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Sample records for chronic ankle instability

  1. Can Chronic Ankle Instability be Prevented? Rethinking Management of Lateral Ankle Sprains.

    Science.gov (United States)

    Denegar, Craig R.; Miller, Sayers J., III

    2002-01-01

    Investigates whether chronic ankle instability can be prevented, discussing: the relationship between mechanical and functional instability; normal ankle mechanics, sequelae to lateral ankle sprains, and abnormal ankle mechanics; and tissue healing, joint dysfunction, and acute lateral ankle sprain management. The paper describes a treatment model…

  2. Effects of ankle balance taping with kinesiology tape for a patient with chronic ankle instability

    Science.gov (United States)

    Kim, Byeong-Jo; Lee, Jung-Hoon; Kim, Chang-Tae; Lee, Sun-Min

    2015-01-01

    [Purpose] To report the effects of ankle balance taping for a patient with chronic ankle instability (CAI). [Subject] A 33-year-old man with a 10 year history of chronic ankle stability. [Methods] ABT with kinesiology tape was performed for 2 months (average, 16 h/day) around the right ankle. [Results] At the end of two months, no ankle instability was noted when ascending and descending the stairs, jumping, turning, operating the pedals while driving, and lifting heavy objects. [Conclusion] The repeated use of kinesiology tape in ankle balance taping may be an effective treatment for recovering the ankle stability of patients with chronic ankle instability. PMID:26311206

  3. Dorsiflexion deficit during jogging with chronic ankle instability.

    Science.gov (United States)

    Drewes, Lindsay K; McKeon, Patrick O; Kerrigan, D Casey; Hertel, Jay

    2009-11-01

    The purpose of the study was to determine whether individuals with chronic ankle instability (CAI) demonstrate altered dorsiflexion/plantar flexion range of motion (ROM) compared to controls during jogging. The case control study took place in a university motion analysis laboratory. Fourteen volunteers participated in the study, seven suffered from CAI (age 25+/-4.2 years, height 173+/-9.4 cm, mass 71+/-8.1kg) and seven were healthy, matched controls (age 25+/-4.5 years, height 168+/-5.9 cm, mass 67+/-9.8kg). All subjects jogged on an instrumented treadmill while a ten-camera motion analysis system collected three-dimensional kinematics of the lower extremities. The main outcome measure was sagittal plane (dorsiflexion/plantar flexion) range of motion of the ankle throughout the gait cycle. CAI subjects had significantly less dorsiflexion compared to the control group from 9% to 25% during jogging (4.83+/-0.55 degrees ). CAI subjects demonstrated limited ankle dorsiflexion ROM during the time of maximal dorsiflexion during jogging. Limited dorsiflexion ROM during gait among individuals with CAI may be a risk factor for recurrent ankle sprains. These deficits should be treated appropriately by rehabilitation clinicians.

  4. An examination of ankle, knee, and hip torque production in individuals with chronic ankle instability.

    Science.gov (United States)

    Gribble, Phillip A; Robinson, Richard H

    2009-03-01

    There is some debate in the literature as to whether strength deficits exist at the ankle in individuals with chronic ankle instability (CAI). Additionally, there is evidence to suggest that knee and hip performance is altered in those with CAI. Therefore, the purpose of this study was to determine whether CAI is associated with deficits in ankle, knee, and hip torque. Fifteen subjects with unilateral CAI and fifteen subjects with healthy ankles participated. Subjects reported to the laboratory for one session during which the torque production of ankle plantar flexion/dorsiflexion, knee flexion/extension, and hip flexion/extension were measured with an isokinetic device. Subjects performed 5 maximum-effort repetitions of a concentric/concentric protocol at 60 degrees .s for both extremities. Average peak torque (APT) values were calculated. The subjects with CAI demonstrated significantly less APT production for knee flexion (F1,28 = 5.40; p = 0.03) and extension (F1,28 = 5.34; p = 0.03). Subjects with CAI exhibited significantly less APT for ankle plantar flexion in the injured limb compared with their noninjured limb (F1,28 = 6.51; p = 0.02). No significant difference in ankle dorsiflexion or hip flexion/extension APT production existed between the 2 groups. Individuals with CAI, in addition to deficits in ankle plantar flexion torque, had deficits in knee flexor and extensor torque, suggesting that distal joint instability may lead to knee joint neuromuscular adaptations. There were no similar deficits at the hip. Future research should determine what implications this has for prevention and rehabilitation of lower-extremity injury. Clinicians may need to consider including rehabilitation efforts to address these deficits when rehabilitating patients with CAI.

  5. Diminished Foot and Ankle Muscle Volumes in Young Adults With Chronic Ankle Instability

    Science.gov (United States)

    Feger, Mark A.; Snell, Shannon; Handsfield, Geoffrey G.; Blemker, Silvia S.; Wombacher, Emily; Fry, Rachel; Hart, Joseph M.; Saliba, Susan A.; Park, Joseph S.; Hertel, Jay

    2016-01-01

    Background: Patients with chronic ankle instability (CAI) have demonstrated altered neuromuscular function and decreased muscle strength when compared with healthy counterparts without a history of ankle sprain. Up to this point, muscle volumes have not been analyzed in patients with CAI to determine whether deficits in muscle size are present following recurrent sprain. Purpose: To analyze intrinsic and extrinsic foot and ankle muscle volumes and 4-way ankle strength in young adults with and without CAI. Study Design: Cross-sectional study; Level of evidence, 3. Methods: Five patients with CAI (mean age, 23.0 ± 4 years; 1 male, 4 females) and 5 healthy controls (mean age, 23.8 ± 4.5 years; 1 male, 4 females) volunteered for this study. Novel fast-acquisition magnetic resonance imaging (MRI) was used to scan from above the femoral condyles through the foot and ankle. The perimeter of each muscle was outlined on each axial slice and then the 2-dimensional area was multiplied by the slice thickness (5 mm) to calculate the muscle volume. Plantar flexion, dorsiflexion, inversion, and eversion isometric strength were measured using a handheld dynamometer. Patients with CAI were compared with healthy controls on all measures of muscle volume and strength. Extrinsic muscle volumes of patients with CAI were also compared with a normative database of healthy controls (n = 24) by calculating z scores for each muscle individually for each CAI subject. Results: The CAI group had smaller total shank, superficial posterior compartment, soleus, adductor hallucis obliqus, and flexor hallucis brevis muscle volumes compared with healthy controls as indicated by group means and associated 90% CIs that did not overlap. Cohen d effect sizes for the significant group differences were all large and ranged from 1.46 to 3.52, with 90% CIs that did not cross zero. The CAI group had lower eversion, dorsiflexion, and 4-way composite ankle strength, all with group means and associated 90

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

    Science.gov (United States)

    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.

  7. The effect of kinesiotape on dynamic balance following muscle fatigue in individuals with chronic ankle instability.

    Science.gov (United States)

    Kodesh, Einat; Dar, Gali

    2015-01-01

    This study aimed to evaluate the effect of kinesiotape (KT) on dynamic stability following ankle muscle fatigue among individuals with chronic ankle instability (CAI). Twenty participants with CAI participated in the study. Participants were tested under three conditions: KT, non-elastic tape, and no tape pre- and post-fatigue of the ankle muscles. Ankle muscles fatigue was induced using an isokinetic apparatus, activity of the fibularis muscle was recorded using one-channel vibromyography (VMG), and dynamic balance and neuromuscular control were assessed using the Y-Balance Test. Following fatigue exercises, the VMG signal significantly decreased in all groups (p < 0.01), without differences between groups. No significant difference in dynamic balance test scores was found between the pre- and post-fatigue condition for each group and between groups. Our results demonstrate that KT had no significant effects on dynamic balance and muscle activity following ankle muscle fatigue among individuals with CAI.

  8. Recent developments on models and inclusion criteria for chronic ankle instability

    Institute of Scientific and Technical Information of China (English)

    Songning; Zhang

    2012-01-01

    <正>In the most recent report of injury data on 15 sports from the U.S.National Collegiate Athletic Association(NCAA) Injury Surveillance System over a span of 16 years (1988-2004),ankle ligament sprains were the most common injury.Residual symptoms such as recurrent sprains,pain, instability,and giving way are common after an initial,acute ligament sprain.Chronic ankle instability(CAI) is one of these common problems,and has enjoyed increased interest in the recent literature.However,CAI remains a poorly-defined and understood condition.

  9. The Eccentric Torque Production Capacity of the Ankle, Knee, and Hip Muscle Groups in Patients with Unilateral Chronic Ankle Instability

    Science.gov (United States)

    Negahban, Hossein; Moradi-Bousari, Aida; Naghibi, Saeed; Sarrafzadeh, Javad; Shaterzadeh-Yazdi, Mohammad-Jafar; Goharpey, Shahin; Etemadi, Malihe; Mazaheri, Masood; Feizi, Awat

    2013-01-01

    Purpose The aim of this study was to investigate eccentric torque production capacity of the ankle, knee and hip muscle groups in patients with unilateral chronic ankle instability (CAI) as compared to healthy matched controls. Methods In this case-control study, 40 participants (20 with CAI and 20 controls) were recruited based on convenient non-probability sampling. The average peak torque to body weight (APT/BW) ratio of reciprocal eccentric contraction of ankle dorsi flexor/plantar flexor, ankle evertor/invertor, knee flexor/extensor, hip flexor/extensor and hip abductor/adductor was determined using an isokinetic dynamometer. All subjects participated in two separate sessions with a rest interval of 48 to 72 hours. In each testing session, the torque production capacity of the ankle, knee, and hip muscle groups of only one lower limb was measured. At first, 3 repetitions of maximal eccentric-eccentric contraction were performed for the reciprocal muscles of a joint in a given movement direction. Then, the same procedure of practice and testing trials was repeated for the next randomly-ordered muscle group or joint of the same limb. Results There was no significant interaction of group (CAI and healthy controls) by limb (injured and non-injured) for any muscle groups. Main effect of limb was not significant. Main effect of group was only significant for eccentric torque production capacity of ankle dorsi flexor and hip flexor muscle groups. The APT/BW ratio of these muscles was significantly lower in the CAI group than the healthy controls (P<0.05). Conclusion CAI is associated with eccentric strength deficit of ankle dorsi flexor and hip flexor muscles as indicated by reduction in torque production capacity of these muscles compared to healthy controls. This strength deficit appeared to exist in both the injured and non-injured limbs of the patients. PMID:23802057

  10. The clinimetric qualities of patient-assessed instruments for measuring chronic ankle instability: A systematic review

    Directory of Open Access Journals (Sweden)

    Asman Sara

    2007-01-01

    Full Text Available Abstract Background The assessment of outcomes from the patient's perspective becomes more recognized in health care. Also in patients with chronic ankle instability, the degree of present impairments, disabilities and participation problems should be documented from the perspective of the patient. The decision about which patient-assessed instrument is most appropriate for clinical practice should be based upon systematic reviews. Only rating scales constructed for patients with acute ligament injuries were systematically reviewed in the past. The aim of this study was to review systematically the clinimetric qualities of patient-assessed instruments designed for patients with chronic ankle instability. Methods A computerized literature search of Medline, Embase, Cinahl, Web of Science, Sport Discus and the Cochrane Controlled Trial Register was performed to identify eligible instruments. Two reviewers independently evaluated the clinimetric qualities of the selected instruments using a criteria list. The inter-observer reliability of both the selection procedure and the clinimetric evaluation was calculated using modified kappa coefficients. Results The inter-observer reliability of the selection procedure was excellent (k = .86. Four instruments met the eligibility criteria: the Ankle Joint Functional Assessment Tool (AJFAT, the Functional Ankle Outcome Score (FAOS, the Foot and Ankle Disability Index (FADI and the Functional Ankle Ability Measure (FAAM. The inter-observer reliability of the quality assessment was substantial to excellent (k between .64 and .88. Test-retest reliability was demonstrated for the FAOS, the FADI and the FAAM but not for the AJFAT. The FAOS and the FAAM met the criteria for content validity and construct validity. For none of the studied instruments, the internal consistency was sufficiently demonstrated. The presence of floor- and ceiling effects was assessed for the FAOS but ceiling effects were present for all

  11. Development of an efficient rehabilitation exercise program for functional recovery in chronic ankle instability.

    Science.gov (United States)

    Kim, Kewwan; Jeon, Kyoungkyu

    2016-05-01

    [Purpose] The aim of the present study was to construct an integrated rehabilitation exercise program to prevent chronic pain and improve motor ability in cases of ankle injury and re-injury. [Subjects and Methods] Twenty-six male soccer players who required functional strength exercises due to repeated ankle injury were the subjects. A 12-week rehabilitation exercise program was constructed with the aim of improving muscle strength in the ankle and dynamic coordination of the lower limb. Muscle strength and dynamic coordination were evaluated using the Y Balance Test, and isokinetic muscle strength of ankle dorsiflexion, plantarflexion, inversion, and eversion were measured before and after the 12-week program. [Results] Following 12 weeks of rehabilitation exercise, there were statistically significant improvements in the ratios of dorsiflexor strength to plantarflexor strength, eversion strength, and inversion strength on the left side. The other variables showed no significant changes. [Conclusion] The rehabilitation exercise program for chronic ankle instability helped to reduce pain, and to restore normal joint range of motion, muscle strength and endurance, and functional ability. Active protocols to improve complex functions need to be developed to complement these results.

  12. Hemi-Castaing ligamentoplasty for the treatment of chronic lateral ankle instability: a retrospective assessment of outcome

    NARCIS (Netherlands)

    T. Schepers (Tim); L.M.M. Vogels (Lucas); E.M.M. van Lieshout (Esther)

    2011-01-01

    textabstractPurpose: In the treatment of chronic ankle instability, most non-anatomical reconstructions use the peroneus brevis tendon. This, however, sacrifices the natural ankle stabilising properties of the peroneus brevis muscle. The aim of this study was to evaluate the functional outcome of pa

  13. Treatment of chronic lateral ankle instability: a modified broström technique using three suture anchors

    Directory of Open Access Journals (Sweden)

    Busconi Brian D

    2009-12-01

    Full Text Available Abstract Ankle sprains are very common injuries seen in the athletic and young population. Majority of patients will improve with a course of rest and physical therapy. However, with conservative management about twenty percent of all patients will go on to develop chronic lateral ankle instability. This manuscript describes our detailed surgical technique of a modification to the original Broström procedure using three suture anchors to anatomically reconstruct the lateral ankle ligaments to treat high demand patients who have developed chronic lateral ankle instability. The rationale for this modification along with patient selection and workup are discussed. Both the functional outcomes at the two year follow up along with the complications and the detailed postoperative rehabilitation protocol for the high demand athletes are also presented. This modified Broström procedure is shown in both illustrative format and intra-operative photos.

  14. 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。

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

    Directory of Open Access Journals (Sweden)

    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

  16. Effect of a Home-based Balance Training Protocol on Dynamic Postural Control in Subjects with Chronic Ankle Instability.

    Science.gov (United States)

    De Ridder, R; Willems, T M; Vanrenterghem, J; Roosen, P

    2015-06-01

    The aim of this study was to establish the presence of postural deficits in subjects with chronic ankle instability (CAI) and to assess the effect of an 8-week balance training program on dynamic postural control. A total of 43 subjects with CAI and 31 controls participated in this case-control study. Participants with CAI performed an 8-week home-based balance training, including 3 sessions a week. As main outcome measure, postural control was quantified after a vertical drop by means of the dynamic postural stability index (DPSI). Perceptual outcomes were documented using the FADI, FADI-Sport and VAS scales. At baseline, subjects with CAI displayed higher anterior/posterior and vertical postural instability, a poorer DPSI, and lower subjective stability scores compared to the control group. After balance training, all subjective stability scores improved significantly, although no changes were noted for the stability indices. In conclusion, subjects with CAI have an impaired postural control. As a treatment modality, balance training exhibits the capability of improving the subjective feeling of instability in subjects with CAI. However, there was no effect on dynamic postural control. Further research on the explanatory mechanisms of balance training is warranted, and other training modalities should be considered.

  17. Trigger Point Dry Needling and Proprioceptive Exercises for the Management of Chronic Ankle Instability: A Randomized Clinical Trial

    Directory of Open Access Journals (Sweden)

    Jaime Salom-Moreno

    2015-01-01

    Full Text Available Objective. To compare the effects of combined trigger point dry needling (TrP-DN and proprioceptive/strengthening exercises to proprioceptive/strengthening exercises on pain and function in ankle instability. Methods. Twenty-seven (44% female, mean age: 33±3 years individuals with unilateral ankle instability were randomly assigned to an experimental group who received proprioceptive/strengthening exercises combined with TrP-DN into the lateral peroneus muscle and a comparison group receiving the same proprioceptive/strengthening exercise program alone. Outcome included function assessed with the Foot and Ankle Ability Measure (FAAM and ankle pain intensity assessed with a numerical pain rate scale (NPRS. They were captured at baseline and 1-month follow-up after the intervention. Results. The ANOVAs found significant Group ∗ Time Interactions for both subscales of the FAAM (ADL: F=8.211; P=0.008; SPORTS: F=13.943; P 2.1 in favor of the TrP-DN group. Conclusions. This study provides evidence that the inclusion of TrP-DN within the lateral peroneus muscle into a proprioceptive/strengthening exercise program resulted in better outcomes in pain and function 1 month after the therapy in ankle instability.

  18. Trigger Point Dry Needling and Proprioceptive Exercises for the Management of Chronic Ankle Instability: A Randomized Clinical Trial.

    Science.gov (United States)

    Salom-Moreno, Jaime; Ayuso-Casado, Blanca; Tamaral-Costa, Beatriz; Sánchez-Milá, Zacarías; Fernández-de-Las-Peñas, César; Alburquerque-Sendín, Francisco

    2015-01-01

    Objective. To compare the effects of combined trigger point dry needling (TrP-DN) and proprioceptive/strengthening exercises to proprioceptive/strengthening exercises on pain and function in ankle instability. Methods. Twenty-seven (44% female, mean age: 33 ± 3 years) individuals with unilateral ankle instability were randomly assigned to an experimental group who received proprioceptive/strengthening exercises combined with TrP-DN into the lateral peroneus muscle and a comparison group receiving the same proprioceptive/strengthening exercise program alone. Outcome included function assessed with the Foot and Ankle Ability Measure (FAAM) and ankle pain intensity assessed with a numerical pain rate scale (NPRS). They were captured at baseline and 1-month follow-up after the intervention. Results. The ANOVAs found significant Group ∗ Time Interactions for both subscales of the FAAM (ADL: F = 8.211; P = 0.008; SPORTS: F = 13.943; P proprioceptive/strengthening exercises experienced greater improvements in function and pain than those receiving the exercise program alone. Between-groups effect sizes were large in all outcomes (SMD > 2.1) in favor of the TrP-DN group. Conclusions. This study provides evidence that the inclusion of TrP-DN within the lateral peroneus muscle into a proprioceptive/strengthening exercise program resulted in better outcomes in pain and function 1 month after the therapy in ankle instability.

  19. The effect of variable rest intervals and chronic ankle instability on triplanar ankle motion during performance of the Star Excursion Balance Test.

    Science.gov (United States)

    Kwon, Yong Ung; Blaise Williams, D S

    2017-02-12

    Inadequate rest intervals may contribute to impaired performance during functional tests. However, the effect of different rest intervals on performance of the SEBT in individuals with and without CAI is not known. Our purposes were to determine whether different rest intervals impact ankle kinematics during the SEBT and whether there differences between those two populations. 24 controls and 24 CAI completed 3 trials in 3 reach directions (anteromedial; AM, medial; M, posteromedial; PM). The order of rest intervals and reach distance were randomized and counterbalanced. Three visits were required to complete the 3 rest interval conditions (10, 20, 40s). Rest interval did not impact ankle kinematics between controls and CAI during the SEBT. Dorsiflexion (DF) (AM:partial η(2)=0.18; M:partial η(2)=0.23; PM:partial η(2)=0.23) for all directions and tibial internal rotation (TIR) excursions (AM:partial η(2)=0.20) for AM direction were greater in individuals with CAI regardless of rest interval length. Rest intervals ranging from 10 to 40s did not influence ankle kinematics. Differences exist in DF and TIR between controls and CAI during the SEBT. These findings suggest that clinicians can use any rest interval between 10 and 40s when administrating the SEBT. However, triplanar motion differs during a complex functional movement in controls compared to CAI.

  20. Clinical measurement of mechanical ankle instability.

    Science.gov (United States)

    Parasher, Raju K; Nagy, Dawn R; Em, April L; Phillips, Howard J; Mc Donough, Andrew L

    2012-10-01

    Clinicians commonly use the anterior draw test (ligament laxity) and distal fibular position (lateral malleolus displacement), to measure ankle instability. The purpose of this study was to establish intra-rater and inter-rater reliability for the anterior draw test and distal fibular position in a clinical setting. The anterior draw test (AD) was measured with a plastic Goniometer, and was defined as the linear displacement of the foot as it is drawn anteriorly with the ankle held in 20 degrees of plantar-flexion. Distal fibular position (DFP) was measured in standing using a digital vernier caliper and was the relative linear distance between the lateral and the medial malleoli. 20 participants aged 21-28 volunteered for the study and were measured on both ankles. It was found that Intra-tester reliability (ICC) ranged from 0.88 to 0.97 for AD and DFP; while inter-tester reliability (ICC) was 0.6 for AD and 0.77 for DFP. In addition for measures across trials, the standard error of the measurement (SEM) was, on average 0.66 mm for AD and 1.7 mm for DFP. While the limits of agreement (LOA) was ±0.17 mm for AD and ±4.03 mm for DFP. However, the SEM and LOA between testers was 2.27 mm and ±2.27 mm respectively for AD; and for 3.1 mm and ±10.4 mm for DFP. Overall the results suggest that both measures, as defined in this study exhibit moderate to good reliability and low standard error of measurement, suggesting a high degree of repeatability across trials.

  1. 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

  2. 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

  3. Chronic ankle instability: evaluation with stress radiography, CT and CT arthrography; Instabilite chronique externe de la cheville. Apport des radiographies dynamiques, de la tomodensitometrie et de l`arthro-tomodensitometrie

    Energy Technology Data Exchange (ETDEWEB)

    Faure, Ch.; Deplus, F.; Bochu, M. [Hopital Edouard-Herriot, 69 - Lyon (France); Besse, J.L.; Moyen, B. [Centre Hospitalier Lyon-Sud, 69 -Pierre-Benite (France)

    1997-09-01

    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). 12 refs.

  4. 带线锚钉结合改良Brostr(o)m法修复慢性踝关节外侧不稳%Suture anchors in treatment of chronic lateral ankle instability using modified Brostr(o)m technique

    Institute of Scientific and Technical Information of China (English)

    陈刚; 陈封明; 任鹏; 李兵兵; 陈立; 周阳

    2012-01-01

    Objective To discuss the application of suture anchors in the treatment of chronic lateral ankle instability using the modified Brostr(o)m technique.Methods From May 2009 to May 2011,we admitted 16 patients with ankle sprain of degree Ⅲ who had had little improvement after conservative treatment for more than 6 months and deteriorated into chronic lateral ankle instability.They were 7 men and 9 women,aged from 19 to 31 years (average,23.6 years).They all had mild swelling,pain and instability at the lateral ankle.We treated them with suture anchors using the modified Brostr(o)m technique.The pre-and post-operative ankle functions were evaluated by American Orthopaedic Foot and Ankle Society(AOFAS) scores.The patients' subjective feeling after operation was evaluated by the Good grading system.Results The patients were followed up for 6 to 24 months (average,16 months).The AOFAS ankle and hindfoot score improved significantly from preoperative 65.00 ± 6.65 points to postoperative 92.06 ± 3.13 points,the talar antedisplacement from preoperative 11.38 ±2.23 mm to postoperative 3.19 ± 1.1 mm,and the talar tilt angle from preoperative 13.44° ± 2.25° to postoperative 4.69° ± 1.35° (P < 0.05).By the Good grading system for postoperative symptoms,there were 8 cases of grade Ⅰ,6 cases of grade Ⅱ,2 cases of grade Ⅲ and no case of grade Ⅳ,giving a good to excellent rate of 87.5%.Conclusion Suture anchors and modified Brostr(o)m technique is a reasonable and effective surgical method for the treatment of chronic lateral ankle instability.%目的 探讨带线锚钉结合改良Brostr(o)m法修复慢性踝关节外侧不稳的方法和疗效.方法 对2009年5月至2011年5月间收治16例慢性踝关节不稳患者进行回顾性分析,其中男7例,女9例;年龄19 ~31岁,平均23.6岁;均有踝关节外侧轻度肿胀、疼痛、不稳感,均为6个月以上的陈旧性损伤,而且经过3~6个月康复训练无改善,反复扭伤.均采用

  5. 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

    Directory of Open Access Journals (Sweden)

    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.

  6. Short-term ankle motor performance with ankle robotics training in chronic hemiparetic stroke

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    Anindo Roy, PhD

    2011-05-01

    Full Text Available Cerebrovascular accident (stroke often results in impaired motor control and persistent weakness that may lead to chronic disability, including deficits in gait and balance function. Finding ways to restore motor control may help reduce these deficits; however, little is known regarding the capacity or temporal profile of short-term motor adaptations and learning at the hemiparetic ankle. Our objective was to determine the short-term effects of a single session of impedance-controlled ankle robot (“anklebot” training on paretic ankle motor control in chronic stroke. This was a double-arm pilot study on a convenience sample of participants with chronic stroke (n = 7 who had residual hemiparetic deficits and an equal number of age- and sex-matched nondisabled control subjects. Training consisted of participants in each group playing a target-based video game with the anklebot for an hour, for a total of 560 movement repetitions in dorsiflexion/plantar flexion ranges followed by retest 48 hours later. Task difficulty was adjusted to ankle range of motion, with robotic assistance decreased incrementally across training. Assessments included robotic measures of ankle motor control on unassisted trials before and after training and at 48 hours after training. Following exposure to the task, subjects with stroke improved paretic ankle motor control across a single training session as indexed by increased targeting accuracy (21.6 +/– 8.0 to 31.4 +/– 4.8, p = 0.05, higher angular speeds (mean: 4.7 +/– 1.5 degrees/s to 6.5 +/– 2.6 degrees/s, p 0.05 at 48 hours in both groups. Robust maintenance of motor adaptation in the robot-trained paretic ankle over 48 hours may be indicative of short-term motor learning. Our initial results suggest that the anklebot may be a flexible motor learning platform with the potential to detect rapid changes in ankle motor performance poststroke.

  7. PEAK AND END RANGE ECCENTRIC EVERTOR/CONCENTRIC INVERTOR MUSCLE STRENGTH RATIOS IN CHRONICALLY UNSTABLE ANKLES: COMPARISON WITH HEALTHY INDIVIDUALS

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    Mahmut Komurcu

    2003-09-01

    Full Text Available The aim of this study was to evaluate the alterations in eccentric evertor/concentric invertor strength ratio and their importance in the chronically unstable ankle. Eight patients with chronic ankle instability (CAI and nine healthy individuals participated in this study. Isokinetic concentric and eccentric invertor and evertor muscle strength measurement was carried out at an angular velocity of 120°·sec-1 by measuring maximal force moments (torque during isokinetic ankle inversion and eversion movements. Functionally, evertor/invertor muscle strength ratios (E/I strength ratio were calculated separately based on peak moment and angle-specific moments obtained at 0°, 5°, 10°, 15°, 20° ankle joint angles. Peak and angle-specific eccentric evertor strength values at 0°, 5°, 10°, 15°, 20° were significantly lower in the chronic ankle instability (CAI group. In spite of this, no differences were obtained for peak and angle-specific concentric invertor torque values. Eccentric evertor/concentric invertor strength (Eecc/Icon ratios were also significantly lower in the CAI group, but only at 15° and 20°. Eccentric evertor muscle torque and end range (15°-20° Eecc/Icon strength ratio for the chronically unstable ankle were significantly different from those for the healthy ankle. For this reason, measurements of end range eccentric/concentric strength ratios are more valuable in monitoring chronic ankle injuries and rehabilitation should include not only concentric muscle strengthening but also eccentric muscle strengthening, particularly for the evertor muscles

  8. 带线锚钉在11例慢性踝关节外侧不稳韧带重建中的应用%With wire anchors application in the ligament reconstruction of 11 pa-tients with chronic lateral ankle instability

    Institute of Scientific and Technical Information of China (English)

    王波; 武亚娟; 侯勇

    2014-01-01

    Objective To investigate the value of with wire anchors in the treatment of cable anchors with chronic lat-eral ankle instability. Methods Selected 11 patients with chronic lateral ankle instability from January 2009 to Decem-ber 2012,7 males and 4 females,average age were(24.8±6.5) years,all implemented with wire anchors surgery to anatomi-cal reconstruction lateral ligaments,follow-up of 3 to 12 months postoperative,used a modified American Orthopaedic Foot and Ankle Society(AOFAS) scale to evaluate ankle function. Results Modified AOFAS ankle score excellent in 6 cases,good in 3 cases, fine in 1 case, poor in 1 case,good rate was 81.82%.AOFAS ankle scores were higher than preoperative after 3 months (P<0.05 or P<0.01); postoperative talar tilt angle,talar shift distance,ankle medial joint space was less than before(P<0.01). Conclusion With wire anchors application in the anatomical reconstruction of lat-eral ankle ligaments,the ligaments can restore the stability of the ankle, joint function recovered well, worthy of pro-motion apply.%目的:探讨带线锚钉在慢性踝关节外侧不稳治疗中的应用价值。方法选取2009年1月~2013年12月收治的慢性踝关节外侧不稳定患者11例,男7例,女4例;平均年龄(24.8±6.5)岁;均实施带线锚钉手术解剖重建外侧韧带,术后随访3~12个月,采用改良美国足踝骨科协会(AOFAS)足踝评分评价踝关节功能。结果改良AOFAS足踝评分优6例,良3例,可1例,差1例,优良率为81.82%。术后3个月改良AOFAS足踝评分均高于术前(P<0.05或P<0.01);术后距骨倾斜角度、距骨移位距离、踝关节内侧间隙均小于术前(P<0.01)。结论带线锚钉解剖重建踝关节外侧韧带能恢复韧带稳定性,踝关节功能恢复良好,值得临床推广适用。

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

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    Marcelo Pires Prado

    2013-08-01

    Full Text Available 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 were randomized in two treatment options. In group A patients were treated using ankle long orthoosis, weight bearing allowed as confortable, pain care, ice, elevation with restricted joint mobilization for three weeks. After that they were maintained in short, functional orthosis (air cast, starting the reabilitation program. In group B patients were immobilized using a functional orthosis (air cast, following the same other sequences that patients in group A. RESULTS: We did not find significant differences in relation to the residual mechanical ankle instability between both groups. We did not find differences in the intensity of pain, but the functional evaluation using AOFAS score system showed better results in the functional treatment group. CONCLUSION: The functional treatment (Group B had better AOFAS score and few days off their professional activities, comparing with patients treated with rigid orthosis (Group A, without increased chance in developing ankle mechanical instability.

  10. 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

  11. 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

  12. Clinical Efficacy of Functional Exercise on Chronic Ankle Instability%功能锻炼对慢性踝关节不稳定的临床疗效研究

    Institute of Scientific and Technical Information of China (English)

    马雪; 杨珍; 胡亚哲

    2016-01-01

    目的 分析慢性踝关节不稳定的症状,探讨功能锻炼对治疗慢性踝关节不稳定的作用及其临床意义.方法 纳入2011-09/2013-09在武汉市和润合门诊患慢性踝关节不稳定的患者62例,随机分为2组:应用功能锻炼的患者为康复组;不应用功能锻炼的患者为对照组.康复组接受基本的治疗后进行连续4个阶段的功能锻炼.检测在锻炼前和每一阶段后的美国足踝外科学会(American Orthopedic Foot and Ankle Society,AOFAS)踝后足功能评分.对照组在接受基本治疗后,回家休息.结果 应用功能锻炼的康复组AOFAS评分由锻炼前的(72.20±8.70)分提高到锻炼4次后的(89.60±0.55)分,具有统计学差异(P<0.05);4个阶段功能训练评分对比,3阶段的功能锻炼效果具有统计学意义(P<0.05).结论 功能锻炼对慢性踝关节不稳定的治疗有重要价值,1、2阶段是3阶段的基础,此功能锻炼需要坚持效果才会更好.

  13. Increased calf and plantar muscle fibrotic contents in obese subjects may cause ankle instability.

    Science.gov (United States)

    Zhu, Junwei; Zhang, Lei; Chen, Yong; Zhao, Jianning

    2016-08-01

    Obesity is strongly associated with musculoskeletal disorders of the lower limb, including ankle instability and resulting gait problems. In the present study, we aimed to examine, using paired comparisons of subjects, whether moderate duration of obesity in patients with mild to moderate elevations of body mass index (BMI), changes the fibrous contents of muscles that support the ankle mortices, namely calf and plantar muscles. We attempted to examine these parameters because this shall provide direct evidence of whether obesity directly impacts myoarchitecture and support of the adjoining joints. MRI image segmentation and pixel correlations by grey level co-occurrence matrix (GLCM) and entropy were used to analyse the changes. The differences in the means between groups (both GLCM and entropy) were significant from control lean populations (P<0.0001, ANOVA) for the parameters examined for both the calf and the plantar muscles. Reduction in weight should thus be a first-line approach in preventing these changes that may significantly affect quality of life due to gait disturbances.

  14. Physiotherapy Treatment in Patients with Hemophilia and Chronic Ankle Arthropathy: A Systematic Review

    OpenAIRE

    Rubén Cuesta-Barriuso; Antonia Gómez-Conesa; José Antonio López-Pina

    2013-01-01

    Haemophilic arthropathy of the ankle causes pain and deterioration in gait, causing disability. Although some physiotherapy modalities are effective in the management of acute bleeding, the results are unknown in chronic arthropathy. Our objective was to determine the most effective physiotherapy procedures for treating the haemophilic arthropathy of the ankle and to assess the methodological quality of the studies. A systematic review was carried out in the Cochrane Database, PubMed, MEDLINE...

  15. Research Progress of Functional Ankle Instability%功能性踝关节不稳的研究进展

    Institute of Scientific and Technical Information of China (English)

    李男; 檀志宗

    2012-01-01

    By the method of literature study,the mechanism of functional ankle instability is discussed from the aspects of strength,proprioception and postural control,and the effect of methods used in rehabilitation is summarized.This may offer reference for the prevention and treatment of functional ankle instability.%通过文献资料法,对功能性踝关节不稳的形成机制分别从力量、本体感觉、姿势控制等方面进行了分析讨论,并且归纳了目前康复中所采用方法的效果,为功能性踝关节不稳的预防和治疗提供参考。

  16. Foot and ankle instability in flamenco dancing. Inestabilidad del pie y tobillo en el baile flamenco

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    Alfonso Vargas-Macías

    2012-05-01

    Full Text Available The foot is one of the most susceptible areas to get injured in flamenco dancing, due to footwork, characteristics of footwear and heel height. The aim of this article is to analyze the execution of high speed footwork in foot and/or ankle instability for determining differences regarding dance shoes. Ten professional flamenco dancers have taken part in this investigation, 5 female dancers (29,6+4,7 years, 55+3,5 kg, 163,8+7,3 cm and 5 male dancers (25,2+1,30 years, 61,4+7,2 kg, 171+3,1 cm. The participants had to repeat a dancing sequence consisting of 6 footworks for 15 s. This taping combined 4 different techniques. This sequence was repeated with both feet as many times as possible. The amount of footworks realized have been measured (female 171,2+7,40; male 180,6+11,8 as well as the percentage of cases carried out with ankle instability (female 9,2+1,3%; male 26,1+9,1%. Despite the female dance shoe has a higher heel, which is more associated to skin, toe and structural foot injuries, it is more stable than the flamenco boot. This is due to the necessary boot looseness to be put on/off, which causes a worse foot stability and more imbalance situations during the footwork.El pie es una de las zonas más susceptibles de lesión en el baile flamenco debido al gesto de zapateado, características del calzado y altura del tacón. El objetivo de este artículo es observar la ejecución de zapateados en situación de inestabilidad del pie y/o tobillo, para determinar diferencias en función del calzado de baile. Han participado en el estudio 10 profesionales de baile flamenco, 5 bailaoras (29,6+4,7 años, 55+3,5 kg, 163,8+7,3 cm y 5 bailaores (25,2+1,30 años, 61,4+7,2 kg, 171+3,1 cm. Los participantes debían repetir durante 15 s una secuencia de baile de 6 zapateados, que combinaban 4 gestos técnicos. Esta secuencia se repetía con ambos pies el mayor número de veces posible. Se han contabilizado el número zapateados realizados (bailaoras 171

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

    Energy Technology Data Exchange (ETDEWEB)

    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

  18. Conservative and surgical treatment of the chronic Charcot foot and ankle

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    Mehmet Fatih Güven

    2013-08-01

    Full Text Available Charcot neuroarthropathy (CN is a severe joint disease in the foot and ankle that can result in fracture, permanent deformity, and limb loss. It is a serious and potentially limb-threatening lower-extremity late complication of diabetes mellitus. The aim of this manuscript was to evaluate modern concepts of chronic CN through a review of the available literature and to integrate a perspective of management from the authors’ extensive experience.

  19. Physiotherapy Treatment in Patients with Hemophilia and Chronic Ankle Arthropathy: A Systematic Review

    Directory of Open Access Journals (Sweden)

    Rubén Cuesta-Barriuso

    2013-01-01

    Full Text Available Haemophilic arthropathy of the ankle causes pain and deterioration in gait, causing disability. Although some physiotherapy modalities are effective in the management of acute bleeding, the results are unknown in chronic arthropathy. Our objective was to determine the most effective physiotherapy procedures for treating the haemophilic arthropathy of the ankle and to assess the methodological quality of the studies. A systematic review was carried out in the Cochrane Database, PubMed, MEDLINE, ISI Web of Knowledge, PEDro, TESEO, and specialized journals (Haemophilia and Haematologica. It included articles with at least one group undergoing any kind of physiotherapy treatment and with pretest and posttest evaluation, published before April 2013. An analysis of variables was performed and assessed the methodological quality of studies. Five studies met the criteria for inclusion. Hydrotherapy treatments, strength training and balance strength, balance training, and sports therapy, have improved range of movement, pain, balance, and subjective physical performance. The proposed methodological analysis was not possible due to the low quality of the studies. Although the results are positive, they lack rigorous evidence on the effects of treatments. Studies are needed to establish the efficacy of the various forms of physiotherapy in the haemophilic arthropathy of the ankle.

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

    Directory of Open Access Journals (Sweden)

    M. Penso

    2008-02-01

    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.

  1. [Long-term results of active-passive ligament repair of the external lateral ligament of the ankle].

    Science.gov (United States)

    Farizon, F; Paris, D; Azoulai, J J; Bousquet, G

    1996-03-01

    We reviewed 95 ankles at an average of 9 years after an "activo-passive" operation performed for chronic lateral instability. All the patients had suffered recurrent ankle sprain or instability, with pain in 67 patients. Ten ankles showed a subtalar injury at operation. Degenerative changes were noted in 11 ankle joints. On review, 81 ankles (85%) were stable. The 14 cases with persistent instability had developed the problem one to five years after operation. Two cases presented with limitation in mobility. Osteoarthritis, found in 15 ankles, was severe in only two, and had been present on preoperative films. We found no correlation between functional results (talar tilt, anterior-drawer test) and radiological evaluation. The "activo-passive" operation provides long-term stabilization with preservation of the ankle and of subtalar mobility without severe osteoarthritis.

  2. Ankle replacement

    Science.gov (United States)

    Ankle arthroplasty - total; Total ankle arthroplasty; Endoprosthetic ankle replacement; Ankle surgery ... You may not be able to have a total ankle replacement if you have had ankle joint infections in ...

  3. Star excursion balance test for assessment of dynamic instability of the ankle in patients after harvest of a fibular free flap: a two-centre study.

    Science.gov (United States)

    Shah, K C; Peehal, J P; Shah, A; Crank, S; Flora, H S

    2017-04-01

    We aimed to show that the star excursion balance test can identify instability in the ankle of patients who have had harvest of a fibular free flap. We compared the reach distance of the operated leg against that of the non-operated leg in 26 patients who had had harvest of the flap over a period of three years from August 2009 at two different centres. The goal of the test is to reach as far as possible with one leg in eight directions while balancing on the other. We also assessed the overall function of the operated leg using the Foot and Ankle Disability Index (FADI) and the American Orthopaedic Foot and Ankle Score (AOFAS). The star excursion balance test is simple and cheap, and is quick and easy to do in the outpatient department.

  4. Modified Evans peroneus brevis lateral ankle stabilization for balancing varus ankle contracture during total ankle replacement.

    Science.gov (United States)

    Roukis, Thomas S

    2013-01-01

    Lateral ankle instability is frequently encountered when performing total ankle replacement and remains a challenge. In the present techniques report, I have described a modification of the Evans peroneus brevis tendon lateral ankle stabilization harvested through limited incisions using simple topographic anatomic landmarks. The harvested peroneus brevis is then transferred either to the anterior distal tibia concomitantly with total ankle replacement or through the tibia when performed after total ankle replacement and secured with plate and screw fixation. This modified Evans peroneus brevis tendon is useful in providing lateral ankle stability during or after primary and revision total ankle replacement.

  5. 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

  6. 全关节镜下距腓前韧带解剖重建治疗慢性踝关节不稳定的疗效观察%All-inside Arthroscopic Anterior Talofibular Ligament Anatomic Reconstruction for Chronic Ankle Instability

    Institute of Scientific and Technical Information of China (English)

    魏世隽; 蔡贤华; 黄继锋; 徐峰; 刘曦明; 齐凤宇; 兰生辉; 汤明; 陈家

    2016-01-01

    目的 探讨全关节镜下自体股薄肌腱解剖重建距腓前韧带(anterior talofibular ligament,ATFL)治疗慢性踝关节不稳定的方法及临床疗效.方法 将作者医院2015-12/2016-04月收治的9例慢性踝关节不稳定患者纳入研究,其中男性8例,女性1例,年龄20~43岁,平均32.3岁;术前踝关节应力位片提示距骨倾斜平均14.3°(13~19°),关节镜下探查清理,经踝关节镜前外侧入口观察,前外侧辅助入口于腓骨远端和距骨颈外侧面ATFL足印区制作骨隧道,取自体股薄肌腱经骨隧道解剖重建ATFL,5.0mm×15mm界面螺钉固定,术后功能支具固定踝关节于中立位,早期功能锻炼,术后6周在护踝保护下行走,末次随访采用美国足踝外科学会(American Orthopedic Foot and Ankle Society,AOFAS)评分标准及视觉模拟评分(visual analogue scale,VAS)评估疗效.结果 术后随访3~9个月(平均4.9个月),无患者感染及切口延迟愈合,9例患者均于术后3个月恢复体育活动;至末次随访时未观察到踝关节不稳定征象,AOFAS评分平均89.4分(85~96分),VAS评分平均1.4分(1~4分).结论 全关节镜下自体股薄肌肌腱解剖重建ATFL治疗慢性踝关节不稳定,初期疗效理想.

  7. 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.

  8. 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.

  9. Non operative treatment of chronic ankle sprain: a study conducted in teaching general hospital, Telangana, India

    Directory of Open Access Journals (Sweden)

    Sanjay Mattam

    2015-06-01

    Conclusion: The study concludes that lateral elevated foot wear made of micro cellular rubber of 0.75 cm is the choice of treatment for grade 2 and 3 ankle sprains. This foot wear helps in biomechanical correction from varus and also decreases symptoms and signs. Cosmetically acceptable. [Int J Res Med Sci 2015; 3(3.000: 635-639

  10. 功能性踝关节不稳者的静态平衡能力*%Static balance ability of functional ankle instability patients

    Institute of Scientific and Technical Information of China (English)

    张阳; 张秋霞

    2013-01-01

    BACKGROUND:At present, the study to balance ability of functional ankle instability patients is less. The balance ability deficiency may also be one of the important reasons for ankle repeated injury, so the research can effectively reduce the damage probability. OBJECTIVE:To explore the static balance ability characteristics of functional ankle instability patients. METHODS:Ten male subjects with unilateral functional ankle instability were enrol ed as the experimental group in the study, and other 10 healthy match-paired subjects were served as the control group. Their static balance ability was measured under double feet standing and single foot standing using win-pod system, the double feet testing lasted for 30 seconds and the single foot testing lasted for 10 seconds. Evaluation parameters of balance ability were obtained. RESULTS AND CONCLUSION:During double feet testing, there were no significant differences in balance ability parameters between the experimental group and the control group whether eyes be opened or closed (P>0.05), but the index values of double feet testing were obviously less than those of single foot testing. So we concluded that in the double feet standing, there was no significant difference in the static balance ability between functional ankle instability patients and normal persons. Moreover, the static balance ability of double feet was better than that of single feet. In the single foot standing of the affected foot, the static balance ability of functional ankle instability patients was slightly worse than that of the normal persons, especial y with eyes closed. Comparison of the average swing between the X-axis and Y-axis found that in the process of maintaining balance posture, the swing direction of the body center of gravity was mainly in the anteroposterior direction.%  背景:目前国内对功能性踝关节不稳者平衡能力的研究较少,并且其平衡能力的缺失也可能是导致踝关节反复损伤

  11. [PARTICULAR QUALITIES OF DIAGNOSTIC ACUTE LATERAL ANKLE LIGAMENT INJURIES].

    Science.gov (United States)

    Krasnoperov, S N; Shishka, I V; Golovaha, M L

    2015-01-01

    Delayed diagnosis of acute lateral ankle ligaments injury and subsequent inadequate treatment leads to the development of chronic instability and rapid progression of degenerative processes in the joint. The aim of our work was to improve treatment results by developing an diagnostic algorithm and treatment strategy of acute lateral ankle ligament injuries. The study included 48 patients with history of acute inversion ankle injury mechanism. Diagnostic protocol included clinical and radiological examination during 48 hours and after 7-10 days after injury. According to the high rate of inaccurate clinical diagnosis in the first 48 hours of the injury a short course of conservative treatment for 7-10 days is needed with follow-up and controlling clinical and radiographic instability tests. Clinical symptoms of ankle inversion injury showed that the combination of local tenderness in the projection of damaged ligaments, the presence of severe periarticular hematoma in the lateral department and positive anterior drawer and talar tilt tests in 7-10 days after the injury in 87% of cases shows the presence of ligament rupture. An algorithm for diagnosis of acute lateral ankle ligament injury was developed, which allowed us to determine differential indications for surgical repair of the ligaments and conservative treatment of these patients.

  12. Marked loss of sympathetic nerve fibers in chronic Charcot foot of diabetic origin compared to ankle joint osteoarthritis.

    Science.gov (United States)

    Koeck, Franz-Xaver; Bobrik, Verena; Fassold, Alexander; Grifka, Joachim; Kessler, Sigurd; Straub, Rainer H

    2009-06-01

    The pathogenesis of Charcot foot is based on three disputed factors: (1) loss of neurotrophic influence, (2) microtraumatic lesions, and (3) neurovascular disturbances. These etiological causes were uncovered by clinicophysiological tests. However, no results of quantitative nerve density studies of sympathetic and sensory substance P-positive (SP+) nerve fibers are available. We studied the density of sympathetic and SP+ nerve fibers in three distinct areas of the tarsus. Fifteen patients with ankle osteoarthritis (OA) and 15 patients with diabetic Charcot foot were included. Patients with OA did not differ from those with Charcot foot in SP+ sensory nerve fiber density. However, at all three areas, the density of sympathetic nerve fibers was significantly lower in patients with Charcot foot compared to OA (p = 0.006). In addition, we found that the sympathetic nerve repellent factor semaphorin 3C was highly expressed in inflamed tissue in Charcot patients. In Charcot foot of diabetic origin a severe loss of sympathetic nerve fibers was observed. These findings in chronically inflamed Charcot foot lend support to the neurovascular theory in the late chronic phase, which probably depends on the inflammatory upregulation of nerve repellent factors.

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

    NARCIS (Netherlands)

    E. Kemler; I. van de Port; F. Backx; C.N. van Dijk

    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 ta

  14. 运动干预防治踝关节不稳效应的Meta分析%Preventing ankle instability through exercise:A meta-analysis

    Institute of Scientific and Technical Information of China (English)

    高丕明; 罗小兵; 虞亚明; 荣海波; 何栩; 周文琪; 胥龙飞

    2016-01-01

    Objective To explore the effect and mechanism of preventing ankle instability through exer-cise, so as to provide evidence-based references for practice. Methods The randomized and controlled trials ( RCT) on preventing ankle instability through exercise published before December 2014 were searched for in the NCBI, CNKI, VIP and Wanfang databases by computer, supplemented by manual searching. Each study′s quality was evaluated according to the standards of the Cochrane handbook by 3 researchers. The outcome indexes were ex-tracted and analyzed using RevMan 5.2 software. Results After the initial selection, 665 papers (357 in English and 308 in Chinese) were retained. From these 92 were chosen after reading the titles and abstracts. Ultimately, 14 RCT studies ( 12 in English and 2 in Chinese) met the inclusion criteria. They showed that exercise improved ankle function and symptoms of ankle instability significantly [SMD=0.98, 95%CI (0.65,1.31), P≤0.01], improved muscle strength [SMD=1.50, 95%CI (0.99,2.01), P≤0.01], improved balance and postural stability [SMD=-0.54, 95%CI (-0.84,-0.25) ,P≤0.01] , but did not improve proprioception or neuromuscular functioning sig-nificantly. Conclusions Exercise can effectively improve muscle strength, balance and postural stability, but not proprioception or neuromuscular functioning. The details of these findings may be related to the exercise intervention chosen.%目的:探讨运动干预防治踝关节不稳的效应机制,以期为运动干预防治踝关节不稳提供循证依据。方法通过计算机检索NCBI、CNKI、维普、万方数据库中建库至2014年12月所发表的运动干预防治踝关节不稳的随机对照试验,并辅以手工检索。由3位研究人员采用Cochrane handbook提供的文献质量评价标准对纳入文献进行质量评估。由3位研究人员对纳入文献结局指标进行数据抽取,采用Rev-Man 5.2版软件对效果和运动功能数据进行

  15. 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

  16. Ankle-Brachial Index Is a Powerful Predictor of Renal Outcome and Cardiovascular Events in Patients with Chronic Kidney Disease

    Directory of Open Access Journals (Sweden)

    Fu-An Chen

    2012-01-01

    Full Text Available Ankle-brachial index (ABI is an accurate tool to diagnose peripheral arterial disease. The aim of this study was to evaluate whether ABI is also a good predictor of renal outcome and cardiovascular events in patients with chronic kidney disease (CKD. We enrolled 436 patients with stage 3–5 CKD who had not been undergoing dialysis. Patients were stratified into two groups according to the ABI value with a cut point of 0.9. The composite renal outcome, including doubling of serum creatinine level and commencement of dialysis, and the incidence of cardiovascular events were compared between the two groups. After a median follow-up period of 13 months, the lower ABI group had a poorer composite renal outcome (OR=2.719, P=0.015 and a higher incidence of cardiovascular events (OR=3.260, P=0.001. Our findings illustrated that ABI is a powerful predictor of cardiovascular events and renal outcome in patients with CKD.

  17. Reverse Evans peroneus brevis medial ankle stabilization for balancing valgus ankle contracture during total ankle replacement.

    Science.gov (United States)

    Roukis, Thomas S; Prissel, Mark A

    2014-01-01

    Medial ankle instability secondary to deltoid ligament insufficiency is frequently encountered when performing total ankle replacement and remains a challenge. In the present techniques report, we describe a "reverse" Evans peroneus brevis tendon nonanatomic deltoid ligament reconstruction for medial ankle stabilization harvested through limited incisions using simple topographic anatomic landmarks. The harvested peroneus brevis tendon is brought through a drill hole in the talus from laterally to medially, aiming for the junction of the talar neck and body plantar to the midline. The tendon is the brought superiorly and obliquely to the anterior medial aspect of the distal tibia where it is secured under a plate and screw construct. This modified Evans peroneus brevis tendon nonanatomic deltoid ligament reconstruction is useful in providing medial ankle stability during or after primary and revision total ankle replacement.

  18. 功能性踝关节不稳者姿势稳定性的研究进展%Research Advancement on Postural Stability of Subjects with Functional Ankle Instability

    Institute of Scientific and Technical Information of China (English)

    尹彦; 罗冬梅; 刘卉; 于冰

    2016-01-01

    姿势稳定性可以从整体上反映人体的姿势控制能力,对姿势稳定性进行评价是功能性踝关节不稳者损伤预防的重要方面。明确了姿势稳定性比平衡更适合作为反映人体姿势控制能力的专业术语,详细综述了功能性踝关节不稳者静态和动态姿势稳定性的主观和客观评价方法,概括分析了现有评价方法的局限性,为今后功能性踝关节不稳者姿势控制能力测量与评价的方法研究提供理论依据。%Postural stability can reflect the human’ s ability to control posture .Evaluation of postural stability is an important aspect of the prevention from injury of subjects wity function‐al ankle instability .Firstly ,this paper advanced that postural stability was more appropriate as a terminology to reflect the ablity to control posture than balance .Secondly ,the subjective and objective methods of evaluating the static and dynamic postural stability of subjects with func‐tional ankle instability were reviewed .Thirdly ,the limitations of the existing methods were an‐alyzed and summarized .It can provide a theoretical basis for the future research on methods of mearsuring and evaluating the postural stability of subjects wity functional ankle instability .

  19. Lateral collateral ligament reconstruction for chronic varus instability of the hallux interphalangeal joint.

    Science.gov (United States)

    Cho, Jaeho

    2014-01-01

    Chronic varus instability of the hallux interphalangeal joint is a rare injury, and only a few reports of this injury have been published. In some studies, this injury has been related to taekwondo. Taekwondo is an essential martial art in the Korean military. We have described a case of varus instability of the hallux interphalangeal joint in a professional soldier who had practiced taekwondo for 5 years and the surgical outcome after reconstruction of the lateral collateral ligament with the fourth toe extensor tendon.

  20. Ankle pain

    Science.gov (United States)

    ... which cushions joints) Infection in the ankle joint Osteoarthritis , gout , rheumatoid arthritis , Reiter syndrome , and other types ... Ma, MD, assistant professor, chief, sports medicine and shoulder service, UCSF Department of Orthopaedic Surgery, San Francisco, ...

  1. Arthroscopically Assisted Acromioclavicular and Coracoclavicular Ligament Reconstruction for Chronic Acromioclavicular Joint Instability.

    Science.gov (United States)

    Martetschläger, Frank; Tauber, Mark; Habermeyer, Peter; Hawi, Nael

    2016-12-01

    Acromioclavicular (AC) joint injuries are common injuries, especially in the young and active, male population. AC joint injuries account for 12% of all injuries of the shoulder girdle in the overall population. Although conservative treatment is recommended for Rockwood type I and type II injuries, there is controversial debate about optimal treatment for type III injuries. High-grade injuries are typically treated operatively to avoid painful sequelae. A vast number of different surgical methods have been described over the past few decades. Recent advances in arthroscopic surgery have enabled the shoulder surgeon to treat acute and chronic AC lesions arthroscopically assisted. Clinical studies have already shown good and reliable results. Although surgeons agree that a biological augmentation is required to minimize the risk of recurrent instability in chronic cases, a gold standard still needs to be defined. We present an arthroscopically assisted biological augmentation technique to reconstruct the AC and coracoclavicular ligaments, protected by a button-suture tape construct for chronic AC joint instability. The presented arthroscopic biological augmentation technique uses less and/or smaller drill holes in the clavicle and coracoid than previously described, thus reducing weakening of the bony structures. At the same time it enhances both horizontal and vertical stability.

  2. 下肢振动训练对功能性踝关节不稳的影响研究%Research on Influence of Functional Ankle Instability with the Vibration Training to Lower Limb

    Institute of Scientific and Technical Information of China (English)

    黄鹏; 吕倩楠; 陈子嫣; 景玮祎; 段梦楠; 汪德勇; 李玉

    2016-01-01

    Objective 24 functional ankle instability (FAI) patients were divided into two groups with 8 weeks of lower extremity weight-bearing vibration training and regular training,observation of subjects in vibration training before and after ankle stability improved.Methods 24 patients with FAI randomly for vibration training group and routine group for 8 weeks of training were compared,which routine group on the Biodex balance training apparatus for balance training,vibration training group on the basis of balance training and use of lower extremity weight-bearing vibration training,before and after the training by Biodex dynamic static balance test of dynamic balance index,and by Biodex isokinetic muscle strength testing instrument test muscular strength of ankle joint were compared.Results Combined Application of vibration training and balance training can effectively improve the overall posture of the ankle joint.OSI(overall stability index),APSI(before and after the stability index),MLSI(about the stability index) and other three values are significantly different.Vibration training the ankle flexors and extensors relative maximum power increased,muscle strength increased.The ankle plantar flexor relative maximum power was greater than flexors relative maximum power increase.Vibration training the ankle plantar flexion and dorsiflexion relative peak torque were improved. The plantar flexors enhances the effect is more significant.Conclusion Vibration training has a positive effect on the rehabilitation of functional ankle instability with the enhancement of ankle plantar flexion and dorsiflexion strength increases the stability of the ankle joint.%目的:通过对24名功能性踝关节不稳(FAI)患者分组采用8周下肢负重振动训练和常规训练相对照,观察受试者在进行振动训练前后踝关节稳定性改善的效果。方法选取符合条件的FAI患者24名,随机平均分为振动训练组和常规训练组进行8周的训练

  3. Total ankle replacement for posttraumatic arthritis

    Science.gov (United States)

    Weme, Rebecca A Nieuwe; van Solinge, Guido; N Doornberg, Job; Sierevelt, Inger; Haverkamp, Daniël; Doets, H Cornelis

    2015-01-01

    Background and purpose Most studies on total ankle replacement (TAR) have used a case mix of patients. We evaluated the outcome of TAR performed for end-stage arthritis either because of fracture or ligamentous injury. Patients and methods We prospectively followed 88 consecutive patients (50 postfracture ankles and 40 ankles with instability arthritis (2 bilateral)) who underwent TAR between 2001 and 2009. Mean follow-up for both groups was 5 years. Results Preoperative varus deformity of 10° or more was present in 23 ankles in the instability group. At 6 years, survival with revision or salvage fusion as an endpoint was 87% (95% CI: 74–99) in the postfracture group and 79% (95% CI: 63–94) in the instability group. Progressive periprosthetic osteolysis was seen in 23 ankles, and required salvage fusion in 6. The number of reoperations was similar in both groups. Clinical outcome, as assessed with 2 ankle scores and 2 questionnaires, showed good results and was similar at the latest follow-up. Interpretation The outcome was similar in the postfracture and instability groups and also similar to that reported in series including a case mix of patients. In contrast to earlier reports, preoperative frontal plane deformity in this series was not identified as a risk factor for failure. PMID:25772269

  4. Chronic ankle pain and fibrosis successfully treated with a new noninvasive augmented soft tissue mobilization technique (ASTM): a case report.

    Science.gov (United States)

    Melham, T J; Sevier, T L; Malnofski, M J; Wilson, J K; Helfst, R H

    1998-06-01

    This clinical case report demonstrates the clinical effectiveness of a new form of soft tissue mobilization in the treatment of excessive connective tissue fibrosis (scar tissue) around an athlete's injured ankle. The scar tissue was causing the athlete to have pain with activity, pain on palpation of the ankle, decreased range of motion, and loss of function. Surgery and several months of conventional physical therapy failed to alleviate the athlete's symptoms. As a final resort, augmented soft tissue mobilization (ASTM) was administered. ASTM is an alternative nonsurgical treatment modality that is being researched at Performance Dynamics (Muncip, IN). ASTM is a process that uses ergonomically designed instruments that assist therapists in the rapid localization and effective treatment of areas exhibiting excessive soft tissue fibrosis. This is followed by a stretching and strengthening program. Upon the completion of 6 wk of ASTM therapy, the athlete had no pain and had regained full range of motion and function. This case report is an example of how a noninvasive augmented form of soft tissue mobilization (ASTM) demonstrated impressive clinical results in treating a condition caused by connective tissue fibrosis.

  5. Instability of the hindfoot after lesion of the lateral ankle ligaments: investigations of the anterior drawer and adduction maneuvers in autopsy specimens

    DEFF Research Database (Denmark)

    Kjaersgaard-Andersen, P.; Frich, Lars Henrik; Madsen, F.;

    1991-01-01

    instability in adduction, whereas further lesion to the CFL increased adduction in the entire range of flexion, with a maximum median of 14.2 degrees in dorsiflexion. The anterior drawer maneuver can reveal a combined lesion of the ATL and CFL if performed with the tibiotalocalcaneal joint complex...... in dorsiflexion. Significant clinical instability in adduction will only take place when a combined lesion of the ATL and CFL is present....

  6. Chinese Massage Therapy for Ankle Injury

    Institute of Scientific and Technical Information of China (English)

    CHEN Ming-xia; LI Nian-qun; HUANG Guo-qi

    2003-01-01

    Purpose: To explore the therapeutic methods and effects in the treatment of acute and chronic injuries of the ankle joint by Chinese massage therapy in combination with external application of Chinese herbal drugs and functional exercises. Methods: Totally, 36 cases of the patients with acute soft tissue injury, chronic soft tissue injury and post-fracture sequelae of the ankle joint were treated by Chinese massage therapy, external application or external wash of Chinese herbal drugs, and exercises of dorsal flexion and extension of the ankle joint, to observe the restoration of the ankle functions.Results: In 36 cases of the patients, the results showed remarkable effect in 18 cases, effect in 16 cases, failure in 2 cases and the effective rate in 94.4%. Conclusion: The combined use of Chinese massage therapy, external application of Chinese herbal drugs and functional exercises can produce precise effect in the treatment of soft tissue injury of the ankle joint.

