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PubMedDate not supplied

Realignment arthrodesis of the rearfoot and ankle: a comprehensive evaluation.

Ankle and tibiotalocalcaneal arthrodeses are performed for the treatment of painful, arthritic, unstable, and deformed rearfoot and ankle joints. Surgical complications are not uncommon (approximately 30%); some can be attributed to poor preoperative planning and inadequate intraoperative position. Several authors have attempted to define the optimal position for ankle arthrodesis without objective multiplanar radiographic analysis and consistent reference points. This investigation explored the effects of ankle and tibiotalocalcaneal realignment arthrodeses on static lower-extremity position in 20 patients. The most common preoperative diagnosis was severe degenerative joint disease following ankle fractures and ankle instability. Seven tibiotalocalcaneal arthrodeses and 13 isolated ankle arthrodeses were performed (mean follow-up, 22 months). Average time to radiographic osseous union of the isolated ankle and tibiotalocalcaneal arthrodeses was 11 and 7 weeks, respectively. Medical complications occurred in 2 patients (10%). There were no statistically significant differences between preoperative and postoperative angular relationships. This study objectively quantifies multiplanar foot-to-leg realignment and defines the optimal clinical and radiographic positions for ankle and tibiotalocalcaneal realignment arthrodeses.

Ankle↗
PubMed1999

Ankle sprains in players of the field-games Gaelic football and hurling.

BACKGROUND: The objectives of the study were to determine the most common injuries in Gaelic football and hurling and to quantify contributory factors. HYPOTHESIS: The hypothesis tested was "Ankle sprains are a common injury in Gaelic football and hurling and their incidence can be linked to physical characteristics of the players". METHODS EXPERIMENTAL DESIGN: prospective study over four years. SUBJECTS: eighty male players of Gaelic football, and hurling, aged 18-27 years. MEASURES: the injuries sustained over a four-year period. Physical fitness tests and examination at the start of the study which included assessment of: anthropometric variables, lower-limb proprioception, lung function, six aspects of flexibility, 15 aspects of posture and body mechanics. RESULTS: 962 significant sports injuries which included: 218 strains and 184 sprains. 122 were ankle sprains; 79 to the left ankle and 43 to the right. 104 ankle sprains represented a recurrence of this injury in a particular individual. In 26 out of 34 of these subjects both ankles were involved. This suggests that recurrence is not primarily due to previous injury but to intrinsic factors in the subjects that predispose them to ankle sprain. The subjects who sustained ankle sprains had (1) greater height, (2) lower body mass index (3) a higher incidence of posture defects of the ankle and knee, (4) more clinical defects (5) a higher incidence of defective lower-limb proprioception. CONCLUSIONS: Ankle sprains are a common injury. Their incidence is linked to the five intrinsic factors listed above.

Adult↗
PubMed2001

Posttraumatic ankle arthrosis.

Until there is a total ankle implant developed that stands the test of time, ankle arthrodesis will continue to be the gold standard in the operative treatment of the arthritic ankle joint. Ankle arthrodesis techniques include minimally invasive methods that can be performed via arthroscopy or with miniarthrotomy. Extensile techniques include extra-articular fusions, the transfibular approach, removal of both malleoli, and the Blair fusion. An ankle arthrodesis can be fixated utilizing either internal or external fixation. The form of fixation chosen depends on availability and surgeon preference and/or experience, and most importantly, which is the optimal method for the patient. Although ankle arthrodesis is the mainstay treatment for posttraumatic arthrosis, innovations and technical improvements have resulted in reconstructive alternatives for ankle arthritis, including distraction ankle arthroplasty, supramalleolar osteotomy, and total ankle replacement. Advances in biomaterials and instrumentation have allowed for the evolution of arthrodesis techniques as evidenced by the myriad of techniques reported in the literature.

Ankle Injuries↗
PubMed2005

Epidemiology of ankle arthritis: report of a consecutive series of 639 patients from a tertiary orthopaedic center.

