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PubMedDate not supplied

[A case of bilateral isolated talonavicular synostosis in childhood--observations of tarsal joint function and functional adaptation of the proximal ankle joint].

A rare case of bilateral isolated coalition of the talonavicular joint with ball and socket ankle joint is presented. Range of motion of the subtalar joint and hindfoot mobility were measured intraoperatively. The following conclusions may be drawn on development and function of the ankle joint complex: Isolated talonavicular synostosis in the growing foot results in marked impairment of subtalar range of motion. The development of a ball and socket ankle joint may be caused thereby, if tarsal hypomobility becomes effective at an early stage of growth.

Ankle Joint↗
PubMed1995

[Synovial lesions of the upper ankle joint].

The ankle is a typical synovial joint. It is affected by systemic as well as locally limited synovial processes. Looking at oligo- and polyarticular diseases it is affected by Reiter's Syndrome and Rheumatoid Arthritis in young patients. In middle aged people Crystal Synovitides dominate the picture and in old age Gout and tumorous lesions are seen. Looking at monarticular inflammatory processes one has to think of tuberculosis first. Crystal-induced monarthropathies such as hemochromatosis can also start at the ankle. In this review we describe the possible inflammatory diseases of the talocrural joint and present a diagnostic algorithm.

Ankle Joint↗
PubMed1986

[Biomechanics of the upper ankle joint].

In most cases the ankle joint represents a simple hinge, the unimpaired function of which is dependent on normal play of the distal tibiofibular joint. During flexion and extension of the ankle joint, bending of the fibula is responsible for a substantial part of the mediolateral translational movement of the distal tibiofibular syndesmosis. In comparison with articular body forms under typical stress conditions, ligamentous restraints are of secondary importance. Tensile behaviour of fibular collateral ligaments seems to allow restricted, functional follow-up treatment. In the injury pattern of the ankle joint, the role of the interosseous membrane needs further evaluation. The clinical problems associated with tibiofibular subluxation and synostosis can be explained naturally by the impaired biomechanics of the ankle joint.

Ankle Joint↗
PubMed1988

Effect of the forebrain on flexion reflexes in rats with ankle joint urate arthritis.

Ankle joint urate arthritis in rats is associated with increased responses to ankle stimulation and decreased responses to stimulation of the distal foot. To determine the influence of the forebrain on flexion reflexes in this model, responses to ankle and foot stimulation were examined in chronic decerebrate rats, decerebrated either before or after the induction of the arthritis. The increased responsiveness to stimulation of the arthritic ankle which had been observed after 24 h of urate arthritis was equally apparent in animals decerebrated 24 h before the induction of the arthritis and in those decerebrated 24 h after the urate injection. However, the decreased responsiveness of the distal foot to pressure or temperature stimuli, which had been observed in arthritic animals with an intact forebrain, was still apparent in animals decerebrated 24 h after the induction of the arthritis but did not appear in animals who had been decerebrated before the arthritis induction. It is concluded that the forebrain is required for the production of the reduced responsiveness of the distal foot but is not required for its maintenance once the insensitive state has been acquired.

Animals↗
PubMed1992

Lateral instability of the ankle joint.

Acute lateral ankle ligament ruptures are successfully treated nonoperatively with physiotherapy, peroneal strengthening, and coordination training. About 10-20% of patients may develop functional instability despite adequate nonoperative treatment. Chronic functional instability is not always a severe disability, but reconstruction of the lateral ankle ligaments may be necessary for patients with high demands on ankle stability. More than 50 different surgical procedures for the treatment of chronic lateral ankle joint instability have been described. Most of these are tenodeses where one of the peroneus tendons is used, such as Evans, Watson-Jones, and Chrisman-Snook reconstructions. Good short-term results have been reported, but the long-term results after the Evans and Watson-Jones reconstructions are worse than anticipated. Anatomic ligament reconstruction with shortening, reinsertion, and imbrication of the elongated ligaments, a simple procedure with good long-term results, might be a better alternative than other more complex ligament reconstructions.

Ankle Injuries↗
PubMed2003

Transverse plane motion at the ankle joint.

