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PubMed1989

[The lower ankle joint. Anatomic and pathophysiologic observations].

The lower ankle joint is highly variable in ligamental guidance. It has to be considered in unity with the upper ankle joint. Biomechanical investigations have shown the posterior lower ankle joint to be relatively unstable primarily in supination position. Radiological techniques are available to procedure radiographic evidence to that clinical instability of the lower ankle joint. A surgical approach to instability of both upper and lower ankle joints is proposed in this paper and is discussed in some detail.

Ankle Injuries↗
PubMed1985

The forces of ankle joint structures during ergometer cycling.

The ankle joint moment, joint compressive force, and Achilles tendon force obtained during ergometer cycling were calculated by using a quartz force-measuring transducer mounted on the pedal. Six healthy subjects rode in 11 different ways at different workloads, pedalling rates, saddle heights, and pedal foot positions. The mean maximum dorsiflexing load moment about the ankle joint during standardized ergometer cycling was calculated to 30.9 nm. The mean ankle joint compressive force and mean Achilles tendon force measured 1008 N (1.4 times body weight) and 762 N (1.1 times body weight), respectively. The ankle joint moment was significantly changed by a change of workload or pedal foot position.

Achilles Tendon↗
PubMed1987

Ball-and-socket ankle joint.

The ball-and-socket ankle joint is a malformation of the ankle in which the articular surface of the talus is hemispherical in both the anteroposterior and lateral projections and has a congruent, concave tibial articular surface. Fourteen patients with this condition were identified retrospectively. Thirteen patients were thought to have the congenital type of ball-and-socket ankle joint which in many was associated with tarsal coalition, short limb, and ray fusion and deletion anomalies. One case of the acquired type, demonstrating less geometric rounding of the talar margins, was seen in a patient with myelomeningocele, probably resulting from sensory and motor deficits. Although the exact etiology of the congenital type is unknown, its association with other malformations suggests that the ball-and-socket ankle joint results from an overall maldevelopment of the ankle and foot.

Adolescent↗
PubMed2002

Plantar impact causing midfoot fractures result in higher forces in Chopart's joint than in the ankle joint.

PURPOSE: Force effect (impact, extent of foot compartment deformation) and result (fracture pattern) for midfoot fractures in car occupants is known. An analysis of the processes in the foot was intended to improve car safety. MATERIALS AND METHODS: Eleven fresh, unfrozen, unpreserved intact human cadavers (age: 36.8 (16-61) years, gender: male, race: Caucasian) were studied 24-72 h after death. In 3 cadavers (5 feet) the experimental design was established: entire cadaver fixed on a special tray in supine position, pendulum with bar impactor hitting the foot plantar to Lisfranc's joint. A custom-made pressure sensor was inserted in the ankle (A), talonavicular (TN) and calcaneocuboid (CC) joints (resolution: 1 cm2, sampling rate: 500/s). RESULTS: Sixteen feet were measured: midfoot fractures were induced in 11 feet. The maximum pressure amounted to 1.22-2.55 MPa (2.04+/-0.412) at 0.005 0.195 s (0.067+/-0.059) after impact. The maximum pressure occurred in 8 (50%) cases in the ankle, in 7 (44%) of the TN and 1 (6%) of the CC joints. A comparison of the first 200 pressure samples after impact of all sensor fields resulted in higher forces in Chopart's joint than in the ankle (t-test: p < 0.001). These force differences were higher in cases with midfoot fractures (mixed model analysis of variance: p = 0.003). CONCLUSION: Due to considerable forces in Chopart's joint we recommend a modification of the actual crash test dummy lower extremity model with an additional load cell that detects forces in the longitudinal direction of the foot axis.

Adolescent↗
PubMed1994

Segmental reflexes and ankle joint stiffness during co-contraction of antagonistic ankle muscles in man.