The purpose of our study was to identify the cause of symptomatic ankle arthritis in a consecutive series of patients presenting in a tertiary care setting. Between 1991 and 2004, 639 patients with Kellgren grade 3 or 4 ankle arthritis presented to the University of Iowa Orthopaedic Foot and Ankle Surgery service. The cause of the arthritis was determined based on medical history, physical examination, and imaging studies. To get a sense of the relative prevalence of the etiologies of lower extremity arthritis in our setting, we evaluated the cause of arthritis of all new patients presenting to the University of Iowa Orthopaedic Department from 1999-2004 with arthritis of the ankle, to those with arthritis of the hip or knee during one year. Of the 639 arthritic ankles, 445 (70%) were post-traumatic, 76 (12%) were rheumatoid disease and 46 (7%) were idiopathic (primary osteoarthritis). The post-traumatic ankle arthritis patients were most commonly associated with past rotational ankle fractures. The majority of ankle arthritis is associated with previous trauma, whereas the primary cause of knee or hip arthritis is idiopathic. Unique strategies to prevent or treat post-traumatic ankle arthritis are needed.

Ankle Injuries↗
PubMed1981

Ankle arthrography.

Ankle arthrography allows radiologists to assess accurately the degree of damage caused by ankle sprains. Ankle sprains are a significant problem to a large number of people, particularly those who participate in sports. Proper care of these ankle injuries requires the combined expertise of many disciplines. Radiologists should be aware of the significance of these lesions and utilize all modalities, including plain films, stress films, and ankle arthrograms, when indicated, to obtain the exact pathologic diagnosis of severe sprains. The primary role of arthrography is to separate those patients who have moderate or severe sprains that may require surgery from those who will respond to more conservative therapy. Many orthopedists believe that combined lateral ligament tears, or any tear involving the deltoid ligament and perhaps the interosseous ligament, may require surgery. At the other end of the spectrum of ankle sprains, occasionally, one may not be able to distinguish between a very slight sprain and a more severe sprain with rupture of the ankle ligament. This is an important distinction, particularly in young athletes who would like to continue to play a competitive sport despite their injury. Utilizing arthrography, the orthopedic surgeon can suggest a more accurate prognosis as to whether the patient might be able to participate with proper taping. Obviously, if the patient has ruptured a ligament, it is not in the best interest of the patient to participate in a competitive sport without allowing a proper interval for healing. I heartily recommend arthrography of the ankle to any radiologist who is not yet utilizing this procedure. I believe that it can add significantly to the care of those patients who sustain ankle sprains.

Ankle Injuries↗
PubMed1993

Decision rules for the use of radiography in acute ankle injuries. Refinement and prospective validation.

OBJECTIVE: To validate and refine previously derived clinical decision rules that aid the efficient use of radiography in acute ankle injuries. DESIGN: Survey prospectively administered in two stages: validation and refinement of the original rules (first stage) and validation of the refined rules (second stage). SETTING: Emergency departments of two university hospitals. PATIENTS: Convenience sample of adults with acute ankle injuries: 1032 of 1130 eligible patients in the first stage and 453 of 530 eligible patients in the second stage. MAIN OUTCOME MEASURES: Attending emergency physicians assessed each patient for standardized clinical variables and classified the need for radiography according to the original (first stage) and the refined (second stage) decision rules. The decision rules were assessed for their ability to correctly identify the criterion standard of fractures on ankle and foot radiographic series. The original decision rules were refined by univariate and recursive partitioning analyses. MAIN RESULTS: In the first stage, the original decision rules were found to have sensitivities of 1.0 (95% confidence interval [CI], 0.97 to 1.0) for detecting 121 maleolar zone fractures, and 0.98 (95% CI, 0.88 to 1.0) for detecting 49 midfoot zone fractures. For interpretation of the rules in 116 patients, kappa values were 0.56 for the ankle series rule and 0.69 for the foot series rule. Recursive partitioning of 20 predictor variables yielded refined decision rules for ankle and foot radiographic series. In the second stage, the refined rules proved to have sensitivities of 1.0 (95% CI, 0.93 to 1.0) for 50 malleolar zone fractures, and 1.0 (95% CI, 0.83 to 1.0) for 19 midfoot zone fractures. The potential reduction in radiography is estimated to be 34% for the ankle series and 30% for the foot series. The probability of fracture, if the corresponding decision rule were "negative," is estimated to be 0% (95% CI, 0% to 0.8%) in the ankle series, and 0% (95% CI, 0% to 0.4%) in the foot series. CONCLUSION: Refinement and validation have shown the Ottawa ankle rules to be 100% sensitive for fractures, to be reliable, and to have the potential to allow physicians to safely reduce the number of radiographs ordered in patients with ankle injuries by one third. Field trials will assess the feasibility of implementing these rules into clinical practice.

Adolescent↗
PubMed1993

Ankle injuries in basketball players.

