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Sample records for estabilizador active ankle

  1. Efeito do Uso do Estabilizador Active Ankle System® na Altura do Salto Vertical em Jogadores de Voleibol Effect of the Use of the Active Ankle System Stabilizer in The Vertical Jump Height in Volleyball Players

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    Marco Túlio Saldanha dos Anjos

    2009-10-01

    Full Text Available INTRODUÇÃO E OBJETIVO: Na prática do voleibol, as entorses de tornozelo representam 25 a 50% das lesões agudas. Medidas preventivas, como estabilizadores dinâmicos de tornozelo (EDT, são frequentemente utilizadas, porém, há controvérsias se esse dispositivo pode ou não interferir no desempenho esportivo. O objetivo deste estudo foi analisar o efeito do EDT Active Ankle System® (AAS na altura do salto vertical em jogadoras de voleibol. MÉTODOS: Selecionou-se uma amostra de conveniência de 14 atletas entre 14 e 18 anos de idade, do gênero feminino. Estas foram instruídas a saltar simulando o gesto esportivo do ataque e do bloqueio com e sem o EDT, sobre placas de contato conectadas a um computador portátil que, através de um programa, calculava a altura do salto vertical. Previamente, foi feito um estudo-piloto para determinação do coeficiente de correlação intraclasse para as quatro condições de teste (n = 4, no qual os valores encontrados foram: ataque com EDT, 0,95; ataque sem EDT, 0,76; bloqueio com EDT, 0,92; bloqueio sem EDT, 0,89. Os dados de altura de cada tipo de salto vertical nas condições com e sem EDT foram comparadas através de testes t de Student para amostras pareadas. RESULTADOS: Para um nível de significância de α = 0,05, não foi encontrada diferença significativa entre os saltos do ataque com o EDT (0,41 + 0,073m e sem o EDT (0,41 + 0,086m, p = 0,517. Também não foi encontrada diferença significativa para os saltos do bloqueio com o EDT (0,31 ± 0,048m e sem o EDT (0,32 ± 0,050m, p = 0,06. CONCLUSÃO: Os resultados do presente estudo apontam para não interferência do uso do EDT AAS no desempenho do salto vertical em atletas de voleibol.INTRODUCTION AND OBJECTIVES: In volleyball practice, ankle sprains represent 25 to 50% of the acute injuries. Preventive measures such as dynamic ankle bracing (DAB are very often used; however, there is controversy on whether this would affect athletic

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

    NARCIS (Netherlands)

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

    2015-01-01

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

  3. Multivariable Dynamic Ankle Mechanical Impedance With Active Muscles

    Science.gov (United States)

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

    2015-01-01

    Multivariable dynamic ankle mechanical impedance in two coupled degrees-of-freedom (DOFs) was quantified when muscles were active. Measurements were performed at five different target activation levels of tibialis anterior and soleus, from 10% to 30% of maximum voluntary contraction (MVC) with increments of 5% MVC. Interestingly, several ankle behaviors characterized in our previous study of the relaxed ankle were observed with muscles active: ankle mechanical impedance in joint coordinates showed responses largely consistent with a second-order system consisting of inertia, viscosity, and stiffness; stiffness was greater in the sagittal plane than in the frontal plane at all activation conditions for all subjects; and the coupling between dorsiflexion–plantarflexion and inversion–eversion was small—the two DOF measurements were well explained by a strictly diagonal impedance matrix. In general, ankle stiffness increased linearly with muscle activation in all directions in the 2-D space formed by the sagittal and frontal planes, but more in the sagittal than in the frontal plane, resulting in an accentuated “peanut shape.” This characterization of young healthy subjects’ ankle mechanical impedance with active muscles will serve as a baseline to investigate pathophysiological ankle behaviors of biomechanically and/or neurologically impaired patients. PMID:25203497

  4. Início da atividade elétrica dos músculos estabilizadores da patela em indivíduos com SDPF Onset of electrical activity of patellar stabilizer muscles in subjects with patellofemoral pain

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    Débora Bevilaqua-Grossi

    2009-01-01

    Full Text Available OBJETIVO: Avaliar a porcentagem de disparo inicial (PDI dos músculos estabilizadores da patela durante exercícios de contração isométrica voluntária máxima (CIVM em indivíduos com e sem sinais da síndrome da dor patelofemural (SDPF nos exercícios de cadeia cinética aberta (CCA e fechada (CCF. MÉTODO: Foram avaliadas 10 mulheres sem queixa de dor anterior no joelho e 12 mulheres com sinais de SDPF durante a CIM em CCA e CCF com o joelho posicionado a 90º de flexão do joelho. O início da atividade eletromiográfica dos músculos vasto medial obliquo (VMO, vasto lateral obliquo (VLO e vasto lateral longo (VLL foi identificada por meio de um algoritmo no programa Myosystem Br 1. A análise estatística empregada foi o teste Qui-Quadrado e o teste t de student, ambos os teste com nível de significância de 5%. RESULTADOS: Os músculos VMO e VLO apresentaram uma maior PDI em relação ao músculo VLL durante os exercícios em CCA para ambos os grupo e para o grupo SDPF em CCF. Não foi observado diferença entre os grupos. CONCLUSÃO: Pode-se sugerir que tanto os exercícios em CCA quanto em CCF, parecem beneficiar o sincronismo na musculatura estabilizadora da patela, podendo ser indicado nos programas de tratamento fisioterapêutico.OBJECTIVE: To asses the onset (% of patella stabilizer muscles during maximal isometric contraction exercises (MIC in individuals with and without signs of patellofemoral pain syndrome (PFPS in open (OKC and closed (CKC kinetic chain exercises. METHOD: Assessments were carried out on 22 women; ten with no complains of anterior knee pain, and 12 with PFPS signs during MIC in OKC and CKC with the knee flexed at 90º. The onset of the electromyographic activity of the vastus mediallis obliquus (VMO, vastus lateralis obliquus (VLO and vastus lateralis longus (VLL was identified by means of an algorithm in the Myosystem Br 1 software. The statistical analysis used was Chi-Square test and student's t test

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

    Science.gov (United States)

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

    2013-08-01

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

  6. Early Intra-Articular Complement Activation in Ankle Fractures

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    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.

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

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    Asmaa F Abdelmonem

    2018-04-01

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

  8. Ankle arthroscopy

    Science.gov (United States)

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

  9. Ankle replacement

    Science.gov (United States)

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

  10. 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...

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

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

    2013-10-01

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

  12. Ankle torque steadiness is related to muscle activation variability and co-activation in children with cerebral palsy

    DEFF Research Database (Denmark)

    Bandholm, Thomas; Rose, Martin; 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...... contractions in those children. Fourteen children with CP who walked with equinus foot deformity and 14 healthy (control) children performed maximal and steady submaximal ankle dorsi- and plantarflexions. Dorsiflexion torque steadiness was related to agonist and antagonist muscle activation variability as well...

  13. 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

  14. Voluntary activation of ankle muscles is accompanied by subcortical facilitation of their antagonists

    DEFF Research Database (Denmark)

    Geertsen, Svend S.; Zuur, Abraham Theodoor; Nielsen, Jens B.

    2010-01-01

    Flexion and extension movements are organized reciprocally, so that extensor motoneurones in the spinal cord are inhibited when flexor muscles are active and vice versa. During and just prior to dorsiflexion of the ankle, soleus motoneurones are thus inhibited as evidenced by a depression......) or soleus muscle of the left ankle. TMS was applied to the hotspot of TA and soleus muscles on separate days. Stimuli were delivered prior to and at the beginning of contraction. Soleus MEPs were significantly facilitated when TMS was applied 50 ms prior to onset of plantar flexion. Surprisingly, soleus...... was increased prior to plantar flexion, but not prior to dorsiflexion. These findings suggest that voluntary contraction at the ankle is accompanied by preceding facilitation of antagonists by a subcortical motor programme. This may help to ensure that the direction of movement may be changed quickly...

  15. Reviewing Clinical Effectiveness of Active Training Strategies of Platform-Based Ankle Rehabilitation Robots

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    Xiangfeng Zeng

    2018-01-01

    Full Text Available Objective. This review aims to provide a systematical investigation of clinical effectiveness of active training strategies applied in platform-based ankle robots. Method. English-language studies published from Jan 1980 to Aug 2017 were searched from four databases using key words of “Ankle∗” AND “Robot∗” AND “Effect∗ OR Improv∗ OR Increas∗.” Following an initial screening, three rounds of discrimination were successively conducted based on the title, the abstract, and the full paper. Result. A total of 21 studies were selected with 311 patients involved; of them, 13 studies applied a single group while another eight studies used different groups for comparison to verify the therapeutic effect. Virtual-reality (VR game training was applied in 19 studies, while two studies used proprioceptive neuromuscular facilitation (PNF training. Conclusion. Active training techniques delivered by platform ankle rehabilitation robots have been demonstrated with great potential for clinical applications. Training strategies are mostly combined with one another by considering rehabilitation schemes and motion ability of ankle joints. VR game environment has been commonly used with active ankle training. Bioelectrical signals integrated with VR game training can implement intelligent identification of movement intention and assessment. These further provide the foundation for advanced interactive training strategies that can lead to enhanced training safety and confidence for patients and better treatment efficacy.

  16. An Acute Lateral Ankle Sprain Significantly Decreases Physical Activity across the Lifespan

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

    2015-09-01

    Full Text Available We do not know the impact an ankle sprain has on physical activity levels across the lifespan. With the negative consequences of physical inactivity well established, understanding the effect of an ankle sprain on this outcome is critical. The objective of this study was to measure physical activity across the lifespan after a single ankle sprain in an animal model. Thirty male mice (CBA/J were randomly placed into one of three groups: the transected calcaneofibular ligament (CFL group, the transected anterior talofibular ligament (ATFL/CFL group, and a SHAM group. Three days after surgery, all of the mice were individually housed in a cage containing a solid surface running wheel. Physical activity levels were recorded and averaged every week across the mouse’s lifespan. The SHAM mice ran significantly more distance each day compared to the remaining two running groups (post hoc p = 0.011. Daily duration was different between the three running groups (p = 0.048. The SHAM mice ran significantly more minutes each day compared to the remaining two running groups (post hoc p=0.046 while the ATFL/CFL mice ran significantly less minutes each day (post hoc p = 0.028 compared to both the SHAM and CFL only group. The SHAM mice ran at a faster daily speed versus the remaining two groups of mice (post hoc p = 0.019 and the ATFL/CFL mice ran significantly slower each day compared to the SHAM and CFL group (post hoc p = 0.005. The results of this study indicate that a single ankle sprain significantly decreases physical activity across the lifespan in mice. This decrease in physical activity can potentially lead to the development of numerous chronic diseases. An ankle sprain thus has the potential to lead to significant long term health risks if not treated appropriately.

  17. The effect of a knee ankle foot orthosis incorporating an active knee mechanism on gait of a person with poliomyelitis.

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    Arazpour, Mokhtar; Chitsazan, Ahmad; Bani, Monireh Ahmadi; Rouhi, Gholamreza; Ghomshe, Farhad Tabatabai; Hutchins, Stephen W

    2013-10-01

    The aim of this case study was to identify the effect of a powered stance control knee ankle foot orthosis on the kinematics and temporospatial parameters of walking by a person with poliomyelitis when compared to a knee ankle foot orthosis. A knee ankle foot orthosis was initially manufactured by incorporating drop lock knee joints and custom molded ankle foot orthoses and fitted to a person with poliomyelitis. The orthosis was then adapted by adding electrically activated powered knee joints to provide knee extension torque during stance and also flexion torque in swing phase. Lower limb kinematic and kinetic data plus data for temporospatial parameters were acquired from three test walks using each orthosis. Walking speed, step length, and vertical and horizontal displacement of the pelvis decreased when walking with the powered stance control knee ankle foot orthosis compared to the knee ankle foot orthosis. When using the powered stance control knee ankle foot orthosis, the knee flexion achieved during swing and also the overall pattern of walking more closely matched that of normal human walking. The reduced walking speed may have caused the smaller compensatory motions detected when the powered stance control knee ankle foot orthosis was used. The new powered SCKAFO facilitated controlled knee flexion and extension during ambulation for a volunteer poliomyelitis person.

  18. A pneumatically powered knee-ankle-foot orthosis (KAFO with myoelectric activation and inhibition

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    Ferris Daniel P

    2009-06-01

    Full Text Available Abstract Background The goal of this study was to test the mechanical performance of a prototype knee-ankle-foot orthosis (KAFO powered by artificial pneumatic muscles during human walking. We had previously built a powered ankle-foot orthosis (AFO and used it effectively in studies on human motor adaptation, locomotion energetics, and gait rehabilitation. Extending the previous AFO to a KAFO presented additional challenges related to the force-length properties of the artificial pneumatic muscles and the presence of multiple antagonistic artificial pneumatic muscle pairs. Methods Three healthy males were fitted with custom KAFOs equipped with artificial pneumatic muscles to power ankle plantar flexion/dorsiflexion and knee extension/flexion. Subjects walked over ground at 1.25 m/s under four conditions without extensive practice: 1 without wearing the orthosis, 2 wearing the orthosis with artificial muscles turned off, 3 wearing the orthosis activated under direct proportional myoelectric control, and 4 wearing the orthosis activated under proportional myoelectric control with flexor inhibition produced by leg extensor muscle activation. We collected joint kinematics, ground reaction forces, electromyography, and orthosis kinetics. Results The KAFO produced ~22%–33% of the peak knee flexor moment, ~15%–33% of the peak extensor moment, ~42%–46% of the peak plantar flexor moment, and ~83%–129% of the peak dorsiflexor moment during normal walking. With flexor inhibition produced by leg extensor muscle activation, ankle (Pearson r-value = 0.74 ± 0.04 and knee ( r = 0.95 ± 0.04 joint kinematic profiles were more similar to the without orthosis condition compared to when there was no flexor inhibition (r = 0.49 ± 0.13 for ankle, p = 0.05, and r = 0.90 ± 0.03 for knee, p = 0.17. Conclusion The proportional myoelectric control with flexor inhibition allowed for a more normal gait than direct proportional myoelectric control. The current

  19. A pneumatically powered knee-ankle-foot orthosis (KAFO) with myoelectric activation and inhibition

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    Sawicki, Gregory S; Ferris, Daniel P

    2009-01-01

    Background The goal of this study was to test the mechanical performance of a prototype knee-ankle-foot orthosis (KAFO) powered by artificial pneumatic muscles during human walking. We had previously built a powered ankle-foot orthosis (AFO) and used it effectively in studies on human motor adaptation, locomotion energetics, and gait rehabilitation. Extending the previous AFO to a KAFO presented additional challenges related to the force-length properties of the artificial pneumatic muscles and the presence of multiple antagonistic artificial pneumatic muscle pairs. Methods Three healthy males were fitted with custom KAFOs equipped with artificial pneumatic muscles to power ankle plantar flexion/dorsiflexion and knee extension/flexion. Subjects walked over ground at 1.25 m/s under four conditions without extensive practice: 1) without wearing the orthosis, 2) wearing the orthosis with artificial muscles turned off, 3) wearing the orthosis activated under direct proportional myoelectric control, and 4) wearing the orthosis activated under proportional myoelectric control with flexor inhibition produced by leg extensor muscle activation. We collected joint kinematics, ground reaction forces, electromyography, and orthosis kinetics. Results The KAFO produced ~22%–33% of the peak knee flexor moment, ~15%–33% of the peak extensor moment, ~42%–46% of the peak plantar flexor moment, and ~83%–129% of the peak dorsiflexor moment during normal walking. With flexor inhibition produced by leg extensor muscle activation, ankle (Pearson r-value = 0.74 ± 0.04) and knee ( r = 0.95 ± 0.04) joint kinematic profiles were more similar to the without orthosis condition compared to when there was no flexor inhibition (r = 0.49 ± 0.13 for ankle, p = 0.05, and r = 0.90 ± 0.03 for knee, p = 0.17). Conclusion The proportional myoelectric control with flexor inhibition allowed for a more normal gait than direct proportional myoelectric control. The current orthosis design

  20. Effects of Preventative Ankle Taping on Planned Change-of-Direction and Reactive Agility Performance and Ankle Muscle Activity in Basketballers

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    Matthew D. Jeffriess, Adrian B. Schultz, Tye S. McGann, Samuel J. Callaghan, Robert G. Lockie

    2015-12-01

    Full Text Available This study investigated the effects of preventative ankle taping on planned change-of-direction and reactive agility performance and peak ankle muscle activity in basketballers. Twenty male basketballers (age = 22.30 ± 3.97 years; height = 1.84 ± 0.09 meters; body mass = 85.96 ± 11.88 kilograms with no ankle pathologies attended two testing sessions. Within each session, subjects completed six planned and six reactive randomized trials (three to the left and three to the right for each condition of the Y-shaped agility test, which was recorded by timing lights. In one session, subjects had both ankles un-taped. In the other, both ankles were taped using a modified subtalar sling. Peak tibialis anterior, peroneus longus (PL, peroneus brevis (PB, and soleus muscle activity was recorded for both the inside and outside legs across stance phase during the directional change, which was normalized against 10-meter sprint muscle activity (nEMG. Both the inside and outside cut legs during the change-of-direction step were investigated. Repeated measures ANOVA determined performance time and nEMG differences between un-taped and taped conditions. There were no differences in planned change-of-direction or reactive agility times between the conditions. Inside cut leg PL nEMG decreased when taped for the planned left, reactive left, and reactive right cuts (p = 0.01. Outside leg PB and soleus nEMG increased during the taped planned left cut (p = 0.02. There were no other nEMG changes during the cuts with taping. Taping did not affect change-of-direction or agility performance. Inside leg PL activity was decreased, possibly due to the tape following the line of muscle action. This may reduce the kinetic demand for the PL during cuts. In conclusion, ankle taping did not significantly affect planned change-of-direction or reactive agility performance, and did not demonstrate large changes in activity of the muscle complex in healthy basketballers.

  1. Gymnasts and non-athletes muscle activation and torque production at the ankle joint

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    Natália Batista Albuquerque Goulart

    2014-07-01

    Full Text Available http://dx.doi.org/10.5007/1980-0037.2014v16n5p555  Artistic Gymnasts (AG execute specific movements that require substantial movement control and force production at the ankle joint. This high demand might change the neuromechanical properties of the ankle joint muscles in these athletes compared to non-athlete girls (NAG. The aim of this study was to compare muscle activation and torque production at the ankle joint between AG and NAG. Ten AG (11.70 ± 1.06 years of age and 10 NAG (11.70 ± 1.49 years of age participated in the study. Electromyographic  (EMG signals of medial gastrocnemius (MG, soleus (SO and tibialis anterior (TA were obtained simultaneously to the maximal isometric plantarflexion (PFT and dorsiflexion (DFT torques of the dominant limb during a maximal voluntary isometric contraction (MVIC at five different joint angles (20°, 10°, 0°, -10° e -20°. Neuromuscular efficiency was also calculated by the Torque/EMG ratio. AG presented higher PFT (p0.05. In addition, AG showed higher values for plantar flexion neuromuscular efficiency and smaller values of dorsiflexion neuromuscular efficiency compared to the NAG (p<0.01. Higher sports demands of AG determined higher PFT, higher plantar flexor efficiency, smaller DFT but similar activation of MG, SO and TA compared to NAG.

  2. Ankle muscle activity modulation during single-leg stance differs between children, young adults and seniors.

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    Kurz, Eduard; Faude, Oliver; Roth, Ralf; Zahner, Lukas; Donath, Lars

    2018-02-01

    Incomplete maturation and aging-induced declines of the neuromuscular system affect postural control both in children and older adults and lead to high fall rates. Age-specific comparisons of the modulation of ankle muscle activation and behavioral center of pressure (COP) indices during upright stance have been rarely conducted. The objective of the present study was to quantify aging effects on a neuromuscular level. Thus, surface electromyography (SEMG) modulation and co-activity of ankle muscles during single-leg standing was compared in healthy children, young adults and seniors. Postural steadiness (velocity and mean sway frequency of COP), relative muscle activation (SEMG modulation) and co-activation of two ankle muscles (tibialis anterior, TA; soleus, SO) were examined during single-leg stance in 19 children [age, 9.7 (SD 0.5) years], 30 adults [23.3 (1.5) years] and 29 seniors [62.7 (6.1) years]. Velocity of COP in medio-lateral and anterior-posterior directions, mean sway frequency in anterior-posterior direction, relative muscle activation (TA and SO) and co-activation revealed large age effects (P  0.14). Post-hoc comparisons indicated higher COP velocities, anterior-posterior frequencies, relative SO activation and co-activation in children and seniors when compared with adults. Relative TA activation was higher in children and adults compared with seniors (P seniors seems to be counteracted with higher TA/SO co-activity and SO modulation. However, TA modulation is higher in children and adults, whereas seniors' TA modulation capacity is diminished. An aging-induced decline of TA motor units might account for deteriorations of TA modulation in seniors.

  3. Development of an Active Ankle Foot Orthosis to Prevent Foot Drop and Toe Drag in Hemiplegic Patients: A Preliminary Study

    Directory of Open Access Journals (Sweden)

    Jungyoon Kim

    2011-01-01

    Full Text Available We developed an active ankle-foot orthosis (AAFO that controls dorsiflexion/plantarflexion of the ankle joint to prevent foot drop and toe drag during hemiplegic walking. To prevent foot slap after initial contact, the ankle joint must remain active to minimize forefoot collision against the ground. During late stance, the ankle joint must also remain active to provide toe clearance and to aid with push-off. We implemented a series elastic actuator in our AAFO to induce ankle dorsiflexion/plantarflexion. The activator was controlled by signals from force sensing register (FSR sensors that detected gait events. Three dimensional gait analyses were performed for three hemiplegic patients under three different gait conditions: gait without AFO (NAFO, gait with a conventional hinged AFO that did not control the ankle joint (HAFO, and gait with the newly-developed AFO (AAFO. Our results demonstrate that our newly-developed AAFO not only prevents foot drop by inducing plantarflexion during loading response, but also prevents toe drag by facilitating plantarflexion during pre-swing and dorsiflexion during swing phase, leading to improvement in most temporal-spatial parameters. However, only three hemiplegic patients were included in this gait analysis. Studies including more subjects will be required to evaluate the functionality of our newly developed AAFO.

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

    OpenAIRE

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

    2014-01-01

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

  5. Ankle instability

    NARCIS (Netherlands)

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

    2006-01-01

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

  6. Cohesive taping and short-leg casting in acute low-type ankle sprains in physically active patients.

    Science.gov (United States)

    Uslu, Mustafa; Inanmaz, Mustafa E; Ozsahin, Mustafa; Isık, Cengiz; Arıcan, Mehmet; Gecer, Yavuz

    2015-07-01

    Cohesive taping is commonly used for the prevention or treatment of ankle sprain injuries. Short-leg cast immobilization or splinting is another treatment option in such cases. To determine the clinical efficacy and antiedema effects of cohesive taping and short-leg cast immobilization in acute low-type ankle sprains of physically active patients, we performed a preliminary clinical study to assess objective evidence for edema and functional patient American Orthopaedic Foot and Ankle Society (AOFAS) scores with these alternative treatments. Fifty-nine physically active patients were included: 32 in the taping group and 27 in the short-leg cast group within a year. If a sprain was moderate (grade II) or mild (grade I), we used functional taping or short-leg cast immobilization for 10 days. We evaluated the edema and the functional scores of the injured ankle using the AOFAS Clinical Rating System on days 1, 10, and 100. In each group, edema significantly decreased and AOFAS scores increased indicating that both treatment methods were effective. With the numbers available, no statistically significant difference could be detected. Each treatment method was effective in decreasing the edema and increasing the functional scores of the ankle. At the beginning of treatment, not only the level of edema but also the initial functional scores of the ankle and examinations are important in making decisions regarding the optimal treatment option.

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

    Science.gov (United States)

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

    2016-05-01

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

  8. The Effect of Passive Movement for Paretic Ankle-Foot and Brain Activity in Post-Stroke Patients.

    Science.gov (United States)

    Vér, Csilla; Emri, Miklós; Spisák, Tamás; Berényi, Ervin; Kovács, Kázmér; Katona, Péter; Balkay, László; Menyhárt, László; Kardos, László; Csiba, László

    2016-01-01

    This study aims at investigating the short-term efficacy of the continuous passive motion (CPM) device developed for the therapy of ankle-foot paresis and to investigate by fMRI the blood oxygen level-dependent responses (BOLD) during ankle passive movement (PM). Sixty-four stroke patients were investigated. Patients were assigned into 2 groups: 49 patients received both 15 min manual and 30 min device therapy (M + D), while the other group (n = 15) received only 15 min manual therapy (M). A third group of stroke patients (n = 12) was investigated by fMRI before and immediately after 30 min CPM device therapy. There was no direct relation between the fMRI group and the other 2 groups. All subjects were assessed using the Modified Ashworth Scale (MAS) and a goniometer. Mean MAS decreased, the ankle's mean plantar flexion and dorsiflexion passive range of motion (PROM) increased and the equinovalgus improved significantly in the M + D group. In the fMRI group, the PM of the paretic ankle increased BOLD responses; this was observed in the contralateral pre- and postcentral gyrus, superior temporal gyrus, central opercular cortex, and in the ipsilateral postcentral gyrus, frontal operculum cortex and cerebellum. Manual therapy with CPM device therapy improved the ankle PROM, equinovalgus and severity of spasticity. The ankle PM increased ipsi- and contralateral cortical activation. © 2016 S. Karger AG, Basel.

  9. Oscillatory corticospinal activity during static contraction of ankle muscles is reduced in healthy old versus young adults

    DEFF Research Database (Denmark)

    Spedden, Meaghan Elizabeth; Nielsen, Jens Bo; Geertsen, Svend Sparre

    2018-01-01

    Aging is accompanied by impaired motor function, but age-related changes in neural networks responsible for generating movement are not well understood. We aimed to investigate the functional oscillatory coupling between activity in the sensorimotor cortex and ankle muscles during static contract......Aging is accompanied by impaired motor function, but age-related changes in neural networks responsible for generating movement are not well understood. We aimed to investigate the functional oscillatory coupling between activity in the sensorimotor cortex and ankle muscles during static...... contraction. Fifteen young (20–26 yr) and fifteen older (65–73 yr) subjects were instructed to match a target force by performing static ankle dorsi- or plantar flexion, while electroencephalographic (EEG) activity was recorded from the cortex and electromyographic (EMG) activity was recorded from dorsi...

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

    Directory of Open Access Journals (Sweden)

    Henry Wang

    2017-09-01

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

  11. MRI abnormalities of foot and ankle in asymptomatic, physically active individuals

    International Nuclear Information System (INIS)

    Lohman, M.; Kivisaari, A.; Kivisaari, L.; Kallio, P.

    2001-01-01

    Objective. To assess MRI changes in the ankle and foot after physical exercise.Design and patients. Nineteen non-professional marathon runners and 19 age- and sex-matched controls volunteered for the study. All had ankle and foot MR images (1.5 T) taken in three perpendicular planes (STIR, T2F and T1FS sequences) within 3 h of running a full-length marathon (42.125 km). Three radiologists independently analysed the groups on a masked basis using a predefined form.Results. Severe bone marrow oedema was seen in one and slight bone marrow oedema in three marathon runners. Slight bone marrow oedema was found in three control subjects. Signal alteration within the soleus muscle, consistent with a grade 1 strain, was found in one marathon runner. Small punctate hyperintensities within the Achilles tendon were seen in 26% of the marathon runners and in 63% of controls (P=0.016). An increased amount of fluid in the retrocalcaneal bursa was found in one control and in none of the marathon runners. Small amounts of fluid in the retrocalcaneal bursa were seen in 68% of marathon runners and in 53% of controls. Grade 1 or 2 peritendinous joint fluid was found around 22% of tendons, among both marathon runners and controls, most often involving the tendon sheath of the flexor hallucis longus muscle. An increased amount of joint fluid was noted in 34% of the joints of the marathon runners, and in 18% of the controls.Conclusion. MRI shows several abnormalities in the ankle and foot both after marathon races and in asymptomatic physically active individuals without any preceding extraordinary strain. Recreational sports may lead to a number of positive MRI findings without correlation with clinical findings. (orig.)

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

    Science.gov (United States)

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

    2016-01-01

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

  13. Design and experimental evaluation of a lightweight, high-torque and compliant actuator for an active ankle foot orthosis.

    Science.gov (United States)

    Moltedo, Marta; Bacek, Tomislav; Langlois, Kevin; Junius, Karen; Vanderborght, Bram; Lefeber, Dirk

    2017-07-01

    The human ankle joint plays a crucial role during walking. At the push-off phase the ankle plantarflexors generate the highest torque among the lower limb joints during this activity. The potential of the ankle plantarflexors is affected by numerous pathologies and injuries, which cause a decrease in the ability of the subject to achieve a natural gait pattern. Active orthoses have shown to have potential in assisting these subjects. The design of such robots is very challenging due to the contrasting design requirements of wearability (light weight and compact) and high torques capacity. This paper presents the development of a high-torque ankle actuator to assist the ankle joint in both dorsiflexion and plantarflexion. The compliant actuator is a spindle-driven MACCEPA (Mechanically Adjustable Compliance and Controllable Equilibrium Position Actuator). The design of the actuator was made to keep its weight as low as possible, while being able to provide high torques. As a result of this novel design, the actuator weighs 1.18kg. Some static characterization tests were perfomed on the actuator and their results are shown in the paper.

  14. Effects of slip-induced changes in ankle movement on muscle activity and ground reaction forces during running acceleration

    DEFF Research Database (Denmark)

    Ketabi, Shahin; Kersting, Uwe G.

    2013-01-01

    Ground contact in running is always linked to a minimum amount of slipping, e.g., during the early contact phase when horizontal forces are high compared to vertical forces. Studies have shown altered muscular activation when expecting slips [2-4]. It is not known what the mechanical effect of su...... of such slip episodes are on joint loading or performance. The aim of the present study was to examine the effect of changes in ankle movement on ankle joint loading, muscle activity, and ground reaction forces during linear acceleration....

  15. Ankle Problems

    Science.gov (United States)

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

  16. Ankle Sprains

    Science.gov (United States)

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

  17. Ankle sprain - aftercare

    Science.gov (United States)

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

  18. Synergistic co-activation increases the extent of mechanical interaction between rat ankle plantar-flexors

    Directory of Open Access Journals (Sweden)

    Chris Tijs

    2016-09-01

    Full Text Available Force transmission between rat ankle plantar-flexors has been found for physiological muscle lengths and relative positions, but only with all muscles maximally activated. The aims of this study were to assess intermuscular mechanical interactions between ankle plantar-flexors during (i fully passive conditions, (ii excitation of soleus (SO, (iii excitation of lateral gastrocnemius (LG, and (iv during co-activation of SO and LG (SO&LG. We assessed effects of proximal lengthening of LG and plantaris (PL muscles (i.e. simulating knee extension on forces exerted at the distal SO tendon (FSO and on the force difference between the proximal and distal LG+PL tendons (ΔFLG+PL of the rat. LG+PL lengthening increased FSO to a larger extent (p=0.017 during LG excitation (0.0026 N/mm than during fully passive conditions (0.0009 N/mm. Changes in FSO in response to LG+PL lengthening were lower (p=0.002 during SO only excitation (0.0056 N/mm than during SO&LG excitation (0.0101 N/mm. LG+PL lengthening changed ∆FLG+PL to a larger extent (p=0.007 during SO excitation (0.0211 N/mm than during fully passive conditions (0.0157 N/mm. In contrast, changes in ∆FLG+PL in response to LG+PL lengthening during LG excitation (0.0331 N/mm were similar (p=0.161 to that during SO&LG excitation (0.0370 N/mm. In all conditions, changes of FSO were lower than those of ∆FLG+PL. This indicates that muscle forces were transmitted not only between LG+PL and SO, but also between LG+PL and other surrounding structures. In addition, epimuscular myofascial force transmission between rat ankle plantar-flexors was enhanced by muscle activation. However, the magnitude of this interaction was limited.

  19. Intermonitor reliability of the GT3X+ accelerometer at hip, wrist and ankle sites during activities of daily living

    International Nuclear Information System (INIS)

    Ozemek, Cemal; Wilkerson, Brittany S; Kaminsky, Leonard A; Kirschner, Monica M; Byun, Wonwoo

    2014-01-01

    The triaxial GT3X+ accelerometer can measure activity counts in the vertical, horizontal right to left, horizontal front to back planes, and can generate a summative score of the three axes represented by vector magnitude (VM). Information on the reliability of the GT3X+ at the hip, wrist and ankle sites, over all axes and VM during activities of daily living (ADL) is lacking in the literature. Forty healthy adults (14 men and 26 women) were randomly assigned to perform 10 of 20 ADL (consisting of sedentary, housework, yard work, locomotive and recreational activities) while wearing two monitors on the hip, wrist and ankle. Subjects performed each ADL over 7 min and the mean activity counts during the last 4 min were used for analyses. Average intraclass correlations between monitors were high for the three sites for each axis and VM (hip: 0.943, 0.857, 0.864 and 0.966, respectively; wrist: 0.994, 0.963, 0.961 and 0.989, respectively; ankle: 0.977, 0.979, 0.927 and 0.986, respectively). These data suggest that GT3X+ accelerometers measurements made from the hip, wrist and ankle sites are reliable during ADL across all axes and VM. (paper)

  20. Ankle Accelerometry for Assessing Physical Activity among Adolescent Girls: Threshold Determination, Validity, Reliability, and Feasibility

    Science.gov (United States)

    Hager, Erin R.; Treuth, Margarita S.; Gormely, Candice; Epps, LaShawna; Snitker, Soren; Black, Maureen M.

    2015-01-01

    Purpose: Ankle accelerometry allows for 24-hr data collection and improves data volume/integrity versus hip accelerometry. Using Actical ankle accelerometry, the purpose of this study was to (a) develop sensitive/specific thresholds, (b) examine validity/reliability, (c) compare new thresholds with those of the manufacturer, and (d) examine…

  1. Ankle replacement - discharge

    Science.gov (United States)

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

  2. Ankle sprain (image)

    Science.gov (United States)

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

  3. 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.

  4. Ankle sprain

    NARCIS (Netherlands)

    Struijs, Peter; Kerkhoffs, Gino

    2007-01-01

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

  5. Ankle sprain

    NARCIS (Netherlands)

    Struijs, Peter Aa; Kerkhoffs, Gino Mmj

    2010-01-01

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

  6. Sprained Ankles

    Science.gov (United States)

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

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

    Science.gov (United States)

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

    2017-10-01

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

  8. Studies examining the efficacy of ankle foot orthoses should report activity level and mechanical evidence.

    Science.gov (United States)

    Harlaar, Jaap; Brehm, Merel; Becher, Jules G; Bregman, Daan J J; Buurke, Jaap; Holtkamp, Fred; De Groot, Vincent; Nollet, Frans

    2010-09-01

    Ankle Foot Orthoses (AFOs) to promote walking ability are a common treatment in patients with neurological or muscular diseases. However, guidelines on the prescription of AFOs are currently based on a low level of evidence regarding their efficacy. Recent studies aiming to demonstrate the efficacy of wearing an AFO in respect to walking ability are not always conclusive. In this paper it is argued to recognize two levels of evidence related to the ICF levels. Activity level evidence expresses the gain in walking ability for the patient, while mechanical evidence expresses the correct functioning of the AFO. Used in combination for the purpose of evaluating the efficacy of orthotic treatment, a conjunct improvement at both levels reinforces the treatment algorithm that is used. Conversely, conflicting outcomes will challenge current treatment algorithms and the supposed working mechanism of the AFO. A treatment algorithm must use relevant information as an input, derived from measurements with a high precision. Its result will be a specific AFO that matches the patient's needs, specified by the mechanical characterization of the AFO footwear combination. It is concluded that research on the efficacy of AFOs should use parameters from two levels of evidence, to prove the efficacy of a treatment algorithm, i.e., how to prescribe a well-matched AFO.

  9. Sistema estabilizador da adesão de um robô escalador com rodas magnéticas

    OpenAIRE

    Espinoza, Rodrigo Valério

    2015-01-01

    Este trabalho consiste no desenvolvimento de um sistema estabilizador da adesão de um robô escalador com rodas magnéticas. O projeto deste robô surge da necessidade em automatizar o processo de inspeção de tanques de armazenamento de derivados de petróleo, o qual e atualmente realizado de modo manual. O robô vem sendo desenvolvido no Laboratório de Automação e Sistemas de Controle Avençado (LASCA) da Universidade Tecnológica Federal do Paraná (UTFPR). Primeiramente foi realizada uma análise t...

  10. Acute ankle sprain in dancers.

    Science.gov (United States)

    Russell, Jeffrey A

    2010-01-01

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

  11. Avaliação eletromiográfica dos músculos estabilizadores da patela durante exercício isométrico de agachamento em indivíduos com síndrome da dor femoropatelar Evaluacion eletromiográfica de los músculos estabilizadores patelares durante el ejercício isométrico de agachamiento en indivíduos con síndrome de dolor femoropatelar Electromyographic activity evaluation of the patella muscles during squat isometric exercise in individuals with patellofemoral pain syndrome

    Directory of Open Access Journals (Sweden)

    Débora Bevilaqua-Grossi

    2005-06-01

    Full Text Available O objetivo deste trabalho foi comparar a atividade elétrica dos músculos vasto medial oblíquo (VMO, vasto lateral longo (VLL e vasto lateral oblíquo (VLO durante os exercícios isométricos de agachamento wall slide a 45º (WS 45º e 60º (WS 60º de flexão do joelho. Foram avaliadas 15 mulheres clinicamente saudáveis e 15 mulheres com síndrome da dor femoropatelar (SDFP. Os registros eletromiográficos foram obtidos por eletrodos ativos simples conectados a um eletromiógrafo durante a contração isométrica voluntária máxima (CIVM do WS 45º e WS 60º. Os dados foram analisados pela média dos valores do root mean square (RMS do sinal eletromiográfico, normalizado pela média do RMS obtido no agachamento a 75º de flexão do joelho. A análise estatística empregada foi o teste ANOVA two way (p El objetivo de este trabajo fué el de comparar la actvividad eléctrica de los músculos vasto medial oblíqüo (VMO, vasto lateral longo (VLL y vasto lateral oblicuo (VLO durante los ejercicios isometricos de agachamiento wall slide a 45º (WS 45º e 60º (WS 60º de flexión de rodilla. Fueron evaluadas 15 mujeres clinicamente saludables con sindrome de dolor femoropatelar (SDFP. Los registros fueron obtenidos por electrodos activos simples conectados a un electromiografo durante la contraccion isometrica voluntaria máxima (CIVM de WS 45º y de WS 60º. Los datos fueron analizados por la media de los valores de Root Mean Square - RMS de señal eletromiográfica, normalizada por la media del RMS obtenido en el agachamiento a 75º de flexión de la rodilla. El análisis estatístico empleado fue el test ANOVA two way (p The objective of this study was to compare the electromyographic (EMG activity of vastus medialis obliquus (VMO, vastus lateralis longus (VLL and vastus lateralis oblíquus (VLO during wall slide squat isometric exercises at 45º (WS 45º and at 60º (WS 60º of knee flexion. Fifteen healthy control women and fifteen women

  12. Syndesmotic ankle sprain.

    Science.gov (United States)

    Childs, Sharon G

    2012-01-01

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

  13. Examination of a muscular activity estimation model using a Bayesian network for the influence of an ankle foot orthosis.

    Science.gov (United States)

    Inoue, Jun; Kawamura, Kazuya; Fujie, Masakatsu G

    2012-01-01

    In the present paper, we examine the appropriateness of a new model to examine the activity of the foot in gait. We developed an estimation model for foot-ankle muscular activity in the design of an ankle-foot orthosis by means of a statistical method. We chose three muscles for measuring muscular activity and built a Bayesian network model to confirm the appropriateness of the estimation model. We experimentally examined the normal gait of a non-disabled subject. We measured the muscular activity of the lower foot muscles using electromyography, the joint angles, and the pressure on each part of the sole. From these data, we obtained the causal relationship at every 10% level for these factors and built models for the stance phase, control term, and propulsive term. Our model has three advantages. First, it can express the influences that change during gait because we use 10% level nodes for each factor. Second, it can express the influences of factors that differ for low and high muscular-activity levels. Third, we created divided models that are able to reflect the actual features of gait. In evaluating the new model, we confirmed it is able to estimate all muscular activity level with an accuracy of over 90%.

  14. Peculiarities in Ankle Cartilage.

    Science.gov (United States)

    Kraeutler, Matthew J; Kaenkumchorn, Tanyaporn; Pascual-Garrido, Cecilia; Wimmer, Markus A; Chubinskaya, Susanna

    2017-01-01

    Posttraumatic osteoarthritis (PTOA) is the most common form of osteoarthritis (OA) of the ankle joint. PTOA occurs as a result of several factors, including the poor regenerative capacity of hyaline articular cartilage as well as increased contact stresses following trauma. The purpose of this article is to review the epidemiology, pathogenesis, and potential targets for treatment of PTOA in the ankle joint. Previous reviews primarily addressed clinical approaches to ankle PTOA, while the focus of the current article will be specifically on the newly acquired knowledge of the cellular mechanisms that drive PTOA in the ankle joint and means for potential targeted therapeutics that might halt the progression of cartilage degeneration and/or improve the outcome of surgical interventions. Three experimental treatment strategies are discussed in this review: (1) increasing the anabolic potential of chondrocytes through treatment with growth factors such as bone morphogenetic protein-7; (2) limiting chondrocyte cell death either through the protection of cell membrane with poloxamer 188 or inhibiting activity of intracellular proteases, caspases, which are responsible for cell death by apoptosis; and (3) inhibiting catabolic/inflammatory responses of chondrocytes by treating them with anti-inflammatory agents such as tumor necrosis factor-α antagonists. Future studies should focus on identifying the appropriate timing for treatment and an appropriate combination of anti-inflammatory, chondro- and matrix-protective biologics to limit the progression of trauma-induced cartilage degeneration and prevent the development of PTOA in the ankle joint.

  15. Distinguishing active from passive components of ankle plantar flexor stiffness in stroke, spinal cord injury and multiple sclerosis

    DEFF Research Database (Denmark)

    Lorentzen, Jakob; Grey, Michael James; Crone, Clarissa

    2010-01-01

    to distinguish the contribution of active reflex mechanisms from passive muscle properties to ankle joint stiffness in 31 healthy, 10 stroke, 30 multiple sclerosis and 16 spinal cord injured participants. The results were compared to routine clinical evaluation of spasticity. METHODS: A computer...... (Ashworth score1) showed normal reflex torque without normalization. With normalization this was only the case in 11 participants. Increased reflex mediated stiffness was detected in only 64% participants during clinical examination. CONCLUSION: The findings confirm that the clinical diagnosis of spasticity...

  16. The effect of different skin-ankle brace application pressures on quiet single-limb balance and electromyographic activation onset of lower limb muscles

    Directory of Open Access Journals (Sweden)

    Papadakis Stamatios A

    2007-09-01

    Full Text Available Abstract Background Several studies have been carried out in order to investigate the effect of ankle bracing on ankle joint function and performance. However, no study so far has examined the role of skin-brace interface pressure in neuromuscular control. The aim of this study was to investigate the effect of different skin-ankle brace interface pressures on quiet single limb balance and the electromyographic (EMG activation sequence of four lower limb muscles. Methods Thirty three male physical education students who volunteered to take part in the study were measured under three ankle brace conditions: i without brace, ii with brace and 30 kPa application pressure and iii with brace and 60 kPa application pressure. Single limb balance (anteroposterior and mediolateral parameter was assessed on the dominant lower limb, with open and closed eyes, on a force platform, simultaneously with the EMG recording of four lower lower limb muscles' (gastrocnemius, peroneus longus, rectus femoris and biceps femoris activation onset. Results The results showed that overall balance (total stability parameter was not significantly affected in any of the three ankle brace conditions. However, the anteroposterior centre of pressure excursion and centre of pressure excursion velocity were significantly increased with the application of ankle brace, both with 30 and 60 kPa application pressures. Furthermore, it was found that single limb balance was significantly worse with closed eyes compared to open eyes. EMG measurements showed that the sequence of lower limb activation onset was not affected in any of the three ankle brace application conditions. The results of this study showed that the application of an ankle brace with two different skin-brace interface pressures had no effect on overall single limb balance and the sequence of lower limb muscle activation. Conclusion These findings suggest that peripheral joint receptors are either not adequately

  17. Treadmill training with an incline reduces ankle joint stiffness and improves active range of movement during gait in adults with cerebral palsy

    DEFF Research Database (Denmark)

    Lorentzen, Jakob; Kirk, Henrik; Fernandez-Lago, Helena

    2017-01-01

    of gait were obtained before and after the intervention/control period. Intervention subjects trained 31.4 SD 10.1 days for 29.0 SD 2.3 min (total) 15.2 h. RESULTS: Passive ankle joint stiffness was reduced (F = 5.1; p = 0.031), maximal gait speed increased (F = 42.8, p ...PURPOSE: We investigated if 30 min of daily treadmill training with an incline for 6 weeks would reduce ankle joint stiffness and improve active range of movement in adults with cerebral palsy (CP). METHODS: The study was designed as a randomized controlled clinical trial including 32 adults...... prior to heel strike increased (F = 5.3, p reduces ankle joint stiffness and increases active ROM during...

