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PubMed2003

The role of ankle bracing for prevention of ankle sprain injuries.

Lateral ankle sprains are one of the most common injuries incurred in recreational and competitive athletics. These injuries have a significant impact in terms of cost, athletic participation, and activities of daily living. Prophylactic ankle braces are often used to reduce the risk of injury recurrence when individuals return to athletic participation. The purpose of this clinical commentary is to review the literature and provide our own experience relative to the use of prophylactic ankle bracing. Relatively high incidence rates of ankle sprain injury have been reported for basketball and soccer athletes, military trainees, and individuals with a previous history of ankle sprain injury. Semirigid and laced ankle braces have significantly reduced the incidence of initial and recurrent ankle sprain injuries in athletic and military samples. With few exceptions, these braces do not appear to affect functional performance adversely. The prophylactic use of semirigid ankle braces appears warranted to reduce the incidence of initial and, in particular, recurrent ankle sprain injuries for individuals who participate in activities that have the highest risk for these injuries. Additional research is needed to evaluate the many new braces that are available and in use and their influence on the incidence of ankle sprain injury and functional performance.

Ankle Injuries↗
PubMed1995

Expanding the use of the ankle distractor in the treatment of complex ankle fractures.

Use of the ankle distractor with ankle arthroscopy is well known to allow improved evaluation of the intraarticular surfaces. A less common application of the ankle distractor is for the treatment of complex ankle fractures. We evaluated the use of the ankle distractor in the treatment of six patients with ankle trauma. Five of these cases involved comminuted intraarticular fractures of the distal tibia, and one case involved a malunion of an ankle fracture with widening of the mortise. In each case, the ankle distractor increased the exposure of the ankle joint and allowed better access for fracture fragment reduction. There were no complications associated with the use of the distractor. The technique of using the ankle distractor in these situations is described.

Ankle Injuries↗
PubMed1988

Comparative analysis of ankle arthroplasty versus ankle arthrodesis.

In a retrospective study of 41 patients with total ankle arthroplasty (25 patients) and ankle arthrodesis (18 patients), the mean follow-up period was 3.8 years for total ankle arthroplasties and 3.3 for ankle arthrodeses. Sixteen of the 23 ankle arthroplasty patients, and 17 of the 18 arthrodesis patients had good or excellent results. Total ankle arthroplasty was successful in patients with rheumatoid arthritis, but not posttraumatic arthrosis. Total ankle arthroplasty is indicated in rheumatoid patients with severe ankle involvement who have not responded to medical management. It also may be used in the elderly or debilitated patients who will place minimal stress on the ankle. The elderly may not tolerate the prolonged immobilization or repeated operations that fusion may require. Total ankle arthroplasty should not be used in young patients with posttraumatic arthrosis.

Adult↗
PubMed2002

Can Chronic Ankle Instability Be Prevented? Rethinking Management of Lateral Ankle Sprains.

OBJECTIVE: To pose the question, "Can chronic ankle instability be prevented?" The evaluation and treatment of chronic ankle instability is a significant challenge in athletic health care. The condition affects large numbers of athletes and is associated with reinjury and impaired performance. The management of acute injuries varies widely but in athletic training has traditionally focused on initial symptom management and rapid return to activity. A review of practice strategies and philosophies suggests that a more detailed evaluation of all joints affected by the injury, correction of hypomobility, and protection of healing structures may lead to a more optimal long-term outcome. BACKGROUND: Sprains to the lateral ankle are common in athletes, and the reinjury rate is high. These injuries are often perceived as being isolated to the anterior talofibular and calcaneofibular ligaments. It is, however, becoming apparent that a lateral ankle sprain can injure other tissues and result in joint dysfunction throughout the ankle complex. DESCRIPTION: We begin by addressing the relationship between mechanical and functional instability. We then discuss normal ankle mechanics, sequelae to lateral ankle sprains, and abnormal ankle mechanics. Finally, tissue healing, joint dysfunction, and the management of acute lateral ankle sprain are reviewed, with an emphasis on restoring normal mechanics of the ankle-joint complex. A treatment model based on assessment of joint function, treatment of hypomobile segments, and protection of healing tissues at hypermobile segments is described.

Journal Article↗
PubMed1993

Changes in gait and maximum ankle torque in patients with ankle arthritis.

