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At least 127 records · Page 7Linked to original sources
PubMed1995

Ankle arthroscopy in industrial injuries of the ankle.

Industry-related injuries to the foot and ankle are not uncommon. These cases are often difficult to evaluate with respect to degree of damage and even more difficult to quantitate with regard to functional impairment. This article represents an attempt to determine the role of ankle arthroscopy in the evaluation of ankle injuries that involve compensation or liability. A retrospective review was conducted. The study group consisted of 40 patients who underwent a total of 42 arthroscopic procedures. The patients were evaluated with regard to the mechanism of injury and clinical manifestations. Pain and swelling were the most common preoperative symptoms. The majority of patients had pain localized to the lateral and anterolateral ankle. There were a high percentage of positive bone scans that correlated well with bone pathology but poorly with soft-tissue pathology. Computed tomography (CT) scans were equivalent to tomograms in the demonstration of bone pathology. Follow-up was obtained in 24 patients. At least 50% of the patients had some improvement in their symptoms. Thirty-three percent believed there was no change, and 17% said they were worse. Over 70% of the patients were able to return to work, although 20% had to change their occupation. Fifteen percent were considered disabled. In patients without a specific diagnosis, ankle arthroscopy was helpful in establishing a diagnosis.(ABSTRACT TRUNCATED AT 250 WORDS)

Accidents, Occupational↗
PubMedDate not supplied

The effect of exercise, prewrap, and athletic tape on the maximal active and passive ankle resistance of ankle inversion.

This investigation explored alternatives to the null hypotheses that maximal active and passive resistance to inversion developed by a near-maximally inverted and weightbearing ankle is not altered by 1) the use of prophylactic adhesive athletic tape, 2) the use of non-adhesive prewrap (underwrap), or 3) 40 minutes of vigorous exercise. Ten healthy men and 10 healthy women (mean age, 25 +/- 3 years) with no recent ankle injuries underwent testing to determine maximal ankle resistance to inversion under unipedal, weightbearing conditions. Tests were performed with and without the support of athletic tape, and before and after 40 minutes of exercise. Half the testing sessions were performed with prewrap under the tape. At 15 degrees of inversion, without any external ankle support, healthy young men and women could maximally resist a mean (SD) inversion moment of 52.9 (6.4) N-m and 28.3 (5.8) N-m, respectively. Although use of ankle tape provided a 10% increase in maximal resistance to inversion moments, this increase diminished to insignificant levels after 40 minutes of vigorous exercise. Use of prewrap improved maximal resistance to inversion by more than 10%.

Adult↗
PubMed2026

Total ankle replacement versus nonoperative management for end-stage ankle osteoarthritis: A comparative analysis.

BACKGROUND: The optimal management of end-stage ankle osteoarthritis remains debated. This study compared short-term outcomes between non-operative treatment, total ankle replacement (TAR), and cases in which indicated surgery was delayed. METHODS: In this secondary analysis of prospectively collected data, treatment survival, Foot and Ankle Outcome Score (FAOS), and patient satisfaction were assessed at baseline and at 1- and 2-year follow-up. RESULTS: In a total of 316 patients one-year treatment survival was highest for TAR (99.3%), followed by NOM (94.4%) and delayed surgery (80.9%). TAR demonstrated significantly superior FAOS pain and quality-of-life scores compared with NOM and delayed surgery. Delayed surgery was associated with significantly worse pain and quality-of-life outcomes. Patient satisfaction was highest in the TAR group and lowest in the delayed surgery group. CONCLUSIONS: TAR provides superior pain relief, quality of life, and satisfaction compared with non-operative management in end-stage ankle OA. While NOM remains a valid option for selected patients, delaying indicated surgery results in inferior outcomes, underscoring the importance of timely, shared decision-making.

Humans↗
PubMed2003

New concepts in the treatment of ankle joint fractures. The IP-XS (XSL) and IP-XXS (XXSL) nail in the treatment of ankle joint fractures.