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

    Science.gov (United States)

    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

  8. The Position Sense and Muscle Force Sense of the Ankle Joint with Functional Instability%功能性不稳踝关节位置觉和肌肉力觉特征

    Institute of Scientific and Technical Information of China (English)

    张秋霞; 张林; 王国祥; 王国栋

    2012-01-01

    Objective To examine the difference in proprioception of the ankle joint with functional instability through analyzing the joint position sense and force sense, in order to provide the basis for the prevention from and treatment on the sprained ankle. Methods Fourteen males subjects with unilateral functional ankle instability (FAD were enrolled in the study, and other 14 healthy matched-paired subjects were served as controls. The target angle of the ankle passively reposition was set at 5° plantar flexion for measuring joint position sense and the target force of the muscle at 25% maximal voluntary isometric contraction for measuring muscle force sense. 2×2 mixed model ANOVA was used to compare the difference in proprioception between two the groups with and without FAI. Results The VEJPS (variable error of joint position sense) and AEJPS (absolute error of joint position sense) of FAI group were not significantly different from those of the control group (P>0.05) .However, there was significant difference in the RVEFS (relative variable error of force sense) and RAEFS (relative absolute error of force sense) between the two groups (P 0.05).. Conclusion The difference between FAI group and the control group was found not in the joint position sense, but in themuscle force sense. The ability of neuromuscular control for the FAI group was impaired. There was only one subject whose proprioception appeared to be normal.%目的:探讨功能性不稳踝关节的位置觉和肌肉力觉特征及其发生机制,为踝关节损伤防治和康复训练提供依据.方法:选取14名有单侧踝关节功能性不稳的受试者为实验组(FAI组),匹配14名无踝关节伤病的受试者作为对照组.测试受试者踝关节跖屈5°的被动定位并被动复位能力作为踝关节位置觉,计算位置觉的可变误差(VEJPS)和绝对误差(AEJPS).测试受试者踝关节跖屈肌群对25%最大等长峰值力矩值的复制能力作为肌肉力觉,计

  9. 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.

  10. Transcutaneous oximetry but not arterial toe blood pressure or ankle-brachial index is related to macular thickness in patients with chronic diabetic foot ulcers

    Directory of Open Access Journals (Sweden)

    Per Katzman

    2013-04-01

    Full Text Available Objectives: Diabetes related vascular complications of the lower extremity could be classified as micro- and macrovascular. Ankle-brachial index (ABI and toe blood pressure (TBP measurements evaluate macro-circulation, whereas transcutaneous oximetry (TcPO2 is considered to be a composite measure of vascular function, thereby also reflecting microcirculation. Microvascular disease in the eye involves abnormal capillary permeability and possibly thereby increased macular thickness. The aim of the present clinical study was to evaluate if microvascular disease in the eye was related to measures of foot ischemia in patients with diabetes mellitus. Methods: Twenty consecutive patients with diabetes and chronic full-thickness foot ulcers were included. Peripheral ischemia was diagnosed using TcPO2, TBP and ABI. Macular thickness was measured with optical coherence tomography technique. Results: Based on TcPO2, TBP and ABI measurements 14, 13 and 13 patients, respectively, were classified as ischemic. Patients with ischemic TcPO2 levels at the dorsum of the foot had significantly higher macular thicknesses. This was not the case in patients with ischemic TBP or ABI levels. Conclusion: TcPO2, unlike TBP and ABI, seems to be a clinically relevant measure of peripheral microvascular disease in patients with diabetes mellitus and may, if low, indicate an increased risk of macular edema. [J Exp Integr Med 2013; 3(2.000: 81-85

  11. 功能性踝关节不稳者动态平衡能力及等速肌力特征研究%Examination of dynamic balance ability and isokinetic strength in participants with functional ankle instability

    Institute of Scientific and Technical Information of China (English)

    赵丽; 李翠; 顾博雅; 熊开宇

    2012-01-01

    目的 分析功能性踝关节不稳者动态平衡能力和不同速度、不同收缩模式下跖屈、背屈等速肌力特征.方法 应用Biodex Balance System测试系统对FAI组(19例)和对照组(19例)分别进行姿势稳定性测试和60°/s、180°/s跖屈肌群、背屈肌群等速向心、离心肌力测试分析.结果 FAI组健侧、患侧的稳定指数和前后方向稳定指数大于对照组,而左右方向稳定指数无差异;双脚站立姿势稳定性测试结果FAI组和对照组无差异;FAI组跖屈肌群低速离心肌力和高速向心、离心肌力不足;FAI组跖屈肌群的向心、离心峰值力矩差值比在不同速度下均大于10%,背屈肌群均小于10%.结论 功能性踝关节不稳者单脚站立时健侧和患侧都存在动态平衡能力下降,双脚站立时动态平衡能力与常人无异;功能性踝关节不稳者跖屈肌群高速工作能力较差;功能性踝关节不稳者随角速度增加离心力量增加越小者,其跖屈肌群的弹性组织损伤的可能性越大.%Objective To investigate dynamic balance ability and isokinetic strength of plantar flexion or dorsiflexion under different velocity and contraction modes in the participants with the functional ankle instability (FAI). Methods The participants (including 19 participants with a history of unilateral FAI and 19 participants with stable ankles) were tested in both postural stability (PS) and plantar-flexion-dorsiflexion movements at the speed of 60°/s and 180°/s using Biodex Balance System. The injured ankle of the FAI group was matched by side and limb dominance to an ankle in the control group. The order of the test side and movement was counterbalanced for all participants. Results Significant differences were noted for the anterior/posterior stability between FAI group and control group, but medial/lateral stability difference was not significant; two leg standing PS test result showed no significant difference between FAI group and

  12. Foot and ankle injuries in theatrical dancers.

    Science.gov (United States)

    Hardaker, W T; Margello, S; Goldner, J L

    1985-10-01

    The theatrical dancer is a unique combination of athlete and artist. The physical demands of dance class, rehearsal, and performance can lead to injury, particularly to the foot and ankle. Ankle sprains are the most common acute injury. Chronic injuries predominate and relate primarily to the repeated impact loading of the foot and ankle on the dance floor. Contributing factors include anatomic variation, improper technique, and fatigue. Early and aggressive conservative management is usually successful and surgery is rarely indicated. Orthotics play a limited but potentially useful role in treatment. Following treatment, a structured rehabilitation program is fundamental to the successful return to dance.

  13. Arthroscopic anatomical reconstruction of the lateral ankle ligaments: A technical simplification.

    Science.gov (United States)

    Lopes, R; Decante, C; Geffroy, L; Brulefert, K; Noailles, T

    2016-12-01

    Anatomical reconstruction of the lateral ankle ligaments has become a pivotal component of the treatment strategy for chronic ankle instability. The recently described arthroscopic version of this procedure is indispensable to ensure that concomitant lesions are appropriately managed, yet remains technically demanding. Here, we describe a simplified variant involving percutaneous creation of the calcaneal tunnel for the distal attachment of the calcaneo-fibular ligament. The rationale for this technical stratagem was provided by a preliminary cadaver study that demonstrated a correlation between the lateral malleolus and the distal footprint of the calcaneo-fibular ligament. The main objectives are simplification of the operative technique and decreased injury to tissues whose function is crucial to the recovery of proprioception.

  14. 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

  15. 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.

  16. 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

    Directory of Open Access Journals (Sweden)

    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

  17. Ankle Sprain Treatment

    Science.gov (United States)

    ... Emergencies > Sports Injuries > Ankle Sprain Treatment Health Issues Listen Español Text Size Email Print Share Ankle Sprain Treatment Page Content Article Body Acute ankle and foot injuries are common in athletes and other active young people. Sprains account for the greatest number ...

  18. Modified Blair ankle fusion for ankle arthritis

    Institute of Scientific and Technical Information of China (English)

    Wang Shuangli; Huang Zhang; Xiong Gaoxin; Chen Guang; Yin Zhongxiang; Jiang Hua

    2014-01-01

    Objective:To investigate the clinical outcome of modified Blair ankle fusion for ankle arthritis.Methods:Between November 2009 and June 2012,28 patients with ankle arthritis were treated,among whom 11 had obvious foot varus deformity,and 17 were almost normal in appearance.There were 13 males and 15 females with an average age of 49.4 years (range,23-67 years).The main symptoms included swelling,pain,and a limited range of motion of the ankles.The ankle joints functions were assessed by American Orthopedic Foot and Ankle Society (AOFAS) ankle and hindfoot score and visual analog scale (VAS) preoperatively and at 1 year follow-up.Results:Twenty-eight patients were followed up for 19.8 months on average (range,1-2 years).Superficial wound infection occurred in 3 cases,and was cured after debridement; the other incisions healed by first intention without complications.All ankles were fused at 1 year follow-up after operation.The symptom was relieved completely in all patients at last follow-up without complication of implant failure,or nonunion.The postoperative AOFAS ankle and hindfoot score was 83.13±3.76,showing significant difference when compared with the preoperative score (45.38±3.21,P<0.01).VAS was significantly decreased from 8.01±0.63 to 2.31±1.05 at 1 year follow-up (P<0.05).Conclusion:Modified Blair ankle fusion has the advantages of high feasiblity,less cost and rigid fixation.It shows high reliability in pain relief and may obtain a good clinical effectiveness.

  19. 单侧功能性踝关节不稳者的单足静态平衡能力%The single foot static balancing ability of people suffering from single side functional ankle joint instability

    Institute of Scientific and Technical Information of China (English)

    张阳; 张秋霞; 金超

    2014-01-01

    In order to probe into the characteristics of the single foot static balancing ability of people suffering from single side functional ankle joint instability, the authors used a WIN-POD balancing instrument to test the static balancing ability of 15 people suffering from single side functional ankle joint instability and 15 normal people in eyes opened and shut single foot standing conditions for 10, and revealed the following findings: 1) in an eyes opened left foot standing condition, the differences in envelop area and axisY shaking amplitude between the people in the experiment group and the people in the control group were statistically significant (P<0.05); in an eyes shut standing condition, except axesX andY shaking speeds, the differences in other indexes between the people in the experiment group and people in the control group were statistically significant (P<0.05); 2) in an eyes shut right foot standing condition, the differences in envelop area and axisY shaking amplitude between the people in the experi-ment group and the people in the control group were statistically significant (P<0.05); 3) for the people in the ex-periment group, in an eyes opened standing condition, the difference in envelop area between the ill foot and the healthy one was statistically significant (P<0.05), in an eyes shut standing condition, the differences in envelop area and average axisY shaking amplitude between the ill foot and the healthy one were statistically significant (P<0.05); 4) for the people in the control group, in an eyes shut standing condition, except axesX andY shaking speeds, the differences in other indexes between the left foot and the right one were all statistically significant (P<0.05). The said findings indicate the followings: for people suffering from single side functional ankle joint instability, the bal-ancing ability of the ill foot is slightly weaker than that of the corresponding foot of normal people, and also weaker than that of the

  20. Total ankle arthroplasty in end-stage ankle arthritis

    OpenAIRE

    Demetracopoulos, Constantine A.; Halloran, James P.; Maloof, Paul; Samuel B Adams; Parekh, Selene G.

    2013-01-01

    Recent advancements in ankle prosthesis design, combined with improved surgical techniques for correction of coronal plane deformity and ligamentous balancing, have led to a resurgence of interest in total ankle arthroplasty for the treatment of end-stage ankle arthritis. Although ankle arthrodesis has long been considered the gold standard treatment for ankle arthritis, recent studies have shown that patients who undergo total ankle replacement have equivalent pain relief and improved functi...

  1. Effects of Different Training Methods on Rehabilitating Functional Ankle Instability in Athletes%不同训练方法对运动员功能性踝关节不稳康复的影响

    Institute of Scientific and Technical Information of China (English)

    张晓辉; 刘书芳; 廖八根

    2014-01-01

    目的:探讨不同训练方法对运动员功能性踝关节不稳(Functional ankle instability,FAI)康复的影响.方法:选取功能性踝关节不稳运动员20例,随机分为实验组和对照组,每组10例.实验组进行神经肌肉训练,对照组进行肌力及关节活动度康复训练.采用Cumberland踝关节不稳定评价问卷(CAIT)、星状伸展平衡测试(SEBT)、T型敏捷性测试(Agility T-Test)、萨金特纵跳测试(Sargent/Vertical Jump Test)进行评定,对比两种康复程序对功能性踝关节不稳康复的影响.结果:训练前两组CAIT评分、SEBT测试、T型敏捷性测试结果无显著性差异(P>0.05);训练后两组内、组间CAIT评分、SEBT测试、T型敏捷性测试均有显著性差异(P<0.01),实验组优于对照组;训练后,萨金特纵跳测试结果与组内训练前相比有显著性差异(P<0.01),训练后两组间相比无显著性差异(P>0.05).结论:两种康复训练均能改善FAI运动员踝关节的功能,提高肢体敏捷性,发展下肢力量、速度,神经肌肉康复训练效果更佳,且增强平衡控制能力.

  2. Closed medial total subtalar joint dislocation without ankle fracture: a case report

    Science.gov (United States)

    2014-01-01

    Introduction Total subtalar dislocation without fracture of the ankle is a rare clinical entity; it is usually due to a traumatic high-energy mechanism. Standard treatment is successful closed reduction under general anesthesia followed by non-weight bearing and ankle immobilization with a below-knee cast for 6 weeks. Case presentation We present the case of a 30-year-old Moroccan woman who was involved in a road traffic accident. She subsequently received a radiological assessment that objectified a total subtalar dislocation without fracture of her ankle. She was immediately admitted to the operating theater where an immediate reduction was performed under sedation, and immobilization in a plaster boot was adopted for 8 weeks. The management of this traumatic lesion is discussed in the light of the literature. Conclusions Medial subtalar dislocation is a rare dislocation and is not commonly seen as a sports injury because it requires transfer of a large amount of kinetic energy. The weaker talocalcaneal and talonavicular ligaments often bear the brunt of the energy and are more commonly disrupted, compared to the relatively stronger calcaneonavicular ligament. Urgent reduction is important, and closed reduction under general anesthesia is usually successful, often facilitated by keeping the knee in flexion to relax the gastrocnemius muscle. Long-term sequelae include talar avascular necrosis and osteochondral fracture, as well as chronic instability and pain. PMID:25240955

  3. Chronic Neck Pain: Making the Connection Between Capsular Ligament Laxity and Cervical Instability

    OpenAIRE

    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 narra...

  4. A anquilose tíbio-társica e sua importância na insuficiência venosa crônica Ankle ankylosis and its importance in chronic venous insufficiency

    Directory of Open Access Journals (Sweden)

    Jorge Ribas Timi

    2009-09-01

    Full Text Available CONTEXTO: O desenvolvimento de anquilose em pacientes com insuficiência venosa crônica (IVC pode ser evidenciado em diversos estágios da patologia através de medidas da amplitude de movimento da articulação do tornozelo tomadas com a utilização de um goniômetro. OBJETIVO: Relacionar a diminuição da amplitude de movimento da articulação tíbio-társica na IVC dos membros inferiores (MMII medida por goniometria com a gravidade da IVC, utilizando-se a classificação CEAP. MÉTODOS: No período de março de 2003 a agosto de 2004, 86 pacientes (67 mulheres e 19 homens com média de idade de 50,6 anos foram submetidos à goniometria do tornozelo. Os indivíduos foram divididos conforme a gravidade da IVC de seus MMII (121 avaliados de acordo com a classificação CEAP. Quarenta membros foram caracterizados como C0 (grupo-controle, 40 como C3, e 41 como C4. As medidas obtidas nos diferentes grupos foram comparadas entre si. RESULTADOS: A média da amplitude de movimento da articulação tíbio-társica do grupo C0 foi de 42,4º (variação de 26-54; a do grupo C3 foi de 37,9º (variação de 10-61; e a do grupo C4 foi de 24,5º (variação de 8-50. A diferença das médias de C4 e C3 foi de 36%, e a de C3 comparada com o grupo-controle (C0, de 11%, caracterizando a maior diferença entre C3 e C4. CONCLUSÃO: A goniometria do tornozelo auxilia a graduar a hipertensão venosa crônica, pois demonstra a existência de correlação entre a gravidade da anquilose e a severidade da IVC.BACKGROUND: Development of ankylosis in patients with chronic venous insufficiency (CVI can be observed in different stages of the disease as the ankle range of motion is measured by a goniometer. OBJECTIVE: To relate a reduced ankle range of motion in patients with CVI of the lower limbs measured by goniometry and the severity of CVI according to the CEAP classification. METHODS: From March 2003 to August 2004, 86 patients (67 females and 19 males with a mean

  5. Clinical observation on treating chronic ankle sprain in TCM medicine%中药洗药治疗陈旧性踝关节扭伤的临床疗效观察

    Institute of Scientific and Technical Information of China (English)

    刘照富; 张振南

    2014-01-01

    To observe clinical effects of TCM medicine on chronic ankle sprains. Methods:60 cases of chronic ankle sprains were randomly divided into the treatment group and the control group. The treatment group was given TCM form foot for 30 min, twice a day; The control group was given topical indomethacin papua cream. Clinical effects in two groups were recorded in 2 courses. Results: Clinical efficacy in two groups was 93.33% and 73.33% respectively, with significant difference (P<0.05). Conclusion: TCM medicine shows curative effects and was worthy of application.%目的:观察中药洗药治疗陈旧性踝关节扭伤的临床疗效。方法:选出符合条件的陈旧性踝关节扭伤病人60例,随机分成治疗组30例,对照组30例。治疗组用中药洗药泡足30min,2次/d;对照组外用吲哚美辛巴布膏,1片/次,1次/d;2个疗程后两组进行临床疗效评分。结果:治疗组和对照组有效率分别为93.33%、73.33%,差异具有显著性(P<0.05)。结论:中药洗药治疗陈旧性踝关节扭伤临床疗效显著,值得临床推广应用。

  6. What Is a Foot and Ankle Surgeon?

    Science.gov (United States)

    ... Foot & Ankle Surgeon? A A A | Print | Share What is a Foot & Ankle Surgeon? Foot and ankle ... of conditions that affect people of every age. What education has a foot and ankle surgeon received? ...

  7. Stresses in the ankle joint and total ankle replacement design.

    Science.gov (United States)

    Kakkar, Rahul; Siddique, M S

    2011-06-01

    The ankle is a highly congruent joint with a surface area of 11-13 cm(2). Total ankle replacements have been attempted since the early 1970s and design has continually evolved as the early designs were a failure. This was because the stresses involved and the mutiaxial motion of the ankle has not been understood until recently. It has been shown that the talus slides as well as rolls during the ankle arc of motion from plantarflexion to dorsiflexion. Furthermore, the articular surfaces and the calcaneofibular and tibiocalcaneal ligaments have been shown to form a four bar linkage dictating ankle motion. A new design ankle replacement has been suggested recently which allows multiaxial motion at the ankle while maintaining congruency throughout the arc of motion. The early results of this ankle replacement have been encouraging without any reported failures due to mechanical loosening.

  8. X-Ray Exam: Ankle

    Science.gov (United States)

    ... Old Feeding Your 1- to 2-Year-Old X-Ray Exam: Ankle KidsHealth > For Parents > X-Ray Exam: Ankle A A A What's in ... español Radiografía: tobillo What It Is An ankle X-ray is a safe and painless test that ...

  9. Footballer's ankle: a case report

    Institute of Scientific and Technical Information of China (English)

    2002-01-01

    @@ Footballer' s ankle is anterior bony spur or anterior impingement symptom of the ankle with anterior ankle pain, limited and painful dorsiflexion. The cause is commonly seen in athletes and dancers, and is probably due to repetitive minor trauma. The condition was firstly described by Morris;1 McMurray2 reported good results from excision of the spurs, naming it footballer's ankle. Opening resection of osteophytes of the anterior tibial and superior talar is an effective treatment for anterior impingement of the ankle.

  10. FUNCTIONAL OUTCOME FOLLOWING RECONSTRUCTION FOR CHRONIC ISOLATED DORSAL DISTAL RADIOULNAR JOINT INSTABILITY BY FULKERSON-WATSON METHOD-A PROSPECTIVE STUDY

    Directory of Open Access Journals (Sweden)

    Santhamoorthy

    2014-10-01

    Full Text Available BACKGROUND: Chronic isolated distal radioulnar joint instability is a relatively rare entity. Several methods of reconstruction were available to stabilize the joint and each method has some advantage over others. We proposed to assess the functional outcome following reconstruction of chronic dorsal distal radio ulnar instability using extra articular reconstruction by Fulkerson – Watson method. AIM: To assess the functional outcome following reconstruction for chronic isolated dorsal distal radio ulnar instability using Fulkerson –Watson method. METHODS: We conducted a prospective study in five patients over three years from 2010 to 2013 with chronic isolated dorsal distal radio ulnar instability who were treated by Fulkerson-Watson method of reconstruction. All patients underwent MRI evaluation before surgery to assess ligament pathology and for adequacy of sigmoid notch. Arthroscopy performed in all patients. Functional outcomes were assessed using VAS score, quick-DASH score and Mayo wrist score at every 6 months follow-up. Radiological assessment done using plain x-rays at each follow up. RESULTS: Three patients required Arthroscopic debridement for TFCC. All five patients had achieved stability at distal radio ulnar joint after surgery and remained so till their last follow up. One patient had persistent pain near ulnar styloid. The average loss of motion for pronation was 10 degrees and supination was 3 degrees in reference to the normal side. All except one patient achieved ulnar grip strength of >90 % compared to normal side. The mean pre and postoperative VAS score, quick-DASH score, Mayo wrist score were 76.6 and 17.2, 37.3 and 11.3, 45 and 77 respectively. CONCLUSION: Though extra articular reconstruction for DRUJ by Fulkerson-Watson method is non-anatomical, the procedure is simple than intra articular reconstruction and gives similar functional outcome like intra articular reconstructions as shown by our results.

  11. Ultrasound of ankle and foot: overuse and sports injuries.

    Science.gov (United States)

    Khoury, Viviane; Guillin, Raphaël; Dhanju, Jag; Cardinal, Etienne

    2007-06-01

    Sports and overuse injuries of the ankle and foot are commonly encountered in clinical practice. Ultrasound (US) has been established as an excellent diagnostic modality for foot and ankle injuries, providing a rapid noninvasive, economical, and readily available tool that is well tolerated by the patient with acute or chronic pain. The opportunity for dynamic examination is another advantage of US in evaluating ankle and foot pathology, where maneuvers such as muscle contraction and stressing of the joint may be particularly helpful. In many cases, US can be used as a first-line and only imaging modality for diagnosis. This article focuses on ankle disorders related to sports or overuse that affect tendons, including tendinosis, tenosynovitis, paratendinitis, rupture, dislocation, and ligaments that are commonly torn. The sonographic features of certain common foot disorders related to physical activity and overuse are also discussed, including plantar fasciitis, Morton's neuroma, stress fractures, and plantar plate injury.

  12. Arthroscopic-Assisted Combined Dorsal and Volar Scapholunate Ligament Reconstruction with Tendon Graft for Chronic SL Instability.

    Science.gov (United States)

    Ho, Pak-Cheong; Wong, Clara Wing-Yee; Tse, Wing-Lim

    2015-11-01

    Background Both the dorsal and the volar portion of the scapholunate interosseous ligament (SLIL) are major stabilizers of the scapholunate (SL) joint. Most reconstruction methods to restore SL stability do not address the volar constraints and frequently fail to reduce the SL gapping. Wrist arthroscopy allows a complete evaluation of the SL interval, accompanying ligament status, and associated SL advanced collapse (SLAC) wrist changes. It enables simultaneous reconstruction of the dorsal and palmar SL ligaments anatomically with the use tendon graft in a boxlike structure. Materials and Methods From October 2002 to June 2012, the treatment method was applied in 17 patients of chronic SL instability of average duration of 9.5 months (range 1.5-18 months). There were three Geissler grade 3 and 14 grade 4 instability cases. The average preoperative SL interval was 4.9 mm (range 3-9 mm). Dorsal intercalated segment instability (DISI) deformity was present in 13 patients. Six patients had stage 1 SLAC wrist change radiologically. Concomitant procedures were performed in four patients. Description of Technique With the assistance of arthroscopy and intraoperative imaging as a guide, a combined limited dorsal and volar incision exposed the dorsal and palmar SL interval without violating the wrist joint capsule. Bone tunnels of 2.4 mm were made on the proximal scaphoid and lunate. A palmaris longus tendon graft was delivered through the wrist capsule and the bone tunnels to reduce and connect the two bones in a boxlike fashion. Once the joint diastasis is reduced and any DISI malrotation corrected, the tendon graft was knotted and sutured on the dorsal surface of the SL joint extra-capsularly in a shoe-lacing manner. The scaphocapitate joint was transfixed with Kirschner wires (K-wires) to protect the reconstruction for 6-8 weeks. Results The average follow-up was 48.3 months (range 11-132 months). Thirteen returned to their preinjury job level. Eleven

  13. 一期韧带修复联合拉力螺钉固定治疗踝关节不稳的疗效观察%Efficacy of phase Ⅰ ligament repair combined with lag screw fixation for ankle instability

    Institute of Scientific and Technical Information of China (English)

    罗静涛; 韩铭

    2015-01-01

    Objective To evaluate the clinical efficacy of phase Ⅰ ligament repair combined with lag screw fixation for ankle instability. Methods From Jan. 2011 to Jun. 2013, 34 patients with acute ankle sprain, including 18 males and 16 females, aged 28. 0 to 69. 0 years (mean 49. 3 years), were randomly divid-ed into external fixation group and screw fixation group (n=17 each), given external fixation with plaster or brace, and phase Ⅰ line of rivets in-situ repair combined with lag screw, respectively. All lesion limbs were not weight-bearing and followed up for 3 months. Hospital costs and complications were observed. Therapeutic effect was evaluated by AOFAS and VAS score. Results The cost of hospitalization was (1. 72±0. 30) ten thousand yuan in screw fixation group, and (0. 68±0. 20) ten thousand yuan in external fixation group (P<0. 05). AOFAS scores at 1st, 2nd, and 3rd month during the followed-up period were (66. 2±1. 3), (88. 5±2. 1) and (97. 2 ±1. 9) in screw fixation group, and (46. 8±1. 6), (53. 5±2. 7) and (75. 6±1. 2) in external fixation group (P<0. 05), respectively. VAS scores at 1st, 2nd, and 3rd month during the followed-up period were (3. 2 ± 0. 8), (2. 5±0. 6) and (1. 2±0. 2) in screw fixation group, and (4. 0±0. 7), (3. 1±0. 6) and (2. 6±0. 4) in external fixation group (P<0. 05), respectively. There was no screw cut out, nails broken, traumatic arthritis, inferior tibiofibular instability and other complications in screw fixation group. In external fixation group, 2 patients complained of ankle stiffness that eased after exercise and physiotherapy, and 4 patients administered phase Ⅱ ankle ligament reconstruction due to pain and instability in the knee. Conclusion Phase Ⅰ ligament repair combined with lag screw fixation for acute ankle instability manifests excellent postop-erative ankle function and fewer complications, although the cost of hospitalization is higher. It is a practicable procedure for ankle sprains.%目的:

  14. Simulations of foot stability during gait characteristic of ankle dorsiflexor weakness in the elderly.

    Science.gov (United States)

    Gefen, A

    2001-12-01

    Falls are common among the elderly and often cause injuries. They most frequently occut during walking and are associated with the chronic deterioration in neuromuscular and sensory systems, as well as with ankle dorsiflexor muscular weakness and lowered endurance of these muscles to fatigue. In the present study, a three-dimensional (3-D) finite element model of the structure of the foot was utilized to determine the effects of ankle dorsiflexor muscle weakness on the structural stability of the foot and, consequently, on the risk of falls during gait. The medial-lateral tendency of instability of the foot during gait in such conditions of weakness was analyzed by means of this model to identify the most important muscles used in controlling foot stability in affected individuals. The values of the eccentricity of the center of pressure under the heel during foot placement were used to indicate the degree of foot stability. The computational analysis indicated that it is the tibialis anterior muscle's weakness that dramatically decreases foot stability. Clinical investigation is now needed to correlate the significance of tibialis anterior muscle weakness with other known risk factors affecting the tendency to falls among the elderly, e.g., deterioration of sensory abilities. Rehabilitation practitioners and physical therapists may apply the present analytic approach to evaluate the stability of a foot before treatment and compare the predicted with the actual therapeutic results in terms of optimization of foot-ground pressure.

  15. [Arthrodesis versus total joint replacement of the ankle].

    Science.gov (United States)

    Mittlmeier, T

    2013-06-01

    In general, for the treatment of end-stage osteoarthritis of the ankle joint arthrodesis is considered to be the gold standard based on its versatility and eligibility for numerous indications. Nowadays, total ankle arthroplasty represents a viable alternative to ankle arthrodesis taking into account distinct premises as both procedures provide a calculable reduction of the preoperative pain level and a comparable functional gain. Furthermore, current 10-year-survival rates of total ankle replacement are reported to range between 76 % and 89 %. Revision rates of up to 10 % for both techniques have been reported with manifest differences within the respective spectrum of complications. Due to the fact that more than two thirds of patients suffer from post-traumatic osteoarthritis with a relatively low average of age concomitant malalignment, soft tissue damage or instability may frequently occur. A restoration of anatomic axes and an adequate centering of the talus under the tibia appear to be crucial for the outcome as well as an adequate soft tissue balancing, in particular in total ankle replacement. Thus, the selection of the correct indication and the right choice of treatment on the basis of complete preoperative diagnostics considering necessary additive surgical measures are of paramount importance for the final outcome.

  16. Effect of kidney damage indicators on ankle-brachial index of patients with chronic kidney disease%慢性肾脏病患者肾脏损伤指标对踝臂指数的影响

    Institute of Scientific and Technical Information of China (English)

    牛福坤; 阎磊; 邵凤民

    2012-01-01

    目的:探讨慢性肾脏病(CKD)患者肾脏损伤指标对踝臂指数(ABI)的影响.方法:收集295例CKD患者及体检中心170例无CKD的对照人群的资料,对2组尿白蛋白/肌酐比值(ACR)、估计肾小球滤过率(eGFR)与ABI进行logistic回归分析.结果:对CKD患者进行的多变量logistic回归分析显示,在校正了传统的心血管危险因素后,ACR与eGFR<60 mL/(min·1.73m2)均是低ABI的独立危险因素,OR(95%CI)分别为1.065(1.022~1.105)和1.122(1.032~2.577).结论:高ACR与低 eGFR可能导致CKD患者ABI降低.%Aim:To explore the effect of kidney damage indicators on abnormal ankle-brachial index( ABI ) of patients with chronic kidney disease( CKD ). Methods:A total of 295 patients with CKD and 170 non-CKD participants were enrolled. Association between kidney damage indicators, including estimated glomerular filtration rate ( eGFR ) and urinary albumin to creatinine ratio( ACR ) and abnormal ABI were analyzed by multivariable logistic regression model. Results: After adjusting for traditional cardiovascular risk factors among patients with CKD, ACR and eGFR were both independently associated with low ABI,OR( 95% CI) was 1.065( 1.022 ~ 1. 105 ) and 1. 122( 1.032~2.577 ),respectively. Conclusion: High ACR and low eGFR may induce low ABI of CKD patients.

  17. 10-year survival of total ankle arthroplasties

    Science.gov (United States)

    2011-01-01

    Background and purpose 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. Patients and methods 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. Results 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. Interpretation 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. PMID:22066551

  18. Total ankle replacement or ankle fusion in painful advanced hemophilic arthropathy of the ankle.

    Science.gov (United States)

    Rodriguez-Merchan, E Carlos

    2015-12-01

    In advanced painful hemophilic arthropathy of the ankle, the last resort is surgical treatment (ankle arthrodesis [AA] or total ankle replacement [TAR]). There is a controversy in the literature on which of the two procedures is more appropriate. A review of the literature was performed to clarify such a controversy. The first search engine was MedLine (keywords: total ankle replacement, ankle arthrodesis). Seventy articles were found in MedLine. Of these, only 16 were selected and reviewed because they were strictly focused on the topic of this article. The second search engine was the Cochrane Library, where only nine systematic reviews were found on the role of TAR and AA in non-hemophilia patients. TAR and AA provide pain relief and patient satisfaction in hemophilia patients in the short term. The available non-hemophilia literature is insufficient to conclude which treatment is superior. My current view is that AA may be preferable in most hemophilia patients.

  19. The Effect of Fatigue and Instability on Postural Control Parameters in Standing Posture in Healthy Adults and Patients with Chronic Low Back Pain

    Directory of Open Access Journals (Sweden)

    Amir Hosein Kahlaee

    2012-06-01

    Full Text Available Background: This study aims at analyzing the effect of fatigue and instability on postural control parameters in both healthy people and patients with the chronic nonspecific low-back pain.Materials and Methods: In this non-experimental case-control study, oscillations of center of pressure were statistically analyzed in 16 healthy people and 15 patients with the chronic nonspecific low back pain. The analysis was conducted through two stages: before and after fatigue and under both stable and unstable surfaces. Results: Under the pre-fatigue, stable condition, there was not any difference between the two groups. Both fatigue and unstable surface changed our variables (sway area, range, velocity, frequency and total power of the signal. All the changes in variables were significant in the low-back pain group; while changes in the healthy group only covered the time-domain variables. The effect of instability was higher than that of fatigue. Conclusion: The postural control system for patients with low-back pain before fatigue and under stable condition, revealed sufficient competence to provide postural stability and its function cannot be differentiated from that in healthy people. Meanwhile, different mechanisms were used by these patients to confront stability challenging factors and further neural activity was required to counteract such factors.

  20. Treatment of Unstable Ankle Fractures

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    Yaniel Truffín Rodríguez

    2015-11-01

    Full Text Available Patients with unstable ankle fractures frequently attend the emergency rooms. It is estimated that there are 122 ankle fractures per 100 000 people a year. Surgical treatment of those that are unstable is inevitable since they can not be corrected in a conservative way. Several surgical procedures for repair of such lesions have been described and all of them constitute important tools for the orthopedic surgeon. Therefore, we conducted a literature review to discuss the current management of unstable ankle fractures based on the analysis of the published literature and the experiences in the Dr. Gustavo Aldereguía Lima University General Hospital of Cienfuegos.

  1. Resting and Post-Exercise Ankle-Brachial Index Measurements to Diagnose Asymptomatic Peripheral Arterial Disease in Middle Aged and Elderly Chronic Obstructive Pulmonary Disease Patients: A Pilot Study

    Science.gov (United States)

    Alagiakrishnan, Kannayiram; Brokop, Michael; Cave, Andrew; Rowe, Brian H.; Wong, Eric; Senthilselvan, Ambikaipakan

    2016-01-01

    Background Chronic obstructive pulmonary disease (COPD) patients are at risk for asymptomatic peripheral arterial disease (PAD) because smoking is a risk factor for COPD and PAD. The objectives of this study were to determine the proportion of COPD patients with asymptomatic PAD and to investigate whether the estimated risk of asymptomatic PAD in subjects with COPD differs using resting and exercise ankle-brachial index (ABI) in smokers. Methods Using a cross-sectional study design, consecutive smokers > 50 years old were recruited over 2 months from the inpatient units and the outpatient clinics. Subjects previously diagnosed with PAD, unstable angina, recent (< 3 months) myocardial infarction or abdominal, intracranial, eye or lung surgery, and palliative care patients were excluded. Vascular risk factors, ABI (supine and post-3-minute walk supine), self-reported PAD symptoms, and spirometry were obtained. Two measurements of systolic blood pressure on all limbs were obtained using a sphygmomanometer and a Doppler ultrasound, and the ABI was calculated. Data were expressed as means ± standard deviation (SD). Dichotomous outcomes were assessed using Chi-square statistics; P-values of < 0.05 were considered significant. Results Thirty patients with no previous diagnosis of PAD were recruited. Mean age was 67.7 years (SD: 10.5). Overall, 21 subjects (70%) had spirometry-proven COPD. Significant ABI for PAD (< 0.9) was seen in 7/21 COPD (33.5%) and 0/9 non-COPD subjects in the supine resting position (P = 0.07), and in 9/21 COPD (42.9%) vs. 0/9 non-COPD subjects after exercise (P = 0.03). Conclusions A significant proportion of patients with spirometry-proven COPD screened positive for asymptomatic PAD after exercise. Resting ABI may not be very sensitive to diagnose asymptomatic PAD in COPD subjects. ABI may be a reliable, sensitive and practical screening tool to assess cardiovascular risk in COPD patients. Future large-scale studies are required to confirm this

  2. Avaliação da circulação arterial pela medida do índice tornozelo/braço em doentes de úlcera venosa crônica Evaluation of arterial circulation using the ankle/brachial blood pressure index in patients with chronic venous ulcers

    Directory of Open Access Journals (Sweden)

    Fabiane Noronha Bergonse

    2006-03-01

    Full Text Available FUNDAMENTOS: As úlceras venosas dos membros inferiores são freqüentes e têm grande impacto na qualidade de vida e produtividade do indivíduo, além de alto custo para a saúde pública. OBJETIVOS: Detecção de alterações arteriais em pacientes de úlcera venosa crônica dos membros inferiores com emprego de método não invasivo, de modo a discriminar aqueles em que estaria contra-indicado o tratamento compressivo. MÉTODOS: Foram estudados 40 doentes portadores de úlcera venosa crônica, com o intuito de se avaliar a presença de doença arterial periférica pela medida do índice tornozelo/braço por doppler-ultra-som. RESULTADOS: O índice tornozelo/braço mostrou-se alterado (menor que 1 em 9/22 (40,9% doentes com úlcera venosa crônica e hipertensão arterial concomitante, e apenas em 1/13 (7,7% doentes de úlcera venosa crônica sem hipertensão arterial. CONCLUSÕES: Doentes de úlcera venosa crônica e hipertensão arterial concomitantes devem ser submetidos rotineiramente à medida do índice tornozelo/braço para detecção de possível insuficiência arterial periférica associada.BACKGROUND: Chronic venous ulcers are extremely frequent and have a significant impact on quality of life and work productivity of individuals, in addition to high costs to public health. OBJECTIVES: Detection of arterial circulation alterations in chronic venous ulcer legs using a non-invasive method to discriminate patients not indicated to have compressive treatment. METHODS: Forty patients with chronic venous ulcers were investigated for the presence of peripheral arterial disease with measurement of the ankle/brachial index by Doppler ultrasound. RESULTS: The resting ankle/brachial pressure index was abnormal (lower than 1 in 9/22 (40.9% patients with concomitant chronic venous ulcers and hypertension and only in one out of 13 (7.7% patients with chronic venous ulcers and no hypertension. CONCLUSIONS: Patients with concomitant chronic venous

  3. Observation of clinical efficacy of acupuncture, ultrashort wave combined with kinesio taping in the treatment of chronic ankle sprain%针灸、超短波联合肌内效贴治疗慢性踝关节扭伤的临床疗效观察

    Institute of Scientific and Technical Information of China (English)

    宋瑞军; 董莉莉; 李明阳; 张明; 尚明臣; 梁海龙

    2015-01-01

    Objective To explore the curative effects of acupuncture, ultrashort wave combined with kinesio taping in the treatment of chronic ankle sprain for clinical references. Methods All 80 patients with chronic ankle sprain were randomly assigned to the control group and the treatment group. The control group was given the treatment of acupunc-ture and ultrashort wave, and the treatment group was further given the treatment of kinesio taping on the basis of acupuncture and ultrashort wave. One course of treatment lasted for seven days,and the treatment lasted for two courses of 14 days in total. The differences of clinical efficacy were observed between the two groups of patients. VAS and A Modern Practical Handbook of Orthopedics were applied for evaluation before and after the treatment. Results VAS scores and curative effective rate in the two groups all improved,and the improvement in the treatment group was more significant than that in the control group (P<0.01). Conclusion The application of acupuncture, ultrashort wave com-bined with kinesio taping in the treatment of chronic ankle sprain is effective in alleviating pain and improving ankle function.%目的:探讨针灸、超短波联合肌内效贴治疗慢性踝关节扭伤的疗效,以供临床参考。方法80例慢性踝关节扭伤患者随机分为对照组和治疗组,对照组采用针灸、超短波治疗,治疗组在针灸、超短波基础上加入肌内效贴治疗,以7 d为一个疗程,连续治疗2个疗程,共14 d,观察两组患者的临床疗效。治疗前后采用视觉模拟评分法(VAS)、《实用骨伤科手册》进行评定。结果两组患者VAS评分和治疗有效率均改善,治疗组较对照组改善更明显(P<0.01)。结论运用针灸、超短波联合肌内效贴治疗慢性踝关节扭伤能更有效缓解疼痛,改善踝关节功能。

  4. Simultaneous surgical management of chronic grade-2 valgus instability of the knee and anterior cruciate ligament deficiency in athletes.

    Science.gov (United States)

    Osti, Leonardo; Papalia, Rocco; Del Buono, Angelo; Merlo, Franco; Denaro, Vincenzo; Maffulli, Nicola

    2010-03-01

    We report on 22 patients with chronic grade-2 valgus laxity of the knee combined with chronic anterior cruciate ligament (ACL) insufficiency, in whom the two lesions were addressed at the same surgical setting. At a minimum follow-up of 24 months, clinical and functional variables had improved significantly (P pre-injury level. There were no operative complications in this series. In selected athletes with chronic symptomatic valgus laxity of the knee combined with ACL insufficiency, surgical repair of the MCL in association with ACL reconstruction is a suitable and reliable option to restore knee stability and allow return to pre-injury activity level.

  5. 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.

  6. Total ankle replacement. Design evolution and results.

    Science.gov (United States)

    van den Heuvel, Alexander; Van Bouwel, Saskia; Dereymaeker, Greta

    2010-04-01

    The ankle joint has unique anatomical, biomechanical and cartilaginous structural characteristics that allow the joint to withstand the very high mechanical stresses and strains over years. Any minor changes to any of these features predispose the joint to osteoarthritis. Total ankle replacement (TAR) is evolving as an alternative to ankle arthrodesis for the treatment of end-stage ankle osteoarthritis. Initial implant designs from the early 1970s had unacceptably high failure and complication rates. As a result many orthopaedic surgeons have restricted the use of TAR in favour of ankle arthrodesis. Long term follow-up studies following ankle arthrodesis show risks of developing adjacent joint osteoarthritis. Therefore research towards a successful ankle replacement continues. Newer designs and longer-term outcome studies have renewed the interest in ankle joint replacement. We present an overview of the evolution, results and current concepts of total ankle replacement.

  7. Ankle Brachial Index

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    Wikstroem, J.; Hansen, T.; Johansson, L.; Lind, L.; Ahlstroem, H. (Dept. of Radiology and Dept. of Medical Sciences, Uppsala Univ. Hospital, Uppsala (SE))

    2008-03-15

    Background: Whole-body magnetic resonance angiography (WBMRA) permits noninvasive vascular assessment, which can be utilized in epidemiological studies. Purpose: To assess the relation between a low ankle brachial index (ABI) and high-grade stenoses in the pelvic and leg arteries in the elderly. Material and Methods: WBMRA was performed in a population sample of 306 subjects aged 70 years. The arteries below the aortic bifurcation were graded after the most severe stenosis according to one of three grades: 0-49% stenosis, 50-99% stenosis, or occlusion. ABI was calculated for each side. Results: There were assessable WBMRA and ABI examinations in 268 (right side), 265 (left side), and 258 cases (both sides). At least one >=50% stenosis was found in 19% (right side), 23% (left side), and 28% (on at least one side) of the cases. The corresponding prevalences for ABI <0.9 were 4.5%, 4.2%, and 6.6%. An ABI cut-off value of 0.9 resulted in a sensitivity, specificity, and positive and negative predictive value of 20%, 99%, 83%, and 84% on the right side, and 15%, 99%, 82%, and 80% on the left side, respectively, for the presence of a >= 50% stenosis in the pelvic or leg arteries. Conclusion: An ABI <0.9 underestimates the prevalence of peripheral arterial occlusive disease in the general elderly population

  8. Late diagnosis of lateral meningocele syndrome in a 55-year-old woman with symptoms of joint instability and chronic musculoskeletal pain.

    Science.gov (United States)

    Castori, Marco; Morlino, Silvia; Ritelli, Marco; Brancati, Francesco; De Bernardo, Carmelilia; Colombi, Marina; Grammatico, Paola

    2014-02-01

    Lateral meningocele syndrome (LMS) is a rare hereditary connective tissue disorder characterized by pan-spinal meningoceles, specific facial dysmorphism, skeletal and soft tissue abnormalities, and hypotonia and/or muscle weakness. LMS has been observed in eleven patients with two instances of vertical transmission, and seven sporadic cases with an age at diagnosis ranging from 25 months to 33 years. We report on a further observation of LMS in a 55-year-old woman presenting with a long history of joint instability, chronic musculoskeletal pain, and iatrogenic bladder and anorectal dysfunction due to irreversible nerve damage after surgical excision of a meningeal cyst. Her clinical characteristics are compared with those of previously reported patients, as well as two further cases originally diagnosed with Hajdu-Cheney and Ehlers-Danlos syndromes, but displaying typical features of LMS.

  9. Posterior Ankle Structure Injury During Total Ankle Replacement.

    Science.gov (United States)

    Reb, Christopher W; McAlister, Jeffrey E; Hyer, Christopher F; Berlet, Gregory C

    2016-01-01

    Total ankle replacement studies have focused on reporting complications that are directly observed clinically or radiographically, including wound problems, technical errors, implant loosening, subsidence, infection, bone fractures, and heterotopic ossification. However, patients can still experience unresolved pain even when these problems have been ruled out. We initiated a study to more clearly define the relative risk of injury to the anatomic structures in the posterior ankle during total ankle replacement using a third-generation implant system. Ten fresh-frozen adult cadaveric below-the-knee specimens were positioned in the intraoperative positioning frame of an approved total ankle replacement system and adjusted to achieve proper foot alignment using fluoroscopic imaging. The relationship between the tibial cutting guide pins and the posterior neurovascular and tendon structures was measured using digital calipers. High rates of posterior structural injury were found. Nearly all proximal-medial pins encountered a posteromedial neurovascular structure, most commonly the tibial nerve. The distal-medial pins mainly encountered posteromedial tendinous structures, in particular, the flexor digitorum longus tendon. The proximal lateral pins were highly likely to encounter the Achilles tendon and the sural nerve. Our results support our hypothesis that the tibial neurovascular structures are at the greatest risk when preparing for and completing the bony resection, particularly with the medial and proximal cuts. Posterior ankle soft tissue structure injuries can occur during implantation but currently with unknown frequency and undetermined significance. Further study of posterior structural injuries could result in a more informed approach to post-total ankle replacement complications and management.

  10. American Orthopaedic Foot and Ankle Society

    Science.gov (United States)

    ... education site of the American Orthopaedic Foot & Ankle Society. Patients Visit the official patient education site of the American Orthopaedic Foot & Ankle Society. Patients Visit the official patient education site of ...

  11. Acute Ankle Sprains in Primary Care

    NARCIS (Netherlands)

    R.M. van Rijn (Rogier)

    2010-01-01

    textabstractOf all injuries of the musculoskeletal system, 25% are acute lateral ankle sprains.1 In the USA and the UK there are about 23,000 and 5000 ankle sprains, respectively, each day. In the Netherlands approximately 600,000 people sustain an ankle injury each year, of those 120,000 occur duri

  12. The Incidence of Ankle Sprains in Orienteering.

    Science.gov (United States)

    Ekstrand, Jan; And Others

    1990-01-01

    Investigates relationship between ankle sprains and participation time in competitive orienteering. Examined 15,474 competitors in races in the Swedish O-ringen 5-day event in 1987. Injuries requiring medical attention were analyzed, showing 137 (23.9 percent) ankle sprains. Injury incidence was 8.4/10,000 hours. Incidence of ankle sprains was…

  13. Flexor Digitorum Accessorius Longus: Importance of Posterior Ankle Endoscopy

    Science.gov (United States)

    Batista, Jorge Pablo; del Vecchio, Jorge Javier; Golanó, Pau; Vega, Jordi

    2015-01-01

    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. PMID:26060592

  14. 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.

  15. The Scandinavian Total Ankle Replacement and the ideal biomechanical requirements of ankle replacements.

    Science.gov (United States)

    Robati, Shibby; Salih, Alan; Ghosh, Koushik; Vinayakam, Parthiban

    2016-03-01

    The complex anatomy of the articular bone surfaces, ligaments, tendon attachments and muscles makes the ankle joint difficult to replicate in prosthetic replacements. Ever since the early 1970s, which saw the dawn of the first total ankle replacements, there have been numerous other attempts at replicating the joint, often with poor clinical outcomes. The anatomy of the ankle is discussed, followed by evidence of the normal ankle biomechanics and the ideal requirements of an ankle replacement. We focus on the Scandinavian Total Ankle Replacement and evaluate whether these requirements have been met.

  16. Hydrocolonotherapy ankle joints after injuries

    Directory of Open Access Journals (Sweden)

    Volodymyr Muchin

    2016-02-01

    Full Text Available Purpose: to improve efficiency of gydrokinesitherapy by means of specially designed devices and monolasts for patients after ankle joint injuries. Material & Methods: there are pedagogical methods, clinical and radiological methods, anthropometric measurements and goniometry were used. Results: the author's technique of hydrokinesitherapy with application hydrokinesimechanotherapy device in the program of physical rehabilitation which provides optimum conditions for the recovery process was developed. Conclusions: the specially designed hydrokinesomechanotherapeutic device and monolasts are allow strictly controlled movement in all planes of the ankle joint, which contributes to the acceleration of the recovery; the conducted anthropometric and goniometric studies were indicate more rapid elimination of edema, increase movement amplitude, carries opposition to the development of contractures and muscle atrophy.

  17. Annular lipoatrophy of the ankles.

    Science.gov (United States)

    Dimson, Otobia G; Esterly, Nancy B

    2006-02-01

    Lipoatrophic panniculitis likely represents a group of disorders characterized by an inflammatory panniculitis followed by lipoatrophy. It occurs locally in a variety of settings and has been reported in the literature under various terms, including annular atrophic connective tissue panniculitis of the ankles, annular and semicircular lipoatrophy, abdominal lipoatrophy, and connective tissue panniculitis. Herein, a case of annular lipoatrophy of the ankles is described in a 6-year-old girl with autoimmune thyroid disease. Histologically, a mixed lobular panniculitis with lipophages was present. This pattern resembles that seen in lipoatrophic panniculitis. After a single, acute episode of an inflammatory process with subsequent lipoatrophy, her skin lesions have stabilized for 2 years requiring no treatment.

  18. Hydrocolonotherapy ankle joints after injuries

    OpenAIRE

    Volodymyr Muchin; Oleksandr Zviriaka

    2016-01-01

    Muchin V., Zviriaka O. Purpose: to improve efficiency of gydrokinesitherapy by means of specially designed devices and monolasts for patients after ankle joint injuries. Material & Methods: there are pedagogical methods, clinical and radiological methods, anthropometric measurements and goniometry were used. Results: the author's technique of hydrokinesitherapy with application hydrokinesimechanotherapy device in the program of physical rehabilitation which provides optimum conditions for...

  19. Total Ankle Arthroplasty: A Brief Review

    Directory of Open Access Journals (Sweden)

    Roger A. Mann

    2012-12-01

    Full Text Available Ankle fusion has long been the standard of treatment for end-stage ankle arthritis, and a successful arthroplasty has been a long sought alternative. It is a motion sparing procedure and may greatly reduce the potential for adjacent level degeneration as seen with arthrodesis. The typical candidate for arthroplasty is a healthy low demand patient, although the indications are widening as the success of the procedure has increased. Nevertheless, it is not fail-safe, technical expertise and experience are necessary to achieve a successful result. We have been treating ankle arthritis with the Scandinavian Total Ankle Replacement (STAR ankle replacement prosthesis for over ten years. We believe that arthroplasty will surpass arthrodesis as the standard of care for severe ankle arthritis.

  20. Maisonneuve-hyperplantarflexion variant ankle fracture.

    Science.gov (United States)

    Hinds, Richard M; Tran, Wesley H; Lorich, Dean G

    2014-11-01

    Maisonneuve fractures are rare ankle injuries, accounting for up to 7% of all ankle fractures. They consist of a proximal third fibula fracture, syndesmotic disruption, and medial ankle injury (either a deltoid ligament disruption or a medial malleolus fracture), and are often successfully managed with nonoperative treatment of the proximal fibula fracture and open reduction and internal fixation (ORIF) of the medial ankle injury and syndesmotic disruption. The hyperplantarflexion variant ankle fracture comprises approximately 7% of all ankle fractures and features dual posterior tibial lip fractures featuring a posterolateral fragment and a posteromedial fragment. Good functional results have been reported in the literature after ORIF of both the posterolateral and posteromedial fragments of this variant fracture that is not described by the Lauge-Hansen classification. In this report, the authors present the unique case of an isolated ankle fracture demonstrating characteristics of both a Maisonneuve fracture and a hyperplantarflexion variant ankle fracture. They also highlight the diagnostic imaging characteristics, including magnetic resonance imaging (MRI) and preoperative radiograph findings, surgical treatment, and postoperative clinical outcome for this patient with a Maisonneuve-hyperplantarflexion variant ankle fracture. To the authors' knowledge, this unique fracture pattern has not been reported previously in the literature. The authors conclude that although good results were seen postoperatively in this case, the importance of ORIF of both the posteromedial and posterolateral fragments of variant fractures cannot be overstated. They also found MRI to be a particularly helpful adjunct in formulating the correct diagnosis and treatment plan.

  1. Fusion following failed total ankle replacement.

    Science.gov (United States)

    Wünschel, Markus; Leichtle, Ulf G; Leichtle, Carmen I; Walter, Christian; Mittag, Falk; Arlt, Eva; Suckel, Andreas

    2013-04-01

    Although mid- to long-term results after total ankle replacement have improved because of available second- and third-generation devices, failure of total ankle replacement is still more common compared with total hip replacement and total knee replacement. The portfolio of available total ankle replacement revision component options is small. Furthermore, the bone stock of the tibiotalar region is scarce making it difficult and in some situations impossible to perform revision total ankle replacement. In these cases tibiotalar and tibiotalocalcaneal fusions are valuable options. This article describes which surgical procedures should be performed depending on the initial situation and gives detailed advice on surgical technique, postoperative care, and clinical results.

  2. Total Ankle Arthroplasty: An Imaging Overview.

    Science.gov (United States)

    Kim, Da-Rae; Choi, Yun Sun; Potter, Hollis G; Li, Angela E; Chun, Ka-Young; Jung, Yoon Young; Kim, Jin-Su; Young, Ki-Won

    2016-01-01

    With advances in implant technology, total ankle arthroplasty (TAA) has become an increasingly popular alternative to arthrodesis for the management of end-stage ankle arthritis. However, reports in the literature do not focus on the imaging features of TAA. Through a literature review, we demonstrate basic design features of the current ankle arthroplasty system, and the normal and abnormal postoperative imaging features associated with such devices. Pre- and postoperative evaluations of ankle arthroplasty mainly include radiography; in addition, computed tomography and magnetic resonance imaging provide further characterization of imaging abnormalities. Familiarization with multimodal imaging features of frequent procedural complications at various postoperative intervals is important in radiological practice.

  3. Total ankle arthroplasty: An imaging overview

    Energy Technology Data Exchange (ETDEWEB)

    Kim, Da Rae; Choi, Yun Sun; Chun, Ka Young; Jung, Yoon Young; Kim, Jin Su; Young, Ki Won [Eulji Hospital, Eulji University, Seoul (Korea, Republic of); Potter, Hollis G.; Li, Angela E. [Dept. of Radiology and Imaging, Hospital for Special Surgery, New York (United States)

    2016-06-15

    With advances in implant technology, total ankle arthroplasty (TAA) has become an increasingly popular alternative to arthrodesis for the management of end-stage ankle arthritis. However, reports in the literature do not focus on the imaging features of TAA. Through a literature review, we demonstrate basic design features of the current ankle arthroplasty system, and the normal and abnormal postoperative imaging features associated with such devices. Pre- and postoperative evaluations of ankle arthroplasty mainly include radiography; in addition, computed tomography and magnetic resonance imaging provide further characterization of imaging abnormalities. Familiarization with multimodal imaging features of frequent procedural complications at various postoperative intervals is important in radiological practice.

  4. Haemophilic arthropathy of the ankle treated by total ankle replacement: a case series.

    Science.gov (United States)

    Barg, A; Elsner, A; Hefti, D; Hintermann, B

    2010-07-01

    The standard treatment for end-stage osteoarthritis of the ankle joint in haemophilic patients has been fusion of the ankle joint. Total ankle replacement is still controversial as a treatment option. The objective of this prospective study was to evaluate the mid-term outcome in patients treated with total ankle replacement using an unconstrained three-component ankle implant. Ten haemophilic ankles in eight patients (mean age: 43.2 years, range 26.7-57.5) treated with total ankle replacement were followed up for a minimum of 2.7 years (mean: 5.6, range 2.7-7.6). The outcome was measured with clinical and radiological evaluations. There were no intra- or peri-operative complications. The AOFAS-hindfoot-score increased from 38 (range 8-57) preoperatively to 81 (range 69-95) postoperatively. All patients were satisfied with the results. Four patients became pain free; in the whole patient cohort pain level decreased from 7.1 (range 4-9) preoperatively to 0.8 (range 0-3) postoperatively. All categories of SF-36 score showed significant improvements in quality of life. In one patient, open ankle arthrolysis was performed because of painful arthrofibrosis. For patients with haemophilic osteoarthritis of the ankle joint, total ankle replacement is a valuable alternative treatment to ankle fusion.

  5. Current concepts review: ankle fractures.

    Science.gov (United States)

    Arastu, M H; Demcoe, R; Buckley, R E

    2012-01-01

    Ankle fractures are common injuries that require meticulous technique in order to optimise outcome. The Lauge-Hansen and Danis-Weber classifications in addition to careful evaluation of the injury mechanism can help guide treatment but surgeons must be aware that there are injury patterns that will not always fit the afore mentioned patterns. The principles of atraumatic soft tissue handling, rigid internal fixation and early range of motion exercises are critical for successfully treating these injuries. There are still areas of treatment uncertainty and future directed research is needed in order to address some of these questions.

  6. Osteochondral defects in the ankle: why painful?

    NARCIS (Netherlands)

    van Dijk, C.N.; Reilingh, M.L.; Zengerink, M.; van Bergen, C.J.A.

    2010-01-01

    Osteochondral defects of the ankle can either heal and remain asymptomatic or progress to deep ankle pain on weight bearing and formation of subchondral bone cysts. The development of a symptomatic OD depends on various factors, including the damage and insufficient repair of the subchondral bone pl

  7. Radiological aspects of sprained ankle syndrome

    NARCIS (Netherlands)

    Sijbrandij, E.S.

    2002-01-01

    This thesis addresses several problems related to sprained ankle syndrome. The purpose of this thesis is to evaluate the imaging features of sprained ankles, found on new radiological modalities, and to assess the additional diagnostic understanding and treatment planning of helical CT as well as M

  8. Assessment of acute foot and ankle sprains.

    Science.gov (United States)

    Lynam, Louise

    2006-07-01

    Acute ankle and foot trauma is a regular emergency presentation and prompt strategic assessment skills are required to enable nurses to categorise and prioritise these injuries appropriately. This article provides background information on the anatomy and physiology of the lower limb to help nurses to identify various grades of ankle sprain as well as injuries that are limb threatening

  9. Total ankle replacement - surgical treatment and rehabilitation.

    Science.gov (United States)

    Prusinowska, Agnieszka; Krogulec, Zbigniew; Turski, Piotr; Przepiórski, Emil; Małdyk, Paweł; Księżopolska-Orłowska, Krystyna

    2015-01-01

    Functions of the ankle joint are closely connected with the gait and ability to maintain an upright position. Degenerative lesions of the joint directly contribute to postural disorders and greatly restrict propulsion of the foot, thus leading to abnormal gait. Development of total ankle replacement is connected with the use of the method as an efficient treatment of joint injuries and continuation of achievements in hip and knee surgery. The total ankle replacement technique was introduced as an alternative to arthrodesis, i.e. surgical fixation, which made it possible to preserve joint mobility and to improve gait. Total ankle replacement is indicated in post-traumatic degenerative joint disease and joint destruction secondary to rheumatoid arthritis. In this paper, total ankle replacement and various types of currently used endoprostheses are discussed. The authors also describe principles of early postoperative rehabilitation as well as rehabilitation in the outpatient setting.

  10. Mechanical instability

    CERN Document Server

    Krysinski, Tomasz

    2013-01-01

    This book presents a study of the stability of mechanical systems, i.e. their free response when they are removed from their position of equilibrium after a temporary disturbance. After reviewing the main analytical methods of the dynamical stability of systems, it highlights the fundamental difference in nature between the phenomena of forced resonance vibration of mechanical systems subjected to an imposed excitation and instabilities that characterize their free response. It specifically develops instabilities arising from the rotor-structure coupling, instability of control systems, the se

  11. Collective instabilities

    Energy Technology Data Exchange (ETDEWEB)

    K.Y. Ng

    2003-08-25

    The lecture covers mainly Sections 2.VIII and 3.VII of the book ''Accelerator Physics'' by S.Y. Lee, plus mode-coupling instabilities and chromaticity-driven head-tail instability. Besides giving more detailed derivation of many equations, simple interpretations of many collective instabilities are included with the intention that the phenomena can be understood more easily without going into too much mathematics. The notations of Lee's book as well as the e{sup jwt} convention are followed.