Findings from quantitative gait analysis and maximum ankle torque were used to assess the walking pattern of patients with ankle arthritis and to correlate the changes of gait parameters and muscle strength with severity of arthritis. Gait analysis and the isokinetic maximum ankle torque test were performed in 20 patients with first to fourth degree traumatic ankle arthritis. Six patients without evidence of traumatic arthritis were used as controls. Isokinetic maximum ankle plantarflexion and dorsiflexion torques were determined with Cybex instrumentation. Force plate and foot switch data were gathered during level walking. Maximum ankle plantarflexion and dorsiflexion torques were diminished in the injured ankles. Velocity, stride length, and cadence were decreased in arthritic patients compared with controls. The arthritic limbs had shorter single limb stance and longer double stance during free and fast walking speeds compared with the controls' affected ankles. The patterns of ground reaction forces were similar in the injured and uninvolved limbs as well as the control subjects, except the magnitude of vertical forces during push-off were reduced in arthritic ankles. The gait parameters and muscle strength deteriorated as the arthritis became severe, but they showed significant changes only when the patients had third or fourth degree arthritis.

Adult↗
PubMed2004

The human ankle during walking: implications for design of biomimetic ankle prostheses.

The non-disabled human ankle joint was examined during walking in an attempt to determine overall system characteristics for use in the design of ankle prostheses. The hypothesis of the study was that the quasi-stiffness of the ankle changes when walking at different walking speeds. The hypothesis was examined using sagittal plane ankle moment versus ankle angle curves from 24 able-bodied subjects walking over a range of speeds. The slopes of the moment versus ankle angle curves (quasi-stiffness) during loading appeared to change as speed was increased and the relationship between the moment and angle during loading became increasingly non-linear. The loading and unloading portions of the moment versus angle curves showed clockwise loops (hysteresis) at self-selected slow speeds that reduced essentially to zero as the speed increased to self-selected normal speeds. Above self-selected normal speeds, the loops started to traverse a counter-clockwise path that increased in area as the speed was increased. These characteristics imply that the human ankle joint could be effectively replaced with a rotational spring and damper for slow to normal walking speeds. However, to mimic the characteristics of the human ankle during walking at fast speeds, an augmented system would be necessary. This notion is supported by the sign of the ankle power at the time of opposite heel contact, which was negative for slow speeds, was near zero at normal speeds, and was positive for fast walking speeds.

Adult↗
PubMed1998

Ankle orthoses effect on single-limb standing balance in athletes with functional ankle instability.

OBJECTIVE: To test whether a rigid or a flexible ankle orthosis affects postural sway in single-limb stance as quantified by stabilometry. DESIGN: Crossover trial. SETTING: University laboratory. PARTICIPANTS: Twenty-two athletes with functional ankle instability (consecutive sample of patients with recurrent ankle sprains but without mechanical instability) and 22 healthy athletes (control group of volunteers matched to age, height, weight, physical activity). INTERVENTIONS: Stabilometry in single-limb stance on a force platform. Participants were tested on each leg with and without a rigid or a flexible ankle orthosis. The order of test conditions was randomized. MAIN OUTCOME MEASURES: Sway velocities, sway pattern, and sway area as calculated from center of pressure movements. The two groups were compared by Mann-Whitney test, and the different orthoses within each group were compared by Wilcoxon test, paired samples (type I error 5%, Bonferroni adjustment). RESULTS: In athletes with functional ankle instability, both a rigid and a flexible ankle orthosis significantly reduced mediolateral sway velocity. A flexible ankle orthosis also changed sway pattern significantly, by reducing the percentage of linear movements of less than 5 degrees per .01 sec. CONCLUSIONS: In athletes with functional ankle instability, ankle orthoses reduce mediolateral sway velocity, possibly because of improved mediolateral proprioception.

Adult↗
PubMed2004

The effect of an ankle brace on the 3-dimensional kinematics and tibio-talar contact condition for lateral ankle sprains.

