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PubMed2004

[Sprained ankle in children].

OBJECTIVE: To review the literature on sprained ankle in children. We can describe our clinical experience but not statistical analysis because of the few cases. MATERIALS AND METHODS: We searched MedLine with sprain, ankle, children, talo-fibular ligament, ligament injury as key words. RESULTS: We found few and no results from a prospective or randomized trial. We analyzed three surgical publications: Vahvanen (1983, 1984), and Chaumien (1986). Vahvanen's studies concerned 50 ankles treated nonoperatively and 40 treated operatively, and Chaumien described 19 patients. Vahvanen's results suggest that sprained ankle is surprisingly common in children and that primary repair of the ligament will resolve symptoms and lead to a stable ankle joint. Chaumien's description revealed severe lesions defined by radiographic criteria. Sixteen of the 18 patients who underwent surgery healed without any complications. The surgical repair of acute ankle sprain in children has generated much controversy. CONCLUSION: Ankle sprain is a common injury in children and probably underestimated. Clinical evaluation and pain on pressure at the anterior talo-fibular ligament are used in diagnosis. Radiographic studies are necessary to eliminate fractures or an avulsion fragment. Ultrasound can be helpful. Most practitioners and orthopedic surgeons prefer to treat ankle sprains in children nonoperatively.

Ankle Injuries↗
PubMed1996

Ankle arthroscopy: outcome in 79 consecutive patients.

Seventy-nine consecutive ankle arthroscopies were analyzed at a minimum 2-year follow-up to evaluate the risks and benefits of the procedure. All arthroscopies were performed over a 2-year period by a single surgeon using the same nonskeletal traction technique. Forty-four arthroscopies were performed for therapeutic reasons only, whereas 35 were performed for both diagnostic and therapeutic purposes. Clinical examination with visual analog scores were used for assessment preoperatively and postoperatively. The diagnoses were osteochondral lesions of the talus in 21; post-ankle fracture scarring in 14, osteoarthritis and chondromalacia in 11, anterior bony impingement in 14; anterolateral soft tissue impingement or synovitis in 15; miscellaneous diagnosis in 4. Overall, 63 of 79 patients benefited in some way from the procedure. There were diagnostic benefits in 27 of 35 (77%) of ankles in which the diagnosis was clarified by the arthroscopy. In those ankles in which the procedure was performed for therapeutic purposes only, 36 of 44 (82%) of the patients benefited. Those patients with an underlying diagnosis of osteoarthritis of the ankle, posttraumatic chondromalacia and arthrofibrosis, or who were on disability and worker's compensation benefits, had poor results, whereas patients with a localized osteochondral lesion of the talus, localized bony or soft tissue impingement, or localized lateral plica had the best results. There were three significant neurological complications from ankle arthroscopy in this series. Two patients developed a postoperative partial deep peroneal nerve neuropraxia, and one patient had superficial peroneal nerve irritation at the site of the anterolateral portal. Ankle arthroscopy appears to be a relatively low-risk procedure with substantial benefits, particularly in localized disease of the ankle joint. Skeletal distraction was not used in any of these cases.

Adolescent↗
PubMed2003

Medial ankle instability.

Medial instability is suspected on the basis of a patient's ankle feeling like it is "giving way," especially medially, when walking on uneven ground, downhill, or down stairs, pain at the anteromedial aspect of the ankle, and sometimes pain in the lateral ankle, especially during dorsiflexion of the foot. A history of a chronically unstable feeling that is manifested by recurrent injuries with pain, tenderness, and sometimes bruising over the medial and lateral ligaments, is considered to indicate combined medial and lateral instability that is believed to result in rotational instability of the talus in the ankle mortise. Pain on the medial gutter of the ankle and a valgus and pronation deformity of the foot are hallmarks of the disorder. The deformity typically can be corrected by the activation of the posterior tibial muscle. In contrast to stress radiographs, arthroscopy is a helpful diagnostic tool in verifying medial instability; it proved that the lateral ankle ligaments also can be involved. The treatment for symptomatic medial instability of the ankle might include reconstruction of all involved ligaments at the medial, and, if necessary, the lateral ankle. In the case of progressed foot deformity or bilateral long-standing valgus and pronation deformity of the foot, an additional calcaneal lengthening osteotomy might be considered. A classification of the instability into three types has been helpful for determining surgical treatment and the after treatment. This treatment concept provides high patient satisfaction and reliable clinical results.

