied greatly. Lateral ligament complex injuries are by far the most common of the ankle sprains. Lateral ligament injuries typically occur during plantar flexion and inversion, which is the position of maximum stress on the anterotalofibular liagment (ATFL. For this reason, the ATFL is the most commonly torn ligament during an inversion injury. In more severe inversion injuries the calcaneofibular (CFL, posterotalofibular (PTFL and subtalar ligament can also be injured. Most acute lateral ankle ligament injuries recover quickly with nonoperative management. The treatment program, called "functional treatment," includes application of the RICE principle (rest, ice, compression, and elevation immediately after the injury, a short period of immobilization and protection with an elastic or inelastic tape or bandage, and early motion exercises followed by early weight bearing and neuromuscular ankle training. Proprioceptive training with a tilt board is commenced as soon as possible, usually after 3 to 4 weeks. The purpose is to improve the balance and neuromuscular control of the ankle. Sequelae after ankle ligament injuries are very common. As much as 10% to 30% of patients with a lateral ligament injury may have chronic symptoms. Symptoms usually include persistent synovitis or tendinitis, ankle stiffness, swelling, and pain, muscle weakness, and frequent giving-way. A well designed physical therapy program with peroneal strengthening and proprioceptive training, along with bracing and/or taping can alleviate instability problems in most patients. For cases of chronic instability that are refractory to bracing and external support, surgical treatment can be explored. If the chronic instability is associated with subtalar instability

Effects of Nintendo Wii Fit Plus training on ankle strength with functional ankle instability.

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Kim, Ki-Jong; Jun, Hyun-Ju; Heo, Myoung

2015-11-01

[Purpose] The objective of this study was to examine the effects of a training program using the Nintendo Wii Fit Plus on the ankle muscle strengths of subjects with functional ankle instability. [Subjects and Methods] This study was conducted using subjects in their 20s who had functional ankle instability. They were randomized to a strengthening training group and a balance training group with 10 subjects in each, and they performed an exercise using Nintendo Wii Fit Plus for 20 minutes. In addition, every participant completed preparation and finishing exercises for 5 minutes, respectively. [Results] The muscle strengths after conducting plantar flexion and dorsiflexion significantly increased at the angular velocities of 60° and 120° in the strengthening training group. Furthermore, the muscle strengths after conducting plantar flexion, dorsiflexion, eversion, and inversion significantly increased at the angular velocities of 60° and 120° in the balance training group. [Conclusion] The balance training group using Nintendo Wii Fit Plus showed better results than the strengthening training group. Consequently, it is recommended to add the balance training program of the Nintendo Wii Fit Plus to conventional exercise programs to improve ankle muscle strength in functional ankle instability at a low cost.

Acute ankle sprain: conservative or surgical approach?

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Al-Mohrej, Omar A.; Al-Kenani, Nader S.

2016-01-01

Ankle sprains fall into two main categories: acute ankle sprains and chronic ankle instability, which are among the most common recurrent injuries during occupational activities, athletic events, training and army service. Acute ankle sprain is usually managed conservatively and functional rehabilitation failure by conservative treatment leads to development of chronic ankle instability, which most often requires surgical intervention. Enhancing the in-depth knowledge of the ankle anatomy, biomechanics and pathology helps greatly in deciding the management options. Cite this article: Al-Mohrej OA, Al-Kenani NS. Acute ankle sprain: conservative or surgical approach? EFORT Open Rev 2016;1:34-44. DOI: 10.1302/2058-5241.1.000010. PMID:28461926

Influence of Passive Joint Stiffness on Proprioceptive Acuity in Individuals With Functional Instability of the Ankle.

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Marinho, Hellen Veloso Rocha; Amaral, Giovanna Mendes; de Souza Moreira, Bruno; Araújo, Vanessa Lara; Souza, Thales Rezende; Ocarino, Juliana Melo; da Fonseca, Sérgio Teixeira

2017-12-01

Study Design Controlled laboratory study, cross-sectional. Background Deficits in ankle proprioceptive acuity have been reported in persons with functional instability of the ankle. Passive stiffness has been proposed as a possible mechanism underlying proprioceptive acuity. Objective To compare proprioceptive acuity and passive ankle stiffness in persons with and without functional ankle instability, and to assess the influence of passive joint stiffness on proprioceptive acuity in persons with functional ankle instability. Methods A sample of 18 subjects with and 18 without complaints of functional ankle instability following lateral ankle sprain participated. An isokinetic dynamometer was used to compare motion perception threshold, passive position sense, and passive ankle stiffness between groups. To evaluate the influence of passive stiffness on proprioceptive acuity, individuals in the lateral functional ankle instability group were divided into 2 subgroups: "high" and "low" passive ankle stiffness. Results The functional ankle instability group exhibited increased motion perception threshold when compared with the corresponding limb of the control group. Between-group differences were not found for passive position sense and passive ankle stiffness. Those in the functional ankle instability group with higher passive ankle stiffness had smaller motion perception thresholds than those with lower passive ankle stiffness. Conclusion Unlike motion perception threshold, passive position sense is not affected by the presence of functional ankle instability. Passive ankle stiffness appears to influence proprioceptive acuity in persons with functional ankle instability. J Orthop Sports Phys Ther 2017;47(12):899-905. Epub 7 Oct 2017. doi:10.2519/jospt.2017.7030.

Factors contributing to chronic ankle instability: a protocol for a systematic review of systematic reviews.

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Thompson, Cassandra; Schabrun, Siobhan; Romero, Rick; Bialocerkowski, Andrea; Marshall, Paul

2016-06-07

Ankle sprains are a significant clinical problem. Researchers have identified a multitude of factors contributing to the presence of recurrent ankle sprains including deficits in balance, postural control, kinematics, muscle activity, strength, range of motion, ligament laxity and bone/joint characteristics. Unfortunately, the literature examining the presence of these factors in chronic ankle instability (CAI) is conflicting. As a result, researchers have attempted to integrate this evidence using systematic reviews to reach conclusions; however, readers are now faced with an increasing number of systematic review findings that are also conflicting. The overall aim of this review is to critically appraise the methodological quality of previous systematic reviews and pool this evidence to identify contributing factors to CAI. A systematic review will be conducted on systematic reviews that investigate the presence of various deficits identified in CAI. Databases will be searched using pre-determined search terms. Reviews will then be assessed for inclusion based on the set eligibility criteria. Two independent reviewers will assess the articles for inclusion before evaluating the methodological quality and presence of bias of the included studies; any disagreements will be resolved by discussion between reviewers to reach consensus or by a third reviewer. Data concerning the specific research question, search strategy, inclusion/exclusion criteria, population, method and outcomes will be extracted. Findings will be analysed with respect to the methodological quality of the included reviews. It is expected that this review will clarify the cause of contradicting findings in the literature and facilitate future research directions. PROSPERO CRD42016032592 .

Outcomes of the modified Brostrom procedure using suture anchors for chronic lateral ankle instability--a prospective, randomized comparison between single and double suture anchors.

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Cho, Byung-Ki; Kim, Yong-Min; Kim, Dong-Soo; Choi, Eui-Sung; Shon, Hyun-Chul; Park, Kyoung-Jin

2013-01-01

The present prospective, randomized study was conducted to compare the clinical outcomes of the modified Brostrom procedure using single and double suture anchors for chronic lateral ankle instability. A total of 50 patients were followed up for more than 2 years after undergoing the modified Brostrom procedure. Of the 50 procedures, 25 each were performed using single and double suture anchors by 1 surgeon. The Karlsson scale had improved significantly to 89.8 points and 90.6 points in the single and double anchor groups, respectively. Using the Sefton grading system, 23 cases (92%) in the single anchor group and 22 (88%) in the double anchor group achieved satisfactory results. The talar tilt angle and anterior talar translation on stress radiographs using the Telos device had improved significantly to an average of 5.7° and 4.6 mm in the single anchor group and 4.5° and 4.3 mm in the double anchor group, respectively. The double anchor technique was superior with respect to the postoperative talar tilt. The single and double suture anchor techniques produced similar clinical and functional outcomes, with the exception of talar tilt as a reference of mechanical stability. The modified Brostrom procedure using both single and double suture anchors appears to be an effective treatment method for chronic lateral ankle instability. Copyright © 2013 American College of Foot and Ankle Surgeons. Published by Elsevier Inc. All rights reserved.

All-inside arthroscopic modified Broström operation for chronic ankle instability: a biomechanical study.

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Lee, Kyung Tai; Kim, Eung Soo; Kim, Young Ho; Ryu, Je Seong; Rhyu, Im Joo; Lee, Young Koo

2016-04-01

The all-inside arthroscopic modified Broström operation has been developed for lateral ankle instability. We compared the biomechanical parameters of the all-inside arthroscopic procedure to the open modified Broström operation. Eleven matched pairs of human cadaver specimens [average age 71.5 (range 58-98) years] were subject to the arthroscopic modified Broström operation using a suture anchor and the open modified Broström operation. The ligaments were loaded cyclically 20 times and then tested to failure. Torque to failure, degrees to failure, and stiffness were measured. A matched-pair analysis was performed. There was no significant difference in torque to failure between the open and arthroscopic modified Broström operation (19.9 ± 8.9 vs. 23.3 ± 12.1 Nm, n.s). The degrees to failure did not differ significantly between the open and arthroscopic modified Broström operations (46.8 ± 9.9° vs. 46.7 ± 7.6°, n.s). The working construct stiffness (or stiffness to failure) was no significant difference in the two groups (0.438 ± 0.21 vs. 0.487 ± 0.268 Nm/deg for the open and arthroscopic modified Broström operations, respectively, n.s). The all-inside arthroscopic modified Broström operation and the open modified Broström operation resulted in no significantly different torque to failure, degrees to failure, and working construct stiffness with no significant differences (n.s, n.s, and n.s, respectively). Our results indicate that the arthroscopic modified Broström operation is a reasonable alternative procedure for chronic ankle instability.

Evaluation of the Talar Cartilage in Chronic Lateral Ankle Instability with Lateral Ligament Injury Using Biochemical T2* Mapping: Correlation with Clinical Symptoms.

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Hu, Yiwen; Tao, Hongyue; Qiao, Yang; Ma, Kui; Hua, Yinghui; Yan, Xu; Chen, Shuang

2018-06-19

This study aims to quantitatively compare T2* measurements of the talar cartilage between chronic lateral ankle instability (LAI) patients with lateral ligament injury and healthy volunteers, and to assess the association of T2* value with American Orthopedic Foot and Ankle Society (AOFAS) score. Nineteen consecutive patients with chronic LAI (LAI group) and 19 healthy individuals (control group) were enrolled. Biochemical magnetic resonance examination of the ankle was performed in all participants using three-dimensional gradient-echo T2* mapping. Total talar cartilage was divided into six subcompartments, including medial anterior (MA), central medial, medial posterior, lateral anterior, central lateral (LC), and lateral posterior regions. T2* values of respective cartilage areas were measured and compared between the two groups using Student t test. AOFAS scoring was performed for clinical evaluation. Then, the association of T2* value with AOFAS score was evaluated by Pearson correlation. The T2* values of total talar cartilage, as well as MA and LC cartilage compartments, in the chronic LAI group were significantly higher than control values (P T2* value of MA in the chronic LAI group was negatively correlated with AOFAS score (r =-0.8089, P T2* measurements. The clinical score correlates highly with T2* value of the MA cartilage compartment, indicating that MA may be the principal cartilage area conferring clinical symptoms. Copyright © 2018 The Association of University Radiologists. Published by Elsevier Inc. All rights reserved.

Analysis of Two Different Arthroscopic Broström Repair Constructs for Treatment of Chronic Lateral Ankle Instability in 110 Patients: A Retrospective Cohort Study.

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Cottom, James M; Baker, Joseph; Plemmons, Britton S

Chronic lateral ankle instability is a common condition treated by most foot and ankle surgeons. Once conservative treatment has failed, patients often undergo surgical reconstruction, either anatomic or nonanatomic. The present retrospective cohort study compared the clinical outcomes of 2 different arthroscopic Broström procedures. A total of 110 patients (83 females [75.5%] and 27 males [24.5%]) were treated with 1 of the 2 lateral ankle stabilization techniques from October 1, 2014 to December 31, 2015. Of the 110 patients, 75 were included in the arthroscopic lateral ankle stabilization group with an additional suture anchor used proximally and 35 were included in the arthroscopic lateral ankle stabilization group using the knotless design. The age of the cohort was 46.05 ± 17.89 (range 12 to 83) years. The body mass index was 30.03 ± 7.42 (range 18.3 to 52.5) kg/m 2 . Of the 110 patients, 25 (22.7%) had undergone concomitant procedures during lateral ankle stabilization. Overall, postoperative complications occurred in 14 patients (12.7%). No statistically significant differences were found between the 2 groups regarding the complication rates, use of concomitant procedures, and the presence of diabetes and workers compensation claims. No statistically significant differences were found in the mean age, body mass index, or gender distribution between the 2 groups. The preoperative American Orthopaedic Foot and Ankle Society (AOFAS) Ankle-Hindfoot scores were 50.85 ± 13.56 (range 18 to 76) and 51.26 ± 13.32 (range 18 to 69) in groups 1 and 2, respectively. The postoperative AOFAS Ankle-Hindfoot scores were 88.19 ± 10.72 (range 54 to 100) and 84 ± 15.41 (range 16 to 100) in groups 1 and 2, respectively. No statistically significant difference was found between these 2 groups. The preoperative visual analog scale score was 7.45 ± 1.39 (range 3 to 10) and 6.97 ± 1.25 (range 5 to 10), which had improved to 1.12 ± 1.38 (range 0 to 5) and

Recalcitrant Lateral Premalleolar Bursitis of the Ankle Associated with Lateral Ankle Instability

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Masashi Naito

2017-01-01

Full Text Available Lateral premalleolar bursitis of the ankle is a rarely reported disorder in the English literature although it is not uncommon in Asian countries where people commonly sit on their feet. Here, we present the case of a 66-year-old woman with recalcitrant lateral premalleolar bursitis associated with lateral ankle instability which was successfully treated with surgical resection of the bursa and repair of the anterior talofibular ligament. Operative findings revealed a communication between the bursa and articular cavity of the ankle joint via the sheath of the extensor digitorum longus tendon, which was considered to act as a check valve leading to a large and recalcitrant bursitis. This report provides a novel concept about the etiology of recalcitrant lateral premalleolar bursitis of the ankle.

Gait Biomechanics in Participants, Six Months after First-time Lateral Ankle Sprain.

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Doherty, C; Bleakley, C; Hertel, J; Caulfield, B; Ryan, J; Delahunt, E

2016-06-01

No research currently exists predicating a link between the injury-affiliated sensorimotor deficits of acute ankle sprain and those of chronic ankle instability during gait. This analysis evaluates participants with a 6-month history of ankle sprain injury to affirm this link. 69 participants with a 6-month history of acute first-time lateral ankle sprain were divided into subgroups ('chronic ankle instability' and 'coper') based on their self-reported disability and compared to 20 non-injured participants during a gait task. Lower extremity kinematic and kinetic data were collected from 200 ms pre- to 200 ms post-heel strike (period 1) and from 200 ms pre- to 200 ms post-toe off (period 2). The 'chronic ankle instability' subgroup (who reported greater disability) displayed increased knee flexion during period 1. During period 2, this subgroup exhibited greater total displacement at their ankle joint and greater extensor dominance at their knee. That many of these features are present, both in individuals with acute ankle sprain and those with chronic ankle instability may advocate a link between acute deficits and long-term outcome. Clinicians must be aware that the sensorimotor deficits of ankle sprain may persevere beyond the acute stage of injury and be cognizant of the capacity for impairments to pervade proximally. © Georg Thieme Verlag KG Stuttgart · New York.

Muscle Activation During Landing Before and After Fatigue in Individuals With or Without Chronic Ankle Instability

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Webster, Kathryn A.; Pietrosimone, Brian G.; Gribble, Phillip A.

2016-01-01

Context: Ankle instability is a common condition in physically active individuals. It often occurs during a jump landing or lateral motion, particularly when participants are fatigued. Objective: To compare muscle activation during a lateral hop prefatigue and postfatigue in individuals with or without chronic ankle instability (CAI). Design: Cross-sectional study. Setting: Sports medicine research laboratory. Patients or Other Participants: A total of 32 physically active participants volunteered for the study. Sixteen participants with CAI (8 men, 8 women; age = 20.50 ± 2.00 years, height = 172.25 ± 10.87 cm, mass = 69.13 ± 13.31 kg) were matched with 16 control participants without CAI (8 men, 8 women; age = 22.00 ± 3.30 years, height = 170.50 ± 9.94 cm, mass = 69.63 ± 14.82 kg) by age, height, mass, sex, and affected side. Intervention(s): Electromyography of the tibialis anterior, peroneus longus, gluteus medius, and gluteus maximus was measured before and after a functional fatigue protocol. Main Outcome Measure(s): Activation of 4 lower extremity muscles was measured 200 milliseconds before and after landing from a lateral hop. Results: We observed no interactions. The group main effects for the peroneus longus demonstrated higher muscle activation in the CAI group (52.89% ± 11.36%) than in the control group (41.12% ± 11.36%) just before landing the lateral hop (F1,30 = 8.58, P = .01), with a strong effect size (d = 1.01). The gluteus maximus also demonstrated higher muscle activation in the CAI group (45.55% ± 12.08%) than in the control group (36.81% ± 12.08%) just before landing the lateral hop (F1,30 = 4.19, P = .049), with a moderate effect size (d = 0.71). We observed a main effect for fatigue for the tibialis anterior, with postfatigue activation higher than prefatigue activation (F1,30 = 7.45, P = .01). No differences were present between groups for the gluteus medius. Conclusions: Our results support the presence of a centralized feed

POSITION-SPECIFIC DEFICIT OF JOINT POSITION SENSE IN ANKLES WITH CHRONIC FUNCTIONAL INSTABILITY

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Shigeki Yokoyama

2008-12-01

Full Text Available The present study was aimed to test a hypothesis that individuals with functional ankle instability (FAI underestimate the joint angle at greater plantarflexion and inversion. Seventeen males with unilateral FAI and 17 controls (males without FAI consented for participation in this IRB-approved, case-control study. Using a passive reproduction test, we assessed ankle joint position sense (JPS for test positions between 30 and -10 degrees plantarflexion with an inclement of 10 degrees with or without 20° inversion at each plantarflexion angle. The constant error (CE was defined as the value obtained by subtracting the true angle of a test position from the corresponding perceived angle. At plantarflexed and inverted test positions, the CE values were smaller in negative with greater in the FAI group than in the control group. That is, in the FAI group, the FAI group underestimated the true plantarflexion angle at combined 30° plantarflexion and 20° inversion. We conclude that the ankle with FAI underestimate the amount of plantarflexion, which increases the chance of reaching greater planterflexion and inversion than patients' intention at high risk situations of spraining such as landing

Short- to Medium-term Outcomes After a Modified Broström Repair for Lateral Ankle Instability With Immediate Postoperative Weightbearing.

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Petrera, Massimo; Dwyer, Tim; Theodoropoulos, John S; Ogilvie-Harris, Darrell J

2014-07-01

Anatomic techniques of ankle ligament repair have the advantage of restoring the anatomy and kinematics of the joint. This study presents a technique for anatomic reconstruction of the lateral ligament complex by way of lateral ligament advancement using suture anchors associated with immediate protected full weightbearing; 2- to 5-year clinical outcomes are reported. This technique of providing an anatomic reconstruction with a secure fixation will enable early rehabilitation with immediate, protected weightbearing, with favorable outcomes. Case series; Level of evidence, 4. Fifty-five patients with chronic lateral ankle instability who failed nonoperative management underwent modified Broström repair (lateral ligament fibular advancement) between 2005 and 2008. The anterior talofibular ligament and calcaneofibular ligament were released from the fibula and advanced using 2 double-loaded metallic suture anchors (3.5 mm). Full weightbearing in a walking boot was allowed from the first postoperative day. Patients were assessed preoperatively and at a minimum 2-year follow-up using the Foot and Ankle Outcome Score. Complication, failure (recurrent instability), and return-to-sport rates were also recorded. Six patients (11%) were lost to follow-up, leaving a study group of 49 patients (23 men, 26 women). The mean age at the time of surgery was 25 years (range, 18-37 years), with a mean duration of symptoms of 1.8 years (range, 6 months to 5 years). The mean follow-up time was 42 months (range, 24-60 months). Significant improvement was seen in the Foot and Ankle Outcome Score from preoperatively to postoperatively (from 36 to 75.4, P ankle-related quality of life subscale from 35 to 78 (P anchor fixation is an effective procedure for the treatment of chronic lateral ankle instability and allows immediate weightbearing. © 2014 The Author(s).

Comparison of the Modified Broström Procedure for Chronic Lateral Ankle Instability With and Without Subfibular Ossicle.

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Ahn, Hyeon-Wook; Lee, Keun-Bae

2016-12-01

Subfibular ossicles are frequently found in patients with chronic lateral ankle instability (CLAI). However, there is a lack of consensus about the optimal surgical treatment for CLAI with subfibular ossicle. To evaluate the clinical and radiographic outcomes of the modified Broström procedure with subfibular ossicle excision compared with the same procedure for CLAI without subfibular ossicle. Cohort study; Level of evidence, 3. Ninety-six patients (96 ankles) treated with the modified Broström procedure using bone tunnel and suture anchor techniques for CLAI constituted the study cohort. The 96 ankles were divided into 2 groups with and without subfibular ossicles. The ossicle group (42 ankles) and nonossicle group (54 ankles) consisted of patients with a mean age of 26.6 and 30.3 years, respectively, at the time of surgery with a mean follow-up duration of 63.7 and 62.1 months, respectively. Subfibular ossicles were excised in the ossicle group. Mean Karlsson scores improved from 55.2 to 95.3 in the ossicle group and from 56.4 to 94.8 in the nonossicle group at final follow-up. Mean American Orthopaedic Foot and Ankle Society (AOFAS) ankle-hindfoot scores also improved from 63.3 to 95.9 in the ossicle group and from 62.8 to 95.1 in the nonossicle group at final follow-up. Mean talar tilt angles were 14.0° in the ossicle group and 12.2° in the nonossicle group preoperatively and 7.6° and 6.8° at the final follow-up, respectively. Mean anterior talar translations in the ossicle group and nonossicle groups improved from 9.3 and 9.4 mm preoperatively to 5.8 and 5.7 mm at final follow-up, respectively. No significant differences were found between the 2 groups in terms of Karlsson score, AOFAS score, talar tilt angle, and anterior talar translation at final follow-up (P > .05). The modified Broström procedure with subfibular ossicle excision provided similarly good clinical and radiographic outcomes compared with the same procedure without subfibular ossicle

Progress on diagnosis and treatment of chronic ankle injuries%踝关节陈旧性损伤的诊断和治疗进展

Institute of Scientific and Technical Information of China (English)

李永恒; 陈兆军

2017-01-01

陈旧性踝关节扭伤多由急性踝关节扭伤疾病失治、误治或积劳成疾所致.其最主要的危害是后期的踝关节不稳,相关文献显示高达20%~40%的踝关节扭伤将演变成慢性踝关节不稳定.大多数学者认为陈旧性踝关节扭伤的伤害是踝关节内外侧韧带在松弛位愈合后造成的踝关节不稳,其中尤以踝关节外侧不稳多见.患者多表现为行走不平地面时的恐惧感或不稳定感、长时间行走时关节的酸痛及酸胀感,以及踝关节活动受限.本文对踝关节陈旧性扭伤的诊断、非手术治疗、手术治疗的方法及进展进行综述.%Chronic ankle injuries usually result from non-treatment and mistreatment of acute ankle sprain and overwork. It develops mostly to ankle instability. Literatures show that 20%to 40%of the ankle sprain will evolve into chronic ankle instability. Most scholars believe that the injury of the chronic ankle sprain is due to the healing of medial and lateral liga-ments in the relaxation of the joint, especially in lateral instability. Patients have a fear and a sense of instability when walk-ing on an uneven ground, and joint pain and limited ankle function will appear after distant walking. In this article, we re-viewed the diagnosis, conservative treatment, and surgical treatment of chronic ankle sprain.

Ankle instability

NARCIS (Netherlands)

Krips, Rover; de Vries, Jasper; van Dijk, C. Niek

2006-01-01

The ankle joint is the most congruent joint of the human body. Stability is provided by the bony configuration of the ankle mortise and the talar dome and by the ankle ligaments. During ankle motions, rotation and translation around and along the movement axes occur. Soft tissue stability is

The role of arthroscopy in the treatment of functional instability of the ankle.

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Kerr, Hui-Ling; Bayley, Edward; Jackson, Rosalyn; Kothari, Paresh

2013-12-01

Ankle sprains are common, the majority resolving with functional rehabilitation. Some patients are left with symptoms of functional instability (FI). Ankle arthroscopy in those with symptoms of FI is not well covered in the literature. Our aim was to assess its role in FI of the ankle. Retrospective case note analysis of patients with FI following an ankle sprain from 2005 to 2007. All underwent arthroscopy, provided mechanical instability was excluded (EUA and stress X-rays), and there were no signs of soft tissue impingement. These patients had exhausted all options of conservative therapy. Seventy-seven patients with a mean age of 38.1: five had true mechanical instability and were excluded. 72 underwent arthroscopy: 67 (93.1%) had significant amounts of scar tissue needing debridement, most commonly in the antero-lateral corner (58.3%). 52 patients improved (72.2%) at a minimum of 6 months follow-up. Our study supports the role of ankle arthroscopy in the treatment of FI following trauma. It should be considered when conservative measures have failed. Copyright © 2013 European Foot and Ankle Society. Published by Elsevier Ltd. All rights reserved.

The ability of modified star excursion balance test to differentiate between women athletes with and without chronic ankle instability

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Asma Razeghi

2016-05-01

Full Text Available The Star Excursion Balance Test (SEBT is one functional clinical test that widely used to assess dynamic balance in patients with ankle injuries. Since the ability of this test to detect impairments between athletes with and without chronic ankle instability(CAI is not clear, the aim of present study was to determine if the modified SEBT could detect reach deficits in patients with unilateral CAI. A convenience sample of thirty elite and sub elite women athletes were selected and assigned into two groups: CAI group (Mean ± SD: age: 25±3.5 years; height: 1.68±0.09 m; weight: 62.7±7.3kg, and healthy controls (Mean ± SD: age: 26±4.2 years; height: 1.69±0.05 m; weigh t: 62.7±7.3 kg.The dynamic balance test was obtained using modified SEBT from both limbs of each participant. The independent sample t-test was used for both between group and within group inter-limb comparisons. There was no significant difference in any directions of modified SEBT between two groups in both limbs. No significant interlimb differences were also observed within both groups. The modified SEBT may not enough sensitive to differentiate between athletes with and without CAI. Other factors such as ankle range of motion, muscle strength and pain intensity should be considered for better interpretation of the SEBT results.

Coordination and Symmetry Patterns During the Drop Vertical Jump in People With Chronic Ankle Instability and Lateral Ankle Sprain Copers.

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Doherty, Cailbhe; Bleakley, Chris; Hertel, Jay; Caulfield, Brian; Ryan, John; Sweeney, Kevin; Patterson, Matthew R; Delahunt, Eamonn

2016-08-01

The drop vertical jump (DVJ) task has previously been used to identify movement patterns associated with a number of injury types. However, no current research exists evaluating people with chronic ankle instability (CAI) compared with people coping with lateral ankle sprain (LAS) (referred to as "LAS copers") during this task. The aim of this study was to identify the coping movement and motor control patterns of LAS copers in comparison with individuals with CAI during the DVJ task. This was a case-control study. Seventy individuals were recruited at convenience within 2-weeks of sustaining a first-time acute LAS injury. One year following recruitment, these individuals were stratified into 2 groups: 28 with CAI and 42 LAS copers. They attended the testing laboratory to complete a DVJ task. Three-dimensional kinematic and sagittal-plane kinetic profiles were plotted for the lower extremity joints of both limbs for the drop jump phase (phase 1) and drop landing phase (phase 2) of the DVJ. The rate of impact modulation relative to body weight during both phases of the DVJ also was determined. Compared with LAS copers, participants with CAI displayed significant increases in hip flexion on their "involved" limb during phase 1 of the DVJ (23° vs 18°) and bilaterally during phase 2 (15° vs 10°). These movement patterns coincided with altered moment-of-force patterns at the hip on the "uninvolved" limb. It is unknown whether these movement and motor control patterns preceded or occurred as a result of the initial LAS injury. Participants with CAI displayed hip-centered changes in movement and motor control patterns during a DVJ task compared with LAS copers. The findings of this study may give an indication of the coping mechanism underlying outcome following initial LAS injury. © 2016 American Physical Therapy Association.

Instrumentos de avaliação para limitações funcionais associadas à instabilidade crônica de tornozelo: uma revisão sistemática da literatura Assessment instruments for chronic ankle instability: a systematic review of literature

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Eneida Yuri Suda

2012-03-01

patients with chronic ankle instability. A computerized literature search was performed in the databases of PubMed, Embase, VHL, LILACS and SciELO to identify eligible instruments. Five studies were included and presented five different instruments - Foot and Ankle Disability Index (FADI, Ankle Joint Functional Assessment Tool (AJFAT, Foot and Ankle Ability Measure (FAAM, Ankle Joint Functional Assessment Tool (AII e Cumberland Ankle Instability Tool (CAIT. There were instruments that can detect functional limitations in subjects with functional ankle instability but that are not reliable to detect this condition. There is still a need for further clinimetric studies in order to validate these tools to obtain an effective and complete evaluation of the functional instability of the ankle.

Radiology of chronic diseases of the ankle joint

International Nuclear Information System (INIS)

Rand, T.; Trattnig, S.; Breitenseher, M.; Imhof, H.; Wagesreither, S.

1999-01-01

The etiology of chronic diseases of the ankle joint comprises a wide spectrum including chronic inflammatory processes and chronic degenerative, tumorous and neuropathic processes, as well as some specific syndromes based on chronic changes of the ankle joint. Of the inflammatory processes, chronic juvenile arthritis (JVC) is the most common disease. However, also Reiter disease, psoriasis or chronic monoarthritid diseases such as gout, as well as granulomatous diseases (tuberculosis, sarcoidosis) and fungal infections, may affect the ankle joint in a chronic course. Chronic degenerative changes are usually secondary due to abnormal positioning of the joint constituents or repetitive trauma. Neuropathic changes, as frequently seen in the course of diabetes, present with massive osseous destruction and malposition of the articular constituents. Chronic osseous as well as cartilaginous and synovial changes are seen in hemoplici patients. Chronic traumatic changes are represented by pigmented villonodular synovitis (PVNS), and chondromatosis, both with a predilection for the ankle joint. Due to the possibilities of magnetic resonance imaging (MRI), diagnosis of chronic ankle changes includes chronic ligamentous, tendinous and soft tissue changes. With the use MRI, specific syndromes can be defined which particularly affect the ankle joint in a chronic way, such as the os trigonum syndrome, the anterolateral impingement syndrome and the sinus tarsi syndrome. Nevertheless, plain film radiographs are still the basic element of any investigation. MRI, however, can be potentially used as a second investigation, saving an unnecessary cascade of investigations with ultrasound and CT. The latter investigations are used only with very specific indications, for instance CT for subtle bone structures and sonography for a limited investigation of tendons or evaluation of fluid. Particularly due to the possibilities of MRI and the development of special gradient-echo imaging or

The predictive value of MRI in the syndesmotic instability of ankle fracture

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Park, Young Hwan; Choi, Won Seok; Kim, Hak Jun [Korea University Guro Hospital, Department of Orthopedic Surgery, Seoul (Korea, Republic of); Yoon, Min A.; Hong, Suk Joo [Korea University Guro Hospital, Department of Radiology, Seoul (Korea, Republic of); Choi, Gi Won [Korea University Ansan Hospital, Department of Orthopedic Surgery, Ansan (Korea, Republic of)

2018-04-15

Although many types of ankle fracture can be combined with syndesmosis injury, preoperative imaging studies rarely reveal instability of the syndesmosis. This study assessed the use of magnetic resonance imaging (MRI) for syndesmotic instability in patients with unstable ankle fracture. A total of 74 patients who were treated for Lauge-Hansen supination external rotation/Weber B type fracture or pronation external rotation/Weber C type fracture and who underwent MRI for preoperative assessment were enrolled. The MRI findings of the syndesmotic ligament and the results of an intraoperative stress test were evaluated. Twenty-six patients had a positive result on the intraoperative stress test for syndesmotic instability. The MRI findings of the syndesmotic ligaments revealed that complete tear of the posterior inferior tibiofibular ligament (PITFL) was the most reliable predictor of syndesmotic instability (sensitivity, 74%; specificity, 78%; positive predictive value, 54%). Interobserver agreement for the intraoperative stress test and MRI assessment was excellent, except for the MRI findings of the interosseous ligament (62% agreement; kappa, 0.3). Complete tear of the PITFL on MRI has additional diagnostic value for syndesmotic instability in ankle fracture. However, because the sensitivity might not be sufficient to justify the costs associated with MRI, cost-effectiveness should be considered. (orig.)

The predictive value of MRI in the syndesmotic instability of ankle fracture

International Nuclear Information System (INIS)

Park, Young Hwan; Choi, Won Seok; Kim, Hak Jun; Yoon, Min A.; Hong, Suk Joo; Choi, Gi Won

2018-01-01

Although many types of ankle fracture can be combined with syndesmosis injury, preoperative imaging studies rarely reveal instability of the syndesmosis. This study assessed the use of magnetic resonance imaging (MRI) for syndesmotic instability in patients with unstable ankle fracture. A total of 74 patients who were treated for Lauge-Hansen supination external rotation/Weber B type fracture or pronation external rotation/Weber C type fracture and who underwent MRI for preoperative assessment were enrolled. The MRI findings of the syndesmotic ligament and the results of an intraoperative stress test were evaluated. Twenty-six patients had a positive result on the intraoperative stress test for syndesmotic instability. The MRI findings of the syndesmotic ligaments revealed that complete tear of the posterior inferior tibiofibular ligament (PITFL) was the most reliable predictor of syndesmotic instability (sensitivity, 74%; specificity, 78%; positive predictive value, 54%). Interobserver agreement for the intraoperative stress test and MRI assessment was excellent, except for the MRI findings of the interosseous ligament (62% agreement; kappa, 0.3). Complete tear of the PITFL on MRI has additional diagnostic value for syndesmotic instability in ankle fracture. However, because the sensitivity might not be sufficient to justify the costs associated with MRI, cost-effectiveness should be considered. (orig.)

The effects of mobilization with movement on dorsiflexion range of motion, dynamic balance, and self-reported function in individuals with chronic ankle instability.

Science.gov (United States)

Gilbreath, Julie P; Gaven, Stacey L; Van Lunen, L; Hoch, Matthew C

2014-04-01

Previous studies have examined the effectiveness of a manual therapy intervention known as Mobilization with Movement (MWM) to increase dorsiflexion range of motion (ROM) in individuals with chronic ankle instability (CAI). While a single talocrural MWM treatment has increased dorsiflexion ROM in these individuals, examining the effects of multiple treatments on dorsiflexion ROM, dynamic balance, and self-reported function would enhance the clinical application of this intervention. This study sought to determine if three treatment sessions of talocrural MWM would improve dorsiflexion ROM, Star Excursion Balance Test (SEBT) reach distances, and self-reported function using the Foot and Ankle Ability Measure (FAAM) in individuals with CAI. Eleven participants with CAI (5 Males, 6 Females, age: 21.5 ± 2.2 years, weight: 83.9 ± 15.6 kg, height: 177.7 ± 10.9 cm, Cumberland Ankle Instability Tool: 17.5 ± 4.2) volunteered in this repeated-measures study. Subjects received three MWM treatments over one week. Weight-bearing dorsiflexion ROM (cm), normalized SEBT reach distances (%), and self-reported function (%) were assessed one week before the intervention (baseline), prior to the first MWM treatment (pre-intervention), and 24–48 h following the final treatment (post-intervention). No significant changes were identified in dorsiflexion ROM, SEBT reach distances, or the FAAM-Activities of Daily Living scale (p > 0.05). Significant changes were identified on the FAAM-Sport (p = 0.01). FAAM-Sport scores were significantly greater post-intervention (86.82 ± 9.18%) compared to baseline (77.27 ± 11.09%; p = 0.01) and pre-intervention (79.82 ± 13.45%; p = 0.04). These results indicate the MWM intervention did not improve dorsiflexion ROM, dynamic balance, or patient-centered measures of activities of daily living. However, MWM did improve patient-centered measures of sport-related activities in individuals with CAI.

Altered neuromuscular control and ankle joint kinematics during walking in subjects with functional instability of the ankle joint.

Science.gov (United States)

Delahunt, Eamonn; Monaghan, Kenneth; Caulfield, Brian

2006-12-01

The ankle joint requires very precise neuromuscular control during the transition from terminal swing to the early stance phase of the gait cycle. Altered ankle joint arthrokinematics and muscular activity have been cited as potential factors that may lead to an inversion sprain during the aforementioned time periods. However, to date, no study has investigated patterns of muscle activity and 3D joint kinematics simultaneously in a group of subjects with functional instability compared with a noninjured control group during these phases of the gait cycle. To compare the patterns of lower limb 3D joint kinematics and electromyographic activity during treadmill walking in a group of subjects with functional instability with those observed in a control group. Controlled laboratory study. Three-dimensional angular velocities and displacements of the hip, knee, and ankle joints, as well as surface electromyography of the rectus femoris, peroneus longus, tibialis anterior, and soleus muscles, were recorded simultaneously while subjects walked on a treadmill at a velocity of 4 km/h. Before heel strike, subjects with functional instability exhibited a decrease in vertical foot-floor clearance (12.62 vs 22.84 mm; P joint before, at, and immediately after heel strike (1.69 degrees , 2.10 degrees , and -0.09 degrees vs -1.43 degrees , -1.43 degrees , and -2.78 degrees , respectively [minus value = eversion]; P < .05) compared with controls. Subjects with functional instability were also observed to have an increase in peroneus longus integral electromyography during the post-heel strike time period (107.91%.millisecond vs 64.53%.millisecond; P < .01). The altered kinematics observed in this study could explain the reason subjects with functional instability experience repeated episodes of ankle inversion injury in situations with only slight or no external provocation. It is hypothesized that the observed increase in peroneus longus activity may be the result of a change in

All-inside arthroscopic lateral collateral ligament repair for ankle instability with a knotless suture anchor technique.

Science.gov (United States)

Vega, Jordi; Golanó, Pau; Pellegrino, Alexandro; Rabat, Eduard; Peña, Fernando

2013-12-01

Recently, arthroscopic-assisted techniques have been described to treat lateral ankle instability with excellent results. However, complications including neuritis of the superficial peroneal or sural nerve, and pain or discomfort due to a prominent anchor or suture knot have been reported. The aim of this study was to describe a novel technique, the "all-inside arthroscopic lateral collateral ankle ligament repair," and its results for treating patients with ankle instability. Sixteen patients (10 men and 6 women, mean age 29.3 years, 17-46) with lateral ankle instability were treated with an arthroscopic procedure. Using a suture passer and a knotless anchor, the ligaments were repaired with an all-inside technique. The right ankle was affected in 10 cases. Mean follow-up was 22.3 (12-35) months. On arthroscopic examination, 13 patients had an isolated anterior talofibular ligament (ATFL) injury, and in 3 patients, both the ATFL and calcaneofibular ligament (CFL) were affected. All-inside arthroscopic anatomic repair of the lateral collateral ligament complex was performed in all cases. All patients reported subjective improvement of their ankle instability. The mean AOFAS score increased from 67 preoperatively to 97 at final follow-up. No major complications were reported. The all-inside arthroscopic ligament repair was a safe, reliable, and reproducible technique that both provided an anatomic repair of the lateral collateral ligament complex and restored ankle stability while preserving all the advantages of an arthroscopic technique. Level IV, retrospective case series.

Functional ankle instability as a risk factor for osteoarthritis: using T2-mapping to analyze early cartilage degeneration in the ankle joint of young athletes.

Science.gov (United States)

Golditz, T; Steib, S; Pfeifer, K; Uder, M; Gelse, K; Janka, R; Hennig, F F; Welsch, G H

2014-10-01

The aim of this study was to investigate, using T2-mapping, the impact of functional instability in the ankle joint on the development of early cartilage damage. Ethical approval for this study was provided. Thirty-six volunteers from the university sports program were divided into three groups according to their ankle status: functional ankle instability (FAI, initial ankle sprain with residual instability); ankle sprain Copers (initial sprain, without residual instability); and controls (without a history of ankle injuries). Quantitative T2-mapping magnetic resonance imaging (MRI) was performed at the beginning ('early-unloading') and at the end ('late-unloading') of the MR-examination, with a mean time span of 27 min. Zonal region-of-interest T2-mapping was performed on the talar and tibial cartilage in the deep and superficial layers. The inter-group comparisons of T2-values were analyzed using paired and unpaired t-tests. Statistical analysis of variance was performed. T2-values showed significant to highly significant differences in 11 of 12 regions throughout the groups. In early-unloading, the FAI-group showed a significant increase in quantitative T2-values in the medial, talar regions (P = 0.008, P = 0.027), whereas the Coper-group showed this enhancement in the central-lateral regions (P = 0.05). Especially the comparison of early-loading to late-unloading values revealed significantly decreasing T2-values over time laterally and significantly increasing T2-values medially in the FAI-group, which were not present in the Coper- or control-group. Functional instability causes unbalanced loading in the ankle joint, resulting in cartilage alterations as assessed by quantitative T2-mapping. This approach can visualize and localize early cartilage abnormalities, possibly enabling specific treatment options to prevent osteoarthritis in young athletes. Copyright © 2014 Osteoarthritis Research Society International. Published by Elsevier Ltd. All rights reserved.

Measurement of passive ankle stiffness in subjects with chronic hemiparesis using a novel ankle robot

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Roy, Anindo; Bever, Christopher T.; Forrester, Larry W.; Macko, Richard F.; Hogan, Neville

2011-01-01

Our objective in this study was to assess passive mechanical stiffness in the ankle of chronic hemiparetic stroke survivors and to compare it with those of healthy young and older (age-matched) individuals. Given the importance of the ankle during locomotion, an accurate estimate of passive ankle stiffness would be valuable for locomotor rehabilitation, potentially providing a measure of recovery and a quantitative basis to design treatment protocols. Using a novel ankle robot, we characterized passive ankle stiffness both in sagittal and in frontal planes by applying perturbations to the ankle joint over the entire range of motion with subjects in a relaxed state. We found that passive stiffness of the affected ankle joint was significantly higher in chronic stroke survivors than in healthy adults of a similar cohort, both in the sagittal as well as frontal plane of movement, in three out of four directions tested with indistinguishable stiffness values in plantarflexion direction. Our findings are comparable to the literature, thus indicating its plausibility, and, to our knowledge, report for the first time passive stiffness in the frontal plane for persons with chronic stroke and older healthy adults. PMID:21346215

Evidence-based treatment for ankle injuries: a clinical perspective

OpenAIRE

Lin, Chung-Wei Christine; Hiller, Claire E; de Bie, Rob A

2010-01-01

The most common ankle injuries are ankle sprain and ankle fracture. This review discusses treatments for ankle sprain (including the management of the acute sprain and chronic instability) and ankle fracture, using evidence from recent systematic reviews and randomized controlled trials. After ankle sprain, there is evidence for the use of functional support and non-steroidal anti-inflammatory drugs. There is weak evidence suggesting that the use of manual therapy may lead to positive short-t...

Gait kinematics of subjects with ankle instability using a multisegmented foot model.

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De Ridder, Roel; Willems, Tine; Vanrenterghem, Jos; Robinson, Mark; Pataky, Todd; Roosen, Philip

2013-11-01

Many patients who sustain an acute lateral ankle sprain develop chronic ankle instability (CAI). Altered ankle kinematics have been reported to play a role in the underlying mechanisms of CAI. In previous studies, however, the foot was modeled as one rigid segment, ignoring the complexity of the ankle and foot anatomy and kinematics. The purpose of this study was to evaluate stance phase kinematics of subjects with CAI, copers, and controls during walking and running using both a rigid and a multisegmented foot model. Foot and ankle kinematics of 77 subjects (29 subjects with self-reported CAI, 24 copers, and 24 controls) were measured during barefoot walking and running using a rigid foot model and a six-segment Ghent Foot Model. Data were collected on a 20-m-long instrumented runway embedded with a force plate and a six-camera optoelectronic system. Groups were compared using statistical parametric mapping. Both the CAI and the coper group showed similar differences during midstance and late stance compared with the control group (P foot segment showed a more everted position during walking compared with the control group. Based on the Ghent Foot Model, the rear foot also showed a more everted position during running. The medial forefoot showed a more inverted position for both running and walking compared with the control group. Our study revealed significant midstance and late stance differences in rigid foot, rear foot, and medial forefoot kinematics The multisegmented foot model demonstrated intricate behavior of the foot that is not detectable with rigid foot modeling. Further research using these models is necessary to expand knowledge of foot kinematics in subjects with CAI.

Deltoid ligament and tibiofibular syndesmosis injury in chronic lateral ankle instability: Magnetic resonance imaging evaluation at 3T and comparison with arthroscopy

International Nuclear Information System (INIS)

Chun, Ka Young; Choi, Yun Sun; Lee, Seok Hoon; Kim, Jin Su; Young, Ki Won; Jeong, Min Sun; Kim, Dae Jung

2015-01-01

To evaluate the prevalence of deltoid ligament and distal tibiofibular syndesmosis injury on 3T magnetic resonance imaging (MRI) in patients with chronic lateral ankle instability (CLAI). Fifty patients (mean age, 35 years) who had undergone preoperative 3T MRI and surgical treatment for CLAI were enrolled. The prevalence of deltoid ligament and syndesmosis injury were assessed. The complexity of lateral collateral ligament complex (LCLC) injury was correlated with prevalence of deltoid or syndesmosis injuries. The diagnostic accuracy of ankle ligament imaging at 3T MRI was analyzed using arthroscopy as a reference standard. On MRI, deltoid ligament injury was identified in 18 (36%) patients as follows: superficial ligament alone, 9 (50%); deep ligament alone 2 (11%); and both ligaments 7 (39%). Syndesmosis abnormality was found in 21 (42%) patients as follows: anterior inferior tibiofibular ligament (AITFL) alone, 19 (90%); and AITFL and interosseous ligament, 2 (10%). There was no correlation between LCLC injury complexity and the prevalence of an accompanying deltoid or syndesmosis injury on both MRI and arthroscopic findings. MRI sensitivity and specificity for detection of deltoid ligament injury were 84% and 93.5%, and those for detection of syndesmosis injury were 91% and 100%, respectively. Deltoid ligament or syndesmosis injuries were common in patients undergoing surgery for CLAI, regardless of the LCLC injury complexity. 3T MRI is helpful for the detection of all types of ankle ligament injury. Therefore, careful interpretation of pre-operative MRI is essential

Deltoid ligament and tibiofibular syndesmosis injury in chronic lateral ankle instability: Magnetic resonance imaging evaluation at 3T and comparison with arthroscopy

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Chun, Ka Young; Choi, Yun Sun; Lee, Seok Hoon; Kim, Jin Su; Young, Ki Won; Jeong, Min Sun; Kim, Dae Jung [Eulji Hospital, Eulji University, Seoul (Korea, Republic of)

2015-10-15

To evaluate the prevalence of deltoid ligament and distal tibiofibular syndesmosis injury on 3T magnetic resonance imaging (MRI) in patients with chronic lateral ankle instability (CLAI). Fifty patients (mean age, 35 years) who had undergone preoperative 3T MRI and surgical treatment for CLAI were enrolled. The prevalence of deltoid ligament and syndesmosis injury were assessed. The complexity of lateral collateral ligament complex (LCLC) injury was correlated with prevalence of deltoid or syndesmosis injuries. The diagnostic accuracy of ankle ligament imaging at 3T MRI was analyzed using arthroscopy as a reference standard. On MRI, deltoid ligament injury was identified in 18 (36%) patients as follows: superficial ligament alone, 9 (50%); deep ligament alone 2 (11%); and both ligaments 7 (39%). Syndesmosis abnormality was found in 21 (42%) patients as follows: anterior inferior tibiofibular ligament (AITFL) alone, 19 (90%); and AITFL and interosseous ligament, 2 (10%). There was no correlation between LCLC injury complexity and the prevalence of an accompanying deltoid or syndesmosis injury on both MRI and arthroscopic findings. MRI sensitivity and specificity for detection of deltoid ligament injury were 84% and 93.5%, and those for detection of syndesmosis injury were 91% and 100%, respectively. Deltoid ligament or syndesmosis injuries were common in patients undergoing surgery for CLAI, regardless of the LCLC injury complexity. 3T MRI is helpful for the detection of all types of ankle ligament injury. Therefore, careful interpretation of pre-operative MRI is essential.

A prospective outcome and cost-effectiveness comparison between two ligament reattachment techniques using suture anchors for chronic ankle instability.

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Cho, Byung-Ki; Kim, Yong-Min; Park, Kyoung-Jin; Park, Ji-Kang; Kim, Do-Kyoon

2015-02-01

There are various ligament reattachment techniques for the modified Brostrom procedure. There have been few comparative studies on recently developed techniques. This prospective study was performed to compare the functional outcomes of 2 different ligament reattachment techniques using suture anchors. We furthermore evaluated the cost-effectiveness of the suture bridge technique. Forty-five amateur athletes under 30 years of age were followed for more than 2 years. Twenty-four procedures with the suture anchor technique and 21 procedures with the suture bridge technique were performed by one surgeon. The functional evaluation consisted of the American Orthopaedic Foot & Ankle Society (AOFAS) score, Foot and Ankle Outcome Score (FAOS), Karlsson score, Sefton grading system, and the period to return to various forms of exercise (jogging, spurt running, jumping, one leg standing for >1 minute, walking on uneven ground, and going down stairs). Measurement of talar tilt angle and anterior talar translation was obtained from stress radiographs to evaluate mechanical stability. There were no significant differences on AOFAS score, FAOS, Karlsson score, Sefton grade, and stress radiographs. There were no significant differences on the return to exercises, except for jumping. As the most common complication, there were 3 cases of skin irritation by suture materials in the suture anchor group and 2 cases of intraoperative breakage of the suture anchor in suture bridge group. Both ligament reattachment techniques using suture anchors showed similar functional outcomes. Considering the additional medical expenses incurred by more suture anchors, the modified Brostrom procedure using the suture bridge technique had low cost-effectiveness. Proper indication and clinical usefulness of suture bridge technique for chronic ankle instability will be addressed in further studies. Level II, prospective comparative study. © The Author(s) 2014.

