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PubMed1978

[Biomechanical investigations of the ankle joint after shortening of the distal end of the fibula (author's transl)].

Shortening of the distal fibula after malleolar fracture is accompanied with important alterations of the biomechanics and the compressive forces of the ankle joint. The relationship between the extent of shortening, the degree of valgus position of the talus and the reduction of the joint surfaces is described on the basis of experimental investigations. The importance of these circumstances for treatment of malleolar fractures is discussed.

Ankle Injuries↗
PubMed1998

Ankle-joint salvage following a tibial pilon fracture. A case report.

This article presents a case of a tibial pilon fracture following a motor-vehicle accident. It discusses the main classification system and mechanism of injury for such fractures and emphasizes an alternative form of treatment of the usually suggested ankle fusion: an arthrectomy, which allows motion, thereby salvaging the ankle joint.

Adult↗
PubMed1993

Feedback of ankle joint angle and soleus electromyography in the rehabilitation of hemiplegic gait.

A computer-assisted feedback system was developed to present to walking subjects instantaneous feedback of their muscle activity or joint angular excursions during gait. Targets for muscle activity or joint motion were displayed on the feedback screen along with timing cues that prompted muscle activity or joint flexion/extension at specific times during the gait cycle. The purpose was to compare the effectiveness of joint angle and electromyographic (EMG) feedback to a focused program of physical therapy for gait. Eight hemiplegic stroke patients were treated with ankle joint angle feedback, EMG biofeedback from the soleus muscle, and conventional physical therapy for gait in a three-period crossover design. PT was given either first or last in the sequence of treatments. Gait analysis prior to and following each type of treatment revealed that the feedback treatments resulted in significant increases in stride length and walking velocity and in positive changes in push-off impulse, gait symmetry, and standing weight-bearing symmetry, as evaluated in a general linear model and paired t-tests. Overall, physical therapy produced no significant changes. However, when physical therapy was the first treatment of the sequence, significant increases in stride length and velocity were observed. When physical therapy was last, there were significant negative changes in gait symmetry and standing weight-bearing symmetry, and negative trends in stride length, walking velocity, and push-off impulse. It is concluded that computer-assisted feedback is an effective tool for retraining gait in stroke patients.

Ankle Joint↗
PubMed2006

Effects of electroacupuncture with different frequencies on the glycoconjugate alterations in articular cartilage in the ankle joints of complete Freund's adjuvant-injected rats.

The aim of this study was to investigate the effects of electroacupuncture (EA) on the glycoconjugate (GC) changes in articular cartilage in the ankle of an arthritic model. Arthritis was induced by an intraplantar injection of complete Freund's adjuvant (CFA) into the hindpaw of male Sprague-Dawley rats. Bilateral EA stimulation at 2 Hz, 15 Hz and 120 Hz was applied at those acupoints corresponding to Zusanli and Sanyinjiao in man, using needles for 3-day intervals for 30 days. To determine the presence of arthritis, paw edema was measured by a water displacement plethysmometer. Edema of the hindpaw induced by CFA-injection was strongly inhibited by EA stimulation throughout the experimental period. At 30 days after CFA-injection, GC changes of articular cartilage of the ankle joint were observed using conventional and lectin histochemistry. The CFA-injected rat revealed general reduction of staining abilities and lectin affinities for GC in comparison with normal rats. Significant reductions of neutral and acidic GC were observed in interterritorial matrix and chondrocyte capsules, respectively. All lectin affinities examined except DBA were also decreased in CFA-injected rats compared to normal ones. However, EA-treated rats, showed similar staining patterns and lectin affinities for GC as to normal ones, especially neutral GC in interterritorial matrix and sWGA and RCA-1 affinities in chondrocytes. It is concluded that EA in all frequencies examined, especially 2 Hz, can attenuate inflammatory edema in CFA-injected rats through alleviation of alterations of GC components in articular cartilage.

Animals↗
PubMed1998

[Combination of intramedullary nail and covered screw osteosynthesis for managing distal tibial fracture with ankle joint involvement].