INTRODUCTION: The most important factor in the treatment of ankle joint fractures is stable anatomical reconstruction of the syndesmosis and joint surface. In the course of this, attention must be paid to soft-tissue damage with the risk of deep infections. Early functional therapy and exercise tolerance must be called for. The choice of surgical access route, in particular in the case of critical arterial circulation, and the possible irritation of the soft tissue by the osteosynthesis material prompted us to seek alternative osteosynthesis techniques. MATERIAL AND METHODS: Following a preclinical study and very good initial results with the XS nail in the treatment of patella and olecranon fractures, this was now also used for ankle joint fractures at the medial malleolus and lateral malleolus. In the period from 5/2000 to 1/2002, 194 ankle joint fractures were treated using the XS nail. These were predominantly Weber B, C and bimalleolar fractures. In the case of ankle joint fractures, osteosynthesis was carried out following precise open fracture repositioning. In the case of isolated fibula fractures, early loading was allowed within 1 week; in the case of bimalleolar fractures, there was immediate partial loading with 20 kg for 4 weeks, after which they were subjected to full loading. Where there was an additional Volkmann fracture, we allowed only immediate partial loading with 10 kg for 6 weeks. All 194 patients were observed prospectively, and 162 (83.5%) could be followed up after 15 months. The results were classified according to the scale described by Olerud. RESULTS: It has been possible to follow up 162 patients, with an average age of 49.7 years. There were 62 (38.3%) Weber B and 45 (27.8%) Weber C fractures. In 55 (34.0%) cases, bimalleolar fractures were present. According to the Olerud score, 95 (58.6%) of the patients had an excellent outcome, 54 (33.3%) a good one, 9 (5.5%) a fair one and 4 (2.5%) an unsatisfactory outcome. In 3 cases a threaded wire dislocation occurred, without complications. Two mesh graft transplants were necessary; otherwise, there were no soft-tissue problems requiring review. One pseudarthrosis was seen. CONCLUSION: The XS nail which is introduced here fulfils the requirements made of an implant as regards maximum protection of soft tissue, secure fracture fixation and early exercise tolerance, including ankle fractures. No implant dislocation, no deep infection and no re-osteosynthesis were observed. Its advantages over conventional techniques lie precisely in the treatment of complex fractures and for patients with poor bone, vascular and soft-tissue situations.

Adolescent↗
PubMed1992

Ligament strain and ankle joint opening during ankle distraction.

To determine the efficacy of ankle distraction and to investigate possible complications of the procedure, the strain on four ankle ligaments and the tibiotalar joint opening resulting from distraction force and various foot positions were studied. We mounted strain gauges on the deltoid, calcaneofibular, tibiofibular, and anterior talofibular ligaments of six fresh human cadaver ankles. An Acufex ankle distractor was used to apply forces of 45, 90, 135, and 180 N at 20 degrees dorsiflexion, neutral, and 10 degrees plantar flexion. The ankle distractor proved to be effective in opening the joint space for better visualization, but complications of pin bending, excessive ligament strain, and bony destruction did occur within the clinically recommended range. Based on the observed results, the safest method of distraction was to use forces < 135 N in the neutral position.

Ankle Joint↗
PubMedDate not supplied

Effect of the ankle stabilizing orthosis on foot and ankle kinematics during cutting maneuvers.

This study was to examine the stability and functionality of the Ankle Stabilizing Orthosis (ASO) in normal ankle kinematics during sideward and forward lateral cutting. Fifteen college students with normal ankles were randomly assigned to each of the following four conditions: sideward and forward lateral cutting, with and without the ASO. Ankle inversion-eversion and dorsiflexion-plantarflexion angular displacements and velocities during movement were recorded by a 3-D Qualisys system and analyzed with repeated measures ANOVA and Bonferroni test. In forward lateral cutting, the ASO decreased inversion angle at touchdown. On both lateral cutting conditions, the ASO decreased inversion angle at footflat and push-off, and decreased plantarflexion angle at touchdown. Furthermore, the ASO did not change inversion-eversion and dorsiflexion-plantarflexion angular velocities or stance phase duration. The ASO is likely to prevent ankle sprains during activities that involve lateral cutting while not hindering athletic performance. Information presented may help clinicians it brace prescription.

Adult↗
PubMed2004

Mobility of the human ankle and the design of total ankle replacement.