Modulation of the Fibularis Longus Hoffmann Reflex and Postural Instability Associated With Chronic Ankle Instability

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Kim, Kyung-Min; Hart, Joseph M.; Saliba, Susan A.; Hertel, Jay

2016-01-01

Context: Individuals with chronic ankle instability (CAI) present with decreased modulation of the Hoffmann reflex (H-reflex) from a simple to a more challenging task. The neural alteration is associated with impaired postural control, but the relationship has not been investigated in individuals with CAI. Objective: To determine differences in H-reflex modulation and postural control between individuals with or without CAI and to identify if they are correlated in individuals with CAI. Design: Descriptive laboratory study. Setting: Laboratory. Patients or Other Participants: A total of 15 volunteers with CAI (9 males, 6 females; age = 22.6 ± 5.8 years, height = 174.7 ± 8.1 cm, mass = 74.9 ± 12.8 kg) and 15 healthy sex-matched volunteers serving as controls (9 males, 6 females; age = 23.8 ± 5.8 years, height = 171.9 ± 9.9 cm, mass = 68.9 ± 15.5 kg) participated. Intervention(s): Maximum H-reflex (Hmax) and motor wave (Mmax) from the soleus and fibularis longus were recorded while participants lay prone and then stood in unipedal stance. We assessed postural tasks of unipedal stance with participants' eyes closed for 10 seconds using a forceplate. Main Outcome Measure(s): We normalized Hmax to Mmax to obtain Hmax : Mmax ratios for the 2 positions. For each muscle, H-reflex modulation was quantified using the percentage change scores in Hmax : Mmax ratios calculated from prone position to unipedal stance. Center-of-pressure data were used to compute 4 time-to-boundary variables. Separate independent-samples t tests were performed to determine group differences. Pearson product moment correlation coefficients were calculated between the modulation and balance measures in the CAI group. Results: The CAI group presented less H-reflex modulation in the soleus (t26 = −3.77, P = .001) and fibularis longus (t25 = −2.59, P = .02). The mean of the time-to-boundary minima in the anteroposterior direction was lower in the CAI group (t28 = −2.06, P = .048

Effects of the application of ankle functional rehabilitation exercise on the ankle joint functional movement screen and isokinetic muscular function in patients with chronic ankle sprain.

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Ju, Sung-Bum; Park, Gi Duck

2017-02-01

[Purpose] This study was conducted to investigate the effects of ankle functional rehabilitation exercise on ankle joint functional movement screen results and isokinetic muscular function in patients with chronic ankle sprain patients. [Subjects and Methods] In this study, 16 patients with chronic ankle sprain were randomized to an ankle functional rehabilitation exercise group (n=8) and a control group (n=8). The ankle functional rehabilitation exercise centered on a proprioceptive sense exercise program, which was applied 12 times for 2 weeks. To verify changes after the application, ankle joint functional movement screen scores and isokinetic muscular function were measured and analyzed. [Results] The ankle functional rehabilitation exercise group showed significant improvements in all items of the ankle joint functional movement screen and in isokinetic muscular function after the exercise, whereas the control group showed no difference after the application. [Conclusion] The ankle functional rehabilitation exercise program can be effectively applied in patients with chronic ankle sprain for the improvement of ankle joint functional movement screen score and isokinetic muscular function.

A Medial Malleolar "Fleck Sign" May Predict Ankle Instability in Ligamentous Supination External Rotation Ankle Fractures.

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Nwosu, Kenneth; Schneiderman, Brian Andrew; Shymon, Stephen Joseph; Harris, Thomas

2018-06-01

Ankle joint stability dictates treatment in ligamentous supination external rotation ankle injuries (LSERAI). Investigation of the medial structures that support the ankle mortise is critical, and a small avulsion fracture, or "fleck", of the medial malleolus is occasionally encountered. This study aimed to assess the utility of this medial malleolus fleck sign (MMFS) in diagnosing instability requiring surgery in LSERAI. This retrospective observational study examined 166 LSERAI at a single level I trauma center. A standardized diagnostic and treatment protocol for ankle fractures was followed. LSERAI at presentation were reported as having a normal, dynamically wide, or statically wide medial clear space. Patient demographics, MMFS characteristics, and the use of operative management were recorded. MMFS incidence in the cohort was 16 (10%) of 166 and was present in 25% of patients with unstable LSERAI. Fifteen (94%) of 16 patients with a MMFS were deemed to have an unstable LSERAI (P < .005). MMFS had a 25% sensitivity and 99% specificity in diagnosing an unstable LSERAI. For the subgroup of patients without a statically wide medial clear space, MMFS had a 50% sensitivity and 99% specificity in determining instability. A MMFS may be indicative of an unstable LSERAI. With previous MRI studies demonstrating complete deltoid disruption in unstable LSERAI, we deduce the MMFS may be associated with extensive deltoid incompetence. The MMFS may help to diagnose a complete deltoid injury in LSERAI with a normal medial clear space, which could influence treatment and reduce patient morbidity, radiation exposure, and healthcare costs. Level III: Retrospective Cohort Study.

PERONEUS LONGUS ACTIVITY IN DIFFERENT TYPES OF TAPING: ATHLETES WITH ANKLE INSTABILITY

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Muhammad Rahmani Jaffar

Full Text Available ABSTRACT Introduction: Participation in sport among university athletes in Malaysia has progressed right up to Olympic level. However, some of these athletes are prevented from competing due to injuries. Ankle injuries, in particular, are among the common types of injury. Even so, there is still lack of local data and research describing the incidence of ankle injuries. Objectives: To determine peroneus longus muscle activity in different taped ankles and positions among subjects with functional ankle instability (FAI. Methods: Twenty-three subjects with ankle instability (AJFAT score > 26 volunteered to take part in the study. The subjects were tested under three conditions; 1 no tape (NT, 2 Kinesio(r tape (KT, and 3 rigid tape (RT. The subjects completed two postural stability tests, followed by a sudden inversion perturbation test with EMG, recording throughout the procedures. The EMG data were analyzed, filtered, full-wave rectified and normalized. The data were analyzed by analysis of variance (Independent T-test and ANOVA to evaluate differences in peak muscle activation (mV and peroneal latency (ms. Results: Peak muscle activation of the peroneus was activated more in the RT group during both the Static and Dynamic Stability Tests. Apart from that, there were no statistically significant differences. During sudden inversion perturbation, the RT group was the one that was most activated (p=0.001. Peroneal latency was even delayed in KT and RT during the three tests, and shorter in the NT group. There were significant differences during the Dynamic Stability Test, between the NT and KT groups (p=0.001 and between the NT, RT and KT groups (p=0.001. Conclusion: RT tape may enhance the peroneus longus response by maintaining a higher level of muscle activation, especially during dynamic movements and sudden inversion of the ankle, and may selectively benefit individuals with FAI. The KT ankle did not show superior effect to the NT ankle, and

Effects of virtual reality programs on balance in functional ankle instability.

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Kim, Ki-Jong; Heo, Myoung

2015-10-01

[Purpose] The aim of present study was to identify the impact that recent virtual reality training programs used in a variety of fields have had on the ankle's static and dynamic senses of balance among subjects with functional ankle instability. [Subjects and Methods] This study randomly divided research subjects into two groups, a strengthening exercise group (Group I) and a balance exercise group (Group II), with each group consisting of 10 people. A virtual reality program was performed three times a week for four weeks. Exercises from the Nintendo Wii Fit Plus program were applied to each group for twenty minutes along with ten minutes of warming up and wrap-up exercises. [Results] Group II showed a significant decrease of post-intervention static and dynamic balance overall in the anterior-posterior, and mediolateral directions, compared with the pre-intervention test results. In comparison of post-intervention static and dynamic balance between Group I and Group II, a significant decrease was observed overall. [Conclusion] Virtual reality programs improved the static balance and dynamic balance of subjects with functional ankle instability. Virtual reality programs can be used more safely and efficiently if they are implemented under appropriate monitoring by a physiotherapist.

Longer reaction time of the fibularis longus muscle and reduced postural control in basketball players with functional ankle instability: A pilot study.

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Méndez-Rebolledo, Guillermo; Guzmán-Muñoz, Eduardo; Gatica-Rojas, Valeska; Zbinden-Foncea, Hermann

2015-08-01

Motor control evaluation in subjects with functional ankle instability is questionable when both ankles of the same subject are compared (affected vs non-affected). To compare the postural control and reaction time of ankle muscles among: basketball players with FAI (instability group), basketball players without FAI (non-instability group) and healthy non-basketball-playing participants (control group). Case-control study. Laboratory. Instability (n = 10), non-instability (n = 10), and control groups (n = 11). Centre of pressure variables (area, velocity and sway) were measured with a force platform. Reaction time of ankle muscles was measured via electromyography. A one-way ANOVA demonstrated that there were significant differences between the instability and non-instability groups in the fibularis longus (p postural control and longer reaction time of the fibularis and tibialis anterior muscles. Copyright © 2014 Elsevier Ltd. All rights reserved.

The effectiveness of foot orthotics in improving postural control in individuals with chronic ankle instability: a critically appraised topic.

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Gabriner, Michael L; Braun, Brittany A; Houston, Megan N; Hoch, Matthew C

2015-02-01

Chronic ankle instability (CAI) is a condition commonly experienced by physically active individuals. It has been suggested that foot orthotics may increase a CAI patient's postural control. For patients with CAI, is there evidence to suggest that an orthotic intervention will help improve postural control? The literature was searched for studies of level 2 evidence or higher that investigated the effects of foot orthotics on postural control in patients with CAI. The search of the literature produced 5 possible studies for inclusion; 2 studies met the inclusion criteria and were included. One randomized controlled trial and 1 outcomes study were included. Foot orthotics appear to be effective at improving postural control in patients with CAI. There is moderate evidence to support the use of foot orthotics in the treatment of CAI to help improve postural control. There is grade B evidence that foot orthotics help improve postural control in people with CAI. The Centre of Evidence Based Medicine recommends a grade of B for level 2 evidence with consistent findings.

Reliability of a functional test battery evaluating functionality, proprioception, and strength in recreational athletes with functional ankle instability.

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Sekir, U; Yildiz, Y; Hazneci, B; Ors, F; Saka, T; Aydin, T

2008-12-01

In contrast to the single evaluation methods used in the past, the combination of multiple tests allows one to obtain a global assessment of the ankle joint. The aim of this study was to determine the reliability of the different tests in a functional test battery. Twenty-four male recreational athletes with unilateral functional ankle instability (FAI) were recruited for this study. One component of the test battery included five different functional ability tests. These tests included a single limb hopping course, single-legged and triple-legged hop for distance, and six and cross six meter hop for time. The ankle joint position sense and one leg standing test were used for evaluation of proprioception and sensorimotor control. The isokinetic strengths of the ankle invertor and evertor muscles were evaluated at a velocity of 120 degrees /s. The reliability of the test battery was assessed by calculating the intraclass correlation coefficient (ICC). Each subject was tested two times, with an interval of 3-5 days between the test sessions. The ICCs for ankle functional and proprioceptive ability showed high reliability (ICCs ranging from 0.94 to 0.98). Additionally, isokinetic ankle joint inversion and eversion strength measurements represented good to high reliability (ICCs between 0.82 and 0.98). The functional test battery investigated in this study proved to be a reliable tool for the assessment of athletes with functional ankle instability. Therefore, clinicians may obtain reliable information from the functional test battery during the assessment of ankle joint performance in patients with functional ankle instability.

Mechanical instability after acute ankle ligament injury: randomized prospective comparison of two forms of conservative treatment

OpenAIRE

Prado, Marcelo Pires; Fernandes, Tulio Diniz; Camanho, Gilberto Luis; Mendes, Alberto Abussamra Moreira; Amodio, Daniel Tassetto

2013-01-01

OBJECTIVE: This trial has the objective to investigate the incidence of mechanical ankle instability after the conservative treatment of first episode, severe ankle ligamentar lesions. This common lesion affects young, professional and physical active patients, causing important personal and economic consequences. There are difficulties related to adequate diagnosis and treatment for these lesions. METHOD: 186 patients with severe ankle ligament lesions were included in this trial. They ...

Effects of balance training by knee joint motions on muscle activity in adult men with functional ankle instability.

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Nam, Seung-Min; Kim, Won-Bok; Yun, Chang-Kyo

2016-05-01

[Purpose] This study examined the effects of balance training by applying knee joint movements on muscle activity in male adults with functional ankle instability. [Subjects and Methods] 28 adults with functional ankle instability, divided randomly into an experimental group, which performed balance training by applying knee joint movements for 20 minutes and ankle joint exercises for 10 minutes, and a control group, which performed ankle joint exercise for 30 minutes. Exercises were completed three times a week for 8 weeks. Electromyographic values of the tibialis anterior, peroneus longus, peroneus brevis, and the lateral gastrocnemius muscles were obtained to compare and analyze muscle activity before and after the experiments in each group. [Results] The experimental group had significant increases in muscle activity in the tibialis anterior, peroneus longus, and lateral gastrocnemius muscles, while muscle activity in the peroneus brevis increased without significance. The control group had significant increases in muscle activity in the tibialis anterior and peroneus longus, while muscle activity in the peroneus brevis and lateral gastrocnemius muscles increased without significance. [Conclusion] In conclusion, balance training by applying knee joint movements can be recommended as a treatment method for patients with functional ankle instability.

Combined medial and lateral anatomic ligament reconstruction for chronic rotational instability of the ankle.

Science.gov (United States)

Buchhorn, Tomas; Sabeti-Aschraf, Manuel; Dlaska, Constantin E; Wenzel, Florian; Graf, Alexandra; Ziai, Pejman

2011-12-01

This study aimed to extend knowledge on the arthroscopic evaluation of the unstable ankle joint and the outcome of ligament reconstruction on rotational instability. In contrast to previous studies, we investigated the combined repair of lateral and medial ligaments. Ninety-six patients underwent medial and lateral ligament reconstruction between 2006 and 2008, 81 of whom, with a mean age of 31.9 (range, 14 to 44) years, completed the 12-month followup and were therefore included in this study (Table 1). Clinical, radiographic, and concomitant arthroscopic examination was performed prior to the ligament stabilization. Postoperative followup included clinical and radiographic evaluation after 3, 6, and 12 months. Arthroscopy showed a lesion of the anterior fibulotalar ligament (AFTL), calcaneofibular ligament (CFL), and tibiocalcanear ligament (TCL) (Deep part of deltoid ligament complex) in 67 patients. An avulsion of the proximal insertion point of the ATTL was additionally found in 14 cases. Clinical results 3 months after surgery showed a significant increase in the AOFAS-Hindfoot Score as well as a significant decrease of the Visual Analogue-Scale for pain (VAS) (p ankle joint in most cases has an injury of the lateral ligaments and a component of the deltoid, the TCL, but rarely with a combined lesion of the TCL and the anterior tibiotalar ligament (ATTL) (Superficial part of deltoid ligament complex). The combined lateral and medial ligament reconstruction with an anchor technique had a good clinical outcome with high patient satisfaction with few complications.

Selection criteria for patients with chronic ankle instability in controlled research: a position statement of the international ankle consortium

NARCIS (Netherlands)

Gribble, P.A.; Delahunt, E.; Bleakley, C.; Caulfield, B.; Docherty, C.L.; Fourchet, F.; Fong, D.; Hertel, J.; Hiller, C.; Kaminski, T.W.; McKeon, P.O.; Refshauge, K.M.; Wees, P.J. van der; Vicenzino, B.; Wikstrom, E.A.

2013-01-01

The International Ankle Consortium is an international community of researchers and clinicians whose primary scholastic purpose is to promote scholarship and dissemination of research-informed knowledge related to pathologies of the ankle complex. The constituents of the International Ankle

Electromiography comparison of distal and proximal lower limb muscle activity patterns during external perturbation in subjects with and without functional ankle instability.

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Kazemi, Khadijeh; Arab, Amir Massoud; Abdollahi, Iraj; López-López, Daniel; Calvo-Lobo, César

2017-10-01

Ankle sprain is one of the most common injuries among athletes and the general population. Most ankle injuries commonly affect the lateral ligament complex. Changes in postural sway and hip abductor muscle strength may be generated after inversion ankle sprain. Therefore, the consequences of ankle injury may affect proximal structures of the lower limb. The aim is to describe and compare the activity patterns of distal and proximal lower limb muscles following external perturbation in individuals with and without functional ankle instability. The sample consisted of 16 women with functional ankle instability and 18 healthy women were recruited to participate in this research. The external perturbation via body jacket using surface electromyography, amplitude and onset of muscle activity of gluteus maximums, gluteus medius, tibialis anterior, and peroneus longus was recorded and analyzed during external perturbation. There were differences between the onset of muscles activity due to perturbation direction in the two groups (healthy and functional ankle instability). In the healthy group, there were statistically significant differences in amplitude of proximal muscle activity with distal muscle activity during front perturbation with eyes open and closed. In the functional ankle instability group; there were statistically significant differences in amplitude of proximal muscle activity with distal muscle activity during perturbation of the front and back with eyes open. There were statistically significant differences in the onset of muscle activity and amplitude of muscle activity, with-in and between groups (Pankle instability, activation patterns of the lower limb proximal muscles may be altered. Copyright © 2017 Elsevier B.V. All rights reserved.

Chronic Ankle Instability and Neural Excitability of the Lower Extremity.

Science.gov (United States)

McLeod, Michelle M; Gribble, Phillip A; Pietrosimone, Brian G

2015-08-01

Neuromuscular dysfunction of the leg and thigh musculature, including decreased strength and postural control, is common in patients with chronic ankle instability (CAI). Understanding how CAI affects specific neural pathways may provide valuable information for targeted therapies. To investigate differences in spinal reflexive and corticospinal excitability of the fibularis longus and vastus medialis between limbs in patients with unilateral CAI and between CAI patients and participants serving as healthy controls. Case-control study. Research laboratory. A total of 56 participants volunteered, and complete data for 21 CAI patients (9 men, 12 women; age = 20.81 ± 1.63 years, height = 171.57 ± 11.44 cm, mass = 68.84 ± 11.93 kg) and 24 healthy participants serving as controls (7 men, 17 women; age = 22.54 ± 2.92 years, height = 172.35 ± 10.85 cm, mass = 69.15 ± 12.30 kg) were included in the final analyses. Control participants were matched to CAI patients on sex, age, and limb dominance. We assigned "involved" limbs, which corresponded with the involved limbs of the CAI patients, to control participants. Spinal reflexive excitability was assessed via the Hoffmann reflex and normalized to a maximal muscle response. Corticospinal excitability was assessed using transcranial magnetic stimulation. Active motor threshold (AMT) was defined as the lowest transcranial magnetic stimulation intensity required to elicit motor-evoked potentials equal to or greater than 100 μV in 5 of 10 consecutive stimuli. We obtained motor-evoked potentials (MEPs) at percentages ranging from 100% to 140% of AMT. Fibularis longus MEP amplitudes were greater in control participants than in CAI patients bilaterally at 100% AMT (control involved limb: 0.023 ± 0.031; CAI involved limb: 0.014 ± 0.008; control uninvolved limb: 0.021 ± 0.022; CAI uninvolved limb: 0.015 ± 0.007; F1,41 = 4.551, P = .04) and 105% AMT (control involved limb: 0.029 ± 0.026; CAI involved limb: 0.021 ± 0

The effect of additional joint mobilization on neuromuscular performance in individuals with functional ankle instability.

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Shih, Yi-Fen; Yu, Hsiang-Ting; Chen, Wen-Yin; Liao, Kwong-Kum; Lin, Hsiu-Chen; Yang, Yea-Ru

2018-03-01

To examine the effects of joint mobilization and exercise training on neuromuscular performance in individuals with functional ankle instability (FAI). A cross-sectional study. Forty five subjects with FAI were randomized into three groups: control (CG, n = 15, 27.9 ± 6.6yr), training (TG, n = 15, 26.9 ± 5.8yr) and mobilization with training group (MTG, n = 15, 26.5 ± 4.8yr). Four weeks of neuromuscular training for TG; neuromuscular training and joint mobilization for MTG. Electromyography of the peroneus longus (PL), tibialis anterior (TA), and soleus (SOL) and the reaching distance of the Y balance test (YBT), dorsiflexion range of motion (DFROM), Cumberland ankle instability tool (CAIT), and global rating scale (GRS). Two-way repeated measures MANOVA were used with the significance level p Joint mobilization resulted in additional benefits on self-reported ankle instability severity, dorsiflexion mobility, and posterolateral balance performance in individuals with FAI, but its effects on general improvement, muscle activation, and other balance tasks remained uncertain. Copyright © 2017 Elsevier Ltd. All rights reserved.

Managing ankle ligament sprains and tears: current opinion

Directory of Open Access Journals (Sweden)

McGovern RP

2016-03-01

Full Text Available Ryan P McGovern,1 RobRoy L Martin,1,2 1Department of Physical Therapy, Rangos School of Health Sciences, Duquesne University, 2Centers for Sports Medicine – University of Pittsburgh, Pittsburgh, PA, USA Abstract: The purpose of this paper is to present a current review of pathoanatomical features, differential diagnosis, objective assessment, intervention, and clinical course associated with managing lateral ankle ligament sprains. Proper diagnosis and identification of affected structures should be obtained through history and objective assessment. From this information, an individualized evidence-based intervention plan can be developed to enable recovery while decreasing the risk of reinjury. An appropriate evaluation is needed not only to determine the correct diagnosis but also to allow for grading and determining the prognosis of the injury in those with an acute lateral ankle sprain. Examination should include an assessment of impairments as well as a measure of activity and participation. Evidence-based interventions for those with an acute lateral ankle sprain should include weight bearing with bracing, manual therapy, progressive therapeutic exercises, and cryotherapy. For those with chronic ankle instability (CAI, interventions should include manual therapy and a comprehensive rehabilitation program. It is essential to understand the normal clinical course for athletes who sustain a lateral ankle sprain as well as risk factors for an acute injury and CAI. Risk factors for both an acute lateral ankle sprain and CAI include not using an external support and not participating in an appropriate exercise program. Incorporating the latest evidence-based rehabilitation techniques provides the best course of treatment for athletes with an acute ankle sprain or CAI. Keywords: reinjury, chronic ankle instability, rehabilitation techniques, diagnosis, intervention, athlete

Deviations in gait metrics in patients with chronic ankle instability: a case control study.

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Gigi, Roy; Haim, Amir; Luger, Elchanan; Segal, Ganit; Melamed, Eyal; Beer, Yiftah; Nof, Matityahu; Nyska, Meir; Elbaz, Avi

2015-01-01

Gait metric alterations have been previously reported in patients suffering from chronic ankle instability (CAI). Previous studies of gait in this population have been comprised of relatively small cohorts, and the findings of these studies are not uniform. The objective of the present study was to examine spatiotemporal gait metrics in patients with CAI and examine the relationship between self-reported disease severity and the magnitude of gait abnormalities. Forty-four patients with CAI were identified and compared to 53 healthy controls. Patients were evaluated with spatiotemporal gait analysis via a computerized mat and with the Short Form (SF) - 36 health survey. Patients with CAI were found to walk with approximately 16% slower walking velocity, 9% lower cadence and approximately 7% lower step length. Furthermore, the base of support, during walking, in the CAI group was approximately 43% wider, and the single limb support phase was 3.5% shorter compared to the control group. All of the SF-36 8-subscales, as well as the SF-36 physical component summary and SF-36 mental component summary, were significantly lower in patients with CAI compared to the control group. Finally, significant correlations were found between most of the objective gait measures and the SF-36 mental component summary and SF-36 physical component summary. The results outline a gait profile for patients suffering from CAI. Significant differences were found in most spatiotemporal gait metrics. An important finding was a significantly wider base of support. It may be speculated that these gait alterations may reflect a strategy to deal with imbalance and pain. These findings suggest the usefulness of gait metrics, alongside with the use of self-evaluation questionnaires, in assessing disease severity of patients with CAI.

Evidence of Reliability for Persian Version of the “Cumberland Ankle Instability Tool (CAIT” in Iranian Athletes with lateral Ankle Sprain

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Mitra Haji-Maghsoudi

2016-01-01

Full Text Available Objectives: The purpose of the present study was to evaluate the reliability of persian version of the “Cumberland Ankle Instability Tool (CAIT” in Iranian athletes with lateral ankle sprain. Matterials & Methods: The present study is a methodological and non-experimental study. After forward and backward translation of CAIT, 46 athletes were selected with convenient nonprobably sampling from Physical Education Faculty of Tehran university and Taekwondo Club. Questionnaire was given to participants who experienced at least one lateral ankle sprain based on doctor’s diagnosis. In the second phase (one week later the questionnaire was distributed among the participants again to test the reliability of the measured between the two tests. After collecting the data, the test-retest reliability of  Persian version of the questionnaire was evaluated by calculating the intraclass correlation coefficient, standard error of measurement, smallest detectable change and Cronbach’s alpha coefficients were calculated to assess the internal consistency of the questionnaire’s items. Results Cronbach’s alpha was 0.64, which is close to acceptable level of internal consistency (0.7-0.95. Factor analysis showed that questionnaires’ items can be classified  in 4 categories with maximum of 72% variance cover. The test-retest correlation coefficient ICC for the total score of CAIT was 0.95 (P>100.0, indicating excellent reproducibility of the Persian version of the questionnaire. The standard error of measurement (SEM was 1 and the smallest acceptable change (SDC was 2.76 with 95% confidence. Conclusion: The results show that the Persian version of the CAIT can be used in athletes with functional ankle instability as a reliable tool to detect instability and assess changes caused by therapeutic interventions.

CROSS-CULTURAL ADAPTATION AND VALIDATION OF THE KOREAN VERSION OF THE CUMBERLAND ANKLE INSTABILITY TOOL.

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Ko, Jupil; Rosen, Adam B; Brown, Cathleen N

2015-12-01

The Cumberland Ankle Instability Tool (CAIT) is a valid and reliable patient reported outcome used to assess the presence and severity of chronic ankle instability (CAI). The CAIT has been cross-culturally adapted into other languages for use in non-English speaking populations. However, there are no valid questionnaires to assess CAI in individuals who speak Korean. The purpose of this study was to translate, cross-culturally adapt, and validate the CAIT, for use in a Korean-speaking population with CAI. Cross-cultural reliability study. The CAIT was cross-culturally adapted into Korean according to accepted guidelines and renamed the Cumberland Ankle Instability Tool-Korean (CAIT-K). Twenty-three participants (12 males, 11 females) who were bilingual in English and Korean were recruited and completed the original and adapted versions to assess agreement between versions. An additional 168 national level Korean athletes (106 male, 62 females; age = 20.3 ± 1.1 yrs), who participated in ≥ 90 minutes of physical activity per week, completed the final version of the CAIT-K twice within 14 days. Their completed questionnaires were assessed for internal consistency, test-retest reliability, criterion validity, and construct validity. For bilingual participants, intra-class correlation coefficients (ICC2,1) between the CAIT and the CAIT-K for test-retest reliability were 0.95 (SEM=1.83) and 0.96 (SEM=1.50) in right and left limbs, respectively. The Cronbach's alpha coefficients were 0.92 and 0.90 for the CAIT-K in right and left limbs, respectively. For native Korean speakers, the CAIT-K had high internal consistency (Cronbach's α=0.89) and intra-class correlation coefficient (ICC2,1 = 0.94, SEM=1.72), correlation with the physical component score (rho=0.70, p = 0.001) of the Short-Form Health Survey (SF-36), and the Kaiser-Meyer-Olkin score was 0.87. The original CAIT was translated, cross-culturally adapted, and validated from English to Korean

EFFECT OF KINESIO TAPE VERSUS ATHLETIC TAPE ON MYOELECTRIC ACTIVITY OF ANKLE MUSCLES IN PATIENTS WITH CHRONIC ANKLE SPRAIN

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Asmaa F Abdelmonem

2018-04-01

Full Text Available Background: Sprained ankle a common orthopedic injury. The standard treatment for ankle sprains remains nonoperative. Ankle taping was used to protect and prevent ligaments excessive strain. So, the current study aimed at investigating the effect of spa-care Kinesio tape versus standard white athletic tape on myoelectric activities (EMG of ankle evertors (peroneus longus and invertors (tibialis anterior in a chronic ankle sprain. Methods: A convenient sample of 30 patients with a chronic ankle sprain (18 females and 12 males were included in this study. Their mean age ±SD was 24 ±1.2 years. Their height was 175±4.8 cm among men & 163±5.2 cm for females, and weight was 85±5.2 kg for males & 74±5.5 kg for women. It was a within-group design in which the same participant experienced the two types of taping compared to no taping condition. Root mean square (RMS was measured while participants were moving the isokinetic dynamometer at an angular velocity of 120°/sec using concentric contraction mode through full ankle range of motion. The EMG (RMS of evertors and invertors was measured immediately after the three taping ways (no tape, Kinesio tape, and athletic tape with a one-week interval between each taping. Results: Spa-care Kinesiotape significantly reduced evertors and invertors EMG (RMS compared with no tape or athletic tape in patients with chronic ankle sprain. Mean± SD of the evertors was 0.7 (±0.1 for no tape and 0.58 (±0.2 for Kinesio tape. The P value was 0.000 for kinesio tape in evertors compared with no tape. Also, mean± SD of the invertors was 0.87 (±0.23 for no tape, and 0.54 (±0.1 for Kinesio tape and the P value was 0.001 for Kinesio tape in invertors compared with no tape. Conclusion: Spa-care Kinesio tape may be useful for reducing EMG activity of ankle muscles in a chronic ankle sprain.

Effectiveness of exercise therapy and manual mobilisation in ankle sprain and functional instability: a systematic review.

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van der Wees, Philip J; Lenssen, Anton F; Hendriks, Erik J M; Stomp, Derrick J; Dekker, Joost; de Bie, Rob A

2006-01-01

This study critically reviews the effectiveness of exercise therapy and manual mobilisation in acute ankle sprains and functional instability by conducting a systematic review of randomised controlled trials. Trials were searched electronically and manually from 1966 to March 2005. Randomised controlled trials that evaluated exercise therapy or manual mobilisation of the ankle joint with at least one clinically relevant outcome measure were included. Internal validity of the studies was independently assessed by two reviewers. When applicable, relative risk (RR) or standardised mean differences (SMD) were calculated for individual and pooled data. In total 17 studies were included. In thirteen studies the intervention included exercise therapy and in four studies the effects of manual mobilisation of the ankle joint was evaluated. Average internal validity score of the studies was 3.1 (range 1 to 7) on a 10-point scale. Exercise therapy was effective in reducing the risk of recurrent sprains after acute ankle sprain: RR 0.37 (95% CI 0.18 to 0.74), and with functional instability: RR 0.38 (95% CI 0.23 to 0.62). No effects of exercise therapy were found on postural sway in patients with functional instability: SMD: 0.38 (95% CI -0.15 to 0.91). Four studies demonstrated an initial positive effect of different modes of manual mobilisation on dorsiflexion range of motion. It is likely that exercise therapy, including the use of a wobble board, is effective in the prevention of recurrent ankle sprains. Manual mobilisation has an (initial) effect on dorsiflexion range of motion, but the clinical relevance of these findings for physiotherapy practice may be limited.

Comparison of Postural Stubility and Auditory Short- Term Memory Taks Interference between Patients with Functional Ankle Instability and Healthy Individuals

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Maryam Hayati

2010-04-01

Full Text Available Objective: With increased recognition of the importance of conscious process and cognition activities in the stability and regulation of posture and also in line of probable adaptation in central nervous system in patients with functional ankle instability, this study was aimed to assess interference patterns between short–term memory task and postural stability tasks in functional ankle instability patients in comparison with healthy individuals. Materials & Methods: In this cross–sectional and case–control study, with dual–task paradigm fifteen functional ankle instability patients whom were selected simply and conveniently and fifteen healthy persons whom were matched with patients as control group were assessed and compared. Six steps of tests were performed for every case with two situation of balance Biodex system instability and three situation of auditory short–term memory task. Data were analyzed by repeated measurement ANOVA. Results: Finding showed that there was significant interference between postural task and cognitive task in both groups (P<0.05 , but there was no significant difference between interferences of two groups. Conclusion: Present study, certificated disruption in information processing in a peripheral musculoskeletal injury such as functional ankle instability. Application of training programs in order to facilitate central information processing in balance rehabilitation process of this patients and improved dual–task paradigms with different degrees of cognitive and postural tasks seems to be effective.

Psychological factors and personality traits associated with patients in chronic foot and ankle pain.

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Shivarathre, Deepak Gubbi; Howard, Nicholas; Krishna, Sowmya; Cowan, Chris; Platt, Simon R

2014-11-01

The impact of psychosocial factors and personality traits in chronic pain is well established. However, there has been limited literature analyzing the influence of psychological issues in chronic foot and ankle pain. The aim of our study was to identify the association of certain psychosocial factors and personality traits in individuals with chronic painful foot and ankle disorders. Patients with chronic foot and ankle pain were recruited from the specialist foot and ankle clinic. The Eysenck Personality Questionnaire-Revised (EPQ-R), Dysfunctional Attitude Scale (DAS), and Hospital Anxiety Depression (HAD) scale were administered in the form of questionnaires. An age- and sex-matched cohort of healthy volunteers served as the control group. Sample size was determined after power calculation, and a total of 90 participants were recruited with informed consent with 45 participants in each arm. Results were analyzed and statistical analyses were performed using SPSS. Patients with chronic foot and ankle pain had significantly higher neuroticism scores than the control group (P pain (P pain. Clinicians should recognize the influence of these specific psychological issues to provide a more holistic approach to the clinical problem. Level III, case control study. © The Author(s) 2014.

Revision with suture-tape augmentation after failed collateral ligament reconstruction for chronic interphalangeal instability of the hallux.

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Cho, Byung-Ki; Park, Ji-Kang; Choi, Seung-Myung; SooHoo, Nelson F

2017-12-01

Chronic varus instability or recurrent subluxation following isolated interphalangeal dislocation of the hallux is a rare injury. No consensus has been reached regarding the best joint-salvage procedure for patients with the failed collateral ligament reconstruction using tendon graft. We report a case who achieved satisfactory clinical outcome through a modified surgical procedure (revision collateral ligament reconstruction augmented with suture-tape). Copyright © 2017 European Foot and Ankle Society. Published by Elsevier Ltd. All rights reserved.

Enhanced balance associated with coordination training with stochastic resonance stimulation in subjects with functional ankle instability: an experimental trial

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Brown Cathleen N

2007-12-01

Full Text Available Abstract Background Ankle sprains are common injuries that often lead to functional ankle instability (FAI, which is a pathology defined by sensations of instability at the ankle and recurrent ankle sprain injury. Poor postural stability has been associated with FAI, and sports medicine clinicians rehabilitate balance deficits to prevent ankle sprains. Subsensory electrical noise known as stochastic resonance (SR stimulation has been used in conjunction with coordination training to improve dynamic postural instabilities associated with FAI. However, unlike static postural deficits, dynamic impairments have not been indicative of ankle sprain injury. Therefore, the purpose of this study was to examine the effects of coordination training with or without SR stimulation on static postural stability. Improving postural instabilities associated with FAI has implications for increasing ankle joint stability and decreasing recurrent ankle sprains. Methods This study was conducted in a research laboratory. Thirty subjects with FAI were randomly assigned to either a: 1 conventional coordination training group (CCT; 2 SR stimulation coordination training group (SCT; or 3 control group. Training groups performed coordination exercises for six weeks. The SCT group received SR stimulation during training, while the CCT group only performed coordination training. Single leg postural stability was measured after the completion of balance training. Static postural stability was quantified on a force plate using anterior/posterior (A/P and medial/lateral (M/L center-of-pressure velocity (COPvel, M/L COP standard deviation (COPsd, M/L COP maximum excursion (COPmax, and COP area (COParea. Results Treatment effects comparing posttest to pretest COP measures were highest for the SCT group. At posttest, the SCT group had reduced A/P COPvel (2.3 ± 0.4 cm/s vs. 2.7 ± 0.6 cm/s, M/L COPvel (2.6 ± 0.5 cm/s vs. 2.9 ± 0.5 cm/s, M/L COPsd (0.63 ± 0.12 cm vs. 0.73 ± 0

All-inside, anatomical lateral ankle stabilization for revision and complex primary lateral ankle stabilization: a technique guide.

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Prissel, Mark A; Roukis, Thomas S

2014-12-01

Lateral ankle instability is a common mechanical problem that often requires surgical management when conservative efforts fail. Historically, myriad open surgical approaches have been proposed. Recently, consideration for arthroscopic management of lateral ankle instability has become popular, with promising results. Unfortunately, recurrent inversion ankle injury following lateral ankle stabilization can occur and require revision surgery. To date, arthroscopic management for revision lateral ankle stabilization has not been described. We present a novel arthroscopic technique combining an arthroscopic lateral ankle stabilization kit with a suture anchor ligament augmentation system for revision as well as complex primary lateral ankle stabilization. © 2014 The Author(s).

2016 consensus statement of the International Ankle Consortium: prevalence, impact and long-term consequences of lateral ankle sprains.

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Gribble, Phillip A; Bleakley, Chris M; Caulfield, Brian M; Docherty, Carrie L; Fourchet, François; Fong, Daniel Tik-Pui; Hertel, Jay; Hiller, Claire E; Kaminski, Thomas W; McKeon, Patrick O; Refshauge, Kathryn M; Verhagen, Evert A; Vicenzino, Bill T; Wikstrom, Erik A; Delahunt, Eamonn

2016-12-01

The Executive Committee of the International Ankle Consortium presents this 2016 position paper with recommendations for information implementation and continued research based on the paradigm that lateral ankle sprain (LAS), and the development of chronic ankle instability (CAI), serve as a conduit to a significant global healthcare burden. We intend our recommendations to serve as a mechanism to promote efforts to improve prevention and early management of LAS. We believe this will reduce the prevalence of CAI and associated sequelae that have led to the broader public health burdens of decreased physical activity and early onset ankle joint post-traumatic osteoarthritis. Ultimately, this can contribute to healthier lifestyles and promotion of physical activity. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://www.bmj.com/company/products-services/rights-and-licensing/.

Effect of isokinetic training on strength, functionality and proprioception in athletes with functional ankle instability.

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Sekir, Ufuk; Yildiz, Yavuz; Hazneci, Bulent; Ors, Fatih; Aydin, Taner

2007-05-01

The purpose of this study was to investigate the effects of isokinetic exercise on strength, joint position sense and functionality in recreational athletes with functional ankle instability (FAI). Strength, proprioception and balance of 24 recreational athletes with unilateral FAI were evaluated by using isokinetic muscle strength measurement, ankle joint position sense and one leg standing test. The functional ability was evaluated using five different tests. These were; single limb hopping course (SLHC), one legged and triple legged hop for distance (OLHD-TLHD), and six and cross six meter hop for time (SMHT-CSMHT). Isokinetic peak torque of the ankle invertor and evertor muscles were assessed eccentrically and concentrically at test speeds of 120 degrees /s. Isokinetic exercise protocol was carried out at an angular velocity of 120 degrees /s. The exercise session was repeated three times a week and lasted after 6 weeks. At baseline, concentric invertor strength was found to be significantly lower in the functionally unstable ankles compared to the opposite healthy ankles (p 0.05). Ankle joint position sense in the injured ankles declined significantly from 2.35 +/- 1.16 to 1.33 +/- 0.62 degrees for 10 degrees of inversion angle (p isokinetic exercise. One leg standing test score decreased significantly from 15.17 +/- 8.50 to 11.79 +/- 7.81 in the injured ankles (p isokinetic exercise protocol, all of the worsened functional test scores in the injured ankles as compared to the opposite healthy ankles displayed a significant improvement (p isokinetic exercise program used in this study had a positive effect on these parameters.

T2 -Mapping evaluation of early cartilage alteration of talus for chronic lateral ankle instability with isolated anterior talofibular ligament tear or combined with calcaneofibular ligament tear.

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Tao, Hongyue; Hu, Yiwen; Qiao, Yang; Ma, Kui; Yan, Xu; Hua, Yinghui; Chen, Shuang

2018-01-01

To quantitatively evaluate the cartilage alteration of talus for chronic lateral ankle instability (LAI) with isolated anterior talofibular ligament (ATFL) tear and combined ATFL and calcaneofibular ligament (CFL) tear using T 2 -mapping at 3.0T. In all, 27 patients including 17 with isolated ATFL tear and 10 with ATFL+CFL tear, and 21 healthy subjects were recruited. All participants underwent T 2 -mapping scan at 3T and patients completed American Orthopaedic Foot and Ankle Society (AOFAS) scoring. The total talar cartilage (TTC) was segmented into six compartments: medial anterior (MA), medial center (MC), medial posterior (MP), lateral anterior (LA), lateral center (LC), and lateral posterior (LP). The T 2 value of each compartment was measured from T 2 -mapping images. Data were analyzed with one-way analysis of variance (ANOVA), Student's t-test, and Pearson's correlation coefficient. The T 2 values of MA, MC, MP, TTC in the ATFL group and MA, MC, MP, LC, LP, TTC in the ATFL+CFL group were higher than those in the control group (P < 0.05). Moreover, the T 2 values of MC, MP, LC, and TTC in the ATFL+CFL group were higher than those in the ATFL group (P < 0.05). The T 2 values of MA in both patient groups were negatively correlated with AOFAS scores (r = -0.596, r = -0.690, P < 0.05). Chronic LAI with ATFL tear had a trend of increasing cartilage T 2 values in talar trochlea, mainly involving medial cartilage compartments. Chronic LAI with ATFL+CFL tear might result in higher T 2 values in a much larger cartilage region than with ATFL tear. MA could be the main cartilage compartment that may affect the patient's clinical symptoms. 1 Technical Efficacy: Stage 3 J. Magn. Reson. Imaging 2018;47:69-77. © 2017 International Society for Magnetic Resonance in Medicine.

Results of lateral ankle ligament repair surgery in one hundred and nineteen patients: do surgical method and arthroscopy timing matter?

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Araoye, Ibukunoluwa; De Cesar Netto, Cesar; Cone, Brent; Hudson, Parke; Sahranavard, Bahman; Shah, Ashish

2017-11-01

Ankle sprains are the most common athletic injury. One of five chronic lateral ankle instability patients will require surgery, making operative outcomes crucial. The purpose of this study is to determine if operative method influences failure and complication rates in chronic lateral ankle ligament repair surgery. We retrospectively reviewed 119 cases (118 patients) of lateral ankle ligament surgery between 2006 and 2016. Patient charts and operative reports were examined for demographics, use and timing of ankle arthroscopy, ligament fixation method, type of surgical incision, presence of calcaneofibular ligament repair, and operative technique. Impact of operative methods on failure (one-year minimum follow-up) and complication outcomes was explored using Chi-square test of independence (or Fisher's exact test). Statistical significance was set at p less than .05. Mean age at surgery was 40 (range, 18-73) years. Mean follow-up was 51 (range, 12-260) weeks. Failure rate was 8.4% (10/89 cases) while complication rate was 17.6% (21/119). Failure rate did not differ significantly between any data subgroups (p > .05). Single stage arthroscopy was associated with a significantly lower complication rate (11%, 4/37) than double-stage arthroscopy (47%, 9/19) (p anchor ligament fixation (9%, 6/67) compared to direct suture ligament fixation (29%, 15/52) (p anchors and concurrent ankle arthroscopy may be favourable options to achieve fewer complications in chronic lateral ankle instability repair surgery.

Validity of an ankle joint motion and position sense measurement system and its application in healthy subjects and patients with ankle sprain.

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Lin, Chueh-Ho; Chiang, Shang-Lin; Lu, Liang-Hsuan; Wei, Shun-Hwa; Sung, Wen-Hsu

2016-07-01

Ankle motion and proprioception in multiple axis movements are crucial for daily activities. However, few studies have developed and used a multiple axis system for measuring ankle motion and proprioception. This study was designed to validate a novel ankle haptic interface system that measures the ankle range of motion (ROM) and joint position sense in multiple plane movements, investigating the proprioception deficits during joint position sense tasks for patients with ankle instability. Eleven healthy adults (mean ± standard deviation; age, 24.7 ± 1.9 years) and thirteen patients with ankle instability were recruited in this study. All subjects were asked to perform tests to evaluate the validity of the ankle ROM measurements and underwent tests for validating the joint position sense measurements conducted during multiple axis movements of the ankle joint. Pearson correlation was used for validating the angular position measurements obtained using the developed system; the independent t test was used to investigate the differences in joint position sense task performance for people with or without ankle instability. The ROM measurements of the device were linearly correlated with the criterion standards (r = 0.99). The ankle instability and healthy groups were significantly different in direction, absolute, and variable errors of plantar flexion, dorsiflexion, inversion, and eversion (p ankle joint motion and position sense measurement system is valid and can be used for measuring the ankle ROM and joint position sense in multiple planes and indicate proprioception deficits for people with ankle instability. Copyright © 2016 Elsevier Ireland Ltd. All rights reserved.

Brain control of volitional ankle tasks in people with chronic stroke and in healthy individuals.

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Beaulieu, L D; Massé-Alarie, H; Brouwer, B; Schneider, C

2014-03-15

This study explored the relationships between motor cortical control of ankle dorsiflexors and clinical impairments of volitional ankle dorsiflexion in people with chronic stroke. Eighteen persons with stroke and 14 controls were evaluated. Clinical tools were used to assess ankle dorsiflexion amplitude and isometric strength. Transcranial magnetic stimulation (TMS) of the primary motor cortex (M1) tested the functional integrity of cortical circuits controlling the tibialis anterior (TA). All clinical scores and most TMS outcomes were impaired in people with chronic stroke. The lower clinical scores were related to the reduction of the strength of corticospinal projections onto spinal motoneurons. Concurrent TMS and clinical testing in chronic stroke provided original data demonstrating relationships between the integrity of cortical and corticospinal components of TA motor control and volitional ankle tasks. Our study proposes that volitional ankle mobilization in chronic stroke may be explained by the residual abnormal M1 circuits which may be responsive for rehabilitation intervention. This should be confirmed in longitudinal studies with larger samples to determine whether TMS outcomes associated with lower limb muscles are predictive of clinical changes or vice versa. Copyright © 2013 Elsevier B.V. All rights reserved.

Outcomes and Return to Activity After Operative Repair of Chronic Latent Syndesmotic Instability.

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Ryan, Paul M; Rodriguez, Ryan M

2016-02-01

This study is a retrospective review of prospectively gathered data determining the postoperative outcomes of patients who underwent operative treatment to address chronic syndesmotic instability. The cohort is composed of 19 individuals who elected to undergo operative treatment of chronic syndesmotic instability. The operative repair consisted of arthroscopic debridement in all cases with reduction and suture button fixation of those patients who had greater than 4 mm of syndesmotic diastasis on arthroscopic evaluation. All patients had a minimum of 24 months follow-up. This study retrospectively examined the prospectively gathered preoperative and postoperative outcome scores to include a Visual Analog Scale (VAS) pain score and an American Orthopaedic Foot & Ankle Society (AOFAS) ankle-hindfoot score. In addition, patients were questioned on their ability to return to their preinjury level of activity and their ability to continue running sports. Fourteen patients returned their postoperative surveys. Mean AOFAS scores improved significantly from 48 to 82.7 (P = .014). Mean VAS scores improved from 6.1 to 1.0 (P = .002). Overall, 86% (12/14) of patients were able to return to running and 79% (11/14) of patients were able to return to their preinjury level of sport. Preoperative and postoperative weight-bearing ankle radiographs were reviewed to evaluate the tibiofibular clear space and overlap. The clear space measured on anteroposterior (AP) radiographs decreased from 5.4 mm to 4.6 mm (P = .005), the clear space evaluated on the mortise radiograph decreased from 4.5 mm to 3.6 mm (P = .006), and the overlap measured on the AP radiograph increased from 5.7 mm to 6.9 mm (P = .019). All radiographs were measured by a board-certified musculoskeletal radiologist. This study presents a treatment method that can be instituted at the time of diagnosis for syndesmotic injuries with greater than 4 mm of diastasis that were treated with debridement and stabilization. The

Ankle sprain: pathophysiology, predisposing factors, and management strategies

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Tricia J Hubbard

2010-07-01

Full Text Available Tricia J Hubbard, Erik A WikstromUNC Charlotte, Department of Kinesiology, CharlotteAbstract: With the high percentage (up to 75% of initial lateral ankle sprains (LAS leading to repetitive sprains and chronic symptoms, it is imperative to better understand how best to treat and rehabilitate LAS events. The purpose of this paper is to review LAS pathophysiology, predisposing factors, and the current evidence regarding therapeutic modalities and exercises used in the treatment of LAS. Functional rehabilitation, early mobilization with support, is the current standard of care for LAS. However, the high percentage of reinjury occurrence and development of chronic symptoms (up to 75% after a LAS, suggests the current standard of care may not be effective. Recent evidence has shown the need for more stringent immobilization to facilitate ligament healing and restoration of joint stability and function after a LAS. Additionally, the importance of adding adjunctive therapies, specifically joint mobilizations and balance training have been shown to improve function and decrease the incidence of reinjury after a LAS. Modifying current rehabilitation protocols to include protecting the ankle joint with stringent immobilization, and including joint mobilizations and balance training may be the first step to decreasing the incidence of short and long term ankle joint dysfunction.Keywords: rehabilitation, recurrent sprains, chronic ankle instability (CAI

Changes in Postural Control After a Ball-Kicking Balance Exercise in Individuals With Chronic Ankle Instability

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Conceição, Josilene Souza; Schaefer de Araújo, Felipe Gustavo; Santos, Gilmar Moraes; Keighley, John

2016-01-01

Context:  Rehabilitation programs for patients with chronic ankle instability (CAI) generally involve balance-perturbation training (BPT). Anticipatory postural adjustments (APAs) and compensatory postural adjustments (CPAs) are the primary strategies used to maintain equilibrium during body perturbations. Little is known, however, about how APAs and CPAs are modified to promote better postural control for individuals with CAI after BPT. Objective:  To investigate the effect of BPT that involves kicking a ball on postural-control strategies in individuals with CAI. Design:  Randomized controlled clinical trial. Setting:  Laboratory. Patients or Other Participants:  We randomly assigned 44 volunteers with CAI to either a training group (TG; 11 women, 11 men; age = 24 ± 4 years, height = 173.0 ± 9.8 cm, mass = 72.64 ± 11.98 kg) or control group (CG; 11 women, 11 men; age = 22 ± 3 years, height = 171.0 ± 9.7 cm, mass = 70.00 ± 11.03 kg). Intervention(s):  The TG performed a single 30-minute training session that involved kicking a ball while standing on 1 foot. The CG received no intervention. Main Outcome Measure(s):  The primary outcome was the sum of the integrated electromyographic activity (∑∫EMG) of the lower extremity muscles in the supporting limb that were calculated during typical intervals for APAs and CPAs. A secondary outcome was center-of-pressure displacement during similar intervals. Results:  In the TG after training, the ∑∫EMG decreased in both dorsal and ventral muscles during compensatory adjustment (ie, the time interval that followed lower limb movement). During this interval, muscle activity (∑∫EMG) was less in the TG than in the CG. Consequently, center-of-pressure displacement increased during the task after training. Conclusions:  A single session of ball-kicking BPT promoted changes in postural-control strategies in individuals with CAI. These results should stimulate new and more comprehensive studies to

Radiology of chronic diseases of the ankle joint; Chronische Krankheitsbilder am Sprunggelenk

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Rand, T. [Vienna Univ. (Austria). Einrichtung fuer Magnetresonanztomographie]|[Universitaetsklinik fuer Radiodiagnostik, Vienna (Austria); Trattnig, S.; Breitenseher, M.; Imhof, H. [Vienna Univ. (Austria). Einrichtung fuer Magnetresonanztomographie; Kreuzer, S. [Universitaetsklinik fuer Radiodiagnostik, Vienna (Austria); Wagesreither, S. [Vienna Univ. (Austria). Klinik fuer Zahn-, Mund- und Kieferheilkunde

1999-01-01

The etiology of chronic diseases of the ankle joint comprises a wide spectrum including chronic inflammatory processes and chronic degenerative, tumorous and neuropathic processes, as well as some specific syndromes based on chronic changes of the ankle joint. Of the inflammatory processes, chronic juvenile arthritis (JVC) is the most common disease. However, also Reiter disease, psoriasis or chronic monoarthritid diseases such as gout, as well as granulomatous diseases (tuberculosis, sarcoidosis) and fungal infections, may affect the ankle joint in a chronic course. Chronic degenerative changes are usually secondary due to abnormal positioning of the joint constituents or repetitive trauma. Neuropathic changes, as frequently seen in the course of diabetes, present with massive osseous destruction and malposition of the articular constituents. Chronic osseous as well as cartilaginous and synovial changes are seen in hemoplici patients. Chronic traumatic changes are represented by pigmented villonodular synovitis (PVNS), and chondromatosis, both with a predilection for the ankle joint. Due to the possibilities of magnetic resonance imaging (MRI), diagnosis of chronic ankle changes includes chronic ligamentous, tendinous and soft tissue changes. With the use MRI, specific syndromes can be defined which particularly affect the ankle joint in a chronic way, such as the os trigonum syndrome, the anterolateral impingement syndrome and the sinus tarsi syndrome. Nevertheless, plain film radiographs are still the basic element of any investigation. MRI, however, can be potentially used as a second investigation, saving an unnecessary cascade of investigations with ultrasound and CT. The latter investigations are used only with very specific indications, for instance CT for subtle bone structures and sonography for a limited investigation of tendons or evaluation of fluid. Particularly due to the possibilities of MRI and the development of special gradient-echo imaging or

Effects of ankle eversion taping using kinesiology tape in a patient with ankle inversion sprain

OpenAIRE

Lee, Sun-Min; Lee, Jung-Hoon

2016-01-01

[Purpose] The aim of this study was to report the effects of ankle eversion taping using kinesiology tape on ankle inversion sprain. [Subject] The subject was a 21-year-old woman with Grade 2 ankle inversion sprain. [Methods] Ankle eversion taping was applied to the sprained left ankle using kinesiology tape for 4 weeks (average, 15?h/day). [Results] Ankle instability and pain were reduced, and functional dynamic balance was improved after ankle eversion taping for 4 weeks. The Cumberland Ank...