Fractures of the distal metaphysis of the tibia often include an extension into the ankle. Intramedullary nailing combined with covered screw osteosynthesis should reduce the high incidence of soft tissue and ankle problems and should be an alternative to open plate fixation, with good ultimate functional outcome. Between January 1993 and December 1995, a prospective study on 49 patients with distal metaphyseal tibia fracture and involvement of the ankle was performed. All the fractures were treated with intramedullary nailing combined with covered screw osteosynthesis, and plate fixation in cases of fibula fractures. There were 27 men and 22 women with an average age of 46.4 +/- 12.7 years (range 21-90). In most studies of the use of intramedullary nailing in distal tibial fractures the classification has been inadequate. Therefore a new classification according to Robinson et al. (1995) was used: 10 fractures were type II B (20.4%), 13 were type II C (26.5%), and 26 patients suffered a combination of type II B and type II C (53.1%). This fracture type was defined as type II D for use in this study. The severity of soft tissue injury was recorded using the Gustilo system in case of open (n = 19) and the Tscheme system in case of closed fractures (n = 30). In 31 patients distal tibia fracture was accompanied by a fracture of the fibula, which was first stabilized using a plate. For reconstruction of the distal articular surface, covered screw osteosynthesis was done. At the next step intramedullary nails were inserted and were statically locked proximally and distally. From January 1993 to February 1994, the reamed AO standard nail was used. After introduction of the unreamed tibial nail (UTN) all fractures were treated by this implant. Full load on the operated leg was allowed after 8 weeks. Union of the fracture was assessed by standard radiological and clinical criteria. Misalignment was defined as more than 5 degrees of angular rotation. Further surgery due to a valgus deformity in the ankle joint had to be done in three cases. There were no deep infections. Three patients had a superficial infection in the ankle area, but surgical debridement was not necessary. A leg shortening was found in 4 cases, but it was less than 1 cm in every case. Therefore, surgical correction was not done. Patients were reviewed at intervals of 2, 6, and 12 weeks, and after 6, and at least 12 months. All 49 patients were finally reviewed after an average time of 15.7 months (range 12-38). Bone fusion was reached 12.8 weeks (range 9-21) after the operative treatment. A specific assessment of the ankle symptoms was made using the score of Olerud and Molander (1984). In 29 patients excellent results were recorded. A satisfactory result was attained with 17 patients and just 3 patients were found to be unsatisfactory. Although proximity of distal tibia fracture to the ankle makes the treatment more complicated than for fractures of the tibial diaphysis, closed intramedullary nailing combined with covered screw fixation is a good alternative to open reduction and plate fixation. The major advantages are closed procedure and simplified interlocking techniques. Therefore, closed intramedullary nailing combined with covered screw fixation is a safe and effective method of managing this type of fracture.

Adult↗
PubMed2004

Effects of ankle joint effusion on lower leg function.

