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PubMed1991

[Sonographic versus radiological assessment of chronic outer ligament instability of the upper ankle joint].

Chronic instability of the lateral upper ankle joint ligament is usually diagnosed by clinical and radiological examination. For the evaluation of an ultrasound method of testing lateral instability of the ankle joint we carried out a prospective study. We examined 23 adults who were actively engaged in some form of sport (21 male, 2 female, mean age 32 years) and had a preexisting lateral instability of the ankle. The instability was measured in the standard planes using Scheuba's stress apparatus with simultaneous ultrasound monitoring. The ultrasound examination was performed by positioning the 5-MHz applicator on the lateral side of the Achilles tendon, thus defining a plane from which the instability could be measured in both examination planes by observing the deviation between dorsal inferior edge of the tibia and the dorsal border of the talar roll. For the two examination planes, Spearman's rank-correlation coefficient between the radiological and ultrasound methods was 0.83 and 0.92. The sensitivity of the ultrasound method was 0.90, and the specificity was 0.85. Our study showed a good correlation between the two methods. A pathological talar tilt according to radiological criteria was also revealed by ultrasonography. Thus, all the advantages of ultrasound are now available for the evaluation of chronic lateral instability of the ankle joint.

Adult↗
PubMed2005

Ankle joint proprioception and postural control in basketball players with bilateral ankle sprains.

BACKGROUND: Deficiencies in ankle proprioception and standing balance in basketball players with multiple ankle sprains have been reported in separate studies. However, the question of how ankle proprioceptive inputs and postural control in stance are related is still unclear. HYPOTHESIS: Ankle repositioning errors and the amount of postural sway in stance are increased in basketball players with multiple ankle sprains. STUDY DESIGN: Controlled laboratory study. METHODS: Twenty healthy male basketball players and 19 male basketball players who had suffered bilateral ankle sprains within the past 2 years were examined. Both groups were similar in age. Passive ankle joint repositioning errors at 5 degrees of plantar flexion were used to test for ankle joint proprioception. The Sensory Organization Test was applied with dynamic posturography to assess postural sway angle under 6 sensory conditions. RESULTS: A significant increase in ankle repositioning errors was demonstrated in basketball players with bilateral ankle sprains (P < .05). The mean errors in the right and left ankles were increased from 1.0 degrees (standard deviation, 0.4 degrees ) and 0.8 degrees (standard deviation, 0.2 degrees ), respectively, in the healthy players to 1.4 degrees (standard deviation, 0.7 degrees ) and 1.1 degrees (standard deviation, 0.5 degrees ) in the injured group. A significant increase in the amount of postural sway in the injured subjects was also found in conditions 1, 2, and 5 of the Sensory Organization Test (P < .05). Furthermore, there were positive associations between averaged errors in repositioning both ankles and postural sway angles in conditions 1, 2, and 3 of the Sensory Organization Test (r = 0.39-0.54, P < .05). CONCLUSIONS: Ankle repositioning errors and postural sway in stance increased in basketball players with multiple ankle sprains. A positive relationship was found between these 2 variables. CLINICAL RELEVANCE: Such findings highlight the need for the rehabilitation of patients with multiple ankle sprains to include proprioceptive and balance training.

Adult↗
PubMed1985

Stability of the ankle joint. Analysis of the function and traumatology of the ankle ligaments.

