Ankle Region Research Articles

Genu varum (Rt) genu valgum (Lt), post traumatic ankle varus deformity (Lt)

Ilizarov Technique is a fantastic tool for correcting femoral varus, genu valgum and ankle varus. The case demonstrates an approach to large complex deformity in both right & left knee, and left ankle region. All of the aforementioned deformities were fully corrected by the help of Ilizarov Technique.1,2,3

Prolonged Time to Brake Following Lower Extremity Injuries.

No guidelines exist for recommending return to driving. This study will examine time to brake (TTB) after lower extremity injuries versus in uninjured people. The potential effect of various types of lower extremity injuries on TTB will be measured. Patients with injuries to the pelvis, hip, femur, knee, tibia, ankle, and foot underwent testing using a driving simulator to assess TTB. Comparison was with a control group of uninjured people. Two-hundred thirty-two patients with lower extremity injuries participated. The majority were in the tibia and ankle regions (47%). Mean TTB for control subjects was 0.74 seconds, compared with 0.83 for injured patients, noting a 0.09-second difference (P = 0.017). Left-sided injuries averaged TTB of 0.80 seconds, right-sided injuries averaged TTB of 0.86 seconds, and bilateral injuries averaged TTB of 0.83 seconds, all prolonged versus control subjects. The longest TTB was exhibited after ankle and foot injuries (0.89 seconds) while the shortest was after tibial shaft fractures (0.76 seconds). Any lower extremity injury caused a prolonged TTB compared with control patients. Left, right, and bilateral injuries all had longer TTB. Ankle and foot injuries experienced the longest TTB. Additional investigation is warranted to develop safe guidelines for return to driving.

Aesthetic Considerations in Extremity Salvage and Reconstruction.

After studying this article, the participant should be able to: 1. Have an in-depth understanding of the functional and aesthetic requirements of lower extremity reconstruction. 2. Describe the considerations for achieving an optimal aesthetic outcome in the primary reconstruction settings. 3. Describe modalities of secondary flap revision for achieving an optimal aesthetic outcome. Significant advancements have been made in the management of lower extremity reconstruction since Dr. Taylor's seminal case in 1973. Improvements in our understanding of vascular anatomy and evolution of microsurgical techniques have allowed for an ever-increasing array of free tissue transfer options for lower extremity reconstruction. The resulting expertise has engendered a paradigm shift toward the reconstructive elevator approach, with increased emphasis on cosmetic results. In the primary setting, aesthetic considerations play an important role in precoverage wound preparation, flap selection, and harvest technique, with the goal of achieving excellent like-with-like reconstruction at the time of initial surgery. Flap selection should be made to best match the three-dimensional architecture of the wound, and take into account the defect thickness, flap thickness, flap composition, and pedicle length. Primary flap thinning and harvest in the superficial fascial plane has been shown to be an effective modality to address excess adiposity and improve contour. Despite these efforts, secondary procedures are often required to optimize the limb's final appearance and functional outcomes, particularly in the foot and ankle region. These include debulking, liposuction, and staged excisions. As the field of limb salvage keeps evolving, aesthetics will continue to play an important role in extremity reconstruction planning and execution.

Temporal and spatial assembly of inner ear hair cell ankle link condensate through phase separation

Stereocilia are actin-based cell protrusions of inner ear hair cells and are indispensable for mechanotransduction. Ankle links connect the ankle region of developing stereocilia, playing an essential role in stereocilia development. WHRN, PDZD7, ADGRV1 and USH2A have been identified to form the so-called ankle link complex (ALC); however, the detailed mechanism underlying the temporal emergence and degeneration of ankle links remains elusive. Here we show that WHRN and PDZD7 orchestrate ADGRV1 and USH2A to assemble the ALC through liquid-liquid phase separation (LLPS). Disruption of the ALC multivalency for LLPS largely abolishes the distribution of WHRN at the ankle region of stereocilia. Interestingly, high concentration of ADGRV1 inhibits LLPS, providing a potential mechanism for ALC disassembly. Moreover, certain deafness mutations of ALC genes weaken the multivalent interactions of ALC and impair LLPS. In conclusion, our study demonstrates that LLPS mediates ALC formation, providing essential clues for understanding the pathogenesis of deafness.