  18. 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

  19. Acute ankle sprain: conservative or surgical approach?

    Science.gov (United States)

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

    2016-01-01

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

  20. Ankle Sprain Treatment

    Science.gov (United States)

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

  1. Ankle fracture - aftercare

    Science.gov (United States)

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

  2. Effects of spinal cord injury-induced changes in muscle activation on foot drag in a computational rat ankle model.

    Science.gov (United States)

    Hillen, Brian K; Jindrich, Devin L; Abbas, James J; Yamaguchi, Gary T; Jung, Ranu

    2015-04-01

    Spinal cord injury (SCI) can lead to changes in muscle activation patterns and atrophy of affected muscles. Moderate levels of SCI are typically associated with foot drag during the swing phase of locomotion. Foot drag is often used to assess locomotor recovery, but the causes remain unclear. We hypothesized that foot drag results from inappropriate muscle coordination preventing flexion at the stance-to-swing transition. To test this hypothesis and to assess the relative contributions of neural and muscular changes on foot drag, we developed a two-dimensional, one degree of freedom ankle musculoskeletal model with gastrocnemius and tibialis anterior muscles. Anatomical data collected from sham-injured and incomplete SCI (iSCI) female Long-Evans rats as well as physiological data from the literature were used to implement an open-loop muscle dynamics model. Muscle insertion point motion was calculated with imposed ankle trajectories from kinematic analysis of treadmill walking in sham-injured and iSCI animals. Relative gastrocnemius deactivation and tibialis anterior activation onset times were varied within physiologically relevant ranges based on simplified locomotor electromyogram profiles. No-atrophy and moderate muscle atrophy as well as normal and injured muscle activation profiles were also simulated. Positive moments coinciding with the transition from stance to swing phase were defined as foot swing and negative moments as foot drag. Whereas decreases in activation delay caused by delayed gastrocnemius deactivation promote foot drag, all other changes associated with iSCI facilitate foot swing. Our results suggest that even small changes in the ability to precisely deactivate the gastrocnemius could result in foot drag after iSCI. Copyright © 2015 the American Physiological Society.

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

    Science.gov (United States)

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

    2014-03-01

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

  4. Outcome of ankle arthrodesis in posttraumatic arthritis

    Directory of Open Access Journals (Sweden)

    B S Narayana Gowda

    2012-01-01

    Full Text Available Background: Ankle arthrodesis is still a gold standard salvage procedure for the management of ankle arthritis. There are several functional and mechanical benefits of ankle arthrodesis, which make it a viable surgical procedure in the management of ankle arthritis. The functional outcomes following ankle arthrodesis are not very well known. The purpose of this study was to perform a clinical and radiographic evaluation of ankle arthrodesis in posttraumatic arthritis performed using Charnley′s compression device. Materials and Methods: Between January 2006 and December 2009 a functional assessment of 15 patients (10 males and 5 females who had undergone ankle arthrodesis for posttraumatic arthritis and/or avascular necrosis (AVN talus (n=6, malunited bimalleolar fracture (n=4, distal tibial plafond fractures (n=3, medial malleoli nonunion (n=2. All the patients were assessed clinically and radiologically after an average followup of 2 years 8 months (range 1-5.7 years. Results: All patients had sound ankylosis and no complications related to the surgery. Scoring the patients with the American Orthopaedic Foot and Ankle Society (AOFAS Ankle-Hindfoot scale, we found that 11 of the 15 had excellent results, two had good, and two showed fair results. They were all returned to their preinjury activities. Conclusion: We conclude that, the ankle arthrodesis can still be considered as a standard procedure in ankle arthritis. On the basis of these results, patients should be counseled that an ankle fusion will help to relieve pain and to improve overall function. Still, one should keep in mind that it is a salvage procedure that will cause persistent alterations in gait with a potential for deterioration due to the development of subtalar arthritis.

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

    Directory of Open Access Journals (Sweden)

    Mineta S

    2017-06-01

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

  6. Chronic Ankle Instability

    Science.gov (United States)

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

  7. LATERAL ANKLE INJURY

    OpenAIRE

    Pollard, Henry; Sim, Patrick; McHardy, Andrew

    2002-01-01

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

  8. Advancements in ankle arthroscopy

    NARCIS (Netherlands)

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

    2008-01-01

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

  9. Complications in ankle arthroscopy

    NARCIS (Netherlands)

    Zengerink, Maartje; van Dijk, C. Niek

    2012-01-01

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

  10. Assessment of Ankle Injuries

    Science.gov (United States)

    Mai, Nicholas; Cooper, Leslie

    2009-01-01

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

  11. Ankle Injuries and Disorders

    Science.gov (United States)

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

  12. Altered left ventricular performance in aging physically active mice with an ankle sprain injury.

    Science.gov (United States)

    Turner, Michael J; Guderian, Sophie; Wikstrom, Erik A; Huot, Joshua R; Peck, Bailey D; Arthur, Susan T; Marino, Joseph S; Hubbard-Turner, Tricia

    2016-02-01

    We assessed the impact of differing physical activity levels throughout the lifespan, using a musculoskeletal injury model, on the age-related changes in left ventricular (LV) parameters in active mice. Forty male mice (CBA/J) were randomly placed into one of three running wheel groups (transected CFL group, transected ATFL/CFL group, SHAM group) or a SHAM Sedentary group (SHAMSED). Before surgery and every 6 weeks after surgery, LV parameters were measured under 2.5 % isoflurane inhalation. Group effects for daily distance run was significantly greater for the SHAM and lesser for the ATLF/CFL mice (p = 0.013) with distance run decreasing with age for all mice (p age, interaction (group × age) was noted with LV posterior wall thickness-to-radius ratios (h/r) where h/r increased with age in the ATFL/CFL and SHAMSED mice while the SHAM and CFL mice exhibited decreased h/r with age (p = 0.0002). Passive filling velocity (E wave) was significantly greater in the SHAM mice and lowest for the ATFL/CFL and SHAMSED mice (p age. Active filling velocity (A wave) was not different between groups (p = 0.10). Passive-to-active filling velocity ratio (E/A ratio) was different between groups (p activity beginning at 9 months of age. Passive-to-active filling velocity ratio decreased with age (p activity throughout the lifespan improved LV structure, passive filling velocity, and E/A ratio by 6 to 9 months of age and attenuated any negative alterations throughout the second half of life. The diastolic filling differences were found to be significantly related to the amount of activity performed by 9 months and at the end of the lifespan.

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

    Science.gov (United States)

    Lewis, John S; DeOrio, James K

    2015-04-01

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

  14. Total ankle joint replacement.

    Science.gov (United States)

    2016-02-01

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

  15. Rapid limb-specific modulation of vestibular contributions to ankle muscle activity during locomotion

    NARCIS (Netherlands)

    Forbes, Patrick A.; Vlutters, Mark; Dakin, Christopher J.; van der Kooij, Herman; Blouin, Jean Sébastien; Schouten, Alfred C.

    2017-01-01

    Key points: -The vestibular influence on human walking is phase-dependent and modulated across both limbs with changes in locomotor velocity and cadence. -Using a split-belt treadmill, we show that vestibular influence on locomotor activity is modulated independently in each limb. -The independent

  16. Rapid limb-specific modulation of vestibular contributions to ankle muscle activity during locomotion

    NARCIS (Netherlands)

    Forbes, P.A.; Vlutters, M; Dakin, CJ; van der Kooij, H.; Blouin, JS; Schouten, A.C.

    2017-01-01

    During walking, the vestibular influence on locomotor activity is phase-dependent and modulated in both limbs with changes in velocity. It is unclear, however, whether this bilateral modulation is due to a coordinated mechanism between both limbs or instead through limb-specific processes that

  17. Circadian and individual variations in duration of spontaneous activity among ankle muscles of the cat

    NARCIS (Netherlands)

    Hensbergen, E; Kernell, D

    This article concerns the spontaneous motor behavior of cat hindlimb muscles and muscle regions using 24-h electromyographic (EMG) recordings. Previously, we found marked differences in average daily "duty time" (i.e., the percentage of total sampling time filled with EMG activity) between different

  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. Relationship between activation of ankle muscles and quasi-joint stiffness in early and middle stances during gait in patients with hemiparesis.

    Science.gov (United States)

    Sekiguchi, Yusuke; Muraki, Takayuki; Tanaka, Naofumi; Izumi, Shin-Ichi

    2015-09-01

    It is unclear whether muscle contraction is necessary to increase quasi-joint stiffness (QJS) of the ankle joint during gait in patients with hemiparesis. The purpose of the present study was to investigate the relationship between QJS and muscle activation at the ankle joint in the stance phase during gait in patients with hemiparesis. Spatiotemporal and kinetic gait parameters and activation of the medial head of the gastrocnemius (MG), soleus (SOL), and tibialis anterior (TA) muscles were measured using a 3-dimensional motion analysis system and surface electromyography, in 21 patients with hemiparesis due to stroke and 10 healthy individuals. In the early stance, the QJS on the paretic side (PS) of patients was greater than that on the non-PS (phemiparesis, plantarflexor activation may not contribute to QJS in the early stance. On the other hand, QJS in the middle stance may be attributed to activation of the MG and SOL. Our findings suggest that activation of the MG and SOL in the middle stance on the PS may require to be enhanced to increase QJS during gait in patients with hemiparesis. Copyright © 2015 Elsevier B.V. All rights reserved.

  20. [Motor skills and safety of patients with bi- or trimalleolar ankle injury : Comparison with healthy, active, age-matched control subjects].

    Science.gov (United States)

    Loudovici-Krug, Dana; Benkenstein, Monique; Derlien, Steffen; Best, Norman

    2018-06-01

    Do patients with bi- or trimalleolar ankle injury show differences in motor skills and safety in comparison with healthy, active, age-matched control subjects? Prospective controlled cross-sectional study. Inclusion of 17 patients with bi- or trimalleolar ankle injury (mean 1.5 years postsurgery) and 23 healthy, active subjects of comparable age (fitness studio). Measurement instruments: motor test procedures and questionnaires. Comparison of patients and control subjects by routine daily motor function: patients  0.05), fear of falling: patients > controls (p = 0.003) and physical activity: patients motor deficits in activities of daily life between the patients and controls, only tendencies; however, the patients showed definite limitations with an increased fear of falling and a reduced physical activity compared with the healthy control group. The resulting differences should be positively influenced by appropriate enhancement of training or participation in sports courses. The aim is to achieve a similar quality of life by a perception of safety and trust in one's own motor skills.

  1. Different ankle muscle coordination patterns and co-activation during quiet stance between young adults and seniors do not change after a bout of high intensity training.

    Science.gov (United States)

    Donath, Lars; Kurz, Eduard; Roth, Ralf; Zahner, Lukas; Faude, Oliver

    2015-03-04

    Available evidence suggests that young adults and seniors use different strategies to adjust for increasing body sway during quiet standing. Altered antagonist muscle co-activation and different ankle muscle coordination patterns may account for this finding. Consequently, we aimed at addressing whether aging leads to changes in neuromuscular coordination patterns as well as co-activation during quiet stance. We additionally investigated whether a bout of high intensity interval training additionally alters these patterns. Twenty healthy seniors (age: 70 ± 4 y) and twenty young adults (age: 27 ± 3 y) were enrolled in the present study. In between the testing procedures, four consecutive high-intensity intervals of 4 min duration at a target exercise intensity of 90 to 95% HRmax were completed on a treadmill. The total center of pressure (COP) path length displacement served as standing balance performance outcome. In order to assess ankle muscle coordination patterns, amplitude ratios (AR) were calculated for each muscle (e.g. tibialis anterior (TA) [%] = (TA × 100)/(gastrocnemius medialis (GM) + soleus (SOL) + peroneus longus (PL) + TA). The co-activation was calculated for the SOL and TA muscles computing the co-activation index (CAI = 2 × TA/TA + SOL). Seniors showed an inverted ankle muscle coordination pattern during single limb stance with eyes open (SLEO), compared to young adults (rest: GM, S: 15 ± 8% vs Y: 24 ± 9%; p = 0.03; SOL, S: 27 ± 14% vs Y: 37 ± 18%; p = 0.009; TA, S: 31 ± 13% vs Y: 13 ± 7%; p = 0.003). These patterns did not change after a high-intensity training session. A moderate correlation between amplitude ratios of the TA-contribution and postural sway was observed for seniors during SLEO (r = 0.61). Ankle co-activation was twofold elevated in seniors compared to young adults during SLEO (p Seniors with decreased postural control showed higher TA

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

    Science.gov (United States)

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

    2013-01-01

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

  3. Análise funcional dos estabilizadores patelares Functional analysis of the patellar stabilizers

    Directory of Open Access Journals (Sweden)

    Débora Bevilaqua Grossi

    2004-06-01

    Full Text Available O músculo vasto medial obliquo (VMO desempenha importante papel na estabilização medial da patela. No entanto, o padrão de recrutamento dos componentes laterais, o músculo vasto lateral longo (VLL e vasto lateral obliquo (VLO não está estabelecido. O objetivo deste trabalho foi analisar a atividade eletromiográfica dos músculos VMO, VLL e VLO de 21 indivíduos saudáveis (X=23,3 e DP=2,9, sendo 10 mulheres e 11 homens, sem história clínica de dor ou lesão osteomioarticular. Para tanto foi utilizado um eletromiógrafo NICOLET VIKING II de 8 canais (NICOLET Biomedical Instruments e eletrodos bipolares de superfície para registrar a atividade elétrica dos músculos VMO, VLL e VLO durante a realização de exercícios isométricos de extensão do joelho a 15º e 90º de flexão. Os dados eletromiográficos foram normalizados pela contração isométrica voluntária máxima de extensão do joelho a 50º de flexão e revelaram que os músculos VLL e VLO apresentam diferença significativa no padrão de recrutamento podendo ser considerados fisiologicamente distintos. O músculo VMO desempenhou juntamente com o VLO um papel recíproco e sincrônico na estabilização patelar e apresentou maior ativação em relação ao músculo VLL nos exercícios isométricos de extensão do joelho a 90º.The vastus medialis obliquus muscle (VMO performs an important role in the medial patellar stability . However , the recruitment of the lateral components, the vastus lateralis longus (VLL and vastus laterallis oblique (VLO is not established. The main purpose of this work was to investigate the electromyographic (EMG activity of the VMO, VLL and VLO muscles of twenty one health volunteers (X= 23,3 ± DP 2,9, 10 female and eleven males, without clinical pain symptoms or osteomioarticular injuries EMG NICOLET VIKING II was used with eight channels (NICOLET Biomedical Instruments, and bipolar electrodes surface in order to record the electrical activity

  4. Responses of spinal dorsal horn neurons to foot movements in rats with a sprained ankle

    OpenAIRE

    Kim, Jae Hyo; Kim, Hee Young; Chung, Kyungsoon; Chung, Jin Mo

    2011-01-01

    Acute ankle injuries are common problems and often lead to persistent pain. To investigate the underlying mechanism of ankle sprain pain, the response properties of spinal dorsal horn neurons were examined after ankle sprain. Acute ankle sprain was induced manually by overextending the ankle of a rat hindlimb in a direction of plantarflexion and inversion. The weight-bearing ratio (WBR) of the affected foot was used as an indicator of pain. Single unit activities of dorsal horn neurons in res...

  5. Vladimir Byurchiev, Ankle Bones

    OpenAIRE

    Churyumov, Anton

    2017-01-01

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

  6. Ankle Sprains. A Round Table.

    Science.gov (United States)

    Physician and Sportsmedicine, 1986

    1986-01-01

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

  7. Foot, leg, and ankle swelling

    Science.gov (United States)

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

  8. Musculoskeletal ultrasonography delineates ankle symptoms in rheumatoid arthritis.

    Science.gov (United States)

    Toyota, Yukihiro; Tamura, Maasa; Kirino, Yohei; Sugiyama, Yumiko; Tsuchida, Naomi; Kunishita, Yosuke; Kishimoto, Daiga; Kamiyama, Reikou; Miura, Yasushi; Minegishi, Kaoru; Yoshimi, Ryusuke; Ueda, Atsuhisa; Nakajima, Hideaki

    2017-05-01

    To clarify the use of musculoskeletal ultrasonography (US) of ankle joints in rheumatoid arthritis (RA). Consecutive RA patients with or without ankle symptoms participated in the study. The US, clinical examination (CE), and patients' visual analog scale for pain (pVAS) for ankles were assessed. Prevalence of tibiotalar joint synovitis and tenosynovitis were assessed by grayscale (GS) and power Doppler (PD) US using a semi-quantitative grading (0-3). The positive US and CE findings were defined as GS score ≥2 and/or PD score ≥1, and joint swelling and/or tenderness, respectively. Multivariate analysis with the generalized linear mixed model was performed by assigning ankle pVAS as a dependent variable. Among a total of 120 ankles from 60 RA patients, positive ankle US findings were found in 21 (35.0%) patients. The concordance rate of CE and US was moderate (kappa 0.57). Of the 88 CE negative ankles, US detected positive findings in 9 (10.2%) joints. Multivariate analysis revealed that ankle US, clinical disease activity index, and foot Health Assessment Questionnaire, but not CE, was independently associated with ankle pVAS. US examination is useful to illustrate RA ankle involvement, especially for patients who complain ankle pain but lack CE findings.

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

    Science.gov (United States)

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

    2004-08-01

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

  10. Intrinsic ankle stiffness during standing increases with ankle torque and passive stretch of the Achilles tendon

    Science.gov (United States)

    Gill, Jaspret

    2018-01-01

    Individuals may stand with a range of ankle angles. Furthermore, shoes or floor surfaces may elevate or depress their heels. Here we ask how these situations impact ankle stiffness and balance. We performed two studies (each with 10 participants) in which the triceps surae, Achilles tendon and aponeurosis were stretched either passively, by rotating the support surface, or actively by leaning forward. Participants stood freely on footplates which could rotate around the ankle joint axis. Brief, small stiffness-measuring perturbations (torque or passive stretch. Sway was minimally affected by stretch or lean, suggesting that this did not underlie the alterations in stiffness. In quiet stance, maximum ankle stiffness is limited by the tendon. As tendon strain increases, it becomes stiffer, causing an increase in overall ankle stiffness, which would explain the effects of leaning. However, stiffness also increased considerably with passive stretch, despite a modest torque increase. We discuss possible explanations for this increase. PMID:29558469

  11. The foot and ankle

    International Nuclear Information System (INIS)

    Berquist, T.H.

    1985-01-01

    Imaging of the foot and ankle can be difficult because of the complex anatomy. Familiarity with the bony and ligamentous anatomy is essential for proper evaluation of radiographic findings. Therefore, pertinent anatomy is discussed as it applies to specific injuries. Special views, tomography, arthrography, and other techniques may be indicated for complete evaluation of foot and ankle trauma

  12. Relationship between viscosity of the ankle joint complex and functional ankle instability for inversion ankle sprain patients.

    Science.gov (United States)

    Lin, Che-Yu; Kang, Jiunn-Horng; Wang, Chung-Li; Shau, Yio-Wha

    2015-03-01

    Measurement of viscosity of the ankle joint complex is a novel method to assess mechanical ankle instability. In order to further investigate the clinical significance of the method, this study intended to investigate the relationship between ankle viscosity and severity of functional ankle instability. Cross-sectional study. 15 participants with unilateral inversion ankle sprain and 15 controls were recruited. Their ankles were further classified into stable and unstable ankles. Ankle viscosity was measured by an instrumental anterior drawer test. Severity of functional ankle instability was measured by the Cumberland Ankle Instability Tool. Unstable ankles were compared with stable ankles. Injured ankles were compared with uninjured ankles of both groups. The spearman's rank correlation coefficient was applied to determine the relationship between ankle viscosity and severity of functional ankle instability in unstable ankles. There was a moderate relationship between ankle viscosity and severity of functional ankle instability (r=-0.64, pankles exhibited significantly lower viscosity (pankle instability (pankles. Injured ankles exhibited significantly lower viscosity and more severe functional ankle instability than uninjured ankles (pankle viscosity and severity of functional ankle instability. This finding suggested that, severity of functional ankle instability may be partially attributed to mechanical insufficiencies such as the degenerative changes in ankle viscosity following the inversion ankle sprain. In clinical application, measurement of ankle viscosity could be a useful tool to evaluate severity of chronic ankle instability. Copyright © 2014 Sports Medicine Australia. Published by Elsevier Ltd. All rights reserved.

  13. 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.

  14. 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.

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

    Science.gov (United States)

    Hunt, Michael A; Hatfield, Gillian L

    2017-08-01

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

  16. Effect of Ankle Taping and Fatigue on Dynamic Stability in Athletes With and Without Chronic Ankle Instability

    Directory of Open Access Journals (Sweden)

    Tahereh Pourkhani

    2017-07-01

    Conclusion In the athletes with chronic ankle instability, taping without fatigue improved dynamic balance in the vertical direction. Taping after fatigue could not improve dynamic stability in the athletes with and without chronic ankle instability. Future researchers should examine injured and uninjured participants tested under these conditions to determine if these results are useful in selecting appropriate prophylactic method that can treat or prevent injury to the ankle during functional activities.

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

    Science.gov (United States)

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

    2014-03-01

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

  18. Sprained ankle (image)

    Science.gov (United States)

    A sprain is caused by the twisting or bending of a joint into a position it was not designed to move. The ankle is the most commonly sprained joint. Some common symptoms of a sprain are pain around the joint, ...

  19. Evaluation and tuning of control algorithms for power system stabilizers; Evaluacion y sintonizacion de algoritmos de control para el estabilizador de sistemas de potencia

    Energy Technology Data Exchange (ETDEWEB)

    Ramirez Gonzalez, Miguel

    1998-08-01

    A procedure based on the phase compensation technique for tuning satisfactorily lead-lag power system stabilizers (PSS) is presented in this work. This procedure can be applied to standard models of PSS`s (with two phase compensation stages) where rotor speed deviation or an equivalent rotor speed signal is used as input. An analysis of several state of the art advanced control schemes is also presented, which are proposed for overcoming the limitations of conventional fixed parameters PSS`s. The advantages and drawbacks in designing certain types of PSS`s which are based on adaptive control, fuzzy logic and neural networks techniques are investigated. Based on this study, and taking into account the highly complex and non-linear nature of power systems, a fuzzy logic PSS is designed. In order to have good damping characteristics, speed deviation ({Delta}{omega}) of a machine and its acceleration ({Delta}{omega}) are chosen as the input signals to the fuzzy stabilizer of that particular machine. The performance of the lead-lag PSS and fuzzy stabilizer are validated through the simulation of two case studies: a single machine-infinite bus system, and a multimachine power system. All simulations were performed using a tool based on algorithms developed in MATLAB for the study of power system stability. [Espanol] Se presenta un procedimiento basado en la tecnica de compensacion de fase para ajustar en forma satisfactoria los parametros de los estabilizadores de sistemas de potencia (ESP) del tipo de adelanto-atraso. Este procedimiento es aplicable a modelos estandar de ESP`s (con dos redes de compensacion de fase) que utilizan como senal de entrada la velocidad del rotor del generador en cuestion, o una senal de velocidad equivalente. Por otra parte, se realiza un estudio de diversos esquemas de control avanzado del ESP que se proponen en la literatura actual para superar las limitantes de los estabilizadores convencionales. Basicamente, se analizan las ventajas y

  20. Ultrasonography of the ankle joint

    Energy Technology Data Exchange (ETDEWEB)

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

    2017-10-15

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

  1. Ultrasonography of the ankle joint

    International Nuclear Information System (INIS)

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

    2017-01-01

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

  2. Ankle ligament injuries

    Directory of Open Access Journals (Sweden)

    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

  3. Gait analysis after successful mobile bearing total ankle replacement.

    NARCIS (Netherlands)

    Doets, H.C.; van Middelkoop, M.; Houdijk, J.H.P.; Nelissen, R.G.; Veeger, H.E.J.

    2007-01-01

    Background: The effect of total ankle replacement on gait is not fully known in terms of joint kinematics, ground reaction force, and activity of the muscles of the lower leg. Methods: A comparative gait study was done in 10 patients after uneventful unilateral mobile-bearing total ankle replacement

  4. Ankle injuries in the Netherlands : Trends over 10-25 years

    NARCIS (Netherlands)

    Kemler, Ellen; van de Port, I.; Valkenberg, H.; Hoes, A. W.; Backx, F. J G

    2015-01-01

    Ankle injuries are a common health problem; data on ankle injury rates and time trends in the population at large are scarce. Our aim was to investigate the incidence of and time trends in population-based and emergency department-treated ankle injuries related to sports activities and other

  5. Simulations Results of an Ankle Rehabilitation Device

    Directory of Open Access Journals (Sweden)

    Ioan Doroftei

    2015-12-01

    Full Text Available The ankle structure is one of the most important structures of the human body. Due to its important role in human’s activities, this joint is the most injured part of the lower limb. For a complete recovery of the range of motion, recovery exercises are mandatory. The introduction of robotic physical recovery systems represents a modern alternative to traditional recovery. In this paper we present the development of a new ankle rehabilitation device, that aims to fully recover the range of motion required for daily activities.

  6. Responses of spinal dorsal horn neurons to foot movements in rats with a sprained ankle

    Science.gov (United States)

    Kim, Jae Hyo; Kim, Hee Young; Chung, Kyungsoon

    2011-01-01

    Acute ankle injuries are common problems and often lead to persistent pain. To investigate the underlying mechanism of ankle sprain pain, the response properties of spinal dorsal horn neurons were examined after ankle sprain. Acute ankle sprain was induced manually by overextending the ankle of a rat hindlimb in a direction of plantarflexion and inversion. The weight-bearing ratio (WBR) of the affected foot was used as an indicator of pain. Single unit activities of dorsal horn neurons in response to plantarflexion and inversion of the foot or ankle compression were recorded from the medial part of the deep dorsal horn, laminae IV-VI, in normal and ankle-sprained rats. One day after ankle sprain, rats showed significantly reduced WBRs on the affected foot, and this reduction was partially restored by systemic morphine. The majority of deep dorsal horn neurons responded to a single ankle stimulus modality. After ankle sprain, the mean evoked response rates were significantly increased, and afterdischarges were developed in recorded dorsal horn neurons. The ankle sprain-induced enhanced evoked responses were significantly reduced by morphine, which was reversed by naltrexone. The data indicate that movement-specific dorsal horn neuron responses were enhanced after ankle sprain in a morphine-dependent manner, thus suggesting that hyperactivity of dorsal horn neurons is an underlying mechanism of pain after ankle sprain. PMID:21389306

  7. Adaptive sports ankle prosthetics. Interview by Sarah A. Curran.

    Science.gov (United States)

    Lyle, David K

    2012-09-01

    Participating in sport at all levels is gaining a dedicated following and this is also apparent in individuals with an amputation. Currently, there is a wide variety of ankle prostheses available which attempt to provide function, control, and comfort, as well as good aesthetic appeal. Participation in sport, however, increases the demands placed upon ankle prostheses. This can compromise function and performance, and constrain the opportunities of participation in various outdoor and water sports. In acknowledging this limitation and the need to develop more versatile ankle prostheses, this article introduces the evolution of a prototype ankle prosthesis referred to as "Adaptive Sports Ankle." The ankle prosthesis, which is compatible with any foot pyramid adapter, offers the same range of motion as the normal human ankle joint and is made up of components that are chemical and corrosion resistant. These design features that are specifically created to accommodate below-the-knee amputees provide an ideal prosthesis for those wishing to lead an active lifestyle and participate in aquatic (i.e. swimming, surfing, and scuba diving), snowboarding, and equestrian activities. Although it is acknowledged that there is a need to establish research on the Adaptive Sports Ankle, its introduction to the market will enhance and expand opportunities of those individuals with a lower limb amputation to lead an active and healthy lifestyle.

  8. Ankle Fractures Often Not Diagnosed

    Science.gov (United States)

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

  9. X-Ray Exam: Ankle

    Science.gov (United States)

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

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

    Science.gov (United States)

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

    2010-01-19

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

  11. Neuromuscular control and ankle instability.

    Science.gov (United States)

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

    2009-04-01

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

  12. Paratrooper's ankle fracture: posterior malleolar fracture.

    Science.gov (United States)

    Young, Ki Won; Kim, Jin-su; Cho, Jae Ho; Kim, Hyung Seuk; Cho, Hun Ki; Lee, Kyung Tai

    2015-03-01

    We assessed the frequency and types of ankle fractures that frequently occur during parachute landings of special operation unit personnel and analyzed the causes. Fifty-six members of the special force brigade of the military who had sustained ankle fractures during parachute landings between January 2005 and April 2010 were retrospectively analyzed. The injury sites and fracture sites were identified and the fracture types were categorized by the Lauge-Hansen and Weber classifications. Follow-up surveys were performed with respect to the American Orthopedic Foot and Ankle Society ankle-hindfoot score, patient satisfaction, and return to preinjury activity. The patients were all males with a mean age of 23.6 years. There were 28 right and 28 left ankle fractures. Twenty-two patients had simple fractures and 34 patients had comminuted fractures. The average number of injury and fractures sites per person was 2.07 (116 injuries including a syndesmosis injury and a deltoid injury) and 1.75 (98 fracture sites), respectively. Twenty-three cases (41.07%) were accompanied by posterior malleolar fractures. Fifty-five patients underwent surgery; of these, 30 had plate internal fixations. Weber type A, B, and C fractures were found in 4, 38, and 14 cases, respectively. Based on the Lauge-Hansen classification, supination-external rotation injuries were found in 20 cases, supination-adduction injuries in 22 cases, pronation-external rotation injuries in 11 cases, tibiofibular fractures in 2 cases, and simple medial malleolar fractures in 2 cases. The mean follow-up period was 23.8 months, and the average follow-up American Orthopedic Foot and Ankle Society ankle-hindfoot score was 85.42. Forty-five patients (80.36%) reported excellent or good satisfaction with the outcome. Posterior malleolar fractures occurred in 41.07% of ankle fractures sustained in parachute landings. Because most of the ankle fractures in parachute injuries were compound fractures, most cases had to

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

    Science.gov (United States)

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

    2011-03-01

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

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

    Science.gov (United States)

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

    2015-03-01

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

  15. The role of series ankle elasticity in bipedal walking.

    Science.gov (United States)

    Zelik, Karl E; Huang, Tzu-Wei P; Adamczyk, Peter G; Kuo, Arthur D

    2014-04-07

    The elastic stretch-shortening cycle of the Achilles tendon during walking can reduce the active work demands on the plantarflexor muscles in series. However, this does not explain why or when this ankle work, whether by muscle or tendon, needs to be performed during gait. We therefore employ a simple bipedal walking model to investigate how ankle work and series elasticity impact economical locomotion. Our model shows that ankle elasticity can use passive dynamics to aid push-off late in single support, redirecting the body's center-of-mass (COM) motion upward. An appropriately timed, elastic push-off helps to reduce dissipative collision losses at contralateral heelstrike, and therefore the positive work needed to offset those losses and power steady walking. Thus, the model demonstrates how elastic ankle work can reduce the total energetic demands of walking, including work required from more proximal knee and hip muscles. We found that the key requirement for using ankle elasticity to achieve economical gait is the proper ratio of ankle stiffness to foot length. Optimal combination of these parameters ensures proper timing of elastic energy release prior to contralateral heelstrike, and sufficient energy storage to redirect the COM velocity. In fact, there exist parameter combinations that theoretically yield collision-free walking, thus requiring zero active work, albeit with relatively high ankle torques. Ankle elasticity also allows the hip to power economical walking by contributing indirectly to push-off. Whether walking is powered by the ankle or hip, ankle elasticity may aid walking economy by reducing collision losses. Copyright © 2013 Elsevier Ltd. All rights reserved.

  16. Efeitos adversos metabólicos de antipsicóticos e estabilizadores de humor Metabolic side effects of antipsychotics and mood stabilizers

    Directory of Open Access Journals (Sweden)

    Paulo José Ribeiro Teixeira

    2006-08-01

    Full Text Available INTRODUÇÃO: Um aumento na incidência de obesidade e diabetes melito entre pacientes psiquiátricos foi observado ainda na década de 60, como resultado indesejável do uso de antipsicóticos. Nos anos 80 e 90, a reabilitação da clozapina, a síntese dos demais antipsicóticos atípicos e a disseminação do uso do lítio e do ácido valpróico chamaram novamente a atenção para os efeitos metabólicos desses medicamentos. Este estudo tem por objetivo revisar a literatura médica a respeito dos efeitos adversos metabólicos associados ao uso de antipsicóticos e estabilizadores de humor. MÉTODO: Foi realizada uma extensa pesquisa nas bases de dados MEDLINE e LILACS até outubro de 2005. CONCLUSÃO: Os efeitos adversos metabólicos permanecem como problemas importantes da psicofarmacologia. Ganho de peso clinicamente relevante ocorre com freqüência em pacientes em uso de antipsicóticos e estabilizadores de humor, principalmente naqueles em uso de clozapina, olanzapina, lítio e ácido valpróico. A clozapina e a olanzapina associam-se também a uma maior incidência de diabetes melito e dislipidemias, seja devido ao ganho de peso, seja por ação deletéria direta sobre o metabolismo da glicose. A incidência de obesidade e outros distúrbios metabólicos é menor com a risperidona, se comparada à olanzapina ou à clozapina. Carbamazepina associa-se a menor ganho de peso, se comparada ao lítio ou ao ácido valpróico. Drogas como o haloperidol, a ziprasidona, o aripiprazol e a lamotrigina não estão associadas a ganho importante de peso ou a maior incidência de diabetes melito e são alternativas para pacientes mais propensos a desenvolver tais efeitos adversos.BACKGROUND: An increase in the incidence of obesity and diabetes mellitus in psychiatric patients using antipsychotic drugs was observed as early as the 1960's. In the 1980's and 1990's, rehabilitation of clozapine, synthesis of other atypical antipsychotics, and spread of the

  17. Ajuste de Estabilizadores de Potencia en generadores utilizando el paquete Power Systems Analysis Toolbox PSAT; Setting of Power System Stabilizers based in PSAT free package calculations

    Directory of Open Access Journals (Sweden)

    Antonio A. Martínez García

    2015-04-01

    Full Text Available La regulación de la tensión es el modo más elemental de control de los Sistemas Eléctricos de Potencia que mejora la estabilidad y la estabilidad transitoria. La introducción de reguladores de tensión muy rápidos facilita la capacidad del sistema de generar acciones que conserven su estabilidad (incremento del torque sincronizante. No obstante, estos dispositivos disminuyen el amortiguamiento del sistema. La forma más económica de mejorar el amortiguamiento de las oscilaciones mecánicas de las unidades generadoras se logra con la adición de un control suplementario agregado en el sistema de excitación, que se conoce como estabilizador de potencia (PSS, por sus siglas en inglés Power System Stabilizer. En el presente trabajo se utilizan las posibilidades del paquete PSAT para seleccionar la mejor ubicación y ajustar PSS en un sistema longitudinal sencillo de dos áreas, similar al caso del Sistema Eléctrico de la República de Cuba. Normally, voltage regulation is the primary mode of control, which improves voltage and transient stability. The introduction of generator´s fast voltage regulators improves Electrical Power Systems ability to generate synchronizing torque to maintain stability. These control devices have a negative effect in damping system oscillations. Supplementary control in generator’s voltage regulators (PSS is the most economic solution to improve system damping. This supplementary control is obtained using power system dampers. PSAT abilities are used in order to obtain setting of this supplementary control in a simple longitudinal two areas system, similar to Cuban Electric Power System.

  18. Return to sports after ankle fractures: a systematic review.

    Science.gov (United States)

    Del Buono, Angelo; Smith, Rebecca; Coco, Manuela; Woolley, Laurence; Denaro, Vincenzo; Maffulli, Nicola

    2013-01-01

    This review aims to provide information on the time athletes will take to resume sports activity following ankle fractures. We systematically searched Medline (PubMED), EMBASE, CINHAL, Cochrane, Sports Discus and Google scholar databases using the combined keywords 'ankle fractures', 'ankle injuries', 'athletes', 'sports', 'return to sport', 'recovery', 'operative fixation', 'pinning', 'return to activity' to identify articles published in English, Spanish, French, Portuguese and Italian. Seven retrospective studies fulfilled our inclusion criteria. Of the 793 patients, 469 (59%) were males and 324 (41%) were females, and of the 356 ankle fractures we obtained information on, 338 were acute and 18 stress fractures. The general principles were to undertake open reduction and internal fixation of acute fractures, and manage stress fractures conservatively unless a thin fracture line was visible on radiographs. The best timing to return to sports after an acute ankle fracture is still undefined, given the heterogeneity of the outcome measures and results. The time to return to sports after an acute stress injury ranged from 3 to 51 weeks. When facing athletes with ankle fractures, associated injuries have to be assessed and addressed to improve current treatment lines and satisfy future expectancies. The best timing to return to sports after an ankle fracture has not been established yet. The ideas of the return to activity parameter and surgeon databases including sports-related information could induce research to progress.

  19. Arthrography of the ankle

    International Nuclear Information System (INIS)

    Lindholmer, E.; Foged, N.; Jensen, J. Th.

    1978-01-01

    Arthrography was performed in 105 cases with freshly sprained ankles and signs of rupture of the anterior talofibular ligament. They were subsequently operated upon. The arthrographic films were examined retrospectively to assess the value of different criteria for the differential diagnosis between rupture of the anterior talofibular ligament and combined rupture of this and the calcaneofibular ligament. The diagnostic value of arthrography was found to be high in isolated rupture of the anterior talofibular ligament, and is acceptable in the combined ruptures. (Auth.)

  20. Changes in Muscle Activation Following Ankle Strength Training in Children with Spastic Cerebral Palsy: An Electromyography Feasibility Case Report

    Science.gov (United States)

    Olsen, Jamie E.; Ross, Sandy A.; Foreman, Matthew H.; Engsberg, Jack R.

    2013-01-01

    Children with cerebral palsy (CP) are likely to experience decreased participation in activities and less competence in activities of daily living. Studies of children with spastic CP have shown that strengthening programs produce positive results in strength, gait, and functional outcomes (measured by the Gross Motor Function Measure). No…

  1. Hypoalgesic effect of a passive accessory mobilisation technique in patients with lateral ankle pain.

    Science.gov (United States)

    Yeo, Hwee Koon; Wright, Anthony

    2011-08-01

    A randomised, double blind, repeated measures study was conducted to investigate the initial effects of an accessory mobilisation technique applied to the ankle joint in 13 patients with a unilateral sub-acute ankle supination injury. Ankle dorsiflexion range of motion, pressure pain threshold, visual analogue scale rating of pain during functional activity and ankle functional scores were assessed before and after application of treatment, manual contact control and no contact control conditions. There were significant improvements in ankle dorsiflexion range of motion (p = 0.000) and pressure pain threshold (p = 0.000) during the treatment condition. However no significant effects were observed for the other measures. These findings demonstrate that mobilisation of the ankle joint can produce an initial hypoalgesic effect and an improvement in ankle dorsiflexion range of motion. Crown Copyright © 2011. Published by Elsevier Ltd. All rights reserved.

  2. What Is a Foot and Ankle Surgeon?

    Science.gov (United States)

    ... A A | Print | Share What is a Foot & Ankle Surgeon? Foot and ankle surgeons are the surgical ... every age. What education has a foot and ankle surgeon received? After completing undergraduate education, the foot ...

  3. Mobile ankle and knee perturbator.

    Science.gov (United States)

    Andersen, Jacob Buus; Sinkjaer, Thomas

    2003-10-01

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

  4. Chronic ankle instability: Arthroscopic anatomical repair.

    Science.gov (United States)

    Arroyo-Hernández, M; Mellado-Romero, M; Páramo-Díaz, P; García-Lamas, L; Vilà-Rico, J

    Ankle sprains are one of the most common injuries. Despite appropriate conservative treatment, approximately 20-40% of patients continue to have chronic ankle instability and pain. In 75-80% of cases there is an isolated rupture of the anterior talofibular ligament. A retrospective observational study was conducted on 21 patients surgically treated for chronic ankle instability by means of an arthroscopic anatomical repair, between May 2012 and January 2013. There were 15 men and 6 women, with a mean age of 30.43 years (range 18-48). The mean follow-up was 29 months (range 25-33). All patients were treated by arthroscopic anatomical repair of anterior talofibular ligament. Four (19%) patients were found to have varus hindfoot deformity. Associated injuries were present in 13 (62%) patients. There were 6 cases of osteochondral lesions, 3 cases of posterior ankle impingement syndrome, and 6 cases of peroneal pathology. All these injuries were surgically treated in the same surgical time. A clinical-functional study was performed using the American Orthopaedic Foot and Ankle Society (AOFAS) score. The mean score before surgery was 66.12 (range 60-71), and after surgery it increased up to a mean of 96.95 (range 90-100). All patients were able to return to their previous sport activity within a mean of 21.5 weeks (range 17-28). Complications were found in 3 (14%) patients. Arthroscopic anatomical ligament repair technique has excellent clinical-functional results with a low percentage of complications, and enables patients to return to their previous sport activity within a short period of time. Copyright © 2016 SECOT. Publicado por Elsevier España, S.L.U. All rights reserved.

  5. Functional Instability of the Ankle Joint: Etiopathogenesis

    Directory of Open Access Journals (Sweden)

    Aydan ÖRSÇELİK

    2016-09-01

    Full Text Available Ankle sprain is one of the most common sports injuries. Chronic ankle instability is a common complication of ankle sprains. Two causes of chronic ankle instability are mechanical instability and functional instability. It is important to understand functional instability etiopathogenesis of the ankle joint in order to guide diagnosis and treatment. This article aims to understand the etiopathogenesis of functional ankle instability.

  6. Managing ankle ligament sprains and tears: current opinion

    Science.gov (United States)

    McGovern, Ryan P; Martin, RobRoy L

    2016-01-01

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

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

    Science.gov (United States)

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

    2014-01-01

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

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

    Science.gov (United States)

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

    2016-07-01

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

  9. Talofibular compartment of the ankle joint after recent ankle sprain

    International Nuclear Information System (INIS)

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

    1978-01-01

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

  10. Electroacupuncture reduces the evoked responses of the spinal dorsal horn neurons in ankle-sprained rats

    Science.gov (United States)

    Kim, Jae Hyo; Kim, Hee Young; Chung, Kyungsoon

    2011-01-01

    Acupuncture is shown to be effective in producing analgesia in ankle sprain pain in humans and animals. To examine the underlying mechanisms of the acupuncture-induced analgesia, the effects of electroacupuncture (EA) on weight-bearing forces (WBR) of the affected foot and dorsal horn neuron activities were examined in a rat model of ankle sprain. Ankle sprain was induced manually by overextending ligaments of the left ankle in the rat. Dorsal horn neuron responses to ankle movements or compression were recorded from the lumbar spinal cord using an in vivo extracellular single unit recording setup 1 day after ankle sprain. EA was applied to the SI-6 acupoint on the right forelimb (contralateral to the sprained ankle) by trains of electrical pulses (10 Hz, 1-ms pulse width, 2-mA intensity) for 30 min. After EA, WBR of the sprained foot significantly recovered and dorsal horn neuron activities were significantly suppressed in ankle-sprained rats. However, EA produced no effect in normal rats. The inhibitory effect of EA on hyperactivities of dorsal horn neurons of ankle-sprained rats was blocked by the α-adrenoceptor antagonist phentolamine (5 mg/kg ip) but not by the opioid receptor antagonist naltrexone (10 mg/kg ip). These data suggest that EA-induced analgesia in ankle sprain pain is mediated mainly by suppressing dorsal horn neuron activities through α-adrenergic descending inhibitory systems at the spinal level. PMID:21389301

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

    OpenAIRE

    Lee, Sun-Min; Lee, Jung-Hoon

    2016-01-01

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

  12. 2016 consensus statement of the International Ankle Consortium: prevalence, impact and long-term consequences of lateral ankle sprains.

    Science.gov (United States)

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

    2016-12-01

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

  13. Ultrasonography of ankle ligaments

    International Nuclear Information System (INIS)

    Peetrons, P.A.; Silvestre, A.; Cohen, M.; Creteur, V.

    2002-01-01

    The lateral collateral ligament of the ankle is a complex of 3 ligaments: The anterior and posterior talofibular ligaments and the calcaneofibular ligament; these ligaments work together to support the lateral aspect of the ankle. The anterior talofibular (ATF) ligament (Fig. 1) runs from the anterior of the talus. The probe is placed in a slightly oblique position from the malleolus toward the forefoot. The ligament is hyperechoic when its fibres are perpendicular to the ultrasound beam (anisotropy artifact is present in ligaments as well as in tendons). It is approximately 2 mm thick and, during examination, must be straight and tight from one insertion point to the other, as seen in Fig. 2. The posterior talofibular (PTF) ligament, which runs from the posterior part of the malleolus to the posterior part of the talus, is difficult to see on US, being partially or sometimes completely hidden by the malleolus. The calcaneofibular ligament forms the middle portion of the lateral collateral ligament. It is tight between the inferior part of the lateral malleolus and the calcaneus, and runs in a slightly posterior oblique direction toward the heel (Fig. 3). The ligament lies on the deep surface of the fibular tendons, forming a hammock to fall deep on the calcaneus surface (Fig. 4). The calcaneofibular ligament is approximately 2-3 nun thick and is hyperechoic in the distal two-thirds only because of the obliquity of the proximal part. When examining this ligament, it is mandatory that the ankle be flexed dorsally; this stretches the ligament so that it can be seen clearly. (author)

  14. Arthroscopy of the ankle joint

    NARCIS (Netherlands)

    van Dijk, C. N.; Scholte, D.