A new approach of the Star Excursion Balance Test to assess dynamic postural control in people complaining from chronic ankle instability.

Science.gov (United States)

Pionnier, Raphaël; Découfour, Nicolas; Barbier, Franck; Popineau, Christophe; Simoneau-Buessinger, Emilie

2016-03-01

The purpose of this study was to quantitatively and qualitatively assess dynamic balance with accuracy in individuals with chronic ankle instability (CAI). To this aim, a motion capture system was used while participants performed the Star Excursion Balance Test (SEBT). Reached distances for the 8 points of the star were automatically computed, thereby excluding any dependence to the experimenter. In addition, new relevant variables were also computed, such as absolute time needed to reach each distance, lower limb ranges of motion during unipodal stance, as well as absolute error of pointing. Velocity of the center of pressure and range of variation of ground reaction forces have also been assessed during the unipodal phase of the SEBT thanks to force plates. CAI group exhibited smaller reached distances and greater absolute error of pointing than the control group (p<0.05). Moreover, the ranges of motion of lower limbs joints, the velocity of the center of pressure and the range of variation of the ground reaction forces were all significantly smaller in the CAI group (p<0.05). These reduced quantitative and qualitative performances highlighted a lower dynamic postural control. The limited body movements and accelerations during the unipodal stance in the CAI group could highlight a protective strategy. The present findings could help clinicians to better understand the motor strategies used by CAI patients during dynamic balance and may guide the rehabilitation process. Copyright © 2016 Elsevier B.V. All rights reserved.

The Hemi-Castaing ligamentoplasty for chronic lateral ankle instability does not modify proprioceptive, muscular and posturographic parameters.

Science.gov (United States)

Baray, Anne-Laure; Philippot, Rémi; Neri, Thomas; Farizon, Frédéric; Edouard, Pascal

2016-04-01

The Hemi-Castaing ligamentoplasty uses a powerful dynamic stabilizer of the ankle which is the peroneus brevis tendon. To our knowledge, there is no study available evaluating the effects of this type of surgery on proprioceptive, muscular and posturographic parameters. This case-control study included 39 subjects divided into two groups: the operated (n = 24) and the control group (n = 15). All subjects underwent a clinical, proprioceptive and isokinetic assessment using a CON-TREX dynamometer, and a postural evaluation using the Win-Posturo force platform. At a mean period of 23 (SD 5.4) post-operative months, the Karlsson ankle functional score was 84.2 (SD 23.8) and the AOFAS score was 88.1 (SD 16.2). The mean ankle joint position error for operated ankles was from 1.9° (SD 0.9) at 10° of inversion range of motion to 2.5° (SD 1.7) at 20°. It was similar to that achieved in the control group ranging from 2.2° (SD 1) at 10° to 2.3° (SD 1.3) at 20°. No significant loss of ankle eversion strength could be observed after ligamentoplasty. Ankle eversion/inversion ratio when tested under all velocities and contraction modes failed to reveal any statistical difference between the operated and healthy ankles in the patient group, neither between the patient and control groups. This surgical technique achieved excellent functional outcomes. It did not impair the agonist/antagonist balance of ankle muscles, and use of half the peroneus brevis tendon did not lessen the eversion strength. Case-control study, Level III.

The impact of chiropractic manipulative therapy on chronic recurrent lateral ankle sprain syndrome in two young athletes.

Science.gov (United States)

Gillman, Scott F

2004-01-01

To describe two cases of abrupt resolution of chronic, recurrent, inversion sprain to ankles in young recreational athletes. A 13-year-old, female, avid recreational soccer player with ankles that would spontaneously invert during various inconsistent points in the weight bearing gait cycle, sometimes with acute pain or sprain to the ankle. No intervention was attempted prior to her entry to the chiropractic office. A 17-year-old male avid skate- boarder and snowboarder whose left ankle routinely "gave out" into inversion upon mundane weight bearing activity, usually with pain and with dependence on wearing an ankle support when skateboarding to lessen ankle pain. The patient had used an ankle support prior to seeking chiropractic care. High velocity, low amplitude chiropractic manipulative therapy applied to the spine, pelvis and extremity joints was the primary intervention in both cases, with particular focus on the ankle. Other procedures used included taping and orthotics, but not before the manipulation effect was noted. High velocity, low amplitude chiropractic manipulative therapy to the spine, pelvis, and extremities, particularly at the ankle, should be considered when managing young recreational athletes with functional chronic, recurrent, ankle inversion sprains.

Task-specific ankle robotics gait training after stroke: a randomized pilot study.

Science.gov (United States)

Forrester, Larry W; Roy, Anindo; Hafer-Macko, Charlene; Krebs, Hermano I; Macko, Richard F

2016-06-02

An unsettled question in the use of robotics for post-stroke gait rehabilitation is whether task-specific locomotor training is more effective than targeting individual joint impairments to improve walking function. The paretic ankle is implicated in gait instability and fall risk, but is difficult to therapeutically isolate and refractory to recovery. We hypothesize that in chronic stroke, treadmill-integrated ankle robotics training is more effective to improve gait function than robotics focused on paretic ankle impairments. Participants with chronic hemiparetic gait were randomized to either six weeks of treadmill-integrated ankle robotics (n = 14) or dose-matched seated ankle robotics (n = 12) videogame training. Selected gait measures were collected at baseline, post-training, and six-week retention. Friedman, and Wilcoxon Sign Rank and Fisher's exact tests evaluated within and between group differences across time, respectively. Six weeks post-training, treadmill robotics proved more effective than seated robotics to increase walking velocity, paretic single support, paretic push-off impulse, and active dorsiflexion range of motion. Treadmill robotics durably improved gait dorsiflexion swing angle leading 6/7 initially requiring ankle braces to self-discarded them, while their unassisted paretic heel-first contacts increased from 44 % to 99.6 %, versus no change in assistive device usage (0/9) following seated robotics. Treadmill-integrated, but not seated ankle robotics training, durably improves gait biomechanics, reversing foot drop, restoring walking propulsion, and establishing safer foot landing in chronic stroke that may reduce reliance on assistive devices. These findings support a task-specific approach integrating adaptive ankle robotics with locomotor training to optimize mobility recovery. NCT01337960. https://clinicaltrials.gov/ct2/show/NCT01337960?term=NCT01337960&rank=1.

[Calcaneo-fibular ligament surgery for chronic lateral instability of the upper ankle : Broström technique with modification by Wille. Video article].

Science.gov (United States)

Kosiol, J; Wille, M; Putzer, D; Biedermann, R

2015-11-01

An acute ligament rupture of the lateral ligament complex of the ankle joint is treated without surgery. Treatment failure may lead to a chronically unstable situation of the ankle joint, in which case surgery is an effective procedure for stabilizing the ruptured ligaments. Anatomical reconstruction is the best operative technique if the ligament tissue is of good quality. In our video we demonstrate a new possibility for the positioning of an anchor to tighten the calcaneo-fibular ligament. Modified Broström repairs are described in the literature in which the calcaneo-fibular ligament is released and reattached to the fibula to tighten it. We present the option to release the ligament at the calcaneus and reattach it using a suture anchor. This offers the advantage of preventing the possible dislocation of the peroneal tendons.

The role of arthroscopy in chronic elbow instability.

Science.gov (United States)

Goodwin, David; Dynin, Maria; Macdonnell, J Ryan; Kessler, Michael W

2013-12-01

Elbow arthroscopy has had an emerging role in the management of many disorders of the elbow. In patients with chronic elbow instability, several arthroscopic techniques have been described in the diagnosis and management of posterolateral rotatory instability and valgus instability. We performed a systematic review investigating the role of arthroscopy in posterolateral rotatory instability and valgus instability in the elbow using the PubMed and CINAHL (Cumulative Index to Nursing and Allied Health Literature) databases, and the Cochrane Database of Systematic Reviews, consisting of articles from peer-reviewed journals published in the English language after January 1, 1991. Search criteria initially identified 249 articles. Twenty-five articles met criteria for inclusion. This included 17 review articles, 4 cadaveric studies, 3 retrospective studies, and 1 prospective study. Two of the retrospective studies compared arthroscopic and open techniques. Articles included in this systematic review concluded that arthroscopy is an accurate adjunct to physical examination and imaging in the diagnosis of chronic elbow instability and affords an exceptional view of the joint with the ability to address intra-articular pathologic conditions. Arthroscopic surgical techniques have shown equivalent clinical outcomes in a comparison of arthroscopic and open techniques. Elbow arthroscopy is a valuable tool in the diagnosis and management of chronic elbow instability. Patients treated arthroscopically benefit from additional diagnostic techniques, improved visualization of the elbow joint, the ability to address coexisting intra-articular pathologic conditions, and minimal soft tissue injury with no clinical consequences in outcomes. With such significant advantages, the use of elbow arthroscopy is likely to expand in the management of chronic elbow instability. Level IV, systematic review. Copyright © 2013 Arthroscopy Association of North America. Published by Elsevier Inc

Effect of a 6-week dynamic neuromuscular training programme on ankle joint function: A Case report.

Science.gov (United States)

O'Driscoll, Jeremiah; Kerin, Fearghal; Delahunt, Eamonn

2011-06-09

Ankle joint sprain and the subsequent development of chronic ankle instability (CAI) are commonly encountered by clinicians involved in the treatment and rehabilitation of musculoskeletal injuries. It has recently been advocated that ankle joint post-sprain rehabilitation protocols should incorporate dynamic neuromuscular training to enhance ankle joint sensorimotor capabilities. To date no studies have reported on the effects of dynamic neuromuscular training on ankle joint positioning during landing from a jump, which has been reported as one of the primary injury mechanisms for ankle joint sprain. This case report details the effects of a 6-week dynamic neuromuscular training programme on ankle joint function in an athlete with CAI. The athlete took part in a progressive 6-week dynamic neuromuscular training programme which incorporated postural stability, strengthening, plyometric, and speed/agility drills. The outcome measures chosen to assess for interventional efficacy were: 1 Cumberland Ankle Instability Tool (CAIT) scores, 2 Star Excursion Balance Test (SEBT) reach distances, 3 ankle joint plantar flexion during drop landing and drop vertical jumping, and 4 ground reaction forces (GRFs) during walking. CAIT and SEBT scores improved following participation in the programme. The angle of ankle joint plantar flexion decreased at the point of initial contact during the drop landing and drop vertical jumping tasks, indicating that the ankle joint was in a less vulnerable position upon landing following participation in the programme. Furthermore, GRFs were reduced whilst walking post-intervention. The 6-week dynamic neuromuscular training programme improved parameters of ankle joint sensorimotor control in an athlete with CAI. Further research is now required in a larger cohort of subjects to determine the effects of neuromuscular training on ankle joint injury risk factors.

Effects of circumferential ankle pressure on ankle proprioception, stiffness, and postural stability: a preliminary investigation.

Science.gov (United States)

You, Sung H; Granata, Kevin P; Bunker, Linda K

2004-08-01

Cross-sectional repeated-measures design. Determine the effects of circumferential ankle pressure (CAP) intervention on proprioceptive acuity, ankle stiffness, and postural stability. The application of CAP using braces, taping, and adaptive shoes or military boots is widely used to address chronic ankle instability (CAI). An underlying assumption is that the CAP intervention might improve ankle stability through increased proprioceptive acuity and stiffness in the ankle. METHOD AND MEASURES: A convenience sample of 10 subjects was recruited from the local university community and categorized according to proprioceptive acuity (high, low) and ankle stability (normal, CAI). Proprioceptive acuity was measured when blindfolded subjects were asked to accurately reproduce a self-selected target ankle position before and after the application of CAP. Proprioceptive acuity was determined in 5 different ankle joint position sense tests: neutral, inversion, eversion, plantar flexion, and dorsiflexion. Joint position angles were recorded electromechanically using a potentiometer. Passive ankle stiffness was computed from the ratio of applied static moment versus angular displacement. Active ankle stiffness was determined from biomechanical analyses of ankle motion following a mediolateral perturbation. Postural stability was quantified from the center of pressure displacement in the mediolateral and the anteroposterior directions in unipedal stance. All measurements were recorded with and without CAP applied by a pediatric blood pressure cuff. Data were analyzed using a separate mixed-model analysis of variance (ANOVA) for each dependent variable. Post hoc comparison using Tukey's honestly significant difference (HSD) test was performed if significant interactions were obtained. Significance level was set at P<.05 for all analyses. Significant group (high versus low proprioceptive acuity) x CAP interactions were identified for postural stability. Passive ankle stiffness was

Managing ankle ligament sprains and tears: current opinion

Science.gov (United States)

McGovern, Ryan P; Martin, RobRoy L

2016-01-01

The purpose of this paper is to present a current review of pathoanatomical features, differential diagnosis, objective assessment, intervention, and clinical course associated with managing lateral ankle ligament sprains. Proper diagnosis and identification of affected structures should be obtained through history and objective assessment. From this information, an individualized evidence-based intervention plan can be developed to enable recovery while decreasing the risk of reinjury. An appropriate evaluation is needed not only to determine the correct diagnosis but also to allow for grading and determining the prognosis of the injury in those with an acute lateral ankle sprain. Examination should include an assessment of impairments as well as a measure of activity and participation. Evidence-based interventions for those with an acute lateral ankle sprain should include weight bearing with bracing, manual therapy, progressive therapeutic exercises, and cryotherapy. For those with chronic ankle instability (CAI), interventions should include manual therapy and a comprehensive rehabilitation program. It is essential to understand the normal clinical course for athletes who sustain a lateral ankle sprain as well as risk factors for an acute injury and CAI. Risk factors for both an acute lateral ankle sprain and CAI include not using an external support and not participating in an appropriate exercise program. Incorporating the latest evidence-based rehabilitation techniques provides the best course of treatment for athletes with an acute ankle sprain or CAI. PMID:27042147

Effect of a 6-week dynamic neuromuscular training programme on ankle joint function: A Case report

Directory of Open Access Journals (Sweden)

O'Driscoll Jeremiah

2011-06-01

Full Text Available Abstract Background Ankle joint sprain and the subsequent development of chronic ankle instability (CAI are commonly encountered by clinicians involved in the treatment and rehabilitation of musculoskeletal injuries. It has recently been advocated that ankle joint post-sprain rehabilitation protocols should incorporate dynamic neuromuscular training to enhance ankle joint sensorimotor capabilities. To date no studies have reported on the effects of dynamic neuromuscular training on ankle joint positioning during landing from a jump, which has been reported as one of the primary injury mechanisms for ankle joint sprain. This case report details the effects of a 6-week dynamic neuromuscular training programme on ankle joint function in an athlete with CAI. Methods The athlete took part in a progressive 6-week dynamic neuromuscular training programme which incorporated postural stability, strengthening, plyometric, and speed/agility drills. The outcome measures chosen to assess for interventional efficacy were: 1 Cumberland Ankle Instability Tool (CAIT scores, 2 Star Excursion Balance Test (SEBT reach distances, 3 ankle joint plantar flexion during drop landing and drop vertical jumping, and 4 ground reaction forces (GRFs during walking. Results CAIT and SEBT scores improved following participation in the programme. The angle of ankle joint plantar flexion decreased at the point of initial contact during the drop landing and drop vertical jumping tasks, indicating that the ankle joint was in a less vulnerable position upon landing following participation in the programme. Furthermore, GRFs were reduced whilst walking post-intervention. Conclusions The 6-week dynamic neuromuscular training programme improved parameters of ankle joint sensorimotor control in an athlete with CAI. Further research is now required in a larger cohort of subjects to determine the effects of neuromuscular training on ankle joint injury risk factors.

Effect of a 6-week dynamic neuromuscular training programme on ankle joint function: A Case report

LENUS (Irish Health Repository)

O'Driscoll, Jeremiah

2011-06-09

Abstract Background Ankle joint sprain and the subsequent development of chronic ankle instability (CAI) are commonly encountered by clinicians involved in the treatment and rehabilitation of musculoskeletal injuries. It has recently been advocated that ankle joint post-sprain rehabilitation protocols should incorporate dynamic neuromuscular training to enhance ankle joint sensorimotor capabilities. To date no studies have reported on the effects of dynamic neuromuscular training on ankle joint positioning during landing from a jump, which has been reported as one of the primary injury mechanisms for ankle joint sprain. This case report details the effects of a 6-week dynamic neuromuscular training programme on ankle joint function in an athlete with CAI. Methods The athlete took part in a progressive 6-week dynamic neuromuscular training programme which incorporated postural stability, strengthening, plyometric, and speed\\/agility drills. The outcome measures chosen to assess for interventional efficacy were: 1 Cumberland Ankle Instability Tool (CAIT) scores, 2 Star Excursion Balance Test (SEBT) reach distances, 3 ankle joint plantar flexion during drop landing and drop vertical jumping, and 4 ground reaction forces (GRFs) during walking. Results CAIT and SEBT scores improved following participation in the programme. The angle of ankle joint plantar flexion decreased at the point of initial contact during the drop landing and drop vertical jumping tasks, indicating that the ankle joint was in a less vulnerable position upon landing following participation in the programme. Furthermore, GRFs were reduced whilst walking post-intervention. Conclusions The 6-week dynamic neuromuscular training programme improved parameters of ankle joint sensorimotor control in an athlete with CAI. Further research is now required in a larger cohort of subjects to determine the effects of neuromuscular training on ankle joint injury risk factors.

Osteoligamentous injuries of the medial ankle joint.

Science.gov (United States)

Lötscher, P; Lang, T H; Zwicky, L; Hintermann, B; Knupp, M

2015-12-01

Injuries of the ankle joint have a high incidence in daily life and sports, thus, playing an important socioeconomic role. Therefore, proper diagnosis and adequate treatment are mandatory. While most of the ligament injuries around the ankle joint are treated conservatively, great controversy exists on how to treat deltoid ligament injuries in ankle fractures. Missed injuries and inadequate treatment of the medial ankle lead to inferior outcome with instability, progressive deformity, and ankle joint osteoarthritis.

Management of chronic ankle pain using joint mobilization and ASTYM® treatment: a case report.

Science.gov (United States)

Slaven, Emily J; Mathers, Jessie

2011-05-01

Treatment of ankle sprains predominately focuses on the acute management of this condition; less emphasis is placed on the treatment of ankle sprains in the chronic phase of recovery. Manual therapy, in the form of joint mobilization and manipulation, has been shown to be effective in the management of this condition, but the combination of joint mobilization and manipulation in tandem with ASTYM® treatment has not been explored. The purpose of this case report is to chronicle the management of a patient with chronic ankle pain who was treated with manual therapy including manipulation and ASTYM treatment. As a result of a fall down stairs 6 months previously, the patient sustained a severe ankle sprain. The soft tissue damage was accompanied by bony disruptions which warranted the patient spending 3 weeks in a walking boot. At the initial evaluation, the patient reported difficulty with descending stairs reciprocally and not being able to run more than 4 minutes on the treadmill before the pain escalated to the level that she had to stop running. After five sessions of therapy consisting of joint mobilization, manipulation and ASTYM, the patient was able to descend stairs and run 40 minutes without pain.

Developing a Framework for Ankle Function: A Delphi Study

Science.gov (United States)

Snyder, Kelli R.; Evans, Todd A.; Neibert, Peter J.

2014-01-01

Context: Addressing clinical outcomes is paramount to providing effective health care, yet there is no consensus regarding the appropriate outcomes to address after ankle injuries. Compounding the problem is the repetitive nature of lateral ankle sprains, referred to as functional (FAI) or chronic (CAI) ankle instability. Although they are commonly used terms in practice and research, FAI and CAI are inconsistently defined and assessed. Objective: To establish definitions of a healthy/normal/noninjured ankle, FAI, and CAI, as well as their characteristics and assessment techniques. Design: Delphi study. Setting: Telephone interviews and electronic surveys. Patients or Other Participants: Sixteen experts representing the fields of ankle function and treatment, ankle research, and outcomes assessment and research were selected as panelists. Data Collection and Analysis: A telephone interview produced feedback regarding the definition of, functional characteristics of, and assessment techniques for a healthy/normal/noninjured ankle, an unhealthy/acutely injured ankle, and FAI/CAI. Those data were compiled, reduced, and returned through electronic surveys and were either included by reaching consensus (80% agreement) or excluded. Results: The definitions of a healthy/normal/noninjured ankle and FAI reached consensus. Experts did not agree on a definition of CAI. Eleven functional characteristics of a healthy/normal/noninjured ankle, 32 functional characteristics of an unhealthy/acutely injured ankle, and 13 characteristics of FAI were agreed upon. Conclusions: Although a consensus was reached regarding the definitions and functional characteristics of a healthy/normal/noninjured ankle and FAI, the experts could only agree on 1 characteristic to include in the FAI definition. Several experts did, however, provide additional comments that reinforced the differences in the interpretation of those concepts. Although the experts could not agree on the definition of CAI, its

Lower extremity function during gait in participants with first time acute lateral ankle sprain compared to controls.

Science.gov (United States)

Doherty, Cailbhe; Bleakley, Chris; Hertel, Jay; Caulfield, Brian; Ryan, John; Delahunt, Eamonn

2015-02-01

Laboratory analyses of chronic ankle instability populations during gait have elucidated a number of anomalous movement patterns. No current research exists analysing these movement patterns in a group in the acute phase of lateral ankle sprain (LAS) injury. It is possible that participants with an acute LAS display movement patterns continuous with their chronically impaired counterparts. Sixty eight participants with acute LAS and nineteen non-injured participants completed five gait trials. 3D lower extremity temporal kinematic and kinetic data were collected from 200 ms pre- to 200 ms post-heel strike (period 1) and from 200 ms pre- to 200 ms post-toe off (period 2). During period 1, the LAS group displayed increased knee flexion with increased net extensor pattern at the knee joint, increased ankle inversion with a greater inversion moment, and reduced ankle plantar flexion, compared to the non-injured control group. During period 2, the LAS group displayed decreased hip extension with a decrease in the flexor moment at the hip, and decreased ankle plantar flexion with a decrease in the net plantar flexion moment, compared to the non-injured control group. These results indicate that participants with acute LAS display coordination strategies which may play a role in the onset of chronicity or recovery. Copyright © 2014 Elsevier Ltd. All rights reserved.

Reliability of the Identification of Functional Ankle Instability (IdFAI) Scale Across Different Age Groups in Adults.

Science.gov (United States)

Gurav, Reshma S; Ganu, Sneha S; Panhale, Vrushali P

2014-10-01

Functional ankle instability (FAI) is the tendency of the foot to 'give way'. Identification of Functional Ankle Instability questionnaire (IdFAI) is a newly developed questionnaire to detect whether individuals meet the minimum criteria necessary for inclusion in an FAI population. However, the reliability of the questionnaire was studied only in a restricted age group. The purpose of this investigation was to examine the reliability of IdFAI across different age groups in adults. One hundred and twenty participants in the age group of 20-60 years consisting of 30 individuals in each age group were asked to complete the IdFAI on two occasions. Test-retest reliability was evaluated by intraclass correlation coefficient (ICC2,1). The study revealed that IdFAI has excellent test-retest reliability when studied across different age groups. The ICC2,1 in the age groups 20-30 years, 30-40 years, 40-50 years and 50-60 years was 0.978, 0.975, 0.961 and 0.922, respectively with Cronbach's alpha >0.9 in all the age groups. The IdFAI can accurately predict if an individual meets the minimum criterion for FAI across different age groups in adults. Thus, the questionnaire can be applied over different age groups in clinical and research set-ups.

The immediate effects of two manual therapy techniques on ankle musculoarticular stiffness and dorsiflexion range of motion in people with chronic ankle rigidity: A randomized clinical trial.

Science.gov (United States)

Hidalgo, Benjamin; Hall, Toby; Berwart, Mathilde; Biernaux, Elinor; Detrembleur, Christine

2017-12-29

Ankle rigidity is a common musculoskeletal disorder affecting the talocrural joint, which can impair weight-bearing ankle dorsiflexion (WBADF) and daily-life in people with or without history of ankle injuries. Our objective was to compare the immediate effects of efficacy of Mulligan Mobilization with Movement (MWM) and Osteopathic Mobilization (OM) for improving ankle dorsiflexion range of motion (ROM) and musculoarticular stiffness (MAS) in people with chronic ankle dorsiflexion rigidity. A randomized clinical trial with two arms. Patients were recruited by word of mouth and via social network as well as posters, and analyzed in the neuro musculoskeletal laboratory of the "Université Catholique de Louvain-la-Neuve", Brussels, Belgium. 67 men (aged 18-40 years) presenting with potential chronic non-specific and unilateral ankle mobility deficit during WBDF were assessed for eligibility and finally 40 men were included and randomly allocated to single session of either MWM or OM. Two modalities of manual therapy indicated for hypothetic immediate effects in chronic ankle dorsiflexion stiffness, i.e. MWM and OM, were applied during a single session on included patients. Comprised blinding measures of MAS with a specific electromechanical device (namely: Lehmann's device) producing passive oscillatory ankle joint dorsiflexion and with clinical measures of WBADF-ROM as well. A two-way ANOVA revealed a non-significant interaction between both techniques and time for all outcome measures. For measures of MAS: elastic-stiffness (p= 0.37), viscous-stiffness (p= 0.83), total-stiffness (p= 0.58). For WBADF-ROM: toe-wall distance (p= 0.58) and angular ROM (p= 0.68). Small effect sizes between groups were determined with Cohen's d ranging from 0.05 to 0.29. One-way ANOVA demonstrated non-significant difference and small to moderate effects sizes (d= 0.003-0.58) on all outcome measures before and after interventions within both groups. A second two-way ANOVA analyzed the

Role of Ankle Arthroscopy in Management of Acute Ankle Fracture.

Science.gov (United States)

Chan, Kwok Bill; Lui, Tun Hing

2016-11-01

To report the operative findings of ankle arthroscopy during open reduction and internal fixation of acute ankle fractures. This was a retrospective review of 254 consecutive patients with acute ankle fractures who were treated with open reduction and internal fixation of the fractures, and ankle arthroscopy was performed at the same time. The accuracy of fracture reduction, the presence of syndesmosis disruption and its reduction, and the presence of ligamentous injuries and osteochondral lesions were documented. Second-look ankle arthroscopy was performed during syndesmosis screw removal 6 weeks after the key operation. There were 6 patients with Weber A, 177 patients with Weber B, 51 patients with Weber C, and 20 patients with isolated medial malleolar fractures. Syndesmosis disruption was present in 0% of patients with Weber A fracture, 52% of patients with Weber B fracture, 92% of patients with Weber C fracture, and 20% of the patients with isolated medial malleolar fracture. Three patients with Weber B and one patient with Weber C fracture have occult syndesmosis instability after screw removal. Osteochondral lesion was present in no patient with Weber A fracture, 26% of the Weber B cases, 24% of the Weber C cases, and 20% of isolated medial malleolar fracture cases. The association between the presence of deep deltoid ligament tear and syndesmosis disruption (warranting syndesmosis screw fixation) in Weber B cases was statistically significant but not in Weber C cases. There was no statistically significant association between the presence of posterior malleolar fracture and syndesmosis instability that warrant screw fixation. Ankle arthroscopy is a useful adjuvant tool to understand the severity and complexity of acute ankle fracture. Direct arthroscopic visualization ensures detection and evaluation of intra-articular fractures, syndesmosis disruption, and associated osteochondral lesions and ligamentous injuries. Level IV, case series

Management of chronic ankle pain using joint mobilization and ASTYM® treatment: a case report

OpenAIRE

Slaven, Emily J; Mathers, Jessie

2011-01-01

Treatment of ankle sprains predominately focuses on the acute management of this condition; less emphasis is placed on the treatment of ankle sprains in the chronic phase of recovery. Manual therapy, in the form of joint mobilization and manipulation, has been shown to be effective in the management of this condition, but the combination of joint mobilization and manipulation in tandem with ASTYM® treatment has not been explored. The purpose of this case report is to chronicle the management ...

Repair of acute injuries of the lateral ligament complex of the ankle by suture anchors

Science.gov (United States)

Liu, Xiang-Fei; Fang, Yang; Cao, Zhong-Hua; Li, Guang-Feng; Yang, Guo-Qing

2015-01-01

Objective: The objective of this study was to investigate the clinical curative effect of stage I repair of acute injuries of the lateral ligament complex of the ankle by the application of suture anchors. Methods: We retrospectively analyzed 18 cases of III degree acute injuries of the lateral ligament complex of the ankle. Results: There were statistically significant differences in preoperative and last follow-up VAS pain scores and AOFAS ankle hind-foot function scores. The X-ray talus displacement values in the anterior drawer test and pressure anteroposterior X-ray talar tilt in the ankle talar tilt test also showed statistically significant differences. Complications occurred in 2 patients, incision surface infection in one, and postoperative lateral dorsal skin numbness in one. All these cases were cured after symptomatic treatment. At the last follow-up all patients’ ankle joint activity recovered to their preinjury function levels. Conclusion: The application of suture anchors for small incision stage I repair of the lateral collateral ligament of ankle joint degree III injury, can effectively restored the stability of ankle joint, and prevent the occurrence of chronic ankle instability complications. It is effective and feasible for the treatment of ankle joint lateral collateral ligament injuries. PMID:26885144

临床护理人员踝关节的稳定性调查与防护研究%Investigation of functional ankle instability in nurses and exploration of its preventive and protective methods

Institute of Scientific and Technical Information of China (English)

李振香; 秦发伟; 卢凤娟; 李淑媛

2013-01-01

Objective To investigate the functional ankle instability in nurses,and provide references for increase preventive and protective awareness and establishment of preventive measures.Methods 100 nurses recruited from 10 wards of Provincial Hospital Affiliated to Shandong University were included into this study.Chinese version of the Cumberland Ankle Instability Tool (CAIT) was used to investigate the condition of functional ankle instability of these nurses.A self-designed questionnaire was used to investigate cognitive degree of ankle sprain prevention and treatment knowledge.Results Only 16％ of these nurses had no unstable problems in both of their two ankles.There were functional ankle instable problems in either single or both of the two ankles of the other 84％ nurses.And most of the nurses had little knowledge of how to prevent or treat ankle sprain properly.Conclusions There is a high rote of functional ankle instability in nurses.It is necessary to pay great attention to the prevention of ankle sprain and instability in nurses,which is of great importance to health and occupational safety assurance of nurses.%目的 对护理人员功能性踝关节不稳定情况进行调查分析,为提高防护意识、制订预防措施提供依据.方法 自我院10个病房中随机抽取共计100名护理人员,采用中文版cumberland踝关节不稳定问卷(CAIT)进行踝关节不稳定情况调查,同时采用自行设计的踝关节扭伤防治常规认知情况量表,调查受试者对踝关节扭伤防护及诊疗常规的了解程度.结果 仅有16％的受试者双侧踝关节稳定性正常,剩余84％的受试者存在单侧或双侧踝关节功能性不稳定的因素.大多数护理人员对踝关节扭伤的防治知识了解较少.结论 护理人员中功能性踝关节不稳定现象较为严重,增强对踝关节功能的重视,积极防治踝关节扭伤和踝关节不稳定,对于保证护士健康,提高职业安全性、稳定性具有重要意义.

Can pre-operative axial CT imaging predict syndesmosis instability in patients sustaining ankle fractures? Seven years' experience in a tertiary trauma center

Energy Technology Data Exchange (ETDEWEB)

Yeung, Tsz Wai; Chan, Chung Yan Grace; Chan, Wun Cheung Samuel; Yuen, Ming Keung [Tuen Mun Hospital, Department of Radiology, Tuen Mun (China); Yeung, Yuk Nam [Tune Mun Hospital, Department of Orthopaedics and Traumatology, Tuen Mun (China)

2015-06-01

The purpose of this study is to explore the diagnostic accuracy of CT measurements in predicting syndesmosis instability of injured ankle, with correlation to operative findings. From July 2006 to June 2013, 123 patients presented to a single tertiary hospital who received pre-operative CT for ankle fractures were retrospectively reviewed. All patients underwent open reduction and internal fixation for fractures and intra-operative syndesmosis integrity tests. The morphology of incisura fibularis was categorized as deep or shallow. The tibiofibular distance (TFD) between the medial border of the fibula and the nearest point of the lateral border of tibia were measured at anterior (aTFD), middle (mTFD), posterior (pTFD), and maximal (maxTFD) portions across the syndesmosis on axial CT images at 10 mm proximal to the tibial plafond. Statistical analysis was performed with independent samples t test and ROC curve analysis. Intraobserver reproducibility and inter-observers agreement were also evaluated. Of the 123 patients, 39 (31.7 %) were operatively diagnosed with syndesmosis instability. No significant difference of incisura fibularis morphology (deep or shallow) and TFDs was demonstrated respective to genders. The axial CT measurements were significantly higher in ankles diagnosed with syndesmosis instability than the group without (maxTFD means 7.2 ± 2.96 mm vs. 4.6 ± 1.4 mm, aTFD mean 4.9 ± 3.7 mm vs. 1.8 ± 1.4 mm, mTFD mean 5.3 ± 2.4 mm vs. 3.2 ± 1.6 mm, pTFD mean 5.3 ± 1.8 mm vs. 4.1 ± 1.3 mm, p < 0.05). Their respective cutoff values with best sensitivity and specificity were calculated; the aTFD (AUC 0.798) and maxTFD (AUC 0.794) achieved the highest diagnostic accuracy. The optimal cutoff levels were aTFD = 4 mm (sensitivity, 56.4 %; specificity, 91.7 %) and maxTFD = 5.65 mm (sensitivity, 74.4 %; specificity, 79.8 %). The inter-observer agreement was good for all aTFD, mTFD, pTFD, and maxTFD measurements (ICC 0.959, 0.799, 0.783, and 0.865). The ICC

Can pre-operative axial CT imaging predict syndesmosis instability in patients sustaining ankle fractures? Seven years' experience in a tertiary trauma center

International Nuclear Information System (INIS)

Yeung, Tsz Wai; Chan, Chung Yan Grace; Chan, Wun Cheung Samuel; Yuen, Ming Keung; Yeung, Yuk Nam

2015-01-01

The purpose of this study is to explore the diagnostic accuracy of CT measurements in predicting syndesmosis instability of injured ankle, with correlation to operative findings. From July 2006 to June 2013, 123 patients presented to a single tertiary hospital who received pre-operative CT for ankle fractures were retrospectively reviewed. All patients underwent open reduction and internal fixation for fractures and intra-operative syndesmosis integrity tests. The morphology of incisura fibularis was categorized as deep or shallow. The tibiofibular distance (TFD) between the medial border of the fibula and the nearest point of the lateral border of tibia were measured at anterior (aTFD), middle (mTFD), posterior (pTFD), and maximal (maxTFD) portions across the syndesmosis on axial CT images at 10 mm proximal to the tibial plafond. Statistical analysis was performed with independent samples t test and ROC curve analysis. Intraobserver reproducibility and inter-observers agreement were also evaluated. Of the 123 patients, 39 (31.7 %) were operatively diagnosed with syndesmosis instability. No significant difference of incisura fibularis morphology (deep or shallow) and TFDs was demonstrated respective to genders. The axial CT measurements were significantly higher in ankles diagnosed with syndesmosis instability than the group without (maxTFD means 7.2 ± 2.96 mm vs. 4.6 ± 1.4 mm, aTFD mean 4.9 ± 3.7 mm vs. 1.8 ± 1.4 mm, mTFD mean 5.3 ± 2.4 mm vs. 3.2 ± 1.6 mm, pTFD mean 5.3 ± 1.8 mm vs. 4.1 ± 1.3 mm, p < 0.05). Their respective cutoff values with best sensitivity and specificity were calculated; the aTFD (AUC 0.798) and maxTFD (AUC 0.794) achieved the highest diagnostic accuracy. The optimal cutoff levels were aTFD = 4 mm (sensitivity, 56.4 %; specificity, 91.7 %) and maxTFD = 5.65 mm (sensitivity, 74.4 %; specificity, 79.8 %). The inter-observer agreement was good for all aTFD, mTFD, pTFD, and maxTFD measurements (ICC 0.959, 0.799, 0.783, and 0.865). The ICC

Arthroscopy and Endoscopy of the Ankle and Hindfoot

NARCIS (Netherlands)

de Leeuw, Peter A. J.; van Sterkenburg, Maayke N.; van Dijk, C. Niek

2009-01-01

Ankle arthroscopy provides the surgeon with a minimally invasive treatment option for a wide variety of indications such as impingement, osteochondral defects, loose bodies, ossicles, synovitis, adhesions, and instability. Posterior ankle pathology can be treated using endoscopic hindfoot portals.

National Athletic Trainers' Association Position Statement: Conservative Management and Prevention of Ankle Sprains in Athletes

Science.gov (United States)

Kaminski, Thomas W.; Hertel, Jay; Amendola, Ned; Docherty, Carrie L.; Dolan, Michael G.; Hopkins, J. Ty; Nussbaum, Eric; Poppy, Wendy; Richie, Doug

2013-01-01

Objective: To present recommendations for athletic trainers and other allied health care professionals in the conservative management and prevention of ankle sprains in athletes. Background: Because ankle sprains are a common and often disabling injury in athletes, athletic trainers and other sports health care professionals must be able to implement the most current and evidence-supported treatment strategies to ensure safe and rapid return to play. Equally important is initiating preventive measures to mitigate both first-time sprains and the chance of reinjury. Therefore, considerations for appropriate preventive measures (including taping and bracing), initial assessment, both short- and long-term management strategies, return-to-play guidelines, and recommendations for syndesmotic ankle sprains and chronic ankle instability are presented. Recommendations: The recommendations included in this position statement are intended to provide athletic trainers and other sports health care professionals with guidelines and criteria to deliver the best health care possible for the prevention and management of ankle sprains. An endorsement as to best practice is made whenever evidence supporting the recommendation is available. PMID:23855363

Clinical evaluation of a new noninvasive ankle arthrometer.

Science.gov (United States)

Nauck, Tanja; Lohrer, Heinz; Gollhofer, Albert

2010-06-01

A nonradiographic arthrometer was developed to objectively quantify anterior talar drawer instability in stable and unstable ankles. Diagnostic validity of this device was previously demonstrated in a cadaver study. The aim of the present study was to validate the ankle arthrometer in an in vivo setting. Twenty-three subjects participated in the study. An orthopedic surgeon first performed a manual anterior talar drawer test to classify the subjects' ankles as stable or unstable. The subjects were then evaluated using the ankle arthrometer, and filled out a validated self-reported questionnaire (German version of the Foot and Ankle Ability Measure [FAAM-G]). Ankle stiffness was calculated from the low linear region (40-60 N) of the load deformation curves obtained from the ankle arthrometer. Reliability testing of these stiffness values was done based on load deformation curves, with 150 and 200 N maximum anterior drawer loads applied in the ankle arthrometer. Using the manual anterior drawer test, 16 ankles were classified as stable and 7 were classified as unstable. Arthrometer stiffness analysis differentiated stable from unstable ankles (P = 0.00 and P = 0.01, respectively). Test-retest demonstrated an accurate reliability (intraclass correlation coefficient = 0.80). A significant correlation was found between both FAAM-G subscales and the arthrometer stiffness values (r = 0.43 and 0.54; P = 0.04 and 0.01). Discussion Subjects with and without mechanical ankle instability could be differentiated by ankle arthrometer stiffness analysis and the FAAM-G questionnaire results. This nonradiographic device may be relevant for screening athletes at risk for ankle injuries, for clinical follow-up studies, and implementing preventive strategies. Validity and reliability of the new ankle arthrometer is demonstrated in a small cohort in an in vivo setting.

Neuromuscular training to enhance sensorimotor and functional deficits in subjects with chronic ankle instability: a systematic review and best evidence synthesis

LENUS (Irish Health Repository)

O'Driscoll, Jeremiah

2011-09-22

Abstract Objective To summarise the available evidence for the efficacy of neuromuscular training in enhancing sensorimotor and functional deficits in subjects with chronic ankle instability (CAI). Design Systematic review with best evidence synthesis. Data Sources An electronic search was conducted through December 2009, limited to studies published in the English language, using the Pubmed, CINAHL, Embase, and SPORTDiscus databases. Reference screening of all included articles was also undertaken. Methods Studies were selected if the design was a RCT, quasi RCT, or a CCT; the patients were adolescents or adults with confirmed CAI; and one of the treatment options consisted of a neuromuscular training programme. The primary investigator independently assessed the risk of study bias and extracted relevant data. Due to clinical heterogeneity, data was analysed using a best-evidence synthesis. Results Fourteen studies were included in the review. Meta-analysis with statistical pooling of data was not possible, as the studies were considered too heterogeneous. Instead a best evidence synthesis was undertaken. There is limited to moderate evidence to support improvements in dynamic postural stability, and patient perceived functional stability through neuromuscular training in subjects with CAI. There is limited evidence of effectiveness for neuromuscular training for improving static postural stability, active and passive joint position sense (JPS), isometric strength, muscle onset latencies, shank\\/rearfoot coupling, and a reduction in injury recurrence rates. There is limited evidence of no effectiveness for improvements in muscle fatigue following neuromuscular intervention. Conclusion There is limited to moderate evidence of effectiveness in favour of neuromuscular training for various measures of static and dynamic postural stability, active and passive JPS, isometric strength, muscle onset latencies, shank\\/rearfoot coupling and injury recurrence rates. Strong

Relationship between stress ankle radiographs and injured ligaments on MRI

International Nuclear Information System (INIS)

Lee, Kyoung Min; Chung, Chin Youb; Chung, Myung Ki; Won, Sung Hun; Lee, Seung Yeol; Park, Moon Seok; Kwon, Soon-Sun

2013-01-01

This study was performed to investigate the relationship between the injured lateral ankle ligaments on MRI and stress ankle radiographs. Two hundred and twenty-nine consecutive patients (mean age 35.5 years, SD 14.6 years; 136 males and 93 females) that underwent ankle stress radiographs and MRI for lateral ankle instability were included. Tibiotalar tilt angle and anterior translation of talus were measured on stress ankle radiographs. Degree of lateral ligaments (anterior talofibular, calcaneofibular, and posterior talofibular) and deltoid ligament injuries were evaluated and scored as intact (0), partial injury (1), and complete injury (2) on MR images. Effusion of ankle joint was also recorded. The effects of gender, age, injuries of ligaments, and ankle joint effusion on stress radiographs were statistically analyzed. Gender (p = 0.010), age (p = 0.020), and anterior talofibular ligament (ATFL) injury (p < 0.001) were the factors significantly affecting tibiotalar tilt angle. Posterior talofibular ligament (PTFL) injury (p = 0.014) was found to be the only significant factor affecting the anterior translation on the anterior drawer radiographs. ATFL injury and PTFL injury on MRI significantly affected tibiotalar tilt angle and anterior drawer on stress radiographs. Other factors, such as age and gender, need to be considered in evaluating radiographic lateral ankle instability. (orig.)

Anatomy of the ankle ligaments: a pictorial essay

NARCIS (Netherlands)

Golanó, Pau; Vega, Jordi; de Leeuw, Peter A. J.; Malagelada, Francesc; Manzanares, M. Cristina; Götzens, Víctor; van Dijk, C. Niek

2010-01-01

Understanding the anatomy of the ankle ligaments is important for correct diagnosis and treatment. Ankle ligament injury is the most frequent cause of acute ankle pain. Chronic ankle pain often finds its cause in laxity of one of the ankle ligaments. In this pictorial essay, the ligaments around the

Anatomy of the ankle ligaments: a pictorial essay

NARCIS (Netherlands)

Golanó, Pau; Vega, Jordi; de Leeuw, Peter A. J.; Malagelada, Francesc; Manzanares, M. Cristina; Götzens, Víctor; van Dijk, C. Niek

2016-01-01

Understanding the anatomy of the ankle ligaments is important for correct diagnosis and treatment. Ankle ligament injury is the most frequent cause of acute ankle pain. Chronic ankle pain often finds its cause in laxity of one of the ankle ligaments. In this pictorial essay, the ligaments around the

Operative Fixation Options for Elective and Diabetic Ankle Arthrodesis.

Science.gov (United States)

Ramanujam, Crystal L; Stapleton, John J; Zgonis, Thomas

2017-07-01

Ankle arthrodesis remains one of the most definitive treatment options for end-stage arthritis, paralysis, posttraumatic and postinfectious conditions, failed total ankle arthroplasty, and severe deformities. The general aims of ankle arthrodesis are to decrease pain and instability, correct the accompanying deformity, and create a stable plantigrade foot. Several surgical approaches have been reported for ankle arthrodesis with internal fixation options. External fixation has also evolved for ankle arthrodesis in certain clinical scenarios. This article provides a comprehensive analysis of midterm to long-term outcomes for ankle arthrodesis using internal and/or external fixation each for elective and diabetic conditions. Copyright © 2017 Elsevier Inc. All rights reserved.

THERAPEUTIC EFFECTS OF ELECTROACUPUNCTURE PLUS POINT-PENETRATION FOR CHRONIC ANKLE JOINT SPRAIN

Institute of Scientific and Technical Information of China (English)

ZHAO Yi-zao

2005-01-01

Objective: To observe clinical therapeutic effects of electroacupuncture plus point-penetration for chronic ankle joint sprain. Methods: 76 patients were randomly divided into treatment group (n=43) and control group (n=33).In teatment group, penetration needling from Qiuxu (丘墟 GB 40) to Zhaohai (照海 KI 6) was performed, combined with electrical stimulation for 30 min. Patients of control group were ordered to take Antinfan (50 mg,b.I.d.),supplemented with local external application of Votalin cream (b.I.d.).After 14 treatments (two courses), the therapeutic effect was assessed. Results: Following two courses of treatment, of the 43 cases and 33 cases in treatment and control groups,33 (76.7%) and 15 (45.5%) were cured, 4 (9.3%) and 7 (21.2%) had marked improvement in their symptoms, 3 (7.0%) and 2 (6.1%) had improvement, and 3 (7.0%) and 9(27.3%) failed, with the effective rates being 93.0% and 72.7% respectively. The therapeutic effect of treatment group was significantly superior to that of control group (P<0.05). Conclusion: Penetrative needling plus EA is significantly superior to medication in relieving chronic ankle spain patient's clinical symptoms and signs.

Trends in Ankle Arthroscopy and Its Use in the Management of Pathologic Conditions of the Lateral Ankle in the United States: A National Database Study.

