Ankle Complex Research Articles

Techniques for the treatment and reversion of tendon injuries in the ankle complex literature review

Drop foot is a clinical condition resulting from the blockage of nerve impulses, causing the inability to dorsiflex the ankle, causing a reduction in functional capacity. There are techniques such as the transfer of the posterior tibial tendon via interosseous transmembrane. Objective: To evaluate the best technique for foot drop therapy and relate it to clinical practice. Methodology: literature review by searching the Virtual Health Library databases and the Google Scholar browser, consulting published and indexed journals using the descriptors: “posterior tibial tendon” and “traumatic lesions” and “drop foot” and “tendon transfer” and “tendon transfer techniques”. Results: selected 13 articles published in the period between 2012 and 2021, 6 retrospective studies, 1 cross-sectional, 1 prospective, 2 review and update articles, 2 systematic reviews and a case study. Conclusion: The clinical evidence favors the use of posterior tibial tendon transfer techniques, or another suitable tendon, via the interosseous membrane, and studies with better quality methodological designs are required. In Brazil, a group of researchers chose their own evaluation material, which reinforces the need for standardization for the practice of the national clinic. There was little production and publication of studies on the subject. It is essential to develop more research, when limitations of more up-to-date studies are seen.

INVESTIGATION OF THE LOADING AT THE KNEE JOINT COMPLEX USING AN EMG-BASED CONSTITUTIVE LAW FOR SKELETAL MUSCLE FORCE

This study investigated the predictive ability of the skeletal muscle force model presented by Knodel et al. [Knodel NB, Lawson LB, Nauman EA, “An emg-based constitutive law for force generation in skeletal muscle-part i: Model development,” J Biomech Eng (in press), doi: 10.1115/1.4053568] on the knee joint. It has previously been validated on the ankle joint [Knodel NB, Calvert LB, Bywater EA, Lamia JP, Patel SN, Nauman EA, “An emg-based constitutive law for force generation in skeletal muscle-part ii: Model validation on the ankle joint complex,” Submitted for Publication] and this paper aimed to identify how well it, and the solution process, performed on a more complex articulation. The knee joint’s surrounding musculoskeletal tissue loading was also identified. Ten subjects (five male and five female) performed six exercises targeting the muscles that cross the knee joint. Motion capture, electromyography, and force plate data was collected during the exercises for use in the analysis program written in MATLAB and magnetic resonance images were used to observe subject-specific ligament and tendon data at the knee articulation. OpenSim [Delp, SL, Anderson FC, Arnold AS, Loan P, Habib A, John CT, Guendelman E, Thelen DG, “Opensim: Open-source software to create and analyze dynamic simulations of movement,” IEEE Trans Biomed Eng 54(11):1940–1950, 2007, doi: 10.1109/TBME.2007.901024] was used for scaling a generic lower extremity anatomical model of each subject. Five of the six exercises were used to calculate each muscle’s constant, [Formula: see text] [Knodel NB, Lawson LB, Nauman EA, “An emg-based constitutive law for force generation in skeletal muscle-part i: Model development,” J Biomech Eng (in press), doi: 10.1115/1.4053568; Knodel NB, Calvert LB, Bywater EA, Lamia JP, Patel SN, Nauman EA, “An emg-based constitutive law for force generation in skeletal muscle-part ii: Model validation on the ankle joint complex,” Submitted for Publication], and the sixth was used as a testing set to identify the model’s predictive ability. Average percent errors ranged from 9.4% to 26.5% and the average across all subjects was 20.6%. The solution process produced physiologically relevant muscle forces and the surrounding tissue loading behaved as expected between the various exercises without approaching respective tensile strength values.

Lisfranc Injury: Recent Trends in Management.

Lisfranc injury refers to a group of bony or ligamentous injuries in which one or more of the metatarsals are displaced with respect to the tarsus. These injuries can occur as a result of either high-energy trauma like motor vehicle accidents and falls from height, or low-energy trauma from sports activities. A significant proportion of Lisfranc injuries are missed initially. The effects of delayed and missed diagnosed cases can be devastating as patients may develop progressive midfoot instability, collapse of arch, abduction of forefoot, and post-traumatic osteoarthritis, which can cause chronic pain, stiffness, and foot and ankle complex dysfunction. Favourable outcomes are associated with early diagnosis and prompt treatment. Open reduction and internal fixation (ORIF) with arthrodesis has better results than ORIF alone in functional outcomes. Dorsal bridge plates are currently the preferred mode of fixation due to advantages over trans-articular screws.