The size of soleus H-reflexes and short-latency stretch reflexes was measured at different levels of plantar flexion or co-contraction (simultaneous activation of dorsi- and plantar flexors) in seven healthy subjects. In four of seven subjects the short-latency stretch reflex was smaller during weak co-contraction than during isolated plantar flexion at matched background electromyogram (EMG) levels in the soleus muscle. In three of these four subjects the stretch reflex was larger during strong co-contraction than during plantar flexion, whereas it had the same size during the two tasks in the last subject. In the remaining subjects the stretch reflex either had the same size or was larger at all levels of co-contraction than at similar levels of plantar flexion. In contrast, the H-reflex was found to decrease with co-contraction at all contraction levels in all subjects. The decrease in the reflexes during weak co-contraction might be caused by presynaptic inhibition of Ia afferents. It is unclear why only the H-reflex decreased during strong co-contraction. The stiffness of the ankle joint was measured from the torque increment following the stretch of the plantar flexors divided by the stretch amplitude. In all subjects the total stiffness of the ankle joint was larger during strong co-contraction than during plantar flexion of similar strength. The stiffness was smaller during weak co-contraction than during weak plantar flexion in three out of seven subjects.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMed1994

Right to left differences in the ankle joint complex range of motion.

Rehabilitation of the ankle joint complex after injury is often considered complete when the injured ankle has the same range of motion and strength as the uninjured contralateral limb even though this symmetry has never been quantified. The purpose of this investigation was to determine whether there were differences in the ankle joint complex range of motion between right and left legs. Total right and left ankle joint complex range of motion was measured on 18 subjects using a fixture allowing six degrees of freedom. A four-camera video system was used to record all range of motion movements. The results indicated that total dorsiflexion-plantarflexion, eversion-inversion, and abduction-adduction ranges of motion were not significantly different between right and left legs. However, separate abduction and adduction differences occurred, with the right foot tending to abduct more than the left, while the left foot tended to adduct more than the right. These differences in the abduction and adduction range of motion may be inherent in the measuring device. As a result of this study, it appears that the contralateral ankle joint complex can be used as a measure for establishing restoration of total range of motion of the ankle joint complex following injury.

Adult↗
PubMed1999

Prophylactic ankle stabilizers affect ankle joint kinematics during drop landings.

PURPOSE: Ankle joint dorsiflexion contributes to energy absorption during landing, but wearing ankle stabilizers is known to restrict passive measures of dorsiflexion. This study compared the effects of various ankle stabilizers on ankle joint kinematics during soft and stiff landings. METHODS: Subjects (N = 14) performed two-legged landings off a 0.59-m platform. Kinematics of the right ankle were calculated from a sagittal plane video recording (120 Hz). Five soft and five stiff landings were performed in five ankle stabilizer conditions (no stabilizer, taping, Swede-O, AirCast, and Active Ankle), a total of 50 trials per subject. Style and stabilizer conditions were randomized across subjects. Each subject's five-trial mean value of selected kinematic variables for each landing style/stabilizer condition was entered into a two-way repeated MANOVA (alpha = 0.05). RESULTS: Differences between soft and stiff landing conditions were similar to those reported in the literature. Compared with the No stabilizer condition, most stabilizer conditions significantly reduced ankle dorsiflexion ROM and angular velocity during landing. CONCLUSIONS: The results indicate that some ankle stabilizers adversely affect ankle joint kinematics during landing.

Adult↗
PubMed1999

[Chronic diseases of the ankle joint].

The etiology of chronic diseases of the ankle joint comprises a wide spectrum including chronic inflammatory processes and chronic degenerative, tumorous and neuropathic processes, as well as some specific syndromes based on chronic changes of the ankle joint. Of the inflammatory processes, chronic juvenile arthritis (JVC) is the most common disease. However, also Reiter disease, psoriasis or chronic monoarthritid diseases such as gout, as well as granulomatous diseases (tuberculosis, sarcoidosis) and fungal infections, may affect the ankle joint in a chronic course. Chronic degenerative changes are usually secondary due to abnormal positioning of the joint constituents or repetitive trauma. Neuropathic changes, as frequently seen in the course of diabetes, present with massive osseous destruction and malposition of the articular constituents. Chronic osseous as well as cartilaginous and synovial changes are seen in hemophilic patients. Chronic traumatic changes are represented by pigmented villonodular synovitis (PVNS), and chondromatosis, both with a predilection for the ankle joint. Due to the possibilities of magnetic resonance imaging (MRI), diagnosis of chronic ankle changes includes chronic ligamentous, tendinous and soft tissue changes. With the use of MRI, specific syndromes can be defined which particularly affect the ankle joint in a chronic way, such as the os trigonum syndrome, the anterolateral impingement syndrome and the sinus tarsi syndrome. Nevertheless, plain film radiographs are still the basic element of any investigation. MRI, however, can be potentially used as a second investigation, saving an unnecessary cascade of investigations with ultrasound and CT. The latter investigations are used only with very specific indications, for instance CT for subtle bone structures and sonography for a limited investigation of tendons or evaluation of fluid. Particularly due to the possibilities of MRI and the development of special gradient-echo imaging or high-resolution coils, the investigation of the ankle joint still offers a wide spectrum of innovation for the next years, which is particularly enforced by the increasing demand for specific diagnosis of chronic diseases in orthopedic medicine.