Ankle Injuries↗
PubMed2004

The initial effects of a Mulligan's mobilization with movement technique on dorsiflexion and pain in subacute ankle sprains.

Physiotherapists frequently use manipulative therapy techniques to treat dysfunction and pain resulting from ankle sprain. This study investigated whether a Mulligan's mobilization with movement (MWM) technique improves talocrural dorsiflexion, a major impairment following ankle sprain, and relieves pain in subacute populations. Fourteen subjects with subacute grade II lateral ankle sprains served as their own control in a repeated measures, double-blind randomized controlled trial that measured the initial effects of the MWM treatment on weight bearing dorsiflexion and pressure and thermal pain threshold. The subacute ankle sprain group studied displayed deficits in dorsiflexion and local pressure pain threshold in the symptomatic ankle. Significant improvements in dorsiflexion occurred initially post-MWM ( F(2,26) = 7.82, P = 0.002 ), but no significant changes in pressure or thermal pain threshold were observed after the treatment condition. Results indicate that the MWM treatment for ankle dorsiflexion has a mechanical rather than hypoalgesic effect in subacute ankle sprains. The mechanism by which this occurs requires investigation if we are to better understand the role of manipulative therapy in ankle sprain management.

Acute Disease↗
PubMed1997

Ankle trauma significantly impairs posture control--a study in basketball players and controls.

Both ankle and hip movements are used to maintain balance in strategies defined as bottom up and top down models. This suggests that pathological impairment of either of these articulations could modify the parameters of balance control. In order to appreciate the bearing of ankle damage on the proper control of equilibrium, posturographic recordings were compared, in a static and two dynamic tests, between 15 professional national basketball players, with histories of 10 to 15 ankle sprains, and 50 controls. In statokinesigrams obtained with eyes open or closed, center of foot pressure displacements were of similar length (way) between controls and players, while the area covered was increased for the latter and related to the history of ankle trauma. In a toes-up dynamic test (4 degrees, 50 degrees/s) coupled with electromyographic recordings, the short latency response (myotatic reflex in the triceps surae muscle) normalized to one meter body height, was shorter in players without relationship to histories of ankle damage. In a prolonged sinusoidal dynamic test, players with the largest number of ankle trauma showed greater difficulties in maintaining posture control. These data pinpoint the role of ankles in the control of both static and dynamic balance and demonstrate that the role of the hip joints becomes more important (top down strategy) in the case of damaged ankles.

Adolescent↗
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↗
PubMed1987

Effects of recurrent lateral ankle sprains on active and passive judgements of joint position.

The purpose of this study was to examine the effects of recurrent lateral ankle sprains on subjects' active and passive judgments of joint position. Fourteen subjects with recurrent unilateral ankle sprains contributed data to two groups: 1) In Group 1, the subjects' 14 sprained ankles were tested and 2) in Group 2, the same 14 subjects' contralateral nonsprained ankles were tested. An additional seven subjects with no history of injury to either ankle comprised Group 3 with 14 nonsprained control ankles. The experimenter tested all blindfolded subjects with active and passive attempts at replicating predetermined ankle joint positions in the inversion-eversion range of motion. An isokinetic dynamometer measured joint position. A two-way analysis of variance indicated no significant effect caused by ankle injury or noninjury. Passive judgments were significantly better than active judgments of joint position (p less than .01) in the nonsprained control group. The results suggest that joint receptors play a dominant role in joint angle detection and that muscle receptors are more valuable in the perception of joint movement.

Adolescent↗
PubMed1979

The lateral ankle sprain: an experimental study.

An experimental study in 39 ankles of the mechanisms of lateral ankle sprains was carried out using a simple qualitative apparatus. The mechanisms studied were: 1) supination-inversion, which was divided into ankle in plantar flexion and ankle in neutral position, since the orientation and tension of the ankle capsule and ligaments are related to the ankle position; 2) supination-internal rotation; and 3) supination-plantar flexion. Fresh amputation specimens were used. It was concluded that complete rupture of the anterior fibulotalar ligament is always the first lesion to occur in the lateral ankle sprain except when a supination force is applied to the ankle in neutral position when an incomplete tear of the fibulocalcaneal ligament may precede the total rupture of the anterior fibulotalar ligament. A partial rupture of the anterior deep fibers of the deltoid ligament can occur in extreme degrees of internal rotation or plantar flexion. A four-part grading system is suggested.

