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PubMed1986

Position dependence of ankle joint dynamics--I. Passive mechanics.

System identification techniques were used to examine the position dependence of passive ankle joint mechanics. The relaxed ankle was stochastically perturbed about different angles in the range of motion (ROM). The linear dynamic relation between ankle position and torque was identified and modelled as a second-order underdamped system, having inertial (I), viscous (B) and elastic (K) parameters. Mean joint torque changed as the ankle was rotated through the ROM; it was small at mid-range and became much larger toward either extreme. While I remained constant both B and K changed as a function of ankle angle. At the extremes of the ROM, K was much larger than previously assumed and the relation between stiffness and the passive torque generated when the ankle was placed at different mean positions was linear. These results show that large variations in joint mechanics are possible even in the absence of voluntary muscle contraction. Moreover, these changes appear to be related to the torque generated when passive joint structures are stretched.

Adult↗

PubMed1994

Sensory properties of ankle joint capsule mechanoreceptors in acute monoarthritic chickens.

The physiological properties of joint capsule mechanoreceptors in the ankle joint of monoarthritic chickens were studied by recording the electrical activity from single sensory afferent nerve fibres dissected from the parafibular nerve. A monoarticular arthritis was induced by the intra-articular injection of Freund's complete adjuvant which resulted in an acute inflammatory condition and a very rapid onset of destructive cartilage damage. A detailed description of the anatomy in both the normal and arthritic joints was presented. It was considered that by day 3 after adjuvant injection there was a reproducible severe destructive arthropathy which was of value for investigating the physiological responses of the joint capsule receptors. The majority of receptor units identified were slowly adapting mechanoreceptors which were divided into groups III (CV: 2.5-20 m/sec) and IV (CV: < 2.5 m/sec) units. At least 3 significant differences were observed in the response characteristics of the joint capsule receptors from arthritic joints compared to those receptors found in normal joints. Firstly, there was an increase in receptive field size with 62% of group IV and 80% of group III units having large receptive fields. Secondly, there was a decrease in response threshold to mechanical stimulation of the joint capsule. Thirdly, a higher proportion of units responded to joint movement in the arthritic joints. These changes in sensitivity of the joint capsule receptors showed some similarities to adjuvant arthritis models in the rat and provide peripheral neural evidence for the possible painful consequences of the inflammatory arthropathies found in chicken.

Acute Disease↗

PubMed1991

Long-term effects of tibial angular malunion on the knee and ankle joints.

Twenty-seven patients with 28 tibial fractures were evaluated for an average of 8.2 years (range 6.0-12.3 years) following their injuries. There were 16 closed and 12 open fractures, all of which healed uneventfully. Overall, 50% of the ankles and 75% of the knees were rated good to excellent. The patients' knee and ankle joint malalignments were extrapolated using a method previously published. This was made possible by knowing both the degree and site of angular deformity. Correlation between joint malalignments and clinical outcome were performed. Analysis showed that greater degrees of ankle malalignment produce poorer clinical results (p = 0.001). Conversely, the patients with lesser degrees of ankle joint malalignment had a higher percentage of good to excellent results (p = 0.006, p = 0.003, p = 0.03). The knee results did not correlate with the degree of joint malalignment (p = 0.82). The findings in this study show that there is merit in reducing tibial fractures as close to anatomical configuration as possible to lessen the chance of early degenerative arthritis.

Adult↗

PubMed1996

Effect of passive stretching and jogging on the series elastic muscle stiffness and range of motion of the ankle joint.

OBJECTIVE: To determine the effect of stretching and jogging on the series elastic muscle stiffness of the plantar flexors and on the range of dorsiflexion at the ankle joint. METHODS: 24 healthy subjects participated in this study. Each subject undertook all of the following protocols, in random order: (1) stretching protocol: five 30 s static stretches with 30 s rest between stretches; (2) aerobic jogging protocol: subjects ran on a treadmill for 10 min at 60% of their maximum age predicted heart rate; (3) combined protocol: subjects ran first and then stretched. A damped oscillation technique was used to measure the series elastic stiffness of the plantar flexors. Dorsiflexion of the ankle was assessed with a weights and pulley system that moved the ankle joint from a neutral position into dorsiflexion passively. Electromyography was used to monitor the activity of the plantar and dorsiflexors during these procedures. The statistical analysis of these data involved an analysis of covariance. RESULTS: For decreasing series elastic muscle stiffness running was more effective than stretching (P < 0.05). In contrast, the results for range of motion showed that the combination protocol and the stretching only protocol were more effective than the running only protocol (P < 0.05) for increasing dorsiflexion range of motion at the ankle. CONCLUSIONS: Both jogging and static stretching exercises appear to be beneficial to individuals participating in sporting activities.