BACKGROUND: Inversion ankle sprains are among the most frequently encountered injuries in and outside of sport. Altered feedback from joint damage and/or edema may negatively affect dynamic stabilization, thereby increasing the patients' susceptibility to further injury. In order to understand better how the sensorimotor system responds to the presence of ankle edema during a functional task, further examination is warranted. OBJECTIVE: To quantify muscle activation in the peroneal, tibialis anterior, and soleus musculature as well as to determine ankle joint peak torque, peak power, and root mean square (RMS) power during a closed kinetic chain activity following artificial ankle effusion. DESIGN: Dependent variables were compared within subjects across time intervals and between groups. SETTING: All data were collected in the biomechanics laboratory. PARTICIPANTS: Subjects were 20 healthy, neurologically sound volunteers (age 21.9 +/- 2.1 y, height 174.5 +/- 9.3 cm, mass 79.3 +/- 15.9 kg) with no lower extremity injuries. INTERVENTIONS: Subjects were prepared for surface electrodes on the peroneus longus (PL), tibialis anterior (TA), soleus (Sol), and medial malleolus (ground). Anthropometric measures for the lower extremity were recorded for use by the Omnikinetic closed chain dynamometer. Measurements were taken prior to ankle effusion (baseline), immediately following effusion (post), and again at 30 minutes. MAIN OUTCOME MEASUREMENTS: Testing consisted of 6 repetitions at 35% of 1-repetition max and a constant speed of 1.5 Hz. Separate two-way MANOVAs with repeated measures on time intervals were used to detect differences between groups (effusion and control) over time for torque, power, and RMS power and for peak and average EMG. RESULTS: An overall time x group interaction was detected for EMG (F4,72=3.878; P=0.007) and kinetic variables (F6,70=5.55; P=0.0001). Average and peak PL EMG decreased immediately following effusion (Sidak's; P=0.048), and average EMG remained depressed 30 minutes following effusion (Sidak's; P=0.02). Immediately posteffusion, a decrease in ankle torque was detected (Sidak's; P=0.007). No differences in TA or Sol EMG, power, or RMS power were detected (P>0.05). CONCLUSIONS: Decreases in ankle plantarflexion torque and PL EMG indicate that a neuromuscular deficit exists in the presence of edema that could increase the susceptibility for further ankle injury.

Adult↗
PubMed2006

Three-dimensional bone kinematics in an anterior laxity test of the ankle joint.

Questions addressed in this in-vitro study are (1) what are the actual three-dimensional kinematics of talus and calcaneus during an anterior drawer test as performed with the quasi-static anterior ankle tester (QAAT) (2) does laxity measurement with the QAAT represent the true anterior translation of talus relative to the tibia? Simultaneous measurements were made with the QAAT and a three-dimensional kinematics analysis system in five specimens. The three-dimensional translations and rotations on three axes were analysed at 25, 50 and 100 N of applied anterior load, with increased ligament damage. For four out of five remaining specimens, anterior translation values of talus and calcaneus and values as measured with the QAAT show a significant increase with growing ligament damage and with higher loads. Skeletal motions of talus and calcaneus show great similarity in three different motion axes, with increased ligament damage and at any given load. Skeletal translations and rotations of talus and calcaneus show great similarity during an anterior drawer movement of the ankle joint. Anterior skeletal translation of the talus and calcaneus show fair correlation with the anterior displacements measurements of the QAAT. These QAAT measurements show an overestimation of the laxity value by more than 200% irrespective of the load applied.

Aged↗
PubMed1987

Ankle joint urate arthritis (AJUA) in rats: an alternative animal model of arthritis to that produced by Freund's adjuvant.

Injection of sodium urate crystals into one ankle joint in the rat produces arthritis which is fully developed within 24 h. The time-course and dose-response of associated inflammation and sensory abnormalities are described. Following intra-articular sodium urate rats reduce the weight placed on the paw of the treated hind limb and develop a limp in their gait. The ankle swells and becomes more sensitive to pressure and passive movements. Touch, pressure and thermal stimuli applied to the foot distal to the treatment produce decreased responses, presumably because active flexion movements are noxious. Joint pathology is reflected by tissue oedema and the infiltration of polymorphonuclear leucocytes. However, there is no destruction or decrease in density of bone. It is proposed that this model of arthritis may have ethical and scientific advantages over adjuvant arthritis in the study of some aspects of the neural mechanisms of arthritis.

Animals↗
PubMed2002

Effect of linear polarized near-infrared light irradiation on flexibility of shoulder and ankle joints.