Short-term foot warming impacts foot sensitivity and body sway differently in older adults

BackgroundAging is accompanied by loss of foot skin sensitivity and reduced postural control. Increasing foot temperature can improve both skin sensitivity and postural control in adults. However, it remains unclear whether similar effects can be observed in older adults. Research questionCan foot warming improve postural control in older adults, similar to observations in younger adults? MethodsTwo foot warming protocols were conducted in 18 older adults (14 women, 4 men) to increase foot temperature by using infrared radiation to (1) warm the plantar aspect and (2) the skin of the entire foot and ankle area. We assessed the foot skin sensitivity before and after warming, considering tactile stimulation and center of pressure (CoP) displacement during 30-s standing with eyes open and closed. Results and significanceBoth foot warming protocols led to similar increases in skin temperature (∼6 °C) compared to the basal condition, but only warming the entire foot and ankle area increased foot sensitivity for the different regions assessed. No main effects or interactions were found for CoP variables in response to the two warming protocols. The short-term effects identified after warming the entire foot and ankle region suggest that this might be a strategy to improve skin sensitivity in older adults as observed in younger adults, but this was not the case for CoP. Future research should clarify whether the magnitude and long-lasting effects of warming could be determinant of CoP results.

The bifurcation and topography of the posterior tibial artery within the tarsal tunnel

PurposeThe tarsal tunnel (TT) is a fibro-osseous anatomical space coursing from the medial ankle to the medial midfoot. This tunnel acts as a passage for both tendinous and neurovascular structures, including the neurovascular bundle containing the posterior tibial artery (PTA), posterior tibial veins (PTVs) and tibial nerve (TN). Tarsal tunnel syndrome (TTS) is the entrapment neuropathy that describes the compression and irritation of the TN within this space. Iatrogenic injury to the PTA plays a significant role in both the onset and exacerbation of TTS symptoms. The current study aims to produce a method to allow clinicians and surgeons to easily and accurately predict the bifurcation of the PTA, to avoid iatrogenic injury during treatment of TTS.MethodsFifteen embalmed cadaveric lower limbs were dissected at the medial ankle region to expose the TT. Various measurements regarding the location of the PTA within the TT were recorded and multiple linear regression analysis performed using RStudio.ResultsAnalysis provided a clear correlation (p < 0.05) between the length of the foot (MH), length of hind-foot (MC) and location of bifurcation of the PTA (MB). Using these measurements, this study developed an equation (MB = 0.3*MH + 0.37*MC – 28.24 mm) to predict the location of bifurcation of the PTA within a 23° arc inferior to the medial malleolus.ConclusionsThis study successfully developed a method whereby clinicians and surgeons can easily and accurately predict the bifurcation of the PTA, to avoid iatrogenic injury that would previously lead to an exacerbation of TTS symptoms.

Empirical Evidence on the Reliability of Lateral Supramalleolar Flap over Reverse Sural Flap for Local Soft Tissue Coverage of Dorsum of the Foot and Ankle Defects.

Background Soft tissue coverage of the distal foot and ankle region has been an area of debate due to the paucity of local flap options. To provide empirical evidence on the reliability of an underreported local alternative for foot and ankle defects, we aim to compare the lateral supramalleolar flap (LSMF) to the reverse sural flap (RSF). Methods During 2016-2019, 48 patients were divided randomly into two equal groups, LSMF and RSF groups respectively. The patients' demographic, surgical, and clinical outcome details were recorded and analyzed. Results Flap necrosis was found in five patients in the group treated with RSF and none in the LSMF group. The mean total number of stages in RSF group was significantly higher than in LSMF group ( p < 0.05). The mean operative time for patients in LSMF group was 85.8 ± 18.5 and 54.2 ± 11.2 in RSF group ( p < 0.05). Five patients in the RSF group needed additional procedures following flap complications. Nine patients in the LSMF group reported satisfaction outcomes to be "excellent," five patients reported "good" whereas, in the RSF group, 14 patients reported "excellent," 5 reported "good," 3 reported "fair," and 2 reported "poor" outcomes. Compared to the RSF (46.4 ± 4.3) group, the LSMF group had significantly better foot function indices (34.03 ± 3.9). Conclusion The lateral supramalleolar flap for foot and ankle defects offers better results, reduced complications as well a lesser number of stages and secondary procedures over the traditionally used reverse sural flap.