Our prior research has shown that currently available total ankle implants fail to restore physiologic ankle mobility. Most of the modern mobile-bearing designs that feature a flat tibial component and a talar component with anatomic curvature in the sagittal plane function nonphysiologically with the natural ligament apparatus. To establish a more natural relationship between the implanted components and the retained ankle ligaments, we have developed a new design. According to our prior research, we suggest that physiologic ankle mobility is reproduced best with a design featuring a spherical convex tibial component, a talar component with radius of curvature in the sagittal plane longer than that of the natural talus, and a fully conforming meniscal component. Our preliminary observations in trial implantation and in a few patients suggest that while reproducing physiologic ankle mobility, the new design is capable of maintaining complete congruence at the two articulating surfaces of the meniscal bearing over the entire motion arc, with the prospect of minimizing wear of this component.

Ankle Joint↗
PubMed2006

Altered neuromuscular control and ankle joint kinematics during walking in subjects with functional instability of the ankle joint.

BACKGROUND: The ankle joint requires very precise neuromuscular control during the transition from terminal swing to the early stance phase of the gait cycle. Altered ankle joint arthrokinematics and muscular activity have been cited as potential factors that may lead to an inversion sprain during the aforementioned time periods. However, to date, no study has investigated patterns of muscle activity and 3D joint kinematics simultaneously in a group of subjects with functional instability compared with a noninjured control group during these phases of the gait cycle. PURPOSE: To compare the patterns of lower limb 3D joint kinematics and electromyographic activity during treadmill walking in a group of subjects with functional instability with those observed in a control group. STUDY DESIGN: Controlled laboratory study. METHODS: Three-dimensional angular velocities and displacements of the hip, knee, and ankle joints, as well as surface electromyography of the rectus femoris, peroneus longus, tibialis anterior, and soleus muscles, were recorded simultaneously while subjects walked on a treadmill at a velocity of 4 km/h. RESULTS: Before heel strike, subjects with functional instability exhibited a decrease in vertical foot-floor clearance (12.62 vs 22.84 mm; P < .05), as well as exhibiting a more inverted position of the ankle joint before, at, and immediately after heel strike (1.69 degrees , 2.10 degrees , and -0.09 degrees vs -1.43 degrees , -1.43 degrees , and -2.78 degrees , respectively [minus value = eversion]; P < .05) compared with controls. Subjects with functional instability were also observed to have an increase in peroneus longus integral electromyography during the post-heel strike time period (107.91%.millisecond vs 64.53%.millisecond; P < .01). CONCLUSION: The altered kinematics observed in this study could explain the reason subjects with functional instability experience repeated episodes of ankle inversion injury in situations with only slight or no external provocation. It is hypothesized that the observed increase in peroneus longus activity may be the result of a change in preprogrammed feed-forward motor control.

Ankle Joint↗
PubMedDate not supplied

Retrospective comparison of taping and ankle stabilizers in preventing ankle injuries.

The effectiveness of taping and the effectiveness of wearing a laced stabilizer in preventing ankle injuries and reinjuries over six seasons of collegiate football practices and games were assessed retrospectively. For 1 1/2 years the players all had taped ankles, and for the remaining 4 1/2 years the players chose their type of ankle support. Over the entire period, the players chose high-top or low-top shoes as preferred. During 51,931 exposures to injury (46,789 practice-exposures and 5,142 game-exposures), the 297 players sustained 224 ankle injuries and 24 reinjuries. Tape was worn during 38,658 exposures to injury (233 players), stabilizers during 13,273 exposures (127 players). Tape had been worn when 159 of the injuries and 23 of the reinjuries occurred; a stabilizer had been worn when 37 of the injuries (P = 0.003) and one of the reinjuries occurred. The combination allowing the fewest injuries overall was low-top shoes and laced ankle stabilizers.

Adult↗
PubMed1995

Ankle performance after ankle fracture: a randomized study of early mobilization.

In a prospective, randomized study, 30 patients were evaluated after ankle fracture treated by means of open reduction and internal fixation. The patients were randomized to either postoperative immobilization in a plaster cast for 6 weeks or early mobilization (1-2 weeks after surgery) in an ankle brace. Both regimens allowed weightbearing. Evaluation after 10 weeks and after 12 months included clinical assessment and isokinetic muscle strength measurements. Patients with impaired ankle function, as shown by means of an ankle score at 12 months, were followed for 3 years. At 10 weeks, impaired muscle torque and restricted range of motion was found on the affected side. This impairment was significantly less in the brace group. At 12 months, range of motion of the ankle and subtalar joints was restored, but dorsiflexion was still better in the brace group. Score values from a functional score did not correlate with muscle strength.

