Ankle Immobilization Research Articles

The Effects of Heat Therapy During Immobilization and Rehabilitation on Muscle Atrophy and Strength Loss at Return to Sports in Healthy Humans.

Animal research suggests that repeated heat exposures may stimulate skeletal muscle protein synthesis and downregulate protein degradation. Repeated heat exposures during ankle immobilization and rehabilitation would preserve human muscle strength and mass. Controlled laboratory study. A total of 20 male participants (age, 33.6 ± 2.8 years; weight, 83.8 ± 9.2 kg; height, 182 ± 6 cm) underwent 4 weeks of supervised training, 2 weeks of single-lower leg immobilization, and 2 weeks of supervised rehabilitation before return to sports (RTS). Participants were split into 2 groups: (1) whole-body heat therapy (HEAT) and (2) sham treatment (SHAM) throughout the immobilization and rehabilitation periods. Measures of muscle strength (isometric and isokinetic), volume (magnetic resonance imaging and ultrasound), and muscle biopsies were obtained preimmobilization, postimmobilization, and at RTS. Maximal isometric strength of the plantarflexors was lower at RTS compared with preimmobilization in SHAM (P = .027) but not HEAT (P = .301). Isokinetic strength during a fatigue test was higher at RTS compared with preimmobilization in HEAT (P = .039) but not SHAM (P = .245). Pennation angle and muscle thickness were lower at postimmobilization compared with preimmobilization only in SHAM (P≤ .027). Muscle cross-sectional area decreased in soleus and both gastrocnemius medialis and lateralis (all P≤ .035) in SHAM, but only in gastrocnemius medialis in HEAT. There was a large (d = 0.91) but not significant (P = .054) decrease in the ratio of phosphorylated/total nuclear factor-kappa B (NFκB) from preimmobilization to postimmobilization in HEAT only. There was an increase in phosphorylated fork head box O proteins (FoxO) only in HEAT (P = .034), suggesting a decrease in FoxO activity. Caspase 3 expression increased from preimmobilization to postimmobilization in SHAM only (P = .004). These results indicate that using heat therapy throughout immobilization and rehabilitation reduces skeletal muscle atrophy and maintains plantarflexor strength in healthy humans. Moreover, heat therapy may lead to the inactivation of the FoxO and NFκB signaling pathways involved in atrophy. Repeated heat exposures should be considered a novel therapeutic intervention to counteract muscle atrophy during immobilization.

The Difference in Achilles Tendon Loading within Immobilizing Boots Based on Ankle Angle, Boot Type, and Walking Speed.

Achilles tendon rupture is an increasingly common injury treated with progressive rehabilitation in an immobilizing boot. However, it is poorly understood how ankle angle, boot type, and walking speed affect Achilles tendon loading. These different parameters would affect Achilles tendon loading in terms of (from greatest to least) ankle angle constraint, immobilization style, boot construction, and walking speed. Descriptive laboratory study. Ten healthy young adults (8 women and 2 men; age, 21 ± 2 years; body mass index, 21.5 ± 3.0 kg/m2) walked in 3 different immobilizing boots at self-selected slow, medium, and fast walking speeds. The authors estimated Achilles tendon loading using a 3-part instrumented insole within the immobilizing boot. The authors averaged tendon load across every stride for each condition and calculated 2-sided bootstrap confidence intervals. Peak tendon loading was compared across all boots, ankle angles, and walking speeds. All boots and immobilization styles decreased tendon loading with respect to shod walking. Immobilization angle had the largest effect on tendon loading, followed by boot construction, and finally walking speed. Ankle angle, boot type, and walking speed can be modified to change loading progression during rehabilitation. Understanding how immobilization affects tendon loading will enable clinicians to modify rehabilitation to improve functional outcomes.

Management of zone 2 fifth metatarsal fractures varies based on treating specialty.