  12. Revision of the aseptic and septic total ankle replacement.

    Science.gov (United States)

    Espinosa, Norman; Wirth, Stephan Hermann

    2013-04-01

    Total ankle replacement has become a popular treatment of symptomatic end-stage ankle osteoarthritis. Contemporary total ankle replacement systems provide more anatomic and biomechanically sound function. However, longevity is still limited and long-term results of modern total ankle replacement designs are not available. In the case of failure, conversion into arthrodesis has remained the treatment of choice but at the cost of hindfoot function and potential degeneration of the adjacent joints. Thus, revision total ankle replacement by exchange of the prosthetic components represents an attractive solution. This article focuses on revision total ankle replacement and conversion to ankle arthrodesis.

  13. [Biomechanics of the ankle joint].

    Science.gov (United States)

    Zwipp, H

    1989-03-01

    According to Fick, the tree-dimensional patterns of foot motion are best characterized as jawlike movement. Anatomically and biomechanically, this process represents conjoined, synchronous motion within the three mobile segments of the hindfoot: the ankle joint, the posterior subtalar joint, and the anterior subtalar joint. Foot kinematics can be described more completely if the anterior subtalar joint is defined not only as the talocalcaneal navicular joint, but as including the calcaneocuboid joint, thus representing the transverse joint of the tarsus, i.e., the Chopart joint. The axes of these three joints can be defined precisely. In some parts they represent a screwlike motion, clockwise or counter-clockwise, around the central ligamentous structures (fibulotibial ligament, talocalcaneal interosseous ligament, bifurcate ligament). The individual anatomy and structure of these ligaments provide variations in the degree and direction of foot motion. A precise knowledge of foot kinematics is important in surgical ligament and joint reconstruction and in selective foot arthrodeses.

  14. Biomechanics of the ankle joint and clinical outcomes of total ankle replacement.

    Science.gov (United States)

    Michael, Junitha M; Golshani, Ashkahn; Gargac, Shawn; Goswami, Tarun

    2008-10-01

    Until the 1970s ankle arthrodesis was considered to be the "gold-standard" to treat arthritis. But the low fusion rate of ankle arthrodeses along with the inability to achieve normal range of motion led to the growing interest in the development of total ankle replacements. Though the short-term outcomes were good, their long-term outcomes were not as promising. To date, most models do not exactly mimic the anatomical functionality of a natural ankle joint. Therefore, research is being conducted worldwide to either enhance the existing models or develop new models while understanding the intricacies of the joint more precisely. This paper reviews the anatomical and biomechanical aspects of the ankle joint. Also, the evolution and comparison of clinical outcomes of various total ankle replacements are presented.

  15. Position versus force control: using the 2-DOF robotic ankle trainer to assess ankle's motor control.

    Science.gov (United States)

    Farjadian, Amir B; Nabian, Mohsen; Hartman, Amber; Corsino, Johnathan; Mavroidis, Constantinos; Holden, Maureen K

    2014-01-01

    An estimated of 2,000,000 acute ankle sprains occur annually in the United States. Furthermore, ankle disabilities are caused by neurological impairments such as traumatic brain injury, cerebral palsy and stroke. The virtually interfaced robotic ankle and balance trainer (vi-RABT) was introduced as a cost-effective platform-based rehabilitation robot to improve overall ankle/balance strength, mobility and control. The system is equipped with 2 degrees of freedom (2-DOF) controlled actuation along with complete means of angle and torque measurement mechanisms. Vi-RABT was used to assess ankle strength, flexibility and motor control in healthy human subjects, while playing interactive virtual reality games on the screen. The results suggest that in the task with 2-DOF, subjects have better control over ankle's position vs. force.

  16. Conversion of ankle autofusion to total ankle replacement using the Salto XT revision prosthesis.

    Science.gov (United States)

    Williamson, Emilie R C; Demetracopoulos, Constantine A; Ellis, Scott J

    2016-09-01

    Few reports in the literature have described the conversion of a surgically fused ankle to a total ankle replacement. The takedown of an autofusion and conversion to a prosthesis has not been described. We report the case of a patient with severe rheumatoid arthritis with an ankle autofusion fixed in equinus and severe talonavicular arthritis that was converted to ankle replacement using the Salto XT revision system. We describe the reasons why the decision was made to perform total ankle arthroplasty while concomitantly fusing the talonavicular joint, and discuss the rationale of the various surgical treatment options considered. We describe the clinical and radiographic outcomes achieved in this case. At 12 months post-operatively the patient reported significant reduction of pain, increased FAOS scores and had increased ankle range of motion.

  17. FATIGUE DEVICE FOR TESTING ANKLE JOINT ENDOPROSTHESES

    Directory of Open Access Journals (Sweden)

    Cristian TOADER-PASTI

    2012-05-01

    Full Text Available The paper proposes a model of a fatigue device for testing dedicated to ankle prostheses. The concept of the testing device relies on two aspects: almost any type of ankle prosthesis can be tested on it and it has to work on INSTRON axial-torsion testing machine. Starting from these requirements, a 3D functional assembly that reproduces the real movement of the ankle joint during gait cycle has been designed. The device is based on a cam-follower mechanism.

  18. 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.

  19. Transfibular ankle arthrodesis: A novel method for ankle fusion – A short term retrospective study

    Science.gov (United States)

    Balaji, S Muthukumar; Selvaraj, V; Devadoss, Sathish; Devadoss, Annamalai

    2017-01-01

    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. PMID:28216754

  20. 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.

  1. Lichen simplex chronicus on the ankle (image)

    Science.gov (United States)

    Lichen simplex chronicus on the ankle: Lichen simplex chronicus is also known as neurodermatitis. A minor itch may encourage scratching which increases the irritation, leading to more scratching. This ...

  2. American College of Foot and Ankle Surgeons

    Science.gov (United States)

    ... Practice Management Education Opportunities Practice Management e-Learning e-Learning CME Transcripts Corporate Relations Faculty Application Research & Publications Journal of Foot and Ankle Surgery ACFAS Update Read ...

  3. Chronic Kidney Disease

    Science.gov (United States)

    ... of the feet and ankles Causes & Risk FactorsWhat causes CKD?The most common causes of CKD are high blood pressure, diabetes and heart disease. ... caused by CKD.How else is CKD treated?Chronic kidney disease can cause other problems. Talk with your doctor about how ...

  4. An epidemiological survey on ankle sprain.

    OpenAIRE

    Yeung, M S; Chan, K. M.; So, C H; Yuan, W Y

    1994-01-01

    Ankle sprain is a common sports injury and is often regarded as trivial by athletes and coaches. This epidemiological study was conducted among three categories of Hong Kong Chinese athletes: national teams, competitive athletes and recreational athletes. This study shows that as much as 73% of all athletes had recurrent ankle sprain and 59% of these athletes had significant disability and residual symptoms which led to impairment of their athletic performance. This study indicates that a pro...

  5. Total Ankle Arthroplasty: A Brief Review

    OpenAIRE

    Mann, Roger A.; Harrison, Matthew J.

    2012-01-01

    Ankle fusion has long been the standard of treatment for end-stage ankle arthritis, and a successful arthroplasty has been a long sought alternative. It is a motion sparing procedure and may greatly reduce the potential for adjacent level degeneration as seen with arthrodesis. The typical candidate for arthroplasty is a healthy low demand patient, although the indications are widening as the success of the procedure has increased. Nevertheless, it is not fail-safe, technical expertise and exp...

  6. Salvage arthrodesis for failed total ankle arthroplasty

    Science.gov (United States)

    Zürcher, Arthur W

    2010-01-01

    Background and purpose Total ankle arthroplasty (TAA) has gained popularity in recent years. If it fails, however, salvage arthrodesis must be reliable as a rescue procedure. We therefore investigated the clinical, radiographic, and subjective outcome after salvage arthrodesis in a consecutive group of patients, and concentrated on the influence of the method of fixation on union rate and on salvage in inflammatory joint disease. Patients and methods Between 1994 and 2005, salvage arthrodesis was performed on 18 ankles (18 patients). Diagnosis was inflammatory joint disease (IJD) in 15 cases and osteoarthritis (OA) in 3. Tibio-talar fusion was performed in 7 ankles, and tibio-talocalcaneal fusion in 11. Serial radiographs were studied for time to union. Clinical outcome at latest follow-up was measured by the AOFAS score, the foot function index (FFI) and by VAS scores for pain, function, and satisfaction. Results Blade plates were used in 7 ankles (4 IJD, 3 OA); all united. Nonunion developed in 7 of the 11 rheumatic ankles stabilized by other methods. 11 patients (8 fused ankles, 3 nonunions) were available for clinical evaluation. Their mean AOFAS score was 62 and mean overall FFI was 70. VAS score for pain was 20, for function 64, and for satisfaction 74. The scores were similar in united and non-united ankles. Interpretation Blade plate fixation is successful in salvage arthrodesis for failed TAA. A high nonunion rate was found after salvage ankle arthrodesis in IJD with other methods of fixation. Clinical results were fair to good. PMID:20175648

  7. Postoperative infection in the foot and ankle.

    LENUS (Irish Health Repository)

    Chan, Victoria O

    2012-07-01

    Our discussion highlights the commonly performed surgical procedures in the foot and ankle and reviews the various imaging modalities available for the detection of infection with graphic examples to better enable radiologists to approach the radiological evaluation of postoperative infection in the foot and ankle. Discrimination between infectious and noninfectious inflammation remains a diagnostic challenge usually needing a combination of clinical assessment, laboratory investigations, and imaging studies to increase diagnostic accuracy.

  8. TOTAL ANKLE REPLACEMENT: WHY, WHEN AND HOW?

    Science.gov (United States)

    Bonasia, Davide Edoardo; Dettoni, Federico; Femino, John E; Phisitkul, Phinit; Germano, Margherita; Amendola, Annunziato

    2010-01-01

    Total ankle replacement (TAR) was first attempted in the 1970s, but poor results led to its being considered inferior to ankle fusion until the late 1980s and early 1990s. By that time, newer designs which more closely replicated the natural anatomy of the ankle, showed improved clinical outcomes.1 Currently, even though controversy still exists about the effectiveness of TAR compared to ankle fusion, TAR has shown promising mid-term results and should no longer be considered an experimental procedure. Factors related to improved TAR outcomes include: 1) better patient selection, 2) more precise knowledge and replication of ankle biomechanics, 3) the introduction of less-constrained designs with reduced bone resection and no need for cementation, and 4) greater awareness of soft-tissue balance and component alignment. When TAR is performed, a thorough knowledge of ankle anatomy, pathologic anatomy and biomechanics is needed along with a careful pre-operative plan. These are fundamental in obtaining durable and predictable outcomes. The aim of this paper is to outline these aspects through a literature review. PMID:21045984

  9. Outcome and quality of life after surgically treated ankle fractures in patients 65 years or older

    Directory of Open Access Journals (Sweden)

    Ekdahl Charlotte

    2007-12-01

    Full Text Available Abstract Background Despite high incidence of ankle fractures in the elderly, studies evaluating outcome and impact of quality of life in this age group specifically are sparse. The aim of this study was to evaluate outcome and quality of life 6 and 12 months after injury in patients 65 years or older who had been operated on due to an ankle fracture. Methods Sixty patients 65 years or older were invited to participate in the study. 6 and 12 months after the injury a questionnaire including inquiry to participate, the Olerud-Molander Ankle Score (OMAS, Short-Form 36 (SF-36, Linear Analogue Scale (LAS, Self-rated Ankle Function and some supplementary questions was sent home to the patients. The supplementary questions concerned subjective experience of ankle instability, sporting and physical activity level before injury and recaptured activity level at follow-ups, need of walking aid before injury, state of living before injury and at follow-ups and co-morbidities. After the 12-month follow-up the patients were also called for a radiological examination. Results Fifty patients (83% answered the questionnaire at 6-month and 46 (77% at the 12-month follow-up. Although, 45 (90% fractures were low-energy trauma 44 (88% were bi- or trimalleolar and post-operative reduction results were complete in 23 (46% ankles. The median OMAS improved from 60 (Interquartile range (IQR 36 at 6-month to 70 (IQR 35 at 12-month (p = 0.002, but at 12-month still sixty percent or more of the patients reported pain, swelling, problems when stair-climbing and reduced activities of daily life. Twenty (40% rated their ankle function as 'good' or 'very good' at 6-month and 30 (60% at 12-month. Forty-one (82% were physically active before injury but still one year after only 18/41 had returned to their pre-injury physical activity level. According to SF-36 four dimensions differed from the age- and gender matched normative data of the Swedish population, 'physical function

  10. Can textured insoles improve ankle proprioception and performance in dancers?

    Science.gov (United States)

    Steinberg, Nili; Waddington, Gordon; Adams, Roger; Karin, Janet; Begg, Rezaul; Tirosh, Oren

    2016-08-01

    With the aim of determining both the acute and the chronic effects of textured insoles on the ankle discrimination and performance ability of dancers, 60 ballet dancers from the Australian Ballet School, aged 14-19 years, were divided into three groups (two intervention groups and a control group), age- and level-matched. In the first 5 weeks (weeks 1 to 5), the first intervention group (GRP1) was asked to wear textured insoles in their ballet shoes and the second intervention group (GRP2) was not given textured insoles to wear. In the next 5 weeks (weeks 6 to 10), GRP2 was asked to wear the same type of textured insoles and GRP1 did not wear the textured insoles. The control group (CTRL) did not wear textured insoles during the whole 10 weeks. All participants were tested preintervention, after 5 weeks and after 10 weeks for ankle discrimination score (AUC scores). Dance performance was assessed by 5-7 dance teachers. Pre-to-post change in AUC scores was significantly greater for the groups wearing insoles than for the controls (P = .046) and the size of pre-to-post changes did not differ between the two intervention groups (P = .834). Significant correlation was found between ankle discrimination score and performance scores, using the textured insoles (r = .412; P = .024). In conclusion, the stimulation to the proprioceptive system arising from textured insoles worn for five weeks was sufficient to improve the proprioceptive ability and performance ability of ballet dancers.

  11. [Revision arthroplasty of the ankle joint].

    Science.gov (United States)

    Hintermann, B; Barg, A; Knupp, M

    2011-11-01

    In the last 20 years total ankle replacement has become a viable alternative to arthrodesis for end-stage osteoarthritis of the ankle. Numerous ankle prosthesis designs have appeared on the market in the past and attracted by the encouraging intermediate results reported in the literature, many surgeons have started to perform this procedure. With increased availability on the market the indications for total ankle replacement have also increased in recent years. In particular, total ankle replacement may now be considered even in younger patients. Therefore, despite progress in total ankle arthroplasty the number of failures may increase. Up to now, arthrodesis was considered to be the gold standard for salvage of failed ankle prostheses. Because of extensive bone loss on the talar side, in most instances tibiocalcaneal fusion is the only reliable solution. An alternative to such extended hindfoot fusions would be revision arthroplasty. To date, however, there are no reported results of revision arthroplasty for salvage of a failed ankle replacement.Based on our experience prosthetic components with a flat undersurface are most likely to be able to find solid support on remaining bone stock. The first 83 cases (79 patients, 46 males, 33 females, average age 58.9 years, range 30.6-80.7 years) with a average follow-up of 5.4 years (range 2-11 years) showed excellent to good results in 69 cases (83%), a satisfactory result in 12 cases (15%) and a fair result in 2 cases (2%) and 47 patients (56%) were pain free. Primary loosening was noted in three cases and of these two cases were successfully revised by another total ankle replacement and in one case with arthrodesis. Another case with hematogenous infection was also revised by arthrodesis. At the last follow-up control two components were considered to be loose and the overall loosening rate was thus 6%.This series has proven that revision arthroplasty can be a promising option for patients with failed total

  12. Effects of ankle joint mobilization with movement and weight-bearing exercise on knee strength, ankle range of motion, and gait velocity in patients with stroke: a pilot study.

    Science.gov (United States)

    An, Chang-Man; Won, Jong-Im

    2016-01-01

    [Purpose] The purpose of this study was to investigate the effects of ankle joint mobilization with movement on knee strength, ankle range of motion, and gait velocity, compared with weight-bearing exercise in stroke patients. [Subjects and Methods] Thirty subjects with chronic stroke were divided into three groups: MWM (n = 12), WBE (n = 8), and control (n = 10). All groups attended physical therapy sessions 3 times a week for 5 weeks. Subjects in the MWM group performed mobilization with movement exercises, whilst participants in the WBE group performed weight-bearing exercises. Knee peak torque, ankle range of motion, and spatiotemporal gait parameters were evaluated before and after the interventions. [Results] Knee extensor peak torque increased significantly in both MWM and WBE groups. However, only the MWM group showed significant improvement in passive and active ankle range of motion and gait velocity, among the three groups. [Conclusion] Ankle joint mobilization with movement intervention is more effective than simple weight-bearing intervention in improving gait speed in stroke patients with limited ankle motion.

  13. Do Ankle Orthoses Improve Ankle Proprioceptive Thresholds or Unipedal Balance in Older Persons with Peripheral Neuropathy?

    Science.gov (United States)

    Son, Jaebum; Ashton-Miller, James A.; Richardson, James K.

    2010-01-01

    Objective To determine whether ankle orthoses that provide medial and lateral support, and have been found to decrease gait variability in older persons with peripheral neuropathy, decrease (improve) frontal plane ankle proprioceptive thresholds or increase unipedal stance time in that same population. Design Observational study in which unipedal stance time was determined with a stopwatch, and frontal plane ankle (inversion and eversion) proprioceptive thresholds were quantified during bipedal stance with and without the ankle orthoses, in 11 older diabetic subjects with peripheral neuropathy (8 men; age 72 ± 7.1 years) using a foot cradle system which presented a series of 100 rotational stimuli. Results The subjects demonstrated no change in combined frontal plane (inversion + eversion) proprioceptive thresholds or unipedal stance time with versus without the orthoses (1.06 ± 0.56 versus 1.13 ± 0.39 degrees, respectively; p = 0.955 and 6.1 ± 6.5 versus 6.2 ± 5.4 seconds, respectively; p = 0.922). Conclusion Ankle orthoses which provide medial-lateral support do not appear to change ankle inversion/eversion proprioceptive thresholds or unipedal stance time in older persons with diabetic peripheral neuropathy. Previously identified improvements in gait variability using orthoses in this population are therefore likely related to an orthotically-induced stiffening of the ankle rather than a change in ankle afferent function. PMID:20407302

  14. Recombination instability

    DEFF Research Database (Denmark)

    D'Angelo, N.

    1967-01-01

    A recombination instability is considered which may arise in a plasma if the temperature dependence of the volume recombination coefficient, alpha, is sufficiently strong. Two cases are analyzed: (a) a steady-state plasma produced in a neutral gas by X-rays or high energy electrons; and (b) an af...

  15. The results of ankle arthrodesis with screws for end stage ankle arthrosis.

    Science.gov (United States)

    Torudom, Yingyong

    2010-02-01

    Aim of this study was to evaluate the results of ankle arthrodesis with screws in patients with ankle arthrosis. The author studied 19 patients (20 feet) who had been treated by ankle arthrodesis with screws from 2003 to 2008. Ten patients were men (11 feet) and nine (9 feet) were women. Their mean age was 56 years (30 to 65), and the average duration of follow-up was four years (2 to 6). Two compression screws were used in all feet. Union was achieved in 19 of the 20 feet (95%). Average scores for pain and clinical condition are increase after operation. One re-operation was performed for nonunion. Author conclude that ankle arthrodesis with screws was effective treatment for ankle arthrosis.

  16. Prospective study of ankle and foot fractures in elderly women

    Directory of Open Access Journals (Sweden)

    Yadagiri Surender Rao

    2015-01-01

    Full Text Available The epidemiology of ankle fractures in old people is changing as time passes on. The incidence of ankle fractures increases with advancing age. The study conducted was among a rural popula-tion which comprised of 68 women (32 women with ankle fractures & 36 women with foot fractures. Patients studied were in the age group more than 50 years. The study highlights the etiological & risk factors for fractures of ankle & foot. The commonest ankle fracture was the lateral malleolar fracture & the commonest foot fracture was the 5th Metatarsal fracture. Diabetes is a risk factor which increases the occurrence of ankle and foot injuries.

  17. Arthroscopic Management of Complications Following Total Ankle Replacement.

    Science.gov (United States)

    Lui, Tun Hing; Roukis, Thomas S

    2015-10-01

    There is great potential of managing the complications of total ankle replacement arthroscopically and endoscopically, and these procedures can be summarized into 3 groups. Group 1 includes procedures of the ankle joint proper with close proximity to the articular components of the total ankle replacement. Group 2 includes procedures of the tibia and talus with close proximity to the nonarticular parts of the total ankle replacement. Group 3 includes procedures that are away from the total ankle replacement. However, these remain master arthroscopist procedures and should be performed by foot and ankle surgeons who perform them with regularity.

  18. [Ankle joint arthritis--etiology, diagnosis and treatment].

    Science.gov (United States)

    Uri, Ofir; Haim, Amir

    2008-11-01

    Ankle joint arthritis causes functional limitation and affects the quality of life many patients. It follows traumatic injuries, inflammatory joint arthritis, primary osteoarthritis, hemochromatosis and infections. Understanding the unique anatomy and biomechanics of the ankle is important for diagnosis and treatment of ankle joint pathology. The treatment of ankle joint arthritis has advanced considerably in recent years and it is still a surgical challenge. Total ankle replacement seems to be a promising form of treatment, even though current data does not demonstrate advantages over ankle joint arthrodesis.

  19. Effects of a powered ankle-foot prosthesis on kinetic loading of the contralateral limb: a case series.

    Science.gov (United States)

    Hill, David; Herr, Hugh

    2013-06-01

    Lower-extremity amputees encounter a series of stress-related challenges. Among them is an increased risk of chronic joint disorders. For unilateral, transtibial amputees, we hypothesize that increasing the power output of the trailing, ankle-foot prosthesis during powered plantar flexion could mitigate kinetic loading applied to the leading, contralateral leg during walking. Here, we present a case series that analyzes kinetic factors of unilateral, transtibial amputee gait and forms a comparison between two types of ankle prostheses with varying power outputs. The factors examined here are impact resultant force, peak foot pressure at heel-strike, step-to-step transition work, and knee external adduction moment. The two prostheses are the amputee participant's daily-use passive ankle-foot prosthesis and the BiOM powered ankle-foot prosthesis capable of biologically accurate powered plantar flexion during late stance. In a preliminary study on two transtibial amputees walking over level terrain at a controlled speed (1.25 m/s), we observed average reductions of 8% in peak impact resultant force, 18% in impact resultant force loading rate, 8% in peak heel-strike foot pressure, and 15% in the 1(st) peak knee external adduction moment when the powered ankle-foot prosthesis was compared to the conventional passive prosthesis. Overall, our preliminary results suggest that more biomimetic prosthetic ankle-foot push-off during late stance may limit leading-leg musculoskeletal stress in walking.

  20. Acute traumatic open posterolateral dislocation of the ankle without tearing of the tibiofibular syndesmosis ligaments: a case report.

    Science.gov (United States)

    Demiralp, Bahtiyar; Komurcu, Mahmut; Ozturk, Cagatay; Ozturan, Kutay; Tasatan, Ersin; Erler, Kaan

    2008-01-01

    Pure open dislocation of the ankle, or dislocation not accompanied by rupture of the tibiofibular syndesmosis ligaments or fractures of the malleoli or of the posterior border of the tibia, is an extremely rare injury. A 62-year-old man injured his right ankle in a motor vehicle accident. Besides posterolateral ankle dislocation, there was a 7-cm transverse skin cut on the medial malleolus, and the distal end of the tibia was exposed. After reduction, we made a 2- to 2.5-cm longitudinal incision on the lateral malleolus; the distal fibular fracture was exposed. Two Kirschner wires were placed intramedullary in a retrograde manner, and the fracture was stabilized. The deltoid ligament and the medial capsule were repaired. The tibiofibular syndesmosis ligaments were intact. At the end of postoperative year 1, right ankle joint range of motion had a limit of approximately 5 degrees in dorsiflexion, 10 degrees in plantarflexion, 5 degrees in inversion, and 0 degrees in eversion. The joint appeared normal on radiographs, with no signs of osteoarthritis or calcification. The best result can be obtained with early reduction, debridement, medial capsule and deltoid ligament restoration, and early rehabilitation. Clinical and radiographic features at long-term follow-up also confirm good mobility of the ankle without degenerative change or mechanical instability.

  1. Radiographic Evaluation of the Ankle Mortise

    Directory of Open Access Journals (Sweden)

    Hamid Mirbagheri

    2010-05-01

    Full Text Available The ankle joint is the most frequently injured joint in adults. Decisions on management are usually based on clinical examination and interpretation of the x-rays. Stability of the ankle mortise relies on the configuration of the osseous structures and the ligaments. A basic radiographic examination consists of a mortise-view and a lateral view. Some add the AP-view. The Mortise view is an AP-view with 15-25 degrees endorotation of the foot. "nThe view clearly demonstrates both lateral and medial joint spaces. On a true AP-view the talus overlaps a portion of the lateral malleolus obscuring the lateral aspect of the ankle joint. However, the AP-view will give you an extra view on both malleoli from a different angle. The lateral radiograph of the ankle should include the base of the fifth metatarsal because of the frequency of fractures at this side that clinically mimic a fracture of the ankle.

  2. [Carpal instability].

    Science.gov (United States)

    Redeker, J; Vogt, P M

    2011-01-01

    Carpal instability can be understood as a disturbed anatomical alignment between bones articulating in the carpus. This disturbed balance occurs either only dynamically (with movement) under the effect of physiological force or even statically at rest. The most common cause of carpal instability is wrist trauma with rupture of the stabilizing ligaments and adaptive misalignment following fractures of the radius or carpus. Carpal collapse plays a special role in this mechanism due to non-healed fracture of the scaphoid bone. In addition degenerative inflammatory alterations, such as chondrocalcinosis or gout, more rarely aseptic bone necrosis of the lunate or scaphoid bones or misalignment due to deposition (Madelung deformity) can lead to wrist instability. Under increased pressure the misaligned joint surfaces lead to bone arrosion with secondary arthritis of the wrist. In order to arrest or slow down this irreversible process, diagnosis must occur as early as possible. Many surgical methods have been thought out to regain stability ranging from direct reconstruction of the damaged ligaments, through ligament replacement to partial stiffening of the wrist joint.

  3. 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.

  4. Bilateral ankle edema with bilateral iritis.

    Science.gov (United States)

    Kumar, Sunil

    2007-07-01

    I report two patient presented to me with bilateral symmetrical ankle edema and bilateral acute iritis. A 42-year-old female of Indian origin and 30-year-old female from Somalia both presented with bilateral acute iritis. In the first patient, bilateral ankle edema preceded the onset of bilateral acute iritis. Bilateral ankle edema developed during the course of disease after onset of ocular symptoms in the second patient. Both patients did not suffer any significant ocular problem in the past, and on systemic examination, all clinical parameters were within normal limit. Lacrimal gland and conjunctival nodule biopsy established the final diagnosis of sarcoidosis in both cases, although the chest x-rays were normal.

  5. POSTTRAUMATIC SHOULDER INSTABILITY IN CHILDREN: CLINICAL PRESENTATION, DIAGNOSIS AND TREATMENT

    Directory of Open Access Journals (Sweden)

    Ярослав Николаевич Прощенко

    2014-09-01

    Full Text Available The article presents an analysis of the treatment of 15 patients with posttraumatic shoulder instability aged 11-17 years, as a result of primary traumatic dislocation and chronic instability. We identified the following causes of chronic shoulder instability: Bankart injury, SLAP-injury; Hill-Sachs defect; fracture of the glenoid, type 3 humeral head-glenoid relation, and retroversion of the humeral head, as well as defects in the treatment of primary shoulder dislocation. Surgical treatment is performed in 7 patients with chronic instability (7 joints. Unsatisfactory result was detected in 1 patient (1 joints, which is caused by a type 3 humeral head-glenoid relation.

  6. Seronegative inflammations of the ankle and foot: diagnostic challenges

    Energy Technology Data Exchange (ETDEWEB)

    Capen, D.; Scheck, M.

    Seronegative inflammatory disease was diagnosed in seven patients who had pain, swelling, and redness of the foot and/or ankle. Since the clinical findings mimicked infection, tendinitis, fasciitis, or chronic strain, the initial diagnosis was erroneous and treatment ineffective. In addition to the test for the HLA-B27 antigen, technetium-99m-diphosphonate scintigraphy and magnification roentgenograms have proved valuable tools. Increased isotope uptake was found in all involved extremities, and magnification roentgenograms helped to detect early and subtle lesions of bone. The lesions comprised cortical erosion, increased intracortical absorption of bone, periosteal reactions, and osteoporosis. The response to anti-inflammatory drugs was good in all seven patients. Limited and preliminary follow-up data, including repeat bone scans, suggest that the inflammation may be of a transient nature.

  7. Management of Osseous and Soft-Tissue Ankle Equinus During Total Ankle Replacement.

    Science.gov (United States)

    Roukis, Thomas S; Simonson, Devin C

    2015-10-01

    Obtaining functional alignment of a total ankle replacement, including physiologic sagittal plane range of motion, is paramount for a successful outcome. This article reviews the literature on techniques available for correction of osseous and soft-tissue equinus at the time of index total ankle replacement. These techniques include anterior tibiotalar joint cheilectomy, posterior superficial muscle compartment lengthening, posterior ankle capsule release, and release of the posterior portions of the medial and lateral collateral ligament complexes. The rationale for these procedures and the operative sequence of events for these procedures are presented.

  8. FINANCIAL INSTABILITY AND POLITICAL INSTABILITY

    Directory of Open Access Journals (Sweden)

    Ionescu Cristian

    2012-12-01

    Full Text Available There is an important link between the following two variables: financial instability and political instability. Often, the link is bidirectional, so both may influence each other. This is way the lately crisis are becoming larger and increasingly complex. Therefore, the academic environment is simultaneously talking about economic crises, financial crises, political crises, social crises, highlighting the correlation and causality between variables belonging to the economic, financial, political and social areas, with repercussions and spillover effects that extend from one area to another. Given the importance, relevance and the actuality of the ones described above, I consider that at least a theoretical analysis between economic, financial and political factors is needed in order to understand the reality. Thus, this paper aims to find links and connections to complete the picture of the economic reality.

  9. Characterization of ankle function during stair ambulation

    OpenAIRE

    Gates, Deanna H.; Lelas, Jennifer L.; Della Croce, Ugo; Herr, Hugh; Bonato, Paolo

    2004-01-01

    The aim of this study was to examine the ankle joint during level walking, stair ascent, and stair descent to determine models for use in the design of prosthetic and orthotic systems. Ten healthy subjects were asked to walk (1) across a level walkway, (2) up, and (3) down an instrumented stairway. Sagittal plane kinematic and kinetic data were analyzed to obtain ankle biomechanics during the stance phase of each task. Each stance phase was broken down into sub-phases based on the power traje...

  10. Ankle fusion using a 2-incision, 3-screw technique

    NARCIS (Netherlands)

    R.P.M. Hendrickx; G.M.M.J. Kerkhoffs; S.A.S. Stufkens; C.N. van Dijk; R.K. Marti

    2011-01-01

    Reliable fusion and optimal correction of the alignment of the ankle joint using a 2-incision, 3-screw technique. Symptomatic osteoarthritis of the ankle joint after insufficient other treatment, severe deformity of the osteoarthritic ankle joint, or salvation procedure after failed arthroplasty. Ac

  11. Acupuncture Treatment for Acute Ankle Injury in the Emergency Department: A Preliminary Case Report.

    Science.gov (United States)

    Tantivesruangdet, Nopmanee

    2016-02-01

    Acupuncture is an ancient medical treatment that is increasingly attracting the interest of the public. It is a complementary therapy that is widely used for management of pain, especially chronic discomfort caused by migraine, low-back pain and osteoarthritis of the knee(¹⁻³). The evidence base for the effectiveness of acupuncture and its clinical applications is controversial, and although its efficacy and safety in the management of acute pain have been demonstrated, the quality of this modality is still questionable. The present study reports a case of acute ankle injury, which was treated with acupuncture. A 33-year-old man presented with acute twisted ankle injury. He had pain with swelling around the ankle, and he was experiencing difficulty in walking. His clinical diagnosis was acute ankle sprain with severe pain. Several drug treatments are used for pain control, but in this case, we used acupuncture. After treatment, his pain diminished significantly with a decrease in VAS pain level from 8 to 4 in 20 minutes. At follow-up after one month, we found no skin infection in this case.

  12. Association between improved trunk stability and walking capacity using ankle-foot orthosis in hemiparetic patients with stroke: evidence from three-dimensional gait analysis

    Institute of Scientific and Technical Information of China (English)

    LAN Yue; XU Guang-qing; HUANG Dong-feng; MAO Yu-rong; CHEN Shao-zhen; PEI Zhong; ZENG Jin-sheng

    2013-01-01

    Background Restoration of both normal movement of the pelvis and centre of mass is a primary goal of walking rehabilitation in post-stroke patients because these movements are essential components of effective gait.The aim of this study is to quantitatively analyze the effect of ankle-foot orthosis on walking ability,and to investigate the correlation between improvements in trunk motion and walking capacity.Methods Walking speed,centre of mass displacement,and pelvic movements were examined in 20 post-stroke hemiparetic patients with and without ankle-foot orthosis using three-dimensional motion analysis.Results Using ankle-foot orthosis improved walking speed,pelvic rotation and tilt,and lateral and vertical displacements of the centre of mass (P <0.01).Moreover,the gait asymmetry index was significantly decreased (P <0.01),and the Functional Ambulation Categories score improved significantly when patients used an anklefoot orthosis (P <0.05).There was significant correlation between improvements in the walking capacity and the displacement of the centre of mass in both vertical and lateral directions (P <0.01).Conclusions Using ankle-foot orthosis improves the walking capacity by improving the stability and concordant of the trunk in hemiplegic patients.The improvement in the walking capacity from using an ankle-foot orthosis may be attributed to its prevention of foot drop and compensation for the instability of the ankle joint.

  13. Midcarpal instability: a radiological perspective

    Energy Technology Data Exchange (ETDEWEB)

    Toms, Andoni Paul [Norfolk and Norwich University Hospital NHS Trust, Department of Radiology, Norwich, Norfolk (United Kingdom); Radiology Academy, Cotman Centre, Norwich, Norfolk (United Kingdom); Chojnowski, Adrian [Norfolk and Norwich University Hospital NHS Trust, Department of Orthopaedic Surgery, Norwich, Norfolk (United Kingdom); Cahir, John G. [Norfolk and Norwich University Hospital NHS Trust, Department of Radiology, Norwich, Norfolk (United Kingdom)

    2011-05-15

    Midcarpal instability (MCI) is the result of complex abnormal carpal motion at the midcarpal joint of the wrist. It is a form of non-dissociative carpal instability (CIND) and can be caused by various combinations of extrinsic ligament injuries that then result in one of several subtypes of MCI. The complex patterns of injury and the kinematics are further complicated by competing theories, terminology and classifications of MCI. Palmar, dorsal, ulna midcarpal instability, and capitolunate or chronic capitolunate instability are all descriptions of types of MCI with often overlapping features. Palmar midcarpal instability (PMCI) is the most commonly reported type of MCI. It has been described as resulting from deficiencies in the ulna limb of the palmar arcuate ligament (triquetrohamate-capitate) or the dorsal radiotriquetral ligaments, or both. Unstable carpal articulations can be treated with limited carpal arthrodesis or the ligamentous defects can be treated with capsulorrhaphy or ligament reconstruction. Conventional radiographic abnormalities are usually limited to volar intercalated segment instability (VISI) patterns of carpal alignment and are not specific. For many years stress view radiographs and videofluoroscopy have been the methods of choice for demonstrating carpal instability and abnormal carpal kinematics respectively. Dynamic US can be also used to demonstrate midcarpal dyskinesia including the characteristic triquetral ''catch-up'' clunk. Tears of the extrinsic ligaments can be demonstrated with MR arthrography, and probably with CT arthrography, but intact yet redundant ligaments are more difficult to identify. The exact role of these investigations in the diagnosis, categorisation and management of midcarpal instability has yet to be determined. (orig.)

  14. Malignant melanoma of the foot and ankle.

    Science.gov (United States)

    John, K J; Hayes, D W; Green, D R; Dickerson, J

    2000-04-01

    Malignant melanoma is a serious and devastating skin disease that podiatrists may be called upon to treat. It is pertinent that delays in diagnosis and treatment of malignant melanoma be avoided. Some of the topics discussed in this article are causes, clinical features, classification, and treatment of malignant melanoma, focusing on the foot and ankle.

  15. SPARKy-Spring Ankle with Regenerative Kinematics

    Science.gov (United States)

    2011-09-01

    89-93215-02-1 98560/10/$15 ©ICROS 142 1 BIONIC RUNNING FOR UNILATERAL TRANSTIBIAL MILITARY AMPUTEES Joseph Hitt, James Merlo, and Jonathan...ankle joint, and n optical switch embedded at the heel provides the necessary ensor feedback. Advantech’s 650MHZ PC-104 with 512MB on oard memory is

  16. Cutaneous mechanisms of isometric ankle force control.

    Science.gov (United States)

    Choi, Julia T; Lundbye-Jensen, Jesper; Leukel, Christian; Nielsen, Jens Bo

    2013-07-01

    The sense of force is critical in the control of movement and posture. Multiple factors influence our perception of exerted force, including inputs from cutaneous afferents, muscle afferents and central commands. Here, we studied the influence of cutaneous feedback on the control of ankle force output. We used repetitive electrical stimulation of the superficial peroneal (foot dorsum) and medial plantar nerves (foot sole) to disrupt cutaneous afferent input in 8 healthy subjects. We measured the effects of repetitive nerve stimulation on (1) tactile thresholds, (2) performance in an ankle force-matching and (3) an ankle position-matching task. Additional force-matching experiments were done to compare the effects of transient versus continuous stimulation in 6 subjects and to determine the effects of foot anesthesia using lidocaine in another 6 subjects. The results showed that stimulation decreased cutaneous sensory function as evidenced by increased touch threshold. Absolute dorsiflexion force error increased without visual feedback during peroneal nerve stimulation. This was not a general effect of stimulation because force error did not increase during plantar nerve stimulation. The effects of transient stimulation on force error were greater when compared to continuous stimulation and lidocaine injection. Position-matching performance was unaffected by peroneal nerve or plantar nerve stimulation. Our results show that cutaneous feedback plays a role in the control of force output at the ankle joint. Understanding how the nervous system normally uses cutaneous feedback in motor control will help us identify which functional aspects are impaired in aging and neurological diseases.

  17. Osteoarthritis of the Foot and Ankle

    Science.gov (United States)

    ... that creates an increased risk of arthritis. Symptoms People with osteoarthritis in the foot or ankle experience, in varying degrees, one or more of the following: Pain and stiffness in the joint Swelling in or near the joint Difficulty walking or bending the joint Some patients with osteoarthritis ...

  18. Total Ankle Arthroplasty: An Overview of the Canadian Experience.

    Science.gov (United States)

    Latham, Warren C W; Lau, Johnny T C

    2016-06-01

    Total ankle arthroplasty use has increased across Canada over the last two decades. Multiple implant designs are readily available and implanted across Canada. Although arthrodesis is a reliable procedure for treating end-stage ankle arthritis, ankle replacement is often the preferred surgical treatment by patients. A recent prospective study evaluated intermediate-term outcomes of ankle replacement and arthrodesis at multiple centers across Canada, with variability in prosthesis type, surgeon, and surgical technique. Intermediate-term clinical outcomes of total ankle replacement and ankle arthrodesis were comparable in a diverse cohort in which treatment was tailored to patient presentation; however, rates of reoperation and major complications were higher after ankle replacement.

  19. 踝关节内侧韧带损伤及其病理机制初探%Preliminary investigation on the medial ankle ligament injury and its pathomechanism

    Institute of Scientific and Technical Information of China (English)

    徐向阳; 刘津浩; 朱渊; 王碧菠

    2010-01-01

    目的 探讨踝关节内韧带损伤后内侧不稳定的病理机制.方法 患者15例,男8例,女7例;年龄22~58岁,平均40岁.其中踝关节急性扭伤患者2例,踝关节慢性损伤3例,先天性平足3例,胫后肌腱失能5例,旋前外旋骨折1例,陈旧性的内踝撕脱骨折1例.所有患者均行三角韧带修补术,同时行跟骨延长术8例,内侧楔骨闭合截骨5例,跟骨截骨内移术1例.全部患者术后随访7~56个月,运用美国足踝外科协会(America Orthopedic Foot and Ankle Society,AOFAS)踝-后足功能评分进行评估,统计学分析采用t检验.结果 1例踝关节急性骨折患者,由于术前无法评分,不放在统计分析内.其余14例患者术前评分为(42.4±10.6)分,术后评分(89.8±6.2)分(P<0.05).结论 三角韧带是一个重要的解剖结构,在以下几种情况下须注意其修复:(1)三角韧带损伤范围较广,涉及前部的胫弹簧韧带和胫舟韧带.(2)先天性的平足以及获得性的胫后肌腱失能患者.(3)以往有经常的踝关节扭伤,有外侧韧带的损伤,此次发生了伴有内侧韧带损伤的骨折.%Objective To discuss the pathomechanism of medial ankle instability after medial ligament injury. Methods The study involved 15 patients including eight males and seven females, at average age of 40 years (range 22-58 years). There were two patients with acute ankle sprain, three with chronic ankle injury, three with congenital pes planus, five with posterior tibial tendon dysfunction, one with pronation external rotation ankle fracture and one with old avulsion medial malleolus. All patients were treated surgically with deltoid ligament repair, when eight patients further received calcaneal lengthing osteotomy, five received medial cuneiform close wedge osteotomy and one received medial shift calcaneal osteotomy. All patients were followed up for 7-56 months. American Orthopedic Foot and Ankle Society (AOFAS) ankle-hindfoot scale was used for pre- and post

  20. Finite element analysis of stress and wear characterization in total ankle replacements.

    Science.gov (United States)

    Jay Elliot, Bradley; Gundapaneni, Dinesh; Goswami, Tarun

    2014-06-01

    Total Ankle Arthroplasty is performed in order to reduce the pain and loss of ambulation in patients with various forms of arthritis and trauma. Although replacement devices fail by a number of mechanisms, wear in the polyethylene liner constitutes one of the dominating failure modes. This leads to instability and loosening of the implant. Mechanisms that contribute to wear in the liners are high contact and subsurface stresses that break down the material over time. Therefore, it is important to understand the gait that generates these stresses. Methods to characterize and decrease wear in Ohio Total Ankle Replacements (TARs) have been performed in this research. This research utilizes finite element analysis of Wright State University (WSU) patented TAR models. From the Finite element analysis (FEA) results, mathematical models of contact conditions and wear mechanics were developed. The maximum wear rate values obtained in the study (at 25.598MPa, 3.74mm(3)/year) and maximum surface Mises stress obtained with new optimization model (11.52MPa) seem to be comparable with the maximum wear values obtained in other similar studies. These models were used to determine the best methods for wear characterization and reduction. Furthermore, optimization models were developed based on geometry of the implants. These equations optimize geometry, thus congruency and anatomical simulations for total ankle implants.

  1. Design of a simple, lightweight, passive-elastic ankle exoskeleton supporting ankle joint stiffness

    Science.gov (United States)

    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.

  2. Predicting functional recovery after acute ankle sprain.

    Directory of Open Access Journals (Sweden)

    Sean R O'Connor

    Full Text Available INTRODUCTION: Ankle sprains are among the most common acute musculoskeletal conditions presenting to primary care. Their clinical course is variable but there are limited recommendations on prognostic factors. Our primary aim was to identify clinical predictors of short and medium term functional recovery after ankle sprain. METHODS: A secondary analysis of data from adult participants (N = 85 with an acute ankle sprain, enrolled in a randomized controlled trial was undertaken. The predictive value of variables (age, BMI, gender, injury mechanism, previous injury, weight-bearing status, medial joint line pain, pain during weight-bearing dorsiflexion and lateral hop test recorded at baseline and at 4 weeks post injury were investigated for their prognostic ability. Recovery was determined from measures of subjective ankle function at short (4 weeks and medium term (4 months follow ups. Multivariate stepwise linear regression analyses were undertaken to evaluate the association between the aforementioned variables and functional recovery. RESULTS: Greater age, greater injury grade and weight-bearing status at baseline were associated with lower function at 4 weeks post injury (p<0.01; adjusted R square=0.34. Greater age, weight-bearing status at baseline and non-inversion injury mechanisms were associated with lower function at 4 months (p<0.01; adjusted R square=0.20. Pain on medial palpation and pain on dorsiflexion at 4 weeks were the most valuable prognostic indicators of function at 4 months (p< 0.01; adjusted R square=0.49. CONCLUSION: The results of the present study provide further evidence that ankle sprains have a variable clinical course. Age, injury grade, mechanism and weight-bearing status at baseline provide some prognostic information for short and medium term recovery. Clinical assessment variables at 4 weeks were the strongest predictors of recovery, explaining 50% of the variance in ankle function at 4 months. Further

  3. Comparative study on isokinetic capacity of knee and ankle joints by functional injury.

    Science.gov (United States)

    Jeon, Kyoungkyu; Seo, Byoung-Do; Lee, Sang-Ho

    2016-01-01

    [Purpose] To collect basic data for exercise programs designed to enhance functional knee and ankle joint stability based on isokinetic measurement and muscle strength evaluations in normal and impaired functional states. [Subjects and Methods] Twenty-four subjects were randomly assigned to the athlete group and the control group (n = 12 each). Data were collected of isokinetic knee extensor and flexor strength at 60°/sec, 180°/sec, and 240°/sec and ankle plantar and dorsiflexor strength at 30°/sec and 120°/sec. [Results] Significant intergroup differences were observed in peak torque of the right extensors at 60°/sec, 180°/sec, and 240°/sec and the right flexors at 240°/sec. Significant differences were observed in peak torque/body weight in the right extensors at 60°/sec, 180°/sec, and 240°/sec and in the right flexors at 180°/sec and 240°/sec. Significant peak torque differences were noted in the left ankle joint dorsiflexor at 30°/sec and 120°/sec, right plantar flexor at 120°/sec, left plantar flexor at 30°/sec, left dorsiflexor at 30°/sec and 120°/sec, and right dorsiflexor at 120°/sec. [Conclusion] Isokinetic evaluation stimulates muscle contraction at motion-dependent speeds and may contribute to the development of intervention programs to improve knee and ankle joint function and correct lower-extremity instability.

  4. Resistance Training With Ankle Weight Cuffs Is Feasible in Patients With Acute Exacerbation of COPD

    DEFF Research Database (Denmark)

    Kofod, Linette Marie; Døssing, Martin; Steentoft, Johnna;

    2017-01-01

    PURPOSE: Quadriceps muscle weakness is a serious complication of physical inactivity following hospitalization due to acute exacerbations of chronic obstructive pulmonary disease (AECOPD). Preventing strength loss during AECOPD is therefore a high priority. We aimed to evaluate the feasibility...... of progressive knee-extension resistance training, using ankle weight cuffs on patients with AECOPD, based on prespecified criteria for feasibility. METHODS: Thirty-four patients (18 men, mean age 74 years, forced expiratory volume in 1 second = 33% predicted) with AECOPD participated in daily knee......-extension strength training. During training, the patients were seated on the bedside and performed 3 sets of 10-repetition maximum loads, using ankle weight cuffs. The primary outcome was the change in load from the first to last training sessions. The secondary outcomes were changes in maximal isometric knee...

  5. Tibiocalcaneal Fusion for Charcot Ankle With Severe Talar Body Loss: Case Report and a Review of the Surgical Literature.

    Science.gov (United States)

    Aikawa, Takao; Watanabe, Koji; Matsubara, Hidenori; Nomura, Issei; Tsuchiya, Hiroyuki

    2016-01-01

    Severe bone loss resulting from talar body necrosis in the Charcot ankle can be challenging to treat. In particular, the Charcot ankle will demonstrate progressive instability and deformity, causing protrusion of the medial or lateral malleolus, which will mostly lead to skin ulcers or osteomyelitis and, in some cases, will ultimately require transtibial amputation. Problems such as bone fragility, poor compliance with load-bearing restrictions, susceptibility to infection, and circulatory disorders cause difficulties in the surgical treatment of the Charcot ankle. We believe that tibiocalcaneal fusion is a reliable method to obtain satisfactory outcomes in these difficult cases. However, no study has reported on the use of a locking plate for tibiocalcaneal fusion. Therefore, we report on tibiocalcaneal fusion using a locking plate in 3 patients with Charcot ankle and severe talar body loss. All patients achieved bony union with a plantigrade foot and without any skin complications. We have concluded that a locking plate provides rigid fixation and easier insertion of additional screws, when necessary.

  6. The effects of ankle Kinesio taping on ankle stiffness and dynamic balance.

    Science.gov (United States)

    Fayson, Shirleeah D; Needle, Alan R; Kaminski, Thomas W

    2013-01-01

    The purpose of this study was to determine the effects of Kinesio® taping on static restraint and dynamic postural control of the ankle joint. Thirty female subjects with no history of ankle injury participated in this study. Subjects were tested for passive ankle laxity and stiffness, and time to stabilization following forward, backward, medial, and lateral hops. Subjects were tested prior to tape application, immediately following application, and following 24 hours of use. Differences between taping conditions were investigated using analyses of variance and pairwise comparisons. Stiffness increased following initial application and 24 hours of Kinesio® tape use (F = 6.99, p = .003), despite no observed changes in ankle laxity (F = 0.77, p = .49); however, no changes were observed in time-to-stabilization (F = 0.03, p = .97). Our results suggest that Kinesio® tape may improve static restraint in the ankle joint without altering peak motion or dynamic postural control. A future investigation into Kinesio® tape efficacy in injury prevention or rehabilitation is warranted.

  7. Cutaneous mechanisms of isometric ankle force control

    DEFF Research Database (Denmark)

    Choi, Julia T; Jensen, Jesper Lundbye; Leukel, Christian

    2013-01-01

    The sense of force is critical in the control of movement and posture. Multiple factors influence our perception of exerted force, including inputs from cutaneous afferents, muscle afferents and central commands. Here, we studied the influence of cutaneous feedback on the control of ankle force...... of transient stimulation on force error were greater when compared to continuous stimulation and lidocaine injection. Position-matching performance was unaffected by peroneal nerve or plantar nerve stimulation. Our results show that cutaneous feedback plays a role in the control of force output at the ankle...... joint. Understanding how the nervous system normally uses cutaneous feedback in motor control will help us identify which functional aspects are impaired in aging and neurological diseases....

  8. The management of Charcot joint disease affecting the ankle and foot by arthrodesis controlled by an Ilizarov frame: early results.

    Science.gov (United States)

    El-Gafary, K A M; Mostafa, K M; Al-Adly, W Y

    2009-10-01

    Charcot osteoarthropathy of the foot is a chronic and progressive disease of bone and joint associated with a risk of amputation. The main problems encountered in this process are osteopenia, fragmentation of the bones of the foot and ankle, joint subluxation or even dislocation, ulceration of the skin and the development of deep sepsis. We report our experience of a series of 20 patients with Charcot osteoarthropathy of the foot and ankle treated with an Ilizarov external fixator. The mean age of the group was 30 years (21 to 50). Diabetes mellitus was the underlying cause in 18 patients. Five had chronic ulcers involving the foot and ankle. Each patient had an open lengthening of the tendo Achillis with excision of all necrotic and loose bone from the ankle, subtalar and midtarsal joints when needed. The resulting defect was packed with corticocancellous bone graft harvested from the iliac crest and an Ilizarov external fixator was applied. Arthrodesis was achieved after a mean of 18 weeks (15 to 20), with healing of the skin ulcers. Pin track infection was not uncommon, but no frame had to be removed before the arthrodesis was sound. Every patient was able to resume wearing regular shoes after a mean of 26.5 weeks (20 to 45).

  9. [Ankle joint prosthesis for bone defects].

    Science.gov (United States)

    Lampert, C

    2011-11-01

    Large defects of the talus, i.e. due to tumors, large areas of osteolysis in total ankle replacement (TAR) and posttraumatic talus body necrosis are difficult to manage. The gold standard in these circumstances is still tibiocalcaneal arthrodesis with all the negative aspects of a completely rigid hindfoot. We started 10 years ago to replace the talus by a custom-made, all cobalt-chrome implant (laser sintering). The first patient with a giant cell tumor did very well but the following patients showed all subsidence of the metal talus into the tibia due to missing bony edges. Therefore, we constructed a custom-made talus (mirrored from the healthy side) and combined it with a well functioning total ankle prosthesis (Hintegra). So far we have implanted this custom-made implant into 3 patients: the first had a chondrosarcoma of the talus (1 year follow-up), the second had massive osteolysis/necrosis of unknown origin (6 months follow-up) and the third massive osteolysis following a correct TAR (2 months follow-up). The results are very encouraging as all of the patients are practically pain free and have a good range of movement (ROM): D-P flexion 15°-0-20° but less motion in the lower ankle joint: ROM P-S 5°-0-5°. No subsidence was detected in the tibia or the calcaneus. The custom-made talus combined with the Hintegra total ankle replacement will probably be an interesting alternative to a tibiocalcaneal arthrodesis in selected cases with massive defects of the talus.

  10. Charcot foot and ankle with osteomyelitis

    OpenAIRE

    Donegan, Ryan; Sumpio, Bauer; Peter A. Blume

    2013-01-01

    This paper presents a review of the current literature discussing topics of Charcot osteoarthropathy, osteomyelitis, diagnosing osteomyelitis, antibiotic management of osteomyelitis, and treatment strategies for management of Charcot osteoarthropathy with concurrent osteomyelitis.Keywords: Charcot foot; osteomyelitis; diabetes mellitus; infection; neuropathy(Published: 1 October 2013)Citation: Diabetic Foot & Ankle 2013, 4: 21361 - http://dx.doi.org/10.3402/dfa.v4i0.21361

  11. Forces predicted at the ankle during running.

    Science.gov (United States)

    Burdett, R G

    1982-01-01

    A biomechanical model of the ankle joint was developed and was used to predict the forces at the ankle during the stance phase of running. Measurements from five cadavers were averaged to obtain insertion points and directions of pull of equivalent tendons with respect to the assumed center of the ankle joint. A minimum joint force solution was obtained by assuming that only two equivalent muscle groups could exert force at one time. Three subjects ran at 4.47 m/s across a force platform that recorded the external forces and moments acting on the foot. Cinematography was used to measure the foot and leg positions during stance. Peak resultant joint forces ranging from 9.0 to 13.3 times body weight and peak Achilles tendon forces ranging from 5.3 to 10.0 times body weight were predicted. Small variations in some cases resulted in large differences in predicted forces. The highest tendon forces predicted exceeded those reported to cause damage to cadaver tendons in other studies.

  12. Control method for exoskeleton ankle with surface electromyography signals

    Institute of Scientific and Technical Information of China (English)

    ZHANG Zhen; WANG Zhen; JIANG Jia-xin; QIAN Jin-wu

    2009-01-01

    This paper is concerned with a control method for an exoskeleton ankle with clectromyography (EMG) signals.The EMG signals of human ankle and the exoskeleton ankle are introduced.Then a control method is proposed to control the exoskeleton ankle using the EMG signals.The feed-forward neural network model applied here is composed of four layers and uses the back-propagation training algorithm.The output signals from neural network are processed by the wavelet transform.Finally the control orders generated from the output signals are passed to the motor controller and drive the exoskeleton to move.Through experiments,the equality of neural network prediction of ankle movement is evaluated by giving the correlation coefficient.It is shown from the experimental results that the proposed method can accurately control the movement of ankle joint.

  13. Talar Osteochondroma Fracture Presenting as Posterior Ankle Impingement.

    Science.gov (United States)

    Ercin, Ersin; Bilgili, Mustafa Gokhan; Gamsizkan, Mehmet; Avsar, Serdar

    2016-05-01

    Osteochondromas are the most common benign bone tumors. They are usually asymptomatic and found incidentally. When symptomatic, the symptoms are usually due to its location and size. Fracture of an osteochondroma presenting as posterior ankle impingement is a rare condition. We describe a 22-year-old man with solitary exostosis who presented with a posterior ankle mass and posterior ankle impingement with 2 years of follow-up. Surgical intervention was the treatment of choice in this patient, and histologic examination revealed a benign osteochondroma. Osteochondromas found in the posterior aspect of the talus can be complicated by fracture due to persistent motion of the ankle. Talar osteochondroma should be included in the differential diagnosis of posterior ankle impingement causes. Posterior talar osteochondromas, especially when a stalk is present, should be treated surgically before it is more complicated by a fracture and posterior ankle impingement.

  14. Total ankle replacement. Early experiences with STAR prosthesis.

    Science.gov (United States)

    Murnaghan, J. M.; Warnock, D. S.; Henderson, S. A.

    2005-01-01

    Early designs of Total Ankle Replacement (TAR) had a high failure rate. More recent experience with the 3-piece, meniscal bearing, total ankle replacement has been more promising. We report a review of the early results of our first 22 prostheses in 20 patients undergoing Scandinavian Total Ankle Replacement (STAR) in Northern Ireland. There was a mean follow-up time of 26 months. Seventeen patients are pain-free at the ankle joint during normal daily activities. Two of the early cases have required revision surgery due to technical errors. Other complications have included malleolar fractures, poor wound healing and postoperative stiffness. These early results show high levels of patient satisfaction, and we are encouraged to continue with total ankle arthroplasty. There is a steep initial learning curve and use of TAR should be restricted to foot and ankle surgeons. Images Fig 1 Figs 2a and b Figs 2 c and d PMID:16022128

  15. Design, modelling and simulation aspects of an ankle rehabilitation device

    Science.gov (United States)

    Racu, C. M.; Doroftei, I.

    2016-08-01

    Ankle injuries are amongst the most common injuries of the lower limb. Besides initial treatment, rehabilitation of the patients plays a crucial role for future activities and proper functionality of the foot. Traditionally, ankle injuries are rehabilitated via physiotherapy, using simple equipment like elastic bands and rollers, requiring intensive efforts of therapists and patients. Thus, the need of robotic devices emerges. In this paper, the design concept and some modelling and simulation aspects of a novel ankle rehabilitation device are presented.

  16. Assessment and management of patients with ankle injuries.

    Science.gov (United States)

    Walker, Jennie

    2014-08-19

    Foot and ankle injuries are common and can have a significant effect on an individual's daily activities. Nurses have an important role in the assessment, management, ongoing care and support of patients with ankle injuries. An understanding of the anatomy and physiology of the ankle enables nurses to identify significant injuries, which may result in serious complications, and communicate effectively with the multidisciplinary team to improve patient care and outcomes.

  17. Benign and malignant tumors of the foot and ankle

    Energy Technology Data Exchange (ETDEWEB)

    Singer, Adam D.; Datir, Abhijit; Langley, Travis [Emory University Hospital, Department of Radiology, Section of Musculoskeletal Imaging, Atlanta, GA (United States); Tresley, Jonathan [University of Wisconsin, Department of Radiology, Madison, WI (United States); Clifford, Paul D.; Jose, Jean; Subhawong, Ty K. [University of Miami, Department of Radiology, Miami, FL (United States)

    2016-03-15

    Pain and focal masses in the foot and ankle are frequently encountered and often initiate a workup including imaging. It is important to differentiate benign lesions from aggressive benign or malignant lesions. In this review, multiple examples of osseous and soft tissue tumors of the foot and ankle will be presented. Additionally, the compartmental anatomy of the foot and ankle will be discussed in terms of its relevance for percutaneous biopsy planning and eventual surgery. Finally, a general overview of the surgical management of benign, benign aggressive and malignant tumors of the foot and ankle will be discussed. (orig.)

  18. Comparison of total ankle replacement and ankle arthrodesis in patients with haemophilia using gait analysis: two case reports

    OpenAIRE

    Dauty, Marc; Gross, Raphael; Leboeuf, Fabien; Trossaert, Marc

    2015-01-01

    Background Severe hemophilia is an inherited, lifelong bleeding disorder characterized by spontaneous bleeding, which results in painful joint deformities. Currently two surgical treatments are available to treat haemophilia-related ankle joint destruction: ankle arthrodesis and total ankle replacement. The aim of the present study was to compare these two surgical procedures in haemophiliac subjects. Case presentation Kinematic and dynamic parameters were quantified using a three-dimensional...

  19. Is End-Stage Ankle Arthrosis Best Managed with Total Ankle Replacement or Arthrodesis? A Systematic Review

    OpenAIRE

    Jordan, Robert W.; Chahal, Gurdip S.; Anna Chapman

    2014-01-01

    Introduction. End-stage ankle osteoarthritis is a debilitating condition. Traditionally, ankle arthrodesis (AA) has been the surgical intervention of choice but the emergence of total ankle replacement (TAR) has challenged this concept. This systematic review aims to address whether TAR or AA is optimal in terms of functional outcomes. Methods. We conducted a systematic review according to PRISMA checklist using the online databases Medline and EMBASE after January 1, 2005. Participants must ...