We carried out a retrospective study of the frequency of ankle sprains in basketball players. A questionnaire about previous ankle injuries, time off after such injuries, current ankle problems, personal data, number of practice hours and the use of prophylactic measures was sent out to 102 basketball players in a second division league in Sweden. Ninety-six players answered. 92% of them had suffered an ankle sprain while playing basketball, and of these 83% reported repeated sprains of one ankle. In the last two seasons, 78% of the players had injured at least one ankle. The injury frequency in the investigation was 5.5 ankle injuries per 1000 activity hours. 22% of the players used some kind of prophylactic support of their ankle joints. Because of the great number of ankle sprains and the disability in terms of time away from sports that they cause, prevention of these injuries is essential.

Adult↗
PubMed1997

The long-term results of ankle joint synovectomy for rheumatoid arthritis.

The clinical and radiological results of synovectomy for rheumatoid arthritis in the ankle joint were investigated in 20 ankles of 15 patients. The average follow-up period after synovectomy was 15 years, ranging from 10 to 25 years. The clinical evaluation at the time of follow-up, found that only two ankles showed recurrence of synovitis, and no patient complained of severe ankle pain disturbing the activities of daily life. During the period between the synovectomy and our investigation, no patients required further surgical procedures for their ankle joints. The radiological evaluation found that in approximately two-thirds of the cases, deterioration of the radiological grade, evaluated with Larsen's criteria, had continued after synovectomy. There was no considerable radiological deterioration in the less-erosive subset patients, classified according to Ochi's criteria (1). In the unilateral synovectomized cases, using the non-operated ankles as the natural-course control, osteoarthritic changes were predominant in the operated ankle joint, and the non-operated ankle demonstrated inflammatory disease changes. These results indicate that: (1) synovectomy for a rheumatoid ankle is still a preferred treatment, lessening the clinical symptom of persistent, marked synovial proliferation resistant to medical treatment. (2) Radiological deterioration continues after synovectomy in many cases. However, a radiogram demonstrates predominant osteoarthritic destruction, which indicates the natural course of rheumatoid destruction in the operated site could be altered by synovectomy.

Adult↗
PubMed2005

[Ankle arthrodesis using the arthroscopic technique].

OBJECTIVE: Fast, safe and reliable ankle fusion through minimally invasive technique. INDICATIONS: Painful ankle arthritis unresponsive to conservative treatment. CONTRAINDICATIONS: Severe axial malalignment of ankle. Significant anteroposterior talar translation. Extensive bone defect. SURGICAL TECHNIQUE: Standard anteromedial and anterolateral arthroscopic portals. Excision of all anterior hypertrophic synovium using a soft-tissue shaver. Removal of anterior osteophytes with a motorized arthroscopic abrader (burr) to get better access to the joint. Removal of the remaining ankle cartilage using a sharp curette. Superficial opening of the subchondral bone with a motorized burr and deeper opening with an osteotome. Without arthroscopy but under image intensification, ankle fixation in neutral position by inserting two (or three) 6.5-mm cancellous lag screws from the tibia (medial and lateral) into the talus. POSTOPERATIVE MANAGEMENT: Partial weight bearing (15 kg) with a removable boot for 6 weeks. Then, first radiologic follow-up and in the presence of evidence of consolidation, full weight bearing with the boot for additional 2-4 weeks. RESULTS: Between September 1998 and February 2003, 28 arthroscopic ankle arthrodeses were performed. 23 ankles (82%) showed definite radiologic evidence of consolidation at 6 weeks postoperatively; patients were allowed to bear full weight without any consequences. All patients except two (93%) showed complete ankle fusion at their last radiologic follow-up at 1 year. Both patients with absent fusion were smokers; one of them was asymptomatic (stable fibrous union) and the other's ankle finally fused after surgical revision with open technique and bone grafting.

Adult↗
PubMed2005

The effect of time to peak ankle torque on balance stability boundary: experimental validation of a biomechanical model.

