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At least 199 records · Page 11Linked to original sources
PubMed1977

Ankle arthrography and ankle distortion.

A ligament rupture is found in some 60% of patients with ankle distortion. The rupture usually involves the anterior talofibular ligament, and there may be associated ruptures of other ankle ligaments. Clinical findings and conventional radiological examination (including stress exposures) are insufficiently reliable for demonstration or exclusion of a ligament lesion. Ankle arthography is a relatively simple method of investigation; interpretation of the images obtained is generally no problem. Surgical exploration has nearly always confirmed the arthrographic diagnosis 'ligament lesion'.

Ankle Injuries↗
PubMed1993

An ankle protocol for second-degree ankle sprains.

Returning to full activity is of primary concern for the injured patient with a second-degree ankle sprain. This is especially true of a member of the United States Marine Corps. Unfortunately, many patients are not referred to physical therapy for comprehensive management of acute ankle sprains. An ankle protocol based on previous clinical experience was developed which included an acute and rehabilitative phase. An air stirrup orthosis was used as an adjunct to therapy to resume activities safely. This combination allowed Marines to return to full duty in less than 2 weeks.

Adolescent↗
PubMed1993

A system for the continuous measurement of ankle joint moment in hemiplegic patients wearing ankle-foot orthoses.

Plastic ankle-foot orthoses (PAFOs) are now commonly used in clinical practice to supplement the gait disabilities of hemiplegic patients. However, few biomechanical investigation have been performed to analyze the corrective functions of PAFOs. In this paper, a measuring system was developed to assess the effect of dorsi/plantar flexibility of a PAFO on patient's gait. First, a mathematical model of gait with a PAFO was established so that the overall ankle joint moment can be separated into the muscle moment and the corrective moment generated by a PAFO. An experimental AFO, which simulates PAFOs, was specially designed and fabricated to continuously measure the corrective moment of the experimental AFO during gait. A device was also developed to continuously measure the overall ankle joint moment, so that the muscle moment can be estimated from the data obtained by the two devices. The measurement accuracy of the device was evaluated using gait data of eight healthy subjects who simulated hemiplegic gait. The range of the mean +/- 1 SD of the errors, calculated for the eight subjects, fell within +/- 5 Nm, which well compares with the error of commonly used comprehensive gait analysis systems.

Adult↗
PubMed1996

[Functional therapy using a laced ankle brace in supination trauma of the ankle joint with lesions of the capsule-ligament apparatus].

Based on the results of comparable studies, patients of the Kantonsspital Liestal, who had sustained injuries of the lateral capsulo-ligamentous structures of the ankle are treated with early functional therapy. Osseous lesions are excluded prior for treatment. Since 1990 a special ankle brace with laces is used. A standardised questionnaire was developed for follow-up. Subjects of interest were: the patients individual experience regarding treatment method and the patients subjective feelings regarding stability, remaining symptoms and limitations in daily activity. 89 questionnaires were returned. 91% rated the treatment as excellent or good. 15% reported a chronic instability. Only 1 patient underwent secondary reconstruction of the lateral ankle ligaments.

Adolescent↗
PubMed1998

Ankle arthrography and chronic lateral ankle instability.

Sixty-five ankle arthrograms of the patients who underwent surgical reconstruction for their chronic ankle instability from 1987 to 1995 were studied retrospectively by comparing their operative findings. There were 15 cases (23.1%) with definite positive arthrographic findings. In the remaining 50 cases (76.9%), the arthrograms showed a "tear-drop" extravasation of dye beneath the fibular tip which we called "suspectable positive". Of these all but one, which had normal ligament, proved to correspond to the operative finding. As there was only one false positive finding among our surgical cases with both the "definite" and "suspectable" positive arthrograms, we concluded that ankle arthrography is relatively reliable and may be worth doing even in chronic cases if only for reference. Even when other diagnostic methods are negative, arthrography might help surgeons make surgical decisions in clinical symptomatic cases.

Adolescent↗
PubMedDate not supplied

The effects of ankle-foot orthoses on the ankle and knee in persons with myelomeningocele: an evaluation using three-dimensional gait analysis.