Ankle Injuries↗

PubMed2003

Progressive post-traumatic ankle arthrosis treated with total ankle joint replacement: a case review.

This article discusses the joint degeneration progression associated with post-traumatic arthrosis of the ankle. A representative case study of this debilitating condition was outlined, and treatment with total ankle joint replacement was presented. Although ankle arthrodesis continues to be a standard option following the progression of severe post-traumatic osteoarthritis, total ankle replacement is maturing as a viable option for this condition.

Adult↗

PubMed1987

[Arthrography--expanded diagnosis in capsule-ligament injuries of the upper ankle joint].

Arthrography was performed in 563 cases of ankle injury to determine its diagnostic information. No complications occurred in our study. Experiences are described and indications for arthrography are pointed out. Stress radiography using a sophisticated apparatus and reproducible amounts of pressure does not have the diagnostic accuracy of arthrography. Arthrography of the ankle joint makes it possible to diagnose ligament rupture and classify injuries by negative stress radiography.

Ankle Injuries↗

PubMed1987

Osteoarthritis associated with a ball-and-socket ankle joint. A case report.

A ball-and-socket joint is an unusual disturbance of normal ankle development. Previous reports have noted good function and the absence of osteoarthritic change in ankles with this configuration. A 50-year-old man with no history of injury developed an osteoarthritic ball-and-socket deformity of the ankle joint. Associated musculoskeletal anomalies included toe syndactylization, genu valgum deformity, and tarsal coalition, a condition that may predispose to the development of this ankle anomaly. Associated valgus deformity of the ankle contributed to the osteoarthritic changes. The conspicuous absence of osteoarthritis in other joints of patients previously reported with this abnormality may be explained by the lack of long-term follow-up examinations.

Ankle Joint↗

PubMed1995

Stress in the Achilles tendon during a topple-over movement in the ankle joint.

The achilles tendon is one of the strongest tendons in the human body, and a healthy tendon will only rupture under very severe conditions. Experiments and statistics show a high probability of tendon rupture in the case of a person trying to make a quick start and thereby toppling over in the ankle joint. Toppling over means a quick overturning in the lower ankle joint as it may occur when starting out of the sagittal plane. Based on a verified model of the achilles tendon, of M. Gastrocnemius and M. Soleus (Hatze, H. (1980) IEEE Trans. Automatic Control 25, 375-385; Hoy et al. (1990) J. Biomechanics 23, 1185-1198.), the stress in different tendon fibres during such a movement is investigated. The results of this simulation show that the expected extreme stresses in the lateral tendon fibres are a possible starting point for a rupture.

Achilles Tendon↗

PubMed1997

Identification of time-varying stiffness dynamics of the human ankle joint during an imposed movement.

The time-varying stiffness dynamics of the human ankle joint were identified during a large stretch imposed upon the active triceps surae muscles. Small stochastic position perturbations were superimposed upon many repetitions of the larger movement and an ensemble time-varying identification technique was then used to characterize the relationship between the small perturbation and the torque it evoked at each sample in time throughout the movement. This technique was found to provide an excellent description of the ankle stiffness dynamics throughout this movement, with the identified stiffness impulse response functions accounting for more than 80% of the torque variance at all times. The average low-frequency stiffness values (K(low)) derived from the stiffness impulse responses at each sample in time are believed to reflect primarily the instantaneous elastic properties of active crossbridges. These properties, which reflect the contractile state of the muscles more directly than force or torque measurements, have not been obtained previously from an intact muscle-joint system. We found that stiffness actually increased during the later portion of the large imposed stretch, indicating the triceps surae muscles did not yield significantly, and that the post-stretch steady-state stiffness level was approximately 60% higher than prior to the stretch. Reflex activity evoked by the large stretch did not produce a detectable change in K(low), even though this activity did produce a clear twitch-like response in joint torque beginning approximately 60 ms following stretch onset. A second-order mechanical model was found to provide an adequate characterization of stiffness dynamics for steady-state periods before and well after the imposed movement, but it could not adequately describe the observed changes in stiffness dynamics during the movement itself. However, the variation of model parameters indicated that the torque evoked by the stochastic displacement was predominantly elastic in nature. The stiffness behavior during stretch observed here for the intact human ankle joint is largely consistent with previous studies performed in isolated muscle preparations.

