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PubMed2000

Arthrography of the foot and ankle. Ankle and subtalar joint.

Arthrography is the intra-articular injection of contrast media. This article reviews the normal and pathologic findings of standard arthrography and MR imaging arthrography of the ankle and subtalar joint. Standard arthrography is used primarily after acute ankle sprains, whereas MR imaging arthrography is used for staging and detecting osteochondritis dissecans of the talus, anterolateral soft tissue impingement, and chronic lateral ankle instability.

Ankle Injuries↗
PubMed1991

Early local experience of ankle arthrography and its influence on management of patients with ankle injury.

Ankle arthrography was performed on 64 patients with a history of ankle injury from 21 January 1986 to 11 October 1988. There was a male predominance in the ratio of 15 to 1 and the mean age of our patients was 22 years. A total of 65 arthrograms were obtained as one patient had bilateral ankle arthrograms. Of these, 29 arthrograms were normal. A year after completing this study, we attempted to retrieve our patients' case-notes and reviewed their subsequent management. Our results showed that multiple factors influenced the further management of our patients and arthrogram did play a role in this respect.

Adolescent↗
PubMed1981

Irreducible fracture-dislocations of the ankle associated with interposition of the tibialis posterior tendon: case report and review of the literature of a specific ankle fracture syndrome.

A severe closed pronation-eversion fracture-dislocation of the ankle that was irreducible by closed means was encountered. Exploration to accomplish open reduction revealed displacement of the tibialis posterior tendon through the diastasis between the distal tibia and fibula. The tibialis posterior tendon was found to pass posteriorly to an anteriorly between the distal tibia and fibula and laterally to medially across the anterior surfaces of the distal tibia and neck of the talus. Reduction was blocked by the tibialis posterior tendon in its abnormal course. After replacement of the tibialis posterior tendon in its anatomic position, reduction was accomplished. Internal fixation was then performed uneventfully. Two previous similar cases of irreducible ankle fractures due to displacement of the tibialis posterior tendon through the diastasis between the distal tibia and fibula have been reported in the literature. This uncommon syndrome is reported as a possible etiology to be considered when failure of reduction of an ankle fracture is encountered.

Adult↗
PubMed2006

Reconstruction of the lateral ankle ligaments with allograft in patients with chronic ankle instability.

The management of chronic lateral instability of the ankle remains controversial. In general, the anterior talofibular ligament (ATFL) must be reconstructed in all patients. Some will also need reconstruction of the calcaneofibular ligament (CFL) (or its function) to regain stability of both the ankle and the subtalar joints, and to avoid recurrence of instability. After reconstruction, most authors report good to excellent results in 80% to 85% of patients. We describe the augmented reconstruction technique of ATFL and CFL with a semitendinosus tendon allograft through a peroneal bone tunnel fixed with biodegradable anchors, and advocate this procedure as a safe, effective method to manage lateral ankle instability.

Chronic Disease↗
PubMed2005

Best reproducibility of the ankle-arm index was calculated using Doppler and dividing highest ankle pressure by highest arm pressure.

BACKGROUND AND OBJECTIVE: To investigate which method of ankle-arm index (AAI) measurement in terms of selected arteries and blood pressure devices yields the highest reproducibility. STUDY DESIGN AND SETTING: In this cross-sectional study, duplicate AAI measurements were obtained at the right and left side in 320 postmenopausal women. Analyses were done as proposed by Bland and Altman and intraclass correlation coefficients were calculated. RESULTS: The mean and standard deviation (SD) of the first and second systolic blood pressure (SBP) measurement separately did not differ from the mean and SD of the duplicate SBP measurements averaged. Coefficients of repeatability and intraclass correlation coefficients were comparable when the ankle SBP was measured in the posterior tibial artery or dorsalis pedis artery. Coefficients of repeatability as well as the intraclass correlation were better when the SBP in the brachial artery was measured with Doppler than with Dinamap. CONCLUSIONS: To achieve the best reproducibility and smallest systematic difference in the AAI, single SBP measurements should be obtained by Doppler in the brachial artery, posterior tibial artery and dorsalis pedis artery. The AAI should be calculated for each foot separately by dividing the highest ankle SBP by the highest arm SBP.

Aged↗
PubMed1999

Comparison of current local practice and the Ottawa Ankle Rules to determine the need for radiography in acute ankle injury.