The purpose of this study was to determine the effects of the ankle-foot orthosis (AFO) on gait patterns in patients with low-level myelomeningocele and to identify any abnormal gait patterns that may lead to future knee instability and pain. A total of 28 children (26 L4-level sides, 18 L5-level sides, and 10 S1-2-level sides) underwent a three-dimensional gait analysis when ambulating barefoot and with AFOs. Results show significant improvements in sagittal plane function with reductions in excessive ankle dorsiflexion, increases in peak plantar flexor moment, and reductions in crouch and knee extensor moment in the L4 and L5 groups. The only improvement in the S1-2 group was a reduction in excessive dorsiflexion, but there was a reduction in power generation at the ankle. The S1-2 group had normal transverse plane knee motion in stance during barefoot walking that increased significantly (p < 0.01) with the AFO. Both the L5 and L4 groups showed greater-than-normal transverse plane knee motion in stance during barefoot walking that also increased significantly (p < 0.01) with the AFO. The results suggest that excessive knee transverse plane rotation may contribute to knee instability more than coronal plane abnormalities. The AFO in S1-2-level patients may be more detrimental for the knee than barefoot walking.

Ankle Joint↗
PubMed1994

Segmental reflexes and ankle joint stiffness during co-contraction of antagonistic ankle muscles in man.

The size of soleus H-reflexes and short-latency stretch reflexes was measured at different levels of plantar flexion or co-contraction (simultaneous activation of dorsi- and plantar flexors) in seven healthy subjects. In four of seven subjects the short-latency stretch reflex was smaller during weak co-contraction than during isolated plantar flexion at matched background electromyogram (EMG) levels in the soleus muscle. In three of these four subjects the stretch reflex was larger during strong co-contraction than during plantar flexion, whereas it had the same size during the two tasks in the last subject. In the remaining subjects the stretch reflex either had the same size or was larger at all levels of co-contraction than at similar levels of plantar flexion. In contrast, the H-reflex was found to decrease with co-contraction at all contraction levels in all subjects. The decrease in the reflexes during weak co-contraction might be caused by presynaptic inhibition of Ia afferents. It is unclear why only the H-reflex decreased during strong co-contraction. The stiffness of the ankle joint was measured from the torque increment following the stretch of the plantar flexors divided by the stretch amplitude. In all subjects the total stiffness of the ankle joint was larger during strong co-contraction than during plantar flexion of similar strength. The stiffness was smaller during weak co-contraction than during weak plantar flexion in three out of seven subjects.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMed1995

The role of external nonrigid ankle bracing in limiting ankle inversion.

The purpose of this study was to measure the effectiveness of the nonrigid subtalar stabilizer (STS) ankle brace under conditions similar to an unexpected fall that could lead to a lateral ligament injury. The calcaneal inversion angles, times, and ground reaction forces were measured when the subject's right foot, bearing body weight, was suddenly inverted to a side slope of 22 degrees. Thirty subjects, 15 women and 15 men, participated in the study. The overall inversion drop was divided into two phases, free fall and loading. Based on the data of this study it is suggested that the major function of a brace is to restrict the amount of foot inversion during the fall before actual landing occurs rather than functioning as a force bypass for the lateral ligaments during loading after foot contact. The results showed that the brace significantly (p < 0.05) reduced the maximum calcaneal inversion angle from 27.4 +/- 6.1 to 18.3 +/- 6.0 degrees for the overall drop, significantly lengthened the inversion time from 0.14 +/- 0.04 to 0.18 +/- 0.04 s for the overall drop, and significantly reduced the calcaneal peak inversion velocity from 324.6 +/- 111.9 to 165.2 +/- 66.5 degrees/s during loading, and from 278.7 +/- 120.0 to 183.0 +/- 108.7 degrees/s for the overall drop. Following exercise, which incorporated lateral movements and sprinting, the STS ankle brace continued to provide significant (p < 0.05) reduction in the calcaneal inversion angle and velocity, although some of its effectiveness was reduced.(ABSTRACT TRUNCATED AT 250 WORDS)

Accidental Falls↗
PubMed1996

Chronic ankle pain in soldiers: the role of ankle arthroscopy and soft tissue excision.

We describe 13 cases of soft tissue impingement in the ankle by localized synovial proliferation and scar tissue. A number of papers have described symptomatic improvement in sportsmen who have undergone resection of this tissue. We report the results of this procedure in Army personnel. Of the 13 patients, 8 had excellent or good results, while 5 had poor results. Two of the latter subsequently revealed another significant problem and were then excluded, thus 8 out of 11 patients had an excellent or good result. We therefore believe that this procedure is useful in the management of chronic ankle pain in Army personnel.

Adult↗
PubMedDate not supplied

A randomized controlled trial of piroxicam in the management of acute ankle sprain in Australian Regular Army recruits. The Kapooka Ankle Sprain Study.