Adult↗

PubMedDate not supplied

[Muscular stabilization of the upper ankle joint in lateral instability. An experimental study].

The mechanical stabilizing effect of artificially applied muscular strength to the peroneal tendons was examined in an experimental study using cadaveric lower legs with unstable ankle joints. Therefore the anterior fibulo-talar and the fibulo-calcanear ligament was dissected and the resulting instability with examination of the anterior drawer sign and the talar tilt was measured under standardized conditions. After initial measurement under standardized conditions a muscular strength of 75 N and 150 N was applied and the resulting stability was measured again. In a second experiment an additional orthotic device was applied and the stability was measured again under applied muscular strength. The results demonstrated that stable conditions at the lateral unstable ankle joint are only achievable when a muscular strength of 75 N (ant. drawer sign) or 150 N (talar tilt) is combined with the application of an orthotic device. For clinical treatment this means that functional treatment for ankle sprains with application of an orthotic device needs additional training for improvement of the muscular strength of the peroneal muscles.

Ankle Injuries↗

PubMed1977

Anterior instability in the ankle joint following acute lateral sprain.

The relation between anterior instability in the ankle joint and rupture of the anterior talofibular ligament was investigated in patients with acute ankle sprains. Various techniques were used to provoke anterior displacement of the talus. The actual condition of the anterior talofibular ligament was assessed at operation. The appropriate radiographic method was defined, and its valve in diagnosing an acute rupture of the anterior talofibular ligament was assessed.

Acute Disease↗

PubMed1981

Evans' repair of lateral instability of the ankle joint.

A follow-up study is presented of 26 ankle joints with recurrent lateral instability, treated with surgical repair by the Evans method. The median follow-up period was 3.1 (range 1.1-6.9) years. Normal stability was achieved in 73 per cent of the ankles, and another 12 per cent were improved. Similar results are obtained with other methods of surgical repair. Preoperatively 82 per cent of the joints had a positive anterior drawer symptom. This was only found in 12 per cent postoperatively, and these ankles were all classified as having poor results, indicating the importance of reconstruction of the anterior talofibular ligament.

Adolescent↗

PubMed2006

Improving human ankle joint position sense using an artificial tongue-placed tactile biofeedback.

Proprioception is comprised of sensory input from several sources including muscle spindles, joint capsule, ligaments and skin. The purpose of the present experiment was to investigate whether the central nervous system was able to integrate an artificial biofeedback delivered through electrotactile stimulation of the tongue to improve proprioceptive acuity at the ankle joint. To address this objective, nine young healthy adults were asked to perform an active ankle-matching task with and without biofeedback. The underlying principle of the biofeedback consisted of supplying subjects with supplementary information about the position of their matching ankle position relative to their reference ankle position through a tongue-placed tactile output device (Tongue Display Unit). Measures of the overall accuracy and the variability of the positioning were determined using the absolute error and the variable error, respectively. Results showed more accurate and more consistent matching performances with than without biofeedback, as indicated by decreased absolute and variable errors, respectively. These findings suggested that the central nervous system was able to take advantage of an artificial tongue-placed tactile biofeedback to improve the position sense at the ankle joint.

Adult↗

PubMed2002

[Prosthesis implantation in the proximal ankle joint--a real therapeutic alternative in post-traumatic arthrosis?].