  20. Robot-Assisted Rehabilitation of Ankle Plantar Flexors Spasticity: A Three-Month Study with Proprioceptive Neuromuscular Facilitation

    Directory of Open Access Journals (Sweden)

    Zhihao Zhou

    2016-11-01

    Full Text Available In this paper, we aim to investigate the effect of Proprioceptive Neuromuscular Facilitation (PNF based rehabilitation for ankle plantar flexors spasticity by using a Robotic Ankle-foot Rehabilitation System (RARS. A modified robot-assisted system was proposed and seven post-stroke patients with hemiplegic spastic ankles participated a three-month of robotic PNF training. Their impaired sides were used as the experimental group while their unimpaired sides as the control group. A robotic intervention for the experimental group generally started from a two minutes passive stretching to warm-up or relax the soleus and gastrocnemius muscle and also ended with the same one. Then a PNF training session included 30 trails was activated between them. The rehabilitation trainings were carried out three times a week as an addition of their regular rehabilitation exercise. Passive ankle joint range of motion, resistance torque and stiffness were measured in both ankles before and after the intervention. The changes in Achilles' tendon length, walking speed, and lower limb function were also evaluated by the same physician or physiotherapist for each participant. Biomechanical measurements before interventions showed significant difference between the experimental group and the control group due to ankle spasticity. For the control group, there was no significant difference in the three months with no robotic intervention. But for the experimental group, passive dorsiflexion range of motion increased ( p0.05 . The robotic rehabilitation also improved the muscle strength ( p0.05 and fast walking speed ( p<0.05 . These results indicated that PNF based robotic intervention could significantly alleviate lower limb spasticity and improve the motor function in chronic stroke participant. The robotic system could potentially be used as an effective tool in post-stroke rehabilitation training.

  1. Increased reward in ankle robotics training enhances motor control and cortical efficiency in stroke

    Directory of Open Access Journals (Sweden)

    Ronald N. Goodman, PhD

    2014-03-01

    Full Text Available Robotics is rapidly emerging as a viable approach to enhance motor recovery after disabling stroke. Current principles of cognitive motor learning recognize a positive relationship between reward and motor learning. Yet no prior studies have established explicitly whether reward improves the rate or efficacy of robotics-assisted rehabilitation or produces neurophysiologic adaptations associated with motor learning. We conducted a 3 wk, 9-session clinical pilot with 10 people with chronic hemiparetic stroke, randomly assigned to train with an impedance-controlled ankle robot (anklebot under either high reward (HR or low reward conditions. The 1 h training sessions entailed playing a seated video game by moving the paretic ankle to hit moving onscreen targets with the anklebot only providing assistance as needed. Assessments included paretic ankle motor control, learning curves, electroencephalograpy (EEG coherence and spectral power during unassisted trials, and gait function. While both groups exhibited changes in EEG, the HR group had faster learning curves (p = 0.05, smoother movements (p

  2. Increased reward in ankle robotics training enhances motor control and cortical efficiency in stroke.

    Science.gov (United States)

    Goodman, Ronald N; Rietschel, Jeremy C; Roy, Anindo; Jung, Brian C; Diaz, Jason; Macko, Richard F; Forrester, Larry W

    2014-01-01

    Robotics is rapidly emerging as a viable approach to enhance motor recovery after disabling stroke. Current principles of cognitive motor learning recognize a positive relationship between reward and motor learning. Yet no prior studies have established explicitly whether reward improves the rate or efficacy of robotics-assisted rehabilitation or produces neurophysiologic adaptations associated with motor learning. We conducted a 3 wk, 9-session clinical pilot with 10 people with chronic hemiparetic stroke, randomly assigned to train with an impedance-controlled ankle robot (anklebot) under either high reward (HR) or low reward conditions. The 1 h training sessions entailed playing a seated video game by moving the paretic ankle to hit moving onscreen targets with the anklebot only providing assistance as needed. Assessments included paretic ankle motor control, learning curves, electroencephalograpy (EEG) coherence and spectral power during unassisted trials, and gait function. While both groups exhibited changes in EEG, the HR group had faster learning curves (p = 0.05), smoother movements (p

  3. Effect of peroneal electrical stimulation versus an ankle-foot orthosis on obstacle avoidance ability in people with stroke-related foot drop.

    NARCIS (Netherlands)

    Swigchem, R. van; Duijnhoven, H.J.R. van; Boer, J. den; Geurts, A.C.H.; Weerdesteijn, V.G.

    2012-01-01

    BACKGROUND: Walking ability of people with foot drop in the chronic phase after stroke is better with functional electrical stimulation (FES) of the peroneal nerve than without an orthotic device. However, the literature is not conclusive on whether peroneal FES also is better than an ankle-foot ort

  4. Effects of a powered ankle-foot prosthesis on kinetic loading of the unaffected leg during level-ground walking

    OpenAIRE

    Grabowski, Alena M.; D’Andrea, Susan

    2013-01-01

    Background People with a lower-extremity amputation that use conventional passive-elastic ankle-foot prostheses encounter a series of stress-related challenges during walking such as greater forces on their unaffected leg, and may thus be predisposed to secondary musculoskeletal injuries such as chronic joint disorders. Specifically, people with a unilateral transtibial amputation have an increased susceptibility to knee osteoarthritis, especially in their unaffected leg. Previous studies hav...

  5. Total ankle prostheses in rheumatoid arthropathy

    Science.gov (United States)

    Schutte, Bernard; Louwerens, Jan Willem K; van den Hoogen, Frank H J; de Waal Malefijt, Maarten C

    2009-01-01

    Background and purpose The first generations of total ankle replacements (TARs) showed a high rate of early failure. In the last decades, much progress has been made in the development of TARs, with the newer generation showing better results. We evaluated TARs implanted with rheumatoid arthritis (RA) or juvenile inflammatory arthritis (JIA) as indication. Patients and methods 58 total ankle prostheses (Buechel-Pappas and STAR type) were implanted in patients with RA (n = 53) or JIA (n = 5) in 54 patients (4 bilateral). After a mean follow-up of 2.7 (1–9) years, all patients were reviewed by two orthopedic surgeons who were not the surgeons who performed the operation. Standard AP and lateral radiographs were taken and a Kofoed ankle score was obtained; this is a clinical score ranging from 0–100 and consists of sub-scores for pain, disability, and range of motion. Results 2 patients died of unrelated causes. Of the 52 patients who were alive (56 prostheses), 51 implants were still in place and showed no signs of loosening on the most recent radiographs. The mean Kofoed score at follow-up was 73 points (SD 16, range 21–92). 4 patients showed a poor result (score < 50) with persistent pain for which no obvious reason could be found. 5 implants were removed, 4 because of infection and 1 because of aseptic loosening. Interpretation Medium-term results of the STAR and BP types of TAR in RA were satisfactory. The main reason for failure of the implant was infection. PMID:19634020

  6. Robotic Ankle for Omnidirectional Rock Anchors

    Science.gov (United States)

    Parness, Aaron; Frost, Matthew; Thatte, Nitish

    2013-01-01

    Future robotic exploration of near-Earth asteroids and the vertical and inverted rock walls of lava caves and cliff faces on Mars and other planetary bodies would require a method of gripping their rocky surfaces to allow mobility without gravitational assistance. In order to successfully navigate this terrain and drill for samples, the grippers must be able to produce anchoring forces in excess of 100 N. Additionally, the grippers must be able to support the inertial forces of a moving robot, as well gravitational forces for demonstrations on Earth. One possible solution would be to use microspine arrays to anchor to rock surfaces and provide the necessary load-bearing abilities for robotic exploration of asteroids. Microspine arrays comprise dozens of small steel hooks supported on individual suspensions. When these arrays are dragged along a rock surface, the steel hooks engage with asperities and holes on the surface. The suspensions allow for individual hooks to engage with asperities while the remaining hooks continue to drag along the surface. This ensures that the maximum possible number of hooks engage with the surface, thereby increasing the load-bearing abilities of the gripper. Using the microspine array grippers described above as the end-effectors of a robot would allow it to traverse terrain previously unreachable by traditional wheeled robots. Furthermore, microspine-gripping robots that can perch on cliffs or rocky walls could enable a new class of persistent surveillance devices for military applications. In order to interface these microspine grippers with a legged robot, an ankle is needed that can robotically actuate the gripper, as well as allow it to conform to the large-scale irregularities in the rock. The anchor serves three main purposes: deploy and release the anchor, conform to roughness or misalignment with the surface, and cancel out any moments about the anchor that could cause unintentional detachment. The ankle design contains a

  7. A Survey of Parachute Ankle Brace Breakages

    Science.gov (United States)

    2008-01-10

    reduced since it was subject to abrasion from the concrete in the harness shed, asphalt on the loading ramp, and dirt on the drop zone. b. DJ...strap was also directly under the heel and subject to abrasion from concrete in the harness shed, asphalt on the loading ramp, and dirt on the drop...airborne injuries), airborne students who did not wear the brace were 1.90 times more likely to experience an ankle sprain, 1.47 times more likely to

  8. Mechanically induced ankle inversion during human walking and jumping.

    NARCIS (Netherlands)

    Nieuwenhuijzen, P.H.J.A.; Grüneberg, C.; Duysens, J.E.J.

    2002-01-01

    A new method to study sudden ankle inversions during human walking and jumping is presented. Ankle inversions of 25 degrees were elicited using a box containing a trap door. During the gait task, subjects walked at a speed of 4 km/h. At a pre-programmed delay after left heel strike, an electromagnet

  9. Medium- to long-term outcome of ankle arthrodesis

    NARCIS (Netherlands)

    R.P.M. Hendrickx; S.A.S. Stufkens; E.E. de Bruijn; I.N. Sierevelt; C.N. van Dijk; G.M.M.J. Kerkhoffs

    2011-01-01

    Despite improvement in outcome after ankle arthroplasty, fusion of the ankle joint is still considered the gold standard. A matter of concern is deterioration of clinical outcome as a result of loss of motion and advancing degeneration of adjacent joints. We performed a long-term study to address th

  10. THE EFFECTS OF KINESIO TAPING ON PROPRIOCEPTION AT THE ANKLE

    Directory of Open Access Journals (Sweden)

    Mark DeBeliso

    2004-03-01

    Full Text Available An experiment was designed to determine if KinesioTM taping the anterior and lateral portion of the ankle would enhance ankle proprioception compared to the untaped ankle. 30 subjects, 15 men, 15 women, ages 18-30 participated in this study. Exclusion criteria: Ankle injury < 6 months prior to testing, significant ligament laxity as determined through clinical evaluation by an ATC, or any severe foot abnormality. Experiment utilized a single group, pretest and posttest. Plantar flexion and inversion with 20° of plantar flexion reproduction of joint position sense (RJPS was determined using an ankle RJPS apparatus. Subjects were barefooted, blindfolded, and equipped with headphones playing white noise to eliminate auditory cues. Subjects had five trials in both plantar flexion and inversion with 20° plantar flexion before and after application of the KinesioTM tape to the anterior/lateral portion of the ankle. Constant error and absolute error were determined from the difference between the target angle and the trial angle produced by the subject. The treatment group (KinesioTM taped subjects showed no change in constant and absolute error for ankle RJPS in plantar flexion and 20º of plantar flexion with inversion when compared to the untaped results using the same motions. The application of KinesioTM tape does not appear to enhance proprioception (in terms of RJPS in healthy individuals as determined by our measures of RJPS at the ankle in the motions of plantar flexion and 20º of plantar flexion with inversion.

  11. Dislocated ankle fracture complicated by near total distal ischaemia

    Science.gov (United States)

    Duygun, Fatih; Sertkaya, Omer; Aldemir, Cengiz; Dogan, Ali

    2013-01-01

    Total arterial ischaemia is rarely seen following a dislocated ankle fracture but if it does and intervention is not made, it can lead to serious morbidity. We present a 39-year-old woman with almost total occlusion in the arteria tibialis and arteria dorsalis pedis following a dislocated ankle fracture as a result of a bicycle fall. PMID:24248319

  12. Simultaneous bilateral total ankle replacement using a 3-component prosthesis

    Science.gov (United States)

    2011-01-01

    Background and purpose Total ankle replacement is an established surgical procedure in patients with end-stage ankle osteoarthritis. We analyzed complications and medium-term results in patients with simultaneous bilateral total ankle replacement. Patients and methods 10 women and 16 men, mean age 60 (SD 13) years, were followed for a median of 5 (2–10) years. Results There were no intraoperative or perioperative complications, with the exception of 1 patient with prolonged wound healing. Major revision surgery was necessary in 6 of the 52 ankles, including 4 revisions of prosthetic components. The average pain score decreased from 6.9 (4−10) to 1.8 (0−4) points. The American Orthopaedic Foot and Ankle Society hindfoot score increased from 32 (SD 14) points preoperatively to 74 (SD 12) points postoperatively. The average range of motion increased from 28° (SD 12) preoperatively to 38° (SD 9) postoperatively. All 8 categories of SF-36 score improved. Interpretation Simultaneous bilateral total ankle replacement is a suitable method for restoration of function and attainment of pain relief in patients with bilateral end-stage ankle osteoarthritis. The results of this procedure, including complication rates, revision rates, and functional outcome, are comparable to those reported in patients with unilateral total ankle replacement. PMID:21999622

  13. Hindfoot endoscopy for posterior ankle impingement. Surgical technique

    NARCIS (Netherlands)

    van Dijk, C.N.; de Leeuw, P.A.J.; Scholten, P.E.

    2009-01-01

    BACKGROUND: The surgical treatment of posterior ankle impingement is associated with a high rate of complications and a substantial time to recover. An endoscopic approach to the posterior ankle (hindfoot endoscopy) may lack these disadvantages. We hypothesized that hindfoot endoscopy causes less mo

  14. Recycling energy to restore impaired ankle function during human walking.

    Directory of Open Access Journals (Sweden)

    Steven H Collins

    Full Text Available BACKGROUND: Humans normally dissipate significant energy during walking, largely at the transitions between steps. The ankle then acts to restore energy during push-off, which may be the reason that ankle impairment nearly always leads to poorer walking economy. The replacement of lost energy is necessary for steady gait, in which mechanical energy is constant on average, external dissipation is negligible, and no net work is performed over a stride. However, dissipation and replacement by muscles might not be necessary if energy were instead captured and reused by an assistive device. METHODOLOGY/PRINCIPAL FINDINGS: We developed a microprocessor-controlled artificial foot that captures some of the energy that is normally dissipated by the leg and "recycles" it as positive ankle work. In tests on subjects walking with an artificially-impaired ankle, a conventional prosthesis reduced ankle push-off work and increased net metabolic energy expenditure by 23% compared to normal walking. Energy recycling restored ankle push-off to normal and reduced the net metabolic energy penalty to 14%. CONCLUSIONS/SIGNIFICANCE: These results suggest that reduced ankle push-off contributes to the increased metabolic energy expenditure accompanying ankle impairments, and demonstrate that energy recycling can be used to reduce such cost.

  15. Recycling Energy to Restore Impaired Ankle Function during Human Walking

    NARCIS (Netherlands)

    Collins, S.H.; Kuo, A.D.

    2010-01-01

    Background: Humans normally dissipate significant energy during walking, largely at the transitions between steps. The ankle then acts to restore energy during push-off, which may be the reason that ankle impairment nearly always leads to poorer walking economy. The replacement of lost energy is nec

  16. Understanding acute ankle ligamentous sprain injury in sports

    Directory of Open Access Journals (Sweden)

    Fong Daniel TP

    2009-07-01

    Full Text Available Abstract This paper summarizes the current understanding on acute ankle sprain injury, which is the most common acute sport trauma, accounting for about 14% of all sport-related injuries. Among, 80% are ligamentous sprains caused by explosive inversion or supination. The injury motion often happens at the subtalar joint and tears the anterior talofibular ligament (ATFL which possesses the lowest ultimate load among the lateral ligaments at the ankle. For extrinsic risk factors to ankle sprain injury, prescribing orthosis decreases the risk while increased exercise intensity in soccer raises the risk. For intrinsic factors, a foot size with increased width, an increased ankle eversion to inversion strength, plantarflexion strength and ratio between dorsiflexion and plantarflexion strength, and limb dominance could increase the ankle sprain injury risk. Players with a previous sprain history, players wearing shoes with air cells, players who do not stretch before exercising, players with inferior single leg balance, and overweight players are 4.9, 4.3, 2.6, 2.4 and 3.9 times more likely to sustain an ankle sprain injury. The aetiology of most ankle sprain injuries is incorrect foot positioning at landing – a medially-deviated vertical ground reaction force causes an explosive supination or inversion moment at the subtalar joint in a short time (about 50 ms. Another aetiology is the delayed reaction time of the peroneal muscles at the lateral aspect of the ankle (60–90 ms. The failure supination or inversion torque is about 41–45 Nm to cause ligamentous rupture in simulated spraining tests on cadaver. A previous case report revealed that the ankle joint reached 48 degrees inversion and 10 degrees internal rotation during an accidental grade I ankle ligamentous sprain injury during a dynamic cutting trial in laboratory. Diagnosis techniques and grading systems vary, but the management of ankle ligamentous sprain injury is mainly conservative

  17. Electron heat flux instability

    Science.gov (United States)

    Saeed, Sundas; Sarfraz, M.; Yoon, P. H.; Lazar, M.; Qureshi, M. N. S.

    2017-02-01

    The heat flux instability is an electromagnetic mode excited by a relative drift between the protons and two-component core-halo electrons. The most prominent application may be in association with the solar wind where drifting electron velocity distributions are observed. The heat flux instability is somewhat analogous to the electrostatic Buneman or ion-acoustic instability driven by the net drift between the protons and bulk electrons, except that the heat flux instability operates in magnetized plasmas and possesses transverse electromagnetic polarization. The heat flux instability is also distinct from the electrostatic counterpart in that it requires two electron species with relative drifts with each other. In the literature, the heat flux instability is often called the 'whistler' heat flux instability, but it is actually polarized in the opposite sense to the whistler wave. This paper elucidates all of these fundamental plasma physical properties associated with the heat flux instability starting from a simple model, and gradually building up more complexity towards a solar wind-like distribution functions. It is found that the essential properties of the instability are already present in the cold counter-streaming electron model, and that the instability is absent if the protons are ignored. These instability characteristics are highly reminiscent of the electron firehose instability driven by excessive parallel temperature anisotropy, propagating in parallel direction with respect to the ambient magnetic field, except that the free energy source for the heat flux instability resides in the effective parallel pressure provided by the counter-streaming electrons.

  18. Technique of Arthroscopic Treatment of Impingement After Total Ankle Arthroplasty.

    Science.gov (United States)

    Gross, Christopher E; Neumann, Julie A; Godin, Jonathan A; DeOrio, James K

    2016-04-01

    Rates of medial and/or lateral gutter impingement after total ankle replacement are not insignificant. If impingement should occur, it typically arises an average of 17 months after total ankle replacement. Our patient underwent treatment for right ankle medial gutter bony impingement with arthroscopic debridement 5 years after her initial total ankle replacement. Standard anteromedial and anterolateral portals and a 30° 2.7-mm-diameter arthroscope were used. An aggressive soft-tissue and bony resection was performed using a combination of curettes, a 3.5-mm shaver, a 5.5-mm unsheathed burr, a drill, and a radiofrequency ablator. This case shows that arthroscopic treatment is an effective and potentially advantageous alternative to open treatment of impingement after total ankle replacement. In addition, symptoms of impingement often improve in a short amount of time after arthroscopic debridement of the medial and/or lateral gutter.

  19. Total ankle replacement – surgical treatment and rehabilitation

    Science.gov (United States)

    Krogulec, Zbigniew; Turski, Piotr; Przepiórski, Emil; Małdyk, Paweł; Księżopolska-Orłowska, Krystyna

    2015-01-01

    Functions of the ankle joint are closely connected with the gait and ability to maintain an upright position. Degenerative lesions of the joint directly contribute to postural disorders and greatly restrict propulsion of the foot, thus leading to abnormal gait. Development of total ankle replacement is connected with the use of the method as an efficient treatment of joint injuries and continuation of achievements in hip and knee surgery. The total ankle replacement technique was introduced as an alternative to arthrodesis, i.e. surgical fixation, which made it possible to preserve joint mobility and to improve gait. Total ankle replacement is indicated in post-traumatic degenerative joint disease and joint destruction secondary to rheumatoid arthritis. In this paper, total ankle replacement and various types of currently used endoprostheses are discussed. The authors also describe principles of early postoperative rehabilitation as well as rehabilitation in the outpatient setting. PMID:27407223

  20. Finite element analysis of a composite artificial ankle

    Science.gov (United States)

    Perkins, Leigh Ann; Johnston, Lawrence; Denniston, Charles; Czekalski, Blaise E.

    1993-01-01

    Ultra-light carbon fiber composite materials are being utilized in artificial limbs with increasing frequency in recent years. Dr. Arthur Copes, an orthotist from Baton Rouge, Louisiana, has developed a graphite expoxy composite material artificial ankle (Copes/Bionic Ankle) that is intended to be used by amputees who require the most advanced above-and-below-the-knee prosthetic devices. The Copes/Bionic Ankle is designed to reproduce the function of the natural ankle joint by allowing the composite material to act as a spring mechanism without the use of metal mechanical parts. NASA Marshall Space Flight Center has agreed to participate in the design effort by providing the structural analysis of the artificial ankle design.

  1. Charcot neuroarthropathy of the foot and ankle: a review.

    Science.gov (United States)

    Varma, Ajit Kumar

    2013-01-01

    Charcot neuroarthropathy is a limb-threatening, destructive process that occurs in patients with neuropathy associated with medical diseases such as diabetes mellitus. Clinicians' treating diabetic patients should be vigilant in recognizing the early signs of acute Charcot neuroarthropathy, such as pain, warmth, edema, or pathologic fracture in a neuropathic foot. Early detection and prompt treatment can prevent joint and bone destruction, which, if untreated, can lead to morbidity and high-level amputation. A high degree of suspicion is necessary. Once the early signs have been detected, prompt immobilization and offloading are important. Treatment should be determined on an individual basis, and it must be determined whether a patient can be treated conservatively or will require surgical intervention when entering the chronic phase. If diagnosed early, medical and conservative measures only will be required. Surgery is indicated for patients with severe or unstable deformities that, if untreated, will result in major amputations. A team approach that includes a foot and ankle surgeon, a diabetologist, a physiotherapist, a medical social councilor, and, most importantly, the patient and immediate family members is vital for successful management of this serious condition.

  2. Evaluating shoulder instability treatment

    NARCIS (Netherlands)

    van der Linde, J.A.

    2016-01-01

    Shoulder instability common occurs. When treated nonoperatively, the resulting societal costs based on health care utilization and productivity losses are significant. Shoulder function can be evaluated using patient reported outcome measurements (PROMs). For shoulder instability, these include the

  3. Total ankle replacement: a population-based study of 515 cases from the Finnish Arthroplasty Register

    Science.gov (United States)

    Koivu, Helka; Eskelinen, Antti; Ikävalko, Mikko; Paavolainen, Pekka; Remes, Ville

    2010-01-01

    Background and purpose Although total ankle replacement (TAR) is a recognized procedure for treatment of the painful arthritic ankle, the best choice of implant and the long-term results are still unknown. We evaluated the survival of two TAR designs and factors associated with survival using data from the nationwide arthroplasty registry in Finland. Methods 573 primary TARs were performed during the period 1982–2006 because of rheumatic, arthritic, or posttraumatic ankle degeneration. We selected contemporary TAR designs that were each used in more than 40 operations, including the S.T.A.R. (n = 217) and AES (n = 298), to assess their respective survival rates. The mean age of the patients was 55 (17–86) years and 63% of operations were performed in women. Kaplan-Meier analysis and the Cox regression model were used for survival analysis. The effects of age, sex, diagnosis, and hospital volume were also studied. Results The annual incidence of TAR was 1.5 per 105 inhabitants. The 5-year overall survivorship for the whole TAR cohort was 83% (95% CI: 81–86), which agrees with earlier reports. The most frequent reasons for revision were aseptic loosening of one or both of the prosthesis components (39%) and instability (39%). We found no difference in survival rate between the S.T.A.R. and AES designs. Furthermore, age, sex, diagnosis, and hospital volume ( 100 replacements in each of 17 hospitals) did not affect the TAR survival. Interpretation Based on our findings, we cannot conclude that any prosthesis was superior to any other. A high number of technical errors in primary TARs suggests that this low-volume field of implant arthroplasty should be centralized to fewer units. PMID:20180720

  4. Mobile-bearing total ankle arthroplasty : a fundamental assessment of the clinical, radiographic and functional outcomes

    NARCIS (Netherlands)

    Doets, Hendrik Cornelis

    2009-01-01

    Ankle arthritis often leads to significant impairments for the patient. As total ankle arthroplasty (TAA) with use of fixed-bearing (2-component) total ankle prostheses has a high rate of early failures, fusion of the ankle joint is, until today, considered to be the standard surgical treatment for

  5. Influence of distal tibiofibular synostosis on ankle function

    Institute of Scientific and Technical Information of China (English)

    HOU Zhen-hai; ZHOU Ji-hong; YE Hong; SHI Jian-guo; ZHENG Long-bao; YAO Jun; NI Zhi-ming

    2009-01-01

    Objective: To study the influence distal tibiofibular synostosis on ankle function.Methods: From October 1998 to October 2004,a total of 281 consecutive patients underwent operations because of ankle fractures or distal fractures of the tibia and fibula.Distal tibiofibular synostosis occurred after operation in 8 Patients.The duration of follow-up averaged 20.6 months (14-44 months).The ankle function was assessed on the basis of functional rating system described by Mazur.1Results: According to Mazur's ankle evaluation system,4 patients achieved an excellent result,2 a good result and 2 a fair result.The dorsiflexion of the synostosis ankle reduced by 8.26 degrees as compared with that of the contralateral ankle.and there was little influence on the plantar flexion.All the Patients had a normal gait.Conclusion: The distal tibiofibular synostosis after the operation of ankle fractures or distal fractures of the tibia and fibula usually gives rise to few symptoms and needs no specific treatment.

  6. Summary of Human Ankle Mechanical Impedance During Walking

    Science.gov (United States)

    Rouse, Elliott J.; Krebs, Hermano Igo

    2016-01-01

    The human ankle joint plays a critical role during walking and understanding the biomechanical factors that govern ankle behavior and provides fundamental insight into normal and pathologically altered gait. Previous researchers have comprehensively studied ankle joint kinetics and kinematics during many biomechanical tasks, including locomotion; however, only recently have researchers been able to quantify how the mechanical impedance of the ankle varies during walking. The mechanical impedance describes the dynamic relationship between the joint position and the joint torque during perturbation, and is often represented in terms of stiffness, damping, and inertia. The purpose of this short communication is to unify the results of the first two studies measuring ankle mechanical impedance in the sagittal plane during walking, where each study investigated differing regions of the gait cycle. Rouse et al. measured ankle impedance from late loading response to terminal stance, where Lee et al. quantified ankle impedance from pre-swing to early loading response. While stiffness component of impedance increases significantly as the stance phase of walking progressed, the change in damping during the gait cycle is much less than the changes observed in stiffness. In addition, both stiffness and damping remained low during the swing phase of walking. Future work will focus on quantifying impedance during the “push off” region of stance phase, as well as measurement of these properties in the coronal plane. PMID:27766187

  7. Registry data trends of total ankle replacement use.

    Science.gov (United States)

    Roukis, Thomas S; Prissel, Mark A

    2013-01-01

    Joint arthroplasty registry data are meaningful when evaluating the outcomes of total joint replacement, because they provide unbiased objective information regarding survivorship and incidence of use. Critical evaluation of the registry data information will benefit the surgeon, patient, and industry. However, the implementation and acceptance of registry data for total ankle replacement has lagged behind that of hip and knee implant arthroplasty. Currently, several countries have national joint arthroplasty registries, with only some procuring information for total ankle replacement. We performed an electronic search to identify publications and worldwide registry databanks with pertinent information specific to total ankle replacement to determine the type of prostheses used and usage trends over time. We identified worldwide registry data from 33 countries, with details pertinent to total ankle replacement identified in only 6 countries. The obtained information was arbitrarily stratified into 3 distinct periods: 2000 to 2006, 2007 to 2010, and 2011. Within these study periods, the data from 13 total ankle replacement systems involving 3,980 ankles were identified. The vast majority (97%) of the reported ankle replacements were 3-component, mobile-bearing, uncemented prostheses. Three usage trends were identified: initial robust embracement followed by abrupt disuse, minimal use, and initial embracement followed by sustained growth in implantation. Before the widespread acceptance of new total ankle replacements, the United States should scrutinize and learn from the international registry data and develop its own national joint registry that would include total ankle replacement. Caution against the adoption of newly released prostheses, especially those without readily available revision components, is recommended.

  8. Preoperative gait characterization of patients with ankle arthrosis.

    Science.gov (United States)

    Khazzam, Michael; Long, Jason T; Marks, Richard M; Harris, Gerald F

    2006-08-01

    The purpose of this study was to evaluate the kinematic changes that occur about the foot and ankle during gait in patients with degenerative joint disease (DJD). By comparing a normal adult population with what was found in the DJD population we determined how the motion of theses groups differed, thereby characterizing how this pathology affects foot and ankle motion. A 15-camera Vicon Motion Analysis System was used in conjunction with weight bearing radiographs to obtain three-dimensional motion of the foot and ankle during ambulation. The study was comprised of 34 patients and 35 ankles diagnosed with DJD (19 men and 15 women) of the ankle and 25 patients with normal ankles (13 men and 12 women). Dynamic foot and ankle motion was analyzed using the four-segment Milwaukee Foot Model (MFM). The data from this model resulted in three-dimensional (3D) kinematic parameters in the sagittal, coronal, and transverse planes as well as spatial-temporal parameters. Patient health status was evaluated using the SF-36 Health Survey and American Orthopaedics Foot and Ankle Society (AOFAS) hindfoot scores. The DJD group showed significant differences (pgait. This decreased range of motion may be related to several factors including bony deformity, muscle weakness, and attempts to decrease the pain associated with weight bearing. To date there has not been a study which describes the effect of this disease process on motion of the foot and ankle. These findings may prove to be useful in the pre-operative assessment of these patients.

  9. Agility to INBONE: anterior and posterior approaches to the difficult revision total ankle replacement.

    Science.gov (United States)

    DeVries, J George; Scott, Ryan T; Berlet, Gregory C; Hyer, Christopher F; Lee, Thomas H; DeOrio, James K

    2013-01-01

    Total ankle replacement is now acknowledged as a viable alternative to ankle arthrodesis for end-stage ankle arthritis. The authors present a series of 14 patients who were converted from the Agility total ankle replacement to an INBONE total ankle replacement. This report is unique in that anterior and posterior approaches are discussed and detailed. Although the authors present successful conversion of the Agility total ankle replacement to an INBONE total ankle replacement, the difficulty of this procedure is demonstrated by the high complication rate and 2 early failures.

  10. A Biomechanical Comparison of Locking Versus Conventional Plate Fixation for Distal Fibula Fractures in Trimalleolar Ankle Injuries.

    Science.gov (United States)

    Nguyentat, Annie; Camisa, William; Patel, Sandeep; Lagaay, Pieter

    2016-01-01

    Previous biomechanical studies have advocated the use of locking plates for isolated distal fibula fractures in osteoporotic bone. Complex rotational ankle injuries involve an increased number of fractures, which can result in instability, potentially requiring the same fixed angle properties afforded by locking plates. However, the mechanical indication for locking plate technology has not been tested in this fracture model. The purpose of the present study was to compare the biomechanical properties of locking and conventional plate fixation for distal fibula fractures in trimalleolar ankle injuries. Fourteen (7 matched pairs) fresh-frozen cadaver leg specimens were used. The bone mineral density of each was obtained using dual x-ray absorptiometry scans. The fracture model simulated an OTA 44-B3.3 fracture. The syndesmosis was not disrupted. Each fracture was fixated in the same fashion, except for the distal fibula plate construct: locking (n = 7) and one-third tubular (n = 7). The specimens underwent axial and torsional cyclic loading, followed by torsional loading to failure. No statistically significant differences were found between the locking and conventional plate constructs during both fatigue and torque to failure testing (p > .05). Our specimen bone mineral density averages did not represent poor bone quality. The clinical implication of the present study is that distal fibular locking plates do not provide a mechanical advantage for trimalleolar ankle injuries in individuals with normal bone density and in the absence of fracture comminution.

  11. Outcome of unilateral ankle arthrodesis and total ankle replacement in terms of bilateral gait mechanics.

    Science.gov (United States)

    Chopra, Swati; Rouhani, Hossein; Assal, Mathieu; Aminian, Kamiar; Crevoisier, Xavier

    2014-03-01

    Previous studies assessed the outcome of ankle arthrodesis (AA) and total ankle replacement (TAR) surgeries; however, the extent of postoperative recovery towards bilateral gait mechanics (BGM) is unknown. We evaluated the outcome of the two surgeries at least 2 years post rehabilitation, focusing on BGM. 36 participants, including 12 AA patients, 12 TAR patients, and 12 controls were included. Gait assessment over 50 m distance was performed utilizing pressure insoles and 3D inertial sensors, following which an intraindividual comparison was performed. Most spatiotemporal and kinematic parameters in the TAR group were indicative of good gait symmetry, while the AA group presented significant differences. Plantar pressure symmetry among the AA group was also significantly distorted. Abnormality in biomechanical behavior of the AA unoperated, contralateral foot was observed. In summary, our results indicate an altered BGM in AA patients, whereas a relatively fully recovered BGM is observed in TAR patients, despite the quantitative differences in several parameters when compared to a healthy population. Our study supports a biomechanical assessment and rehabilitation of both operated and unoperated sides after major surgeries for ankle osteoarthrosis.

  12. Use of a trabecular metal implant in ankle arthrodesis after failed total ankle replacement

    Science.gov (United States)

    2010-01-01

    Background and purpose Arthrodesis after failed total ankle replacement is complicated and delayed union, nonunion, and shortening of the leg often occur—especially with large bone defects. We investigated the use of a trabecular metal implant and a retrograde intramedullary nail to obtain fusion. Patients and methods 13 patients with a migrated or loose total ankle implant underwent arthrodesis with the use of a retrograde intramedullary nail through a trabecular metal Tibial Cone. The mean follow-up time was 1.4 (0.6–3.4) years. Results At the last examination, 7 patients were pain-free, while 5 had some residual pain but were satisfied with the procedure. 1 patient was dissatisfied and experienced pain and swelling when walking. The implant-bone interfaces showed no radiographic zones or gaps in any patient, indicating union. Interpretation The method is a new way of simplifying and overcoming some of the problems of performing arthrodesis after failed total ankle replacement. PMID:21067435

  13. Strategies for Revision Total Ankle Replacement

    Directory of Open Access Journals (Sweden)

    Thomas S. Roukis, DPM, PhD, FACFAS

    2014-12-01

    Full Text Available As the frequency of primary total ankle replacement (TAR continues to build, revision will become more commonplace. At present there are no “standard principles” associated with revision TAR. What is clear is that the current approaches are technically complex, fraught with complications and no one approach represents the only answer. Exchange of TAR metallic components to the same system standard or dedicated revision components are viable options with limited occurrence of complications. Explantation and conversion to custom-design long stemmed components has limited availability. Explantation and conversion to another TAR system is high-risk and has strong potential for complications. The use of metal reinforced polymethylmethacrylate cement augmentation of failed TAR systems and tibio-talo-calcaneal arthrodesis should be reserved for very select situations where other options are not possible. There is a real need for long-term survivorship following revision TAR and future efforts ought to be directed in this area.

  14. Internal Fixation of Open Ankle Fracture. Report of Two Cases

    Directory of Open Access Journals (Sweden)

    Yaniel Truffin Rodríguez

    2014-10-01

    Full Text Available Open ankle fracture is sporadically seen in the orthopedic practice. Its clinical course is subject to multiple factors, showing a propensity to cause ankle osteoarthritis over the years. Two cases treated at the Dr. Gustavo Aldereguía Lima University General Hospital in Cienfuegos are presented. The patients underwent emergency surgical treatment consisting of surgical cleaning of the open wound, reduction of the dislocation and internal fixation of the fracture. These cases are presented due to the infrequency of this type of ankle injury and its importance for the medical staff, especially orthopedic doctors.

  15. Multicenter follow-up study of ankle fracture surgery

    Institute of Scientific and Technical Information of China (English)

    XU Hai-lin; WANG Gang; WANG Guang-lin; WU Xin-bao; LIU Li-min; LI Xuan; ZHANG Dian-ying; FU Zhong-guo; WANG Tian-bing; ZHANG Pei-xun; JIANG Bao-guo; SHEN Hui-liang

    2012-01-01

    Background Few data on ankle fractures in China from large multicenter epidemiological and clinical studies are available.The aim of this research was to evaluate the epidemiological features and surgical outcomes of ankle fractures by reviewing 235 patients who underwent ankle fracture surgery at five hospitals in China.Methods This study included patients who underwent ankle fracture surgery at five Chinese hospitals from January 2000 to July 2009.Age,gender,mechanism of injury,Arbeitsgemeinschaft für Osteosynthesefragen (AO) fracture type,fracture pattern,length of hospital stay and treatment outcome were recorded.Statistical analyses were conducted using SPSS software.The American Orthopedic Foot and Ankle Society (AOFAS) ankle-hindfoot scale,visual analogue scale (VAS),and arthritis scale were used to evaluate outcome.Results Of 235 patients with ankle fractures,105 were male with an average age of 37.8 years and 130 were female with an average age of 47.3 years.The average follow-up period was 55.7 months.There were significant differences in the ratios of patients in different age groups between males and females,and in mechanisms of injury among different age groups.There were also significant differences in the length of hospital stay among different fracture types and mechanisms of injury.In healed fractures,the average AOFAS ankle-hindfoot score was 95.5,with an excellence rate of 99.6%,the average VAS score was 0.17,and the average arthritis score was 0.18.Movement of the injured ankle was significantly different to that of the uninjured ankle.There were no significant differences between AO fracture types,fracture patterns or follow-up periods and AOFAS score,but there were some significant differences between these parameters and ankle joint movements,pain VAS score and arthritis score.Conclusions Ankle fractures occur most commonly in middle-aged and young males aged 20-39 years and in elderly females aged 50-69 years.The most common mechanisms of

  16. Early intra-articular complement activation in ankle fractures

    DEFF Research Database (Denmark)

    Schmal, Hagen; Salzmann, Gian M; Niemeyer, Philipp;

    2014-01-01

    osteochondritis dissecans (OCD) of the ankle. All fractures needed external fixation during which joint effusions were collected. Fluid analysis was done by ELISA measuring aggrecan, bFGF, IL-1 β, IGF-1, and the complement components C3a, C5a, and C5b-9. The time periods between occurrence of fracture...... and OCD patients, bFGF, IGF-1, and all complement components were significantly higher concentrated in ankle joints with fractures (P Complement activation and inflammatory cell infiltration characterize the joint biology following acute ankle fractures....

  17. Ultrasound-guided interventions of the foot and ankle.

    Science.gov (United States)

    Yablon, Corrie M

    2013-02-01

    Ultrasound (US) provides excellent delineation of tendons and ligaments in the foot and ankle and provides real-time visualization of a needle during interventions, yielding greater accuracy and efficacy than the traditional blind approach using anatomical landmarks. For this reason, US is rapidly gaining acceptance as the preferred modality for guiding interventions in the foot and ankle where the anatomy is complex, neurovascular structures should be identified, and precise technique is demanded. In the foot and ankle, US is especially useful to guide tendon sheath, bursal, and Achilles paratenon injections, Morton neuroma injections, plantar fascial injections, and joint aspirations and injections.

  18. Review of ankle inversion sprain simulators in the biomechanics laboratory

    Directory of Open Access Journals (Sweden)

    Sophia Chui-Wai Ha

    2015-10-01

    Full Text Available Ankle inversion ligamentous sprain is one of the most common sports injuries. The most direct way is to investigate real injury incidents, but it is unethical and impossible to replicate on test participants. Simulators including tilt platforms, trapdoors, and fulcrum devices were designed to mimic ankle inversion movements in laboratories. Inversion angle was the only element considered in early designs; however, an ankle sprain is composed of inversion and plantarflexion in clinical observations. Inversion velocity is another parameter that increased the reality of simulation. This review summarised the simulators, and aimed to compare and contrast their features and settings.

  19. Seasonality of Ankle Swelling: Population Symptom Reporting Using Google Trends.

    Science.gov (United States)

    Liu, Fangwei; Allan, G Michael; Korownyk, Christina; Kolber, Michael; Flook, Nigel; Sternberg, Harvey; Garrison, Scott

    2016-07-01

    In our experience, complaints of ankle swelling are more common in summer, typically from patients with no obvious cardiovascular disease. Surprisingly, this observation has never been reported. To objectively establish this phenomenon, we sought evidence of seasonality in the public's Internet searches for ankle swelling. Our data, obtained from Google Trends, consisted of all related Google searches in the United States from January 4, 2004, to January 26, 2016. Consistent with our expectations and confirmed by similar data for Australia, Internet searches for information on ankle swelling are highly seasonal (highest in midsummer), with seasonality explaining 86% of search volume variability.

  20. Diabetic charcot neuroarthropathy of the foot and ankle with osteomyelitis.

    Science.gov (United States)

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

    2014-10-01

    One of the most devastating foot and/or ankle complications in the diabetic population with peripheral neuropathy is the presence of Charcot neuroarthropathy (CN). In recent years, diabetic limb salvage has been attempted more frequently as opposed to major lower extremity amputation for CN of the foot and ankle with ulceration and/or deep infection. Treatment strategies for osteomyelitis in the diabetic population have evolved. This article reviews some of the most common surgical strategies recommended for the diabetic patient with CN of the foot and/or ankle and concomitant osteomyelitis.

  1. Optimal management of ankle syndesmosis injuries

    Directory of Open Access Journals (Sweden)

    Porter DA

    2014-08-01

    Full Text Available David A Porter, Ryan R Jaggers, Adam Fitzgerald Barnes, Angela M Rund Methodist Sports Medicine/The Orthopedic Specialists, Indianapolis, IN, USA Abstract: Syndesmosis injuries occur when there is a disruption of the distal attachment of the tibia and fibula. These injuries occur commonly (up to 18% of ankle sprains, and the incidence increases in the setting of athletic activity. Recognition of these injuries is key to preventing long-term morbidity. Diagnosis and treatment of these injuries requires a thorough understanding of the normal anatomy and the role it plays in the stability of the ankle. A complete history and physical examination is of paramount importance. Patients usually experience an external rotation mechanism of injury. Key physical exam features include detailed documentation about areas of focal tenderness (syndesmosis and deltoid and provocative maneuvers such as the external rotation stress test. Imaging workup in all cases should consist of radiographs with the physiologic stress of weight bearing. If these images are inconclusive, then further imaging with external rotation stress testing or magnetic resonance imaging are warranted. Nonoperative treatment is appropriate for stable injuries. Unstable injuries should be treated operatively. This consists of stabilizing the syndesmosis with either trans-syndesmotic screw or tightrope fixation. In the setting of a concomitant Weber B or C fracture, the fibula is anatomically reduced and stabilized with a standard plate and screw construct. Proximal fibular fractures, as seen in the Maisonneuve fracture pattern, are not repaired operatively. Recent interest is moving toward repair of the deltoid ligament, which may provide increased stability, especially in rehabilitation protocols that involve early weight bearing. Rehabilitation is focused on allowing patients to return to their pre-injury activities as quickly and safely as possible. Protocols initially focus on

  2. Effects of hip and head position on ankle range of motion, ankle passive torque, and passive gastrocnemius tension.

    Science.gov (United States)

    Andrade, R J; Lacourpaille, L; Freitas, S R; McNair, P J; Nordez, A

    2016-01-01

    Ankle joint range of motion (ROM) is notably influenced by the position of the hip joint. However, this result remains unexplained. Thus, the aim of this study was to test if the ankle passive torque and gastrocnemius muscle tension are affected by the hip and the head positions. The torque and the muscle shear elastic modulus (measured by elastography to estimate muscle tension) were collected in nine participants during passive ankle dorsiflexions performed in four conditions (by combining hip flexion at 90 or 150°, and head flexed or neutral). Ankle maximum dorsiflexion angle significantly decreased by flexing the hip from 150 to 90° (P  0.05). Maximal passive torque and shear elastic modulus were higher with the hip flexed at 90° (P  0.05) were found for both torque and shear elastic modulus at a given common ankle angle among conditions. Shifts in maximal ankle angle due to hip angle manipulation are not related neither to changes in passive torque nor tension of the gastrocnemius. Further studies should be addressed to better understand the functional role of peripheral nerves and fasciae in the ankle ROM limits.

  3. The effects of ankle mobilization and active stretching on the difference of weight-bearing distribution, low back pain and flexibility in pronated-foots subjects.

    Science.gov (United States)

    Yoon, Ki-Seok; Park, Seong-Doo

    2013-04-01

    The purpose of this study was designed to analyze the effects mobilization and active stretching on the difference of weight-bearing distribution, low back pain, and flexibility in pronated-foot subjects. The subjects of this study were 16 chronic low back pain patients. They were randomly divided into the control and experimental group. The experimental group had used the model of ankle mobilization and calf muscle active stretching three times per week, for 4 weeks. The control group did same method without an ankle mobilization. The range of flexion and extension motion of the lumbar vertebrae and low back pain degree and difference of weight-bearing were measured before and after the experiment. The model of ankle mobilization and calf muscle stretching of pronated-foot significantly improved the range of flexion and extension motion of the vertebrae. And the visual analogue scale and distribution of weight-bearing were decreased in both of two groups. In other word, the exercise of this study showed that the model of ankle mobilization and calf muscle stretching of pronated-foot had positive effects on improving the range of flexion and extension motion of the vertebrae. The calf muscle stretching was easy and it is effective in therapy that patients by themselves and helped to recover the balance of the vertebrae to combine ankle mobilization and muscle stretching.

  4. Effect of anterior translation of the talus on outcomes of three-component total ankle arthroplasty

    Science.gov (United States)

    2013-01-01

    Background Ankle osteoarthritis commonly involves sagittal malalignment with anterior translation of the talus relative to the tibia. Total ankle arthroplasty has become an increasingly popular treatment for patients with symptomatic ankle osteoarthritis. However, no comprehensive study has been conducted on the outcomes of total ankle arthroplasty for osteoarthritis with preoperative sagittal malalignment. The purpose of this study was to evaluate the effect of anterior translation of the talus on outcomes of three-component total ankle arthroplasty. Methods One hundred and four osteoarthritic ankles in 104 patients who underwent three-component total ankle arthroplasty were included in this study. The 104 ankles were divided into 2 groups: ankles with anteriorly translated talus (50 ankles), and ankles with non-translated talus (54 ankles). Clinical and radiographic outcomes were assessed in both groups. The mean follow-up duration was 42.8 ± 17.9 months (range, 24 to 95 months). Results Forty-six (92%) of 50 ankles with anterior translation of the talus showed relocation of the talus within the mortise at 6 months, and 48 (96%) ankles were relocated at 12 months after total ankle arthroplasty. But, 2 (4%) ankles were not relocated until the final follow-up. The AOFAS scores, ankle range of motion, and radiographic outcomes showed no significant difference between the two groups at the final follow-up (p > 0.05 for each). Conclusions In majority of cases, the anteriorly translated talus in osteoarthritic ankles was restored to an anatomical position within 6 months after successful three-component total ankle arthroplasty. The clinical and radiographic outcomes in the osteoarthritic ankles with anteriorly translated talus group were comparable with those in non-translated talus group. PMID:24007555

  5. Analysis of 3-dimensional finite element after reconstruction of impaired ankle deltoid ligament

    OpenAIRE

    Ji, Yunhan; Tang, Xianzhong; Li, Yifan; Xu, Wei; Qiu, Wenjun

    2016-01-01

    We compared four repair techniques for impaired ankle ligament deltoideum, namely Wiltberger, Deland, Kitaoka and Hintermann using a 3-dimensional finite element. We built an ankle ligament deltoideum model, including six pieces of bone structures, gristles and main ligaments around the ankle. After testing the model, we built an impaired ligament deltoideum model plus four reconstruction models. Subsequently, different levels of force on ankles with different flexion were imposed and ankle b...

  6. Treatment of Isolated Ankle Osteoarthritis with Arthrodesis or the Total Ankle Replacement: A Comparison of Early Outcomes

    Science.gov (United States)

    Saltzman, Charles L.; Kadoko, Robert G.

    2010-01-01

    Background Ankle arthrodesis and replacement are two common surgical treatment options for end-stage ankle osteoarthritis. However, the relative value of these alternative procedures is not well defined. This study compared the clinical and radiographic outcomes as well as the early perioperative complications of the two procedures. Methods Between January 2, 1998 and May 31, 2002, 138 patients were treated with ankle fusion or replacements. Seventy one patients had isolated posttraumatic or primary ankle arthritis. However, patients with inflammatory arthritis, neuropathic arthritis, concomitant hind foot fusion, revision procedures and two component system ankle replacement were excluded. Among them, one group of 42 patients had a total ankle replacement (TAR), whereas the other group of 29 patients underwent ankle fusion. A complete follow-up could be performed on 89% (37/42) and 73% (23/29) of the TAR and ankle fusion group, respectively. The mean follow-up period was 4.2 years (range, 2.2 to 5.9 years). Results The outcomes of both groups were compared using a student's t-test. Only the short form heath survery mental component summary score and Ankle Osteoarthritis Scale pain scale showed significantly better outcomes in the TAR group (p < 0.05). In the radiographic evaluation, there was no significant difference in preoperative and postoperative osteoarthritis between the TAR and fusion groups. Conclusions The clinical results of TAR are similar to those of fusion at an average follow-up of 4 years. However, the arthroplasty group showed better pain relief and more postoperative complications that required surgery. PMID:20190994

  7. Shoulder instability; Schulterinstabilitaeten

    Energy Technology Data Exchange (ETDEWEB)

    Kreitner, Karl-Friedrich [Mainiz Univ. (Germany). Klinik und Poliklinik fuer Diagnostische und Interventionelle Radiologie

    2014-06-15

    In the shoulder, the advantages of range of motion are traded for the disadvantages of vulnerability to injury and the development of instability. Shoulder instability and the lesion it produces represent one of the main causes of shoulder discomfort and pain. Shoulder instability is defined as a symptomatic abnormal motion of the humeral head relative to the glenoid during active shoulder motion. Glenohumeral instabilities are classified according to their causative factors as the pathogenesis of instability plays an important role with respect to treatment options: instabilities are classified in traumatic and atraumatic instabilities as part of a multidirectional instability syndrome, and in microtraumatic instabilities. Plain radiographs ('trauma series') are performed to document shoulder dislocation and its successful reposition. Direct MR arthrography is the most important imaging modality for delineation the different injury patterns on the labral-ligamentous complex and bony structures. Monocontrast CT-arthrography with use of multidetector CT scanners may be an alternative imaging modality, however, regarding the younger patient age, MR imaging should be preferred in the diagnostic work-up of shoulder instabilities. (orig.)

  8. X-ray image characteristics and related measurements in the ankles of 118 adult patients with Kashin-Beck disease

    Institute of Scientific and Technical Information of China (English)

    Zeng Yi; Zhou Zongke; Shen Bin; Yang Jing; Kang Pengde; Zhou Xuan; Zou Ling

    2014-01-01

    Background Kashin-Beck disease (KBD) is a chronic,degenerative osteoarthropathy that causes severe skeletal deformation.Although many researchers have proven that almost all KBD patients who showed an increaseing proximo-distal gradient had radiographic abnormalities of the ankle,few detailed description of radiographic changes in the ankles of patients with KBD has been reported,especially for variable measurements of ankle changes.The purpose of this study was to demonstrate the radiographic characteristics of the ankles of adult KBD patients.Methods One hundred and eighteen adult KBD patients from september to October 2010 in Rongtang county in China were examined with lateral radiographs of the right ankle.The morphological abnormalities in the talus,calcaneus,navicular bone,distal tibia,and joint space were analyzed,and the calcaneus length,height,length-height ratio,tuber angle,front angle,plantar angle,and distal tibia anteroposterior (AP) length were measured using Riepert's method.Results Eighty-one patients (68.6%) had abnormal ankle radiographs; 72 (88.9%) patients had talus changes,69 (85.2%) patients had calcaneus changes,28 (34.6%) patients had navicular bone changes,and 48 (59.2%) patients had distal tibia changes.For 118 KBD patients,the average calcaneus length was 7.4 cm,height was 4.3 cm,and the length-height ratio was 1.7.The calcaneus tuber angle was 28.2°,front angle was 38.0° and the plantar angle was 74.2°.The distal tibia anteroposterior length was 4.05 cm.Compared with 50 normal adults (control group),significant differences were found for the calcaneus length,the calcaneus length-height ratio,and the distal tibia AP length.Conclusions Patients with KBD have characteristic abnormalities on ankle radiographs; talus depression and deformity,calcaneus shortening deformity,and distal tibia deformity with AP length widening were the most typical changes.

  9. TO COMPARE THE EFFECTIVENESS OF CRYOTHERAPY WITH EXERCISES VERSUS TAPING WITH EXERCISES IN TREATING ACUTE LATERAL ANKLE SPRAIN

    Directory of Open Access Journals (Sweden)

    Suresh

    2014-12-01

    Full Text Available BACKGROUND: Ankle sprain is a common form of sport injuries and it is a leading cause of pain and disability in common man and sportsman worldwide. Rate of this injury is 1 per 10, 000 persons in common man whereas lateral ligament injuries account for 15 to 25% of all sports injuries. Lateral ankle sprains are one of the most common injuries sustained in sports and exercise activities. It is one of the most common soft tissue injury encountered in clinical practice. Complications such as prolonged ankle pain, a high recurrence rate, and chronic laxity underline the importance of careful diagnosis and treatment of ankle sprain. Physical therapy such as cryotherapy and taping technique are frequently used and have been cited that use of cryotherapy and taping technique have shown significant improvement in relieving pain and improving functional ability. OBJECTIVES: This study is intended to find and compare the effectiveness of Cryotherapy and exercises versus taping and exercises in acute lateral ankle sprain. DESIGN: A comparative study. SETTING: Kempegowda department of Orthopaedics and Rehabilitation unit-Kempegowda institute of physiotherapy. SUBJECTS: 40 patients (20 in each group. INTERVENTION: Forty males and female patients with lateral ankle sprain belonging to an age group of 15-35 years were selected for the study who fulfilled the inclusion and exclusion criteria and were divided into two groups. Group A was treated with Cryotherapy and exercises and group B was treated with taping and exercises with a frequency of 7 sittings for one week. Treatment outcomes were assessed using VAS, ROM, and LEFS for pain and functional ability. OUTCOME MEASURES: VAS to measure pain intensity, ROM for stiffness and Lower extremity functional scale for functional ability. RESULT: In comparison with VAS, ROM and LEFS, Group B shows significant improvement of all the parameters than Group A. INTERPRETATION & CONCLUSION: Study findings concluded that

  10. Ilizarov External Fixator Versus Retrograde Intramedullary Nailing for Ankle Joint Arthrodesis in Diabetic Charcot Neuroarthropathy.

    Science.gov (United States)

    ElAlfy, Barakat; Ali, Ayman M; Fawzy, Sallam I

    Charcot neuroarthropathy of the ankle joint is a destructive process that leads to instability and significant morbidity that can end with amputation. Surgical arthrodesis in Charcot neuroarthropathy has a high failure rate. The aim of the present prospective study was to compare the outcomes of an Ilizarov external fixator and retrograde intramedullary nailing (IMN) for tibiotalar arthrodesis in Charcot neuroarthropathy. From February 2010 to October 2013, 27 patients (16 males and 11 females) with Charcot neuropathy of the ankle joint were treated in our department. Their ages ranged from 32 to 75 (average 54) years. Of the 27 patients, 14 received an Ilizarov external fixator and 13 underwent IMN. A preoperative clinical and radiologic assessment of all patients was performed. The outcomes were measured for bone union, development of complications, and clinical follow-up. The mean score of modified American Orthopaedic Foot and Ankle Society ankle hindfoot scale was 80 ± 2.7 points in the Ilizarov group and 75 ± 1.9 points in the IMN group. In the Ilizarov group, 12 of 14 patients achieved union, and in the IMN group, 10 of 13 patients achieved union. The complication rate was significantly greater in the external fixator group than in the IMN group. The complications in the Ilizarov group included nonunion in 2 patients (14%), pin tract infection in 8 (57%), pin tract loosening in 3 (21%), surgical wound infection in 3 (21%), and wound breakdown in 1 patient (7%). In the IMN group, nonunion occurred in 3 patients (23.1%), back-out of a distal locking bolt in 2 (15.4 %), and a superficial wound infection that resolved with antibiotics in 1 patient (7.7%). In conclusion, retrograde IMN and the Ilizarov external fixator both yielded better union for tibiotalar arthrodesis in Charcot neuroarthropathy. The Ilizarov external fixator resulted in a greater union rate than IMN but the complications with external fixation were significantly greater than those

  11. Anthropometric measurements of ankle mortise for evaluating mortise fracture reductions with an aim to develop contoured implants

    Directory of Open Access Journals (Sweden)

    M.S. Patil

    2012-10-01

    Full Text Available Background: Ankle injuries are unique as they are not only intra-articular of weight bearing joint, but also caused by a variety of mechanism, each resulting in different pattern with ankle fractures. The primary concern is residual instability of the joint as malalignment or residual displacement can adversely affect the biomechanical behaviour of ankle and resulting loss of function, due to non restoration of normal anatomy. Therefore essential of proper anatomical parameters for assessment of reduction and improved designs of implants used to get good results. Objectives: Measuring various radiological and Anatomical normal parameters of the ankle mortise. Material and Methods: Cadaveric 20 fibula and 27 tibia. Anteroposterior and 15○ internal rotation radiographs, of both Ankles in 20 adult individuals formed the material. Following parameters measured- a Tibiofibular clearspace b Tibiofibular overlap c Talocrural angle d Length of medial and lateral malleoli e Angles sustained on medial surface of medial malleoli and lateral surface of lateral malleoli. Results: a Tibiofibular clear space on Anteroposterior 2.4mm (±1.3mm in 15○ rotation 4.5mm (±1.2mm. b Tibiofibular overlap in Anteroposterior 11.2mm (±4.4mm in 15○ rotation 4.2mm (±1.7mm. c Talocrural angle in Anteroposterior 77.7mm (±3.2mm in 15○ rotation 79.9mm (±2.9mm. d Length of medial malleolus in Anteroposterior 15.3mm (±1.01mm in 15○ rotation 15.3mm (±0.8mm. e Length of lateral malleolus in Anteroposterior 27.35mm (±3.8mm in 15○ rotation 26.5mm (±5.1mm. Angles- Lateral bend of lateral malleolus was ranging 8○-21○ average being 16.2○. Medial bend of medial malleolus was ranging 10○-34○, average 19.5○. Conclusion: The unique measurement of angles on both surface of malleoli and other parameters definitely contribute for assessment of reduction and prognostic evaluations of ankle fracture, Designing, moulding and manufacturing of prebent plates for use

  12. Near-fatal infection following an elective ankle-fracture fixation: less risk should not mean less vigilance

    Institute of Scientific and Technical Information of China (English)

    Giada Bianchi; Dingxin Qin; Joseph A.Dearani; Qi Qian

    2011-01-01

    Surgical fixation of closed ankle fracture is traditionally viewed as having low risk for post-operative infection. Only a few cases of surgical-site confined infection have been reported. Because of the low infection risk, the necessity for perioperative prophylaxis has been questioned. We report a case of fulminant methicillin-resistant Staphylococcus aureus endocarditis occurring shortly after an elective ankle fixation surgery in an elderly woman with chronic rheumatoid arthritis. Because systemic infection was unexpected, she had been given antipyretics for postoperative fever until just before rapid clinical deterioration. A nearly fatal hematogenous infection occurred after such a procedure, indicating the necessity for being on high alert and considering the possibility of bloodstream infection.

  13. Find an Orthopaedic Foot and Ankle MD/DO

    Science.gov (United States)

    ... AAOS). Selecting a Medical Provider When selecting a medical provider to care for your feet and ankles, be sure to ask him/her about: Medical school education Accredited residency training Areas of practice ...

  14. MR imaging in sports-related glenohumeral instability

    Energy Technology Data Exchange (ETDEWEB)

    Woertler, Klaus; Waldt, Simone [Technische Universitaet Muenchen, Klinikum rechts der Isar, Department of Radiology, Munich (Germany)

    2006-12-15

    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.)