Adult↗
PubMed2002

Relation of maximal ankle dorsiflexion angle and passive resistive torque to passive-elastic stiffness of ankle dorsiflexion stretch.

The maximal passive ankle dorsiflexion angle and the maximal passive resistive torque at this angle were measured for 81 women 20 to 84 years of age and correlated with the passive-elastic stiffness (stiffness) of an ankle dorsiflexion stretch. Pearson correlation coefficients and multiple regression analyses were used to examine whether the two clinical measurements could predict ankle stiffness. The maximal passive resistive torque showed a moderate correlation with stiffness in the full stretch range (r = .69) and high correlation with stiffness in the last half of the full stretch range (r = .84). The maximal dorsiflexion angle showed a low correlation with stiffness in the full stretch range (r = .27) and in the last half of the full stretch range (r = .36). The maximal passive resistive torque and the dorsiflexion angle together accounted for 54% of the stiffness variance in the full stretch range and 76% of the stiffness variance in the last half of the full stretch range. Thus, the clinical measurements of the maximal passive dorsiflexion angle and the maximal passive resistive torque were directly and significantly related to the ankle dorsiflexion passive-elastic stiffness and good predictors of stiffness in the last half of the passive ankle dorsiflexion stretch.

Adult↗
PubMed1995

Treatment of acute ankle sprain. Comparison of a semi-rigid ankle brace and compression bandage in 73 patients.

We randomized 73 patients with grades II and III ankle sprain to treatment with an Air-Stirrup ankle brace or a compression bandage. All patients were instructed to attempt early motion and weight bearing when comfortable. Ankle function was evaluated after 3-5 days and 2, 4, and 10 weeks with a clinical examination, the Sickness Impact Profile questionnaire, Karlsson's scoring scale and recording of sick leaves. The group treated with the Air-Stirrup ankle brace was more mobile in the initial phase of rehabilitation and had a shorter sick leave. Ankle brace treatment resulted in socioeconomic savings.

Acute Disease↗
PubMed1992

Ligamentous injuries to the lateral aspect of the ankle: the ankle sprain.

Good protective devices are available which will prevent or reduce the severity of ankle sprains. If an injury to the lateral ligaments of the ankle--an ankle sprain--is sustained, functional treatment with early tape support, followed by a plastic support device will return the vast majority of the injured athletes to competition rapidly and with a stable ankle. In a few cases, surgical repair is the most appropriate treatment to return the individual to his chosen endeavor with a stable ankle.

Ankle Injuries↗
PubMedDate not supplied

Lateral ankle instability: a discussion of the Lee ankle stabilization.

Ankle sprains resulting in chronic ankle instability can be very disabling for the patient. There have been several procedures developed to stabilize the lateral aspect of the ankle. It will be shown that the Lee ankle stabilization is an appropriate procedure when surgical correction is indicated for the chronic unstable ankle. An important aspect of this particular procedure is the use of a periosteal flap, from the lateral malleolus, with the peroneus brevis tendon.

Adult↗
PubMed1987

The optimum position of arthrodesis of the ankle. A gait study of the knee and ankle.