The results of total ankle arthroplasty were poor in the 1970s and 1980s compared to those of the arthrodeses. Because of the good long term results this technique has been accepted as the treatment of the choice for posttraumatic arthritis of the ankle. Recently the development of an unconstrained total ankle arthroplasty with an additional mobile polyethylene inlay between the fixed tibial and the talar component which enables a three dimensional range of motion seems to improve significantly the long term results of total ankle replacement. This technique, however, is an extremely demanding procedure. The range of motion after total ankle replacement following posttraumatic arthritis is poor compared to the results of total ankle replacement for rheumatoid arthritis. Furthermore, these data are obtained yet only by a few experienced surgeons in specialized centers. Further clinical trials have to be performed to answer the question whether the total ankle arthroplasty is a reliable alternative treatment of posttraumatic arthritis of the ankle. At present, the arthrodesis should be regarded as the treatment of choice for the posttraumatic arthritis of the ankle joint.

Ankle Injuries↗

PubMed1992

[Biomechanical considerations of the load on the ankle joint].

The biomechanical approach to the characteristics of load on the ankle joint and the surrounding structures allows a better understanding of the cause and effect of externally acting forces in human movement (walking, running, jumping). This detailed understanding of the mechanics involved (not only in the functional anatomical sense) makes preventive measures possible that can reduce the risk of distortion at the ankle. With the same mechanical models, clinically applicable methods allow biomechanically monitored rehabilitation. The case studies reported here illustrate that therapeutic success can be measured objectively, leading to improvement in therapy and in the ability to make decisions in the clinical environment.

Achilles Tendon↗

PubMed2004

Arthrodesis of the ankle joint.

Arthrodesis of the ankle that uses lag screws for internal fixation is a safe and biomechanically stable method to obtain a solid ankle fusion; it generates good to excellent results in most patients. Prompt bone healing can be expected and allows a functional rehabilitation with full weight bearing. The surgical technique can be simplified further when using cannulated screws. Malalignment hazards while doing the ankle fusion are minimized by respecting the shape of the ankle mortise because no osteotomy of the lateral malleolus is performed. Generally, removal of the implanted material is not necessary. Major complications such as infection, stress fractures, or nonunion were not seen in our series. A meticulous resection of all cartilage and sclerotic bone and an atraumatic surgical technique are essential for preventing those major complications. The need for revision surgery is minimized by correction of talar malalignment, fusion with the ankle in a 90 degrees position, and preoperative evaluation of the subtalar joint. External fixation methods are used in cases of osteitis, osteonecrosis, osteoporosis, and poor soft tissue conditions. With severe loss of bone stock at the distal tibia, stability can be achieved by using an intramedullary nail for ankle fusion.

Ankle Joint↗

PubMed2000

Immunohistochemical study of NGF and its receptors in the synovial membrane of the ankle joint of adjuvant-induced arthritic rats.

To study the role of nerve growth factor (NGF) in local inflammation, we investigated the expression of NGF and its receptors, trkA and p75, in the ankle joints of adjuvant-induced arthritic rats. Infiltrated mononuclear cells revealed a positive immunoreactivity for NGF and trkA; they were also positive for immunostaining for W3/25 and ED1, which mainly stain T cells and macrophages, respectively. Changes in the ratios of NGF-positive cells to mononuclear cells showed a relatively similar pattern for trkA-positive cells, which peaked at weeks 2 to 3 after the adjuvant injection. In double-immunofluorescence staining, 80% and 65% of NGF-positive cells stained for W3/25 and ED1, respectively. Similarly, 67% and 80% of trkA-positive cells also corresponded to W3/25- and ED1-positive cells, respectively. However, p75 immunoreactivity localized on the nerve fibers but not on the cells of the ankle joints. Dense meshworks of p75-positive nerve fibers with numerous terminal varicosities were observed at weeks 2 to 4. The present findings suggest that infiltrated mononuclear cells may secrete NGF in an autocrine or paracrine manner in the inflamed synovium. An upregulation of NGF in these mononuclear cells and an increase in density of the synovial nerve fibers may be involved in the development of adjuvant arthritis in rats.

Animals↗

PubMed1984

[Arthrodesis of the upper ankle joint--a non-mutilating intervention].

The resection arthrodesis of the ankle joint is advocated in cases of excessive destruction in combination with extensive painful limitation of motion. The osteosynthesis is performed by an external stabilization with "fixateur externe" or by an internal stabilization with screw or plate. We prefer the internal screw-compression arthrodesis because of a higher interfragmentary compression.

Ankle Injuries↗