The ankle is often considered to have little or no capacity to move in the transverse plane. This is clear in the persistent concept that it is the role of the subtalar joint to accommodate the transverse plane motion of the leg while the foot remains in a fixed transverse plane position on the floor. We present data from noninvasive in vivo study of the ankle subtalar complex during standing internal and external rotation of the leg and study of the ankle subtalar complex during walking. These data reinforce the results of cadaver study and invasive in vivo study of the ankle/subtalar complex. We suggest that the ankle is capable of considerable movement in the transverse plane (generally greater than 15 degrees) and that its role in the mechanism that allows the foot to remain in a fixed transverse plane position on the floor while the leg rotates in the transverse plane, is not simply the transfer of the transverse plane moment to the subtalar joint, but is accommodation of some of the necessary movement.

Adult↗
PubMed2005

A measurement device for anterior laxity of the ankle joint complex.

BACKGROUND: Evaluation of anterior ankle joint laxity remains an intriguing clinical problem. Manual examination is of subjective nature. The aim of the present in-vitro and in-vivo study was to develop a tester for quantitative measurement of anterior ankle joint laxity. METHODS: The tester was evaluated on 7 cadaver specimens and on 24 individuals, 14 with prior ligament injury and 10 without. Subsequently, a post hoc analysis was performed on 6 individuals without ligament injury. FINDINGS: In the cadaver tests, mean increase in anterior displacement was 2.0 mm (SD 1.6) with cut anterior talofibular ligament, 2.7 mm (SD 2.7) with cut anterior talofibular and calcaneofibular ligaments and 3.3 mm (SD 3.3) with cut anterior talofibular, calcaneofibular and posterior talofibular ligaments. In the normal subjects, mean displacement was 23 mm (SD 6.6) for left and 25 mm (SD 7.5) for right ankles. In the group of subjects with prior ankle ligament injuries but no instability symptoms, there was no detectable laxity difference between injured and non-injured. The intra-observer reliability for the tester was 0.94. Post-hoc analysis showed a device-related systematic error of < 1mm. INTERPRETATION: The displacement values present the motion between the anterior aspect of the distal tibia and the posterior aspect of the heel, not solely motion in the ankle joint but in the entire ankle joint complex. The test principle has the potential to provide an objective value for anterior displacement values of the ankle joint. The test apparatus in its present form is not suitable for use in clinical practice.

Adult↗
PubMed1995

[Biomechanical study of the initial stability of various arthrodesis methods for the upper ankle joint].

Arthrodesis of the ankle joint is commonly, performed to treat severe arthritis. Three different techniques have been biomechanically evaluated for initial stability: fusion with three isolated tibio-talar lag screws (type I), which was inaugurated by Wagner; a second fusion technique with two isolated tibio-talar lag screws and an anterior tibio-talar three-hole 3.5 mm AO compression plate (type II); and type-II fusion with an additional lag screw through the center hole of the anterior plate (type III). Ten fresh cadaver ankles were used for biomechanical evaluation. Bone stock quality was compared before fusion by CT scan and osteodensitometry. Osteopenic ankle joints (bone density less than 80% of the median density) were excluded. Each ankle fusion was stressed with 15 Nm in a universal testing machine (UTS 10, Ulm, Germany) in antero-posterior and medio-lateral directions and in a rotational torque technique. The movements at the fusion gap were recorded by computer-assisted image analysis. A video camera recorded the displacement of four active markers on both sides of the fusion line during loading in real time. A computer-assisted calculation of the dislocation at the fusion gap was performed. This technique provides comparable results except for systemic failure induced by the fixation device of the testing machine. The results revealed comparable initial stability with types I (0.063 mm/Nm) and III (0.074 mm/Nm; P = 0.95) ankle fusion. Type-II fusion was significantly less favorable concerning initial stability (0.14 mm/Nm; P < 0.01, Duncan's test for multiple comparisons). Our biomechanical results advertise isolated lag screws for ankle fusion.

Ankle Joint↗
PubMed1994

Contact characteristics of the ankle joint. Part 1. The normal joint.