    1997-01-01

    Ankle arthroscopy has become a standard procedure for a variety of indications. Joint distraction is applied by many authors. A recent retrospective multicentre study provoked the following questions. Is there an indication for diagnostic arthroscopy? Can arthroscopic surgery of the ankle joint be

  15. Ankle Fractures: The Operative Outcome

    Directory of Open Access Journals (Sweden)

    Ahmad Hafiz Z

    2011-03-01

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

  16. Alterações hemodinâmicas devido ao uso de estabilizadores em revascularização do miocárdio: estudo experimental Hemodynamic disorders related to beating heart surgery using cardiac stabilizers: experimental study

    Directory of Open Access Journals (Sweden)

    Pedro Paulo Martins de Oliveira

    2007-12-01

    Full Text Available OBJETIVO: Estudar, em suínos, as alterações hemodinâmicas secundárias ao uso de estabilizadores para operações de revascularização do miocárdio sem circulação extracorpórea, um por sucção (Octopus e outro por compressão (Speroni. MÉTODOS: Dez suínos submetidos à esternotomia e monitorizados com eletrocardiograma, débito cardíaco contínuo e pressões: arterial média, pulmonar média, atriais médias direita e esquerda, ventriculares diastólicas direita e esquerda, calculando-se volume sistólico e resistência vascular sistêmica. Estudaram-se os estabilizadores posicionados em três artérias: interventricular anterior, interventricular posterior e ramo marginal da circunflexa. Para cada animal foi sorteada a ordem de aplicação do estabilizador com relação ao tipo e à artéria. As mensurações foram realizadas antes e após aplicar-se o estabilizador. RESULTADOS: Na artéria interventricular anterior, ocorreram alterações somente com o Speroni, havendo queda do débito cardíaco, do volume sistólico e da pressão arterial média, com aumento da resistência vascular sistêmica. Na artéria interventricular posterior, constatamos alterações com o Speroni, havendo queda do débito cardíaco e do volume sistólico, com aumento da freqüência cardíaca. Com o Octopus houve aumento da freqüência cardíaca e da resistência vascular sistêmica, com queda do volume sistólico. No ramo marginal da circunflexa, ocorreu queda do débito cardíaco, do volume sistólico e da pressão arterial média com os dois estabilizadores, havendo também queda na pressão arterial pulmonar média e aumento da pressão atrial direita média com o estabilizador por compressão. CONCLUSÕES: Ambos os estabilizadores causaram alterações hemodinâmicas. O que atua por compressão provocou mais alterações do que o que atua por sucção.OBJECTIVE: To study in swine the hemodynamic changes secondary to the use of stabilizers for off

  17. MRI of ankle sprain

    International Nuclear Information System (INIS)

    Nishimura, Gen

    1995-01-01

    We reviewed MR (magnetic resonance) studies in 54 patients with a sprained ankle. MR examination was able to depict the following injuries: lateral collateral ligamentous injuries, fluid collection in the peroneal tendon sheath, injury to the peroneal tendon, deltoid ligamentous injuries, the extent of subcutaneous soft tissue swelling, and various kinds of osseous injuries. A total of 21 patients underwent repair or reconstructive surgery to the lateral collateral ligaments, the findings of which were correlated with those on MR examination. MR diagnosis of anterior talofibular ligamentous injury was confirmed in 16/21; the discrepancy could be attributed to remodeling and/or reorganization which progressed during the time lapse between the MR examination and surgery in three, while the misdiagnosis resulted from the difficulty in distinguishing the acute tear from the injured scar in two. The calcaneofibular ligamentous injury was confirmed in 10/12; two false negatives were responsible for the difficulty in delineating its entire length on a single image and/or in differentiating between the attenuated star and the normal calcaneofibular ligament. MR imaging is a useful tool to use in deciding the surgical indication and predicting the prognosis of the patients with ankle sprain. (author)

  18. MRI of ankle sprain

    Energy Technology Data Exchange (ETDEWEB)

    Nishimura, Gen [Dokkyo Univ., Mibu, Tochigi (Japan). School of Medicine

    1995-06-01

    We reviewed MR (magnetic resonance) studies in 54 patients with a sprained ankle. MR examination was able to depict the following injuries: lateral collateral ligamentous injuries, fluid collection in the peroneal tendon sheath, injury to the peroneal tendon, deltoid ligamentous injuries, the extent of subcutaneous soft tissue swelling, and various kinds of osseous injuries. A total of 21 patients underwent repair or reconstructive surgery to the lateral collateral ligaments, the findings of which were correlated with those on MR examination. MR diagnosis of anterior talofibular ligamentous injury was confirmed in 16/21; the discrepancy could be attributed to remodeling and/or reorganization which progressed during the time lapse between the MR examination and surgery in three, while the misdiagnosis resulted from the difficulty in distinguishing the acute tear from the injured scar in two. The calcaneofibular ligamentous injury was confirmed in 10/12; two false negatives were responsible for the difficulty in delineating its entire length on a single image and/or in differentiating between the attenuated star and the normal calcaneofibular ligament. MR imaging is a useful tool to use in deciding the surgical indication and predicting the prognosis of the patients with ankle sprain. (author)

  19. 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…

  20. Direct measurement of the intrinsic ankle stiffness during standing.

    Science.gov (United States)

    Vlutters, M; Boonstra, T A; Schouten, A C; van der Kooij, H

    2015-05-01

    Ankle stiffness contributes to standing balance, counteracting the destabilizing effect of gravity. The ankle stiffness together with the compliance between the foot and the support surface make up the ankle-foot stiffness, which is relevant to quiet standing. The contribution of the intrinsic ankle-foot stiffness to balance, and the ankle-foot stiffness amplitude dependency remain a topic of debate in the literature. We therefore developed an experimental protocol to directly measure the bilateral intrinsic ankle-foot stiffness during standing balance, and determine its amplitude dependency. By applying fast (40 ms) ramp-and-hold support surface rotations (0.005-0.08 rad) during standing, reflexive contributions could be excluded, and the amplitude dependency of the intrinsic ankle-foot stiffness was investigated. Results showed that reflexive activity could not have biased the torque used for estimating the intrinsic stiffness. Furthermore, subjects required less recovery action to restore balance after bilateral rotations in opposite directions compared to rotations in the same direction. The intrinsic ankle-foot stiffness appears insufficient to ensure balance, ranging from 0.93±0.09 to 0.44±0.06 (normalized to critical stiffness 'mgh'). This implies that changes in muscle activation are required to maintain balance. The non-linear stiffness decrease with increasing rotation amplitude supports the previous published research. With the proposed method reflexive effects can be ruled out from the measured torque without any model assumptions, allowing direct estimation of intrinsic stiffness during standing. Copyright © 2015 Elsevier Ltd. All rights reserved.

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

    OpenAIRE

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

    2013-01-01

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

  2. Osteoligamentous injuries of the medial ankle joint.

    Science.gov (United States)

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

    2015-12-01

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

  3. Managing ankle ligament sprains and tears: current opinion

    Directory of Open Access Journals (Sweden)

    McGovern RP

    2016-03-01

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

  4. 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.

  5. Arthrography of the ankle sprains

    International Nuclear Information System (INIS)

    Han, Moon Hee

    1985-01-01

    Ankle arthrography, by direct puncture of joint cavity, is considered to be a simple and accurate diagnostic method for a precise evaluation of ligamentous injury. Forty-seven cases of ankle arthrography were successively performed in the patients of acute ankle sprains. The purpose of this study is to demonstrate how ankle arthrography can delineate the pathologic anatomy in such cases. The results are as follows: 1. Thirty cases among forty seven revealed the findings of ligament tears. 2. For better diagnostic accuracy, the arthrography should be performed within 72 hrs. after injury. 3. The anterior talofibular ligament tears were the most common (twenty-nine cases) of all and seventeen of them revealed tears without association of any other ligament tears. 4. There were ten cases of calcaneofibular ligament tears and nine of them were associated with anterior talofibular ligament tears. 5. Three cases of anterior tibiofibular and one deltoid ligament tears were demonstrated

  6. Postoperative MRI of the ankle

    International Nuclear Information System (INIS)

    Sharabianlou Korth, M.; Fritz, L.B.

    2017-01-01

    Postoperative imaging of the ankle can be challenging, even for the experienced radiologist. Pathological and postoperative changes to the primarily complex anatomy of the ankle with its great variety of bone structures, tendons, ligaments, and soft tissue in a very limited space may cause great difficulty in differentiating underlying pathology from expected postoperative changes and artifacts, especially in magnetic resonance imaging (MRI). Selecting the appropriate radiological modality is key to making the correct diagnosis. Therefore, knowledge of the initial and current symptoms is just as important as familiarity with the most frequently performed operations in the ankle. This article aims to give its reader a summary of the most important and frequently performed operation techniques of the ankle and discusses the expected appearance and possible complications in postoperative imaging. (orig.) [de

  7. Complications in ankle fracture surgery

    OpenAIRE

    Ovaska, Mikko

    2015-01-01

    Mikko Ovaska. Complications in Ankle Fracture Surgery. Helsinki Bone and Joint Research Group, Department of Orthopaedic Surgery and Traumatology, Faculty of Medicine, University of Helsinki, Finland. Helsinki 2014. Ankle fractures are among the most frequently encountered surgically treated fractures. The operative treatment of this fracture may be associated with several complications. The most frequently encountered complications are related wound healing, and deep infection may have d...

  8. A neuromechanics-based powered ankle exoskeleton to assist walking post-stroke: a feasibility study.

    Science.gov (United States)

    Takahashi, Kota Z; Lewek, Michael D; Sawicki, Gregory S

    2015-02-25

    In persons post-stroke, diminished ankle joint function can contribute to inadequate gait propulsion. To target paretic ankle impairments, we developed a neuromechanics-based powered ankle exoskeleton. Specifically, this exoskeleton supplies plantarflexion assistance that is proportional to the user's paretic soleus electromyography (EMG) amplitude only during a phase of gait when the stance limb is subjected to an anteriorly directed ground reaction force (GRF). The purpose of this feasibility study was to examine the short-term effects of the powered ankle exoskeleton on the mechanics and energetics of gait. Five subjects with stroke walked with a powered ankle exoskeleton on the paretic limb for three 5 minute sessions. We analyzed the peak paretic ankle plantarflexion moment, paretic ankle positive work, symmetry of GRF propulsion impulse, and net metabolic power. The exoskeleton increased the paretic plantarflexion moment by 16% during the powered walking trials relative to unassisted walking condition (p exoskeleton assistance appeared to reduce the net metabolic power gradually with each 5 minute repetition, though no statistical significance was found. In three of the subjects, the paretic soleus activation during the propulsion phase of stance was reduced during the powered assistance compared to unassisted walking (35% reduction in the integrated EMG amplitude during the third powered session). This feasibility study demonstrated that the exoskeleton can enhance paretic ankle moment. Future studies with greater sample size and prolonged sessions are warranted to evaluate the effects of the powered ankle exoskeleton on overall gait outcomes in persons post-stroke.

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

    Science.gov (United States)

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

    2015-01-01

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

  10. 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. Copyright © 2013 Elsevier B.V. All rights reserved.

  11. Is Hardware Removal Recommended after Ankle Fracture Repair?

    Directory of Open Access Journals (Sweden)

    Hong-Geun Jung

    2016-01-01

    Full Text Available The indications and clinical necessity for routine hardware removal after treating ankle or distal tibia fracture with open reduction and internal fixation are disputed even when hardware-related pain is insignificant. Thus, we determined the clinical effects of routine hardware removal irrespective of the degree of hardware-related pain, especially in the perspective of patients’ daily activities. This study was conducted on 80 consecutive cases (78 patients treated by surgery and hardware removal after bony union. There were 56 ankle and 24 distal tibia fractures. The hardware-related pain, ankle joint stiffness, discomfort on ambulation, and patient satisfaction were evaluated before and at least 6 months after hardware removal. Pain score before hardware removal was 3.4 (range 0 to 6 and decreased to 1.3 (range 0 to 6 after removal. 58 (72.5% patients experienced improved ankle stiffness and 65 (81.3% less discomfort while walking on uneven ground and 63 (80.8% patients were satisfied with hardware removal. These results suggest that routine hardware removal after ankle or distal tibia fracture could ameliorate hardware-related pain and improves daily activities and patient satisfaction even when the hardware-related pain is minimal.

  12. The origin of the ankle

    International Nuclear Information System (INIS)

    Codino, Antonio; Plouin, Francois

    2007-01-01

    The differential intensity of cosmic radiation shows a sequence of depressions referred to as knees in a large energy band above 10 15 eV. The global depression entailed in the complete spectrum with respect to the extrapolated intensity based on low energy data, amounts to a maximum factor of 8, occurring at 5x10 18 eV, where flux measurements exhibit a relative minimum, referred to as the ankle. It is demonstrated by a full simulation of cosmic ray trajectories in the Galaxy that the intensity minimum around the ankle energy is primarily due to the nuclear interactions of the cosmic ions with the interstellar matter and to the galactic magnetic field. Ankles signal the onset energies of the rectilinear propagation in the Milky Way at Earth, being for example, 4x10 18 eV for helium and 6x10 19 eV for iron. The ankle, in spite of its notable importance at Earth, is a local perturbation of the universal spectrum which, between the knee and the ankle, decreases by a round factor 10 9 regaining its unperturbed status above 10 19 eV

  13. Cirurgia de revascularização do miocárdio minimamente invasiva: resultados com o uso da videotoracoscopia e do estabilizador de sutura

    Directory of Open Access Journals (Sweden)

    Fabio B. JATENE

    1997-07-01

    Full Text Available Objetivo: No sentido de associar os maiores benefícios da operação de revascularização do miocárdio tradicional com a utilização da anastomose da artéria interventricular anterior, com vários dos benefícios da angioplastia, alguns grupos têm começado a realizar a cirurgia de revascularização do miocárdio minimamente invasiva. O objetivo deste trabalho é o relato de nossa experiência inicial com essa abordagem técnica, especialmente com a utilização de videotoracoscopia (VDT e do estabilizador de sutura (ES. Métodos: Foram operados 73 pacientes, sendo 51 do sexo masculino, com idades variando de 37 a 83 anos, com média de 61,2 anos, portadores de lesão isolada do ramo interventricular anterior acima de 80%. Foi utilizada intubação orotraqueal com sonda de duplo lume. O paciente foi colocado em decúbito lateral direito com 30 graus de rotação. A minitoracotomia anterior, com 8 a 10 cm de extensão, foi realizada no quarto espaço intercostal. Através dessa incisão foram colocados a ótica da videotoracoscopia e os instrumentos cirúrgicos. O pericárdio foi aberto longitudinalmente e reparado para facilitar a exposição do RIA. Não foi utilizada circulação extracorpórea e a freqüência cardíaca foi diminuída no momento da anastomose com o uso de betabloqueador endovenoso. Para a realização da anastomose ATI-RIA, foi utilizado torniquete proximal e distal, além de uso de CO2 para manter o campo operatório livre de sangue. Previamente ao fechamento dos torniquetes, foi feita a administração de 1,5 mg/kg de peso de heparina endovenosa. A anastomose da ATI com o RIA foi realizada com fio de Polipropilene 7-0. O ES, dispositivo metálico acoplado ao afastador foi utilizado na parede anterior do coração, nos últimos 15 casos, para reduzir a movimentação cardíaca, criando condições para uma anastomose mais segura. Resultados: Todos os pacientes apresentaram boa evolução pós-operatória, sem complica

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

    Science.gov (United States)

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

    2018-05-01

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

  15. Application of the Superelastic NiTi Spring in Ankle Foot Orthosis (AFO to Create Normal Ankle Joint Behavior

    Directory of Open Access Journals (Sweden)

    Amirhesam Amerinatanzi

    2017-12-01

    Full Text Available Hinge-based Ankle Foot Orthosis (HAFO is one of the most common non-surgical solutions for the foot drop. In conventional HAFOs, the ankle joint is almost locked, and plantar flexion is restricted due to the high stiffness of the hinge mechanism. This often leads to a rigid walking gate cycle, poor muscle activity, and muscle atrophy. Since the ankle torque-angle loop has a non-linear profile, the use of a superelastic NiTi spring within the hinge, due to its nonlinear behavior, could recreate a close-to-normal stiffness of the normal ankle joint, which, in turn, could create a more natural walk. The focus of this study is to evaluate the performance of a superelastic NiTi spring versus a conventional Stainless Steel spring in a hinge mechanism of a custom-fit HAFO. To this aim, a custom-fit HAFO was fabricated via the fast casting technique. Then, motion analysis was performed for two healthy subjects (Case I and Case II: (i subjects with bare foot; (ii subjects wearing a conventional HAFO with no spring; (iii subjects wearing a conventional Stainless Steel-based HAFO; and (iv subjects wearing a NiTi spring-based HAFO. The data related to the ankle angle and the amount of moment applied to the ankle during walking were recorded using Cortex software and used for the evaluations. Finally, Finite Element Analysis (FEA was performed to evaluate the safety of the designed HAFO. The NiTi spring offers a higher range of motion (7.9 versus 4.14 degree and an increased level of moment (0.55 versus 0.36 N·m/kg. Furthermore, a NiTi spring offers an ankle torque-angle loop closer to that of the healthy subjects.

  16. Application of the Superelastic NiTi Spring in Ankle Foot Orthosis (AFO) to Create Normal Ankle Joint Behavior.

    Science.gov (United States)

    Amerinatanzi, Amirhesam; Zamanian, Hashem; Shayesteh Moghaddam, Narges; Jahadakbar, Ahmadreza; Elahinia, Mohammad

    2017-12-07

    Hinge-based Ankle Foot Orthosis (HAFO) is one of the most common non-surgical solutions for the foot drop. In conventional HAFOs, the ankle joint is almost locked, and plantar flexion is restricted due to the high stiffness of the hinge mechanism. This often leads to a rigid walking gate cycle, poor muscle activity, and muscle atrophy. Since the ankle torque-angle loop has a non-linear profile, the use of a superelastic NiTi spring within the hinge, due to its nonlinear behavior, could recreate a close-to-normal stiffness of the normal ankle joint, which, in turn, could create a more natural walk. The focus of this study is to evaluate the performance of a superelastic NiTi spring versus a conventional Stainless Steel spring in a hinge mechanism of a custom-fit HAFO. To this aim, a custom-fit HAFO was fabricated via the fast casting technique. Then, motion analysis was performed for two healthy subjects (Case I and Case II): (i) subjects with bare foot; (ii) subjects wearing a conventional HAFO with no spring; (iii) subjects wearing a conventional Stainless Steel-based HAFO; and (iv) subjects wearing a NiTi spring-based HAFO. The data related to the ankle angle and the amount of moment applied to the ankle during walking were recorded using Cortex software and used for the evaluations. Finally, Finite Element Analysis (FEA) was performed to evaluate the safety of the designed HAFO. The NiTi spring offers a higher range of motion (7.9 versus 4.14 degree) and an increased level of moment (0.55 versus 0.36 N·m/kg). Furthermore, a NiTi spring offers an ankle torque-angle loop closer to that of the healthy subjects.

  17. ANKLE JOINT CONTROL DURING SINGLE-LEGGED BALANCE USING COMMON BALANCE TRAINING DEVICES - IMPLICATIONS FOR REHABILITATION STRATEGIES

    DEFF Research Database (Denmark)

    Strøm, Mark; Thorborg, Kristian; Bandholm, Thomas

    2016-01-01

    (MVC), and in addition amplitude probability distribution function (APDF) between 90 and 10% was calculated as a measure of muscle activation variability. RESULTS: Balancing on BOSU® Ball and wobble board generally resulted in increased ankle kinematic and muscle activity variables, compared......BACKGROUND: A lateral ankle sprain is the most prevalent musculoskeletal injury in sports. Exercises that aim to improve balance are a standard part of the ankle rehabilitation process. In an optimal progression model for ankle rehabilitation and prevention of future ankle sprains, it is important...... to characterize different balance exercises based on level of difficulty and sensori-motor training stimulus. PURPOSE: The purpose of this study was to investigate frontal-plane ankle kinematics and associated peroneal muscle activity during single-legged balance on stable surface (floor) and three commonly used...

  18. Stabilization of a three-dimensional limit cycle walking model through step-to-step ankle control.

    Science.gov (United States)

    Kim, Myunghee; Collins, Steven H

    2013-06-01

    Unilateral, below-knee amputation is associated with an increased risk of falls, which may be partially related to a loss of active ankle control. If ankle control can contribute significantly to maintaining balance, even in the presence of active foot placement, this might provide an opportunity to improve balance using robotic ankle-foot prostheses. We investigated ankle- and hip-based walking stabilization methods in a three-dimensional model of human gait that included ankle plantarflexion, ankle inversion-eversion, hip flexion-extension, and hip ad/abduction. We generated discrete feedback control laws (linear quadratic regulators) that altered nominal actuation parameters once per step. We used ankle push-off, lateral ankle stiffness and damping, fore-aft foot placement, lateral foot placement, or all of these as control inputs. We modeled environmental disturbances as random, bounded, unexpected changes in floor height, and defined balance performance as the maximum allowable disturbance value for which the model walked 500 steps without falling. Nominal walking motions were unstable, but were stabilized by all of the step-to-step control laws we tested. Surprisingly, step-by-step modulation of ankle push-off alone led to better balance performance (3.2% leg length) than lateral foot placement (1.2% leg length) for these control laws. These results suggest that appropriate control of robotic ankle-foot prosthesis push-off could make balancing during walking easier for individuals with amputation.

  19. Determination of Ankle and Metatarsophalangeal Stiffness During Walking and Jogging.

    Science.gov (United States)

    Mager, Fabian; Richards, Jim; Hennies, Malika; Dötzel, Eugen; Chohan, Ambreen; Mbuli, Alex; Capanni, Felix

    2018-05-29

    Forefoot stiffness has been shown to influence joint biomechanics. However, little or no data exists on metatarsophalangeal stiffness. Twenty-four healthy rearfoot strike runners were recruited from a staff and student population at the University of Central Lancashire. Five repetitions of shod, self-selected speed level walking and jogging were performed. Kinetic and kinematic data were collected using retro-reflective markers placed on the lower limb and foot, to create a three-segment foot model using the Calibrated Anatomical System Technique. Ankle and metatarsophalangeal moments and angles were calculated. Stiffness values were calculated using a linear best fit line of moment versus of angle plots. Paired t-tests were used to compare values between walking and jogging conditions. Significant differences were seen in ankle range of motion (ROM), but not in metatarsophalangeal ROM. Maximum moments were significantly greater in the ankle during jogging, but these were not significantly different at the metatarsophalangeal joint. Average ankle joint stiffness exhibited significantly lower stiffness when walking compared to jogging. However, the metatarsophalangeal joint exhibited significantly greater stiffness when walking compared to jogging. A greater understanding of forefoot stiffness may inform the development of footwear, prosthetic feet and orthotic devices, such as ankle-foot orthoses for walking and sporting activities.

  20. 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…

  1. The conservative treatment of ankle osteoarthritis

    NARCIS (Netherlands)

    Witteveen, A.G.H.

    2015-01-01

    In 70% to 78% of patients with ankle osteoarthritis (OA), they present themselves with the sequelae of a traumatic event in the past. Ankle trauma occurs in many patients at a relatively young age. Consequently, the expected life span of many patients with ankle OA is relatively long. Many treatment

  2. Exercise and ankle sprain injuries: a comprehensive review.

    Science.gov (United States)

    Calatayud, Joaquin; Borreani, Sebastien; Colado, Juan Carlos; Flandez, Jorge; Page, Phil; Andersen, Lars L

    2014-02-01

    Ankle sprains are common in team sports and sports played on courts, and often result in structural and functional alterations that lead to a greater reinjury risk. Specific exercises are often used to promote neuromuscular improvements in the prevention and rehabilitation of ankle injuries. This literature review summarizes the neuromuscular characteristics of common ankle sprains and the effectiveness of exercise as an intervention for improving neuromuscular function and preventing reinjury. Our review found that appropriate exercise prescription can increase static and dynamic balance and decrease injury recurrence. In particular, the addition of dynamic activities in the exercise program can be beneficial because of the anticipatory postural adjustments identified as a key factor in the injury mechanism.

  3. Role of Ankle Arthroscopy in Management of Acute Ankle Fracture.

    Science.gov (United States)

    Chan, Kwok Bill; Lui, Tun Hing

    2016-11-01

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

  4. 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.

  5. Anterior ankle arthroscopy, distraction or dorsiflexion?

    Science.gov (United States)

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

    2010-05-01

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

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

    Science.gov (United States)

    Gillman, Scott F

    2004-01-01

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

  7. Ankle and Midfoot Power During Walking and Stair Ascent in Healthy Adults.

    Science.gov (United States)

    DiLiberto, Frank E; Nawoczenski, Deborah A; Houck, Jeff

    2018-02-27

    Ankle power dominates forward propulsion of gait, but midfoot power generation is also important for successful push off. However, it is unclear if midfoot power generation increases or stays the same in response to propulsive activities that induce larger external loads and require greater ankle power. The purpose of this study was to examine ankle and midfoot power in healthy adults during progressively more demanding functional tasks. Multi-segment foot motion (tibia, calcaneus, forefoot) and ground reaction forces were recorded as participants (N=12) walked, ascended a standard step, and ascended a high step. Ankle and midfoot positive peak power and total power, and the proportion of midfoot to ankle total power were calculated. One-way repeated measures ANOVAs were conducted to evaluate differences across tasks. Main effects were found for ankle and midfoot peak and total powers (all p power (p = .331). Ankle and midfoot power significantly increased across each task. Midfoot power increased in proportion to ankle power and in congruence to the external load of a task. Study findings may serve to inform multi-segment foot modeling applications and internal mechanistic theories of normal and pathological foot function.

  8. Ankle Dorsiflexion in Childhood Cancer Patients: A Review of the Literature.

    Science.gov (United States)

    Beulertz, Julia; Wurz, Amanda; Culos-Reed, Nicole; Chamorro Viña, Carolina; Bloch, Wilhelm; Baumann, Freerk T

    2015-01-01

    Improved treatment protocols necessary for survival in pediatric oncology are associated with the development of serious late effects. Of particular importance, especially with regard to physical activity, may be ankle dorsiflexion (DF). This review summarizes the results of observational and exercise intervention studies exploring ankle DF-range of motion (DF-ROM) and/or ankle DF strength in pediatric oncology. PUBMED, Medline, Cochrane library, and SportDiscus were searched by 2 researchers using predefined search terms. The reference lists of included papers and Google scholar were then searched to that ensure all appropriate articles were included. Twelve studies were identified and were observational (n = 8), providing information regarding the status of DF-ROM and/or DF strength, or intervention studies (n = 4) using exercise as a strategy to improve DF function. All observational studies reported some degree of impairment in ankle DF. Two intervention studies found a positive effect of exercise on ankle DF-ROM. The preliminary results suggest that pediatric cancer patients and survivors suffer from limitations in ankle DF with interventions varying in efficacy. It is hoped that this review will enhance the recognition of the limited ankle DF function in pediatric oncology and initiate further research programs focused on targeting and evaluating ankle DF.

  9. Possible factors for ankle fractures

    Directory of Open Access Journals (Sweden)

    Tabaković Dejan

    2010-01-01

    Full Text Available Background/Aim. Classification of ankle fractures is commonly used for selecting an appropriate treatment and prognosing an outcome of definite management. One of the most used classifications is the Danis-Weber classification. To the best of our knowledge, in the available literature, there are no parameters affecting specific types of ankle fractures according to the Danis-Weber classification. The aim of this study was to analyze the correlation of the following parameters: age, body weight, body mass index (BMI, height, osteoporosis, osteopenia and physical exercises with specific types of ankle fractures using the Danis-Weber classification. Methods. A total of 85 patients grouped by the Danis-Weber classification fracture types were analyzed and the significance of certain parameters for specific types of ankle fractures was established. Results. The proportion of females was significantly higher (p < 0.001 with a significantly higher age (59.9 years, SD ± 14.2 in relation to males (45.1 years, SD ± 12.8 (p < 0.0001. Type A fracture was most frequent in the younger patients (34.2 years, SD ± 8.6, and those with increased physical exercises (p = 0.020. In type B fracture, the risk factor was osteoporosis (p = 0.0180, while in type C fracture, body weight (p = 0.017 and osteoporosis (p = 0.004 were significant parameters. Conclusion. Statistical analysis using the Danis-Weber classification reveals that there are certain parameters suggesting significant risk factors for specific types of ankle fractures.

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

    OpenAIRE

    Lee, Sun-Min; Lee, Jung-Hoon

    2015-01-01

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

  11. ANKLE JOINT CONTROL DURING SINGLE-LEGGED BALANCE USING COMMON BALANCE TRAINING DEVICES - IMPLICATIONS FOR REHABILITATION STRATEGIES

    DEFF Research Database (Denmark)

    Strøm, Mark; Thorborg, Kristian; Bandholm, Thomas

    2016-01-01

    BACKGROUND: A lateral ankle sprain is the most prevalent musculoskeletal injury in sports. Exercises that aim to improve balance are a standard part of the ankle rehabilitation process. In an optimal progression model for ankle rehabilitation and prevention of future ankle sprains, it is important...... to characterize different balance exercises based on level of difficulty and sensori-motor training stimulus. PURPOSE: The purpose of this study was to investigate frontal-plane ankle kinematics and associated peroneal muscle activity during single-legged balance on stable surface (floor) and three commonly used...... balance devices (Airex®, BOSU® Ball and wobble board). DESIGN: Descriptive exploratory laboratory study. METHODS: Nineteen healthy subjects performed single-legged balance with eyes open on an Airex® mat, BOSU® Ball, wobble board, and floor (reference condition). Ankle kinematics were measured using...

  12. Short-Term Motor Compensations to Denervation of Feline Soleus and Lateral Gastrocnemius Result in Preservation of Ankle Mechanical Output during Locomotion

    Science.gov (United States)

    Prilutsky, Boris I.; Maas, Huub; Bulgakova, Margarita; Hodson-Tole, Emma F.; Gregor, Robert J.

    2011-01-01

    Denervation of selected ankle extensors in animals results in locomotor changes. These changes have been suggested to permit preservation of global kinematic characteristics of the hindlimb during stance. The peak ankle joint moment is also preserved immediately after denervation of several ankle extensors in the cat, suggesting that the animal's response to peripheral nerve injury may also be aimed at preserving ankle mechanical output. We tested this hypothesis by comparing joint moments and power patterns during walking before and after denervation of soleus and lateral gastrocnemius muscles. Hindlimb kinematics, ground reaction forces and electromyographic activity of selected muscles were recorded during level, downslope (−50%) and upslope (50%) walking before and 1–3 weeks after nerve denervation. Denervation resulted in increased activity of the intact medial gastrocnemius and plantaris muscles, greater ankle dorsiflexion, smaller knee flexion, and the preservation of the peak ankle moment during stance. Surprisingly, ankle positive power generated in the propulsion phase of stance was increased (up to 50%) after denervation in all walking conditions (p ankle. The additional mechanical energy generated at the ankle during propulsion can result, in part, from increased activity of intact synergists, the use of passive tissues around the ankle and by the tendon action of ankle two-joint muscles and crural fascia. PMID:21411965

  13. Fracture reduction and primary ankle arthrodesis: a reliable approach for severely comminuted tibial pilon fracture.

    Science.gov (United States)

    Beaman, Douglas N; Gellman, Richard

    2014-12-01

    Posttraumatic arthritis and prolonged recovery are typical after a severely comminuted tibial pilon fracture, and ankle arthrodesis is a common salvage procedure. However, few reports discuss the option of immediate arthrodesis, which may be a potentially viable approach to accelerate overall recovery in patients with severe fracture patterns. (1) How long does it take the fracture to heal and the arthrodesis to fuse when primary ankle arthrodesis is a component of initial fracture management? (2) How do these patients fare clinically in terms of modified American Orthopaedic Foot and Ankle Society (AOFAS) scores and activity levels after this treatment? (3) Does primary ankle arthrodesis heal in an acceptable position when anterior ankle arthrodesis plates are used? During a 2-year period, we performed open fracture reduction and internal fixation in 63 patients. Eleven patients (12 ankles) with severely comminuted high-energy tibial pilon fractures were retrospectively reviewed after surgical treatment with primary ankle arthrodesis and fracture reduction. Average patient age was 58 years, and minimum followup was 6 months (average, 14 months; range, 6-22 months). Anatomically designed anterior ankle arthrodesis plates were used in 10 ankles. Ring external fixation was used in nine ankles with concomitant tibia fracture or in instances requiring additional fixation. Clinical evaluation included chart review, interview, the AOFAS ankle-hindfoot score, and radiographic evaluation. All of the ankle arthrodeses healed at an average of 4.4 months (range, 3-5 months). One patient had a nonunion at the metaphyseal fracture, which healed with revision surgery. The average AOFAS ankle-hindfoot score was 83 with 88% having an excellent or good result. Radiographic and clinical analysis confirmed a plantigrade foot without malalignment. No patients required revision surgery for malunion. Primary ankle arthrodesis combined with fracture reduction for the severely comminuted

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

    Science.gov (United States)

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

    2017-09-01

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

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

    Science.gov (United States)

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

    2015-01-01

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

  16. 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.

  17. Anatomy of the ankle ligaments: a pictorial essay

    NARCIS (Netherlands)

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

    2010-01-01

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

  18. Anatomy of the ankle ligaments: a pictorial essay

    NARCIS (Netherlands)

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

    2016-01-01

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

  19. Rehabilitation for ankle fractures in adults.

    Science.gov (United States)

    Lin, Chung-Wei Christine; Donkers, Nicole A J; Refshauge, Kathryn M; Beckenkamp, Paula R; Khera, Kriti; Moseley, Anne M

    2012-11-14

    Rehabilitation after ankle fracture can begin soon after the fracture has been treated, either surgically or non-surgically, by the use of different types of immobilisation that allow early commencement of weight-bearing or exercise. Alternatively, rehabilitation, including the use of physical or manual therapies, may start following the period of immobilisation. This is an update of a Cochrane review first published in 2008. To assess the effects of rehabilitation interventions following conservative or surgical treatment of ankle fractures in adults. We searched the Specialised Registers of the Cochrane Bone, Joint and Muscle Trauma Group and the Cochrane Rehabilitation and Related Therapies Field, CENTRAL via The Cochrane Library (2011 Issue 7), MEDLINE via PubMed, EMBASE, CINAHL, PEDro, AMED, SPORTDiscus and clinical trials registers up to July 2011. In addition, we searched reference lists of included studies and relevant systematic reviews. Randomised and quasi-randomised controlled trials with adults undergoing any interventions for rehabilitation after ankle fracture were considered. The primary outcome was activity limitation. Secondary outcomes included quality of life, patient satisfaction, impairments and adverse events. Two review authors independently screened search results, assessed risk of bias and extracted data. Risk ratios and 95% confidence intervals (95% CIs) were calculated for dichotomous variables, and mean differences or standardised mean differences and 95% CIs were calculated for continuous variables. End of treatment and end of follow-up data were presented separately. For end of follow-up data, short term follow-up was defined as up to three months after randomisation, and long-term follow-up as greater than six months after randomisation. Meta-analysis was performed where appropriate. Thirty-eight studies with a total of 1896 participants were included. Only one study was judged at low risk of bias. Eight studies were judged at high

  20. Difference in balance measures between patients with chronic ankle instability and patients after an acute ankle inversion trauma

    NARCIS (Netherlands)

    de Vries, J. S.; Kingma, I.; Blankevoort, L.; van Dijk, C. N.

    2010-01-01

    Neuromuscular control of the ankle is disturbed in patients with chronic ankle instability due to an initial ankle inversion trauma. Static balance is assumed to be a measure for this disturbance. Functional (ankle) scores are another way to evaluate ankle impairment. The hypothesis was that there

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

    Science.gov (United States)

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

    2012-07-01

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

  2. 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.

  3. Xanthomatous infiltration of ankle tendons

    International Nuclear Information System (INIS)

    Kelman, C.G.; Disler, D.G.; Kremer, J.M.; Jennings, T.A.

    1997-01-01

    We present a case of type II hyperbetalipoproteinemia in a patient whose diagnosis had been previously unrecognized, and who had previously been misdiagnosed with rheumatoid arthritis and later gout. Radiographic and MR imaging features of the patient's ankles were pronounced but otherwise typical of xanthomatous infiltration. Radiologic assessment can be useful in permitting a specific diagnosis to be made in patients with periarticular and tendinous swelling. (orig.). With 4 figs

  4. Arthrography of the ankle joint

    International Nuclear Information System (INIS)

    Crespi Porro, R.; Zellner, A.; Puricelli, G.; Quaglia, R.; Chelazzi, G.

    1984-01-01

    Arthrography of the ankle joint was first carried out by Johnson and Palmer at the Military Hospital in Stockholm in 1940. Arthrography can be used for judging the integrity of the articular cartilage, of osteochondritis dissecans, arthritis or adhesive capsulitis. The literature shows, however, that more than 95% of the patients on whom this examination has been performed has suffered from acute trauma. (orig.) [de

  5. Anterior ankle arthroscopy, distraction or dorsiflexion?

    OpenAIRE

    de Leeuw, P.A.J.; Golanó, P.; Clavero, J.A.; van Dijk, C.N.

    2010-01-01

    Anterior ankle arthroscopy can basically be performed by two different methods; the dorsiflexion- or distraction method. The objective of this study was to determine the size of the anterior working area for both the dorsiflexion and distraction method. The anterior working area is anteriorly limited by the overlying anatomy which includes the neurovascular bundle. We hypothesize that in ankle dorsiflexion the anterior neurovascular bundle will move away anteriorly from the ankle joint, where...

  6. Enhanced spinal excitation from ankle flexors to knee extensors during walking in stroke patients

    DEFF Research Database (Denmark)

    Achache, V.; Mazevet, D.; Iglesias, C.

    2010-01-01

    : The spinal, presumed group II, excitation from ankle dorsiflexors to knee extensors is particularly enhanced during post-stroke walking probably due to plastic adaptations in the descending control. SIGNIFICANCE: This adaptation may help to stabilize the knee in early stance when the patients have recover......OBJECTIVES: It is still unclear to what an extent altered reflex activity contributes to gait deficit following stroke. Spinal group I and group II excitations from ankle dorsiflexors to knee extensors were investigated during post-stroke walking. METHODS: Electrical stimulation was applied...... ankle dorsiflexor functions....

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

    NARCIS (Netherlands)

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

    2016-01-01

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

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

    Science.gov (United States)

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

    2017-09-20

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

  9. 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.

  10. 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. PMID:25360524

  11. Epidemiology, rehabilitation and prevention of ankle sprains in basketball players

    Directory of Open Access Journals (Sweden)

    Anna Lewandowska

    2017-08-01

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

  12. 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.

  13. Evidence-based treatment for ankle injuries: a clinical perspective

    OpenAIRE

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

    2010-01-01

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

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

    NARCIS (Netherlands)

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

    2013-01-01

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

  15. Ankle taping does not impair performance in jump or balance tests.

    Science.gov (United States)

    Abián-Vicén, Javier; Alegre, Luis M; Fernández-Rodríguez, J Manuel; Lara, Amador J; Meana, Marta; Aguado, Xavier

    2008-01-01

    This study aimed to investigate the influence of prophylactic ankle taping on two balance tests (static and dynamic balance) and one jump test, in the push off and the landing phase. Fifteen active young subjects (age: 21.0 ± 4.4 years) without previous ankle injuries volunteered for the study. Each participant performed three tests in two different situations: with taping and without taping. The tests were a counter movement jump, static balance, and a dynamic posturography test. The tests and conditions were randomly performed. The path of the center of pressures was measured in the balance tests, and the vertical ground reaction forces were recorded during the push-off and landing phases of the counter movement jump. Ankle taping had no influence on balance performance or in the push off phase of the jump. However, the second peak vertical force value during the landing phase of the jump was 12% greater with ankle taping (0.66 BW, 95% CI -0.64 to 1.96). The use of prophylactic ankle taping had no influence on the balance or jump performance of healthy young subjects. In contrast, the taped ankle increased the second peak vertical force value, which could be related to a greater risk of injury produced by the accumulation of repeated impacts in sports where jumps are frequently performed. Key pointsAnkle taping has no influence on balance performance.Ankle taping does not impair performance during the push-off phase of the jump.Ankle taping could increase the risk of injury during landings by increasing peak forces.

  16. Dynamic Functional Stiffness Index of the Ankle Joint During Daily Living.

    Science.gov (United States)

    Argunsah Bayram, Hande; Bayram, Mehmed B

    2018-03-30

    Exploring ankle joint physiologic functional stiffness is crucial for improving the design of prosthetic feet that aim to mimic normal gait. We hypothesized that ankle joint stiffness would vary among the different activities of daily living and that the magnitude of the stiffness would indicate the degree of energy storage element sufficiency in terms of harvesting and returning energy. We examined sagittal plane ankle moment versus flexion angle curves from 12 healthy subjects during the daily activities. The slopes of these curves were assessed to find the calculated stiffness during the peak energy return and harvest phases. For the energy return and harvest phases, stiffness varied from 0.016 to 0.283 Nm/kg° and 0.025 and 0.858 Nm/kg°, respectively. The optimum stiffness during the energy return phase was 0.111 ± 0.117 Nm/kg° and during the energy harvest phase was 0.234 ± 0.327 Nm/kg°. Ankle joint stiffness varied significantly during the activities of daily living, indicating that an energy storage unit with a constant stiffness would not be sufficient in providing energy regenerative gait during all activities. The present study was directed toward the development of a complete data set to determine the torque-angle properties of the ankle joint to facilitate a better design process. Copyright © 2017 The American College of Foot and Ankle Surgeons. Published by Elsevier Inc. All rights reserved.

  17. Ankle Taping Does Not Impair Performance in Jump or Balance Tests

    OpenAIRE

    Abián-Vicén, Javier; Alegre, Luis M.; Fernández-Rodríguez, J. Manuel; Lara, Amador J.; Meana, Marta; Aguado, Xavier

    2008-01-01

    This study aimed to investigate the influence of prophylactic ankle taping on two balance tests (static and dynamic balance) and one jump test, in the push off and the landing phase. Fifteen active young subjects (age: 21.0 ± 4.4 years) without previous ankle injuries volunteered for the study. Each participant performed three tests in two different situations: with taping and without taping. The tests were a counter movement jump, static balance, and a dynamic posturography test. The tests a...

  18. The incidence and prevalence of ankle sprain injury: a systematic review and meta-analysis of prospective epidemiological studies.

    Science.gov (United States)

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

    2014-01-01

    Ankle sprain is one of the most common musculoskeletal injuries, yet a contemporary review and meta-analysis of prospective epidemiological studies investigating ankle sprain does not exist. Our aim is to provide an up-to-date account of the incidence rate and prevalence period of ankle sprain injury unlimited by timeframe or context activity. We conducted a systematic review and meta-analyses of English articles using relevant computerised databases. Search terms included Medical Search Headings for the ankle joint, injury and epidemiology. The following inclusion criteria were used: the study must report epidemiology findings of injuries sustained in an observed sample; the study must report ankle sprain injury with either incidence rate or prevalence period among the surveyed sample, or provide sufficient data from which these figures could be calculated; the study design must be prospective. Independent extraction of articles was performed by two authors using pre-determined data fields. One-hundred and eighty-one prospective epidemiology studies from 144 separate papers were included. The average rating of all the included studies was 6.67/11, based on an adapted version of the STROBE (STrengthening the Reporting of OBservational studies in Epidemiology) guidelines for rating observational studies. 116 studies were considered high quality and 65 were considered low quality. The main findings of the meta-analysis demonstrated a higher incidence of ankle sprain in females compared with males (13.6 vs 6.94 per 1,000 exposures), in children compared with adolescents (2.85 vs 1.94 per 1,000 exposures) and adolescents compared with adults (1.94 vs 0.72 per 1,000 exposures). The sport category with the highest incidence of ankle sprain was indoor/court sports, with a cumulative incidence rate of 7 per 1,000 exposures or 1.37 per 1,000 athlete exposures and 4.9 per 1,000 h. Low-quality studies tended to underestimate the incidence of ankle sprain when compared with

  19. Radiological aspects of sprained ankle syndrome

    NARCIS (Netherlands)

    Sijbrandij, E.S.

    2001-01-01

    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

  20. 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

  1. A novel tool for measuring ankle dorsiflexion

    DEFF Research Database (Denmark)

    Larsen, Peter; B Nielsen, Henrik; Lund, Christoffer

    2016-01-01

    correlation coefficients (ICC). RESULTS: The study sample consisted of 24 patients: fifteen females and nine males post-immobilisation following surgery for ankle fractures. The mean age was 51.0 years, ranging from 22–92 years. All patients had sustained an AO classification 44- fracture of the ankle...

  2. Ankle and Other Signatures in Uhecr

    Science.gov (United States)

    Berezinsky, Veniamin

    2015-03-01

    The interaction signatures of UHE protons propagating through CMB are discussed. Much attention is given to ankle, which starting from 1963 is usually interpreted as a feature of transition from galactic to extragalactic cosmic rays. We argue here that this interpretation is now excluded. It gives more credit to alternative explanation of the ankle as an intrinsic part of the pair-production dip.