UNLABELLED: Findings from biomechanical analyses of gait were used to estimate the optimum position of arthrodesis of the ankle. Nineteen patients who were followed for an average of 10.4 years (range, four to seventeen years) were studied. By including the knee in the analysis as well as studying the effects on gait of different ground conditions, objective data for the weight-bearing extremities in the transverse, sagittal, and coronal planes were generated. Genu recurvatum was shown to be associated with a plantar-flexion position of fusion of the ankle. Laxity of the medial collateral ligament of the knee was noted in twelve patients (63 per cent). Among these patients, in three (16 per cent) the laxity was graded as moderate to severe, possibly due to external rotation of the extremity during gait to avoid rolling over the rigid plantar-flexed ankle. The patterns of gait showed that a valgus position of the arthrodesis is more advantageous and provides more normal gait, particularly on uneven ground. To attain more normal function of the knee and improve performance on rough ground, the optimum position of arthrodesis of the ankle appears to be neutral flexion, slight (zero to 5 degrees) valgus angulation, and approximately 5 to 10 degrees of external rotation. Posterior displacement of the talus under the tibia tends to produce a more normal pattern of gait and decreases the stress at the knee. CLINICAL RELEVANCE: This study has shown the ideal position of fusion of the ankle to be neutral flexion, slight (zero to 5 degrees) valgus angulation of the hind part of the foot, and 5 to 10 degrees of external rotation. This position allows the greatest compensatory motion at the foot and places the least strain on the knee.

Adult↗
PubMed2005

The effect of ankle ligament damage and surgical reconstructions on the mechanics of the ankle and subtalar joints revealed by three-dimensional stress MRI.

Common image-based diagnostic techniques used to detect ankle ligament injuries or the effects of those injuries (e.g., mechanical instability) include magnetic resonance imaging (MRI) and stress radiography. Each of these techniques has limitations. The interpretation of the results obtained through stress radiography, a two-dimensional technique, is highly controversial. MRI can facilitate visualization of soft tissue, but three-dimensional visualization of the full length of the ligaments or detecting partial ligament damage is difficult. This work is part of a long-term study aimed at improving the diagnostic ability of MRI by utilizing it not only to visualize the ligaments but also to detect the mechanical instability produced at the ankle and subtalar joints due to ligament damage. The goal of the present study was to evaluate the ability of a previously developed technique called 3D stress MRI (sMRI) to detect in vitro the effect of damage to the lateral collateral ligaments and the stabilizing effect produced by two common surgical reconstruction techniques. MRI data were collected from eight cadaver limbs in a MR compatible ankle-loading device in neutral, inversion, and anterior drawer. Each specimen was tested intact, after cutting the anterior talo-fibular ligament followed by the calcaneo-fibular ligament and after applying two reconstructions. Ligament injuries produced significant changes in the response of the ankle and subtalar joints to load as detected by the 3D stress MRI technique. Both surgical procedures restored mechanical stability to the joints but they differed in the amount and type of stabilization achieved. We concluded that 3D sMRI can extend the diagnostic power of MRI from the current practice of slice-by-slice visualization to the assessment of mechanical function, the compromise in this function due to injury, and the effects of surgery.

Aged↗
PubMed2006

Alternatives to ankle implant arthroplasty for posttraumatic ankle arthrosis.

Various surgical options beyond implant arthroplasty are available to treat posttraumatic ankle arthrosis. Conservative options are usually employed in combination and include the use of nonsteroidal anti-inflammatories, bracing, and orthoses, as well as injections of intra-articular corticosteroid and hyaluronic acid. If these conservative treatments fail, surgical intervention can be entertained. Alternatives to total ankle implant arthroplasty include (1) arthroscopic debridement, (2) arthrodiastasis, (3) peri-articular resurfacing using allograft or cartilage transplantation, and (4) peri-articular osteotomies to correct angular, rotational, or translational malalignment. However, ankle arthrodesis is the standard technique for end-stage ankle arthrosis. This article reviews the literature and presents an in-depth surgical technique for each procedure. The article also describes how to prevent and address the most common complications.

Ankle Injuries↗
PubMed2006

Ankle anatomy for the arthroscopist. Part II: Role of the ankle ligaments in soft tissue impingement.

The biomechanical anatomy of the ankle ligaments continues to be a subject of interest because detailed knowledge of these structures is essential for proper diagnosis and treatment of the injuries affecting them. Lesions to the ankle ligaments are one of the most common sports injuries and the origin of soft tissue impingement syndrome. Together with the ligaments of the tibiofibular syndesmosis, two large ligamentous complexes are the main static stabilizers of the ankle joint: the lateral collateral ligament and the medial collateral (or deltoid) ligament. This article provides an anatomic description of the various ligaments of the ankle joint, with particular emphasis on specific anatomic details that are often omitted or little known and that have considerable clinical interest because of their involvement in soft tissue syndrome.

Ankle Injuries↗