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Saiga, Kenta, Suguru Yokoo, Hideki Ohashi, Masahiro Horita, Takayuki Furumatsu, and Toshifumi Ozaki. "Effect of Lateral Gutter Osteophyte Resection on Correction of Varus Deformity in Arthroscopic Ankle Arthrodesis." Foot & Ankle International 41, no. 6 (March 5, 2020): 683–88. http://dx.doi.org/10.1177/1071100720910388.
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Background: Recently, arthroscopic ankle arthrodesis has been performed for moderate-to-severe varus-deformed ankle osteoarthritis. However, the effect of osteophyte resection in the lateral gutter in arthroscopic ankle arthrodesis has not been clarified. We hypothesized that a varus-deviated ankle with lateral gutter osteophytes can be corrected by osteophyte resection. Methods: Thirty-nine ankles of 38 patients were included. The mean age of patients was 70.0 (45-83) years. The patients were divided into the following groups: group with an osteophyte in the lateral gutter (osteophyte) and group with no osteophytes (nonosteophyte). Preoperative and postoperative tibiotalar angle, tibial plafond angle, and tibiotalar angle under valgus stress, as well as the Japanese Society for Surgery of the Foot (JSSF) ankle/hindfoot scale, were recorded. Twelve ankles underwent lateral gutter osteophyte resection, whereas the other 27 ankles did not require osteophyte resection. Results: Preoperative tibiotalar angle was higher in the osteophyte group than in the nonosteophyte group (21.8 vs 11.2 degrees, P = .01). The tibiotalar angle in the preoperative valgus stress imaging was higher in the osteophyte group (12.9 vs 5.7, P < .01). However, the postoperative tibiotalar angle was similar between the 2 groups (7.1 vs 5.4, P = .183). JSSF ankle/hindfoot scale improved in both groups. Conclusion: Lateral gutter osteophyte resection enabled correction of the varus malalignment in arthroscopic ankle arthrodesis. Level of Evidence: Level III, retrospective comparative series.
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Lee, Seung Yeol, Soon-Sun Kwon, Moon Seok Park, Ki Hyuk Sung, Seungbum Koo, Sung Jin Kim, Shin Sangyeop, Hyun Choi, Sangho Chun, and Kyoung min Lee. "Is there a Relationship between Bone Morphology and Injured Ligament on Imaging Studies and Laxity on Ankle Stress Radiographs?" Foot & Ankle Orthopaedics 2, no. 3 (September 1, 2017): 2473011417S0002. http://dx.doi.org/10.1177/2473011417s000259.
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Category: Ankle, Sports Introduction/Purpose: We hypothesized that the bony configuration of the ankle could also be associated with ankle stress radiographs, in addition to ligament injury of the ankle. Therefore, this study aimed to investigate the relationship between bone morphology and injured ligament on imaging studies and laxity on ankle stress radiographs in patients with lateral ankle instability. Methods: In total, 115 patients who had undergone ankle MRI, ankle radiography, and stress radiography were included. Distal tibial articular surface angle, bimalleolar tilt, medial and lateral malleolar relative length, medial malleolar slip angle, anterior inclination of the tibia, and fibular position were measured on ankle radiographs. Tibiotalar tilt angle and anterior translation of the talus were measured on ankle stress radiographs. Degree of ligament injury was evaluated on ankle MRIs. Multiple regression analysis was performed using the following independent variables: age, sex, and factors significantly associated with ankle stress view on univariate linear regression analysis. Results: Age (p = 0.041), sex (p = 0.014), degree of anterior talofibular ligament injury (p < 0.001), and bimalleolar tilt (p = 0.016) were correlated with tibiotalar tilt angle (Table). Younger patients demonstrated a larger tibiotalar tilt angle than older patients, and the angle decreased by 0.07° per year of age. Tibiotalar tilt angle in female patients was 2.2° larger than that in male patients. Fibular position and degree of posterior talofibular ligament injury were factors significantly related to anterior translation of the talus. Conclusion: Differences in patient characteristics might predispose ankle stress radiograph results. Comparison of both ankles on stress radiographs is superior to applying fixed numerical values to the injured side, in order to reduce the influence of patient factors.
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Gougoulias, Nikolaos E., Filon G. Agathangelidis, and Stephen W. Parsons. "Arthroscopic Ankle Arthrodesis." Foot & Ankle International 28, no. 6 (June 2007): 695–706. http://dx.doi.org/10.3113/fai.2007.0695.
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Background: Arthroscopic arthrodesis has been used mainly for in situ fusion of arthritic ankles without deformity. This paper presents the application of arthroscopic arthrodesis of ankles with marked deformity. Methods: The results of 78 consecutive cases of arthroscopic ankle arthrodeses, performed in 74 patients, were retrospectively evaluated. Forty-eight ankles had minor deformity (group A), whereas 30 ankles had a varus or valgus deformity of more than 15 degrees (maximum 45 degrees) (group B). The average hospital stay was 3.8 and 3.4 days in groups A and B, respectively ( p = 0.74). Postoperative treatment included ankle immobilization for 3 months. Progressive weightbearing was initiated at 2 weeks. Mean followup was 21.1 months. Results: Fusion occurred in 47 of 48 (97.9%) ankles in group A at an average time of 13.1 ± 5.8 weeks and in 29 of 30 (96.7%) ankles at 11.6 ± 2.4 weeks in group B ( p = 0.19). Unplanned operative procedures were required in 11 ankles (14.1%). One superficial wound infection occurred. Symptomatic arthritis from the adjacent joints developed in six ankles (7.7%). Postoperative ankle alignment in the frontal plane averaged 0.7 and 0.4 degrees of valgus ( p = 0.41), whereas the sagittal plane angle averaged 106 ± 4 degrees and 104.5 ± 7 degrees in groups A and B, respectively ( p = 0.22). The outcome was graded as very good in 79.2% (38 feet) in group A and 80% (24 feet) in group B, fair in 18.8% (9 feet) in group A and 16.7% (5 feet) in group B and poor in one ankle in each group ( p = 0.68). Conclusions: The arthroscopic technique offered high fusion rates and low morbidity. Deformity correction was achieved with good results.
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Piga, Camilo, Federico Giuseppe Usuelli, Camilla Maccario, and Claudia A. Di Silvestri. "Total Ankle Arthroplasty in Valgus Deformity." Foot & Ankle Orthopaedics 5, no. 4 (October 1, 2020): 2473011420S0038. http://dx.doi.org/10.1177/2473011420s00386.
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Category: Ankle Arthritis Introduction/Purpose: Total ankle replacement use has increased among patients with end-stage ankle arthritis. Substantial coronal plane deformity is usual in that context. In addition, recent literature shows a trend towards the extension of the indication of total ankle arthroplasty in increasingly severe coronal deformities, showing good results when correct alignment is achieved. Nevertheless, the results of lateral transfibular total ankle replacement (LTTAR) in valgus has not been extensively studied. We aimed to evaluate if the outcomes of LTTAR in ankles with valgus deformity are similar with those with no major deformity. Methods: This retrospective cohort study included 228 LTTAR. Patients were classified into 2 groups according to the preoperative coronal plane tibiotalar angle (TTS): neutral (less than 10° of coronal deformity, 209 patients) and valgus (above 10° of valgus, 19 patients). Clinical evaluation was performed using American Orthopaedic Foot & Ankle Society Score (AOFAS), Visual analogue scale (VAS), short Form 12 Quality of Life (SF-12) regarding its physical (PCS) and mental (MCS) items. Radiographic evaluation considered anteroposterior and lateral ankle radiographs. Surgical times were recorded in all the cases. There were no differences between groups regarding mean age, mean body mass index and follow up. The minimum follow up was 24 months. Results: The average AOFAS, VAS and SF-12 scores improved significantly postoperatively (p-value<0.01), without differences between groups. At final radiographic follow up, the valgus alignment group did not show significant differences with the neutral alignment group regarding TTS, lateral distal tibial angle or anterior distal tibial angle (p-value>0.05). Surgical time was longer in the valgus group (152.84 +- 40.86 mins vs 129.51 +- 52.13), but the difference was not statistically significant. Conclusion: Lateral transfibular total ankle replacement in ankles with valgus deformity achieved and maintained correction of coronal alignment in a short term follow up, as obtained in neutral alignment ankles. Clinical outcomes improved significantly regardless preoperative valgus deformity. Additional surgical time may be needed in order to obtain a good deformity correction in a valgus ankle. This short term analysis shows that LTTAR in a valgus ankle seems to be a safe option in experienced surgeons hands.
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Witchalls, Jeremy, Gordon Waddington, Peter Blanch, and Roger Adams. "Ankle Instability Effects on Joint Position Sense When Stepping Across the Active Movement Extent Discrimination Apparatus." Journal of Athletic Training 47, no. 6 (November 1, 2012): 627–34. http://dx.doi.org/10.4085/1062-6050-47.6.12.
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Context Individuals with and without functional ankle instability have been tested for deficits in lower limb proprioception with varied results. Objective To determine whether a new protocol for testing participants' joint position sense during stepping is reliable and can detect differences between participants with unstable and stable ankles. Design Descriptive laboratory study. Setting University clinical laboratory. Patients or Other Participants Sample of convenience involving 21 young adult university students and staff. Ankle stability was categorized by score on the Cumberland Ankle Instability Tool; 13 had functional ankle instability, 8 had healthy ankles. Intervention(s) Test-retest of ankle joint position sense when stepping onto and across the Active Movement Extent Discrimination Apparatus twice, separated by an interim test, standing still on the apparatus and moving only 1 ankle into inversion. Main Outcome Measure(s) Difference in scores between groups with stable and unstable ankles and between test repeats. Results Participants with unstable ankles were worse at differentiating between inversion angles underfoot in both testing protocols. On repeated testing with the stepping protocol, performance of the group with unstable ankles was improved (Cohen d = 1.06, P = .006), whereas scores in the stable ankle group did not change in the second test (Cohen d = 0.04, P = .899). Despite this improvement, the unstable group remained worse at differentiating inversion angles on the stepping retest (Cohen d = 0.99, P = .020). Conclusions The deficits on proprioceptive tests shown by individuals with functional ankle instability improved with repeated exposure to the test situation. The learning effect may be the result of systematic exposure to ankle-angle variation that led to movement-specific learning or increased confidence when stepping across the apparatus.