The purpose of this study was to elucidate the function of the ligamentous structures of the ankle joint, the traumas in which they may rupture, and the types of instability caused by such ruptures. Most previous experimental investigations on the function of ankle ligaments have been performed on osteoligamentous preparations either by forcing a movement in the joint into more or less well-defined directions and observing the resulting injuries or else by cutting ligaments in various combinations and describing the resulting instability. As a rule, this has been done without inducing the increased mobility by a defined torque and without being able to demonstrate the instability continuously in all degrees of dorsi- or plantar flexion. On the basis of these previous studies, the anterior talofibular ligament appears to limit internal rotation, while its role in adduction of the talus has not been clarified. The calcaneofibular ligament per se does not seem to be a factor in adduction. True, there is not complete agreement in this respect, and a few authors have been able to rupture this ligament in isolation by forced adduction. The posterior talofibular ligament seems to restrict dorsiflexion, and perhaps it plays a role, in conjunction with the calcaneofibular ligament, in adduction when the ankle joint is in dorsiflexion. The anterior tibiofibular ligament, and the distal tibiofibular structures on the whole, are assumed to limit external rotation, but it has not been clarified whether they influence adduction and abduction in the ankle joint. Little has been reported about the individual structures which make up the deltoid ligament, as most authors have not distinguished them from each other. However, in combination with the anterior talofibular ligament, the tibiotalar ligament seems to limit the translatory forward gliding of the talus - the so-called anterior drawer sign - and together they presumably inhibit plantar flexion. It has not been possible to find any description of the function of the intermediate tibiotalar ligament, while the posterior tibiotalar ligament has been reported by one author to inhibit internal rotation. Judging by the literature, the function of the tibiocalcaneal ligament seems comprehensive, since it is reported to limit external rotation, dorsiflexion, as well as plantar flexion. The present investigations were divided into three phases: Phase 1 was concerned with elucidating the correlation of injuries to the lateral collateral ligaments to internal rotatory instability, talar tilt, and the anterior drawer sign.(ABSTRACT TRUNCATED AT 400 WORDS)

Ankle Joint↗
PubMed1999

[The childhood ankle joint. Deformities, abnormalities and clinical variations].

The ankle joint unites high functionality with high load on a small surface. Congenital as well as acquired variations lead to a derangement of the complex concerted action of tendons, ligaments and joints. This causes dysfunction and the development of typical deformities. It is necessary to discriminate physiological variants, congenital, posttraumatic and tumoral variations for the differential diagnosis. In most instances this is only possible with the aid of radiological clarification. Congenital malformations in the region of the upper and lower ankle joint are generally rare. One disease is club foot, with malposition and deformity in the upper and lower ankle joint. Extreme malposition can also be found in talus verticalis and congenital hypoplasias and aplasias of fibula and tibia. A rather frequently found disease, which first occurs in the adolescence, is osteochondrosis dissecans.

Adolescent↗
PubMed1980

The joints of the evolving foot. Part I. The ankle joint.

Evidence is presented to suggest that the eutherian ankle joint has been derived from a meniscus-containing joint such as that found in extant arboreal marsupials. Probable morphological derivatives of this meniscus are identifiable in the Eutheria. The form and function of the joint are described in sub-human Primates and the adaptations which characterize the joint in bipedal man are noted. These morphological findings permit some speculation about the palaeocology of the earliest mammals with particular reference to the emergence of the order Primates.

Animals↗
PubMed1981

[Results of surgical treatment of 248 lateral ligamentous lesions of the ankle joint (author's transl)].

From 1975 to 1980, 414 patients suffering from lateral ligamentous lesions of the ankle joint had undergone surgical treatment. 248 patients were seen in two follow-up examination; of these, 122 patients were examined by x-ray films taken in forced extreme joint position in two planes (a.p. and lateral) of both ankle joints, the uninjured ankle being examined for comparison. In 76.2% of the cases, both ankle joints were found to possess equal stability. Less than 10% of the follow-up patients examined showed slight restriction in mobility of the upper ankle joint. 97% of the patients questioned stated that the results of surgery were good. Only 3% expressed dissatisfaction. A severe complication was observed in 1 patient, who had an infection of the joint; cure was effected by means of arthrodesis of the upper ankle joint.

Ankle Injuries↗
PubMed1998

[Biomechanics of the ankle joint--injury mechanisms].

The complex mechanics of the ankle joint complex depends highly on the integrity of the ankle ligaments. An incomplete restoration of the antero-fibular ligament after trauma may result in a mechanical dissociation of the talus from the ankle mortise. The force that is needed to induce a non-physiological movement of the foot is determined by the individual configuration of the bony and articular structures of the hindfoot. A pes cavus is less protected to suffer of an ankle sprain than a flatfoot. As the leverarm of the peroneal muscles decreases with increasing plantarflexion of the foot, the active protection to resist against a supination stress decreases with plantarflexion. These findings have significant implications for the practice. First of all an adequate treatment of any ankle sprain is necessary to restore the mechanical interplay of the ankle joint complex. Ankle orthoses should protect the foot against supination stress and excessive plantarflexion. The prevention of ankle injury may be significantly improved by recognition of the individual mechanical disposition.