BACKGROUND: There is a possibility that heat stimulus by linear polarized near-infrared light irradiation (PL: Super Lizer HA-30, Tokyo Medical Laboratory) improves the range of joint motion, because the flexibility of soft-part tissues, such as a muscle or a tendon, is improved by increasing the muscle temperature. The purpose of this study was to examine the influence of PL-irradiation on the ranges of shoulder and ankle motions. METHODS EXPERIMENTAL DESIGN: 30 healthy young adults (15 males: mean+/-SD, age 19.1+/-0.8 yrs, height 173.3+/-4.6 cm, body mass 68.5+/-8.0 kg and 15 females: mean+/-SD, age 19.2+/-0.7 yrs, height 162.3+/-4.5 cm, body mass 58.1+/-6.6 kg) participated in the experiment under PL-irradiation and no-irradiation (placebo) conditions. MEASURES: the angles of shoulder and ankle joint motions were measured twice, before and after the PL- and placebo-irradiations. The angle of a motion was defined as the angle connecting 3 points at linearity as follows: for the shoulder, the greater trochanter, acromion, and caput ulnare, and for the ankle, the knee joint, fassa of lateral malleolus and metacarpal bone. Each angle was measured when a subject extended or flexed maximally without support. RESULTS: The trial-to-trial reliability of each range of joint motion was very high. All parameters in PL-irradiation were significantly larger in postirradiation than pre-irradiation, and the value of postirradiation in PL-irradiation was significantly greater than that for placebo. The ranges of shoulder and ankle motions in placebo-irradiation were also significantly greater in postirradiation than pre-irradiation. Moreover, the change rate for each range of joint motion between pre- and postirradiations was significantly greater in PL-irradiation in both joints. In PL-irradiation, most subject's motions were greater in postirradiation than pre-irradiation, but not in the placebo-irradiation. The effect of PL-irradiation tended to be greater on subjects with a small range of a joint motion. CONCLUSIONS: It is considered from the present results that the ranges of shoulder and ankle motions became greater with PL-irradiation, and is effective as a warming-up method.

Adult↗
PubMed1995

The effect of a unilateral inflammation at the rat's ankle joint on the expression of preprotachykinin-A mRNA and preprosomatostatin mRNA in dorsal root ganglion cells--a study using non-radioactive in situ hybridization.

In rats with an acute (2 days) and chronic (20 days) unilateral ankle joint inflammation (induced by Freund's complete adjuvant), the proportion of dorsal root ganglion cells containing preprotachykinin-A mRNA or preprosomatostatin mRNA was determined using non-radioactive in situ hybridization. At the acute stage of inflammation, the proportion of neurons containing preprotachykinin-A mRNA was similar to that in control rats. At the chronic stage, the proportion of neurons expressing preprotachykinin-A mRNA was significantly higher on the inflamed side than on the contralateral side. The proportion of dorsal root ganglion cells containing preprosomatostatin mRNA did not change. These data suggest that inflammation influences the synthesis of substance P but not of somatostatin in afferent neurons.

Acute Disease↗
PubMed1984

Passive and active components of the internal moment developed about the ankle joint during human ambulation.

The internal moment developed about a joint during a functional activity is the result of contraction of muscles and the visco-elastic properties of the joint and its surrounding soft tissues. In this study, the contribution of each one of these mechanisms to the total internal moment developed about the ankle joint during human level walking was assessed. The results indicate that during normal level walking the internal moment about the ankle is mainly due to contraction of muscles surrounding the joint. The contribution of the passive component was found to be negligible. These results, however, were found to be different for the pathological case tested. The results indicated that in a subject with a mild equinus ankle deformity, a substantial portion (21%) of the total internal moment was contributed by the passive resistance of the joint and its surrounding structures.

Adult↗
PubMed2004

[Development of muscle strength in knee, hip and ankle joints after ACL reconstruction].