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Perotti, L. R., O. Abousamra, M. del Pilar Duque Orozco, K. J. Rogers, J. P. Sees, and F. Miller. "Foot and ankle deformities in children with Down syndrome." Journal of Children's Orthopaedics 12, no. 3 (June 2018): 218–26. http://dx.doi.org/10.1302/1863-2548.12.170197.
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Purpose Foot and ankle deformities are common orthopaedic disorders in children with Down syndrome. However, radiographic measurements of the foot and ankle have not been previously reported. The aim of this study is to describe the foot and ankle deformity in children with Down syndrome. Methods Children who had foot and ankle radiographs in the standing weight-bearing position were selected. Three groups of patients were identified. The relationship of radiographic measurements with age, body mass index and pain is discussed. In all, 41 children (79 feet) had foot radiographs and 60 children (117 ankles) had ankle radiographs, with 15 children overlapping between Groups I and II. Results In Group I, hallux valgus deformity was seen before ten years of age and hallux valgus angle increased afterwards. Metatarsus adductus angle showed a significant increase (p = 0.006) with obesity and was higher in patients who had foot pain (p = 0.05). In Group II, none of the ankle measurements showed a significant difference with age or body mass index percentiles. Tibiotalar angle (TTA) and medial distal tibial angle (MDTA) were higher in patients who had ankle pain. In Group III, correlation analysis was performed between the different measurements with the strongest correlations found between TTA and MDTA. Conclusion In children with Down syndrome, radiographic evaluation of the foot and ankle reveals higher prevalence of deformities than clinical examination. However, foot and ankle radiographs are needed only for symptomatic children with pain and gait changes. Level of Evidence Level IV - Prognostic Study
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Jung, Hong-Geun, Hwa-Jun Kang, Mao-Yuan Sun, and Juan Agustin Coruna. "Magnetic Resonance Imaging Findings of the Lateral Ankle Instability after Anatomical Ligament Reconstruction Using a Semitendinosus Allograft Tendon with Biotenodesis Screws." Foot & Ankle Orthopaedics 3, no. 3 (July 1, 2018): 2473011418S0027. http://dx.doi.org/10.1177/2473011418s00274.
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Category: Ankle Introduction/Purpose: Surgery for lateral ankle instability is indicated in patients who have repetitive inversion ankle sprains despite conservative therapy. There have been many reconstruction procedures performed for the lateral ankle ligament instability. However, there has not been any report of postoperative MRI findings of lateral ankle instability after ligament reconstruction using a free tendon and biotenodesis screws. Therefore, this study was to analysis the MRI finding of the postoperative lateral ankle reconstruction using semitendinosus allograft tendon and the correlation with clinical outcome. Methods: The study is based on 34 ankles (33 patients) of chronic lateral ankle instability which underwent anatomical lateral ankle ligament reconstruction using a semitendinosus allograft tendon with bio-tendosis screws from July 2009 to April 2017 with at least 6 month postoperative ankle MRI checked (mean follow-up 16.5mo). In addition, clinical outcomes were evaluated using VAS pain score, American Orthopedic Foot and Ankle Society (AOFAS) ankle-hindfoot score, Karlsson-Peterson score, ankle stress views and subjective patient satisfaction. Results: Six ankles (17.6%) showed normal signal intensity(SI) while 28 ankles (82.4%) showed high SI on reconstructed allograft tendon area. High signal was shown around the biotenodesis screws. Eleven ankles showed synovitis (39.3%), partial tear of reconstructed allograft tendon 6 ankles (21.4), 5 osteolysis of the bone tunnel (17.9%), 4 screw pulled-outs (14.3%), 2 tendon complete tear (7.1%), 2 mucoid changes (7.1%), 2 cystic changes (7.1%). One ankle showed post-op MRI findings of reconstructed tendon infection (3.6%). The mean VAS pain score significantly decreased from 5.7 to 1.5. The mean AOFAS score improved from 72.0 to 89.1, while the Karlsson-Peterson score significantly improved from 54.7 to 85.7 (p<0.01) with 88% patient satisfaction. Stress talar tilt angle improved from 15.7o to 5.4 o. Conclusion: In the current study, various postoperative MRI findings were found after lateral ankle ligament reconstruction using allograft tendon and biotenodesis screws including high signal change of tendon, synovitis, tunnel osteolysis, screw pull-outs, tendon tears and etc. However, these MRI findings did not present as clinical complications and did not correlate with poor clinical outcomes.
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Ebaugh, M. Pierce, Greg Grenier, Satbir Singh, Oussama Abousamra, and Kevin Klingele. "Ankle Mortise Instability in Multiple Hereditary Exostoses." Foot & Ankle Orthopaedics 4, no. 4 (October 1, 2019): 2473011419S0016. http://dx.doi.org/10.1177/2473011419s00167.
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Category: Ankle, Ankle Arthritis, Pediatric Foot and Ankle Introduction/Purpose: Ankle valgus has been reported in 50% of patients with multiple hereditary exostoses (MHE) and, untreated, results in early arthrosis. Widening of the ankle mortise has also been reported; however, there has been a lack of data regarding its natural history and management. Alterations of mortise anatomy result in poor functional outcomes and accelerated arthrosis of the ankle. The aim of our study was to report the characteristics and outcomes of mortise widening in a group of patients with MHE. Methods: A total of 13 patients with MHE and mortise widening (16 ankles) were identified. Age, sex, BMI, laterality, origin of osteochondroma, pain, instability, clinical deformity, operative data, and complications were recorded. Mortise (M), Talocrural angle (TC), and Tibiotalar angle (TT) measurements were collected on preoperative and last follow up radiographs. The majority of patients underwent medial distal tibia hemiepiphysiodesis. Post-surgical AOFAS and SF36 scores were collected. Results: Preoperatively, no patient complained of instability, however, 9/16 ankles were painful and 14/16 were clinically in valgus. Patients underwent surgery at an age of 11.8 years (9.7-15). Radiographic and clinical follow up were 2.6 years (0.2-7.3) and 6 years (1.5-11.7), respectively. There were no significant differences between pre/postoperative M, TC, TT angles. Operative patients improved mean M (5.17 to 4.63 mm) and TT (8.71 to 4.54 degrees), neither angle reached normal values. TC (fibular length) was within normal limits (82.2 to 84.8). Questionnaires were obtained for 8/16 ankles, at a mean age of 19 years (13-25.1). The average AOFAS score was 66.7 out of 100. Patients scored 8.6/10 for alignment, 32/40 for pain, 25.6/50 for function. SF-36 scores were excellent. Conclusion: The improvement in M and TT was modest and their values remained outside the normal limits. TC angle was within normal limits but displayed an overall fibular shortening and thus, decreased lateral buttress with potential for talar shift. This was reflected in the mean functional and overall AOFAS score. However, our patients are functionally compensating as evidenced by SF36 scores. More studies are needed to optimize the management of MHE patients with ankle malalignment. Earlier valgus correction and possible addition of fibular lengthening to simultaneously address mortise widening may need to be considered to prevent early ankle arthritis.
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Krähenbühl, Nicola, Lukas Zwicky, Manja Deforth, Beat Hintermann, and Markus Knupp. "Subtalar Joint Alignment in Ankle Osteoarthritis." Foot & Ankle Orthopaedics 2, no. 3 (September 1, 2017): 2473011417S0002. http://dx.doi.org/10.1177/2473011417s000249.
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Category: Ankle Arthritis, Hindfoot Introduction/Purpose: The influence of the subtalar joint on the evolution of ankle joint osteoarthritis is still a matter of debate. Although subtalar joint compensation of deformities above the ankle joint was proposed until mid-stage of ankle osteoarthritis, the evidence of this assumption is weak. In this study, we investigated the subtalar joint alignment in different stages of ankle joint osteoarthritis using weightbearing CT scans. The influence of the tibio-talar tilt and presence of subtalar joint osteoarthritis was additionally assessed. We hypothesized, that the subtalar joint compensates for deformities above the ankle joint in early- to mid-stage of ankle osteoarthritis. We also hypothesized, that subtalar joint compensation increases with a pronounced tibio-talar tilt and decreases with the presence of subtalar joint osteoarthritis. Methods: We included patients with ankle joint osteoarthritis treated in our institution from January 2013 to April 2016. A control group of 28 patients was additionally assessed. Varus and valgus ankles were subdivided according to the modified Takakura classification, the tilt of the talus in the ankle mortise and stage of subtalar joint osteoarthritis. The type of ankle osteoarthritis was diagnosed on a plain weightbearing anterior to posterior radiograph of the ankle. The medial distal tibial angle (TAS) and the angle between the tibial shaft and the surface of the talar dome (TTS) were measured. The subtalar joint alignment was assessed using weightbearing CT scans. Two angles were assessed: The subtalar inclination angle (SIA) was measured to investigate the subtalar compensation. For assessment of the morphology of the talus, the inftal-subtal angle (ISA) was determined. Results: This analysis showed significant differences of the subtalar inclination between varus feet and the controls (SIA, P=.001). Regarding the talar morphology, significant differences were found between varus/ valgus feet and the controls (ISA, P=.001 and .036, respectively). No significant differences of the subtalar joint inclination and talar morphology could be identified comparing different stages of ankle joint osteoarthritis inside the varus or valgus group. No relationship between the tilt of the talus in the ankle joint mortise and the subtalar joint inclination or talar morphology was identified. Neither presence nor absence of subtalar joint osteoarthritis influenced the subtalar joint inclination and talar morphology. Conclusion: Varus ankles compensate in the subtalar joint for deformities above the ankle joint. Compensation had no influence on the stage of ankle osteoarthritis, extent of the tibio-talar tilt and stage of subtalar joint osteoarthritis. Consequently, the progression of ankle joint osteoarthritis is more depended on the supramalleolar alignment and integrity of the periarticular structures (i.e. ligaments and tendons) than on the osseous alignment of the subtalar joint.
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Rolfe, Bruce, William Nordt, Julian G. Sallis, and Michael Distefano. "Assessing Fibular Length Using Bimalleolar Angular Measurements." Foot & Ankle 10, no. 2 (October 1989): 104–9. http://dx.doi.org/10.1177/107110078901000210.