Physiotherapeutic Interventions for Individuals Suffering From Plantar Fasciitis: A Systematic Review.

The foot and the lower leg comprise the ankle joint complex. The foot is crucial for the maintenance of posture. Frequently, overuse or repeated microtrauma to the fascia causes plantar fasciitis. This review aims to suggest the efficacy of various plantar fasciitis (PF) interventions based on modifications in clinical results. This review included studies from 2019 to March 2023 identified through a systematic literature search. The measures used to predict improvement in pain, discomfort, and foot function symptoms included the Visual Analog scale, Numerical Pain Rating Scale, Pressure Point Threshold by algometer, Weight-Bearing Lunge Test by inch tape, and range of motion. The review included 20 studies that fulfilled the inclusion criteria. Therapeutic interventions included insoles, foot orthosis, foam roller stretching, manual stretching, muscle strengthening, intrinsic muscle activities, extracorporeal shock wave lithotripsy, dry needling, laser, ultrasound, and others, which resulted in pain reduction, improved foot function, and ease of everyday routine. All therapeutic strategies used impacts resulting from minimal to maximal recovery. Various advanced approaches are more effective than conventional physical therapy. In conclusion, conservative therapeutic strategies with manual techniques, orthoses, and alternative intervention strategies can be combined to effectively relieve pain and improve function and overall results. Further high-quality studies are essential to learn more about the ideal dose, treatment approaches, and long-term impacts of these therapies.

Accuracy of radiographic techniques in detection of the calcaneofibular ligament calcaneal insertion for lateral ankle ligament complex surgery.

Grade III ankle sprains that fail conservative treatment can require surgical management. Anatomic procedures have been shown to properly restore joint mechanics, and precise localization of insertion sites of the lateral ankle complex ligaments can be determined through radiographic techniques. Ideally, radiographic techniques that are easily reproducible intraoperatively will lead to a consistently well-placed CFL reconstruction in lateral ankle ligament surgery. To determine the most accurate method to locate the calcaneofibular ligament (CFL) insertion radiographically. MRIs of 25 ankles were utilized to identify the "true" insertion of the CFL. Distances between the true insertion and three bony landmarks were measured. Three proposed methods (Best, Lopes, and Taser) for determining the CFL insertion were applied to lateral ankle radiographs. X and Y coordinate distances were measured from the insertion found on each proposed method to the three bony landmarks: the most superior point of the postero-superior surface of the calcaneus, the posterior most aspect of the sinus tarsi, and the distal tip of the fibula. X and Y distances were compared to the true insertion found on MRI. All measurements were made using a picture archiving and communication system. The average, standard deviation, minimum, and maximum were obtained. Statistical analysis was performed using repeated measures ANOVA, and a post hoc analysis was performed with the Bonferroni test. The Best and Taser techniques were found to be closest to the true CFL insertion when combining X and Y distances. For distance in the X direction, there was no significant difference between techniques (P = 0.264). For distance in the Y direction, there was a significant difference between techniques (P = 0.015). For distance in the combined XY direction, there was a significant difference between techniques (P = 0.001). The CFL insertion as determined by the Best method was significantly closer to the true insertion compared to the Lopes method in the Y (P = 0.042) and XY (P = 0.004) directions. The CFL insertion as determined by the Taser method was significantly closer to the true insertion compared to the Lopes method in the XY direction (P = 0.017). There was no significant difference between the Best and Taser methods. If the Best and Taser techniques can be readily used in the operating room, they would likely prove the most reliable for finding the true CFL insertion.

Effect of foot orthoses on dynamic balance in taekwondo athletes with flexible flatfoot: A randomized controlled trial

BackgroundFlexible flatfoot (FFF) cause biomechanical and sensorimotor disorders of the foot and ankle complex and reduce of postural stability. Postural stability is an important movement skill that affects the performance of taekwondo (TKD) athletes and can lead to fall injuries. The purpose of this study is the effect 12-week application of foot orthosis (FOs) on dynamic balance in TKD athletes with FFF. MethodIn this trial, 30 girls of the TKD athletes with FFF were recruited. They were randomly assigned to experimental and control groups (15 subjects in each group). The experimental group used FOs with medial longitudinal arch support for 12 weeks, and the control group did not have any intervention. The outcome measures include navicular drop and balance in three directions: anterior-posterior, medial-lateral and overall stability. Covariance analysis was used to compare the results between two groups. ResultsThe covariance results showed that the experimental group compared to the control group with a high effect size had a significant difference in reducing of navicular drop (P = 0.000, ηp2 =0.512), anterior-posterior sway (P = 0.000, (ηp2 =0.397) medial-lateral sway (P = 0.019, ηp2 = 0.186) and overall stability sway (P = 0.008, ηp2 = 0.232). ConclusionsThe FOs with medial longitudinal arch support leads to FFF correction and provides mechanical stability of the foot and ankle complex. Also, the impulses sent from plantar receptors are increased and a better understanding of postural sway is transmitted to the central nervous system and balance strategies are improved.