Ankle injuries are a frequent cause of attendance to accident and emergency (A&E) departments. Although often classed as 'minor injuries', the consequences of mismanagement can be debilitating for patients. In addition, it is not always easy to differentiate those injuries with bony fractures from solely ligamentous injuries, and most patients are radiographed unnecessarily. Clinical prediction rules such as the Ottawa Ankle Rules have been devised to reduce the degree of radiographic requests, thus limiting harmful radiation exposure, and reducing departmental costs. The A&E environment of our centre often includes a variety of clinicians with little pure orthopaedic training or knowledge of these clinical prediction rules, hence, providing a prime atmosphere for their assessing their effectiveness. A prospective study was performed in our centre to investigate the validity of the clinician's decision in diagnosis of a bony injury in the absence of training with the Ottawa Ankle Rules. The effectiveness of applying the rules was then determined on the same set of patients.

Acute Disease↗
PubMed2001

Quantitative EMG analysis to investigate synergistic coactivation of ankle and knee muscles during isokinetic ankle movement. Part 2: time frequency analysis.

Fundamental to intralimb coordination in the lower extremity, ankle-knee synergy induced by motor irradiation has long been employed to secure facilitation of paralyzed muscles. This study, a companion research subsequent to the time amplitude analysis of surface electromyography in part 1, was to investigate the recruitment strategy of irradiated muscles and prime movers during ankle isokinetic contraction at different contraction speeds (30, 60, 120 and 240 degrees/s) with time frequency analysis. The results indicated the recruitment strategies of the major irradiated muscles (ipsilateral rectus femoris/ipsilateral biceps femoris) and prime movers (anterior tibialis/gastrocnemius) were time-dependent and significantly different in terms of the instantaneous median frequency. In general, the prime movers for ankle isokinetic concentric contraction demonstrated a similar recruitment strategy, irrespective of different contraction speeds. This finding is consistent with the idea of generalized motor programs that speed is one of the constraint parameters supplied to motor programs. Nevertheless, the recruitment strategies of the irradiated muscles were highly inconsistent, varying across trials at different contraction speeds, and were not relevant to those of the prime movers. In addition, the recruitment in the irradiated muscles seemly limited to motor units of low threshold, in spite of maximal voluntary contraction of the prime movers.

Adult↗
PubMed2000

Nurse practitioners and the Ottawa Ankle Rules: comparisons with medical staff in requesting X-rays for ankle injured patients.

This paper reports on part of a study of 354 consecutive attendances to an Accident and Emergency (A&E) department by patients with ankle injuries. The aim of this study was to examine the percentage of X-ray photographs requested by nurse practitioners compared to those requested by medical practitioners. The study took place in an A&E department where nurse practitioners have the authority to request X-rays photographs for ankle injuries, either at triage assessment or at the subsequent treatment stage. Nurse practitioners applied the Ottawa Ankle Rules (OAR) in 187 patients. The results show that nurse practitioners requested X-rays for 61.5% of patients assessed using the OAR. This is compared with 80.4% for patients assessed by medical practitioners. The difference is highly significant. Detection rates show that fractures were identified in 29.6% of patients sent for X-ray by nurse practitioners compared with 22.8% in patients seen by medical practitioners, although this difference is not significant. Although nurse practitioners applied the OAR appropriately in all 187 cases, four patients who were assessed by nurse practitioners and judged not to need an X-ray photograph were subsequently found to have a fracture.

Ankle Injuries↗
PubMed2002

Ankle-foot orthosis has limited effect on walking test parameters among patients with peripheral ankle dorsiflexor paresis.

The aim of this study was to determine the relationship between ankle dorsiflexor strength and performances on several walking tests and to determine the effect of ankle-foot orthosis (AFO) use on walking tests. The following tests were used: 10-metre walking test (with and without three stairs), a complex walking task (6-minute walk with cognitive loading) and a subjective evaluation (SIP68 mobility scale and questionnaire). Isometric strength of the ankle dorsiflexors was measured. All walking tests were performed with and without AFO in random order. When relating torque values to walking performances, the highest correlation was found with the "10 metre" and "10 metre with stairs" test (r = -0.51, i.e. an inverse relationship). No threshold in the degree of paresis was found below which walking disability suddenly increased. No significant improvement could be demonstrated from AFO use on the 10-metre tests. Improvement on the 6-minute test was nearly significant (p = 0.06), the questionnaire revealed a positive opinion on AFO use related to overall walking function and effort. Thus, we have to conclude that these walking tests do not aid the clinician in estimating the severity of (progression of) the paresis nor to detect differences in degree of paresis between subjects.