Ankle Injuries↗
PubMed1996

[Effectiveness of outer stability aids on rotational stability of the ankle joints].

The main goal in nonoperative treatment of lateral ankle ligament injuries is the reduction of the possible supination at the ankle joint complex. Complete ligament healing can only be achieved when protected from overstress. There is general agreement that talar tilt should be avoided. Recent reports, however, have shown that instability of the ankle joint is at least in one form an axial rotational one. Therefore, the reduction of tibial rotation should also be taken into consideration. The purpose of this study was to determine the effect of three commonly used ankle braces and ankle taping on rotational stability of the ankle joint complex. The Künzli stabilizing shoe was the only orthosis that stabilized sufficiently the ankle joint complex when the foot was in slight plantarflexion. The reduction of external tibial rotation was in foot flexion of 20 degrees: Künzli stabilizing shoe, 58%; Aircast, 23%; Mikros, 12%; and taping, 10%. This becomes more relevant as this foot position is the most dangerous one where most of the ligament injuries does occur. It could be that the insufficient effect of various ankle braces on rotational stability may be the reason for residual problems after ankle sprain.

Adult↗
PubMed2001

[The effect of supervised rehabilitation on ankle joint function and the risk of recurrence after acute ankle distortion].

INTRODUCTION: The effect of an early rehabilitation programme, including postural training, on ankle joint function after an ankle ligament sprain was investigated prospectively. METHODS: Ninety-two subjects, matched for age, sex, and level of sports activity, were randomised to a control or training group. All subjects received the same standard information about early ankle mobilisation. In addition, the training group participated in supervised physical therapy rehabilitation (one hour, twice weekly) with emphasis on balance training. Postural sway, position sense, and isometric ankle strength were measured six weeks and four months after the injury, and at 12 months data on re-injury were collected. RESULTS: In both the training group and the control group, there were a significant difference between the injured and the uninjured side for all variables except for position sense at six weeks. The side-to-side differences in per cent were similar for both groups for all variables (p > 0.05) at six weeks, and there were no such differences at four months. Re-injury occurred in 11/38 (29%) is the control group, but in only 2/29 (7%) in the training group (p < 0.05). CONCLUSION: These data showed that an ankle injury led to reduced ankle strength and postural control at six weeks, but that these variables had become normal at four months, irrespective of supervised rehabilitation. However, the findings also showed that supervised rehabilitation may reduce the number of re-injuries, and may therefore play a role in injury prevention.

Adult↗
PubMed2000

The effect of axial load on the in vivo anterior drawer test of the ankle joint complex.

The anterior drawer test is commonly used in the diagnosis of ankle joint mechanical instability. However, the effect of axial load on the anterior drawer test has not been examined in vivo. The purpose of the study was to assess the effect of axial load on passive anterior instability, and on the diagnostic measurement of the anterior drawer instability of the ankle joint complex. A total of 21 subjects with various degrees of ankle sprains were tested on a device that could continuously record applied anterior force and the resultant displacement of the rear-foot. Anterior drawer flexibility of the ankle joint complex in a neutral dorsi/plantar flexion position was quantified on both feet for all subjects without and with an axial load (385 N). Flexibility of the ankle joint complex in anterior drawer was defined as the slope of a linear load-displacement curve (which fitted test data with high correlation coefficients (r>0.991)). With axial load, anterior drawer flexibility was significantly reduced by 28.8% compared to that without axial load. The difference in anterior drawer flexibility between injured and intact ankles significantly decreased with axial load. An axial load increased the stability of ankle joint complex. However, axial load reduced the sensitivity of anterior drawer test to mechanical instability of the ankle joint complex.

Adult↗
PubMed2003

Ligament fibre recruitment and forces for the anterior drawer test at the human ankle joint.