Effects of high-heeled shoes on lower extremity biomechanics and balance in females: a systematic review and meta-analysis

BackgroundHigh-heeled shoes (HHS) are widely worn by women in daily life. Limited quantitative studies have been conducted to investigate the biomechanical performance between wearing HHS and wearing flat shoes or barefoot. This study aimed to compare spatiotemporal parameters, kinematics, kinetics and muscle function during walking and balance between wearing HHS and flat shoes or barefoot.MethodsAccording to the Preferred Reporting Items for Systematic reviews and Meta-Analyses (PRISMA) statement, PubMed Medline, Cochrane, EMBASE, CINAHL Complete and Web of Science databases were searched from the earliest record to December 2021. A modified quality index was applied to evaluate the risk of bias, and effect sizes with 95% confidence intervals were calculated as the standardized mean differences (SMD). Potential publication bias was evaluated graphically using funnel plot and the robustness of the overall results was assessed using sensitivity analyses.ResultsEighty-one studies (n = 1501 participants) were included in this study. The reduced area of support requires the body to establish a safer and more stable gait pattern by changing gait characteristics when walking in HHS compared with walking in flats shoes or barefoot. Walking in HHS has a slight effect on hip kinematics, with biomechanical changes and adaptations concentrated in the knee and foot–ankle complex. Females wearing HHS performed greater ground reaction forces earlier, accompanied by an anterior shift in plantar pressure compared with those wearing flat shoes/barefoot. Furthermore, large effect sizes indicate that wearing HHS resulted in poor static and dynamic balance.ConclusionSpatiotemporal, kinematic, kinetic and balance variables are affected by wearing HHS. The effect of specific heel heights on women’s biomechanics would benefit from further research.

Intrinsic Kinematics of the Tibiotalar and Subtalar Joints during Human Walking based on Dynamic Biplanar Fluoroscopy

Accurate knowledge of the kinematics of the in vivo Ankle Joint Complex (AJC) is critical for understanding the biomechanical function of the foot and assessing postoperative rehabilitation of ankle disorders, as well as an essential guide to the design of ankle–foot assistant devices. However, detailed analysis of the continuous 3D motion of the tibiotalar and subtalar joints during normal walking throughout the stance phase is still considered to be lacking. In this study, dynamic radiographs of the hindfoot were acquired from eight subjects during normal walking. Natural motions with six Degrees of Freedom (DOF) and the coupled patterns of the two joints were analyzed. It was found that the movements of the two joints were mostly in opposite directions (including rotation and translation), mainly in the early and late stages. There were significant differences in the Range of Motion (ROM) in Dorsiflexion/Plantarflexion (D/P), Inversion/Eversion (In/Ev), and Anterior–Posterior (AP) and Medial–Lateral (ML) translation of the tibiotalar and subtalar joints (p < 0.05). Plantarflexion of the tibiotalar joint was coupled with eversion and posterior translation of the subtalar joint during the impact phase (R2 = 0.87 and 0.86, respectively), and plantarflexion of the tibiotalar joint was coupled with inversion and anterior translation of the subtalar joint during the push-off phase (R2 = 0.93 and 0.75, respectively). This coordinated coupled motion of the two joints may be a manifestation of the AJC to move flexibly while bearing weight and still have stability.