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Shortening of the fibula after fracture is common and often difficult to appreciate. Loss of lateral malleolar anatomy causes significant biomechanical changes in the ankle and correlates with poor clinical results. We studied angular measurements of distal fibular length to serve as a guide for assessing fibular reduction after ankle fracture. Mortise view X-rays of 50 normal ankles from 25 healthy volunteers were obtained. The average talocrural angle measured 78.5°. However, individual variation was high with values ranging from 75 to 86°. Comparing contralateral ankles demonstrated an average difference of 1.3° (range 0 to 4°). A new, simpler bimalleolar angle was devised which compares the long axis of the fibula with a line drawn between the tips of the malleoli. The average bimalleolar angle measured 77.8° (range 72 to 86°). The contralateral difference averaged 1.2° (range 0 to 3°). This angle was simpler to use and more reproducible. Angular measurements were tolerant of usual radiographic techniques. Internal or external rotation of the ankle up to 5° caused an insignificant change in the angular measurements. One degree change in the talocrural or bimalleolar angle was found to correspond with a 1 mm change in fibular length for the average ankle, calculated radiographically and confirmed in a cadaver study. Abnormal fibular shortening is detected with an angular difference between injured and contralateral sides of 3.0° using the talocrural angle or 2.5° using the bimalleolar angle (95% confidence limits). Thus, a 2.5 to 3.0° contralateral difference should serve as a minimum value required to direct a change in therapy. We conclude that comparing angular measurements of the injured with the contralateral ankle provides the most accurate guide for assessing fibular length.
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Yoshikawa, Masahiro, Tomoyuki Nakasa, Mikiya Sawa, Yusuke Tsuyuguchi, Munekazu Kanemitsu, Yuki Ota, and Nobuo Adachi. "Evaluation of the ankle position sense in the fatigue foot." Foot & Ankle Orthopaedics 3, no. 3 (July 1, 2018): 2473011418S0052. http://dx.doi.org/10.1177/2473011418s00524.
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Category: Ankle Introduction/Purpose: Previous studies have described the damage of sensori-motor control in ankle sprain as being a possible cause of functional instability. The methods to demonstrate the functional instability, have included the postural balance test, peroneal muscle reaction time to sudden ankle inversion, peroneal nerve conduction velocity, and joint position sense of the ankle. On the other hand, isokinetic fatigue of ankle plantar flexion and dorsiflexion exhibits the correlation with postural instability. We hypothesize muscle fatigue around ankle joint causes abnormality of joint position sense, especially inversion at ankle joint, and it will be one of the causes of the ankle sprain. The aim of this study was to evaluate the inversion angle replication errors of before fatigue and after fatigue. Methods: 11 subjects were included in this study. The subjects were placed in a sitting position with the knee flexed at 70°. Each subject placed the foot on a goniometer footplate with the ankle at 20° planter flexion. Subjects were blindfolded to eliminate visual input and to facilitate concentration during testing. The foot was passively rotated internally at random to one of six positions (5°to 30°), always starting from 0°. The footplate was rotated manually to the index angle in approximately 1 s, and held in position for 5 s. Then the ankle was returned to the 0° position. After that, the subjects moved their ankle to match the previous test angle actively. The difference between the index angle and replication angle was measured. Ankles were enforced planter and dorsiflexion according to previous reports, and replication error was measured before and after fatigue. Results: The side-to-side difference of the replication errors was 1.9±1.7° in the before-fatigue group and 2.6±1.8° in the after-fatigue group. There was a statistically significant difference between both the groups (p<0.05). In each inversion angle, there were significant differences of the side-to-side differences of the replication errors at 5°and 10°inversion angles (0.8±0.9°, 1.5±1.4° in the before-fatigue group and 2.2±1.7°, 2.6±1.5° in the after-fatigue group respectively). Conclusion: This study revealed the deficit of joint position sense in ankle inversion induced by fatigue. Fatigue may be one of the risk factor of ankle sprain through the deficit of joint position sense in inversion angle during sports activity.
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Moore, Andrew M., Anish R. Kadakia, Richard E. Hughes, and Ramon A. Ruberte Thiele. "Effect of Ankle Flexion Angle on Axial Alignment of Total Ankle Replacement." Foot & Ankle International 31, no. 12 (December 2010): 1093–98. http://dx.doi.org/10.3113/fai.2010.1093.
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Piga, Camilo, Camilla Maccario, Riccardo D’Ambrosi, Fausto Romano, and Federico Giuseppe Usuelli. "Total Ankle Arthroplasty With Valgus Deformity." Foot & Ankle International 42, no. 7 (February 1, 2021): 867–76. http://dx.doi.org/10.1177/1071100720985281.
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Background: A substantial coronal plane deformity is common in the context of end-stage ankle osteoarthritis. Recent literature shows a trend toward extending the indication of total ankle arthroplasty in increasingly severe coronal deformities, showing promising results when correct alignment is achieved. Nevertheless, the results of lateral transfibular total ankle replacement (LTTAR) in valgus has not been extensively studied. We aimed to evaluate if the outcomes of LTTAR in ankles with valgus deformity were similar to those with no major deformity at short-term follow-up. Methods: This retrospective cohort study included 228 LTTARs. Patients were classified into 2 groups according to the preoperative coronal plane tibiotalar angle (TTS): neutral (less than 10 degrees of coronal deformity, 209 patients) and valgus (above 10 degrees of valgus, 19 patients). Clinical evaluation was performed using the American Orthopaedic Foot & Ankle Society (AOFAS) score, visual analog scale (VAS), 12-Item Short Form Health Survey 12 (SF-12) regarding its Physical and Mental Component Summary items. The radiographic evaluation considered anteroposterior and lateral ankle radiographs. Complications were also registered and classified as major or minor. The minimum follow-up was 2 years. Results: The average AOFAS, VAS, and SF-12 scores improved significantly postoperatively ( P < .001), without differences between groups. At final radiographic follow-up, the valgus alignment group did not show significant differences with the neutral alignment group regarding TTS, lateral distal tibial angle, or anterior distal tibial angle ( P > .05). Conclusion: LTTAR in cases with valgus deformity achieved and maintained correction at short-term follow-up, as obtained in neutral alignment ankles. Clinical outcomes improved significantly regardless of preoperative valgus deformity. Level of Evidence: Prognostic Level III, retrospective cohort study.
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Fu, Amy S. N., and Christina W. Y. Hui-Chan. "Ankle Joint Proprioception and Postural Control in Basketball Players with Bilateral Ankle Sprains." American Journal of Sports Medicine 33, no. 8 (August 2005): 1174–82. http://dx.doi.org/10.1177/0363546504271976.
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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° 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° (standard deviation, 0.4°) and 0.8° (standard deviation, 0.2°), respectively, in the healthy players to 1.4° (standard deviation, 0.7°) and 1.1° (standard deviation, 0.5°) 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.
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Zhou, Yunfeng, and Bin Song. "Arthroscopic anatomical reconstruction of anterior talofibular ligament and calcaneofibular ligament for chronic ankle instability." Foot & Ankle Orthopaedics 3, no. 3 (July 1, 2018): 2473011418S0054. http://dx.doi.org/10.1177/2473011418s00540.
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Category: Arthroscopy Introduction/Purpose: To evaluate the clinical results of an anatomical reconstruction of anterior talofibular ligament and calcaneofibular ligament under arthroscopy in treatment of chronic ankle instability. Methods From June 2013 to August 2016, 27 patients (28 ankles) with chronic ankle instability were treated with the anatomical reconstruction of anterior talofibular ligaments and calcaneofibular ligaments. All patients were evaluated preoperatively and at the last follow up using the visual analog scale(VAS) score, American Orthopaedic Foot and Ankle Society (AOFAS) score. The talar tilt angle and anterior translation were assessed radiographically in pre- and postoperative ankle stress views. Methods: From June 2013 to August 2016, 27 patients (28 ankles) with chronic ankle instability were treated with the anatomical reconstruction of anterior talofibular ligaments and calcaneofibular ligaments. All patients were evaluated preoperatively and at the last follow up using the visual analog scale(VAS) score, American Orthopaedic Foot and Ankle Society (AOFAS) score. The talar tilt angle and anterior translation were assessed radiographically in pre- and postoperative ankle stress views. Results: The operations were lasted for 75.8 minutes(72~104 minutes). 28 cases were received a mean follow up of 14.8 months(range, 12~25 months. The mean VAS pain score decreased from 5.79 to 1.54(t=26.63, P<0.01), and the medial AOFAS score improved from 63.64 to 90.21(t=-16.57, P<0.01). Imageological examination were completed 16.8 months after the operation (range, 12~25 months). The mean talar tilt decreased from 15.6°to 6.01°(t=25.39, P<0.01),and anterior translation of the talar reduced from a mean of 10.82 to 4.03 mm(t=15.79, P<0.01). Conclusion: Arthroscopic anatomical reconstruction of anterior talofibular ligament and calcaneofibular ligament could improve the function and stability of ankle joints effectively, providing a valid option for treating chronic ankle instability.
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Chun, Dong-Il, Jahyung Kim, Sung Hun Won, Jaeho Cho, Jeongku Ha, Minkyu Kil, and Young Yi. "Changes in Coronal Alignment of the Knee Joint after Supramalleolar Osteotomy." BioMed Research International 2021 (February 19, 2021): 1–8. http://dx.doi.org/10.1155/2021/6664279.