Pai and Patton (1997), using a biomechanical model, determined a set of feasible center of mass (CM) velocity-position combinations (balance stability boundary) that guarantee upright stability. In their study, the magnitude of the restoring ankle torque was used to study the subject's ability to recover balance. Recent studies have suggested that the ability to maintain a stable posture depends not only on the magnitude of the restoring torque but also on the time to generate this torque. The objectives of the present study were: (1) to build a biomechanical model that predicts the balance stability boundary which includes time to peak ankle torque, (2) to determine the capability of the model to predict successful and failed experimental balance recovery trials, and (3) to compare the predictive capability of the biomechanical model with that of a statistical model (logistic regression). A single-link-plus-foot biomechanical model was used to determine a set of balance stability boundaries, computed from the combination of maximum CM velocity and related CM position, for various times to peak ankle torque. An experiment was conducted to validate the biomechanical model. The participants self-initiated a forward destabilization and were asked to regain balance using an ankle feet-in-place strategy. Also, a forward stepwise logistic regression (predictors: CM position and velocity and time to peak ankle torque) was used to discriminate between successful and failed experimental trials. (1) The outcomes of the biomechanical model confirmed that the time to peak ankle torque drastically constrained the stability boundaries. (2) The biomechanical model predicted 79.9% of the failed experimental trials and 74.5% of the successful experimental trials. (3) The stepwise logistic regression included all independent variables and predicted 57.2% of the failed and 93.7% of the successful experimental trials. Hence, the biomechanical model showed better predictive capability than the statistical model for identifying unsuccessful balance recovery. It is noteworthy that the balance stability boundaries constrained by the speed of ankle torque development predicted the outcome of the experimental trial earlier in the time series than balance stability boundary constrained by constant ankle torque. Overall, the present biomechanical model may serve as an assessment tool to develop specific interventions towards improving a patient's speed of ankle torque development and to possibly reduce falling frequency.

Accidental Falls↗
PubMed2005

Identification of intrinsic and reflex ankle stiffness components in stroke patients.

Reflex and intrinsic contributions to ankle stiffness were examined in 11 stroke patients with clinical evidence of ankle spasticity and nine gender-matched and age-matched controls. Subjects lay supine with one foot placed in a custom-fitted boot attached to an electro-hydraulic actuator. They were instructed to relax while pseudo-random binary sequence perturbations were applied to their ankle joint. The ankle position and torque, as well as EMG from the ankle dorsiflexors and plantarflexors were recorded. These were used to identify reflex and intrinsic components of ankle stiffness, using a non-linear, parallel-cascade, system identification method. Results demonstrated that the majority of stroke patients (7/11) had ankle stiffness similar to that of control subjects. In contrast, a minority of stroke patients (4/11) had an abnormal increase in ankle stiffness, most of which could be attributed to an increased reflex gain. Reflex stiffness increased as the ankle was dorsiflexed in all subjects. These results differ from a previous study showing that reflex gain and intrinsic stiffness were increased in all patients with spinal cord injury. This difference may reflect the different topography of the lesions in the two neurological conditions.

Adult↗
PubMed2000

Morphologic changes of the ankle in children as assessed by radiography and arthrography.

Chronological changes in the morphology of the ankle, a joint that consists primarily of chondral components in children, were investigated by arthrography and plain radiography. Arthrography was performed in 57 ankles of 40 patients with normal ankles (aged from 2 months to 3 years, 4 months; mean, 1 year, 7 months), and plain radiography was performed on 183 joints of 126 patients with normal ankles (aged from 3 years, 6 months to 14 years, 5 months (mean, 7 years, 8 months). The angle of the distal tibial joint surface was then measured on each radiograph. Despite being evident at birth, valgus inclination in the ankle rapidly changed during the first and second years of life. Thereafter, change continued gradually and spontaneously, and the ankles were in the neutral position by 3 years of age. However, the morphology of the ankles did not change much after that time. Normal ankles show valgus inclination at birth, but this configuration is changed naturally over time, and the ankles are in the neutral or slightly varus position by the age of bone maturity.

Adolescent↗
PubMedDate not supplied

Relationship between ankle muscle and joint kinetics during the stance phase of locomotion in the cat.

The purpose of this study was to examine the relationship between internal force production in selected skeletal muscles and the externally calculated joint moment during overground locomotion in the adult cat. Hindlimb segments were modelled as a linked system of rigid bodies and a generalized muscle moment (GMM), the sum over all active and passive tissues acting about the joint, was calculated using principles of inverse dynamics. Moments produced by individual muscles were calculated using tendon transducers implanted in freely moving cats and muscle moment arm information. Results indicated that the externally measured variables of peak ground reaction force and joint position were equally important to the determination of peak ankle GMM. Examination of peak moments revealed that increases in peak ankle GMM were met by increases in medial (MG) and lateral (LG) gastrocnemius output. Peak soleus (SOL) moments did not change significantly as a function of peak ankle GMM. The role of the plantaris (PLT) was less clear, with peak moments increasing significantly as a function of peak ankle GMM in one cat. All four ankle extensors were important to the attainment of peak ankle GMM early in stance. Subsequently, SOL and PLT contributed substantially to the ankle GMM throughout stance, LG moments declined to near zero, soon after peak ankle GMM; and MG moments demonstrated a substantial but more gradual decline. The relative contributions of these individual muscles to the ankle GMM were supported by their respective architecture, uniarticular versus multiarticular function, and physiological profiles.