Although the anterior drawer test at the ankle joint is commonly used in routine clinical practice, very little is known about the sharing of load between the individual passive structures and the joint response at different flexion angles.A mathematical model of the ankle joint was devised to calculate ligament fibre recruitment and load/displacement curves at different flexion angles. Ligaments were modelled as three-dimensional arrays of fibres, and their orientations at different flexion angles were taken from a previously validated four-bar-linkage model in the sagittal plane. A non-linear stress/strain relationship was assumed for ligament fibres and relevant mechanical parameters were taken from two reports in the literature. Talus and calcaneus were assumed to move as a single rigid body. Antero/distal motion of the talus relative to the tibia was analysed. The ankle joint was found to be stiffer at the two extremes of the flexion range, and the highest laxity was found around the neutral position, confirming previous experimental works. With a first dataset, a 20N anterior force produced 4.3, 5.5, and 4.4mm displacement respectively at 20 degrees plantarflexion, at neutral, and at 20 degrees dorsiflexion. At 10 degrees plantarflexion, for a 6mm displacement, 65% of the external force was supported by the anterior talofibular, 11% by the deep anterior tibiotalar and 5.5% by the tibionavicular ligament. Corresponding results from a second dataset were 1.4, 2.4 and 1.8mm at 40N force, and 80%, 0% and 2% for a 3mm displacement. A component of the contact force supported the remainder.

Ankle Joint↗
PubMed2006

Changes in lower limb kinematics, kinetics, and muscle activity in subjects with functional instability of the ankle joint during a single leg drop jump.

The purpose of this study was to identify differences in 3D kinematics, kinetics, and ankle joint muscle activity in subjects with functional instability (FI) of the ankle joint during a drop jump. Twenty-four subjects with the subjective complaint of FI of the ankle joint and 24 noninjured control subjects performed 10 single leg drop jumps onto a force-plate. Timing and magnitude of kinetic data, timing of kinematic data, and integrated EMG (IEMG) activity of the rectus femoris, peroneus longus, tibialis anterior, and soleus muscles during two 200-ms time periods either side of initial contact (IC) with the ground were analyzed and compared between groups. Subjects with FI demonstrated a significant decrease in pre-IC peroneus longus IEMG activity, which was accompanied by a change in frontal plane movement at the ankle joint during the same time period. Following IC, FI subjects were less efficient than control group subjects in reaching the closed packed position of the ankle joint. Significant differences were seen between the groups' time-averaged and peak vertical and sagittal components of ground reaction force. The altered pre-IC peroneus longus IEMG and increased inversion of the ankle joint observed in FI subjects could help to explain why subjects with FI may suffer from inversion injury to their ankle joint when subjected to an unanticipated ground contact. The kinematic and kinetic differences observed in subjects with FI may lead to repeated injury and damage to the supporting structures of the ankle joint.

Adult↗
PubMed1991

[Epidemiologic data of rupture of the fibular ligament of the upper ankle joint].

Epidemical studies of fibular ligament lesions of the ankle joint lateral ligamentous lesions at the ankle joint are one of the most accidental injuries. It is necessary to bestow great care on prevention and therapy to avoid after effects. We report about 150 cases of acute injuries of the fibular ligament lesions of the ankle joint in 1987 treated by surgery and followed up to explore the cause of injury, its dimensions, the groups of patients and time of accident. Corresponding to literature sports activities were mostly the reason of accidents followed by casional accidents and industrial accidents. Mainly young people suffered from this injury preferring men. The part of reruptures was 14%. In 61.3% both Lig. fibulotal. ant. and Lig. fibulocalc. were ruptured followed by isolated rupture of the Lig. fibulotal.ant. in 32.7% of the cases.

Adolescent↗
PubMed1990

[Experiences with joint-preserving operations in arthrosis of the upper ankle joint].

During a period of ten years we performed 140 joint conserving operations on patients with arthrosis of the ankle joint. The use of this procedure was analysed in 85 patients, whom we followed up. Mainly (in 89%) positive results were obtained. The success of such joint conserving surgery depends on the one hand on the seriousness of the injury leading to arthrosis and on the other hand on the duration of the complaints. If attention is paid to these factors we have after the failure of conservative therapy a satisfying complementary treatment before using the arthrodesis.