Science.gov (United States)

Werner, Brian C; Burrus, M Tyrrell; Park, Joseph S; Perumal, Venkat; Gwathmey, F Winston

2015-07-01

This study aimed to investigate current trends in ankle arthroscopy across time, sex, age, and region of the United States as well as the use of ankle arthroscopy in the management of lateral ankle instability. Patients who underwent ankle arthroscopy and those who underwent ankle arthroscopy and lateral ankle ligament repair or peroneal retinacular repair from 2007 through 2011 were identified using the PearlDiver national database. These searches yielded volumes of unique patients, sex and age distribution, and regional volumes of patients. Χ-square linear-by-linear association analysis was used for comparisons, with P arthroscopy procedures in the database from 2007 to 2011. Over the 5-year study period, there was a significant increase in the overall number of ankle arthroscopies being performed, from 2,814 in 2007 to 3,314 in 2011 (P arthroscopy more frequently than did male patients (P = .027). The majority of patients who had ankle arthroscopy were between the ages of 30 and 49 years. The use of ankle arthroscopy during lateral ligament repair procedures increased from 37.2% in 2007 to 43.7% in 2011 (P arthroscopy and peroneal tendon retinacular repair increased 50%, from 2.8/100 ankle arthroscopies in 2007 to 4.2/100 ankle arthroscopies in 2011 (P arthroscopy increased significantly from 2007 to 2011, outpacing shoulder, knee, and elbow arthroscopy. Ankle arthroscopy was performed more frequently in female patients and most commonly in patients younger than 50 years. The use of ankle arthroscopy in the surgical management of lateral ankle instability also increased significantly. The incidence of concomitant ankle arthroscopy and lateral ligament repair increased significantly, as did the incidence of concomitant ankle arthroscopy and repair of peroneal tendon subluxation. Level IV, therapeutic case series. Copyright © 2015 Arthroscopy Association of North America. Published by Elsevier Inc. All rights reserved.

Long-term stress distribution patterns of the ankle joint in varus knee alignment assessed by computed tomography osteoabsorptiometry.

Science.gov (United States)

Onodera, Tomohiro; Majima, Tokifumi; Iwasaki, Norimasa; Kamishima, Tamotsu; Kasahara, Yasuhiko; Minami, Akio

2012-09-01

The stress distribution of an ankle under various physiological conditions is important for long-term survival of total ankle arthroplasty. The aim of this study was to measure subchondral bone density across the distal tibial joint surface in patients with malalignment/instability of the lower limb. We evaluated subchondral bone density across the distal tibial joint in patients with malalignment/instability of the knee by computed tomography (CT) osteoabsorptiometry from ten ankles as controls and from 27 ankles with varus deformity/instability of the knee. The quantitative analysis focused on the location of the high-density area at the articular surface, to determine the resultant long-term stress on the ankle joint. The area of maximum density of subchondral bone was located in the medial part in all subjects. The pattern of maximum density in the anterolateral area showed stepwise increases with the development of varus deformity/instability of the knee. Our results should prove helpful for designing new prostheses and determining clinical indications for total ankle arthroplasty.

A Systematic Review on the Treatment of Acute Ankle Sprain Brace versus Other Functional Treatment Types

NARCIS (Netherlands)

Kemler, Ellen; van de Port, Ingrid; Backx, Frank; van Dijk, C. Niek

2011-01-01

Ankle injuries, especially ankle sprains, are a common problem in sports and medical care. Ankle sprains result in pain and absenteeism from work and/or sports participation, and can lead to physical restrictions such as ankle instability. Nowadays, treatment of ankle injury basically consists of

Proceedings of the SRBR-KBVR osteoarticular section meeting of October 18, 2003 in Antwerp--Part one. Imaging of chronic ankle pain, with a focus on soccer injuries

NARCIS (Netherlands)

Maas, M.; de Jonge, M. C.

2004-01-01

Chronic ankle pain is a very common problem encountered in soccer injuries. It can be divided into three regional entities, including anterior ankle pain, deep ankle pain and posterior ankle pain. The purpose of this presentation is to present the value of each imaging technique (standard

Effects of Ankle Arthrodesis on Biomechanical Performance of the Entire Foot.

Directory of Open Access Journals (Sweden)

Yan Wang

Full Text Available Ankle arthrodesis is one popular surgical treatment for ankle arthritis, chronic instability, and degenerative deformity. However, complications such as foot pain, joint arthritis, and bone fracture may cause patients to suffer other problems. Understanding the internal biomechanics of the foot is critical for assessing the effectiveness of ankle arthrodesis and provides a baseline for the surgical plan. This study aimed to understand the biomechanical effects of ankle arthrodesis on the entire foot and ankle using finite element analyses. A three-dimensional finite element model of the foot and ankle, involving 28 bones, 103 ligaments, the plantar fascia, major muscle groups, and encapsulated soft tissue, was developed and validated. The biomechanical performances of a normal foot and a foot with ankle arthrodesis were compared at three gait instants, first-peak, mid-stance, and second-peak.Changes in plantar pressure distribution, joint contact pressure and forces, von Mises stress on bone and foot deformation were predicted. Compared with those in the normal foot, the peak plantar pressure was increased and the center of pressure moved anteriorly in the foot with ankle arthrodesis. The talonavicular joint and joints of the first to third rays in the hind- and mid-foot bore the majority of the loading and sustained substantially increased loading after ankle arthrodesis. An average contact pressure of 2.14 MPa was predicted at the talonavicular joint after surgery and the maximum variation was shown to be 80% in joints of the first ray. The contact force and pressure of the subtalar joint decreased after surgery, indicating that arthritis at this joint was not necessarily a consequence of ankle arthrodesis but rather a progression of pre-existing degenerative changes. Von Mises stress in the second and third metatarsal bones at the second-peak instant increased to 52 MPa and 34 MPa, respectively, after surgery. These variations can provide

Chronic neck pain: making the connection between capsular ligament laxity and cervical instability.

Science.gov (United States)

Steilen, Danielle; Hauser, Ross; Woldin, Barbara; Sawyer, Sarah

2014-01-01

The use of conventional modalities for chronic neck pain remains debatable, primarily because most treatments have had limited success. We conducted a review of the literature published up to December 2013 on the diagnostic and treatment modalities of disorders related to chronic neck pain and concluded that, despite providing temporary relief of symptoms, these treatments do not address the specific problems of healing and are not likely to offer long-term cures. The objectives of this narrative review are to provide an overview of chronic neck pain as it relates to cervical instability, to describe the anatomical features of the cervical spine and the impact of capsular ligament laxity, to discuss the disorders causing chronic neck pain and their current treatments, and lastly, to present prolotherapy as a viable treatment option that heals injured ligaments, restores stability to the spine, and resolves chronic neck pain. The capsular ligaments are the main stabilizing structures of the facet joints in the cervical spine and have been implicated as a major source of chronic neck pain. Chronic neck pain often reflects a state of instability in the cervical spine and is a symptom common to a number of conditions described herein, including disc herniation, cervical spondylosis, whiplash injury and whiplash associated disorder, postconcussion syndrome, vertebrobasilar insufficiency, and Barré-Liéou syndrome. When the capsular ligaments are injured, they become elongated and exhibit laxity, which causes excessive movement of the cervical vertebrae. In the upper cervical spine (C0-C2), this can cause a number of other symptoms including, but not limited to, nerve irritation and vertebrobasilar insufficiency with associated vertigo, tinnitus, dizziness, facial pain, arm pain, and migraine headaches. In the lower cervical spine (C3-C7), this can cause muscle spasms, crepitation, and/or paresthesia in addition to chronic neck pain. In either case, the presence of

Effect of kinesio-taping on ankle joint stability

Directory of Open Access Journals (Sweden)

Mervat A. Mohamed

2016-05-01

Full Text Available Ankle Instability is characterized by recurrent giving way and often develops after repeated lateral ankle sprains. Kinesiotape is more elastic than traditional athletic tape and is becoming increasingly popular. It is reported to decrease pain, improve muscle function, circulation and proprioception, however, research examining the effects of Kinesiotape in ankle instability is limited. The objective of this study was to determine if applying Kinesiotape to unstable ankle may improve performance in the Star Excursion Balance Test (SEBT, which has been shown to be a sensitive and reliable measure for quantifying dynamic balance. Thirty subjects with first degree ankle sprain were participated in this study. SEBT was used to test the subject dynamic balance under three conditions; without taping, with white athletic tape and with kinesiotape. One way repeated measure ANOVA using Greenhouse-Geisser corrections were conducted to evaluate differences in SEBT for the three conditions. Pairwise comparison of the outcome measures in the three occasions (without taping, with athletic taping, and with kinesio taping revealed statistically significant differences of all outcomes between occasion 1 (without taping and occasion 2 (with athletic taping favoring the athletic taping (p < 0.05. Also, a statistically significant difference between occasion 1 (without taping and occasion 3 (with kinesio taping were found (p < 0.05 favoring kinesio taping. Moreover, pairwise comparison of the ankle stability outcomes using athletic taping versus kinesio taping indicated a statistically significant difference (p < 0.05 in favor of kinesio taping measures. Conclusion: kinesiotape has superior effect than athletic tape in patients with first degree ankle sprain and can be used safely for improving ankle joint stability.

Neuromuscular training to enhance sensorimotor and functional deficits in subjects with chronic ankle instability: A systematic review and best evidence synthesis

Directory of Open Access Journals (Sweden)

O'Driscoll Jeremiah

2011-09-01

Full Text Available Abstract Objective To summarise the available evidence for the efficacy of neuromuscular training in enhancing sensorimotor and functional deficits in subjects with chronic ankle instability (CAI. Design Systematic review with best evidence synthesis. Data Sources An electronic search was conducted through December 2009, limited to studies published in the English language, using the Pubmed, CINAHL, Embase, and SPORTDiscus databases. Reference screening of all included articles was also undertaken. Methods Studies were selected if the design was a RCT, quasi RCT, or a CCT; the patients were adolescents or adults with confirmed CAI; and one of the treatment options consisted of a neuromuscular training programme. The primary investigator independently assessed the risk of study bias and extracted relevant data. Due to clinical heterogeneity, data was analysed using a best-evidence synthesis. Results Fourteen studies were included in the review. Meta-analysis with statistical pooling of data was not possible, as the studies were considered too heterogeneous. Instead a best evidence synthesis was undertaken. There is limited to moderate evidence to support improvements in dynamic postural stability, and patient perceived functional stability through neuromuscular training in subjects with CAI. There is limited evidence of effectiveness for neuromuscular training for improving static postural stability, active and passive joint position sense (JPS, isometric strength, muscle onset latencies, shank/rearfoot coupling, and a reduction in injury recurrence rates. There is limited evidence of no effectiveness for improvements in muscle fatigue following neuromuscular intervention. Conclusion There is limited to moderate evidence of effectiveness in favour of neuromuscular training for various measures of static and dynamic postural stability, active and passive JPS, isometric strength, muscle onset latencies, shank/rearfoot coupling and injury recurrence

Understanding and treating lateral ankle sprains and their consequences: a constraints-based approach.

Science.gov (United States)

Wikstrom, Erik A; Hubbard-Turner, Tricia; McKeon, Patrick O

2013-06-01

Lateral ankle sprains are a common consequence of physical activity. If not managed appropriately, a cascade of negative alterations to both the joint structure and a person's movement patterns continue to stress the injured ligaments. These alterations result in an individual entering a continuum of disability as evidenced by the ~30 % of ankle sprains that develop into chronic ankle instability (CAI) and up to 78 % of CAI cases that develop into post-traumatic ankle osteoarthritis (OA). Despite this knowledge, no significant improvements in treatment efficacy have been made using traditional treatment paradigms. Therefore, the purpose of this review is to (1) provide an overview of the consequences associated with acute lateral ankle sprains, CAI and post-traumatic ankle OA; (2) introduce the patient-, clinician-, laboratory (PCL)-oriented) model that addresses the lateral ankle sprains and their consequences from a constraints perspective; and (3) introduce the dynamic systems theory as the framework to illustrate how multiple post-injury adaptations create a singular pathology that predisposes individuals with lateral ankle sprains to fall into a continuum of disability. The consequences associated with lateral ankle sprains, CAI and ankle OA are similar and encompass alterations to the structure of the ankle joint (e.g. ligament laxity, positional faults, etc.) and the sensorimotor function responsible for proper ankle joint function (e.g. postural control, gait, etc.). Further, the impairments have been quantified across a range of patient-oriented (e.g. self-report questionnaires), clinician-oriented (e.g. bedside measures of range of motion and postural control), and laboratory-oriented (e.g. arthrometry, gait analysis) outcome measures. The interaction of PCL-oriented outcomes is critically important for understanding the phenomenon of CAI across the continuum of disability. Through the integration of all three sources of evidence, we can clearly see that

Political instability, chronic poverty and food production systems in Central Chad

NARCIS (Netherlands)

Dijk, van J.W.M.

2008-01-01

In many parts of the world long-term political instability combined with frequent droughts results in chronic poverty and high levels of malnutrition and child mortality. Despite the magnitude and importance of the problem in these areas, the relation between political instability, resource tenure

Lower Limb Interjoint Postural Coordination One Year after First-Time Lateral Ankle Sprain.

Science.gov (United States)

Doherty, Cailbhe; Bleakley, Chris; Hertel, Jay; Caulfield, Brian; Ryan, John; Sweeney, Kevin; Patterson, Matthew R; Delahunt, Eamonn

2015-11-01

Longitudinal analyses of participants with a history of lateral ankle sprain are lacking. This investigation combined measures of lower limb interjoint coordination and stabilometry to evaluate static unipedal stance with the eyes open (condition 1) and closed (condition 2) in a group of participants with chronic ankle instability (CAI) compared to lateral ankle sprain "copers" (both recruited 12 months after sustaining an acute first-time lateral ankle sprain) and a group of noninjured controls. Twenty-eight participants with CAI, 42 lateral ankle sprain "copers," and 20 noninjured controls completed three 20-s single-limb stance trials in conditions 1 and 2. An adjusted coefficient of multiple determination statistic was used to compare stance limb three-dimensional kinematic data for similarity to establish patterns of interjoint coordination. The fractal dimension of the stance limb center of pressure path was also calculated. Between-group analyses revealed that participants with CAI displayed notable increases in ankle-hip linked coordination compared with both lateral ankle sprain "copers" (-0.52 (1.05) vs 0.28 (0.9), P = 0.007) and controls (-0.52 (1.05) vs 0.63 (0.64), P = 0.006) in condition 1 and compared with controls only (0.62 (1.92) vs 0.1 (1.0) P = 0.002) in condition 2. Participants with CAI also exhibited a decrease in the fractal dimension of the center-of-pressure path during condition 2 compared with both controls and lateral ankle sprain "copers." Participants with CAI present with a hip-dominant strategy of eyes-open and eyes-closed static unipedal stance. This coincided with reduced complexity of the stance limb center of pressure path in the eyes-closed condition.

Arthroscopic repair of lateral ankle ligament complex by suture anchor.

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Wang, Jingwei; Hua, Yinghui; Chen, Shiyi; Li, Hongyun; Zhang, Jian; Li, Yunxia

2014-06-01

Arthroscopic repair of the lateral ligament complex with suture anchors is increasingly used to treat chronic ankle instability (CAI). Our aims are (1) to analyze and evaluate the literature on arthroscopic suture anchor repair of the anterior talofibular ligament and (2) to conduct a systematic review of the clinical evidence on the reported outcomes and complications of treating CAI with this technique. We performed a systematic review of the literature using PubMed, Ovid, Elsevier ScienceDirect, Web of Science-Conference Proceedings Citation Index, and the Cochrane Database of Systematic Reviews from 1987 to September 2013. Clinical studies using the arthroscopic suture anchor technique to treat CAI were included. Outcome measures consisted of clinical assessment of postoperative ligament stability and complications. In addition, the methodologic quality of the included studies was assessed by use of the modified Coleman Methodology Score. After reviewing 371 studies, we identified 6 studies (5 retrospective case series and 1 prospective case series, all Level IV) that met the inclusion criteria, with a mean Coleman Methodology Score of 71.8 ± 7.52 (range, 63 to 82). In these studies 178 patients (179 ankles) underwent arthroscopic suture anchor repair of the anterior talofibular ligament with a mean follow-up period of 38.9 months (range, 6 to 117.6 months). All patients were reported to have subjective improvement of their ankle instability, with complications in 31 cases. Studies of arthroscopic suture anchor technique to treat CAI are sparse, with moderate mean methodologic quality. The included studies suggest that the arthroscopic technique is a feasible procedure to restore ankle stability; however, on the basis of our review, this technique seems to be associated with a relatively high complication rate. Extensive cadaveric studies, clinical trials, and comparative studies comparing arthroscopic and open repair should be performed in the future. Level

Proprioceptive exercises for ankle ligament injury: a CAT

Directory of Open Access Journals (Sweden)

Raúl Aguilera Eguía

2013-06-01

Full Text Available This CAT (Critically Appraised Topic answered the question: In recreational athletes suffering from chronic ankle sprain, can proprioceptive exercises reduce its recurrence?The clinical question was analyzed in three parts: patient, intervention and outcome. The purpose was to test the validity, results and effectiveness of proprioceptive exercises in recreational athletes suffering from chronic ankle sprain to reduce its recurrence from the article "Effectiveness of proprioceptive exercises for ankle ligament injury in adults: A systematic literature and meta-analisys "Postle”1 (2012.

Mini-open reconstruction of lateral collateral ligaments of ankle with partial tendon of its peroneus brevis%小切口取部分腓骨短肌腱重建踝关节外侧副韧带

Institute of Scientific and Technical Information of China (English)

陈前博; 唐康来; 吴雪晖; 徐格; 谭晓康; 周兵华; 周运平; 许建中

2008-01-01

Objective To describe a new technique with mini-open reconstruction of lateral ligaments of ankle with partial tendon of its peroneus brevis and evaluate its effect in treatment of chronic lateral ankle instability. Methods A total of 11 cases of chronic lateral ankle instability;at mean age of 27.6 years(16-42 years),were treated with mini-open reconstruction of the lateral ligaments of the ankle with partial tendon of its peroneus brevis.The mean delay between the initial episode of ankle sprain and the surgery was 10.3 months(4-32 months).Postoperatively,all cases were examined with MRI,stress X-rays and comparative stability of bilateral ankle inspection at clinical follow-up.The function of the ankle were evaluated bv American Orthopaedic Foot & Ankle Society (AOFAS)score and ankle-hind foot scale. Results The average duration of follow-up was 17.5 months(12-37 months).The mean AOFAS ankle-hindfoot score was 88.3 points(72-96 points)at the time of the latest follow-up,including excellent result in 6 cases(55%),good in 4(36%)and fair in 1(9%).MRI results showed that the ruptured lateral collateral ligaments of the ankle were repaired and remodeled very well in all patients.There was no recurrence of the ankle instability or other complications. Conclusion Mini-open reconstruction of the lateral ligaments of ankle with partial tendon of its peroneus brevis is safe and effective for treatment of chronic lateral ankle instability.%目的 介绍小切口取部分腓骨短肌腱解剖重建外侧副韧带治疗慢性踝关节外侧不稳的疗效.方法 11例慢性踝关节外侧不稳患者接受小切口取部分腓骨短肌腱解剖重建踝关节外侧副韧带的手术治疗,年龄16～42岁,平均27.6岁.术前病程4～32个月,平均10.3个月.术后定期行双侧踝关节对比稳定检查、应力位X线片及MRI检查,并按美国足踝外科协会(AOFAS)踝-后足功能评分表进行功能评分.结果 11例患者术后平均随访17.5个月(12～37�

Postural steadiness and ankle force variability in peripheral neuropathy

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Paxton, Roger J.; Feldman-Kothe, Caitlin; Trabert, Megan K.; Hitchcock, Leah N.; Reiser, Raoul F.; Tracy, Brian L.

2015-01-01

Introduction The purpose was to determine the effect of peripheral neuropathy (PN) on motor output variability for ankle muscles of older adults, and the relation between ankle motor variability and postural stability in PN patients. Methods Older adults with (O-PN) and without PN (O), and young adults (Y) underwent assessment of standing postural stability and ankle muscle force steadiness. Results O-PN displayed impaired ankle muscle force control and postural stability compared with O and Y groups. For O-PN, the amplitude of plantarflexor force fluctuations was moderately correlated with postural stability under no-vision conditions (r = 0.54, P = 0.01). Discussion The correlation of variations in ankle force with postural stability in PN suggests a contribution of ankle muscle dyscontrol to the postural instability that impacts physical function for older adults with PN. PMID:26284897

Long-term results of the Weber operation for chronic ankle instability: 37 patients followed for 20-30 years

NARCIS (Netherlands)

de Vries, Jasper; Struijs, Peter A. A.; Raaymakers, Ernst L. F. B.; Marti, René K.

2005-01-01

BACKGROUND: The Weber operation is an anatomical reconstruction of the anterior talofibular ligament with the plantaris tendon. Few long-term studies have been published. METHODS: We evaluated 40 ankles in 37 patients (19 women) at an average of 24 years after the procedure. RESULTS: At follow-up,

[Advances on biomechanics and kinematics of sprain of ankle joint].

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Zhao, Yong; Wang, Gang

2015-04-01

Ankle sprains are orthopedic clinical common disease, accounting for joint ligament sprain of the first place. If treatment is not timely or appropriate, the joint pain and instability maybe develop, and even bone arthritis maybe develop. The mechanism of injury of ankle joint, anatomical basis has been fully study at present, and the diagnostic problem is very clear. Along with the development of science and technology, biological modeling and three-dimensional finite element, three-dimensional motion capture system,digital technology study, electromyographic signal study were used for the basic research of sprain of ankle. Biomechanical and kinematic study of ankle sprain has received adequate attention, combined with the mechanism research of ankle sprain,and to explore the the biomechanics and kinematics research progress of the sprain of ankle joint.

Dynamic ultrasound of peroneal tendon instability.

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Pesquer, Lionel; Guillo, Stéphane; Poussange, Nicolas; Pele, Eric; Meyer, Philippe; Dallaudière, Benjamin

2016-07-01

Ankle snapping may be caused by peroneal tendon instability. Anterior instability occurs after traumatic superior peroneal retinaculum injury, whereas peroneal tendon intrasheath subluxation is atraumatic. Whereas subluxation is mainly dynamic, ultrasound allows for the diagnosis and classification of peroneal instability because it allows for real-time exploration. The purpose of this review is to describe the anatomic and physiologic bases for peroneal instability and to heighten the role of dynamic ultrasound in the diagnosis of snapping.

Ankles back in randomized controlled trial (ABrCt): braces versus neuromuscular exercises for the secondary prevention of ankle sprains. Design of a randomised controlled trial.

Science.gov (United States)

Janssen, Kasper W; van Mechelen, Willem; Verhagen, Evert Alm

2011-09-27

Ankle sprains are the most common sports and physical activity related injury. There is extensive evidence that there is a twofold increased risk for injury recurrence for at least one year post injury. In up to 50% of all cases recurrences result in disability and lead to chronic pain or instability, requiring prolonged medical care. Therefore ankle sprain recurrence prevention in athletes is essential. This RCT evaluates the effect of the combined use of braces and neuromuscular training (e.g. proprioceptive training/sensorimotor training/balance training) against the individual use of either braces or neuromuscular training alone on ankle sprain recurrences, when applied to individual athletes after usual care. This study was designed as three way randomized controlled trial with one year follow-up. Healthy individuals between 12 and 70 years of age, who were actively participating in sports and who had sustained a lateral ankle sprain in the two months prior to inclusion, were eligible for inclusion. After subjects had finished ankle sprain treatment by means of usual care, they were randomised to any of the three study groups. Subjects in group 1 received an eight week neuromuscular training program, subjects in group 2 received a sports brace to be worn during all sports activities for the duration of one year, and group 3 received a combination of the neuromuscular training program and a sports brace to be worn during all sports activities for the duration of eight weeks. Outcomes were assessed at baseline and every month for 12 months therafter. The primary outcome measure was incidence of ankle sprain recurrences. Secondary outcome measures included the direct and indirect costs of recurrent injury, the severity of recurrent injury, and the residual complaints during and after the intervention. The ABrCt is the first randomized controlled trial to directly compare the secondary preventive effect of the combined use of braces and neuromuscular training

Injury of the ankle joint ligaments

International Nuclear Information System (INIS)

Breitenseher, M.J.

2007-01-01

The diagnosis of lateral collateral ankle ligament trauma is based on patient history, clinical examination and clinical stress tests. If the clinical stress test is positive, stress radiography can be performed. There is, however, no consensus about the usefulness of stress radiography in acute ankle sprain, and in particular about the cut-off talar tilt angle beyond which a two-ligament rupture would be certain, ranging from 5 to 30 . Today, magnetic resonance imaging (MRI) is not used in this area, although it does allow controlled positioning of the foot and defined section visualization of injured lateral collateral ankle ligaments. In acute and chronic sinus tarsi injuries, MRI forms the established basis for diagnostic imaging, and can provide a definitive answer in most cases. MRI is also the method of choice for chronic posttraumatic pain with anterolateral impingement after rupture of the anterior talofibular ligament. Generally, for the evaluation of acute ankle injuries, MRI has developed to be the most important second-step procedure when projection radiology is non-diagnostic. (orig.) [de

The effect of ankle brace type on braking response time-A randomised study.

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Dammerer, Dietmar; Waidmann, Cornelia; Haid, Christian; Thaler, Martin; Krismer, Martin; Liebensteiner, Michael C

2015-11-01

The question whether or not a patient with an ankle brace should drive a car is of obvious importance because brake response time (BRT) is considered one of the most important factors for driving safety. Applying a crossover study design, 70 healthy participants (35 women, 35 men) participated in our study. BRT was assessed using a custom-made driving simulator. We assessed BRT under six conditions: without a brace (control) (1), with a typical postoperative ankle brace with adjustable ROM and the settings: unrestricted (2), fixed at 15° (3) plantar flexion, restricted with 15°/50° (4) (dorsal/plantar flexion), a brace for ligament instabilities (5) and an elastic ankle bandage (6). Participants were instructed to apply the brake pedal exclusively with the right foot as quickly as possible on receipt of a visual stimulus. The 70 participants showed significantly impaired BRT with the ankle brace for ROM restriction in the settings: unrestricted (p<0.001), fixed at 15° plantar flexion (p<0.001) and 15°/50° dorsal/plantar flexion (p<0.001) as compared to the control group. BRT was not impaired with the brace for ankle instabilities or the elastic ankle bandage. In conclusion, right-sided ROM restricting ankle braces involve significant impairment of BRT in healthy participants. No such prolonged BRT was found for an elastic ankle bandage or the ligament brace. Copyright © 2015 Elsevier Ltd. All rights reserved.

The effectiveness of mobilisation with movement for chronic medial ankle pain: a case study

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M. Penso

2008-01-01

Full Text Available Introduction and Purpose: It has been shown that approximatelythirty percent of those sustaining an ankle sprain are likely to develop chronicfunctional limitations. Mulligan has developed mobilisation with movement (MWMfor treatment of joint dysfunction and suggests that it is a positional fault of the jointthat causes pain and movement restriction. Method: This single case reports on the effects of a MWM technique on chronicmedial ankle pain. The patient was a 25-year-old female runner who had experiencedpain since an initial ankle sprain at 8 years of age. The main findings of the subjective and physical examinations were decrease in active and passive dorsiflexion and eversion range of motion (ROM, shortening of gastrocnemiusand soleus muscles and the functional limitation of pain when running. The patient was treated twice with the MWMtechnique.Results: Outcomes of immediate reduction in pain, restoration of full dorsiflexion and eversion ROM, increase in calfmuscle length and pain free running were observed. This was maintained over a four-month follow up period.Conclusion: This case concurs with previous studies detailing increases in range of motion and restoration of painfree movement as well as adding new support for the resolution of chronic pain with MWM.

Treatment and prevention of acute and recurrent ankle sprain: an overview of systematic reviews with meta-analysis.

Science.gov (United States)

Doherty, Cailbhe; Bleakley, Chris; Delahunt, Eamonn; Holden, Sinead

2017-01-01

Ankle sprains are highly prevalent with high risk of recurrence. Consequently, there are a significant number of research reports examining strategies for treating and preventing acute and recurrent sprains (otherwise known as chronic ankle instability (CAI)), with a coinciding proliferation of review articles summarising these reports. To provide a systematic overview of the systematic reviews evaluating treatment strategies for acute ankle sprain and CAI. Overview of intervention systematic reviews. Individuals with acute ankle sprain/CAI. The primary outcomes were injury/reinjury incidence and function. 46 papers were included in this systematic review. The reviews had a mean score of 6.5/11 on the AMSTAR quality assessment tool. There was strong evidence for bracing and moderate evidence for neuromuscular training in preventing recurrence of an ankle sprain. For the combined outcomes of pain, swelling and function after an acute sprain, there was strong evidence for non-steroidal anti-inflammatory drugs and early mobilisation, with moderate evidence supporting exercise and manual therapy techniques. There was conflicting evidence regarding the efficacy of surgery and acupuncture for the treatment of acute ankle sprains. There was insufficient evidence to support the use of ultrasound in the treatment of acute ankle sprains. For the treatment of acute ankle sprain, there is strong evidence for non-steroidal anti-inflammatory drugs and early mobilisation, with moderate evidence supporting exercise and manual therapy techniques, for pain, swelling and function. Exercise therapy and bracing are supported in the prevention of CAI. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://www.bmj.com/company/products-services/rights-and-licensing/.

The Consequence of a Medial Ankle Sprain on Physical and Self-reported Functional Limitations: A Case Study Over a 5-Month Period.

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Terada, Masafumi; Thomas, Abbey C; Pietrosimone, Brian; Hiller, Claire E; Bowker, Samantha; Gribble, Phillip A

2015-10-01

Case report. Little evidence exists about impairments and perceived disability following eversion injury to the deltoid ligament. This case study prospectively examined the neuromuscular, biomechanical, and psychological consequences of a case of a medial ankle sprain. A recreationally active man with a history of a lateral ankle sprain (grade I) was participating in a university Institutional Review Board-approved research study examining the neuromuscular and mechanical characteristics associated with chronic ankle instability. Twenty-two days after the testing session, the participant sustained an eversion injury to his left ankle while playing basketball. Outcomes The outcomes of this case are presented using the International Classification of Functioning, Disability and Health model. Outcome variables were assessed at preinjury (medial ankle sprain), 3 months postinjury, and 5 months postinjury. Measurements included neural excitability of the soleus, balance assessment, joint stability, and psychological assessments. Data from this case study revealed that a medial ankle sprain reduces joint mobility and alters neural excitability of the soleus, with concurrent deficits in balance and self-reported function. These impairments forced the participant to downgrade his physical activity lifestyle up to 5 months postinjury. These data suggest the need for the development of intervention strategies to address impairments in neural excitability and joint mobility at the ankle to help patients meet the goal of maintaining long-term joint health. Prognosis, level 4.

Therapeutic interventions for increasing ankle dorsiflexion after ankle sprain: a systematic review.

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Terada, Masafumi; Pietrosimone, Brian G; Gribble, Phillip A

2013-01-01

Clinicians perform therapeutic interventions, such as stretching, manual therapy, electrotherapy, ultrasound, and exercises, to increase ankle dorsiflexion. However, authors of previous studies have not determined which intervention or combination of interventions is most effective. To determine the magnitude of therapeutic intervention effects on and the most effective therapeutic interventions for restoring normal ankle dorsiflexion after ankle sprain. We performed a comprehensive literature search in Web of Science and EBSCO HOST from 1965 to May 29, 2011, with 19 search terms related to ankle sprain, dorsiflexion, and intervention and by cross-referencing pertinent articles. Eligible studies had to be written in English and include the means and standard deviations of both pretreatment and posttreatment in patients with acute, subacute, or chronic ankle sprains. Outcomes of interest included various joint mobilizations, stretching, local vibration, hyperbaric oxygen therapy, electrical stimulation, and mental-relaxation interventions. We extracted data on dorsiflexion improvements among various therapeutic applications by calculating Cohen d effect sizes with associated 95% confidence intervals (CIs) and evaluated the methodologic quality using the Physiotherapy Evidence Database (PEDro) scale. In total, 9 studies (PEDro score = 5.22 ± 1.92) met the inclusion criteria. Static-stretching interventions with a home exercise program had the strongest effects on increasing dorsiflexion in patients 2 weeks after acute ankle sprains (Cohen d = 1.06; 95% CI = 0.12, 2.42). The range of effect sizes for movement with mobilization on ankle dorsiflexion among individuals with recurrent ankle sprains was small (Cohen d range = 0.14 to 0.39). Static-stretching intervention as a part of standardized care yielded the strongest effects on dorsiflexion after acute ankle sprains. The existing evidence suggests that clinicians need to consider what may be the limiting factor of

Study protocol: the effect of whole body vibration on acute unilateral unstable lateral ankle sprain- a biphasic randomized controlled trial.

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Baumbach, Sebastian Felix; Fasser, Mariette; Polzer, Hans; Sieb, Michael; Regauer, Markus; Mutschler, Wolf; Schieker, Matthias; Blauth, Michael

2013-01-14

Ankle sprains often result in ankle instability, which is most likely caused by damage to passive structures and neuromuscular impairment. Whole body vibration (WBV) is a neuromuscular training method improving those impaired neurologic parameters. The aim of this study is to compare the current gold standard functional treatment to functional treatment plus WBV in patients with acute unilateral unstable inversion ankle sprains. 60 patients, aged 18-40 years, presenting with an isolated, unilateral, acute unstable inversion ankle sprain will be included in this bicentric, biphasic, randomized controlled trial. Samples will be randomized by envelope drawing. All patients will be allowed early mobilization and pain-dependent weight bearing, limited functional immobilization by orthosis, PRICE, NSARDs as well as home and supervised physiotherapy. Supervised physical therapy will take place twice a week, for 30 minutes for a period of 6 weeks, following a standardized intervention protocol. During supervised physical therapy, the intervention group will perform exercises similar to those of the control group, on a side-alternating sinusoidal vibration platform. Two time-dependent primary outcome parameters will be assessed: short-term outcome after six weeks will be postural control quantified by the sway index; mid-term outcome after one year will be assessed by subjective instability, defined by the presence of giving-way attacks. Secondary outcome parameters include: return to pre-injury level of activities, residual pain, recurrence, objective instability, energy/coordination, Foot and Ankle Disability Index and EQ 5D. This is the first trial investigating the effects of WBV in patients with acute soft tissue injury. Inversion ankle sprains often result in ankle instability, which is most likely due to damage of neurological structures. Due to its unique, frequency dependent, influence on various neuromuscular parameters, WBV is a promising treatment method for

High lateral plantar pressure is related to an increased tibialis anterior/fibularis longus activity ratio in patients with recurrent lateral ankle sprain

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Mineta S

2017-06-01

Full Text Available Shinshiro Mineta,1 Takayuki Inami,2 Raldy Mariano,3 Norikazu Hirose4 1Graduate School of Sport Sciences, 2Institute of Physical Education, Keio University, Hiyoshi, Yokohama, 3Graduate School of Asia-Pacific Studies, Waseda University, Shinjuku, Tokyo, 4Faculty of Sport Sciences, Waseda University, Higashifushimi, Nishitokyo, Japan Introduction: Center of pressure (COP is a sudden displacement at the time of a lateral ankle sprain (LAS. It has been suggested that the distribution of plantar pressure and the quantity of COP displacement are important for assessing the risk of LAS. Therefore, we evaluated the plantar pressure during a single-leg balance test with eyes closed (SLB-C to identify the factors and characteristics of plantar pressure in people with repeated cases of LAS.Methods: We recruited 22 collegiate athletes and divided them into an instability group (IG; n=11 and a control group (CG; n=11. We measured the distribution of plantar pressure and lower extremity muscle activity during a SLB-C along with static alignment and isometric ankle strength.Results: The fibularis longus (FL activity was significantly lower in the IG than in the CG. The lateral plantar pressure (LPP/medial plantar pressure (MPP ratio was also higher in the IG than in the CG. In addition, the LPP/MPP ratio was correlated with the tibialis anterior (TA/FL ratio.Conclusion: These results suggest that increased lateral plantar pressure is related to decreased FL activity and increased TA/FL ratio. Keywords: chronic ankle instability, ankle sprain, postural stability, soccer, prevention

Effect of athletic taping and kinesiotaping® on measurements of functional performance in basketball players with chronic inversion ankle sprains.

Science.gov (United States)

Bicici, Seda; Karatas, Nihan; Baltaci, Gul

2012-04-01

Chronic inversion ankle sprains are common in basketball players. The effect of taping on functional performance is disputed in the literature. Kinesiotaping® (KT®) is a new method that is being used as both a therapeutic and performance enhancement tool. To date, it appears that no study has investigated the effect of ankle KT® on functional performance. To investigate the effects of different types of taping (KT® using Kinesio Tex®, athletic taping) on functional performance in athletes with chronic inversion sprains of the ankle. Crossover Study Design Fifteen male basketball players with chronic inversion ankle sprains between the ages of 18 and 22 participated in this study. Functional performance tests (Hopping test by Amanda et al, Single Limb Hurdle Test, Standing Heel Rise test, Vertical Jump Test, The Star Excursion Balance Test [SEBT] and Kinesthetic Ability Trainer [KAT] Test) were used to quantify agility, endurance, balance, and coordination. These tests were conducted four times at one week intervals using varied conditions: placebo tape, without tape, standard athletic tape, and KT®. One-way ANOVA tests were used to examine difference in measurements between conditions. Bonferroni correction was applied to correct for repeated testing. There were no significant differences among the results obtained using the four conditions for SEBT (anterior p=0.0699; anteromedial p=0.126; medial p=0.550; posteromedial p=0.587; posterior p=0.754; posterolateral p=0.907; lateral p=0.124; anterolateral p=0.963) and the KAT dynamic measurement (p=0.388). Faster performance times were measured with KT® and athletic tape in single limb hurdle test when compared to placebo and non-taped conditions (Athletic taping- placebo taping: p=0.03; athletic taping- non tape p=0.016;KT®- Placebo taping p=0.042; KT®-Non tape p=0.016). In standing heel rise test and vertical jump test, athletic taping led to decreased performance. (Standing heel rise test: Athletic taping

Knee and Ankle Arthroplasty in Hemophilia

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Luigi Piero Solimeno

2017-11-01

Full Text Available Today, major surgical procedures can be safely performed in hemophilic patients with chronic arthropathy, using available factor concentrates. In this setting, total knee replacement is considered the “gold standard”, while the use of total ankle replacement is still debated. Indeed, the unsatisfactory results obtained with the previous available design of implants did not raise enthusiasm as knee or hip replacement. Recently, the introduction of new implant designs and better reported outcomes have renewed the interest in total ankle replacement in people with hemophilia. In this review, the role of replacement surgery in the treatment of chronic hemophilic arthropathy will be described.

Facilitation of Hoffmann reflexes of ankle muscles in prone but not standing positions by focal ankle-joint cooling.

Science.gov (United States)

Kim, Kyung-Min; Ingersoll, Christopher D; Hertel, Jay

2015-05-01

Focal ankle-joint cooling (FAJC) has been shown to increase Hoffmann (H) reflex amplitudes of select leg muscles while subjects lie prone, but it is unknown whether the neurophysiological cooling effects persist in standing. To assess the effects of FAJC on H-reflexes of the soleus and fibularis longus during 3 body positions (prone, bipedal, and unipedal stances) in individuals with and without chronic ankle instability (CAI). Crossover. Laboratory. 15 young adults with CAI (9 male, 6 female) and 15 healthy controls. All subjects received both FAJC and sham treatments on separate days in a randomized order. FAJC was accomplished by applying a 1.5-L plastic bag filled with crushed ice to the ankle for 20 min. Sham treatment involved room-temperature candy corn. Maximum amplitudes of H-reflexes and motor (M) waves were recorded while subjects lay prone and then stood in quiet bipedal and unipedal stances before and immediately after each treatment. Primary outcome measures were H(max):M(max) ratios for the soleus and fibularis longus. Three-factor (group × treatment condition × time) repeated-measures ANOVAs and Fisher LSD tests were performed for statistical analyses. Significant interactions of treatment condition by time for prone H(max):M(max) ratios were found in the soleus (P = .001) and fibularis longus (P = .003). In both muscles, prone H(max):M(max) ratios moderately increased after FAJC but not after sham treatment. The CAI and healthy groups responded similarly to FAJC. In contrast, there were no significant interactions or main effects in the bipedal and unipedal stances in either muscle (P > .05). FAJC moderately increased H-reflex amplitudes of the soleus and fibularis longus while subjects were prone but not during bipedal or unipedal standing. These results were not different between groups with and without CAI.

Ankles back in randomized controlled trial (ABrCt: braces versus neuromuscular exercises for the secondary prevention of ankle sprains. Design of a randomised controlled trial

Directory of Open Access Journals (Sweden)

Verhagen Evert ALM

2011-09-01

Full Text Available Abstract Background Ankle sprains are the most common sports and physical activity related injury. There is extensive evidence that there is a twofold increased risk for injury recurrence for at least one year post injury. In up to 50% of all cases recurrences result in disability and lead to chronic pain or instability, requiring prolonged medical care. Therefore ankle sprain recurrence prevention in athletes is essential. This RCT evaluates the effect of the combined use of braces and neuromuscular training (e.g. proprioceptive training/sensorimotor training/balance training against the individual use of either braces or neuromuscular training alone on ankle sprain recurrences, when applied to individual athletes after usual care. Methods/Design This study was designed as three way randomized controlled trial with one year follow-up. Healthy individuals between 12 and 70 years of age, who were actively participating in sports and who had sustained a lateral ankle sprain in the two months prior to inclusion, were eligible for inclusion. After subjects had finished ankle sprain treatment by means of usual care, they were randomised to any of the three study groups. Subjects in group 1 received an eight week neuromuscular training program, subjects in group 2 received a sports brace to be worn during all sports activities for the duration of one year, and group 3 received a combination of the neuromuscular training program and a sports brace to be worn during all sports activities for the duration of eight weeks. Outcomes were assessed at baseline and every month for 12 months therafter. The primary outcome measure was incidence of ankle sprain recurrences. Secondary outcome measures included the direct and indirect costs of recurrent injury, the severity of recurrent injury, and the residual complaints during and after the intervention. Discussion The ABrCt is the first randomized controlled trial to directly compare the secondary preventive

Joint instability and osteoarthritis.

Science.gov (United States)

Blalock, Darryl; Miller, Andrew; Tilley, Michael; Wang, Jinxi

2015-01-01

Joint instability creates a clinical and economic burden in the health care system. Injuries and disorders that directly damage the joint structure or lead to joint instability are highly associated with osteoarthritis (OA). Thus, understanding the physiology of joint stability and the mechanisms of joint instability-induced OA is of clinical significance. The first section of this review discusses the structure and function of major joint tissues, including periarticular muscles, which play a significant role in joint stability. Because the knee, ankle, and shoulder joints demonstrate a high incidence of ligament injury and joint instability, the second section summarizes the mechanisms of ligament injury-associated joint instability of these joints. The final section highlights the recent advances in the understanding of the mechanical and biological mechanisms of joint instability-induced OA. These advances may lead to new opportunities for clinical intervention in the prevention and early treatment of OA.

Accuracy of MRI findings in chronic lateral ankle ligament injury: Comparison with surgical findings

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Park, H.-J. [Department of Radiology, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul (Korea, Republic of); Department of Radiology, Kangwon National University, School of Medicine, Chuncheon (Korea, Republic of); Cha, S.-D. [Department of Orthopedic Surgery, Myongji Hospital, Kwandong University, College of Medicine, Koyang (Korea, Republic of); Kim, S.S. [Department of Radiology, Kangwon National University, School of Medicine, Chuncheon (Korea, Republic of); Rho, M.-H., E-mail: parkhiji@kangwon.ac.kr [Department of Radiology, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul (Korea, Republic of); Kwag, H.-J. [Department of Radiology, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul (Korea, Republic of); Park, N.-H. [Department of Radiology, Myongji Hospital, Kwandong University, College of Medicine, Koyang (Korea, Republic of); Lee, S.-Y. [Department of Radiology, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul (Korea, Republic of)

2012-04-15

Aim: To evaluate the accuracy of magnetic resonance imaging (MRI) findings in chronic lateral ankle ligament injury in comparison with that of surgical findings. Materials and methods: Forty-eight cases (25 men, 23 women, mean age 36 years) of clinically suspected chronic ankle ligament injury underwent MRI studies and surgery. Sagittal, coronal, and axial, T1-weighted, spin-echo, proton density and T2-weighted, fast spin-echo images with fat saturation were obtained in all patients. MRI examinations were read in consensus by two fellowship-trained academic musculoskeletal radiologists who evaluated the lateral ankle ligaments, including the anterior talofibular ligament (ATFL) and calcaneofibular ligament (CFL) without clinical information. The results of the MRI studies were then compared with the surgical findings. Results: The MRI findings of ATFL injury showed a sensitivity of detection of complete tears of 75% and specificity of 86%. The sensitivity of detection of partial tears was 75% and the specificity was 78%. The sensitivity of detection of sprains was 44% and the specificity was 88%. Regarding the MRI findings of CFL injury, the sensitivity of detection of complete tears was 50% and the specificity was 98%. The sensitivity of detection of partial tear was 83% and the specificity was 93%. The sensitivity of detection of sprains was 100% and the specificity was 90%. Regarding the ATFL, the accuracies of detection were 88, 58, 77, and 85% for no injury, sprain, partial tear, and complete tear, respectively, and for the CFL the accuracies of detection were 90, 90, 92, and 96% for no injury, sprain, partial tear, and complete tear, respectively. Conclusions: The diagnosis of a complete tear of the ATFL on MRI is more sensitive than the diagnosis of a complete tear of the CFL. MRI findings of CFL injury are diagnostically specific but are not sensitive. However, only normal findings and complete tears were statistically significant between ATFL and CFL (p

Accuracy of MRI findings in chronic lateral ankle ligament injury: Comparison with surgical findings

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Park, H.-J.; Cha, S.-D.; Kim, S.S.; Rho, M.-H.; Kwag, H.-J.; Park, N.-H.; Lee, S.-Y.

2012-01-01

Aim: To evaluate the accuracy of magnetic resonance imaging (MRI) findings in chronic lateral ankle ligament injury in comparison with that of surgical findings. Materials and methods: Forty-eight cases (25 men, 23 women, mean age 36 years) of clinically suspected chronic ankle ligament injury underwent MRI studies and surgery. Sagittal, coronal, and axial, T1-weighted, spin-echo, proton density and T2-weighted, fast spin-echo images with fat saturation were obtained in all patients. MRI examinations were read in consensus by two fellowship-trained academic musculoskeletal radiologists who evaluated the lateral ankle ligaments, including the anterior talofibular ligament (ATFL) and calcaneofibular ligament (CFL) without clinical information. The results of the MRI studies were then compared with the surgical findings. Results: The MRI findings of ATFL injury showed a sensitivity of detection of complete tears of 75% and specificity of 86%. The sensitivity of detection of partial tears was 75% and the specificity was 78%. The sensitivity of detection of sprains was 44% and the specificity was 88%. Regarding the MRI findings of CFL injury, the sensitivity of detection of complete tears was 50% and the specificity was 98%. The sensitivity of detection of partial tear was 83% and the specificity was 93%. The sensitivity of detection of sprains was 100% and the specificity was 90%. Regarding the ATFL, the accuracies of detection were 88, 58, 77, and 85% for no injury, sprain, partial tear, and complete tear, respectively, and for the CFL the accuracies of detection were 90, 90, 92, and 96% for no injury, sprain, partial tear, and complete tear, respectively. Conclusions: The diagnosis of a complete tear of the ATFL on MRI is more sensitive than the diagnosis of a complete tear of the CFL. MRI findings of CFL injury are diagnostically specific but are not sensitive. However, only normal findings and complete tears were statistically significant between ATFL and CFL (p

Arthroscopic Repair of Ankle Instability With All-Soft Knotless Anchors.

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Pereira, Hélder; Vuurberg, Gwen; Gomes, Nuno; Oliveira, Joaquim Miguel; Ripoll, Pedro L; Reis, Rui Luís; Espregueira-Mendes, João; Niek van Dijk, C

2016-02-01

In recent years, arthroscopic and arthroscopically assisted techniques have been increasingly used to reconstruct the lateral ligaments of the ankle. Besides permitting the treatment of several comorbidities, arthroscopic techniques are envisioned to lower the amount of surgical aggression and to improve the assessment of anatomic structures. We describe our surgical technique for arthroscopic, two-portal ankle ligament repair using an all-soft knotless anchor, which is made exclusively of suture material. This technique avoids the need for classic knot-tying methods. Thus it diminishes the chance of knot migration caused by pendulum movements. Moreover, it avoids some complications that have been related to the use of metallic anchors and some currently available biomaterials. It also prevents prominent knots, which have been described as a possible cause of secondary complaints.

Conservative treatment of ankle sprain according to a recent literature

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Urszula Kaźmierczak

2017-02-01

Full Text Available Due to complicated structure of ankle, it is exceptionally susceptible to injuries, of which one of the most common is a sprain. The sprain involves soft-tissue injuries that, depending on their level of seriousness, are categorized as first-, second- or third-degree sprains. The main goals of rehabilitation in the acute phase after the injury include reduction of pain, swelling and hematoma, as well as prevention from secondary injuries. During the subacute phase the emphasis should be put on restoring the joint’s function and its range of motion, as well as on gentle loading of the joint. Proprioception training, strength and stretching exercises should also be introduced. The next stage, during which the reconstruction of the damaged tissues takes place, involves the implementation of gradual progressive loading and the variety of earlier introduced procedures. In the final phase of rehabilitation, it is vital to reassure that the patient is able to return to full activity, especially if he or she is an athlete. Therefore, functional testing such as the Dorsiflexion Lunge Test or The Star Excursion Balance Test may be of help. The main predisposing factor for an ankle sprain is a previous injury of the same type. It is due to the fact that such an injury leads to impaired proprioceptive function and impaired postural control. Improper rehabilitation or the lack of thereof may cause the development of chronic ankle instability, which substantially reduces the chances of physical activity and the patient’s quality of life. The implementation of adequate preventive measures based on employing external stabilisers and neuromuscular training appears to be essential. The objective is to regain a good sense of proprioception as well as muscle reaction time within the ankle joint.

A systematic review on the treatment of acute ankle sprain: brace versus other functional treatment types.