Unmasking the “Great Masquerader:” Tuberculosis of the Foot

Abstract Introduction: Osteoarticular tuberculosis (TB) accounts for only 1%–3% of extrapulmonary TB, of which ankle and foot involvement accounts for only 8%–10%. Foot and ankle TB has a varied clinical and radiological presentation and can mimic many conditions. The aim of this study is to throw light on the varied clinical and radiological presentations of this disease. Materials and Methods: We studied 20 patients with suspected osteoarticular TB of the ankle and foot region over 3 years. The patients were evaluated based on clinical presentation, radiology, magnetic resonance imaging (MRI) findings, molecular studies (cartridge-based nucleic acid amplification test [CBNAAT]), biopsy, microbiological staining and culture, erythrocyte sedimentation rate ESR, and C-reactive protein levels. The patients were categorized into subgroups in accordance with their findings. Results: All cases had some form of pain, swelling, tenderness, or inability to bear weight. Twenty-five percent presented with single or multiple draining sinuses at or around the ankle. On X-rays, 30% had unremarkable radiographs, and osteopenia/cavitation of one or more bones was found in 30% of cases. Sequestrum formation was seen in 20% of the cases. No advanced arthritis and collapse were noted. In MRI, all cases had marrow edema of one or more bones. Twenty percent had features of tenosynovitis. CBNAAT was done for all the patients of whom eight turned positive for the pathogen. Discussion: The classical features of skeletal TB may elusive in cases of TB of the foot and ankle. Plain radiographs may not be sensitive in detecting early cases. In MRI studies, the calcaneum and talus were mostly affected. This may indicate toward a hypothesis that the calcaneum/talus may be the primary source of origin in osteoarticular TB of the ankle and foot region. Biopsy remains the gold standard in diagnosing TB. All patients responded well to the medical management. We can conclude with surety that TB of the foot and ankle is primarily a medical condition if prompt and early diagnosis is made.

Retro Bladder Synovialosarcoma: About a Case

Introduction: Synovialosarcoma is a mesenchymal tumor that usually affects the soft parts of the lower limbs, especially in the knee or ankle region, in adolescents or young adults. Much more rarely, it is observed in the retrovesical region. Objective: The aim of our work is to illustrate and show the primordial interest of imaging in the positive diagnosis and follow-up of this pathology. Case Report: This is a 13-year-old patient, with no pathological history, who presented for 9 months a urinary obstructive and irritative syndrome, complicated by acute retention of urine. Pelvic ultrasound showed a midline, rounded pelvic mass measuring 8x9 cm isoechoic, with areas of cystization, infiltrating the bladder base and the prostate. Abdominal-pelvic CT scan with and without injection of contrast product revealed a bulky retrovesical mass, roughly rounded, hypodense, of homogeneous tissue density, discreetly enhanced after injection of contrast product. The histological and immuno-histo-chemical study of the biopsy revealed a Synovialosarcoma. The recommended treatment was primary chemotherapy. Conclusion: Imaging is essential to guide the diagnosis, establish prognostic criteria and ensure post-therapeutic follow-up.