  15. Ultrasound-guided intervention in the ankle and foot

    Science.gov (United States)

    Allen, Gina M; Watura, Roland

    2016-01-01

    In this comprehensive review, we discuss the main interventions performed in the foot and ankle for Achilles tendinopathy, Morton's neuromas and Plantar fasciitis as well as techniques for intra-articular and peritendinous injections. We present the different imaging techniques and injectable agents that can be used in clinical practice, trying to help the reader decide the most appropriate way of managing the patient with a problem in the ankle and foot. PMID:26537692

  16. Multivariable dynamic ankle mechanical impedance with relaxed muscles.

    Science.gov (United States)

    Lee, Hyunglae; Krebs, Hermano Igo; Hogan, Neville

    2014-11-01

    Neurological or biomechanical disorders may distort ankle mechanical impedance and thereby impair locomotor function. This paper presents a quantitative characterization of multivariable ankle mechanical impedance of young healthy subjects when their muscles were relaxed, to serve as a baseline to compare with pathophysiological ankle properties of biomechanically and/or neurologically impaired patients. Measurements using a highly backdrivable wearable ankle robot combined with multi-input multi-output stochastic system identification methods enabled reliable characterization of ankle mechanical impedance in two degrees-of-freedom (DOFs) simultaneously, the sagittal and frontal planes. The characterization included important ankle properties unavailable from single DOF studies: coupling between DOFs and anisotropy as a function of frequency. Ankle impedance in joint coordinates showed responses largely consistent with a second-order system consisting of inertia, viscosity, and stiffness in both seated (knee flexed) and standing (knee straightened) postures. Stiffness in the sagittal plane was greater than in the frontal plane and furthermore, was greater when standing than when seated, most likely due to the stretch of bi-articular muscles (medial and lateral gastrocnemius). Very low off-diagonal partial coherences implied negligible coupling between dorsiflexion-plantarflexion and inversion-eversion. The directions of principal axes were tilted slightly counterclockwise from the original joint coordinates. The directional variation (anisotropy) of ankle impedance in the 2-D space formed by rotations in the sagittal and frontal planes exhibited a characteristic "peanut" shape, weak in inversion-eversion over a wide range of frequencies from the stiffness dominated region up to the inertia dominated region. Implications for the assessment of neurological and biomechanical impairments are discussed.

  17. Supramalleolar osteotomy for realignment of the ankle joint.

    Science.gov (United States)

    Siddiqui, Noman A; Herzenberg, John E; Lamm, Bradley M

    2012-10-01

    Ankle replacement systems have not been as reliable as hip replacements in providing long-term relief of pain, increased motion, and return to full activity. Supramalleolar Osteotomy is an extraarticular procedure that realigns the mechanical axis, thereby restoring ankle function. The literature discussing knee arthritis has shown that realignment osteotomies of the tibia improve function and prolong total knee replacement surgery. The success of the procedure is predicated on understanding the patient's clinical and radiographic presentation and proper preoperative assessment and planning.

  18. Stress Fractures of the Foot and Ankle in Athletes

    OpenAIRE

    Mayer, Stephanie W.; Joyner, Patrick W.; Almekinders, Louis C.; Parekh, Selene G.

    2014-01-01

    Context: Stress fractures of the foot and ankle are a common problem encountered by athletes of all levels and ages. These injuries can be difficult to diagnose and may be initially evaluated by all levels of medical personnel. Clinical suspicion should be raised with certain history and physical examination findings. Evidence Acquisition: Scientific and review articles were searched through PubMed (1930-2012) with search terms including stress fractures and 1 of the following: foot ankle, me...

  19. Syndesmotic Malreduction after Ankle ORIF; Is Radiography Sufficient?

    Directory of Open Access Journals (Sweden)

    Alireza Manafi Rasi

    2013-12-01

    Full Text Available Background: Ankle fractures, especially those resulting from external rotation mechanisms are associated with injury to the distal tibiofibular syndesmosis. Some authors have recommended performing CT scanning after open ankle surgery to evaluate the reduction of syndesmosis. In this current study, we aimed to investigate the sensitivity of plain radiography in diagnosing syndesmosis malreduction after open reduction and internal fixation (ORIF in patients with ankle fractures.   Methods: Thirty patients with ankle fractures participated in this prospective study. ORIFs were performed with respect to all of the technical guidelines shown in orthopedic literature for exact syndesmosis reduction, such as fibular length and proper settings. In the operating room, plain radiography was performed in anteroposterior, mortise and lateral views to assess whether syndesmosis was malreduced. If malreduction was detected, the patient was revised. As the gold standard, patients underwent postoperative bilateral CT scanning to investigate the syndesmosis reduction which was then compared to the healthy side. Finally, the sensitivity of plain radiography in the diagnosis of syndesmosis malreduction was determined by comparing this method to CT scanning. Results: In both of the methods we did not find any patient with syndesmosis malreduction. Hence, the sensitivity of plain radiography was determined 100%. Conclusion: Based on our findings, there is no need to perform CT scanning to evaluate syndesmosis reduction after ankle ORIF in patients with ankle fractures. Plain radiography is sufficient and has satisfactory sensitivity in these patients.

  20. Syndesmotic Malreduction after Ankle ORIF; Is Radiography Sufficient?

    Directory of Open Access Journals (Sweden)

    Alireza Manafi Rasi

    2013-12-01

    Full Text Available   Background: Ankle fractures, especially those resulting from external rotation mechanisms are associated with injury to the distal tibiofibular syndesmosis. Some authors have recommended performing CT scanning after open ankle surgery to evaluate the reduction of syndesmosis. In this current study, we aimed to investigate the sensitivity of plain radiography in diagnosing syndesmosis malreduction after open reduction and internal fixation (ORIF in patients with ankle fractures.   Methods: Thirty patients with ankle fractures participated in this prospective study. ORIFs were performed with respect to all of the technical guidelines shown in orthopedic literature for exact syndesmosis reduction, such as fibular length and proper settings. In the operating room, plain radiography was performed in anteroposterior, mortise and lateral views to assess whether syndesmosis was malreduced. If malreduction was detected, the patient was revised. As the gold standard, patients underwent postoperative bilateral CT scanning to investigate the syndesmosis reduction which was then compared to the healthy side. Finally, the sensitivity of plain radiography in the diagnosis of syndesmosis malreduction was determined by comparing this method to CT scanning. Results: In both of the methods we did not find any patient with syndesmosis malreduction. Hence, the sensitivity of plain radiography was determined 100%. Conclusion: Based on our findings, there is no need to perform CT scanning to evaluate syndesmosis reduction after ankle ORIF in patients with ankle fractures. Plain radiography is sufficient and has satisfactory sensitivity in these patients.

  1. Flap surgery in treatment of patients with pathology of ankle

    Directory of Open Access Journals (Sweden)

    D. I. Kutyanov

    2013-01-01

    Full Text Available Objective: to determine the capabilities and perspectives of flap surgery in treatment of patients with traumas and diseases of ankle joint region. Material and methods. The results of surgical treatment of 88 such patients. All the patients were treated in the Vreden Russian Research Institute of Traumatology and Orthopedics within the period from 2000 to 2011. All the patients had pedicled flap transfer (46 cases or free tissue transfer (45 cases. 11 patients had additional need in other open orthopedic operations of ankle joint. Besides this, scientific works dealing with the studied problem have been analyzed. Results and conclusions. It has been stated that flap surgery is predominantly used as the only and exhaustive method of treatment of such patients (87,5%. In these situations pedicled flap transfer and free tissue transfer tend to be used in comparatively equal quantities. Flap surgery is now seldom used as a component of complex surgical treatment. It is used only in some cases of bone reconstruction of distal tibia by Ilizarov bone transport, in some cases of tumors of ankle joint as well as in some cases of local infectious complications after internal fixation and total ankle arthroplasty. Patients with the pathology of this kind have a high need in free tissue transfer (from 66,7% to 83,3%. Progressing technology of total ankle arthroplasty will contribute to the frequency of use of flap surgery for patients with pathology of ankle joint.

  2. The Effects of Kinesiotape Applied to the Lateral Aspect of the Ankle: Relevance to Ankle Sprains--A Systematic Review.

    Directory of Open Access Journals (Sweden)

    Brendan Wilson

    Full Text Available To identify, evaluate and synthesise evidence on the effect of kinesiotape applied to the lateral aspect of the ankle, through a systematic review of quantitative studies.A search for quantitative studies was undertaken using key terms of "kinesiotape" and "ankle" in seven electronic databases, using the maximum date ranges. Databases included: the Cochrane Library, Cumulative Index to Nursing and Allied Health Literature, Medline, Physiotherapy Evidence Database, Scopus, SPORTDiscus and Web of Science.Database hits were evaluated against explicit inclusion criteria. From 107 database hits, 8 quantitative studies were included.Two independent reviewers appraised the methodological rigour of the studies using the McMaster Critical Review Form for Quantitative Studies. Data were extracted on participant characteristics, kinesiotape parameters, comparison interventions, outcome measures and findings.Most studies (n=7 had good to very good methodological rigour. Meta-analysis was not possible due to heterogeneity in participants, interventions and outcome measures. No adverse events were reported. Kinesiotape may produce different effects in healthy and injured ankles. In healthy ankles, kinesiotape may increase postural control, whereas in injured ankles it may improve proprioception, plantarflexor endurance and the performance of activities. These trends were identified from a small body of evidence including 276 participants.It is recommended that kinesiotape may be used in clinical practice to prevent lateral ankle injuries (through its effects on postural control and manage lateral ankle injuries due to its positive effects on proprioception, muscle endurance and activity performance. It appears that kinesiotape may not provide sufficient mechanical support to improve postural control in unstable ankles. Adverse events associated with kinseiotape are unlikely.

  3. Ankle mechanics during sidestep cutting implicates need for 2-degrees of freedom powered ankle-foot prostheses.

    Science.gov (United States)

    Ficanha, Evandro M; Rastgaar, Mohammad; Kaufman, Kenton R

    2015-01-01

    The ankle joint of currently available powered prostheses is capable of controlling one degree of freedom (DOF), focusing on improved mobility in the sagittal plane. To increase agility, the requirements of turning in prosthesis design need to be considered. Ankle kinematics and kinetics were studied during sidestep cutting and straight walking. There were no significant differences between the ankle sagittal plane mechanics when comparing sidestep cutting and straight walking; however, significant differences were observed in ankle frontal plane mechanics. During straight walking, the inversion-eversion (IE) angles were smaller than with sidestep cutting. The ankle that initiated the sidestep cutting showed progressively increasing inversion from 2 to 13 degrees while the following contralateral step showed progressively decreasing inversion from 8 to -4 degrees during normal walking speed. The changes in IE kinematics were the most significant during sidestep cutting compared with straight walking. The IE moments of the step that initiated the sidestep cutting were always in eversion, acting as a braking moment opposing the inverting motion. This suggests that an ankle-foot prosthesis with active DOFs in the sagittal and frontal planes will increase the agility of gait for patients with limb loss.

  4. Ankle mechanics during sidestep cutting implicates need for 2-degrees of freedom powered ankle-foot prostheses

    Directory of Open Access Journals (Sweden)

    Evandro M. Ficanha

    2015-04-01

    Full Text Available The ankle joint of currently available powered prostheses is capable of controlling one degree of freedom (DOF, focusing on improved mobility in the sagittal plane. To increase agility, the requirements of turning in prosthesis design need to be considered. Ankle kinematics and kinetics were studied during sidestep cutting and straight walking. There were no significant differences between the ankle sagittal plane mechanics when comparing sidestep cutting and straight walking; however, significant differences were observed in ankle frontal plane mechanics. During straight walking, the inversion-eversion (IE angles were smaller than with sidestep cutting. The ankle that initiated the sidestep cutting showed progressively increasing inversion from 2 to 13 degrees while the following contralateral step showed progressively decreasing inversion from 8 to –4 degrees during normal walking speed. The changes in IE kinematics were the most significant during sidestep cutting compared with straight walking. The IE moments of the step that initiated the sidestep cutting were always in eversion, acting as a braking moment opposing the inverting motion. This suggests that an ankle-foot prosthesis with active DOFs in the sagittal and frontal planes will increase the agility of gait for patients with limb loss.

  5. The mid-term outcome of total ankle arthroplasty and ankle fusion in rheumatoid arthritis: a systematic review

    Science.gov (United States)

    2013-01-01

    Background While arthrodesis is the standard treatment of a severely arthritic ankle joint, total ankle arthroplasty has become a popular alternative. This review provides clinical outcomes and complications of both interventions in patients with rheumatoid arthritis. Methods Studies were obtained from Pubmed, Embase and Web of Science (January 1980 – June 2011) and additional manual search. Inclusion criteria: original clinical study, > 5 rheumatoid arthritis (population), internal fixation arthrodesis or three-component mobile bearing prosthesis (intervention), ankle scoring system (outcome). The clinical outcome score, complication- and failure rates were extracted and the methodological quality of the studies was analysed. Results 17 observational studies of 868 citations were included. The effect size concerning total ankle arthroplasty ranged between 1.9 and 6.0, for arthrodesis the effect sizes were 4.0 and 4.7. Reoperation due to implant failure or reoperation due to non-union, was 11% and 12% for respectively total ankle arthroplasty and arthrodesis. The methodological quality of the studies was low (mean 6.4 out of a maximum of 14 points) and was lower for arthrodesis (mean 4.8) as compared to arthroplasty (mean 7.8) (p = 0.04). Conclusions 17 observational and no (randomized) controlled clinical trials are published on the effectiveness of arthroplasty or arthrodesis of the ankle in rheumatoid arthritis. Regardless of the methodological limitations it can be concluded that both interventions show clinical improvement and in line with current literature neither procedure is superior to the other. PMID:24161014

  6. Instability in evolutionary games.

    Directory of Open Access Journals (Sweden)

    Zimo Yang

    Full Text Available BACKGROUND: Phenomena of instability are widely observed in many dissimilar systems, with punctuated equilibrium in biological evolution and economic crises being noticeable examples. Recent studies suggested that such instabilities, quantified by the abrupt changes of the composition of individuals, could result within the framework of a collection of individuals interacting through the prisoner's dilemma and incorporating three mechanisms: (i imitation and mutation, (ii preferred selection on successful individuals, and (iii networking effects. METHODOLOGY/PRINCIPAL FINDINGS: We study the importance of each mechanism using simplified models. The models are studied numerically and analytically via rate equations and mean-field approximation. It is shown that imitation and mutation alone can lead to the instability on the number of cooperators, and preferred selection modifies the instability in an asymmetric way. The co-evolution of network topology and game dynamics is not necessary to the occurrence of instability and the network topology is found to have almost no impact on instability if new links are added in a global manner. The results are valid in both the contexts of the snowdrift game and prisoner's dilemma. CONCLUSIONS/SIGNIFICANCE: The imitation and mutation mechanism, which gives a heterogeneous rate of change in the system's composition, is the dominating reason of the instability on the number of cooperators. The effects of payoffs and network topology are relatively insignificant. Our work refines the understanding on the driving forces of system instability.

  7. Cavitation Instabilities in Inducers

    Science.gov (United States)

    2006-11-01

    gas handling turbomachines . The fluctuation of the cavity length is plotted in Fig.8 under the surge mode oscillation vi . The major differences...Cavitation Instabilities of Turbomachines .” AIAA Journal of Propulsion and Power, Vol.17, No.3, 636-643. [5] Tsujimoto, Y., (2006), “Flow Instabilities in

  8. THE EFFECT OF CRYOTHERAPY ON THREE DIMENSIONAL ANKLE KINEMATICS DURING A SIDESTEP CUTTING MANEUVER

    Directory of Open Access Journals (Sweden)

    Jean L. McCrory

    2004-06-01

    Full Text Available Although cryotherapy is commonly used in the treatment of acute and chronic athletic injuries, the deleterious effects of limb cooling, such as decreased nerve and muscle function, slowed sensation and inhibition of normal relaxes, may put an athlete at increased risk of additional injury. The purpose of this study was to determine the effects of cryotherapy on subtalar and ankle joint kinematics of healthy athletes performing a sidestep 45° cut. We hypothesized that greater joint displacements and velocities would be seen after icing. Twenty one subjects performed a 45° sidestep cut prior to and after limb cooling. Retroreflective markers were placed on the subject's shank and foot while 6 high-speed cameras were used to collect the kinematic data. In this test-retest controlled laboratory study, a repeated measures ANOVA was performed on the PRE and POST icing data for the minimum and maximum joint displacements and velocities. No statistical differences were noted between the PRE and POST icing conditions. The results indicate that a 10-minute icing treatment did not have an effect on either the movement patterns or angular velocities. Our results do not support any change in practice of icing injured ankles for ten minutes during halftime of athletic events

  9. Total ankle replacement--evolution of the technology and future applications.

    Science.gov (United States)

    Yu, John J; Sheskier, Steven

    2014-01-01

    Total ankle arthroplasty was developed to reduce pain and retain motion of the ankle joint in patients with osteoarthritis much like its total hip and knee counterparts. Orthopaedic surgeons are well equipped to evaluate and treat patients with end-stage hip or knee arthritis; however, the management of patients with ankle arthritis represents a challenge to both general orthopaedic surgeons and to the foot and ankle surgeons to whom these patients are often referred. Although techniques for both hip and knee arthroplasty have evolved to provide long-term pain relief and functional improvement, neither ankle arthrodesis nor arthroplasty has demonstrated comparably favorable outcomes in long-term follow-up studies. Early ankle arthroplasty designs with highly constrained cemented components were abandoned due to unacceptably high failure rates and complications. While arthrodesis is still considered the "gold standard" for treatment of end-stage ankle arthritis, progression of adjacent joint arthrosis and diminished gait efficiency has led to a resurgence of interest in ankle arthroplasty. Long-term outcome studies for total ankle replacement found excellent or good results in 82% of patients who received a newer generation ankle device compared with 72% if undergoing ankle fusion. Continued long-term follow-up studies are necessary, but total ankle arthroplasty has become a viable option for surgical treatment of ankle arthritis.

  10. Congenital Pseudoarthrosis of Medial Malleolus in A Young Soccer Player – Diagnosis in Clinical setting of Ankle Sprain

    Directory of Open Access Journals (Sweden)

    Giuliano Cerulli

    2014-01-01

    Full Text Available Introduction: We report a case of a young female soccer player affected by congenital medial bilateral malleolus pseudoarthrosis and os subfibulare. Congenital pseudoarthrosis is the failure of the bones to fuse prior or at birth. The etiology is still unknown, although frequency is high in subjects affected by neurofibromatosis or correlated syndromes, so it has been suggested that these congenital disorders may be the cause of congenital pseudoarthrosis. Case Report: Our patient, a 16-year-old female, high level soccer player, was referred to us following a right ankle sprain during a match. She reported no medical history of tibia-tarsus joint injuries or disease. Pain, swelling and functional impairment were noted immediately after the accident. Standard radiographs in the emergency department revealed a displaced fracture of the medial malleolus and the presence of os subfibularis. The patient was transferred to our Traumatology and Orthopaedic Department to undergo malleolus ostheosynthesis. Before surgery swelling, functional impairment and intense pain at the medial malleolus level were confirmed. However, there was no radiological opening of ankle, instability or pronation pain; furthermore the flexion-extension was preserved with slight pain. Twenty-four hours later a considerable remission of symptoms was evident with increased range of motion and reduction in the swelling and post-traumatic edema. A radiograph on the left ankle to compare with that of the right ankle was necessary to overcome the discrepancy between the radiological diagnosis and the clinical examination. The radiographic results of both medial malleoli were comparable although on the left the os subfibularis was absent. Since the diagnosis of fracture by the association between the radiographs and the symptomatology was doubtful, a bilateral CT was performed. The scan revealed a medial bilateral malleolus pseudoarthrosis and an accessory right subfibularis nucleus

  11. The Effects of Kinesiotape Applied to the Lateral Aspect of the Ankle: Relevance to Ankle Sprains – A Systematic Review

    Science.gov (United States)

    Wilson, Brendan; Bialocerkowski, Andrea

    2015-01-01

    Objective To identify, evaluate and synthesise evidence on the effect of kinesiotape applied to the lateral aspect of the ankle, through a systematic review of quantitative studies. Data Sources A search for quantitative studies was undertaken using key terms of “kinesiotape” and “ankle” in seven electronic databases, using the maximum date ranges. Databases included: the Cochrane Library, Cumulative Index to Nursing and Allied Health Literature, Medline, Physiotherapy Evidence Database, Scopus, SPORTDiscus and Web of Science. Study Selection Database hits were evaluated against explicit inclusion criteria. From 107 database hits, 8 quantitative studies were included. Data Extraction Two independent reviewers appraised the methodological rigour of the studies using the McMaster Critical Review Form for Quantitative Studies. Data were extracted on participant characteristics, kinesiotape parameters, comparison interventions, outcome measures and findings. Data Syntheses Most studies (n=7) had good to very good methodological rigour. Meta-analysis was not possible due to heterogeneity in participants, interventions and outcome measures. No adverse events were reported. Kinesiotape may produce different effects in healthy and injured ankles. In healthy ankles, kinesiotape may increase postural control, whereas in injured ankles it may improve proprioception, plantarflexor endurance and the performance of activities. These trends were identified from a small body of evidence including 276 participants. Conclusions It is recommended that kinesiotape may be used in clinical practice to prevent lateral ankle injuries (through its effects on postural control) and manage lateral ankle injuries due to its positive effects on proprioception, muscle endurance and activity performance. It appears that kinesiotape may not provide sufficient mechanical support to improve postural control in unstable ankles. Adverse events associated with kinseiotape are unlikely. PMID

  12. Nonlinear helical MHD instability

    Energy Technology Data Exchange (ETDEWEB)

    Zueva, N.M.; Solov' ev, L.S.

    1977-07-01

    An examination is made of the boundary problem on the development of MHD instability in a toroidal plasma. Two types of local helical instability are noted - Alfven and thermal, and the corresponding criteria of instability are cited. An evaluation is made of the maximum attainable kinetic energy, limited by the degree to which the law of conservation is fulfilled. An examination is made of a precise solution to a kinematic problem on the helical evolution of a cylindrical magnetic configuration at a given velocity distribution in a plasma. A numerical computation of the development of MHD instability in a plasma cylinder by a computerized solution of MHD equations is made where the process's helical symmetry is conserved. The development of instability is of a resonance nature. The instability involves the entire cross section of the plasma and leads to an inside-out reversal of the magnetic surfaces when there is a maximum unstable equilibrium configuration in the nonlinear stage. The examined instability in the tore is apparently stabilized by a magnetic hole when certain limitations are placed on the distribution of flows in the plasma. 29 references, 8 figures.

  13. FIBULAR MOTOR NERVE CONDUCTION STUDIES AND ANKLE SENSORIMOTOR CAPACITIES*

    Science.gov (United States)

    Richardson, James K.; Allet, Lara; Kim, Hogene; Ashton-Miller, James A.

    2012-01-01

    Introduction Nerve conduction studies provide information regarding the status of the peripheral nerve, but relationships with sensorimotor capacities that influence mobility have not been defined. Methods A secondary analysis was conducted of data from 41 older subjects (20 women, age 69.1 ± 8.3 years), 25 with diabetic neuropathy of varying severity, and 16 without diabetes or neuropathy. Measurements included routine fibular motor nerve conduction studies and laboratory-based determination of ankle inversion/eversion proprioceptive thresholds and ankle inversion/eversion motor function. Results Independent of age, fibular amplitude correlated robustly with ankle inversion/eversion proprioceptive thresholds (R2 = .591, p < .001), moderately with ankle inversion and eversion rates of torque generation (R2 = .216; p = .004 and R2 = .200; p = .006, respectively), and more strongly when fibular motor amplitude was normalized for body mass index (R2 = .350; p < .001 and R2 = .275; p = .001). Discussion Fibular motor amplitude was strongly associated with ankle sensorimotor capacities that influence lateral balance and recovery from perturbations during gait. The results suggest that nerve conduction study measures have potential for an expanded clinical role in evaluating mobility function in the population studied. PMID:23225524

  14. Adaptation to walking with an exoskeleton that assists ankle extension.

    Science.gov (United States)

    Galle, S; Malcolm, P; Derave, W; De Clercq, D

    2013-07-01

    The goal of this study was to investigate adaptation to walking with bilateral ankle-foot exoskeletons with kinematic control that assisted ankle extension during push-off. We hypothesized that subjects would show a neuromotor and metabolic adaptation during a 24min walking trial with a powered exoskeleton. Nine female subjects walked on a treadmill at 1.36±0.04ms(-1) during 24min with a powered exoskeleton and 4min with an unpowered exoskeleton. Subjects showed a metabolic adaptation after 18.5±5.0min, followed by an adapted period. Metabolic cost, electromyography and kinematics were compared between the unpowered condition, the beginning of the adaptation and the adapted period. In the beginning of the adaptation (4min), a reduction in metabolic cost of 9% was found compared to the unpowered condition. This reduction was accompanied by reduced muscular activity in the plantarflexor muscles, as the powered exoskeleton delivered part of the necessary ankle extension moment. During the adaptation this metabolic reduction further increased to 16%, notwithstanding a constant exoskeleton assistance. This increased reduction is the result of a neuromotor adaptation in which subjects adapt to walking with the exoskeleton, thereby reducing muscular activity in all leg muscles. Because of the fast adaptation and the significant reductions in metabolic cost we want to highlight the potential of an ankle-foot exoskeleton with kinematic control that assists ankle extension during push-off.

  15. Early Intra-Articular Complement Activation in Ankle Fractures

    Directory of Open Access Journals (Sweden)

    Hagen Schmal

    2014-01-01

    Full Text Available Cytokine regulation possibly influences long term outcome following ankle fractures, but little is known about synovial fracture biochemistry. Eight patients with an ankle dislocation fracture were included in a prospective case series and matched with patients suffering from grade 2 osteochondritis dissecans (OCD of the ankle. All fractures needed external fixation during which joint effusions were collected. Fluid analysis was done by ELISA measuring aggrecan, bFGF, IL-1β, IGF-1, and the complement components C3a, C5a, and C5b-9. The time periods between occurrence of fracture and collection of effusion were only significantly associated with synovial aggrecan and C5b-9 levels (P<0.001. Furthermore, synovial expressions of both proteins correlated with each other (P<0.001. Although IL-1β expression was relatively low, intra-articular levels correlated with C5a (P<0.01 and serological C-reactive protein concentrations 2 days after surgery (P<0.05. Joint effusions were initially dominated by neutrophils, but the portion of monocytes constantly increased reaching 50% at day 6 after fracture (P<0.02. Whereas aggrecan and IL-1β concentrations were not different in fracture and OCD patients, bFGF, IGF-1, and all complement components were significantly higher concentrated in ankle joints with fractures (P<0.01. Complement activation and inflammatory cell infiltration characterize the joint biology following acute ankle fractures.

  16. 78 FR 34708 - Proposed Information Collection (Ankle Conditions Disability Benefits Questionnaire) Activity...

    Science.gov (United States)

    2013-06-10

    ... AFFAIRS Proposed Information Collection (Ankle Conditions Disability Benefits Questionnaire) Activity... Control No. 2900--NEW (Ankle Conditions Disability Benefits Questionnaire)'' in any correspondence. During... Conditions Disability Benefits Questionnaire, VA Form 21-0960M-2. OMB Control Number: 2900--NEW...

  17. 78 FR 68908 - Agency Information Collection (Ankle Conditions Disability Benefits Questionnaire) Under OMB Review

    Science.gov (United States)

    2013-11-15

    ... AFFAIRS Agency Information Collection (Ankle Conditions Disability Benefits Questionnaire) Under OMB... Questionnaire)'' in any correspondence. FOR FURTHER INFORMATION CONTACT: Crystal Rennie, Enterprise Records... Disability Benefits Questionnaire)''. SUPPLEMENTARY INFORMATION: Title: Ankle Conditions Disability...

  18. The Effects of Anesthetic Technique on Postoperative Opioid Consumption in Ankle Fracture Surgery

    DEFF Research Database (Denmark)

    Christensen, Kristian P; Møller, Ann M; Nielsen, Jesper Kjær;

    2015-01-01

    OBJECTIVES: To investigate the impact of common anesthetic techniques on postoperative opioid consumption in ankle fracture surgery. MATERIALS AND METHODS: We performed a retrospective cohort study on 622 patients with isolated ankle fractures undergoing primary reconstructive surgery. Patients...

  19. Assessment of AK (Above Knee) Prosthesis with Different Ankle Assembly Using GRF Pattern in Stance Phase

    Science.gov (United States)

    Kim, Sung-Min; Kim, Sung-Jae; Bae, Ha-Suk

    In this study, ground reaction force (GRF), absolute symmetry index (ASI) and coefficient of variation (CV) of fixed, single-axis and multi-axis prosthetic ankle assemblies were investigated by biomechanical evaluation of above knee amputees. In the experiments, 37 normal male volunteers, two male and two female Above Knee (AK) amputees GRF data were tested with fixed, single-axis and multi-axis prosthetic ankle assembly. A gait analysis was carried out to derive the ratio of GRF to weight as the percentage of total stance phase for ten points. The results showed that fixed-axis ankle assembly was superior to other two ankle assemblies for forwarding and braking forces. Multi-axis ankle was relatively superior to other two ankle assemblies for gait balancing and movement of the mass center. Single-axis ankle was relatively superior to the other two ankle assemblies for CV and ASI of GRF.

  20. Study Casts Doubt on Need for Physical Therapy After Ankle Sprain

    Science.gov (United States)

    ... 162090.html Study Casts Doubt on Need for Physical Therapy After Ankle Sprain Rates of 'excellent recovery' similar ... a sprained ankle often involves some kind of physical therapy, but a new study questions the usefulness of ...

  1. Screening for Peripheral Artery Disease and Cardiovascular Disease Risk Assessment with Ankle Brachial Index in Adults

    Science.gov (United States)

    ... Force Recommendations Screening for Peripheral Artery Disease and Cardiovascular Disease Risk Assessment with Ankle Brachial Index in Adults ... on Screening for Peripheral Artery Disease (PAD) and Cardiovascular Disease (CVD) Risk Assessment with Ankle Brachial Index (ABI) ...

  2. Modeling and stress analyses of a normal foot-ankle and a prosthetic foot-ankle complex.

    Science.gov (United States)

    Ozen, Mustafa; Sayman, Onur; Havitcioglu, Hasan

    2013-01-01

    Total ankle replacement (TAR) is a relatively new concept and is becoming more popular for treatment of ankle arthritis and fractures. Because of the high costs and difficulties of experimental studies, the developments of TAR prostheses are progressing very slowly. For this reason, the medical imaging techniques such as CT, and MR have become more and more useful. The finite element method (FEM) is a widely used technique to estimate the mechanical behaviors of materials and structures in engineering applications. FEM has also been increasingly applied to biomechanical analyses of human bones, tissues and organs, thanks to the development of both the computing capabilities and the medical imaging techniques. 3-D finite element models of the human foot and ankle from reconstruction of MR and CT images have been investigated by some authors. In this study, data of geometries (used in modeling) of a normal and a prosthetic foot and ankle were obtained from a 3D reconstruction of CT images. The segmentation software, MIMICS was used to generate the 3D images of the bony structures, soft tissues and components of prosthesis of normal and prosthetic ankle-foot complex. Except the spaces between the adjacent surface of the phalanges fused, metatarsals, cuneiforms, cuboid, navicular, talus and calcaneus bones, soft tissues and components of prosthesis were independently developed to form foot and ankle complex. SOLIDWORKS program was used to form the boundary surfaces of all model components and then the solid models were obtained from these boundary surfaces. Finite element analyses software, ABAQUS was used to perform the numerical stress analyses of these models for balanced standing position. Plantar pressure and von Mises stress distributions of the normal and prosthetic ankles were compared with each other. There was a peak pressure increase at the 4th metatarsal, first metatarsal and talus bones and a decrease at the intermediate cuneiform and calcaneus bones, in

  3. Is End-Stage Ankle Arthrosis Best Managed with Total Ankle Replacement or Arthrodesis? A Systematic Review

    Directory of Open Access Journals (Sweden)

    Robert W. Jordan

    2014-01-01

    Full Text Available Introduction. End-stage ankle osteoarthritis is a debilitating condition. Traditionally, ankle arthrodesis (AA has been the surgical intervention of choice but the emergence of total ankle replacement (TAR has challenged this concept. This systematic review aims to address whether TAR or AA is optimal in terms of functional outcomes. Methods. We conducted a systematic review according to PRISMA checklist using the online databases Medline and EMBASE after January 1, 2005. Participants must be skeletally mature and suffering from ankle arthrosis of any cause. The intervention had to be an uncemented TAR comprising two or three modular components. The comparative group could include any type of ankle arthrodesis, either open or arthroscopic, using any implant for fixation. The study must have reported at least one functional outcome measure. Results. Of the four studies included, two reported some significant improvement in functional outcome in favour of TAR. The complication rate was higher in the TAR group. However, the quality of studies reviewed was poor and the methodological weaknesses limited any definitive conclusions being drawn. Conclusion. The available literature is insufficient to conclude which treatment is superior. Further research is indicated and should be in the form of an adequately powered randomised controlled trial.

  4. Is End-Stage Ankle Arthrosis Best Managed with Total Ankle Replacement or Arthrodesis? A Systematic Review

    Science.gov (United States)

    Jordan, Robert W.; Chahal, Gurdip S.; Chapman, Anna

    2014-01-01

    Introduction. End-stage ankle osteoarthritis is a debilitating condition. Traditionally, ankle arthrodesis (AA) has been the surgical intervention of choice but the emergence of total ankle replacement (TAR) has challenged this concept. This systematic review aims to address whether TAR or AA is optimal in terms of functional outcomes. Methods. We conducted a systematic review according to PRISMA checklist using the online databases Medline and EMBASE after January 1, 2005. Participants must be skeletally mature and suffering from ankle arthrosis of any cause. The intervention had to be an uncemented TAR comprising two or three modular components. The comparative group could include any type of ankle arthrodesis, either open or arthroscopic, using any implant for fixation. The study must have reported at least one functional outcome measure. Results. Of the four studies included, two reported some significant improvement in functional outcome in favour of TAR. The complication rate was higher in the TAR group. However, the quality of studies reviewed was poor and the methodological weaknesses limited any definitive conclusions being drawn. Conclusion. The available literature is insufficient to conclude which treatment is superior. Further research is indicated and should be in the form of an adequately powered randomised controlled trial. PMID:25215242

  5. Salto Talaris fixed-bearing total ankle replacement system.

    Science.gov (United States)

    Rush, Shannon M; Todd, Nicholas

    2013-01-01

    The Salto Talaris total ankle replacement is an anatomically designed fixed bearing prosthesis available in the United States based on the successful design of the mobile-bearing Salto prosthesis available outside the United States. The original mobile-bearing design was modified and the mobile-bearing was transferred to the precision instrumentation at the trial phase evaluation. Instrumentation and technique allow the surgeon to determine the functional joint axis before final implantation. The Salto Talaris total ankle replacement design blends minimal bone resection and optimizes surface area, cortical contact, and ultra-high molecular weight polyethylene conformity. The authors present an overview of the Salto Talaris total ankle replacement surgical technique and pearls for successful application.

  6. Spondylolisthesis and Posterior Instability

    Energy Technology Data Exchange (ETDEWEB)

    Niggemann, P.; Beyer, H.K.; Frey, H.; Grosskurth, D. (Privatpraxis fuer Upright MRT, Koeln (Germany)); Simons, P.; Kuchta, J. (Media Park Klinik, Koeln (Germany))

    2009-04-15

    We present the case of a patient with a spondylolisthesis of L5 on S1 due to spondylolysis at the level L5/S1. The vertebral slip was fixed and no anterior instability was found. Using functional magnetic resonance imaging (MRI) in an upright MRI scanner, posterior instability at the level of the spondylolytic defect of L5 was demonstrated. A structure, probably the hypertrophic ligament flava, arising from the spondylolytic defect was displaced toward the L5 nerve root, and a bilateral contact of the displaced structure with the L5 nerve root was shown in extension of the spine. To our knowledge, this is the first case described of posterior instability in patients with spondylolisthesis. The clinical implications of posterior instability are unknown; however, it is thought that this disorder is common and that it can only be diagnosed using upright MRI.

  7. Perineural fibrosis of superficial peroneal nerve complicating ankle sprain: a case report.

    Science.gov (United States)

    Acus, R W; Flanagan, J P

    1991-02-01

    The peroneal nerve is susceptible to traction injury during inversion ankle sprains. Previously, these traction lesions have been identified only at the fibular neck and popliteal fossa level. This report illustrates a previously unreported condition of perineural fibrosis of the superficial peroneal nerve at the level of the ankle following an inversion ankle sprain. Perineural fibrosis should be considered in the differential diagnosis of patients with persistent pain after ankle sprain.

  8. Acute paediatric ankle trauma: MRI versus plain radiography

    Energy Technology Data Exchange (ETDEWEB)

    Lohman, M. [Helsinki Univ. Central Hospital (Finland). Dept. of Radiology; Radiological Dept., Helsinki University Central Hospital (Finland); Kivisaari, A.; Kivisaari, L. [Helsinki Univ. Central Hospital (Finland). Dept. of Radiology; Kallio, P.; Puntila, J. [Dept. of Paediatric Surgery, Hospital for Children and Adolescents, Helsinki Univ. Central Hospital, Helsinki (Finland); Vehmas, T. [Finnish Institute of Occupational Health, Helsinki (Finland)

    2001-09-01

    Objective: To evaluate the diagnosis of acute physeal ankle fractures on plain radiographs using MRI as the gold standard. Methods: Sixty consecutive children, 29 with a clinical diagnosis of lateral ligament injury and 31 with physeal ankle fractures, were examined using both radiographs and MRI in the acute period. The imaging data were reviewed by three ''masked'' radiologists. The fracture diagnosis and Slater-Harris classification of radiographs were compared with findings on MRI. Results: Plain radiography produced five of 28 (18%) false negative and 12 of 92 (13%) false positive fracture diagnoses compared with MRI. Six of the 12 false positive fractures were due to a misclassification of lateral ligament disruption as SH1 fractures. Altogether a difference was found in 21% of cases in either the diagnosis or the classification of the fractures according to Salter- Harris. All bone bruises in the distal tibia and fibula and 64% of bone bruises in the talus were seen in association with lateral ligament injuries. Talar bone bruises in association with fractures occurred on the same side as the malleolar fracture; talar bone bruises in association with lateral ligament disruption were seen in different locations. The errors identified on radiographs by MRI did not affect the management of the injury. Conclusions: The incidence of false negative ankle fractures in plain radiographs was small and no complex ankle fractures were missed on radiographs. The total extent of complex fractures was, however, not always obvious on radiographs. In an unselected series of relatively mild ankle injuries, we were unable to show a single case where the treatment or prognosis based on plain radiography should have been significantly altered after having done a routine MRI examination. Plain radiography is still the diagnostic cornerstone of paediatric ankle injuries. (orig.)

  9. Deltoid ligament in acute ankle injury: MR imaging analysis

    Energy Technology Data Exchange (ETDEWEB)

    Jeong, Min Sun; Choi, Yun Sun; Kim, Yun Jung; Jung, Yoon Young [Eulji University, Department of Radiology, Eulji Hospital, Seoul (Korea, Republic of); Kim, Jin Su; Young, Ki Won [Eulji University, Department of Orthopedic Surgery, Eulji Hospital, Seoul (Korea, Republic of)

    2014-05-15

    To identify the pattern of deltoid ligament injury after acute ankle injury and the relationship between ankle fracture and deltoid ligament tear by magnetic resonance imaging (MRI). Thirty-six patients (32 male, and 4 female; mean age, 29.8 years) with acute deltoid ligament injury who had undergone MRI participated in this study. The deltoid ligament was classified as having 3 superficial and 2 deep components. An image analysis included the integrity and tear site of the deltoid ligament, and other associated injuries. Association between ankle fracture and deltoid ligament tear was assessed using Fisher's exact test (P < 0.05). Of the 36 patients, 21 (58.3 %) had tears in the superficial and deep deltoid ligaments, 6 (16.7 %) in the superficial ligaments only, and 4 (11.1 %) in the deep ligaments only. The most common tear site of the three components of the superficial deltoid and deep anterior tibiotalar ligaments was their proximal attachments (94 % and 91.7 % respectively), and that of the deep posterior tibiotalar ligament (pTTL) was its distal attachment (82.6 %). The common associated injuries were ankle fracture (63.9 %), syndesmosis tear (55.6 %), and lateral collateral ligament complex tear (44.4 %). All the components of the deltoid ligament were frequently torn in patients with ankle fractures (tibionavicular ligament, P = 0.009). The observed injury pattern of the deltoid ligament was complex and frequently associated with concomitant ankle pathology. The most common tear site of the superficial deltoid ligament was the medial malleolar attachment, whereas that of the deep pTTL was near its medial talar insertion. (orig.)

  10. Intraoperative Radiation Exposure During Revision Total Ankle Replacement.

    Science.gov (United States)

    Roukis, Thomas S; Iceman, Kelli; Elliott, Andrew D

    2016-01-01

    Intraoperative C-arm image intensification is required for primary total ankle replacement implantation. Significant radiation exposure has been linked to these procedures; however, the radiation exposure during revision total ankle replacement remains unknown. Therefore, we sought to evaluate the radiation exposure encountered during revision total ankle replacement. The data from 41 patients were retrospectively analyzed from a prospective database: 19 Agility(™) to Agility(™); 4 Agility(™) to Custom Agility(™); 9 Agility(™) to INBONE(®) II; 5 Agility(™) to Salto Talaris(®) XT; 2 Scandinavian Total Ankle Replacement Prosthesis to Salto Talaris(®) XT; and 2 INBONE(®) I to INBONE(®) II revision total ankle replacements were performed. Two broad categories were identified: partial revision (Agility(™) to Agility(™), Agility(™) to Custom Agility(™), INBONE(®) I to INBONE(®) II) and complete conversion (Agility(™) to INBONE(®) II, Agility(™) to Salto Talaris(®) XT, Scandinavian Total Ankle Replacement Prosthesis to Salto Talaris(®) XT). The mean radiation exposure per case was significant at 3.49 ± 2.21 mGy. Complete conversions, specifically Agility(™) to INBONE(®) II, exhibited the greatest radiation exposure and C-arm time. Revision implant selection and revision type (complete or partial) directly contributed to radiation exposure. Accordingly, revision systems requiring less radiation exposure are preferable. Surgeons should strive to minimize intraoperative complications and limit additional procedures to those necessary, because both lead to additional radiation exposure.

  11. Chronic sleep reduction, functioning at school and school achievement in preadolescents

    NARCIS (Netherlands)

    Meijer, A.M.

    2008-01-01

    This study investigates the relationship between chronic sleep reduction, functioning at school and school achievement of boys and girls. To establish individual consequences of chronic sleep reduction (tiredness, sleepiness, loss of energy and emotional instability) the Chronic Sleep Reduction Ques

  12. The effects of powered ankle-foot orthoses on joint kinematics and muscle activation during walking in individuals with incomplete spinal cord injury

    Directory of Open Access Journals (Sweden)

    Domingo Antoinette

    2006-02-01

    Full Text Available Abstract Background Powered lower limb orthoses could reduce therapist labor during gait rehabilitation after neurological injury. However, it is not clear how patients respond to powered assistance during stepping. Patients might allow the orthoses to drive the movement pattern and reduce their muscle activation. The goal of this study was to test the effects of robotic assistance in subjects with incomplete spinal cord injury using pneumatically powered ankle-foot orthoses. Methods Five individuals with chronic incomplete spinal cord injury (ASIA C-D participated in the study. Each subject was fitted with bilateral ankle-foot orthoses equipped with artificial pneumatic muscles to power ankle plantar flexion. Subjects walked on a treadmill with partial bodyweight support at four speeds (0.36, 0.54, 0.72 and 0.89 m/s under three conditions: without wearing orthoses, wearing orthoses unpowered (passively, and wearing orthoses activated under pushbutton control by a physical therapist. Subjects also attempted a fourth condition wearing orthoses activated under pushbutton control by them. We measured joint angles, electromyography, and orthoses torque assistance. Results A therapist quickly learned to activate the artificial pneumatic muscles using the pushbuttons with the appropriate amplitude and timing. The powered orthoses provided ~50% of peak ankle torque. Ankle angle at stance push-off increased when subjects walked with powered orthoses versus when they walked with passive-orthoses (ANOVA, p Two of the five subjects were able to control the orthoses themselves using the pushbuttons. The other three subjects found it too difficult to coordinate pushbutton timing. Orthoses assistance and maximum ankle angle at push-off were smaller when the subject controlled the orthoses compared to when the therapist-controlled the orthoses (p Conclusion Mechanical assistance from powered ankle-foot orthoses improved ankle push-off kinematics without

  13. Instabilities in nuclei

    CERN Document Server

    Csernai, László P; Papp, G

    1995-01-01

    The evolution of dynamical perturbations is examined in nuclear multifragmentation in the frame of Vlasov equation. Both plane wave and bubble type of perturbations are investigated in the presence of surface (Yukawa) forces. An energy condition is given for the allowed type of instabilities and the time scale of the exponential growth of the instabilities is calculated. The results are compared to the mechanical spinodal region predictions. PACS: 25.70 Mn

  14. Prediction of Algebraic Instabilities

    Science.gov (United States)

    Zaretzky, Paula; King, Kristina; Hill, Nicole; Keithley, Kimberlee; Barlow, Nathaniel; Weinstein, Steven; Cromer, Michael

    2016-11-01

    A widely unexplored type of hydrodynamic instability is examined - large-time algebraic growth. Such growth occurs on the threshold of (exponentially) neutral stability. A new methodology is provided for predicting the algebraic growth rate of an initial disturbance, when applied to the governing differential equation (or dispersion relation) describing wave propagation in dispersive media. Several types of algebraic instabilities are explored in the context of both linear and nonlinear waves.

  15. Identifying Instability Pockets

    Science.gov (United States)

    2014-12-04

    TYPE SAMS Monograph 3. DATES COVERED (From - To) FEB 2014 – DEC 2014 4. TITLE AND SUBTITLE IDENTIFYING INSTABILITY POCKETS 5a. CONTRACT...century, and if the first few years of the new century are indicative of the future, Central Asia is surely destined to be a focus of the world...reasons. First, there is a possibility of the collapse and instability of Afghanistan once all the U.S troops vacate .107 This stability will most

  16. Motion Simulation of a New Ankle Rehabilitation Device

    Directory of Open Access Journals (Sweden)

    Cristina Racu (Cazacu

    2016-06-01

    Full Text Available The ankle structure holds one of the most important role in the human biomechanics. Due to complexity of everyday activities this joint is the most prone to be injured part of the lower limb. For a complete recovery of the locomotion function, recovery exercises are mandatory. The introduction of robotic physical recovery systems represents a modern alternative to traditional recovery. Based on the 3D virtual model and a previous dimensional synthesis of a new ankle rehabilitation device, its motion simulation is presented in this paper, to prove that it may fully recover the range of motion required for this joint.

  17. Triceps surae contracture: implications for foot and ankle surgery.

    Science.gov (United States)

    Abdulmassih, Sami; Phisitkul, Phinit; Femino, John E; Amendola, Annunziato

    2013-07-01

    Restricted ankle dorsiflexion secondary to contracture of the gastrocnemius-soleus complex is frequently encountered in patients with foot and ankle pain and is well documented in the literature. During gait, decreased dorsiflexion shifts weight-bearing pressures from the heel to the forefoot, which may result in or exacerbate one of several pathologic conditions. Modest success has been achieved with nonsurgical management of triceps surae contracture, including splinting and stretching exercises. Surgical lengthening of the gastrocnemius-soleus complex at multiple levels has been described, and early clinical results have been promising. Additional research is required to further elucidate the long-term outcomes of various lengthening techniques.

  18. Functional bandage for ankle sprains. Recommendations for nursing

    Directory of Open Access Journals (Sweden)

    Mª Isabel Arcos Cirauqui

    2011-11-01

    Full Text Available Three quarters of ankle injuries are diagnosed as sprains. For the most part sprains are caused by a forced inversion movement with involvement of the lateral collateral ligament (LCL. One of the recommended guidelines is immobilization by taping. The aim of this article is to unify the recommendations for nursing, on taping in the treatment of ankle sprains. The methodology used was a literature review, analyzing the information found in books and journals in hospital libraries and nursing databases on the Internet. The main results are a set of guidelines for the most accurate and therapeutic taping.

  19. Imaging of Soft Tissue Lesions of the Foot and Ankle

    Directory of Open Access Journals (Sweden)

    Seyed Hassan Mostafavi

    2010-05-01

    Full Text Available Differential diagnosis of soft tissue lesions of the foot may be narrowed with imaging. The cystic nature of ganglia, synovial cysts, and bursitis can be confirmed with MR imaging or sonography. Location and signal characteristics of noncystic lesions may suggest Morton's neuroma, giant cell tumor of the tendon sheath and plantar fibromatosis. Synovial-based lesions of the foot and ankle can be differentiated based on presence or absence of mineralization, lesion density, signal intensity, and the enhancement pattern. Knowledge of the incidence of specific neoplasms of the foot and ankle based on patient age aids in providing a limited differential diagnosis

  20. The effect of ankle foot orthosis stiffness on the energy cost of walking: A simulation study

    NARCIS (Netherlands)

    Bregman, D.J.J.; Van der Krogt, M.M.; De Groot, V.; Harlaar, J.; Wisse, M.; Collins, S.H.

    2011-01-01

    Background In stroke and multiple sclerosis patients, gait is frequently hampered by a reduced ability to push-off with the ankle caused by weakness of the plantar-flexor muscles. To enhance ankle push-off and to decrease the high energy cost of walking, spring-like carbon-composite Ankle Foot Ortho

  1. The feasibility of total ankle prosthesis for severe arthropathy in haemophilia and prothrombin deficiency.

    NARCIS (Netherlands)

    Heide, H.J. van der; Nováková, I.R.O.; Waal Malefijt, M.C. de

    2006-01-01

    The standard treatment for end-stage arthropathy of the ankle joint in haemophilia has been fusion of the ankle joint. Total ankle replacement is used in osteoarthritis and especially in rheumatoid arthritis with good medium-term results. In this case series three patients are being described, in wh

  2. Diagnosis, treatment and prevention of ankle sprains: an evidence-based clinical guideline.

    NARCIS (Netherlands)

    Kerkhoffs, G.M.; Bekerom, M. van den; Elders, L.A.; Beek, P.A. van; Hullegie, W.A.; Bloemers, G.M.; Heus, E.M. de; Loogman, M.C.; Rosenbrand, K.C.; Kuipers, T.; Hoogstraten, J.W.; Dekker, R.; Duis, H.J. Ten; Dijk, C.N. van; Tulder, M.W. van; Wees, P.J. van der; Bie, R.A. de

    2012-01-01

    Ankle injuries are a huge medical and socioeconomic problem. Many people have a traumatic injury of the ankle, most of which are a result of sports. Total costs of treatment and work absenteeism due to ankle injuries are high. The prevention of recurrences can result in large savings on medical cost

  3. Use of an acrylic mold for mortise view improvement in ankle fractures: a feasibility study

    NARCIS (Netherlands)

    Donken, C.C.; Verhofstad, M.H.J.; Edwards, M.J.R.; Schoemaker, M.C.; Laarhoven, C.J.H.M. van

    2011-01-01

    We investigated an acrylic mold for use in obtaining ankle radiographs in 31 consecutive patients with ankle fracture. The radiologic examination consisted of routine lateral and mortise views, with the same views procured with the use of the acrylic mold to position the ankle. Radiographic evidence

  4. Diagnosis, treatment and prevention of ankle sprains : an evidence-based clinical guideline

    NARCIS (Netherlands)

    Kerkhoffs, Gino M.; van den Bekerom, Michel; Elders, Leon A. M.; van Beek, Peter A.; Hullegie, Wim A. M.; Bloemers, Guus M. F. M.; de Heus, Elly M.; Loogman, Masja C. M.; Rosenbrand, Kitty C. J. G. M.; Kuipers, Ton; Hoogstraten, J. W. A. P.; Dekker, Rienk; ten Duis, Henk-Jan; van Dijk, C. Niek; van Tulder, Maurits W.; van der Wees, Philip J.; de Bie, Rob A.

    2012-01-01

    Ankle injuries are a huge medical and socioeconomic problem. Many people have a traumatic injury of the ankle, most of which are a result of sports. Total costs of treatment and work absenteeism due to ankle injuries are high. The prevention of recurrences can result in large savings on medical cost

  5. Propagating Instabilities in Solids

    Science.gov (United States)

    Kyriakides, Stelios

    1998-03-01

    Instability is one of the factors which limit the extent to which solids can be loaded or deformed and plays a pivotal role in the design of many structures. Such instabilities often result in localized deformation which precipitates catastrophic failure. Some materials have the capacity to recover their stiffness following a certain amount of localized deformation. This local recovery in stiffness arrests further local deformation and spreading of the instability to neighboring material becomes preferred. Under displacement controlled loading the propagation of the transition fronts can be achieved in a steady-state manner at a constant stress level known as the propagation stress. The stresses in the transition fronts joining the highly deformed zone to the intact material overcome the instability nucleation stresses and, as a result, the propagation stress is usually much lower than the stress required to nucleate the instability. The classical example of this class of material instabilities is L/"uders bands which tend to affect mild steels and other metals. Recent work has demonstrated that propagating instabilities occur in several other materials. Experimental and analytical results from four examples will be used to illustrate this point: First the evolution of L=FCders bands in mild steel strips will be revisited. The second example involves the evolution of stress induced phase transformations (austenite to martensite phases and the reverse) in a shape memory alloy under displacement controlled stretching. The third example is the crushing behavior of cellular materials such as honeycombs and foams made from metals and polymers. The fourth example involves the axial broadening/propagation of kink bands in aligned fiber/matrix composites under compression. The microstructure and, as a result, the micromechanisms governing the onset, localization, local arrest and propagation of instabilities in each of the four materials are vastly different. Despite this

  6. International Foot and Ankle Biomechanics Community (i-FAB: past, present and beyond

    Directory of Open Access Journals (Sweden)

    Rosenbaum Dieter

    2009-06-01

    Full Text Available Abstract The International Foot and Ankle Biomechanics Community (i-FAB is an international collaborative activity which will have an important impact on the foot and ankle biomechanics community. It was launched on July 2nd 2007 at the foot and ankle session of the International Society of Biomechanics (ISB meeting in Taipei, Taiwan. i-FAB is driven by the desire to improve our understanding of foot and ankle biomechanics as it applies to health, disease, and the design, development and evaluation of foot and ankle surgery, and interventions such as footwear, insoles and surfaces.

  7. Analysis and simulation of fully ankle actuated planar bipedal robots

    NARCIS (Netherlands)

    Franken, Michel; Oort, van Gijs; Stramigioli, Stefano

    2008-01-01

    This paper deals with the analysis of planar bipedal robots, based on passive dynamic walkers, which are actuated only by actuation of the ankle joints. An overview of the major design characteristics of such robots and their influence on the feasibility of a stable limit cycle is presented. It is s

  8. Ankle Injuries and Disorders - Multiple Languages: MedlinePlus

    Science.gov (United States)

    ... Information Translations Spanish (español) Lesiones y enfermedades del tobillo Ukrainian (Українська) Ankle Sprain Розтягування зв'язок гомілковостопного ...

  9. An Irreducible Ankle Fracture Dislocation: The Bosworth Injury

    NARCIS (Netherlands)

    T. Schepers (Tim); T. Hagenaars (Tjebbe); D. den Hartog (Dennis)

    2012-01-01

    textabstractIrreducible fracture dislocations of the ankle are rare and represent true orthopedic emergencies. We present a case of a fracture dislocation that was irreducible owing to a fixed dislocation of the proximal fibular fragment posterior to the lateral ridge of the tibia. This particular t

  10. A controlled-release ergometer for the human ankle

    NARCIS (Netherlands)

    Hof, AL

    1997-01-01

    A hydraulic ergometer for the human foot is described that can apply ankle rotations up to 1 rad at a constant high speed of 10-20 rad/s against moments up to 200 N m. The initial acceleration is damped, so as not to exceed a preset value. With the presented set-up the series elasticity of the intac

  11. Genetic determinants of the ankle-brachial index

    DEFF Research Database (Denmark)

    Wassel, Christina L; Lamina, Claudia; Nambi, Vijay

    2012-01-01

    Candidate gene association studies for peripheral artery disease (PAD), including subclinical disease assessed with the ankle-brachial index (ABI), have been limited by the modest number of genes examined. We conducted a two stage meta-analysis of ∼50,000 SNPs across ∼2100 candidate genes to iden...... to identify genetic variants for ABI....

  12. Gait Training and Ankle Dorsiflexors in Cerebral Palsy

    Directory of Open Access Journals (Sweden)

    J Gordon Millichap

    2015-03-01

    Full Text Available Investigators at University of Copenhagen, Denmark, evaluated whether 4 weeks of 30 min daily treadmill training with an incline may facilitate corticospinal transmission and improve control of the ankle joint in 16 children, aged 5-14 years, with cerebral palsy.

  13. Long-term Results After Ankle Syndesmosis Injuries

    NARCIS (Netherlands)

    Vlijmen, N. van; Denk, K.; Kampen, A. van; Jaarsma, R.L.

    2015-01-01

    Syndesmotic disruption occurs in more than 10% of ankle fractures. Operative treatment with syndesmosis screw fixation has been successfully performed for decades and is considered the gold standard of treatment. Few studies have reported the long-term outcomes of syndesmosis injuries. This study in

  14. Reconstructive foot and ankle surgeries in diabetic patients

    Directory of Open Access Journals (Sweden)

    Ajit Kumar Varma

    2011-01-01

    Full Text Available Diabetic foot and ankle deformities are secondary to long-standing diabetes and neglected foot care. The concept of surgical correction for these deformities is quite recent. The primary objective of reconstructive foot and ankle surgery is the reduction of increased plantar pressures, reduction of pain and the restoration of function, stability and proper appearance. Foot and ankle deformities can result in significant disability, loss of life style, employment and even the loss of the lower limb. Therefore, restoration of normal, problem free foot function and activities will have a significant impact on peoples′ lives. Reconstructive surgical procedures are complex and during reconstruction, internal and external fixation devices, including pins, compression screws, staples, and wires, may be used for repair and stabilization. The surgeries performed depend on the type and severity of the condition. Surgery can involve any part of the foot and ankle, and may involve tendon, bone, joint, tissue or skin repair. Corrective surgeries can at times be performed on an outpatient basis with minimally invasive techniques. Recovery time depends on the type of condition being treated.

  15. Ultrasound Findings of the Painful Ankle and Foot

    Directory of Open Access Journals (Sweden)

    Suheil Artul

    2014-01-01

    Full Text Available Objectives: To document the prevalence and spectrum of musculoskeletal ultrasound (MSKUS findings at different parts of the foot. Materials and Methods: All MSKUS studies conducted on the foot during a 2-year period (2012-2013 at the Department of Radiology were reviewed. Demographic parameters including age, gender, and MSKUS findings were documented. Results: Three hundred and sixty-four studies had been conducted in the 2-year period. Ninety-three MSKUS evaluations were done for the ankle, 30 studies for the heel, and 241 for the rest of the foot. The most common MSKUS finding at the ankle was tenosynovitis, mostly in female patients; at the heel it was Achilles tendonitis, also mostly in female patients; and for the rest of the foot it was fluid collection and presence of foreign body, mainly in male patients. The number of different MSKUS abnormalities that were reported was 9 at the ankle, 9 at the heel, and 21 on the rest of the foot. Conclusions: MSKUS has the potential for revealing a huge spectrum of abnormalities. The most common finding was collection/hematoma and foreign bodies at the foot, tenosynovitis at the ankle, and Achilles tendinitis at the heel.

  16. New ankle actuation mechanism for a humanoid robot

    NARCIS (Netherlands)

    Oort, van Gijs; Reinink, Roelof; Stramigioli, Stefano

    2011-01-01

    In this article we discuss the design of a new ankle actuation mechanism for the humanoid robot TUlip. The new mechanism consists of two coupled series-elastic systems. We discuss the choice of actuators according to calculations for maximum achievable walking speed. Some control issues, MIMO and no

  17. Robot-Aided Neurorehabilitation: A Pediatric Robot for Ankle Rehabilitation.

    Science.gov (United States)

    Michmizos, Konstantinos P; Rossi, Stefano; Castelli, Enrico; Cappa, Paolo; Krebs, Hermano Igo

    2015-11-01

    This paper presents the pediAnklebot, an impedance-controlled low-friction, backdriveable robotic device developed at the Massachusetts Institute of Technology that trains the ankle of neurologically impaired children of ages 6-10 years old. The design attempts to overcome the known limitations of the lower extremity robotics and the unknown difficulties of what constitutes an appropriate therapeutic interaction with children. The robot's pilot clinical evaluation is on-going and it incorporates our recent findings on the ankle sensorimotor control in neurologically intact subjects, namely the speed-accuracy tradeoff, the deviation from an ideally smooth ankle trajectory, and the reaction time. We used these concepts to develop the kinematic and kinetic performance metrics that guided the ankle therapy in a similar fashion that we have done for our upper extremity devices. Here we report on the use of the device in at least nine training sessions for three neurologically impaired children. Results demonstrated a statistically significant improvement in the performance metrics assessing explicit and implicit motor learning. Based on these initial results, we are confident that the device will become an effective tool that harnesses plasticity to guide habilitation during childhood.

  18. Wear prediction on total ankle replacement effect of design parameters

    CERN Document Server

    Saad, Amir Putra Bin Md; Harun, Muhamad Noor; Kadir, Mohammed Rafiq Abdul

    2016-01-01

    This book develops and analyses computational wear simulations of the total ankle replacement for the stance phase of gait cycle. The emphasis is put on the relevant design parameters. The book presents a model consisting of three components; tibial, bearing and talar representing their physiological functions.

  19. Radiographic evaluation of foot and ankle injuries in the athlete.

    Science.gov (United States)

    Rettig, A C; Shelbourne, K D; Beltz, H F; Robertson, D W; Arfken, P

    1987-10-01

    Injuries of the ankle and foot in athletes are quite common. They range from the extremely simple sprain to the difficult stress fracture, and may result in long-term disability. In all cases, the athlete is best treated after an accurate diagnosis is achieved.