Ankle↗
PubMed1983

Compression arthrodesis of the knee and ankle with the Hoffmann external fixator.

We performed 12 arthrodeses of the knee and eight of the ankle, using the Hoffmann device as a compressor-fixator. For the knees, the double rectangular frame was used with the added fixation of a cylinder cast in six cases. In four cases a separate half frame was used in the anterior plane. Posttraumatic arthritis was the indication in seven cases, and failed arthroplasties in five cases (three of them infected). For the ankles, a double triangular compression frame was used, with transfixing pins across the talus (after trauma) or the calcaneus (after ankle replacement). The ankle arthrodeses were done for posttraumatic arthritis in five cases (ankle fracture in one case, pylon fracture in three cases, fracture of the talus in one case), and failed ankle arthroplasty in three cases. Solid union occurred in all but one of the knee arthrodeses and in all but two of the ankle arthrodeses. Two infected total ankle replacements eventually terminated in amputation.

Ankle Injuries↗
PubMed2003

Ankle fusion attributable to posttraumatic arthrosis: a long-term followup of 48 patients.

The subjective, clinical, functional, and radiologic long-term results of 48 patients after tibiotalar arthrodesis done for posttraumatic and isolated arthrosis of the ankle are reported. After an average followup of 9.3 years, good and very good results were achieved in 92% for subjective parameters and in 73% for clinical and functional parameters as reflected in the American Orthopaedic Foot and Ankle Society ankle and hindfoot score. Fusion of the ankle in a position greater than 5 degrees plantar flexion was correlated with a worse late clinical outcome monitored by the American Orthopaedic Foot and Ankle Society ankle and hindfoot score. At the followup, average tarsal mobility in the surgically treated foot was reduced to 54% of the contralateral side and that loss of tarsal mobility led to a poorer clinical outcome. However, a high incidence of subsequent arthrosis in the adjacent joints of the foot seems not to be completely avoidable in the long-term. The subtalar joint had moderate and severe arthrosis in 47% of patients. Long-term outcome was worse in these patients compared with patients with mild or without degenerative changes in this joint. The current study justifies the value of ankle fusion as a surgical treatment option in patients with end-stage arthrosis in the ankle, provided precise intraoperative positioning of the arthrodesis and the importance of the subtalar joint, are given due consideration.

Adult↗
PubMed2001

Intra-articular load distribution in the human ankle joint during motion.

The rational treatment of injuries to the ankle is predicated on an understanding of biomechanics of the ankle. While several investigators have reported on three-dimensional dynamic kinematics of the ankle and on the static distribution of pressure within the ankle, it has not been possible to measure intra-articular forces reliably under dynamic conditions. The assumption that the distribution of forces under dynamic conditions is well represented by statically determined forces has not been validated, leaving in question the applicability to dynamic conditions of data obtained under static conditions. This study characterizes an electro-mechanical thin-membrane force transducer with potential for intra-articular use. The sensor was found to yield a reproducible linear response to loads experienced in the ankle, and was insensitive to both a moist environment and shearing forces. On the basis of these results, these force-transducers were placed in axially loaded cadaveric ankles that were either statically or dynamically cycled through a physiologic range of motion. In each of six specimens, sensors were secured to the medial and lateral malleolar articular surfaces, and to articular surfaces of the medial and lateral tibial plafond. Both medial and lateral malleolar-talar forces increased with dorsiflexion. Moving from plantarflexion to dorsiflexion caused an increase in lateral tibio-talar load accompanied by a decrease in the medial tibio-talar loading. There was no significant hysteresis in force-distribution with respect to the direction of sagittal motion. There was no difference between the forces measured under static or dynamic conditions. This study validates the use of static loading methodologies in future studies of force-distribution. Our data in intact ankles closely corresponded to data on forces under dynamic conditions. Dorsiflexion caused an increase in both medially and laterally directed forces towards the malleoli. This is the first demonstration of such forces, which are responsible for the external rotation and lateral translation of the distal fibula that occurs in dorsiflexion of the ankle.