This study evaluated the effect of treating clinician speciality on management of zone 2 fifth metatarsal fractures. This was a retrospective cohort study of patients with acute zone 2 fifth metatarsal fractures who presented to a single large, urban, academic medical centre between December 2012 and April 2022. Zone 2 was the region of the fifth metatarsal base bordered by the fourth and fifth metatarsal articulation on the oblique radiograph. The proportion of patients allowed to bear weight as tolerated immediately after injury was compared between patients treated by orthopaedic surgeons and podiatrists. The effects of unrestricted weightbearing and foot and/or ankle immobilization on clinical healing were assessed. A total of 487 patients with zone 2 fractures were included (mean age 53.5 years (SD 16.9), mean BMI 27.2 kg/m2 (SD 6.0)) with a mean follow-up duration of 2.57 years (SD 2.64). Overall, 281 patients (57.7%) were treated by orthopaedic surgeons, and 206 patients (42.3%) by podiatrists. When controlling for age, sex, and time between symptom onset and presentation, the likelihood of undergoing operative treatment was significantly greater when treated by a podiatrist (odds ratio (OR) 2.9 (95% CI 1.2 to 8.2); p = 0.029). A greater proportion of patients treated by orthopaedic surgeons were allowed to immediately bear weight on the injured foot (70.9% (178/251) vs 47.3% (71/150); p < 0.001). Patients treated by podiatrists were immobilized for significantly longer (mean 8.4 weeks (SD 5.7) vs 6.8 weeks (SD 4.3); p = 0.002) and experienced a significantly longer mean time to clinical healing (12.1 (SD 10.6) vs 9.0 weeks (SD 7.3), p = 0.003). Although there was considerable heterogeneity among zone 2 fracture management, orthopaedic surgeons were less likely to treat patients operatively and more likely to allow early full weightbearing compared to podiatrists.

Current Concepts in Clinical Treatment of Osteochondral Lesions of the Talus

Osteochondral lesions of the talus (OLTs) are common reason for the deep ankle pain and seriously affect patient’s sports and the daily life. Managements of the OLTs including conservative treatment, cartilage repair surgery, cartilage replacement surgery and cartilage regeneration surgery. For asymptomatic, serendipitous, or acute OLTs with no displaced fragments, conservative treating is suitable to execute, including mainly including affected ankle immobilization with or without physical therapy, bone stimulation, or drugs used. For small OLTs, cartilage repair strategy like bone marrow stimulation technique (BMS) was recommended, and microfracture is the most commonly used surgical procedure. For larger OLTs, both cartilage replacement and cartilage regeneration could be considered including. Although there are many treatment options, each treatment option may have certain limitations and may not be applicable. With the continuous development of science and technology, the development of biological adjuvants and tissue engineering technology has been accelerated and promoted. The combined application of surgery and biological adjuvants and tissue engineering technology has gradually become a hot spot in clinical research. This work briefly introduced present strategies and advance in treatment of OLTs and discussed the potential application problems aiming to provide reference for the future treatment selection and research of OLTs.

Clinical Outcomes of Arthroscopic Ankle Lateral Ligament Repair with Accelerated Rehabilitation