Adult↗
PubMed1999

Ankle effusions following acute ankle injury.

We prospectively studied 56 patients with an acute ankle injury and an effusion to determine the significance of the ankle effusion to functional outcome. The average size of effusion was 15 mm. Most injuries occurred following a fall (73%) and most (73%) were inversion injuries. At 6 months all but two patients had returned to their normal activities with no further problems. No correlation was found with size of effusion and the functional and clinical outcome. We conclude that an ankle effusion does not reliably distinguish which injuries require further investigations and unless there are clinical indications further investigations are not indicated.

Acute Disease↗
PubMed2003

Pirogoff ankle disarticulation as an option for ankle disarticulation.

Eleven patients (12 ankles) who had Pirogoff ankle disarticulation were followed up for an average of 5.6 years (range, 2.1-8.9 years). After disarticulation of the Chopart joint, the talus was removed and the calcaneus was cut off in the coronal plane. The heel then was rotated 90 degrees to the tibial plafond. The postoperative result was evaluated using a scoring sheet. Excellent results were seen in four feet: two in patients with trauma, one in a patient with a metastatic tumor, and one in a patient with osteomyelitis. Good results were seen in two feet: one in a patient with trauma and one in a patient with diabetes mellitus. A fair result was seen in one foot in a patient with diabetes mellitus. Poor results were seen in four feet in three patients with arteriosclerosis and one foot in a patient with diabetes mellitus. In Pirogoff ankle disarticulation, the leg-length discrepancy is compensated for by using the calcaneus. The patients only had a leg-length discrepancy of 2.8 cm on average, which enabled them to walk outdoors wearing only a shoe orthosis. The postoperative results were unfavorable in patients with vascular diseases and were satisfying in patients without vascular diseases.

Adolescent↗
PubMed1992

Controlled trial of an ankle support (Malleotrain) in acute ankle injuries.

A randomized, controlled parallel-group trial has assessed 14 days' use of a new ankle support (Malleotrain, Bauerfeind, Aldershot, UK) in 220 patients (118 Malleotrain, 102 control group) with acute ankle injuries. Self-assessed pain levels were significantly lower in the group using Malleotrain at the end of the trial (P less than 0.05), as were median times taken for reduction of symptom scores to 10% (P less than 0.05) and total analgesic consumption during the trial (P less than 0.05). Overall clinical assessment scores were significantly superior in the Malleotrain group (P less than 0.02). Of those patients who received Malleotrain, 112 of 116 patients who commented (95% of all Malleotrain-treated patients) did so positively and only one patient stopped wearing the support during the trial. Malleotrain is acceptable to patients with acute ankle injuries and its use increases the rate of alleviation of symptoms. Its use should therefore be considered in the management of all such patients.

Acute Disease↗
PubMed2003

Current treatment options for ankle injuries: lateral ankle sprain, Achilles tendonitis, and Achilles rupture.

The ankle is the site of many sports-related injuries. There is, however, continued debate over which treatment strategies are most effective for various conditions. This article reviews the relevant literature from the past year to shed some light on the ongoing controversy regarding the best treatment options along the treatment continuum, from conservative to operative management, for three common ankle conditions: lateral ankle sprains, Achilles tendonitis, and Achilles tendon rupture.

Achilles Tendon↗
PubMed2005

Cut-off value of the ankle-brachial pressure index at which the accuracy of brachial-ankle pulse wave velocity measurement is diminished.

BACKGROUND: The present study was conducted to establish the cutoff value of the ankle-brachial pressure index (ABI) at which the accuracy of brachial-ankle pulse wave velocity (baPWV) measurement is diminished. METHODS AND RESULTS: The baPWV and ABI were measured in 1,361 patients with an atherosclerosis-related disease and 7,889 subjects without any atherosclerotic risk factors, in order to determine the percent difference of the brachial-ankle PWV (%baPWV), the angle of the rise of the anacrotic limb (%angle) and of the amplitude of the entire waveform (%amplitude) in both sides. The %angle and %amplitude were significantly higher in subjects whose %baPWV was >or=19% than in those subjects whose %baPWV was <19% (19% was the mean value+3SD of 7,889 healthy subjects). The %baPWV >or=19% was defined as the abnormal discrepancy of baPWV caused by arterial stenosis in both sides. The receiver operator characteristic curve discriminated the abnormal discrepancy of baPWV by ABI because the area under the curve was 0.86. The highest discriminating sensitivity and specificity were 91% and 75% at ABI =0.95. CONCLUSION: An ABI <0.95 seems to be the marker of diminished baPWV accuracy.