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

    Science.gov (United States)

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

    2016-04-01

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

  4. Ball-and-socket ankle joint

    International Nuclear Information System (INIS)

    Pistoia, F.; Ozonoff, M.B.; Wintz, P.; Hartford Hospital, CT

    1987-01-01

    The ball-and-socket ankle joint is a malformation of the ankle in which the articular surface of the talus is hemispherical in both the anteroposterior and lateral projections and has a congruent, concave tibial articular surface. Fourteen patients with this condition were identified retrospectively. Thirteen patients were thought to have the congenital type of ball-and-socket ankle joint which in many was associated with tarsal coalition, short limb, and ray fusion and deletion anomalies. One case of the acquired type, demonstrating less geometric rounding of the talar margins, was seen in a patient with myelomeningocele, probably resulting from sensory and motor deficits. Although the exact etiology of the congenital type is unknown, its association with other malformations suggests that the ball-and-socket ankle joint results from an overall maldevelopment of the ankle and foot. (orig.)

  5. Sway‐dependent changes in standing ankle stiffness caused by muscle thixotropy

    Science.gov (United States)

    Sakanaka, Tania E.; Lakie, Martin

    2016-01-01

    Key points The passive stiffness of the calf muscles contributes to standing balance, although the properties of muscle tissue are highly labile.We investigated the effect of sway history upon intrinsic ankle stiffness and demonstrated reductions in stiffness of up to 43% during conditions of increased baseline sway.This sway dependence was most apparent when using low amplitude stiffness‐measuring perturbations, and the short‐range stiffness component was smaller during periods of high sway.These characteristics are consistent with the thixotropic properties of the calf muscles causing the observed changes in ankle stiffness.Periods of increased sway impair the passive stabilization of standing, demanding more active neural control of balance. Abstract Quiet standing is achieved through a combination of active and passive mechanisms, consisting of neural control and intrinsic mechanical stiffness of the ankle joint, respectively. The mechanical stiffness is partly determined by the calf muscles. However, the viscoelastic properties of muscle are highly labile, exhibiting a strong dependence on movement history. By measuring the effect of sway history upon ankle stiffness, the present study determines whether this lability has consequences for the passive stabilization of human standing. Ten subjects stood quietly on a rotating platform whose axis was collinear with the ankle joint. Ankle sway was increased by slowly tilting this platform in a random fashion, or decreased by fixing the body to a board. Ankle stiffness was measured by using the same platform to simultaneously apply small, brief perturbations (ankle stiffness by up to 43% compared to the body‐fixed condition. Normal quiet stance was associated with intermediate values. The effect was most apparent when using smaller perturbation amplitudes to measure stiffness (0.1 vs. 0.6 deg). Furthermore, torque responses exhibited a biphasic pattern, consisting of an initial steep rise followed by a

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

    Science.gov (United States)

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

    2013-06-01

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

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

    Science.gov (United States)

    Kahn, Michelle; Williams, Gavin

    2015-02-01

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

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

    Science.gov (United States)

    Simondson, David; Brock, Kim; Cotton, Susan

    2012-02-01

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

  9. Evaluation of a Powered Ankle-Foot Prosthesis during Slope Ascent Gait.

    Directory of Open Access Journals (Sweden)

    Christopher A Rábago

    Full Text Available Passive prosthetic feet lack active plantarflexion and push-off power resulting in gait deviations and compensations by individuals with transtibial amputation (TTA during slope ascent. We sought to determine the effect of active ankle plantarflexion and push-off power provided by a powered prosthetic ankle-foot (PWR on lower extremity compensations in individuals with unilateral TTA as they walked up a slope. We hypothesized that increased ankle plantarflexion and push-off power would reduce compensations commonly observed with a passive, energy-storing-returning prosthetic ankle-foot (ESR. We compared the temporal spatial, kinematic, and kinetic measures of ten individuals with TTA (age: 30.2 ± 5.3 yrs to matched abled-bodied (AB individuals during 5° slope ascent. The TTA group walked with an ESR and separately with a PWR. The PWR produced significantly greater prosthetic ankle plantarflexion and push-off power generation compared to an ESR and more closely matched AB values. The PWR functioned similar to a passive ESR device when transitioning onto the prosthetic limb due to limited prosthetic dorsiflexion, which resulted in similar deviations and compensations. In contrast, when transitioning off the prosthetic limb, increased ankle plantarflexion and push-off power provided by the PWR contributed to decreased intact limb knee extensor power production, lessening demand on the intact limb knee.

  10. Evaluation of a Powered Ankle-Foot Prosthesis during Slope Ascent Gait.

    Science.gov (United States)

    Rábago, Christopher A; Aldridge Whitehead, Jennifer; Wilken, Jason M

    2016-01-01

    Passive prosthetic feet lack active plantarflexion and push-off power resulting in gait deviations and compensations by individuals with transtibial amputation (TTA) during slope ascent. We sought to determine the effect of active ankle plantarflexion and push-off power provided by a powered prosthetic ankle-foot (PWR) on lower extremity compensations in individuals with unilateral TTA as they walked up a slope. We hypothesized that increased ankle plantarflexion and push-off power would reduce compensations commonly observed with a passive, energy-storing-returning prosthetic ankle-foot (ESR). We compared the temporal spatial, kinematic, and kinetic measures of ten individuals with TTA (age: 30.2 ± 5.3 yrs) to matched abled-bodied (AB) individuals during 5° slope ascent. The TTA group walked with an ESR and separately with a PWR. The PWR produced significantly greater prosthetic ankle plantarflexion and push-off power generation compared to an ESR and more closely matched AB values. The PWR functioned similar to a passive ESR device when transitioning onto the prosthetic limb due to limited prosthetic dorsiflexion, which resulted in similar deviations and compensations. In contrast, when transitioning off the prosthetic limb, increased ankle plantarflexion and push-off power provided by the PWR contributed to decreased intact limb knee extensor power production, lessening demand on the intact limb knee.

  11. Validity and reliability of Thai version of the Foot and Ankle Outcome Score in patients with arthritis of the foot and ankle.

    Science.gov (United States)

    Angthong, Chayanin

    2016-12-01

    Although the Foot and Ankle Outcome Score (FAOS) is commonly used in several languages for a variety of foot disorders, it has not been validated specifically for foot and ankle arthritic conditions. The aims of the present study were to translate the original English FAOS into Thai and to evaluate the validity and reliability of the Thai version of the FAOS for the foot and ankle arthritic conditions. The original FAOS was translated into Thai using forward-backward translation. The Thai FAOS and validated Thai Short Form-36 (SF-36 ® ) questionnaires were distributed to 44 Thai patients suffering from arthritis of the foot and ankle to complete. For validation, Thai FAOS scores were correlated with SF-36 scores. Test-retest reliability and internal consistency were also analyzed in this study. The Thai FAOS score demonstrated sufficient correlation with SF-36 total score in Pain (Pearson's correlation coefficient (r)=0.45, p=0.002), Symptoms (r=0.45, p=0.002), Activities of Daily Living (ADL) (r=0.47, p=0.001), and Quality of Life (QOL) (r=0.38, p=0.011) subscales. The Sports and Recreational Activities (Sports & Rec) subscale did not correlate significantly with the SF-36 ® (r=0.20, p=0.20). Cronbach's alpha, a measure of internal consistency, for the five subscales was as follows: Pain, 0.94 (pvalidity for the evaluation of foot and ankle arthritis. Although reliability was satisfactory for the major subscale ADL, it was not sufficient for the minor subscales. Our findings suggest that it can be used as a disease-specific instrument to evaluate foot and ankle arthritis and can complement other reliable outcome surveys. Copyright © 2015 European Foot and Ankle Society. Published by Elsevier Ltd. All rights reserved.

  12. Ankle Arthrodesis Following Trauma, a Useful Salvage Procedure ...

    African Journals Online (AJOL)

    progressive loss of ankle-joint motion, weight-bearing pain, and functional disability. ... of patients after the reconstructionof ankle malunions.[6] ... Three patients with severe open ankle ... diabetic nor was he known to be on any steroid medication. He was .... Charnley J. Compression arthrodesis of the ankle and shoulder.

  13. The implementation effectiveness of the 'Strengthen your ankle' smartphone application for the prevention of ankle sprains: design of a randomized controlled trial.

    Science.gov (United States)

    Van Reijen, Miriam; Vriend, Ingrid I; Zuidema, Victor; van Mechelen, Willem; Verhagen, Evert A

    2014-01-07

    Ankle sprains continue to pose a significant burden to the individual athlete, as well as to society as a whole. However, despite ankle sprains being the single most common sports injury and despite an active approach by various Dutch organisations in implementing preventive measures, large-scale community uptake of these preventive measures, and thus actual prevention of ankle sprains, is lagging well behind. In an attempt to bridge this implementation gap, the Dutch Consumer Safety Institute VeiligheidNL developed a freely available interactive App ('Strenghten your ankle' translated in Dutch as: 'Versterk je enkel; available for iOS and Android) that contains - next to general advice on bracing and taping - a proven cost-effective neuromuscular program. The 'Strengthen your ankle' App has not been evaluated against the 'regular' prevention approach in which the neuromuscular program is advocated through written material. The aim of the current project is to evaluate the implementation value of the 'Strengthen your ankle' App as compared to the usual practice of providing injured athletes with written materials. In addition, as a secondary outcome measure, the cost-effectiveness will be assessed against usual practice. The proposed study will be a randomised controlled trial. After stratification for medical caregiver, athletes will be randomised to two study groups. One group will receive a standardized eight-week proprioceptive training program that has proven to be cost-effective to prevent recurrent ankle injuries, consisting of a balance board (machU/ MSG Europe BVBA), and a traditional instructional booklet. The other group will receive the same exercise program and balance board. However, for this group the instructional booklet is exchanged by the interactive 'Strengthen your ankle' App. This trial is the first randomized controlled trial to study the implementation effectiveness of an App for proprioceptive balance board training program in comparison to

  14. Does a not-so-recent ankle sprain influence interjoint coordination during walking?

    Science.gov (United States)

    Dedieu, Philippe; Chamoun, Rima; Lacaud, Guilhaume; Moulinat, Thibault; Queron, Maxime; Zanone, Pier-Giorgio

    2017-12-01

    Ankle sprains are common joint injuries in daily and sports activities, whose underlying mechanisms have been amply studied. If joint structures are directly damaged, neuromuscular activity can be affected, particularly in the time domain. This study aims to establish whether previous ankle injury correlates with changes in the inter-joint synergy of the entire lower limb and in the muscle activity pattern during walking. Three-dimensional walking-gait analysis was conducted on twenty-four adults. Ten of them had never suffered from ankle sprain; fourteen had suffered from ankle sprain at least once during the three preceding years. Continuous Relative Phase (CRP) between the moving limbs assessed inter-joint coordination, and muscular activity was recorded by EMG. CRP between ankle and knee and between ankle and hip indicates that both joints moved in tight synchronization in the same direction on the injured side, whereas there was a time lag between joints on the healthy side for each sprained participants or on both side for the control group. Start-time and/or duration of muscular activity of tibialis anterior, soleus and peroneus longus occurred earlier and were longer on the injured side, respectively. Our findings suggest that ankle sprain modifies inter-joint coordination and muscular activity of the injured limb, inducing not an entirely new pattern of coordination but an alteration of the existing pattern. CRP revealed slight modifications in the extant inter-joint coordination which may not be captured by other kinematic variables, which opens perspectives on therapy and relapse prevention. Copyright © 2017 Elsevier Ltd. All rights reserved.

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

    Science.gov (United States)

    Delahunt, Eamonn; Monaghan, Kenneth; Caulfield, Brian

    2006-12-01

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

  16. 3D strength surfaces for ankle plantar- and dorsi-flexion in healthy adults: an isometric and isokinetic dynamometry study

    Directory of Open Access Journals (Sweden)

    Sara J. Hussain

    2016-11-01

    Full Text Available Abstract Background The ankle is an important component of the human kinetic chain, and deficits in ankle strength can negatively impact functional tasks such as balance and gait. While peak torque is influenced by joint angle and movement velocity, ankle strength is typically reported for a single angle or movement speed. To better identify deficits and track recovery of ankle strength after injury or surgical intervention, ankle strength across a range of movement velocities and joint angles in healthy adults is needed. Thus, the primary goals of this study were to generate a database of strength values and 3-dimensional strength surface models for plantarflexion (PF and dorsiflexion (DF ankle strength in healthy men and women. Secondary goals were to develop a means to estimate ankle strength percentiles as well as examine predictors of maximal ankle strength in healthy adults. Methods Using an isokinetic dynamometer, we tested PF and DF peak torques at five joint angles (−10° [DF], 0° [neutral], 10° [PF], 20° [PF] and 30° [PF] and six velocities (0°/s, 30°/s, 60°/s, 90°/s, 120°/s and 180°/s in 53 healthy adults. These data were used to generate 3D plots, or “strength surfaces”, for males and females for each direction; surfaces were fit using a logistic equation. We also tested predictors of ankle strength, including height, weight, sex, and self-reported physical activity levels. Results Torque-velocity and torque-angle relationships at the ankle interact, indicating that these relationships are interdependent and best modeled using 3D surfaces. Sex was the strongest predictor of ankle strength over height, weight, and self-reported physical activity levels. 79 to 97 % of the variance in mean peak torque was explained by joint angle and movement velocity using logistic equations, for men and women and PF and DF directions separately. Conclusions The 3D strength data and surface models provide a more comprehensive dataset

  17. 3D strength surfaces for ankle plantar- and dorsi-flexion in healthy adults: an isometric and isokinetic dynamometry study.

    Science.gov (United States)

    Hussain, Sara J; Frey-Law, Laura

    2016-01-01

    The ankle is an important component of the human kinetic chain, and deficits in ankle strength can negatively impact functional tasks such as balance and gait. While peak torque is influenced by joint angle and movement velocity, ankle strength is typically reported for a single angle or movement speed. To better identify deficits and track recovery of ankle strength after injury or surgical intervention, ankle strength across a range of movement velocities and joint angles in healthy adults is needed. Thus, the primary goals of this study were to generate a database of strength values and 3-dimensional strength surface models for plantarflexion (PF) and dorsiflexion (DF) ankle strength in healthy men and women. Secondary goals were to develop a means to estimate ankle strength percentiles as well as examine predictors of maximal ankle strength in healthy adults. Using an isokinetic dynamometer, we tested PF and DF peak torques at five joint angles (-10° [DF], 0° [neutral], 10° [PF], 20° [PF] and 30° [PF]) and six velocities (0°/s, 30°/s, 60°/s, 90°/s, 120°/s and 180°/s) in 53 healthy adults. These data were used to generate 3D plots, or "strength surfaces", for males and females for each direction; surfaces were fit using a logistic equation. We also tested predictors of ankle strength, including height, weight, sex, and self-reported physical activity levels. Torque-velocity and torque-angle relationships at the ankle interact, indicating that these relationships are interdependent and best modeled using 3D surfaces. Sex was the strongest predictor of ankle strength over height, weight, and self-reported physical activity levels. 79 to 97 % of the variance in mean peak torque was explained by joint angle and movement velocity using logistic equations, for men and women and PF and DF directions separately. The 3D strength data and surface models provide a more comprehensive dataset of ankle strength in healthy adults than previously reported. These

  18. Predicted percentage dissatisfied with ankle draft.

    Science.gov (United States)

    Liu, S; Schiavon, S; Kabanshi, A; Nazaroff, W W

    2017-07-01

    Draft is unwanted local convective cooling. The draft risk model of Fanger et al. (Energy and Buildings 12, 21-39, 1988) estimates the percentage of people dissatisfied with air movement due to overcooling at the neck. There is no model for predicting draft at ankles, which is more relevant to stratified air distribution systems such as underfloor air distribution (UFAD) and displacement ventilation (DV). We developed a model for predicted percentage dissatisfied with ankle draft (PPD AD ) based on laboratory experiments with 110 college students. We assessed the effect on ankle draft of various combinations of air speed (nominal range: 0.1-0.6 m/s), temperature (nominal range: 16.5-22.5°C), turbulence intensity (at ankles), sex, and clothing insulation (thermal sensation and air speed at ankles are the dominant parameters affecting draft. The seated subjects accepted a vertical temperature difference of up to 8°C between ankles (0.1 m) and head (1.1 m) at neutral whole-body thermal sensation, 5°C more than the maximum difference recommended in existing standards. The developed ankle draft model can be implemented in thermal comfort and air diffuser testing standards. © 2016 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.

  19. Foot and ankle problems in Thai monks.

    Science.gov (United States)

    Vaseenon, Tanawat; Wattanarojanaporn, Thongaek; Intharasompan, Piyapong; Theeraamphon, Nipon; Auephanviriyakul, Sansanee; Phisitkul, Phinit

    2015-01-01

    Foot and ankle problems in Thai monks have not been explored. This is an unshod population, and its members have a unique lifestyle living among others in our modern era. Beginning at their ordainment, they follow strict rules about barefoot walking, the amount of daily walking, and their sitting position, practices that theoretically can increase their risk of developing foot and ankle problems. To evaluate the prevalence ofcommon foot and ankle problems in Thai monks. A cross-sectional survey was conducted in combination with foot and ankle examinations of monks living in northern Thailand Foot morphology was examined using a Harris mat footprint. Results of the interviews and the foot and ankle examinations were evaluated. Two hundred and nine monks from 28 temples were included in this study. Common foot and ankle problems found included callosity (70.8%), toe deformities (18.2%), plantar fasciitis (13.4%), metatarsalgia (3.8%), and numbness (2.9%). Callosity and toe deformities were associated with prolonged barefoot walking over extended periods since ordainment (p < 0.05). The callosity was found on the forefoot (47.3%), lateral malleolus (40.7%), and heel (12%). Arch types were considered normal in 66.4% of cases, high in 21.6%, and low in 12%. No association was found between arch type and foot and ankle problems. Callosity and toe deformity were the most common foot and ankle problems found in Thai monks, especially those with prolonged period of barefoot walking and long-term duration ofordainment. The unique pattern of walking and sitting of Thai monks may have contributed to the development of those feet and ankle problems.

  20. Realignment Surgery for Malunited Ankle Fracture.

    Science.gov (United States)

    Guo, Chang-Jun; Li, Xing-Cheng; Hu, Mu; Xu, Yang; Xu, Xiang-Yang

    2017-02-01

    To investigate the characteristics and the results of realignment surgery for the treatment of malunited ankle fracture. Thirty-three patients with malunited fractures of the ankle who underwent reconstructive surgery at our hospital from January 2010 to January 2014 were reviewed. The tibial anterior surface angle (TAS), the tibiotalar tilt angle (TTA), the malleolar angle (MA), and the tibial lateral surface angle (TLS) were measured. Clinical assessment was performed with use of the American Orthopaedic Foot and Ankle Society (AOFAS) scale and visual analogue scale (VAS) scores, and the osteoarthritis stage was determined radiographically with the modified Takakura classification system. The Wilcoxon matched-pairs test was used to analyze the difference between the preoperative and the postoperative data. The mean follow-up was 36 months (range, 20-60 months). The mean age at the time of realignment surgery was 37.1 years (range, 18-62 years). Compared with preoperation, the TAS at the last follow-up showed a significant increase (88.50° ± 4.47° vs. 90.80° ± 3.49°, P = 0.0035); similar results were observed in TTA (1.62° ± 1.66° vs. 0.83° ± 0.90°, P ankle osteoarthritis, and was treated by ankle joint distraction. Realignment surgery for a malunited ankle fracture can reduce pain, improve function, and delay ankle arthrodesis or total ankle replacement. Postoperative large talar tilt and advanced stages of ankle arthritis are the risk factors for the surgery. © 2017 Chinese Orthopaedic Association and John Wiley & Sons Australia, Ltd.

  1. Compression therapy after ankle fracture surgery

    DEFF Research Database (Denmark)

    Winge, R; Bayer, L; Gottlieb, H

    2017-01-01

    PURPOSE: The main purpose of this systematic review was to investigate the effect of compression treatment on the perioperative course of ankle fractures and describe its effect on edema, pain, ankle joint mobility, wound healing complication, length of stay (LOS) and time to surgery (TTS). The aim...... undergoing surgery, testing either intermittent pneumatic compression, compression bandage and/or compression stocking and reporting its effect on edema, pain, ankle joint mobility, wound healing complication, LOS and TTS. To conclude on data a narrative synthesis was performed. RESULTS: The review included...

  2. Validation of Patient-Reported Outcomes Measurement Information System Computerized Adaptive Tests Against the Foot and Ankle Outcome Score for 6 Common Foot and Ankle Pathologies.

    Science.gov (United States)

    Koltsov, Jayme C B; Greenfield, Stephen T; Soukup, Dylan; Do, Huong T; Ellis, Scott J

    2017-08-01

    The field of foot and ankle surgery lacks a widely accepted gold-standard patient-reported outcome instrument. With the changing infrastructure of the medical profession, more efficient patient-reported outcome tools are needed to reduce respondent burden and increase participation while providing consistent and reliable measurement across multiple pathologies and disciplines. The primary purpose of the present study was to validate 3 Patient-Reported Outcomes Measurement Information System computer adaptive tests (CATs) most relevant to the foot and ankle discipline against the Foot and Ankle Outcome Score (FAOS) and the Short Form 12 general health status survey in patients with 6 common foot and ankle pathologies. Patients (n = 240) indicated for operative treatment for 1 of 6 common foot and ankle pathologies completed the CATs, FAOS, and Short Form 12 at their preoperative surgical visits, 1 week subsequently (before surgery), and at 6 months postoperatively. The psychometric properties of the instruments were assessed and compared. The Patient-Reported Outcomes Measurement Information System CATs each took less than 1 minute to complete, whereas the FAOS took 6.5 minutes, and the Short Form 12 took 3 minutes. CAT scores were more normally distributed and had fewer floor and ceiling effects than those on the FAOS, which reached as high as 24%. The CATs were more precise than the FAOS and had similar responsiveness and test-retest reliability. The physical function and mobility CATs correlated strongly with the activities subscale of the FAOS, and the pain interference CAT correlated strongly with the pain subscale of the FAOS. The CATs and FAOS were responsive to changes with operative treatment for 6 common foot and ankle pathologies. The CATs performed as well as or better than the FAOS in all aspects of psychometric validity. The Patient-Reported Outcomes Measurement Information System CATs show tremendous potential for improving the study of patient

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

    Science.gov (United States)

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

    2016-06-02

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

  4. Arthroscopic Lateral Ligament Repair Through Two Portals in Chronic Ankle Instability.

    Science.gov (United States)

    Batista, Jorge Pablo; Del Vecchio, Jorge Javier; Patthauer, Luciano; Ocampo, Manuel

    2017-01-01

    Injury to the lateral ligament complex of the ankle is one of the most common sports-related injury. Usually lateral ankle evolves with excellent clinical recovery with non surgical treatment, however, near about 30% develop a lateral chronic instability sequela. Several open and arthroscopic surgical techniques have been described to treat this medical condition. Of the 22 patients who were treated; 18 males and 4 females, and aged from 17-42 years (mean 28 years). All patients presented a history of more than three ankle sprains in the last two years and presented positive anterior drawer and talar tilt test of the ankle in the physical examination. We perform an anterior arthroscopy of the ankle in order to treat asociated disease and then we performed "All inside¨ lateral ligament repair through two portals (anteromedial and anterolateral) using an anchor knotless suture. Clinical outcome evaluations were performed at a mean follow up of 25 months. (R: 17-31). Overall results has been shown by means of the American Orthopaedic Foot and Ankle Society (AOFAS). Mean AOFAS scores improved from 63 points (range 52-77) preoperatively to 90 points (range 73-100) at final follow up. No recurrences of ankle instability were found in the cases presented. Several surgical procedures have been described during the last years in order to treat chronic ankle instability. ¨All inside¨ lateral ligament reconstruction presents lower local morbidity than open procedures with few complications. Moreover, it is a reproductible technique, with high clinical success rate, few complications and relatively quick return to sports activities. A high knowledge of the anatomic landmarks should be essential to avoid unwated injuries.

  5. Arthroscopic anterior talofibular ligament repair for chronic ankle instability with a suture anchor technique.

    Science.gov (United States)

    Kim, Eung Soo; Lee, Kyung Tai; Park, Jun Sic; Lee, Young Koo

    2011-04-11

    The goal of this study was to retrospectively evaluate the clinical outcomes of arthroscopic repair for chronic ankle instability using a bioabsorbable anchor with 2 sutures. We evaluated the results of 28 ankles treated with arthroscopic anterior talofibular ligament repair using bioabsorbable anchors with a FiberWire and TigerWire suture (Arthrex, Inc, Naples, Florida) placed on the fibula from March 2008 to January 2009. Average follow-up was 15.9 months (range, 13-25 months). Patients were evaluated using the American Orthopaedic Foot and Ankle Society (AOFAS) hindfoot ankle score and stress radiographs. Mean AOFAS hindfoot ankle score was 92.48 ± 6.14 at last follow-up compared to the mean preoperative score of 60.78 ± 16.38 (P=.041). Mean postoperative anterior draw test score difference between 2 ankles was 0.61 ± 0.75 compared to the mean preoperative score difference of 3.59 ± 0.68 (P=.00). There was a 14% complication rate, including 3 cases of portal site irritation and 1 case of superficial infection. Stress radiographs revealed 3 cases of anterior displacement >3 mm compared to the other side. All patients returned to their previous activity level.Arthroscopic ligament reconstruction for chronic lateral ankle instability using suture anchors is effective in returning patients to their preinjury function levels. Good clinical results were obtained with some minor complications. This minimally invasive technique is a reasonable alternative to other open surgical procedures for chronic ankle instability. Copyright 2011, SLACK Incorporated.

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

    Science.gov (United States)

    Prissel, Mark A; Roukis, Thomas S

    2014-12-01

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

  7. Differences in kinematic control of ankle joint motions in people with chronic ankle instability.

    Science.gov (United States)

    Kipp, Kristof; Palmieri-Smith, Riann M

    2013-06-01

    People with chronic ankle instability display different ankle joint motions compared to healthy people. The purpose of this study was to investigate the strategies used to control ankle joint motions between a group of people with chronic ankle instability and a group of healthy, matched controls. Kinematic data were collected from 11 people with chronic ankle instability and 11 matched control subjects as they performed a single-leg land-and-cut maneuver. Three-dimensional ankle joint angles were calculated from 100 ms before, to 200 ms after landing. Kinematic control of the three rotational ankle joint degrees of freedom was investigated by simultaneously examining the three-dimensional co-variation of plantarflexion/dorsiflexion, toe-in/toe-out rotation, and inversion/eversion motions with principal component analysis. Group differences in the variance proportions of the first two principal components indicated that the angular co-variation between ankle joint motions was more linear in the control group, but more planar in the chronic ankle instability group. Frontal and transverse plane motions, in particular, contributed to the group differences in the linearity and planarity of angular co-variation. People with chronic ankle instability use a different kinematic control strategy to coordinate ankle joint motions during a single-leg landing task. Compared to the healthy group, the chronic ankle instability group's control strategy appeared to be more complex and involved joint-specific contributions that would tend to predispose this group to recurring episodes of instability. Copyright © 2013 Elsevier Ltd. All rights reserved.

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

    Science.gov (United States)

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

    2015-02-01

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

  9. Anterolateral ankle impingement in adolescents: outcomes of nonoperative and operative treatment.

    Science.gov (United States)

    Edmonds, Eric W; Chambers, Reid; Kaufman, Elizabeth; Chambers, Henry G

    2010-03-01

    Ankle sprains in adolescents usually resolve with conservative management but a few patients may develop ankle impingement syndrome. There have been adult studies addressing surgical treatment of this pathology, but our study evaluated the surgical management of anterolateral ankle impingement in adolescents by comparing their outcomes after nonoperative treatment and subsequent surgical intervention. Thirteen patients (children and adolescents) diagnosed with ankle impingement by history, physical examination, and magnetic resonance imaging during a 9-year period at our institution underwent eventual arthroscopic debridement. A retrospective chart review of these patients was performed and they were evaluated using the American Orthopedic Foot and Ankle Society (AOFAS) functional rating scale on 3 separate occasions: (1) initial presentation, (2) termination of nonoperative management, and (3) final postoperative follow-up visit. Thirteen adolescents (11 girls and 2 boys; 14 ankles) with a mean age of 15.6 (11.9-18.3) years met the inclusion criteria; of these, all had arthroscopic surgery. Mean duration of reported symptoms was 9.6 (4-15) months and mean duration of nonoperative management (physical therapy, activity modifications) was 6.9 (2-12) months. The mean AOFAS rating (out of 100 total) at initial presentation was 68.4 (40-84) and after nonoperative management was no better with a mean of 68.2 (63-76). The mean AOFAS rating at final follow-up was 90.6 (52-100), which was statistically significant (Pankle impingement in the adolescent population.

  10. Amputation effects on the underlying complexity within transtibial amputee ankle motion

    Energy Technology Data Exchange (ETDEWEB)

    Wurdeman, Shane R., E-mail: shanewurdeman@gmail.com [Nebraska Biomechanics Core Facility, University of Nebraska at Omaha, Omaha, Nebraska 68182 (United States); Advanced Prosthetics Center, Omaha, Nebraska 68134 (United States); Myers, Sara A. [Nebraska Biomechanics Core Facility, University of Nebraska at Omaha, Omaha, Nebraska 68182 (United States); Stergiou, Nicholas [Nebraska Biomechanics Core Facility, University of Nebraska at Omaha, Omaha, Nebraska 68182 (United States); College of Public Health, University of Nebraska Medical Center, Omaha, Nebraska 68198 (United States)

    2014-03-15

    The presence of chaos in walking is considered to provide a stable, yet adaptable means for locomotion. This study examined whether lower limb amputation and subsequent prosthetic rehabilitation resulted in a loss of complexity in amputee gait. Twenty-eight individuals with transtibial amputation participated in a 6 week, randomized cross-over design study in which they underwent a 3 week adaptation period to two separate prostheses. One prosthesis was deemed “more appropriate” and the other “less appropriate” based on matching/mismatching activity levels of the person and the prosthesis. Subjects performed a treadmill walking trial at self-selected walking speed at multiple points of the adaptation period, while kinematics of the ankle were recorded. Bilateral sagittal plane ankle motion was analyzed for underlying complexity through the pseudoperiodic surrogation analysis technique. Results revealed the presence of underlying deterministic structure in both prostheses and both the prosthetic and sound leg ankle (discriminant measure largest Lyapunov exponent). Results also revealed that the prosthetic ankle may be more likely to suffer loss of complexity than the sound ankle, and a “more appropriate” prosthesis may be better suited to help restore a healthy complexity of movement within the prosthetic ankle motion compared to a “less appropriate” prosthesis (discriminant measure sample entropy). Results from sample entropy results are less likely to be affected by the intracycle periodic dynamics as compared to the largest Lyapunov exponent. Adaptation does not seem to influence complexity in the system for experienced prosthesis users.

  11. ANKLE TAPING DOES NOT IMPAIR PERFORMANCE IN JUMP OR BALANCE TESTS

    Directory of Open Access Journals (Sweden)

    Javier Abián-Vicén

    2008-09-01

    Full Text Available This study aimed to investigate the influence of prophylactic ankle taping on two balance tests (static and dynamic balance and one jump test, in the push off and the landing phase. Fifteen active young subjects (age: 21.0 ± 4.4 years without previous ankle injuries volunteered for the study. Each participant performed three tests in two different situations: with taping and without taping. The tests were a counter movement jump, static balance, and a dynamic posturography test. The tests and conditions were randomly performed. The path of the center of pressures was measured in the balance tests, and the vertical ground reaction forces were recorded during the push-off and landing phases of the counter movement jump. Ankle taping had no influence on balance performance or in the push off phase of the jump. However, the second peak vertical force value during the landing phase of the jump was 12% greater with ankle taping (0.66 BW, 95% CI -0.64 to 1.96. The use of prophylactic ankle taping had no influence on the balance or jump performance of healthy young subjects. In contrast, the taped ankle increased the second peak vertical force value, which could be related to a greater risk of injury produced by the accumulation of repeated impacts in sports where jumps are frequently performed

  12. Amputation effects on the underlying complexity within transtibial amputee ankle motion

    International Nuclear Information System (INIS)

    Wurdeman, Shane R.; Myers, Sara A.; Stergiou, Nicholas

    2014-01-01

    The presence of chaos in walking is considered to provide a stable, yet adaptable means for locomotion. This study examined whether lower limb amputation and subsequent prosthetic rehabilitation resulted in a loss of complexity in amputee gait. Twenty-eight individuals with transtibial amputation participated in a 6 week, randomized cross-over design study in which they underwent a 3 week adaptation period to two separate prostheses. One prosthesis was deemed “more appropriate” and the other “less appropriate” based on matching/mismatching activity levels of the person and the prosthesis. Subjects performed a treadmill walking trial at self-selected walking speed at multiple points of the adaptation period, while kinematics of the ankle were recorded. Bilateral sagittal plane ankle motion was analyzed for underlying complexity through the pseudoperiodic surrogation analysis technique. Results revealed the presence of underlying deterministic structure in both prostheses and both the prosthetic and sound leg ankle (discriminant measure largest Lyapunov exponent). Results also revealed that the prosthetic ankle may be more likely to suffer loss of complexity than the sound ankle, and a “more appropriate” prosthesis may be better suited to help restore a healthy complexity of movement within the prosthetic ankle motion compared to a “less appropriate” prosthesis (discriminant measure sample entropy). Results from sample entropy results are less likely to be affected by the intracycle periodic dynamics as compared to the largest Lyapunov exponent. Adaptation does not seem to influence complexity in the system for experienced prosthesis users

  13. Epidemiological Patterns of Ankle Sprains in Youth, High School, and College Football.

    Science.gov (United States)

    Clifton, Daniel R; Koldenhoven, Rachel M; Hertel, Jay; Onate, James A; Dompier, Thomas P; Kerr, Zachary Y

    2017-02-01

    Variations in ankle injury rates and distributions among competition levels are unclear, but such data may help inform strategies to prevent ankle sprains during American football. To describe the epidemiological patterns of ankle sprains in youth, high school (HS), and collegiate American football. Descriptive epidemiological study. Data regarding youth, HS, and college football athletes were collected from 3 injury surveillance programs: (1) the Youth Football Safety Study (YFSS), (2) the National Athletic Treatment, Injury and Outcomes Network (NATION), and (3) the National Collegiate Athletic Association (NCAA) Injury Surveillance Program (ISP). During the 2012-2014 seasons, the YFSS, NATION, and NCAA ISP included 310, 184, and 71 football team-seasons, respectively. Athletic trainers (ATs) attended each practice and game and reported injuries and athlete-exposures (AEs) via their preferred injury documentation application. Ankle sprain rates for each type of ankle sprain were calculated overall, by event type (ie, practices and games), and specifically for severe injuries (ie, participation restriction time >21 days) and recurrent injuries (as defined by ATs). Rate ratios (RRs) were used to compare ankle sprain rates by competition level and event type. Injury proportion ratios (IPRs) were used to compare differences in severity, surgical needs, recurrence, injury mechanism, and injury activity by competition level. RRs and IPRs with 95% confidence intervals excluding 1.00 were considered statistically significant. A total of 124, 897, and 643 ankle sprains were reported in youth, HS, and college football, respectively. This led to respective rates of 0.59, 0.73, and 1.19 sprains per 1000 AEs. The ankle sprain rate in college football was higher than the rates in HS (RR = 1.64; 95% CI, 1.48-1.82) and youth (RR = 2.01; 95% CI, 1.65-2.43) football. The proportion of ankle sprains that were recurrent in youth football was higher than the proportions in HS (IPR

  14. Conservative treatment of ankle sprain according to a recent literature

    Directory of Open Access Journals (Sweden)

    Urszula Kaźmierczak

    2017-02-01

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

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

    NARCIS (Netherlands)

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

    2010-01-01

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

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

    Directory of Open Access Journals (Sweden)

    Basir Majdoleslami

    2004-06-01

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

  17. 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.

  18. Spontaneous resolution of posterior ankle joint loose bodies after total ankle replacement: A case report.

    Science.gov (United States)

    Lee, Raymond P; Cheng, Sally H S

    2017-06-01

    Late stage ankle osteoarthritis often presents with debilitating pain. It is common to find osteophytes and loose body formation around the joint. Total ankle arthroplasty can preserve joint mobility and pain relieve for such patient. However, when trying to remove the osteophytes and loose bodies at the posterior ankle joint, there is risk of damaging posterior structures such as the neurovascular bundle during the procedure. We are presenting a case where the posterior loose bodies remained untouched during the operation, and patient showed spontaneous resolution of the lesions with time. Patient enjoyed good function outcome after the surgery. Copyright © 2016 European Foot and Ankle Society. Published by Elsevier Ltd. All rights reserved.

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

    Science.gov (United States)

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

    2012-06-01

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

  20. New arthroscopic assisted technique for ankle instability

    International Nuclear Information System (INIS)

    Gerstner Garces, Juan Ricardo

    2004-01-01

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

  1. A Survey of Parachute Ankle Brace Breakages

    National Research Council Canada - National Science Library

    Knapik, Joseph J; Spiess, Anita; Darakjy, Salima; Grier, Tyson; Manning, Fred; Livingston, Elaine; Swedler, David; Amoroso, Paul; Jones, Bruce H

    2008-01-01

    ...) of the Defense Safety Oversight Council (DSOC) to evaluate the parachute ankle brace (PAB). Information provided by the questionnaire identified potential injury risk factors and comments on the PAB...

  2. Postoperative MR study of the ankle

    International Nuclear Information System (INIS)

    Tosch, U.; Sander, B.; Schubeus, P.; Tepe, H.; Goudarzi, Y.M.

    1991-01-01

    20 patients with acute traumatic rupture of the anterior talofibular ligament and ligamental suture were studied postoperatively by MRI. MR results were correlated with stress X-ray studies. We found a normal anterior talofibular ligament in eight cases. However, stress X-ray images showed normal stability of the ankle joint in eighteen cases. In six patients the anterior talofibular ligament was thickened, in another six cases it could not be separated from scar tissue. Therefore MR imaging of ankle ligaments did not allow a diagnosis of their function. Nevertheless, sequelae of the ankle trauma such as osteochondrosis, exsudation into the ankle joint and tendovaginitis of the flexor muscles were sensitively visualised by MR. (orig.) [de

  3. 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.

  4. Ankle Joint Contact Loads and Displacement With Progressive Syndesmotic Injury.

    Science.gov (United States)

    Hunt, Kenneth J; Goeb, Yannick; Behn, Anthony W; Criswell, Braden; Chou, Loretta

    2015-09-01

    Ligamentous injuries to the distal tibiofibular syndesmosis are predictive of long-term ankle dysfunction. Mild and moderate syndesmotic injuries are difficult to stratify, and the impact of syndesmosis injury on the magnitude and distribution of forces within the ankle joint during athletic activities is unknown. Eight below-knee cadaveric specimens were tested in the intact state and after sequential sectioning of the following ligaments: anterior-inferior tibiofibular, anterior deltoid (1 cm), interosseous/transverse (IOL/TL), posterior-inferior tibiofibular, and whole deltoid. In each condition, specimens were loaded in axial compression to 700 N and then externally rotated to 20 N·m torque. During axial loading and external rotation, both the fibula and the talus rotated significantly after each ligament sectioning as compared to the intact condition. After IOL/TL release, a significant increase in posterior translation of the fibula was observed, although no syndesmotic widening was observed. Mean tibiotalar contact pressure increased significantly after IOL/TL release, and the center of pressure shifted posterolaterally, relative to more stable conditions, after IOL/TL release. There were significant increases in mean contact pressure and peak pressure along with a reduction in contact area with axial loading and external rotation as compared to axial loading alone for all 5 conditions. Significant increases in tibiotalar contact pressures occur when external rotation stresses are added to axial loading. Moderate and severe injuries are associated with a significant increase in mean contact pressure combined with a shift in the center of pressure and rotation of the fibula and talus. Considerable changes in ankle joint kinematics and contact mechanics may explain why moderate syndesmosis injuries take longer to heal and are more likely to develop long-term dysfunction and, potentially, ankle arthritis. © The Author(s) 2015.

  5. The influence of a powered knee-ankle-foot orthosis on walking in poliomyelitis subjects: A pilot study.

    Science.gov (United States)

    Arazpour, Mokhtar; Moradi, Alireza; Samadian, Mohammad; Bahramizadeh, Mahmood; Joghtaei, Mahmoud; Ahmadi Bani, Monireh; Hutchins, Stephen W; Mardani, Mohammad A

    2016-06-01

    Traditionally, the anatomical knee joint is locked in extension when walking with a conventional knee-ankle-foot orthosis. A powered knee-ankle-foot orthosis was developed to provide restriction of knee flexion during stance phase and active flexion and extension of the knee during swing phase of gait. The purpose of this study was to determine differences of the powered knee-ankle-foot orthosis compared to a locked knee-ankle-foot orthosis in kinematic data and temporospatial parameters during ambulation. Quasi-experimental design. Subjects with poliomyelitis (n = 7) volunteered for this study and undertook gait analysis with both the powered and the conventional knee-ankle-foot orthoses. Three trials per orthosis were collected while each subject walked along a 6-m walkway using a calibrated six-camera three-dimensional video-based motion analysis system. Walking with the powered knee-ankle-foot orthosis resulted in a significant reduction in both walking speed and step length (both 18%), but a significant increase in stance phase percentage compared to walking with the conventional knee-ankle-foot orthosis. Cadence was not significantly different between the two test conditions (p = 0.751). There was significantly higher knee flexion during swing phase and increased hip hiking when using the powered orthosis. The new powered orthosis permitted improved knee joint kinematic for knee-ankle-foot orthosis users while providing knee support in stance and active knee motion in swing in the gait cycle. Therefore, the new powered orthosis provided more natural knee flexion during swing for orthosis users compared to the locked knee-ankle-foot orthosis. This orthosis has the potential to improve knee joint kinematics and gait pattern in poliomyelitis subjects during walking activities. © The International Society for Prosthetics and Orthotics 2015.

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

    Science.gov (United States)

    Ju, Sung-Bum; Park, Gi Duck

    2017-02-01

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

  7. Proprioceptive Training for the Prevention of Ankle Sprains: An Evidence-Based Review.

    Science.gov (United States)

    Rivera, Matthew J; Winkelmann, Zachary K; Powden, Cameron J; Games, Kenneth E

    2017-11-01

    Reference:  Schiftan GS, Ross LA, Hahne AJ. The effectiveness of proprioceptive training in preventing ankle sprains in sporting populations: a systematic review and meta-analysis. J Sci Med Sport. 2015;18(3):238-244.   Does the use of proprioceptive training as a sole intervention decrease the incidence of initial or recurrent ankle sprains in the athletic population?   The authors completed a comprehensive literature search of MEDLINE, CINAHL, SPORTDiscus, and Physiotherapy Evidence Database (PEDro) from inception to October 2013. The reference lists of all identified articles were manually screened to obtain additional studies. The following key words were used. Phase 1 population terms were sport*, athlet*, and a combination of the two. Phase 2 intervention terms were propriocept*, balance, neuromusc* adj5 train*, and combinations thereof. Phase 3 condition terms were ankle adj5 sprain*, sprain* adj5 ankle, and combinations thereof.   Studies were included according to the following criteria: (1) the design was a moderate- to high-level randomized controlled trial (>4/10 on the PEDro scale), (2) the participants were physically active (regardless of previous ankle injury), (3) the intervention group received proprioceptive training only, compared with a control group that received no proprioceptive training, and (4) the rate of ankle sprains was reported as a main outcome. Search results were limited to the English language. No restrictions were placed on publication dates.   Two authors independently reviewed the studies for eligibility. The quality of the pertinent articles was assessed using the PEDro scale, and data were extracted to calculate the relative risk. Data extracted were number of participants, intervention, frequency, duration, follow-up period, and injury rate.   Of the initial 345 studies screened, 7 were included in this review for a total of 3726 participants. Three analyses were conducted for proprioceptive training used (1) to

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

    Science.gov (United States)

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

    2011-09-27

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

  9. 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

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

    Science.gov (United States)

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

    2015-01-01

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

  11. Measurement of blood pressure, ankle blood pressure and calculation of ankle brachial index in general practice

    DEFF Research Database (Denmark)

    Nexøe, Jørgen; Damsbo, Bent; Lund, Jens Otto

    2012-01-01

    BACKGROUND: Low ankle brachial index (ABI) is a sensitive measure of 'burden' of atherosclerosis, indicating cardiovascular risk of the asymptomatic patient. Conventionally, ABI values......BACKGROUND: Low ankle brachial index (ABI) is a sensitive measure of 'burden' of atherosclerosis, indicating cardiovascular risk of the asymptomatic patient. Conventionally, ABI values...

  12. Operative Fixation Options for Elective and Diabetic Ankle Arthrodesis.

    Science.gov (United States)

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

    2017-07-01

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

  13. 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.