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Background. Assessing knee joint orientation changes after SMO may help clinical advancement in managing patients with ipsilateral ankle and knee joint arthritis. However, knee joint changes after supramalleolar osteotomy (SMO) have not been reported. We investigated changes in coronal alignment of the knee joint after SMO. Methods. In this multicentre study, from January 2014 to December 2018, 47 ankles with varus osteoarthritis treated with SMO were retrospectively identified. Ankle joint changes were assessed using the tibiotalar angle, talar tilt angle, and lateral distal tibial angle (LDTA); knee joint changes using the medial proximal tibial angle (MPTA), medial and lateral joint space widths (mJSW and lJSW, respectively), and medial and lateral joint line convergence angles (JLCA); and lower limb alignment changes using mechanical axis deviation angle (MADA) and the hip-knee-ankle (HKA) angle measured on full-length anteroposterior radiographs of the lower extremity. Correlation analysis and binary logistic regression analysis were performed. Results. Postoperatively, LDTA ( p < 0.001 ) and tibiotalar angle ( p < 0.001 ) significantly changed, indicating meaningful improvement in the ankle joint varus deformity. Regarding the knee joint changes, JLCA significantly changed into valgus direction ( p = 0.044 ). As for lower limb alignment changes, MADA significantly decreased ( p < 0.001 ), whereas the HKA angle significantly increased ( p < 0.001 ). In univariate and multivariate logistic regression analyses, changes in the MADA ( p < 0.001 ) and the HKA angle ( p < 0.001 ) were significantly correlated with the correction angle. Conclusions. SMO remarkably improves ankle joint varus deformity, followed by significant lower limb alignment changes. Despite meaningful changes in JLCA, the relationship between the amount of osteotomy near the ankle joint and improvement in knee joint radiographic parameters was not significant. Radiographic parameters of the knee joint would less likely be changed following SMO.
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Lee, Si Wook. "Transfixing Screw Placement for Syndesmotic Injury." Foot & Ankle Orthopaedics 3, no. 3 (July 1, 2018): 2473011418S0031. http://dx.doi.org/10.1177/2473011418s00313.
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Category: Trauma Introduction/Purpose: The strategy of transfixing screw fixation including screw number, size, material, the number of cortex involved, and penetrating angle is controversial. The purpose of this fresh frozen cadaveric study is to demonstrate the optimal degree of transfixing screw insertion after syndesmotic reduction in the Pronation External Rotation (PER) type ankle fractures, and to study reliable parameters to evaluate the syndesmotic reduction. Methods: Twenty paired fresh frozen anatomic specimens of the ankles were obtained. Before dissection, CT scans were taken preoperatively. Then, preparation was performed by cutting and dissection of anterior interior tibiofibular ligament (AITFL), interosseous ligament and membrane. Two types of screw placement were set. Ten screws were inserted into right ankle at an angle of 25 to 30 degrees from neutral position. The other 10 screws were inserted into the left ankle at a 0 degree angle from neutral position. Postoperative CT scan was performed after screw insertion. Anterior fibular distance(AFD), posterior fibular distance(PFD), anterior translation distance(AT), diastasis, anterior-posterior translation(APT) were measured in 2D axial section and volume of the syndesmotic space were measured in 3D reconstruction data of preoperative and postoperative CT scan. Results: The transfixing screw fixation induce the significant difference in syndesmotic space regardless of insertion angle. There was significant difference only in fibular diastasis between both ankle model. There was no statistically significant difference in AFD, PFD, AT, APT and 3D reconstructed volume according to transfixing screw insertion angle when each measured value was compared through left and right ratio and absolute volume value. Conclusion: In ankle syndesmotic injury, transfixing screw insertion should be considered for the ankle stability. But, regardless of the insertion angle, transfixing screw insertion would have a significant therapeutic effect on ankle syndesmotic injury. Fibular diastasis would be the reliable parameters to evaluate syndesmotic reduction.
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Kernozek, Thomas, Christopher J. Durall, Allison Friske, and Matthew Mussallem. "Ankle Bracing, Plantar-Flexion Angle, and Ankle Muscle Latencies During Inversion Stress in Healthy Participants." Journal of Athletic Training 43, no. 1 (January 1, 2008): 37–43. http://dx.doi.org/10.4085/1062-6050-43.1.37.
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Abstract Context: Ankle braces may enhance ankle joint proprioception, which in turn may affect reflexive ankle muscle activity during a perturbation. Despite the common occurrence of plantar-flexion inversion ankle injuries, authors of previous studies of ankle muscle latencies have focused on inversion stresses only. Objective: To examine the latency of the peroneus longus (PL), peroneus brevis (PB), and tibialis anterior (TA) muscles in response to various degrees of combined plantar-flexion and inversion stresses in braced and unbraced asymptomatic ankles. Design: Repeated measures. Setting: University biomechanics laboratory. Patients or Other Participants: Twenty-eight healthy females and 12 healthy males (n = 40: mean age = 23.63 years, range = 19 to 30 years; height = 172.75 ± 7.96 cm; mass = 65.53 ± 12.0 kg). Intervention(s): Participants were tested under 2 conditions: wearing and not wearing an Active Ankle T1 brace while dropping from a custom-made platform into 10°, 20°, and 30° of plantar flexion and 30° of inversion. Main Outcome Measure(s): The time between platform drop and the onset of PL, PB, and TA electromyographic activity was measured to determine latencies. We calculated a series of 2-way analyses of variance to determine if latencies were different between the conditions (braced and unbraced) and among the plantar-flexion angles (α = .05). Results: No interaction was found between condition and plantar-flexion angle. No significant main effects were found for condition or plantar-flexion angle. Overall means for braced and unbraced conditions were not significantly different for each muscle tested. Overall means for angle for the PL, PB, and TA were not significantly different. Conclusions: Reflexive activity of the PL, PB, or TA was unaffected by the amount of plantar flexion or by wearing an Active Ankle T1 brace during an unanticipated plantar-flexion inversion perturbation.
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Baumhauer, Judith F. "Ankle Arthrodesis Versus Ankle Replacement for Ankle Arthritis." Clinical Orthopaedics and Related Research 471, no. 8 (August 2013): 2439–42. http://dx.doi.org/10.1007/s11999-013-3084-6.
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Kwon, Yong. "Static Postural Stability in Chronic Ankle Instability, an Ankle Sprain and Healthy Ankles." International Journal of Sports Medicine 39, no. 08 (May 18, 2018): 625–29. http://dx.doi.org/10.1055/a-0608-4552.
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AbstractTo identify the single leg balance (SLB) test that discriminates among healthy, coper, and chronic ankle instability (CAI) groups and to determine effects of ankle muscles on the balance error scoring system (BESS) among the three populations. 60 subjects (20 per group) performed the SLB test with eyes open (EO) and eyes closed (EC). Normalized mean amplitude (NMA) of the tibia anterior (TA), fibularis longus (FL), and medial gastrocnemius (MG) muscles and BESS were measured while performing the SLB test. The coper group had a lower error score than the CAI group in the EC. NMA was greater in the CAI group compared to in the healthy and coper groups regardless of muscle type. NMA of the TA was less than the PL and MG regardless of the group in the EO. The CAI group demonstrated greater NMAs of the PL and MG than the healthy and coper groups in the EC. The CAI group demonstrated greater NMA of the PL and MG by compensating their ankle muscles in the EO and EC. BESS suggests that the coper group may have coping mechanisms to stabilize static postural control compared to the CAI group. The EC may be better to detect static postural instability in the CAI or coper group.
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KITABATA, Kosuke, Satoshi KOMADA, Daisuke YASHIRO, and Kazuhiro YUBAI. "Estimation of ankle torque by plantar flexor muscles using EMG and ankle angle." Proceedings of JSME annual Conference on Robotics and Mechatronics (Robomec) 2019 (2019): 2A1—G09. http://dx.doi.org/10.1299/jsmermd.2019.2a1-g09.
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Wanner, Philipp, Thomas Schmautz, Felix Kluge, Björn Eskofier, Klaus Pfeifer, and Simon Steib. "Ankle angle variability during running in athletes with chronic ankle instability and copers." Gait & Posture 68 (February 2019): 329–34. http://dx.doi.org/10.1016/j.gaitpost.2018.11.038.
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Ciufo, David J., Erin A. Baker, and Paul T. Fortin. "Tibial Torsion May Predict Morphology of the Talus." Foot & Ankle Orthopaedics 5, no. 4 (October 1, 2020): 2473011420S0017. http://dx.doi.org/10.1177/2473011420s00171.
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Category: Ankle Arthritis; Ankle; Hindfoot Introduction/Purpose: The role of implant positioning in total ankle arthroplasty (TAA) has garnered increasing attention, particularly in defining coronal and sagittal plane alignment. With the ongoing developments in patient specific instrumentation, advanced imaging is becoming a more common tool in preoperative planning. Despite this, there is limited information available on axial rotation of the ankle or variations in anatomy of the talus and foot. We aim to evaluate the rotational profile of the distal tibia and its relationship to morphology of the talus, as well as assess tibiotalar tilt, in a cohort of end-stage arthritic ankles. Methods: Computed tomography (CT) scans and plain radiographs were reviewed in 59 patients with end-stage ankle arthritis. Patients with previous tibial or ankle trauma were excluded. Scans were obtained prior to total ankle arthroplasty surgery as part of standard preoperative planning protocol. Demographic data was recorded. Measurements were obtained at the posterior condyles of the tibial plateau and transmalleolar axis to calculate tibial torsion, as well as along the talar neck and body to evaluate talar angle. Tibiotalar tilt angle was measured on weightbearing mortise view radiographs. Linear regression was performed to evaluate statistical associations between tibial torsion and other measured parameters. Results: The mean tibial torsion was 29.5±9.2 degrees external (range 13.6-50.8 degrees), no internal torsion was found. Mean talar neck-body angle was 38.2±8.8 degrees medial (range 24.1-59.5 degrees). Tibiotalar angle ranged from 26.5 degrees varus to 23.5 degree valgus. There was a statistically significant relationship between increasing tibial torsion and decreasing talar neck-body angle (r=-0.49, p<0.001), demonstrating more angulation of the talar neck corresponding to the least tibial torsion as seen in Figure 1. No relationship was found between tibial rotation and tibiotalar angle when assessing varus/valgus tilt on a spectrum (p=.89) or when evaluating absolute angulation from neutral (p=.43). Our cohort had a mean age of 63.1±8.2 years, and 54% were male. Conclusion: Our cohort displayed wide variation in axial anatomy of the ankle. Our analysis identifies a statistically significant correlation between tibial torsion and morphology of the talus. This is a previously unreported association that could help understand development of foot and ankle deformity and pathology. While there was no clear correlation to degree of tibiotalar angulation, these axial deformities surely play a role in altered foot and ankle mechanics and the development of end-stage ankle arthrosis. In patients undergoing ankle arthroplasty, these are important parameters for the surgeon to consider in conjunction with other aspects of the hindfoot deformity.