The contact characteristics of ankle joints in 18 fresh cadaver specimens were studied by using pressure-sensitive film to provide baseline information for subsequent studies of various pathologic ankle conditions. Specimens, consisting of the distal half of the tibia and fibula and the intact ankle and foot, were mounted in a materials testing system on a loading frame that allowed positioning in neutral, and 20 degrees of plantarflexion and dorsiflexion. An 800 N load (1 body weight) was axially applied to the specimens through the tibia with 10% of the total load distributed through the fibula. Transducers made of pressure-sensitive film were used to make a contact print and were scanned along with calibration strips to form a digital image. The image was analyzed quantitatively to determine total contact area, mean contact pressure, ratio of contact to plafond areas, and high pressure zone centroid location as a function of sagittal plane foot position in the normal ankle joint. The results demonstrated significant changes in ankle joint contact characteristics with different foot positions.

Ankle Joint↗
PubMed1996

Angioplasty balloon catheters used for distraction of the ankle joint.

Arthroscopy of the ankle joint is now routinely performed in diagnostic and therapeutic interventions but is still a demanding and difficult operative procedure in this very small and tight joint. Arthroscopy can be facilitated by a sufficient distraction that gives a better overview of the joint space. However, it is still a matter of debate how to obtain the adequate distraction. Distention by manual strength as well as by the help of a technical device have been proposed. We report our experience with distraction of the ankle joint by the help of one or two intraarticularily located and secondarily insufflated angioplasty balloon catheters that are routinely used in interventional radiology. These special catheters allow a careful and controlled distention of the joint with a fixed space of distraction and, according to our limited experience, without any morbidity.

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↗
PubMed1999

[Anatomy and kinematics of the human ankle joint].

In the ankle (talocrural) joint, the lower end of the tibia and fibula embrace the trochlea tali. Thus, an approximately uniaxial joint is formed which permits dorsiflexion and plantarflexion of the foot against the leg. Due to the geometry of the trochlea tali, conjunct lateral rotation of the fibula against the tibia occurs at the tibiofibular articulations synchronously with active dorsiflexion at the ankle joint. Movements at the talocrural joints are mainly limited by the opposing muscles as well as by strong collateral ligaments. Talus and calcaneus form a functional unit connected by posterior and anterior articulations. The posterior articulation is the subtalar (talocalcaneal) joint; in the anterior articulation, talar facets of the calcaneus together with the posterior surface of the navicular and the superior fibrocartilaginous surface of the plantar calcaneonavicular ligament form a concavity for the talar head. Thus, the talocalcaneonavicular joint is a compound and--like the subtalar joint--a multiaxial articulation. On the weight-bearing foot, the distal tarsus and metatarsus are pronated and supinated against the talus in order to maintain plantigrade contact. When the foot is off the ground, these movements are modified to eversion and inversion, also involving the calcaneocuboid joint. In addition, movements between the calcaneus and cuboid also occur during pronative or supinative changes between the fore- and hindfoot. Limitation of movements is due to leg muscles as well as strong ligaments. Finally, the cuneonavicular, cuboideonavicular, intercuneiform and cuneocuboid joints permit some additional alterations of the loaded foot in contact with the ground.

Ankle Joint↗
PubMed1991

Age-related changes in the tensile properties of human articular cartilage: a comparative study between the femoral head of the hip joint and the talus of the ankle joint.

Specimens of articular cartilage from the superficial and mid-depth zones of the human femoral head and the talus of the ankle joint were tested in tension in planes parallel to the articular surface and parallel to the predominant orientation of the superficial collagen fibrils. The tensile fracture stress of cartilage from both the superficial and mid-depth zones of the femoral head decreased considerably with age. The superficial zone decreased from 33 MPa at 7 years to 10 MPa by the age of 90 years, while the mid-depth zone decreased from 32 MPa at 7 years to 2 MPa by the age of 85 years. In contrast the fracture stress of both levels of cartilage from the talus of the ankle did not decrease significantly with increasing age. The tensile stiffness at 10 MPa of both the superficial and mid-depth zones of the femoral head decreased with age. That of the superficial zone decreased from 150 MPa at 7 years to 80 MPa at 90 years, while the mid-depth zone decreased from 60 MPa at 7 years to 10 MPa at 60 years. The stiffness of talar cartilage from the superficial zone decreased by 20%, while that of the mid-depth zone showed a slight increase in stiffness at 10 MPa with increasing age. There was no significant decrease in the tensile stiffness at 1 MPa with age for either the femoral head or talar cartilage. Based on the results of previous studies it is possible to conclude that the decrease in tensile properties seen in the femoral head results from a deterioration in the tensile properties of the network of collagen fibrils. It is suggested that progressive fatigue failure, perhaps with associated changes in the structure of cartilage due to altered chondrocyte metabolism, causes the reduction in tensile properties with age. The results offer a potential explanation for the observation that osteoarthritis commonly occurs in the hip and knee joints at an increasing incidence as age increases, while the condition only rarely occurs in the ankle joint except as a secondary event to trauma.