LIGAMENTOUS ANKLE LESIONS IN RELATION TO THE MORPHOMETRICS OF THE INCISURA FIBULARIS: A SYSTEMATIC REVIEW

The incisura fibularis (IF) provides intrinsic stability to the ankle joint complex by interlocking the distal tibia and fibula. Despite a high frequency of ligamentous ankle injuries, scant attention has been given to the morphology of the IF morphology incisura fibularis in the onset and development of these lesions. Therefore, we systematically reviewed the relation between ligamentous ankle disorders and the morphometrics of the IF.A systematic literature search was conducted on following databases: PubMed, Embase and Web of Science. Search terms consisted of ‘ankle trauma’, ‘ankle injury’, ‘ankle sprain’, ‘ankle fracture’, ‘tibiofibular’, ‘fibular notch’, ‘fibular incisura’, ‘incisura fibularis’, ‘morphometric analysis’, ‘ankle syndesmosis’, ‘syndesmotic stability’. The evaluation instrument developed by Hawker et al. was used to assess the quality of the selected studies. This protocol was performed according to the PRISMA guidelines and is registered on PROSPERO (CRD42021282862).Nineteen studies were included and consisted of prospective cohort (n=1), retrospective comparative (n=10), and observational (n=8) study design. Comparative studies have found certain morphological characteristics in patients with ankle instability. Several studies (n=5) have correlated a shallow IF depth with a higher incidence of ankle injury. A significant difference has also been found concerning the incisura height and angle (n=3): a shorter incisura and more obtuse angle have been noted in patients with ankle sprains. The mean Hawker score was 28 out of 36 (range=24-31).A shallower IF is associated with ligamentous ankle lesions and might be due to a lower osseous resistance against tibiofibular displacement. However, these results should be interpreted in light of moderate methodological quality and should always be correlated with clinical findings. Further prospective studies are needed to further assess the relation between the incisura morphometrics and ligamentous disorders of the ankle joint.Keywords: ankle instability, ankle injury, incisura fibularis, fibular notch, tibiofibular morphometrics, ankle syndesmosis

Participant-Level Analysis of the Effects of Interventions on Patient-Reported Outcomes in Patients With Chronic Ankle Instability.

Intervention studies for chronic ankle instability (CAI) often focus on improving physical impairments of the ankle complex. However, using an impairments-focused approach may miss psychological factors that may mediate function and recovery. Patient-reported outcome (PRO) measures can be used to assess several dimensions of the health-related quality of life (HRQoL) and deliver enhanced patient-centered care. Therefore, the purpose of this investigation was to evaluate group-level improvements in HRQoL and treatment response rates following various interventions in patients with CAI. Cross-sectional. Data from 7 previous studies were pooled by the chronic ankle instability outcomes network for participant-level analysis, resulting in 136 patients with CAI. Several interventions were assessed including balance training, gait biofeedback, joint mobilizations, stretching, and strengthening, with treatment volume ranging from 1 to 4weeks. Outcome measures were PROs that assessed ankle-specific function (Foot and Ankle Ability Measure), injury-related fear (Tampa Scale of Kinesiophobia and Fear Avoidance Belief Questionnaire), and global well-being (Disablement in the Physically Active); the PROs assessed varied between studies. Preintervention to postintervention changes were evaluated using separate Wilcoxon signed-rank tests and effect sizes, and a responder analysis was conducted for each PRO. Significant, moderate to large improvements were observed in PROs that assessed ankle-specific function, injury-related fear, and global well-being following intervention (P < .001). Responder rates ranged from 39.0% to 53.3%, 12.8% to 51.4%, and 37.8% for ankle specific function, injury-related fear, and global well-being, respectively. Various interventions can lead to positive improvements in HRQoL in patients with CAI. Treatment response rates at improving HRQoL are similar to response rates at improving impairments such as balance, further reinforcing the need for individualized treatment approaches when treating a patient with CAI.

How Does a Novel In Situ Fixed-bearing Implant Design Perform in Revision Ankle Arthroplasty in the Short Term? A Survival, Clinical, and Radiologic Analysis.