Category: Arthroscopy; Ankle; Sports Introduction/Purpose: Although the minimal invasiveness of arthroscopic ankle lateral ligament repair (ALLR) means that an early return to sporting activities can be anticipated, many reports have described postoperative cast immobilization and the avoidance of weight-bearing for a certain period of time. Accelerated rehabilitation (AR), in which the period of immobilization is kept to a minimum and early weight-bearing exercises are actively introduced, may be helpful for an early return to sport. The purpose of this study was to investigate the therapeutic outcomes of ALLR with AR including the minimum duration of postoperative ankle immobilization and proactive early weight-bearing. Methods: A total of 23 ankles of 22 patients (11 men, 11 women; mean age 38.7 years) who underwent ALLR for chronic lateral ankle instability were investigated. Postoperative management included the avoidance of weight-bearing until postoperative day (POD) 3, after which full weight-bearing walking with a brace was permitted. The objective was to return to competitive sport 8 weeks after surgery. Preoperative and postoperative major symptoms, ankle range of motion (ROM), stress X-ray assessment, anterior translation (AT) measured with a capacitance-type strain sensor, the Japanese Society for Surgery of the Foot (JSSF) ankle-hindfoot scale, and the Self-Administered Foot Evaluation Questionnaire (SAFE-Q) were evaluated. Results: Postoperatively, instability and pain resolved or improved in all patients. There was no significant postoperative change in ROM. There were significant improvements in the mean talar tilt angle (from 12° to 5.6°), in the mean anterior drawer distance (from 8.2 mm to 4.4 mm) on stress X-rays, and in the mean AT (from 10.5 mm to 4.6 mm). The JSSF scale improved significantly (from 68.8 to 96.8), and the SAFE-Q improved significantly on all subscales. Complete return to sport was achieved by 75% of the patients at 8 weeks after surgery. Conclusion: When AR with proactive weight-bearing exercises was implemented from POD 3 without ankle immobilization after ALLR, there were significant improvements in both objective assessments of ankle stability and clinical scores, and as many as 75% of the patients were able to make a complete return to sport within 8 weeks.

Effect of Accelerated Rehabilitation on Early Return to Sport After Arthroscopic Ankle Lateral Ligament Repair.

Background:Although the minimal invasiveness of arthroscopic ankle lateral ligament repair (ALLR) means that an early return to sporting activities can be anticipated, studies have described postoperative cast immobilization and the avoidance of weightbearing for a certain period. Accelerated rehabilitation may be helpful for an early return to sport.Purpose:To investigate clinical outcomes of ALLR and accelerated rehabilitation with a minimum duration of postoperative ankle immobilization and proactive early weightbearing.Study Design:Case series; Level of evidence, 4.Methods:This study investigated 23 ankles of 22 patients (11 men, 11 women; mean age, 38.7 years) who underwent ALLR for chronic lateral ankle instability. Postoperative management included the avoidance of weightbearing until postoperative day 3, after which full weightbearing walking with a brace was permitted. The objective was to return to competitive sport 8 weeks after surgery. The following were evaluated: pre- and postoperative instability and pain symptoms, ankle range of motion, anterior drawer distance on stress radiograph, anterior translation measured with a capacitance-type strain sensor, the Ankle-Hindfoot Scale from the Japanese Society for Surgery of the Foot, and the SAFE-Q (Self-Administered Foot Evaluation Questionnaire).Results:Two male patients dropped out and were excluded from analysis. Postoperatively, instability and pain resolved or improved in all patients. There was no significant postoperative change in range of motion. There were significant pre- to postoperative improvements in talar tilt angle (from 12.2°-5.6°, P < .01), anterior drawer distance (8.2-4.4 mm, P < .01), and anterior translation (10.5-4.6 mm, P < .01) as well as the Ankle-Hindfoot Scale score (68.8-96.8, P < .01) and all subscales of the SAFE-Q (P ≤ .01 for all). Complete return to sport was achieved by 75% of the patients at 8 weeks postoperatively.Conclusion:When accelerated rehabilitation with proactive weightbearing exercises was implemented from postoperative day 3 without ankle immobilization after ALLR, there were significant improvements in objective assessments of ankle stability and clinical scores, and as many as 75% of the patients were able to make a complete return to sport within 8 weeks.

A retrospective review of Tendoachilles repair in complete avulsion rupture with lengthening of Achilles tendon and suture anchor with immediate post operative neutral ankle immobilization

A retrospective review of Tendoachilles repair in complete avulsion rupture with lengthening of Achilles tendon and suture anchor with immediate post operative neutral ankle immobilization

Ankle Injuries.

Ankle Injuries.