Adolescent↗
PubMed1983

Response of the normal human ankle joint to imposed sinusoidal movements.

Ankle joints were subjected to sinusoidal movements at a range of amplitudes and frequencies. Records were made of electromyograms (e.m.g.s) in calf muscles, and of the forces at the joints. When the leg is relaxed, the ankle joint resists an imposed sinusoidal movement with a small approximately sinusoidal force. It is stiffer in its resistance to small movements than to large ones, and this resistance is greater when the joint is dorsiflexed than when it is plantarflexed. If the subject exerts a steady mean flexing force, the imposed sinusoidal movement generates reflex activity which may be recorded as a modulation of the gastrocnemius and soleus e.m.g.s. The e.m.g. response to the sinusoidal movement occurs later in cycles of movement at high than at low frequencies, as one could expect of a reflex pathway that involves a delay. The results suggest that this delay is between 50 and 60 ms, and we conclude that under these circumstances spinal stretch reflexes are playing the important part. The relation of the resisting force to the movement has been displayed as a vector. As the frequency changes, this vector describes the circular path that is characteristic of a system which includes delays or lags; this path enables one to draw conclusions about the amplitude and timing of the reflex resistance to the movement. When a subject exerts a moderate flexing force against the sinusoidal movement for some minutes, the reflex response becomes progressively potentiated. A subject whose reflex responses are normally slight may then exhibit a vigorous reflex response to the movement of that ankle. This enhancement of spinal reflex activity was accompanied by an increase in the myotatic reflex response at the ankle. Reflex responses to sinusoidal movement were most clearly seen when the subject exerted a mean flexing force that amounted to about one-fifth of his maximum. Very small movements (+/- 0.5 degrees) generated little or no reflex response. With large amplitudes of movement there was more reflex activity, but at some amplitude (which varied from subject to subject and from time to time) the reflex mechanism appeared to 'saturate', and further increases in amplitude were not accompanied by comparable increases in the reflex response. With movements at 10-15 Hz the e.m.g. response often became large in alternate cycles, with less activity in the intervening cycles.(ABSTRACT TRUNCATED AT 400 WORDS)

Adult↗
PubMed2000

Septic arthritis of the ankle joint.

BACKGROUND: Septic arthritis of the ankle joint is a rare but serious disease. Very few reports in the literature have mentioned the method of care and treatment results of septic ankle. This study was designed to retrospectively review the treatment results and to analyze the prognostic factors of septic arthritis of the ankle inpatients at our hospital. We also formulated a protocol for the management of septic arthritis of the ankle joint. METHODS: All records of those patients with a diagnosis of septic ankle from 1985 to 1997 were retrospectively reviewed. There were 29 patients that met the diagnostic criteria of septic arthritis of the ankle joint (21 male and 8 female patients; 6 children and 23 adults). The average follow-up time was 5.5 years (ranging from 1.5 to 13.7 years). The patients' ages, associated diseases, single or multiple joint(s) involved, timing of treatment, and the final results of these cases were assessed. The infecting organism and drug sensitivity were discussed to determine the proper antibiotics regimen. RESULTS: Staphylococcus aureus was the most common infecting microorganism in the septic ankles. Combined therapy with oxacillin and gentamicine was effective against 88.1% of the infecting microorganisms. The poor prognostic factors for septic ankle included a positive bacterial culture, involvement of multiple joints simultaneously, a delay in treatment, and an increased number of associated diseases. In addition, a high proportion of patients with septic ankle had gouty arthritis (43.5%). CONCLUSION: Early treatment (symptom duration of less than 5 days) significantly affected the final results. The early recognition and prompt treatment of this condition may reduce morbidity and mortality. Based on our results, oxacillin and gentamicine are recommended as the first-line antibiotics for the management of septic ankle.

Adolescent↗
PubMed2005

The relationship between hallux dorsiflexion and ankle joint complex frontal plane kinematics: a preliminary study.