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Kemler, Ellen; van de Port, Ingrid; Backx, Frank; van Dijk, C Niek

2011-03-01

Ankle injuries, especially ankle sprains, are a common problem in sports and medical care. Ankle sprains result in pain and absenteeism from work and/or sports participation, and can lead to physical restrictions such as ankle instability. Nowadays, treatment of ankle injury basically consists of taping the ankle. The purpose of this review is to evaluate the effectiveness of ankle braces as a treatment for acute ankle sprains compared with other types of functional treatments such as ankle tape and elastic bandages. A computerized literature search was conducted using PubMed, EMBASE, CINAHL and the Cochrane Clinical Trial Register. This review includes randomized controlled trials in English, German and Dutch, published between 1990 and April 2009 that compared ankle braces as a treatment for lateral ankle sprains with other functional treatments. The inclusion criteria for this systematic review were (i) individuals (sports participants as well as non-sports participants) with an acute injury of the ankle (acute ankle sprains); (ii) use of an ankle brace as primary treatment for acute ankle sprains; (iii) control interventions including any other type of functional treatment (e.g. Tubigrip™, elastic wrap or ankle tape); and (iv) one of the following reported outcome measures: re-injuries, symptoms (pain, swelling, instability), functional outcomes and/or time to resumption of sports, daily activities and/or work. Eight studies met all inclusion criteria. Differences in outcome measures, intervention types and patient characteristics precluded pooling of the results, so best evidence syntheses were conducted. A few individual studies reported positive outcomes after treatment with an ankle brace compared with other functional methods, but our best evidence syntheses only demonstrated a better treatment result in terms of functional outcome. Other studies have suggested that ankle brace treatment is a more cost-effective method, so the use of braces after acute

Hip strength and star excursion balance test deficits of patients with chronic ankle instability.

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McCann, Ryan S; Crossett, Ian D; Terada, Masafumi; Kosik, Kyle B; Bolding, Brenn A; Gribble, Phillip A

2017-11-01

To examine isometric hip strength in those with and without CAI, and determine the degree of Star Excursion Balance Test (SEBT) variance explained by isometric hip strength. Single-blinded, cross-sectional, case-control study. Thirty individuals with CAI, 29 lateral ankle sprain (LAS) copers, and 26 healthy controls participated. We assessed dynamic postural control with the SEBT anterior (SEBT-ANT), posteromedial (SEBT-PM), and posterolateral (SEBT-PL) reaches, and isometric hip extension (EXT), abduction (ABD) and external rotation (ER) strength with hand-held dynamometry. The CAI and LAS coper groups' involved limbs and randomly selected limbs in controls were tested. Separate Kruskal-Wallis tests compared SEBT scores and isometric hip strength between groups. Backwards linear regression models determined the degree of SEBT variance explained by isometric hip strength. Statistical significance was set a priori at Phip strength compared to LAS copers and controls. Additionally, the CAI group's isometric hip strength significantly influenced dynamic postural control performance. Future CAI rehabilitation strategies should consider hip muscular strengthening to facilitate improvements in dynamic postural control. Copyright © 2017 Sports Medicine Australia. Published by Elsevier Ltd. All rights reserved.

Talar anchor placement for modified Brostrom lateral ankle stabilization procedure.

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Angirasa, Arush K; Barrett, Michael J

2008-01-01

The modified Brostrom procedure has been a proven procedure with excellent utility in the treatment of lateral ankle instability within limitation. Multiple variations of the original technique have been described in the literature to date. Included in these variations are differences in anchor placement, suture technique, or both. In this research study, we propose placing a bone screw anchor into the lateral shoulder of the talus rather than the typical placement at the lateral malleolus for anatomic reconstruction of the lateral ankle ligaments.

Joint Instability and Osteoarthritis

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Darryl Blalock

2015-01-01

Full Text Available Joint instability creates a clinical and economic burden in the health care system. Injuries and disorders that directly damage the joint structure or lead to joint instability are highly associated with osteoarthritis (OA. Thus, understanding the physiology of joint stability and the mechanisms of joint instability-induced OA is of clinical significance. The first section of this review discusses the structure and function of major joint tissues, including periarticular muscles, which play a significant role in joint stability. Because the knee, ankle, and shoulder joints demonstrate a high incidence of ligament injury and joint instability, the second section summarizes the mechanisms of ligament injury-associated joint instability of these joints. The final section highlights the recent advances in the understanding of the mechanical and biological mechanisms of joint instability-induced OA. These advances may lead to new opportunities for clinical intervention in the prevention and early treatment of OA.

Study protocol: the effect of whole body vibration on acute unilateral unstable lateral ankle sprain- a biphasic randomized controlled trial

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Baumbach Sebastian Felix

2013-01-01

Full Text Available Abstract Background Ankle sprains often result in ankle instability, which is most likely caused by damage to passive structures and neuromuscular impairment. Whole body vibration (WBV is a neuromuscular training method improving those impaired neurologic parameters. The aim of this study is to compare the current gold standard functional treatment to functional treatment plus WBV in patients with acute unilateral unstable inversion ankle sprains. Methods/Design 60 patients, aged 18–40 years, presenting with an isolated, unilateral, acute unstable inversion ankle sprain will be included in this bicentric, biphasic, randomized controlled trial. Samples will be randomized by envelope drawing. All patients will be allowed early mobilization and pain-dependent weight bearing, limited functional immobilization by orthosis, PRICE, NSARDs as well as home and supervised physiotherapy. Supervised physical therapy will take place twice a week, for 30 minutes for a period of 6 weeks, following a standardized intervention protocol. During supervised physical therapy, the intervention group will perform exercises similar to those of the control group, on a side-alternating sinusoidal vibration platform. Two time-dependent primary outcome parameters will be assessed: short-term outcome after six weeks will be postural control quantified by the sway index; mid-term outcome after one year will be assessed by subjective instability, defined by the presence of giving-way attacks. Secondary outcome parameters include: return to pre-injury level of activities, residual pain, recurrence, objective instability, energy/coordination, Foot and Ankle Disability Index and EQ 5D. Discussion This is the first trial investigating the effects of WBV in patients with acute soft tissue injury. Inversion ankle sprains often result in ankle instability, which is most likely due to damage of neurological structures. Due to its unique, frequency dependent, influence on various

Motor-neuron pool excitability of the lower leg muscles after acute lateral ankle sprain.

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Klykken, Lindsey W; Pietrosimone, Brian G; Kim, Kyung-Min; Ingersoll, Christopher D; Hertel, Jay

2011-01-01

Neuromuscular deficits in leg muscles that are associated with arthrogenic muscle inhibition have been reported in people with chronic ankle instability, yet whether these neuromuscular alterations are present in individuals with acute sprains is unknown. To compare the effect of acute lateral ankle sprain on the motor-neuron pool excitability (MNPE) of injured leg muscles with that of uninjured contralateral leg muscles and the leg muscles of healthy controls. Case-control study. Laboratory. Ten individuals with acute ankle sprains (6 females, 4 males; age= 19.2 ± 3.8 years, height= 169.4 ± 8.5 cm, mass= 66.3 ± 11.6 kg) and 10 healthy individuals(6 females,4 males; age= 20.6 ± 4.0 years, height = 169.9 ± 10.6 cm, mass= 66.3 ± 10.2 kg) participated. The independent variables were group (acute ankle sprain, healthy) and limb (injured, uninjured). Separate dependent t tests were used to determine differences in MNPE between legs. The MNPE of the soleus, fibularis longus, and tibialis anterior was measured by the maximal Hoffmann reflex (H(max)) and maximal muscle response (M(max)) and was then normalized using the H(max):M(max) ratio. The soleus MNPE in the ankle-sprain group was higher in the injured limb (H(max):M(max) = 0.63; 95% confidence interval [Cl],0.46, 0.80) than the uninjured limb (H(max):M(max) = 0.47; 95%Cl, 0.08, 0.93)(t(6) = 3.62,P =.01).In the acute ankle-sprain group, tibialis anterior MNPE tended to be lower in the injured ankle (H(max):M(max) =0.06; 95% Cl, 0.01, 0.10) than in the uninjured ankle (H(max):M(max) =0.22; 95%Cl, 0.09, 0.35),but this finding was not different (t(9) =-2.01, P =.07). No differences were detected between injured (0.22; 95% Cl, 0.14, 0.29) and uninjured (0.25; 95%Cl, 0.12, 0.38) ankles for the fibularis longus in the ankle-sprain group (t(9) =-0.739, P =.48). We found no side-to-side differences in any muscle among the healthy group. Facilitated MNPE was present in the involved soleus muscle of patients with acute

Magnetic resonance imaging findings in anterolateral impingement of the ankle

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Jordan, L.K. III.; Cooperman, A.E.; Helms, C.A.; Speer, K.P.

2000-01-01

Objective. To demonstrate the MR imaging findings of anterolateral impingement (ALI) of the ankle.Design and patients. Nine patients with a history of ankle inversion injury and chronic lateral ankle pain were imaged with MR imaging, and the findings correlated with the results of arthroscopy. Three additional patients with clinically suspected ALI of the ankle were also included. Ankle MR imaging studies from 20 control patients in whom ALI was not suspected clinically were examined for similar findings to the patient group.Results. MR imaging findings in the patients with ALI included a soft tissue signal mass in the anterolateral gutter of the ankle in 12 of 12 (100%) cases, corresponding to the synovial hypertrophy and soft tissue mass found at arthroscopy in the nine patients who underwent arthroscopy. Disruption, attenuation, or marked thickening of the anterior talofibular ligament was seen in all cases. Additional findings included signs of synovial hypertrophy elsewhere in the tibiotalar joint in seven of 12 patients (58%) and bony and cartilaginous injuries to the tibiotalar joint in five of 12 (42%). None of the control patients demonstrated MR imaging evidence of a soft tissue mass in the anterolateral gutter.Conclusions. ALI of the ankle is a common cause for chronic lateral ankle pain. It has been well described in the orthopedic literature but its imaging findings have not been clearly elucidated. The MR imaging findings, along with the appropriate clinical history, can be used to direct arthroscopic examination and subsequent debridement. (orig.)

Single-leg drop landing movement strategies 6 months following first-time acute lateral ankle sprain injury.

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Doherty, C; Bleakley, C; Hertel, J; Caulfield, B; Ryan, J; Delahunt, E

2015-12-01

No research exists predicating a link between acute ankle sprain injury-affiliated movement patterns and those of chronic ankle instability (CAI) populations. The aim of the current study was to perform a biomechanical analysis of participants, 6 months after they sustained a first-time acute lateral ankle sprain (LAS) injury to establish this link. Fifty-seven participants with a 6-month history of first-time LAS and 20 noninjured participants completed a single-leg drop landing task on both limbs. Three-dimensional kinematic (angular displacement) and sagittal plane kinetic (moment of force) data were acquired for the joints of the lower extremity, from 200 ms pre-initial contact (IC) to 200 ms post-IC. Individual joint stiffnesses and the peak magnitude of the vertical component of the ground reaction force (GRF) were also computed. LAS participants displayed increases in hip flexion and ankle inversion on their injured limb (P < 0.05); this coincided with a reduction in the net flexion-extension moment at the hip joint, with an increase in its stiffness (P < 0.05). There was no difference in the magnitude of the peak vertical GRF for either limb compared with controls. These results demonstrate that altered movement strategies persist in participants, 6 months following acute LAS, which may precipitate the onset of CAI. © 2015 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.

REVISION ANKLE SYNDESMOSIS FIXATION - FUNCTIONAL OUTCOME AFTER TIGHTROPE ® FIXATION

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Sendhilvelan Rajagopalan

2016-07-01

Full Text Available BACKGROUND Syndesmotic disruptions are often seen in ankle fractures. Malreduction of these fractures can result in arthritis and instability. A proportion of these patients with malreduction require revision fixation. This study presents the results of revision fixation in such patients, using the Ankle TightRope ® (Arthrex system. METHODS Between January 2000 to December 2009, 124 patients who underwent ankle fracture fixations with syndesmotic stabilisation were analysed. Out of 124 patients, 8 patients were diagnosed with failure of primary stabilisation (based on radiological and clinical criteria and subjected to revision fixation using the Ankle TightRope ® (Arthrex system. Followup was done at periodic time intervals of 3, 6 and 12 months. Both clinical and radiological assessment was performed. Complications and duration of hospital stay was recorded. Functional evaluation was performed using the American Orthopaedic Foot and Ankle Society (AOFAS scoring system. RESULTS Five patients had good results, one satisfactory and two had poor outcomes. CONCLUSIONS Ankle TightRope ® fixation is an alternative method of stabilisation in patients who require revision syndesmosis fixation. Further studies are required to evaluate this method of revision stabilisation as compared to screws.

Gait adaptations in patients with chronic posterior instability of the knee.

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Hooper, D M; Morrissey, M C; Crookenden, R; Ireland, J; Beacon, J P

2002-03-01

A retrospective analysis was performed to assess gait in individuals with a long history of posterior knee instability. Descriptive study. There are few studies in the literature concerning evaluation of the biomechanics of the knee in patients with knee posterior instability. Nine individuals with posterior knee instability and a matched control group of uninjured subjects were tested in regards to knee kinematics and kinetics while walking and ascending and descending stairs. The mean follow up time for the individuals with posterior instability was 11.1 years. Individual satisfaction with the knee was measured by having participants complete the Flandry (also known as Hughston Clinic) self-assessment questionnaire. It was found that patients with knee posterior instability who indicated a higher level of satisfaction on the Flandry score walked in a manner that demonstrated greater peak knee extensor torque during stance phase, while less satisfied patients with knee posterior instability demonstrated lower peak knee extensor torque. There was a significant correlation between the self-assessment score and the peak knee extensor torque during level walking (P=0.003). During stair ascent and descent, patients with posterior instability averaged lower knee extensor torque and power than the control subjects, but those differences were only statistically significant in power while descending stairs (P=0.048). Individuals with chronic knee posterior instability modify their gait, and the adaptation can be predicted based upon the individuals self-assessment of their knee using the Flandry questionnaire. These data suggest that gait retraining may be a valuable addition to the traditional muscle strengthening programs, which are commonly used during conservative management of knee posterior instability.

Use of infrared thermography for the diagnosis and grading of sprained ankle injuries

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Oliveira, João; Vardasca, Ricardo; Pimenta, Madalena; Gabriel, Joaquim; Torres, João

2016-05-01

Ankle joint sprains are a common medical condition estimated to be responsible for 15-25% of all musculoskeletal injuries worldwide. The pathophysiology of the lesion can represent considerable time lost to injury, as well as long-term disability in up to 60% of patients. A percentage between 10% and 20% may complicate with chronic instability of the ankle joint and disability in walking, contributing to morbidity and poor life quality. Ankle sprains can be classified as grade I, II, or III, based on the extent of damage and number of ligaments affected. The diagnostic grading is important for setting further treatment and rehabilitation, since more severe injuries carries risk of recurrence, added morbidity and decrease in life quality. The aim of this work was to evaluate the adequacy of infrared thermography as a potential complimentary diagnostic tool of the distinct lesions grades. Evaluation of different thermographic values of the ankle region (in both affected and non-affected foot) was conducted for this purpose. The principal results to be highlighted are that some of the regions, namely anterior view for non defined time after injury analysis, and anterior, frontal, posterior and anterior talofibular ligament regions and proximal calcaneofibular ligament regions in acute lesions (herein defined as less than 6 h post-traumatic event) presented consistent profiles of variation. The analyses were performed considering affected and non-affected ankles results on plotted graphics representing termographic evaluation and grading of these lesions performed using ultrasound by experimented medical radiologists. An increase in temperature values was observed when progressing from mild to severe ankle sprain injuries, with these regions presenting lower values for the affected ankle when compared to the non-affected ankle in all the analysis performed. The remaining analysed regions did not present the same variations. Statistical analysis using Kruskal

Modified arthroscopic Brostrom procedure.

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Lui, Tun Hing

2015-09-01

The open modified Brostrom anatomic repair technique is widely accepted as the reference standard for lateral ankle stabilization. However, there is high incidence of intra-articular pathologies associated with chronic lateral ankle instability which may not be addressed by an isolated open Brostrom procedure. Arthroscopic Brostrom procedure with suture anchor has been described for anatomic repair of chronic lateral ankle instability and management of intra-articular lesions. However, the complication rates seemed to be higher than open Brostrom procedure. Modification of the arthroscopic Brostrom procedure with the use of bone tunnel may reduce the risk of certain complications. Copyright © 2015 European Foot and Ankle Society. Published by Elsevier Ltd. All rights reserved.

Clinical examination and magnetic resonance imaging in the assessment of ankle sprains treated with an orthosis.

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De Simoni, C; Wetz, H H; Zanetti, M; Hodler, J; Jacob, H; Zollinger, H

1996-03-01

This is a prospective clinical study of treatment of ankle sprains with an ankle brace that permits ankle dorsiflexion and plantarflexion of 20 degrees, but limits inversion and eversion for 6 weeks. The ankle brace is followed by physiotherapy for another 6 weeks. Thirty patients were evaluated with clinical examination and magnetic resonance (MR) imaging before treatment and after 12 weeks of treatment. MR imaging revealed acute tears in the anterior talofibular ligament in all 30 ankles (100%) and tears in the calcaneofibular ligament in 25 of 30 ankles (83%). At 12 weeks after injury, MR evidence of healing was present for the anterior talofibular ligament in 22 of 30 ankles (73%) and for the calcaneofibular ligament in 23 of 25 ankles (92%). Postural sway analysis after therapy was used to quantify functional stability of the ankle. There was no correlation with MR findings, but there was a correlation with the subjective impression of functional instability. Twenty-eight of 30 patients (93%) had a functionally stable ankle after 12 weeks of treatment. MR findings after ankle sprain could not predict clinical outcome.

Arthroscopic Broström repair with Gould augmentation via an accessory anterolateral port for lateral instability of the ankle.

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Matsui, Kentaro; Takao, Masato; Miyamoto, Wataru; Innami, Ken; Matsushita, Takashi

2014-10-01

Although several arthroscopic surgical techniques for the treatment of lateral instability of the ankle have been introduced recently, some concern remains over their procedural complexity, complications, and unclear clinical outcomes. We have simplified the arthroscopic technique of Broström repair with Gould augmentation. This technique requires only two small skin incisions for two ports (medial midline and accessory anterolateral ports), without needing a percutaneous procedure or extension of the skin incisions. The anterior talofibular ligament is reattached to its anatomical footprint on the fibula with suture anchor, under arthroscopic view. The inferior extensor retinaculum is directly visualized through the accessory anterolateral port and is attached to the fibula with another suture anchor under arthroscopic view via the anterolateral port. The use of two small ports offers a procedure that is simple to perform and less morbid for patients.

The 2BFit study: is an unsupervised proprioceptive balance board training programme, given in addition to usual care, effective in preventing ankle sprain recurrences? Design of a Randomized Controlled Trial

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van Mechelen Willem

2008-05-01

Full Text Available Abstract Background There is strong evidence that athletes have a twofold risk for re-injury after a previous ankle sprain, especially during the first year post-injury. These ankle sprain recurrences could result in disability and lead to chronic pain or instability in 20 to 50% of these cases. When looking at the high rate of ankle sprain recurrences and the associated chronic results, ankle sprain recurrence prevention is important. Objective To evaluate the effect of a proprioceptive balance board training programme on ankle sprain recurrences, that was applied to individual athletes after rehabilitation and treatment by usual care. Methods/Design This study was designed as a randomized controlled trial with a follow-up of one year. Healthy individuals between 12 and 70 years of age, who were actively participating in sports and who had sustained a lateral ankle sprain up to two months prior to inclusion, were eligible for inclusion in the study. The intervention programme was compared to usual care. The intervention programme consisted of an eight-week proprioceptive training, which started after finishing usual care and from the moment that sports participation was again possible. Outcomes were assessed at baseline and every month for 12 months. The primary outcome of this study was the incidence of recurrent ankle injuries in both groups within one year after the initial sprain. Secondary outcomes were severity and etiology of re-injury and medical care. Cost-effectiveness was evaluated from a societal perspective. A process evaluation was conducted for the intervention programme. Discussion The 2BFit trial is the first randomized controlled trial to study the effect of a non-supervised home-based proprioceptive balance board training programme in addition to usual care, on the recurrence of ankle sprains in sports. Results of this study could possibly lead to changes in practical guidelines on the treatment of ankle sprains. Results will

Arthroscopic suture anchor repair of the lateral ligament ankle complex: a cadaveric study.

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Giza, Eric; Shin, Edward C; Wong, Stephanie E; Acevedo, Jorge I; Mangone, Peter G; Olson, Kirstina; Anderson, Matthew J

2013-11-01

Operative treatment of mechanical ankle instability is indicated for patients with multiple sprains and continued episodes of instability. Open repair of the lateral ankle ligaments involves exposure of the attenuated ligaments and advancement back to their anatomic insertions on the fibula using bone tunnels or suture implants. Open and arthroscopic fixation are equal in strength to failure for anatomic Broström repair. Controlled laboratory study. Seven matched pairs of human cadaveric ankle specimens were randomized into 2 groups of anatomic Broström repair: open or arthroscopic. The calcaneofibular ligament and anterior talofibular ligament were excised from their origin on the fibula. In the open repair group, 2 suture anchors were used to reattach the ligaments to their anatomic origins. In the arthroscopic repair group, identical suture anchors were used for repair via an arthroscopic technique. The ligaments were cyclically loaded 20 times and then tested to failure. Torque to failure, degrees to failure, initial stiffness, and working stiffness were measured. A matched-pair analysis was performed. Power analysis of 0.8 demonstrated that 7 pairs needed to show a difference of 30%, with a 15% standard error at a significance level of α = .05. There was no difference in the degrees to failure, torque to failure, or stiffness for the repaired ligament complex. Nine of 14 specimens failed at the suture anchor. There is no statistical difference in strength or stiffness of a traditional open repair as compared with an arthroscopic anatomic repair of the lateral ligaments of the ankle. An arthroscopic technique can be considered for lateral ligament stabilization in patients with mild to moderate mechanical instability.

Prospective study of the " Inside-Out" arthroscopic ankle ligament technique: Preliminary result.

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Nery, Caio; Fonseca, Lucas; Raduan, Fernando; Moreno, Marcus; Baumfeld, Daniel

2017-03-22

spontaneously. Despite the limited cohort and the relatively short follow-up period, the use of the "inside-out" arthroscopic technique may be considered as a valid option for the treatment of chronic ankle instability. Copyright © 2017 European Foot and Ankle Society. Published by Elsevier Ltd. All rights reserved.

The ankle-foot orthosis improves balance and reduces fall risk of chronic spastic hemiparetic patients.

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Cakar, E; Durmus, O; Tekin, L; Dincer, U; Kiralp, M Z

2010-09-01

Ankle foot orthoses (AFO) are commonly used orthotic device in order to restore the ankle foot function and to improve the balance and gait in post-stroke hemiparetic patients. However, there remain some discussions about their effectiveness on long term hemiparetic patients who had mild to moderate spasticity. To investigate the relative effect of prefabricated thermoplastic posterior leaf spring AFO (PLS-AFO) on balance and fall risk. A cross-over interventional study The Department of PMR of a tertiary hospital. Twenty-five chronic post-stroke long duration hemiparetic patients who had Ashworth grade 1-2 spasticity at affected calf muscles and lower limb Brunnstrom stage 2-3 and also able to walk independently without an assistive device. Berg Balance Scale (BERG), and the postural stability test (PST) and the fall risk test (FRT) of Biodex balance systems were used for the assessments. All of the patients were assessed with AFO and without AFO. All assessments were made with footwear. The mean post-stroke duration was 20,32±7,46 months. The BERG scores were 42,12±9,05 without AFO and 47,52±7,77 with AFO; the overall stability scores of FRT were 3,35±1,97 without AFO and 2,69±1,65 with AFO (Pbalance and provide fall risk reduction in chronic post-stroke ambulatory hemiparetic patients who had mild to moderate spasticity on their affected lower limb. These results encourage the usage of AFO on long duration hemiparetic patients in order to provide better balance and lesser fall risk.

Is transcutaneous peroneal stimulation beneficial to patients with chronic stroke using an ankle-foot orthosis? A within-subjects study of patients' satisfaction, walking speed and physical activity level.

NARCIS (Netherlands)

Swigchem, R. van; Vloothuis, J.; Boer, J. de; Weerdesteijn, V.G.M.; Geurts, A.C.H.

2010-01-01

OBJECTIVE: The aim of this study was to evaluate whether community-dwelling chronic stroke patients wearing an ankle-foot orthosis would benefit from changing to functional electrical stimulation of the peroneal nerve. METHODS: In 26 community-dwelling chronic (> 6 months post-onset) patients after

[Ankle arthroscopy in clinical application: a preliminary report].

Science.gov (United States)

Xu, J S

1989-01-01

The results of arthroscopy or arthroscopic synovectomy on 31 ankle joints in 24 cases were reported. All the patients were followed for 2 to 10 months with an average of 6 months. The results were as follows of the 26 rheumatoid arthritis: excellent in 5 ankles (19.2%), good in 8 (30.8%), fair in 7 (26.9%), and poor in 6 (23.6%), of the three traumatic arthritis: good in one and fair in two; of the remaining 2: good in 1 tuberculous synovitis and fair in 1 chronic pyogenic arthritis. The operative procedure, indications and value of ankle arthroscopy together with its advantages were discussed in detail.

Some benefit from physiotherapy intervention in the subgroup of patients with severe ankle sprain as determined by the ankle function score: a randomised trial.

Science.gov (United States)

van Rijn, Rogier M; van Heest, Jos A C; van der Wees, Philip; Koes, Bart W; Bierma-Zeinstra, Sita M A

2009-01-01

Do patients with a severe ankle injury (baseline ankle function score 40)? Does physiotherapy intervention have more effect on patients with a severe injury compared with a mild injury in the short- or long-term? Is self-reported recovery related to ankle function score over time? Subgroup analysis of a randomised trial. 102 adults with an acute lateral ankle sprain. The experimental group received physiotherapist-supervised exercises in addition to conventional intervention. Outcomes were self-reported recovery, pain, and instability all measured on a 10-point visual analogue scale, and incidence of re-sprain. Measurements were collected at baseline, 4 and 8 weeks, 3 and 12 months. Participants with a severe injury did worse in 3 out of 7 outcomes than those with a mild injury at 4 weeks but not at 8 weeks. There was no difference in effect of physiotherapy intervention in those with a severe injury compared with a mild injury, at 8 weeks or 12 months. However, there was an effect of physiotherapy intervention in those with a severe injury in 3 out of 7 outcomes at 8 weeks. Self-reported recovery was related to ankle function score at all points in time (r = 0.48 to 0.79). The results of this study only partially support the recommendations regarding the use of the ankle function score in the 'Acute Ankle Injury' guideline of the Royal Dutch Society of Physiotherapists.

Ankle arthroscopy

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Ankle surgery; Arthroscopy - ankle; Surgery - ankle - arthroscopy; Surgery - ankle - arthroscopic ... Arthroscopy may be recommended for these ankle problems: Ankle pain. Arthroscopy allows the surgeon to explore what ...

Mechanical stability of the subtalar joint after lateral ligament sectioning and ankle brace application: a biomechanical experimental study.

Science.gov (United States)

Kamiya, Tomoaki; Kura, Hideji; Suzuki, Daisuke; Uchiyama, Eiichi; Fujimiya, Mineko; Yamashita, Toshihiko

2009-12-01

The roles of each ligament supporting the subtalar joint have not been clarified despite several biomechanical studies. The effects of ankle braces on subtalar instability have not been shown. The ankle brace has a partial effect on restricting excessive motion of the subtalar joint. Controlled laboratory study. Ten normal fresh-frozen cadaveric specimens were used. The angular motions of the talus were measured via a magnetic tracking system. The specimens were tested while inversion and eversion forces, as well as internal and external rotation torques, were applied. The calcaneofibular ligament, cervical ligament, and interosseous talocalcaneal ligament were sectioned sequentially, and the roles of each ligament, as well as the stabilizing effects of the ankle brace, were examined. Complete sectioning of the ligaments increased the angle between the talus and calcaneus in the frontal plane to 51.7 degrees + or - 11.8 degrees compared with 35.7 degrees + or - 6.0 degrees in the intact state when inversion force was applied. There was a statistically significant difference in the angles between complete sectioning of the ligaments and after application of the brace (34.1 degrees + or - 7.3 degrees ) when inversion force was applied. On the other hand, significant differences in subtalar rotation were not found between complete sectioning of the ligaments and application of the brace when internal and external rotational torques were applied. The ankle brace limited inversion of the subtalar joint, but it did not restrict motion after application of internal or external rotational torques. In cases of severe ankle sprains involving the calcaneofibular ligament, cervical ligament, and interosseous talocalcaneal ligament injuries, application of an ankle brace might be less effective in limiting internal-external rotational instabilities than in cases of inversion instabilities in the subtalar joint. An improvement in the design of the brace is needed to restore

Chronic social instability increases anxiety-like behavior and ethanol preference in male Long Evans rats.

Science.gov (United States)

Roeckner, Alyssa R; Bowling, Alexandra; Butler, Tracy R

2017-05-01

Chronic stress during adolescence is related to increased prevalence of anxiety disorders and alcohol use disorders in humans. This phenotype has been consistently recapitulated in animal models with male subjects, but models using female subjects are fewer. The aim of these studies was to test the hypothesis that chronic social instability (CSI) during adolescence engenders increased anxiety-like behavior, increased corticosterone, and greater ethanol intake and/or preference than control groups in male and female rats. A chronic social instability (CSI) procedure was conducted in separate cohorts of female and male adolescent Long Evans rats. CSI included daily social isolation for 1h, and then pair housing with a novel cage mate for 23h until the next 1h isolation period from PND 30-46. Control groups included social stability (SS), chronic isolation (ISO), and acute social instability (aSI). At PND 49-50, anxiety-like behavior was assessed on the elevated plus maze, and on PND 51 tails bloods were obtained for determination of corticosterone (CORT) levels. This was followed by 4weeks of ethanol drinking in a home cage intermittent access ethanol drinking paradigm (PND 55-81 for males, PND 57-83 for females). Planned contrast testing showed that the male CSI group had greater anxiety-like behavior compared controls, but group differences were not apparent for CORT. CSI males had significantly higher levels of ethanol preference during drinking weeks 2-3 compared to all other groups and compared to SS and ISO groups in week 4. For the female cohort, we did not observe consistent group differences in anxiety-like behavior, CORT levels were unexpectedly lower in the ISO group only compared to the other groups, and group differences were not apparent for ethanol intake/preference. In conclusion, chronic stress during adolescence in the form of social instability increases anxiety-like behavior and ethanol preference in male rats, consistent with other models of

The hematoma block: a simple, effective technique for closed reduction of ankle fracture dislocations.

Science.gov (United States)

Ross, Adrianne; Catanzariti, Alan R; Mendicino, Robert W

2011-01-01

Management of a dislocated ankle fracture can be challenging because of instability of the ankle mortise, a compromised soft tissue envelope, and the potential neurovascular compromise. Every effort should be made to quickly and efficiently relocate the disrupted ankle joint. Within the emergency department setting, narcotics and benzodiazepines can be used to sedate the patient before attempting closed reduction. The combination of narcotics and benzodiazepines provides relief of pain and muscle guarding; however, it conveys a risk of seizure as well as respiratory arrest. An alternative to conscious sedation is the hematoma block, or an intra-articular local anesthetic injection in the ankle joint and the associated fracture hematoma. The hematoma block offers a comparable amount of analgesia to conscious sedation without the additional cardiovascular risk, hospital cost, and procedure time. Copyright © 2011 American College of Foot and Ankle Surgeons. Published by Elsevier Inc. All rights reserved.

ARTHROSCOPIC TREATMENT OF ANTERIOR IMPINGEMENT IN THE ANKLE

Directory of Open Access Journals (Sweden)

Martin Mikek

2004-12-01

Full Text Available Background. Anterior soft tissue impingement is a common cause of chronic pain in the ankle. The preferred method of operative treatment is an arthroscopic excision of hypertrophic fibrous and synovial tissue in the anterior part of the ankle joint.Methods. We present the results of arthroscopic treatment of anterior ankle impingement in group of 14 patients.Results. Subjective improvement after the procedure was observed in all patients and 13 of them (93% were without any symptoms after the operation. One patient reported of intermittent pain, especially when walking on uneven grounds.Conclusions. We conclude that arthroscopic excision of hypertrophic synovial tissue in the anterior part of the ankle which causes the symptoms of impingement is a minimally invasive procedure that is both safe and reliable. When used for appropriate indications, an improvement can be expected in over 90% of patients.

Epidemiology, rehabilitation and prevention of ankle sprains in basketball players

Directory of Open Access Journals (Sweden)

Anna Lewandowska

2017-08-01

Full Text Available Basketball is a sports discipline in which the ankle sprain is the most common injury. It is considered to be an aggravated activity by its dimension of teamwork, contact and requiring a variety of motion dynamics. The aim of this paper is to identify basketball game elements that contribute to the development of traumatic torsion injuries, to present methods of injury prevention and to present possible methods for the rehabilitation of athletes in different stages of injury healing. A sprain and a torsion of the ankle is not a traumatic event defined at one time, but is often a cycle of repetitive trauma. It is also important to educate competitors not to underestimate these types of injuries and to treat them with serious medical and rehabilitation procedures. Rehabilitation of the ankle joint is dependent on the degree of injury, and above all on the extent of the damaged tissue. In order to avoid trauma, proprioception and global stabilization training play a very important role. Unstable ankle instability is associated with serious complications.

Ankle replacement

Science.gov (United States)

Ankle arthroplasty - total; Total ankle arthroplasty; Endoprosthetic ankle replacement; Ankle surgery ... Ankle replacement surgery is most often done while you are under general anesthesia. This means you will ...

Biomechanical Analysis of an Arthroscopic Broström Ankle Ligament Repair and a Suture Anchor-Augmented Repair.

Science.gov (United States)

Giza, Eric; Whitlow, Scott R; Williams, Brady T; Acevedo, Jorge I; Mangone, Peter G; Haytmanek, C Thomas; Curry, Eugene E; Turnbull, Travis Lee; LaPrade, Robert F; Wijdicks, Coen A; Clanton, Thomas O

2015-07-01

Secondary surgical repair of ankle ligaments is often indicated in cases of chronic lateral ankle instability. Recently, arthroscopic Broström techniques have been described, but biomechanical information is limited. The purpose of the present study was to analyze the biomechanical properties of an arthroscopic Broström repair and augmented repair with a proximally placed suture anchor. It was hypothesized that the arthroscopic Broström repairs would compare favorably to open techniques and that augmentation would increase the mean repair strength at time zero. Twenty (10 matched pairs) fresh-frozen foot and ankle cadaveric specimens were obtained. After sectioning of the lateral ankle ligaments, an arthroscopic Broström procedure was performed on each ankle using two 3.0-mm suture anchors with #0 braided polyethylene/polyester multifilament sutures. One specimen from each pair was augmented with a 2.9-mm suture anchor placed 3 cm proximal to the inferior tip of the lateral malleolus. Repairs were isolated and positioned in 20 degrees of inversion and 10 degrees of plantarflexion and loaded to failure using a dynamic tensile testing machine. Maximum load (N), stiffness (N/mm), and displacement at maximum load (mm) were recorded. There were no significant differences between standard arthroscopic repairs and the augmented repairs for mean maximum load and stiffness (154.4 ± 60.3 N, 9.8 ± 2.6 N/mm vs 194.2 ± 157.7 N, 10.5 ± 4.7 N/mm, P = .222, P = .685). Repair augmentation did not confer a significantly higher mean strength or stiffness at time zero. Mean strength and stiffness for the arthroscopic Broström repair compared favorably with previous similarly tested open repair and reconstruction methods, validating the clinical feasibility of an arthroscopic repair. However, augmentation with an additional proximal suture anchor did not significantly strengthen the repair. © The Author(s) 2015.

Manual therapy in joint and nerve structures combined with exercises in the treatment of recurrent ankle sprains: A randomized, controlled trial.

Science.gov (United States)

Plaza-Manzano, Gustavo; Vergara-Vila, Marta; Val-Otero, Sandra; Rivera-Prieto, Cristina; Pecos-Martin, Daniel; Gallego-Izquierdo, Tomás; Ferragut-Garcías, Alejandro; Romero-Franco, Natalia

2016-12-01

Recurrent ankle sprains often involve residual symptoms for which subjects often perform proprioceptive or/and strengthening exercises. However, the effectiveness of mobilization to influence important nerve structures due to its anatomical distribution like tibial and peroneal nerves is unclear. To analyze the effects of proprioceptive/strengthening exercises versus the same exercises and manual therapy including mobilizations to influence joint and nerve structures in the management of recurrent ankle sprains. A randomized single-blind controlled clinical trial. Fifty-six patients with recurrent ankle sprains and regular sports practice were randomly assigned to experimental or control group. The control group performed 4 weeks of proprioceptive/strengthening exercises; the experimental group performed 4 weeks of the same exercises combined with manual therapy (mobilizations to influence joint and nerve structures). Pain, self-reported functional ankle instability, pressure pain threshold (PPT), ankle muscle strength, and active range of motion (ROM) were evaluated in the ankle joint before, just after and one month after the interventions. The within-group differences revealed improvements in all of the variables in both groups throughout the time. Between-group differences revealed that the experimental group exhibited lower pain levels and self-reported functional ankle instability and higher PPT, ankle muscle strength and ROM values compared to the control group immediately after the interventions and one month later. A protocol involving proprioceptive and strengthening exercises and manual therapy (mobilizations to influence joint and nerve structures) resulted in greater improvements in pain, self-reported functional joint stability, strength and ROM compared to exercises alone. Copyright © 2016 Elsevier Ltd. All rights reserved.

Validation of the Foot and Ankle Outcome Score in adult acquired flatfoot deformity.

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Mani, Sriniwasan B; Brown, Haydée C; Nair, Pallavi; Chen, Lan; Do, Huong T; Lyman, Stephen; Deland, Jonathan T; Ellis, Scott J

2013-08-01

The American Orthopaedic Foot and Ankle Society (AOFAS) Ankle-Hindfoot Score has been under recent scrutiny. The Foot and Ankle Outcome Score (FAOS) is an alternative subjective survey, assessing outcomes in 5 subscales. It is validated for lateral ankle instability and hallux valgus patients. The aim of our study was to validate the FAOS for assessing outcomes in flexible adult acquired flatfoot deformity (AAFD). Patients from the authors' institution diagnosed with flexible AAFD from 2006 to 2011 were eligible for the study. In all, 126 patients who completed the FAOS and the Short-Form 12 (SF-12) on the same visit were included in the construct validity component. Correlation was deemed moderate if the Spearman's correlation coefficient was .4 to .7. Content validity was assessed in 63 patients by a questionnaire that asked patients to rate the relevance of each FAOS question, with a score of 2 or greater considered acceptable. Reliability was measured using intraclass correlation coefficients (ICCs) in 41 patients who completed a second FAOS survey. In 49 patients, preoperative and postoperative FAOS scores were compared to determine responsiveness. All of the FAOS subscales demonstrated moderate correlation with 2 physical health related SF-12 domains. Mental health related domains showed poor correlation. Content validity was high for the Quality of Life (QoL; mean 2.26) and Sports/Recreation subscales (mean 2.12). All subscales exhibited very good test-retest reliability, with ICCs of .7 and above. Symptoms, QoL, pain, and daily activities (ADLs) were responsive to change in postoperative patients (P validated the FAOS for AAFD with acceptable construct and content validity, reliability, and responsiveness. Given its previous validation for patients with ankle instability and hallux valgus, the additional findings in this study support its use as an alternative to less reliable outcome surveys. Level II, prospective comparative study.

Anterior-inferior tibiofibular ligament anatomical repair and augmentation versus trans-syndesmosis screw fixation for the syndesmotic instability in external-rotation type ankle fracture with posterior malleolus involvement: A prospective and comparative study.

Science.gov (United States)

Zhan, Yu; Yan, Xiaoyu; Xia, Ronggang; Cheng, Tao; Luo, Congfeng

2016-07-01

Syndesmosis injury is common in external-rotation type ankle fractures (ERAF). Trans-syndesmosis screw fixation, the gold-standard treatment, is currently controversial for its complications and biomechanical disadvantages. The purpose of this study was to introduce a new method of anatomically repairing the anterior-inferior tibiofibular ligament (AITFL) and augmentation with anchor rope system to treat the syndesmotic instability in ERAF with posterior malleolus involvement and to compare its clinical outcomes with that of trans-syndesmosis screw fixation. 53 ERAFs with posterior malleolus involvement received surgery, and the syndesmosis was still unstable after fracture fixation. They were randomised into screw fixation group and AITFL anatomical repair with augmentation group. Reduction quality, syndesmosis diastasis recurrence, pain (VAS score), time back to work, Olerud-Molander ankle score and range of motion (ROM) of ankle were investigated. Olerud-Molander score in AITFL repair group and screw group was 90.4 and 85.8 at 12-month follow-up (P>0.05). Plantar flexion was 31.2° and 34.3° in repair and screw groups (P=0.04). Mal-reduction happened in 5 cases (19.2%) in screw group while 2 cases (7.4%) in repair group. Postoperative syndesmosis re-diastasis occurred in 3 cases in screw group while zero in repair group (P>0.05). Pain score was similar between the two groups (P>0.05). Overall complication rate and back to work time were 26.9% and 3.7% (P=0.04), 7.15 months and 5.26 months (P=0.02) in screw group and repair group, respectively. For syndesmotic instability in ERAF with posterior malleolus involvement, the method of AITFL anatomical repair and augmentation with anchor rope system had an equivalent functional outcome and reduction, earlier rehabilitation and less complication compared with screw fixation. It can be selected as an alternative. Copyright © 2016 Elsevier Ltd. All rights reserved.

Effect of Ankle-foot Orthosis on Lower Limb Muscle Activities and Static Balance of Stroke Patients Authors’ Names

OpenAIRE

Lee, Youngmin; Her, Jin Gang; Choi, Youngeun; Kim, Heesoo

2014-01-01

[Purpose] This study examined the effects of an ankle-foot orthosis worn during balance training on lower limb muscle activity and static balance of chronic stroke patients. [Subjects] The subjects were twenty-five inpatients receiving physical therapy for chronic stroke. [Methods] The chronic stroke patients were divided into two groups: thirteen patients were assigned to the ankle-foot orthosis group, while the remaining twelve patients wore only their shoes. Each group performed balance tr...

Intrinsic predictive factors for ankle sprain in active university students: a prospective study.

Science.gov (United States)

de Noronha, M; França, L C; Haupenthal, A; Nunes, G S

2013-10-01

The ankle is the joint most affected among the sports-related injuries. The current study investigated whether certain intrinsic factors could predict ankle sprains in active students. The 125 participants were submitted to a baseline assessment in a single session were then followed-up for 52 weeks regarding the occurrence of sprain. The baseline assessment were performed in both ankles and included the questionnaire Cumberland ankle instability tool - Portuguese, the foot lift test, dorsiflexion range of motion, Star Excursion Balance Test (SEBT), the side recognition task, body mass index, and history of previous sprain. Two groups were used for analysis: one with those who suffered an ankle sprain and the other with those who did not suffer an ankle sprain. After Cox regression analysis, participants with history of previous sprain were twice as likely to suffer subsequent sprains [hazard ratio (HR) 2.21 and 95% confidence interval (CI) 1.07-4.57] and people with better performance on the SEBT in the postero-lateral (PL) direction were less likely to suffer a sprain (HR 0.96 and 95% CI 0.92-0.99). History of previous sprain was the strongest predictive factor and a weak performance on SEBT PL was also considered a predictive factor for ankle sprains. © 2012 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.

Minimally invasive soft tissue release of foot and ankle contracture secondary to stroke.

Science.gov (United States)

Boffeli, Troy J; Collier, Rachel C

2014-01-01

Lower extremity contracture associated with stroke commonly results in a nonreducible, spastic equinovarus deformity of the foot and ankle. Rigid contracture deformity leads to gait instability, pain, bracing difficulties, and ulcerations. The classic surgical approach for stroke-related contracture of the foot and ankle has been combinations of tendon lengthening, tendon transfer, osteotomy, and joint fusion procedures. Recovery after traditional foot and ankle reconstructive surgery requires a period of non-weightbearing that is not typically practical for these patients. Little focus has been given in published studies on minimally invasive soft tissue release of contracture. We present the case of a 61-year-old female with an equinovarus foot contracture deformity secondary to stroke. The patient underwent Achilles tendon lengthening, posterior tibial tendon Z lengthening, and digital flexor tenotomy of each toe with immediate weightbearing in a walking boot, followed by transition to an ankle-foot orthosis. The surgical principles and technique tips are presented to demonstrate our minimally invasive approach to release of foot and ankle contracture secondary to stroke. The main goal of this approach is to improve foot and ankle alignment for ease of bracing, which, in turn, will improve gait, reduce the risk of falls, decrease pain, and avoid the development of pressure sores. Copyright © 2014 American College of Foot and Ankle Surgeons. Published by Elsevier Inc. All rights reserved.

MR imaging of accessory muscles of the ankle

International Nuclear Information System (INIS)

Mondello, Eduardo; Nazar, Miguel E.; Martin, Eduardo

2001-01-01

Purpose: The purpose of this work is to describe the normal anatomy and the characteristics in MRI of the accessory muscles of the posterior ankle: the accessory soleus, accessory flexor digitorum longus, peroneus quartus, tibiocalcaneus internus and peroneocalcaneus internus. Material and methods: There were evaluated 280 symptomatic patients between 18 and 40 years old (85 % males). MR was performed in High Field Magnetic Resonance Units (1.5 T y 1.0 T) and multiplanar sequences. Results: We found 2 peroneus quartus (0.7%), 2 accessory soleus muscles (0.7%), 3 accessory flexor digitorum longus (1.07%) and 1 peroneocalcaneus internus (0.35%). Conclusion: The knowledge of the accessory muscles of the posterior ankle allow to explain different painful pathologies with instability or tendinous tears, which are difficult to diagnose if the muscle are not adequately recognized. (author)

The identification of risk factors for ankle sprains sustained during netball participation.

Science.gov (United States)

Attenborough, Alison S; Sinclair, Peter J; Sharp, Tristan; Greene, Andrew; Stuelcken, Max; Smith, Richard M; Hiller, Claire E

2017-01-01

Ankle sprains account for a large percentage of injuries sustained in netball. The identification of risk factors for ankle sprain is the preliminary action required to inform future prevention strategies. Prospective study. Ninety-four netball players from club and inter-district teams. Preseason data were collected for; vertical jump height, perceived ankle instability, sprain history, arthrometry inversion-eversion angles, star excursion balance test reach distances, the number of foot lifts during unilateral stance and demi-pointe balance test results. Participants were followed for the duration of one netball season and ankle sprains were recorded. Eleven sprains were recorded for eleven players using a time-loss definition of injury. Ankle sprains occurred at an incidence rate of 1.74/1000 h of netball exposure. One risk factor was identified to increase the odds of sustaining an ankle sprain during netball participation - a reach distance in the posterior-medial direction of the star excursion balance test of less than or equal to 77.5% of leg length (OR = 4.04, 95% CI = 1.00-16.35). The identified risk factor can be easily measured and should be considered for preseason injury risk profiling of netball players. Netball players may benefit from training programs aimed at improving single leg balance. Copyright © 2016 Elsevier Ltd. All rights reserved.

软组织贴扎技术预防及治疗踝关节扭伤的临床应用进展%Progress in Application of Soft Tissue Taping Techniques for Ankle Sprains (review)

Institute of Scientific and Technical Information of China (English)

柴松; 余波; 陈文华

2015-01-01

踝关节扭伤临床极为常见，如处理不当很容易再次扭伤，甚至发展成慢性踝关节不稳，影响人们的日常生活与运动。本文对以肌内效贴为代表的软组织贴扎技术预防及治疗踝关节扭伤的临床应用进展进行综述。作为一种非侵入性治疗手段，软组织贴扎技术可缓解踝关节扭伤症状，稳定关节，改善功能，预防踝关节扭伤反复发作，值得临床进一步研究与应用。%The ankle sprain is very common in clinic. It will be sprained again if it is not handled properly, and even develop into chron-ic ankle instability which will affect people's daily life and exercise. This paper discussed the soft tissue techniques, especially kinesio tap-ing, applied for ankle sprain in clinical. As a non-invasive therapy, soft tissue taping can relieve the symptoms of ankle sprains, stable ankle, improve ankle function and prevent recurrent ankle sprain, which is worthy of further research and application.

Ankle replacement - discharge

Science.gov (United States)

... total - discharge; Total ankle arthroplasty - discharge; Endoprosthetic ankle replacement - discharge; Osteoarthritis - ankle ... You had an ankle replacement. Your surgeon removed and reshaped ... an artificial ankle joint. You received pain medicine and were ...

[Eleven-Year Experience with Total Ankle Arthroplasty].

Science.gov (United States)

Popelka, S; Sosna, A; Vavřík, P; Jahoda, D; Barták, V; Landor, I

2016-01-01

frequent complication and had to be removed in six patients (4.5%). No early infection was recorded and late infection was treated in three patients. The prosthesis had to be removed and ankle arthrodesis performed in seven patients (5.3%). All had necrosis of the talus with ankle instability. In five, the retrograde nail Medin was used and extensive defects remaining after talar necrosis were filled with massive bone grafts obtained from a bone bank. One patient required tibio-calcaneal arthrodesis with external fixator; surgery in one case involved the use of a Zimmer Trabecular Metal Ankle Fusion Spacer with retrograde nail fixation. The development of cystic radiolucencies adjacent to tibial or talar components presents another post-operative complication. It was recorded mostly in the patients after AES implantation, in whom eight of 52 (15.3%) had these findings. DISCUSSION Total ankle arthroplasty is a complicated surgical procedure potentially associated with various technical problems. The occurrence of complications is indirectly related to the experience of the orthopaedist performing surgery; literature data show that the number of complication decreases with an increased frequency of ankle replacements done. CONCLUSIONS Total ankle arthroplasty, as every orthopaedic surgery, has its advantages and disadvantages. The positive aspects are pain relief and improved mobility of the ankle allowing for physiological gait. However, it shows a lower survivorship rate that the other large joint replacements. A successful outcome depends on the correct indication. The ankle should be stable, the talus without signs of necrosis and valgus or varus deviations of the ankle should not exceed 10 to 15 degrees. total ankle arthroplasty, re-implantation, aseptic loosening, retrograde nail, Trabecular Metal spacer, revision arthroplasty.

Syndesmotic ankle sprain.

Science.gov (United States)

Childs, Sharon G

2012-01-01

Ankle sprain injuries are the most common type of joint sprain. The prevalence of ankle joint sprains accounts for 21% of joint injuries in the body. Although somewhat rare, high-ankle or syndesmotic ankle sprains occur in up to 15% of ankle trauma. This article will present the pathomechanics of the high-ankle or syndesmotic sprain.