The effects of 72 h of dynamic ankle immobilization on neural excitability and lower extremity kinematics

BackgroundAnkle injuries can foster maladaptive changes in nervous system function that predisposes patients to subsequent injury. Patients are often placed in a dynamic boot immobilizer (BI) following injury; however, little is known about the effects of this treatment on neuromechanical function. Research questionWe aimed to determine the effect of 72 h of BI-use on neural excitability and lower extremity joint motion in a healthy cohort. MethodsTwelve uninjured individuals (20.8 ± 1.4 yrs, 1.7 ± 0.1 m, 75.2 ± 9.9 kg) participated in this crossover study. Neural excitability and lower extremity kinematics were assessed before and after 72 h of BI or compression sock (CS) use. Neural excitability was assessed via the Hoffmann (H) reflex and transcranial magnetic stimulation of the motor cortex by measuring muscle activation at the tibialis anterior, peroneus longus, and soleus of the immobilized extremity. Three-dimensional lower extremity joint angles were assessed while participants walked on a treadmill. Repeated-measures analyses of variance detected changes in neural excitability and peak joint angles across time-points and testing conditions, while statistical parametric mapping (SPM) was implemented to determine continuous joint angle changes (α = 0.05). ResultsPre-BI to post-BI, HMax:MMax ratio (F = 6.496; p = 0.031) significantly decreased. The BI did not alter resting motor threshold (F = 0.601; p = 0.468), or motor evoked potential amplitudes (F > 2.82; p > 0.608). Significant changes in peak knee and hip angles in the frontal and transverse planes were observed (p < 0.05), with no changes at the ankle. SPM analyses revealed significant hip and knee changes in range of motion (p < 0.05). SignificanceDecreased measures of reflex but not corticospinal excitability suggest that BI-use for 72 h unloaded the joint enough to generate peripheral changes, but not the CNS, as has been described in casting models. Further, kinematic changes were observed in proximal lower extremity joints, likely due to swing-phase adaptations while wearing the BI.

Contact Pressure Reduction in the Anterior Ankle During Placement of Short Leg Splints

Category:Trauma; AnkleIntroduction/Purpose:Lower extremity splints are commonly used in orthopaedic care throughout emergency departments, operating rooms, and outpatient clinics. Although the mainstay of ankle immobilization, they have been associated with ulcers due to high contact pressures over bony prominences and the anterior ankle. High contact pressures may occur in the anterior ankle when splint padding is applied while the ankle is in a plantarflexed position and subsequently dorsiflexed as the plaster or fiberglass hardens. The purpose of this study is to measure contact pressures in the anterior ankle when cast padding is applied in a plantarflexed position and subsequently dorsiflexed. We hypothesized, that the removal of padding over the anterior ankle following dorsiflexion would result in reduced anterior ankle contact pressures.Methods:Short leg posterior U-splints were applied to the right lower extremity in two healthy volunteers with an underlying pressure transducer [Tekscan I-Scan system (Tekscan Inc, South Boston, MA, USA)] on the skin surface centered over the tibialis anterior tendon. Anterior ankle surface pressures were measured when the padding was applied in maximum plantar flexion and dorsiflexed to neutral position as measured by a goniometer. This was then repeated in the same subjects but prior to dorsiflexion, a 3cm x 3cm square of padding was removed over the pressure transducer prior to dorsiflexion. Percent change from initial contact pressure centered on the tibialis anterior with either Webril (Covidien/Medtronic, Dublin, Ireland), or Specialist Cotton Blend Cast Padding (BSN Medical, Charlotte, NC, USA) was calculated.Results:There were 2 limbs analyzed for presentation of this pilot data. The percent change in anterior ankle contact pressure when padding was applied in plantar flexion and then placed in neutral was an average increase of 264% with just padding and 238% with padding and plaster. [TP1] Subsequently, the removal of padding from the anterior ankle resulted in an average decrease of 126% of[TP2] the increased pressure relative to baseline measurements (Figure 1). The reduction in contact force with the removal of Webril was greater than Specialist.Conclusion:In this pilot data, we report increases in anterior ankle contact pressures when splint padding is applied in plantar flexion and re-positioned into neutral. However, removal of anterior ankle padding reduces pressure over the anterior ankle and may reduce the risk of iatrogenic splint related ulcers in this area. Additionally, this technique may elicit varying reductions in anterior ankle pressure depending on the type of cast padding utilized. This data, though preliminary, underscores the importance of avoiding excess padding over the anterior ankle during splint application.