Given the growing number of primary total ankle replacements (TAR), an increase in the number of patients undergoing subsequent revisions might be expected. Achieving a stable and balanced ankle while preserving the remaining bone stock as much as possible is crucial for success in revision TAR. Most reported techniques rely on bulky implants with extended fixation features. Since 2018, we have used a novel, three-component ankle prosthesis for revision that is converted in situ to a fixed-bearing, two-component ankle prosthesis once the components have found their position according to an individual's anatomy. The results of this novel concept (fixation, revision, pain, or function) have not, to our knowledge, been reported. What are the short-term results with this new revision TAR design, in terms of (1) repeat revision surgery, (2) patient-reported outcomes on the American Orthopaedic Foot and Ankle Society (AOFAS) ankle-hindfoot score, (3) pain according to the VAS, and (4) radiographic signs of fixation? Between February 2018 and February 2020, we performed 230 TAR surgeries (in 206 patients) for any indication in our clinic. The novel semiconstrained, uncemented Hintermann Series H2 © implant was used in 96% (220 of 230) of procedures (201 patients). Fifty-four percent (119 of 220) of these were converted from an existing TAR to H2, which was the focus of the present study. However, only 45% (54 of 119) of these conversions to H2 were eligible for analysis. These patients had a mean age of 63 ± 12 years, and 43% (23 of 54) were women. The median (range) follow-up time was 3.2 years (2.0 to 4.3). The H2 design allows in situ conversion to a fixed-bearing system, with minimal bone resection. It achieves translational and rotational stability while preserving function and supporting the periarticular soft tissues. We defined repeat revision as exchange of one or both metal components, ankle fusion, or amputation and assessed it using a cumulative incidence survivorship estimator. Factors potentially associated with revision were assessed using Cox regression analyses. Clinical and radiologic outcomes were assessed preoperatively and at the most recent follow-up interval. Clinical outcomes included pain on the VAS (average pain during normal daily activity during the past seven days) and AOFAS score. Radiologic outcomes were the tibial articular surface angle, tibiotalar surface angle, talar tilt angle in the coronal plane, and AP offset ratio in the sagittal plane, as well as radiolucent lines and radiographic signs of loosening, defined as change in position greater than 2° of the flat base of the tibia component in relation to the long axis of the tibia, subsidence of the talar component into the talus greater than 5 mm, or change in position greater than 5° relative to a line drawn from the top of the talonavicular joint to the tuberosity of the calcaneus, as seen on plain weightbearing radiographs. The cumulative incidence of repeat revision after 1 and 2 years was 5.6% (95% CI 0% to 11%) and 7.4% (95% CI 0% to 14%), respectively. With the numbers available, no clinical factors we analyzed were associated with the risk of repeat revision. The median values of all assessed clinical outcomes improved; however, not all patients improved by clinically important margins. The median (range) AOFAS ankle-hindfoot score increased (from 50 [16 to 94] to 78 [19 to 100], difference of medians 28; p < 0.01), and the median pain on the VAS decreased (from 5 [0 to 9] to 2 [0 to 9], difference of medians 3; p < 0.01) from before surgery to follow-up at a minimum of 2 years. Radiographically, lucency was seen in 12% (6 of 49 patients) and loosening was seen in 8% (4 of 49). One of these patients showed symptomatic loosening and was among the four patients overall who underwent revision. We could not assess risk factors for repeat revision because of the low number of events (four). The investigated new in situ fixed-bearing ankle design achieved overall better short-term results than those reported in previous research. Destabilization of the ankle joint complex, soft tissue insufficiency, and possible changes of the joint configuration need an optimal solution in revision arthroplasty. The studied implant might be the answer to this complex issue and help surgeons in the perioperative decision-making process. However, a relatively high percentage of patients did not achieve a clinically important difference. Observational studies are needed to understand long-term implant behavior and possibly to identify ankles benefiting the most from revision. Level IV, therapeutic study.

Literature review of biomechanics of the ankle/ foot complex: changes in functional activities postoperatively for ankle fractures

The ankle plays an important role in daily life under the functional point of view. It is essential to perform basic movements such as walking, running, etc. The ankle joint complex is a part of the body most frequently injured of the musculoskeletal system. Orthopedic fractures in this joint may be classified as low trauma and high energy, the latter trauma, usually found in traffic accidents and falls from great heights are the most disabling. In the general context often this type of fracture compromises neighboring joints due to misalignment of the loading axis of the involved segment, emerging pain and progressive functional disability. In this context, this study aimed to review the literature of studies that were willing to analyze the biomechanical causes of the functional outcome of fractures of the complex orthopedic foot/ankle trauma generated by high and low energy. For this, a search was made in electronic databases indexing scientific articles, using the keyword search previously created. For better understanding we divided the literature review on topics: classification of ankle fractures, surgical treatment, no surgical indications and contraindications in cases of surgery, types of surgery with open reduction and internal fixation (ORIF), external and hybrid; wounds and complications consequences: amputation, obesity, arthritis and osteoarthritis, early motion, range of motion, gait pathology. From this review study, it is necessary that other publications in the field of physical therapy related biomechanical results of ankle fractures are carried out, since most studies were found in articles reporting on the medical surgeries.