  20. Normal values of patellar and ankle tendon reflex latencies

    NARCIS (Netherlands)

    Frijns, CJM; Laman, DM; vanDuijn, MAJ; vanDuijn, H

    1997-01-01

    The clinical value of latency measurement of tendon reflexes in neurological patients has been reported by several authors. However, normal values are not readily comparable. In the present study, latencies and amplitudes of patellar (PTR) and ankle tendon reflexes (ATR) were measured at rest and af

  1. TOTAL ANKLE ARTHROPLASTY: BRAZILIAN EXPERIENCE WITH THE HINTEGRA PROSTHESIS.

    Science.gov (United States)

    Nery, Caio; Fernandes, Túlio Diniz; Réssio, Cibele; Fuchs, Mauro Luiz; Godoy Santos, Alexandre Leme de; Ortiz, Rafael Trevisan

    2010-01-01

    Ankle arthrosis is becoming more and more common. The search for solutions that preserve joint function has led to a new generation of prosthesis with three components and more degrees of freedom. This paper presents the results achieved for ten patients treated with the HINTEGRA Prosthesis (Integra, New Deal), through collaborative action between the Foot and Ankle Groups of the Orthopedics and Traumatology divisions of Escola Paulista de Medicina, Unifesp, and the School of Medicine of the University of São Paulo (USP). The ten patients (six women and four men, aged between 29 and 66 years), underwent a surgical procedure consisting of Hintermann's technique, between January and June 2005. They were evaluated at prearranged intervals, and the data were subjected to statistical analysis. The surgery led to a significant improvement in ankle mobility. Radiological evaluation showed no signs of loosening or failure in the prosthetic components in any of the patients studied. Although the complication rate in our sample was high, it was equivalent to the rates found by other authors, and directly represents the learning curve associate with this kind of procedure. Four years after the procedure, it was found that the patients pain levels had significantly decreased, and that their functional patterns had significantly improved, with AOFAS and Hintermann scores indicating results that were excellent for 20%, good for 70% and poor for 10%. Treatment of ankle arthritis by means of total arthroplasty using the HINTEGRA prosthesis was capable of providing good results over an average observation period of four years.

  2. Factors Affecting Ankle Support Device Usage in Young Basketball Players

    Directory of Open Access Journals (Sweden)

    Michael D. Cusimano

    2013-05-01

    Full Text Available This cross-sectional study explores factors affecting the decision of basketball players to wear ankle support devices (ASDs. A questionnaire regarding attitudes towards ASD usage was developed based on the Health Belief Model (HBM. The questionnaire assessed HBM perceptions (susceptibility, severity, benefits, and barriers and modifying factors (demographic, personal history of ankle injury, influence of coach to preventive action that may affect an athlete’s decision to wear ASDs. One hundred forty basketball players competing at the recreational, high school, or university levels completed the questionnaire, with the questionnaires being completed at the basketball gymnasium or at home. It was found that athletes whose coaches enforced ASD use were significantly more likely to wear them (OR: 35.71; 95% CI: 10.01, 127.36, as were athletes who perceived ankle injuries to be severe (OR: 2.77; 95% CI: 1.04, 7.37. Previous injury did not significantly increase the odds of using an ASD. The combined influence of coach enforcement and previous injury had the greatest effect on increasing ASD use. The largest barrier to ASD use was a lack of aesthetic appeal. Strategies aimed at increasing players’ willingness to wear ankle protection should be emphasized among coaches and parents as this may increase use of ASDs.

  3. Combined total ankle replacement and modified bridle tendon transfer for end-stage ankle joint arthrosis with paralytic dropfoot: report of an unusual case.

    Science.gov (United States)

    Bibbo, Christopher; Baronofsky, Hyim J; Jaffe, Leland

    2011-01-01

    In recent years, total ankle replacement has become a reasonable option for many patients with end-stage ankle arthrosis. In order to be successful, total ankle replacement requires a relatively balanced alignment of the foot in relation to the leg. Such alignment is traditionally achieved surgically by means of stabilization of the hindfoot in conjunction with relocation osteotomy of the calcaneus and/or tibia. In this report, we describe the unconventional combination of total ankle replacement in an adult patient with concomitant paralysis that was addressed by means of tendon transfer.

  4. Potential savings of a program to prevent ankle sprain recurrence: Economic evaluation of a randomized controlled trial

    NARCIS (Netherlands)

    Hupperets, M.D.W.; Verhagen, E.A.L.M.; Heymans, M.W.; Bosmans, J.E.; Tulder, M.W. van; Mechelen, W. van

    2010-01-01

    Background: The most common ankle injury is the lateral ankle sprain. Dutch annual sports-related ankle sprain costs can roughly be estimated at 187,200,000. Research has shown that proprioceptive training accounts for an approximated overall 50% reduction in ankle sprain recurrence rate. Hypothesis

  5. [Arthrodesis and endoprostheses of the ankle joint: indications, techniques and pitfalls].

    Science.gov (United States)

    Wirth, S H; Klammer, G; Espinosa, N

    2013-09-01

    If adequate conservative measures for the treatment of end-stage ankle osteoarthritis have failed, surgery may be taken into consideration. After exorbitant failure rates in the beginning of total ankle replacement, nowadays this kind of treatment has regained lot of interest and has become a viable alternative to ankle fusion. The correct indication and a precise explanation of the surgical procedure, outcomes and potential complications provide a solid base for future success.Currently, there is no doubt that total ankle replacement has become an important player in the treatment of symptomatic and debilitating end-stage ankle arthritis. With increasing number of patients who undergo total ankle replacement the experience with this kind of procedure increases too. As a consequence several surgeons have started to stretch indications favoring total ankle replacement. However, it must be mentioned here, despite progress in terms of improved anatomical and biomechanical understanding of the hindfoot and improved surgical techniques and instruments, total ankle replacement and ankle fusion remain challenging and difficult procedures. We provide a review article including an overview of the relevant techniques. This article should serve as rough guide for surgeons and help in decision-making regarding total ankle replacement and ankle fusion.

  6. Activation of brain areas following ankle dorsiflexion versus plantar flexion Functional magnetic resonance imaging verification

    Institute of Scientific and Technical Information of China (English)

    Tianyu Jiang; Weiping Wu; Xinglin Wang; Changshui Weng; Qiuhua Wang; Yanmei Guo

    2012-01-01

    Changes in activated areas of the brain during ankle active dorsiflexion and ankle active plantar flexion were observed in six healthy subjects using functional magnetic resonance imaging.Excited areas of ankle active dorsiflexion involved the bilateral primary motor area and the primary somatosensory area, as well as the bilateral supplementary sensory area, the primary visual area, the right second visual area, and the vermis of cerebellum.Excited areas of ankle active plantar flexion included the ipsilateral supplementary motor area, the limbic system, and the contralateral corpus striatum.Fine movements of the cerebral cortex control the function of the ankle dorsiflexion to a larger extent than ankle plate flexion, and the function of ankle plate flexion is more controlled by the subcortical area.

  7. Evaluation of flexibility of the ankle in elementary students with mental retardation

    Directory of Open Access Journals (Sweden)

    Stavrou V.

    2011-01-01

    Full Text Available Aim: This study aims to measure and evaluate the flexibility of the legs, namely the ankle by measuring the maximum values in flexion and extension of both legs. Method: The study included twelve students with mental retardation. Measured and recorded values of ankle-bending extent of both legs and assign the average of each test. Calculated and measurement the temperature of space and time. The measurement flexion and extension of the ankle was a plastic protractor. Results: The flexion presents decrease at the right ankle relationship with the left ankle by 1.86. The extension presents decrease at the left ankle relationship with the right ankle by 11.43. Conclusions: The results found that the normal range of motion of joints has a significant role in improving efficiency and thus on quality of life of persons with mental retardation. The flexibility is a determinant of performance and therefore should be evaluated at regular intervals.

  8. The postoperative COFAS end-stage ankle arthritis classification system: interobserver and intraobserver reliability.

    Science.gov (United States)

    Krause, Fabian G; Di Silvestro, Matthew; Penner, Murray J; Wing, Kevin J; Glazebrook, Mark A; Daniels, Timothy R; Lau, Johnny T C; Younger, Alastair S E

    2012-02-01

    End-stage ankle arthritis is operatively treated with numerous designs of total ankle replacement and different techniques for ankle fusion. For superior comparison of these procedures, outcome research requires a classification system to stratify patients appropriately. A postoperative 4-type classification system was designed by 6 fellowship-trained foot and ankle surgeons. Four surgeons reviewed blinded patient profiles and radiographs on 2 occasions to determine the interobserver and intraobserver reliability of the classification. Excellent interobserver reliability (κ = .89) and intraobserver reproducibility (κ = .87) were demonstrated for the postoperative classification system. In conclusion, the postoperative Canadian Orthopaedic Foot and Ankle Society (COFAS) end-stage ankle arthritis classification system appears to be a valid tool to evaluate the outcome of patients operated for end-stage ankle arthritis.

  9. Ankle tenosynovitis in rheumatoid arthritis: clinical and ultrasonographic evaluation

    Directory of Open Access Journals (Sweden)

    Ana Luiza Naves Pereira

    2016-11-01

    Full Text Available Objective: To investigate ankle tenosynovitis in rheumatoid arthritis patients, regarding its presence, the kind of tendon involved and the concordance between clinical and ultrasound findings. Methods: Twenty patients with rheumatoid arthritis and pain or swollen ankle joint were evaluated. Tendon involvement was evaluated with ultrasound imaging. The Health Assessment Questionnaire (HAQ was performed for disability evaluation. Age, sex, disease duration, and vocational activity levels were also obtained. The statistical analysis included Fisher’s exact test. The significance level was 0.05. Results: Tenosynovitis was found in 13 of 20 (65.0% patients in 19 joints, in which 6 were bilaterally (46.1% and unilateral in 7 (53.8%. Tibialis posterior tenosynovitis was seen in nine (45.0% patients, Achilles tenosynovitis in seven (35.0%, tibialis anterior tenosynovitis in three (15.0%, and peroneal tenosynovitis in three (15.0% patients. We found concordance between symptomatic ankle and ultrasonographic findings in 92.3% of the patients with tenosynovitis. Association between severe HAQ with tendon involvement was not found (p>0.05. Disease duration was not associated with tenosynovitis. Patients were predominantly older, female, with mean age around 50.8 years. The long disease duration of patients presented a mean of 11.4 years and, most of them, with no vocational activity (65.0%. Conclusions: The results indicate that ankle tenosynovitis is very common in rheumatoid arthritis patients, both unilateral and bilateral. Tibialis posterior was the most common tendon involvement found. Finally, we found concordance between the clinical and ultrasound findings in almost all rheumatoid arthritis patients with ankle tenosynovitis.

  10. Ankle and hip postural strategies defined by joint torques

    Science.gov (United States)

    Runge, C. F.; Shupert, C. L.; Horak, F. B.; Zajac, F. E.; Peterson, B. W. (Principal Investigator)

    1999-01-01

    Previous studies have identified two discrete strategies for the control of posture in the sagittal plane based on EMG activations, body kinematics, and ground reaction forces. The ankle strategy was characterized by body sway resembling a single-segment-inverted pendulum and was elicited on flat support surfaces. In contrast, the hip strategy was characterized by body sway resembling a double-segment inverted pendulum divided at the hip and was elicited on short or compliant support surfaces. However, biomechanical optimization models have suggested that hip strategy should be observed in response to fast translations on a flat surface also, provided the feet are constrained to remain in contact with the floor and the knee is constrained to remain straight. The purpose of this study was to examine the experimental evidence for hip strategy in postural responses to backward translations of a flat support surface and to determine whether analyses of joint torques would provide evidence for two separate postural strategies. Normal subjects standing on a flat support surface were translated backward with a range of velocities from fast (55 cm/s) to slow (5 cm/s). EMG activations and joint kinematics showed pattern changes consistent with previous experimental descriptions of mixed hip and ankle strategy with increasing platform velocity. Joint torque analyses revealed the addition of a hip flexor torque to the ankle plantarflexor torque during fast translations. This finding indicates the addition of hip strategy to ankle strategy to produce a continuum of postural responses. Hip torque without accompanying ankle torque (pure hip strategy) was not observed. Although postural control strategies have previously been defined by how the body moves, we conclude that joint torques, which indicate how body movements are produced, are useful in defining postural control strategies. These results also illustrate how the biomechanics of the body can transform discrete control

  11. Neutrino beam plasma instability

    Indian Academy of Sciences (India)

    Vishnu M Bannur

    2001-10-01

    We derive relativistic fluid set of equations for neutrinos and electrons from relativistic Vlasov equations with Fermi weak interaction force. Using these fluid equations, we obtain a dispersion relation describing neutrino beam plasma instability, which is little different from normal dispersion relation of streaming instability. It contains new, nonelectromagnetic, neutrino-plasma (or electroweak) stable and unstable modes also. The growth of the instability is weak for the highly relativistic neutrino flux, but becomes stronger for weakly relativistic neutrino flux in the case of parameters appropriate to the early universe and supernova explosions. However, this mode is dominant only for the beam velocity greater than 0.25 and in the other limit electroweak unstable mode takes over.

  12. Causes of genome instability

    DEFF Research Database (Denmark)

    Langie, Sabine A S; Koppen, Gudrun; Desaulniers, Daniel;

    2015-01-01

    chemicals present in our modern society could contribute to carcinogenesis by indirectly affecting genome stability. The selected chemicals with their mechanisms of action proposed to indirectly contribute to genome instability are: heavy metals (DNA repair, epigenetic modification, DNA damage signaling...... function, chromosome segregation, telomere length). The purpose of this review is to describe the crucial aspects of genome instability, to outline the ways in which environmental chemicals can affect this cancer hallmark and to identify candidate chemicals for further study. The overall aim is to make......Genome instability is a prerequisite for the development of cancer. It occurs when genome maintenance systems fail to safeguard the genome's integrity, whether as a consequence of inherited defects or induced via exposure to environmental agents (chemicals, biological agents and radiation). Thus...

  13. Staged bilateral ankle arthroplasty for the treatment of patient with severe defect of the talus (case report

    Directory of Open Access Journals (Sweden)

    K. S. Mikhaylov

    2013-01-01

    Full Text Available Ankle arthroplasty is known to become more successful procedure versus ankle fusion in patients with ankle osteoarthritis. This article represents a clinical case of performing three-staged bilateral ankle arthroplasty by means of HINTEGRA and Mobility implants in a patient with severe defect of the talus. The patient was followed up for 2 years for right ankle and 4 years - for left ankle. The correct treatment strategy gave the patient a new lease of life. He resumed sports activities, being pain-free in both the ankle joints.

  14. Chronic pancreatitis

    Science.gov (United States)

    Chronic pancreatitis - chronic; Pancreatitis - chronic - discharge; Pancreatic insufficiency - chronic; Acute pancreatitis - chronic ... alcohol abuse over many years. Repeated episodes of acute ... chronic pancreatitis. Genetics may be a factor in some cases. ...

  15. Comparing Arc-shaped Feet and Rigid Ankles with Flat Feet and Compliant Ankles for a Dynamic Walker

    DEFF Research Database (Denmark)

    Kuhlemann, Ilyas; Matthias Braun, Jan; Wörgötter, Florentin

    2014-01-01

    walking robot RunBot, controlled by an reflexive neural network, uses only few sensors for generating its stable gait. The results show that at feet and compliant ankles extend RunBot's parameter range especially to more leaning back postures. They also allow the robot to stably walk over obstacles...

  16. Three-dimensional computer graphics-based ankle morphometry with computerized tomography for total ankle replacement design and positioning.

    Science.gov (United States)

    Kuo, Chien-Chung; Lu, Hsuan-Lun; Leardini, Alberto; Lu, Tung-Wu; Kuo, Mei-Ying; Hsu, Horng-Chaung

    2014-05-01

    Morphometry of the bones of the ankle joint is important for the design of joint replacements and their surgical implantations. However, very little three-dimensional (3D) data are available and not a single study has addressed the Chinese population. Fifty-eight fresh frozen Chinese cadaveric ankle specimens, 26 females, and 32 males, were CT-scanned in the neutral position and their 3D computer graphics-based models were reconstructed. The 3D morphology of the distal tibia/fibula segment and the full talus was analyzed by measuring 31 parameters, defining the relevant dimensions, areas, and volumes from the models. The measurements were compared statistically between sexes and with previously reported data from Caucasian subjects. The results showed that, within a general similarity of ankle morphology between the current Chinese and previous Caucasian subjects groups, there were significant differences in 9 out of the 31 parameters analyzed. From a quantitative comparison with available prostheses designed for the Caucasian population, few of these designs have both tibial and talar components suitable in dimension for the Chinese population. The current data will be helpful for the sizing, design, and surgical positioning of ankle replacements and for surgical instruments, especially for the Chinese population.

  17. Multi-segment foot kinematics after total ankle replacement and ankle arthrodesis during relatively long-distance gait.

    Science.gov (United States)

    Rouhani, H; Favre, J; Aminian, K; Crevoisier, X

    2012-07-01

    This study aimed to investigate the influence of ankle osteoarthritis (AOA) treatments, i.e., ankle arthrodesis (AA) and total ankle replacement (TAR), on the kinematics of multi-segment foot and ankle complex during relatively long-distance gait. Forty-five subjects in four groups (AOA, AA, TAR, and control) were equipped with a wearable system consisting of inertial sensors installed on the tibia, calcaneus, and medial metatarsals. The subjects walked 50-m twice while the system measured the kinematic parameters of their multi-segment foot: the range of motion of joints between tibia, calcaneus, and medial metatarsals in three anatomical planes, and the peaks of angular velocity of these segments in the sagittal plane. These parameters were then compared among the four groups. It was observed that the range of motion and peak of angular velocities generally improved after TAR and were similar to the control subjects. However, unlike AOA and TAR, AA imposed impairments in the range of motion in the coronal plane for both the tibia-calcaneus and tibia-metatarsals joints. In general, the kinematic parameters showed significant correlation with established clinical scales (FFI and AOFAS), which shows their convergent validity. Based on the kinematic parameters of multi-segment foot during 50-m gait, this study showed significant improvements in foot mobility after TAR, but several significant impairments remained after AA.

  18. Mixing through shear instabilities

    CERN Document Server

    Brüggen, M

    2000-01-01

    In this paper we present the results of numerical simulations of the Kelvin-Helmholtz instability in a stratified shear layer. This shear instability is believed to be responsible for extra mixing in differentially rotating stellar interiors and is the prime candidate to explain the abundance anomalies observed in many rotating stars. All mixing prescriptions currently in use are based on phenomenological and heuristic estimates whose validity is often unclear. Using three-dimensional numerical simulations, we study the mixing efficiency as a function of the Richardson number and compare our results with some semi-analytical formalisms of mixing.

  19. Italian translation, cultural adaptation and validation of the "American Orthopaedic Foot and Ankle Society's (AOFAS) ankle-hindfoot scale".

    Science.gov (United States)

    Leigheb, Massimiliano; Janicka, Paulina; Andorno, Silvano; Marcuzzi, Augusto; Magnani, Corrado; Grassi, Federico

    2016-05-06

    Background and Aim of the workAnkle and hindfoot injuries are common and may lead to functional impairment, disability, exclusion from occupational and daily activities. It's necessary a standardized method for assessing treatment outcomes in people with same condition and disease.American-Orthopaedics-Foot-and-Ankle-Society's-Ankle-Hindfoot-Evaluation-Scale (AOFAS-AHES) is specific to estimate clinical problems of the ankle-hindfoot.Outcome evaluation scales should be translated and culturally adapted into the language of the investigated patient.Our purpose was to translate and culturally adapt into Italian AOFAS-AHES, and to check its reproducibility and validity.MethodsAn Italian translation of the AOFAS-scale was retranslated into English by a native English and compared to the original to define a second correct Italian-version, that was submitted to 50 randomized patients operated at their ankle or hindfoot with a minimum follow-up of 6 months for cultural adaptation, and to 10 healthcare professionals to check comprehension of the medical part.To check intra and inter-observer reproducibility each patient underwent 2 interviews by interviewer-A and 1 by B. ShortForm(SF)-36-questionnaire for quality of life and Visual-Analogue-Scale (VAS) for pain were also compared for validation. The Pearson's-Correlation-Coefficient and the Intra-Class-Correlation coefficient were calculated to check inter and intra-observer reproducibility for validation.ResultsCultural adaptation revealed to be good. We obtained a good correlation of the inter and intra-observer reproducibility. Further validation of the Italian-AOFAS-AHES was obtained comparing AOFAS results to SF-36.ConclusionsItalian translation, cultural adaptation and validation of the AOFAS-AHES has been performed successfully and could be useful to improve assistance quality in care practice.

  20. Patient-specific finite element analysis of chronic contact stress exposure after intraarticular fracture of the tibial plafond.

    Science.gov (United States)

    Li, Wendy; Anderson, Donald D; Goldsworthy, Jane K; Marsh, J Lawrence; Brown, Thomas D

    2008-08-01

    The role of altered contact mechanics in the pathogenesis of posttraumatic osteoarthritis (PTOA) following intraarticular fracture remains poorly understood. One proposed etiology is that residual incongruities lead to altered joint contact stresses that, over time, predispose to PTOA. Prevailing joint contact stresses following surgical fracture reduction were quantified in this study using patient-specific contact finite element (FE) analysis. FE models were created for 11 ankle pairs from tibial plafond fracture patients. Both (reduced) fractured ankles and their intact contralaterals were modeled. A sequence of 13 loading instances was used to simulate the stance phase of gait. Contact stresses were summed across loadings in the simulation, weighted by resident time in the gait cycle. This chronic exposure measure, a metric of degeneration propensity, was then compared between intact and fractured ankle pairs. Intact ankles had lower peak contact stress exposures that were more uniform and centrally located. The series-average peak contact stress elevation for fractured ankles was 38% (p = 0.0015; peak elevation was 82%). Fractured ankles had less area with low contact stress exposure than intact ankles and a greater area with high exposure. Chronic contact stress overexposures (stresses exceeding a damage threshold) ranged from near zero to a high of 18 times the matched intact value. The patient-specific FE models represent substantial progress toward elucidating the relationship between altered contact stresses and the outcome of patients treated for intraarticular fractures.

  1. MR arthrography of the ankle joint; MR-Arthrographie des Sprunggelenkes

    Energy Technology Data Exchange (ETDEWEB)

    Trattnig, S.; Rand, T.; Breitenseher, M.; Ba-Ssalamah, A.; Schick, S.; Imhof, H. [Universitaetsklinik fuer Radiodiagnostik, AKH-Wien (Austria)

    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.) [Deutsch] Aufgrund des ausgezeichneten Weichteilkontrastes ist die konventionelle MRT die bildgebende Methode der Wahl in der Beurteilung von Sprunggelenkserkrankungen. Die konventionelle MRT kann zuverlaessig normale und akut verletzte Ligamente darstellen. Im subakuten und chronischen Stadium der Verletzung fehlt jedoch oft die Gelenksfluessigkeit die fuer eine exakte Abgrenzung der verletzten Ligamente notwendig ist. Die MR-Arthrographie sollte in diesen Faellen durchgefuehrt werden, da die intraartikulaere KM-Applikation den Gelenksraum distendiert mit verbesserter Unterscheidbarkeit intraartikulaerer Strukturen. Diese Gelenksdistension mit der MR-Arthrographie ist auch in der Stadiumbeurteilung der Osteochondritis dissecans hilfreich, da in Faellen von instabilen Laesionen eine KM-Umspuelung des Dissekats leichter dargestellt werden kann. Schliesslich verbessert die MR-Arthrographie aufgrund des hohen Kontrastes und der Gelenksdistension auch den Nachweis von

  2. Arthrodesis with external fixation in the unstable or misaligned Charcot ankle in patients with diabetes mellitus.

    Science.gov (United States)

    Fabrin, Jesper; Larsen, Kirsten; Holstein, Per E

    2007-06-01

    The unstable or misaligned Charcot ankle with or without chronic foot ulceration is a major clinical challenge. When it cannot be accommodated with an ankle foot orthosis, surgical treatment is indicated in order to avoid leg amputation. This requires extensive soft tissue release and bony resection to realign the foot and arthrodesis with internal or external fixation. The guidance in the literature favors internal fixation. This article reports results with external fixation in 11 patients (12 feet) over a period of 12 years. External fixation was chosen as the surgical option because of the presence of foot ulcers with the attendent risk of infection. There were 7 tibio-talar and 5 tibio-calcaneal fusions. Compression was applied for 6 weeks with an external frame according to Charnley, followed by 6 weeks with total-contact cast. Weight bearing with a rigid leather brace was allowed after 12 weeks. In one case, transtibial amputation was required due to loosening of the distal pins from osteopenic disintegrating bone. In 11 cases (92%), the foot was successfully realigned and independent walking with a brace retained during the follow-up of median 48 months (10-102 months). Bony union took place in 5 out of 7 cases with tibio-talar fusion and in 1 out of 5 with tibio-calcaneal fusion. The functional result in cases with fibrous union was, however, satisfactory. Although meaningful comparisons of series are difficult to conduct and interpret from, the limb salvage rate was similar to results with internal fixation. The authors consider the results to be encouraging and to be used to develop a higher level of evidence.

  3. Shock instability in dissipative gases

    OpenAIRE

    Radulescu, Matei I.; Sirmas, Nick

    2011-01-01

    Previous experiments have revealed that shock waves in thermally relaxing gases, such as ionizing, dissociating and vibrationally excited gases, can become unstable. To date, the mechanism controlling this instability has not been resolved. Previous accounts of the D'yakov-Kontorovich instability, and Bethe-Zel'dovich-Thompson behaviour could not predict the experimentally observed instability. To address the mechanism controlling the instability, we study the propagation of shock waves in a ...

  4. Total Ankle Replacement for Treatment of End-Stage Osteoarthritis in Elderly Patients

    Directory of Open Access Journals (Sweden)

    Beat Hintermann

    2012-01-01

    Full Text Available End-stage osteoarthritis of the ankle is a disabling problem, particularly in elderly patients who experience an overall loss of mobility and functional impairment and who then need compensatory adaption. Ankle arthrodesis, which has been demonstrated to provide postoperative pain relief and hindfoot stability, leaves the patient with a stiff foot and gait changes. For elderly patient, these changes may be more critical than generally believed. Additionally, the long duration of healing and rehabilitation process needed for ankle arthrodesis may be problematic in the elderly. In contrast to ankle arthrodesis, total ankle replacement has significant advantages including a less strenuous postoperative rehabilitation and preservation of ankle motion which supports physiological gait. Recently, total ankle replacement has evolved as a safe surgical treatment in patients with end-stage ankle osteoarthritis with reliable mid- to long-term results. Total ankle replacement needs less immobilization than arthrodesis and does allow for early weight-bearing and should be considered as a treatment option of first choice in many elderly patients with end-stage osteoarthritis of the ankle, especially in elderly patients with lower expectations and physical demands.

  5. Total Ankle Replacement for Treatment of End-Stage Osteoarthritis in Elderly Patients

    Science.gov (United States)

    Hintermann, Beat; Knupp, Markus; Zwicky, Lukas; Barg, Alexej

    2012-01-01

    End-stage osteoarthritis of the ankle is a disabling problem, particularly in elderly patients who experience an overall loss of mobility and functional impairment and who then need compensatory adaption. Ankle arthrodesis, which has been demonstrated to provide postoperative pain relief and hindfoot stability, leaves the patient with a stiff foot and gait changes. For elderly patient, these changes may be more critical than generally believed. Additionally, the long duration of healing and rehabilitation process needed for ankle arthrodesis may be problematic in the elderly. In contrast to ankle arthrodesis, total ankle replacement has significant advantages including a less strenuous postoperative rehabilitation and preservation of ankle motion which supports physiological gait. Recently, total ankle replacement has evolved as a safe surgical treatment in patients with end-stage ankle osteoarthritis with reliable mid- to long-term results. Total ankle replacement needs less immobilization than arthrodesis and does allow for early weight-bearing and should be considered as a treatment option of first choice in many elderly patients with end-stage osteoarthritis of the ankle, especially in elderly patients with lower expectations and physical demands. PMID:22720158

  6. A one year prospective study on ankle stability and landing technique : The occurrence of ankle and knee injuries in elite ball team athletes

    NARCIS (Netherlands)

    Does, Henrike van der; Brink, M.S.; Lemmink, K.A.P.M.

    2014-01-01

    Background: In team sports lower extremity injuries account for more than 50% of all injuries, indicating the importance of early detection of athletes at risk. Objective: To investigate the predictive value of ankle stability and landing technique at baseline for ankle and knee injury occurrence du

  7. Running with a powered knee and ankle prosthesis.

    Science.gov (United States)

    Shultz, Amanda H; Lawson, Brian E; Goldfarb, Michael

    2015-05-01

    This paper presents a running control architecture for a powered knee and ankle prosthesis that enables a transfemoral amputee to run with a biomechanically appropriate running gait and to intentionally transition between a walking and running gait. The control architecture consists firstly of a coordination level controller, which provides gait biomechanics representative of healthy running, and secondly of a gait selection controller that enables the user to intentionally transition between a running and walking gait. The running control architecture was implemented on a transfemoral prosthesis with powered knee and ankle joints, and the efficacy of the controller was assessed in a series of running trials with a transfemoral amputee subject. Specifically, treadmill trials were conducted to assess the extent to which the coordination controller provided a biomechanically appropriate running gait. Separate trials were conducted to assess the ability of the user to consistently and reliably transition between walking and running gaits.

  8. Foot and Ankle Deformity in Young Acrobatic and Artistic Gymnasts

    Directory of Open Access Journals (Sweden)

    Sobera Anna

    2015-09-01

    Full Text Available Purpose. The aim of the paper was to determine the occurrence of feet and ankle deformities in trampoline and artistic gymnasts. Methods. Ten acrobatic gymnasts (trampolinists and 10 artistic gymnasts aged 6-14 years were recruited. The calcaneal-tibial (rearfoot angle was determined as the angle of the upper calcaneal tendon and the longitudinal heel axis while Clarke angles were determined by podoscopy. Results. The trampolinists showed significantly greater medial angulation (calcaneal valgus than the group of gymnasts. Right and left foot Clark’s angles in both the trampoline and artistic gymnasts were above 55°. Conclusions. Trampolinists exhibit significantly more pronounced calcaneal valgus than artistic gymnasts. The prevalence of foot and ankle deformities in both populations should be addressed by coaches in the gymnastics training of young children.

  9. Journal of Foot and Ankle Research, one year on

    Directory of Open Access Journals (Sweden)

    Borthwick Alan M

    2009-11-01

    Full Text Available Abstract Journal of Foot and Ankle Research was launched one year ago, and a number of its key achievements are highlighted in this editorial. Although the journal is underpinned by professional bodies associated with the podiatry professions in the UK and Australasia, its content is aimed at the wider foot and ankle research community. Nevertheless, the journal's achievements over the past year reflect the development of research in the profession of podiatry. From this perspective, the journal may be viewed as contributing to the overall attainment of some of the profession's key goals and strategic aims over the last decade, across the UK and Australasia. The journal has also witnessed policy changes in the last year, and these are discussed - notably, the decision not to accept case reports for publication. We also report on a few of the key metrics, providing readers with a summary of the journal's performance over the last year.

  10. SIRT2 regulates nuclear envelope reassembly through ANKLE2 deacetylation

    Science.gov (United States)

    Kaufmann, Tanja; Kukolj, Eva; Brachner, Andreas; Beltzung, Etienne; Bruno, Melania; Kostrhon, Sebastian; Opravil, Susanne; Hudecz, Otto; Mechtler, Karl; Warren, Graham

    2016-01-01

    ABSTRACT Sirtuin 2 (SIRT2) is an NAD-dependent deacetylase known to regulate microtubule dynamics and cell cycle progression. SIRT2 has also been implicated in the pathology of cancer, neurodegenerative diseases and progeria. Here, we show that SIRT2 depletion or overexpression causes nuclear envelope reassembly defects. We link this phenotype to the recently identified regulator of nuclear envelope reassembly ANKLE2. ANKLE2 acetylation at K302 and phosphorylation at S662 are dynamically regulated throughout the cell cycle by SIRT2 and are essential for normal nuclear envelope reassembly. The function of SIRT2 therefore extends beyond the regulation of microtubules to include the regulation of nuclear envelope dynamics. PMID:27875273

  11. Ankle Arthritis: You Can't Always Replace It.

    Science.gov (United States)

    Hayes, Brandon J; Gonzalez, Tyler; Smith, Jeremy T; Chiodo, Christopher P; Bluman, Eric M

    2016-02-01

    End-stage arthritis of the tibiotalar joint is disabling and causes substantial functional impairment. Most often it is the residual effect of a previous traumatic injury. Nonsurgical treatment of end-stage arthritis of the ankle includes bracing, shoe-wear modifications, and selective joint injections. For patients who fail to respond to nonsurgical modalities, the two primary treatment options are arthroplasty and arthrodesis. Each has its proponents. Although no ideal treatment of ankle arthritis exists, high-quality studies can help guide treatment in patients of varying demographics. Inherent risks are linked with each treatment option, but those of greatest concern are early implant loosening that requires revision following arthroplasty and the acceleration of adjacent joint degeneration associated with arthrodesis.

  12. Can an Ankle-Foot Orthosis Change Hearts and Minds?

    Science.gov (United States)

    2011-01-01

    ities. The most common fracture of the lower extremity is to the tibia and fibula . As opposed to prior military From 1Orthopaedic Surgery Service...patients, demonstrates that 26% of patients with extremity wounds have fractures , 82% of which are open, divided evenly between the upper and lower extrem...sustained a severe open ankle fracture and underwent irrigation and debridement with splint immobilization in theater on the day of injury. Thereafter he

  13. THE FEATURES OF TIBIOFIBULAR INJURY IN PATENTS WITH ANKLE FRACTURES

    Directory of Open Access Journals (Sweden)

    N. F. Fomin

    2010-01-01

    Full Text Available The role of interposition of soft tissues into tibiofibular syndesmosis is analyzed as a cause of unsatisfactory outcomes in the ankle joint pronation fracture treatment. The study is based on clinical (452 patients and experimental material (36 experiments including unfixed anatomic objects. The elevator for minimal invasive operative elimination of interposition of stumps of distal tibiofibular syndesmosis anterior and posterior ligaments is developed and tested.

  14. Surgical efficacy of the ankle tourniquet for forefoot surgery.

    Science.gov (United States)

    Roberts, Rachel K; Cleave, Elizabeth S; Rambani, Rohit

    2014-12-01

    For precise, safe and proficient procedures haemostasis is critical. For forefoot surgery, the customary thigh tourniquet is commonly accepted for this role as the additional muscle mass and minimal bony prominences in the thigh avert neuromuscular and skin injury. However, for patients with pathophysiological issues that may be exacerbated by a thigh tourniquet, application of an ankle tourniquet may decrease the risks and increase cuff tolerance as the volume of ischaemic tissue is reduced.

  15. Immediate Weight-Bearing after Ankle Fracture Fixation

    Directory of Open Access Journals (Sweden)

    Reza Firoozabadi

    2015-01-01

    Full Text Available We believe that a certain subset of surgical ankle fracture patients can be made weight-bearing as tolerated immediately following surgery. Immediate weight-bearing as tolerated (IWBAT allows patients to return to ambulation and activities of daily living faster and may facilitate rehabilitation. A prospectively gathered orthopaedic trauma database at a Level 1 trauma center was reviewed retrospectively to identify patients who had ORIF after unstable ankle injuries treated by the senior author. Patients were excluded if they were not IWBAT based on specific criteria or if they did meet followup requirement. Only 1/26 patients was noted to have loss of fixation. This was found at the 6-week followup and was attributed to a missed syndesmotic injury. At 2-week followup, 2 patients had peri-incisional erythema that resolved with a short course of oral antibiotics. At 6-week followup, 20 patients were wearing normal shoes and 6 patients continued to wear the CAM Boot for comfort. To conclude, IWBAT in a certain subset of patients with stable osteosynthesis following an ankle fracture could potentially be a safe alternative to a period of protected weight-bearing.

  16. Experimental and computational analysis of composite ankle-foot orthosis.

    Science.gov (United States)

    Zou, Dequan; He, Tao; Dailey, Michael; Smith, Kirk E; Silva, Matthew J; Sinacore, David R; Mueller, Michael J; Hastings, Mary K

    2014-01-01

    Carbon fiber (CF) ankle-foot orthoses (AFOs) can improve gait by increasing ankle plantar-flexor power and improving plantar-flexor ankle joint moment and energy efficiency compared with posterior leaf spring AFOs made of thermoplastic. However, fabricating a CF AFO to optimize the performance of the individual user may require multiple AFOs and expensive fabrication costs. Finite element analysis (FEA) models were developed to predict the mechanical behavior of AFOs in this study. Three AFOs, two made of CF composite material and one made of thermoplastic material, were fabricated and then mechanically tested to produce force-displacement data. The FEA models were validated by comparing model predictions with mechanical testing data performed under the same loading and boundary conditions. The actual mechanical testing demonstrated that CF performs better than thermoplastic. The simulation results showed that FEA models produced accurate predictions for both types of orthoses. The relative error of the energy return ratio predicted by the CF AFO FEA model developed in this study is less than 3%. We conclude that highly accurate FEA models will allow orthotists to improve CF AFO fabrication without wasting resources (time and money) on trial and error fabrications that are expensive and do not consistently improve AFO and user performance.

  17. Celiac disease manifested by polyneuropathy and swollen ankles

    Institute of Scientific and Technical Information of China (English)

    Zlatko Djuric; Borislav Kamenov; Vuka Katic

    2007-01-01

    A 27-year-old male started to have his ankles swollen during his military service. He was examined at a military hospital where electromyoneurography showed the signs of distal sensory-motor polyneuropathy with axon demyelinization and weak myopathic changes,whereas histopathological examination of gastrocnemius muscle biopsy revealed some mild and nonspecific myopathy. Besides, he was found to have subcutaneous ankle tissue edemas and hypertransaminasemia. Due to these reasons, he was dismissed from the military service and examined at another hospital where bone osteodensitometry revealed low bone mineral density of the spine. However, his medical problems were not resolved and after the second discharge from hospital he was desperately seeing doctors from time to time. Finally, at our institution he was shown to have celiac disease (CD) by positive serology (antitissue transglutaminase and antiendomysial antibodies) and small bowel mucosal histopathological examination,which showed total small bowel villous atrophy. Three months after the initiation of gluten-free diet, his ankle edema disappeared, electromyoneurographic signs of polyneuropathy improved and liver aminotransferases normalized. Good knowledge of CD extraintestinal signs and serologic screening are essential for early CD recognition and therapy.

  18. SHADE: A Shape-Memory-Activated Device Promoting Ankle Dorsiflexion

    Science.gov (United States)

    Pittaccio, S.; Viscuso, S.; Rossini, M.; Magoni, L.; Pirovano, S.; Villa, E.; Besseghini, S.; Molteni, F.

    2009-08-01

    Acute post-stroke rehabilitation protocols include passive mobilization as a means to prevent contractures. A device (SHADE) that provides repetitive passive motion to a flaccid ankle by using shape memory alloy actuators could be of great help in providing this treatment. A suitable actuator was designed as a cartridge of approximately 150 × 20 × 15 mm, containing 2.5 m of 0.25 mm diameter NiTi wire. This actuator was activated by Joule’s effect employing a 7 s current input at 0.7 A, which provided 10 N through 76 mm displacement. Cooling and reset by natural convection took 30 s. A prototype of SHADE was assembled with two thermoplastic shells hinged together at the ankle and strapped on the shin and foot. Two actuators were fixed on the upper shell while an inextensible thread connected each NiTi wire to the foot shell. The passive ankle motion (passive range of motion, PROM) generated by SHADE was evaluated optoelectronically on three flaccid patients (58 ± 5 years old); acceptability was assessed by a questionnaire presented to further three flaccid patients (44 ± 11.5 years old) who used SHADE for 5 days, 30 min a day. SHADE was well accepted by all patients, produced good PROM, and caused no pain. The results prove that suitable limb mobilization can be produced by SMA actuators.

  19. Experimental and computational analysis of composite ankle-foot orthosis

    Directory of Open Access Journals (Sweden)

    Dequan Zou, DSc

    2015-03-01

    Full Text Available Carbon fiber (CF ankle-foot orthoses (AFOs can improve gait by increasing ankle plantar-flexor power and improving plantar-flexor ankle joint moment and energy efficiency compared with posterior leaf spring AFOs made of thermoplastic. However, fabricating a CF AFO to optimize the performance of the individual user may require multiple AFOs and expensive fabrication costs. Finite element analysis (FEA models were developed to predict the mechanical behavior of AFOs in this study. Three AFOs, two made of CF composite material and one made of thermoplastic material, were fabricated and then mechanically tested to produce force-displacement data. The FEA models were validated by comparing model predictions with mechanical testing data performed under the same loading and boundary conditions. The actual mechanical testing demonstrated that CF performs better than thermoplastic. The simulation results showed that FEA models produced accurate predictions for both types of orthoses. The relative error of the energy return ratio predicted by the CF AFO FEA model developed in this study is less than 3%. We conclude that highly accurate FEA models will allow orthotists to improve CF AFO fabrication without wasting resources (time and money on trial and error fabrications that are expensive and do not consistently improve AFO and user performance.

  20. Ultrasound of the ankle and foot in rheumatology.

    Science.gov (United States)

    Micu, Mihaela C; Nestorova, Rodina; Petranova, Tzvetanka; Porta, Francesco; Radunovic, Goran; Vlad, Violeta; Iagnocco, Annamaria

    2012-03-01

    In the last years musculoskeletal ultrasound (US) has become a very useful imaging tool for the evaluation of rheumatic patients and a natural extension of the clinical examination of the ankle and foot. Musculoskeletal US allows the evaluation of the symptomatic and asymptomatic ankle and foot with a detailed analysis of a wide range of elementary lesions at the level of different anatomical structures and their distribution in early or long standing disease. In inflammatory pathology, it helps in the assessment of the disease activity and severity at the joint, tendon or entheseal level and in the detection of subclinical pathological features in early disease or residual activity after therapy. Moreover, US guided procedures allow accurate diagnostic and therapeutic interventions. It is a valuable imaging method that can be also used in the follow up of the treated patients (systemic and/ or local therapies or surgical procedures), being a patient friendly, non-invasive, and quick to perform method. The aim of this paper is to review the US technique of scanning and the indications of US in the analysis of the ankle and foot in rheumatic diseases.

  1. Effect of ankle proprioceptive training on static body balance.

    Science.gov (United States)

    Karakaya, Mehmet Gürhan; Rutbİl, Hilal; Akpinar, Ercan; Yildirim, Alİ; Karakaya, İlkİm Çitak

    2015-10-01

    [Purpose] This study aimed to investigate the effect of ankle proprioceptive training on static body balance. [Subjects and Methods] In this randomized-controlled, single-blind study, 59 university students (35 females, 24 males) were randomized into study (n=29) and control (n=30) groups. The study group received a foot and ankle proprioceptive exercise program including stretching, strengthening (plantar and dorsi-flexors, invertor and evertor muscles), and balance board exercises, each with 10 repetitions per session, 5 days a week, for a total of 10 sessions. The control group did not receive any intervention. Static body balance was evaluated by a kinesthetic ability trainer, which showed the balance index scores under both single foot and both feet conditions. This evaluation was repeated at the end of two weeks for both groups. [Results] Outcome measures of the groups were similar at the baseline. Balance index scores of both groups improved at the end of two weeks, and the study group had significantly lower index scores than those of the control group, indicating better balance. [Conclusion] Ankle proprioceptive training had positive effects on static body balance parameters in healthy individuals, and it is worth investigating the effects of this type of training in patients with balance disorders.

  2. Genetic instability in Gynecological Cancer

    Institute of Scientific and Technical Information of China (English)

    ZHAO Qing-hua; ZHOU Hong-lin

    2003-01-01

    Defects of mismatch repair (MMR) genes also have beenidentified in many kinds of tumors. Loss of MMR functionhas been linked to genetic instability especially microsatelliteinstability that results in high mutation rate. In this review, wediscussed the microsatellite instability observed in thegynecological tumors. We also discussed defects in the DNAmismatch repair in these tumors and their correlation to themicrosatellite instability, as well as the gene mutations due tothe microsatellite instability in these tumors. From thesediscussion, we tried to understand the mechanism ofcarcinogenesis in gynecological tumors from the aspect ofgenetic instability due to mismatch repair defects.

  3. Modulation instability: The beginning

    Science.gov (United States)

    Noskov, Roman; Belov, Pavel; Kivshar, Yuri

    2012-11-01

    The study of metal nanoparticles plays a central role in the emerging novel technologies employing optics beyond the diffraction limit. Combining strong surface plasmon resonances, high intrinsic nonlinearities and deeply subwavelength scales, arrays of metal nanoparticles offer a unique playground to develop novel concepts for light manipulation at the nanoscale. Here we suggest a novel principle to control localized optical energy in chains of nonlinear subwavelength metal nanoparticles based on the fundamental nonlinear phenomenon of modulation instability. In particular, we demonstrate that modulation instability can lead to the formation of long-lived standing and moving nonlinear localized modes of several distinct types such as bright and dark solitons, oscillons, and domain walls. We analyze the properties of these nonlinear localized modes and reveal different scenarios of their dynamics including transformation of one type of mode to another. We believe this work paves a way towards the development of nonlinear nanophotonics circuitry.

  4. Instabilities in sensory processes

    Science.gov (United States)

    Balakrishnan, J.

    2014-07-01

    In any organism there are different kinds of sensory receptors for detecting the various, distinct stimuli through which its external environment may impinge upon it. These receptors convey these stimuli in different ways to an organism's information processing region enabling it to distinctly perceive the varied sensations and to respond to them. The behavior of cells and their response to stimuli may be captured through simple mathematical models employing regulatory feedback mechanisms. We argue that the sensory processes such as olfaction function optimally by operating in the close proximity of dynamical instabilities. In the case of coupled neurons, we point out that random disturbances and fluctuations can move their operating point close to certain dynamical instabilities triggering synchronous activity.

  5. Instability and internet design

    Directory of Open Access Journals (Sweden)

    Sandra Braman

    2016-09-01

    Full Text Available Instability - unpredictable but constant change in one’s environment and the means with which one deals with it - has replaced convergence as the focal problem for telecommunications policy in general and internet policy in particular. Those who designed what we now call the internet during the first decade of the effort (1969-1979, who in essence served simultaneously as its policy-makers, developed techniques for coping with instability of value for network designers today and for those involved with any kind of large-scale sociotechnical infrastructure. Analysis of the technical document series that was medium for and record of that design process reveals coping techniques that began with defining the problem and went on to include conceptual labour, social practices, and technical approaches.

  6. Semi-rigid brace and taping decrease variability of the ankle joint position sense

    Directory of Open Access Journals (Sweden)

    Márcia Barbanera

    2014-12-01

    Full Text Available The present study investigated the effect of taping and the semi-rigid ankle brace on ankle joint position sense. Sixteen healthy women (20.8 ± 2.3 years old actively placed the ankle in a target position. The experimental conditions were: 1 wearing no orthosis device, 2 using semi-rigid brace, and 3 wearing ankle taping. Absolute error (AE and variable error (VE were calculated to obtain the joint position sense. We found an interaction effect between condition and target angle at 15o of plantar flexion for the variable VE, which showed smaller errors during the use of taping and semi-rigid brace. In conclusion, the use of ankle joint orthoses, whether taping or semi-rigid brace, decrease the variability of the position sense at 15o of plantar flexion, potentially decreasing ankle sprains occurrence.

  7. Three-dimensional Motion Analysis of the Ankle during Backward Walking.

    Science.gov (United States)

    Soda, Naoki; Ueki, Tsutomu; Aoki, Takaaki

    2013-06-01

    [Purpose] The purpose of this study was to perform kinematic and kinetic analyses of the ankle during both forward and backward walking using three-dimensional motion analysis. [Subjects] The subjects were 11 healthy adults. [Methods] Measurements of forward and backward walking motions were taken using a three-dimensional motion analysis device and 3 ground reaction force plates. The analysis segment was the standing phase and the items analyzed were walking time, maximum dorsal flexion of the ankle, maximum angle of plantar flexion, peak ankle power in the sagittal plane, workload of the ankle, and work rate. Statistical analysis consisted of comparisons using the t-test for each of the items measured during both forward and backward walking. [Results] The backward walking group had significantly lower ankle power, workload, and work rate. [Conclusion] The propulsive force in backward walking must come from some factor other than the ankle. The analysis of joint power is an important index for understanding the motion.

  8. Modulation instability: The beginning

    Science.gov (United States)

    Zakharov, V. E.; Ostrovsky, L. A.

    2009-03-01

    We discuss the early history of an important field of “sturm and drang” in modern theory of nonlinear waves. It is demonstrated how scientific demand resulted in independent and almost simultaneous publications by many different authors on modulation instability, a phenomenon resulting in a variety of nonlinear processes such as envelope solitons, envelope shocks, freak waves, etc. Examples from water wave hydrodynamics, electrodynamics, nonlinear optics, and convection theory are given.

  9. The instability of markets

    CERN Document Server

    Huberman, B A; Huberman, Bernardo A; Youssefmir, Michael

    1995-01-01

    Recent developments in the global liberalization of equity and currency markets, coupled to advances in trading technologies, are making markets increasingly interdependent. This increased fluidity raises questions about the stability of the international financial system. In this paper, we show that as couplings between stable markets grow, the likelihood of instabilities is increased, leading to a loss of general equilibrium as the system becomes increasingly large and diverse.

  10. Carpal instability nondissociative.

    Science.gov (United States)

    Wolfe, Scott W; Garcia-Elias, Marc; Kitay, Alison

    2012-09-01

    Carpal instability nondissociative (CIND) represents a spectrum of conditions characterized by kinematic dysfunction of the proximal carpal row, often associated with a clinical "clunk." CIND is manifested at the midcarpal and/or radiocarpal joints, and it is distinguished from carpal instability dissociative (CID) by the lack of disruption between bones within the same carpal row. There are four major subcategories of CIND: palmar, dorsal, combined, and adaptive. In palmar CIND, instability occurs across the entire proximal carpal row. When nonsurgical management fails, surgical options include arthroscopic thermal capsulorrhaphy, soft-tissue reconstruction, or limited radiocarpal or intercarpal fusions. In dorsal CIND, the capitate subluxates dorsally from its reduced resting position. Dorsal CIND usually responds to nonsurgical management; refractory cases respond to palmar ligament reefing and/or dorsal intercarpal capsulodesis. Combined CIND demonstrates signs of both palmar and dorsal CIND and can be treated with soft-tissue or bony procedures. In adaptive CIND, the volar carpal ligaments are slackened and are less capable of inducing the physiologic shift of the proximal carpal row from flexion into extension as the wrist ulnarly deviates. Treatment of choice is a corrective osteotomy to restore the normal volar tilt of the distal radius.

  11. Chromosomal instability in meningiomas.

    Science.gov (United States)

    van Tilborg, Angela A G; Al Allak, Bushra; Velthuizen, Sandra C J M; de Vries, Annie; Kros, Johan M; Avezaat, Cees J J; de Klein, Annelies; Beverloo, H Berna; Zwarthoff, Ellen C

    2005-04-01

    Approximately 60% of sporadic meningiomas are caused by inactivation of the NF2 tumor suppressor gene on chromosome 22. No causative gene is known for the remaining 40%. Cytogenetic analysis shows that meningiomas caused by inactivation of the NF2 gene can be divided into tumors that show monosomy 22 as the sole abnormality and tumors with a more complex karyotype. Meningiomas not caused by the NF2 gene usually have a diploid karyotype. Here we report that, besides the clonal chromosomal aberrations, the chromosome numbers in many meningiomas varied from one metaphase spread to the other, a feature that is indicative of chromosomal instability. Unexpectedly and regardless of genotype, a subgroup of tumors was observed with an average number of 44.9 chromosomes and little variation in the number of chromosomes per metaphase spread. In addition, a second subgroup was recognized with a hyperdiploid number of chromosomes (average 48.5) and considerable variation in numbers per metaphase. However, this numerical instability resulted in a clonal karyotype with chromosomal gains and losses in addition to loss of chromosome 22 only in meningiomas caused by inactivation of the NF2 gene. In cultured cells of all tumor groups, bi- and multinucleated cells were seen, as well as anaphase bridges, residual chromatid strings, multiple spindle poles, and unseparated chromatids, suggesting defects in the mitotic apparatus or kinetochore. Thus, we conclude that even a benign and slow-growing tumor like a meningioma displays chromosomal instability.

  12. The Effects of Kinesiotape Applied to the Lateral Aspect of the Ankle: Relevance to Ankle Sprains – A Systematic Review

    OpenAIRE

    Brendan Wilson; Andrea Bialocerkowski

    2015-01-01

    Objective To identify, evaluate and synthesise evidence on the effect of kinesiotape applied to the lateral aspect of the ankle, through a systematic review of quantitative studies. Data Sources A search for quantitative studies was undertaken using key terms of “kinesiotape” and “ankle” in seven electronic databases, using the maximum date ranges. Databases included: the Cochrane Library, Cumulative Index to Nursing and Allied Health Literature, Medline, Physiotherapy Evidence Database, Scop...

  13. Effects of ankle joint cooling on peroneal short latency response.

    Science.gov (United States)

    Hopkins, J Ty; Hunter, Iain; McLoda, Todd

    2006-01-01

    While cryotherapy has direct physiological effects on contractile tissues, the extent to which joint cooling affects the neuromuscular system is not well understood. The purpose of the study was to detect changes in ankle dynamic restraint (peroneal short latency response and muscle activity amplitude) during inversion perturbation following ankle joint cryotherapy. A 2x3 factorial design was used to compare reaction time and EMG amplitude data of treatment conditions (cryotherapy and control) across time (pre-treatment, post-treatment, and 30 min post-treatment). Thirteen healthy volunteers (age 23 ± 4 yrs, ht 1.76 ± 0.09 m, mass 78.8 ± 16.6 kg), with no history of lower extremity joint injury participated in this study. Surface EMG was collected from the peroneus longus (PL) of the dominant leg during an ankle inversion perturbation triggered while walking. Subjects walked the length of a 6.1 m runway 30 times. A trap door mechanism, inducing inversion perturbation, was released at heel contact during six randomly selected trials for each leg. Following baseline measurements, a 1.5 L bag of crushed ice was applied to the lateral ankle of subjects in the treatment group with an elastic wrap. A bag similar in weight and consistency was applied to the lateral ankle of subjects in the control group. A repeated measures ANOVA was used to compare treatment conditions across time (p 0.05) for PL reaction time. Average RMS EMG, normalized to an isometric reference position, increased in the cryotherapy group at the 30 min post-treatment interval relative to the control group (p movement is unknown.Short latency response should be measured during functional movement instead of during stance to take into consideration alterations in motor drive.Joint cooling has no effect on peroneal short latency response, and joint cooling may result in increased short term peroneal activation.Joint cooling has no effect on the peroneus longus as a dynamic stabilizer during walking.

  14. Screening Characteristics of Ultrasonography in Detection of Ankle Fractures

    Directory of Open Access Journals (Sweden)

    Majid Shojaee

    2016-08-01

    Full Text Available Introduction: Ankle fracture is one of the most common joint fractures. X-ray and physical examination are itsmain methods of diagnosis. Recently, ultrasonography (US is considered as a simple and non-invasive methodof fracture diagnosis. This study evaluated the diagnostic accuracy of US in detection of ankle fracture in comparisonto plain radiography. Methods: In this diagnostic accuracy study, which was done in emergency departmentsof Imam Hossein and Shohadaye Tajrish hospitals, Tehran, Iran, during 2014, 141 patients with suspecteddiagnosis of distal leg or ankle fracture were examined by US and radiography (gold standard, independently.Screening performance characteristics of US in detection of distal leg fractures were calculated using SPSS version21. Results: 141 patients with the mean age of 34§11.52 years (range: 15–50 were evaluated (75.9% male.Radiography confirmed ankle fracture in 102 (72.3% patients. There was a significant correlation between theresults of US and radiography [Agreement: 95%; kappa: 0.88 (95% CI: 0.80–0.97; P Ç 0.001]. The screening performancecharacteristics of US in detection ankle fracture were as follows: sensitivity 98.9% (95% CI: 93.5% -99.9%, specificity 86.4% (95% CI: 71.9%–94.3%, PPV 94.1% (95% CI: 87.1%–97.6%, NPV 97.4% (95% CI: 84.9%–99.8%, PLR 16 (95% CI: 7.3–34.8, and NLR 0.02 (95% CI: 0.003 – 0.182. The area under the ROC curve of USin this regard was 95.8 (95% CI: 91.9§99.7. Conclusion: According to the results of this study, we can use USas an accurate and non-invasive method with high sensitivity and specificity in diagnosis ofmalleolus fractures.However, the inherent limitations of US such as operator dependency should be considered in this regard.

  15. Microsatellite instability and cytogenetic survey in myeloid leukemias

    Directory of Open Access Journals (Sweden)

    E.M.S.F. Ribeiro

    2002-02-01

    Full Text Available Microsatellites are short tandem repeat sequences dispersed throughout the genome. Their instability at multiple genetic loci may result from mismatch repair errors and it occurs in hereditary nonpolyposis colorectal cancer. This instability is also found in many sporadic cancers. In order to evaluate the importance of this process in myeloid leukemias, we studied five loci in different chromosomes of 43 patients, 22 with chronic myelocytic leukemia (CML in the chronic phase, 7 with CML in blast crisis, and 14 with acute myeloid leukemia (AML, by comparing leukemic DNA extracted from bone marrow and constitutional DNA obtained from buccal epithelial cells. Only one of the 43 patients (2.1%, with relapsed AML, showed an alteration in the allele length at a single locus. Cytogenetic analysis was performed in order to improve the characterization of leukemic subtypes and to determine if specific chromosome aberrations were associated with the presence of microsatellite instability. Several chromosome aberrations were observed, most of them detected at diagnosis and during follow-up of the patients, according to current literature. These findings suggest that microsatellite instability is an infrequent genetic event in myeloid leukemias, adding support to the current view that the mechanisms of genomic instability in solid tumors differ from those observed in leukemias, where specific chromosome aberrations seem to play a major role.

  16. An unusual cause of pain post ankle arthrodesis in patients with rheumatoid arthritis.

    LENUS (Irish Health Repository)

    Burke, Neil G

    2012-02-01

    Rheumatoid arthritis is an autoimmune disease which frequently affects the ankle and foot. End stage ankle arthritis from rheumatic disease is commonly managed by the established practice of ankle arthrodesis. Among the adverse sequelae causing pain following this surgery is infection, pseudo-arthrosis and non-union. Stress fracture of the distal third is a recognised but unusual cause of pain of tibia following ankle arthrodesis. The authors\\' present three patients with rheumatoid arthritis who sustained a stress fracture of the distal tibia following arthrodesis, and discuss the contributing factors and highlight the need for orthopaedic surgeons to be suspicious of this complication post surgery.

  17. The influence of a hydraulic prosthetic ankle on residual limb loading during sloped walking.

    Science.gov (United States)

    Koehler-McNicholas, Sara R; Nickel, Eric A; Medvec, Joseph; Barrons, Kyle; Mion, Spencer; Hansen, Andrew H

    2017-01-01

    In recent years, numerous prosthetic ankle-foot devices have been developed to address the demands of sloped walking for individuals with lower-limb amputation. The goal of this study was to compare the performance of a passive, hydraulic ankle-foot prosthesis to two related, non-hydraulic ankles based on their ability to minimize the socket reaction moments of individuals with transtibial amputation during a range of sloped walking tasks. After a two-week accommodation period, kinematic data were collected on seven subjects with a transtibial amputation walking on an instrumented treadmill set at various slopes. Overall, this study was unable to find significant differences in the torque at the distal end of the prosthetic socket between an ankle-foot prosthesis with a hydraulic range-of-motion and other related ankle-foot prosthesis designs (rigid ankle, multiaxial ankle) during the single-support phase of walking. In addition, socket comfort and perceived exertion were not significantly different for any of the ankle-foot prostheses tested in this study. These results suggest the need for further work to determine if more advanced designs (e.g., those with microprocessor control of hydraulic features, powered ankle-foot designs) can provide more biomimetic function to prosthesis users.

  18. Total ankle replacement using HINTEGRA, an unconstrained, three-component system: surgical technique and pitfalls.

    Science.gov (United States)

    Barg, Alexej; Knupp, Markus; Henninger, Heath B; Zwicky, Lukas; Hintermann, Beat

    2012-12-01

    Total ankle replacement (TAR) has become a valuable treatment option in patients with end-stage ankle osteoarthritis. One popular 3-component system, the HINTEGRA TAR, is an unconstrained system that provides inversion-eversion stability. More natural biomechanics of the replaced ankle may be expected when anatomic considerations drive prosthesis design. The HINTEGRA prosthesis includes 2 anatomically contoured metal components and a polyethylene insert, providing axial rotation and physiologic flexion-extension mobility. This article describes the HINTEGRA TAR design and surgical technique. Use of the prosthesis for complex hindfoot reconstruction in patients with an osteoarthritic, varus, or valgus ankle deformity is described.