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Benevides, Pedro Costa, Caio Augusto de Souza Nery, Alexandre Leme Godoy-Santos, José Felipe Marion Alloza, and Marcelo Pires Prado. "Study of the radiographic parameters of normal ankles." Journal of the Foot & Ankle 14, no. 1 (April 30, 2020): 84–88. http://dx.doi.org/10.30795/jfootankle.2020.v14.1125.
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Objective: The authors carried out a bibliographic search for the radiographic parameters used to determine tibiotalar joint alignment, and suggest a set of parameters that constitute the minimum radiographic evaluation sufficient for the proper assessment of tibiotalar alignment. Methods: The search was conducted between May 2019 and January 2020 on the online platforms PudMed and Google Scholar with the following terms, used separately or jointly: “ankle arthritis, radiographic measurement, ankle alignment, alignment, anterior ankle instability, X-ray, and ankle injury”. Results: We selected twelve studies evaluating radiographic patterns of normal ankles, and identified a total of 15 radiographic measurements. Conclusion: The authors believe that a minimum radiographic assessment of tibiotalar alignment should include the following parameters on the anteroposterior radiograph: the distal tibial articular angle, the talar tilt and talus center migration. On the lateral radiograph, it should include: lateral distal tibial angle and lateral talar station. Level of Evidence V; Diagnostic Study; Expert Opinion.
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Silvestri, Claudia A. Di, Riccardo D’Ambrosi, Camilla Maccario, Cristian Indino, and Federico Giuseppe Usuelli. "Severe Ankle Varus Malalignment Management with a Fix-Bearing Total Ankle Replacement Implant." Foot & Ankle Orthopaedics 5, no. 4 (October 1, 2020): 2473011420S0019. http://dx.doi.org/10.1177/2473011420s00194.
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Category: Ankle Arthritis; Ankle Introduction/Purpose: Despite Total ankle replacement (TAR) is currently considered a safe procedure and an optimal alternative to ankle fusion in end-stage ankle arthritis, still the precise indications and the limits of TAR are a highly controversial topic. Coronal malalignment correction with TAR is also a widely debated point. Purpose of this work was to confront two patient groups undergoing Total Ankle Replacement (a group of patients with a pre-operative ankle varus misalignment on coronal plane, versus a group of patients with neutral pre-operative ankle alignment) comparing clinical and radiographic results, complications and survival rate of the implant. Methods: 171 patients, all affected by end-stage ankle arthritis and all treated with total ankle replacement with fix-bearing Trabecular Metal Total Ankle System (Zimmer-Biomet, Warsaw IN, USA), were divided in two groups. Group ‘A’ included 159 patients having a normal alignment or a slight valgus or valgus misalignment within 10°. Group ‘B’ included 12 patients with a pre- operative varus malalignment >10°. Each patient of the study was evaluated, clinically and radiologically, before and after surgery, and subsequently at 6 and 12 months follow-up, then once every year. Clinical evaluation comprised some score: visual analogue scale (VAS); American Foot and Ankle Society Score (AOFAS); and the Short Form (SF)-12 Quality of Life, in both of its ‘physical’ (PCS) and ‘mental’ (MCS) components. Radiological evaluated parameters were: tibio-talar surface angle (TTS), lateral distal tibial angle (LDTA-α), and anterior distal tibial angle (ADTA-β). Complications and implant survival rate were evaluated for both groups. Results: At a mean follow up of 2,75 years (range 2.09-5.66 years), improvement was found in all clinical and radiological evaluated parameters of two groups, without statistically significant differences between two groups at last follow-up. In group A most frequent reported complication was the presence of a fibular symptomatic hardware. Major complication were a deep arthroplasty infection and a 3 months post-operative ankle fracture-dislocation/periprostethic fracture. In group B there were 2 delayed wound healing, and one case of loosening of correction. No significant difference in complication and revision rate comparison between two groups was founded. Conclusion: Mid-term results reported in the present show that in patients with varus greater than 10 ° it is possible to obtain a post-operative alignment similar to pre-operative neutral ankles and that the complication rate is not greater. Despite this, is Authors opinion that major and complex misalignment should be approached by skilled surgeons, with an adequate learning curve experience, with a wide range of cases and in highly specialized centers.
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Lee, Gun-Woo, Asep Santoso, and Keun-Bae Lee. "Comparison of Intermediate-term Outcomes of Total Ankle Arthroplasty in Primary and Ligamentous Post-traumatic Osteoarthritis." Foot & Ankle International 40, no. 11 (September 13, 2019): 1273–81. http://dx.doi.org/10.1177/1071100719866472.
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Background: Ankle ligamentous injuries without fracture can result in end-stage ligamentous post-traumatic osteoarthritis, which may cause ligamentous imbalance after total ankle arthroplasty (TAA). However, outcomes of TAA in these patients are not well known. The purpose of this study was to evaluate intermediate-term clinical and radiographic outcomes of TAA in patients with ligamentous post-traumatic osteoarthritis and compare them with results of TAA for patients with primary osteoarthritis. Methods: We enrolled 114 patients (119 ankles) with consecutive primary TAA using HINTEGRA prosthesis at a mean follow-up duration of 6.0 years (range, 3-13). We divided all patients into 2 groups according to the etiology of osteoarthritis: (1) primary osteoarthritis group (69 ankles) and (2) ligamentous post-traumatic osteoarthritis group (50 ankles). Results: There was no significant intergroup difference in mean Ankle Osteoarthritis Scale (AOS), American Orthopaedic Foot & Ankle Society (AOFAS) ankle-hindfoot score, Short Form-36 Physical Component Summary, visual analog scale pain score, ankle range of motion, or complications at the final follow-up. However, the final tibiotalar angle was less corrected to 4.2 degrees in the ligamentous post-traumatic osteoarthritis group compared to 2.7 degrees in the primary osteoarthritis group ( P = .001). More concomitant procedures were required at the index surgery for the ligamentous post-traumatic osteoarthritis group ( P = .001). The estimated 5-year survivorship was 93.4% (primary osteoarthritis group: 91.3%; ligamentous post-traumatic osteoarthritis group: 95.8%). Conclusions: Clinical outcomes, complication rate, and 5-year survivorship of TAA in ankles with primary and ligamentous post-traumatic osteoarthritis were comparable with intermediate-term follow-up. Our results suggest that TAA would be a reliable treatment in ankles with ligamentous post-traumatic osteoarthritis when neutrally aligned stable ankles are achieved postoperatively. Level of Evidence: Level III, retrospective cohort study.
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Choi, Ji Hye, Hee Soo Han, Young Jin Park, Seungbum Koo, Taeyong Lee, and Kyoung Min Lee. "Relationship between ankle varus moment during gait and radiographic measurements in patients with medial ankle osteoarthritis." PLOS ONE 16, no. 6 (June 24, 2021): e0253570. http://dx.doi.org/10.1371/journal.pone.0253570.
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Background Kinetic data obtained during gait can be used to clarify the biomechanical pathogenesis of osteoarthritis of the lower extremity. This study aimed to investigate the difference in ankle varus moment between the varus angulation and medial translation types of medial ankle osteoarthritis, and to identify the radiographic measurements associated with ankle varus moment. Methods Twenty-four consecutive patients [mean age 65.8 (SD) 8.0 years; 9 men and 15 women] with medial ankle osteoarthritis were included. Fourteen and 10 patients had the varus angulation (tibiotalar tilt angle≥3 degrees) and medial translation (tibiotalar tilt angle<3 degrees) types, respectively. All patients underwent three-dimensional gait analysis, and the maximum varus moment of the ankle was recorded. Radiographic measurement included tibial plafond inclination, tibiotalar tilt angle, talar dome inclination, and lateral talo-first metatarsal angle. Comparison between the two types of medial ankle osteoarthritis and the relationship between the maximum ankle varus moment and radiographic measurements were analyzed. Results The mean tibial plafond inclination, tibiotalar tilt angle, talar dome inclination, lateral talo-first metatarsal angle, and maximum ankle varus moment were 6.4 degrees (SD 3.3 degrees), 5.0 degrees (SD 4.6 degrees), 11.4 degrees (SD 5.2 degrees), -6.5 degrees (SD 11.7 degrees), and 0.185 (SD 0.082) Nm/kg, respectively. The varus angulation type showed a greater maximum ankle varus moment than the medial translation type (p = .005). The lateral talo-first metatarsal angle was significantly associated with the maximum ankle varus moment (p = .041) in the multiple regression analysis. Conclusion The varus angulation type of medial ankle osteoarthritis is considered to be more imbalanced biomechanically than the medial displacement type. The lateral talo-first metatarsal angle, being significantly associated with the ankle varus moment, should be considered for correction during motion-preserving surgeries for medial ankle osteoarthritis to restore the biomechanical balance of the ankle.
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Kovaleski, John E., Robert J. Heitman, Larry R. Gurchiek, J. M. Hollis, Wei Liu, and Albert W. Pearsall IV. "Joint Stability Characteristics of the Ankle Complex in Female Athletes With Histories of Lateral Ankle Sprain, Part II: Clinical Experience Using Arthrometric Measurement." Journal of Athletic Training 49, no. 2 (March 1, 2014): 198–203. http://dx.doi.org/10.4085/1062-6050-49.2.08.
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Context: This is part II of a 2-part series discussing stability characteristics of the ankle complex. In part I, we used a cadaver model to examine the effects of sectioning the lateral ankle ligaments on anterior and inversion motion and stiffness of the ankle complex. In part II, we wanted to build on and apply these findings to the clinical assessment of ankle-complex motion and stiffness in a group of athletes with a history of unilateral ankle sprain. Objective: To examine ankle-complex motion and stiffness in a group of athletes with reported history of lateral ankle sprain. Design: Cross-sectional study. Setting: University research laboratory. Patients or Other Participants: Twenty-five female college athletes (age = 19.4 ± 1.4 years, height = 170.2 ± 7.4 cm, mass = 67.3 ± 10.0 kg) with histories of unilateral ankle sprain. Intervention(s): All ankles underwent loading with an ankle arthrometer. Ankles were tested bilaterally. Main Outcome Measure(s): The dependent variables were anterior displacement, anterior end-range stiffness, inversion rotation, and inversion end-range stiffness. Results: Anterior displacement of the ankle complex did not differ between the uninjured and sprained ankles (P = .37), whereas ankle-complex rotation was greater for the sprained ankles (P = .03). The sprained ankles had less anterior and inversion end-range stiffness than the uninjured ankles (P < .01). Conclusions: Changes in ankle-complex laxity and end-range stiffness were detected in ankles with histories of sprain. These results indicate the presence of altered mechanical characteristics in the soft tissues of the sprained ankles.