Ten fresh-frozen cadaveric ankles were studied to investigate the effect of an ankle brace (Air-Stirrup) on the three-dimensional (3-D) motion and contact-pressure distribution of the talo-tibial joint with lateral ligamentous injury. Three-dimensional motion and contact-pressure distribution were simultaneously measured under dynamic conditions employing a direct linear-transformation technique and a dynamic-pressure sensor, respectively. Inversion increased significantly upon severing of the anterior talo-fibular (ATF) ligament and calcaneo-fibular (CF) ligaments; however, restoration to the intact level was observed following application of the ankle brace. Internal rotation also increased upon severing of the lateral ligaments in the plantar flexion; however, this difference was not altered by using the ankle brace. The contact area on the articular surface of the talus shifted from posterior to anterior between plantar flexion and dorsal flexion; additionally, a high pressure area was evident in the medial aspect of the talus following severing of the lateral ligaments. Upon application of the ankle brace, however, no significant changes were apparent in the contact condition. The results of this study suggest that stabilization against inversion is the major function of braces in terms of protection of ankle sprains. Ankle sprains, however, often occur in combinations of inversion, plantar flexion and internal rotation; therefore, restriction of plantar flexion and internal rotation may also be an important function of the ankle brace.

Ankle Injuries↗
PubMed2000

The effect of recurrent ankle inversion sprain and taping on proprioception at the ankle.

PURPOSE: A common explanation for the tendency for ankle inversion sprains to recur is that proprioception is impaired by the initial sprain. It is further hypothesized that the application of tape prevents further sprains by enhancing proprioceptive acuity. The purpose of this study was to determine whether proprioception was impaired in people with recurrent ankle inversion sprain, and whether taping the ankle provided enhanced proprioceptive ability. METHODS: We compared the ability to perceive passive plantarflexion and dorsiflexion movements imposed at the relaxed ankle in 25 subjects with recurrent ankle inversion sprain, with a group of 18 healthy control subjects, matched for age, height, weight, and activity level. Subjects were tested with the ankle both taped and untaped. Detection thresholds were determined at three velocities, 0.1 degrees x s(-1), 0.5 degrees x s(-1), and 2.5 degrees x s(-1). Velocity of the imposed movements and testing of the taped and untaped conditions were randomized. RESULTS: There was no significant difference in the ability to perceive ankle movements between subjects with sprains and healthy controls at any velocity of movement tested. In addition, there was no significant difference in movement perception between the taped and untaped conditions for either subject group at any velocity. CONCLUSION: The ability to detect passive plantarflexion and dorsiflexion movements is not impaired in subjects with recurrent ankle inversion sprain. Furthermore, the protective effect of taping was shown not to arise from enhanced proprioception in the dorsiflexion-plantarflexion plane.

Adolescent↗
PubMedDate not supplied

Ankle disk training influences reaction times of selected muscles in a simulated ankle sprain.

Ankle disk training has been used as an exercise in sports medicine clinics to help protect against ankle sprains. This study investigated the effects of ankle disk training on the contraction pattern of the anterior tibialis, posterior tibialis, peroneus longus, and flexor digitorum longus muscles in a simulated ankle sprain. Twenty adults were recruited and divided into a control group and an experimental group. A platform with a trapdoor was used to simulate a lateral ankle sprain. Electromyographic data were recorded from each subject in pretraining and posttraining tests. The experimental group underwent ankle disk training for 8 weeks between the pretraining and posttraining tests. In the pretraining test, the four muscles started to contract simultaneously; in the posttraining test, the contractions of the anterior and posterior tibialis muscles were delayed. This delay favors the correction of excessive ankle inversion. This study examined the effects of one form of proprioceptive training on muscle reaction times, and its results may explain why such training can help protect against ankle sprains.

Adolescent↗
PubMed2006

Ankle ligament tensile forces at the end points of passive circumferential rotating motion of the ankle and subtalar joint complex.