  19. Techniques for managing varus and valgus malalignment during total ankle replacement.

    Science.gov (United States)

    Choi, Woo Jin; Yoon, Hang Seob; Lee, Jin Woo

    2013-01-01

    The ultimate goal of primary total ankle replacement is to provide a well-balanced soft-tissue envelope around a well-aligned, well-fixated implant. Some surgeons have emphasized that good outcomes in total ankle replacement are more dependent on ligament balancing, along with the procedure itself, than the extent of preoperative coronal deformity in the ankle. Thus, it is imperative that the surgeon be familiar with additional procedures to address the varus, valgus, and other associated deformities commonly encountered in primary total ankle replacement.

  20. Septic arthritis of the adult ankle joint secondary to Salmonella enteritidis: a case report.

    LENUS (Irish Health Repository)

    Munigangaiah, Sudarshan

    2011-09-01

    Salmonella septic arthritis in healthy individuals is a rare phenomenon. However, septic arthritis of the native adult ankle joint in healthy patients has not been previously described in the published data. This is a case report of a 70-year-old farmer who presented with a 2-week history of a painful, swollen right ankle and an inability to bear weight. He had no history of ankle injury or any predisposing conditions. Joint aspirations were positive for Salmonella enteritidis that was successfully treated with right ankle arthrotomy and washout, along with a 6-week course of intravenous antibiotic therapy.

  1. Differences between measured and resultant joint moments during isometric contractions at the ankle joint.

    Science.gov (United States)

    Arampatzis, Adamantios; Morey-Klapsing, Gaspar; Karamanidis, Kiros; DeMonte, Gianpiero; Stafilidis, Savvas; Brüggemann, Gert-Peter

    2005-04-01

    The purpose of this study was to examine two hypotheses: (a) during voluntary and electrically induced isometric contractions the moments measured at the dynamometer are different from the resultant moments in the same plane around the ankle joint and (b) at a given resultant moment during electrically induced isometric contractions the ankle angle while loading is different from the ankle angle while unloading. Twenty-seven long distance runners participated in the study. All subjects performed isometric maximal voluntary contractions (MVC) and contractions induced by electrostimulation at four different ankle-knee angle combinations on a Biodex-dynamometer. The kinematics of the leg were recorded using the vicon 624 system with eight cameras operating at 120 Hz. The main findings were: (a) the resultant moment at the ankle joint and the moment measured by the Biodex-dynamometer during isometric contractions are different, (b) during a plantar flexion effort the ankle angle changes significantly, whereas the knee angle shows only small and in most cases not significant changes, and (c) at identical resultant ankle joint moments the ankle angles are different between the loading and the unloading phases. The observed differences may lead to erroneous conclusions concerning the following: (a) diagnostic of muscle architecture, (b) estimation of the moment-ankle angle relationship and (c) estimation of the strain and hysteresis of tendons and aponeuroses.

  2. Design and characterization of a biologically inspired quasi-passive prosthetic ankle-foot.

    Science.gov (United States)

    Mooney, Luke M; Lai, Cara H; Rouse, Elliott J

    2014-01-01

    By design, commonly worn energy storage and release (ESR) prosthetic feet cannot provide biologically realistic ankle joint torque and angle profiles during walking. Additionally, their anthropomorphic, cantilever architecture causes their mechanical stiffness to decrease throughout the stance phase of walking, opposing the known trend of the biological ankle. In this study, the design of a quasi-passive pneumatic ankle-foot prosthesis is detailed that is able to replicate the biological ankle's torque and angle profiles during walking. The prosthetic ankle is comprised of a pneumatic piston, bending spring and solenoid valve. The mechanical properties of the pneumatic ankle prosthesis are characterized using a materials testing machine and the properties are compared to those from a common, passive ESR prosthetic foot. The characterization spanned a range of ankle equilibrium pressures and testing locations beneath the foot, analogous to the location of center of pressure within the stance phase of walking. The pneumatic ankle prosthesis was shown to provide biologically appropriate trends and magnitudes of torque, angle and stiffness behavior, when compared to the passive ESR prosthetic foot. Future work will focus on the development of a control system for the quasi-passive device and clinical testing of the pneumatic ankle to demonstrate efficacy.

  3. The influence of a hydraulic prosthetic ankle on residual limb loading during sloped walking

    Science.gov (United States)

    Nickel, Eric A.; Medvec, Joseph; Barrons, Kyle; Mion, Spencer; Hansen, Andrew H.

    2017-01-01

    In recent years, numerous prosthetic ankle-foot devices have been developed to address the demands of sloped walking for individuals with lower-limb amputation. The goal of this study was to compare the performance of a passive, hydraulic ankle-foot prosthesis to two related, non-hydraulic ankles based on their ability to minimize the socket reaction moments of individuals with transtibial amputation during a range of sloped walking tasks. After a two-week accommodation period, kinematic data were collected on seven subjects with a transtibial amputation walking on an instrumented treadmill set at various slopes. Overall, this study was unable to find significant differences in the torque at the distal end of the prosthetic socket between an ankle-foot prosthesis with a hydraulic range-of-motion and other related ankle-foot prosthesis designs (rigid ankle, multiaxial ankle) during the single-support phase of walking. In addition, socket comfort and perceived exertion were not significantly different for any of the ankle-foot prostheses tested in this study. These results suggest the need for further work to determine if more advanced designs (e.g., those with microprocessor control of hydraulic features, powered ankle-foot designs) can provide more biomimetic function to prosthesis users. PMID:28278172

  4. Quadruple-component superficial circumflex iliac artery perforator (SCIP) flap: A chimeric SCIP flap for complex ankle reconstruction of an exposed artificial joint after total ankle arthroplasty.

    Science.gov (United States)

    Yamamoto, Takumi; Saito, Takafumi; Ishiura, Ryohei; Iida, Takuya

    2016-09-01

    Total ankle arthroplasty (TAA) is becoming popular in patients with rheumatoid arthritis (RA)-associated ankle joint degeneration. However, ankle wound complications can occur after TAA, which sometimes requires challenging reconstruction due to anatomical complexity of the ankle. Superficial circumflex iliac artery (SCIA) perforator (SCIP) flap has been reported to be useful for various reconstructions, but no case has been reported regarding a chimeric SCIP flap for complex ankle reconstruction. We report a case of complex ankle defect successfully reconstructed with a free quadruple-component chimeric SCIP flap. A 73-year-old female patient with RA underwent TAA, and suffered from an extensive ankle soft tissue defect (13 × 5 cm) with exposure of the implanted artificial joint and the extensor tendons. A chimeric SCIP flap was raised based on the deep branch and the superficial branch of the SCIA, which included chimeric portions of the sartorius muscle, the deep fascia, the inguinal lymph node (ILN), and the skin/fat. The flap was transferred to the recipient ankle. The sartorius muscle was used to cover the artificial joint, the deep fascia to reconstruct the extensor retinaculum, the ILN to prevent postoperative lymphedema, and the adiposal tissue to put around the extensor tendons for prevention of postoperative adhesion. Postoperatively, the patient could walk by herself without persistent leg edema or bowstringing of the extensor tendons, and was satisfied with the concealable donor scar. Although further studies are required to confirm efficacy, multicomponent chimeric SCIP has a potential to be a useful option for complex defects of the ankle.

  5. Radiation Induced Genomic Instability

    Energy Technology Data Exchange (ETDEWEB)

    Morgan, William F.

    2011-03-01

    Radiation induced genomic instability can be observed in the progeny of irradiated cells multiple generations after irradiation of parental cells. The phenotype is well established both in vivo (Morgan 2003) and in vitro (Morgan 2003), and may be critical in radiation carcinogenesis (Little 2000, Huang et al. 2003). Instability can be induced by both the deposition of energy in irradiated cells as well as by signals transmitted by irradiated (targeted) cells to non-irradiated (non-targeted) cells (Kadhim et al. 1992, Lorimore et al. 1998). Thus both targeted and non-targeted cells can pass on the legacy of radiation to their progeny. However the radiation induced events and cellular processes that respond to both targeted and non-targeted radiation effects that lead to the unstable phenotype remain elusive. The cell system we have used to study radiation induced genomic instability utilizes human hamster GM10115 cells. These cells have a single copy of human chromosome 4 in a background of hamster chromosomes. Instability is evaluated in the clonal progeny of irradiated cells and a clone is considered unstable if it contains three or more metaphase sub-populations involving unique rearrangements of the human chromosome (Marder and Morgan 1993). Many of these unstable clones have been maintained in culture for many years and have been extensively characterized. As initially described by Clutton et al., (Clutton et al. 1996) many of our unstable clones exhibit persistently elevated levels of reactive oxygen species (Limoli et al. 2003), which appear to be due dysfunctional mitochondria (Kim et al. 2006, Kim et al. 2006). Interestingly, but perhaps not surprisingly, our unstable clones do not demonstrate a “mutator phenotype” (Limoli et al. 1997), but they do continue to rearrange their genomes for many years. The limiting factor with this system is the target – the human chromosome. While some clones demonstrate amplification of this chromosome and thus lend

  6. The effect of varying the plantarflexion resistance of an ankle-foot orthosis on knee joint kinematics in patients with stroke.

    Science.gov (United States)

    Kobayashi, Toshiki; Leung, Aaron K L; Akazawa, Yasushi; Hutchins, Stephen W

    2013-03-01

    Ankle-foot orthoses (AFOs) can improve gait in patients with hemiplegia. However, it is anecdotally known that excessive plantarflexion resistance of an AFO could induce undesired knee flexion at early stance. The aim of this study was to systematically investigate the effect of varying the degrees of plantarflexion resistance of an AFO on knee flexion angles at early stance in five subjects with chronic stroke who demonstrated two clear knee flexion peaks at early stance and swing. Each subject wore an experimental AFO constructed with an oil-damper type ankle joint and was instructed to walk at their self-selected walking speed under five plantarflexion resistance conditions. The sagittal plane ankle and knee joint kinematics and gait speed were analyzed using a 3-D Motion Analysis System. A number of significant differences (Pknee flexion angles at early stance amongst different plantarflexion resistance conditions were revealed. The knee flexion angle was 23.80 (3.25) degrees under the free hinge joint condition (condition 1), while that was 26.09 (3.79) degrees under the largest resistance condition (condition 5). It was therefore demonstrated that increasing the plantarflexion resistance of an AFO would induce more knee flexion at early stance phase in patients with stroke.

  7. Noninvasive ankle distraction: relationship between force, magnitude of distraction, and nerve conduction abnormalities.

    Science.gov (United States)

    Dowdy, P A; Watson, B V; Amendola, A; Brown, J D

    1996-02-01

    Seven healthy volunteers (14 ankles; four males, 3 females) with no history of ankle or foot pathology were placed in a modified beach chair position on an operating table for ankle distraction using a noninvasive ankle distractor. In-line traction of 0 to 225 N (50 lb) in 22.5-N (5-lb) increments was applied to the ankle. A direct lateral radiograph was obtained at each distraction force. The joint space was measured on the lateral radiographs using electronic microcalipers. Surface recordings of the superficial peroneal, deep peroneal dorsal digital cutaneous, and sural nerves were obtained. The ankle joint space increased progressively from an average 3.1 mm with no force applied to an average 4.2 mm with 225 N (50 lb) distraction force applied. The maximum joint distraction averaged 1.3 mm (range, 0.35 to 2.35 mm). The sensory amplitudes were diminished or absent with increasing time and force of distraction. The decreased amplitudes were most marked after 1 hour of distraction with 135 N (30 lb) or greater distraction force. This correlated with symptoms of paresthesias. The superficial and deep peroneal cutaneous nerves were affected to a much greater extent than the sural nerve. The amplitudes quickly returned to normal values with the weight being released from the ankle. The noninvasive ankle distractor safely increased ankle joint space by more than 1 mm. Distraction with 135 N (30 lb) or more for 1 hour is associated with reversible nerve conduction changes. Based on these findings, we recommend using the noninvasive ankle distraction apparatus for ankle arthroscopy, with up to 135 N (30 lb) of traction applied to the foot for up to 1 hour. Greater force, applied for longer periods, is associated with increasing nerve conduction abnormalities.

  8. In vivo kinematics and articular surface congruency of total ankle arthroplasty during gait.

    Science.gov (United States)

    Yamaguchi, Satoshi; Tanaka, Yasuhito; Banks, Scott; Kosugi, Shinichi; Sasho, Takahisa; Takahashi, Kazuhisa; Takakura, Yoshinori

    2012-08-09

    Relatively high rates of loosening and implant failure have been reported after total ankle arthroplasty. Abnormal kinematics and incongruency of the articular surface may cause increased contact pressure and rotational torque applied to the implant, leading to loosening and implant failure. We measured in vivo kinematics of two-component total ankle arthroplasty (TNK ankle), and assessed congruency of the articular surface during the stance phase of gait. Eighteen ankles of 15 patients with a mean age of 75±6 years (mean±standard deviation) and follow-up of 44±38 months were enrolled. Lateral fluoroscopic images were taken during the stance phase of gait. 3D-2D model-image registration was performed using the fluoroscopic image and the implant models, and three-dimensional kinematics of the implant and incongruency of the articular surface were determined. The mean ranges of motion were 11.1±4.6°, 0.8±0.4°, and 2.6±1.5° for dorsi-/plantarflexion, inversion/eversion, and internal/external rotation, respectively. At least one type of incongruency of the articular surface occurred in eight of 18 ankles, including anterior hinging in one ankle, medial or lateral lift off in four ankles, and excessive axial rotation in five ankles. Among the four ankles in which lift off occurred during gait, only one ankle showed lift off in the static weightbearing radiograph. Our observations will provide useful data against which kinematics of other implant designs, such as three-component total ankle arthroplasty, can be compared. Our results also showed that evaluation of lift off in the standard weightbearing radiograph may not predict its occurrence during gait.

  9. Modulational instability of nematic phase

    Indian Academy of Sciences (India)

    T Mithun; K Porsezian

    2014-02-01

    We numerically observe the effect of homogeneous magnetic field on the modulationally stable case of polar phase in = 2 spinor Bose–Einstein condensates (BECs). Also we investigate the modulational instability of uniaxial and biaxial (BN) states of polar phase. Our observations show that the magnetic field triggers the modulational instability and demonstrate that irrespective of the magnetic field effect the uniaxial and biaxial nematic phases show modulational instability.

  10. Weibel instability with nonextensive distribution

    Energy Technology Data Exchange (ETDEWEB)

    Qiu, Hui-Bin; Liu, Shi-Bing [Strong-field and Ultrafast Photonics Lab, Institute of Laser Engineering, Beijing University of Technology, Beijing 100124 (China)

    2013-10-15

    Weibel instability in plasma, where the ion distribution is isotropic and the electron component of the plasma possesses the anisotropic temperature distribution, is investigated based on the kinetic theory in context of nonextensive statistics mechanics. The instability growth rate is shown to be dependent on the nonextensive parameters of both electron and ion, and in the extensive limit, the result in Maxwellian distribution plasma is recovered. The instability growth rate is found to be enhanced as the nonextensive parameter of electron increases.

  11. Political Instability and Economic Growth

    OpenAIRE

    Swagel, Phillip; Roubini, Nouriel; Ozler, Sule; Alesina, Alberto

    1992-01-01

    This paper investigates the relationship between political instability and per capita GDP growth in a sample of 113 countries for the period 1950-1982. We define ?political instability? as the propensity of a government collapse, and we estimate a model in which political instability and economic growth are jointly determined. The main result of this paper is that in countries and time periods with a high propensity of government collapse, growth is significantly lower than otherwise. This ef...

  12. Total ankle replacement through a lateral approach: surgical tips

    Science.gov (United States)

    Usuelli, Federico Giuseppe; Indino, Cristian; Maccario, Camilla; Manzi, Luigi; Salini, Vincenzo

    2016-01-01

    Purpose: Recently, the Zimmer Trabecular Metal Total Ankle Replacement (Zimmer TM TAR) was developed to be used through a lateral transfibular approach. The purpose of this paper is to describe the surgical technique and early outcomes of the TAR via the lateral approach using the Zimmer TM TARs. Methods: Sixty-seven patients underwent primary TAR using the Zimmer TM TAR between May 2013 and May 2015. Patients were clinically evaluated preoperatively and postoperatively at six and twelve months and annually using the American Orthopaedic Foot & Ankle Society (AOFAS) ankle and hindfoot scores, visual analogue scale (VAS) pain score, and the Short Form Health Survey (SF-12) questionnaire. The minimum follow-up was 12 months. Results: The mean AOFAS hindfoot score increased from 32.8 preoperatively to 85.0 at the latest follow-up (p-value < 0.001). The mean VAS pain score decreased from 8.0 to 2.0 at the latest follow-up (p-value < 0.001). The Physical and Mental Health Composite Scale scores (PCS and MCS) of the SF-12 passed from a mean value of 30.2 preoperatively to 43.1 (p-value < 0.001) and from a mean value of 44.6 to 53.5 at the latest follow-up (p-value < 0.001), respectively. Conclusions: We present our surgical tips and the early results of this prosthetic design which are encouraging. They could be useful as an adjunct to the manufacturer’s surgical technique guidance for surgeons who utilize these implants. PMID:27855774

  13. Total ankle replacement through a lateral approach: surgical tips

    Directory of Open Access Journals (Sweden)

    Usuelli Federico Giuseppe

    2016-01-01

    Full Text Available Purpose: Recently, the Zimmer Trabecular Metal Total Ankle Replacement (Zimmer TM TAR was developed to be used through a lateral transfibular approach. The purpose of this paper is to describe the surgical technique and early outcomes of the TAR via the lateral approach using the Zimmer TM TARs. Methods: Sixty-seven patients underwent primary TAR using the Zimmer TM TAR between May 2013 and May 2015. Patients were clinically evaluated preoperatively and postoperatively at six and twelve months and annually using the American Orthopaedic Foot & Ankle Society (AOFAS ankle and hindfoot scores, visual analogue scale (VAS pain score, and the Short Form Health Survey (SF-12 questionnaire. The minimum follow-up was 12 months. Results: The mean AOFAS hindfoot score increased from 32.8 preoperatively to 85.0 at the latest follow-up (p-value < 0.001. The mean VAS pain score decreased from 8.0 to 2.0 at the latest follow-up (p-value < 0.001. The Physical and Mental Health Composite Scale scores (PCS and MCS of the SF-12 passed from a mean value of 30.2 preoperatively to 43.1 (p-value < 0.001 and from a mean value of 44.6 to 53.5 at the latest follow-up (p-value < 0.001, respectively. Conclusions: We present our surgical tips and the early results of this prosthetic design which are encouraging. They could be useful as an adjunct to the manufacturer’s surgical technique guidance for surgeons who utilize these implants.

  14. Validating a new computed tomography atlas for grading ankle osteoarthritis.

    Science.gov (United States)

    Cohen, Michael M; Vela, Nathan D; Levine, Jason E; Barnoy, Eran A

    2015-01-01

    As the most common joint disease, osteoarthritis (OA) poses a significant source of pain and disability. It can be defined by classic radiographic findings, particular symptoms, or a combination of the 2. Although specific grading scales have been developed to evaluate OA in various joints, such as the shoulder, hip, and knee, no definitive classification system is available for grading OA in the ankle. The purpose of the present study was to create and validate a standardized atlas for grading (or staging) ankle osteoarthritis using computed tomography (CT) and "hallmark" findings noted on coronal, sagittal, and axial views extrapolated from the Kellgren-Lawrence radiographic scale. The CT scans of 226 patients at the Miami Veterans Affairs Medical Center were reviewed. An atlas was derived from a retrospective review of 30 remaining CT scans taken from July 2008 to November 2011. After this review, 3 orthogonal static CT images, obtained from 11 remaining patients, were chosen to represent the various stages on the OA scale and were used to test the validity of the atlas developed by 2 of us (M.M.C. and N.D.V.). A multispecialty panel of 9 examiners, excluding ourselves, independently rated the 11 CT scan subjects. The differences among examiners and specialties were calculated, including an intra-examiner agreement for 2 separate readings spaced 9 months apart. Although the small number of subspecialty examiners made the intraspecialty comparisons difficult to validate, the findings nevertheless indicated excellent agreement among all specialty groups, with good intra-investigational (intraclass correlation coefficient 0.962 and 1) inter-investigational (intraclass correlation coefficient 0.851) values. These results appeared to validate the CT ankle OA atlas, which we believe will be a valuable clinical and research tool, one that will likely be more beneficial than less relevant generalized OA grading scales in use today.

  15. Diclofenac epolamine topical patch relieves pain associated with ankle sprain

    Directory of Open Access Journals (Sweden)

    David R Lionberger

    2011-03-01

    Full Text Available David R Lionberger1, Eric Joussellin2, Arturo Lanzarotti3, Jillmarie Yanchick4, Merrell Magelli5 1Southwest Orthopedic Group, LLP, Houston, Texas, USA; 2Institut National du Sport, Paris, France; 3Institut Biochimique SA, Pambionoranco, Switzerland; 4Alpharma Pharmaceuticals LLC, a wholly owned subsidiary of King Pharmaceuticals®, Inc, Piscataway, New Jersey, USA; 5GTx, Inc, Memphis, Tennessee, USABackground: Sports-related injuries, such as sprains and strains, commonly occur during exercise and athletic events. Current therapy includes nonsteroidal anti-inflammatory drugs (NSAIDs, which have a high incidence of upper gastrointestinal side effects. The present study assessed the efficacy and safety of the diclofenac epolamine topical patch (DETP, 1.3%, a topical NSAID for the treatment of acute minor sprains and strains.Methods: This multicenter, randomized, placebo-controlled clinical study enrolled adult patients (n = 134 with acute ankle pain (due to a minor sprain occurring less than 48 hours prior to entering the study. Patients were treated with either the DETP or a placebo topical patch daily for seven days. Pain intensity was evaluated during the first six hours after application of the patch, and on treatment days 1, 2, 3, and 7.Results: Patients treated with the DETP experienced a significantly greater reduction in pain associated with their ankle injury compared with placebo, beginning four hours after the first patch application (P = 0.02. The DETP was well tolerated and was comparable with placebo in terms of safety.Conclusion: Overall, the results of this study demonstrate that the DETP is an effective analgesic for local treatment of pain in mild acute ankle sprain.Keywords: soft tissue injury, acute pain, visual analog scale, efficacy, tolerability 

  16. Libration driven multipolar instabilities

    CERN Document Server

    Cébron, David; Herreman, Wietze

    2014-01-01

    We consider rotating flows in non-axisymmetric enclosures that are driven by libration, i.e. by a small periodic modulation of the rotation rate. Thanks to its simplicity, this model is relevant to various contexts, from industrial containers (with small oscillations of the rotation rate) to fluid layers of terrestial planets (with length-of-day variations). Assuming a multipolar $n$-fold boundary deformation, we first obtain the two-dimensional basic flow. We then perform a short-wavelength local stability analysis of the basic flow, showing that an instability may occur in three dimensions. We christen it the Libration Driven Multipolar Instability (LDMI). The growth rates of the LDMI are computed by a Floquet analysis in a systematic way, and compared to analytical expressions obtained by perturbation methods. We then focus on the simplest geometry allowing the LDMI, a librating deformed cylinder. To take into account viscous and confinement effects, we perform a global stability analysis, which shows that...

  17. Instability of enclosed horizons

    CERN Document Server

    Kay, Bernard S

    2013-01-01

    We study the classical massless scalar wave equation on the region of 1+1-dimensional Minkowski space between the two branches of the hyperbola $x^2-t^2=1$ with vanishing boundary conditions on it. We point out that there are initially finite-energy initially, say, right-going waves for which the stress-energy tensor becomes singular on the null-line $t+x=0$. We also construct the quantum theory of this system and show that, while there is a regular Hartle-Hawking-Israel-like state, there are coherent states built on this for which there is a similar singularity in the expectation value of the renormalized stress-energy tensor. We conjecture that in 1+3-dimensional situations with 'enclosed horizons' such as a (maximally extended) Schwarzschild black hole in equilibrium in a stationary box or the (maximally extended) Schwarzschild-AdS spacetime, there will be a similar singularity at the horizon and that would signal an instability when matter perturbations and/or gravity are switched on. Such an instability ...

  18. [Aspirin suppresses microsatellite instability].

    Science.gov (United States)

    Wallinger, S; Dietmaier, W; Beyser, K; Bocker, T; Hofstädter, F; Fishel, R; Rüschoff, J

    1999-01-01

    Nonsteroidal anti-inflammatory drugs (NSAIDs) exhibit cancer preventive effects and have been shown to induce regression of adenomas in FAP patients. In order to elucidate the probable underlying mechanism, the effect of NSAIDs on mismatch repair related microsatellite instability was investigated. Six colorectal cancer cell lines all but one deficient for human mismatch repair (MMR) genes were examined for microsatellite instability (MSI) prior and after treatment with Aspirin or Sulindac. For rapid in vitro analysis of MSI a microcloning assay was developed by combining Laser microdissection and random (PEP-) PCR prior to specific MSI-PCR. Effects of NSAIDs on cell cycle and apoptosis were systematically investigated by using flow cytometry and cell-sorting. MSI frequency in cells deficient of MMR genes (hMSH2, hMLH1, hMSH6) was markedly reduced after long-term (> 10 weeks) NSAID treatment. This effect was reversible, time- and concentration dependent. However, in the hPMS2 deficient endometrial cancer cell line (HEC-1-A) the MSI phenotype kept unchanged. According to cell sorting, non-apoptotic cells were stable and apoptotic cells were unstable. These results suggest that aspirin/sulindac induces a genetic selection for microsatellite stability in a subset of MMR-deficient cells and may thus provide an effective prophylactic therapy for HNPCC related colorectal carcinomas.

  19. [A very slow growing ankle swelling in a healthy male].

    Science.gov (United States)

    Merlo, Christoph; Merlo, Pierina; Holzinger, Fernando; Pranghofer, Sigrid; Pfeiffer, David; Nüesch, Reto

    2014-08-20

    We describe the case report of a 66-year-old man with a very slow growing ankle tumour caused by a subcutaneous fungal abscess. Phaeoacremonium inflatipes, a member of the Dematiaceae family, was identified by needle puncture and culture of the non-odorous creamy yellow brown fluid. The fungal pseudocyst was surgically removed in toto and no further fungicidal drug therapy was required. Human infections by dematiaceous fungi causes subcutaneous phaeohyphomycosis, a rare, deep fungal infection of the skin and subcutaneous tissues usually acquired through traumatic skin lesions. In addition, systemic infections are reported, predominantly in immunosuppressed individuals.

  20. An Unusual Ankle Injury: The Bosworth-Pilon Fracture.

    Science.gov (United States)

    Peterson, Nicholas D; Shah, Feisal; Narayan, Badri

    2015-01-01

    The Bosworth injury occurs when the distal fibula becomes entrapped posterior to the posterior tibial tubercle, usually as a result of a supination external rotation injury. This uncommon occurrence is a recognized cause of an irreducible ankle dislocation. A pilon fracture is usually a high-energy injury caused by the talus being driven upward into the tibial plafond. The resulting bone and soft tissue injuries often require a staged approach to management. The present report is the first in the medical data to describe a Bosworth injury complicating a pilon fracture. We also discuss a management approach for this rare fracture.

  1. Gait: the role of the ankle and foot in walking.

    Science.gov (United States)

    Dubin, Andrew

    2014-03-01

    Evaluation of gait and its associated deviations from normal requires an in-depth evaluation of the patient and an appreciation for the complexity of the task. Understanding gait starts with an appreciation of the basic determinants of gait. Foot drop is a common gait deviation. Functionally, a foot drop results in a long limb. This will result in alterations of the gait cycle during swing phase. The common compensations for a foot drop include steppage gait, circumduction, and a persistently abducted limb. Noninterventional options for management of common gait deviations secondary to ankle/foot dysfunction present challenges.

  2. Septic arthritis of the ankle due to Salmonella enteritidis.

    LENUS (Irish Health Repository)

    Dineen, Patrick F

    2011-06-01

    Salmonella septic arthritis in healthy, immunocompetent patients is extremely rare. We present the case of a 70-year-old man who presented with a one-day history of painful swelling of his ankle from which was aspirated pus which subsequently grew Salmonella enteritidis. There was no history of trauma or symptoms consistent with Salmonella enterocolitis. Our patient recovered fully after two weeks on intravenous ceftriaxone and six weeks on oral ciprofloxacin. Salmonella is a notifiable disease in the European Union and the United States of America, and is associated with outbreaks as a result of food contamination. The nature of Salmonella arthritis and its appropriate management are outlined.

  3. Isolated Hydatid Cyst of Ankle: A Case Report

    Directory of Open Access Journals (Sweden)

    Tuna Demirdal

    2015-11-01

    Full Text Available Hydatid cyst is a zoonotic infection usually caused by Echinococcus granulosus. Hydatid cysts are most often localized in the liver and lungs. Isolated cases of hydatid cyst in soft tissue is very rare. The incidance of isolated soft tissue hydatid cyst is 2.3% in endemic areas. Medical treatment is successful in 30-40% of cases. The first choice of treatment is surgery, especially in atypical localization of hydatid cyst. We aimed to present our patient with ankle hydatid cyst, a rare case in the literature.

  4. Osteomyelitis of the foot and ankle: diagnosis, epidemiology, and treatment.

    Science.gov (United States)

    Lindbloom, Benjamin J; James, Eric R; McGarvey, William C

    2014-09-01

    Osteomyelitis of the foot and ankle is a common, potentially devastating condition with diagnostic and treatment challenges. Understanding the epidemiology and pathogenesis of osteomyelitis can raise clinical suspicion and guide testing and treatments. History and physical examination, laboratory studies, vascular studies, histologic and microbiologic analyses, and various imaging modalities contribute to diagnosis and treatment. Treatment including empiric broad-spectrum antibiotics and surgery should take a multidisciplinary approach to optimize patient factors, ensure eradication of the infection, and restore function. Optimization of vascular status, soft tissues, limb biomechanics, and physiologic state of the patient must be considered to accelerate and ensure healing.

  5. Spinal instability in ankylosing spondylitis

    Directory of Open Access Journals (Sweden)

    Badve Siddharth

    2010-01-01

    Full Text Available Background: Unstable spinal lesions in patients with ankylosing spondylitis are common and have a high incidence of associated neurological deficit. The evolution and presentation of these lesions is unclear and the management strategies can be confusing. We present retrospective analysis of the cases of ankylosing spondylitis developing spinal instability either due to spondylodiscitis or fractures for mechanisms of injury, presentations, management strategies and outcome. Materials and Methods: In a retrospective analysis of 16 cases of ankylosing spondylitis, treated surgically for unstable spinal lesions over a period of 12 years (1995-2007; 87.5% (n=14 patients had low energy (no obvious/trivial trauma while 12.5% (n=2 patients sustained high energy trauma. The most common presentation was pain associated with neurological deficit. The surgical indications included neurological deficit, chronic pain due to instability and progressive deformity. All patients were treated surgically with anterior surgery in 18.8% (n=3 patients, posterior in 56.2% (n=9 patients and combined approach in 25% (n=4 patients. Instrumented fusion was carried out in 87.5% (n=14 patients. Average surgical duration was 3.84 (Range 2-7.5 hours, blood loss 765.6 (± 472.5 ml and follow-up 54.5 (Range 18-54 months. The patients were evaluated for pain score, Frankel neurological grading, deformity progression and radiological fusion. One patient died of medical complications a week following surgery. Results: Intra-operative adverse events like dural tears and inadequate deformity correction occurred in 18.7% (n=3 patients (Cases 6, 7 and 8 which could be managed conservatively. There was a significant improvement in the Visual analogue score for pain from a pre-surgical median of 8 to post-surgical median of 2 (P=0.001, while the neurological status improved in 90% (n=9 patients among those with preoperative neurological deficit who could be followed-up (n =10. Frankel

  6. Motion of the foot and ankle during the stance phase in rats

    NARCIS (Netherlands)

    Varejao, ASP; Cabrita, AM; Meek, MF; Bulas-Cruz, J; Gabriel, RC; Filipe, VM; Melo-Pinto, P; Winter, DA

    2002-01-01

    Computerized analysis of rat gait is becoming an invaluable technique used by some peripheral nerve investigators for the evaluation of function. In this article we describe the use of a biomechanical model of the foot and ankle that allows a quantitative assessment and description of the ankle angl

  7. Epidemiology of ankle and foot overuse injuries in sports : A systematic review

    NARCIS (Netherlands)

    Sobhani, S.; Dekker, R.; Postema, K.; Dijkstra, P. U.

    2013-01-01

    Studies regarding ankle and foot overuse injuries are quite diverse in research methodology, data reporting, and outcomes. The aims of this systematic review were to analyze the methodology of published studies regarding ankle and foot overuse injuries in different sports disciplines and to summariz

  8. Tourniquet use during ankle surgery leads to increased postoperative opioid use

    DEFF Research Database (Denmark)

    Kruse, Heidi; Christensen, Kristian P; Møller, Ann M;

    2015-01-01

    STUDY OBJECTIVE: Ankle surgery is often done using a tourniquet. Ischemia/reperfusion injury caused by the tourniquet may increase postoperative pain. The study objective was to investigate the amount of opioids given to patients after ankle surgery with and without tourniquet. DESIGN: We did a c...

  9. 21 CFR 888.3100 - Ankle joint metal/composite semi-constrained cemented prosthesis.

    Science.gov (United States)

    2010-04-01

    ... cemented prosthesis. 888.3100 Section 888.3100 Food and Drugs FOOD AND DRUG ADMINISTRATION, DEPARTMENT OF... Ankle joint metal/composite semi-constrained cemented prosthesis. (a) Identification. An ankle joint metal/composite semi-constrained cemented prosthesis is a device intended to be implanted to replace...

  10. 21 CFR 888.3110 - Ankle joint metal/polymer semi-constrained cemented prosthesis.

    Science.gov (United States)

    2010-04-01

    ... cemented prosthesis. 888.3110 Section 888.3110 Food and Drugs FOOD AND DRUG ADMINISTRATION, DEPARTMENT OF... Ankle joint metal/polymer semi-constrained cemented prosthesis. (a) Identification. An ankle joint metal/polymer semi-constrained cemented prosthesis is a device intended to be implanted to replace an...

  11. 21 CFR 888.3120 - Ankle joint metal/polymer non-constrained cemented prosthesis.

    Science.gov (United States)

    2010-04-01

    ... prosthesis. 888.3120 Section 888.3120 Food and Drugs FOOD AND DRUG ADMINISTRATION, DEPARTMENT OF HEALTH AND... metal/polymer non-constrained cemented prosthesis. (a) Identification. An ankle joint metal/polymer non-constrained cemented prosthesis is a device intended to be implanted to replace an ankle joint. The...

  12. Ankle Injuries: Reduce the Risk by Using a Soccer-Specific Warm-up Routine

    Science.gov (United States)

    Elliott, Steven; Ellis, Margery; Combs, Sue; Hunt Long, Lynn

    2015-01-01

    Injuries to the ankle are among the most common injuries for soccer players at any age. Soccer coaches should be aware of current research and best practices that suggest it is possible to decrease the incidence of soccer players' ankle injuries by providing an appropriate warm-up to utilize prior to practices and games. This article introduces…

  13. Ankle proprioception is not targeted by exercises on an unstable surface

    NARCIS (Netherlands)

    Kiers, H.; Brumagne, S.; Dieen, J. van; Wees, P.J. van der; Vanhees, L.

    2012-01-01

    Laboratory study using a repeated measures design. The aim of this study was to determine if ankle proprioception is targeted in exercises on unstable surfaces. Lateral ankle sprain (LAS) has recurrence rates over 70%, which are believed to be due to a reduced accuracy of proprioceptive signals from

  14. Arthroscopic washout of the ankle for septic arthritis in a three-month-old boy

    Directory of Open Access Journals (Sweden)

    Hagino Tetsuo

    2011-10-01

    Full Text Available Abstract There is no report of athroscopic treatment for septic arthritis of the ankle in infants. We report a case of successful management of septic arthritis of the ankle in a three-month-old boy by arthroscopic washout. Arthroscopic washout may be a useful treatment for septic arthritis in young infants when performed early after onset.

  15. Ankle torque steadiness is related to muscle activation variability and coactivation in children with cerebral palsy

    DEFF Research Database (Denmark)

    Bandholm, Thomas; Rose, Martin Høyer; Sløk, Rikke;

    2009-01-01

    The aims of this study were to: (1) investigate the significance of muscle activation variability and coactivation for the ability to perform steady submaximal ankle torque (torque steadiness) in healthy children and those with cerebral palsy (CP), and (2) assess ankle function during isometric...

  16. Compensatory strategies during walking in response to excessive muscle co-contraction at the ankle joint.

    Science.gov (United States)

    Wang, Ruoli; Gutierrez-Farewik, Elena M

    2014-03-01

    Excessive co-contraction causes inefficient or abnormal movement in several neuromuscular pathologies. How synergistic muscles spanning the ankle, knee and hip adapt to co-contraction of ankle muscles is not well understood. This study aimed to identify the compensation strategies required to retain normal walking with excessive antagonistic ankle muscle co-contraction. Muscle-actuated simulations of normal walking were performed to quantify compensatory mechanisms of ankle and knee muscles during stance in the presence of normal, medium and high levels of co-contraction of antagonistic pairs gastrocnemius+tibialis anterior and soleus+tibialis anterior. The study showed that if co-contraction increases, the synergistic ankle muscles can compensate; with gastrocmemius+tibialis anterior co-contraction, the soleus will increase its contribution to ankle plantarflexion acceleration. At the knee, however, almost all muscles spanning the knee and hip are involved in compensation. We also found that ankle and knee muscles alone can provide sufficient compensation at the ankle joint, but hip muscles must be involved to generate sufficient knee moment. Our findings imply that subjects with a rather high level of dorsiflexor+plantarflexor co-contraction can still perform normal walking. This also suggests that capacity of other lower limb muscles to compensate is important to retain normal walking in co-contracted persons. The compensatory mechanisms can be useful in clinical interpretation of motion analyses, when secondary muscle co-contraction or other deficits may present simultaneously in subjects with motion disorders.

  17. Surgical versus conservative interventions for treating ankle fractures in adults (Review)

    NARCIS (Netherlands)

    Donken, C.C.M.A.; Al-Khateeb, H.; Verhofstad, M.H.J.; Laarhoven, C.J.H.M. van

    2012-01-01

    BACKGROUND: The annual incidence of ankle fractures is 122 per 100,000 people. They usually affect young men and older women. The question of whether surgery or conservative treatment should be used for ankle fractures remains controversial. OBJECTIVES: To assess the effects of surgical versus conse

  18. Foot and ankle history and clinical examination: A guide to everyday practice

    Science.gov (United States)

    Alazzawi, Sulaiman; Sukeik, Mohamed; King, Daniel; Vemulapalli, Krishna

    2017-01-01

    This review summarises the key points in taking a history and performing a comprehensive clinical examination for patients with foot and/or ankle problems. It is a useful guide for residents who are preparing for their specialty exams, as well as family doctors and any other doctor who has to deal with foot and ankle problems in adults. PMID:28144575

  19. Dynamic postural stability differences between male and female players with and without ankle sprain

    NARCIS (Netherlands)

    Dallinga, Joan M.; Does, van der Henrike T. D.; Benjaminse, Anne; Lemmink, Koen A. P. M.

    2016-01-01

    Objectives: To evaluate dynamic stability index (DSI) differences between males and females for different jump directions. To examine both preseason DSI differences between players with and without a history of ankle sprain, and between players with and without an ankle sprain during the subsequent

  20. Intra-articular Pressure Based Stress Analysis of the Distal Tibia Following Insertion of a Total Ankle Replacement

    OpenAIRE

    Soodmand, Ehsan; Natsakis, Tassos; Jonkers, Ilse; Vander Sloten, Jos

    2015-01-01

    The ankle joint plays an important role in transferring the human body weight to the ground. Given the associated loading, Osteoarthritis (OA) is one of the most common disorders in the ankle joint. The most common treatment of ankle OA is total ankle arthroplasty (TAA). However it is not known whether TAA influences the stress levels of the bone structures and specially the distal tibia. Clinical studies previously related the occurrence of tibia cysts to focal stress concentrations. In this...

  1. American Orthopaedic Foot and Ankle Society (AOFAS) Ankle-Hindfoot Score: a study protocol for the translation and validation of the Dutch language version

    Science.gov (United States)

    Van Lieshout, Esther M M; De Boer, A Siebe; Meuffels, Duncan E; Den Hoed, P Ted; Van der Vlies, Cornelis H; Tuinebreijer, Wim E; Verhofstad, Michael H J

    2017-01-01

    Introduction The American Orthopaedic Foot and Ankle Society (AOFAS) Ankle-Hindfoot Score is among the most commonly used instruments for measuring the outcome of treatment in patients who sustained a complex ankle or hindfoot injury. It combines a clinician-reported and a patient-reported part. A valid Dutch version of this instrument is currently not available. Such a translated and validated instrument would allow objective comparison across hospitals or between patient groups, and with shown validity and reliability it may become a quality of care indicator in future. The main aims of this study are to translate and culturally adapt the AOFAS Ankle-Hindfoot Score questionnaire into Dutch according to international guidelines, and to evaluate the measurement properties of the AOFAS Ankle-Hindfoot Score-Dutch language version (DLV) in patients with a unilateral ankle or hindfoot fracture. Methods and analysis The design of the study will be a multicentre prospective observational study (case series) in patients who presented to the emergency department with a unilateral ankle or hindfoot fracture or (fracture) dislocation. A research physician or research assistant will complete the AOFAS Ankle-Hindfoot Score-DLV based on interview for the subjective part and a physical examination for the objective part. In addition, patients will be asked to complete the Foot Function Index (FFI) and the Short Form-36 (SF-36). Descriptive statistics (including floor and ceiling effects), internal consistency, construct validity, reproducibility (ie, test–retest reliability, agreement and smallest detectable change) and responsiveness will be assessed for the AOFAS DLV. Ethics and dissemination This study has been exempted by the Medical Research Ethics Committee (MREC) Erasmus MC (Rotterdam, the Netherlands). Each participant will provide written consent to participate and remain anonymised during the study. The results of the study are planned to be published in an

  2. The Role of Ankle Proprioception for Balance Control in relation to Sports Performance and Injury.

    Science.gov (United States)

    Han, Jia; Anson, Judith; Waddington, Gordon; Adams, Roger; Liu, Yu

    2015-01-01

    Balance control improvement is one of the most important goals in sports and exercise. Better balance is strongly positively associated with enhanced athletic performance and negatively associated with lower limb sports injuries. Proprioception plays an essential role in balance control, and ankle proprioception is arguably the most important. This paper reviews ankle proprioception and explores synergies with balance control, specifically in a sporting context. Central processing of ankle proprioceptive information, along with other sensory information, enables integration for balance control. When assessing ankle proprioception, the most generalizable findings arise from methods that are ecologically valid, allow proprioceptive signals to be integrated with general vision in the central nervous system, and reflect the signal-in-noise nature of central processing. Ankle proprioceptive intervention concepts driven by such a central processing theory are further proposed and discussed for the improvement of balance control in sport.

  3. The Role of Ankle Proprioception for Balance Control in relation to Sports Performance and Injury

    Directory of Open Access Journals (Sweden)

    Jia Han

    2015-01-01

    Full Text Available Balance control improvement is one of the most important goals in sports and exercise. Better balance is strongly positively associated with enhanced athletic performance and negatively associated with lower limb sports injuries. Proprioception plays an essential role in balance control, and ankle proprioception is arguably the most important. This paper reviews ankle proprioception and explores synergies with balance control, specifically in a sporting context. Central processing of ankle proprioceptive information, along with other sensory information, enables integration for balance control. When assessing ankle proprioception, the most generalizable findings arise from methods that are ecologically valid, allow proprioceptive signals to be integrated with general vision in the central nervous system, and reflect the signal-in-noise nature of central processing. Ankle proprioceptive intervention concepts driven by such a central processing theory are further proposed and discussed for the improvement of balance control in sport.

  4. Supramalleolar osteotomies for degenerative joint disease of the ankle joint: indication, technique and results.

    Science.gov (United States)

    Barg, Alexej; Pagenstert, Geert I; Horisberger, Monika; Paul, Jochen; Gloyer, Marcel; Henninger, Heath B; Valderrabano, Victor

    2013-09-01

    Patients with varus or valgus hindfoot deformities usually present with asymmetric ankle osteoarthritis. In-vitro biomechanical studies have shown that varus or valgus hindfoot deformity may lead to altered load distribution in the tibiotalar joint which may result in medial (varus) or lateral (valgus) tibiotalar joint degeneration in the short or medium term. The treatment of asymmetric ankle osteoarthritis remains challenging, because more than half of the tibiotalar joint surface is usually preserved. Therefore, joint-sacrificing procedures like total ankle replacement or ankle arthrodesis may not be the most appropriate treatment options. The shortand midterm results following realignment surgery, are very promising with substantial pain relief and functional improvement observed post-operatively. In this review article we describe the indications, surgical techniques, and results from of realignment surgery of the ankle joint in the current literature.

  5. Ankle arthritis predicts polyarticular disease course and unfavourable outcome in children with juvenile idiopathic arthritis

    DEFF Research Database (Denmark)

    Esbjörnsson, Anna-Clara; Aalto, Kristiina; Broström, Eva W;

    2015-01-01

    the first eight years of disease. Ankle arthritis was least common in the persistent oligoarticular category (25%) and most common in children with extended oligoarticular (83%) and polyarticular RF-negative (85%) JIA. Children who developed ankle arthritis during the first year of disease were younger......OBJECTIVES: To evaluate the occurrence, clinical characteristics and prognostic factors associated with ankle arthritis in children with juvenile idiopathic arthritis (JIA). METHODS: 440 children with JIA were followed for eight years in a prospective Nordic population-based cohort study. Data...... on remission was available for 427 of these children. Occurrence of clinically assessed ankle arthritis was analysed in relation to JIA category, clinical characteristics and remission data eight years after disease onset. RESULTS: In 440 children with JIA, 251 (57%) experienced ankle arthritis during...

  6. The top 10 things foot and ankle specialists wish every primary care physician knew.

    Science.gov (United States)

    Paige, Neil M; Nouvong, Aksone

    2006-06-01

    Foot and ankle problems are common complaints of patients presenting to primary care physicians. These problems range from minor disorders, such as ankle sprains, plantar fasciitis, bunions, and iIngrown toenails, to more serious conditions such as Charcot arthropathy and Achilles tendon rupture. Early recognition and treatment of foot and ankle problems are imperative to avoid associated morbidities. Primary care physicians can address many of these complaints successfully but should be cognizant of which patients should be referred to a foot and ankle specialist to prevent common short-term and long-term complications. This article provides evidence-based pearls to assist primary care physicians in providing optimal care for their patients with foot and ankle complaints.

  7. Disentangling the contribution of the paretic and non-paretic ankle to balance control in stroke patients

    NARCIS (Netherlands)

    Asseldonk, van E.H.F.; Buurke, Jaap H.; Bloem, Bastiaan R.; Renzenbrink, Gerbert J.; Nene, Anand V.; Helm, van der Frans C.T.; Kooij, van der Herman

    2006-01-01

    During stroke recovery, restoration of the paretic ankle and compensation in the non-paretic ankle may contribute to improved balance maintenance. We examine a new approach to disentangle these recovery mechanisms by objectively quantifying the contribution of each ankle to balance maintenance. Eigh

  8. Disentangling the contribution of the paretic and non-paretic ankle to balance control in stroke patients.

    NARCIS (Netherlands)

    Asseldonk, E.H.F. van; Buurke, J.; Bloem, B.R.; Renzenbrink, G.J.; Nene, A.V.; Helm, F.C. van der; Kooij, H. van der

    2006-01-01

    During stroke recovery, restoration of the paretic ankle and compensation in the non-paretic ankle may contribute to improved balance maintenance. We examine a new approach to disentangle these recovery mechanisms by objectively quantifying the contribution of each ankle to balance maintenance. Eigh

  9. Dynamic ankle stability and ankle sprain occurrence in elite ball team athletes : a one season prospective study

    NARCIS (Netherlands)

    Does, Henrike van der; Dallinga, Joan; Benjaminse, Anne; Brink, Michel; Visscher, Chris; Lemmink, Koen

    2013-01-01

    To compare the dynamic stability index (DSI) measured at baseline between elite ball team athletes with and without an ankle sprain during the season. Methods Forty-four elite male (age:22.5±3.6yr,height:193.7±8.0cm,mass:87.1±10.9kg) and eighteen female (age:21.3±2.9yr,height:175.5±7.2cm,mass:68.7±1

  10. Mobility of the ankle joint: recording of rotatory movements in the talocrural joint in vitro with and without the lateral collateral ligaments of the ankle.

    Science.gov (United States)

    Rasmussen, O; Tovborg-Jensen, I

    1982-02-01

    A method for graphic recording of rotatory movements in osteoligamentous ankle preparations is described. By this method it is possible to record characteristic mobility patterns in two planes at the same time. The ankle is affected by a known torque, so that the individual mobility patterns are reproducible with unchanged condition of the ligaments. Six amputated legs were investigated in the sagittal and horizontal planes and another six in the sagittal and frontal planes. Mobility patterns were recorded with intact ligaments and after successive cutting of the lateral collateral ligaments of the ankle in the anteroposterior direction. In the sagittal plane increased dorsiflexion was observed after total cutting of the lateral ligaments, while plantar flexion remained unchanged. In the horizontal plane the internal rotation of the talus increased in step with increasing injury to the ligament, particularly when the ankle was plantar flexed. When all collateral ligaments had been cut, an increase in external rotation occurred, especially in dorsiflexion. In the frontal plane the talar tilt increased gradually with increasing injury to the ligaments. Talar tilt was at a maximum in the neutral position of the ankle or in plantar flexion. After total severing of the collateral ligaments, however, talar tilt was most marked in dorsiflexion of the ankle.

  11. Predisposing factors to lateral ankle injury in male comrades marathon runners

    Directory of Open Access Journals (Sweden)

    J. Hiemstra

    2009-02-01

    Full Text Available Introduction: More than two million people experience ankle ligament traumaeach year in the United States. Half of these are severe ligament sprains, however verylittle is known about the factors that predispose individuals to these injuries. The purpose of this study, (which was conducted as an undergraduate research project,was to find a correlation between the characteristics of height, weight and limbdominance and lateral ankle ligament injuries. Method: A  retrospective study was conducted on 114 ultra distance runners whoparticipated in the 2006 Comrades Marathon. During race registration, the runners’ height and weight were measuredafter answering a questionnaire regarding their training. Results: 114 runners responded to the questionnaire. From this cohort, 38 (33.3% had sustained previous lateral ankle injuries. Of these 38 injuries, 47.4% of the injuries occurred on the runner’s dominant limb and 36.8% occurred on thenon-dominant side. 15.8% of the runners sustained previous ankle injuries to both ankles. There was a low negative correlation coefficient of 0.24 with regards to weight as a risk factor. This indicated that the power of the correlationwas 5.93%. The study demonstrates that there is no correlation between an increase in weight and an increase in theincidence of ankle injury. The correlation coefficient indicated a low correlation between an increase in height and the incidence of ankle injury. However, the power of the correlation at 18.37% makes inaccurate any attempt to predict the height at which a runner would be at most risk for lateral ankle injury. Conclusion: Height and weight are not risk factors predisposing subjects to lateral ankle injury. In addition, the studyillustrated that there was no effect of limb dominance on the incidence of lateral ankle injury.

  12. Magnetic resonance imaging of the ankle in female ballet dancers en pointe

    Energy Technology Data Exchange (ETDEWEB)

    Russell, Jeffrey A. (Dept. of Dance, Univ. of California-Irvine, Irvine, CA (United States)), e-mail: jeff.russell@uci.edu; Shave, Ruth M. (Dept. of Radiology, Russells Hall Hospital, Dudley (United Kingdom)); Yoshioka, Hiroshi (Dept. of Radiological Sciences, Univ. of California-Irvine, Irvine, CA (United States)); Kruse, David W. (Dept. of Orthopaedic Surgery and Family Medicine, Univ. of California-Irvine, Irvine, CA (United States)); Koutedakis, Yiannis; Wyon, Matthew A. (School of Sport, Performing Arts and Leisure, Univ. of Wolverhampton, Walsall (United Kingdom))

    2010-07-15

    Background: Ballet dancers require extreme range of motion of the ankle, especially weight-bearing maximum plantar flexion (en pointe). In spite of a high prevalence of foot and ankle injuries in ballet dancers, the anatomy and pathoanatomy of this position have not been sufficiently studied in weight-bearing. Magnetic resonance imaging (MRI) is a beneficial method for such study. Purpose: To develop an MRI method of evaluating the ankles of female ballet dancers standing en pointe and to assess whether pathological findings from the MR images were associated with ankle pain reported by the subjects. Material and Methods: Nine female ballet dancers (age, 21+-2.9 years; dance experience, 16+-4.1 years; en pointe dance experience, 7+-4.9 years) completed an ankle pain visual analog scale questionnaire and underwent T1- and T2-weighted scans using a 0.25 T open MRI device. The ankle was scanned in three positions: supine with full plantar flexion, standing with the ankle in anatomical position, and standing en pointe. Results: Obtaining MR images of the ballet dancers en pointe was successful in spite of limitations imposed by the difficulty of remaining motionless in the en pointe position during scanning. MRI signs of ankle pathology and anatomical variants were observed. Convergence of the posterior edge of the tibial plafond, posterior talus, and superior calcaneus was noted in 100% of cases. Widened anterior joint congruity and synovitis/joint effusion were present in 71% and 67%, respectively. Anterior tibial and/or talar spurs and Stieda's process were each seen in 44%. However, clinical signs did not always correlate with pain reported by the subjects. Conclusion: This study successfully established an ankle imaging technique for ballet dancers en pointe that can be used in the future to assess the relationship between en pointe positioning and ankle pathoanatomy in ballet dancers

  13. Bony instability of the shoulder.

    Science.gov (United States)

    Bushnell, Brandon D; Creighton, R Alexander; Herring, Marion M

    2008-09-01

    Instability of the shoulder is a common problem treated by many orthopaedists. Instability can result from baseline intrinsic ligamentous laxity or a traumatic event-often a dislocation that injures the stabilizing structures of the glenohumeral joint. Many cases involve soft-tissue injury only and can be treated successfully with repair of the labrum and ligamentous tissues. Both open and arthroscopic approaches have been well described, with recent studies of arthroscopic soft-tissue techniques reporting results equal to those of the more traditional open techniques. Over the last decade, attention has focused on the concept of instability of the shoulder mediated by bony pathology such as a large bony Bankart lesion or an engaging Hill-Sachs lesion. Recent literature has identified unrecognized large bony lesions as a primary cause of failure of arthroscopic reconstruction for instability, a major cause of recurrent instability, and a difficult diagnosis to make. Thus, although such bony lesions may be relatively rare compared with soft-tissue pathology, they constitute a critically important entity in the management of shoulder instability. Smaller bony lesions may be amenable to arthroscopic treatment, but larger lesions often require open surgery to prevent recurrent instability. This article reviews recent developments in the diagnosis and treatment of bony instability.

  14. Cinerama sickness and postural instability

    NARCIS (Netherlands)

    Bos, J.E.; Ledegang, W.D.; Lubeck, A.J.A.; Stins, J.F.

    2013-01-01

    Motion sickness symptoms and increased postural instability induced by motion pictures have been reported in a laboratory, but not in a real cinema. We, therefore, carried out an observational study recording sickness severity and postural instability in 19 subjects before, immediately and 45 min af

  15. Marital instability after midlife.

    Science.gov (United States)

    Wu, Z; Penning, M J

    1997-09-01

    "Divorce in later life has been shown to produce dramatic declines in the economic, psychological, and physical well-being of marital partners. This study examines the prevalence and determinants of marital disruption after midlife using Becker's theory of marital instability. Using recent Canadian national data, the marital outcomes of women and men who were married as of age 40 are tracked across the remaining years of the marriage. Cox proportional hazard regression models indicate stabilizing effects of the duration of the marriage, the age at first marriage, the presence of young children, as well as of remarriage for middle-aged and older persons. Other significant risk factors include education, heterogamous marital status, premarital cohabitation, number of siblings, and region."

  16. Structural and Material Instability

    DEFF Research Database (Denmark)

    Cifuentes, Gustavo Cifuentes

    This work is a small contribution to the general problem of structural and material instability. In this work, the main subject is the analysis of cracking and failure of structural elements made from quasi-brittle materials like concrete. The analysis is made using the finite element method. Three...... use of interface elements) is used successfully to model cases where the path of the discontinuity is known in advance, as is the case of the analysis of pull-out of fibers embedded in a concrete matrix. This method is applied to the case of non-straight fibers and fibers with forces that have....... Numerical problems associated with the use of elements with embedded cracks based on the extended finite element method are presented in the next part of this work. And an alternative procedure is used in order to successfully remove these numerical problems. In the final part of this work, a computer...

  17. The bar instability revisited

    CERN Document Server

    Chiodi, Filippo; Claudin, Philippe

    2012-01-01

    The river bar instability is revisited, using a hydrodynamical model based on Reynolds averaged Navier-Stokes equations. The results are contrasted with the standard analysis based on shallow water Saint-Venant equations. We first show that the stability of both transverse modes (ripples) and of small wavelength inclined modes (bars) predicted by the Saint-Venant approach are artefacts of this hydrodynamical approximation. When using a more reliable hydrodynamical model, the dispersion relation does not present any maximum of the growth rate when the sediment transport is assumed to be locally saturated. The analysis therefore reveals the fundamental importance of the relaxation of sediment transport towards equilibrium as it it is responsible for the stabilisation of small wavelength modes. This dynamical mechanism is characterised by the saturation number, defined as the ratio of the saturation length to the water depth Lsat/H. This dimensionless number controls the transition from ripples (transverse patte...

  18. Instability and Information

    CERN Document Server

    Patzelt, Felix

    2015-01-01

    Many complex systems exhibit extreme events far more often than expected for a normal distribution. This work examines how self-similar bursts of activity across several orders of magnitude can emerge from first principles in systems that adapt to information. Surprising connections are found between two apparently unrelated research topics: hand-eye coordination in balancing tasks and speculative trading in financial markets. Seemingly paradoxically, locally minimising fluctuations can increase a dynamical system's sensitivity to unpredictable perturbations and thereby facilitate global catastrophes. This general principle is studied in several domain-specific models and in behavioural experiments. It explains many findings in both fields and resolves an apparent antinomy: the coexistence of stabilising control or market efficiency and perpetual instabilities resembling critical phenomena in physical systems.

  19. Wear study of Total Ankle Replacement explants by microstructural analysis.

    Science.gov (United States)

    Cottrino, S; Fabrègue, D; Cowie, A P; Besse, J-L; Tadier, S; Gremillard, L; Hartmann, D J

    2016-08-01

    The implantation of Total Ankle Replacement (TAR) prostheses generally gives satisfactory results. However, a high revision rate is associated with the Ankle Evolutive System (AES) implant, due to periprosthetic osteolysis that generates significant cortical lesions and bone cysts in the periprosthetic region. Radioclinical and histological analyses of peri-implant tissues show the presence of numerous foreign particles that may come from the implant. It is known that a precocious wear of materials may lead to an important rate of foreign body in tissues and may generate osteolysis lesions and inflammatory reactions. Thus the objectives of this retrospective study of 10 AES TAR implants (recovered after revision surgeries) are to understand how the prostheses wear out, which part is the most stressed and to determine the nature and size of foreign body particles. A better understanding of friction mechanisms between the three parts of the implant and of the nature and morphology of foreign particles generated was needed to explain the in vivo behavior of the implant. This was achieved using microstuctural and tomographic analysis of both implants parts and periprosthetic tissues.

  20. MORPHOMETRIC STUDY OF MEDIAL COLLATERAL LIGAMENTS OF ANKLE

    Directory of Open Access Journals (Sweden)

    Neelu Prasad

    2016-06-01

    Full Text Available BACKGROUND The ankle joint is one of the most frequently injured joint. A sprained ankle results due to tear of anterior talofibular and calcaneofibular ligaments when the foot is twisted in lateral direction. In forcible eversion of the foot, the deltoid ligament may be torn. At times, the deltoid ligament pulls the medial malleolus thereby causing avulsion fracture of the malleolus. The strong eversion pull on the deltoid ligament causes transverse fracture of medial malleolus. If the tibia is carried anteriorly, the posterior margin of the distal end of the tibia is also broken by the talus producing a trimalleolar fracture. The talocrural joint is a major weight bearing joint of the body. The weight of the body is transmitted from the tibia and fibula to the talus which distributes the weight anteriorly and posteriorly within the foot. One sixth of the static load of the leg is carried by the fibula at the tibiofibular joint. These require a high degree of stability which is determined by the passive and dynamic factors. A sprained ankle results due to tear of anterior talofibular and calcaneofibular ligaments when the foot is twisted in lateral direction. In forcible eversion of the foot, the deltoid ligament may be torn. At times, the deltoid ligament pulls the medial malleolus thereby causing avulsion fracture of the malleolus. The strong eversion pull on the deltoid ligament causes transverse fracture of medial malleolus. If the tibia is carried anteriorly, the posterior margin of the distal end of the tibia is also broken by the talus producing a trimalleolar fracture. Conventionally, X-ray techniques have been used to diagnose ligament injuries. Magnetic resonance (MR imaging has opened new horizons in the diagnosis and treatment of many musculoskeletal diseases of the ankle and foot. It demonstrates abnormalities in the bones and soft tissues before they become evident at other imaging modalities. The anatomy of the deltoid ligament

  1. Gravitational Instabilities in Circumstellar Disks

    CERN Document Server

    Kratter, Kaitlin M

    2016-01-01

    [Abridged] Star and planet formation are the complex outcomes of gravitational collapse and angular momentum transport mediated by protostellar and protoplanetary disks. In this review we focus on the role of gravitational instability in this process. We begin with a brief overview of the observational evidence for massive disks that might be subject to gravitational instability, and then highlight the diverse ways in which the instability manifests itself in protostellar and protoplanetary disks: the generation of spiral arms, small scale turbulence-like density fluctuations, and fragmentation of the disk itself. We present the analytic theory that describes the linear growth phase of the instability, supplemented with a survey of numerical simulations that aim to capture the non-linear evolution. We emphasize the role of thermodynamics and large scale infall in controlling the outcome of the instability. Despite apparent controversies in the literature, we show a remarkable level of agreement between analyt...