BACKGROUND: It has been suggested that the function of the first metatarsophalangeal joint may be related to the motion of the ankle joint complex. OBJECTIVE: This study explored the relationship between ankle joint complex and first metatarsophalangeal joint motion during gait in a group of 14 who demonstrated clinically limited passive hallux dorsiflexion in quiet standing (cases), and 15 matched controls. METHOD: An electromagnetic tracking system was used to measure the ankle joint complex frontal plane motion and first metatarsophalangeal joint sagittal plane motion during gait, in both cases and controls. The case group was then evaluated further to investigate the effect of an orthosis on first metatarsophalangeal joint motion. FINDINGS: The correlation between maximum ankle joint complex eversion and maximum first metatarsophalangeal joint dorsiflexion during gait was r=0.471. Within the case group, maximum rearfoot eversion was reduced following the application of the orthoses, but there was no change in sagittal first metatarsophalangeal joint rotations. INTERPRETATION: The relationship between maximum ankle joint complex eversion and first metatarsophalangeal joint dorsiflexion kinematics found in this study was moderate, and decreasing maximum ankle joint complex eversion with an orthosis did not result in any increase in first metatarsophalangeal joint dorsiflexion during gait in patients with functional first metatarsophalangeal joint limitation. These results do not support the assumption that ankle joint complex eversion influences first metatarsophalangeal joint motion substantially.

Adult↗
PubMed1984

Signaling of ankle joint position by receptors in different muscles.

Plots were made of multiunit activity versus ankle joint position for receptors in each of the 12 muscles crossing the cat ankle joint, except peroneus tertius, by recording from populations of afferent fibers in muscle nerves. The discharge was measured 15 or 30 sec after terminating the movements that altered the position of the joint. These recordings were dominated by large-spike activity that would be expected to originate mainly from primary spindle endings. Seven of the 12 muscles also cross other joints. Their responses at a given ankle joint position were so altered by changes in the position of the knee or toe joints that they could not reliably signal the position of the ankle joint. As judged from multiunit recording, receptors in each of the five muscles specific to the ankle joint were influenced by more than one axis of ankle joint displacement. Single-unit recording from dorsal root filaments was used to determine whether primary or secondary spindle receptors in soleus and tibialis anterior could selectively signal one axis of ankle joint rotation. Individual soleus receptors were tested both on the flexion-extension axis and with a combined adduction-eversion movement. For 38 of the 70 soleus receptors examined (54%), firm adduction-eversion produced a level of activity greater than that caused by 10 degrees of flexion, and for 77% the level of activity was greater than that caused by 5 degrees of flexion. For 168 of the 184 tibialis anterior receptors studied (91%), firm abduction-inversion produced a level of activity greater than that caused by 10 degrees of extension. Thus few receptors were found that responded exclusively to one axis of rotation. One way in which the position of the ankle joint could be specified in the face of multiaxial receptor activity is by examining the receptor discharge from more than one muscle. A suggestion for how the nervous system might do this is given in the discussion.

Afferent Pathways↗
PubMed2002

[Function of fibula in stability of ankle joint].

OBJECTIVE: To summarize the function of fibula in stability of ankle joints. METHODS: Recent original articles were extensively reviewed, which were related to the physiological function and biomechanical properties of fibula, the influence of fibular fracture on stability of ankle joints and mechanism of osteoarthritis of ankle joints. RESULTS: The fibula had the function of weight-bearing; and it was generally agreed that discontinued fibula could lead to intra-articular disorder of ankle joint in children; but there were various viewpoints regarding the influence of fibular fracture on the ankle joint in adults. CONCLUSION: Fibula may play an important role in stability of ankle joint.

Ankle Joint↗
PubMed1977

Force and motion analysis of the normal, diseased, and prosthetic ankle joint.

A 2-dimensional motion and force study of the ankle joint during gait has been carried out on normal subjects and patients with ankle joint disease, before and 1 year following total ankle replacemetn. The methods employed involved the use of high-speed motion picture film, force plate and foot-switch data. The Achilles and anterior tibial tendon forces, the compressive and tangential (shear) forces across the ankle during stance phase of gait were determined, based on a quasi-static analysis. During stance phase of gait normal subjects used a mean of 24.4 degree of sagittal plane ankle motion. Patients with ankle joint disease showed reduced motion which returned to near normal values 1 year following total ankle replacement. Compressive force across the ankle joint rose to about 5 times body weight during the latter part of stance phase. Backward, or aft, shear forces or nearly full body weight were demonstrated during all but the last 20% of stance phase. Patients with ankle joint disease apparently altered their gait to markedly reduce these forces. Following total ankle replacement, shear forces returned toward more normal values, but compressive forces were not significantly changed.