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

    Science.gov (United States)

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

    2014-01-01

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

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

    Science.gov (United States)

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

    2016-08-01

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

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

    Directory of Open Access Journals (Sweden)

    Xin Wang

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

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

    Science.gov (United States)

    Yim, JongEun; Petrofsky, Jerrold; Lee, Haneul

    2018-03-01

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

  18. Examining Ankle-Joint Laxity Using 2 Knee Positions and With Simulated Muscle Guarding.

    Science.gov (United States)

    Hanlon, Shawn; Caccese, Jaclyn; Knight, Christopher A; Swanik, Charles Buz; Kaminski, Thomas W

    2016-02-01

    Several factors affect the reliability of the anterior drawer and talar tilt tests, including the individual clinician's experience and skill, ankle and knee positioning, and muscle guarding. To compare gastrocnemius activity during the measurement of ankle-complex motion at different knee positions, and secondarily, to compare ankle-complex motion during a simulated trial of muscle guarding. Cross-sectional study. Research laboratory. Thirty-three participants aged 20.2 ± 1.7 years were tested. The ankle was loaded under 2 test conditions (relaxed, simulated muscle guarding) at 2 knee positions (0°, 90° of flexion) while gastrocnemius electromyography (EMG) activity was recorded. Anterior displacement (mm), inversion-eversion motion (°), and peak EMG amplitude values of the gastrocnemius (μV). Anterior displacement did not differ between the positions of 0° and 90° of knee flexion (P = .193). Inversion-eversion motion was greater at 0° of knee flexion compared with 90° (P ankle laxity at the 2 most common knee positions for anterior drawer testing; however, talar tilt testing may be best performed with the knee in 0° of knee flexion. Finally, our outcomes from the simulated muscle-guarding condition suggest that clinicians should use caution and be aware of reduced perceived laxity when performing these clinical examination techniques immediately postinjury.

  19. Misdiagnosis of Talar Body or Neck Fractures as Ankle Sprains in Low Energy Traumas

    Science.gov (United States)

    Young, Ki-Won; Kim, Jin-Su; Cho, Hun-Ki; Choo, Ho-Sik; Park, Jang-Ho

    2016-01-01

    Background The talus has a very complex anatomical morphology and is mainly fractured by a major force caused by a fall or a traffic accident. Therefore, a talus fracture is not common. However, many recent reports have shown that minor injuries, such as sprains and slips during sports activities, can induce a talar fracture especially in the lateral or posterior process. Still, fractures to the main parts of the talus (neck and body) after ankle sprains have not been reported as occult fractures. Methods Of the total 102 cases from January 2005 to December 2012, 7 patients had confirmed cases of missed/delayed diagnosis of a talus body or neck fracture and were included in the study population. If available, medical records, X-rays, computed tomography scans, and magnetic resonance imaging of the confirmed cases were retrospectively reviewed and analyzed. Results In the 7-patient population, there were 3 talar neck fractures and 4 talar body fractures (coronal shearing type). The mechanisms of injuries were all low energy trauma episodes. The causes of the injuries included twisting of the ankle during climbing (n = 2), jumping to the ground from a 1-m high wall (n = 2), and twisting of the ankle during daily activities (n = 3). Conclusions A talar body fracture and a talar neck fracture should be considered in the differential diagnosis of patients with acute and chronic ankle pain after a minor ankle injury. PMID:27583114

  20. Muscle recruitment and coordination with an ankle exoskeleton.

    Science.gov (United States)

    Steele, Katherine M; Jackson, Rachel W; Shuman, Benjamin R; Collins, Steven H

    2017-07-05

    Exoskeletons have the potential to assist and augment human performance. Understanding how users adapt their movement and neuromuscular control in response to external assistance is important to inform the design of these devices. The aim of this research was to evaluate changes in muscle recruitment and coordination for ten unimpaired individuals walking with an ankle exoskeleton. We evaluated changes in the activity of individual muscles, cocontraction levels, and synergistic patterns of muscle coordination with increasing exoskeleton work and torque. Participants were able to selectively reduce activity of the ankle plantarflexors with increasing exoskeleton assistance. Increasing exoskeleton net work resulted in greater reductions in muscle activity than increasing exoskeleton torque. Patterns of muscle coordination were not restricted or constrained to synergistic patterns observed during unassisted walking. While three synergies could describe nearly 95% of the variance in electromyography data during unassisted walking, these same synergies could describe only 85-90% of the variance in muscle activity while walking with the exoskeleton. Synergies calculated with the exoskeleton demonstrated greater changes in synergy weights with increasing exoskeleton work versus greater changes in synergy activations with increasing exoskeleton torque. These results support the theory that unimpaired individuals do not exclusively use central pattern generators or other low-level building blocks to coordinate muscle activity, especially when learning a new task or adapting to external assistance, and demonstrate the potential for using exoskeletons to modulate muscle recruitment and coordination patterns for rehabilitation or performance. Copyright © 2017 Elsevier Ltd. All rights reserved.

  1. Tenosynovitis of the ankles as onset of sarcoidosis in a patient with ulcerative colitis

    Directory of Open Access Journals (Sweden)

    F. Cozzi

    2011-09-01

    Full Text Available Arthritis and tenosynovitis are frequently reported as complications of inflammatory bowel diseases. About 10% of patients with ulcerative colitis presents articular inflammation, usually in the phases of activity of intestinal disease. Tenosynovitis is also a frequent complication of ulcerative colitis. We describe here a case of tenosynovitis of both ankles occurring in a patient affected by ulcerative colitis not in active phase. Chest X-ray and TC showed hilar lymphonode enlargement and transbronchial biopsy confirmed the diagnosis of sarcoidosis. In this disease tenosynovitis is very rare, unlike arthritis that is rather common. In conclusion we observed a case of ankle bilateral tenosynovitis as onset manifestation of sarcoidosis.

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

    Science.gov (United States)

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

    2011-09-01

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

  3. Acute injury of the ankle joint

    International Nuclear Information System (INIS)

    Breitenseher, M.J.

    1999-01-01

    The diagnosis of lateral collateral ankle ligament trauma is based on patient history, clinical examination, and clinical stress tests. If the clinical stress test is positive, stress radiography could be performed. There is no consensus about the usefulness of stress radiography in acute ankle sprain, particularly about the cut-off talar tilt angle beyond which a two-ligament rupture would be certain, ranging from 5 to 30 . Today MRI is not used for this indication, although it allows, with controlled positioning of the foot and with defined sections, visualization of injured lateral collateral ankle ligaments. In ankle injuries, plain radiographs form the established basis of diagnostic imaging and can provide definitive answers in most cases. CT is used in complex fractures for complete visualization. MRI is the method of choice for several diagnostic problem cases, including occult fractures and post-traumatic avascular necrosis. In tendon injuries, MRI is important if ultrasound is not diagnostic. Generally, for the evaluation of acute ankle injuries, MRI is the most important second-step procedure when radiographs are nondiagnostic. (orig.) [de

  4. 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.

  5. Arthroscopy and Endoscopy of the Ankle and Hindfoot

    NARCIS (Netherlands)

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

    2009-01-01

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

  6. Common Types and Countermeasures of Ankle Ligament Injury ...

    African Journals Online (AJOL)

    2017-09-14

    Sep 14, 2017 ... Objective: To analyze ankle ligament injury of basketball players caused during movement, summarize ... players with ankle ligament injury during basketball movement and admitted to different .... Road Success 2010;8:70. 5.

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

    OpenAIRE

    Suresh; Ranganath; Sridhar; Rohit; Rajeev; Afrin

    2014-01-01

    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. Compl...

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

    Science.gov (United States)

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

    2011-01-01

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

  9. Learning to walk with an adaptive gain proportional myoelectric controller for a robotic ankle exoskeleton.

    Science.gov (United States)

    Koller, Jeffrey R; Jacobs, Daniel A; Ferris, Daniel P; Remy, C David

    2015-11-04

    Robotic ankle exoskeletons can provide assistance to users and reduce metabolic power during walking. Our research group has investigated the use of proportional myoelectric control for controlling robotic ankle exoskeletons. Previously, these controllers have relied on a constant gain to map user's muscle activity to actuation control signals. A constant gain may act as a constraint on the user, so we designed a controller that dynamically adapts the gain to the user's myoelectric amplitude. We hypothesized that an adaptive gain proportional myoelectric controller would reduce metabolic energy expenditure compared to walking with the ankle exoskeleton unpowered because users could choose their preferred control gain. We tested eight healthy subjects walking with the adaptive gain proportional myoelectric controller with bilateral ankle exoskeletons. The adaptive gain was updated each stride such that on average the user's peak muscle activity was mapped to maximal power output of the exoskeleton. All subjects participated in three identical training sessions where they walked on a treadmill for 50 minutes (30 minutes of which the exoskeleton was powered) at 1.2 ms(-1). We calculated and analyzed metabolic energy consumption, muscle recruitment, inverse kinematics, inverse dynamics, and exoskeleton mechanics. Using our controller, subjects achieved a metabolic reduction similar to that seen in previous work in about a third of the training time. The resulting controller gain was lower than that seen in previous work (β=1.50±0.14 versus a constant β=2). The adapted gain allowed users more total ankle joint power than that of unassisted walking, increasing ankle power in exchange for a decrease in hip power. Our findings indicate that humans prefer to walk with greater ankle mechanical power output than their unassisted gait when provided with an ankle exoskeleton using an adaptive controller. This suggests that robotic assistance from an exoskeleton can allow

  10. Solarização do solo com filmes plásticos com e sem aditivo estabilizador de luz ultravioleta Soil solarization with plastic films with and without UV light stabilizers

    Directory of Open Access Journals (Sweden)

    Benedito C. Barros

    2004-06-01

    Full Text Available Visando auxiliar na escolha de filmes plásticos adequados para a solarização, dois experimentos foram instalados em Mogi das Cruzes e Piracicaba (SP, em janeiro e fevereiro de 2000. Três tipos de filmes plásticos transparentes de polietileno de baixa densidade (PEBD, com 100 mm de espessura, produzidos pela empresa Nortène Plásticos Ltda., foram testados: a FES, filme estufa super tricarpa super aditivado, com aditivo estabilizador de luz ultravioleta (baseado em aminas estericamente impedidas; b FSOL, filme para solarização produzido com metade da quantidade do mesmo aditivo e c LT, lona plástica transparente, sem aditivo, além de uma testemunha sem cobertura plástica, em delineamento de blocos casualizados, com quatro repetições. Após a retirada dos plásticos foi conduzida uma safra de alface em ambos os locais. Foi realizada análise química dos solos e das plantas colhidas, além de avaliada a infestação por plantas daninhas e a massa fresca das plantas colhidas. Em Piracicaba também foram realizadas análises microbiológicas dos solos e determinada a viabilidade de Pythium aphanidermattum. Em Mogi das Cruzes foi avaliada a incidência de podridão de esclerotínia, causada por Sclerotinia minor. As temperaturas médias registradas, a 10 cm de profundidade, nos solos sob os diferentes filmes plásticos foram semelhantes, de 44-41ºC nos solos solarizados e de 33,9-30,2ºC nos solos não solarizados de Piracicaba e Mogi das Cruzes, respectivamente. Detectou-se aumento na massa fresca das plantas colhidas nas parcelas solarizadas, de 49% em Piracicaba e 24% em Mogi das Cruzes, independente do plástico testado. Nos dois locais também houve drástica redução na infestação por plantas daninhas nas áreas solarizadas. Nas análises microbianas não foram verificadas alterações na liberação de CO2, no carbono da biomassa microbiana, no quociente metabólico e no número total de bactérias. O número de fungos foi

  11. Biomechanical Study about Lateral Ankle Laxity

    Directory of Open Access Journals (Sweden)

    Bogdan Voicu

    2009-12-01

    Full Text Available The objective of this paper is to study the contribution of the anterior talofibular ligament to ankle laxity at 18 cadaver ankles. For this, there was made an original, bipolar transoseus system, in a monitorized test stand Mx-500N Schmidt with a digital force gauge Imada. It was measured the motion response for applied antero-posterior force, inversion-eversion moment and internal-external rotary torque, in three positions of flexion of the ankle, with an intact anterior talofibular ligament and after it’s sectioning. The results showed a significant increases in laxity in plantar flexion for the inversion and internal rotary torque, this mechanism coresponding with common modes of injury.

  12. Mechanical performance of artificial pneumatic muscles to power an ankle-foot orthosis.

    Science.gov (United States)

    Gordon, Keith E; Sawicki, Gregory S; Ferris, Daniel P

    2006-01-01

    We developed a powered ankle-foot orthosis that uses artificial pneumatic muscles to produce active plantar flexor torque. The purpose of this study was to quantify the mechanical performance of the orthosis during human walking. Three subjects walked at a range of speeds wearing ankle-foot orthoses with either one or two artificial muscles working in parallel. The orthosis produced similar total peak plantar flexor torque and network across speeds independent of the number of muscles used. The orthosis generated approximately 57% of the peak ankle plantar flexor torque during stance and performed approximately 70% of the positive plantar flexor work done during normal walking. Artificial muscle bandwidth and force-length properties were the two primary factors limiting torque production. The lack of peak force and work differences between single and double muscle conditions can be explained by force-length properties. Subjects altered their ankle kinematics between conditions resulting in changes in artificial muscle length. In the double muscle condition greater plantar flexion yielded shorter artificial muscles lengths and decreased muscle forces. This finding emphasizes the importance of human testing in the design and development of robotic exoskeleton devices for assisting human movement. The results of this study outline the mechanical performance limitations of an ankle-foot orthosis powered by artificial pneumatic muscles. This orthosis could be valuable for gait rehabilitation and for studies investigating neuromechanical control of human walking.

  13. Management of high-energy foot and ankle injuries in the geriatric population.

    Science.gov (United States)

    Herscovici, Dolfi; Scaduto, Julia M

    2012-03-01

    By the year 2035 almost 20% of the US population of 389 million people will be 65 years and older. What this group has, compared with aged populations in the past, is better health, more mobility, and more active lifestyles. From January 1989 through December 2010, a total of 494 elderly patients with 536 foot and ankle injuries were identified. Within this group, 237 (48%) patients with 294 injuries were sustained as a result of a high-energy mechanism. These mechanisms consisted of 170 motor vehicle accidents, 30 as a result of high (not ground level) energy falls, 2 from industrial accidents, and 35 classified as other, which included sports, blunt trauma, bicycle, airplane or boating accidents, crush injuries, and injuries resulting from a lawn mower. The injuries produced were 17 metatarsal fractures, 9 Lisfranc injuries, 10 midfoot (navicular, cuneiform, or cuboid) fractures, 23 talus fractures, 63 calcaneal fractures, 73 unimalleolar, bimalleolar, or trimalleolar ankle fractures, 45 pilon fractures, and 3 pure dislocations of the foot or ankle. Overall, 243 (83%) of these injuries underwent surgical fixation and data have shown that when surgery is used to manage high-energy injuries of the foot and ankle in the elderly individuals, the complications and outcomes are similar to those seen in younger patients. Therefore, the decision for surgical intervention for high-energy injuries of the foot and ankle should be based primarily on the injury pattern and not solely on the age of the patient.

  14. Two ankle joint laxity testers: reliability and validity

    NARCIS (Netherlands)

    Kerkhoffs, Gino M. M. J.; Blankevoort, Leendert; Sierevelt, Inger N.; Corvelein, Ruby; Janssen, Guido H. W.; van Dijk, C. Niek

    2005-01-01

    Two test devices were manufactured to objectively measure ankle joint laxity: the dynamic anterior ankle tester (DAAT) and the quasi-static anterior ankle tester (QAAT). The primary aim was to analyse the reliability of both testers; The secondary aim was to assess validity in correlation with TELOS

  15. Direct measurement of the intrinsic ankle stiffness during standing

    NARCIS (Netherlands)

    Vlutters, Mark; Vlutters, M.; Boonstra, Tjitske; Schouten, Alfred Christiaan; van der Kooij, Herman

    2015-01-01

    Ankle stiffness contributes to standing balance, counteracting the destabilizing effect of gravity. The ankle stiffness together with the compliance between the foot and the support surface make up the ankle-foot stiffness, which is relevant to quiet standing. The contribution of the intrinsic

  16. Predicting functional recovery after acute ankle sprain.

    Directory of Open Access Journals (Sweden)

    Sean R O'Connor

    Full Text Available 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.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.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.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 prospective research is required to highlight the factors

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

    Science.gov (United States)

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

    2017-03-01

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

  18. Muscle Reaction Time During a Simulated Lateral Ankle Sprain After Wet-Ice Application or Cold-Water Immersion.

    Science.gov (United States)

    Thain, Peter K; Bleakley, Christopher M; Mitchell, Andrew C S

    2015-07-01

    Cryotherapy is used widely in sport and exercise medicine to manage acute injuries and facilitate rehabilitation. The analgesic effects of cryotherapy are well established; however, a potential caveat is that cooling tissue negatively affects neuromuscular control through delayed muscle reaction time. This topic is important to investigate because athletes often return to exercise, rehabilitation, or competitive activity immediately or shortly after cryotherapy. To compare the effects of wet-ice application, cold-water immersion, and an untreated control condition on peroneus longus and tibialis anterior muscle reaction time during a simulated lateral ankle sprain. Randomized controlled clinical trial. University of Hertfordshire human performance laboratory. A total of 54 physically active individuals (age = 20.1 ± 1.5 years, height = 1.7 ± 0.07 m, mass = 66.7 ± 5.4 kg) who had no injury or history of ankle sprain. Wet-ice application, cold-water immersion, or an untreated control condition applied to the ankle for 10 minutes. Muscle reaction time and muscle amplitude of the peroneus longus and tibialis anterior in response to a simulated lateral ankle sprain were calculated. The ankle-sprain simulation incorporated a combined inversion and plantar-flexion movement. We observed no change in muscle reaction time or muscle amplitude after cryotherapy for either the peroneus longus or tibialis anterior (P > .05). Ten minutes of joint cooling did not adversely affect muscle reaction time or muscle amplitude in response to a simulated lateral ankle sprain. These findings suggested that athletes can safely return to sporting activity immediately after icing. Further evidence showed that ice can be applied before ankle rehabilitation without adversely affecting dynamic neuromuscular control. Investigation in patients with acute ankle sprains is warranted to assess the clinical applicability of these interventions.

  19. Intramuscular Pressure of Tibialis Anterior Reflects Ankle Torque but Does Not Follow Joint Angle-Torque Relationship

    Directory of Open Access Journals (Sweden)

    Filiz Ateş

    2018-01-01

    Full Text Available Intramuscular pressure (IMP is the hydrostatic fluid pressure that is directly related to muscle force production. Electromechanical delay (EMD provides a link between mechanical and electrophysiological quantities and IMP has potential to detect local electromechanical changes. The goal of this study was to assess the relationship of IMP with the mechanical and electrical characteristics of the tibialis anterior muscle (TA activity at different ankle positions. We hypothesized that (1 the TA IMP and the surface EMG (sEMG and fine-wire EMG (fwEMG correlate to ankle joint torque, (2 the isometric force of TA increases at increased muscle lengths, which were imposed by a change in ankle angle and IMP follows the length-tension relationship characteristics, and (3 the electromechanical delay (EMD is greater than the EMD of IMP during isometric contractions. Fourteen healthy adults [7 female; mean (SD age = 26.9 (4.2 years old with 25.9 (5.5 kg/m2 body mass index] performed (i three isometric dorsiflexion (DF maximum voluntary contraction (MVC and (ii three isometric DF ramp contractions from 0 to 80% MVC at rate of 15% MVC/second at DF, Neutral, and plantarflexion (PF positions. Ankle torque, IMP, TA fwEMG, and TA sEMG were measured simultaneously. The IMP, fwEMG, and sEMG were significantly correlated to the ankle torque during ramp contractions at each ankle position tested. This suggests that IMP captures in vivo mechanical properties of active muscles. The ankle torque changed significantly at different ankle positions however, the IMP did not reflect the change. This is explained with the opposing effects of higher compartmental pressure at DF in contrast to the increased force at PF position. Additionally, the onset of IMP activity is found to be significantly earlier than the onset of force which indicates that IMP can be designed to detect muscular changes in the course of neuromuscular diseases impairing electromechanical transmission.

  20. Knee and Ankle Arthroplasty in Hemophilia

    Directory of Open Access Journals (Sweden)

    Luigi Piero Solimeno

    2017-11-01

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

  1. Arthroscopic treatment of impingement of the ankle reduces pain and enhances function

    DEFF Research Database (Denmark)

    Rasmussen, S; Hjorth Jensen, C

    2002-01-01

    A consecutive series of 105 patients with a median age of 35 (16-62) years who were operated on with arthroscopic resection for impingement of the ankle using standardized technique without distraction is presented. All patients complained of painful dorsiflexion and had failed to respond to cons...... synovectomy and intravenous antibiotics. In one patient persistent symptoms were recorded. Ankle arthroscopy yielded good results in the treatment of anterior impingement of the ankle as it effectively reduced pain and enhanced function....... of pain. Gait was improved in 30/41 patients and 22 resumed sporting activities. The results were graded excellent in 67, good in 25, fair in six and poor in seven patients. There were four deep infections and one synovial fistula in this series. The deep infections all responded well to arthroscopic...

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

    NARCIS (Netherlands)

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

    2012-01-01

    In patients with central neurological disorders, gait is often limited by a reduced ability to push off with the ankle. To overcome this reduced ankle push-off, energy-storing, spring-like carbon-composite Ankle Foot Orthoses (AFO) can be prescribed. It is expected that the energy returned by the

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

    Directory of Open Access Journals (Sweden)

    Masashi Naito

    2017-01-01

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

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

    Science.gov (United States)

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

    2013-01-01

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

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

    Science.gov (United States)

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

    2011-07-01

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

  6. Modular ankle robotics training in early subacute stroke: a randomized controlled pilot study.

    Science.gov (United States)

    Forrester, Larry W; Roy, Anindo; Krywonis, Amanda; Kehs, Glenn; Krebs, Hermano Igo; Macko, Richard F

    2014-09-01

    BACKGROUND. Modular lower extremity robotics may offer a valuable avenue for restoring neuromotor control after hemiparetic stroke. Prior studies show that visually guided and visually evoked practice with an ankle robot (anklebot) improves paretic ankle motor control that translates into improved overground walking. To assess the feasibility and efficacy of daily anklebot training during early subacute hospitalization poststroke. Thirty-four inpatients from a stroke unit were randomly assigned to anklebot (n = 18) or passive manual stretching (n = 16) treatments. All suffered a first stroke with residual hemiparesis (ankle manual muscle test grade 1/5 to 4/5), and at least trace muscle activation in plantar- or dorsiflexion. Anklebot training employed an "assist-as-needed" approach during >200 volitional targeted paretic ankle movements, with difficulty adjusted to active range of motion and success rate. Stretching included >200 daily mobilizations in these same ranges. All sessions lasted 1 hour and assessments were not blinded. Both groups walked faster at discharge; however, the robot group improved more in percentage change of temporal symmetry (P = .032) and also of step length symmetry (P = .038), with longer nonparetic step lengths in the robot (133%) versus stretching (31%) groups. Paretic ankle control improved in the robot group, with increased peak (P ≤ .001) and mean (P ≤ .01) angular speeds, and increased movement smoothness (P ≤ .01). There were no adverse events. Though limited by small sample size and restricted entry criteria, our findings suggest that modular lower extremity robotics during early subacute hospitalization is well tolerated and improves ankle motor control and gait patterning. © The Author(s) 2014.

  7. Modular Ankle Robotics Training in Early Sub-Acute Stroke: A Randomized Controlled Pilot Study

    Science.gov (United States)

    Forrester, Larry W.; Roy, Anindo; Krywonis, Amanda; Kehs, Glenn; Krebs, Hermano Igo; Macko, Richard F.

    2014-01-01

    Background Modular lower extremity (LE) robotics may offer a valuable avenue for restoring neuromotor control after hemiparetic stroke. Prior studies show that visually-guided and visually-evoked practice with an ankle robot (anklebot) improves paretic ankle motor control that translates into improved overground walking. Objective Assess the feasibility and efficacy of daily anklebot training during early sub-acute hospitalization post-stroke. Methods Thirty-four inpatients from a stroke unit were randomly assigned to anklebot (N=18) or passive manual stretching (N=16) treatments. All suffered a first stroke with residual hemiparesis (ankle manual muscle test grade 1/5 to 4/5), and at least trace muscle activation in plantar- or dorsiflexion. Anklebot training employed an “assist-as-needed” approach during > 200 volitional targeted paretic ankle movements, with difficulty adjusted to active range of motion and success rate. Stretching included >200 daily mobilizations in these same ranges. All sessions lasted 1 hour and assessments were not blinded. Results Both groups walked faster at discharge, however the robot group improved more in percent change of temporal symmetry (p=0.032) and also of step length symmetry (p=0.038), with longer nonparetic step lengths in the robot (133%) vs. stretching (31%) groups. Paretic ankle control improved in the robot group, with increased peak (p≤ 0.001) and mean (p≤ 0.01) angular speeds, and increased movement smoothness (p≤ 0.01). There were no adverse events. Conclusion Though limited by small sample size and restricted entry criteria, our findings suggest that modular lower extremity robotics during early sub-acute hospitalization is well tolerated and improves ankle motor control and gait patterning. PMID:24515923

  8. Early functional outcome of two different orthotic concepts in ankle sprains: a randomized controlled trial.

    Science.gov (United States)

    Best, Raymond; Böhle, Caroline; Schiffer, Thorsten; Petersen, Wolf; Ellermann, Andree; Brueggemann, Gert Peter; Liebau, Christian

    2015-07-01

    Purpose of the study was the evaluation of the early functional outcome of patients with an acute ankle sprain treated either with a semirigid, variable, phase-adapted modular ankle orthosis or an invariable orthotic reference device. Forty-seven patients with acute ankle sprain grade II or more were included. In addition, 77 healthy controls as a reference were investigated. The injured subjects were treated with one of the two devices by random for 6 weeks. Ankle scores (FAOS, AOFAS) were taken at baseline after injury, 1 and 3 months after injury. Functional performance tests (balance platform, zig zag run, shuttle run, vertical drop jump) were performed at 1 and 3 months after injury. No significant score differences could be found between the two intervention groups except for achieving a preinjury activity level after 3 months only in the modular orthosis group. Postural functional performances (balance test) also showed no significant differences whereas the results of the agility tests revealed small but significant better results in the modular orthosis group in comparison to the invariable orthosis group. Cohen's effect sizes were high. Differences between the two intervention groups were marginal and very small but significant and--regarding Cohen's effect sizes--effective. Especially relating to functional performance, this might be a careful indication that a more effective strategy for promoting a protected, rapid recovery to physical activity after ankle sprains might be achieved by applying a phase-adapted ankle orthosis. Especially in athletic patients, phase-adapted orthosis should be further investigated and considered to ensure fully protected ligament healing as well as to regain early functional recovery.

  9. Directing clinical care using lower extremity biomechanics in patients with ankle osteoarthritis and ankle arthroplasty.

    Science.gov (United States)

    Queen, Robin

    2017-11-01

    Ankle osteoarthritis is a debilitating disease with approximately 50,000 new cases per year leading to skeletal deformity, severe and recurrent pain, cartilage breakdown, and gait dysfunction limiting patient mobility and well-being. Although many treatments (total ankle arthroplasty [TAA], ankle fusion [arthrodesis], and ankle distraction arthroplasty) relieve pain, it is not clear that these procedures significantly improve patient mobility. The goal of the research presented here is to summarize what is presently known about lower extremity gait mechanics and outcomes and to quantify the impact of ankle osteoarthritis and TAA have on these measures using an explicitly holistic and mechanistic approach. Our recent studies have explored physical performance and energy recovery and revealed unexpected patterns and sequelae to treatment including incomplete restoration of gait function. These studies demonstrated for the first time the extreme levels and range of gait and balance dysfunction present in ankle osteoarthritis patients as well as quantifying the ways in which the affected joint alters movement and loading patterns not just in the painful joint, but throughout both the ipsilateral and contralateral lower extremity. Through this work, we determined that relieving pain alone through TAA is not enough to restore normal walking mechanics and balance due to underlying causes including limited ankle range of motion and balance deficits leading to long-term disability despite treatment. The results indicate the need to consider additional therapeutic interventions aimed at restoring balance, ankle range of motion, and movement symmetry in order to improve long-term health and function. © 2017 Orthopaedic Research Society. Published by Wiley Periodicals, Inc. J Orthop Res 35:2345-2355, 2017. © 2017 Orthopaedic Research Society. Published by Wiley Periodicals, Inc.

  10. An in Silico Analysis of Ankle Joint Loads in Secondary Ankle Osteoarthritis. Case Study.

    Science.gov (United States)

    Lorkowski, Jacek; Mrzygłód, Mirosław W; Grzegorowska, Oliwia; Kotela, Ireneusz

    2015-01-01

    Secondary, post-traumatic, degenerative lesions of the ankle joint remain a serious clinical challenge. This paper presents the case of a 66-year-old patient with secondary, post-traumatic ankle osteoarthritis and subchondral cysts. The use of rapid computer modelling FEM 2D enabled optimization of surgical treatment. A FEM 2D model of biomechanical changes in bones may help in streamlining treatment as well as improve our understanding of the pathomechanism of osteoarthritis.

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

    Science.gov (United States)

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

    2015-02-01

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

  12. The physiological cost index of walking with a powered knee-ankle-foot orthosis in subjects with poliomyelitis: A pilot study.

    Science.gov (United States)

    Arazpour, Mokhtar; Ahmadi Bani, Monireh; Samadian, Mohammad; Mousavi, Mohammad E; Hutchins, Stephen W; Bahramizadeh, Mahmood; Curran, Sarah; Mardani, Mohammad A

    2016-08-01

    A powered knee-ankle-foot orthosis was developed to provide restriction of knee flexion during stance phase and active flexion and extension of the knee during swing phase of gait. The purpose of this study was to determine its effect on the physiological cost index, walking speed and the distance walked in people with poliomyelitis compared to when walking with a knee-ankle-foot orthosis with drop lock knee joints. Quasi experimental study. Seven subjects with poliomyelitis volunteered for the study and undertook gait analysis with both types of knee-ankle-foot orthosis. Walking with the powered knee-ankle-foot orthosis significantly reduced walking speed (p = 0.015) and the distance walked (p = 0.004), and also, it did not improve physiological cost index values (p = 0.009) compared to walking with the locked knee-ankle-foot orthosis. Using a powered knee-ankle-foot orthosis did not significantly improve any of the primary outcome measures during walking for poliomyelitis subjects. This powered knee-ankle-foot orthosis design did not improve the physiological cost index of walking for people with poliomyelitis when compared to walking with a knee-ankle-foot orthosis with drop lock knee joints. This may have been due to the short training period used or the bulky design and additional weight of the powered orthosis. Further research is therefore warranted. © The International Society for Prosthetics and Orthotics 2015.

  13. Injury of the ankle joint ligaments

    International Nuclear Information System (INIS)

    Breitenseher, M.J.

    2007-01-01

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

  14. Anterior ankle arthroscopy, distraction or dorsiflexion?

    NARCIS (Netherlands)

    de Leeuw, P.A.J.; Golanó, P.; Clavero, J.A.; van Dijk, C.N.

    2010-01-01

    Anterior ankle arthroscopy can basically be performed by two different methods; the dorsiflexion- or distraction method. The objective of this study was to determine the size of the anterior working area for both the dorsiflexion and distraction method. The anterior working area is anteriorly

  15. Ambulatory assessment of ankle and foot dynamics

    NARCIS (Netherlands)

    Schepers, H. Martin; Koopman, Hubertus F.J.M.; Veltink, Petrus H.

    Ground reaction force (GRF) measurement is important in the analysis of human body movements. The main drawback of the existing measurement systems is the restriction to a laboratory environment. This paper proposes an ambulatory system for assessing the dynamics of ankle and foot, which integrates

  16. Bimalleolar ankle fracture with proximal fibular fracture

    NARCIS (Netherlands)

    Colenbrander, R. J.; Struijs, P. A. A.; Ultee, J. M.

    2005-01-01

    A 56-year-old female patient suffered a bimalleolar ankle fracture with an additional proximal fibular fracture. This is an unusual fracture type, seldom reported in literature. It was operatively treated by open reduction and internal fixation of the lateral malleolar fracture. The proximal fibular

  17. Arthroscopy for problems after ankle fracture

    NARCIS (Netherlands)

    van Dijk, C. N.; Verhagen, R. A.; Tol, J. L.

    1997-01-01

    From 1990 to 1994 we undertook arthroscopy of the ankle on 34 consecutive patients with residual complaints following fracture. Two groups were compared prospectively. Group I comprised 18 patients with complaints which could be attributed clinically to anterior bony or soft-tissue impingement. In

  18. A surgical ankle sprain pain model in the rat: Effects of morphine and indomethacin

    OpenAIRE

    Young Kim, Hee; Wang, Jigong; Chung, Kyungsoon; Mo Chung, Jin

    2008-01-01

    Ankle sprain is a frequent injury in humans that results in pain, swelling and difficulty in walking on the affected ankle. Currently a suitable animal model resembling human ankle sprain is lacking. Here, we describe an animal ankle sprain model induced by ankle ligament injury (ALI) in rats. Cutting combinations of the lateral ankle ligament complex produced pain, edema and difficulty of weight bearing, thereby mimicking severe (grade III) ankle sprain in humans. Analgesic compounds, morphi...

  19. Medial gastrocnemius myoelectric control of a robotic ankle exoskeleton.

    Science.gov (United States)

    Kinnaird, Catherine R; Ferris, Daniel P

    2009-02-01

    A previous study from our laboratory showed that when soleus electromyography was used to control the amount of plantar flexion assistance from a robotic ankle exoskeleton, subjects significantly reduced their soleus activity to quickly return to normal gait kinematics. We speculated that subjects were primarily responding to the local mechanical assistance of the exoskeleton rather than directly attempting to reduce exoskeleton mechanical power via decreases in soleus activity. To test this observation we studied ten healthy subjects walking on a treadmill at 1.25 m/s while wearing a robotic exoskeleton proportionally controlled by medial gastrocnemius activation. We hypothesized that subjects would primarily decrease soleus activity due to its synergistic mechanics with the exoskeleton. Subjects decreased medial gastrocnemius recruitment by 12% ( p exoskeleton (soleus). These findings indicate that anatomical morphology needs to be considered carefully when designing software and hardware for robotic exoskeletons.

  20. Clinical evaluation of a new noninvasive ankle arthrometer.

    Science.gov (United States)

    Nauck, Tanja; Lohrer, Heinz; Gollhofer, Albert

    2010-06-01

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

  1. [Prevention and treatment of perioperative period complication of total ankle replacement].

    Science.gov (United States)

    Liao, Xiang; Gao, Zhizeng; Huang, Shanhu; Yang, Shuhua

    2008-01-01

    To explore the cause of the perioprative period complication of scandinavian total ankle replacement (STAR) and to summarize the experience in the treatment and prevention. From March 1999 to November 2006, 35 patients were given total ankle replacement (TAR) with STAR system. There were 19 males and 16 females with an average age of 50.5 years (27 to 68 years), including 12 cases of posttraumatic arthritis, 8 cases of osteoarthritis and 15 cases of rheumatoid arthritis. All patients had pain of ankle joint, swelling and limitation of joint motion. The disease course was 9-64 months. The curative effect was estimated by Kofoed total ankle scoring system. The mean preoperative ankle score was 29 (6-48); the mean pain score was 18.3 (0-35); the mean function score was 11.7 (6-18); and the mean activity score was 9.2 (3-12). The type of all complications were record, and its cause, prevetion and treatment were analyszed. Thirty-three patients achieved healing by first intention, 2 achieved delayed union because of infection. Twenty-eight patients were followed up 3-80 months (mean 43.5 months). Medial malleolus fracture occurred in 2 cases, unstable ankle joint introversion in 2 cases, limitation of ankle dorsiextension in 1 case and 1 case had hypoesthesia at intermediate dorsal skin of foot and 3rd-5th metatarsal skin without obvious dysfunction; all were treated with symptomatic medication. The postoperative mean ankle score was 85.5 (58-95); the mean pain score was 48.3 (35-50); the mean function score was 20.7 (18-30); the mean activity score was 17.2 (16-20). There were statistically significant differences when compared with preoperative score (P<0.01). The clinical results were excellent in 16 patients, good in 9 patients and fair in 3 patients. The X-ray films showed no loosening and subsidence of prosthesis. Although STAR can retain the functions of the operated joint, it has its special complications. It is important to obey operation principle with

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

    Science.gov (United States)

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

    2013-01-14

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

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

    Directory of Open Access Journals (Sweden)

    Baumbach Sebastian Felix

    2013-01-01

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

  4. Bone stress injury of the ankle in professional ballet dancers seen on MRI

    Directory of Open Access Journals (Sweden)

    Besser Marcus P

    2008-03-01

    Full Text Available Abstract Background Ballet Dancers have been shown to have a relatively high incidence of stress fractures of the foot and ankle. It was our objective to examine MR imaging patterns of bone marrow edema (BME in the ankles of high performance professional ballet dancers, to evaluate clinical relevance. Methods MR Imaging was performed on 12 ankles of 11 active professional ballet dancers (6 female, 5 male; mean age 24 years, range 19 to 32. Individuals were imaged on a 0.2 T or 1.5 T MRI units. Images were evaluated by two musculoskeletal radiologists and one orthopaedic surgeon in consensus for location and pattern of bone marrow edema. In order to control for recognized sources of bone marrow edema, images were also reviewed for presence of osseous, ligamentous, tendinous and cartilage injuries. Statistical analysis was performed to assess the strength of the correlation between bone marrow edema and ankle pain. Results Bone marrow edema was seen only in the talus, and was a common finding, observed in nine of the twelve ankles imaged (75% and was associated with pain in all cases. On fluid-sensitive sequences, bone marrow edema was ill-defined and centered in the talar neck or body, although in three cases it extended to the talar dome. No apparent gender predilection was noted. No occult stress fracture could be diagnosed. A moderately strong correlation (phi = 0.77, p= 0.0054 was found between edema and pain in the study population. Conclusion Bone marrow edema seems to be a specific MRI finding in the talus of professional ballet dancers, likely related to biomechanical stress reactions, due to their frequently performed unique maneuvers. Clinically, this condition may indicate a sign of a bone stress injury of the ankle.

  5. Bone stress injury of the ankle in professional ballet dancers seen on MRI

    Science.gov (United States)

    Elias, Ilan; Zoga, Adam C; Raikin, Steven M; Peterson, Judith R; Besser, Marcus P; Morrison, William B; Schweitzer, Mark E

    2008-01-01

    Background Ballet Dancers have been shown to have a relatively high incidence of stress fractures of the foot and ankle. It was our objective to examine MR imaging patterns of bone marrow edema (BME) in the ankles of high performance professional ballet dancers, to evaluate clinical relevance. Methods MR Imaging was performed on 12 ankles of 11 active professional ballet dancers (6 female, 5 male; mean age 24 years, range 19 to 32). Individuals were imaged on a 0.2 T or 1.5 T MRI units. Images were evaluated by two musculoskeletal radiologists and one orthopaedic surgeon in consensus for location and pattern of bone marrow edema. In order to control for recognized sources of bone marrow edema, images were also reviewed for presence of osseous, ligamentous, tendinous and cartilage injuries. Statistical analysis was performed to assess the strength of the correlation between bone marrow edema and ankle pain. Results Bone marrow edema was seen only in the talus, and was a common finding, observed in nine of the twelve ankles imaged (75%) and was associated with pain in all cases. On fluid-sensitive sequences, bone marrow edema was ill-defined and centered in the talar neck or body, although in three cases it extended to the talar dome. No apparent gender predilection was noted. No occult stress fracture could be diagnosed. A moderately strong correlation (phi = 0.77, p= 0.0054) was found between edema and pain in the study population. Conclusion Bone marrow edema seems to be a specific MRI finding in the talus of professional ballet dancers, likely related to biomechanical stress reactions, due to their frequently performed unique maneuvers. Clinically, this condition may indicate a sign of a bone stress injury of the ankle. PMID:18371230

  6. Acupuncture for ankle sprain: systematic review and meta-analysis

    Science.gov (United States)

    2013-01-01

    Background Ankle sprain is one of the most frequently encountered musculoskeletal injuries; however, the efficacy of acupuncture in treating ankle sprains remains uncertain. We therefore performed a systematic review to evaluate the evidence regarding acupuncture for ankle sprains. Methods We searched 15 data sources and two trial registries up to February 2012. Randomized controlled trials of acupuncture were included if they involved patients with ankle sprains and reported outcomes of symptom improvement, including pain. A Cochrane risk of bias assessment tool was used. Risk ratio (RR) or mean difference (MD) was calculated with 95% confidence intervals (CIs) in a random effects model. Subgroup analyses were performed based on acupuncture type, grade of sprain, and control type. Sensitivity analyses were also performed with respect to risk of bias, sample size, and outcomes reported. Results Seventeen trials involving 1820 participants were included. Trial quality was generally poor, with just three reporting adequate methods of randomization and only one a method of allocation concealment. Significantly more participants in acupuncture groups reported global symptom improvement compared with no acupuncture groups (RR of symptoms persisting with acupuncture = 0.56, 95% CI 0.42–0.77). However, this is probably an overestimate due to the heterogeneity (I2 = 51%) and high risk of bias of the included studies. Acupuncture as an add-on treatment also improved global symptoms compared with other treatments only, without significant variability (RR 0.61, 95% CI 0.51–0.73, I2 = 1%). The benefit of acupuncture remained significant when the analysis was limited to two studies with a low risk of bias. Acupuncture was more effective than various controls in relieving pain, facilitating return to normal activity, and promoting quality of life, but these analyses were based on only a small number of studies. Acupuncture did not appear to be associated with

  7. Acupuncture for ankle sprain: systematic review and meta-analysis.

    Science.gov (United States)

    Park, Jimin; Hahn, Seokyung; Park, Ji-Yeun; Park, Hi-Joon; Lee, Hyangsook

    2013-03-04

    Ankle sprain is one of the most frequently encountered musculoskeletal injuries; however, the efficacy of acupuncture in treating ankle sprains remains uncertain. We therefore performed a systematic review to evaluate the evidence regarding acupuncture for ankle sprains. We searched 15 data sources and two trial registries up to February 2012. Randomized controlled trials of acupuncture were included if they involved patients with ankle sprains and reported outcomes of symptom improvement, including pain. A Cochrane risk of bias assessment tool was used. Risk ratio (RR) or mean difference (MD) was calculated with 95% confidence intervals (CIs) in a random effects model. Subgroup analyses were performed based on acupuncture type, grade of sprain, and control type. Sensitivity analyses were also performed with respect to risk of bias, sample size, and outcomes reported. Seventeen trials involving 1820 participants were included. Trial quality was generally poor, with just three reporting adequate methods of randomization and only one a method of allocation concealment. Significantly more participants in acupuncture groups reported global symptom improvement compared with no acupuncture groups (RR of symptoms persisting with acupuncture = 0.56, 95% CI 0.42-0.77). However, this is probably an overestimate due to the heterogeneity (I2 = 51%) and high risk of bias of the included studies. Acupuncture as an add-on treatment also improved global symptoms compared with other treatments only, without significant variability (RR 0.61, 95% CI 0.51-0.73, I2 = 1%). The benefit of acupuncture remained significant when the analysis was limited to two studies with a low risk of bias. Acupuncture was more effective than various controls in relieving pain, facilitating return to normal activity, and promoting quality of life, but these analyses were based on only a small number of studies. Acupuncture did not appear to be associated with adverse events. Given

  8. Gain modulation of the middle latency cutaneous reflex in patients with chronic joint instability after ankle sprain.

    Science.gov (United States)

    Futatsubashi, Genki; Sasada, Shusaku; Tazoe, Toshiki; Komiyama, Tomoyoshi

    2013-07-01

    To investigate the neural alteration of reflex pathways arising from cutaneous afferents in patients with chronic ankle instability. Cutaneous reflexes were elicited by applying non-noxious electrical stimulation to the sural nerve of subjects with chronic ankle instability (n=17) and control subjects (n=17) while sitting. Electromyographic (EMG) signals were recorded from each ankle and thigh muscle. The middle latency response (MLR; latency: 70-120 ms) component was analyzed. In the peroneus longus (PL) and vastus lateralis (VL) muscles, linear regression analyses between the magnitude of the inhibitory MLR and background EMG activity showed that, compared to the uninjured side and the control subjects, the gain of the suppressive MLR was increased in the injured side. This was also confirmed by the pooled data for both groups. The degree of MLR alteration was significantly correlated to that of chronic ankle instability in the PL. The excitability of middle latency cutaneous reflexes in the PL and VL is modulated in subjects with chronic ankle instability. Cutaneous reflexes may be potential tools to investigate the pathological state of the neural system that controls the lower limbs in subjects with chronic ankle instability. Copyright © 2013 International Federation of Clinical Neurophysiology. Published by Elsevier Ireland Ltd. All rights reserved.

  9. Articular congruity is associated with short-term clinical outcomes of operatively treated SER IV ankle fractures.

    Science.gov (United States)

    Berkes, Marschall B; Little, Milton T M; Lazaro, Lionel E; Pardee, Nadine C; Schottel, Patrick C; Helfet, David L; Lorich, Dean G

    2013-10-02

    With regard to supination-external rotation type-IV (SER IV) ankle fractures, there is no consensus regarding which patient, injury, and treatment variables most strongly influence clinical outcome. The purpose of this investigation was to examine the impact of articular surface congruity on the functional outcomes of operatively treatment of SER IV ankle fractures. A prospectively generated database consisting of operatively treated SER IV ankle fractures was reviewed. Postoperative computed tomography (CT) scans were used to assess ankle joint congruity. Ankles were considered incongruent in the presence of >2 mm of articular step-off, intra-articular loose bodies, or an articular surface gap of >2 mm (despite an otherwise anatomic reduction) due to joint impaction and comminution. Patients with at least one year of clinical follow-up were eligible for analysis. The primary and secondary outcome measures were the Foot and Ankle Outcome Score (FAOS) and ankle motion. One hundred and eight SER IV fractures met our inclusion criteria. The average duration of follow-up was twenty-one months. Seventy-two patients (67%) had a congruent ankle joint, and thirty-six (33%) had elements of articular surface incongruity on postoperative CT scanning. These two groups were similar with regard to comorbidities and injury and treatment variables. At the time of the final follow-up, the group with articular incongruity had a significantly worse FAOS with regard to symptoms (p = 0.012), pain (p = 0.004), and activities of daily living (p = 0.038). Those with articular incongruity had worse average scores in the FAOS sport domain as well. No significant differences in ankle motion were found between the two groups. In this population of patients with an operatively treated SER IV ankle fracture, the presence of postoperative articular incongruity correlated with inferior early clinical outcomes. Orthopaedic surgeons should scrutinize ankle fracture reductions and strive for

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

    Science.gov (United States)

    Vega, Jordi; Peña, Fernando; Golanó, Pau

    2016-04-01

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

  11. 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.