A new method of augmented Achilles tendon repair without ankle immobilization

A new method of augmented Achilles tendon repair without ankle immobilization

Technique Tip: Combined Suspensory and Aperture Fixation of Posterior Tibialis Tendon Anterior Transfer for Dropfoot

Anterior transfer of the tibialis posterior tendon is a widely used technique to restore ankle dorsiflexion in patients suffering from a foot drop. One of the limitations of this procedure is the need for postoperative ankle immobilization, which can lead to a number of complications—muscle atrophy, joint stiffness, adhesions, and venous thromboembolism, to name a few. We present a new way of tendon docking which enables patients to weight-bear immediately after surgery, thus significantly reducing the above mentioned risks. This modification addresses the weakest point of the fixation—the tendon/screw interface, by utilizing a tension slide bicortical biceps button. Our initial case series of 8 patients (9 feet) has shown good results with no patients showing late radiologic or clinical loss of fixation of the construct at 6 months follow-up. Level of Evidence: Diagnostic Level IV–case series. See Instructions for Authors for a complete description of levels of evidence.

836 Custom Fabricated Open Anterior Ankle Foot Orthosis to Promote Early Mobility with Lower Extremity Grafts

Abstract Introduction Distal lower extremity STSG’s present a challenge with the balance of early mobility and immobilization of the ankle. Traditional commercially available ambulation boots or pre-fabricated orthotics may impose circumferential compression endangering graft integrity. Custom fabricated posterior AFO’s comprised of thermoplastic, scotch cast or fiberglass materials are not recommended for weight-bearing of the lower extremity during mobility/ambulation. What may also hinder promotion of early mobility is having a multitude of injuries or advanced age with decreased ability to adhere to a LE NWB status. An anterior approach to immobilization of the ankle was thought of to free the plantar surface of the foot for weight-bearing. The open concept of the orthosis itself minimizes direct contact with the involved LE graft. This promotes graft integrity during mobility with ankle immobilization. Methods Materials: Thermoplastic material, scissors, strapping, dense adhesive foam, adhesive Velcro and a heat gun. Fabrication: Measure the point of distance between where the desired proximal end of the orthosis would be to the patient’s metatarsal heads on the dorsal aspect of the foot; double it to calculate the amount of material needed. The width of the material should be approx. 3 to 4 inches. Warm material and tri-fold it together reducing width to approx. 1 ½ to 2 inches to increase stability. Shape the folded material into a continuous oval and place on the patient’s distal LE. As the material cools, shape the oval away from the medial/ lateral aspects of the distal LE restricting the points of contact to the anterior most proximal and distal aspect of the desired splint parameters. Remove once cooled and add dense adhesive foam to the 2 points of contact that will rest against the patient. This will allow for a slight area of “give” against the patient during weight-bearing of the LE/foot. Velcro and straps are added to the proximal/distal ends of the oval; heating the adhesive side will imbed the Velcro allowing increased durability with repeated donning/doffing. Results The open construction of this orthosis allows different degrees of weight-bearing eliminating contact with the distal LE STSG. The forefoot and heel are available to weight bear safely within the confines of the open anterior ankle foot orthosis. Conclusions Patients have been trialed with/without an AD with success in the achievement of ankle immobilization with mobility. Weight-bearing instructions that accompany this splint wear is foot placement rather than a normal heel strike cadence to avoid undue pressure at the proximal aspect of the splint on the lower extremity. Applicability of Research to Practice This splint has been successfully utilized for immobilization without compromise to STSG integrity due to the anterior open support it offers the ankle. Perhaps this concept could be applied to other joints to avoid direct contact of the splint with STSG during the initial stages of healing.