Adult↗
PubMed2002

An instrumented, dynamic test for anterior laxity of the ankle joint complex.

Evaluation of anterior laxity of the ankle joint complex is a difficult clinical problem. Currently, the prime determinant for anterolateral ligament function is the subjective manual examination of anterior laxity of the ankle joint complex. An instrumented dynamic test was developed for objective measurement of anterior laxity of the ankle joint complex. The principle of the test was to apply a force-impulse to the calcaneus, within the muscle reflex time, and to measure anterior-posterior and mediolateral rotation. The test was performed on a cadaver specimen and on 15 volunteers of which five subjects suffered from chronic one-sided lateral ankle ligament instability. In the cadaver test, anterior translation values increased from 5 to 11 mm, after cutting the anterior talofibular ligament and subsequently cutting the calcaneofibular ligament. In the 10 normal subjects, the mean anterior translation value was 6.7 mm (+/-1.9 mm). The relative variation of the test result within a measurement session was 2.5% (+/-1.6%). Between the sessions the relative laxity variation was 2.6% (+/-2.6%). In the ten normal subjects the mean right-left difference was not significantly different from zero. In four out of the five patients it was more than 2mm. As in the cadaver test in all measurements, the mediolateral rotations were small (<2.5 degrees ). The volunteers complained about same pain at the heel after multiple test sessions. In conclusion the dynamic, functional test appears to be capable of objectively measuring a value for anterior laxity of the ankle joint complex reflecting the functional status of the anterolateral ankle ligaments.

Ankle Injuries↗
PubMed2002

Use of dual Euler angles to quantify the three-dimensional joint motion and its application to the ankle joint complex.

This paper presents a modified Euler angles method, dual Euler angles approach, to describe general spatial human joint motions. In dual Euler angles approach, the three-dimensional joint motion is considered as three successive screw motions with respect to the axes of the moving segment coordinate system; accordingly, the screw motion displacements are represented by dual Euler angles. The algorithm for calculating dual Euler angles from coordinates of markers on the moving segment is also provided in this study. As an example, the proposed method is applied to describe motions of ankle joint complex during dorsiflexion-plantarflexion. A Flock of Birds electromagnetic tracking device (FOB) was used to measure joint motion in vivo. Preliminary accuracy tests on a gimbal structure demonstrate that the mean errors of dual Euler angles evaluated by using source data from FOB are less than 1 degrees for rotations and 1mm for translations, respectively. Based on the pilot study, FOB is feasible for quantifying human joint motions using dual Euler angles approach.

Algorithms↗
PubMed1993

[Surgical treatment of soccer player's ankle joint].

In experienced football players spurring and calcifications of the ankle joint's capsule attachments may be found more often than in other sportsmen. Basing on functional and sometimes already established ankle joint instability pain may develop. Out of 374 football players throughout 1989-1992 with injuries to the ankle joint 49 were operated on. These showed chronical instability and radiologically visible alterations in accordance with the imaging of footballer's ankle joint. 40 of these patients could be followed up. 16 exact fibular ligament repairs and 19 reconstructions were performed, 15 tibioventral, 6 talodorsal, 12 fibular and three medial capsule calcifications and spurs were excised, 8 loose bodies removed, three cases of osteochondritis dissecans drilled. After an average follow up of 25.6 months we saw stable ankle joints in all patients with resting local pain in 15 patients, among them 7 load dependent and 6 with slight limitation of dorsiflexion. Sport activity level showed 25 patients improved, 11 equal, one worse and three with changed disciplines.

Adult↗
PubMed1981

[Osseous ligament ruptures in the ankle joint].

An osseous ligament rupture in the ankle joint can conceal a distorsion. The exact diagnosis is possible only by X-ray. The origin of those injuries is frequently twisting of the ankle by walking on smooth or uneven ground. Osseous ligament tear out injuries in the ankle joint are found frequently in defined areas of ligament-passage points and insertions of the ankle joint. Mostly the collateral ligaments are concerned.

Adolescent↗