Biomechanical Analysis of Foot–Ankle Complex during Jogging with Rearfoot Strike versus Forefoot Strike

Background and Aim. In order to reduce foot and ankle injuries induced by jogging, two-foot strike patterns, rearfoot strike (RFS), and forefoot strike (FFS), were adopted and compared. First, RFS jogging and FFS jogging were experimentally studied, so as to acquire kinematic and kinetic data, including foot strike angle, knee flexion angle, and ground reaction force (GRF). Then, a 3D finite element model of foot–ankle complex was reconstructed from the scanned 2D-stacked images. Biomechanical characteristics, including plantar pressure, stress of metatarsals, midfoot bone, calcaneus and cartilage, and tensile force of plantar fascia and ligaments, were obtained. The results showed that RFS jogging and FFS jogging had a similar change trend and a close peak value of GRF. Since possessing more momentum in the push stage and less momentum in the brake stage, FFS jogging could be in favor of a higher jogging speed. However, FFS jogging produced larger metatarsal stress in the 5th metatarsal and much larger tensile force of plantar fascia, which might cause metatarsal fracture and heel pain. While RFS jogging produced larger plantar pressure in the hindfoot area, larger calcaneus stress, and much larger tarsal navicular stress, which might cause heel tissue injury, calcaneus damage, and stress fracture of naviculocuneiform joint. In addition, talocrural and talocalcaneal joint cartilage could bear jogging loads, as the peak contact pressure were both small in RFS jogging and FFS jogging. Therefore, jogging with rearfoot or FFS pattern should be chosen according to the health condition of foot–ankle parts.

Relationship of Subtalar Joint Range of Motion to Ankle Injuries in NBA G League and Collegiate Basketball Players.

This study sought to determine whether range of motion (ROM) of the ankle and subtalar joint complex (STJ) is correlated with ankle injuries in National Basketball Association (NBA) G-league and collegiate basketball players to identify an at-risk population that may benefit from participation in an ankle injury prevention program. This prospective cohort study encompassed 103 player-seasons (68 collegiate, 35 NBA G-League). Patient demographics, passive ankle and STJ range of motion measurements, anterior drawer, and talar tilt tests were collected at preseason physicals along with plain radiographs. Subtalar eversion and inversion measurements were added to assess the Combination Motion (CM) of the STJ and subtracted to calculate the Subtalar Difference (SD). We defined the ratio of CM to SD as Subtalar Mobility Index (SMI=CM/SD). Twenty-one ankle injuries occurred with 10 405 player exposures yielding an incidence of 2.11/1000 exposures, resulting in 113 days of missed playing time. No direct measures of ankle, subtalar, or combined motion were associated with risk of injury, rejecting our original hypothesis that increased STJ ROM would predispose to ankle injuries. However, we did find that athletes with CM >16 degrees in combination with either SD <6 degrees (P = .025) or SMI >3.75 (P = .032) were nearly 3 times more likely to have an ankle injury (3.14 vs 2.97, respectively). Using the predictive subtalar mobility thresholds found in this study may help identify at-risk players that may benefit from targeted ankle injury prevention programs. Level II, prospective cohort study.

Prospective Study of the Inversion Destabilization Maneuver in the Treatment of Acute Ankle Ligament Injury: Case Series

Category: Ankle; Sports; Trauma Introduction/Purpose: Ankle sprains are highly prevalent injuries in athletes whether they are amateurs or professionals. It is estimated that around 5,000 sprains occur a day in the UK, while American data point to around 23,000 cases daily (1/10,000 individuals). The world literature has pointed out that about 7 - 10% of orthopedic visits in an emergency service are due to ankle sprains, corresponding to about 25% of all musculoskeletal injuries. The objective of this paper is to present the clinical results obtained from the prospective observation of a series of patients with lateral ankle sprains treated by the destabilization technique in Inversion of the ankle added to the conventional treatment. Methods: Design Case series, prospective, single center location. The study will be carried out at Hospital São Paulo - University Hospital of UNIFESP (HSP-UNIFESP), at the Orthopedics Outpatient Clinic of the Department of Orthopedics and Traumatology (DOT)/EPM-UNIFESP. Inclusion criteria - Over 18 years of age of both sexes; - Complaint of ankle sprain up to 48 hours - Complete or partial injury to any of the ligaments of the lateral ankle complex; - Isolated or associated ligament injuries; Non-Inclusion Criteria - Past history of surgery on the affected foot or ankle; - Previous complaint in the ankle region; - Any fracture associated with the sprain or influencing injuries; - Any condition that is a contraindication to the proposed therapies; - Refusal to participate in the study Results: We observed in our series of 100 individuals with lateral ankle sprains 6 new episodes of sprain in a follow-up of 12 month. we did not observe the occurrence of spontaneous ankle sprains in the 6 cases, external causal factors were pointed out by the patients. In 1 case the patient stepped on a squash ball, 1 case the patient had his ankle stepped on during a soccer match, in another case the patient suffered a fall while walking with high heel shoes. We also observed a fall from the stairs, a fall on another player's foot during a volleyball game and in the last case the patient suffered a fall after stepping on a hole in the sidewalk during street racing. Conclusion: Based on the findings of the present study, we concluded that in a 12-month follow-up, the ankle inversion destabilization maneuver proved to be efficient in preventing new episodes of lateral ankle sprain, however, new studies with a longer follow-up time, as well as and in order to compare the maneuver described in the study with techniques already described in the literature and used by physical therapists in their clinical practice should be performed.