Does Early Functional Mobilization Affect Long-Term Outcomes After an Achilles Tendon Rupture? A Randomized Clinical Trial.

Background:Functional deficits and health-related impairments are common after an Achilles tendon rupture (ATR). Rehabilitation protocols vary greatly, and few studies have allowed loading in combination with ankle motion immediately after surgery (ie, early functional mobilization [EFM]). It is unclear whether EFM may counteract the negative impact of ankle immobilization after an ATR.Purpose:The primary aim of this study was to assess the efficacy of EFM compared with standard treatment (ie, 2 weeks of unloading in a plaster cast followed by 4 weeks of weightbearing in an orthosis) regarding patient-reported and functional outcomes in patients with an ATR after acute operative repair. The secondary aim was to explore whether the occurrence of deep venous thrombosis (DVT) during the 2 postoperative treatments affected outcomes.Study Design:Randomized controlled trial; Level of evidence, 1.Methods:A total of 135 patients who underwent ATR repair, randomized to either EFM, including immediate postoperative loading and ankle motion, or standard treatment, were evaluated with functional tests and 5 self-administered outcome questionnaires at 6 and 12 months postoperatively.Results:At 6 months, the EFM group scored higher on the RAND 36-Item Health Survey (RAND-36) questionnaire subscales of general health and vitality (P < .05) compared with the control group. No significant differences between the groups were found on disease-specific questionnaires (Achilles tendon Total Rupture Score [ATRS] and Foot and Ankle Outcome Score [FAOS]). At 12 months, no significant differences on any of the patient-reported outcome measures or the functional heel-rise test were seen between the groups. The RAND-36 subscale of general health, however, exhibited higher values in the EFM group (82.6 ± 16.9) than the control group (77.1 ± 17.0) (P = .051) at 12 months after the injury. Patients sustaining DVT postoperatively had lower self-reported outcomes on the ATRS, FAOS, and RAND-36 questionnaires at 6 and 12 months compared with patients not having sustained DVT (all P < .05).Conclusion:This study demonstrated that an accelerated postoperative protocol with immediate loading and ankle motion resulted in better general health and vitality at 6 months. However, there were no differences between the groups in the recovery of heel-rise function. Future studies should focus on the means to reduce the risk of DVT to improve patient outcomes after ATR.Registration:NCT02318472 (ClinicalTrials.gov identifier).

Heterotopic Ossification After an Achilles Tendon Rupture Cannot Be Prevented by Early Functional Rehabilitation: A Cohort Study.

Tendon loading might play a role in the development of heterotopic ossification after Achilles tendon ruptures. Early heavy loading on a healing tendon in animals has been shown to prolong the proinflammatory response, and inflammatory cells are thought to drive heterotopic ossification formation. Taken together, this suggests that early rehabilitation might influence heterotopic ossification development. The purposes of this study were to investigate (1) whether the presence of heterotopic ossification after Achilles tendon ruptures influences clinical outcome and (2) whether early mobilization or weightbearing prevents the development of heterotopic ossification. This was a retrospective analysis of 69 patients from a previous clinical trial. All patients were treated surgically, but with three different early rehabilitation protocols after surgery: late weightbearing and ankle immobilization, late weightbearing and ankle mobilization, and early weightbearing and ankle mobilization. Plain radiographs taken 2, 6, 12, 26, and 52 weeks postoperatively were analyzed for heterotopic ossification, which was detected in 19% of patients (13 of 69) at 52 weeks. Heterotopic ossification was measured, scored, and correlated to clinical outcomes; heel-raise index (HRI), ankle joint ROM, tendon strain, Achilles tendon rupture score (ATRS), and Victorian Institute of Sport Assessment-Achilles (VISA-A) questionnaire scores at 26 and 52 weeks postoperatively. Heterotopic ossification had no adverse effects on patient-reported outcomes (ATRS or VISA-A), tendon strain, or ROM. In fact, patients with heterotopic ossification tended to have a better HRI at 52 weeks compared with patients without (mean difference 14% [95% CI -0.2 to 27]; p = 0.053). Neither the occurrence (heterotopic ossification/no heterotopic ossification) nor the heterotopic ossification severity (ossification score) differed between the three rehabilitation groups. Seventeen percent of the patients (four of 24) with early functional rehabilitation (early weightbearing and ankle joint mobilization exercise) had heterotopic ossification (score, 2-3) while late weightbearing and immobilization resulted in heterotopic ossification in 13% of the patients (score, 3-4). Heterotopic ossification occurs relatively frequently after Achilles tendon ruptures but appears to have no adverse effects on functional outcomes. Furthermore, heterotopic ossification develops during the first 6 weeks after rupture, and weightbearing or ankle-joint mobilization does not prevent this from occurring. Level III, prognostic study.