Ankle Injuries↗
PubMed2004

Assessment of the lateral ligaments of the ankle after healed fractures.

BACKGROUND: Lateral ligament complex injuries are difficult to diagnose immediately after ankle fracture, and treatment is focused on the fracture. This study examines the prevalence of ligamentous injuries after severe ankle fractures. METHODS: Lateral ligament instability can be revealed by inversion and anterior stress views after fracture healing. The results of 54 inversion and anterior stress examinations of the ankle after fracture healing, using a Telos stress device at 15 kPa force, were compared with uninjured ankles. RESULTS: No patient had 5 degrees or more of talar tilt or 6 mm or more of anterior displacement of the talus in uninjured ankles; however, in ankles with fractures, we found abnormal talar tilt angle in 12 and excessive anterior displacement in five. An abnormal inversion stress test was found to be considerably more common in the fractured ankles. CONCLUSION: Our study revealed that lateral ligament injuries may occur simultaneously with ankle fractures, with the most frequently injured being the calcaneofibular ligament.

Adolescent↗
PubMed2005

Effects of the subtalar sling ankle taping technique on combined talocrural-subtalar joint motions.

BACKGROUND: The findings of research on the effectiveness of ankle taping for protection against ligament injury have been inconsistent, and the topic remains controversial. The precise orientation of the force vectors created by tension within the various tape strip components of an ankle taping procedure may be a critical factor influencing the degree of motion restraint that is provided. We hypothesized that the addition of the subtalar sling component to the widely recognized standard (Gibney) ankle taping procedure would enhance restraint of ankle motion. This was a controlled laboratory study, with fully repeated measures (subjects served as their own controls). METHODS: An ankle arthrometer was used to quantify anteroposterior (AP) translation and frontal plane inversion-eversion (I-E) tilt of the talocrural-subtalar joints under untaped and taped conditions in normal subjects. A 15-minute exercise session was conducted to loosen the tape before measurement of its effect on motion restraint. RESULTS: The ankle taping procedure that incorporated the subtalar sling provided significantly greater restriction of postexercise AP translation (p < 0.001, eta(2) = 0.63) and postexercise I-E tilt (p < 0.001, eta(2) = 0.66). CONCLUSIONS: The subtalar sling ankle taping procedure provides greater restriction of motions associated with ankle instability than the more widely used Gibney procedure.

Adult↗
PubMed1991

Risk factors for lateral ankle sprain: a prospective study among military recruits.

In a prospective study of risk factors for lateral ankle sprain among 390 male Israeli infantry recruits, a 18% incidence of lateral ankle sprains was found in basic training. There was no statistically significant difference in the incidence of lateral ankle sprains between recruits who trained in modified basketball shoes or standard lightweight infantry boots. By multivariate stepwise logistic regression a statistically significant relationship was found between body weight x height (a magnitude which is proportional to the mass moment of inertia of the body around a horizontal axis through the ankle), a previous history of ankle sprain, and the incidence of lateral ankle sprains. Recruits who were taller and heavier and thus had larger mass moments of inertia (P = 0.004), and those with a prior history of ankle sprain (P = 0.01) had higher lateral ankle sprain morbidity in basic training.

Analysis of Variance↗
PubMed1999

Reconstruction of the lateral ankle ligaments using a split peroneus brevis tendon graft.

Thirty-one consecutive ankles in 30 patients with chronic lateral ankle instability were reconstructed using a split peroneus brevis tendon graft. All patients had pain and instability despite adequate treatment and a rehabilitation program. Six patients had clinical and radiographic evidence of associated subtalar laxity. Four patients (four ankles) had prior Brostrom ligament reconstructions. The average time from the initial injury or treatment to surgery was 23 months. At a mean follow-up of 44 months (range, 24-64 months), the functional results included excellent in 20 ankles, good in 9, fair in 1, and poor in 1. Ankle stability, which did not deteriorate with time, was achieved in 30 of 31 ankles. This procedure is simple, safe, and reliable with a 94% good to excellent clinical result and 97% mechanical stability. It is an excellent reconstruction choice for those individuals with high demand ankles, with a longstanding ankle instability with or without subtalar instability, and for failed primary reconstruction.

