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PubMed · 15544834

Ankle problems masquerading as sprains.

Kim Edward LeBlanc
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Abstract

The most common ankle injury is a ligamentous sprain, usually involving the lateral side. This is usually treated very successfully with conservative management. Those patients who have continued complaints despite such management should be suspected of having something more than a simple sprain. The diagnostic entities discussed herein should always be part of the differential diagnosis of a sprained ankle, so that when one of these injuries is initially missed, the examining physician will be able to re-examine and eventually diagnose and treat these injuries properly. They should be managed appropriately as soon as possible for the best outcome. Needless delays should be avoided.

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AnkleCalcaneusFractures, BoneHumansMagnetic Resonance ImagingSprains and StrainsTalusTarsal BonesTomography, X-Ray ComputedJournal Article

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BibTeXRIS

Kim Edward LeBlanc. 2004. Ankle problems masquerading as sprains.. https://doi.org/10.1016/j.pop.2004.07.010

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Low ankle-brachial index associated with rise in creatinine level over time: results from the atherosclerosis risk in communities study.

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PubMed2005

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Dialysis patients have severe exercise limitations related to metabolic disturbances, but muscle fatigue has not been well studied in this population. We investigated the magnitude and mechanisms of fatigue of the ankle dorsiflexor muscles in patients on maintenance hemodialysis. Thirty-three dialysis patients and twelve healthy control subjects performed incremental isometric dorsiflexion exercise, beginning at 10% of their maximal voluntary contraction (MVC) and increasing by 10% every 2 min. Muscle fatigue (fall of MVC), completeness of voluntary activation, and metabolic responses to exercise were measured. Before exercise, dialysis subjects exhibited reduced strength and impaired peripheral activation (lower compound muscle activation potential amplitude) but no metabolic perturbation. During exercise, dialysis subjects demonstrated threefold greater fatigue than controls with evidence of central activation failure but no change in peripheral activation. All metabolic parameters were significantly more perturbed at end exercise in dialysis subjects than in controls, including lower phosphocreatine (PCr) and pH, and higher P(i), P(i)/PCr, and H(2)PO(4)(-). Oxidative potential was markedly lower in patients than in controls [62.5 (SD 27.2) vs. 134.6 (SD 31.7), P < 0.0001]. Muscle fatigue was negatively correlated with oxidative potential among dialysis subjects (r = -0.52, P = 0.04) but not controls. Changes in central activation ratio were also correlated with muscle fatigue in the dialysis subjects (r = 0.59, P = 0.001) but not the controls. This study provides new information regarding the excessive muscular fatigue of dialysis patients and demonstrates that the mechanisms of this fatigue include both intramuscular energy metabolism and central activation failure.

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PubMed2005

Sensitivity and specificity of the ankle-brachial index to predict future cardiovascular outcomes: a systematic review.

OBJECTIVE: The ankle-brachial index is the ratio of the ankle and the brachial systolic blood pressure and is used to assess individuals with peripheral arterial disease. An ankle-brachial index <0.90 suggests the presence of peripheral arterial disease and is a marker of cardiovascular risk. The objective of this review is to determine the sensitivity and specificity of an ankle-brachial index <0.90 to predict future cardiovascular events, including coronary heart disease, stroke, and death. METHODS AND RESULTS: We conducted a systematic review of the literature and included studies that used an ankle-brachial index cutoff between 0.80 and 0.90 to classify patients with or without peripheral arterial disease, followed patients prospectively, and recorded cardiovascular outcomes (ie, myocardial infarction, stroke, or mortality). Data were combined using a random-effects model meta-analysis to determine the sensitivity, specificity, relative risks, and likelihood ratios of a low ankle-brachial index to predict future cardiovascular disease. A total of 22 studies were identified, 13 were excluded, and 9 studies were included in the meta-analysis. The sensitivity and specificity of a low ankle-brachial index to predict incident coronary heart diseases were 16.5% and 92.7%, for incident stroke were 16.0% and 92.2%, and for cardiovascular mortality were 41.0% and 87.9%, respectively. The corresponding positive likelihood ratios were 2.53 (95% CI, 1.45 to 4.40) for coronary heart disease, 2.45 (95% CI, 1.76 to 3.41) for stroke, and 5.61 (95% CI, 3.45 to 9.13) for cardiovascular death. CONCLUSIONS: The specificity of a low ankle-brachial index to predict future cardiovascular outcomes is high, but its sensitivity is low. The ankle-brachial index should become part of the vascular risk assessment among selected individuals.

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