Animals↗
PubMed2004

Incidence of ankle contracture after moderate to severe acquired brain injury.

OBJECTIVE: To examine an adult population undergoing rehabilitation after brain injury to determine the incidence of ankle contracture and factors contributing to the development of this deformity. DESIGN: Descriptive study SETTING: Specialist inpatient neurosurgical rehabilitation unit in Australia. PARTICIPANTS: Patients (N=105) admitted with a new diagnosis of moderate to severe brain injury over a 12-month period. INTERVENTIONS: Not applicable. MAIN OUTCOME MEASURES: Maximal ankle dorsiflexion range and the presence of abnormal muscle tone affecting the lower limb(s) were evaluated at weekly intervals. Ankle contracture was defined as maximal passive range of less than 0 degrees dorsiflexion with the knee in extension. Patients were grouped into 3 muscle tone categories: normal, predominantly spastic, or predominantly dystonic. Age, sex, mechanism and severity of brain injury, time to onset of ankle contracture, total length of hospital stay, and discharge mobility status data were also recorded. RESULTS: Muscle tone was designated as normal in 68 (64.7%), as spastic in 14 (13.3%), and as dystonic in 23 (21.9%) patients. The incidence of ankle contracture was 16.2% (17/105 cases). Ankle deformity correlated closely with muscle tone category. Of 23 cases with dystonic muscle overactivity, 17 developed contracture at some point between 1 and 16 weeks after brain injury, although no subject with normal tone or spasticity developed the deformity. There was a weak association between the severity of brain injury and development of ankle contracture. CONCLUSIONS: The incidence of ankle contracture was much lower than previously reported. Dystonic overactivity of the plantarflexor and invertor muscles is a major predisposing factor to ankle contracture.

Activities of Daily Living↗
PubMed2006

The arthroscopic management of frozen ankle.

PURPOSE: The purpose of this study was to evaluate a combined anterior and posterior arthroscopic approach in the treatment of frozen ankle. TYPE OF STUDY: Retrospective case series. METHODS: Five patients with post-traumatic frozen ankle were evaluated. RESULTS: After an average follow-up of 32.6 months (range, 24 to 42 months), the average American Orthopaedic Foot and Ankle Society hindfoot-ankle score was improved from 63.8 point (range, 55-74) to 88.6 point (range, 81-100). The average ankle dorsiflexion improved from 1 degrees (range, 0 degrees to 5 degrees) to 19 degrees (range, 15 degrees to 25 degrees). The average ankle plantarflexion improved from 16 degrees (range 10 degrees to 20 degrees) to 39 degrees (range, 30 degrees to 45 degrees). CONCLUSIONS: Combined posterior ankle endoscopy and anterior ankle arthroscopy is effective in the treatment of post-traumatic frozen ankle. LEVEL OF EVIDENCE: Level 4.

Adult↗
PubMed2004

Ankle joint evertor-invertor muscle torque ratio decrease due to recurrent lateral ligament sprains.

OBJECTIVE: To determine an ankle inversion-eversion movement range part where evertor/invertor muscles torque ratio is altered after recurrent ankle lateral ligament sprains. DESIGN: The ankle evertor/invertor muscles torque ratios were determined in the different range parts of angular positions by the muscle isokinetic movements. BACKGROUND: It is important to determine the movement range part where the evertor muscle weakness after the ankle lateral ligament sprains is more expressed and a repeated trauma of the lateral ligaments is more probable. METHODS: Twenty-eight male handball players participated in the tests using an ankle isokinetic inversion-eversion movement investigation dynamometer system. Thirty-three ankle joints were uninjured, but 23 underwent recurrent lateral ligament sprains. RESULTS: The ankle evertor/invertor muscles torque ratio for the sprained ankles was significantly lower in comparison with the uninjured joints in inversion positions at 50 degrees and 60 degrees of the range of movements in all applied velocities, except the slowest movement (30 degrees /s). CONCLUSIONS: The recurrent ankle lateral ligament sprains reduced the evertor/invertor muscles torque ratio in the inversion positions of the range of movements and therefore the evertor muscle weakness was more expressed in the beginning of the eversion movement.