Ankle sprain (image)

Science.gov (United States)

An ankle sprain is a common injury to the ankle. The most common way the ankle is injured is when ... swelling, inflammation, and bruising around the ankle. An ankle sprain injury may take a few weeks to many ...

A Biomechanical Comparison of 3 Different Arthroscopic Lateral Ankle Stabilization Techniques in 36 Cadaveric Ankles.

Science.gov (United States)

Cottom, James M; Baker, Joseph S; Richardson, Phillip E; Maker, Jared M

Arthroscopic lateral ankle stabilization has become an increasingly popular option among foot and ankle surgeons to address lateral ankle instability, because it combines a modified Broström-Gould procedure with the ability to address any intra-articular pathologic findings at the same session. The present study evaluated 3 different constructs in a cadaveric model. Thirty-six fresh frozen cadaver limbs were used, and the anterior talofibular ligament was identified and sectioned. The specimens were then placed into 1 of 3 groups. Group 1 received a repair with a single-row, 2-suture anchor construct; group 2 received repair with a novel, double-row, 4-anchor knotless construct; and group 3 received repair with a double-row, 3-anchor construct. Specimens were then tested for stiffness and load to ultimate failure using a customized jig. Stiffness was measured in each of the groups and was 12.10 ± 5.43 (range 5.50 to 22.24) N/mm for group 1, 13.40 ± 7.98 (range 6.71 to 36.28) N/mm for group 2, and 12.55 ± 4.00 (range 6.48 to 22.14) N/mm for group 3. No significant differences were found among the 3 groups in terms of stiffness (p = .939, 1-way analysis of variance, ɑ = 0.05). The groups were tested to failure, with observed force measurements of 156.43 ± 30.39 (range 83.69 to 192.00) N for group 1, 206.62 ± 55.62 (range 141.37 to 300.29) N for group 2, and 246.82 ± 82.37 (range 164.26 to 384.93) N for group 3. Statistically significant differences were noted between groups 1 and 3 (p = .006, 1-way analysis of variance, ɑ = 0.05). The results of the present study have shown that a previously reported arthroscopic lateral ankle stabilization procedure, when modified with an additional proximal suture anchor into the fibula, results in a statistically significant increase in strength in terms of the maximum load to failure. Additionally, we have described a previously unreported, knotless technique for arthroscopic lateral ankle

Acute Ankle Sprain in a Mouse Model: Changes in Knee-Joint Space.

Science.gov (United States)

Hubbard-Turner, Tricia; Wikstrom, Erik A; Guderian, Sophie; Turner, Michael J

2017-06-02

  Ankle sprains remain the most common orthopaedic injury. Conducting long-term studies in humans is difficult and costly, so the long-term consequences of an ankle sprain are not entirely known.   To measure knee-joint space after a single surgically induced ankle sprain in mice.   Randomized controlled trial.   University research laboratory.   Thirty male mice (CBA/2J) were randomly placed into 1 of 3 surgical groups: the transected calcaneofibular ligament (CFL) group, the transected anterior talofibular ligament/CFL group, or a sham treatment group. The right ankle was operated on in all mice.   Three days after surgery, all of the mice were individually housed in cages containing a solid-surface running wheel, and daily running-wheel measurements were recorded. Before surgery and every 6 weeks after surgery, a diagnostic ultrasound was used to measure medial and lateral knee-joint space in both hind limbs.   Right medial (P = .003), right lateral (P = .002), left medial (P = .03), and left lateral (P = .002) knee-joint spaces decreased across the life span. The mice in the anterior talofibular ligament/CFL group had decreased right medial (P = .004) joint space compared with the sham and CFL groups starting at 24 weeks of age and continuing throughout the life span. No differences occurred in contralateral knee-joint degeneration among any of the groups.   Based on current data, mice that sustained a surgically induced severe ankle sprain developed greater joint degeneration in the ipsilateral knee. Knee degeneration could result from accommodation to the laxity of the ankle or biomechanical alterations secondary to ankle instability. A single surgically induced ankle sprain could significantly affect knee-joint function.

Management of chronic lateral instability due to lateral collateral ligament deficiency after total knee arthroplasty: a case report

Directory of Open Access Journals (Sweden)

Petersilge William J

2010-05-01

Full Text Available Abstract Introduction Lateral instability following total knee arthroplasty (TKA is a rare condition with limited report of treatment options. The objective of this case presentation is to demonstrate the outcomes of different surgical procedures performed in a single patient with lateral collateral ligament (LCL deficiency. Case presentation We present a case of chronic lateral instability due to LCL deficiency after primary TKA in a 47-year-old Caucasian woman with an obesity problem. Multiple treatment options have been performed in order to manage this problem, including the following: ligament reconstruction; combined ligament reconstruction and constrained implant; and rotating-hinge knee prosthesis that was the most recent surgery. All ligament reconstruction procedures failed within one year. The varus-valgus constrained prosthesis provided stability for six years. Conclusions Ligament reconstruction alone cannot provide enough stability for the treatment of chronic lateral instability in patients with obesity problems and LCL deficiency. When the reconstruction fails, a salvage procedure with rotating-hinge knee is still available.

Ankle sprain - aftercare

Science.gov (United States)

Lateral ankle sprain - aftercare; Medial ankle sprain - aftercare; Medial ankle injury - aftercare; Ankle syndesmosis sprain - aftercare; Syndesmosis injury - aftercare; ATFL injury - aftercare; CFL injury - ...

The Effect of Backpack Load Carriage on the Kinetics and Kinematics of Ankle and Knee Joints During Uphill Walking.

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Lee, Jinkyu; Yoon, Yong-Jin; Shin, Choongsoo S

2017-12-01

The purpose of this study was to investigate the effect of load carriage on the kinematics and kinetics of the ankle and knee joints during uphill walking, including joint work, range of motion (ROM), and stance time. Fourteen males walked at a self-selected speed on an uphill (15°) slope wearing military boots and carrying a rifle in hand without a backpack (control condition) and with a backpack. The results showed that the stance time significantly decreased with backpack carriage (p < .05). The mediolateral impulse significantly increased with backpack carriage (p < .05). In the ankle joints, the inversion-eversion, and dorsi-plantar flexion ROM in the ankle joints increased with backpack carriage (p < .05). The greater dorsi-plantar flexion ROM with backpack carriage suggested 1 strategy for obtaining high plantar flexor power during uphill walking. The result of the increased mediolateral impulse and inversion-eversion ROM in the ankle joints indicated an increase in body instability caused by an elevated center of mass with backpack carriage during uphill walking. The decreased stance time indicated that an increase in walking speed could be a compensatory mechanism for reducing the instability of the body during uphill walking while carrying a heavy backpack.

Intrinsic risk factors of noncontact ankle sprains in soccer: a prospective study on 100 professional players.

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Fousekis, Konstantinos; Tsepis, Elias; Vagenas, George

2012-08-01

Ankle sprain is an extremely common injury in soccer players. Despite extensive research, the intrinsic cause of this injury under noncontact conditions remains unclear. To identify intrinsic risk factors for noncontact ankle sprains in professional soccer players. Cohort study; Level of evidence, 2 One hundred professional soccer players were assessed in the preseason for potential risk factors of noncontact ankle sprains. The assessment included (A) ankle joint asymmetries (right-left) in isokinetic muscle strength, flexibility, proprioception, and stability; (B) somatometric asymmetries; (C) previous injuries; and (D) lateral dominance traits. Noncontact ankle sprains were prospectively recorded and diagnosed for a full competition period (10 months). Seventeen of the players sustained at least 1 noncontact ankle sprain. Logistic regression revealed that players with (A) eccentric isokinetic ankle flexion strength asymmetries (odds ratio [OR] = 8.88; 95% confidence interval [CI], 1.95-40.36, P = .005), (B) increased body mass index (OR = 8.16; 95% CI, 1.42-46.63, P = .018), and (C) increased body weight (OR = 5.72; 95% CI, 1.37-23.95, P = .017 ) each had a significantly higher risk of a noncontact ankle sprain. A trend for younger players (OR = 0.28; 95% CI, 0.061-1.24, P = .092) and for players with ankle laxity asymmetries (OR = 3.38; 95% CI, 0.82-14.00, P = .093) to be at greater risk for ankle sprain was also apparent to the limit of statistical significance (.05 ankle flexors and increased body mass index and body weight raise the propensity for ankle sprains in professional soccer players. Age and asymmetries in ankle laxity are potential factors worth revisiting, as there was an indication for younger players and players with ankle instability to be at higher risk for ankle injury. Proper preseason evaluation may improve prevention strategies for this type of injury in soccer.

The efficacy of manual joint mobilisation/manipulation in treatment of lateral ankle sprains: a systematic review.

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Loudon, Janice K; Reiman, Michael P; Sylvain, Jonathan

2014-03-01

Lateral ankle sprains are common and can have detrimental consequences to the athlete. Joint mobilisation/manipulation may limit these outcomes. Systematically summarise the effectiveness of manual joint techniques in treatment of lateral ankle sprains. This review employed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. A computer-assisted literature search of MEDLINE, CINHAL, EMBASE, OVID and Physiotherapy Evidence Database (PEDro) (January 1966 to March 2013) was used with the following keywords alone and in combination 'ankle', 'sprain', 'injuries', 'lateral', 'manual therapy', and 'joint mobilisation'. The methodological quality of individual studies was assessed using the PEDro scale. After screening of titles, abstracts and full articles, eight articles were kept for examination. Three articles achieved a score of 10 of 11 total points; one achieved a score of 9; two articles scored 8; one article scored a 7 and the remaining article scored a 5. Three articles examined joint techniques for acute sprains and the remainder examined subacute/chronic ankle sprains. Outcome measures included were pain level, ankle range of motion, swelling, functional score, stabilometry and gait parameters. The majority of the articles only assessed these outcome measures immediately after treatment. No detrimental effects from the joint techniques were revealed in any of the studies reviewed. For acute ankle sprains, manual joint mobilisation diminished pain and increased dorsiflexion range of motion. For treatment of subacute/chronic lateral ankle sprains, these techniques improved ankle range-of-motion, decreased pain and improved function.

Subintimal angioplasty for below-the-ankle arterial occlusion in diabetic patients with chronic critical limb ischemia

International Nuclear Information System (INIS)

Xu Ying; Zhu Yueqi; Zhao Jungong; Wang Jianbo; Tan Huaqiao; Cheng Yingsheng; Li Minghua; Wang Jue; Cheng Yongde

2011-01-01

Objective: To assess the feasibility and efficacy of subintimal angioplasty (SA) for the treatment of below-the-arterial occlusion in diabetic patients with chronic critical limb ischemia (CLI). Methods: SA was adopted for 57 diseased lower limbs in 37 diabetic patients with chronic CLI and occlusive disease of the dorsalis pedis artery (DPA) and/or planter artery (PA), who were not suitable candidates for intraluminal angioplasty or bypass surgery. Of the total 57 diseased lower limbs, tissue loss was seen in 31 (54.4%) and pain was reported in 51 (89.5%). SA was carried out to create continuous arterial flow to the foot for limb salvage. Both before and after the procedure the clinical symptoms, DPA or PA pulse volume scores and ankle-brachial indexes (ABI) were determined in all patients, the results were compared and statistically analysed. During the follow-up period, the healing of the wound, the salvage of the diseased limb and the re-stenosis occurrence of the target vessels were evaluated. Kaplan-Meier curves were constructed to evaluate limb salvage, survival rate and freedom from amputation. Results: A total of 66 below-the-ankle arterial lesions were detected in 57 affected limbs. Of the 66 lesions, SA was successfully performed in 55 (83.3%). Before SA the median pulse volume scores and ABIs were 0.33±0.54 and 0.31±0.19 respectively, which became 2.04±1.05 and 0.80±0.14 respectively after SA, the differences in both median pulse volume scores and ABI were statistically significant (P<0.01 for both). One patient (2.7%) died within 30 days after the procedure. Mild complications, such as bleeding, thrombosis or angiospasm etc. occurred in five patents (13.5%). Twelve months after SA. Kaplan-Meier analysis showed that the limb salvage rate was 94.6%, the freedom from amputation was 89.2% and the survival rate was 97.3%. Conclusion: SA of the dorsalis pedis artery and/or planter artery is an effective technique for lower limb salvage in diabetic

Re-sprains during the first 3 months after initial ankle sprain are related to incomplete recovery: an observational study.

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van Middelkoop, Marienke; van Rijn, Rogier M; Verhaar, Jan A N; Koes, Bart W; Bierma-Zeinstra, Sita M A

2012-01-01

What are prognostic factors for incomplete recovery, instability, re-sprains and pain intensity 12 months after patients consult primary care practitioners for acute ankle sprains? Observational study. One hundred and two patients who consulted their general practitioner or an emergency department for an acute ankle sprain were included in the study. Possible prognostic factors were assessed at baseline and at 3 months follow-up. Outcome measures assessed at 12 months follow-up were self-reported recovery, instability, re-sprains and pain intensity. At 3 months follow-up, 65% of the participants reported instability and 24% reported one or more re-sprains. At 12 months follow-up, 55% still reported instability and more than 50% regarded themselves not completely recovered. None of the factors measured at baseline could predict the outcome at 12 months follow-up. Additionally, prognostic factors from the physical examination of the non-recovered participants at 3 months could not be identified. However, among the non-recovered participants at 3 months follow-up, re-sprains and self-reported pain at rest at 3 months were related to incomplete recovery at 12 months. A physical examination at 3 months follow-up for the non-recovered ankle sprain patient seems to have no additional value for predicting outcome at 12 months. However, for the non-recovered patients at 3 months follow-up, self-reported pain at rest and re-sprains during the first 3 months of follow-up seem to have a prognostic value for recovery at 12 months. Copyright © 2012 Australian Physiotherapy Association. Published by .. All rights reserved.

Ankle and pantalar arthrodeses using vascularized fibular grafts.

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Yajima, Hiroshi; Kobata, Yasunori; Tomita, Yasuharu; Kawate, Kenji; Sugimoto, Kazuya; Takakura, Yoshinori

2004-01-01

From 1989 to 1998 ankle and pantalar arthrodeses using vascularized fibular grafts were performed for seven patients. The indications for surgery were chronic nonunion following fracture of the distal tibia in four patients, rheumatoid arthritis in two, and talus necrosis in one. The ankle joint was fused in the two patients with a pilon fracture, and in the other five patients, both the ankle and subtalar joints were fused. In one patient, additional bone grafting was required for delayed union. In the other six patients, the mean period required to obtain radiographic bone union was 6 months (range, 4-9 months). The time until the patients could walk without braces ranged from 6 to 20 months (mean, 12.3 months). Local infection was not encountered in any patients. This procedure represents a viable option for patients in whom a standard, less complicated arthrodesis cannot be performed.

Ankle-foot orthoses that restrict dorsiflexion improve walking in polio survivors with calf muscle weakness

NARCIS (Netherlands)

Ploeger, Hilde E.; Bus, Sicco A.; Brehm, Merel-Anne; Nollet, Frans

2014-01-01

In polio survivors with calf muscle weakness, dorsiflexion-restricting ankle-foot orthoses (DR-AFOs) aim to improve gait in order to reduce walking-related problems such as instability or increased energy cost. However, evidence on the efficacy of DR-AFOs in polio survivors is lacking. We

Musculoskeletal management of a patient with a history of chronic ankle sprains: identifying rupture of peroneal brevis and peroneal longus with diagnostic ultrasonography.

Science.gov (United States)

Bruin, Dick B; von Piekartz, Harry

2014-09-01

The purpose of this case report is to describe the use of mobilization and eccentric exercise training for a patient with ankle pain and a history of chronic ankle sprains and discuss the course of diagnostic decision making when the patient did not respond to care. A 48-year-old police officer who had sustained multiple ankle sprains throughout his life presented with pain and restriction in his ability to walk, run, and work. The Global Rating of Change Scale score was - 6, the Numeric Pain Rating Scale score was 7/10, and the Lower Extremity Functional Scale score was - 33. Palpation of the peroneus longus and brevis muscles and inversion with overpressure reproduced the chief concern (Numeric Pain Rating Scale 7/10). The patient was initially diagnosed with chronic peroneal tendinopathy. Treatment included lateral translation mobilization of the talocrural joint combined with eccentric exercise using an elastic band for the peroneal muscles. The patient reported improvement in pain and function during the course of intervention but not as rapidly as expected. Therefore, follow-up ultrasonographic imaging and radiography were performed. These studies revealed partial rupture of the peroneal brevis muscle and total rupture of the peroneal longus muscle. A patient with long-term concerns of the foot complex with a diagnosis of peroneal tendinopathy showed slight improvement with eccentric exercises combined with manual therapy of the talocrural joint. After a course of treatment but minimal response, a diagnosis of tendon rupture was confirmed with diagnostic ultrasonography. Clinicians should be aware that when injuries do not improve with care, tendon rupture should be considered.

Ankle Sprains

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... Staying Safe Videos for Educators Search English Español Ankle Sprains KidsHealth / For Teens / Ankle Sprains What's in this ... How Do I Know if I Have a Sprain? If your ankle hurts enough after an injury that you need ...

Expecting ankle tilts and wearing an ankle brace influence joint control in an imitated ankle sprain mechanism during walking.

Science.gov (United States)

Gehring, Dominic; Wissler, Sabrina; Lohrer, Heinz; Nauck, Tanja; Gollhofer, Albert

2014-03-01

A thorough understanding of the functional aspects of ankle joint control is essential to developing effective injury prevention. It is of special interest to understand how neuromuscular control mechanisms and mechanical constraints stabilize the ankle joint. Therefore, the aim of the present study was to determine how expecting ankle tilts and the application of an ankle brace influence ankle joint control when imitating the ankle sprain mechanism during walking. Ankle kinematics and muscle activity were assessed in 17 healthy men. During gait rapid perturbations were applied using a trapdoor (tilting with 24° inversion and 15° plantarflexion). The subjects either knew that a perturbation would definitely occur (expected tilts) or there was only the possibility that a perturbation would occur (potential tilts). Both conditions were conducted with and without a semi-rigid ankle brace. Expecting perturbations led to an increased ankle eversion at foot contact, which was mediated by an altered muscle preactivation pattern. Moreover, the maximal inversion angle (-7%) and velocity (-4%), as well as the reactive muscle response were significantly reduced when the perturbation was expected. While wearing an ankle brace did not influence muscle preactivation nor the ankle kinematics before ground contact, it significantly reduced the maximal ankle inversion angle (-14%) and velocity (-11%) as well as reactive neuromuscular responses. The present findings reveal that expecting ankle inversion modifies neuromuscular joint control prior to landing. Although such motor control strategies are weaker in their magnitude compared with braces, they seem to assist ankle joint stabilization in a close-to-injury situation. Copyright © 2013 Elsevier B.V. All rights reserved.

Neuromuscular Alterations After Ankle Sprains: An Animal Model to Establish Causal Links After Injury.

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Lepley, Lindsey K; McKeon, Patrick O; Fitzpatrick, Shane G; Beckemeyer, Catherine L; Uhl, Timothy L; Butterfield, Timothy A

2016-10-01

The mechanisms that contribute to the development of chronic ankle instability are not understood. Investigators have developed a hypothetical model in which neuromuscular alterations that stem from damaged ankle ligaments are thought to affect periarticular and proximal muscle activity. However, the retrospective nature of these studies does not allow a causal link to be established. To assess temporal alterations in the activity of 2 periarticular muscles of the rat ankle and 2 proximal muscles of the rat hind limb after an ankle sprain. Controlled laboratory study. Laboratory. Five healthy adult male Long Evans rats (age = 16 weeks, mass = 400.0 ± 13.5 g). Indwelling fine-wire electromyography (EMG) electrodes were implanted surgically into the biceps femoris, medial gastrocnemius, vastus lateralis, and tibialis anterior muscles of the rats. We recorded baseline EMG measurements while the rats walked on a motor-driven treadmill and then induced a closed lateral ankle sprain by overextending the lateral ankle ligaments. After ankle sprain, the rats were placed on the treadmill every 24 hours for 7 days, and we recorded postsprain EMG data. Onset time of muscle activity, phase duration, sample entropy, and minimal detectable change (MDC) were assessed and compared with baseline using 2-tailed dependent t tests. Compared with baseline, delayed onset time of muscle activity was exhibited in the biceps femoris (baseline = -16.7 ± 54.0 milliseconds [ms]) on day 0 (5.2 ± 64.1 ms; t 4 = -4.655, P = .043) and tibialis anterior (baseline = 307.0 ± 64.2 ms) muscles on day 3 (362.5 ± 55.9 ms; t 4 = -5.427, P = .03) and day 6 (357.3 ± 39.6 ms; t 4 = -3.802, P = .02). Longer phase durations were observed for the vastus lateralis (baseline = 321.9 ± 92.6 ms) on day 3 (401.3 ± 101.2 ms; t 3 = -4.001, P = .03), day 4 (404.1 ± 93.0 ms; t 3 = -3.320, P = .048), and day 5 (364.6 ± 105.2 ms; t 3 = -3.963, P = .03) and for the tibialis anterior (baseline = 103.9 ± 16.4 ms

Revision anatomical reconstruction of the lateral ligaments of the ankle augmented with suture tape for patients with a failed Broström procedure.

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Cho, B K; Kim, Y M; Choi, S M; Park, H W; SooHoo, N F

2017-09-01

The aim of this prospective study was to evaluate the intermediate-term outcomes after revision anatomical ankle ligament reconstruction augmented with suture tape for a failed modified Broström procedure. A total of 30 patients with persistent instability of the ankle after a Broström procedure underwent revision augmented with suture tape. Of these, 24 patients who were followed up for more than two years were included in the study. There were 13 men and 11 women. Their mean age was 31.8 years (23 to 44). The mean follow-up was 38.5 months (24 to 56) The clinical outcome was assessed using the Foot and Ankle Outcome Score (FAOS) and the Foot and Ankle Ability Measure (FAAM) score. The stability of the ankle was assessed using stress radiographs. The mean FAOS and FAAM scores improved significantly to 87.5 (73 to 94) and 85.1 (70 to 95) points at final follow-up, respectively (p failed in one patient who underwent a further revision using allograft tendon. The revision modified Broström procedure augmented with suture tape is an effective form of treatment for recurrent instability of the ankle following a failed Broström procedure. This technique provides reliable stability and satisfactory clinical outcomes at intermediate-term follow-up. Cite this article: Bone Joint J 2017;99-B:1183-9. ©2017 The British Editorial Society of Bone & Joint Surgery.

Gait comparison of subjects with hemiplegia walking unbraced, with ankle-foot orthosis, and with Air-Stirrup brace.

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Burdett, R G; Borello-France, D; Blatchly, C; Potter, C

1988-08-01

The effects of the Air-Stirrup (AS) standard ankle brace on the gait of 19 subjects with hemiplegia resulting from a cerebrovascular accident who exhibited excessive subtalar joint motion were studied. Videotaped trials and footprint analyses were used to measure subjects' hip, knee, and ankle sagittal plane angles; inversion and eversion of the calcaneus; and time-distance gait characteristics. A one-way analysis of variance for repeated measures was used to compare the gait of 19 subjects with the AS brace and unbraced and 11 subjects with the AS brace, unbraced, and with an ankle-foot orthosis. The AS brace was associated with more calcaneal stability during standing than the unbraced condition. The ankle-foot orthosis was associated with less plantar flexion at foot-strike than either the AS brace or unbraced condition. Both the AS brace and the ankle-foot orthosis were associated with less mid-swing plantar flexion and increased step length on the paretic side compared with no brace. These results support the effectiveness of the AS brace in controlling inversion and eversion instability in patients with hemiplegia.

MR arthrography of the ankle joint

International Nuclear Information System (INIS)

Trattnig, S.; Rand, T.; Breitenseher, M.; Ba-Ssalamah, A.; Schick, S.; Imhof, H.

1999-01-01

Due to its superior soft tissue contrast conventional MRI is the imaging method of choice in the evaluation of ankle joint disorders. Conventional MR imaging can accurately demonstrate normal or acutely injured ligaments; however, in subacute and chronic injury joint fluid necessary for delineation of injured ligaments is absent and MR arthrography should be performed. MR arthrography uses the intraarticular injection of contrast material to distend the joint, yielding improved discrimination of intraarticular structures. This joint distension with MR arthrography is also helpful in the staging of osteochondritis dissecans, since in cases of unstable lesions tracking of contrast material into the interface can be more easily demonstrated. Finally, high contrast and joint distension by MR arthrography improves the detection of intraarticular loose bodies, which often require surgery. MR artrography, although invasive, may provide additional information in various ankle joint disorders. (orig.) [de

Influence of Elastic Bandage and Neoprene Ankle Support on Ankle Position Sense and Pain in Subjects with Ankle Sprain (Grade I & II

Directory of Open Access Journals (Sweden)

Basir Majdoleslami

2004-06-01

Full Text Available Objective: to investigate whether a neoprene ankle support and elastic bandage around the ankle joint of subjects with ankle sprain (grade I&II would , in short term (a reduce pain (b improve ankle joint position sense and comparison of their effect with each other if they have. Materials & Methods: In a semi-experimental study, 30 subjects (16men, 14 women, age between 16-52 with ankle sprain grade I&II. Subjects had to have at least 2cm from 10cm visual analogue scale (VAS of ankle pain for study entry. All patients were randomly assigned to either an elastic bandage or a neoprene ankle support. One week later they were assigned to the opposite selection. Joint position sense was assessed in the sitting position using an electrogoniometer and pain by VAS where 0cm equals no pain and 10 cm equals worst pain. ankle pain and JPS were assessed for each selection one week apart. During each visit assessment were performed at baseline and after 20 min of bandage/neoprene ankle support application. Results: the mean of scores for ankle variables JPS and VAS was taken and paired-t test and Wilcoxon signed rank test was employed to calculate the different between two trails. Neoprene ankle support had significant effect on ankle JPS (P=0.034. But elastic bandage had no effect (P=0.539. Both of them had significantly reduced ankle pain. (P=0.000  Conclusion: In subjects with both neoprene ankle support and elastic bandage reduced ankle pain with more effect of neoprene ankle support. Only the neoprene ankle support had effect on knee JPS.

Orthopaedic management of haemophilia arthropathy of the ankle.

Science.gov (United States)

Pasta, G; Forsyth, A; Merchan, C R; Mortazavi, S M J; Silva, M; Mulder, K; Mancuso, E; Perfetto, O; Heim, M; Caviglia, H; Solimeno, L

2008-07-01

Joint bleeding, or haemarthrosis, is the most common type of bleeding episode experienced by individuals with haemophilia A and B. This leads to changes within the joints, including synovial proliferation, which results in further bleeding and chronic synovitis. Blood in the joint can also directly damage the cartilage, and with repeated bleeding, there is progressive destruction of both cartilage and bone. The end result is known as haemophilic arthropathy. The joints most commonly affected are the knees, elbows and ankles, although any synovial joint may be involved. In the ankle, both the tibiotalar and subtalar joints may be affected and joint bleeding and arthropathy can lead to a number of deformities. Haemophilic arthropathy can be prevented through regular factor replacement prophylaxis and implementing physiotherapy. However, when necessary, there are multiple surgical and non-surgical options available. In early ankle arthropathy with absent or minimal joint changes, both radioisotopic and chemical synoviorthesis can be used to reduce the hypertrophied synovium. These procedures can decrease the frequency of bleeding episodes, minimizing the risk of articular cartilage damage. Achilles tendon lengthening can be performed, in isolation or in combination with other surgical measures, to correct Achilles tendon contractures. Both arthroscopic and open synovectomies are available as a means to remove the friable villous layer of the synovium and are often indicated when bleeding episodes cannot be properly controlled by factor replacement therapy or synoviorthesis. In the later stages of ankle arthropathy, other surgical options may be considered. Debridement may be indicated when there are loose pieces of cartilage or anterior osteophytes, and can help to improve the joint function, even in the presence of articular cartilage damage. Supramalleolar tibial osteotomy may be indicated in patients with a valgus deformity of the hindfoot without degenerative

Dorsoradial capsulodesis for trapeziometacarpal joint instability.

Science.gov (United States)

Rayan, Ghazi; Do, Viet

2013-02-01

We describe an alternative method for treating chronic trapeziometacarpal (TM) joint instability after acute injury or chronic repetitive use of the thumb by performing a dorsoradial capsulodesis procedure. The procedure is done by imbricating the redundant TM joint dorsoradial ligament and capsule after reducing the joint by pronating the thumb. The dorsoradial capsulodesis is a reasonable reconstructive option for chronic TM joint instability and subluxation. Copyright © 2013 American Society for Surgery of the Hand. Published by Elsevier Inc. All rights reserved.

Flexor Digitorum Accessorius Longus: Importance of Posterior Ankle Endoscopy

Directory of Open Access Journals (Sweden)

Jorge Pablo Batista

2015-01-01

Full Text Available Endoscopy for the posterior region of the ankle through two portals is becoming more widespread for the treatment of a large number of conditions which used to be treated with open surgery years ago. The tendon of the flexor hallucis longus (FHL travels along an osteofibrous tunnel between the posterolateral and posteromedial tubercles of the talus. Chronic inflammation of this tendon may lead to painful stenosing tenosynovitis. The aim of this report is to describe two cases depicting an accessory tendon which is an anatomical variation of the flexor hallucis longus in patients with posterior friction syndrome due to posterior ankle impingement and associated with a posteromedial osteochondral lesion of the talus. The anatomical variation (FDAL described was a finding during an endoscopy of the posterior region of the ankle, and we have spared it by sectioning the superior flexor retinaculum only. The accessory flexor digitorum longus is an anatomical variation and should be taken into account when performing an arthroscopy of the posterior region of the ankle. We recommend this treatment on this type of injury although we admit this does not make a definite conclusion.

Calcaneocuboid joint instability: a novel operative technique for anatomic reconstruction.

Science.gov (United States)

Lohrer, Heinz; Arentz, Sabine

2004-05-01

A case history of a 13-year-old female national top-level gymnast, suffering from calcaneocuboid joint instability, is presented. The procedure was done as an anatomic repair by capsular reefing, which was augmented using a local periosteal flap. Initially, the athlete twisted her ankle. Clinical investigation revealed no sign of a lateral ankle ligament injury, but following this initial examination, recurrent giving-way of the foot occurred. She additionally felt significant but diffuse pain on the lateral side of the foot during loading in training and competition. For 2 months she was unable to run and conservative treatment failed. Diagnosis of a calcaneocuboid instability was established 4 months after the initial lesion by clinical and x-ray stress examination of the calcaneocuboid joint. Open surgery was successfully performed. Early functional posttreatment was done and the patient returned to full high-level gymnastics ability 16 weeks after surgery. Two years later, a similar injury occurred to the opposite calcaneocuboid joint and the same operative procedure again led to full sports ability.

Ankle fracture - aftercare

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... this page: //medlineplus.gov/ency/patientinstructions/000548.htm Ankle fracture - aftercare To use the sharing features on this page, please enable JavaScript. An ankle fracture is a break in 1 or more ankle ...

MR imaging as a problem solving tool in posterior ankle pain: A review

Energy Technology Data Exchange (ETDEWEB)

Wong, Gloria N.L., E-mail: gnlwong@gmail.com; Tan, Tien Jin, E-mail: tien_jin_tan@cgh.com.sg

2016-12-15

Highlights: • Conditions causing posterior ankle pain may occur in isolation or in co-existence. • Identification of the causative pathology is therefore often difficult. • The pathology and MR imaging findings of common causative conditions are discussed. • MRI aids accurate and timely diagnoses in cases of posterior ankle pain. - Abstract: Posterior ankle pain is a cause of chronic pain and disability, afflicting a wide range of individuals. While proper identification of the cause is essential for timely and adequate treatment, identifying the cause and excluding mimickers is often challenging for the physician due to the complex nature of the joint. In addition, pathology that can cause posterior ankle pain may occur on their own or in co-existence. Clinical conditions that can present as posterior ankle pain include: posterior ankle impingement, Achilles tendon pathology, medial flexor tendon pathology, peroneal pathology, retrocalcaneal bursitis, posterior subtalar tarsal coalition, sinus tarsi, and tarsal tunnel syndrome. In this review we introduce current concepts of pathophysiology in the main conditions involved in posterior ankle pain, and review the role of MR in the diagnosis and management of each condition. When pathology can be detected earlier and with more specificity, appropriate and time-sensitive treatment can be commenced, thus improving clinical outcomes.

MR imaging as a problem solving tool in posterior ankle pain: A review

International Nuclear Information System (INIS)

Wong, Gloria N.L.; Tan, Tien Jin

2016-01-01

Highlights: • Conditions causing posterior ankle pain may occur in isolation or in co-existence. • Identification of the causative pathology is therefore often difficult. • The pathology and MR imaging findings of common causative conditions are discussed. • MRI aids accurate and timely diagnoses in cases of posterior ankle pain. - Abstract: Posterior ankle pain is a cause of chronic pain and disability, afflicting a wide range of individuals. While proper identification of the cause is essential for timely and adequate treatment, identifying the cause and excluding mimickers is often challenging for the physician due to the complex nature of the joint. In addition, pathology that can cause posterior ankle pain may occur on their own or in co-existence. Clinical conditions that can present as posterior ankle pain include: posterior ankle impingement, Achilles tendon pathology, medial flexor tendon pathology, peroneal pathology, retrocalcaneal bursitis, posterior subtalar tarsal coalition, sinus tarsi, and tarsal tunnel syndrome. In this review we introduce current concepts of pathophysiology in the main conditions involved in posterior ankle pain, and review the role of MR in the diagnosis and management of each condition. When pathology can be detected earlier and with more specificity, appropriate and time-sensitive treatment can be commenced, thus improving clinical outcomes.

Correlation between radiological assessment of acute ankle fractures and syndesmotic injury on MRI

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Hermans, J.J. [Radboud University Nijmegen Medical Center, Department of Radiology, P.O. Box 9101, Nijmegen (Netherlands); Wentink, N. [Atrium Medisch Centrum, Department of Surgery, PO Box 4446, Heerlen (Netherlands); Beumer, A.; Moonen, A.F.C.M. [Amphia Ziekenhuis Hospital, Department of Orthopaedics, PO Box 90158, Breda (Netherlands); Hop, W.C.J. [Erasmus University Medical Center Rotterdam, Department of Biostatistics, PO Box 2040, Rotterdam (Netherlands); Heijboer, M.P. [Erasmus University Medical Center Rotterdam, Department of Orthopaedics, PO Box 2040, Rotterdam (Netherlands); Ginai, A.Z. [Erasmus University Medical Center Rotterdam, Department of Radiology, PO Box 2040, Rotterdam (Netherlands)

2012-07-15

Owing to the shortcomings of clinical examination and radiographs, injury to the syndesmotic ligaments is often misdiagnosed. When there is no indication requiring that the fractured ankle be operated on, the syndesmosis is not tested intra-operatively, and rupture of this ligamentous complex may be missed. Subsequently the patient is not treated properly leading to chronic complaints such as instability, pain, and swelling. We evaluated three fracture classification methods and radiographic measurements with respect to syndesmotic injury. Prospectively the radiographs of 51 consecutive ankle fractures were classified according to Weber, AO-Mueller, and Lauge-Hansen. Both the fracture type and additional measurements of the tibiofibular clear space (TFCS), tibiofibular overlap (TFO), medial clear space (MCS), and superior clear space (SCS) were used to assess syndesmotic injury. MRI, as standard of reference, was performed to evaluate the integrity of the distal tibiofibular syndesmosis. The sensitivity and specificity for detection of syndesmotic injury with radiography were compared to MRI. The Weber and AO-Mueller fracture classification system, in combination with additional measurements, detected syndesmotic injury with a sensitivity of 47% and a specificity of 100%, and Lauge-Hansen with both a sensitivity and a specificity of 92%. TFCS and TFO did not correlate with syndesmotic injury, and a widened MCS did not correlate with deltoid ligament injury. Syndesmotic injury as predicted by the Lauge-Hansen fracture classification correlated well with MRI findings. With MRI the extent of syndesmotic injury and therefore fracture stage can be assessed more accurately compared to radiographs. (orig.)

Influence of ankle joint plantarflexion and dorsiflexion on lateral ankle sprain: A computational study.

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Purevsuren, Tserenchimed; Kim, Kyungsoo; Batbaatar, Myagmarbayar; Lee, SuKyoung; Kim, Yoon Hyuk

2018-05-01

Understanding the mechanism of injury involved in lateral ankle sprain is essential to prevent injury, to establish surgical repair and reconstruction, and to plan reliable rehabilitation protocols. Most studies for lateral ankle sprain posit that ankle inversion, internal rotation, and plantarflexion are involved in the mechanism of injury. However, recent studies indicated that ankle dorsiflexion also plays an important role in the lateral ankle sprain mechanism. In this study, the contributions of ankle plantarflexion and dorsiflexion on the ankle joint were evaluated under complex combinations of internal and inversion moments. A multibody ankle joint model including 24 ligaments was developed and validated against two experimental cadaveric studies. The effects of ankle plantarflexion (up to 60°) and dorsiflexion (up to 30°) on the lateral ankle sprain mechanism under ankle inversion moment coupled with internal rotational moment were investigated using the validated model. Lateral ankle sprain injuries can occur during ankle dorsiflexion, in which the calcaneofibular ligament and anterior talofibular ligament tears may occur associated with excessive inversion and internal rotational moment, respectively. Various combinations of inversion and internal moment may lead to anterior talofibular ligament injuries at early ankle plantarflexion, while the inversion moment acts as a primary factor to tear the anterior talofibular ligament in early plantarflexion. It is better to consider inversion and internal rotation as primary factors of the lateral ankle sprain mechanism, while plantarflexion or dorsiflexion can be secondary factor. This information will help to clarify the lateral ankle sprain mechanism of injury.

Ankle Sprain Treatment

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... Issues Listen Español Text Size Email Print Share Ankle Sprain Treatment Page Content Article Body Acute ankle and ... Pediatrics summarizing the treatment phases of rehabilitation for ankle sprain. Phase Summary Description I Phase I treatment involves ...

Fatigue Stress Fracture of the Talar Body: An Uncommon Cause of Ankle Pain.

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Kim, Young Sung; Lee, Ho Min; Kim, Jong Pil; Moon, Han Sol

2016-01-01

Fatigue stress fractures of the talus are rare and usually involve the head of the talus in military recruits. We report an uncommon cause of ankle pain due to a fatigue stress fracture of the body of the talus in a 32-year-old male social soccer player. Healing was achieved after weightbearing suppression for 6 weeks. Although rare, a stress fracture of the body of the talus should be considered in an athlete with a gradual onset of chronic ankle pain. Magnetic resonance imaging and bone scan are useful tools for early diagnosis. Copyright © 2016 American College of Foot and Ankle Surgeons. Published by Elsevier Inc. All rights reserved.

Injury of the ankle joint ligaments; Bandverletzungen des Sprunggelenks

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Breitenseher, M.J. [Institut fuer Radiologie, Landesklinikum Waldviertel Horn, Horn (Austria); Karl Landsteiner Institut, St. Poelten (Austria)

2007-03-15

The diagnosis of lateral collateral ankle ligament trauma is based on patient history, clinical examination and clinical stress tests. If the clinical stress test is positive, stress radiography can be performed. There is, however, no consensus about the usefulness of stress radiography in acute ankle sprain, and in particular about the cut-off talar tilt angle beyond which a two-ligament rupture would be certain, ranging from 5 to 30 . Today, magnetic resonance imaging (MRI) is not used in this area, although it does allow controlled positioning of the foot and defined section visualization of injured lateral collateral ankle ligaments. In acute and chronic sinus tarsi injuries, MRI forms the established basis for diagnostic imaging, and can provide a definitive answer in most cases. MRI is also the method of choice for chronic posttraumatic pain with anterolateral impingement after rupture of the anterior talofibular ligament. Generally, for the evaluation of acute ankle injuries, MRI has developed to be the most important second-step procedure when projection radiology is non-diagnostic. (orig.) [German] Die Diagnose einer lateralen Bandverletzung nach einem Sprunggelenktrauma basiert auf der Anamnese, der klinischen Untersuchung und klinischen Stresstests. Bei positiven klinischen Stresstests kann eine Stressradiographie durchgefuehrt werden. Es gibt keine Uebereinstimmung hinsichtlich des Stellenwerts der Stressradiographie beim frischen Supinationstrauma des Sprunggelenks, insbesondere fuer den Winkel der Aufklappbarkeit bei einer Zweibandverletzung, der von 5 -30 reicht. Die MRT wird bei dieser Indikation zurzeit nur in Einzelfaellen benutzt, obwohl sie mit definierter Fusspositionierung und Ausrichtung der Untersuchungsebene eine ausgezeichnete Beurteilung der Sprunggelenkbaender erlaubt. Sie ist im besonderen Masse geeignet, akute und chronische Verletzungen des Sinus tarsi zu beurteilen. Bei chronischen Beschwerden nach Bandverletzung ist die MRT zur

LATERAL ANKLE INJURY

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Pollard, Henry; Sim, Patrick; McHardy, Andrew

2002-01-01

Background: Injury to the ankle joint is the most common peripheral joint injury. The sports that most commonly produce high ankle injury rates in their participating athletes include: basketball, netball, and the various codes of football. Objective: To provide an up to date understanding of manual therapy relevant to lateral ligament injury of the ankle. A discussion of the types of ligament injury and common complicating factors that present with lateral ankle pain is presented along with ...

Clinical tests of ankle plantarflexor strength do not predict ankle power generation during walking.

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Kahn, Michelle; Williams, Gavin

2015-02-01

The aim of this study was to investigate the relationship between a clinical test of ankle plantarflexor strength and ankle power generation (APG) at push-off during walking. This is a prospective cross-sectional study of 102 patients with traumatic brain injury. Handheld dynamometry was used to measure ankle plantarflexor strength. Three-dimensional gait analysis was performed to quantify ankle power generation at push-off during walking. Ankle plantarflexor strength was only moderately correlated with ankle power generation at push-off (r = 0.43, P < 0.001; 95% confidence interval, 0.26-0.58). There was also a moderate correlation between ankle plantarflexor strength and self-selected walking velocity (r = 0.32, P = 0.002; 95% confidence interval, 0.13-0.48). Handheld dynamometry measures of ankle plantarflexor strength are only moderately correlated with ankle power generation during walking. This clinical test of ankle plantarflexor strength is a poor predictor of calf muscle function during gait in people with traumatic brain injury.

Comparison of custom-moulded ankle orthosis with hinged joints and off-the-shelf ankle braces in preventing ankle sprain in lateral cutting movements.

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Lee, Winson C C; Kobayashi, Toshiki; Choy, Barton T S; Leung, Aaron K L

2012-06-01

A custom moulded ankle orthosis with hinged joints potentially offers a better control over the subtalar joint and the ankle joint during lateral cutting movements, due to total contact design and increase in material strength. To test the above hypothesis by comparing it to three other available orthoses. Repeated measures. Eight subjects with a history of ankle sprains (Grade 2), and 11 subjects without such history performed lateral cutting movements in four test conditions: 1) non-orthotic, 2) custom-moulded ankle orthosis with hinges, 3) Sport-Stirrup, and 4) elastic ankle sleeve with plastic support. A VICON motion analysis system was used to study the motions at the ankle and subtalar joints. The custom-moulded ankle orthosis significantly lowered the inversion angle at initial contact (p = 0.006) and the peak inversion angle (p = 0.000) during lateral cutting movements in comparison to non-orthotic condition, while the other two orthoses did not. The three orthoses did not affect the plantarflexion motions, which had been suggested by previous studies to be important in shock wave attenuation. The custom-moulded ankle orthosis with hinges could better control inversion and thus expected to better prevent ankle sprain in lateral cutting movements. Custom-moulded ankle orthoses are not commonly used in preventing ankle sprains. This study raises the awareness of the use of custom-moulded ankle orthoses which are expected to better prevent ankle sprains.

Weightbearing vs Gravity Stress Radiographs for Stability Evaluation of Supination-External Rotation Fractures of the Ankle.

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Seidel, Angela; Krause, Fabian; Weber, Martin

2017-07-01

Isolated lateral malleolar fractures may result from a supination-external rotation (SER) injury of the ankle. Stable fractures maintain tibiotalar congruence due to competent medial restraints and can be treated nonoperatively with excellent functional results and long-term prognosis. Stability might be assessed with either stress radiographs or weightbearing radiographs. A consecutive series of patients with closed SER fractures (presumed AO 44-B1) were prospectively enrolled from 2008 to 2015. Patients with clearly unstable fractures (medial clear space more than 7 mm) on the initial nonweightbearing radiograph were excluded and operated on. All other patients were examined with a gravity stress and a weightbearing anteroposterior radiograph. Borderline instability of the fracture was assumed when the medial clear space was 4 to 7 mm. Those were treated nonoperatively. Of 104 patients with isolated lateral malleolar fractures of the SER type, 14 patients were treated operatively because of clear instability (displacement) on the initial radiographs. Of the nonoperative patients, 44 patients demonstrated borderline instability on the gravity stress but stability on the weightbearing radiograph ("gravity borderline"); the remaining 46 were stable in both tests ("gravity stable"). At an average follow-up of 23 months, no significant differences were seen in the American Orthopaedic Foot & Ankle Society hindfoot score (92 points gravity-borderline group vs 93 points gravity-unstable group), the Foot Functional Index score (11 vs 10 points), the Short Form 36 (SF-36) physical component (86 vs 85 points), and SF-36 mental component (84 vs 81 points). Radiographically, all fractures had healed with anatomic congruity of the ankle. Weightbearing radiographs provided a reliable basis to decide about stability and nonoperative treatment in isolated lateral malleolar fractures of the SER type with excellent clinical and radiographic outcome at short-term follow-up. Gravity

The effects of total ankle replacement on ankle joint mechanics during walking

Directory of Open Access Journals (Sweden)

Henry Wang

2017-09-01

Conclusion: Three months after surgeries, the STAA patients experienced improvements in ankle function and gait parameters. The STAA ankle demonstrated improved ankle mechanics during daily activities such as walking.

10-year survival of total ankle arthroplasties: a report on 780 cases from the Swedish Ankle Register.

Science.gov (United States)

Henricson, Anders; Nilsson, Jan-Åke; Carlsson, Ake

2011-12-01

There is an ongoing need to review large series of total ankle replacements (TARs) for monitoring of changes in practice and their outcome. 4 national registries, including the Swedish Ankle Register, have previously reported their 5-year results. We now present an extended series with a longer follow-up, and with a 10-year survival analysis. Records of uncemented 3-component TARs were retrospectively reviewed, determining risk factors such as age, sex, and diagnosis. Prosthetic survival rates were calculated with exchange or removal of components as endpoint-excluding incidental exchange of the polyethylene meniscus. Of the 780 prostheses implanted since 1993, 168 (22%) had been revised by June 15, 2010. The overall survival rate fell from 0.81 (95% CI: 0.79-0.83) at 5 years to 0.69 (95% CI: 0.67-0.71) at 10 years. The survival rate was higher, although not statistically significantly so, during the latter part of the period investigated. Excluding the STAR prosthesis, the survival rate for all the remaining designs was 0.78 at 10 years. Women below the age of 60 with osteoarthritis were at a higher risk of revision, but age did not influence the outcome in men or women with rheumatoid arthritis. Revisions due to technical mistakes at the index surgery and instability were undertaken earlier than revisions for other reasons. The results have slowly improved during the 18-year period investigated. However, we do not believe that the survival rates of ankle replacements in the near future will approach those of hip and knee replacements-even though improved instrumentation and design of the prostheses, together with better patient selection, will presumably give better results.

Neuromuscular Control Mechanisms During Single-Leg Jump Landing in Subacute Ankle Sprain Patients: A Case Control Study.

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Allet, Lara; Zumstein, Franziska; Eichelberger, Patric; Armand, Stéphane; Punt, Ilona M

2017-03-01

Optimal neuromuscular control mechanisms are essential for preparing, maintaining, and restoring functional joint stability during jump landing and to prevent ankle injuries. In subacute ankle sprain patients, neither muscle activity nor kinematics during jump landing has previously been assessed. To compare neuromuscular control mechanisms and kinematics between subacute ankle sprain patients and healthy persons before and during the initial contact phase of a 25-cm single-leg jump. Case-control study. University hospital. Fifteen patients with grade I or II acute ankle sprains were followed up after 4 weeks of conservative management not involving physical therapy. Subjects performed alternately 3 single-leg forward jumps of 25 cm (toe-to-heel distance) barefoot. Their results were compared with the data of 15 healthy subjects. Electromyographic (EMG) activity of the musculus (m.) gastrocnemius lateralis, m. tibialis anterior, and m. peroneus longus as well as kinematics for ankle, knee, and hip joint were recorded for pre-initial contact (IC) phase, post-initial contact phase, and reflex-induced phase. The results showed that EMG activity of the 3 muscles did not differ between ankle sprain patients (n = 15) and healthy persons (n = 15) for any of the analyzed time intervals (all P > .05). However, during the pre-IC phase, ankle sprain patients presented less plantar flexion, as well as during the post-IC phase after jump landing, compared to healthy persons (P ankle joint can lead to neuromuscular control mechanism disturbances through which functional instability might arise. III. Copyright © 2017 American Academy of Physical Medicine and Rehabilitation. Published by Elsevier Inc. All rights reserved.

Reliability and smallest real difference of the ankle lunge test post ankle fracture.

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Simondson, David; Brock, Kim; Cotton, Susan

2012-02-01

This study aimed to determine the reliability and the smallest real difference of the Ankle Lunge test in an ankle fracture patient population. In the post immobilisation stage of ankle fracture, ankle dorsiflexion is an important measure of progress and outcome. The Ankle Lunge test measures weight bearing dorsiflexion, resulting in negative scores (knee to wall distance) and positive scores (toe to wall distance), for which the latter has proven reliability in normal subjects only. A consecutive sample of ankle fracture patients with permission to commence weight bearing, were recruited to the study. Three measurements of the Ankle Lunge Test were performed each by two raters, one senior and one junior physiotherapist. These occurred prior to therapy sessions in the second week after plaster removal. A standardised testing station was utilised and allowed for both knee to wall distance and toe to wall distance measurement. Data was collected from 10 individuals with ankle fracture, with an average age of 36 years (SD 14.8). Seventy seven percent of observations were negative. Intra and inter-rater reliability yielded intra class correlations at or above 0.97, p Ankle Lunge test is a practical and reliable tool for measuring weightbearing dorsiflexion post ankle fracture. Copyright © 2011 Elsevier Ltd. All rights reserved.