Adolescent↗
PubMed1995

Effects of a semirigid and softshell prophylactic ankle stabilizer on selected performance tests among high school football players.

No prophylactic ankle stabilizer performance study has been conducted to date using high school football players, ie., players who are at risk of ankle sprains. In addition, the effect that prophylactic ankle stabilizer use has on performance by player position is unknown. The purpose of this study was to determine the effect of a semirigid and softshell prophylactic ankle stabilizer on performance by football player position in events testing vertical jump, speed, and agility. Twenty-five high school football players participated in the study. All subjects denied any history of ankle injury within 1 year of the study and previous experience with prophylactic ankle stabilizer use. Subjects completed three tests [vertical jump, 36.56-m (40-yd) sprint, and 18.28-m (20-yd) shuttle run] under three different ankle treatments: Aircast SportStirrup, DonJoy RocketSoc, and nonbraced control. Results of the study indicated that the Aircast SportStirrup and DonJoy RocketSoc, when compared with a nonbraced control, had no significant effect on vertical jump, 36.56-m (40-yd) sprint, and 18.28-m (20-yd) shuttle run performance. Skill players had faster 36.56-m (40-yd) sprint times than strength players regardless of ankle treatment. In conclusion, the Aircast SportStirrup and DonJoy RocketSoc did not facilitate or adversely affect performance involving vertical jump, speed, and agility of high school football players.

Adolescent↗
PubMed1987

Epiphyseal injuries of the foot and ankle.

A thorough knowledge of functional growth plate anatomy and physiology is essential to proper management of epiphyseal foot and ankle injuries. The ability to classify foot and ankle fractures according to the Salter-Harris anatomic and radiographic classification provides useful prognostic information that may affect treatment. The Dias-Tachdjian mechanistic classification system for pediatric ankle fractures provides useful information about the extent of osseous and soft tissue injury and the best method of closed reduction and correlates well with the Lauge-Hansen system, which is widely used for adult ankle fractures. Most epiphyseal foot fractures involve the metatarsals or phalanges and can usually be managed with closed reduction. Considerable spontaneous correction of deformity can be expected in the younger child (under age 10 years), but one should be aware that sagittal plane and rotational malalignment of the metatarsal heads may cause significant problems. Salter-Harris type I and II fractures of the ankle can usually be managed with closed reduction. Salter-Harris type III and IV ankle fractures with greater than 2 mm of displacement require open reduction and internal fixation. One must also have a high index of suspicion for juvenile Tillaux and triplane transitional fractures that may not be obvious on plain radiographs. Although these fractures usually do not produce significant limb-length discrepancies, they are intra-articular fractures and ankle joint arthritis can result. Finally, younger children (under age 10 years) have a better prognosis for spontaneous correction of nongrowth arrest-induced deformities but a much poorer prognosis with growth arrest injuries than do older children, in whom growth arrest does not usually cause a significant problem. All children with growth plate injuries should be followed at regular intervals for at least 2 years or to skeletal maturity in the case of physeal disturbance. Treatment of epiphyseal fractures of the foot and ankle must be individualized but should always be based upon a thorough knowledge of anatomy, bone growth physiology, classification, potential pitfalls, and prognosis.

Adolescent↗
PubMed1984

Stabilometry in functional instability of the ankle and its value in predicting injury.

Stabilometry is an objective method used for studying postural equilibrium quantitatively. Stabilometric recordings were made in 127 soccer players to demonstrate functional instability of the ankle joint. The presence of previous ankle joint injuries, i.e., sprains or fractures, was documented. Reference values for stabilometry were obtained from a group of 30 normally-active non-soccer players without a history of injury to the ankle joint. A pathological stabilometric value was defined as one exceeding the mean value of the reference group by 2 SD. In players with a history of previous ankle joint injury no increased postural sway was found. On the other hand, players showing abnormal stabilometric values ran a significantly (P less than 0.001) higher risk of sustaining an ankle injury during the following season compared to players with normal values. Players with a history of previous ankle joint injury did not run a higher risk compared to players without previous injury. The findings indicate that an ankle joint injury did not result in a persistent functional instability; however, such instability did increase the risk of ankle joint injury.

Adolescent↗