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Teramoto, Atsushi, Hiroaki Shoji, Hideji Kura, Yuzuru Sakakibara, Tomoaki Kamiya, Kota Watanabe, and Toshihiko Yamashita. "Factors Related to the Occurrence of Osteochondral Lesions of the Talus by 3-dimensional Bone Morphology of the Ankle." Foot & Ankle Orthopaedics 3, no. 3 (July 1, 2018): 2473011418S0048. http://dx.doi.org/10.1177/2473011418s00487.
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Category: Ankle Introduction/Purpose: Repeated microtrauma is thought to play a major role in the occurrence of osteochondral lesions of the talus (OLTs), but much remains unknown. Two-dimensional assessments of the relationship between ankle bone morphology and OLTs are occasionally seen. The purpose of this study was to evaluate the bone morphology of the ankle in OLT 3-dimensionally using three-dimensional computed tomography (3DCT), and to investigate the factors related to the occurrence of OLTs. Methods: The subjects were 19 patients (19 ankles) who underwent surgery for medial OLTs (OLT group). They included 13 men and 6 women. A healthy group without ankle disease served as a control group with the same number of 19 ankles. Three-dimensional ankle joint models were made based on DICOM data obtained with CT images. In the 3D model, the medial malleolus articular surface and the tibial plafond surface, the medial surface of the trochlea of the talus, and the lateral surface of the trochlea of the talus were defined. The tibial axis-medial malleolus (TMM) angle, the medial malleolus surface area (MMA), the medial malleolus volume (MMV), and the anterior opening angle of the talus were measured 3-dimensionally and compared in the OLT and control groups. Results: The mean TMM angle was significantly larger in the OLT group (34.2 ± 4.4°) than in the control group (29.2 ± 4.8°; p = 0.002). The mean MMA was significantly smaller in the OLT group (219.8 ± 42.4 mm2) than in the control group (280.5 ± 38.2 mm2; p < 0.001). The mean MMV was significantly smaller in the OLT group (2119.9 ± 562.5 mm3) than in the control group (2646.4 ± 631.4 mm3; p = 0.01). The mean anterior opening angle of the talus was significantly larger in the OLT group (15.4 ± 3.9°) than in the control group (10.2 ± 3.6°; p < 0.001). Conclusion: It was shown with 3DCT measurements that, in medial OLT patients, the medial malleolus opens distally, the MMA and MMV are small, and the talus anterior opening angle was significantly larger than in controls. This study suggests the possibility that the 3D bone morphology of both the mortise and tenon of the ankle joint are closely related to the occurrence of OLTs.
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Kondo, Hitoshi. "Changes in the Ground Reaction Force, Lower-Limb Muscle Activity, and Joint Angles in Athletes with Unilateral Ankle Dorsiflexion Restriction During A Rebound-Jump Task." Journal of Functional Morphology and Kinesiology 3, no. 4 (October 26, 2018): 52. http://dx.doi.org/10.3390/jfmk3040052.
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Background: This study compared differences between a control group and a group with unilateral ankle dorsiflexion restriction in the ground reaction force (GRF), angles of the lower limbs joints, and muscular activity during a rebound-jump task in athletes who continue to perform sports activities with unilateral ankle dorsiflexion restriction. Methods: The athletes were divided into the following two groups: The dorsiflexion group included those with a difference of ≥7° between bilateral ankle dorsiflexion angles (DF), and the control group included those with a difference of <7° between the two ankles (C). An ankle foot orthosis was attached to subjects in group C to apply a restriction on the right-angle dorsiflexion angle. The percentage of maximum voluntary contraction (%MVC) of the legs musculature, components of the GRF, and the hip and knee joint angles during the rebound-jump task were compared between groups DF and C. Results: Group DF showed increased %MVC of the quadriceps muscle, decreased upward component of the GRF, decreased hip flexion, and increased knee eversion angles. Conclusions: This study highlighted that athletes with ankle dorsiflexion restriction had significantly larger knee eversion angles in the rebound-jump task. The reduced hip flexion was likely caused by the restricted ankle dorsiflexion and compensated by the observed increase in quadriceps muscle activation when performing the jump.
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Lambert, Laura-Ann, Luke Falconer, and Lyndon Mason. "Ankle stability in ankle fracture." Journal of Clinical Orthopaedics and Trauma 11, no. 3 (May 2020): 375–79. http://dx.doi.org/10.1016/j.jcot.2020.03.010.
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Bondi, Manuel, Antonio Zanini, and Andrea Pizzoli. "Ankle Arthroscopy after Ankle Sprains." International Journal of Orthopaedics 6, no. 5 (2019): 1183–88. http://dx.doi.org/10.17554/j.issn.2311-5106.2019.06.326.
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DiGiovanni, Christopher W., and Daniel Guss. "Ankle Replacement or Ankle Fusion." Journal of Bone and Joint Surgery 99, no. 21 (November 2017): e115. http://dx.doi.org/10.2106/jbjs.17.00984.
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Verhagen, Evert. "Ankle: avoid another ankle sprain!" British Journal of Sports Medicine 49, no. 18 (February 25, 2015): 1220. http://dx.doi.org/10.1136/bjsports-2015-094645.
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Sherman, Thomas I., Nick Casscells, Joe Rabe, and Francis X. McGuigan. "Ankle Arthroscopy for Ankle Fractures." Arthroscopy Techniques 4, no. 1 (February 2015): e75-e79. http://dx.doi.org/10.1016/j.eats.2014.11.004.
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Mitsui, Hiroyuki, Takaaki Hirano, Akiyama Yui, Shingo Maeda, and Hisateru Niki. "Relations of ankle alignment and MRI findings of ankle osteoarthritis." Foot & Ankle Orthopaedics 2, no. 3 (September 1, 2017): 2473011417S0002. http://dx.doi.org/10.1177/2473011417s000296.
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Category: Ankle Arthritis Introduction/Purpose: MRI is gaining attention as a tool for examining the severity of osteoarthritis (OA) over X-ray findings. However, there are few reports on the relationship between MRI and X-ray findings in ankle joints. We assessed the combination of ankle joint alignment and MRI to find the factor to predict MRI findings from X-ray findings in OA. Methods: Of the 341 patients who had a diagnosis of ankle OA in our hospital from May 2009 to August 2015, we assessed 46 feet of 45 patients who underwent MRI. We determined ankle joint alignment by measuring tibial anterior surface (TAS) angle, and tibial lateral surface (TLS) angle on X-ray, and determined the areas of Bone Marrow Edema (BME) appearing on STIR, by partitioning 22 areas for talocrural, tarocalcaneal, Chopart joint. In the statistics analysis, we divided into two groups with and without BME, and we compared TAS angle and TLS angle. Moreover, for predicting the occurrence of BME, we divided the disease group into 2 groups, training set and validation set. We then verified the validity of the results by measuring cut-off value of TAS angle and TLS angle from ROC curve, an area which had statistically significant difference. Results: TAS angles or TLS angles were significantly lower in the group which showed BME at the anterior medial part of the tibia canopy and medial malleolus joint surface. From the ROC curve of the training set, the cut-off value (TAS angle of 82 degrees or less and TLS angle of 76 degrees or less) was obtained. Applying the obtained cut-off value to the validation set, it was possible to predict the occurrence of BME on the medial malleolus joint surface (sensitivity 71%, specificity 67%). Conclusion: Association with BME and clinical symptoms as well as disease prognosis has been reported in the OA area, so predicting the appearance of BME can be a useful index for prescribing a treatment plan. It was suggested that the appearance of BME could be predicted from X-ray findings because it was related to ankle alignment and MRI. It is possible that these findings could be used as a new diagnostic tool to estimate disease severity in the future.
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Scheidegger, P., T. Horn Lang, C. Schweizer, L. Zwicky, and B. Hintermann. "A flexion osteotomy for correction of a distal tibial recurvatum deformity." Bone & Joint Journal 101-B, no. 6 (June 2019): 682–90. http://dx.doi.org/10.1302/0301-620x.101b6.bjj-2018-0932.r2.
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Aims There is little information about how to manage patients with a recurvatum deformity of the distal tibia and osteoarthritis (OA) of the ankle. The aim of this study was to evaluate the functional and radiological outcome of addressing this deformity using a flexion osteotomy and to assess the progression of OA after this procedure. Patients and Methods A total of 39 patients (12 women, 27 men; mean age 47 years (28 to 72)) with a distal tibial recurvatum deformity were treated with a flexion osteotomy, between 2010 and 2015. Nine patients (23%) subsequently required conversion to either a total ankle arthroplasty (seven) or an arthrodesis (two) after a mean of 21 months (9 to 36). A total of 30 patients (77%), with a mean follow-up of 30 months (24 to 76), remained for further evaluation. Functional outcome, sagittal ankle joint OA using a modified Kellgren and Lawrence Score, tibial lateral surface (TLS) angle, and talar offset ratio (TOR) were evaluated on pre- and postoperative weight-bearing radiographs. Results Postoperatively, the mean score for pain, using a visual analogue scale, decreased significantly from 4.3 to 2.5 points and the mean American Orthopaedic Foot & Ankle Society (AOFAS) hindfoot score improved significantly from 59 to 75 points (both p < 0.001). The mean TLS angle increased significantly by 6.6°; the mean TOR decreased significantly by 0.24 (p < 0.001). Radiological evaluation showed an improvement or no progression of sagittal ankle joint OA in 32 ankles (82%), while seven ankles (18%) showed further progression. Conclusion A flexion osteotomy effectively improved the congruency of the ankle joint. In 30 patients (77%), the joint could be saved, whereas in nine patients (23%), the treatment delayed a joint-sacrificing procedure. Cite this article: Bone Joint J 2019;101-B:682–690.
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Jung, Hong-Geun, Na-Ra Kim, Tae-Hoon Kim, Joon-Sang Eom, and Dong-Oh Lee. "Magnetic Resonance Imaging and Stress Radiography in Chronic Lateral Ankle Instability." Foot & Ankle International 38, no. 6 (February 1, 2017): 621–26. http://dx.doi.org/10.1177/1071100717693207.