Three hundred sixty-four Australian Regular Army recruits with acute ankle sprains sustained during training were randomized to treatment with either piroxicam or placebo. Compared with the placebo group, subjects treated with piroxicam had less pain, were able to resume training more rapidly, were treated at lower cost, and were found to have increased exercise endurance on resumption of activity. Nausea was the only side effect reported significantly more often in the treatment group than in the placebo group (6.8% versus 0.3%). Interestingly, subjects treated with piroxicam showed some evidence of local abnormalities such as instability and reduced range of movement. We conclude that nonsteroidal antiinflammatory agents should form an integral part of the treatment of acute ankle sprains.

Acute Disease↗
PubMed2001

The role of ankle arthroscopy on the surgical management of ankle fractures.

Nineteen patients were prospectively randomized for operative treatment of their ankle fracture to be supplemented with or without ankle arthroscopy. All patients had an SER or PER fracture with an intact medial malleolus requiring operative treatment without evidence of intra-articular debris preoperatively. All patients underwent plate fixation of their fibula fracture and had a similar postoperative protocol. Ten patients were randomized to the control group with plate fixation only and nine patients randomized to the plate fixation plus operative arthroscopy. The average follow-up was 21 months. The arthroscopic examination of the study group revealed eight of the nine patients to have articular damage to the dome of the talus. Minimal arthroscopic treatment of these joints was required. All patients healed their fractures. No difference was noted between SF-36 scores or lower extremity scores between the two groups. At short-term follow-up, it does not appear that the arthroscopic procedure will impact upon the patient's eventual outcome in this small group of patients.

Ankle Injuries↗
PubMed1983

Experimental ankle injuries. Analysis of the traumatology of the ankle ligaments.

On 32 osteoligamentous ankle preparations forced movements were performed in varying, accurately defined directions. The sequence in which this caused rupture of the individual ligamentous structures of the ankle is described. Dorsiflexion traumas predominantly injured the posterior part of the deltoid ligament, while in plantar flexion traumas the injuries primarily involved the anterior capsule and the anterior talofibular ligament. Internal rotation traumas injured the anterior talofibular ligament and the short, anterior fibres of the posterior talofibular ligament before the calcaneofibular ligament was damaged, whereas in adduction traumas the calcaneofibular ligament ruptured first. Forced external rotation primarily caused rupture of the deep structures of the deltoid ligament, while conversely abduction traumas first caused rupture of the superficial part of this ligament.

Ankle Injuries↗
PubMed2005

The physiological response of ankle systolic blood pressure and ankle to brachial index after maximal exercise in athletes is dependent on age.

The development of sports activities in the over forties has increased the number of middle-aged patients performing heavy-load exercise. The normal response of ankle systolic blood pressure (ASBP) and ankle to brachial index (ABI) to intense exercise is known in young athletes, but little is known for other age groups. Three groups of 21 athletes: <20 (G1), 20-40 (G2), and >40 (G3) years old, respectively, were studied. ASBP and brachial systolic blood pressure (BSBP) were measured simultaneously before and after an incremental maximal cycle ergometer test. Rest ABI was higher in G3 compared to G1 (P<0.001: ANOVA, Bonferroni). Compared to respective resting values, BSBP, at 1 min of recovery, was increased for the three groups of age (P<0.001) whereas ASBP was unchanged for G1 and G2, and significantly increased for G3 (P<0.001). ASBP was significantly higher in G3 than in G1 and G2, ABI was lower in G1 and G2 compared to G3: 0.70+/-0.11, 0.76+/-0.09 and 0.91+/-0.14, respectively. This age-related ABI increase is consistent with the impaired vasodilator capacity observed in aging normal subjects but not with the decrease observed in ABI resting values in epidemiological studies. ABI is higher in older than in younger athletes at rest and after exercise. In aging athletes, aiming to detect mild to moderate arterial lesions, it is likely that normal limits defined in young athletes are not valid.

Adolescent↗
PubMed2006

The effect of custom-made braces for the ankle and hindfoot on ankle and foot kinematics and ground reaction forces.

OBJECTIVE: To assess the effects on gait of custom-made polypropylene orthoses: ankle-foot orthosis (AFO), rigid hindfoot orthosis (HFO-R), and articulated hindfoot orthosis (HFO-A). DESIGN: Experimental assessment. SETTING: Institutional practice, motion analysis laboratory. PARTICIPANTS: Twenty asymptomatic normative subjects. INTERVENTIONS: Not applicable. MAIN OUTCOME MEASURES: Three-dimensional kinematics, ground reaction force, and time-related factors in 4 conditions: shoe only, and shod with the AFO, HFO-R, and HFO-A. RESULTS: The AFO and HFO-R limited sagittal and coronal plane ankle-hindfoot motion. The HFO-A limited hindfoot coronal motion while allowing normal sagittal motion. At the midfoot, the AFO and HFO-A limited transverse motion, but the HFO-A also limited sagittal and coronal motion. Use of the HFO-R resulted in exaggerated midfoot sagittal and coronal motion. Braces that limited motion to a greater degree were associated with more atypical kinetic variables, indicative of less dynamic gait. The HFO-A resulted in ground reaction forces most similar to unbraced conditions. CONCLUSIONS: Alteration in gait was affected by orthosis design. Orthoses with a rigid component crossing a joint restricted motion at that joint, but potentially compromised typical gait kinetic factors. For immobilizing the hindfoot, the HFO-A may be more comfortable and still provide more stability than the HFO-R or AFO.