Comparative Effects of Dynamic Stretching and Ice Bag Application On the Physical Performance in Recreational Basketball Players: A Randomized Crossover Study

Introduction: Researchers found that cryotherapy at the ankle joint heightened adjacent muscle activity and reflex amplitude, which facilitated greater force production at the ankle complex. Furthermore, cryotherapy appears to increase musculoarticular stiffness, which has been associated with heightened muscular performance at a joint. Aim and objective: the aim of the study is to examine the influence of dynamic stretching and IBA technique on the physical performance. Methodology: Total 20 healthy male basketball athletes encompassing two groups participated in the current study. The study consisted of two groups, Group A (ice bag application) and Group B (dynamic stretching). Cold compress was applied over the anterior thigh, posterior thigh, and calf. Subjects were assigned to Group A, and Group B, using Convenience sampling method. Each candidate performed the 5 minutes of jogging before taking intervention. All subjects performed three functional performance tests: Vertical Jump Test, Agility T-test &amp; 20-meter sprint. Each participant attended an orientation session to become familiar with the testing procedures. Subjects were randomly assigned into two groups and exposed to a crossover study design. The experiment was performed on two separate occasions whereby one group received the dynamic stretching in the first session, while the other group uses the cryotherapy first. After 48 hours, (cooling session) on the next occasion, the groups were changed and the second group receives the cryotherapy, while the first group performs dynamic stretching. On both occasions, the dynamic stretching and cryotherapy interventions were the same. Between the sessions, the subjects will not allow to participate in any kind of vigorous physical activity. Results: The present study showed an increase in performance of recreational Basketball players by the combination of 5 minutes of warm up plus 6 min of dynamic stretching on the vertical jump height and 20-meter sprint.

Assessment of the effect of a total contact cast on lower limb kinematics and joint loading

BackgroundTotal contact casts (TCCs) are used to immobilize and unload the foot and ankle for the rehabilitation of ankle fractures and for the management of diabetic foot complications. The kinematic restrictions imposed by TCCs to the foot and ankle also change knee and hip kinematics, however, these changes have not been quantified before. High joint loading is associated with discomfort and increased risk for injuries. To assess joint loading, the effect of the muscle forces acting on each joint must also be considered. This challenge can be overcome with the help of musculoskeletal modelling. Research questionHow does a TCC affect lower extremity joint loading? MethodsTwelve healthy participants performed gait trials with and without a TCC. Kinematic and kinetic recordings served as input to subject-specific musculoskeletal models that enabled the computation of joint angles and loading. Cast-leg interaction was modelled by means of reaction forces between a rigid, zero-mass cast segment and the segments of the lower extremity. Resultsand Significance: Reduced ankle, knee and hip range of motion was observed for the TCC condition. Statistical parametric mapping indicated decreased hip abduction and flexion moments during initial contact with the TCC. The anterior knee force was significantly decreased during the mid and terminal stance and the second peak of the compressive knee force was significantly reduced for the TCC. As expected, the TCC resulted in significantly reduced ankle loading. SignificanceThis study is the first to quantify the effect of a TCC on lower limb joint loading. Its results demonstrate the efficiency of a TCC in unloading the ankle joint complex without increasing the peak loads on knee and hip. Future studies should investigate whether the observed knee and hip kinematic and kinetic differences could lead to discomfort.