  12. Quantifying normal ankle joint volume: An anatomic study

    Directory of Open Access Journals (Sweden)

    Draeger Reid

    2009-01-01

    Full Text Available Background: Many therapeutic and diagnostic modalities such as intraarticular injections, arthrography and ankle arthroscopy require introduction of fluid into the ankle joint. Little data are currently available in the literature regarding the maximal volume of normal, nonpathologic, human ankle joints. The purpose of this study was to measure the volume of normal human ankle joints. Materials and Methods: A fluoroscopic guided needle was passed into nine cadaveric adult ankle joints. The needle was connected to an intracompartmental pressure measurement device. A radiopaque dye was introduced into the joint in 2 mL boluses, while pressure measurements were recorded. Fluid was injected into the joint until three consecutive pressure measurements were similar, signifying a maximal joint volume. Results: The mean maximum ankle joint volume was 20.9 ± 4.9 mL (range, 16-30 mL. The mean ankle joint pressure at maximum volume was 142.2 ± 13.8 mm Hg (range, 122-166 mm Hg. Two of the nine samples showed evidence of fluid tracking into the synovial sheath of the flexor hallucis longus tendon. Conclusion: Maximal normal ankle joint volume was found to vary between 16-30 mL. This study ascertains the communication between the ankle joint and the flexor hallucis longus tendon sheath. Exceeding maximal ankle joint volume suggested by this study during therapeutic injections, arthrography, or arthroscopy could potentially damage the joint.

  13. Dynamic balance deficits in individuals with chronic ankle instability compared to ankle sprain copers 1 year after a first-time lateral ankle sprain injury.

    Science.gov (United States)

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

    2016-04-01

    To quantify the dynamic balance deficits that characterise a group with chronic ankle instability compared to lateral ankle sprain copers and non-injured controls using kinematic and kinetic outcomes. Forty-two participants with chronic ankle instability and twenty-eight lateral ankle sprain copers were initially recruited within 2 weeks of sustaining a first-time, acute lateral ankle sprain and required to attend our laboratory 1 year later to complete the current study protocol. An additional group of non-injured individuals were also recruited to act as a control group. All participants completed the anterior, posterior-lateral and posterior-medial reach directions of the star excursion balance test. Sagittal plane kinematics of the lower extremity and associated fractal dimension of the centre of pressure path were also acquired. Participants with chronic ankle instability displayed poorer performance in the anterior, posterior-medial and posterior-lateral reach directions compared with controls bilaterally, and in the posterior-lateral direction compared with lateral ankle sprain copers on their 'involved' limb only. These performance deficits in the posterior-lateral and posterior-medial directions were associated with reduced flexion and dorsiflexion displacements at the hip, knee and ankle at the point of maximum reach, and coincided with reduced complexity of the centre of pressure path. In comparison with lateral ankle sprain copers and controls, participants with chronic ankle instability were characterised by dynamic balance deficits as measured using the SEBT. This was attested to reduced sagittal plane motions at the hip, knee and ankle joints, and reduced capacity of the stance limb to avail of its supporting base. III.

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

    NARCIS (Netherlands)

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

    2011-01-01

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

  15. Incidence of hockey ankle injuries in Kwa-Zulu Natal, South Africa ...

    African Journals Online (AJOL)

    ankle injuries amongst hockey players was 26.41%. The most frequent ankle injury sustained by male adolescent hockey players was an inversion ankle sprain (84.62% of the 26.41% injured subjects of the sample cohort). The mechanisms of ankle injuries were attributed to rapid rotational movements of the ankle joint ...

  16. Ankle-foot orthosis bending axis influences running mechanics.

    Science.gov (United States)

    Russell Esposito, Elizabeth; Ranz, Ellyn C; Schmidtbauer, Kelly A; Neptune, Richard R; Wilken, Jason M

    2017-07-01

    Passive-dynamic ankle-foot orthoses (AFOs) are commonly prescribed to improve locomotion for people with lower limb musculoskeletal weakness. The clinical prescription and design process are typically qualitative and based on observational assessment and experience. Prior work examining the effect of AFO design characteristics generally excludes higher impact activities such as running, providing clinicians and researchers limited information to guide the development of objective prescription guidelines. The proximal location of the bending axis may directly influence energy storage and return and resulting running mechanics. The purpose of this study was to determine if the location of an AFO's bending axis influences running mechanics. Marker and force data were recorded as 12 participants with lower extremity weakness ran overground while wearing a passive-dynamic AFO with posterior struts manufactured with central (middle) and off-centered (high and low) bending axes. Lower extremity joint angles, moments, powers, and ground reaction forces were calculated and compared between limbs and across bending axis conditions. Bending axis produced relatively small but significant changes. Ankle range of motion increased as the bending axis shifted distally (pbenefits during running, although individual preference and physical ability should also be considered. Published by Elsevier B.V.

  17. Comparative analysis of arthroscopic debridement in osseous versus soft tissue anterior ankle impingement.

    Science.gov (United States)

    Devgan, Ashish; Rohilla, Rajesh; Tanwar, Milind; Jain, Aditya; Siwach, Karan; Devgan, Radika

    2016-01-01

    Arthroscopic debridement has been a gold standard procedure for anterior ankle impingement, both in cases of osseous and soft tissue impingement. There is sparse literature on comparative outcome with respect to functional results between the two types of impingement post-arthroscopic debridement. Our study included 14 patients diagnosed as cases of anterior ankle impingement on the basis of clinical and radiological examination. They were segregated into two groups (on the basis of cause of impingement (osseous versus soft tissue)). Both groups were treated by arthroscopic debridement. Primary outcome was patient satisfaction, which was assessed by Likert scale and clinical outcomes were measured using AOFAS ankle-hind foot scale, VAS score, range of motion and time to return to pre-injury activity level in both groups. Mean follow-up was of 15 months where eleven patients reported an excellent recovery, two patients had good recovery while one patient reported poor outcome. Mean AOFAS ankle hind foot scale improved from 50.5 preoperatively to 85.71 postoperatively (statistically significant; p value - 0.0001). Mean Likert scale value post-operative was 4.21. VAS score showed significant improvement in patients of both the groups. Range of motion was slightly better in soft tissue impingement type with a relatively shorter time to return to sports or preinjury activity level as compared to osseous impingement group. The patients in both the groups had comparable outcomes with no statistically significant difference with regard to patient satisfaction and clinical outcome.

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

    Science.gov (United States)

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

    2015-11-01

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

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

    Science.gov (United States)

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

    2015-10-01

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

  20. The Influence of Mulligan Ankle Taping on Dynamic Balance in the Athletes with and without Chronic Ankle Instability

    Directory of Open Access Journals (Sweden)

    Tahereh Pourkhani

    2014-04-01

    Full Text Available Objective: The ankle joint is the most frequently injured anatomical site in athletes. Ankle instability is responsible for 25% of all time lost from sport. Clinical efficacy of the effect of taping in athletes with chronic ankle instability is unknown. So the purpose of this investigation is the study of the influence of Mulligan ankle taping on dynamic balance in the athletes with and without chronic ankle instability. Materials & Methods: 32 athletes participated in this investigation: 16 subjects with chronic ankle instability, 6 women and 10 men (age 23.5±0.3 years, height 175.4±10.3 cm, weight 73.6±14.5 kg, Foot Ankle Disability Index 74.5±8.62% and Foot Ankle Disability Index Sport 63.5±7.86% and 16 healthy subjects, 6 women and 10 men (age 22.81±7.1 years, height 173.6±12.26 cm, weight 66.4±11.4 kg, Foot Ankle Disability Index and Foot Ankle Disability Index Sport 100%. Dynamic balance was assessed with Star Excursion Balance Test in 3 reaching directions (medial, antero-medial and postero-medial before and after Mulligan ankle taping. Independent and paired t-test were used for statistical analysis. Results: Dynamic balance in healthy group significantly was better than injured group (P&le0.05. Application of taping caused significantly improvement in dynamic balance in both groups (reaching in media, antero-medial and postero-medial directions (P&le0.05 (except reaching in antero-medial direction in healthy group (P>0.05. Conclusion: So it seems that Mulligan ankle taping can improve dynamic balance in the athletes with and without chronic ankle instability.

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

    Science.gov (United States)

    Williams, Gavin; Banky, Megan; Olver, John

    2016-01-01

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

  2. 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....

  3. Stress fractures of the foot and ankle.

    Science.gov (United States)

    Welck, M J; Hayes, T; Pastides, P; Khan, W; Rudge, B

    2017-08-01

    Stress fractures occur as a result of microscopic injuries sustained when bone is subjected to repeated submaximal stresses. Overtime, with repeated cycles of loading, accumulation of such injuries can lead to macro-structural failure and frank fracture. There are numerous stress fractures about the foot and ankle of which a trauma and orthopaedic surgeon should be aware. These include: metatarsal, tibia, calcaneus, navicular, fibula, talus, medial malleolus, sesamoid, cuneiform and cuboid. Awareness of these fractures is important as the diagnosis is frequently missed and appropriate treatment delayed. Late identification can be associated with protracted pain and disability, and may predispose to non-union and therefore necessitate operative intervention. This article outlines the epidemiology and risk factors, aetiology, presentation and management of the range of stress fractures in the foot and ankle. Copyright © 2015 Elsevier Ltd. All rights reserved.

  4. MR arthrography of the ankle joint

    International Nuclear Information System (INIS)

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

    1999-01-01

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

  5. Diagnostic dilemmas in foot and ankle injuries

    Energy Technology Data Exchange (ETDEWEB)

    Keene, J.S.; Lange, R.H.

    1986-07-11

    Differential diagnosis of foot and ankle injuries should include (1) stress fractures of the great toe sesamoids, the shaft of the fifth metatarsal, and the tarsal navicular bone; (2) transchondral talar-dome fractures; (3) fractures of the os trigonum; and (4) dislocating peroneal tendons. Diagnosis of these injuries is challenging because the initial roentgenograms often are normal, and special clinical tests and ancillary studies are required.

  6. Modern cartilage imaging of the ankle

    International Nuclear Information System (INIS)

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

    2017-01-01

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

  7. Ankle and foot tuberculosis: A diagnostic dilemma

    Directory of Open Access Journals (Sweden)

    Biswaranjan Nayak

    2014-01-01

    Full Text Available Aim and Objective: To know the biological behavior of ankle and foot tuberculosis (AFTB and to know the reasons for delay in diagnosis and treatment of AFTB in our population. Materials and Methods: Patients with non-healing ulcers/sinuses/swellings in the ankle and foot region are the subjects of present study. Detailed clinical history, physical examination and relevant investigations were done in all cases. Pus/wound discharge for acid fast bacillus (AFB study and biopsy from wound margin/sinus tract was taken in all the cases. Results: During the period from July 2007-June 2012, 20 cases of AFTB were treated. Out of them five cases were difficult to diagnose and a mean period of 6 month to 5year was elapsed before final diagnosis was established. Out of these five cases - three cases were diabetic with ulcers and sinuses in the heel and ankle region. One case was wrongly diagnosed as angiodysplasia with A-V malformation of foot and diagnosis was delayed for 5 year. In one case of rheumatoid arthritis with abscess in ankle joint, the diagnosis was delayed for 1year. Conclusion: AFTB is very rare condition. AFTB is suspected in cases with long standing pain/swelling/discharging sinus in the foot and thorough investigations is must to differentiate from other foot diseases. Diagnosis is delayed due to lack of clinical suspicion and non-confirmatory biopsy reports. Early diagnosis and ATT for 9-18 months is must in all cases of AFTB to prevent joint involvement and other complications.

  8. Osteochondral injuries of the foot and ankle.

    Science.gov (United States)

    Frost, Andrew; Roach, Richard

    2009-06-01

    Osteochondral injuries commonly affect the ankle joint and involve the dome of the talus. This article describes the etiology and pathogenesis of these injuries. Their clinical presentation is described and advice is given on how to diagnose and investigate suspected osteochondral injuries. The various treatment options currently available are briefly reviewed. There is some attempt made to give consensus on optimal treatment of this condition at the present time.

  9. Osteoarthritis after osteosynthesis of ankle injuries

    International Nuclear Information System (INIS)

    Lange, S.; Mechsner, K.; Langenscheidt, P.; Krankenhaus Spandau, Berlin

    1984-01-01

    98 patients were clinically and radiographically examined 2 to 9 years following the osteosynthesis of ankle fractures. The rate of secondary osteoarthritis was 70% including 40% of minor, 17% of medium and 13% of serious changes. Depending on the injured structures the frequency of posttraumatic osteoarthritis varies. Medium and serious radiology changes cause obvious dysfunction in 56% and 62% respectively. Joints free of Osteoarthritis one year after the injury will not develop secondary osteoarthritis later. (orig.) [de

  10. Diagnostic dilemmas in foot and ankle injuries

    International Nuclear Information System (INIS)

    Keene, J.S.; Lange, R.H.

    1986-01-01

    Differential diagnosis of foot and ankle injuries should include (1) stress fractures of the great toe sesamoids, the shaft of the fifth metatarsal, and the tarsal navicular bone; (2) transchondral talar-dome fractures; (3) fractures of the os trigonum; and (4) dislocating peroneal tendons. Diagnosis of these injuries is challenging because the initial roentgenograms often are normal, and special clinical tests and ancillary studies are required

  11. Pediatric Ankle Fractures: Concepts and Treatment Principles

    Science.gov (United States)

    Su, Alvin W.; Larson, A. Noelle

    2016-01-01

    Synopsis Current clinical concepts are reviewed regarding the epidemiology, anatomy, evaluation and treatment of pediatric ankle fractures. Correct diagnosis and management relies on appropriate exam, imaging, and knowledge of fracture patterns specific to children. Treatment is guided by patient history, physical examination, plain film radiographs and, in some instances, CT. Treatment goals are to restore acceptable limb alignment, physeal anatomy, and joint congruency. For high risk physeal fractures, patients should be monitored for growth disturbance as needed until skeletal maturity. PMID:26589088

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

    Science.gov (United States)

    Zhao, Yong; Wang, Gang

    2015-04-01

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

  13. Diagnosis of ligament injuries in the superior ankle joint

    International Nuclear Information System (INIS)

    Gebing, R.; Fiedler, V.

    1991-01-01

    Nearly 40 years after ankle arthrography was first introduced, the anterior and inversion stress views of the ankle are still widely preferred as a noninvasive method of evaluating ligament injuries in the upper ankle. We consider the stress test, bilaterally performed using a standardized stress apparatus, as a basic examination by which to differentiate between slight and severe sprain. Intensive muscel splinting due to painful swelling can sometimes be treated by injection of local anesthetic. Like many authors, we perform ankle arthrography in cases where there is a significant difference between the clinical findings and the stress test. The technique of ankle arthrography can be readily learned and is extremely accurate in delineating the extent of ligamentous injury produced by moderate or severe ankle sprains. It can be performed in any X-ray department. (orig.) [de

  14. Postural steadiness and ankle force variability in peripheral neuropathy

    Science.gov (United States)

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

    2015-01-01

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

  15. Orthopedic rehabilitation using the "Rutgers ankle" interface.

    Science.gov (United States)

    Girone, M; Burdea, G; Bouzit, M; Popescu, V; Deutsch, J E

    2000-01-01

    A novel ankle rehabilitation device is being developed for home use, allowing remote monitoring by therapists. The system will allow patients to perform a variety of exercises while interacting with a virtual environment (VE). These game-like VEs created with WorldToolKit run on a host PC that controls the movement and output forces of the device via an RS232 connection. Patients will develop strength, flexibility, coordination, and balance as they interact with the VEs. The device will also perform diagnostic functions, measuring the ankle's range of motion, force exertion capabilities and coordination. The host PC transparently records patient progress for remote evaluation by therapists via our existing telerehabilitation system. The "Rutgers Ankle" Orthopedic Rehabilitation Interface uses double-acting pneumatic cylinders, linear potentiometers, and a 6 degree-of-freedom (DOF) force sensor. The controller contains a Pentium single-board computer and pneumatic control valves. Based on the Stewart platform, the device can move and supply forces and torques in 6 DOFs. A proof-of-concept trial conducted at the University of Medicine and Dentistry of New Jersey (UMDNJ) provided therapist and patient feedback. The system measured the range of motion and maximum force output of a group of four patients (male and female). Future medical trials are required to establish clinical efficacy in rehabilitation.

  16. MR imaging of the ankle: Normal variants

    International Nuclear Information System (INIS)

    Noto, A.M.; Cheung, Y.; Rosenberg, Z.S.; Norman, A.; Leeds, N.E.

    1987-01-01

    Thirty asymptomatic ankles were studied with high-resolution surface coil MR imaging. The thirty ankles were reviewed for identification or normal structures. The MR appearance of the deltoid and posterior to talo-fibular ligaments, peroneous brevis and longus tendons, and posterior aspect of the tibial-talar joint demonstrated several normal variants not previously described. These should not be misinterpreted as pathologic processes. The specific findings included (1) cortical irregularity of the posterior tibial-talar joint in 27 of 30 cases which should not be mistaken for osteonecrois; (2) normal posterior talo-fibular ligament with irregular and frayed inhomogeneity, which represents a normal variant in seven of ten cases; and (3) fluid in the shared peroneal tendons sheath which may be confused for a longitudinal tendon tear in three of 30 cases. Ankle imaging with the use of MR is still a relatively new procedure. Further investigation is needed to better define normal anatomy as well as normal variants. The authors described several structures that normally present with variable MR imaging appearances. This is clinically significant in order to maintain a high sensitivity and specificity in MR imaging interpretation

  17. An ankle-foot orthosis powered by artificial pneumatic muscles.

    Science.gov (United States)

    Ferris, Daniel P; Czerniecki, Joseph M; Hannaford, Blake

    2005-05-01

    We developed a pneumatically powered orthosis for the human ankle joint. The orthosis consisted of a carbon fiber shell, hinge joint, and two artificial pneumatic muscles. One artificial pneumatic muscle provided plantar flexion torque and the second one provided dorsiflexion torque. Computer software adjusted air pressure in each artificial muscle independently so that artificial muscle force was proportional to rectified low-pass-filtered electromyography (EMG) amplitude (i.e., proportional myoelectric control). Tibialis anterior EMG activated the artificial dorsiflexor and soleus EMG activated the artificial plantar flexor. We collected joint kinematic and artificial muscle force data as one healthy participant walked on a treadmill with the orthosis. Peak plantar flexor torque provided by the orthosis was 70 Nm, and peak dorsiflexor torque provided by the orthosis was 38 Nm. The orthosis could be useful for basic science studies on human locomotion or possibly for gait rehabilitation after neurological injury.

  18. Developing a Framework for Ankle Function: A Delphi Study

    Science.gov (United States)

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

    2014-01-01

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

  19. Lateral ankle injury. Literature review and report of two cases.

    Science.gov (United States)

    Pollard, Henry; Sim, Patrick; McHardy, Andrew

    2002-07-01

    Injury to the ankle joint is the most common peripheral joint injury. The sports that most commonly produce high ankle injury rates in their participating athletes include: basketball, netball, and the various codes of football. To provide an up to date understanding of manual therapy relevant to lateral ligament injury of the ankle. A discussion of the types of ligament injury and common complicating factors that present with lateral ankle pain is presented along with a review of relevant anatomy, assessment and treatment. Also included is a discussion of the efficacy of manual therapy in the treatment of ankle sprain. A detailed knowledge of the anatomy of the ankle as well as the early recognition of factors that may delay the rate of healing are important considerations when developing a management plan for inversion sprains of the ankle. This area appears to be under-researched however it was found that movement therapy and its various forms appear to be the most efficient and most effective method of treating uncomplicated ankle injury. Future investigations should involve a study to determine the effect chiropractic treatment (manipulation) may have on the injured ankle.

  20. 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.)

  1. The effect of ankle bracing on knee kinetics and kinematics during volleyball-specific tasks.

    Science.gov (United States)

    West, T; Ng, L; Campbell, A

    2014-12-01

    The purpose of this study was to examine the effects of ankle bracing on knee kinetics and kinematics during volleyball tasks. Fifteen healthy, elite, female volleyball players performed a series of straight-line and lateral volleyball tasks with no brace and when wearing an ankle brace. A 14-camera Vicon motion analysis system and AMTI force plate were used to capture the kinetic and kinematic data. Knee range of motion, peak knee anterior-posterior and medial-lateral shear forces, and peak ground reaction forces that occurred between initial contact with the force plate and toe off were compared using paired sample t-tests between the braced and non-braced conditions (P volleyball tasks. However, ankle bracing was demonstrated to reduce knee lateral shear forces during all of the lateral movement volleyball tasks. Wearing the Active Ankle T2 brace will not impact knee joint range of motion and may in fact reduce shear loading to the knee joint in volleyball players. © 2013 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.

  2. Cryotherapy for acute ankle sprains: a randomised controlled study of two different icing protocols.

    Science.gov (United States)

    Bleakley, C M; McDonough, S M; MacAuley, D C; Bjordal, J

    2006-08-01

    The use of cryotherapy in the management of acute soft tissue injury is largely based on anecdotal evidence. Preliminary evidence suggests that intermittent cryotherapy applications are most effective at reducing tissue temperature to optimal therapeutic levels. However, its efficacy in treating injured human subjects is not yet known. To compare the efficacy of an intermittent cryotherapy treatment protocol with a standard cryotherapy treatment protocol in the management of acute ankle sprains. Sportsmen (n = 44) and members of the general public (n = 45) with mild/moderate acute ankle sprains. Subjects were randomly allocated, under strictly controlled double blind conditions, to one of two treatment groups: standard ice application (n = 46) or intermittent ice application (n = 43). The mode of cryotherapy was standardised across groups and consisted of melting iced water (0 degrees C) in a standardised pack. Function, pain, and swelling were recorded at baseline and one, two, three, four, and six weeks after injury. Subjects treated with the intermittent protocol had significantly (p<0.05) less ankle pain on activity than those using a standard 20 minute protocol; however, one week after ankle injury, there were no significant differences between groups in terms of function, swelling, or pain at rest. Intermittent applications may enhance the therapeutic effect of ice in pain relief after acute soft tissue injury.

  3. The relation between geometry and function of the ankle joint complex: a biomechanical review.

    Science.gov (United States)

    Kleipool, Roeland P; Blankevoort, Leendert

    2010-05-01

    This review deals with the relation between the anatomy and function of the ankle joint complex. The questions addressed are how high do the forces in the ankle joint get, where can the joints go (range of motion) and where do they go during walking and running. Finally the role of the ligaments and the articular surfaces is discussed, i.e. how does it happen. The magnitude of the loads on the ankle joint complex are primarily determined by muscle activity and can be as high as four times the body weight during walking. For the maximal range of motion, plantar and dorsiflexion occurs in the talocrural joint and marginally at the subtalar joint. In-eversion takes place at both levels. The functional range of motion is well within the limits of the maximal range of motion. The ligaments do not contribute to the forces for the functional range of motion but determine the maximal range of motion together with the articular surfaces. The geometry of the articular surfaces primarily determines the kinematics. Clinical studies must include these anatomical aspects to better understand the mechanism of injury, recovery, and interventions. Models can elucidate the mechanism by which the anatomy relates to the function. The relation between the anatomy and mechanical properties of the joint structures and joint function should be considered for diagnosis and treatment of ankle joint pathology.

  4. Mechanical supports for acute, severe ankle sprain: a pragmatic, multicentre, randomised controlled trial.

    Science.gov (United States)

    Lamb, S E; Marsh, J L; Hutton, J L; Nakash, R; Cooke, M W

    2009-02-14

    Severe ankle sprains are a common presentation in emergency departments in the UK. We aimed to assess the effectiveness of three different mechanical supports (Aircast brace, Bledsoe boot, or 10-day below-knee cast) compared with that of a double-layer tubular compression bandage in promoting recovery after severe ankle sprains. We did a pragmatic, multicentre randomised trial with blinded assessment of outcome. 584 participants with severe ankle sprain were recruited between April, 2003, and July, 2005, from eight emergency departments across the UK. Participants were provided with a mechanical support within the first 3 days of attendance by a trained health-care professional, and given advice on reducing swelling and pain. Functional outcomes were measured over 9 months. The primary outcome was quality of ankle function at 3 months, measured using the Foot and Ankle Score; analysis was by intention to treat. This study is registered as an International Standard Randomised Controlled Trial, number ISRCTN37807450. Patients who received the below-knee cast had a more rapid recovery than those given the tubular compression bandage. We noted clinically important benefits at 3 months in quality of ankle function with the cast compared with tubular compression bandage (mean difference 9%; 95% CI 2.4-15.0), as well as in pain, symptoms, and activity. The mean difference in quality of ankle function between Aircast brace and tubular compression bandage was 8%; 95% CI 1.8-14.2, but there were little differences for pain, symptoms, and activity. Bledsoe boots offered no benefit over tubular compression bandage, which was the least effective treatment throughout the recovery period. There were no significant differences between tubular compression bandage and the other treatments at 9 months. Side-effects were rare with no discernible differences between treatments. Reported events (all treatments combined) were cellulitis (two cases), pulmonary embolus (two cases), and

  5. Persistence of long term isokinetic strength deficits in subjects with lateral ankle sprain as measured with a protocol including maximal preloading.

    Science.gov (United States)

    Perron, Marc; Moffet, Hélène; Nadeau, Sylvie; Hébert, Luc J; Belzile, Sylvain

    2014-12-01

    The assessment of muscle function is a cornerstone in the management of subjects who have sustained a lateral ankle sprain. The ankle range of motion being relatively small, the use of preloading allows to measure maximal strength throughout the whole amplitude and therefore to better characterize ankle muscles weaknesses. This study aimed to assess muscle strength of the injured and uninjured ankles in subjects with a lateral ankle sprain, to document the timeline of strength recovery, and to determine the influence of sprain grade on strength loss. Maximal torque of the periarticular muscles of the ankle in a concentric mode using a protocol with maximal preloading was tested in 32 male soldiers at 8 weeks and 6 months post-injury. The evertor muscles of the injured ankles were weaker than the uninjured ones at 8 weeks and 6 months post-injury (Pankles at 8 weeks (P=0.0014, effect size=0.52-0.58) while at 6 months, only the subjects with a grade II sprain displayed such weaknesses (Pankle sprain in very active individuals. Copyright © 2014 Elsevier Ltd. All rights reserved.

  6. Ankle manual therapy for individuals with post-acute ankle sprains: description of a randomized, placebo-controlled clinical trial

    OpenAIRE

    Fisher Beth E; Kulig Kornelia; Davenport Todd E

    2010-01-01

    Abstract Background Ankle sprains are common within the general population and can result in prolonged disablement. Limited talocrural dorsiflexion range of motion (DF ROM) is a common consequence of ankle sprain. Limited talocrural DF ROM may contribute to persistent symptoms, disability, and an elevated risk for re-injury. As a result, many health care practitioners use hands-on passive procedures with the intention of improving talocrural joint DF ROM in individuals following ankle sprains...

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

    Science.gov (United States)

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

    2016-04-01

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

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

    Science.gov (United States)

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

    2017-09-01

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

  9. Tenosynovitis of the ankles as onset of sarcoidosis in a patient with ulcerative colitis

    OpenAIRE

    F. Cozzi; M. Podswiadek; A. Furlan; S. Todesco

    2011-01-01

    Arthritis and tenosynovitis are frequently reported as complications of inflammatory bowel diseases. About 10% of patients with ulcerative colitis presents articular inflammation, usually in the phases of activity of intestinal disease. Tenosynovitis is also a frequent complication of ulcerative colitis. We describe here a case of tenosynovitis of both ankles occurring in a patient affected by ulcerative colitis not in active phase. Chest X-ray and TC showed hilar lymphonode enlargement and t...

  10. Pre-impact lower extremity posture and brake pedal force predict foot and ankle forces during an automobile collision.

    Science.gov (United States)

    Hardin, E C; Su, A; van den Bogert, A J

    2004-12-01

    The purpose of this study was to determine how a driver's foot and ankle forces during a frontal vehicle collision depend on initial lower extremity posture and brake pedal force. A 2D musculoskeletal model with seven segments and six right-side muscle groups was used. A simulation of a three-second braking task found 3647 sets of muscle activation levels that resulted in stable braking postures with realistic pedal force. These activation patterns were then used in impact simulations where vehicle deceleration was applied and driver movements and foot and ankle forces were simulated. Peak rearfoot ground reaction force (F(RF)), peak Achilles tendon force (FAT), peak calcaneal force (F(CF)) and peak ankle joint force (F(AJ)) were calculated. Peak forces during the impact simulation were 476 +/- 687 N (F(RF)), 2934 +/- 944 N (F(CF)) and 2449 +/- 918 N (F(AJ)). Many simulations resulted in force levels that could cause fractures. Multivariate quadratic regression determined that the pre-impact brake pedal force (PF), knee angle (KA) and heel distance (HD) explained 72% of the variance in peak FRF, 62% in peak F(CF) and 73% in peak F(AJ). Foot and ankle forces during a collision depend on initial posture and pedal force. Braking postures with increased knee flexion, while keeping the seat position fixed, are associated with higher foot and ankle forces during a collision.

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

    Science.gov (United States)

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

    2017-12-01

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

  12. Comparison of quality of life following total ankle arthroplasty and ankle arthrodesis: Retrospective study of 54 cases.

    Science.gov (United States)

    Dalat, F; Trouillet, F; Fessy, M H; Bourdin, M; Besse, J-L

    2014-11-01

    The benefit of ankle arthroplasty compared to arthrodesis continues to be debated, but the quality of life after these two interventions has rarely been assessed. We conducted a case-control study to compare quality of life and functional and athletic ability. Functional results, athletic ability, and quality of life after total ankle arthroplasty (TAA) are better than after ankle arthrodesis. Two continuous series of 59 TAAs and 46 arthrodeses (operated on between 1997 and 2009) were evaluated retrospectively using a questionnaire including the functional items of the AOFAS score, the Foot Function Index (FFI) score, the Foot Ankle Ability Measure (FAAM), and the SF-36. Eighty-three responses (79% of the overall series) were matched in two groups: 32 TAAs [age at the intervention, 51.4years (range, 21-63years); follow-up, 52.2months (range, 30-146months); age at revision, 55.8years (range, 26-67years); BMI, 27.7 (range, 21.7-36.7)] and 22 arthrodeses [age at intervention, 50.1years (range, 24-72years); follow-up 57.9months (range, 12-147months); age at revision 54.9 years (range, 31-75years); BMI, 26.8 (range, 17.6-37)] (NS on all items between the two groups). The pain results were better after TAA, but with no statistically significant difference: AOFAS pain, (/40) 28.1±8.2 vs. 24.5±9.6; FFI pain, 16.6±18.8 vs. 24.3±21.5. The overall FFI score (/100) was better (P=0.048) after TAA (16.2±16.5 vs. 24.8±18.2). The overall mean athletic level compared to the state prior to the injury was relatively low in both groups, but significantly (p=0.007) higher in the TAA group: FAAM sports score (/100), 49.5±24.4 vs. 29.8±26.2. The quality-of-life scores, SF-36 physical health, mental health, and general health were not significantly different after TAA and arthrodesis: mental health score, 63.1±14.7 vs. 57.8±21.5; physical health score, 61.3±17.8 vs. 53.7±23.9, overall score, 63.2±16.4 vs. 55.9±23.5. Very few publications describe activities and quality of

  13. Joint stability characteristics of the ankle complex in female athletes with histories of lateral ankle sprain, part II: clinical experience using arthrometric measurement.

    Science.gov (United States)

    Kovaleski, John E; Heitman, Robert J; Gurchiek, Larry R; Hollis, J M; Liu, Wei; Pearsall, Albert W

    2014-01-01

    This is part II of a 2-part series discussing stability characteristics of the ankle complex. In part I, we used a cadaver model to examine the effects of sectioning the lateral ankle ligaments on anterior and inversion motion and stiffness of the ankle complex. In part II, we wanted to build on and apply these findings to the clinical assessment of ankle-complex motion and stiffness in a group of athletes with a history of unilateral ankle sprain. To examine ankle-complex motion and stiffness in a group of athletes with reported history of lateral ankle sprain. Cross-sectional study. University research laboratory. Twenty-five female college athletes (age = 19.4 ± 1.4 years, height = 170.2 ± 7.4 cm, mass = 67.3 ± 10.0 kg) with histories of unilateral ankle sprain. All ankles underwent loading with an ankle arthrometer. Ankles were tested bilaterally. The dependent variables were anterior displacement, anterior end-range stiffness, inversion rotation, and inversion end-range stiffness. Anterior displacement of the ankle complex did not differ between the uninjured and sprained ankles (P = .37), whereas ankle-complex rotation was greater for the sprained ankles (P = .03). The sprained ankles had less anterior and inversion end-range stiffness than the uninjured ankles (P ankle-complex laxity and end-range stiffness were detected in ankles with histories of sprain. These results indicate the presence of altered mechanical characteristics in the soft tissues of the sprained ankles.

  14. Biomechanics of the natural, arthritic, and replaced human ankle joint

    Science.gov (United States)

    2014-01-01

    The human ankle joint complex plays a fundamental role in gait and other activities of daily living. At the same time, it is a very complicated anatomical system but the large literature of experimental and modelling studies has not fully described the coupled joint motion, position and orientation of the joint axis of rotation, stress and strain in the ligaments and their role in guiding and stabilizing joint motion, conformity and congruence of the articular surfaces, patterns of contact at the articular surfaces, patterns of rolling and sliding at the joint surfaces, and muscle lever arm lengths. The present review article addresses these issues as described in the literature, reporting the most recent relevant findings. PMID:24499639

  15. Quantitative evaluation of the viscoelastic properties of the ankle joint complex in patients suffering from ankle sprain by the anterior drawer test.

    Science.gov (United States)

    Lin, Che-Yu; Shau, Yio-Wha; Wang, Chung-Li; Chai, Huei-Ming; Kang, Jiunn-Horng

    2013-06-01

    Biological tissues such as ligaments exhibit viscoelastic behaviours. Injury to the ligament may induce changes of these viscoelastic properties, and these changes could serve as biomarkers to detect the injury. In the present study, a novel instrument was developed to non-invasive quantify the viscoelastic properties of the ankle in vivo by the anterior drawer test. The purpose of the study was to investigate the reliability of the instrument and to compare the viscoelastic properties of the ankle between patients suffering from ankle sprain and controls. Eight patients and eight controls participated in the present study. The reliability test was performed on three randomly chosen subjects. In patient and control test, both ankles of each subject were tested to evaluate the viscoelastic properties of the ankle. The viscosity index was defined for quantitatively evaluating the viscosity of the ankle. Greater viscosity index was associated with lower viscosity. Injured and uninjured ankles of patient and both ankles of controls were compared. The instrument exhibited excellent test-retest reliability (r > 0.9). Injured ankles exhibited significantly less viscosity than uninjured ankles, since injured ankles of patients had significantly higher viscosity index (8,148 ± 5,266) compared with uninjured ankles of patients (948 ± 617; p = 0.008) and controls (1,326 ± 613; p ankle can serve as sensitive and useful clinical biomarkers to differentiate between injured and uninjured ankles. The method may provide a clinical examination for objectively evaluating lateral ankle ligament injuries.

  16. Reducing the metabolic cost of walking with an ankle exoskeleton: interaction between actuation timing and power.

    Science.gov (United States)

    Galle, Samuel; Malcolm, Philippe; Collins, Steven Hartley; De Clercq, Dirk

    2017-04-27

    Powered ankle-foot exoskeletons can reduce the metabolic cost of human walking to below normal levels, but optimal assistance properties remain unclear. The purpose of this study was to test the effects of different assistance timing and power characteristics in an experiment with a tethered ankle-foot exoskeleton. Ten healthy female subjects walked on a treadmill with bilateral ankle-foot exoskeletons in 10 different assistance conditions. Artificial pneumatic muscles assisted plantarflexion during ankle push-off using one of four actuation onset timings (36, 42, 48 and 54% of the stride) and three power levels (average positive exoskeleton power over a stride, summed for both legs, of 0.2, 0.4 and 0.5 W∙kg -1 ). We compared metabolic rate, kinematics and electromyography (EMG) between conditions. Optimal assistance was achieved with an onset of 42% stride and average power of 0.4 W∙kg -1 , leading to 21% reduction in metabolic cost compared to walking with the exoskeleton deactivated and 12% reduction compared to normal walking without the exoskeleton. With suboptimal timing or power, the exoskeleton still reduced metabolic cost, but substantially less so. The relationship between timing, power and metabolic rate was well-characterized by a two-dimensional quadratic function. The assistive mechanisms leading to these improvements included reducing muscular activity in the ankle plantarflexors and assisting leg swing initiation. These results emphasize the importance of optimizing exoskeleton actuation properties when assisting or augmenting human locomotion. Our optimal assistance onset timing and average power levels could be used for other exoskeletons to improve assistance and resulting benefits.

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

    Science.gov (United States)

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

    2013-08-01

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

  18. EFFICACY OF A SPORTS SPECIFIC BALANCE TRAINING PROGRAMME ON THE INCIDENCE OF ANKLE SPRAINS IN BASKETBALL

    Directory of Open Access Journals (Sweden)

    Elke Cumps

    2007-06-01

    Full Text Available The purpose of the study was to determine the efficacy of a 22- week prescribed sports specific balance training programme on the incidence of lateral ankle sprains in basketball players. A controlled clinical trial was set up. In total 54 subjects of six teams participated and were assigned to either an intervention (IG or a control group (CG. The IG performed a prescribed balance training programme on top of their normal training routine, using balance semi-globes. The programme consisted of 4 basketball skills each session and its difficulty was progressively thought-out. The intervention lasted 22 weeks and was performed 3 times a week for 5 to 10 minutes. Efficacy of the intervention on the incidence of lateral ankle sprains was determined by calculating Relative Risks (RR, including their 95% Confidence Intervals or CI and incidence rates expressed per 1000h. RR (95% CI showed a significantly lower incidence of lateral ankle sprains in the IG compared to the CG for the total sample (RR= 0.30 [95% CI: 0.11-0.84] and in men (RR= 0.29 [95% CI: 0.09-0.93]. The difference in RR was not confirmed when examining the incidence rates and their 95%CI's, which overlapped. The risk for new or recurrent ankle sprains was slightly lower in the IG (new: RR= 0.76 [95% CI: 0.17-3.40]; re-injury: RR= 0.21 [95% CI: 0.03-1.44]. Based on these pilot results, the use of balance training is recommended as a routine during basketball activities for the prevention of ankle sprains

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

    Science.gov (United States)

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

    2018-06-01

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

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

    Science.gov (United States)

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

    2016-10-01

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

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

    Science.gov (United States)

    Jaggi, J; Kneubühler, S; Rogan, S

    2016-06-01

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

  2. Immobilisation for acute ankle sprain. A systematic review

    NARCIS (Netherlands)

    Kerkhoffs, G. M.; Rowe, B. H.; Assendelft, W. J.; Kelly, K. D.; Struijs, P. A.; van Dijk, C. N.

    2001-01-01

    The variation of practice with respect to the treatment of the acutely sprained ankle suggests a lack of evidence-based management strategies for this problem. The objective of this review was to assess the effectiveness of the various methods of immobilisation for acute ankle sprain. An electronic

  3. Surgical procedures in patients with haemophilic arthropathy of the ankle.

    Science.gov (United States)

    Barg, A; Morris, S C; Schneider, S W; Phisitkul, P; Saltzman, C L

    2016-05-01

    In haemophilia, the ankle joint is one of the most common and earliest joints affected by recurrent bleeding, commonly resulting in end-stage ankle osteoarthritis during early adulthood. The surgical treatment of haemophilic ankle arthropathy is challenging. This review aims to highlight the literature addressing clinical outcomes following the most common approaches for different stages of haemophilia-induced ankle osteoarthritis: arthroscopic debridement, joint distraction arthroplasty, supramalleolar osteotomies, total ankle replacement, and ankle arthrodesis. A systematic literature review was performed using established medical literature databases. The following information was retrieved from the literature: patients' demographics, surgical technique, duration of follow-up, clinical outcome including pain relief and complication rate. A total of 42 clinical studies published between 1978 and 2015 were included in the systematic literature review. Eight and 34 studies had prospective and retrospective design, respectively. The most common studies were level IV studies (64.3%). The orthopaedic treatment of patients with haemophilic ankle osteoarthritis is often challenging and requires complete and careful preoperative assessment. In general, both joint-preserving and joint non-preserving procedure types can be performed. All specific relative and absolute contraindications should be considered to achieve appropriate postoperative outcomes. The current literature demonstrated that orthopaedic surgeries, with appropriate indication, in patients with haemophilic ankle arthropathy result in good postoperative results comparable to those observed in non-haemophiliacs. The surgical treatment should be performed in a setting with the ability to have multidisciplinary management, including expertise in haematology. © 2016 John Wiley & Sons Ltd.

  4. Magnetic resonance imaging findings in anterolateral impingement of the ankle

    International Nuclear Information System (INIS)

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

    2000-01-01

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

  5. Relationship between stress ankle radiographs and injured ligaments on MRI

    International Nuclear Information System (INIS)

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

    2013-01-01

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

  6. Rehabilitation of the Ankle after Acute Sprain or Chronic Instability.

    Science.gov (United States)

    Mattacola, Carl G.; Dwyer, Maureen K.

    2002-01-01

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

  7. 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

  8. 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.

  9. Review on design and control aspects of ankle rehabilitation robots.

    Science.gov (United States)

    Jamwal, Prashant K; Hussain, Shahid; Xie, Sheng Q

    2015-03-01

    Ankle rehabilitation robots can play an important role in improving outcomes of the rehabilitation treatment by assisting therapists and patients in number of ways. Consequently, few robot designs have been proposed by researchers which fall under either of the two categories, namely, wearable robots or platform-based robots. This paper presents a review of both kinds of ankle robots along with a brief analysis of their design, actuation and control approaches. While reviewing these designs it was observed that most of them are undesirably inspired by industrial robot designs. Taking note of the design concerns of current ankle robots, few improvements in the ankle robot designs have also been suggested. Conventional position control or force control approaches, being used in the existing ankle robots, have been reviewed. Apparently, opportunities of improvement also exist in the actuation as well as control of ankle robots. Subsequently, a discussion on most recent research in the development of novel actuators and advanced controllers based on appropriate physical and cognitive human-robot interaction has also been included in this review. Implications for Rehabilitation Ankle joint functions are restricted/impaired as a consequence of stroke or injury during sports or otherwise. Robots can help in reinstating functions faster and can also work as tool for recording rehabilitation data useful for further analysis. Evolution of ankle robots with respect to their design and control aspects has been discussed in the present paper and a novel design with futuristic control approach has been proposed.

  10. Blood pressure measurements in the ankle are not equivalent to ...

    African Journals Online (AJOL)

    Background. Blood pressure (BP) is often measured on the ankle in the emergency department (ED), but this has never been shown to be an acceptable alternative to measurements performed on the arm. Objective. To establish whether the differences between arm and ankle non-invasive BP measurements were clinically ...

  11. Common types and countermeasures of ankle ligament injury ...

    African Journals Online (AJOL)

    Objective: To analyze ankle ligament injury of basketball players caused during movement, summarize injury types, analyze the causes of injury, and put forward corresponding control measures. Methods: The author selected 3100 basketball players with ankle ligament injury during basketball movement and admitted to ...

  12. approach to and management of acute ankle ligamentous injuries

    African Journals Online (AJOL)

    Enrique

    Tibionavicular part. Medial (deltoid) ligament of ankle {. Table I. Differential diagnosis of acute ankle injury. ATFL sprain. CFL sprain. Syndesmosis sprain. Anterior process calcaneus fracture. Lateral process talus fracture. Fifth metatarsal base fracture. Subtalar injury. Peroneal tendon injury. Osteochondral injury of the talus.

  13. Ottawa ankle rules and subjective surgeon perception to evaluate ...

    African Journals Online (AJOL)

    Background: Foot and ankle injuries are frequent in emergency departments. Although only a few patients with foot and ankle sprain present fractures and the fracture patterns are almost always simple, lack of fracture diagnosis can lead to poor functional outcomes. Aim: The present study aims to evaluate the reliability of ...

  14. Ottawa Ankle Rules and Subjective Surgeon Perception to Evaluate ...

    African Journals Online (AJOL)

    Abstract. Background: Foot and ankle injuries are frequent in emergency departments. Although only a few patients with foot and ankle sprain present fractures and the fracture patterns are almost always simple, lack of fracture diagnosis can lead to poor functional outcomes. Aim: The present study aims to evaluate the ...