  2. Beam instability Workshop - plenary sessions

    Energy Technology Data Exchange (ETDEWEB)

    NONE

    2001-07-01

    The purpose of this workshop was to provide a review of the mechanisms of limiting beam instabilities, their cures, including feedback, and beam measurement for synchrotron radiation light sources. 12 plenary sessions took place whose titles are: 1) challenging brilliance and lifetime issues with increasing currents; 2) limiting instabilities in multibunch; 3) experience from high currents in B factories; 4) longitudinal dynamics in high intensity/bunch; 5) Transverse instabilities for high intensity/bunch; 6) working group introduction from ESRF experience; 7) impedance modelling: simulations, minimization; 8) report on the broadband impedance measurements and modelling workshop; 9) feedback systems for synchrotron light sources; 10) beam instabilities diagnostics; 11) harmonic cavities: the pros and cons; and 12) experimental study of fast beam-ion instabilities at PLS. This document gathers the 12 articles that were presented during these sessions.

  3. Equilibrium Electro-osmotic Instability

    CERN Document Server

    Rubinstein, Isaak

    2014-01-01

    Since its prediction fifteen years ago, electro-osmotic instability has been attributed to non-equilibrium electro-osmosis related to the extended space charge which develops at the limiting current in the course of concentration polarization at a charge-selective interface. This attribution had a double basis. Firstly, it has been recognized that equilibrium electro-osmosis cannot yield instability for a perfectly charge-selective solid. Secondly, it has been shown that non-equilibrium electro-osmosis can. First theoretical studies in which electro-osmotic instability was predicted and analyzed employed the assumption of perfect charge-selectivity for the sake of simplicity and so did the subsequent numerical studies of various time-dependent and nonlinear features of electro-osmotic instability. In this letter, we show that relaxing the assumption of perfect charge-selectivity (tantamount to fixing the electrochemical potential in the solid) allows for equilibrium electro-osmotic instability. Moreover, we s...

  4. Instability in Shocked Granular Gases

    CERN Document Server

    Sirmas, Nick; Radulescu, Matei

    2013-01-01

    Shocks in granular media, such as vertically oscillated beds, have been shown to develop instabilities. Similar jet formation has been observed in explosively dispersed granular media. Our previous work addressed this instability by performing discrete-particle simulations of inelastic media undergoing shock compression. By allowing finite dissipation within the shock wave, instability manifests itself as distinctive high density non-uniformities and convective rolls within the shock structure. In the present study we have extended this work to investigate this instability at the continuum level. We modeled the Euler equations for granular gases with a modified cooling rate to include an impact velocity threshold necessary for inelastic collisions. Our results showed a fair agreement between the continuum and discrete-particle models. Discrepancies, such as higher frequency instabilities in our continuum results may be attributed to the absence of higher order effects.

  5. Instability in shocked granular gases

    Science.gov (United States)

    Sirmas, Nick; Falle, Sam; Radulescu, Matei

    2014-05-01

    Shocks in granular media, such as vertically oscillated beds, have been shown to develop instabilities. Similar jet formation has been observed in explosively dispersed granular media. Our previous work addressed this instability by performing discrete-particle simulations of inelastic media undergoing shock compression. By allowing finite dissipation within the shock wave, instability manifests itself as distinctive high density non-uniformities and convective rolls within the shock structure. In the present study we have extended this work to investigate this instability at the continuum level. We modeled the Euler equations for granular gases with a modified cooling rate to include an impact velocity threshold necessary for inelastic collisions. Our results showed a fair agreement between the continuum and discrete-particle models. Discrepancies, such as higher frequency instabilities in our continuum results may be attributed to the absence of higher order effects.

  6. Gravitational Instabilities in Circumstellar Disks

    Science.gov (United States)

    Kratter, Kaitlin; Lodato, Giuseppe

    2016-09-01

    Star and planet formation are the complex outcomes of gravitational collapse and angular momentum transport mediated by protostellar and protoplanetary disks. In this review, we focus on the role of gravitational instability in this process. We begin with a brief overview of the observational evidence for massive disks that might be subject to gravitational instability and then highlight the diverse ways in which the instability manifests itself in protostellar and protoplanetary disks: the generation of spiral arms, small-scale turbulence-like density fluctuations, and fragmentation of the disk itself. We present the analytic theory that describes the linear growth phase of the instability supplemented with a survey of numerical simulations that aim to capture the nonlinear evolution. We emphasize the role of thermodynamics and large-scale infall in controlling the outcome of the instability. Despite apparent controversies in the literature, we show a remarkable level of agreement between analytic predictions and numerical results. In the next part of our review, we focus on the astrophysical consequences of the instability. We show that the disks most likely to be gravitationally unstable are young and relatively massive compared with their host star, Md/M*≥0.1. They will develop quasi-stable spiral arms that process infall from the background cloud. Although instability is less likely at later times, once infall becomes less important, the manifestations of the instability are more varied. In this regime, the disk thermodynamics, often regulated by stellar irradiation, dictates the development and evolution of the instability. In some cases the instability may lead to fragmentation into bound companions. These companions are more likely to be brown dwarfs or stars than planetary mass objects. Finally, we highlight open questions related to the development of a turbulent cascade in thin disks and the role of mode-mode coupling in setting the maximum angular

  7. Multiple chronic non-specific ulcer of small intestine characterized by anemia and hypoalbuminemia

    Institute of Scientific and Technical Information of China (English)

    2010-01-01

    A female patient with anemia and hypoalbuminemia was admitted to our hospital due to an over 20-year history of recurrent dizziness,fatigue and ankle edema.She was diagnosed as multiple chronic nonspecific ulcer of the small intestine characterized by non-specific histology and persistent gastrointestinal bleeding.

  8. Conservative treatment of an anterior-lateral ankle dislocation without an associated fracture in a diabetic patient: a case report

    Directory of Open Access Journals (Sweden)

    Panagiotis K. Karampinas

    2012-06-01

    Full Text Available Anterior or anterior-lateral dislocation of the ankle is a rare condition that can be treated conservatively as well as any other similar types of ankle dislocations without associated fractures. We present a case report of an anterior-lateral ankle dislocation with a concomitant avulsion injury of the ankle's anterior capsule in a diabetic patient that was treated conservatively. At the patient's visit 12 months after the initial injury, he was asymptomatic with full range of motion of the ankle joint. To our knowledge, we could not identify this type of an injury in a diabetic patient that was treated successfully with conservative treatment in the existing literature.

  9. Incidence of Complications During the Surgeon Learning Curve Period for Primary Total Ankle Replacement: A Systematic Review.

    Science.gov (United States)

    Simonson, Devin C; Roukis, Thomas S

    2015-10-01

    Surgeons performing primary total ankle replacement have achieved outcomes comparable to ankle arthrodesis. However, while many reports exist suggesting the presence of a surgeon learning curve period during initial performance of primary total ankle replacement, no published analysis of the actual incidence of complications encountered during this period exists. Therefore, we sought to provide such an analysis through systematic review. A total of 2453 primary total ankle replacements with 1085 complications (44.2%) were identified. Our results revealed conflicting data whether an acceptably low incidence of high-grade complications leading to total ankle replacement failure exists during the surgeon learning curve period.

  10. Abelianization of QCD plasma instabilities

    Science.gov (United States)

    Arnold, Peter; Lenaghan, Jonathan

    2004-12-01

    QCD plasma instabilities appear to play an important role in the equilibration of quark-gluon plasmas in heavy-ion collisions in the theoretical limit of weak coupling (i.e. asymptotically high energy). It is important to understand what nonlinear physics eventually stops the exponential growth of unstable modes. It is already known that the initial growth of plasma instabilities in QCD closely parallels that in QED. However, once the unstable modes of the gauge fields grow large enough for non-Abelian interactions between them to become important, one might guess that the dynamics of QCD plasma instabilities and QED plasma instabilities become very different. In this paper, we give suggestive arguments that non-Abelian self-interactions between the unstable modes are ineffective at stopping instability growth, and that the growing non-Abelian gauge fields become approximately Abelian after a certain stage in their growth. This in turn suggests that understanding the development of QCD plasma instabilities in the nonlinear regime may have close parallels to similar processes in traditional plasma physics. We conjecture that the physics of collisionless plasma instabilities in SU(2) and SU(3) gauge theory becomes equivalent, respectively, to (i) traditional plasma physics, which is U(1) gauge theory, and (ii) plasma physics of U(1)×U(1) gauge theory.

  11. Full Scale 3D Preoperative Planning System of the Ankle Joint Replacement Surgery with Multimedia System

    Directory of Open Access Journals (Sweden)

    Shuh-Ping Sun

    2014-05-01

    Full Text Available This study is intended to develop a computer-aided pre-surgical planning and simulating system in a multimedia environment for ankle joint replacement surgery. This system uses full-scale 3D reverse engineering techniques in design and development of the pre-surgical planning modules for ankle joint replacement surgery. This planning system not only develops the real-scale 3D image of the artificial ankle joint but also provides a detailed interior measurement of the ankle joint from various cutting planes. In this study, we apply the multimedia user interface to integrate different software functions into a surgical planning system with integrated functions. The functions include 3D model image acquisition, cutting, horizontal shifting and rotation of related bones (tibia and talus of the ankle joint in the predetermined time. For related bones of the ankle joint, it can also be used to design artificial ankle joints for adults in Taiwan. Those planning procedures can be recorded in this system for further research and investigation. Furthermore, since this system is a multimedia user interface, surgeons can use this system to plan and find a better and more efficient surgical approach before surgery. A database is available for this system to update and expand, which can provide different users with clinical cases as per their experience and learning.

  12. Dynamic high-resolution US of ankle and midfoot ligaments: normal anatomic structure and imaging technique.

    Science.gov (United States)

    Sconfienza, Luca Maria; Orlandi, Davide; Lacelli, Francesca; Serafini, Giovanni; Silvestri, Enzo

    2015-01-01

    The ankle is the most frequently injured major joint in the body, and ankle sprains are frequently encountered in individuals playing football, basketball, and other team sports, in addition to occurring in the general population. Imaging plays a crucial role in the evaluation of ankle ligaments. Magnetic resonance imaging has been proven to provide excellent evaluation of ligaments around the ankle, with the ability to show associated intraarticular abnormalities, joint effusion, and bone marrow edema. Ultrasonography (US) performed with high-resolution broadband linear-array probes has become increasingly important in the assessment of ligaments around the ankle because it is low cost, fast, readily available, and free of ionizing radiation. US can provide a detailed depiction of normal anatomic structures and is effective for evaluating ligament integrity. In addition, US allows the performance of dynamic maneuvers, which may contribute to increased visibility of normal ligaments and improved detection of tears. In this article, the authors describe the US techniques for evaluation of the ankle and midfoot ligaments and include a brief review of the literature related to their basic anatomic structures and US of these structures. Short video clips showing dynamic maneuvers and dynamic real-time US of ankle and midfoot structures and their principal pathologic patterns are included as supplemental material. Use of a standardized imaging technique may help reduce the intrinsic operator dependence of US. Online supplemental material is available for this article.

  13. Which Are the Most Frequently Used Outcome Instruments in Studies on Total Ankle Arthroplasty?

    Science.gov (United States)

    Impellizzeri, Franco M.; Rippstein, Pascal F.

    2009-01-01

    The number of studies reporting on outcomes after total ankle arthroplasty is continuously increasing. As the use of valid outcome measures represents the cornerstone for successful clinical research, we aimed to identify the most frequently used outcome instruments in ankle arthroplasty studies and to analyze the evidence to support their use in terms of different quality criteria. A systematic review of the literature identified 15 outcome instruments reported in 79 original studies. The most commonly used measures were the American Orthopaedic Foot and Ankle Society hindfoot score (n = 41), the Kofoed ankle score (n = 21), a visual analog scale assessing pain (n = 15), and the generic SF-36 (n = 6). Eight additional instruments were used only once or twice. The American Orthopaedic Foot and Ankle Society and Kofoed instruments include a clinical examination and score up to 100 points. Evidence to support their use in terms of validity, reliability, responsiveness, and interpretability is limited, raising the question whether their use is justified. Self-reported questionnaires related to ankle osteoarthritis or arthroplasty are rather disregarded in the current literature, and only the Foot Function Index is associated with evidence in terms of the above-mentioned quality criteria. Future research is warranted to improve the outcome assessment after total ankle arthroplasty. PMID:19672670

  14. Ankle Proprioception Pattern in Women Across Various Trimesters of Pregnancy and Postpartum

    Directory of Open Access Journals (Sweden)

    Ramachandra P

    2016-01-01

    Full Text Available Background and Objectives: Ankle foot complex is the part of the body which is in contact with the ground and it is important to have an intact proprioceptive system in order to maintain postural control. Previous study has established that there is significant difference between ankle proprioception in pregnant women in their third trimester and non-pregnant women. There is lack of literature regarding when the ankle does the ankle proprioception gets affected during pregnancy and whether this change reverts back during postpartum and hence this study. Method: A cohort of 70 primiparous women were included in the study and the women were followed through 12th week, 24th week, 32nd week , immediate postpartum and 6 weeks postpartum. The ankle repositioning error was measured using photography method and was analyzed using UTHSCSA Image tool software. Repeated measures ANOVA was used to measure the differences across various time periods. Results: It was found that there was a significant differences (p<0.001 in ankle repositioning error in pregnant women across the trimesters and in the postpartum period and the value did not reach the first trimester value even after six weeks postpartum. Conclusion: Ankle proprioception was significantly affected across the various trimesters of pregnancy with the peak variability observed in the third trimester and the value did not reach back to the first trimester value even after 6 weeks postpartum.

  15. Powered ankle-foot prosthesis for the improvement of amputee ambulation.

    Science.gov (United States)

    Au, Samuel K; Herr, Hugh; Weber, Jeff; Martinez-Villalpando, Ernesto C

    2007-01-01

    This paper presents the mechanical design, control scheme, and clinical evaluation of a novel, motorized ankle-foot prosthesis, called MIT Powered Ankle-Foot Prosthesis. Unlike a conventional passive-elastic ankle-foot prosthesis, this prosthesis can provide active mechanical power during the stance period of walking. The basic architecture of the prosthesis is a unidirectional spring, configured in parallel with a force-controllable actuator with series elasticity. With this architecture, the anklefoot prosthesis matches the size and weight of the human ankle, and is also capable of delivering high mechanical power and torque observed in normal human walking. We also propose a biomimetic control scheme that allows the prosthesis to mimic the normal human ankle behavior during walking. To evaluate the performance of the prosthesis, we measured the rate of oxygen consumption of three unilateral transtibial amputees walking at self-selected speeds to estimate the metabolic walking economy. We find that the powered prosthesis improves amputee metabolic economy from 7% to 20% compared to the conventional passive-elastic prostheses (Flex-Foot Ceterus and Freedom Innovations Sierra), even though the powered system is twofold heavier than the conventional devices. This result highlights the benefit of performing net positive work at the ankle joint to amputee ambulation and also suggests a new direction for further advancement of an ankle-foot prosthesis.

  16. The Effect of Prosthetic Ankle Units on Roll-Over Shape Characteristics During Walking in Persons with Bilateral Transtibial Amputations

    Science.gov (United States)

    Gard, Steven A.; Su, Po-Fu; Lipschutz, Robert D.; Hansen, Andrew H.

    2015-01-01

    Some important functions of walking are adversely affected or eliminated in prosthesis users due to reduced or absent ankle motion. The purpose of this retrospective data analysis was to determine the effect of prosthetic ankle units on the characteristics of the ankle-foot roll-over shape in persons with bilateral transtibial amputations. Seventeen subjects were fitted with Endolite Multiflex Ankles to provide ankle plantar/dorsiflexion during the stance phase of gait. Two quantitative gait analyses were performed as subjects walked with (1) Seattle Lightfoot II feet (baseline condition) and (2) with the prosthetic ankle units added. Roll-over shape radii and effective foot length ratio were calculated and compared for the two prosthetic configurations. When subjects walked with the ankle units, ankle motion increased (p<0.001), peak ankle plantarflexion moment during stance decreased slightly, and ankle-foot roll-over shape radii were significantly less (p<0.001) compared to the baseline condition. The effective foot length ratio of the roll-over shape was found to increase with walking speed (p<0.001), but it was not significantly affected by the prosthetic ankle units (p=0.066). Prosthetists and manufacturers are encouraged to consider the effect of combining prosthetic components on the overall characteristics of the prosthesis and the functions they impart to the user. PMID:22234709

  17. Tongue-placed tactile biofeedback suppresses the deleterious effects of muscle fatigue on joint position sense at the ankle

    CERN Document Server

    Vuillerme, Nicolas; Chenu, Olivier; Demongeot, Jacques; Payan, Yohan

    2007-01-01

    Whereas the acuity of the position sense at the ankle can be disturbed by muscle fatigue, it recently also has been shown to be improved, under normal ankle neuromuscular state, through the use of an artificial tongue-placed tactile biofeedback. The underlying principle of this biofeedback consisted of supplying individuals with supplementary information about the position of their matching ankle position relative to their reference ankle position through electrotactile stimulation of the tongue. Within this context, the purpose of the present experiment was to investigate whether this biofeedback could mitigate the deleterious effect of muscle fatigue on joint position sense at the ankle. To address this objective, sixteen young healthy university students were asked to perform an active ankle-matching task in two conditions of No-fatigue and Fatigue of the ankle muscles and two conditions of No-biofeedback and Biofeedback. Measures of the overall accuracy and the variability of the positioning were determin...

  18. Instability of ties in compression

    DEFF Research Database (Denmark)

    Buch-Hansen, Thomas Cornelius

    2013-01-01

    Masonry cavity walls are loaded by wind pressure and vertical load from upper floors. These loads results in bending moments and compression forces in the ties connecting the outer and the inner wall in a cavity wall. Large cavity walls are furthermore loaded by differential movements from...... exact instability solutions are complex to derive, not to mention the extra complexity introducing dimensional instability from the temperature gradients. Using an inverse variable substitution and comparing an exact theory with an analytical instability solution a method to design tie...

  19. Microsatellite instability in bladder cancer

    DEFF Research Database (Denmark)

    Gonzalez-Zulueta, M; Ruppert, J M; Tokino, K;

    1993-01-01

    Somatic instability at microsatellite repeats was detected in 6 of 200 transitional cell carcinomas of the bladder. Instabilities were apparent as changes in (GT)n repeat lengths on human chromosome 9 for four tumors and as alterations in a (CAG)n repeat in the androgen receptor gene on the X...... chromosome for three tumors. Single locus alterations were detected in three tumors, while three other tumors revealed changes in two or more loci. In one tumor we found microsatellite instability in all five loci analyzed on chromosome 9. The alterations detected were either minor 2-base pair changes...

  20. Ankle arthrodesis fusion rates for mesenchymal stem cell bone allograft versus proximal tibia autograft.

    Science.gov (United States)

    Anderson, John J; Boone, Joshua J; Hansen, Myron; Brady, Chad; Gough, Adam; Swayzee, Zflan

    2014-01-01

    Ankle arthrodesis is commonly used in the treatment of ankle arthritis. The present study compared mesenchymal stem cell (MSC) bone allografts and proximal tibia autografts as adjuncts in performing ankle arthrodesis. A total of 109 consecutive ankle fusions performed from 2002 to 2008 were evaluated retrospectively. Of the 109 fusions, 24 were excluded from the present study, leaving 85 patients who had undergone ankle arthrodesis. Of the 85 patients, 41 had received a proximal tibia autograft and 44, an MSC bone allograft. These 2 groups were reviewed and compared retrospectively at least 2 years postoperatively for the overall fusion rate, interval to radiographic fusion, and interval to clinical fusion. A modified and adjusted American College of Foot and Ankle Surgeons ankle scale was used to measure patient satisfaction. The overall fusion rate was 84.1% in the MSC bone allograft group and 95.1% in the proximal tibia autograft group (p = .158). The corresponding mean intervals to radiographic fusion were 13.0 ± 2.5 weeks and 11.3 ± 2.8 weeks (p ≤ .001). The interval to clinical fusion was 13.1 ± 2.1 weeks and 11.0 ± 1.5 weeks (p ≤ .001) in the MSC bone allograft and proximal tibia autograft group, respectively. No statistically significant difference was found in the fusion rates between the MSC bone allograft and proximal tibia autograft groups. Also, no statistically significant difference was found between the preoperative and postoperative scores using a modified and adjusted American College of Foot and Ankle Surgeons ankle scale between the 2 groups (p = .41 and p = .44, respectively). A statistically significant delay to radiographic and clinical fusion was present in the MSC bone allograft group compared with the proximal tibia autograft group; however, no difference was found in patient satisfaction.

  1. Biochemical T2* MR quantification of ankle arthrosis in pes cavovarus.

    Science.gov (United States)

    Krause, Fabian G; Klammer, Georg; Benneker, Lorin M; Werlen, Stefan; Mamisch, Tallal C; Weber, Martin

    2010-12-01

    Pes cavovarus affects the ankle biomechanics and may lead to ankle arthrosis. Quantitative T2 STAR (T2*) magnetic resonance (MR) mapping allows high resolution of thin cartilage layers and quantitative grading of cartilage degeneration. Detection of ankle arthrosis using T2* mapping in cavovarus feet was evaluated. Eleven cavovarus patients with symptomatic ankle arthrosis (13 feet, mean age 55.6 years, group 1), 10 cavovarus patients with no or asymptomatic, mild ankle arthrosis (12 feet, mean age 41.8 years, group 2), and 11 controls without foot deformity (18 feet, mean age 29.8 years, group 3) had quantitative T2* MR mapping. Additional assessment included plain radiographs and the American Orthopaedic Foot and Ankle Society (AOFAS) score (groups 1 and 2 only). Mean global T2* relaxation time was significantly different between groups 1 and 2 (p = 0.001) and groups 1 and 3 (p = 0.017), but there was no significance for decreased global T2* values in group 2 compared to group 3 (p = 0.345). Compared to the medial compartment T2* values of the lateral compartment were significantly (p = 0.025) higher within group 1. T2* values in the medial ankle joint compartment of group 2 were significantly lower than those of group 1 (p = 0.019). Ankle arthrosis on plain radiographs and the AOFAS score correlated significantly with T2* values in the medial compartment of group 1 (p = 0.04 and 0.039, respectively). Biochemical, quantitative T2* MR mapping is likely effective to evaluate ankle arthrosis in cavovarus feet but further studies are required.

  2. Three-dimensional ankle moments and nonlinear summation of rat triceps surae muscles.

    Science.gov (United States)

    Tijs, Chris; van Dieën, Jaap H; Baan, Guus C; Maas, Huub

    2014-01-01

    The Achilles tendon and epimuscular connective tissues mechanically link the triceps surae muscles. These pathways may cause joint moments exerted by each muscle individually not to sum linearly, both in magnitude and direction. The aims were (i) to assess effects of sagittal plane ankle angle (varied between 150° and 70°) on isometric ankle moments, in both magnitude and direction, exerted by active rat triceps surae muscles, (ii) to assess ankle moment summation between those muscles for a range of ankle angles and (iii) to assess effects of sagittal plane ankle angle and muscle activation on Achilles tendon length. At each ankle angle, soleus (SO) and gastrocnemius (GA) muscles were first excited separately to assess ankle-angle moment characteristics and subsequently both muscles were excited simultaneously to investigate moment summation. The magnitude of ankle moment exerted by SO and GA, the SO direction in the transverse and sagittal planes, and the GA direction in the transverse plane were significantly affected by ankle angle. SO moment direction in the frontal and sagittal planes were significantly different from that of GA. Nonlinear magnitude summation varied between 0.6±2.9% and -3.6±2.9%, while the nonlinear direction summation varied between 0.3±0.4° and -0.4±0.7° in the transverse plane, between 0.5±0.4° and 0.1±0.4° in the frontal plane, and between 3.0±7.9° and 0.3±2.3° in the sagittal plane. Changes in tendon length caused by SO contraction were significantly lower than those during contraction of GA and GA+SO simultaneously. Thus, moments exerted by GA and SO sum nonlinearly both in the magnitude and direction. The limited degree of nonlinear summation may be explained by different mechanisms acting in opposite directions.

  3. Three-dimensional ankle moments and nonlinear summation of rat triceps surae muscles.

    Directory of Open Access Journals (Sweden)

    Chris Tijs

    Full Text Available The Achilles tendon and epimuscular connective tissues mechanically link the triceps surae muscles. These pathways may cause joint moments exerted by each muscle individually not to sum linearly, both in magnitude and direction. The aims were (i to assess effects of sagittal plane ankle angle (varied between 150° and 70° on isometric ankle moments, in both magnitude and direction, exerted by active rat triceps surae muscles, (ii to assess ankle moment summation between those muscles for a range of ankle angles and (iii to assess effects of sagittal plane ankle angle and muscle activation on Achilles tendon length. At each ankle angle, soleus (SO and gastrocnemius (GA muscles were first excited separately to assess ankle-angle moment characteristics and subsequently both muscles were excited simultaneously to investigate moment summation. The magnitude of ankle moment exerted by SO and GA, the SO direction in the transverse and sagittal planes, and the GA direction in the transverse plane were significantly affected by ankle angle. SO moment direction in the frontal and sagittal planes were significantly different from that of GA. Nonlinear magnitude summation varied between 0.6±2.9% and -3.6±2.9%, while the nonlinear direction summation varied between 0.3±0.4° and -0.4±0.7° in the transverse plane, between 0.5±0.4° and 0.1±0.4° in the frontal plane, and between 3.0±7.9° and 0.3±2.3° in the sagittal plane. Changes in tendon length caused by SO contraction were significantly lower than those during contraction of GA and GA+SO simultaneously. Thus, moments exerted by GA and SO sum nonlinearly both in the magnitude and direction. The limited degree of nonlinear summation may be explained by different mechanisms acting in opposite directions.

  4. Analysis of 3-dimensional finite element after reconstruction of impaired ankle deltoid ligament.

    Science.gov (United States)

    Ji, Yunhan; Tang, Xianzhong; Li, Yifan; Xu, Wei; Qiu, Wenjun

    2016-12-01

    We compared four repair techniques for impaired ankle ligament deltoideum, namely Wiltberger, Deland, Kitaoka and Hintermann using a 3-dimensional finite element. We built an ankle ligament deltoideum model, including six pieces of bone structures, gristles and main ligaments around the ankle. After testing the model, we built an impaired ligament deltoideum model plus four reconstruction models. Subsequently, different levels of force on ankles with different flexion were imposed and ankle biomechanics were compared. In the course of bending, from plantar flexion 20° to back flexion 20°, the extortion of talus decreased while the eversion increased. Four reconstruction models failed to bring back the impaired ankle to normal, with an obvious increase of extortion and eversion. The Kitaoka technique was useful to reduce the extortion angle in a consequential manner. Compared with the other three techniques, the Kitaoka technique produced better results for extortion angle and the difference was statistically significant. However, in case of eversion, there was no significant difference among the four techniques (P>0.05). Lateral ligament's stress in all the four models was different from the normal one. When the ankle was imposed with extortion moment of force, stress of anterior talofibular ligament with the Kitaoka reconstruction method was close to that of the complete deltoid ligament. When ankle was imposed with eversion moment of force, stress of anterior talofibular ligament with Kitaoka and Deland reconstruction methods were close to that of the complete deltoid ligament. We concluded that Kitaoka and Deland tendon reconstruction technique could recover impaired ankle deltoid ligament and re-established its normal biomechanics characteristics.

  5. Arthroscopic and open management of posterolateral rotatory instability of the elbow.

    Science.gov (United States)

    O'Brien, Michael J; Savoie, Felix H

    2014-09-01

    Posterolateral rotatory instability (PLRI) is the most common cause of residual instability following a simple elbow dislocation. PLRI may result from trauma or iatrogenic injury to the radial ulnohumeral ligament during treatment for other conditions, such as lateral epicondylitis. PLRI can be identified through a combination of history and physical examination, and confirmed with magnetic resonance imaging arthrography. Once diagnosed, surgery is necessary to correct persistent instability. Instability can be confirmed arthroscopically through several findings, including subluxation of the radial head on the capitellum and the arthroscopic "drive through sign of the elbow." Acute repairs, both open and arthroscopic, heal with excellent patient outcomes. In the chronic setting, graft reconstruction may be required. This report describes arthroscopic repair of the radial ulnohumeral ligament and open reconstruction with associated outcomes. A high index of suspicion is necessary to correctly diagnosis this condition in patients with lateral elbow pain and feelings of instability.

  6. Foot and ankle injuries during the Athens 2004 Olympic Games

    Directory of Open Access Journals (Sweden)

    Mirones Steven

    2009-04-01

    Full Text Available Abstract Background Major, rare and complex incidents can occur at any mass-gathering sporting event and team medical staff should be appropriately prepared for these. One such event, the Athens Olympic Games in 2004, presented a significant sporting and medical challenge. This study concerns an epidemiological analysis of foot and ankle injuries during the Games. Methods An observational, epidemiological survey was used to analyse injuries in all sport tournaments (men's and women's over the period of the Games. Results A total of 624 injuries (525 soft tissue injuries and 99 bony injuries were reported. The most frequent diagnoses were contusions, sprains, fractures, dislocations and lacerations. Significantly more injuries in male (58% versus female athletes (42% were recorded. The incidence, diagnosis and cause of injuries differed substantially between the team sports. Conclusion Our experience from the Athens Olympic Games will inform the development of public health surveillance systems for future Olympic Games, as well as other similar mass events.

  7. Bird embryos uncover homology and evolution of the dinosaur ankle.

    Science.gov (United States)

    Ossa-Fuentes, Luis; Mpodozis, Jorge; Vargas, Alexander O

    2015-11-13

    The anklebone (astragalus) of dinosaurs presents a characteristic upward projection, the 'ascending process' (ASC). The ASC is present in modern birds, but develops a separate ossification centre, and projects from the calcaneum in most species. These differences have been argued to make it non-comparable to dinosaurs. We studied ASC development in six different orders of birds using traditional techniques and spin-disc microscopy for whole-mount immunofluorescence. Unexpectedly, we found the ASC derives from the embryonic intermedium, an ancient element of the tetrapod ankle. In some birds it comes in contact with the astragalus, and, in others, with the calcaneum. The fact that the intermedium fails to fuse early with the tibiale and develops an ossification centre is unlike any other amniotes, yet resembles basal, amphibian-grade tetrapods. The ASC originated in early dinosaurs along changes to upright posture and locomotion, revealing an intriguing combination of functional innovation and reversion in its evolution.

  8. Management of diabetic neuropathic foot and ankle malunions and nonunions

    Directory of Open Access Journals (Sweden)

    John J. Stapleton

    2011-05-01

    Full Text Available The management of diabetic neuropathic foot and ankle malunions and/or nonunions is often complicated by the presence of broken or loosened hardware, Charcot joints, infection, osteomyelitis, avascular bone necrosis, unstable deformities, bone loss, disuse and pathologic osteopenia, and ulcerations. The author discusses a rational approach to functional limb salvage with various surgical techniques that are aimed at achieving anatomic alignment, long-term osseous stability, and adequate soft tissue coverage. Emphasis is placed on techniques to overcome the inherent challenges that are encountered when surgically managing a diabetic nonunion and/or malunion. Particular attention is directed to the management of deep infection and Charcot neuroarthropathy in the majority of the cases presented.

  9. Bird embryos uncover homology and evolution of the dinosaur ankle

    Science.gov (United States)

    Ossa-Fuentes, Luis; Mpodozis, Jorge; Vargas, Alexander O

    2015-01-01

    The anklebone (astragalus) of dinosaurs presents a characteristic upward projection, the ‘ascending process' (ASC). The ASC is present in modern birds, but develops a separate ossification centre, and projects from the calcaneum in most species. These differences have been argued to make it non-comparable to dinosaurs. We studied ASC development in six different orders of birds using traditional techniques and spin–disc microscopy for whole-mount immunofluorescence. Unexpectedly, we found the ASC derives from the embryonic intermedium, an ancient element of the tetrapod ankle. In some birds it comes in contact with the astragalus, and, in others, with the calcaneum. The fact that the intermedium fails to fuse early with the tibiale and develops an ossification centre is unlike any other amniotes, yet resembles basal, amphibian-grade tetrapods. The ASC originated in early dinosaurs along changes to upright posture and locomotion, revealing an intriguing combination of functional innovation and reversion in its evolution. PMID:26563435

  10. Finite element stress analysis of some ankle joint prostheses.

    Science.gov (United States)

    Falsig, J; Hvid, I; Jensen, N C

    1986-05-01

    A three-dimensional finite element stress analysis was employed to calculate stresses in a distal tibia modelled with three simple total ankle joint replacement tibial components. The bone was modelled as a composite structure consisting of cortical and trabecular bone in which the trabecular bone was either homogeneous with a constant modulus of elasticity or heterogenous with experimentally determined heterogeneity. The results were sensitive to variations in trabecular bone material property distributions, with lower stresses being calculated in the heterogeneous model. An anterolateral application of load, which proved the least favourable, was used in comparing the prosthetic variants. Normal and shear stresses at the trabecular bone-cement interface and supporting trabecular bone were slightly reduced by addition of metal backing to the polyethylene articular surface, and a further reduction to very low values was obtained by addition of a long intramedullary peg bypassing stresses to the cortical bone.

  11. Effects of Ankle Braces Upon Agility Course Performance in High School Athletes

    OpenAIRE

    Beriau, Mark R.; Cox, William B.; Manning, James

    1994-01-01

    The purpose of this study was to compare the effects of wearing the AircastTM Sports Stirrup, AircastTM Training brace, Swede-OTM brace, and DonJoyTM Ankle Ligament Protector while running an agility course. Eighty-five high school athletes with no history of ankle injury and no experience in wearing any ankle support served as subjects. Each subject participated in four separate testing sessions. During sessions 1 and 4, subjects ran the agility course under the control (unbraced) conditions...

  12. Measurement device for ankle joint kinematic and dynamic characterisation.

    Science.gov (United States)

    Giacomozzi, C; Cesinaro, S; Basile, F; De Angelis, G; Giansanti, D; Maccioni, G; Masci, E; Panella, A; Paolizzi, M; Torre, M; Valentini, P; Macellari, V

    2003-07-01

    The paper describes a measurement device for obtaining the kinematic characterisation and isometric loading of ankle joints under different working conditions. Non-invasive, in vivo experiments can be conducted with this experimental apparatus, the potential of which could be usefully exploited in basic biomedical research, prosthesis design, clinical applications, sports medicine and rehabilitation. The device determines the 3D movement of the foot with respect to the shank and evaluates the torques and moments around the three articular axes in relation to any desired angular position of the ankle complex. When integrated with superficial electromyographic techniques and electrical stimulation, it allows the assessment of the functionality of the lower leg in both mechanical and myo-electrical terms. The paper reports the main mechanical and electronic features of the device (high linearity; maximum moment ranges +/- 300 Nm for flexion-extension, +/- 35 Nm for both pronation-supination and internal-external rotation; angular ranges: +/- 100 degrees of dorsi-plantar flexion, +/- 50 degrees of internal-external rotation and prono-supination; linear ranges: +/- 25 mm along each axis). Results from a healthy volunteer, under voluntary or stimulated conditions, helped in testing its operatability, reliability, robustness, repeatability and effectiveness. Preliminary simplified protocols have been also applied to 20 healthy volunteers, and the main results were 80.8 +/- 11.9 degrees of internalexternal rotation, 46.2 +/- 9.1 degrees of prono-supination and 74.6 +/- 13.1 degrees of flexion-extension. Torques and moments were normalised with respect to a body mass index of 30. The maximum plantar flexion moment (57.5 + 21.3 Nm) was measured with the foot at 150 of dorsal flexion; the maximum dorsal flexion moment (50.2 + 20.3 Nm) was measured with the foot at 150 of plantar flexion.

  13. Joint stiffness of the ankle and the knee in running.

    Science.gov (United States)

    Günther, Michael; Blickhan, Reinhard

    2002-11-01

    The spring-mass model is a valid fundament to understand global dynamics of fast legged locomotion under gravity. The underlying concept of elasticity, implying leg stiffness as a crucial parameter, is also found on lower motor control levels, i.e. in muscle-reflex and muscle-tendon systems. Therefore, it seems reasonable that global leg stiffness emerges from local elasticity established by appropriate joint torques. A recently published model of an elastically operating, segmented leg predicts that proper adjustment of joint elasticities to the leg geometry and initial conditions of ground contact provides internal leg stability. Another recent study suggests that in turn the leg segmentation and the initial conditions may be a consequence of metabolic and bone stress constraints. In this study, the theoretical predictions were verified experimentally with respect to initial conditions and elastic joint characteristics in human running. Kinematics and kinetics were measured and the joint torques were estimated by inverse dynamics. Stiffnesses and elastic nonlinearities describing the resulting joint characteristics were extracted from parameter fits. Our results clearly support the theoretical predictions: the knee joint is always stiffer and more extended than the ankle joint. Moreover, the knee torque characteristic on the average shows the higher nonlinearity. According to literature, the leg geometry is a consequence of metabolic and material stress limitations. Adapted to this given geometry, the initial joint angle conditions in fast locomotion are a compromise between metabolic and control effort minimisation. Based on this adaptation, an appropriate joint stiffness ratio between ankle and knee passively safeguards the internal leg stability. The identified joint nonlinearities contribute to the linearisation of the leg spring.

  14. Evaporative instabilities in climbing films

    Science.gov (United States)

    Hosoi, A. E.; Bush, John W. M.

    2001-09-01

    We consider flow in a thin film generated by partially submerging an inclined rigid plate in a reservoir of ethanol or methanol water solution and wetting its surface. Evaporation leads to concentration and surface tension gradients that drive flow up the plate. An experimental study indicates that the climbing film is subject to two distinct instabilities. The first is a convective instability characterized by flattened convection rolls aligned in the direction of flow and accompanied by free-surface deformations; in the meniscus region, this instability gives rise to pronounced ridge structures aligned with the mean flow. The second instability, evident when the plate is nearly vertical, takes the form of transverse surface waves propagating up the plate.

  15. Intrinsic Instability of Coronal Streamers

    CERN Document Server

    Chen, Y; Song, H Q; Shi, Q Q; Feng, S W; Xia, L D; 10.1088/0004-637X/691/2/1936

    2009-01-01

    Plasma blobs are observed to be weak density enhancements as radially stretched structures emerging from the cusps of quiescent coronal streamers. In this paper, it is suggested that the formation of blobs is a consequence of an intrinsic instability of coronal streamers occurring at a very localized region around the cusp. The evolutionary process of the instability, as revealed in our calculations, can be described as follows: (1) through the localized cusp region where the field is too weak to sustain the confinement, plasmas expand and stretch the closed field lines radially outward as a result of the freezing-in effect of plasma-magnetic field coupling; the expansion brings a strong velocity gradient into the slow wind regime providing the free energy necessary for the onset of a subsequent magnetohydrodynamic instability; (2) the instability manifests itself mainly as mixed streaming sausage-kink modes, the former results in pinches of elongated magnetic loops to provoke reconnections at one or many loc...

  16. Atlantoaxial instability in Down's syndrome

    OpenAIRE

    J Gordon Millichap

    1987-01-01

    The radiographs and clinical evaluations of 90 children with Down’s syndrome were reassessed after an interval of 5 years in a study of atlantoaxial instability (AAI) at the Derbyshire Children’s Hospital and Infirmary, Derby, UK.

  17. The effect of talo-crural joint manipulation on range of motion at the ankle joint in subjects with a history of ankle injury.

    Science.gov (United States)

    Andersen, Skye; Fryer, Gary A; McLaughlin, Patrick

    2003-07-01

    Introduction: There is little research available on the effects of peripheral joint manipulation. Only a few studies have examined the effect of manipulation on ankle range of motion, with conflicting results. This study aimed to determine whether a single high-velocity, low-amplitude (HVLA) thrust manipulation to the talo-crural joint altered ankle range of motion in subjects with a history of lateral ligament sprain.Methods: Male and female volunteers (N=52) with a history of lateral ligament sprain were randomly assigned into either an experimental group (n=26) or a control group (n=26). Those in the experimental group received a single HVLA thrust to the talo-crural joint, whilst those in the control group received no treatment intervention. Pre-test and post-test measurements of passive dorsiflexion range of motion were taken.Results: No significant changes in dorsiflexion range of motion were detected between manipulated ankles and those of control subjects using dependent and independent t-tests. Ankles that cavitated displayed a greater mean DFR and large effect size (d=0.8) compared to those that did not gap and cavitate, but analysis with ANOVA revealed these differences to be not significant.Conclusion: HVLA manipulation of the ankle did not increase dorsiflexion range of motion in subjects with a history of lateral ligament sprain.

  18. Material Instabilities in Particulate Systems

    Science.gov (United States)

    Goddard, J. D.

    1999-01-01

    Following is a brief summary of a theoretical investigation of material (or constitutive) instability associated with shear induced particle migration in dense particulate suspensions or granular media. It is shown that one can obtain a fairly general linear-stability analysis, including the effects of shear-induced anisotropy in the base flow as well as Reynolds dilatancy. A criterion is presented here for simple shearing instability in the absence of inertia and dilatancy.

  19. Instability of enclosed horizons

    Science.gov (United States)

    Kay, Bernard S.

    2015-03-01

    We point out that there are solutions to the scalar wave equation on dimensional Minkowski space with finite energy tails which, if they reflect off a uniformly accelerated mirror due to (say) Dirichlet boundary conditions on it, develop an infinite stress-energy tensor on the mirror's Rindler horizon. We also show that, in the presence of an image mirror in the opposite Rindler wedge, suitable compactly supported arbitrarily small initial data on a suitable initial surface will develop an arbitrarily large stress-energy scalar near where the two horizons cross. Also, while there is a regular Hartle-Hawking-Israel-like state for the quantum theory between these two mirrors, there are coherent states built on it for which there are similar singularities in the expectation value of the renormalized stress-energy tensor. We conjecture that in other situations with analogous enclosed horizons such as a (maximally extended) Schwarzschild black hole in equilibrium in a (stationary spherical) box or the (maximally extended) Schwarzschild-AdS spacetime, there will be similar stress-energy singularities and almost-singularities—leading to instability of the horizons when gravity is switched on and matter and gravity perturbations are allowed for. All this suggests it is incorrect to picture a black hole in equilibrium in a box or a Schwarzschild-AdS black hole as extending beyond the past and future horizons of a single Schwarzschild (/Schwarzschild-AdS) wedge. It would thus provide new evidence for 't Hooft's brick wall model while seeming to invalidate the picture in Maldacena's ` Eternal black holes in AdS'. It would thereby also support the validity of the author's matter-gravity entanglement hypothesis and of the paper ` Brick walls and AdS/CFT' by the author and Ortíz.

  20. Vector-Resonance-Multimode Instability

    Science.gov (United States)

    Sergeyev, S. V.; Kbashi, H.; Tarasov, N.; Loiko, Yu.; Kolpakov, S. A.

    2017-01-01

    The modulation and multimode instabilities are the main mechanisms which drive spontaneous spatial and temporal pattern formation in a vast number of nonlinear systems ranging from biology to laser physics. Using an Er-doped fiber laser as a test bed, here for the first time we demonstrate both experimentally and theoretically a new type of a low-threshold vector-resonance-multimode instability which inherits features of multimode and modulation instabilities. The same as for the multimode instability, a large number of longitudinal modes can be excited without mode synchronization. To enable modulation instability, we modulate the state of polarization of the lasing signal with the period of the beat length by an adjustment of the in-cavity birefringence and the state of polarization of the pump wave. As a result, we show the regime's tunability from complex oscillatory to periodic with longitudinal mode synchronization in the case of resonance matching between the beat and cavity lengths. Apart from the interest in laser physics for unlocking the tunability and stability of dynamic regimes, the proposed mechanism of the vector-resonance-multimode instability can be of fundamental interest for the nonlinear dynamics of various distributed systems.

  1. Clinical transformation of ankle joint biomechanics analyzed by three-dimensional finite element%踝关节三维有限元生物力学研究的临床转化

    Institute of Scientific and Technical Information of China (English)

    郭鹏超; 王成伟

    2014-01-01

      结果与结论:踝关节生物力学机制复杂,各种损伤后都可能打破其周围结构的力学平衡而导致不稳定,诱发创伤性关节炎。踝关节三维有限元模型可准确反映解剖学结构特点、虚拟仿真可以再现手术方式及过程逼真的模拟,模拟压缩、拉伸、弯曲、扭转、抗疲劳等力学实验,并从静态的生物力学转向动态的方向研究,为分析临床疾病进而找到更合适的诊治方案。%BACKGROUND:Ankle joint is a center of body weight, foot pressure buffering and human contact with the ground and easily gets injury. The study of orthopedic biomechanics continues to mature and develop. Models were established with three-dimensional finite element software to analyze ankle biomechanics and to study clinical diseases, which gradual y become a hot research topic. OBJECTIVE:To investigate the current status of three-dimensional finite element analysis of biomechanics in the ankle and to review the clinical research progress. METHODS:China National Knowledge Infrastructure and PubMed (from January 1986 to March 2014) were used to search the related finite element articles about ankle. The retrieval words included ankle, finite element, biomechanics and mechanics research. After excluding objective-independent papers or repeated articles, 47 papers were included for further analysis. RESULTS AND CONCLUSION:Ankle joint complex biomechanics mechanism and variety of injury could break mechanics balance of its surrounding structure and lead to instability and traumatic arthritis. Ankle’s three-dimensional finite element model can accurately reflect anatomical structure and virtual simulation can reappear the operation method in the simulation biomechanics experiment, such as compression, tension, bending, torsion and anti-fatigue mechanics. It makes the direction of the research from biomechanics of static to dynamic, which finds a more suitable solution to diagnose and treat

  2. Chronic myelogenous leukemia (CML)

    Science.gov (United States)

    CML; Chronic myeloid leukemia; Chronic granulocytic leukemia; Leukemia - chronic granulocytic ... Chronic myelogenous leukemia is grouped into phases: Chronic Accelerated Blast crisis The chronic phase can last for ...

  3. Improving human ankle joint position sense using an artificial tongue-placed tactile biofeedback

    CERN Document Server

    Vuillerme, N; Demongeot, J; Payan, Y; Vuillerme, Nicolas; Chenu, Olivier; Demongeot, Jacques; Payan, Yohan

    2006-01-01

    Proprioception is comprised of sensory input from several sources including muscle spindles, joint capsule, ligaments and skin. The purpose of the present experiment was to investigate whether the central nervous system was able to integrate an artificial biofeedback delivered through electrotactile stimulation of the tongue to improve proprioceptive acuity at the ankle joint. To address this objective, nine young healthy adults were asked to perform an active ankle-matching task with and without biofeedback. The underlying principle of the biofeedback consisted of supplying subjects with supplementary information about the position of their matching ankle position relative to their reference ankle position through a tongue-placed tactile output device (Tongue Display Unit). Measures of the overall accuracy and the variability of the positioning were determined using the absolute error and the variable error, respectively. Results showed more accurate and more consistent matching performances with than withou...

  4. Design and simulation of a cable-pulley-based transmission for artificial ankle joints

    Science.gov (United States)

    Liu, Huaxin; Ceccarelli, Marco; Huang, Qiang

    2016-06-01

    In this paper, a mechanical transmission based on cable pulley is proposed for human-like actuation in the artificial ankle joints of human-scale. The anatomy articular characteristics of the human ankle is discussed for proper biomimetic inspiration in designing an accurate, efficient, and robust motion control of artificial ankle joint devices. The design procedure is presented through the inclusion of conceptual considerations and design details for an interactive solution of the transmission system. A mechanical design is elaborated for the ankle joint angular with pitch motion. A multi-body dynamic simulation model is elaborated accordingly and evaluated numerically in the ADAMS environment. Results of the numerical simulations are discussed to evaluate the dynamic performance of the proposed design solution and to investigate the feasibility of the proposed design in future applications for humanoid robots.

  5. Effect of a combined inversion and plantarflexion surface on ankle kinematics and EMG activities in landing

    Directory of Open Access Journals (Sweden)

    Divya Bhaskaran

    2015-12-01

    Conclusion: These findings suggest that compared to the inversion surface, the combined plantarflexion and inversion surface seems to provide a more unstable surface condition for lateral ankle sprains during landing.

  6. Do Balance Board Training Programs Reduce the Risk of Ankle Sprains in Athletes?

    Institute of Scientific and Technical Information of China (English)

    Timothy A.McGuine

    2008-01-01

    @@ Introduction Ankle sprains are the most common musculoskeletal injury that occurs in athletes,particularly in sports that require jumping and landing on one foot such as soccer,and basketball(1-4).

  7. A review on the mechanical design elements of ankle rehabilitation robot.

    Science.gov (United States)

    Khalid, Yusuf M; Gouwanda, Darwin; Parasuraman, Subramanian

    2015-06-01

    Ankle rehabilitation robots are developed to enhance ankle strength, flexibility and proprioception after injury and to promote motor learning and ankle plasticity in patients with drop foot. This article reviews the design elements that have been incorporated into the existing robots, for example, backdrivability, safety measures and type of actuation. It also discusses numerous challenges faced by engineers in designing this robot, including robot stability and its dynamic characteristics, universal evaluation criteria to assess end-user comfort, safety and training performance and the scientific basis on the optimal rehabilitation strategies to improve ankle condition. This article can serve as a reference to design robot with better stability and dynamic characteristics and good safety measures against internal and external events. It can also serve as a guideline for the engineers to report their designs and findings.

  8. Effects of 24-week Tai Chi exercise on the knee and ankle proprioception of older women.

    Science.gov (United States)

    Chang, Shuwan; Zhou, Jihe; Hong, Youlian; Sun, Wei; Cong, Yan; Qin, Meiqin; Lian, Jianhua; Yao, Jian; Li, Weiping

    2016-01-01

    This study examined the effects of regular Tai Chi (TC) exercise on the kinaesthesia of the knee and ankle joints of older women. A total of 43 women aged 55-68 years participated in this study. In a 24-week study period, the TC group (n = 22) underwent an organized TC exercise, whereas the control group (n = 21) maintained a sedentary lifestyle. Customized instruments were used to measure the threshold for the detection of the passive motion of the knee and ankle joints. After 24 weeks, the TC group showed a significantly smaller threshold for the detection of passive motion of knee extension (31.4%, p = 0.009), knee flexion (27.0%, p = 0.044), and ankle dorsal flexion (28.9%, p = 0.014) than the control group. Other comparisons showed no significant differences. The 24-week TC exercise benefited the lower-limb kinaesthesia of the knee joint flexion and extension and ankle dorsal flexion.

  9. An EMG-to-force processing approach for determining ankle muscle forces during normal human gait.

    Science.gov (United States)

    Bogey, R A; Perry, J; Gitter, A J

    2005-09-01

    Muscle forces move our limbs. These forces must be estimated with indirect techniques, as direct measurements are neither generally possible nor practical. An electromyography (EMG)-to-force processing technique was developed. Ankle joint moments and, by extension, ankle muscle forces were calculated. The ankle moment obtained by inverse dynamics was calculated for ten normal adults during free speed gait. There was close correlation between inverse dynamics ankle moments and moments determined by the EMG-to-force processing approach. Muscle forces were determined. The gait peak Achilles tendon force occurred in late single limb support. Peak force observed (2.9 kN) closely matched values obtained where force transducers were used to obtain in vivo muscle forces (2.6 kN). The EMG-to-force processing model presented here appears to be a practical means to determine in vivo muscle forces.

  10. Clinical Study on the Wrist-Ankle Acupuncture Treatment for 30 Cases of Diabetic Peripheral Neuritis

    Institute of Scientific and Technical Information of China (English)

    2006-01-01

    Objective: To study the mechanisms of wrist-ankle acupuncture for prevention and treatment of diabetic peripheral neuritis. Methods: Ninety cases of diabetic peripheral neuritis were randomly divided into 3groups, and treated respectively with wrist-ankle acupuncture, body-acupuncture, and the western routine medical treatment, with 30 cases in each of the groups; and therapeutic effects and laboratory results compared. Results: It is proved that the therapeutic effects of the wrist-ankle acupuncture group and body acupuncture group were significantly superior to those of the control group, with no significant differences between the former two groups. Conclusion: Wrist-ankle acupuncture has the actions of improving the metabolisms of blood sugar and blood-lipid, lowering down blood viscosity, and restoring the functions of peripheral nerve cells, thus giving definite therapeutic effects for diabetic peripheral neuritis.

  11. Tightrope fixation of ankle syndesmosis injuries: clinical outcome, complications and technique modification.

    LENUS (Irish Health Repository)

    Naqvi, Gohar A

    2012-06-01

    Ankle syndesmotic injuries are complex and require anatomic reduction and fixation. Tightrope fixation is a relatively new technique and we present the largest series of syndesmosis fixation using Arthrex Tightrope™ (Naples, FL, USA).

  12. EFFICIENCY OF SENSORY-MOTOR REHABILITATION OF ANKLE SPRAIN IN FEMALE HANDBALL PLAYERS

    Directory of Open Access Journals (Sweden)

    Rață Marinela

    2015-12-01

    Full Text Available This paper presents the concept of sensory-motor rehabilitation, the scientific fundamentation of the method and the results of its application on female handball players suffering from an ankle sprain. Being one of the most frequently encountered injuries in handball, the sprained ankle is often treated superficially and can have multiple consequences for the athlete reaching up to serious functional deficits that lead to a decreased efficiency of the player and even to seizing the sports activity. Due to the need to treat and prevent ankle sprain consequences, we assumed that the intervention on the sensory-motor system can have beneficial effects on the functionality of the ankle. After applying the specific assessment tests, as well as the rehabilitation exercises, we have managed to identify sensory-motor problems and intervene objectively by chiropractic means.

  13. Power Doppler ultrasonographic assessment of the ankle in patients with inflammatory rheumatic diseases.

    Science.gov (United States)

    Suzuki, Takeshi

    2014-11-18

    Ankle involvement is frequent in patients with inflammatory rheumatic diseases, but accurate evaluation by physical examination is often difficult because of the complex anatomical structures of the ankle. Over the last decade, ultrasound (US) has become a practical imaging tool for the assessment of articular and periarticular pathologies, including joint synovitis, tenosynovitis, and enthesitis in rheumatic diseases. Progress in power Doppler (PD) technology has enabled evaluation of the strength of ongoing inflammation. PDUS is very useful for identifying the location and kind of pathologies in rheumatic ankles as well as for distinguishing between inflammatory processes and degenerative changes or between active inflammation and residual damage. The aim of this paper is to illustrate the US assessment of ankle lesions in patients with inflammatory rheumatic diseases, including rheumatoid arthritis, spondyloarthritis, and systemic lupus erythematosus, focusing on the utility of PDUS.

  14. Protocol for Evaluating the Cardio-Ankle Vascular Index to Predict Cardiovascular Events in Japan: A Prospective Multicenter Cohort Study

    Science.gov (United States)

    Miyoshi, Toru; Ito, Hiroshi; Horinaka, Shigeo; Shirai, Kohji; Higaki, Jitsuo; Orimio, Hajime

    2017-01-01

    Introduction The cardio-ankle vascular index (CAVI) was developed in Japan and is a blood pressure-independent index of arterial stiffness from the origin of the aorta to the ankle. In recent years, it has been studied by many researchers worldwide, and it is strongly anticipated that it will play a role as a predictive factor for arteriosclerotic diseases. The objective of this study was to examine the benefits of using CAVI as a predictor of cardiovascular events in high-risk patients. Methods and Design This prospective multicenter study to evaluate the usefulness of the CAVI to predict cardiovascular events in Japan (CAVI-J) is a cohort study with central registration. Participants (n = 3,000) will be scheduled to enroll and data will be collected for up to 5 years from entry of participants into the study. To be eligible to participate in the CAVI-J study, individuals have to be aged between 40 and 74 years and have at least one of the following risk factors for arteriosclerosis: (1) type 2 diabetes mellitus; (2) high-risk hypertension; (3) metabolic syndrome; (4) chronic kidney disease (stage 3), or (5) history of coronary artery disease or noncardiogenic cerebral infarction. The primary endpoints of this study are cardiovascular death, nonfatal myocardial infarction, and stroke. The secondary endpoints are composite cardiovascular events including all cause death, angina pectoris with revascularization, new incidence of peripheral artery disease, abdominal aortic aneurysm, aortic dissection, heart failure requiring hospitalization, and deterioration in renal function. The cutoff for CAVI against the incidence of cardiovascular events will be determined. PMID:28275590

  15. Elliptic and magneto-elliptic instabilities

    Directory of Open Access Journals (Sweden)

    Lyra Wladimir

    2013-04-01

    Full Text Available Vortices are the fundamental units of turbulent flow. Understanding their stability properties therefore provides fundamental insights on the nature of turbulence itself. In this contribution I briely review the phenomenological aspects of the instability of elliptic streamlines, in the hydro (elliptic instability and hydromagnetic (magneto-elliptic instability regimes. Vortex survival in disks is a balance between vortex destruction by these mechanisms, and vortex production by others, namely, the Rossby wave instability and the baroclinic instability.

  16. Open Reduction and Internal Fixation of a Fracture-dislocation of the Ankle

    Directory of Open Access Journals (Sweden)

    Yaniel Truffin Rodriguez

    2015-12-01

    Full Text Available Open reduction and internal fixation of the fracture-dislocation of the ankle with plates, screws and Kirschner wires is a well-defined treatment method. This paper presents the management of a fracture-dislocation of the right ankle in a 33-year-old female patient stabilized by using a one-third tubular plate, screws, and Kirschner wires with tension-band wires. Results were satisfactory.

  17. Review for the generalist: evaluation of pediatric foot and ankle pain

    Directory of Open Access Journals (Sweden)

    Houghton Kristin M

    2008-04-01

    Full Text Available Abstract Foot and ankle pain is common in children and adolescents. Problems are usually related to skeletal maturity and are fairly specific to the age of the child. Evaluation and management is challenging and requires a thorough history and physical exam, and understanding of the pediatric skeleton. This article will review common causes of foot and ankle pain in the pediatric population.

  18. Effects of ankle braces upon agility course performance in high school athletes.

    Science.gov (United States)

    Beriau, M R; Cox, W B; Manning, J

    1994-09-01

    The purpose of this study was to compare the effects of wearing the Aircast(TM) Sports Stirrup, Aircast(TM) Training brace, Swede-O(TM) brace, and DonJoy(TM) Ankle Ligament Protector while running an agility course. Eighty-five high school athletes with no history of ankle injury and no experience in wearing any ankle support served as subjects. Each subject participated in four separate testing sessions. During sessions 1 and 4, subjects ran the agility course under the control (unbraced) conditions. Sessions 2 and 3 consisted of randomly wearing the ankle braces while running the agility course. A questionnaire concerning support, comfort, and restriction was completed by each subject after wearing each of the braces. An analysis of variance (ANOVA) with repeated measures revealed that a significant difference existed between the agility times. Tukey's post hoc test indicated that a significant difference existed between each ankle brace and the control 2 agility times as well as a control 1 and control 2 time difference. The control time difference was attributed to a learning effect. An ANOVA with repeated measures of only the four braces revealed that a significant difference existed between the agility times. Tukey's post hoc test showed the only difference was between the DonJoy Ankle Ligament Protector and the Aircast Training brace. We concluded: 1) there is limited practical performance effect upon agility while wearing an ankle brace; and 2) an athlete's perceived comfort, support, and performance restriction are contributing factors that may directly influence the effectiveness of ankle bracing.

  19. Candida Parapsilosis Arthritis Involving the Ankle in a Diabetes Patient: A Case Report

    Energy Technology Data Exchange (ETDEWEB)

    Sung, Jin Kyeong; Chun, Kyung Ah [Dept. of Radiology, The Catholic University of Korea Uijeongbu St. Mary' s Hospital, Uijeongbu (Korea, Republic of)

    2011-06-15

    Candida parapsilosis is a rare opportunistic fungal pathogen of the musculoskeletal region. Immune function of almost all patients is severely disturbed. Most reported cases of septic arthritis of joints by Candida involve the knee, especially Candida parapsilosis. To our knowledge, there has been only one case report of Candida parapsilosis involving the ankle presented on only plain radiography. We report a case of Candida parapsilosis arthritis involving the ankle in a diabetes patient which was shown on MR imaging.

  20. Total Ankle Replacement for Treatment of End-Stage Osteoarthritis in Elderly Patients

    OpenAIRE

    Beat Hintermann; Markus Knupp; Lukas Zwicky; Alexej Barg

    2012-01-01

    End-stage osteoarthritis of the ankle is a disabling problem, particularly in elderly patients who experience an overall loss of mobility and functional impairment and who then need compensatory adaption. Ankle arthrodesis, which has been demonstrated to provide postoperative pain relief and hindfoot stability, leaves the patient with a stiff foot and gait changes. For elderly patient, these changes may be more critical than generally believed. Additionally, the long duration of healing and r...