Ankle↗
PubMed2006

Ankle arthrodesis for failed total ankle replacement.

Between 1999 and 2005, 23 failed total ankle replacements were converted to arthrodeses. Three surgical techniques were used: tibiotalar arthrodesis with screw fixation, tibiotalocalcaneal arthrodesis with screw fixation, and tibiotalocalcaneal arthrodesis with an intramedullary nail. As experience was gained, the benefits and problems became apparent. Successful bony union was seen in 17 of the 23 ankles. The complication rate was higher in ankles where the loosening had caused extensive destruction of the body of the talus, usually in rheumatoid arthritis. In this situation we recommend tibiotalocalcaneal arthrodesis with an intramedullary nail. This technique can also be used when there is severe arthritic change in the subtalar joint. Arthrodesis of the tibiotalar joint alone using compression screws was generally possible in osteoarthritis because the destruction of the body of the talus was less extensive. Tibiotalocalcaneal arthrodesis fusion with compression screws has not been successful in our experience.

Adult↗
PubMed2004

A new hip-knee-ankle-foot sling: kinematic comparison with a traditional ankle-foot orthosis.

In this study, we performed a kinematic analysis of a new, low-cost sling for the lower limb, compared to a common ankle-foot orthosis (AFO). Gait with no orthosis, with the AFO, and with the new sling was analyzed in one hemiplegic subject. Both the AFO and the sling reduced the mean angle and ROM (range of movement) of the ankle and the vertical displacement of the center of mass. The sling, but not the AFO, restored the normal sequence heel-strike, forefoot contact of the affected side. The sling, but not the AFO, reduced the affected limb stance and stride duration, increased stride length, and improved walking speed. In conclusion, the proposed sling for the lower limb equally improved the affected ankle kinematics in contrast to the traditional AFO, and it also improved some gait variables in this hemiplegic subject.

Aged↗
PubMed1999

[Validation of the Ottawa ankle rules for the efficient utilization of radiographies in acute lesions of the ankle].

OBJECTIVE: To test the validity of Ottawa ankle rules (OAR) in our field. To test the agreement physician/nurse in the assessment of the patient with acute ankle injuries. DESIGN: Observational, with application of rules and prospective outcome measurement. SETTING: Hospital emergency departments. PARTICIPANTS: Adults who attended at the emergency department, suffering from a secondary ankle pain to a traumatic injury, from 1st March to 30th September, 1997. MEASUREMENTS AND MAIN RESULTS: Physicians who participated applied the OAR to the patients and asked for a control radiograph, independently from the result of rules application. 100 patients were valued by a physician and a nurse in order to measure the agreement level. Data from 564 patients were recorded, getting a global sensitivity of the OAR of 97.3% (95% CI 89.7-99.5); specificity of 33.3% (95% CI 29.5-37.3). The positive predictive value was of 15.6 (95% CI 12.4-19.3). Thanks to the application of the rules radiography would reduce by 29.5%. 74 (13.1%) patients suffered form fracture: 48 (8.5%), of the maleolar zone and 26 (4.6%) of the midfoot zone. Attending to the OAR criteria, radiographs wouldn't be necessary in two cases of fracture. CONCLUSIONS: We consider the OAR clinically valuable and useful in our field. They can help to work on the basis of uniform criteria when decisions must be taken and to use properly sanitary resources. Triage nurses can apply them.

Adult↗
PubMed1991

[Biomechanical effects of intra-articular ankle bone fractures on the ankle joint. An experimental study].

Intraarticular heelbone fractures lead to cartilage damage by way of joint surface incongruence. This causes arthrosis of the lower ankle joint. The influence of a dislocated calcaneus fracture on the upper ankle joint was documented in an experimental study on eight cadaver legs. We performed an osteotomy of the calcaneus to imitate a typical fracture, placed a pressure film into the upper ankle joint and subjected the joint to axial pressure of 850 N. Changes in contact area and pressure pattern were measured in different flexion/extension positions of the foot. Results with respect to total contact area and high-pressure contact zone are discussed.

Ankle Joint↗