  15. Comparative ultrasound study of acute lateral ankle ligament ...

    African Journals Online (AJOL)

    The return to competitive level of sport dates were also documented and compared. A single blind randomised control study comparing the JSFB rehabilitation programme with conventional ankle rehabilitation programmes was used. Ultrasound examinations were done on all first time lateral ankle ligament injuries 72 ...

  16. Influência da utilização da órtese de tornozelo durante atividades do voleibol: avaliação eletromiográfica Influencia de la utilización de la ortesis del tobillo durante las actividades del voleibol: evaluación electromiográfica Use of ankle bracing for volleyball activities

    Directory of Open Access Journals (Sweden)

    Jefferson Rosa Cardoso

    2005-10-01

    évias en el miembro dominante. Fué colectada la contracción isométrica voluntaria máxima (CIVM de cada músculo y, en seguida, la actividad electromiográfica en diferentes situaciones con y sin la ortesis, en orden aleatoria. La ortesis utilizada poseía apoyos laterales. La señal electromiográfico fué cuantificado por la raiz cuadrada de la média (RMS y normalizado por la CIVM. Se realizó un análisis de la varianza de las medidas repetidas para verificar la diferencia de la actividad eléctrica de los músculos envueltos en cada actividad, con o sin ortesis, con significación estadística de 5% (p The ankle sprain is the most frequently found acute injury in volleyball. Aiming to prevent the occurrence of ankle injuries, prophylactic equipment as the bracing had been developed. This study had the purpose to evaluate the performance of the ankle muscles (tibialis anterior, peroneous longus, and medial and lateral gastrocnemius by measuring the electrical activity in different volleyball activities (vertical jumping and lateral shuffling with and without using ankle bracing. Nine young female volleyball athletes with ages ranging from 14 to 17 years (: 15.8 ± 1.3 were evaluated, all of them without previous injuries in the dominant member. Maximal voluntary isometric contractions (MVIC of each muscle was collected, and after that, the electromyographic activity in different situations with and without using the bracing, randomly. The bracing used had two lateral supports. The electromyographic signal was quantified by the root mean square (RMS, and normalized by the MVIC. Analysis of the variance with repeated measurement was used to verify the difference of the electric activity of the muscles involved in each activity, with and without using the bracing, with 5% (p < 0.05 significance level. It was identified a statistically significant difference in phase I of the jumping in favor of the tibialis anterior (p < 0.001 and in phase II in favor of the three

  17. 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

  18. 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

  19. Design of a Simple and Modular 2-DOF Ankle Physiotherapy Device Relying on a Hybrid Serial-Parallel Robotic Architecture

    Directory of Open Access Journals (Sweden)

    Christos E. Syrseloudis

    2011-01-01

    Full Text Available The aim of this work is to propose a new 2-DOF robotic platform with hybrid parallel-serial structure and to undertake its parametric design so that it can follow the whole range of ankle related foot movements. This robot can serve as a human ankle rehabilitation device. The existing ankle rehabilitation devices present typically one or more of the following shortcomings: redundancy, large size, or high cost, hence the need for a device that could offer simplicity, modularity, and low cost of construction and maintenance. In addition, our targeted device must be safe during operation, disallow undesirable movements of the foot, while adaptable to any human foot. Our detailed study of foot kinematics has led us to a new hybrid architecture, which strikes a balance among all aforementioned goals. It consists of a passive serial kinematics chain with two adjustable screws so that the axes of the chain match the two main ankle-axes of typical feet. An active parallel chain, which consists of two prismatic actuators, provides the movement of the platform. Thus, the platform can follow the foot movements, thanks to the passive chain, and also possesses the advantages of parallel robots, including rigidity, high stiffness and force capabilities. The lack of redundancy yields a simpler device with lower size and cost. The paper describes the kinematics modelling of the platform and analyses the force and velocity transmission. The parametric design of the platform is carried out; our simulations confirm the platform's suitability for ankle rehabilitation.

  20. Heel-Rise Height Deficit 1 Year After Achilles Tendon Rupture Relates to Changes in Ankle Biomechanics 6 Years After Injury.

    Science.gov (United States)

    Brorsson, Annelie; Willy, Richard W; Tranberg, Roy; Grävare Silbernagel, Karin

    2017-11-01

    It is unknown whether the height of a heel-rise performed in the single-leg standing heel-rise test 1 year after an Achilles tendon rupture (ATR) correlates with ankle biomechanics during walking, jogging, and jumping in the long-term. To explore the differences in ankle biomechanics, tendon length, calf muscle recovery, and patient-reported outcomes at a mean of 6 years after ATR between 2 groups that, at 1-year follow-up, had less than 15% versus greater than 30% differences in heel-rise height. Cohort study; Level of evidence, 3. Seventeen patients with less than 15% (30% group) side-to-side difference in heel-rise height at 1 year after ATR were evaluated at a mean (SD) 6.1 (2.0) years after their ATR. Ankle kinematics and kinetics were sampled via standard motion capture procedures during walking, jogging, and jumping. Patient-reported outcome was evaluated with Achilles tendon Total Rupture Score (ATRS), Physical Activity Scale (PAS), and Foot and Ankle Outcome Score (FAOS). Tendon length was evaluated by ultrasonography. The Limb Symmetry Index (LSI = [Injured Side ÷ Healthy Side] × 100) was calculated for side differences. The >30% group had significantly more deficits in ankle kinetics during all activities compared with patients in the 30% group, compared with the biomechanics. Minimizing tendon elongation and regaining heel-rise height may be important for the long-term recovery of ankle biomechanics, particularly during more demanding activities such as jumping.

  1. Kinematic analysis of a televised medial ankle sprain

    Directory of Open Access Journals (Sweden)

    Francesca E. Wade

    2018-04-01

    Full Text Available Ankle sprains are one of the most prevalent athletic injuries. Prior work has investigated lateral ankle sprains, but research on generally more severe medial sprains is lacking. This case report performs a kinematic analysis using novel motion analysis methods on a non-contact medial ankle sprain. Peak eversion (50° occurred 0.2 seconds following ground contact, maximum velocity of 426°/s, while peak dorsiflexion (64° occurred with a greater maximum velocity (573°/s. The combination of dorsiflexion at ground contact and rapid eversion is associated with a non-contact eversion sprain. This study provides a quantitative analysis of the eversion ankle sprain injury mechanism. Keywords: Athletic injury, Biomechanics, Ankle injury, Kinematics

  2. MRI of injuries of the lateral ankle ligaments

    International Nuclear Information System (INIS)

    Breitenseher, Martin

    2011-01-01

    The most frequent sport injury of the ankle is located in the lateral ankle ligaments. The diagnosis of lateral collateral ankle ligament trauma is based on patient history, clinical examination, and stress radiography, allowing a fair diagnosis for the daily routine. For the direct visualization and precise diagnosis of the lateral ankle ligaments MRI provides the best answer. MRI is used with controlled positioning of the foot, correct angulation of sequenzes, and distinct analysis of MR findings. Sinus tarsi ligaments and ligaments of the distal syndesmosis should be included to the report. In selected patients MRI allows the best evaluation of the extent of the lateral ankle ligaments. MRI is the method of choice for combined osteochondral injuries and soft tissue lesions too. (orig.)

  3. Analysis of PITFL injuries in rotationally unstable ankle fractures.

    Science.gov (United States)

    Warner, Stephen J; Garner, Matthew R; Schottel, Patrick C; Hinds, Richard M; Loftus, Michael L; Lorich, Dean G

    2015-04-01

    Reduction and stabilization of the syndesmosis in unstable ankle fractures is important for ankle mortise congruity and restoration of normal tibiotalar contact forces. Of the syndesmotic ligaments, the posterior inferior tibiofibular ligament (PITFL) provides the most strength for maintaining syndesmotic stability, and previous work has demonstrated the significance of restoring PITFL function when it remains attached to a posterior malleolus fracture fragment. However, little is known regarding the nature of a PITFL injury in the absence of a posterior malleolus fracture. The goal of this study was to describe the PITFL injury pattern based on magnetic resonance imaging (MRI) and intraoperative observation. A prospective database of all operatively treated ankle fractures by a single surgeon was used to identify all supination-external rotation (SER) types III and IV ankle fracture patients with complete preoperative orthogonal ankle radiographs and MRI. All patients with a posterior malleolus fracture were excluded. Using a combination of preoperative imaging and intraoperative findings, we analyzed the nature of injuries to the PITFL. In total, 185 SER III and IV operatively treated ankle fractures with complete imaging were initially identified. Analysis of the preoperative imaging and operative reports revealed 34% (63/185) had a posterior malleolus fracture and were excluded. From the remaining 122 ankle fractures, the PITFL was delaminated from the posterior malleolus in 97% (119/122) of cases. A smaller proportion (3%; 3/122) had an intrasubstance PITFL rupture. Accurate and stable syndesmotic reduction is a significant component of restoring the ankle mortise after unstable ankle fractures. In our large cohort of rotationally unstable ankle fractures without posterior malleolus fractures, we found that most PITFL injuries occur as a delamination off the posterior malleolus. This predictable PITFL injury pattern may be used to guide new methods for

  4. 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

    In this paper we show that exchanging curved feet and rigid ankles by at feet and compliant ankles improves the range of gait parameters for a bipedal dynamic walker. The new lower legs were designed such that they t to the old set-up, allowing for a direct and quantitative comparison. The dynamic...

  5. Intra-articular fibrous band of the ankle: an uncommon cause of post-traumatic ankle pain

    International Nuclear Information System (INIS)

    Slavotinek, J.P.; Martin, D.K.

    2006-01-01

    A case of an intra-articular fibrous band of the ankle is presented with emphasis on the MR imaging appearances. This entity is an important but uncommon cause of post-traumatic ankle pain and is well recognized within the arthroscopy literature, but there is little if any documentation of this condition in the imaging literature

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

    Science.gov (United States)

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

    2018-01-01

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

  7. The course of the superficial peroneal nerve in relation to the ankle position: anatomical study with ankle arthroscopic implications

    NARCIS (Netherlands)

    de Leeuw, Peter A. J.; Golanó, Pau; Sierevelt, Inger N.; van Dijk, C. Niek

    2010-01-01

    Despite the fact that the superficial peroneal nerve is the only nerve in the human body that can be made visible; iatrogenic damage to this nerve is the most frequently reported complication in anterior ankle arthroscopy. One of the methods to visualize the nerve is combined ankle plantar flexion

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

    Directory of Open Access Journals (Sweden)

    Brown Cathleen N

    2007-12-01

    .11 cm, M/L COPmax (1.76 ± 0.25 cm vs. 1.98 ± 0.25 cm, and COParea (0.13 ± 0.03 cm2 vs. 0.16 ± 0.04 cm2 than the pooled means of the CCT and control groups (P Conclusion Reduced values in COP measures indicated postural stability improvements. Thus, six weeks of coordination training with SR stimulation enhanced postural stability. Future research should examine the use of SR stimulation for decreasing recurrent ankle sprain injury in physically active individuals with FAI.

  9. The value of arthroscopy in the treatment of complex ankle fractures - a protocol of a randomised controlled trial.

    Science.gov (United States)

    Braunstein, Mareen; Baumbach, Sebastian F; Regauer, Markus; Böcker, Wolfgang; Polzer, Hans

    2016-05-12

    An anatomical reconstruction of the ankle congruity is the important prerequisite in the operative treatment of acute ankle fractures. Despite anatomic restoration patients regularly suffer from residual symptoms after these fractures. There is growing evidence, that a poor outcome is related to the concomitant traumatic intra-articular pathology. By supplementary ankle arthroscopy anatomic reduction can be confirmed and associated intra-articular injuries can be treated. Nevertheless, the vast majority of complex ankle fractures are managed by open reduction and internal fixation (ORIF) only. Up to now, the effectiveness of arthroscopically assisted fracture treatment (AORIF) has not been conclusively determined. Therefore, a prospective randomised study is needed to sufficiently evaluate the effect of AORIF compared to ORIF in complex ankle fractures. We perform a randomised controlled trial at Munich University Clinic enrolling patients (18-65 years) with an acute ankle fracture (AO 44 A2, A3, B2, B3, C1 - C3 according to AO classification system). Patients meeting the inclusion criteria are randomised to either intervention group (AORIF, n = 37) or comparison group (ORIF, n = 37). Exclusion criteria are fractures classified as AO type 44 A1 or B1, pilon or plafond-variant injury or open fractures. Primary outcome is the AOFAS Score (American Orthopaedic Foot and Ankle Society). Secondary outcome parameter are JSSF Score (Japanese Society of Surgery of the Foot), Olerud and Molander Score, Karlsson Score, Tegner Activity Scale, SF-12, radiographic analysis, arthroscopic findings of intra-articular lesions, functional assessments, time to return to work/sports and complications. This study protocol is accordant to the SPIRIT 2013 recommendation. Statistical analysis will be performed using SPSS 22.0 (IBM). The subjective and functional outcome of complex ankle fractures is regularly unsatisfying. As these injuries are very common it is essential to

  10. Multisegmental Foot and Ankle Motion Analysis After Hallux Valgus Surgery

    Science.gov (United States)

    Canseco, Karl; Long, Jason; Smedberg, Thomas; Tarima, Sergey; Marks, Richard M.; Harris, Gerald F.

    2015-01-01

    Background Gait changes in patients with hallux valgus, including altered kinematic and temporal-spatial parameters, have been documented in the literature. Although operative treatment can yield favorable clinical and radiographic results, restoration of normal gait in this population remains unclear. Segmental kinematic changes within the foot and ankle during ambulation after operative correction of hallux valgus have not been reported. The aim of this study was to analyze changes in multisegmental foot and ankle kinematics in patients who underwent operative correction of hallux valgus. Methods A 15-camera Vicon Motion Analysis System was used to evaluate 24 feet in 19 patients with hallux valgus preoperatively and postoperatively. The Milwaukee Foot Model was used to characterize segmental kinematics and temporal-spatial parameters (TSPs). Preoperative and postoperative kinematics and TSPs were compared using paired nonparametric methods; comparisons with normative data were performed using unpaired nonparametric methods. Outcomes were evaluated using the SF-36 assessment tool. Results Preoperatively, patients with hallux valgus showed significantly altered temporal-spatial and kinematic parameters. Postoperatively, kinematic analysis demonstrated restoration of hallux position to normal. Hallux valgus angles and intermetatarsal angles were significantly improved, and outcomes showed a significant increase in performance of physical activities. Temporal-spatial parameters and kinematics in the more proximal segments were not significantly changed postoperatively. Conclusion Postoperative results demonstrated significant improvement in foot geometry and hallux kinematics in the coronal and transverse planes. However, the analysis did not identify restoration of proximal kinematics. Clinical Relevance Further investigation is necessary to explore possible causes/clinical relevance and appropriate treatment interventions for the persistently altered kinematics

  11. Ankle tuberculosis. A case in childhood.

    Science.gov (United States)

    Navarrete, F E; Gómez-Alessandri, J; Tintó, M; Sánchez-González, M; Vicent, V

    Articular tuberculosis of the ankle joint is a rare presentation of skeletal tuberculosis (10% of cases). This unusual location and the low index of clinical suspicion leads to delays in diagnosis and treatment. Radiographic and analytic studies are unspecific in the first stage. CAT and MRI are useful in diagnosis. Chemotherapy is the mainstay of treatment and surgery is often required to establish the diagnosis and in the treatment. We report a case of ankle tuberculosis in a 22 month-old child. The diagnosis was confirmed by synovial biopsy. There was no patient or family contact with tuberculosis patients. There was no risk factor. There was no lung disease. Diagnosis was made 1 year after onset of symptoms. The treatment was with chemotherapy and surgery was performed as preventive treatment of equinus deformity and osteoarthritis. Good clinical and functional outcome was achieved after 20 years of follow up. Copyright © 2017 SECOT. Publicado por Elsevier España, S.L.U. All rights reserved.

  12. [Posttraumatic complications after pediatric ankle injuries].

    Science.gov (United States)

    Schneider, F J; Linhart, W E

    2013-08-01

    Ankle sprains are common injuries in childhood and are generally harmless. However, fractures of the ankle joint are rare, but complications (persistent rotational or axial deformity, alteration of growth of the distal tibia or fibula, or joint deformity) can lead to serious problems during growth. The clinical relevance of growth disturbances at the distal tibia or fibula depends on the age at the time of fracture more than on the fracture type, severity of dislocation, or interponated material in the fracture gap. Both stimulation and inhibition of growth are possible. Inhibition of growth at the distal tibial growth plate regularly leads to varus deformity and shortening. This is of clinical importance as this type of growth disturbance is the most common. Valgus deformity is rare, mostly due to persistent axial deviation of an insufficiently reduced fracture. Transitional fractures always occur at the time of growth plate closure; thus, growth disturbances do not play a role. Transitional fractures could be overlooked or treated insufficiently, leading to a step or gap of the joint surface.

  13. Arthroscopic repair of chronic lateral ankle instability.

    Science.gov (United States)

    Corte-Real, Nuno M; Moreira, Rodrigo M

    2009-03-01

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

  14. Ankle and subtalar synovitis in a ball-and-socket ankle joint causing posterolateral painful coarse crepitus: a case report.

    Science.gov (United States)

    Fan, Ka Yuk; Lui, Tun Hing

    2014-01-01

    A 17-year-old girl with bilateral ball-and-socket ankles reported left medial heel pain. Her left heel had gone into a varus position on tiptoeing, and a painful clunk had occurred when returning to normal standing. The clunk persisted after physiotherapy and treatment with an orthosis. Subtalar arthroscopy and peroneal tendoscopy showed mild diffuse synovitis of the ankle joint, especially over the posterior capsule, and a patch of inflamed and fibrotic synovium at the posterolateral corner of the subtalar joint. The clunk subsided immediately after arthroscopic synovectomy and had not recurred during 5 years of follow-up. We found no other reported cases of ankle and subtalar synovitis occurring in patients with a ball-and-socket ankle joint. Copyright © 2014 American College of Foot and Ankle Surgeons. Published by Elsevier Inc. All rights reserved.

  15. Fracture line index of fibular stalk and the ankle joint bone in the classification of the ankle joint trauma

    International Nuclear Information System (INIS)

    Wu Jun; Zhang Qiang

    2003-01-01

    Objective: To evaluate the fracture line index of fibular stalk and the ankle joint bone in the classification of the ankle joint trauma. Methods: Measure fracture line index of fibular stalk and the ankle joint in 217 adult cases of fracture and dislocation of ankle joint. And the cases were classified by the results of the measurement. Results: Measurement was unavailable in 9 cases of tearing fracture. In 31 cases, the lesions could not be particularly classified. And in the rest 176 cases the trauma were precisely classified. The over all successful rate was 81.6%. Conclusion: Fracture line index of fibular stalk and the ankle joint bone are valuable in classification of the trauma of the angle joint. While the specificity of this method is low in differentiating the adducting and abducting fracture of the medial angle, in which a combined investigation is recommended

  16. Cold water immersion of the ankle decreases neuromuscular response of lower limb after inversion movement

    OpenAIRE

    Macedo, Christiane S. G.; Alonso, Carolina S.; Liporaci, Rogério F.; Vieira, Fernando; Guirro, Rinaldo R. J.

    2014-01-01

    BACKGROUND: Cryotherapy has been associated with a significant decrease in nerve conduction velocity and muscle contraction with possible effects on exercise and physical training. OBJECTIVES: To quantify the electromyographic response of the lateral gastrocnemius, tibialis anterior, fibularis longus, rectus femoris and gluteus medius to ankle inversion following cold water immersion. METHOD: The peak values of the root mean square (RMS) were obtained from 35 healthy and active univ...

  17. [Eleven-Year Experience with Total Ankle Arthroplasty].

    Science.gov (United States)

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

    2016-01-01

    PURPOSE OF THE STUDY Total joint replacement is one of the options in surgical treatment of advanced ankle arthritis. It allows the ankle to remain mobile but, unfortunately, it does not provide the same longevity as total knee or hip replacements. Therefore, decisions concerning the kind of treatment are very individual and depend on the clinical status and opinion of each patient. MATERIAL AND METHODS A total of 132 total ankle replacements were carried out in the period from 2004 to 2015. The prostheses used included the Ankle Evolutive System (AES) in 52 patients, Mobility Total Ankle System (DePuy) in 24 patients and, recently, Rebalance Total Ankle Replacement implant in 53 patients. Three patients allergic to metal received the Taric prosthesis. Revision arthroplasty using the Hintegra prosthesis was carried out in four patients. The outcome of arthroplasty was evaluated on the American Orthopaedic Foot and Ankle Society (AOFAS) scoring scale. Indications for total ankle arthroplasty included post-traumatic arthritis in 83 patients, rheumatoid arthritis in 37 and primary arthritis in 12 patients. There were 78 women and 54 men, with an average age of 55.6 years at the time of surgery. RESULTS The average follow-up was 6.1 years (1-11 years). The average AOFAS score of the whole group increased from 33.2 before surgery to 82.5 after it. The primary indication had an important role. Arthroplasty outcomes were poorer in patients with post-traumatic arthritis than in those with rheumatoid arthritis or primary arthritis. In patients with post-traumatic arthritis, the average AOFAS score rose to 78.6 due to restricted motion of the ankle, and some patients continued to have pain when walking. The average AOFAS score in a total of 49 patients who had rheumatoid arthritis or primary arthritis reached a value of 86.4. Post-operative complications were recorded in ten patients (7.6%) in whom part of the wound was healing by second intention. Ossification was also a

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

    Science.gov (United States)

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

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

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

    Science.gov (United States)

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

    2012-01-01

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

  20. 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

  1. 21 CFR 888.3110 - Ankle joint metal/polymer semi-constrained cemented prosthesis.

    Science.gov (United States)

    2010-04-01

    ... 21 Food and Drugs 8 2010-04-01 2010-04-01 false Ankle joint metal/polymer semi-constrained... 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 ankle...

  2. 21 CFR 888.3100 - Ankle joint metal/composite semi-constrained cemented prosthesis.

    Science.gov (United States)

    2010-04-01

    ... 21 Food and Drugs 8 2010-04-01 2010-04-01 false Ankle joint metal/composite semi-constrained... Ankle joint metal/composite semi-constrained cemented prosthesis. (a) Identification. An ankle joint... ankle joint. The device limits translation and rotation: in one or more planes via the geometry of its...

  3. Ankle fractures have features of an osteoporotic fracture.

    Science.gov (United States)

    Lee, K M; Chung, C Y; Kwon, S S; Won, S H; Lee, S Y; Chung, M K; Park, M S

    2013-11-01

    We report the bone attenuation of ankle joint measured on computed tomography (CT) and the cause of injury in patients with ankle fractures. The results showed age- and gender-dependent low bone attenuation and low-energy trauma in elderly females, which suggest the osteoporotic features of ankle fractures. This study was performed to investigate the osteoporotic features of ankle fracture in terms of bone attenuation and cause of injury. One hundred ninety-four patients (mean age 51.0 years, standard deviation 15.8 years; 98 males and 96 females) with ankle fracture were included. All patients underwent CT examination, and causes of injury (high/low-energy trauma) were recorded. Mean bone attenuations of the talus, medial malleolus, lateral malleolus, and distal tibial metaphysis were measured on CT images. Patients were divided into younger age (fractures than the younger age group. With increasing age, bone attenuations tended to decrease and the difference of bone attenuation between the genders tended to increase in the talus, medial malleolus, lateral malleolus, and distal tibial metaphysis. Ankle fracture had features of osteoporotic fracture that is characterized by age- and gender-dependent low bone attenuation. Ankle fracture should not be excluded from the clinical and research interest as well as from the benefit of osteoporosis management.

  4. An EMG-Controlled SMA Device for the Rehabilitation of the Ankle Joint in Post-Acute Stroke

    Science.gov (United States)

    Pittaccio, S.; Viscuso, S.

    2011-07-01

    The capacity of flexing one's ankle is an indispensible segment of gait re-learning, as imbalance, wrong compensatory use of other joints and risk of falling may depend on the so-called drop-foot. The rehabilitation of ankle dorsiflexion may be achieved through active exercising of the relevant musculature (especially tibialis anterior, TA). This can be troublesome for patients affected by weakness and flaccid paresis. Thus, as needs evolve during patient's improvements, a therapeutic device should be able to guide and sustain gradual recovery by providing commensurate aid. This includes exploiting even initial attempts at voluntary motion and turns those into effective workout. An active orthosis powered by two rotary actuators containing NiTi wire was designed to obtain ankle dorsiflexion. A computer routine that analyzes the electromyographic (sEMG) signal from TA muscle is used to control the orthosis and trigger its activation. The software also provides instructions and feed-back for the patient. Tests on the orthosis proved that it can produce strokes up to 36° against resisting torques exceeding 180 Ncm. Three healthy subjects were able to control the orthosis by modulating their TA sEMG activity. The movement produced in the preliminary tests is interesting for lower limb rehabilitation, and will be further improved by optimizing body-orthosis interface. It is hoped that this device will enhance early rehabilitation and recovery of ankle mobility in stroke patients.

  5. Pseudoaneurysm of the Anterior Tibial Artery following Ankle Arthroscopy in a Soccer Player

    Directory of Open Access Journals (Sweden)

    Ichiro Tonogai

    2017-01-01

    Full Text Available Ankle arthroscopy carries a lower risk of vascular complications when standard anterolateral and anteromedial portals are used. However, the thickness of the fat pad at the anterior ankle affords little protection for the thin-walled anterior tibial artery, rendering it susceptible to indirect damage during procedures performed on the anterior ankle joint. To our knowledge, only 11 cases of pseudoaneurysm involving the anterior tibial artery after ankle arthroscopy have been described in the literature. Here we reported a rare case of a 19-year-old soccer player who presented with pseudoaneurysm of the anterior tibial artery following ankle arthroscopy using an ankle distraction method and underwent anastomosis for the anterior tibial artery injury. Excessive distraction of the ankle puts the neurovascular structures at greater risk for iatrogenic injury of the anterior tibial artery during ankle arthroscopy. Surgeons should look carefully for postoperative ankle swelling and pain after ankle arthroscopy.

  6. Pitfalls in the ankle-brachial index and brachial-ankle pulse wave velocity

    Directory of Open Access Journals (Sweden)

    Ato D

    2018-04-01

    Full Text Available Dai Ato Gakujutsu Shien Co., Ltd., Tokyo, Japan Background: The ankle-brachial index (ABI and pulse wave velocity (PWV are indices of atherosclerosis and arterial stiffness. The Japan-made measuring devices of those indices have spread widely because of their convenience and the significance of the parameters. However, studies that comprehensively discuss the various pitfalls in using these indices are not available.Methods: This study presents several representative pitfalls in using the ABI and brachial-ankle PWV (baPWV by showing the result sheets of the device, “the Vascular Profiler”. Furthermore, some considerations when utilizing these indices in the future are also discussed.Results: Several diseases such as arteriosclerosis obliterans (ASO, arterial calcification in the lower limb, arterial stenosis in the right upper-limb, aortic valve diseases, arterial stenosis in the upper-limb of the contralateral side of the hemodialysis access, are the representative pitfalls when evaluating ABI and baPWV. Moreover, a measurement error is found to actually exist. Furthermore, same phenomena are considered most likely to occur when using other similar indices and devices.Conclusion: The ABI and baPWV are the useful and significant biomarkers. Nevertheless, caution is sometimes necessary when interpreting them. Moreover, rigorous patient exclusion criteria should be considered when using those indices in the severely conditioned patient population. And the results of this study can be applied to enhance the literacy using other indices, such as the cardio-ankle vascular index and other similar devices. Keywords: ankle-brachial index, pulse wave velocity, peripheral arterial disease, aortic valve disease, hemodialysis

  7. Modulation of recurrent inhibition from knee extensors to ankle motoneurones during human walking

    DEFF Research Database (Denmark)

    Lamy, Jean-Charles; Iglesias, Caroline; Lackmy, Alexandra

    2008-01-01

    The neural control for muscle coordination during human locomotion involves spinal and supraspinal networks, but little is known about the exact mechanisms implicated. The present study focused on modulation of heteronymous recurrent inhibition from knee extensors to ankle motoneurones at different...... times in the gait cycle, when quadriceps (Quad) muscle activity overlaps that in tibialis anterior (TA) and soleus (Sol). The effects of femoral nerve stimulation on ankle motoneurones were investigated during treadmill walking and during tonic co-contraction of Quad and TA/Sol while standing. Recurrent...... inhibition of TA motoneurones depended on the level of background EMG, and was similar during walking and standing for matched background EMG levels. On the other hand, recurrent inhibition in Sol was reduced in early stance, with respect to standing, and enhanced in late stance. Reduced inhibition in Sol...

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

    Science.gov (United States)

    Xu, J S

    1989-01-01

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

  9. Proprioceptive exercises for ankle ligament injury: a CAT

    Directory of Open Access Journals (Sweden)

    Raúl Aguilera Eguía

    2013-06-01

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

  10. 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.

  11. 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. Copyright © 2014 Elsevier Inc. All rights reserved.

  12. [High complication rate after surgical treatment of ankle fractures].

    Science.gov (United States)

    Bjørslev, Naja; Ebskov, Lars; Lind, Marianne; Mersø, Camilla

    2014-08-04

    The purpose of this study was to determine the quality and re-operation rate of the surgical treatment of ankle fractures at a large university hospital. X-rays and patient records of 137 patients surgically treated for ankle fractures were analyzed for: 1) correct classification according to Lauge-Hansen, 2) if congruity of the ankle joint was achieved, 3) selection and placement of the hardware, and 4) the surgeon's level of education. Totally 32 of 137 did not receive an optimal treatment, 11 were re-operated. There was no clear correlation between incorrect operation and the surgeon's level of education.

  13. Incidence and Cost of Ankle Sprains in United States Emergency Departments

    Science.gov (United States)

    Shah, Shweta; Thomas, Abbey C.; Noone, Joshua M.; Blanchette, Christopher M.; Wikstrom, Erik A.

    2016-01-01

    Background: Ankle sprains represent a common injury in emergency departments, but little is known about common complications, procedures, and charges associated with ankle sprains in emergency departments. Hypothesis: There will be a higher incidence of ankle sprains among younger populations (≤25 years old) and in female patients. Complications and procedures will differ between ankle sprain types. Lateral ankle sprains will have lower health care charges relative to medial and high ankle sprains. Study Design: Descriptive epidemiological study. Level of Evidence: Level 3. Methods: A cross-sectional study of the 2010 Nationwide Emergency Department Sample was conducted. Outcomes such as charges, complications, and procedures were compared using propensity score matching between lateral and medial as well as lateral and high ankle sprains. Results: The sample contained 225,114 ankle sprains. Female patients sustained more lateral ankle sprains (57%). After propensity score adjustment, lateral sprains incurred greater charges than medial ankle sprains (median [interquartile range], $1008 [$702-$1408] vs $914 [$741-$1108]; P sprain of the foot (2.96% vs 0.70%, P ankle sprain events. Among procedures, medial ankle sprains were more likely to include diagnostic radiology (97.91% vs 83.62%, P ankle sprains (0.87% vs 2.79%, P ankle sprains than lateral ankle sprains (24 [6.06%] vs 1 [0.25%], P Ankle sprain emergency department visits account for significant health care charges in the United States. Age- and sex-related differences persist among the types of ankle sprains. Clinical Relevance: The health care charges associated with ankle sprains indicate the need for additional preventive measures. There are age- and sex-related differences in the prevalence of ankle sprains that suggest these demographics may be risk factors for ankle sprains. PMID:27474161

  14. Deep-vein thrombosis prophylaxis in foot and ankle surgery: what is the current state of practice?

    Science.gov (United States)

    Shah, Kalpesh; Thevendran, Gowreeson; Younger, Alastair; Pinney, Stephen J

    2015-04-01

    When contemplating thromboprophylaxis for patients undergoing elective foot and ankle surgery the potential for complications secondary to venous thromboembolism (VTE) must be balanced against the cost, risk, and effectiveness of prophylactic treatment. The incidence of pulmonary embolism (PE) following foot and ankle surgery is considerably lower than after hip or knee surgery. The purpose of this study was to assess current trends in practice regarding VTE prophylaxis among expert orthopaedic foot and ankle surgeons. An e-mail-based survey of active AOFAS (American Orthopaedic Foot and Ankle Society) committee members was conducted (n = 100). Surgeons were questioned as to their use, type, and duration of thromboprophylaxis following elective ankle fusion surgery. Scenarios included the following: (1) A 50-year-old woman with no risk factors; (2) a 50-year-old woman with a history of PE; and (3) a 35-year-old woman actively using birth control pills (BCPs). The response rate for the survey was 80% (80/100). Replies regarding the use of thromboprophylaxis were as follows: (1) in the absence of risk factors, 57% of respondents (45/80) answered, "No prophylaxis required"; (2) for the scenario in which the patient had experienced a previous PE, 97.5% of respondents (78/80) answered, "Yes" to prophylaxis use; (3) for the scenario in which the patient was on BCP, 61.3% of respondents (49/80) stated that they would give some type of thromboprophylaxis. The most commonly recommended methods of prophylaxis were aspirin, 49% (24/49), and low-molecular-weight heparin, 47% (23/49). The recommended length of time for thromboprophylaxis varied widely, from 1 day to more than 6 weeks. . There remains wide variation in the practice of deep-vein thrombosis thromboprophylaxis within the foot and ankle community. Because risks for foot and ankle patients differ from those in the well-studied areas of hip and knee, specific guidelines are needed for foot and ankle surgery. Level V

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

    Science.gov (United States)

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

    2017-03-22

    Lateral ankle ligament injury is among the most common orthopedic injuries. The objective of this study is to present the preliminary prospective results of treatment using the "Inside-Out" variant of the fully arthroscopic Broström-Gould technique. Twenty six patients were included: 20 male and 6 female, aged 19-60 years, mean 41 years. All patients had positive "anterior drawer" and "talar tilt" tests. When necessary, cartilage injuries were treated with microfracture and arthroscopic resection for anterior impingement; three patients had hindfoot varus, on whom Dwyer osteotomy was performed; one patient had peroneal tendinopathy and was treated with tendoscopic debridement and another one had partial injury of the deltoid ligament, which was treated by direct repair. Two arthroscopic surgery portals were used; the anteromedial and anterolateral. After careful inspection of the joint, the anterior surface of the fibula was cleaned to resect the remains of the anterior talo-fibular ligament. An anchor with two sutures was placed on the anterior aspect of the fibula, 1cm from the distal apex of the malleolus. The sutures were passed through the remnant of the anterior talo-fibular ligament as well as the extensor retinaculum using special curved needles. Duncan knots were used to tie the ligament and the inferior extensor retinaculum while the ankle was kept in a neutral position. Patients were kept immobilized non-weight bearing for 2 weeks and were then allowed to start weight bearing in a removable protective boot for 4 weeks. The patients were able to return to sporting activities 6 months after surgery. After a mean follow-up of 27 months (range 21-36 months), patients were functionally evaluated using the American Orthopedics Foot and Ankle Society (AOFAS) ankle score. The mean preoperative value was 58 points, while the mean postoperative value increased to 90 points. One patient had paresthesia in the superficial fibular nerve area, which resolved

  16. Functional outcome following tibio-talar-calcaneal nailing for unstable osteoporotic ankle fractures.

    Science.gov (United States)

    Jonas, S C; Young, A F; Curwen, C H; McCann, P A

    2013-07-01

    of fracture nonunion. The TTC nail can successfully be used to manage fragility fractures about the ankle in the elderly. Much like fractured neck of femur patients, who also have a high rate of mortality, this allows immediate mobilisation with minimal risk of wound complications. However, careful assessment must be made of each patient's mobility, as there is a significant incidence of device failure in the more active patient. Copyright © 2012 Elsevier Ltd. All rights reserved.

  17. Long-term Follow-up of Revision Osteochondral Allograft Transplantation of the Ankle.

    Science.gov (United States)

    Gaul, Florian; Tírico, Luís E P; McCauley, Julie C; Bugbee, William D

    2018-05-01

    Osteochondral allograft (OCA) transplantation is a useful alternative for treatment of posttraumatic ankle arthritis in young patients but has a relatively high failure rate and further procedures are often required. The purpose of this study was to evaluate outcomes of patients who underwent revision OCA transplantation of the ankle after failed primary OCA transplantation. Twenty patients underwent revision OCA transplantation of the ankle between 1988 and 2015. Mean age was 44 years, 55% (11 of 20) were female. The mean time from primary to revision OCA was 3.0 ± 1.7 years. All patients had a minimum follow-up of 2 years. Outcomes included the American Academy of Orthopaedic Surgeons Foot and Ankle Module (AAOS-FAM) and questionnaires evaluating pain and satisfaction. Failure of the revision OCA was defined as a conversion to arthroplasty, arthrodesis, or amputation. Ten of 20 ankles required further surgery, of which 30% (6 of 20) were considered OCA revision failures (4 arthrodeses, 1 arthroplasty, and 1 amputation). The mean time to failure was 6.7 (range, 0.6-13.1) years. Survivorship of the revision OCA was 84% at 5 years and 65% at 10 years. The 14 patients with grafts remaining in situ had an average follow-up of 10.3 years; mean AAOS-FAM Core Score was 70.5 (range, 42.3-99). Of the patients who answered the follow-up questions, 4 of 7 reported moderate to severe pain, and 5 of 12 were satisfied with the results of the procedure. Although the results of revision ankle OCA transplantation are not inferior to primary OCA transplantation, the high rates of persistent pain, further surgery, and graft failure suggest that the indications for OCA as a revision procedure should be carefully evaluated, with proper patient selection. Considering the treatment alternatives, revising a failed OCA transplantation can be a useful treatment option, especially for young and active patients who wish to avoid arthrodesis or arthroplasty. Level IV, case series.

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

    Science.gov (United States)

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

    2016-12-01

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

  19. Measurement properties of the most commonly used Foot- and Ankle-Specific Questionnaires: the FFI, FAOS and FAAM. A systematic review.

    Science.gov (United States)

    Sierevelt, I N; Zwiers, R; Schats, W; Haverkamp, D; Terwee, C B; Nolte, P A; Kerkhoffs, G M M J

    2017-10-12

    In the foot and ankle literature, a wide range of patient-reported outcome measures (PROMs) is used, however, consensus as to which PROMs are preferred is lacking. Selection of a PROM is among other reasons, often based on measurement properties without considering the methodological quality of the studies that evaluate these measurement properties. The aim of current study was first to identify the most frequently used foot and ankle-specific PROMs in recent orthopaedic foot and ankle literature, and second to conduct a systematic review to synthesize and critically appraise the measurement properties of these PROMS. Six PubMed indexed journals focussing on foot and ankle research were screened to identify most commonly used foot and ankle-specific PROMs over a 2 year period (2015-2016). Subsequently, a systematic literature search was performed in PubMed, EMBASE, SPORTDiscus and Scopus to identify relevant studies on their measurement properties. Methodological quality assessment was performed using the COnsensus-based Standards for the selection of health Measurement INstruments (COSMIN) checklist, criteria for good measurement properties were applied, and a level of evidence was determined for the measurement properties of each domain of the questionnaires. The three most frequently reported PROMs were the Foot Function Index (FFI), the Foot and Ankle Outcome Score (FAOS) and the Foot and Ankle Activity Measure (FAAM). Among 2046 unique citations, 50 studies were included evaluating these PROMs. Evidence to support the measurement properties of the FFI was mainly lacking due to poor methodological quality. More evidence was available for the measurement properties of the FAOS and the FAAM, but overall evidence supporting all measurement properties is not yet sufficient. The best available evidence retrieved in this review showed that the FAOS and the FAAM are promising outcome measures for evaluation of patients with foot and ankle conditions, but their

  20. Manual therapy in addition to physiotherapy does not improve clinical or economic outcomes after ankle fracture.

    Science.gov (United States)

    Lin, Chung-Wei Christine; Moseley, Anne M; Haas, Marion; Refshauge, Kathryn M; Herbert, Robert D

    2008-06-01

    The primary aim of this study was to determine the effectiveness and cost-effectiveness of adding manual therapy to a physiotherapy programme for ankle fracture. Assessor-blinded randomized controlled trial. Ninety-four adults were recruited within one week of cast removal for isolated ankle fracture. Inclusion criteria were: they were able to weight-bear as tolerated or partial weight-bear, were referred for physiotherapy, and experienced pain. Ninety-one participants completed the study. Participants were randomly allocated to receive manual therapy (anterior-posterior joint mobilization over the talus) plus a standard physiotherapy programme (experimental), or the standard physiotherapy programme only (control). They were assessed by a blinded assessor at baseline, and at 4, 12 and 24 weeks. The main outcomes were activity limitation and quality of life. Information on costs and healthcare utilization was collected every 4 weeks up to 24 weeks. There were no clinically worthwhile differences in activity limitation or quality of life between groups at any time-point. There was also no between-group difference in quality-adjusted life-years, but the experimental group incurred higher out-of-pocket costs (mean between-group difference = AU$200, 95% confidence interval 26-432). When provided in addition to a physiotherapy programme, manual therapy did not enhance outcome in adults after ankle fracture.

  1. Differentiation between non-neural and neural contributors to ankle joint stiffness in cerebral palsy.

    Science.gov (United States)

    de Gooijer-van de Groep, Karin L; de Vlugt, Erwin; de Groot, Jurriaan H; van der Heijden-Maessen, Hélène C M; Wielheesen, Dennis H M; van Wijlen-Hempel, Rietje M S; Arendzen, J Hans; Meskers, Carel G M

    2013-07-23

    Spastic paresis in cerebral palsy (CP) is characterized by increased joint stiffness that may be of neural origin, i.e. improper muscle activation caused by e.g. hyperreflexia or non-neural origin, i.e. altered tissue viscoelastic properties (clinically: "spasticity" vs. "contracture"). Differentiation between these components is hard to achieve by common manual tests. We applied an assessment instrument to obtain quantitative measures of neural and non-neural contributions to ankle joint stiffness in CP. Twenty-three adolescents with CP and eleven healthy subjects were seated with their foot fixated to an electrically powered single axis footplate. Passive ramp-and-hold rotations were applied over full ankle range of motion (RoM) at low and high velocities. Subject specific tissue stiffness, viscosity and reflexive torque were estimated from ankle angle, torque and triceps surae EMG activity using a neuromuscular model. In CP, triceps surae reflexive torque was on average 5.7 times larger (p = .002) and tissue stiffness 2.1 times larger (p = .018) compared to controls. High tissue stiffness was associated with reduced RoM (p therapy.

  2. ANKLE SPRAIN: WHO IS MOST FREQUENTLY INJURED AND HOW LONG ATHLETES ARE ABSENT FROM THE FIELD?

    Directory of Open Access Journals (Sweden)

    Ljiljana Cvejanov Kezunović

    2011-09-01

    Full Text Available Some sports, such as basketball and soccer, have very high incidence of ankle sprains. Because of this, a seemingly trivial injury, gained in the prime of their health and strength, active athletes were sidelined in the past for the entire half-season at the peak of their competitive form. Also, recreational athletes lose continuity in the maintenance of their form and often temporarily or permanently cease their activities, sometimes just because of fear from new injuries. The aim of this study was to examine whether the specific demands of different sports and other parameters such as gender and age, had an effect on the incidence of ankle sprains in athletes. Results: Among the injured athletes there were nine times more men than women, out of which half were soccer players. Volleyball and basketball players are often injured during the landing, soccer and tennis players during the running. It is usually diagnosed with stage III sprains (rupture of lateral ligaments. Temporary absence from the field lasted between 14 days for light sprains, 47 days for severe and over 69 days for avulsions. Conclusion: It would be necessary to put more effort in order to improve prevention, establish doctrine and recommendations in the application of treatment protocols for ankle sprains in athletes.

  3. Cold water immersion of the ankle decreases neuromuscular response of lower limb after inversion movement

    Directory of Open Access Journals (Sweden)

    Christiane S. G. Macedo

    2014-03-01

    Full Text Available BACKGROUND: Cryotherapy has been associated with a significant decrease in nerve conduction velocity and muscle contraction with possible effects on exercise and physical training. OBJECTIVES: To quantify the electromyographic response of the lateral gastrocnemius, tibialis anterior, fibularis longus, rectus femoris and gluteus medius to ankle inversion following cold water immersion. METHOD: The peak values of the root mean square (RMS were obtained from 35 healthy and active university subjects after the use of a tilt platform to force the ankle into 30° of inversion before, immediately after, and 10, 20, and 30 minutes after water immersion at 4±2°C, for 20 minutes. The Shapiro-Wilk test, repeated measures analysis, Bonferroni's post-hoc, and linear regression analysis provided the results. RESULTS: Peak RMS was significantly lower at all times after cold water immersion, with residual effect of up to 30 minutes, when compared to pre-immersion for all muscles, except for immediate post-immersion for the gluteus medius. CONCLUSIONS: After cold water immersion of the ankle, special care should be taken in activities that require greater neuromuscular control.