BACKGROUND: Ankle ligament injuries and instability are commonly observed. Knowledge of the relationship between the foot position and tensile forces of the ankle ligaments could be useful for treatment of ankle ligament disorders. The aim of this study was to measure the tensile forces of the ankle ligaments at the end points of passive circumferential rotating motion of the ankle and subtalar joint complex in various foot positions. METHODS: Ligament tensile forces of the anterior talofibular (ATF), calcaneofibular (CF), posterior talofibular (PTF), and tibiocalcaneal (TC) ligaments were measured simultaneously in eight cadaver specimens, with a force probe in each ligament in a custom-made ankle ligament testing device. Weights of 0.5 kg and 1 kg were applied to the foot through a loading arm to provide axial compression and a bending moment to the foot and ankle. The position of the loading arm was changed circumferentially in 10-degree increments. RESULTS: Maximal tensile force in the ATF ligament was observed in supination with plantarflexion (108 +/- 62.8 N at 0.5 kg and 130 +/- 39.1 N at 1 kg). The maximal tensile force in the CF ligament was observed in pronation with plantarflexion (68 +/- 48.6 N at 0.5 kg and 135 +/- 92.9 N at 1 kg). The maximal tensile force in the PTF ligament was observed in dorsiflexion (131 +/- 80.1 N at 0.5 kg and 109 +/- 36.3 N at 1 kg). The maximal tensile force of the TC ligament was observed in pronation with plantarflexion (49.0 +/- 80.1 N at 0.5 kg and 67.4 +/- 69.6 N at 1 kg). Relatively high magnitudes of tensile force were observed in the ankle ligaments, and the peak forces were related to the anatomic position of individual ligaments. CONCLUSIONS: The ATF ligament has an important role in the supination position in plantarflexion, CF and TC ligaments also are important for pronation in plantarflexion, and the PTF is an important stabilizer in dorsiflexion. This study provides baseline information for further research related to ligament instability and reconstruction operations.

Aged↗
PubMed1981

An EMG analysis of the effectiveness of external ankle support during sudden ankle inversion.

The effectiveness of external ankle support in influencing the role of a primary ankle everter during the application of an ankle inverting torque was examined by monitoring the electromyographic (EMG) output of the peroneous longus. Six male intercollegiate athletes were randomly placed in a balanced latin squares design, and were tested under three treatment conditions: (a) wrapped, (b) taped, (c) no external support. The subjects performed a backward stepdown movement. During the experimental step, a trapdoor in the lower platform collapsed so as to form a potential ankle inverting angle of 30 degrees. Sixteen millimeter film was used to record each subject's stepping sequence. The film was in turn synchronized to the subject's recordings of EMG activity. Statistical analysis of the integrated EMG pulse counts showed a significant difference (P less than .05) between the normal (control) and ankle inverting (experimental) steps. No significant differences (P less than .05) were detected between treatments. It was concluded that the apparatus placed a measurable stress on the ankle and that preventive ankle strapping has no statistically significant (P less than .05) effect on the tension developed in the peroneous longus during a quick inversion (less than or equal to 30 degrees) of the ankle joint.

Adult↗
PubMed2004

The ankle meter: an instrument for evaluation of anterior talar drawer in ankle sprain.

The aim of this study was to work out a clinical test which is possible to measure the anterior talar drawer (ATD) in patients after ankle sprain. The instrument for evaluation was called "ankle meter". The instrument consists of two plastic scales (heal scale and tibia scale). The instrument allows quantifying the results of the anterior drawing test. A total of 38 persons (16 men, 22 women) were available as control group. The persons were 28.8+/-10.1 years old. No proband had any ankle problems in his history. A total of 45 patients (25 males, 20 females) suffering from ankle sprain were included in the study. In these patients stress radiography (147.1 N) was performed to measure the ATD. In control group the clinical measured ATD was 1.7+/-1.3 mm. Measurement for detect the interobserver validity did not detect significant differences. The ATD of the joint after ankle sprain was significantly higher (8.9+/-4.3 mm). The difference between healthy and injured ankle in case of an ankle sprain was 7.4+/-4.2 mm. There was a significant correlation between clinical and radiological measured ATD (R=0.91). The results suggest that it is possible to measure the ATD exactly. The values of the clinical ATD measurement showed a good correlation with the results of stress radiography. Diligent clinical examination in combination with this special test are after this experiences sufficient to classify the severity of injury after ankle sprain.

Adolescent↗
PubMed1984

Evaluation of graft patency utilizing the ankle-brachial pressure index and ankle pulse volume recording amplitude.

To determine femoropopliteal graft patency, the ankle-brachial pulse index and the ankle pulse volume recording amplitude were measured. Fourteen healthy volunteer subjects were tested on two occasions over 24 hours (ankle-brachial pressure index 1.14+:-0.16, change 0.03+:-0.05; ankle pulse volume recording amplitude 25+:-7 mm, change 5+:-4 mm). In the second control group, hemodynamic function in the unoperated limb was studied before and after surgery in 40 patients undergoing infrainguinal bypass on the contralateral side (preoperative ankle-brachial pressure index 0.66+:-0.3, change 0.02+:-0.12; preoperative ankle pulse volume recording amplitude 8+:-7 mm, change 1+:-3 mm). After 119 patent femoropopliteal bypasses ankle-brachial pressure index and ankle pulse volume recording amplitude increased by 0.41+:-0.26 and 11+:8 mm, respectively.