Effects of Ankle Joint Motion on Pelvis-Hip Biomechanics and Muscle Activity Patterns of Healthy Individuals in Knee Immobilization Gait.

The purpose of the study was to investigate the pelvis-hip biomechanics and trunk and lower limb muscle activity patterns between healthy people walking in two gaits and evaluate the effects of ankle joint motion on these two gaits. The two gaits included walking with combined knee and ankle immobilization and with individual knee immobilization. Ten healthy participants were recruited and asked to walk along a 10 m walk away at their comfortable speeds in the two gaits. Kinematic data, ground reaction force, and electromyography waveforms of trunk and lower limb muscles on the right side were collected synchronously. Compared to individual knee immobilization gait, people walking in the combined knee and ankle immobilization gait increased the range and average angle of the anterior pelvic tilt during the first double support and the single support phase, respectively. The combined knee and ankle immobilization gait also increased the range of hip abduction during the second double support phase. These kinematic alternations caused changes in trunk and lower limb muscle activity patterns. The ankle immobilization increased the range of gluteus maximus activation in the first double support phase, the range of rectus abdominis activation, the average amplitude of rectus femoris activation in the single support phase, and the range of rectus femoris activation in swing phase and decreased the range of and tibialis anterior activation in the first double support phase. The ankle immobilization also increased the average values of proximodistal component in AKI gait during the single support phase. This study revealed significant differences in pelvis-hip biomechanics and trunk and lower limb muscle activity patterns between the two gaits.

Anteromedial ankle approach for talus fracture

Objective To investigate the therapeutic effect of anteromedial ankle approach for talus fracture. Methods From January 2012 to October 2018, the data of 28 cases of talus fracture treated by anteromedial ankle approach were retrospectively analyzed, including 26 males and 2 females, aged 24-61 years with an average of 38.6 years. All 25 cases of closed injuries and 3 cases of open injuries were fresh injuries. There were 16 cases of traffic injuries, 8 falling injuries, 2 heavy object injuries and 2 sprains. Among the 28 patients, 17 were talus neck fractures, and according to Hawkins talus neck fracture classification, there were 1 case of type I, 12 type II, and 4 type III. There were 11 cases of talus fracture, which were classified according to Sneppen talus fracture types: 2 cases of type I, 8 cases of type II and 1 case of type V. Among them, 2 cases of talus neck fracture complicated with T12 vertebral body fractures and 2 cases complicated with calcaneal fractures. The time from injury to operation for 3 patients with open fracture was 3-6 hours. 25 cases of closed fracture injuries took 2-10 hours to operate, with an average time of 5.6 hours. All patients were fixed with cannulated screws through the anteromedial ankle approach. The weight-bearing time and strength of lower limbs were determined according to fracture healing after surgery. The ankle function was evaluated by American Orthopaedic Foot and Ankle Society (AOFAS) Score. Results All 28 patients were followed up for 23 to 82 months, with an average of 37.5 months. All fractures healed. The healing time of talus neck fracture was 3.5-8 months, with an average of 5 months. The healing time of talus fracture was 3-7 months, averaging 4.5 months. At the latest follow-up, AOFAS score ranged from 68 to 100, with an average of 82.5 points, including excellent in 15 cases, good in 8 cases, fair in 4 cases and poor in 1 case, with the excellent and good rate of 82.1% (23/28). There were no signs of fracture displacement, malunion, loosening and prolapse of internal fixation, fracture and ischemic necrosis of talus after operation. Traumatic arthritis occurred in 9 patients, with an incidence rate of 32.1% (9/28). Tibial joint was involved in 5 cases, talus joint in 3 cases, tibialis in 1 case and talus joint in 1 case. Among them, traumatic arthritis occurred in 2 cases of open injury. Nine patients (32.1%) suffered from traumatic arthritis 6-10 months after operation, with an average of 8 months. According to conservative treatments such as weight control, ankle immobilization, physiotherapy, anti-inflammatory and analgesic, nutrition of articular cartilage drugs, joint traction and plasty were given. The patients' conditions improved to different degrees and could tolerate walking and normal life and work. Conclusion The anteromedial ankle approach has the advantages of minimal vessel injuries, clear exposure for direct reduction, low rate of necrosis of talus and satisfactory curative effect. Key words: Talus; Fractures, bone; Fracture fixation, internal