Perfil termográfico das extremidades inferiores de indivíduos em tratamento de feridas ulcerativas: uma exploração qualitativa das imagens

ABSTRACT Thermography proves to be a new concept in measuring the thermogenesis of biological systems, a valuable method for confirming clinical diagnosis discarding subjective analysis and personal criteria. The result of the thermographic evaluation is the subject of qualitative and quantitative analyses. This study aimed to identify the thermal profile of the lower extremities of individuals diagnosed with cardiovascular and endocrine and metabolic diseases in the treatment of ulcerative wounds. A thermographic evaluation was performed from 19 dorsal, plantar, lateral, and medial extremities. In the qualitative analysis, images with and without a wound were divided according to diagnosis. After the division, a checklist was elaborated for the qualitative evaluation of the images. A total of 100 individuals (49 women and 51 men) participated, 65 with cardiovascular disease and 35 with endocrine and metabolic disease. There was a difference in the thermal pattern between the extremities in both diagnoses. The groups presented similar thermographic characteristics with signs of more radiation in the wounds, predominantly with red and white stains. More regions of interest with lesions on the medial foot, lateral, and medial ankle border were observed in individuals with chronic cardiovascular disease. Those with endocrine and metabolic disease presented more regions with lesions in the plantar (forefoot), dorsal, and medial ankle regions. The profile showed a discrepancy in the thermal pattern in the regions of interest of wounded and without wound extremities according to the diagnoses. Signs of wounds emitting high levels of radiation were similar in both groups, but the physiology of the disease and treatment differed.

만성 발목 불안정성 유소년축구선수의 기능성 양말 착용과 테이핑 처치가 자세 안정성, 통증 척도 및 선수재활 체력요인에 미치는 영향

The purpose of this study was to examine the effects of wearing functional socks and taping treatment on chronic ankle instability (CAI) youth soccer players on postural stability, pain scale, and physical fitness factors. Subjects were randomly assigned to 30 CAI male soccer players (00+00) from the Seoul Youth Club team into functional socks wearing group, ankle kinesiology taping (KT) treatment group, and control group (cross-over design). Participants repeatedly measured the two conditions of KT and functional socks after a 3-day washout period. The KT tape was attached to the injured ankle with a width of 5 cm, a thickness of 0.05 cm, and a tension of 70%. The KT procedure was performed by the same professional physical athlete trainer. The functional sock was designed by Fortium Co., Ltd. to control talar joint motion, including the posterior glide of the talus during dorsiflexion and anterior glide during plantar flexion while preventing adduction. Postural stability was measured as static balance, one leg balance, the pain scale was visual analogue scale (VAS), and the physical variables were lower extremity muscle strength, agility and agility. As a result, there was no difference in physical fitness factors, but both wearing functional socks and taping treatment showed positive differences compared to the control group in postural stability and pain scale. In conclusion, it was suggested that functional socks are an effective method for postural stability and pain in CAI youth soccer players by stimulating sensory receptors in the ankle region as much as the effect of KT treatment.

2D perfusion angiography: an alternative method to evaluate endovascular intervention for acute lower limb ischemia

BackgroundDespite advances in endovascular techniques to treat acute limb ischemia (ALI), evaluation of clinical outcomes for revascularization remains challenging, especially the accurate quantification of post-endovascular limb perfusion. This study aimed to investigate the accuracy and value of 2D perfusion angiography to evaluate endovascular intervention for ALI.MethodsA total of 47 patients with ALI were retrospectively analyzed. The transcutaneous oxygen partial pressure (TcPO2) was obtained using laser Doppler blood perfusion monitoring. The ankle-brachial index (ABI) and angiographic images were obtained before and after endovascular intervention. iFlow imaging was used to obtain color-coded images. Regions of interest (ROIs) at the femoral head, knee joint, and ankle joint were selected to obtain the time to peak (TTP). The differences in the TTP between the knee and femoral head regions (TTP difference in the knee area) and between the ankle and knee regions (TTP difference in the ankle area) were observed. The TTP, ABI, and TcPO2 between the complete response (CR), partial response (PR), no response (NR), and amputation (AM) groups were compared. The correlation between TTP changes in the ankle area (ΔTTP) and changes in ABI (ΔABI)/changes in TcPO2 (ΔTcPO2) was analyzed.ResultsThere was a significant increase in both TcPO2 and ABI compared with the pre-intervention values (27.75 ± 5.32 vs 40.92 ± 4.62, and 0.35 ± 0.16 vs 0.79 ± 0.15, respectively, all p < 0.01). The post-intervention TTP differences in the knee areas (5.12 ± 2.45 s) and ankle areas (6.93 ± 4.37 s) were significantly faster than pre-intervention TTP differences (7.03 ± 2.57 s and 10.66 ± 4.07 s, respectively, all p < 0.05). The post-operative TTP in the ankle area, post-operative TTP difference in the ankle area, and ΔTTP in the AM group were higher than the values in the CR and PR groups. The ΔTTP demonstrated strong correlation with ΔABI (r = −0.722, p < 0.01) and ΔTcPO2 (r = −0.734, p < 0.01).Conclusions2D perfusion angiography with enhanced visual and quantitative analysis exhibits great potential to evaluate the efficacy of endovascular intervention, and provides a quantitative and sensitive tool to evaluate post-endovascular limb perfusion for ALI patients.