Age Factors↗
PubMed1999

Early influence of an ankle sprain on objective measures of ankle joint function. A prospective randomised study of ankle brace treatment.

The purpose of this study was to analyse objective modalities of ankle joint function after an acute ankle sprain and to see whether treatment with an air-cushioned ankle brace could enhance the restoration of function compared with a traditionally used compression bandage. The study included 73 consecutive patients between 15 and 55 years of age with an acute grade II or III ankle sprain, who sought medical care within 24 h of the time of injury. Patients with recurrent sprain were excluded. The patients were allocated at random to treatment with compression bandage or an air-cushioned ankle brace (Air-Stirrup, Aircast). The regimen included early motion and weight-bearing in both groups. The patients were examined initially within 24 h, after 3-5 days, 2, 4 and 10 weeks after the injury by the following tests: clinical examination including range of motion, recording of postural sway by stabilometry, joint position sense test, isokinetic eversion-inversion muscle torques and figure-of-eight running. A decreased active range of motion in eversion-inversion was observed during the entire follow-up period. Increased postural sway was registered when standing on the injured foot up to 4 weeks after the injury, as were a deficit in evertor muscle peak torque and an evertor-invertor muscle imbalance compared with the uninjured side. Women demonstrated a greater impairment in postural sway than men. A longer curve running time with the injured ankle at the outside of the curve was noted at the 10-week follow-up. With the exception of running in a figure of eight, these measures were not influenced by treatment with a semi-rigid ankle brace. The methods used in the present study are well suited for further studies of objective modalities of ankle joint function, with the possible exception of the joint position sense test.

Ankle Injuries↗
PubMed1994

[The effect of proprioception on functional stability of the upper ankle joint with special reference to stabilizing aids].

Both ankle joints of 14 uninjured volunteers and 16 patients with unstable ankle joints were tested regarding their proprioceptive capabilities. Three tests were used for the study: single-leg stance test, single-leg jumping course test, angle-reproduction test. The influence of three stabilization devices (lace-on-brace, stirrup-brace, taping) on the proprioceptivity of stable and unstable ankle joints were evaluated as well. The scores of the single-leg jumping course test without any stabilizing device (category "standard") ranged between 8.06 and 13.68 (10.65 +/- 1.29). In the categories "mikros" (9.85 +/- 0.99), "aircast" (9.99 +/- 1.14) and with the tape bandage (category "taping") (10.27 +/- 0.81) the scores were lower. In general, the scores of all trials with orthoses were lower compared to the category "standard". The differences of the categories "standard-mikros" and "standard-aircast" revealed a significant reduction of the scores when applicating these orthoses (p < 0.01). The differences of the category "standard-taping" as well as the single scores between the categories "mikros" and "aircast" were not statistically significant. According to the results of the single-leg stance test the error rate was within the range of 0-16 (5.12 +/- 2.85) for the category "standard", it was lower for the categories "mikros" (3.65 +/- 2.65) and "aircast" (4.17 +/- 2.59). The error rate was highest in the group with applicated tape bandage (5.79 +/- 3.53). The differences between the categories "standard"-"mikros" as well as "standard"-"aircast" were statistically significant (p < 0.01). There was also a significant difference between these categories regarding injured and uninjured ankle joints (p < 0.01). The pair differences of the categories "standard" and "taping" were below the significance level as well as the error rates of the categories "mikros" and "aircast". The ankle-reproduction-test showed higher values for the category "standard" (2.36 degrees +/- 0.97) in comparison to the categories "mikros" (1.46 degrees +/- 0.72). "aircast" (1.62 degrees +/- 0.91) and "taping" (1.84 degrees +/- 0.41). In the category "standard" the reproduction error of the uninjured ankle joints was lower (2.30 degrees +/- 1.04) compared to the group of unstable ankle joints (2.44 degrees +/- 0.81), whereas in all other categories the reproduction error was higher in the group of uninjured joints. The differences in all findings between the categories "standard"-"mikros" and "standard"-"aircast" were statistically significant (p < 0.01). The results of the three tests showed a statistically highly significant difference between injured and uninjured ankle joints (p < 0.01).(ABSTRACT TRUNCATED AT 400 WORDS)