Bone Marrow Foot Oedema in Adolescents: The Role of Vitamin D.

BackgroundBone marrow oedema (BMO) in children/adolescents is a rare clinical condition without an etiologic cause. It is associated with typical increased signal intensity on T2-weighted magnetic resonance images (MRI) and an increase in bone turnover in which vitamin D plays a pivotal role. No treatment guidelines for these young patients are to date available.MethodsWe performed a retrospective study in a pediatric setting of 13 patients with diagnosis of primary BMO of the foot on the basis of clinical and radiological findings. Data collection included sex, age, patient history, symptoms at presentation, clinical examination, laboratory bone turnover markers, vitamin D levels, MRI, treatment, and outcome.ResultsVitamin D deficiency or insufficiency was found in 76.9% of cases. All patients were treated with adequate vitamin D daily intake, a short course of analgesic therapy, physical therapy, avoiding detrimental feet and ankle immobilization. All fully recovered in 3-month lag period.ConclusionsOur data highlight that environmental factors, such as underestimated articular or bone microtraumatisms, as well as joint hyper mobility, in a bone turnover milieu of vitamin D deficiency could be the cause of this clinical conditions. Adequate vitamin D supplementation, associated with physical and analgesic therapy, is crucial in the management of BMO.

Use Of Ankle Immobilization In Evaluating Treatments To Promote Longitudinal Muscle Growth In Mice.

Difficulty in modeling congenital contractures (deformities of muscle-tendon unit development that include shortened muscles and lengthened tendons) has limited research of new treatments. Early immobilization of the ankle in prepuberal mice was used to produce deformities similar to congenital contractures. Stretch treatment, electrostimulation, and local intramuscular injection of a follistatin analog (FST-288) were assessed as therapeutic interventions for these deformities. Ankle immobilization at full plantarflexion and 90 ° created tendon lengthening and muscle shortening in the tibialis anterior and soleus. Stretch treatment produced minimal evidence for longitudinal muscle growth and electrostimulation provided no additional benefit. Stretch treatment with FST-288 produced greater longitudinal muscle growth and less tendon lengthening, constituting the best treatment response. Ankle immobilization recapitulates key morphologic features of congenital contracture, and these features can be mitigated by a combination of stretch and pharmacological approaches that may be useful in patients. Muscle Nerve 58: 718-725, 2018.

Examination of the relationship between toe grip strength or toe pressure and physical function according to the presence or absence of an ankle immobilization belt

Examination of the relationship between toe grip strength or toe pressure and physical function according to the presence or absence of an ankle immobilization belt