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Background: Studies regarding magnetic resonance imaging (MRI) findings of the lateral ankle ligaments in chronic lateral ankle instability and their clinical relevance for surgery are lacking. This study classified the lateral ankle ligament MRI findings of the anterior talofibular ligament (ATFL) and calcaneofibular ligament (CFL) in chronic lateral ankle instability (CLAI) and correlated these findings with ankle stress radiographs. Methods: We included 132 ankles with CLAI that underwent ligament reconstructions from 2006 to 2013. The distributions of the ATFL and CFL morphologies were evaluated using the following categories: (1) the amount of thickness: normal/thickened/attenuated/non-visualized, (2) the presence of discontinuity, (3) wavy or irregular contour, and (4) increased signal intensity on T2-weighted images. The relationships between the ligament morphologies and stress radiographs were analyzed. Results: The ATFL was normal in 5 (4%) ankles, thickened in 35 (27%), attenuated in 76 (58%), and non-visualized in 16 (12%), while the CFL was normal in 39 (30%) ankles, thickened in 42 (32%), attenuated in 44 (33%), and non-visualized in 7 (5%). Discontinuity of the ATFL or CFL was observed in 46 (35%) ankles. Wavy or irregular contours were observed in 55 (42%) ATFLs and 37 (28%) CFLs, and signal intensity of both ligaments was increased in 19 (14%) ankles. ATFL ( P < .001) and CFL thickness ( P = .007) correlated with the talar tilt angle. Conclusions: The MRI findings of CLAI showed several morphologies and specific incidences for each morphology. Attenuated, wavy appearance was the most frequent MRI pattern. Thickness was related to the degree of instability. Level of Evidence: Level IV, retrospective case series.
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Ruiz, Roxa, Lukas Zwicky, and Beat Hintermann. "Syndesmotic Instability After Total Ankle Replacement." Foot & Ankle Orthopaedics 3, no. 3 (July 1, 2018): 2473011418S0010. http://dx.doi.org/10.1177/2473011418s00103.
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Category: Ankle Arthritis Introduction/Purpose: Total ankle replacement (TAR) evolved over the last decades and has been shown to be an effective concept in the treatment of ankle osteoarthritis (OA). In three-component designs, the second interface between polyethylene insert (PI) and tibial component allows the PI to find its position according the individual physiological properties. This was believed to decrease shear forces within the ankle joint. However, it is not clarified to which extent such an additional degree of freedom may overload the ligamentous structures of the ankle joint over time. This may in particular be the case for the syndesmotic ligaments. Therefore, the purpose of this study was to analyze all ankles after TAR that showed a symptomatic overload of the syndesmotic ligaments and to determine the potential consequences. Methods: Between 2003 and 2017, 31 ankles (females, 17; males 14; mean age 60 [40-79] years) were treated with a tibio-fibular fusion for a symptomatic instability of the syndesmosis. The indication for TAR was posttraumatic OA in 27 (87%), primary OA in 3 (10%), and hemochromatosis in one ankle (3%). The 31 ankles included 23 primary TAR (74%), 6 revision TAR (19%), and two take-down of a fusion and conversion to TAR (7%). Criteria for fusion were the presence of at least two of the followings: (1) tenderness over the syndesmosis, (2) pain while compressing the fibula against the tibia (squeeze test), (3) pain while rotating the foot externally (external rotation test), (4) widening of the syndesmosis on an anteroposterior view. Alignment of TAR (tibial articular surface [TAS] angle) and hindfoot alignment were measured on standard radiographs. Intraoperatively, the syndesmotic instability was confirmed before fusion. The wear of PI was documented. Results: After a mean of 63 (range, 4 – 152) months after TAR, all patients evidenced pain at the level of the syndesmosis of at least 3 months. 25 ankles (81%; 24 after posttraumatic OA) showed a widening of the syndesmotic space and 22 ankles (71%) of the medial clear space with lateral translation of the talus. The PI was seen to overlap the tibial component in 15 ankles (48%). Nine ankles (29%) evidenced cyst formation, and eight ankles (26%) showed a decrease in height of the PI; whereas, in 3 ankles (10%) a fracture of the PI was found. A valgus misalignment of the heel was found in 25 ankles (81%), a valgus TAS in 16 (52%) and a varus TAS in 11 ankles (36%). Conclusion: A syndesmotic instability after a three-component TAR apparently occurred mostly after posttraumatic OA, in particular if the heel was left in valgus. If the talus starts to move lateralward, the PI seems to be at risk for increased wear and finally mechanical failure (Figure 1). Therefore, a valgus misaligned heel should always be corrected during TAR implantation. If there is any sign of syndesmotic instability, a fusion should be considered. Further studies must proof whether in cases with a syndesmotic instability the use of a two-component design will be superior, as it stabilizes the talus in the coronal plane.
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McKiernan, Sharmaine, Michelle Fenech, Deborah Fox, and Ian Stewart. "Sonography of the ankle: The lateral ankle and ankle sprains." Sonography 4, no. 4 (September 28, 2017): 146–55. http://dx.doi.org/10.1002/sono.12120.
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Safaeepour, Zahra, Ali Esteki, Farhad Tabatabai Ghomshe, and Mohammad E. Mousavai. "Design and development of a novel viscoelastic ankle-foot prosthesis based on the human ankle biomechanics." Prosthetics and Orthotics International 38, no. 5 (February 14, 2014): 400–404. http://dx.doi.org/10.1177/0309364613505108.
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Background and aim: In the present study, a new approach was applied to design and develop a viscoelastic ankle-foot prosthesis. The aim was to replicate the intact ankle moment–angle loop in the normal walking speed. Technique: The moment–angle loop of intact ankle was divided into four parts, and the appropriate models including two viscoelastic units of spring-damper mechanism were considered to replicate the passive ankle dynamics. The developed prototype was then tested on a healthy subject with the amputee gait simulator. The result showed that prosthetic ankle moment–angle loop was similar to that of intact ankle with the distinct four periods. Discussion: The findings suggest that the prototype successfully provided the human ankle passive dynamics. Therefore, the viscoelastic units could imitate the four periods of a normal gait. Clinical relevance The novel viscoelastic foot prosthesis could provide natural ankle dynamics in a gait cycle. Applying simple but biomechanical approach is suggested in conception of new designs for prosthetic ankle-foot mechanisms.
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Liu, Wen, Tarang Jain, and Clayton Wauneka. "A New Dimension in the Study of Human Functional Joint Instability." Applied Mechanics and Materials 249-250 (December 2012): 1271–76. http://dx.doi.org/10.4028/www.scientific.net/amm.249-250.1271.
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Functional joint instability is common after joint soft tissue injuries. We present in this report our pilot finding in a study of functional ankle instability. Although past studies have suggested multiple pathological factors for functional ankle instability, none of those factors has been confirmed in the past studies. More importantly, no known factor can provide an explanation for an ankle giving way phenomenon which is a key element in defining a functional ankle instability. In this pilot study, we tested five subjects with functional ankle instability using a dynamic ankle stretching device combined with nociceptive electrical stimulation. Three out of five subjects showed a drastic reaction in which they totally gave up their control of upright standing after their affected ankles were under the combined ankle stretch and nociceptive stimuli. Such drastic reaction was not observed in the same ankles under only the ankle stretch. There was no such drastic reaction in the unaffected ankle under either testing condition. This pilot finding indicates a possibility of a hyper-reactivity to unloading reaction in the ankles with functional ankle instability
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Shih, Han-Ting, Wei-Jen Liao, Kao-Chang Tu, Cheng-Hung Lee, Shih-Chieh Tang, and Shun-Ping Wang. "Poor Correction Capacity of Preexisting Ankle Valgus Deformity after Total Knee Arthroplasty." Journal of Clinical Medicine 10, no. 16 (August 17, 2021): 3624. http://dx.doi.org/10.3390/jcm10163624.
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This study investigated the differences in ankle alignment changes after TKA in patients with varying preexisting ankle deformities. We retrospectively examined 90 knees with osteoarthritis and varus deformity in 78 patients who underwent TKA. Preoperative and postoperative radiographic parameters were analyzed. According to their preexisting ankle deformity, patients were assigned to the valgus or varus group. Overall, 14 (15.6%) cases were of preoperative valgus ankle deformity; the remainder were of preoperative varus ankle deformity. Hip–knee–ankle angle (HKA), tibial plafond–ground angle (PGA), and talus–ground angle (TGA) all exhibited significant correction in both groups; however, tibial plafond–talus angle (PTA) and superior space of ankle joint (SS) only changed in the varus group. The median PTA and SS significantly decreased from 1.2° to 0.3° (p < 0.001) and increased from 2.5 to 2.6 mm (p = 0.013), respectively. Notably, ∆PTA positively correlated with ∆HKA in the varus group (r = 0.247, p = 0.032) but not in the valgus group. Between-group differences in postoperative PTA (p < 0.001) and ∆PTA (p < 0.001) were significant. The degree of ankle alignment correction after TKA differed between patients with preexisting varus and valgus ankle deformities. TKA could not effectively correct the preexisting ankle valgus malalignment.
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Park, Byeong-Seop, Seungbum Koo, Won-keun Park, Ki-bum Kwon, and Kyoung Min Lee. "Opposite Association Between Radiographic Lateral Ankle Instability and Osteochondral Lesions of the Talus in Patients with Ankle Inversion Injuries." Foot & Ankle Orthopaedics 4, no. 4 (October 1, 2019): 2473011419S0033. http://dx.doi.org/10.1177/2473011419s00332.