Ankle↗
PubMed2005

Lumbar extensor fatigue and circumferential ankle pressure impair ankle joint motion sense.

Fatigue of the lumbar extensor muscles has been associated with a degradation of balance, but the mechanism is not well understood. The ankle plays a major role in upright standing, and loss of proprioceptive acuity at the ankle could contribute to a degradation of balance. Therefore, the first objective of this study was to investigate the effect of lumbar extensor fatigue on ankle proprioceptive acuity. The second objective was to investigate the effect of circumferential ankle pressure (CAP) on ankle proprioceptive acuity to evaluate CAP as a potential intervention to mitigate any loss of proprioceptive acuity at the ankle with lumbar extensor fatigue. To address these objectives, ankle joint motion sense was evaluated with and without CAP, both before and after the lumbar extensors were fatigued. Results showed an impairment in joint motion sense with both fatigue and CAP. These results indicate that lumbar extensor fatigue impairs ankle proprioceptive acuity, which may help explain observed increases in postural sway subsequent to lumbar extensor fatigue.

Adaptation, Physiological↗
PubMed2005

Ankle eversion torque response to sudden ankle inversion Torque response in unbraced, braced, and pre-activated situations.

In 13 young ankle stable subjects, ankle eversion torque and peroneal EMG were simultaneously recorded in response to sudden ankle inversion. The eversion torque response was bi-phasic. The initial development of torque, which was responsible for 30% of the maximal eversion torque response, was observed 135 ms after the start of platform rotation and correlated well with the onset of the automatic postural peroneal EMG response. The remaining eversion torque response commenced after 305 ms, strongly correlating with the onset of the peroneal long latency voluntary EMG activity. With the ankle unbraced, 66% of the maximal torque level was reached in 326 ms. While braced, the same torque magnitude was reached using 230 ms (p<0.02), and pre-activation of the peroneal muscles allowed the subjects to reach the same level of torque in 89 ms (p<0.0005). Prior to the study, a common reaction pattern to sudden inversion was expected in an ankle stable population, but review of the eversion torque and EMG data from the 13 subjects revealed three different voluntary reaction patterns: 10 subjects showed an efficient activation of evertor muscles; two subjects stiffened their ankles with activation of both in- and evertor muscles; and one subject showed a marginal voluntary activation of the ankle evertors. The results of the study indicate that the reaction to sudden ankle inversion is not solely automatic. The main part of the torque response is voluntarily mediated and inter-individual differences in strategy seem to exist in healthy subjects.

Adult↗
PubMed2002

Radiography in acute ankle injuries: the Ottawa Ankle Rules versus local diagnostic decision rules.

STUDY OBJECTIVE: We validate the Ottawa Ankle Rules and 2 Dutch ankle rules in distinguishing clinically significant fractures from insignificant fractures and other injuries in patients with a painful ankle presenting to the emergency department. METHODS: This prospective comparison of 3 ankle rules was conducted in the ED of a 580-bed community teaching hospital in Amsterdam from January 1998 to April 1999. Participants included 647 consecutive patients aged 18 years or older presenting with a painful ankle after trauma. All physicians received extensive and pictorial training on how to correctly score the respective items of the rules. The physician on call recorded these items derived from history and physical examination on a standardized data sheet. All patients subsequently underwent standard radiographic assessment. A radiologist and a trauma surgeon evaluated the radiographs blinded from the results of the data sheet form and the treatment given. The diagnostic performance of the 3 rules was measured in terms of sensitivity, specificity, and the reduction of radiographs. Receiver operating characteristic (ROC) curves were constructed, and the area under the ROC curves was calculated and compared. RESULTS: Seventy-four fractures were seen, of which 41 were clinically significant. The Ottawa Ankle Rules had a sensitivity of 98% for identifying clinically significant fractures; the local rules scored 88% and 59%, respectively. The potential savings in radiographs for the 3 decision rules were 24%, 54%, and 82%, respectively. The area under the ROC curve was better for both the local rules (0.84 and 0.83) compared with the Ottawa Ankle Rules (0.76). CONCLUSION: Because the identification of all relevant fractures is more important than a reduction in radiographs, the higher sensitivity of the Ottawa Ankle Rules makes these most suitable for implementation in The Netherlands.

Adult↗