Adolescent↗
PubMed1995

Comparison of passive stiffness variables and range of motion in uninvolved and involved ankle joints of patients following ankle fractures.

BACKGROUND AND PURPOSE: The purpose of this study was to quantify several variables of ankle stiffness and dorsiflexion (DF) range of motion (ROM) in the casted (fractured) and noncasted ankles of humans after cast removal. SUBJECTS: Thirty subjects (mean age = 32.4 years, SD = 15.8) with malleolar ankle fractures were tested within 4 days of cast removal but before they began physical therapy. METHODS: A torque motor system generated torque-versus-displacement graphs by recording angular displacement and resistive torque during a 6 0/s passive cycling of the ankle from 10 degrees of plantar flexion to the limit of DF ROM: Maximum passive DF ROM, passive torque, and passive elastic stiffness at the neutral position and energy loss were measured. Testing was performed in the absence of triceps surae muscle electromyographic activity. For analysis, subjects were separated into two groups based on fracture severity. RESULTS: There was no difference in passive torque between the fractured ankles and the matched noncasted ankles. There was a small difference in passive elastic stiffness between the more severely fractured ankles and the matched noncasted ankles. The fractured ankles were different in terms of energy loss from the matched noncasted ankles. For maximum passive DF ROM, there was a large difference between the fractured ankles (more severe: mean = 4.4 degrees; less severe: mean = 6.8 degrees) and the matched noncasted ankles (more severe: mean = 15.1 degrees; less severe: mean = 19.1 degrees). CONCLUSION AND DISCUSSION: Altered length-tension relationships and neuromuscular mechanisms have been suggested to produce postimmobilization joint contractures. The results of this study on humans are consistent with both possibilities and support the theory that changes that occur during immobilization result in protection from overstretching of the fragile calf musculature after a period of ankle fixation. The time course of normalization of stretch reflexes warrants investigation.

Adolescent↗
PubMed1977

Total ankle joint replacement.

The ankle is an inherently stable, kinematically simple joint that bears tremendous compression forces with relative ease because of a large load-bearing surface area. Disabling disease of the ankle is less common than at the hip or knee joints, but is not rare. Ankle arthrodesis seems less than ideal as a technique of surgical treatment. Total ankle joint replacement seems to be a clinically possible alternative on the basis of experience with 76 procedures performed during a 31-month period. Continuing clinical experience is resulting in more gratifying results by the avoidance of technical errors and better selection of patients.

Adult↗
PubMed1986

[Management of ligament injuries of the anterior ankle joint with ligament suture and a joint plaster cast].

Treatment of ligamentous injuries of the ankle joint by sutures functionplaster. 139 patients had been checked up after treatment by suturing and functionplaster because of ruptures of ligaments of the ankle joint. Four days after a funktionplaster has been applied the leg has been fully loaded. Four weeks later the plaster was taken off. At this time the ankle joint can be fully loaded and is mobile. 127 patients were absolutely restored, ten patients had slight complaints, in one case a slight instability has been remaining. One patient showed a ligament rupture of the ankle joint following newer distorsion. Twelve persons had superficial wound necroses. In one case there was an infection of the wound, the time of treatment was 78 days. This patient complains of pains by loading.

Adolescent↗
PubMed2005

Plantar pressure distribution during gait in athletes with functional instability of the ankle joint: preliminary report.

This study addressed the hypothesis that gait characteristics differ between normal subjects and athletes suffering from functional instability (FI) of the ankle joint. FI of the ankle joint is one of the most common residual disabilities after an acute ankle sprain. However, the influences of the FI of the ankle joint on the gait characteristics are not well understood. Athletes suffering from FI of the ankle joint and healthy control subjects were examined. Pressure, area, and force during gait were measured using a pressure measuring system. These in vivo plantar pressure measurements were performed during free walking. The foot angle and the pronation-supination index were calculated. Those in the FI group were found to exhibit a significantly lower dynamic foot angle and a greater pronation-supination index at the midsupport phase of gait than those in the control group. The results showed increased adduction-supination of the foot at the stance phase of gait in those with FI of the ankle joint.

Adult↗