Ankle Injuries↗
PubMed2005

Estimation of passive ankle joint moment during standing and walking.

This study estimated the passive ankle joint moment during standing and walking initiation and its contribution to total ankle joint moment during that time. The decrement of passive joint moment due to muscle fascicle shortening upon contraction was taken into account. Muscle fascicle length in the medial gastrocnemius, which was assumed to represent muscle fascicle length in plantarflexors, was measured using ultrasonography during standing, walking initiation, and cyclical slow passive ankle joint motion. Total ankle joint moment during standing and walking initiation was calculated from ground reaction forces and joint kinematics. Passive ankle joint moment during the cyclical ankle joint motion was measured via a dynamometer. Passive ankle joint moment during standing and at the time (Tp) when the MG muscle-tendon complex length was longest in the stance phase during walking initiation were 2.3 and 5.4 Nm, respectively. The muscle fascicle shortened by 2.9 mm during standing compared with the length at rest, which decreased the contribution of passive joint moment from 19.9% to 17.4%. The muscle fascicle shortened by 4.3 mm at Tp compared with the length at rest, which decreased the contribution of passive joint moment from 8.0% to 5.8%. These findings suggest that (a) passive ankle joint moment plays an important role during standing and walking initiation even in view of the decrement of passive joint moment due to muscle fascicle shortening upon muscle contraction, and (b) muscle fascicle shortening upon muscle contraction must be taken into account when estimating passive joint moment during movements.

Adult↗
PubMed2003

[Arthroscopy for anterior joint pathology at the upper ankle joint --pathogenesis, therapy and results].

The conservative treatment of chronic ankle pain and at the so-called "footballer's joint" is of limited success. Arthroscopy is a possibility of operative treatment. 25 arthroscopies were carried out at the upper ankle joint at anterior joint pathology from January 1998 to June 1999. 21 patients could be examined in a median follow-up of 16 months (4-24). The median age was 31 years (17-56; female: 6, male: 15). Synovilitis was found in all cases. In 9 cases exophytes of the tibia, in 10 cases osteochondral lesions and in 7 cases antero-lateral impingement ware seen. The preoperative Score of Mazur of median 63 (21-85) points showed a significant raise (p < 0.05) in follow-up to median 93 (81-100) points. The complete athletic rehabilitation could be restored in 2/3 of the patients. The conservative therapy represents a good method of treatment chronic troubles in the upper ankle joint. Arthroscopy is indicated if no recovery can be attained.

Adolescent↗
PubMed1993

Transfibular compression arthrodesis of the ankle joint.

Eleven ankle arthrodeses were performed on ten patients using a transfibular technique. This technique employs a lateral approach in which the distal fibula is resected while preserving the peroneal tendon sheath, allowing excellent exposure and contouring of the tibiotalar joint. Compression is attained by using a T-plate placed across the tibiotalar joint with the aid of an AO compression apparatus. At 2.5 years after operation, fusion was achieved in ten ankles. Average time in immobilization was 11.8 weeks, and the fused ankle was cosmetically pleasing. Fusion occurred in nine of 11 ankles fused using other methods during this period. Pin tract infection occurred in three, the time in immobilization averaged 16.2 weeks, and the cosmetic result was inferior.

Activities of Daily Living↗