Presurgical Perspective and Posttreatment Evaluation of Soft Tissue Tumors of the Ankle and Foot in Adults.

This article discusses soft tissue tumors of the ankle and foot region in adults, including tumors of the joints, and also briefly addresses tumor-simulating lesions. We offer general recommendations and describe specific aspects of common entities in that region, such as typical imaging appearance, therapeutic strategies, and posttherapeutic considerations. Focal masses and diffuse swelling are common in the foot and ankle region; most of them are non-neoplastic. Some of the tumors, such as plantar fibromatosis, tenosynovial giant cell tumor, synovial chondromatosis, or schwannoma, have a very typical appearance on magnetic resonance imaging. Sarcomas are rare among true soft tissue tumors; however, they can be small and well demarcated, may grow slowly, and are often misinterpreted as benign. This is especially true for synovial sarcoma, one of the most common sarcomas in this region. Densely packed tissues in the foot and ankle may hamper determining the tissue of origin. Adherence to diagnostic guidelines and cooperation with tumor centers is crucial including for posttherapeutic surveillance. We also describe typical posttherapeutic changes and complications after surgery, radiation therapy, and chemotherapy, as well as parameters for the detection and exclusion of recurrence of soft tissue tumors of the ankle and foot.

Correction: Diagnosis and Treatment of Intraosseous Ganglion in the Ankle Region.

Correction to: Diagnosis and Treatment of Intraosseous Ganglion in the Ankle RegionZ Orthop Unfall eFirstDOI: 10.1055/a-1938-8449

Right foot – osteochondroma - A case report

Osteochondromas are thought of as benign bone tumours, however they are actually developmental defects.A long tubular bone that may be sessile or pedunculated has an outgrowth with cartilage covering it that is visible on radiographs. Additionally, the cartilage cap can harden. Any changes in radiological appearance are strongly indicative of chondrosarcoma, particularly those with ill-defined border development and thickening of the cartilage cap &amp;#62;15 mm.: An insidious onset, slow progression, and lack of aggravating or alleviating variables were all complaints made by a 21-year-old male patient with swelling and pain across the right foot dorsal side for the past two years Upon examination, there was a firm, irregularly shaped, 5 to 6 cm swelling over the dorsal part of the right foot that was attached to the underlying bone.: The majority of benign bone tumours, or 36% to 41% of all benign bone tumours, are conventional osteochondromas. Osteochondromas are uncommon in the foot and ankle regions, but if a big osteochondroma develops in these areas and is interfering with function, it should be removed. The amount of the lesion, any soft tissue involvement, and the depth and placement of the cartilage cap can all be seen on an MRI, which is helpful in the workup of an osteochondroma that is symptomatic or worrisome.According to histology, the osteochondroma's cap is made of hyaline cartilage, with well-differentiated cells abundantly spaced out by cartilage matrix and oriented in columns that mimic the epiphyseal growth plate in the deepest levels of the cap.