Adolescent↗
PubMed2005

Differences between measured and resultant joint moments during isometric contractions at the ankle joint.

The purpose of this study was to examine two hypotheses: (a) during voluntary and electrically induced isometric contractions the moments measured at the dynamometer are different from the resultant moments in the same plane around the ankle joint and (b) at a given resultant moment during electrically induced isometric contractions the ankle angle while loading is different from the ankle angle while unloading. Twenty-seven long distance runners participated in the study. All subjects performed isometric maximal voluntary contractions (MVC) and contractions induced by electrostimulation at four different ankle-knee angle combinations on a Biodex-dynamometer. The kinematics of the leg were recorded using the vicon 624 system with eight cameras operating at 120 Hz. The main findings were: (a) the resultant moment at the ankle joint and the moment measured by the Biodex-dynamometer during isometric contractions are different, (b) during a plantar flexion effort the ankle angle changes significantly, whereas the knee angle shows only small and in most cases not significant changes, and (c) at identical resultant ankle joint moments the ankle angles are different between the loading and the unloading phases. The observed differences may lead to erroneous conclusions concerning the following: (a) diagnostic of muscle architecture, (b) estimation of the moment-ankle angle relationship and (c) estimation of the strain and hysteresis of tendons and aponeuroses.

Ankle Joint↗
PubMed2006

[Long-term behavior of ankle fusion: assessment of the same series at 7 and 23 year (19-36 years) follow-up].

PURPOSE OF THE STUDY: Theoretically, long-term functional and radiographic degradation is predictable after ankle fusion, but sound evidence from the consecutive analysis of the same cohort is lacking. The purpose of this study was to check the hypothesis by repeating assessment in the same cohort of patients who underwent ankle fusion. MATERIAL AND METHODS: The cohort included 52 ankle fusions which had been analyzed in 1984 at seven years (range 2-22 years) follow-up then again in 2000 using the same evaluation criteria. Among the 52 patients, six were lost to follow-up (11.5%) 20 had died (38.4%) and one had undergone leg amputation. The second analysis thus included 25 patients (48%). The comparison cohort thus included 25 patients (18 men and 7 women), mean age 62+/-12.6 years (range 40-94) at the 2000 assessment performed 23+/-4.5 years (range 19-36 years) after the fusion. Functional outcome was assessed with the 100-point Duquennoy scale. Osteoarthritis of the subtalar and mediotarsal joints were assessed preoperatively and at follow-up using the same scale. RESULTS: The functional outcome did not deteriorate significantly between 1984 and 2000. The mean score was 65.8+/-22.6 (range 19-92) in 1984 and 64.7+/-18.3 (range 34-90) in 2000 (p=0.67). Fifteen patients (60%) had a good or very good outcome at seven years, and 14 (56%) at 23 years. Between 1984 and 2000, ten patients improved their score (on average 10.4 points, range 1-21 points), two had an unchanged score and thirteen a lower score (on average 10 points, range -1 to -24). Ten of these thirteen patients developed severe intercurrent conditions (neurological or cardiac) explaining the degradation. At last follow-up, sixteen ankles were pain free or nearly pain free. Twelve patients considered their ankle as a forgotten problem (VAS 10) and had no regrets concerning the operation. The evolution of the subtalar joint in 16 cases (nine fusions including five at the same time as the ankle fusion and four performed within four years) showed that all developed osteoarthrtic degradation early with aggravation between 1984 and 2000, leading in the majority of cases to severe degenerative disease. This osteoarthritis was painful in less than one-third of the cases (including the four secondary subtalar fusions and the four subtalar fusions which were painful at mobilization). Twenty-three mediotarsal joints were analyzed (two fusions four years after ankle fusion). The degradation was later and less severe than for the subtalar joint with a majority showing moderate osteoarthritis. Ten ankles exhibited compensatory hypermobility of the forefoot measured at more than 15 degrees without pain. DISCUSSION: This long-term follow-up with two successive assessments using the same evaluation criteria did not demonstrated the late degradation of function expected after ankle fusion. It did show however the presence of undeniable radiographic degradation of the subtalar joint but with little or no severe clinical expression at a minimal follow-up of 19 years. There was no need for complementary fusion between 4 and 23 years follow-up.

Adult↗