  4. Cold water immersion of the ankle decreases neuromuscular response of lower limb after inversion movement.

    Science.gov (United States)

    Macedo, Christiane S G; Alonso, Carolina S; Liporaci, Rogério F; Vieira, Fernando; Guirro, Rinaldo R J

    2014-01-01

    Cryotherapy has been associated with a significant decrease in nerve conduction velocity and muscle contraction with possible effects on exercise and physical training. To quantify the electromyographic response of the lateral gastrocnemius, tibialis anterior, fibularis longus, rectus femoris and gluteus medius to ankle inversion following cold water immersion. The peak values of the root mean square (RMS) were obtained from 35 healthy and active university subjects after the use of a tilt platform to force the ankle into 30° of inversion before, immediately after, and 10, 20, and 30 minutes after water immersion at 4±2°C, for 20 minutes. The Shapiro-Wilk test, repeated measures analysis, Bonferroni's post-hoc, and linear regression analysis provided the results. Peak RMS was significantly lower at all times after cold water immersion, with residual effect of up to 30 minutes, when compared to pre-immersion for all muscles, except for immediate post-immersion for the gluteus medius. After cold water immersion of the ankle, special care should be taken in activities that require greater neuromuscular control.

  5. 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.

  6. Trends of Concurrent Ankle Arthroscopy at the Time of Operative Treatment of Ankle Fracture: A National Database Review.

    Science.gov (United States)

    Ackermann, Jakob; Fraser, Ethan J; Murawski, Christopher D; Desai, Payal; Vig, Khushdeep; Kennedy, John G

    2016-04-01

    The purpose of this study was to report trends associated with concurrent ankle arthroscopy at the time of operative treatment of ankle fracture. The current procedural terminology (CPT) billing codes were used to search the PearlDiver Patient Record Database and identify all patients who were treated for acute ankle fracture in the United States. The Medicare Standard Analytic Files were searchable between 2005 and 2011 and the United Healthcare Orthopedic Dataset from 2007 to 2011. Annual trends were expressed only between 2007 and 2011, as it was the common time period among both databases. Demographic factors were identified for all procedures as well as the cost aspect using the Medicare data set. In total, 32 307 patients underwent open reduction internal fixation (ORIF) of an ankle fracture, of whom 313 (1.0%) had an ankle arthroscopy performed simultaneously. Of those 313 cases, 70 (22.4%) patients received microfracture treatment. Between 2005 and 2011, 85 203 patients were treated for an ankle fracture whether via ORIF or closed treatment. Of these, a total of 566 patients underwent arthroscopic treatment within 7 years. The prevalence of arthroscopy after ankle fracture decreased significantly by 45% from 2007 to 2011 (Pankle fracture treatment, it appears that only a small proportion of surgeons in the United States perform these procedures concurrently. Therapeutic, Level IV: Retrospective. © 2015 The Author(s).

  7. Varying negative work assistance at the ankle with a soft exosuit during loaded walking.

    Science.gov (United States)

    Malcolm, Philippe; Lee, Sangjun; Crea, Simona; Siviy, Christopher; Saucedo, Fabricio; Galiana, Ignacio; Panizzolo, Fausto A; Holt, Kenneth G; Walsh, Conor J

    2017-06-26

    Only very recently, studies have shown that it is possible to reduce the metabolic rate of unloaded and loaded walking using robotic ankle exoskeletons. Some studies obtained this result by means of high positive work assistance while others combined negative and positive work assistance. There is no consensus about the isolated contribution of negative work assistance. Therefore, the aim of the present study is to examine the effect of varying negative work assistance at the ankle joint while maintaining a fixed level of positive work assistance with a multi-articular soft exosuit. We tested eight participants during walking at 1.5 ms -1 with a 23-kg backpack. Participants wore a version of the exosuit that assisted plantarflexion via Bowden cables tethered to an off-board actuation platform. In four active conditions we provided different rates of exosuit bilateral ankle negative work assistance ranging from 0.015 to 0.037 W kg -1 and a fixed rate of positive work assistance of 0.19 W kg -1 . All active conditions significantly reduced metabolic rate by 11 to 15% compared to a reference condition, where the participants wore the exosuit but no assistance was provided. We found no significant effect of negative work assistance. However, there was a trend (p = .08) toward greater reduction in metabolic rate with increasing negative work assistance, which could be explained by observed reductions in biological ankle and hip joint power and moment. The non-significant trend of increasing negative work assistance with increasing reductions in metabolic rate motivates the value in further studies on the relative effects of negative and positive work assistance. There may be benefit in varying negative work over a greater range or in isolation from positive work assistance.

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

    Science.gov (United States)

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

    2017-08-01

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

  9. The effect of training in an interactive dynamic stander on ankle dorsiflexion and gross motor function in children with cerebral palsy

    DEFF Research Database (Denmark)

    Curtis, Derek John; Bencke, Jesper; Mygind, Bente

    2014-01-01

    OBJECTIVE: To study the effect of active stretching of ankle plantarflexors using an interactive dynamic stander in children with cerebral palsy (CP). METHODS: Six children in Gross Motor Function Classification System classes I-III, aged 4-10 years, trained intensive active dorsiflexion...... in an interactive dynamic stander using ankle movement to play custom computer games following a 10-week control period. Gross Motor Function Measure Item Set, gait performance and passive and active dorsiflexion with extended and flexed knee were chosen as outcome parameters. RESULTS: Median active and passive......, these results may indicate that intensive active stretching in an interactive dynamic stander could be an effective new conservative clinical treatment of ankle plantarflexor contracture in children with CP....

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

    Science.gov (United States)

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

    2018-03-01

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

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

    Science.gov (United States)

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

    2015-07-01

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

  12. ARTHROSCOPIC TREATMENT OF ANTERIOR IMPINGEMENT IN THE ANKLE

    Directory of Open Access Journals (Sweden)

    Martin Mikek

    2004-12-01

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

  13. Comparison of Stretch Reflex Torques in Ankle Dorsiflexors and Plantarflexors

    National Research Council Canada - National Science Library

    Tung, J

    2001-01-01

    ...) ankle muscles, Pulse, step, and a combination of random perturbation and step inputs were used to identify the reflex and intrinsic contributions to the measured torque, TA reflex torques were very...

  14. Differential contributions of ankle plantarflexors during submaximal isometric muscle action

    DEFF Research Database (Denmark)

    Masood, Tahir; Bojsen-Møller, Jens; Kalliokoski, Kari K

    2014-01-01

    The objective of this study was to investigate the relative contributions of superficial and deep ankle plantarflexors during repetitive submaximal isometric contractions using surface electromyography (SEMG) and positron emission tomography (PET). Myoelectric signals were obtained from twelve...

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

    Directory of Open Access Journals (Sweden)

    Witjes Suzanne

    2012-02-01

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

  16. MR imaging of the lateral collateral ligaments after ankle sprain

    International Nuclear Information System (INIS)

    Grebe, P.; Kreitner, K.F.; Roeder, W.; Kersjes, W.; Hennes, R.; Runkel, M.

    1995-01-01

    35 patients with ankle sprain were examined by MRI and stress radiographs. 13 were operated afterwards, 22 patients underwent a functional conservative therapy and were examined by MRI and stress radiographs and second time after three months. MRI reports were correct in 12 of 13 operated cases. After conservative therapy we did not find any disrupted ankle ligament. MRI showed intact ligaments thickened by scar. (orig./MG) [de

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

    Science.gov (United States)

    2012-01-01

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

  18. Tibial shaft fracture and ankle injury - Case report

    Directory of Open Access Journals (Sweden)

    Caio Zamboni

    Full Text Available ABSTRACT The authors report on a case of tibial shaft fracture associated with ankle injury. The clinical, radiological and surgical characteristics are discussed. Assessment of associated injuries is often overlooked and these injuries are hard to diagnose. When torque occurs in the lower limb, the ankle becomes susceptible to simultaneous injury. It is essential to make careful assessment based on clinical, radiographic, intraoperative and postoperative characteristics in order to attain functional recovery.

  19. Talar anchor placement for modified Brostrom lateral ankle stabilization procedure.

    Science.gov (United States)

    Angirasa, Arush K; Barrett, Michael J

    2008-01-01

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

  20. Foot and ankle problems in Muay Thai kickboxers.

    Science.gov (United States)

    Vaseenon, Tanawat; Intharasompan, Piyapong; Wattanarojanapom, Thongaek; Theeraamphon, Nipon; Auephanviriyakul, Sansanee; Phisitkul, Phinit

    2015-01-01

    Muay Thai kickboxing is a common sport that uses the foot and ankle in fighting. Muay Thai kickboxing trainees usually receive training in Thailand Foot and ankle problems in this group ofpeople who usually train barefoot remain unexplored To evaluate the prevalence of common foot and ankle problems in Muay Thai kick boxers. The present study is a cross-sectional survey of Muay Thai kick boxers practicing in northern Thailand. Interviews were conducted and foot and ankle examinations were evaluated Foot morphology was examined using a Harris mat footprint. One hundred and twenty-three Muay Thai kickbox ersinnine training gyms were included in this study. Common foot and ankle problems found in the Muay Thai kick boxers were callosity (59%), gastrocnemius contracture (57%), toe deformities (49.3%), wounds (10%) and heel pain (9%). Callosity was most commonly found on the forefoot (77.5%), on the plantar first metatarsal (55.3%) and on the big toe (33.3%). An association was found between a tight heel cord and a history of foot injury with prolonged periods of weekly training. Toe deformities such as hallux rigidus (37.6%) were also associated with prolonged periods of training (p = 0.001). No correlation was found between type of foot arch and foot and ankle problems. Plantar forefoot callosities and wounds as well as toe deformities including tight heel cords are some of the foot and ankle problems commonly found in Muay Thai kick boxers. They are associated with prolonged periods of barefoot training. The unique pattern of training and of the kicks in Muay Thai might be a path mechanism, leading to the development of foot and ankle problems.

  1. Effect of kinesio-taping on ankle joint stability

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    Mervat A. Mohamed

    2016-05-01

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

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

    Science.gov (United States)

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

    2018-06-13

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

  3. Immediate effect of a single anteroposterior talus mobilization on dorsiflexion range of motion in participants with orthopedic dysfunction of the ankle and foot.

    Science.gov (United States)

    Teixeira, Luciana Mundim; Pires, Tatiana; Silva, Rafael Duarte; de Resende, Marcos Antônio

    2013-01-01

    The purpose of this study was to determine the immediate effects of a single anteroposterior mobilization of the talus on the active dorsiflexion range of motion (ROM) in participants with different orthopedic foot and ankle injuries. This study included 30 male and female participants aged 18 to 50 years with unilateral orthopedic foot and ankle dysfunction. All participants underwent 3 sets of active dorsiflexion ROM measurement in both ankles. Measurements included baseline, post-first treatment, and post-second treatment values. Participants received either joint mobilization or manual contact (control) on the affected ankle. Active dorsiflexion ROM was assessed using a biplanar goniometer with participants in the prone position and 90° of knee flexion. Both groups (joint mobilization and manual contact) showed increased active dorsiflexion ROM. However, the mean difference of dorsiflexion measurements before and after mobilization was greater than before and after control treatment. A single session of articular mobilization of the talus did not significantly increase dorsiflexion ROM in participants with orthopedic dysfunctions of the ankle and foot compared with a manual contact procedure. Copyright © 2013 National University of Health Sciences. Published by Mosby, Inc. All rights reserved.

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

    Science.gov (United States)

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

    2016-06-07

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

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

    Directory of Open Access Journals (Sweden)

    M. Penso

    2008-01-01

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

  6. Ankle dorsiflexion may play an important role in falls in women with fibromyalgia.

    Science.gov (United States)

    Góes, Suelen M; Leite, Neiva; Stefanello, Joice M F; Homann, Diogo; Lynn, Scott K; Rodacki, André L F

    2015-07-01

    Fibromyalgia is a chronic pain condition, which involves reduced range of motion. This leads to gait changes and high incidence of falls. The understanding of the gait patterns in subjects with fibromyalgia and their relationship with falls may be useful when designing intervention programs. The purpose of this study was to evaluate the range of motion of the hip and ankle joints during gait in women with and without fibromyalgia. Further, we determined the relationship between joint range of motion and falls in this population. Middle-aged women (16 with fibromyalgia and 16 as control group) were recruited. Pain intensity, physical activity level, and fall prevalence were assessed. Three dimensional gait analysis provided temporal and joint kinematic variables. In general, hip and ankle range of motion were similar between groups, except that fibromyalgia group showed higher plantar flexion during toe-off (Pfibromyalgia group the higher number of falls was correlated to reduced dorsiflexion during stance phase. This limitation in dorsiflexion was related to longer length of time with fibromyalgia symptoms. Women with fibromyalgia showed a higher number of falls, reduced dorsiflexion during stance phase, and increased plantar flexion during toe-off. Also, the higher number of falls reported in the fibromyalgia group was related to reduced dorsiflexion during stance phase, which was correlated to a longer length of time living with fibromyalgia symptoms. These data suggest that improving ankle kinematics in patients with fibromyalgia may help prevent falls and improve mobility. Copyright © 2015 Elsevier Ltd. All rights reserved.

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

    Science.gov (United States)

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

    2018-03-01

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

  8. Linking the mechanics and energetics of hopping with elastic ankle exoskeletons.

    Science.gov (United States)

    Farris, Dominic James; Sawicki, Gregory S

    2012-12-15

    The springlike mechanics of the human leg during bouncing gaits has inspired the design of passive assistive devices that use springs to aid locomotion. The purpose of this study was to test whether a passive spring-loaded ankle exoskeleton could reduce the mechanical and energetic demands of bilateral hopping on the musculoskeletal system. Joint level kinematics and kinetics were collected with electromyographic and metabolic energy consumption data for seven participants hopping at four frequencies (2.2, 2.5, 2.8, and 3.2 Hz). Hopping was performed without an exoskeleton; with an springless exoskeleton; and with a spring-loaded exoskeleton. Spring-loaded ankle exoskeletons reduced plantar flexor muscle activity and the biological contribution to ankle joint moment (15-25%) and average positive power (20-40%). They also facilitated reductions in metabolic power (15-20%) across frequencies from 2.2 to 2.8 Hz compared with hopping with a springless exoskeleton. Reductions in metabolic power compared with hopping with no exoskeleton were restricted to hopping at 2.5 Hz only (12%). These results highlighted the importance of reducing the rate of muscular force production and work to achieve metabolic reductions. They also highlighted the importance of assisting muscles acting at the knee joint. Exoskeleton designs may need to be tuned to optimize exoskeleton mass, spring stiffness, and spring slack length to achieve greater metabolic reductions.

  9. The VSPA Foot: A Quasi-Passive Ankle-Foot Prosthesis With Continuously Variable Stiffness.

    Science.gov (United States)

    Shepherd, Max K; Rouse, Elliott J

    2017-12-01

    Most commercially available prosthetic feet do not exhibit a biomimetic torque-angle relationship, and are unable to modulate their mechanics to assist with other mobility tasks, such as stairs and ramps. In this paper, we present a quasi-passive ankle-foot prosthesis with a customizable torque-angle curve and an ability to quickly modulate ankle stiffness between tasks. The customizable torque-angle curve is obtained with a cam-based transmission and a fiberglass leaf spring. To achieve variable stiffness, the leaf spring's support conditions can be actively modulated by a small motor, shifting the torque-angle curve to be more or less stiff. We introduce the design, characterize the available torque-angle curves, and present kinematics from a transtibial amputee subject performing level-ground walking, stair ascent/descent, and ramp ascent/descent. The subject exhibited a more normative range of motion on stairs and ramps at lower stiffness levels, and preferred different stiffness levels for each task. Paired with an appropriate intent recognition system, our novel ankle prosthesis could improve gait biomechanics during walking and many other mobility tasks.

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

    Science.gov (United States)

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

    2018-02-01

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

  11. Arthroscopic ankle arthrodesis with intra-articular distraction.

    Science.gov (United States)

    Kim, Hyong Nyun; Jeon, June Young; Noh, Kyu Cheol; Kim, Hong Kyun; Dong, Quanyu; Park, Yong Wook

    2014-01-01

    Arthroscopic ankle arthrodesis has shown high rates of union comparable to those with open arthrodesis but with substantially less postoperative morbidity, shorter operative times, less blood loss, and shorter hospital stays. To easily perform arthroscopic resection of the articular cartilage, sufficient distraction of the joint is necessary to insert the arthroscope and instruments. However, sometimes, standard noninvasive ankle distraction will not be sufficient in post-traumatic ankle arthritis, with the development of arthrofibrosis and joint contracture after severe ankle trauma. In the present report, we describe a technique to distract the ankle joint by inserting a 4.6-mm stainless steel cannula with a blunt trocar inside the joint. The cannula allowed sufficient intra-articular distraction, and, at the same time, a 4.0-mm arthroscope can be inserted through the cannula to view the joint. Screws can be inserted to fix the joint under fluoroscopic guidance without changing the patient's position or removing the noninvasive distraction device and leg holder, which are often necessary during standard arthroscopic arthrodesis with noninvasive distraction. Copyright © 2014 American College of Foot and Ankle Surgeons. Published by Elsevier Inc. All rights reserved.

  12. Value of arthrography after supination trauma of the ankle

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    Dijk, C.N. van; Tol, J.L.; Marti, R.K. [Acad. Med. Centre, Amsterdam (Netherlands). Dept. of Orthopaedic Surg.; Molenaar, A.H.M. [Department of Radiology, Canisius Ziekenhuis, Weg door Jonkerbos 100, 6532 SZ Nijmegen (Netherlands); Cohen, R.H. [Department of Radiology, Stichting Ziekenhuis Amstelveen, Laan van de Helende Meesters 8, 1186 AM Amstelveen (Netherlands); Bossuyt, P.M.M. [Department of Epidemiology, Academic Medical Centre, P.O. Box 22700, 1100 DE Amsterdam (Netherlands)

    1998-05-01

    Objective. To investigate the merits of arthrography after supination trauma of the ankle. Design and patients. In a group of 160 consecutive patients operative exploration was performed in cases where arthrography and/or a delayed physical examination showed positive findings. In all patients arthrography was performed within 48 h after trauma. To determine interobserver agreement, all arthrograms were independently evaluated by two radiologists, both ignorant of the first assessment. Results. The prevalence of an ankle ligament lesion was found to be 76%. Of the 122 patients with a rupture of one or more ankle ligaments, 52% had an isolated anterior talofibular ligament lesion, 3% had an isolated calcaneofibular ligament lesion, and 45% had combined lesions. The site of the lesion was predominantly intraligamentous. In the determination of the presence or absence of an ankle ligament lesion, the specificity and sensitivity of the ankle arthrogram were 71% and 96% respectively. Interobserver agreement on the arthrogram was very good ({kappa} 0.9). In 1% of patients a clear diagnosis was not possible by means of arthrography. Conclusion. Arthrography provides information of high diagnostic quality with excellent interobserver agreement and therefore remains the gold standard for early diagnosis (within 48 h) of a lateral ankle ligament rupture. (orig.) With 4 figs., 5 tabs., 24 refs.

  13. Value of arthrography after supination trauma of the ankle

    International Nuclear Information System (INIS)

    Dijk, C.N. van; Tol, J.L.; Marti, R.K.; Cohen, R.H.; Bossuyt, P.M.M.

    1998-01-01

    Objective. To investigate the merits of arthrography after supination trauma of the ankle. Design and patients. In a group of 160 consecutive patients operative exploration was performed in cases where arthrography and/or a delayed physical examination showed positive findings. In all patients arthrography was performed within 48 h after trauma. To determine interobserver agreement, all arthrograms were independently evaluated by two radiologists, both ignorant of the first assessment. Results. The prevalence of an ankle ligament lesion was found to be 76%. Of the 122 patients with a rupture of one or more ankle ligaments, 52% had an isolated anterior talofibular ligament lesion, 3% had an isolated calcaneofibular ligament lesion, and 45% had combined lesions. The site of the lesion was predominantly intraligamentous. In the determination of the presence or absence of an ankle ligament lesion, the specificity and sensitivity of the ankle arthrogram were 71% and 96% respectively. Interobserver agreement on the arthrogram was very good (κ 0.9). In 1% of patients a clear diagnosis was not possible by means of arthrography. Conclusion. Arthrography provides information of high diagnostic quality with excellent interobserver agreement and therefore remains the gold standard for early diagnosis (within 48 h) of a lateral ankle ligament rupture. (orig.)

  14. Complications of ankle fracture in patients with diabetes.

    Science.gov (United States)

    Chaudhary, Saad B; Liporace, Frank A; Gandhi, Ankur; Donley, Brian G; Pinzur, Michael S; Lin, Sheldon S

    2008-03-01

    Ankle fractures in patients with diabetes mellitus have long been recognized as a challenge to practicing clinicians. Complications of impaired wound healing, infection, malunion, delayed union, nonunion, and Charcot arthropathy are prevalent in this patient population. Controversy exists as to whether diabetic ankle fractures are best treated noninvasively or by open reduction and internal fixation. Patients with diabetes are at significant risk for soft-tissue complications. In addition, diabetic ankle fractures heal, but significant delays in bone healing exist. Also, Charcot ankle arthropathy occurs more commonly in patients who were initially undiagnosed and had a delay in immobilization and in patients treated nonsurgically for displaced ankle fractures. Several techniques have been described to minimize complications associated with diabetic ankle fractures (eg, rigid external fixation, use of Kirschner wires or Steinmann pins to increase rigidity). Regardless of the specifics of treatment, adherence to the basic principles of preoperative planning, meticulous soft-tissue management, and attention to stable, rigid fixation with prolonged, protected immobilization are paramount in minimizing problems and yielding good functional outcomes.

  15. REVISION ANKLE SYNDESMOSIS FIXATION - FUNCTIONAL OUTCOME AFTER TIGHTROPE ® FIXATION

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    Sendhilvelan Rajagopalan

    2016-07-01

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

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

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    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.

  17. 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.

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

    Science.gov (United States)

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

    2014-03-31

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

  19. Increasing ankle push-off work with a powered prosthesis does not necessarily reduce metabolic rate for transtibial amputees.

    Science.gov (United States)

    Quesada, Roberto E; Caputo, Joshua M; Collins, Steven H

    2016-10-03

    Amputees using passive ankle-foot prostheses tend to expend more metabolic energy during walking than non-amputees, and reducing this cost has been a central motivation for the development of active ankle-foot prostheses. Increased push-off work at the end of stance has been proposed as a way to reduce metabolic energy use, but the effects of push-off work have not been tested in isolation. In this experiment, participants with unilateral transtibial amputation (N=6) walked on a treadmill at a constant speed while wearing a powered prosthesis emulator. The prosthesis delivered different levels of ankle push-off work across conditions, ranging from the value for passive prostheses to double the value for non-amputee walking, while all other prosthesis mechanics were held constant. Participants completed six acclimation sessions prior to a data collection in which metabolic rate, kinematics, kinetics, muscle activity and user satisfaction were recorded. Metabolic rate was not affected by net prosthesis work rate (p=0.5; R 2 =0.007). Metabolic rate, gait mechanics and muscle activity varied widely across participants, but no participant had lower metabolic rate with higher levels of push-off work. User satisfaction was affected by push-off work (p=0.002), with participants preferring values of ankle push-off slightly higher than in non-amputee walking, possibly indicating other benefits. Restoring or augmenting ankle push-off work is not sufficient to improve energy economy for lower-limb amputees. Additional necessary conditions might include alternate timing or control, individualized tuning, or particular subject characteristics. Copyright © 2016 Elsevier Ltd. All rights reserved.

  20. Minimum distraction gap: how much ankle joint space is enough in ankle distraction arthroplasty?

    Science.gov (United States)

    Fragomen, Austin T; McCoy, Thomas H; Meyers, Kathleen N; Rozbruch, S Robert

    2014-02-01

    The success of ankle distraction arthroplasty relies on the separation of the tibiotalar articular surfaces. The purpose of this study was to find the minimum distraction gap needed to ensure that the tibiotalar joint surfaces would not contact each other with full weight-bearing while under distraction. Circular external fixators were mounted to nine cadaver ankle specimens. Each specimen was then placed into a custom-designed load chamber. Loads of 0, 350, and 700N were applied to the specimen. Radiographic joint space was measured and joint contact pressure was monitored under each load. The external fixator was then sequentially distracted, and the radiographic joint space was measured under the three different loads. The experiment was stopped when there was no joint contact under 700N of load. The radiographic joint space was measured and the initial (undistracted) radiographic joint space was subtracted from it yielding the distraction gap. The minimum distraction gap (mDG) that would provide total unloading was calculated. The average mDG was 2.4 mm (range, 1.6 to 4.0 mm) at 700N of load, 4.4 mm (range, 3.7 to 5.8 mm) at 350N of load, and 4.9 mm (range, 3.7 to 7.0 mm) at 0N of load. These results suggest that if the radiographic joint space of on a standing X-ray of an ankle undergoing distraction arthroplasty shows a minimum of 5.8 mm of DG, then there will be no contact between joint surfaces during full weight-bearing. Therefore, 5 mm of radiographic joint space, as recommended historically, may not be adequate to prevent contact of the articular surfaces during weight-bearing.

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

    Science.gov (United States)

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

    2017-08-03

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

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

    Directory of Open Access Journals (Sweden)

    Maryam Hayati

    2010-04-01

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

  3. Stress fractures of the foot and ankle, part 2: site-specific etiology, imaging, and treatment, and differential diagnosis.

    Science.gov (United States)

    Mandell, Jacob C; Khurana, Bharti; Smith, Stacy E

    2017-09-01

    Stress fractures of the foot and ankle are a commonly encountered problem among athletes and individuals participating in a wide range of activities. This illustrated review, the second of two parts, discusses site-specific etiological factors, imaging appearances, treatment options, and differential considerations of stress fractures of the foot and ankle. The imaging and clinical management of stress fractures of the foot and ankle are highly dependent on the specific location of the fracture, mechanical forces acting upon the injured site, vascular supply of the injured bone, and the proportion of trabecular to cortical bone at the site of injury. The most common stress fractures of the foot and ankle are low risk and include the posteromedial tibia, the calcaneus, and the second and third metatarsals. The distal fibula is a less common location, and stress fractures of the cuboid and cuneiforms are very rare, but are also considered low risk. In contrast, high-risk stress fractures are more prone to delayed union or nonunion and include the anterior tibial cortex, medial malleolus, navicular, base of the second metatarsal, proximal fifth metatarsal, hallux sesamoids, and the talus. Of these high-risk types, stress fractures of the anterior tibial cortex, the navicular, and the proximal tibial cortex may be predisposed to poor healing because of the watershed blood supply in these locations. The radiographic differential diagnosis of stress fracture includes osteoid osteoma, malignancy, and chronic osteomyelitis.

  4. Radiology of chronic diseases of the ankle joint

    International Nuclear Information System (INIS)

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

    1999-01-01

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

  5. How does cryotherapy effect ankle proprioception in healthy individuals?

    Science.gov (United States)

    Houten, Daniel; Cooper, Darren

    2017-09-01

    Objectives To investigate how a 15-min cryotherapy intervention effects proprioception by measuring joint positional sense (JPS) and static single legged balance. Design Repeated measures design. Setting Laboratory. Participants Eighteen healthy university sports team students (11 males, 7 females) aged between 20 and 21 years old. Main outcome measures Participants were treated with 15 min of Aircast Cryo-cuff. The subject's skin temperature was measured before and immediately after 15 min of cryotherapy treatment. Ankle active joint positional sense (A-JPS) and passive joint positional sense (P-JPS) were measured at pre-test, immediately post-test, and 5 min post-test. Static balance was measured by centre of pressure (CoP) mean path length, medial-lateral (ML) CoP mean deviation, and anterior-posterior (AP) CoP mean deviation and mean time-to-boundary (TtB) minima for AP and ML directions. Results No significant differences were found for the variables of JPS and static single balance testing after 15 min of cryotherapy treatment. However, mean differences for CoP mean path length and ML mean deviation were shown to improve following cryotherapy treatment, results not previously found in the literature. Conclusion Results suggest that 15 min of Cryo-cuff treatment does not significantly affect proprioception. Although the effect of cryotherapy on proprioception depends on cooling modality used, time frame applied, and joint applied to.

  6. Post-Traumatic Osteoarthritis of the Ankle: A Distinct Clinical Entity Requiring New Research Approaches

    Science.gov (United States)

    Delco, Michelle L.; Kennedy, John G.; Bonassar, Lawrence J.; Fortier, Lisa A.

    2017-01-01

    The diagnosis of ankle osteoarthritis (OA) is increasing as a result of advancements in non-invasive imaging modalities such as magnetic resonance imaging, improved arthroscopic surgical technology and heightened awareness among clinicians. Unlike OA of the knee, primary or age-related ankle OA is rare, with the majority of ankle OA classified as post-traumatic (PTOA). Ankle trauma, more specifically ankle sprain, is the single most common athletic injury, and no effective therapies are available to prevent or slow progression of PTOA. Despite the high incidence of ankle trauma and OA, ankle-related OA research is sparse, with the majority of clinical and basic studies pertaining to the knee joint. Fundamental differences exist between joints including their structure and molecular composition, response to trauma, susceptibility to OA, clinical manifestations of disease, and response to treatment. Considerable evidence suggests that research findings from knee should not be extrapolated to the ankle, however few ankle-specific preclinical models of PTOA are currently available. The objective of this article is to review the current state of ankle OA investigation, highlighting important differences between the ankle and knee that may limit the extent to which research findings from knee models are applicable to the ankle joint. Considerations for the development of new ankle-specific, clinically relevant animal models are discussed. PMID:27764893

  7. Range of Motion of the Ankle According to Pushing Force, Gender and Knee Position.

    Science.gov (United States)

    Cho, Kang Hee; Jeon, Yumi; Lee, Hyunkeun

    2016-04-01

    To investigate the difference of range of motion (ROM) of ankle according to pushing force, gender and knee position. One hundred and twenty-eight healthy adults (55 men, 73 women) between the ages of 20 and 51, were included in the study. One examiner measured the passive range of motion (PROM) of ankle by Dualer IQ Inclinometers and Commander Muscle Testing. ROM of ankle dorsiflexion (DF) and plantarflexion (PF) according to change of pushing force and knee position were measured at prone position. There was significant correlation between ROM and pushing force, the more pushing force leads the more ROM at ankle DF and ankle PF. Knee flexion of 90° position showed low PF angle and high ankle DF angle, as compared to the at neutral position of knee joint. ROM of ankle DF for female was greater than for male, with no significant difference. ROM of ankle PF for female was greater than male regardless of the pushing force. To our knowledge, this is the first study to assess the relationship between pushing force and ROM of ankle joint. There was significant correlation between ROM of ankle and pushing force. ROM of ankle PF for female estimated greater than male regardless of the pushing force and the number of measurement. The ROM of the ankle is measured differently according to the knee joint position. Pushing force, gender and knee joint position are required to be considered when measuring the ROM of ankle joint.

  8. The effect of directional inertias added to pelvis and ankle on gait

    Science.gov (United States)

    2013-01-01

    Background Gait training robots should display a minimum added inertia in order to allow normal walking. The effect of inertias in specific directions is yet unknown. We set up two experiments to assess the effect of inertia in anteroposterior (AP) direction to the ankle and AP and mediolateral (ML) direction to the pelvis. Methods We developed an experimental setup to apply inertia in forward backward and or sideways directions. In two experiments nine healthy subjects walked on a treadmill at 1.5 km/h and 4.5 km/h with no load and with AP loads of 0.3, 1.55 and 3.5 kg to the left ankle in the first experiment and combinations of AP and ML loads on the pelvis (AP loads 0.7, 4.3 and 10.2 kg; ML loads 0.6, 2.3 and 5.3 kg). We recorded metabolic rate, EMG of major leg muscles, gait parameters and kinematics. Results & discussion Adding 1.55 kg or more inertia to the ankle in AP direction increases the pelvis acceleration and decreases the foot acceleration in AP direction both at speeds of 4.5 km/h. Adding 3.5 kg of inertia to the ankle also increases the swing time as well as AP motions of the pelvis and head-arms-trunk (HAT) segment. Muscle activity remains largely unchanged. Adding 10.2 kg of inertia to the pelvis in AP direction causes a significant decrease of the pelvis and HAT segment motions, particularly at high speeds. Also the sagittal back flexion increases. Lower values of AP inertia and ML inertias up to 5.3 kg had negligible effect. In general the found effects are larger at high speeds. Conclusions We found that inertia up to 2 kg at the ankle or 6 kg added to the pelvis induced significant changes, but since these changes were all within the normal inter subject variability we considered these changes as negligible for application as rehabilitation robotics and assistive devices. PMID:23597391

  9. [Reconstruction of ankle and foot with combination of free perforator flaps and skin graft].

    Science.gov (United States)

    Yin, Lu; Gong, Ketong; Yin, Zhonggang; Zhang, Bo; Xu, Jianhua

    2017-03-01

    To evaluate the clinical outcomes of free perforator flaps combined with skin graft for reconstruction of ankle and foot soft tissue defects. Between June 2014 and October 2015, 20 cases of ankle and foot soft tissue defects were treated. There were 16 males and 4 females, aged from 19 to 61 years (mean, 43.3 years). Injury was caused by traffic accident in 7 cases, by crashing in 9 cases, and machine twist in 4 cases. The locations were the ankle in 6 cases, the heel in 3 cases, the dorsum pedis in 4 cases, and the plantar forefoot in 7 cases of avulsion injury after toes amputation. The size of wound ranged from 15 cm×10 cm to 27 cm×18 cm. The time from injury to treatment was from 11 to 52 days (mean, 27 days). The anterolateral thigh perforator flap was used in 11 cases, thoracodorsal antery perforator flap in 3 cases, medial sural artery perforator flap in 4 cases, deep inferior epigastric perforator flap in 1 case, and anteromedial thigh perforator flap in 1 case, including 5 chimeric perforator flaps, 5 polyfoliate perforator flaps, 3 flow-through perforator flaps, and 3 conjoined perforator flaps. The size of the perforator flap ranged from 10.0 cm×6.5 cm to 36.0 cm×8.0 cm, the size of skin graft from 5 cm×3 cm to 18 cm×12 cm. Venous crisis occurred in 2 flaps which survived after symptomatic treatment; 18 flaps survived successfully and skin grafting healed well. The follow-up time ranged 4-18 months (mean, 8.3 months). The flaps had good appearance, texture and color, without infection. The patients could walk normally and do daily activities. Only linear scars were observed at the donor sites. Free perforator flap can be used to reconstruct defects in the ankle and foot, especially in the weight-bearing area of the plantar forefoot. A combination of free perforator flap and skin graft is ideal in reconstruction of great soft tissue defects in the ankle and foot.

  10. Orthopaedic management of haemophilia arthropathy of the ankle.

    Science.gov (United States)

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

    2008-07-01

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

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

    Science.gov (United States)

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

    2016-04-01

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

  12. Magnetic resonance imaging of ankle ligaments and tendon injuries

    International Nuclear Information System (INIS)

    Breitenseher, M.; Trattnig, S.; Kukla, C.; Daebler, C.; Helbich, T.; Haller, J.; Imhof, H.

    1995-01-01

    Today MRI allows evaluation of the integrity of injured ankle ligaments. The major difficulty in MRI is inconsistency in visualization by inadequate appreciation of the three-dimensional orientation of each ankle ligament. Using this technique, 52 patients with sprained ankles underwent MRI. The integrity of rupture of the collateral lateral ligaments was obtained in all 52 ankles. Full-lenght visualization is essential for evaluation of the ankle ligaments with MRI. In these 52 patients the angle of tilt on the stress X-ray was compared with the rate of MRI findings showing an injury affecting two ligaments. We found that none of the patients in whom the angle of lateral tilt was less than 5 had rupture of two laterial ligaments, while 32% of patients with angles of tilt of 6-14 and 42% of those with angles of tilt over 15 on stress X-ray had two ruptured lateral ligaments. The advantages of MRI are that it offers the best visualization of the extent of the tendon lesion. MRI, however, seems to be superior to US in detecting and quantifying lesions of the Achilles tendon. Therefore, MRI may be indicated in particularly difficult cases of tendons injuries in the foot. (orig.) [de

  13. Myoelectric stimulation on peroneal muscles resists simulated ankle sprain motion.

    Science.gov (United States)

    Fong, Daniel Tik-Pui; Chu, Vikki Wing-Shan; Chan, Kai-Ming

    2012-07-26

    The inadequate reaction time of the peroneal muscles in response to an incorrect foot contact event has been proposed as one of the etiological factors contributing to ankle joint inversion injury. Thus, the current study aimed to investigate the efficacy of a myoelectric stimulation applied to the peroneal muscles in the prevention of a simulated ankle inversion trauma. Ten healthy male subjects performed simulated inversion and supination tests on a pair of mechanical sprain simulators. An electrical signal was delivered to the peroneal muscles of the subjects through a pair of electrode pads. The start of the stimulus was synchronized with the drop of the sprain simulator's platform. In order to determine the maximum delay time which the stimulus could still resist the simulated ankle sprain motion, different delay time were test (0, 5, 10, and 15ms). Together with the control trial (no stimulus), there were 5 testing conditions for both simulated inversion and supination test. The effect was quantified by the drop in maximum ankle tilting angle and angular velocity, as determined by a motion analysis system with a standard laboratory procedure. Results showed that the myoelectric stimulation was effective in all conditions except the one with myoelectric stimulus delayed for 15ms in simulated supination test. It is concluded that myoelectric stimulation on peroneal muscles could resist an ankle spraining motion. Copyright © 2012 Elsevier Ltd. All rights reserved.

  14. 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

  15. Balance in single-limb stance after surgically treated ankle fractures: a 14-month follow-up

    Directory of Open Access Journals (Sweden)

    Ageberg Eva

    2006-04-01

    Full Text Available Abstract Background The maintenance of postural control is fundamental for different types of physical activity. This can be measured by having subjects stand on one leg on a force plate. Many studies assessing standing balance have previously been carried out in patients with ankle ligament injuries but not in patients with ankle fractures. The aim of this study was to evaluate whether patients operated on because of an ankle fracture had impaired postural control compared to an uninjured age- and gender-matched control group. Methods Fifty-four individuals (patients operated on because of an ankle fracture were examined 14 months postoperatively. Muscle strength, ankle mobility, and single-limb stance on a force-platform were measured. Average speed of centre of pressure movements and number of movements exceeding 10 mm from the mean value of centre of pressure were registered in the frontal and sagittal planes on a force-platform. Fifty-four age- and gender-matched uninjured individuals (controls were examined in the single-limb stance test only. The paired Student t-test was used for comparisons between patients' injured and uninjured legs and between side-matched legs within the controls. The independent Student t-test was used for comparisons between patients and controls. The Chi-square test, and when applicable, Fisher's exact test were used for comparisons between groups. Multiple logistic regression was performed to identify factors associated with belonging to the group unable to complete the single-limb stance test on the force-platform. Results Fourteen of the 54 patients (26% did not manage to complete the single-limb stance test on the force-platform, whereas all controls managed this (p Conclusion One in four patients operated on because of an ankle fracture had impaired postural control compared to an age- and gender-matched control group. Age over 45 years and decreased strength in the ankle plantar flexors and dorsiflexors

  16. 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) ...

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

    Science.gov (United States)

    2013-11-15

    ...: 2900--NEW (Ankle Conditions Disability Benefits Questionnaire). Type of Review: New data collection... Conditions Disability Benefits Questionnaire) Under OMB Review AGENCY: Veterans Benefits Administration...-- NEW (Ankle Conditions Disability Benefits Questionnaire)'' in any correspondence. FOR FURTHER...

  18. Original Paper Treatment and Outcome of Ankle Fractures at the Moi ...

    African Journals Online (AJOL)

    KIGZ

    Key Words: Ankle fractures, Treatment outcome, Developing country ... protocols, surgeons still face unfavorable treatment outcomes. The injury .... and require special tests like Magnetic Resonance Imaging, ankle arthroscopy and nerve.

  19. What Causes Ankle Swelling During Pregnancy - And What Can I do About it?

    Science.gov (United States)

    ... the ankles or calves. Some research suggests that foot massage and reflexology, which involves applying pressure to certain areas of the feet, hands and ears, might help decrease foot and ankle swelling during pregnancy. Also, swelling doesn' ...

  20. Comparison of Compressive Myofascial Release and the Graston Technique for Improving Ankle-Dorsiflexion Range of Motion.

    Science.gov (United States)

    Stanek, Justin; Sullivan, Taylor; Davis, Samantha

    2018-02-01

      Restricted dorsiflexion (DF) at the ankle joint can cause acute and chronic injuries at the ankle and knee. Myofascial release and instrument-assisted soft tissue mobilization (IASTM) techniques have been used to increase range of motion (ROM); however, evidence directly comparing their effectiveness is limited.   To compare the effects of a single session of compressive myofascial release (CMR) or IASTM using the Graston Technique (GT) on closed chain ankle-DF ROM.   Randomized controlled trial.   Laboratory.   Participants were 44 physically active people (53 limbs) with less than 30° of DF.   Limbs were randomly assigned to 1 of 3 groups: control, CMR, or GT. Both treatment groups received one 5-minute treatment that included scanning the area and treating specific restrictions. The control group sat for 5 minutes before measurements were retaken.   Standing and kneeling ankle DF were measured before and immediately after treatment. Change scores were calculated for both positions, and two 1-way analyses of variance were conducted.   A difference between groups was found in the standing ( F 2,52 = 13.78, P = .001) and kneeling ( F 2,52 = 5.85, P = .01) positions. Post hoc testing showed DF improvements in the standing position after CMR compared with the GT and control groups (both P = .001). In the kneeling position, DF improved after CMR compared with the control group ( P = .005).   Compressive myofascial release increased ankle DF after a single treatment in participants with DF ROM deficits. Clinicians should consider adding CMR as a treatment intervention for patients with DF deficits.

  1. A simple model to estimate plantarflexor muscle-tendon mechanics and energetics during walking with elastic ankle exoskeletons

    Science.gov (United States)

    Sawicki, Gregory S.; Khan, Nabil S.

    2016-01-01

    Goal A recent experiment demonstrated that when humans wear unpowered elastic ankle exoskeletons with intermediate spring stiffness they can reduce their metabolic energy cost to walk by ~7%. Springs that are too compliant or too stiff have little benefit. The purpose of this study was to use modeling and simulation to explore the muscle-level mechanisms for the ‘sweet-spot’ in stiffness during exoskeleton assisted walking. Methods We developed a simple lumped, uniarticular musculoskeletal model of the plantarflexors operating in parallel with an elastic ‘exo-tendon’. Using an inverse approach with constrained kinematics and kinetics, we rapidly simulated human walking over a range of exoskeleton stiffness values and examined the underlying neuromechanics and energetics of the biological plantarflexors. Results Stiffer ankle exoskeleton springs resulted in larger decreases in plantarflexor muscle forces, activations and metabolic energy consumption. However, in the process of unloading the compliant biological muscle-tendon unit (MTU), the muscle fascicles (CE) experienced larger excursions that negatively impacted series elastic element (SEE) recoil that is characteristic of a tuned ‘catapult mechanism’. Conclusion The combination of disrupted muscle-tendon dynamics and the need to produce compensatory forces/moments to maintain overall net ankle moment invariance could explain the ‘sweet spot’ in metabolic performance at intermediate ankle exoskeleton stiffness. Future work will aim to provide experimental evidence to support the model predictions presented here using ultrasound imaging of muscle-level dynamics during walking with elastic ankle exoskeletons. Significance Engineers must account for the muscle-level effects of exoskeleton designs in order to achieve maximal performance objectives. PMID:26485350

  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. Locomotor adaptation to a powered ankle-foot orthosis depends on control method

    Directory of Open Access Journals (Sweden)

    Gordon Keith E

    2007-12-01

    Full Text Available Abstract Background We studied human locomotor adaptation to powered ankle-foot orthoses with the intent of identifying differences between two different orthosis control methods. The first orthosis control method used a footswitch to provide bang-bang control (a kinematic control and the second orthosis control method used a proportional myoelectric signal from the soleus (a physiological control. Both controllers activated an artificial pneumatic muscle providing plantar flexion torque. Methods Subjects walked on a treadmill for two thirty-minute sessions spaced three days apart under either footswitch control (n = 6 or myoelectric control (n = 6. We recorded lower limb electromyography (EMG, joint kinematics, and orthosis kinetics. We compared stance phase EMG amplitudes, correlation of joint angle patterns, and mechanical work performed by the powered orthosis between the two controllers over time. Results During steady state at the end of the second session, subjects using proportional myoelectric control had much lower soleus and gastrocnemius activation than the subjects using footswitch control. The substantial decrease in triceps surae recruitment allowed the proportional myoelectric control subjects to walk with ankle kinematics close to normal and reduce negative work performed by the orthosis. The footswitch control subjects walked with substantially perturbed ankle kinematics and performed more negative work with the orthosis. Conclusion These results provide evidence that the choice of orthosis control method can greatly alter how humans adapt to powered orthosis assistance during walking. Specifically, proportional myoelectric control results in larger reductions in muscle activation and gait kinematics more similar to normal compared to footswitch control.

  4. Ankle manual therapy for individuals with post-acute ankle sprains: description of a randomized, placebo-controlled clinical trial.

    Science.gov (United States)

    Davenport, Todd E; Kulig, Kornelia; Fisher, Beth E

    2010-10-19

    Ankle sprains are common within the general population and can result in prolonged disablement. Limited talocrural dorsiflexion range of motion (DF ROM) is a common consequence of ankle sprain. Limited talocrural DF ROM may contribute to persistent symptoms, disability, and an elevated risk for re-injury. As a result, many health care practitioners use hands-on passive procedures with the intention of improving talocrural joint DF ROM in individuals following ankle sprains. Dosage of passive hands-on procedures involves a continuum of treatment speeds. Recent evidence suggests both slow- and fast-speed treatments may be effective to address disablement following ankle s