Clinically oriented ankle rehabilitation robot with a novel mechanism

AbstractIn order to make the designed ankle robotic system simpler, practical, and clinically oriented, we developed a novel$\underline{R}-2\underline{U}PS/RR$ankle rehabilitation robot with a variety of training functions covering all the required ranges of motion of the ankle joint complex (AJC), where$U$,$P$,$S$, and$R$denote universal, prismatic, spherical, and revolute joints, respectively, and the underlined letter denotes the actuated joint. The robot was designed with three degrees of freedom (DOFs), with a series$R$mechanism and a$2\underline{U}PS/RR$parallel mechanism. The main advantage is that the height of the robot is very low, which is convenient for clinical use by patients. At first, the mechanism design and inverse solution of positions were introduced in detail. Then, the patient-passive exercise based on the predefined trajectory tracking and patient-active exercise based on the spring model were developed to satisfy different rehabilitation stages. Finally, experiments with healthy subjects were conducted to verify the effectiveness of the developed patient-passive and patient-active exercises of the developed ankle rehabilitation robot, with results compared with the existing ankle robotic system showing good trajectory tracking performance and interactive performance.

How Common is Subsequent Posterior Tibial Tendon Dysfunction or Tarsal Tunnel Syndrome After Ankle Sprain Injury?

Posterior tibial tendon dysfunction (PTTD) and tarsal tunnel syndrome (TTS) are debilitating conditions reported to occur after ankle sprain due to their proximity to the ankle complex. The objective of this study was to investigate the incidence of PTTD and TTS in the 2 years following an ankle sprain and which variables are associated with its onset. In total, 22,966 individuals in the Military Health System diagnosed with ankle sprain between 2010 and 2011 were followed for 2 years. The incidence of PTTD and TTS after ankle sprain was identified. Binary logistic regression was used to identify potential demographic or medical history factors associated with PTTD or TTS. In total, 617 (2.7%) received a PTTD diagnosis and 127 (0.6%) received a TTS diagnosis. Active-duty status (odds ratio [OR] 2.18, 95% confidence interval [CI] 1.70-2.79), increasing age (OR 1.03, 95% CI 1.02-1.04), female sex (OR 1.58, 95% CI 1.28-1.95), and if the sprain location was specified by the diagnosis (versus unspecified location) and did not include a fracture contributed to significantly higher (p < 0.001) risk of developing PTTD. Greater age (OR 1.06, 95% CI 1.03-1.09), female sex (OR 2.73, 95% CI 1.74-4.29), history of metabolic syndrome (OR 1.73, 95% CI 1.03-2.89), and active-duty status (OR 2.28, 95% CI 1.38-3.77) also significantly increased the odds of developing TTS, while sustaining a concurrent ankle fracture with the initial ankle sprain (OR 0.45, 95% CI 0.28-0.70) significantly decreased the odds. PTTD and TTS were not common after ankle sprain. However, they still merit consideration as postinjury sequelae, especially in patients with persistent symptoms. Increasing age, type of sprain, female sex, metabolic syndrome, and active-duty status were all significantly associated with the development of one or both subsequent injuries. This work provides normative data for incidence rates of these subsequent injuries and can help increase awareness of these conditions, leading to improved management of refractory ankle sprain injuries.

A step towards dynamic foot classification: Functional grouping using ankle joint frontal plane motion in running

BackgroundThe premise behind static foot classification suggests structure dictate’s function. However, the validity of this has been challenged, as weak association between static foot type and dynamic motion exists. This has led to calls for dynamic assessments and classification of feet based on functional motion, yet methods to do this have been seldom explored. Research questionWithin a group of runners do homogenous sub-groups of ankle joint complex (AJC) frontal plane motion exist? MethodsA k means clustering analysis was conducted on the frontal plane AJC motion patterns of a group of healthy adults running barefoot (n = 42) to identify functional movement groups. Once identified, statistical parametric mapping was employed to determine the differences between clusters across stance. The identified clusters were used to determine dynamic foot type; an agreement analysis was conducted between the newly defined foot types and the Foot Posture Index (FPI-6). ResultsTwo distinct clusters were identified. Waveform analysis identified that cluster 1 displayed significantly (p < 0.001) less AJC eversion between 0% and 97% of the stance phase compared to cluster 2, with the differences between clusters associated with large effect sizes (g > 1). Based on the displayed kinematic profiles, cluster 1 was defined as a Neutral Dynamic Foot Type (NeutralDFT), and cluster 2 a Pronated Dynamic Foot Type (Pronated DynamicDFT). The newly defined foot type measure had only a slight agreement (κ = 0.08) with the FPI-6. SignificanceWe demonstrated a protocol to classify a runner’s foot type derived directly from AJC motion during running. Poor agreement between the dynamic and static classification measures further evidence that these assessments are not analogous. Our results question the validity of static classification when looking to characterise the foot during running, suggesting dynamic assessments are more appropriate to reflect the foots functional response.