INTRODUCTION: We searched for answers for following questions: How does the knee muscle strength change in dependence of post OP time after the same ACL-rehabilitation's program? Which changes in muscle strength occur in hip and ankle muscles after ACL? METHODS: In this study 69 patients with ACL-Reconstruction participated, mean 31 years. The Lysholm- and OAK-scores of all were good respectively very good. 28 patients were 3 - 6 months post OP (Gr. I), 20 were 6 - 12 months post OP (Gr. II), 21 was 12 - 24 months post OP (Gr. II). All patients were tested on the isokinetic Cybex 6000, for dynamic concentric strength and endurance. The evaluation parameters chosen were: max.moment at angle speed of 60 degrees /sec and endurance index at 120 degrees /sec, RESULTS: The analysis of the max. moment showed significant (P < 0.05) changes in both knee extension and flexion in all groups, in the hip flexors and extensors in group I, and hip flexors in group II and III. In the ankle joint we only found significant changes in the plantarflexors of group I. Looking at the endurance index we observed that many muscle groups of the injured leg presented higher values, however the difference is only significant in the knee flexors and extensors of group I and in the hip flexors of group III. CONCLUSION: Our study showed strength loss in both knee extensors and knee flexors in all patients who had undergone reconstruction surgery after the same ACL-rehabilitation's program. We can state that there is strength loss in hip and ankle muscles in 3 - 6 months post OP patients. A reduction of muscle strength at the hip flexor from all patients was seen after 12 months post-OP. It is suggested that the strength loss in the hip flexors could be due to bi-articular muscles surrounding the knee.This results has to be consider on the planning of strength training after ACL injuries.

Adult↗
PubMed1988

Goniometric reliability in a clinical setting. Subtalar and ankle joint measurements.

Measurements of the subtalar joint neutral (STJN) position and passive range of motion (PROM) of the ankle joint and the subtalar joint (STJ) are often part of a physical therapy evaluation. These measurements may be used in treatment planning, such as in the prescription of specialized shoes or orthoses. Therefore, reliability of these measurements, as they are obtained clinically, must be determined. The purpose of this study was to examine the reliability of measurements of the STJN position and of ankle and STJ PROM. To determine reliability, repeated measurements of the STJN position and of STJ PROM were taken on the involved feet of 43 patients with neurologic orthopedic disorders (including both feet of 7 patients), and measurements of ankle PROM (dorsiflexion and plantar flexion) were taken on 42 of these patients (including both feet of 7 patients). Intraclass correlation coefficients (ICCs) for intratester reliability ranged from .74 to .90 for ankle and STJ measurements. The ICCs for intertester reliability were .25 for measuring the STJN position, .32 for STJ inversion, and .17 for SJJ eversion. The ICCs for intertester reliability were .50 for ankle dorsiflexion and .72 for ankle plantar flexion. Goniometric measurements of the STJN position and of PROM of the ankle and STJ appear to be moderately reliable if taken by the same therapist over a short period of time. With the exception of ankle plantar flexion, these measurements cannot be considered to be reliable between therapists.

Adolescent↗
PubMed1989

[Long-term study of an unusual post-traumatic arthrosis of the ankle joint].

Long-term observation for 15 years of an unusual heavy posttraumatic degenerative arthritis in the upper ankle joint with considerable deformations of the structures and surprising good motility in the joint. Demonstration of the case by pictures and x-ray pictures. The question of overrating posttraumatic degenerative arthritis and its sequels is discussed.

Adult↗
PubMed2001

Extrinsic muscle activity, foot motion and ankle joint moments during the stance phase of walking.

This study examined stance phase foot kinematics, kinetics and electromyographic (EMG) activity of extrinsic muscles of 18 healthy males. Three-dimensional kinematic and kinetic data were obtained via video analysis of surface markers and a force plate. Ankle joint moments are described about orthogonal axes in a segmental coordinate system. Kinematic data comprise rearfoot and forefoot motion, described about axes of a joint coordinate system, and medial longitudinal arch height. Surface EMG was obtained for tibialis anterior, soleus, gastocnemius medialis and lateralis, peroneus longus and peroneus brevis and extensor digitorum longus. It was concluded that the demands on the controlling muscles are greatest prior to foot flat and after heel rise. Tibialis anterior restrained rearfoot plantarflexion from heel contact to 10% stance, and eversion between 10% stance and footflat. Activity in peroneus longus was consistent with its role in causing eversion after heel contact, then as a stabiliser of the forefoot after heel rise. Activity in peroneus brevis suggested a role in restraining lateral rotation of the leg over the foot, late in stance.

Adolescent↗