Primary ankle arthrodesis for neglected open Weber B ankle fracture dislocation.

Science.gov (United States)

Thomason, Katherine; Ramesh, Ashwanth; McGoldrick, Niall; Cove, Richard; Walsh, James C; Stephens, Michael M

2014-01-01

Primary ankle arthrodesis used to treat a neglected open ankle fracture dislocation is a unique decision. A 63-year-old man presented to the emergency department with a 5-day-old open fracture dislocation of his right ankle. After thorough soft tissue debridement, primary arthrodesis of the tibiotalar joint was performed using initial Kirschner wire fixation and an external fixator. Definitive soft tissue coverage was later achieved using a latissimus dorsi free flap. The fusion was consolidated to salvage the limb from amputation. The use of primary arthrodesis to treat a compound ankle fracture dislocation has not been previously described. Copyright © 2014 American College of Foot and Ankle Surgeons. Published by Elsevier Inc. All rights reserved.

Eden-Hybinette and Pectoralis Major Transfer for Recurrent Shoulder Instability Due to Failed Latarjet and Chronic Subscapularis Rupture.

Science.gov (United States)

Li, Xinning; Cusano, Antonio; Eichinger, Josef

2017-01-01

Shoulder dislocations are a common injury, with anterior shoulder dislocation among male patients being the most common presentation. A patient with recurrent shoulder instability, anterior-superior escape, and chronic subscapularis tendon rupture following multiple shoulder stabilization surgeries presents the surgeon with a complex and challenging case. This report describes a 40-year-old man with an extensive left shoulder history that included a failed Latarjet procedure, an irreparable, chronic subscapularis tear with grade 4 Goutallier fatty infiltration, and associated anterior-superior escape. Given his marked dysfunction, weakness, pain, and recurrent instability in the absence of glenohumeral arthritis, he underwent an open Eden-Hybinette procedure (iliac crest autograft), a pectoralis major transfer, and an anterior capsule repair. The patient returned to his previous work activities without limitations. To the authors' knowledge, this is the first report describing a combination of anterior glenoid bone grafting with a full pectoralis major muscle transfer for a patient with chronic subscapularis rupture and anterior-superior escape after a failed Latarjet procedure with minimum glenoid bone loss. Furthermore, the authors provide a biomechanical rationale for the reconstruction used for this problem. [Orthopedics. 2017; 40(1):e182-e187.]. Copyright 2016, SLACK Incorporated.

Ankle Problems

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... Read MoreDepression in Children and TeensRead MoreBMI Calculator Ankle ProblemsFollow this chart for more information about problems that can cause ankle pain. Our trusted Symptom Checker is written and ...

Total ankle joint replacement.

Science.gov (United States)

2016-02-01

Ankle arthritis results in a stiff and painful ankle and can be a major cause of disability. For people with end-stage ankle arthritis, arthrodesis (ankle fusion) is effective at reducing pain in the shorter term, but results in a fixed joint, and over time the loss of mobility places stress on other joints in the foot that may lead to arthritis, pain and dysfunction. Another option is to perform a total ankle joint replacement, with the aim of giving the patient a mobile and pain-free ankle. In this article we review the efficacy of this procedure, including how it compares to ankle arthrodesis, and consider the indications and complications. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://www.bmj.com/company/products-services/rights-and-licensing/

Correlation between Mechanical Properties of the Ankle Muscles and Postural Sway during the Menstrual Cycle.

Science.gov (United States)

Yim, JongEun; Petrofsky, Jerrold; Lee, Haneul

2018-03-01

Ankle and foot injuries are common among athletes and physically active individuals. The most common residual disability, ankle sprain, is characterized by instability along with postural sway. If the supporting structures around a joint become lax, posture stability and balance are also affected. Previous studies have examined muscle stiffness and elasticity and postural sway separately; however, the relationship between these factors is yet unknown. It is well known that the levels of sex hormones, especially estrogen, change in women over the phase of the menstrual cycle. Therefore, this study examined the relationship between the mechanical properties of tissue and balance activity using a non-invasive digital palpation device to determine if they undergo any changes over the menstrual cycle in young women. Sixteen young women with regular menstrual cycles completed the study. Tone, stiffness, and elasticity of the ankle muscles (lateral gastrocnemius, peroneus longus, and tibialis anterior) were measured using a non-invasive digital palpation device. Postural sway was recorded while the participants performed balance tasks during ovulation and menstruation. Significantly greater posture sway characteristics and ankle muscle elasticity were found during ovulation than during menstruation; lower tone and stiffness of the ankle muscles were observed at ovulation (p connective tissues. We therefore postulate that estrogen increases joint and muscle laxity and affects posture stability according to the phase of the menstrual cycle.

Three-dimensional analysis of injured lateral ligaments of the ankle with FISP MR imaging

International Nuclear Information System (INIS)

Vaes, P.; Shahabpour, M.; van Cauteren, M.; Osteaux, M.

1989-01-01

In a series of 150 acutely injured or chronically unstable ankles, oblique reconstructions of the anterior talo-fibular (TFA) and calcaneo-fibular (CF) ligaments were performed. Fast three-dimensional (3D) imaging with a flip angle of 40 degrees, a TR/TE of 30/10 msec, and 128 1-mm-thick sections allowed the evaluation of the whole ankle joint in 16 minutes. Partial or complete ruptures of TFA and/or CF ligaments as well as associated bone or cartilage occult fractures are detected. The authors discuss how, by enabling assessment of the severity of ankle sprains, 3D imaging was found to be helpful in defining when surgical therapy was necessary

Ankle taping can reduce external ankle joint moments during drop landings on a tilted surface.

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Sato, Nahoko; Nunome, Hiroyuki; Hopper, Luke S; Ikegami, Yasuo

2017-09-20

Ankle taping is commonly used to prevent ankle sprains. However, kinematic assessments investigating the biomechanical effects of ankle taping have provided inconclusive results. This study aimed to determine the effect of ankle taping on the external ankle joint moments during a drop landing on a tilted surface at 25°. Twenty-five participants performed landings on a tilted force platform that caused ankle inversion with and without ankle taping. Landing kinematics were captured using a motion capture system. External ankle inversion moment, the angular impulse due to the medio-lateral and vertical components of ground reaction force (GRF) and their moment arm lengths about the ankle joint were analysed. The foot plantar inclination relative to the ground was assessed. In the taping condition, the foot plantar inclination and ankle inversion angular impulse were reduced significantly compared to that of the control. The only component of the external inversion moment to change significantly in the taped condition was a shortened medio-lateral GRF moment arm length. It can be assumed that the ankle taping altered the foot plantar inclination relative to the ground, thereby shortening the moment arm of medio-lateral GRF that resulted in the reduced ankle inversion angular impulse.

Ankle fracture spur sign is pathognomonic for a variant ankle fracture.

Science.gov (United States)

Hinds, Richard M; Garner, Matthew R; Lazaro, Lionel E; Warner, Stephen J; Loftus, Michael L; Birnbaum, Jacqueline F; Burket, Jayme C; Lorich, Dean G

2015-02-01

The hyperplantarflexion variant ankle fracture is composed of a posterior tibial lip fracture with posterolateral and posteromedial fracture fragments separated by a vertical fracture line. This infrequently reported injury pattern often includes an associated "spur sign" or double cortical density at the inferomedial tibial metaphysis. The objective of this study was to quantitatively establish the association of the ankle fracture spur sign with the hyperplantarflexion variant ankle fracture. Our clinical database of operative ankle fractures was retrospectively reviewed for the incidence of hyperplantarflexion variant and nonvariant ankle fractures as determined by assessment of injury radiographs, preoperative advanced imaging, and intraoperative observation. Injury radiographs were then evaluated for the presence of the spur sign, and association between the spur sign and variant fractures was analyzed. The incidence of the hyperplantarflexion variant fracture among all ankle fractures was 6.7% (43/640). The spur sign was present in 79% (34/43) of variant fractures and absent in all nonvariant fractures, conferring a specificity of 100% in identifying variant fractures. Positive predictive value and negative predictive value were 100% and 99%, respectively. The ankle fracture spur sign was pathognomonic for the hyperplantarflexion variant ankle fracture. It is important to identify variant fractures preoperatively as patient positioning, operative approach, and fixation construct of variant fractures often differ from those employed for osteosynthesis of nonvariant fractures. Identification of the spur sign should prompt acquisition of advanced imaging to formulate an appropriate operative plan to address the variant fracture pattern. Level III, retrospective comparative study. © The Author(s) 2014.

Analysis of the Effects of Normal Walking on Ankle Joint Contact Characteristics After Acute Inversion Ankle Sprain.

Science.gov (United States)

Bae, Ji Yong; Park, Kyung Soon; Seon, Jong Keun; Jeon, Insu

2015-12-01

To show the causal relationship between normal walking after various lateral ankle ligament (LAL) injuries caused by acute inversion ankle sprains and alterations in ankle joint contact characteristics, finite element simulations of normal walking were carried out using an intact ankle joint model and LAL injury models. A walking experiment using a volunteer with a normal ankle joint was performed to obtain the boundary conditions for the simulations and to support the appropriateness of the simulation results. Contact pressure and strain on the talus articular cartilage and anteroposterior and mediolateral translations of the talus were calculated. Ankles with ruptured anterior talofibular ligaments (ATFLs) had a higher likelihood of experiencing increased ankle joint contact pressures, strains and translations than ATFL-deficient ankles. In particular, ankles with ruptured ATFL + calcaneofibular ligaments and all ruptured ankles had a similar likelihood as the ATFL-ruptured ankles. The push off stance phase was the most likely situation for increased ankle joint contact pressures, strains and translations in LAL-injured ankles.

Primary ankle arthrodesis for neglected open weber B ankle fracture dislocation.

LENUS (Irish Health Repository)

Thomason, Katherine

2014-07-01

Primary ankle arthrodesis used to treat a neglected open ankle fracture dislocation is a unique decision. A 63-year-old man presented to the emergency department with a 5-day-old open fracture dislocation of his right ankle. After thorough soft tissue debridement, primary arthrodesis of the tibiotalar joint was performed using initial Kirschner wire fixation and an external fixator. Definitive soft tissue coverage was later achieved using a latissimus dorsi free flap. The fusion was consolidated to salvage the limb from amputation. The use of primary arthrodesis to treat a compound ankle fracture dislocation has not been previously described.

Cadaver study of anatomic landmark identification for placing ankle arthroscopy portals.

Science.gov (United States)

Scheibling, B; Koch, G; Clavert, P

2017-05-01

Arthroscopy-assisted surgery is now widely used at the ankle for osteochondral lesions of the talus, anterior and posterior impingement syndromes, talocrural or subtalar fusion, foreign body removal, and ankle instability. Injuries to the vessels and nerves may occur during these procedures. To determine whether ultrasound topographic identification of vulnerable structures decreased the risk of iatrogenic injuries to vessels, nerves, and tendons and influenced the distance separating vulnerable structures from the arthroscope introduced through four different portals. Ultrasonography to identify vulnerable structures before or during arthroscopic surgery on the ankle may be useful. Twenty fresh cadaver ankles from body donations to the anatomy institute in Strasbourg, France, were divided into two equal groups. Preoperative ultrasonography to mark the trajectories of vessels, nerves, and tendons was performed in one group but not in the other. The portals were created using a 4-mm trocar. Each portal was then dissected. The primary evaluation criterion was the presence or absence of injuries to vessels, nerves, and tendons. The secondary evaluation criterion was the distance between these structures and the arthroscope. No tendon injuries occurred with ultrasonography. Without ultrasonography, there were two full-thickness tendon lesions, one to the extensor hallucis longus and the other to the Achilles tendon. Furthermore, with the anterolateral, anteromedial, and posteromedial portals, the distance separating the vessels and nerves from the arthroscope was greater with than without ultrasonography (P=0.041, P=0.005, and P=0.002), respectively; no significant difference was found with the anterior portal. Preoperative ultrasound topographic identification decreases the risk of iatrogenic injury to the vessels, nerves, and tendons during ankle arthroscopy and places these structures at a safer distance from the arthroscope. Our hypothesis was confirmed. IV

Ankle and knee biomechanics during normal walking following ankle plantarflexor fatigue.

Science.gov (United States)

Hunt, Michael A; Hatfield, Gillian L

2017-08-01

The purpose of this study was to investigate the immediate effects of unilateral ankle plantarflexor fatigue on bilateral knee and ankle biomechanics during gait. Lower leg kinematics, kinetics, and muscle activation were assessed before and after an ankle plantarflexor fatiguing protocol in 31 healthy individuals. Fatigue (defined as >10% reduction in maximal isometric ankle plantarflexor torque production and a downward shift in the median power frequency of both heads of the gastrocnemius muscle of the fatigued limb) was achieved in 18 individuals, and only their data were used for analysis purposes. Compared to pre-fatigue walking trials, medial gastrocnemius activity was significantly reduced in the study (fatigued) limb. Other main changes following fatigue included significantly more knee flexion during loading, and an associated larger external knee flexion moment in the study limb. At the ankle joint, participants exhibited significantly less peak plantarflexion (occurring at toe-off) with fatigue. No significant differences were observed in the contralateral (non-fatigued) limb. Findings from this study indicate that fatigue of the ankle plantarflexor muscle does not produce widespread changes in gait biomechanics, suggesting that small to moderate changes in maximal ankle plantarflexor force production capacity (either an increase or decrease) will not have a substantial impact on normal lower limb functioning during gait. Copyright © 2017 Elsevier Ltd. All rights reserved.

Ultrasonography of the ankle joint

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Park, Jung Won; Lee, Sun Joo; Choo, Hye Jung; Kim, Sung Kwan; Gwak, Heui Chul [Inje University Busan Paik Hospital, Inje University College of Medicine, Busan (Korea, Republic of); Lee, Sung Moon [Dept. of Radiology, Dae Kyung Imaging Center, Daegu (Korea, Republic of)

2017-10-15

Ankle disorders are a relatively common pathological condition, and ankle injuries account for approximately 14% of sports-related orthopedic emergency visits. Various imaging modalities can be used to make a diagnosis in cases of ankle pain; however, ultrasound (US) has several benefits for the evaluation of ankle pain, especially in the tendons, ligaments, and nerves of the ankle. The purpose of this article is to review the common causes of ankle pathology, with particular reference to US features. In addition, the importance of a dynamic evaluation and a stress test with US is emphasized.

Ultrasonography of the ankle joint

International Nuclear Information System (INIS)

Park, Jung Won; Lee, Sun Joo; Choo, Hye Jung; Kim, Sung Kwan; Gwak, Heui Chul; Lee, Sung Moon

2017-01-01

Ankle disorders are a relatively common pathological condition, and ankle injuries account for approximately 14% of sports-related orthopedic emergency visits. Various imaging modalities can be used to make a diagnosis in cases of ankle pain; however, ultrasound (US) has several benefits for the evaluation of ankle pain, especially in the tendons, ligaments, and nerves of the ankle. The purpose of this article is to review the common causes of ankle pathology, with particular reference to US features. In addition, the importance of a dynamic evaluation and a stress test with US is emphasized

Modern cartilage imaging of the ankle

International Nuclear Information System (INIS)

Weber, Marc-Andre; Wuennemann, Felix; Rehnitz, Christoph; Jungmann, Pia M.; Kuni, Benita

2017-01-01

Talar osteochondral lesions are an important risk factor for the development of talar osteoarthritis. Furthermore, osteochondral lesions might explain persistent ankle pain. Early diagnosis of accompanying chondral defects is important to establish the optimal therapy strategy and thereby delaying or preventing the onset of osteoarthritis. The purpose of this review is to explain modern cartilage imaging with emphasis of MR imaging as well as the discussion of more sophisticated imaging studies like CT-arthrography or functional MR imaging. Pubmed literature search concerning: osteochondral lesions, cartilage damage, ankle joint, talus, 2 D MR imaging, 3 D MR imaging, cartilage MR imaging, CT-arthrography, cartilage repair, microfracture, OATS, MACT. Dedicated MR imaging protocols to delineate talar cartilage and the appearance of acute and chronic osteochondral lesions were discussed. Recent developments of MR imaging, such as isotropic 3 D imaging that has a higher signal-to noise ratio when compared to 2 D imaging, and specialized imaging methods such as CT-arthrography as well as functional MR imaging were introduced. Several classifications schemes and imaging findings of osteochondral lesions that influence the conservative or surgical therapy strategy were discussed. MRI enables after surgery the non-invasive assessment of the repair tissue and the success of implantation. Key points: Modern MRI allows for highly resolved visualization of the articular cartilage of the ankle joint and of subchondral pathologies. Recent advances in MRI include 3 D isotropic ankle joint imaging, which deliver higher signal-to-noise ratios of the cartilage and less partial volume artifacts when compared with standard 2 D sequences. In case of osteochondral lesions MRI is beneficial for assessing the stability of the osteochondral fragment and for this discontinuity of the cartilage layer is an important factor. CT-arthrography can be used in case of contraindications of MRI and

Ankle Injuries and Disorders

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Your ankle bone and the ends of your two lower leg bones make up the ankle joint. Your ligaments, which connect bones to one ... muscles and tendons move it. The most common ankle problems are sprains and fractures. A sprain is ...

Stability-based classification for ankle fracture management and the syndesmosis injury in ankle fractures due to a supination external rotation mechanism of injury.

Science.gov (United States)

Pakarinen, Harri

2012-12-01

The aim of this thesis was to confirm the utility of stability-based ankle fracture classification in choosing between non-operative and operative treatment of ankle fractures, to determine how many ankle fractures are amenable to non-operative treatment, to assess the roles of the exploration and anatomical repair of the AITFL in the outcome of patients with SER ankle fractures, to establish the sensitivities, specificities and interobserver reliabilities of the hook and intraoperative stress tests for diagnosing syndesmosis instability in SER ankle fractures, and to determine whether transfixation of unstable syndesmosis is necessary in SER ankle fractures. The utility of stability based fracture classification to choose between non-operative and operative treatment was assessed in a retrospective study (1) of 253 ankle fractures in skeletally mature patients, 160 of whom were included in the study to obtain an epidemiological profile in a population of 130,000. Outcome was assessed after a minimum follow-up of two years. The role of AITFL repairs was assessed in a retrospective study (2) of 288 patients with Lauge-Hansen SE4 ankle fractures; the AITFL was explored and repaired in one group (n=165), and a similar operative method was used but the AITFL was not explored in another group (n=123). Outcome was measured with a minimum follow-up of two years. Interobserver reliability of clinical syndesomosis tests (study 3) and the role of syndesmosis transfixation (study 4) were assessed in a prospective study of 140 patients with Lauge-Hansen SE4 ankle fractures. The stability of the distal tibiofibular joint was evaluated by the hook and ER stress tests. Clinical tests were carried out by the main surgeon and assistant, separately, after which a 7.5-Nm standardized ER stress test for both ankles was performed; if it was positive, the patient was randomized to either syndesmosis transfixation (13 patients) or no fixation (11 patients) treatment groups. The

Customized Noise-Stimulation Intensity for Bipedal Stability and Unipedal Balance Deficits Associated With Functional Ankle Instability

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Ross, Scott E.; Linens, Shelley W.; Wright, Cynthia J.; Arnold, Brent L.

2013-01-01

Context: Stochastic resonance stimulation (SRS) administered at an optimal intensity could maximize the effects of treatment on balance. Objective: To determine if a customized optimal SRS intensity is better than a traditional SRS protocol (applying the same percentage sensory threshold intensity for all participants) for improving double- and single-legged balance in participants with or without functional ankle instability (FAI). Design: Case-control study with an embedded crossover design. Setting: Laboratory. Patients or Other Participants: Twelve healthy participants (6 men, 6 women; age = 22 ± 2 years, height = 170 ± 7 cm, mass = 64 ± 10 kg) and 12 participants (6 men, 6 women; age = 23 ± 3 years, height = 174 ± 8 cm, mass = 69 ± 10 kg) with FAI. Intervention(s): The SRS optimal intensity level was determined by finding the intensity from 4 experimental intensities at the percentage sensory threshold (25% [SRS25], 50% [SRS50], 75% [SRS75], 90% [SRS90]) that produced the greatest improvement in resultant center-of-pressure velocity (R-COPV) over a control condition (SRS0) during double-legged balance. We examined double- and single-legged balance tests, comparing optimal SRS (SRSopt1) and SRS0 using a battery of center-of-pressure measures in the frontal and sagittal planes. Main Outcome Measure(s): Anterior-posterior (A-P) and medial-lateral (M-L) center-of-pressure velocity (COPV) and center-of-pressure excursion (COPE), R-COPV, and 95th percentile center-of-pressure area ellipse (COPA-95). Results: Data were organized into bins that represented optimal (SRSopt1), second (SRSopt2), third (SRSopt3), and fourth (SRSopt4) improvement over SRS0. The SRSopt1 enhanced R-COPV (P ≤ .05) over SRS0 and other SRS conditions (SRS0 = 0.94 ± 0.32 cm/s, SRSopt1 = 0.80 ± 0.19 cm/s, SRSopt2 = 0.88 ± 0.24 cm/s, SRSopt3 = 0.94 ± 0.25 cm/s, SRSopt4 = 1.00 ± 0.28 cm/s). However, SRS did not improve R-COPV over SRS0 when data were categorized by sensory threshold

Sprained Ankles

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... away before the ligament is injured. Types of Sprains In young children, the ankle is the most commonly sprained joint, followed by ... A walking cast may be necessary if the ankle or foot injury has been severe. Most grade 1 sprains will heal within two weeks without subsequent complications. ...

Advancements in ankle arthroscopy

NARCIS (Netherlands)

van Dijk, C. Niek; van Bergen, Christiaan J. A.

2008-01-01

Important progress has been made during the past 30 years in arthroscopic ankle surgery. Ankle arthroscopy has gradually changed from a diagnostic to a therapeutic tool. Most arthroscopic procedures can be performed by using the anterior working area with the ankle in dorsiflexion or plantar

Complications in ankle arthroscopy

NARCIS (Netherlands)

Zengerink, Maartje; van Dijk, C. Niek

2012-01-01

To determine the complication rate for ankle arthroscopy. A review of a consecutive series of patients undergoing ankle arthroscopy in our hospital between 1987 and 2006 was undertaken. Anterior ankle arthroscopy was performed by means of a 2-portal dorsiflexion method with intermittent soft tissue

X-Ray Exam: Ankle

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... for Educators Search English Español X-Ray Exam: Ankle KidsHealth / For Parents / X-Ray Exam: Ankle What's in this article? What It Is Why ... You Have Questions Print What It Is An ankle X-ray is a safe and painless test ...

Ankle sprain

NARCIS (Netherlands)

Struijs, Peter; Kerkhoffs, Gino

2007-01-01

Injury of the lateral ligament complex of the ankle joint occurs in about one per 10,000 people a day, accounting for a quarter of all sports injuries. We conducted a systematic review and aimed to answer the following clinical question: What are the effects of treatment strategies for acute ankle

Ankle sprain

NARCIS (Netherlands)

Struijs, Peter Aa; Kerkhoffs, Gino Mmj

2010-01-01

Injury of the lateral ligament complex of the ankle joint occurs in about one in 10,000 people a day, accounting for a quarter of all sports injuries. We conducted a systematic review and aimed to answer the following clinical question: What are the effects of treatment strategies for acute ankle

[Conservative treatment using plasma rich in growth factors (PRGF) for injury to the ligamentous complex of the ankle].

Science.gov (United States)

Frei, R; Biosca, F E; Handl, M; Trc, T

2008-02-01

The authors describe the therapeutic utilization of separated/isolated autologous growth factors in semiconservative treatment of type III injury to the ankle ligamentous complex. Between October 2004 and March 2005 a group of 11 patients, two women and nine men, aged 18 to 41 (average, 25.09) years with acute injury to the lateral ligamentous complex of the ankle were treated by plasma rich in growth factors (PRGF) infiltration. On functional radiographic examination, the post-traumatic lateral opening of the tibiotalar intraarticular space was 17.45 degrees (range, 12.0-30.0; s = 5.68). The injured patients were clinically examined and standard forced inversion radiographs were made using topical anesthesia. Autologous PRGF activated with calcium chloride was used to infiltrate the injured tissues. The treatment was followed by immobilization of the joint and its subsequent rehabilitation. Clinical examination of injured tissues was carried out at 4 and 6 weeks of follow-up, using stability assessment tests and functional radiography of the ankle. Physical therapy included standard procedures, but faster regeneration of the soft tissues allowed for more exercises. The average time of healing was 5.18 weeks. Five patients showed no signs of instability at 4 weeks after therapy and could return to their previous sports activities. One patient had lateral ankle instability at 5 weeks and therefore the therapy continued with prolonged immobilization and then rehabilitation at a slower pace. The average lateral opening of the tibiotalar intra-articular space at 4 or 6 follow-up weeks was 4.73 degrees (range, 3.0 - 7.0; s = 1.19). At 6 weeks after therapy, 90.9% of the patients resumed their full sports activities. Ankle distortion with swelling, hematoma and pain, but with no radiographic findings of ligament lesions, is usually treated conservatively by ankle immobilization and early rehabilitation. When an injury to the fibular ankle ligaments occurs (i.e., opening

Ankle inversion taping using kinesiology tape for treating medial ankle sprain in an amateur soccer player

OpenAIRE

Lee, Sun-Min; Lee, Jung-Hoon

2015-01-01

[Purpose] The purpose of this study was to report the effects of ankle inversion taping using kinesiology tape in a patient with a medial ankle sprain. [Subject] A 28-year-old amateur soccer player suffered a Grade 2 medial ankle sprain during a match. [Methods] Ankle inversion taping was applied to the sprained ankle every day for 2 months. [Results] His symptoms were reduced after ankle inversion taping application for 2 months. The self-reported function score, the reach distances in the S...

Ankle Plantarflexor Spasticity Does Not Restrict the Recovery of Ankle Plantarflexor Strength or Ankle Power Generation for Push-Off During Walking Following Traumatic Brain Injury.

Science.gov (United States)

Williams, Gavin; Banky, Megan; Olver, John

2016-01-01

The main aim of this project was to determine the impact of plantarflexor spasticity on muscle performance for ambulant people with traumatic brain injury (TBI). A large metropolitan rehabilitation hospital. Seventy-two ambulant people with TBI who were attending physiotherapy for mobility limitations. Twenty-four participants returned for a 6-month follow-up reassessment. Cross-sectional cohort study. Self-selected walking speed, Tardieu scale, ankle plantarflexor strength, and ankle power generation (APG). Participants with ankle plantarflexor spasticity had significantly lower self-selected walking speed; however, there was no significant difference in ankle plantarflexor strength or APG. Participants with ankle plantarflexor spasticity were not restricted in the recovery of self-selected walking speed, ankle plantarflexor strength, or APG, indicating equivalent ability to improve their mobility over time despite the presence of spasticity. Following TBI, people with ankle plantarflexor spasticity have significantly greater mobility limitations than those without spasticity, yet retain the capacity for recovery of self-selected walking speed, ankle plantarflexor strength, and APG.

Ankle Fractures: The Operative Outcome

Directory of Open Access Journals (Sweden)

Ahmad Hafiz Z

2011-03-01

Full Text Available Ankle fractures are commonly seen in orthopaedic practice. This retrospective study of patients with ankle fractures who underwent surgical treatment in our institution from January 2000 to December 2003 was undertaken to analyze the common causes and patterns of ankle fractures; and the functional outcome of operative treatment for these fractures. Eighty patients were identified and reviewed. There were 65 male (81.3% and 15 female patients (18.7% with age ranging from 13 to 71 years old (mean, 32.3y. Common causes of ankle fractures were trauma (especially motor vehicle accidents, sports injuries and the osteoporotic bones in the elderly. Weber C (64.0% was the most common pattern of fracture at presentation. The most common operative treatment for ankle fractures was open reduction and internal fixation (73 patients, 91.2%. Excellent and good outcomes were achieved in 93.8% of cases when measured using the Olerud and Molander scoring system for foot and ankle. In conclusion, operative treatment for ankle fractures restores sufficient stability and allowed mobility of the ankle joint.

Assessment of Ankle Injuries

Science.gov (United States)

Mai, Nicholas; Cooper, Leslie

2009-01-01

School nurses are faced with the challenge of identifying and treating ankle injuries in the school setting. There is little information guiding the assessment and treatment of these children when an injury occurs. It is essential for school nurses to understand ankle anatomy, pathophysiology of the acute ankle injury, general and orthopedic…

Talofibular compartment of the ankle joint after recent ankle sprain

International Nuclear Information System (INIS)

Lindstrand, A.; Mortensson, W.; Norman, O.

1978-01-01

The validity of predicting the condition of the anterior talofibular ligament from the shape of the lateral compartment of the ankle joint was investigated in patients with recent ankle sprain. The diagnostic value of the method was found to be restricted. (Auth.)

Anterior ankle arthroscopy, distraction or dorsiflexion?

Science.gov (United States)

de Leeuw, Peter A J; Golanó, Pau; Clavero, Joan A; van Dijk, C Niek

2010-05-01

Anterior ankle arthroscopy can basically be performed by two different methods; the dorsiflexion- or distraction method. The objective of this study was to determine the size of the anterior working area for both the dorsiflexion and distraction method. The anterior working area is anteriorly limited by the overlying anatomy which includes the neurovascular bundle. We hypothesize that in ankle dorsiflexion the anterior neurovascular bundle will move away anteriorly from the ankle joint, whereas in ankle distraction the anterior neurovascular bundle is pulled tight towards the joint, thereby decreasing the safe anterior working area. Six fresh frozen ankle specimens, amputated above the knee, were scanned with computed tomography. Prior to scanning the anterior tibial artery was injected with contrast fluid and subsequently each ankle was scanned both in ankle dorsiflexion and in distraction. A special device was developed to reproducibly obtain ankle dorsiflexion and distraction in the computed tomography scanner. The distance between the anterior border of the inferior tibial articular facet and the posterior border of the anterior tibial artery was measured. The median distance from the anterior border of the inferior tibial articular facet to the posterior border of the anterior tibial artery in ankle dorsiflexion and distraction was 0.9 cm (range 0.7-1.5) and 0.7 cm (range 0.5-0.8), respectively. The distance in ankle dorsiflexion significantly exceeded the distance in ankle distraction (P = 0.03). The current study shows a significantly increased distance between the anterior distal tibia and the overlying anterior neurovascular bundle with the ankle in a slightly dorsiflexed position as compared to the distracted ankle position. We thereby conclude that the distracted ankle position puts the neurovascular structures more at risk for iatrogenic damage when performing anterior ankle arthroscopy.

Transfibular ankle arthrodesis: A novel method for ankle fusion - A short term retrospective study

Directory of Open Access Journals (Sweden)

S Muthukumar Balaji

2017-01-01

Full Text Available Background: Ankle arthrodesis has long been the traditional operative treatment for posttraumatic arthritis, rheumatoid arthritis, infection, neuromuscular conditions, and salvage of failed ankle arthroplasty. It remains the treatment of choice for patients in whom heavy and prolonged activity is anticipated. We present our short term followup study of functional outcome of patients who underwent transfibular ankle arthrodesis for arthritis of ankle due to various indications. Materials and Methods: 29 transfibular ankle arthrodesis in 29 patients performed between April 2009 and April 2014 were included in this study. The mean age was 50 years (range 22-75 years. The outcome analysis with a minimum of 1-year postoperative followup were included. All the patients were assessed with the American Orthopaedic Foot and Ankle Society (AOFAS Hindfoot scale. Results: All cases of ankle fusions (100% progressed to solid union in a mean postoperative duration of 3.8 months (range 3-6 months. All patients had sound arthrodesis. The mean followup period was 32.52 months (standard deviation ± 10.34. The mean AOFAS score was 74 (pain score = 32, functional score = 42. We found that twenty patients (68.96% out of 29, had excellent results, 7 (24.13% had good, and 2 (6.89% showed fair results. Conclusion: Transfibular ankle arthrodesis is a simple and effective procedure for ankle arthritis. It achieves a high rate of union and good functional outcome on midterm followup.

The adult ball-and-socket ankle joint: surgical management of late ankle and subtalar arthritis.

Science.gov (United States)

Lewis, John S; DeOrio, James K

2015-04-01

We review the surgical management of 4 adult patients with ball-and-socket ankle deformity who developed end-stage subtalar and/or ankle joint arthritis. We retrospectively reviewed a series of 4 adult patients with ball-and-socket ankle configurations who underwent surgical treatment for either end-stage tibiotalar or subtalar arthritis, with either subtalar arthrodesis or total ankle replacement (TAR). Clinical outcome, including subjective pain assessment, limitation of activities, and difficulty with shoe wear, were assessed at follow-up. A total of 5 ankles in 4 patients were identified that met the inclusion criteria. There were 3 subtalar arthrodeses in 2 patients and 2 primary TARs in 2 patients. At an average follow-up of 30.5 (range = 17 to 59) months, there were no failures, although 1 patient who underwent TAR was considered an impending failure with aseptic component loosening. Of the 4 patients, 3 resumed normal activity with minimal pain and were very pleased with their overall outcome. Standard surgical interventions for ankle and subtalar arthritis, such as total ankle arthroplasty and subtalar arthrodesis, can be successfully performed in patients with ball-and-socket ankles; clinical outcome and survivorship, however, may be inferior to that in patients with normal ankle configurations. Therapeutic, Level IV: Case Series. © 2014 The Author(s).

Current concepts: tissue engineering and regenerative medicine applications in the ankle joint.

Science.gov (United States)

Correia, S I; Pereira, H; Silva-Correia, J; Van Dijk, C N; Espregueira-Mendes, J; Oliveira, J M; Reis, R L

2014-03-06

Tissue engineering and regenerative medicine (TERM) has caused a revolution in present and future trends of medicine and surgery. In different tissues, advanced TERM approaches bring new therapeutic possibilities in general population as well as in young patients and high-level athletes, improving restoration of biological functions and rehabilitation. The mainstream components required to obtain a functional regeneration of tissues may include biodegradable scaffolds, drugs or growth factors and different cell types (either autologous or heterologous) that can be cultured in bioreactor systems (in vitro) prior to implantation into the patient. Particularly in the ankle, which is subject to many different injuries (e.g. acute, chronic, traumatic and degenerative), there is still no definitive and feasible answer to 'conventional' methods. This review aims to provide current concepts of TERM applications to ankle injuries under preclinical and/or clinical research applied to skin, tendon, bone and cartilage problems. A particular attention has been given to biomaterial design and scaffold processing with potential use in osteochondral ankle lesions.

The lambda sign: a new radiographic indicator of latent syndesmosis instability.

Science.gov (United States)

Ryan, Ltc Paul; Hills, Maj Chad; Chang, James; Wilson, Cpt David

2014-09-01

Latent syndesmotic instability is a common cause of chronic ankle pain. The diagnosis is not readily apparent on static imaging as the fibula remains reduced. The hypothesis of this study was that a previously undescribed novel finding on coronal MRI (lambda sign) is an independent indicator of latent syndesmosis instability. We also report on the utility of classic radiographic and physical exam findings. A total of 23 patients with latent syndesmotic instability diagnosed via arthroscopy (group I) were compared to a cohort of 40 patients who were found to have a stable syndesmosis during arthroscopy for unrelated conditions (group II). A retrospective chart review was performed evaluating their clinical history, preoperative physical examination, and radiologic findings. The lambda sign is a high intensity signal seen on coronal MR imaging that resembles the Greek letter lambda. All of the physical exam findings tested were statistically significant. Pain at the syndesmosis had the highest sensitivity (83%), while pain reproduced with the proximal squeeze test resulted in the highest specificity (89%). The external rotation stress test had the highest positive predictive value (75%). Of the radiographic examinations performed, only the lambda sign was found to have statistical significance with a sensitivity of 75% and a specificity of 63%. The presence of a lambda sign on the MRI of patients with physical exam findings suggestive of syndesmotic pain was highly sensitive (75%) and specific (85%). The lambda sign noted on the coronal MRI was both sensitive and specific for injuries involving greater than 2 mm of diastasis on arthroscopic stress examination of the syndesmosis. While neither the lambda sign nor any other finding on physical or radiographic examination represented an independent predictor of syndesmotic instability, the presence of a lambda sign in concert with positive physical exam findings might help health care providers determine which patients

Ankle Sprains. A Round Table.

Science.gov (United States)

Physician and Sportsmedicine, 1986

1986-01-01

Types of ankle sprains, surgical versus nonsurgical treatment, tape versus brace for support, rehabilitation, exercise, and prevention of ankle sprains are discussed by a panel of experts. An acute ankle taping technique is illustrated. (MT)

Foot, leg, and ankle swelling

Science.gov (United States)

Swelling of the ankles - feet - legs; Ankle swelling; Foot swelling; Leg swelling; Edema - peripheral; Peripheral edema ... Foot, leg, and ankle swelling is common when the person also: Is overweight Has a blood clot in the leg Is older Has ...

Ankle voluntary movement enhancement following robotic-assisted locomotor training in spinal cord injury.

Science.gov (United States)

Varoqui, Deborah; Niu, Xun; Mirbagheri, Mehdi M

2014-03-31

In incomplete spinal cord injury (iSCI), sensorimotor impairments result in severe limitations to ambulation. To improve walking capacity, physical therapies using robotic-assisted locomotor devices, such as the Lokomat, have been developed. Following locomotor training, an improvement in gait capabilities-characterized by increases in the over-ground walking speed and endurance-is generally observed in patients. To better understand the mechanisms underlying these improvements, we studied the effects of Lokomat training on impaired ankle voluntary movement, known to be an important limiting factor in gait for iSCI patients. Fifteen chronic iSCI subjects performed twelve 1-hour sessions of Lokomat training over the course of a month. The voluntary movement was qualified by measuring active range of motion, maximal velocity peak and trajectory smoothness for the spastic ankle during a movement from full plantar-flexion (PF) to full dorsi-flexion (DF) at the patient's maximum speed. Dorsi- and plantar-flexor muscle strength was quantified by isometric maximal voluntary contraction (MVC). Clinical assessments were also performed using the Timed Up and Go (TUG), the 10-meter walk (10MWT) and the 6-minute walk (6MWT) tests. All evaluations were performed both before and after the training and were compared to a control group of fifteen iSCI patients. After the Lokomat training, the active range of motion, the maximal velocity, and the movement smoothness were significantly improved in the voluntary movement. Patients also exhibited an improvement in the MVC for their ankle dorsi- and plantar-flexor muscles. In terms of functional activity, we observed an enhancement in the mobility (TUG) and the over-ground gait velocity (10MWT) with training. Correlation tests indicated a significant relationship between ankle voluntary movement performance and the walking clinical assessments. The improvements of the kinematic and kinetic parameters of the ankle voluntary movement

Spring-like Ankle Foot Orthoses reduce the energy cost of walking by taking over ankle work.

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Bregman, D J J; Harlaar, J; Meskers, C G M; de Groot, V

2012-01-01

In patients with central neurological disorders, gait is often limited by a reduced ability to push off with the ankle. To overcome this reduced ankle push-off, energy-storing, spring-like carbon-composite Ankle Foot Orthoses (AFO) can be prescribed. It is expected that the energy returned by the AFO in late stance will support ankle push-off, and reduce the energy cost of walking. In 10 patients with multiple sclerosis and stroke the energy cost of walking, 3D kinematics, joint power, and joint work were measured during gait, with and without the AFO. The mechanical characteristics of the AFO were measured separately, and used to calculate the contribution of the AFO to the ankle kinetics. We found a significant decrease of 9.8% in energy cost of walking when walking with the AFO. With the AFO, the range of motion of the ankle was reduced by 12.3°, and the net work around the ankle was reduced by 29%. The total net work in the affected leg remained unchanged. The AFO accounted for 60% of the positive ankle work, which reduced the total amount of work performed by the leg by 11.1% when walking with the AFO. The decrease in energy cost when walking with a spring-like energy-storing AFO in central neurological patients is not induced by an augmented net ankle push-off, but by the AFO partially taking over ankle work. Copyright © 2011 Elsevier B.V. All rights reserved.

Acute ankle sprain in dancers.

Science.gov (United States)

Russell, Jeffrey A

2010-01-01

Ankle sprain is a common injury in dancers. Because of the relative frequency of this injury and its wide acceptance as a likely part of an active lifestyle, in many individuals it may not receive the careful attention it deserves. An extreme ankle range of motion and excellent ankle stability are fundamental to success in dance. Hence, following a proper treatment protocol is crucial for allowing a dancer who suffers an ankle sprain to return to dance as soon as possible without impaired function. This article reviews the basic principles of the etiology and management of ankle sprain in dancers. Key concepts are on-site examination and treatment, early restoration, dance-specific rehabilitation, and a carefully administered safe return to dance. Additionally, injuries that may occur in conjunction with ankle sprain are highlighted, and practical, clinically relevant summary concepts for dance healthcare professionals, dance scientists, dance teachers, and dancers are provided.

Comparison of Multisegmental Foot and Ankle Motion Between Total Ankle Replacement and Ankle Arthrodesis in Adults.

Science.gov (United States)

Seo, Sang Gyo; Kim, Eo Jin; Lee, Doo Jae; Bae, Kee Jeong; Lee, Kyoung Min; Lee, Dong Yeon

2017-09-01

Total ankle replacement (TAR) and ankle arthrodesis (AA) are usually performed for severe ankle arthritis. We compared postoperative foot segmental motion during gait in patients treated with TAR and AA. Gait analysis was performed in 17 and 7 patients undergoing TAR and AA, respectively. Subjects were evaluated using a 3-dimensional multisegmental foot model with 15 markers. Temporal gait parameters were calculated. The maximum and minimum values and the differences in hallux, forefoot, hindfoot, and arch in 3 planes (sagittal, coronal, transverse) were compared between the 2 groups. One hundred healthy adults were evaluated as a control. Gait speed was faster in the TAR ( P = .028). On analysis of foot and ankle segmental motion, the range of hindfoot sagittal motion was significantly greater in the TAR (15.1 vs 10.2 degrees in AA; P = .004). The main component of motion increase was hindfoot dorsiflexion (12.3 and 8.6 degrees). The range of forefoot sagittal motion was greater in the TAR (9.3 vs 5.8 degrees in AA; P = .004). Maximum ankle power in the TAR (1.16) was significantly higher than 0.32 in AA; P = .008). However, the range of hindfoot and forefoot sagittal motion was decreased in both TAR and AA compared with the control group ( P = .000). Although biomechanical results of TAR and AA were not similar to those in the normal controls, joint motions in the TAR more closely matched normal values. Treatment decision making should involve considerations of the effect of surgery on the adjacent joints. Level III, case-control study.

Vladimir Byurchiev, Ankle Bones

OpenAIRE

Churyumov, Anton

2017-01-01

Vladimir says that today not many children play with ankle bones. He recalls when he was young, children played with bones more often. According to Vladimir, various games using ankle bones develop flexibility, agility, and muscle in children’s hands. Ankles bones are taken from the back legs of a cow or a sheep. It is possible to determine the age and health of animals by examining this particular bone. Arcadia

Prospective Computed Tomographic Analysis of Osteochondral Lesions of the Ankle Joint Associated With Ankle Fractures

NARCIS (Netherlands)

Nosewicz, Tomasz L.; Beerekamp, M. Suzan H.; de Muinck Keizer, Robert-Jan O.; Schepers, Tim; Maas, Mario; Niek van Dijk, C.; Goslings, J. Carel

2016-01-01

Osteochondral lesions (OCLs) associated with ankle fracture correlate with unfavorable outcome. The goals of this study were to detect OCLs following ankle fracture, to associate fracture type to OCLs and to investigate whether OCLs affect clinical outcome. 100 ankle fractures requiring operative

Prospective Computed Tomographic Analysis of Osteochondral Lesions of the Ankle Joint Associated With Ankle Fractures.

Science.gov (United States)

Nosewicz, Tomasz L; Beerekamp, M Suzan H; De Muinck Keizer, Robert-Jan O; Schepers, Tim; Maas, Mario; Niek van Dijk, C; Goslings, J Carel

2016-08-01

Osteochondral lesions (OCLs) associated with ankle fracture correlate with unfavorable outcome. The goals of this study were to detect OCLs following ankle fracture, to associate fracture type to OCLs and to investigate whether OCLs affect clinical outcome. 100 ankle fractures requiring operative treatment were prospectively included (46 men, 54 women; mean age 44 ± 14 years, range 20-77). All ankle fractures (conventional radiography; 71 Weber B, 22 Weber C, 1 Weber A, 4 isolated medial malleolus and 2 isolated posterior malleolus fractures) were treated by open reduction and internal fixation. Multidetector computed tomography (CT) was performed postoperatively. For each OCL, the location, size, and Loomer OCL classification (CT modified Berndt and Harty classification) were determined. The subjective Foot and Ankle Outcome Scoring (FAOS) was used for clinical outcome at 1 year. OCLs were found in 10/100 ankle fractures (10.0%). All OCLs were solitary talar lesions. Four OCLs were located posteromedial, 4 posterolateral, 1 anterolateral, and 1 anteromedial. There were 2 type I OCLs (subchondral compression), 6 type II OCLs (partial, nondisplaced fracture) and 2 type IV OCLs (displaced fracture). Mean OCL size (largest diameter) was 4.4 ± 1.7 mm (range, 1.7 mm to 6.2 mm). Chi-square analysis showed no significant association between ankle fracture type and occurrence of OCLs. OCLs did occur only in Lauge-Hansen stage III/IV ankle fractures. There were no significant differences in FAOS outcome between patients with or without OCLs. Ten percent of investigated ankle fractures had associated OCLs on CT. Although no significant association between fracture type and OCL was found, OCLs only occurred in Lauge-Hansen stage III/IV ankle fractures. With the numbers available, OCLs did not significantly affect clinical outcome at 1 year according to FAOS. Level IV, observational study. © The Author(s) 2016.

Clinical value of the Ottawa ankle rules for diagnosis of fractures in acute ankle injuries.

Directory of Open Access Journals (Sweden)

Xin Wang

Full Text Available BACKGROUND: The Ottawa ankle rules (OAR are clinical decision guidelines used to identify whether patients with ankle injuries need to undergo radiography. The OAR have been proven that their application reduces unnecessary radiography. They have nearly perfect sensitivity for identifying clinically significant ankle fractures. OBJECTIVES: The purpose of this study was to assess the applicability of the OAR in China, to examine their accuracy for the diagnosis of fractures in patients with acute ankle sprains, and to assess their clinical utility for the detection of occult fractures. METHODS: In this prospective study, patients with acute ankle injuries were enrolled during a 6-month period. The eligible patients were examined by emergency orthopedic specialists using the OAR, and then underwent ankle radiography. The results of examination using the OAR were compared with the radiographic results to assess the accuracy of the OAR for ankle fractures. Patients with OAR results highly suggestive of fracture, but no evidence of a fracture on radiographs, were advised to undergo 3-dimensional computed tomography (3D-CT. RESULTS: 183 patients with ankle injuries were enrolled in the study and 63 of these injuries involved fractures. The pooled sensitivity, specificity, positive predictive value and negative predictive value of the OAR for detection of fractures of the ankle were 96.8%, 45.8%, 48.4% and 96.5%, respectively. Our results suggest that clinical application of the OAR could decrease unnecessary radiographs by 31.1%. Of the 21 patients with positive OAR results and negative radiographic findings who underwent 3D-CT examination, five had occult fractures of the lateral malleolus. CONCLUSIONS: The OAR are applicable in the Chinese population, and have high sensitivity and modest specificity for the diagnosis of fractures associated with acute ankle injury. They may detect some occult fractures of the malleoli that are not visible on

A three-dimensional model to assess the effect of ankle joint axis misalignments in ankle-foot orthoses.

Science.gov (United States)

Fatone, Stefania; Johnson, William Brett; Tucker, Kerice

2016-04-01

Misalignment of an articulated ankle-foot orthosis joint axis with the anatomic joint axis may lead to discomfort, alterations in gait, and tissue damage. Theoretical, two-dimensional models describe the consequences of misalignments, but cannot capture the three-dimensional behavior of ankle-foot orthosis use. The purpose of this project was to develop a model to describe the effects of ankle-foot orthosis ankle joint misalignment in three dimensions. Computational simulation. Three-dimensional scans of a leg and ankle-foot orthosis were incorporated into a link segment model where the ankle-foot orthosis joint axis could be misaligned with the anatomic ankle joint axis. The leg/ankle-foot orthosis interface was modeled as a network of nodes connected by springs to estimate interface pressure. Motion between the leg and ankle-foot orthosis was calculated as the ankle joint moved through a gait cycle. While the three-dimensional model corroborated predictions of the previously published two-dimensional model that misalignments in the anterior -posterior direction would result in greater relative motion compared to misalignments in the proximal -distal direction, it provided greater insight showing that misalignments have asymmetrical effects. The three-dimensional model has been incorporated into a freely available computer program to assist others in understanding the consequences of joint misalignments. Models and simulations can be used to gain insight into functioning of systems of interest. We have developed a three-dimensional model to assess the effect of ankle joint axis misalignments in ankle-foot orthoses. The model has been incorporated into a freely available computer program to assist understanding of trainees and others interested in orthotics. © The International Society for Prosthetics and Orthotics 2014.

Retrospective comparison of the Low Risk Ankle Rules and the Ottawa Ankle Rules in a pediatric population.

Science.gov (United States)

Ellenbogen, Amy L; Rice, Amy L; Vyas, Pranav

2017-09-01

A recent multicenter prospective Canadian study presented prospective evidence supporting the Low Risk Ankle Rules (LRAR) as a means of reducing the number of ankle radiographs ordered for children presenting with an ankle injury while maintaining nearly 100% sensitivity. This is in contrast to a previous prospective study which showed that this rule yielded only 87% sensitivity. It is important to further investigate the LRAR and compare them with the already validated Ottawa Ankle Rules (OAR) to potentially curb healthcare costs and decrease unnecessary radiation exposure without compromising diagnostic accuracy. We conducted a retrospective chart review of 980 qualifying patients ages 12months to 18years presenting with ankle injury to a commonly staffed 310 bed children's hospital and auxiliary site pediatric emergency department. There were 28 high-risk fractures identified. The Ottawa Ankle Rules had a sensitivity of 100% (95% CI 87.7-100), specificity of 33.1% (95% CI 30.1-36.2), and would have reduced the number of ankle radiographs ordered by 32.1%. The Low Risk Ankle Rules had a sensitivity of 85.7% (95% CI 85.7-96), specificity of 64.9% (95% CI 61.8-68), and would have reduced the number of ankle radiographs ordered by 63.1%. The latter rule missed 4 high-risk fractures. The Low Risk Ankle Rules may not be sensitive enough for use in Pediatric Emergency Departments, while the Ottawa Ankle Rules again demonstrated 100% sensitivity. Further research on ways to implement the Ottawa Ankle Rules and maximize its ability to decrease wait times, healthcare costs, and improve patient satisfaction are needed. Copyright © 2017 Elsevier Inc. All rights reserved.