Adult↗
PubMed2005

Impact of brachial-ankle pulse wave velocity and ankle-brachial blood pressure index on mortality in hemodialysis patients.

BACKGROUND: Pulse wave velocity (PWV) and ankle-brachial blood pressure index (ABPI) are markers for atherosclerosis, and each predicts mortality in patients undergoing hemodialysis. However, there have been no studies in the past that compared head-to-head the clinical validity of these 2 parameters. Compared with conventional aortic PWV, brachial-ankle PWV (baPWV) is considered simple and thereby easily applicable to clinical use. METHODS: To clarify the relationship between baPWV and ABPI and assess their prognostic values, we analyzed 785 hemodialysis patients with a mean age of 60.2 +/- 12.5 (SD) years for whom ABPI and baPWV at baseline had been measured simultaneously and who were followed up for 33.8 +/- 10.8 months. RESULTS: Of 785 patients, 131 deaths were recorded. In Kaplan-Meier analysis, all-cause mortality was progressively and significantly greater from the lowest quartile of baPWV onward (log-rank test, 41.8; P < 0.001). However, in Cox proportional hazards analysis, the impact of baPWV was insignificant when ABPI was included as a covariate. ABPI maintained strong predictive power in this model. When patients who had advanced peripheral arterial occlusive disease (ABPI < 0.9) were excluded from analysis, patients with the highest quartile of baPWV had significantly increased hazard ratios of all-cause (hazard ratio, 4.08; 95% confidence interval, 1.46 to 11.43; P < 0.007) and cardiovascular (hazard ratio, 7.03; 95% confidence interval, 1.49 to 33.08; P < 0.014) mortality. The predictive power of baPWV in this population was independent from other covariates associated with atherosclerotic disorders. CONCLUSION: In a head-to-head comparison, ABPI, but not baPWV, showed strong power in predicting the mortality of hemodialysis patients. However, baPWV was useful to pick a high-risk population in patients with ABPI greater than 0.9. Thus, screening hemodialysis patients by means of baPWV and ABPI provides complementary information in identifying a high-risk population.

Adult↗
PubMed2000

A case-control study of the transit times through an accident and emergency department of ankle injured patients assessed using the Ottawa Ankle Rules.

This paper reports part of a larger study of 354 consecutive attendances to an Accident and Emergency department by patients with ankle injuries. One hundred and ninety-nine patients met the criteria for inclusion in this study. The case study group (n =79) were those patients assessed by a nurse practitioner who had been trained in, and had authority to use of the Ottawa Ankle Rules (OAR) and were referred for radiographs from triage assessment. The control group (initially 120) consisted of those patients who were assessed by nurses who were not trained to be nurse practitioners and were not empowered to use the OAR but were sent for radiographs when assessed at the treatment stage. Sixteen patients were excluded from the study due to missing time data, reducing the control group to 104 patients. Previous studies have suggested that reductions in transit times through the department can be achieved by empowering nurses to request radiographs at the time of initial assessment, although these studies did not look specifically at the application of the OAR. Significant reductions in transit time are demonstrated for those patients who are required to have an X-ray to confirm a diagnosis if this is requested at the time of the triage assessment by nurse practitioners.

Adolescent↗
PubMed1977

Treatment of ankle sprains with joint aspiration, xylocaine infiltration, and early mobilization. Ankle sprains treated with xylocaine infiltration and early mobilization.

Ninety-nine ankle sprains were arbitrarily divided into a control (54 patients) and a study (45 patients) group. Both groups were treated with elevation, ice compression wraps crutches, and early mobilization. In addition, the study group underwent ankle joint aspiration and local injection of the involved ligaments with 4-10 cc of 1% xylocaine. The difference between recovery times in the control group (mean, 10.7 days) and in the study group (mean, 4.4 days) reached statistical significance at p less than 0.001 by Wilcoxon two-sample test. Because there are inherent risks in this treatment, it is not recommended for all patients. However, for those requiring early remission of symptoms to allow early return to pre-injury activities, this treatment is suggested by the author.

Adult↗