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Category: Ankle Introduction/Purpose: Insufficient bony coverage surrounding the talus could cause considerable mechanical ankle instability, whereas excessive bony coverage could cause bone contusion at the time of injury and subsequent osteochondral lesions of the talus (OLT). This study aimed to investigate the relationship between radiographic lateral ankle instability and OLT in patients that sustained ankle inversion injuries. Methods: One-hundred-ninety-five patients (113 men and 83 women; mean age, 38.7 years; standard deviation, 8.8 years) with a history of ankle inversion injuries were included. All patients underwent ankle magnetic resonance imaging (MRI) and stress X-ray (varus stress and anterior drawer) examination. The tibiotalar tilt angle on varus stress X-ray, anterior translation of the talus on anterior-drawer lateral X-rays, bimalleolar tilt angle, and fibular position were radiographically determined. The anatomical grade of the lateral ankle ligament injury and the presence of OLTs were determined from MRI findings. Results: A greater lateral ankle ligament grade tends to increase the tibiotalar tilt angle (p=0.074), significantly affecting the anterior translation of the talus (p=0.036). The presence of radiographic lateral ankle instability (tibiotalar tilt angle =10°) showed opposite associations with the presence of OLT in the chi-square test (p=0.003). OLT was a negative significant factor (p=0.011) affecting the tibiotalar tilt angle in the multiple regression analysis (Table 1) and was negatively affected by the tibiotalar tilt angle (p=0.016) in the binary logistic regression analysis. Conclusion: This study showed an opposite association between lateral ankle instability and the development of OLT following ankle inversion injury. The role of bony predisposition in the development of sports injuries in the ankle should be considered and investigated further.
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McKnight, Cynthia M., and Charles W. Armstrong. "The Role of Ankle Strength in Functional Ankle Instability." Journal of Sport Rehabilitation 6, no. 1 (May 1997): 21–29. http://dx.doi.org/10.1123/jsr.6.1.21.
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The purpose of this study was to determine if there were any differences in ankle range of motion, strength, or work between persons with normal ankles (Normal,n= 14), those with functional ankle instability (FAI,n= 15), and those with a history of FAI who have been through formal proprioceptive rehabilitation (Rehab,n= 14). A second puipose was to determine normative values for ankle strength and work measurements using the Biodex® isokinetic system. There were no significant differences between groups for ankle range of motion or for any strength or work measurements. The overall strength/work averages were 11.75/3.42 for plantar flexion, 339/1.48 for dorsiflexion, 3.30/2.40 for inversion, and 2.62/1.79 for eversion. Dorsiflexion torque overall was 31.43% of plantar flexion, and the evertors produced 75.42% of the torque produced by the invertors. It is recommended that clinicians continue to rehabilitate ankles with strength and proprioceptive exercises but do not rely on ankle strength/work testing as the only criteria for determining an athlete's readiness to return to full activity.
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Park, Byeong Seop, Chin Youb Chung, Moon Seok Park, Ki Hyuk Sung, Young Choi, Chulhee Park, Seungbum Koo, and Kyoung Min Lee. "Inverse Relationship Between Radiographic Lateral Ankle Instability and Osteochondral Lesions of the Talus in Patients With Ankle Inversion Injuries." Foot & Ankle International 40, no. 12 (August 27, 2019): 1368–74. http://dx.doi.org/10.1177/1071100719868476.
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Background: Insufficient or excessive bony constraint surrounding the talus might contribute to the occurrence of ligamentous injury or bone contusion, respectively, at the time of ankle inversion injuries. This study aimed to investigate the relationship between radiographic lateral ankle instability and osteochondral lesions of the talus (OLT) following ankle inversion injuries. Methods: A total of 195 patients (113 men and 83 women; mean age, 38.7 years) with a history of ankle inversion injuries were included in this study. All patients underwent ankle magnetic resonance imaging (MRI) and stress radiography. The tibiotalar tilt angle on varus stress radiograph, anterior translation of the talus on anterior-drawer lateral radiographs, bimalleolar tilt angle, and fibular position were radiographically determined. The radiographic lateral ankle instability was defined as tibiotalar tilt angle ≥10 degrees, and the presence of OLT was confirmed on MR images. The relationship between the radiographic lateral ankle instability and the presence of OLT was statistically analyzed. Results: The presence of radiographic lateral ankle instability (tibiotalar tilt angle ≥10 degrees) showed an inverse relationship with that of OLT in the chi-squared test ( P = .003). An increased tibiotalar tilt angle was associated with lower incidence of OLT ( P = .011) in the multiple regression analysis, and the presence of OLT was associated with a decreased tibiotalar tilt angle ( P = .016) in the binary logistic regression analysis. Conclusions: This study showed an inverse relationship between lateral ankle instability and the development of OLT following ankle inversion injury. The role of bony constraint in the development of sports injuries in the ankle should be considered with these injuries. Level of Evidence: Level III, diagnostic, comparative study.
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Jeon, In-cheol, Oh-yun Kwon, Chung-Hwi Yi, Heon-Seock Cynn, and Ui-jae Hwang. "Ankle-Dorsiflexion Range of Motion After Ankle Self-Stretching Using a Strap." Journal of Athletic Training 50, no. 12 (December 1, 2015): 1226–32. http://dx.doi.org/10.4085/1062-6050-51.1.01.
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Context A variety of ankle self-stretching exercises have been recommended to improve ankle-dorsiflexion range of motion (DFROM) in individuals with limited ankle dorsiflexion. A strap can be applied to stabilize the talus and facilitate anterior glide of the distal tibia at the talocrural joint during ankle self-stretching exercises. Novel ankle self-stretching using a strap (SSS) may be a useful method of improving ankle DFROM. Objective To compare the effects of 2 ankle-stretching techniques (static stretching versus SSS) on ankle DFROM. Design Randomized controlled clinical trial. Setting University research laboratory. Patients or Other Participants Thirty-two participants with limited active dorsiflexion (<20°) while sitting (14 women and 18 men) were recruited. Main Outcome Measure(s) The participants performed 2 ankle self-stretching techniques (static stretching and SSS) for 3 weeks. Active DFROM (ADFROM), passive DFROM (PDFROM), and the lunge angle were measured. An independent t test was used to compare the improvements in these values before and after the 2 stretching interventions. The level of statistical significance was set at α = .05. Results Active DFROM and PDFROM were greater in both stretching groups after the 3-week interventions. However, ADFROM, PDFROM, and the lunge angle were greater in the SSS group than in the static-stretching group (P < .05). Conclusions Ankle SSS is recommended to improve ADFROM, PDFROM, and the lunge angle in individuals with limited DFROM.
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Brandle, Greggory, Kaitlyn Rizzo, Nicholas A. Cheney, and Brian C. Clark. "A Retrospective Chart Review to Determine Lateral Ankle Instability Treatment based off of the Degree of Varus Tilt." Foot & Ankle Orthopaedics 5, no. 4 (October 1, 2020): 2473011420S0014. http://dx.doi.org/10.1177/2473011420s00143.
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Category: Ankle Introduction/Purpose: One of the most common injuries in the United States is the ankle sprain, accounting for 10-15% of sport injuries. Without proper treatment, about one-third of patients reinjure the same ankle and can progress to chronic lateral ankle instability. An ankle can be clinically evaluated by performing an inversion stress test and measuring the degree of varus tilt. The purpose of this retrospective chart review was to examine if a correlation exists between the degree of varus tilt on a stress x-ray and whether the patients were treated conservatively or surgically. Additionally, this chart review aims to confirm the validity of the guidelines of an abnormal talar tilt value, which is said to be a value greater than 10 degrees. Methods: A total of 584 patients between January 1st, 2016 and June 27th, 2019 were clinically diagnosed with lateral ankle instability and had an inversion stress x-ray. All 584 patients were seen and diagnosed by the same foot and ankle orthopedic surgeon in Columbus, Ohio. Of the 584 patients, 40 had bilateral lateral ankle instability and bilateral stress xrays, given a total of 624 ankles originally included in this chart review. Once the patient’s charts were reviewed, 32 ankles were excluded because their ankle surgery did not involve correction of the lateral ankle instability. A total of 592 ankles (293 left and 299 right) were included in this review. The degree of varus tilt on all 592 ankles were determined by measuring the angle between the tibial plafond and the top of the talus. The angles were compared to the patients with surgical and conservative treatment. Results: The chart review showed that as the degree of varus tilt increases, the more likely the patient is to fail conservative treatment and need surgical correction. The types of conservative treatment that the patients failed were a combination of a brace, boot, physical therapy, orthotics, shoe changes, injection, and casting. The patients who had a varus tilt below 2.5 degrees were treated conservatively 60% of the time, where patients that had a varus tilt over 20.1 degrees were treated surgically 75% of the time. The review also showed a significant number of patients who were treated surgically with a varus tilt value less than 10 degrees (209 of 472 ankles), warranting further evaluation into what is considered an abnormal talar tilt. Conclusion: It is clear that patients with a higher degree of varus tilt have more ankle instability and are more likely to fail conservative treatment and require surgical correction. Additionally, this chart review showed that many patients needed surgical correction even with a low varus tilt value on stress x-ray. Further evaluation needs to be completed to determine what value is considered an abnormal varus tilt. One possible explanation of our findings is that the inversion stress test does not evaluate the subtalar joint, which can contribute to chronic lateral ankle instability.
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Isakov, Eli, Joseph Mizrahi, Pablo Solzi, Zev Susak, and Moshe Lotem. "Response of the Peroneal Muscles to Sudden Inversion of the Ankle during Standing." International Journal of Sport Biomechanics 2, no. 2 (May 1986): 100–109. http://dx.doi.org/10.1123/ijsb.2.2.100.
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The response of the peroneal muscles to sudden inversion of the ankle during standing was investigated. The variation of the inversion angle with time was measured by means of a potentiometer attached to a specially designed test apparatus. During the tests, volunteers were subjected to sudden and unexpected inversion of their ankle, during which the surface EMG of the peroneal muscles was also recorded. Two groups were tested, one of normal subjects and one consisting of subjects with recurrent ankle sprains. There were 8 females and 3 males in each group. The subjects in the second group, who suffered from recurrent ankle sprains, had been asymptomatic during the last 2 months prior to the tests. For each subject in the two groups, both ankles were tested. The results indicated a latency time ranging from 60 to 80 ms for both groups. It was concluded that the reflex contraction of the peroneal muscles due to a sudden stretch inversion motion has no role in protecting the ankle joint during sprain and that this protection is mainly provided by the passive tissues.
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Tian, Maoyi, Phu D. Hoang, Simon C. Gandevia, Lynne E. Bilston, and Robert D. Herbert. "Stress relaxation of human ankles is only minimally affected by knee and ankle angle." Journal of Biomechanics 43, no. 5 (March 2010): 990–93. http://dx.doi.org/10.1016/j.jbiomech.2009.11.017.
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