The ANKLE TRIAL (ANKLE treatment after injuries of the ankle ligaments: what is the benefit of external support devices in the functional treatment of acute ankle sprain? : a randomised controlled trial

Directory of Open Access Journals (Sweden)

Witjes Suzanne

2012-02-01

Full Text Available Abstract Background Acute lateral ankle ligament injuries are very common problems in present health care. Still there is no hard evidence about which treatment strategy is superior. Current evidence supports the view that a functional treatment strategy is preferable, but insufficient data are present to prove the benefit of external support devices in these types of treatment. The hypothesis of our study is that external ankle support devices will not result in better outcome in the treatment of acute ankle sprains, compared to a purely functional treatment strategy. Overall objective is to compare the results of three different strategies of functional treatment for acute ankle sprain, especially to determine the advantages of external support devices in addition to functional treatment strategy, based on balance and coordination exercises. Methods/design This study is designed as a randomised controlled multi-centre trial with one-year follow-up. Adult and healthy patients (N = 180 with acute, single sided and first inversion trauma of the lateral ankle ligaments will be included. They will all follow the same schedule of balancing exercises and will be divided into 3 treatment groups, 1. pressure bandage and tape, 2. pressure bandage and brace and 3. no external support. Primary outcome measure is the Karlsson scoring scale; secondary outcomes are FAOS (subscales, number of recurrent ankle injuries, Visual Analogue Scales of pain and satisfaction and adverse events. They will be measured after one week, 6 weeks, 6 months and 1 year. Discussion The ANKLE TRIAL is a randomized controlled trial in which a purely functional treated control group, without any external support is investigated. Results of this study could lead to other opinions about usefulness of external support devices in the treatment of acute ankle sprain. Trial registration Netherlands Trial Register (NTR: NTR2151

The ANKLE TRIAL (ANKLE treatment after injuries of the ankle ligaments): what is the benefit of external support devices in the functional treatment of acute ankle sprain? : a randomised controlled trial

Science.gov (United States)

2012-01-01

Background Acute lateral ankle ligament injuries are very common problems in present health care. Still there is no hard evidence about which treatment strategy is superior. Current evidence supports the view that a functional treatment strategy is preferable, but insufficient data are present to prove the benefit of external support devices in these types of treatment. The hypothesis of our study is that external ankle support devices will not result in better outcome in the treatment of acute ankle sprains, compared to a purely functional treatment strategy. Overall objective is to compare the results of three different strategies of functional treatment for acute ankle sprain, especially to determine the advantages of external support devices in addition to functional treatment strategy, based on balance and coordination exercises. Methods/design This study is designed as a randomised controlled multi-centre trial with one-year follow-up. Adult and healthy patients (N = 180) with acute, single sided and first inversion trauma of the lateral ankle ligaments will be included. They will all follow the same schedule of balancing exercises and will be divided into 3 treatment groups, 1. pressure bandage and tape, 2. pressure bandage and brace and 3. no external support. Primary outcome measure is the Karlsson scoring scale; secondary outcomes are FAOS (subscales), number of recurrent ankle injuries, Visual Analogue Scales of pain and satisfaction and adverse events. They will be measured after one week, 6 weeks, 6 months and 1 year. Discussion The ANKLE TRIAL is a randomized controlled trial in which a purely functional treated control group, without any external support is investigated. Results of this study could lead to other opinions about usefulness of external support devices in the treatment of acute ankle sprain. Trial registration Netherlands Trial Register (NTR): NTR2151 PMID:22340371

Mobile ankle and knee perturbator.

Science.gov (United States)

Andersen, Jacob Buus; Sinkjaer, Thomas

2003-10-01

A mobile ankle and knee perturbator has been developed. It consists of a functional joint with an integrated clutch. Four Bowden wires connect the joint to a powerful motor and a double pneumatic cylinder. When needed during any time of the gait cycle, it is possible to impose an ankle rotation by engaging the clutch and rotating the ankle or knee joint with a predefined displacement. The system is designed to investigate electrophysiological and biomechanical features of the human ankle or knee joint during gait.

Invariant ankle moment patterns when walking with and without a robotic ankle exoskeleton.

Science.gov (United States)

Kao, Pei-Chun; Lewis, Cara L; Ferris, Daniel P

2010-01-19

To guide development of robotic lower limb exoskeletons, it is necessary to understand how humans adapt to powered assistance. The purposes of this study were to quantify joint moments while healthy subjects adapted to a robotic ankle exoskeleton and to determine if the period of motor adaptation is dependent on the magnitude of robotic assistance. The pneumatically powered ankle exoskeleton provided plantar flexor torque controlled by the wearer's soleus electromyography (EMG). Eleven naïve individuals completed two 30-min sessions walking on a split-belt instrumented treadmill at 1.25m/s while wearing the ankle exoskeleton. After two sessions of practice, subjects reduced their soleus EMG activation by approximately 36% and walked with total ankle moment patterns similar to their unassisted gait (r(2)=0.98+/-0.02, THSD, p>0.05). They had substantially different ankle kinematic patterns compared to their unassisted gait (r(2)=0.79+/-0.12, THSD, probotic ankle exoskeleton (Gordon and Ferris, 2007). Our results strongly suggest that humans aim for similar joint moment patterns when walking with robotic assistance rather than similar kinematic patterns. In addition, greater robotic assistance provided during initial use results in a longer adaptation process than lesser robotic assistance. Copyright 2009 Elsevier Ltd. All rights reserved.

Clinical forms of shoulder instability in pediatric patients

Directory of Open Access Journals (Sweden)

Yaroslav N. Proshchenko

2016-12-01

Full Text Available Background. The recurrence rate of adolescent chronic shoulder instability is approximately 56%–68%. However, this pathology is often missed in childhood and adolescence. Aim. To identify the clinical forms of shoulder joint instability in pediatric patients. Materials and methods. The authors present the data from 57 pediatric patients aged 3−17 years with a total of 61 unstable shoulder joints. All patients were divided into groups according to the form of instability. Traumatic chronic shoulder instability was identified in 40 patients (Bankart and Hill–Sachs injuries. Of these, non-traumatic shoulder instability was diagnose in 17, including five with recurrent dislocation, and spontaneous shoulder dislocation due to dysplasia of glenoid and labrum was diagnosed in 12. Of the 57 patients in the study cohort, 53 underwent surgery. Postoperatively, two patients developed recurrent shoulder dislocation (Andreev–Boichev technique due type III shoulder dysplasia in the first patient and multidirectional injury in the second. Conclusions. Shoulder joint instability should be considered as the traumatic or non-traumatic form. Treatment decisions should be based on anatomical characteristics that predispose to recurrent dislocation.

The American Orthopaedic Foot and Ankle Society Ankle-Hindfoot Scale; translation and validation of the Dutch language version for ankle fractures.

Science.gov (United States)

de Boer, A Siebe; Tjioe, Roderik J C; Van der Sijde, Fleur; Meuffels, Duncan E; den Hoed, Pieter T; Van der Vlies, Cornelis H; Tuinebreijer, Wim E; Verhofstad, Michael H J; Van Lieshout, Esther M M

2017-08-03

The American Orthopaedic Foot and Ankle Society (AOFAS) Ankle-Hindfoot Scale is among the most commonly used instruments for measuring outcome of treatment in patients who sustained a complex ankle or hindfoot injury. It consists of a patient-reported and a physician-reported part. A validated, Dutch version of this instrument is currently not available. The aim of this study was to translate the instrument into Dutch and to determine the measurement properties of the AOFAS Ankle-Hindfoot Scale Dutch language version (DLV) in patients with a unilateral ankle fracture. Multicentre (two Dutch hospitals), prospective observational study. In total, 142 patients with a unilateral ankle fracture were included. Ten patients were lost to follow-up. Patients completed the subjective (patient-reported) part of the AOFAS Ankle-Hindfoot Scale-DLV. A physician or trained physician-assistant completed the physician-reported part. For comparison and evaluation of the measuring characteristics, the Foot Function Index and the Short Form-36 were completed by the patient. Descriptive statistics (including floor and ceiling effects), reliability (ie, internal consistency), construct validity, reproducibility (ie, test-retest reliability, agreement and smallest detectable change) and responsiveness were determined. The AOFAS-DLV and its subscales showed good internal consistency (Cronbach's α >0.90). Construct validity and longitudinal validity were proven to be adequate (76.5% of predefined hypotheses were confirmed). Floor effects were not present. Ceiling effects were present from 6 months onwards, as expected. Responsiveness was adequate, with a smallest detectable change of 12.0 points. The AOFAS-DLV is a reliable, valid and responsive measurement instrument for evaluating functional outcome in patients with a unilateral ankle fracture. This implies that the questionnaire is suitable to compare different treatment modalities within this population or to compare outcome across

Treatment of chronic deltoid ligament injury using suture anchors.

Science.gov (United States)

Wang, Xu; Ma, Xin; Zhang, Chao; Wang, Chen; Huang, Jia-zhang

2014-08-01

To explore the efficacy of overlapping suture-anchor fixation for treatment of chronic deltoid ligament injury. Seventeen patients (11 men, 6 women of mean age 32.1 years [range, 18-58 years]) who had undergone surgery for chronic deltoid ligament injury from January 2007 to December 2011 were retrospectively analyzed. Preoperatively, they had undergone bilateral weight-bearing posterior-anterior radiographs, (MRI) and ultrasound examinations of the ankle. Ankle arthroscopy was performed to confirm the diagnosis, followed by surgery to clear intra-articular proliferating synovial tissues and remove cartilage debris and scar tissue. The deep layer of the deltoid ligament was sutured onto the tip of the medial malleolus and its superficial layer sutured onto its periosteum and fixed with suture anchors. American Orthopedic Foot and Ankle Society (AOFAS) scoring system for the ankle-hindfoot was used to evaluate the ankles pre- and post-operatively. The 17 patients were followed up for 12-34 months (mean 20.1 months). The angle between the long axes of the talus and first metatarsal and the hindfoot angle measured in a hindfoot alignment view (as described by Saltzman) were reduced from 5.4° ± 1.8° and 8.2° ± 2.6° preoperatively to 4.0° ± 0.9° and 5.3° ± 1.3° postoperatively, respectively. The mean AOFAS ankle-hindfoot score was 76.8 ± 7.0 preoperatively and 94.1 ± 3.3 at the last follow-up visit. Ten patients were scored as excellent, six as good, and one as fair. Pain was relieved in all patients and no patients had recurrent deltoid ligament injury. Using suture anchors to treat chronic deltoid ligament injury has relatively satisfactory outcomes. © 2014 Chinese Orthopaedic Association and Wiley Publishing Asia Pty Ltd.

[Arthroscopic therapy of ankle joint impingement syndrome after operation of ankle joint fracture dislocation].

Science.gov (United States)

Feng, Zhibin; Mi, Kun; Wei, Renzhi; Liu, Wu; Wang, Bin

2011-07-01

To study the operative procedure and the effectiveness of arthroscopic therapy for ankle joint impingement syndrome after operation of ankle joint fracture dislocation. Between March 2008 and April 2010, 38 patients with ankle joint impingement syndrome after operation of ankle joint fracture dislocation were treated. Among them, there were 28 males and 10 females with an average age of 28 years (range, 18 to 42 years). The time from internal fixation to admission was 12-16 months (mean, 13.8 months). There were pressing pain in anterolateral and anterior ankle. The dorsal extension ranged from -20 to -5 degrees (mean, -10.6 degrees), and the palmar flexion was 30-40 degrees (mean, 35.5 degrees). The total score was 48.32 +/- 9.24 and the pain score was 7.26 +/- 1.22 before operation according to American Orthopaedic Foot and Ankle Society (AOFAS) ankle and hindfoot score system. The X-ray films showed osteophyte formation in anterior tibia and talus; MRI showed cartilage injury in 22 cases. Arthroscopic intervention included removing osteophytes, debriding fabric scars and synovial membrane tissues, and removing osteochondral fragments. Arthroscopic microfracture technique was used in 22 patients with cartilage injury. All incisions healed primarily. Thirty-eight cases were followed up 10-26 months (mean, 16 months). At last follow-up, 26 patients had normal range of motion (ROM); the dorsal extension was 15-25 degrees (mean, 19.6 degrees) and the palmar flexion was 35-45 degrees (mean, 40.7 degrees). Eight patients had mild limited ROM; the dorsal extension was 5-15 degrees (mean, 7.2 degrees) and the palmar flexion was 35-45 degrees (mean, 39.5 degrees). Four patients had mild limited ROM and pain in posterior portion of the ankle after a long walking (3-4 hours); the dorsal extension was 0-5 degrees (mean, 2.6 degrees) and the palmar flexion was 35-40 degrees (mean, 37.5 degrees). The total score was 89.45 +/- 9.55 and the pain score was 1.42 +/- 1.26 after

Altered Knee and Ankle Kinematics During Squatting in Those With Limited Weight-Bearing–Lunge Ankle-Dorsiflexion Range of Motion

Science.gov (United States)

Dill, Karli E.; Begalle, Rebecca L.; Frank, Barnett S.; Zinder, Steven M.; Padua, Darin A.

2014-01-01

Context: Ankle-dorsiflexion (DF) range of motion (ROM) may influence movement variables that are known to affect anterior cruciate ligament loading, such as knee valgus and knee flexion. To our knowledge, researchers have not studied individuals with limited or normal ankle DF-ROM to investigate the relationship between those factors and the lower extremity movement patterns associated with anterior cruciate ligament injury. Objective: To determine, using 2 different measurement techniques, whether knee- and ankle-joint kinematics differ between participants with limited and normal ankle DF-ROM. Design: Cross-sectional study. Setting: Sports medicine research laboratory. Patients or Other Participants: Forty physically active adults (20 with limited ankle DF-ROM, 20 with normal ankle DF-ROM). Main Outcome Measure(s): Ankle DF-ROM was assessed using 2 techniques: (1) nonweight-bearing ankle DF-ROM with the knee straight, and (2) weight-bearing lunge (WBL). Knee flexion, knee valgus-varus, knee internal-external rotation, and ankle DF displacements were assessed during the overhead-squat, single-legged squat, and jump-landing tasks. Separate 1-way analyses of variance were performed to determine whether differences in knee- and ankle-joint kinematics existed between the normal and limited groups for each assessment. Results: We observed no differences between the normal and limited groups when classifying groups based on nonweight-bearing passive-ankle DF-ROM. However, individuals with greater ankle DF-ROM during the WBL displayed greater knee-flexion and ankle-DF displacement and peak knee flexion during the overhead-squat and single-legged squat tasks. In addition, those individuals also demonstrated greater knee-varus displacement during the single-legged squat. Conclusions: Greater ankle DF-ROM assessed during the WBL was associated with greater knee-flexion and ankle-DF displacement during both squatting tasks as well as greater knee-varus displacement during

Chronic heart failure

OpenAIRE

Hopper, Ingrid; Easton, Kellie

2017-01-01

1. The common symptoms and signs of chronic heart failure are dyspnoea, ankle swelling, raised jugular venous pressure and basal crepitations. Other conditions may be confused with chronic heart failure, including dependent oedema or oedema due to renal or hepatic disease. Shortness of breath may be due to respiratory disease or severe anaemia. Heart failure secondary to lung disease (cor pulmonale) should be distinguished from congestive cardiac failure. Heart failure may also present with l...

正骨手法结合正骨散外用治疗陈旧性踝关节扭伤的疗效观察%Bone-setting manipulation combined with Zhenggu powder treatment of chronic ankle joint sprain of curative effect observation

Institute of Scientific and Technical Information of China (English)

张红川; 王法利

2014-01-01

目的：探讨和分析应用正骨手法结合正骨散治疗陈旧性踝关节扭伤的疗效。方法自2011年6月～2012年5月，采用正骨手法结合正骨散外用治疗陈旧性踝关节共38例，男20例，女18例。年龄21～55岁，平均38岁，病程平均63天。按照Baird-Jackson踝关节评分，治疗3周后比较患者的治疗前后踝关节功能评分。结果38例患者治疗前Baird-Jackson踝关节评分为64.36±4.26，经手法结合正骨散治疗后评分为90.22±5.13，治疗前后存在显著性差异（P＜0.01）。结论正骨手法结合正骨散外用是治疗陈旧性踝关节扭伤的一种有效的方法。%Abastract:ObjectiveTo discussion and analysis of the application of Bone-setting manipulation combined with Zhenggu powder in the treatment of chronic ankle joint sprain effect.Methods From 2011 June to 2012 May, with Bone-setting manipulation combined with Zhenggu powder for the treatment of chronic ankle in 38 cases, male 20 cases, female 18 cases. The age ranged from 21 to 55 years old, average 38 years old, average duration was 63 days. According to Baird-Jackson ankle function score, ankle joint function score were compared before and after treatment and 3 weeks after treatment. Results In 38 cases of patients before treatment ,Baird-Jackson ankle function score was 64.36 ± 4.26, by manipulation combined with Zhenggu powder after treatment was 90.22 ± 5.13 .Before and after treatment, there were significant differences(P<0.01). Conclusion Bone-setting manipulation combined with Zhenggu powder is an effective method for treatment of chronic ankle joint sprain.

Effects of ankle foot orthoses on body functions and activities in people with floppy paretic ankle muscles : a systematic review

NARCIS (Netherlands)

Wilk, van der Dymphy; Dijkstra, Pieter Ubele; Postema, Klaas; Verkerke, Gijsbertus Jacob; Hijmans, Juha Markus

2015-01-01

Background: People with floppy ankle muscles paresis use ankle foot orthoses to improve their walking ability. Ankle foot orthoses also limit ankle range of motion thereby introducing additional problems. Insight in effects of ankle foot orthoses on body functions and activities in people with

Diagnostic Instability and Reversals of Chronic Obstructive Pulmonary Disease Diagnosis in Individuals with Mild to Moderate Airflow Obstruction.

Science.gov (United States)

Aaron, Shawn D; Tan, Wan C; Bourbeau, Jean; Sin, Don D; Loves, Robyn H; MacNeil, Jenna; Whitmore, George A

2017-08-01

Chronic obstructive pulmonary disease (COPD) is a chronic, progressive disease, and reversal of COPD diagnosis is thought to be uncommon. To determine whether a spirometric diagnosis of mild or moderate COPD is subject to variability and potential error. We examined two prospective cohort studies that enrolled subjects with mild to moderate post-bronchodilator airflow obstruction. The Lung Health Study (n = 5,861 subjects; study duration, 5 yr) and the Canadian Cohort of Obstructive Lung Disease (CanCOLD) study (n = 1,551 subjects; study duration, 4 yr) were examined to determine frequencies of (1) diagnostic instability, represented by how often patients initially met criteria for a spirometric diagnosis of COPD but then crossed the diagnostic threshold to normal and then crossed back to COPD over a series of annual visits, or vice versa; and (2) diagnostic reversals, defined as how often an individual's COPD diagnosis at the study outset reversed to normal by the end of the study. Diagnostic instability was common and occurred in 19.5% of the Lung Health Study subjects and 6.4% of the CanCOLD subjects. Diagnostic reversals of COPD from the beginning to the end of the study period occurred in 12.6% and 27.2% of subjects in the Lung Health Study and CanCOLD study, respectively. The risk of diagnostic instability was greatest for subjects whose baseline FEV 1 /FVC value was closest to the diagnostic threshold, and the risk of diagnostic reversal was greatest for subjects who quit smoking during the study. A single post-bronchodilator spirometric assessment may not be reliable for diagnosing COPD in patients with mild to moderate airflow obstruction at baseline.

[Influence of Ankle Braces on the Prevalence of Ankle Inversion Injuries in the Swiss Volleyball National League A].

Science.gov (United States)

Jaggi, J; Kneubühler, S; Rogan, S

2016-06-01

Ankle inversion is a common injury among volleyball players. The injury rate during a game is 2.1 times higher than during training. As a result, the preventive use of ankle braces is frequently observed in Swiss volleyball leagues. Studies have shown that ankle braces have a preventive effect on the prevalence of ankle inversion. In Switzerland there has been no investigation into the preventive use of braces and their influence on prevalence. For this reason, the goals of this study are 1) to determine when, why and by whom ankle braces are worn and 2) to evaluate the injury rate of users and non-users of ankle braces. A modified questionnaire was sent to 18 men's and women's teams of the Swiss National League A. The questionnaire included questions about injury rates and the circumstances of ankle inversion injuries. The data were statistically analysed with Microsoft Excel 2012 and SPSS Version 20. The overall response rate was 61 %, allowing data from 181 players to be analysed. 33 % (59 of 181) of the players used an ankle brace. There was a statistically significant difference in the prevalence of ankle inversion between users (12 injured) and non-users (8 injured) (p = 0.006). Wearing an ankle brace during training or during a game made no difference in the prevention of injuries (p = 0.356). More athletes were injured during training (n = 13) than during a game (n = 7). The results of the present study indicate that volleyball players preferably wear ankle braces to prevent injury. More than one third of the players in the study wore an ankle brace, 60 % for primary prevention and 40 % for secondary prevention due to a previous injury. The study shows that significantly more users than non-users of ankle braces were injured. This is contrary to literature. Furthermore it was shown that more injuries occur during training than during a game. This finding results from the fact that ankle braces were rarely worn during training. It is

Management of chronic unstable acromioclavicular joint injuries.

Science.gov (United States)

Cisneros, Luis Natera; Reiriz, Juan Sarasquete

2017-12-01

The acromioclavicular joint represents the link between the clavicle and the scapula, which is responsible for the synchronized dynamic of the shoulder girdle. Chronic acromioclavicular joint instability involves changes in the orientation of the scapula, which provokes cinematic alterations that might result in chronic pain. Several surgical strategies for the management of patients with chronic and symptomatic acromioclavicular joint instability have been described. The range of possibilities includes anatomical and non-anatomical techniques, open and arthroscopy-assisted procedures, and biological and synthetic grafts. Surgical management of chronic acromioclavicular joint instability should involve the reconstruction of the torn ligaments because it is accepted that from three weeks after the injury, these structures may lack healing potential. Here, we provide a review of the literature regarding the management of chronic acromioclavicular joint instability. Expert opinion, Level V.

The "All-Inside" Arthroscopic Broström Procedure With Additional Suture Anchor Augmentation: A Prospective Study of 45 Consecutive Patients.

Science.gov (United States)

Cottom, James M; Baker, Joseph S; Richardson, Phillip E

Lateral ankle sprains are a common injury that typically respond well to nonoperative therapy. When nonoperative therapy fails and patients develop chronic lateral ankle instability, they become candidates for surgical repair. The present study examined 45 consecutive patients (45 ankles) with chronic lateral ankle instability who underwent arthroscopic Broström repair using a double-row suture anchor construct. The 45 patients (27 females and 18 males) were followed up for a mean of 14 (range 12 to 20) months. The mean time to weightbearing with crutches was 3.3 (range 2 to 4) days, and full weightbearing was initiated at a mean of 14.4 (range 12 to 16) days. All patients participated in structured physical therapy, which was started at 21.6 (range 18 to 23) days. Patients were transitioned to regular shoe gear with a stirrup-style ankle brace at 28.7 (range 26 to 31) days. The American Orthopaedic Foot and Ankle Society scale scores improved from an average preoperative score of 48.7 (range 45 to 55) to 95.4 (range 90 to 100) postoperatively. The average visual analog scale decreased from 8 (range 6 to 10) preoperatively to 0.6 (range 0 to 5) postoperatively at the last follow-up visit. The Karlsson-Peterson score postoperatively was 87 of 100. We have shown that patients with this new arthroscopic Broström technique modified with a proximal suture anchor can begin weightbearing earlier than previously reported, without adverse effects in terms of pain, functional outcomes scores, and clinical outcomes. Copyright © 2016 American College of Foot and Ankle Surgeons. Published by Elsevier Inc. All rights reserved.

Effect of Ankle Position and Noninvasive Distraction on Arthroscopic Accessibility of the Distal Tibial Plafond.

Science.gov (United States)

Akoh, Craig C; Dibbern, Kevin; Amendola, Annuziato; Sittapairoj, Tinnart; Anderson, Donald D; Phisitkul, Phinit

2017-10-01

Osteochondral lesions of the tibial plafond (OLTPs) can lead to chronic ankle pain and disability. It is not known how limited ankle motion or joint distraction affects arthroscopic accessibility of these lesions. The purpose of this study was to determine the effects of different fixed flexion angles and distraction on accessibility of the distal tibial articular surface during anterior and posterior arthroscopy. Fourteen below-knee cadaver specimens underwent anterior and posterior ankle arthroscopy using a 30-degree 2.7-mm arthroscopic camera. Intra-articular working space was measured with a precision of 1 mm using sizing rods. The accessible areas at the plafond were marked under direct visualization at varying fixed ankle flexion positions. Arthroscopic accessibilities were normalized as percent area using a surface laser scan. Statistical analyses were performed to assess the relationship between preoperative ankle range of motion, amount of distraction, arthroscopic approach, and arthroscopic plafond visualization. There was significantly greater accessibility during posterior arthroscopy (73.5%) compared with anterior arthroscopy (51.2%) in the neutral ankle position ( P = .007). There was no difference in accessibility for anterior arthroscopy with increasing level of plantarflexion ( P > .05). Increasing dorsiflexion during posterior arthroscopy significantly reduced ankle accessibility ( P = .028). There was a significant increase in accessibility through the anterior and posterior approach with increasing amount of intra-articular working space (parameter estimates ± SE): anterior = 14.2 ± 3.34 ( P articular working space and arthroscopic accessibility were greater during posterior arthroscopy compared with anterior arthroscopy. Improved accessibility of OLTPs may be achieved from posterior arthroscopy. Arthroscopic accessibility was heavily dependent on the amount of intraoperative joint working space achieved and not on ankle position. OLTPs are

Ball-and-socket ankle joint

International Nuclear Information System (INIS)

Pistoia, F.; Ozonoff, M.B.; Wintz, P.; Hartford Hospital, CT

1987-01-01

The ball-and-socket ankle joint is a malformation of the ankle in which the articular surface of the talus is hemispherical in both the anteroposterior and lateral projections and has a congruent, concave tibial articular surface. Fourteen patients with this condition were identified retrospectively. Thirteen patients were thought to have the congenital type of ball-and-socket ankle joint which in many was associated with tarsal coalition, short limb, and ray fusion and deletion anomalies. One case of the acquired type, demonstrating less geometric rounding of the talar margins, was seen in a patient with myelomeningocele, probably resulting from sensory and motor deficits. Although the exact etiology of the congenital type is unknown, its association with other malformations suggests that the ball-and-socket ankle joint results from an overall maldevelopment of the ankle and foot. (orig.)

Therapeutic Observation of Acupuncture-moxibustion plus Bloodletting for Chronic Ankle Sprain%针灸配合刺血疗法治疗陈旧性踝关节扭伤疗效观察

Institute of Scientific and Technical Information of China (English)

卢振中

2016-01-01

目的：观察针灸配合刺血疗法治疗陈旧性踝关节扭伤的临床疗效。方法将66例陈旧性踝关节扭伤患者随机分为治疗组和对照组，每组33例。治疗组采用针刺远端取穴配合局部温针灸及刺血疗法治疗，对照组采用局部温针灸配合超短波治疗。观察两组患者治疗前后踝关节症状体征评分，比较两组临床疗效。结果治疗组治疗1、2、3个疗程后愈显率分别为51.6%、74.2%和93.5%，对照组分别为26.7%、46.7%和70.0%，两组比较差异具有统计学意义(P＜0.05)。结论针灸配合刺血疗法是一种治疗陈旧性踝关节扭伤的有效方法。%Objective To observe the clinical efficacy of acupuncture-moxibustion plus bloodletting in treating chronic ankle sprain.Method Sixty-six patients with chronic ankle sprain were randomized into a treatment group and a control group, 33 in each group. The treatment group was intervened by acupuncture with distal points plus warm needling and bloodletting method in the topical area; the control group was by warm needling plus ultrashort wave applied to the topical area. The ankle joint symptom and sign score was evaluated before and after intervention, and the clinical efficacies were compared between the two groups.Result The recovery-markedly-effective rate in the treatment group was 51.6%, 74.2%, and 93.5% respectively after 1, 2, and 3 treatment courses, versus 26.7%, 46.7%, and 70.0% in the control group, and the between-group differences were statistically significant (P<0.05).Conclusion Acupuncture-moxibustion is an effective method in treating chronic ankle sprain.

[Study of genome instability using DNA fingerprinting of the offspring of male mice subjected to chronic low dose gamma irradiation].

Science.gov (United States)

Bezlepkin, V G; Vasil'eva, G V; Lomaeva, M G; Sirota, N P; Gaziev, A I

2000-01-01

By a polymerase chain reaction with an arbitrary primer (AP-PCR), the possibility of transmission of genome instability to somatic cells of the offspring (F1 generation) from male parents of mice exposed to chronic low-level gamma-radiation was studied. Male BALB/c mice 15 days after exposure to 10-50 cGy were mated with unirradiated females. Biopsies were taken from tale tips of two month-old offspring mice and DNA was isolated. The primer in the AP-PCR was a 20-mer oligonucleotide flanking the microsatellite locus Atp1b2 on chromosome 11 of the mouse. A comparative analysis of individual fingerprints of AP-PCR products on DNA-templates from the offspring of irradiated and unirradiated male mice revealed an increased variability of microsatellite-associated sequences in the genome of the offspring of the males exposed to 25 and 50 cGy. The DNA-fingerprints of the offspring of male mice exposed to chronic irradiation with the doses 10 and 25 cGy 15 days before fertilization (at the post-meiotic stage of spermatogenesis) showed an increased frequency of "non-parent bands". The results of the study point to the possibility of transmission to the offspring somatic cells of changes increasing genome instability from male parents exposed to chronic low-level radiation prior to fertilization.

Anterolateral Ankle Impingement Syndrome (review)%踝关节前外侧撞击综合征的研究进展

Institute of Scientific and Technical Information of China (English)

闵红巍; 刘克敏

2014-01-01

临床将踝关节扭伤后无骨折脱位，反复出现踝关节前外侧肿痛称为踝关节前外侧撞击综合征，为慢性踝关节疼痛的主要病因之一，受到广泛关注。本文就其发病机制、临床表现、诊断及治疗进行综述。%Ankle sprain without fracture or dislocation, accompanied by repeated ankle swelling is called as Anterolateral Ankle Im-pingement Syndrome. It is a major reason of chronic ankle pain and received extensive attention. This paper summarized its pathogenesis, clinical manifestations, diagnosis and treatment.

MR imaging in sports-related glenohumeral instability

International Nuclear Information System (INIS)

Woertler, Klaus; Waldt, Simone

2006-01-01

Sports-related shoulder pain and injuries represent a common problem. In this context, glenohumeral instability is currently believed to play a central role either as a recognized or as an unrecognized condition. Shoulder instabilities can roughly be divided into traumatic, atraumatic, and microtraumatic glenohumeral instabilities. In athletes, atraumatic and microtraumatic instabilities can lead to secondary impingement syndromes and chronic damage to intraarticular structures. Magnetic resonance (MR) arthrography is superior to conventional MR imaging in the diagnosis of labro-ligamentous injuries, intrinsic impingement, and SLAP (superior labral anteroposterior) lesions, and thus represents the most informative imaging modality in the overall assessment of glenohumeral instability. This article reviews the imaging criteria for the detection and classification of instability-related injuries in athletes with special emphasis on the influence of MR findings on therapeutic decisions. (orig.)

Joint stability characteristics of the ankle complex in female athletes with histories of lateral ankle sprain, part II: clinical experience using arthrometric measurement.

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Kovaleski, John E; Heitman, Robert J; Gurchiek, Larry R; Hollis, J M; Liu, Wei; Pearsall, Albert W

2014-01-01

This is part II of a 2-part series discussing stability characteristics of the ankle complex. In part I, we used a cadaver model to examine the effects of sectioning the lateral ankle ligaments on anterior and inversion motion and stiffness of the ankle complex. In part II, we wanted to build on and apply these findings to the clinical assessment of ankle-complex motion and stiffness in a group of athletes with a history of unilateral ankle sprain. To examine ankle-complex motion and stiffness in a group of athletes with reported history of lateral ankle sprain. Cross-sectional study. University research laboratory. Twenty-five female college athletes (age = 19.4 ± 1.4 years, height = 170.2 ± 7.4 cm, mass = 67.3 ± 10.0 kg) with histories of unilateral ankle sprain. All ankles underwent loading with an ankle arthrometer. Ankles were tested bilaterally. The dependent variables were anterior displacement, anterior end-range stiffness, inversion rotation, and inversion end-range stiffness. Anterior displacement of the ankle complex did not differ between the uninjured and sprained ankles (P = .37), whereas ankle-complex rotation was greater for the sprained ankles (P = .03). The sprained ankles had less anterior and inversion end-range stiffness than the uninjured ankles (P ankle-complex laxity and end-range stiffness were detected in ankles with histories of sprain. These results indicate the presence of altered mechanical characteristics in the soft tissues of the sprained ankles.

Spring-like Ankle Foot Orthoses reduce the energy cost of walking by taking over ankle work

NARCIS (Netherlands)

Bregman, D.J.J.; Harlaar, J.; Meskers, C.G.M.; de Groot, V.

2012-01-01

In patients with central neurological disorders, gait is often limited by a reduced ability to push off with the ankle. To overcome this reduced ankle push-off, energy-storing, spring-like carbon-composite Ankle Foot Orthoses (AFO) can be prescribed. It is expected that the energy returned by the

Design of a simple, lightweight, passive-elastic ankle exoskeleton supporting ankle joint stiffness

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Kim, Seyoung; Son, Youngsu; Choi, Sangkyu; Ham, Sangyong; Park, Cheolhoon

2015-09-01

In this study, a passive-elastic ankle exoskeleton (PEAX) with a one-way clutch mechanism was developed and then pilot-tested with vertical jumping to determine whether the PEAX is sufficiently lightweight and comfortable to be used in further biomechanical studies. The PEAX was designed to supplement the function of the Achilles tendon and ligaments as they passively support the ankle torque with their inherent stiffness. The main frame of the PEAX consists of upper and lower parts connected to each other by tension springs (N = 3) and lubricated hinge joints. The upper part has an offset angle of 5° with respect to the vertical line when the springs are in their resting state. Each spring has a slack length of 8 cm and connects the upper part to the tailrod of the lower part in the neutral position. The tailrod freely rotates with low friction but has a limited range of motion due to the stop pin working as a one-way clutch. Because of the one-way clutch system, the tension springs store the elastic energy only due to an ankle dorsiflexion when triggered by the stop pin. This clutch mechanism also has the advantage of preventing any inconvenience during ankle plantarflexion because it does not limit the ankle joint motion during the plantarflexion phase. In pilot jumping tests, all of the subjects reported that the PEAX was comfortable for jumping due to its lightweight (approximately 1 kg) and compact (firmly integrated with shoes) design, and subjects were able to nearly reach their maximum vertical jump heights while wearing the PEAX. During the countermovement jump, elastic energy was stored during dorsiflexion by spring extension and released during plantarflexion by spring restoration, indicating that the passive spring torque (i.e., supportive torque) generated by the ankle exoskeleton partially supported the ankle joint torque throughout the process.

Outcome of ankle arthrodesis in posttraumatic arthritis

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B S Narayana Gowda

2012-01-01

Full Text Available Background: Ankle arthrodesis is still a gold standard salvage procedure for the management of ankle arthritis. There are several functional and mechanical benefits of ankle arthrodesis, which make it a viable surgical procedure in the management of ankle arthritis. The functional outcomes following ankle arthrodesis are not very well known. The purpose of this study was to perform a clinical and radiographic evaluation of ankle arthrodesis in posttraumatic arthritis performed using Charnley′s compression device. Materials and Methods: Between January 2006 and December 2009 a functional assessment of 15 patients (10 males and 5 females who had undergone ankle arthrodesis for posttraumatic arthritis and/or avascular necrosis (AVN talus (n=6, malunited bimalleolar fracture (n=4, distal tibial plafond fractures (n=3, medial malleoli nonunion (n=2. All the patients were assessed clinically and radiologically after an average followup of 2 years 8 months (range 1-5.7 years. Results: All patients had sound ankylosis and no complications related to the surgery. Scoring the patients with the American Orthopaedic Foot and Ankle Society (AOFAS Ankle-Hindfoot scale, we found that 11 of the 15 had excellent results, two had good, and two showed fair results. They were all returned to their preinjury activities. Conclusion: We conclude that, the ankle arthrodesis can still be considered as a standard procedure in ankle arthritis. On the basis of these results, patients should be counseled that an ankle fusion will help to relieve pain and to improve overall function. Still, one should keep in mind that it is a salvage procedure that will cause persistent alterations in gait with a potential for deterioration due to the development of subtalar arthritis.

Directing clinical care using lower extremity biomechanics in patients with ankle osteoarthritis and ankle arthroplasty.

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Queen, Robin

2017-11-01

Ankle osteoarthritis is a debilitating disease with approximately 50,000 new cases per year leading to skeletal deformity, severe and recurrent pain, cartilage breakdown, and gait dysfunction limiting patient mobility and well-being. Although many treatments (total ankle arthroplasty [TAA], ankle fusion [arthrodesis], and ankle distraction arthroplasty) relieve pain, it is not clear that these procedures significantly improve patient mobility. The goal of the research presented here is to summarize what is presently known about lower extremity gait mechanics and outcomes and to quantify the impact of ankle osteoarthritis and TAA have on these measures using an explicitly holistic and mechanistic approach. Our recent studies have explored physical performance and energy recovery and revealed unexpected patterns and sequelae to treatment including incomplete restoration of gait function. These studies demonstrated for the first time the extreme levels and range of gait and balance dysfunction present in ankle osteoarthritis patients as well as quantifying the ways in which the affected joint alters movement and loading patterns not just in the painful joint, but throughout both the ipsilateral and contralateral lower extremity. Through this work, we determined that relieving pain alone through TAA is not enough to restore normal walking mechanics and balance due to underlying causes including limited ankle range of motion and balance deficits leading to long-term disability despite treatment. The results indicate the need to consider additional therapeutic interventions aimed at restoring balance, ankle range of motion, and movement symmetry in order to improve long-term health and function. © 2017 Orthopaedic Research Society. Published by Wiley Periodicals, Inc. J Orthop Res 35:2345-2355, 2017. © 2017 Orthopaedic Research Society. Published by Wiley Periodicals, Inc.

Realignment Surgery for Malunited Ankle Fracture.

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Guo, Chang-Jun; Li, Xing-Cheng; Hu, Mu; Xu, Yang; Xu, Xiang-Yang

2017-02-01

To investigate the characteristics and the results of realignment surgery for the treatment of malunited ankle fracture. Thirty-three patients with malunited fractures of the ankle who underwent reconstructive surgery at our hospital from January 2010 to January 2014 were reviewed. The tibial anterior surface angle (TAS), the tibiotalar tilt angle (TTA), the malleolar angle (MA), and the tibial lateral surface angle (TLS) were measured. Clinical assessment was performed with use of the American Orthopaedic Foot and Ankle Society (AOFAS) scale and visual analogue scale (VAS) scores, and the osteoarthritis stage was determined radiographically with the modified Takakura classification system. The Wilcoxon matched-pairs test was used to analyze the difference between the preoperative and the postoperative data. The mean follow-up was 36 months (range, 20-60 months). The mean age at the time of realignment surgery was 37.1 years (range, 18-62 years). Compared with preoperation, the TAS at the last follow-up showed a significant increase (88.50° ± 4.47° vs. 90.80° ± 3.49°, P = 0.0035); similar results were observed in TTA (1.62° ± 1.66° vs. 0.83° ± 0.90°, P ankle osteoarthritis, and was treated by ankle joint distraction. Realignment surgery for a malunited ankle fracture can reduce pain, improve function, and delay ankle arthrodesis or total ankle replacement. Postoperative large talar tilt and advanced stages of ankle arthritis are the risk factors for the surgery. © 2017 Chinese Orthopaedic Association and John Wiley & Sons Australia, Ltd.

Anterolateral ankle impingement: findings and diagnostic accuracy with ultrasound imaging

International Nuclear Information System (INIS)

McCarthy, C.L.; Wilson, D.J.; Coltman, T.P.

2008-01-01

The objective was to evaluate the findings and diagnostic accuracy of ultrasound in antero-lateral ankle impingement (ALI) with clinical and arthroscopic correlation. Seventeen elite footballers with chronic ankle pain were referred for ultrasound with a clinical diagnosis of ALI (n = 8) or a control condition (n = 9; lateral mechanical instability, osteochondral defect, intra-articular bodies and osteoarthritis). Ultrasound examination included the antero-lateral gutter for abnormal synovial tissue (synovitic lesion), lateral ligament integrity, tibiotalar joint and osseous spurs of the distal tibia and talus. Ultrasound findings were correlated with subsequent arthroscopic appearance. Ultrasound examination detected a synovitic mass in the antero-lateral gutter in all 8 footballers with clinical ALI (100%) and in 2 patients with a control diagnosis (22%). Arthroscopic correlation of antero-lateral synovitis and fibrosis was present in all 10 cases (100%). The synovitic lesion was seen at ultrasound as a nodular soft tissue mass of mixed echogenicity within the antero-lateral gutter, which extruded anteriorly with manual compression of the distal fibula against the tibia. Increased blood supply was detected using power Doppler imaging in only 1 patient. The synovitic lesion measured >10 mm in its maximum dimension in 7 footballers with clinical ALI and <10 mm in the control group. Additional ultrasound findings in patients with abnormal antero-lateral synovial tissue included an anterior talofibular ligament injury in all patients (n = 10), a tibiotalar joint effusion (n = 6) and osseous spurs (n = 4). Antero-lateral synovitic tissue was accurately identified at ultrasound in the absence of an effusion (n = 4). No synovitic lesion was detected at ultrasound or arthroscopy in the remaining 7 patients with a control diagnosis. Ultrasound is accurate in detecting synovitic lesions within the antero-lateral gutter, demonstrating associated ligamentous injuries and in

[Osteosynthesis of Weber B ankle fractures using the one-third tubular plate and refixation of the syndesmosis].

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Spering, C; Lesche, V; Dresing, K

2015-08-01

Anatomical reconstruction and recovery to complete range of function of the upper ankle joint. Therefore, the most stable but least invasive osteosynthesis is required to enable the patient early functional mobilization. Supination and pronation fracture with luxation mechanism of the upper ankle joint with or without rupture of the syndesmosis. Open fracture of the distal fibula including displaced and instable fractures. Severe peripheral arterial occlusive disease; contaminated open fractures (≥ 2nd degree); pediatric fractures with open epiphyseal plate. Supine position with ipsilateral slightly elevated hip and knee. Incision of about 8 cm length along the dorsal edge of the distal fibula. When reaching the lateral malleolus, a slight ventral angulation is necessary. Open reduction through this posterolateral approach. Secure the reposition using an interfragmentary lag screw and anatomically adjusted third tubular plate. Followed by a revision of the syndesmosis and transfixation using a tricortical position screw. Mobilization on day 1 after surgery with reduced weight-bearing when position screw is not applied; when position screw is implanted with ground contact for 6 weeks. Removal of position screw under local anesthesia after 6 weeks and pain-controlled full weight-bearing. Removal of metal after 1.5 years. Open reduction using the third tubular plate and an interfragmentary lag screw through a dorsolateral approach used in 90 % of all Weber B fractures in our clinic. Additional revision of a ruptured syndesmosis performed in 70 % and transfixation through a position screw in 40 %. Persisting instability in the upper ankle joint significantly reduced after surgical treatment compared to a conservative approach. Revisions necessary in 3.7 % of patients and pseudarthrosis diagnosed in 0.9 %. It has been shown that the preoperative x-ray and clinical examination is limited in detecting a ruptured syndesmosis.

Misdiagnosis of Talar Body or Neck Fractures as Ankle Sprains in Low Energy Traumas

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Young, Ki-Won; Kim, Jin-Su; Cho, Hun-Ki; Choo, Ho-Sik; Park, Jang-Ho

2016-01-01

Background The talus has a very complex anatomical morphology and is mainly fractured by a major force caused by a fall or a traffic accident. Therefore, a talus fracture is not common. However, many recent reports have shown that minor injuries, such as sprains and slips during sports activities, can induce a talar fracture especially in the lateral or posterior process. Still, fractures to the main parts of the talus (neck and body) after ankle sprains have not been reported as occult fractures. Methods Of the total 102 cases from January 2005 to December 2012, 7 patients had confirmed cases of missed/delayed diagnosis of a talus body or neck fracture and were included in the study population. If available, medical records, X-rays, computed tomography scans, and magnetic resonance imaging of the confirmed cases were retrospectively reviewed and analyzed. Results In the 7-patient population, there were 3 talar neck fractures and 4 talar body fractures (coronal shearing type). The mechanisms of injuries were all low energy trauma episodes. The causes of the injuries included twisting of the ankle during climbing (n = 2), jumping to the ground from a 1-m high wall (n = 2), and twisting of the ankle during daily activities (n = 3). Conclusions A talar body fracture and a talar neck fracture should be considered in the differential diagnosis of patients with acute and chronic ankle pain after a minor ankle injury. PMID:27583114

Quantitative evaluation of the viscoelastic properties of the ankle joint complex in patients suffering from ankle sprain by the anterior drawer test.

Science.gov (United States)

Lin, Che-Yu; Shau, Yio-Wha; Wang, Chung-Li; Chai, Huei-Ming; Kang, Jiunn-Horng

2013-06-01

Biological tissues such as ligaments exhibit viscoelastic behaviours. Injury to the ligament may induce changes of these viscoelastic properties, and these changes could serve as biomarkers to detect the injury. In the present study, a novel instrument was developed to non-invasive quantify the viscoelastic properties of the ankle in vivo by the anterior drawer test. The purpose of the study was to investigate the reliability of the instrument and to compare the viscoelastic properties of the ankle between patients suffering from ankle sprain and controls. Eight patients and eight controls participated in the present study. The reliability test was performed on three randomly chosen subjects. In patient and control test, both ankles of each subject were tested to evaluate the viscoelastic properties of the ankle. The viscosity index was defined for quantitatively evaluating the viscosity of the ankle. Greater viscosity index was associated with lower viscosity. Injured and uninjured ankles of patient and both ankles of controls were compared. The instrument exhibited excellent test-retest reliability (r > 0.9). Injured ankles exhibited significantly less viscosity than uninjured ankles, since injured ankles of patients had significantly higher viscosity index (8,148 ± 5,266) compared with uninjured ankles of patients (948 ± 617; p = 0.008) and controls (1,326 ± 613; p ankle can serve as sensitive and useful clinical biomarkers to differentiate between injured and uninjured ankles. The method may provide a clinical examination for objectively evaluating lateral ankle ligament injuries.

Investigation of genomic instability by assay of DNA fingerprint from the offspring of male mice exposed to chronic low-level γ-radiation

International Nuclear Information System (INIS)

Bezlepkin, V.G.; Vasil'eva, G.V.; Lomaeva, M.G.; Sirota, N.P.; Gaziev, A.I.

2000-01-01

By polymerase chain reaction with arbitrary primer (AP-PCR), the possibility of transmission of genome instability to somatic cells of the offspring (F 1 generation) from male parents of mice exposed to chronic low-dose γ-radiation was studied. Male mice 15 days after exposure to 10-50 cGy were mated with unirradiated females. Biopsies were taken from tale tips of two month-old mice progeny for DNA separation. Primer in the AP-PCR was 20-mer oligonucleotide flanking the micro-satellite locus Atplb2 on chromosome 11 of the mouse. Comparative analysis of individual fingerprints of AP-PCR products on DNA-templates from the offspring of irradiated and unirradiated male mice revealed an increased variability of micro-satellite-associated sequences in the genome of the offspring of males exposed to 25 and 50 cGy. DNA-fingerprints of the offspring of male mice exposed to chronic irradiation doses 10 and 25 cGy. 15 days before fertilization (at the post-meiotic stage of spermatogenesis) showed an increased frequency of non-parent bands. Result of the study point to the possibility of transmission to the offspring somatic cells of changes increasing genome instability from male parents exposed to chronic low-dose radiation prior to fertilization [ru

The cost-effectiveness of semi-rigid ankle brace to facilitate return to work following first-time acute ankle sprains.

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Fatoye, Francis; Haigh, Carol

2016-05-01

To examine the cost-effectiveness of semi-rigid ankle brace to facilitate return to work following first-time acute ankle sprains. Economic evaluation based on cost-utility analysis. Ankle sprains are a source of morbidity and absenteeism from work, accounting for 15-20% of all sports injuries. Semi-rigid ankle brace and taping are functional treatment interventions used by Musculoskeletal Physiotherapists and Nurses to facilitate return to work following acute ankle sprains. A decision model analysis, based on cost-utility analysis from the perspective of National Health Service was used. The primary outcomes measure was incremental cost-effectiveness ratio, based on quality-adjusted life years. Costs and quality of life data were derived from published literature, while model clinical probabilities were sourced from Musculoskeletal Physiotherapists. The cost and quality adjusted life years gained using semi-rigid ankle brace was £184 and 0.72 respectively. However, the cost and quality adjusted life years gained following taping was £155 and 0.61 respectively. The incremental cost-effectiveness ratio for the semi-rigid brace was £263 per quality adjusted life year. Probabilistic sensitivity analysis showed that ankle brace provided the highest net-benefit, hence the preferred option. Taping is a cheaper intervention compared with ankle brace to facilitate return to work following first-time ankle sprains. However, the incremental cost-effectiveness ratio observed for ankle brace was less than the National Institute for Health and Care Excellence threshold and the intervention had a higher net-benefit, suggesting that it is a cost-effective intervention. Decision-makers may be willing to pay £263 for an additional gain in quality adjusted life year. The findings of this economic evaluation provide justification for the use of semi-rigid ankle brace by Musculoskeletal Physiotherapists and Nurses to facilitate return to work in individuals with first-time ankle

Spontaneous resolution of posterior ankle joint loose bodies after total ankle replacement: A case report.