Analysis of Front Leg Kinematics of Cricket Bowler Using Wearable Sensors and Machine Learning

A fast bowler in the game of cricket is exposed to high-intensity actions and is more prone to lumbar stress fractures, ankle sprains, and knee, shoulder, and lower back injuries. There are different phases of bowling, from running to ball release, viz., run-up, predelivery stride (PDS), mid-bound (MB), front foot contact (FFC), ball release, and follow through. The front leg motion of the bowler plays a crucial role in delivering the ball efficiently. An improper landing after the jump causes most of the injuries as more strain is induced on the knee, ankle, and groin region. Loss of balance during the follow-through is the other most common reason for injury. A braced front leg at FFC helps the bowler transfer the momentum gained during the run-up into a fast-bowling action. For a refined understanding of the motion of the bowler and the causes of injuries, the identification of bowling phases is crucial. This article proposes the design of a miniature and economical wearable sensor unit using a Bosch BNO055 inertial measurement unit (IMU) sensor that the players can comfortably wear during the game. A novel method for calculating knee flexion of bowlers at FFC using quaternion data gathered from sensors is presented. Two wearable units were placed on the bowler’s front leg to collect motion data. Supervised machine-learning algorithms have been evaluated for classifying bowling phases using statistical features extracted from the sensor data to assist coaches and players with data-driven and evidence-based bowlers’ training.

Diagnosis and Treatment of Intraosseous Ganglion in the Ankle Region.

To investigate the diagnosis and treatment of intraosseous ganglion cyst in the ankle region. A retrospective analysis was performed on the diagnosis and treatment of 18 patients with intraosseous ganglion in the ankle region from January 2005 to March 2016. There were 11 males and 7 females, with an average age of 40.4 years (22-74 years). Thirteen of these had mild intermittent localized pain in the ankle and five were asymptomatic and fortuitously found on images. According to the location of the intraosseous ganglion cyst, nine were located in the distal end of tibia, seven were in the distal end of the fibula, and two were in the talus. After curettage of intraosseous ganglion, 15 cases were filled with autogenous iliac bone and 3 cases with artificial bone. Fifteen cases were diagnosed with radiographs and CT scans, two cases with MR images, and one case was confirmed by postoperative pathology. The cyst contents were jelly-like material with sclerotic bone margins. The mean size of the intraosseous ganglion cyst was 1.5cm × 1.5cm × 1cm. Hematoxylin and eosin (H&E) staining of the tissue showed fibrous tissue, collagenous fiber, mucoid, and a few fibroblasts. Eighteen cases were followed up for 11 months to 10 years, with an average of 5.4 years. No recurrence was found. Sixteen patients were asymptomatic after surgery. Two cases of ankle pain occurred at 1 year and 6 months postoperatively, respectively. According to the American Orthopaedic Foot and Ankle Society (AOFAS) ankle-hindfoot scale, the mean AOFAS ankle-hindfoot score improved from 78.2±13.7 points preoperatively to 97.3±4.5 points at the final follow-up. For the intraosseous ganglion cyst in the ankle region, whether there are clinical symptoms or not, the cyst should be curettaged and the cavity should be filled with bone graft. The operation result is satisfactory.

Combined Arthroscopic and Endoscopic Synovectomy for Diffuse Pigmented Villonodular Synovitis (PVNS) of the Ankle

The current treatment of choice for diffuse-type pigmented villonodular synovitis (PVNS) is surgical excision. Complete synovectomy is necessary because of the local aggressiveness of the disease, with a significant recurrence rate and a minor chance of malignant transformation. The recurrence rate is even greater in those cases with extra-articular extension. Arthroscopic and endoscopic synovectomy have the advantage of avoidance of extensive soft-tissue dissection, which is associated with open synovectomy. The purpose of this Technical Note is to describe the details of combined arthroscopic and endoscopic synovectomy as treatment for diffuse PVNS of the ankle. By a combination of different arthroscopic and endoscopic approaches of the ankle region, a complete synovectomy of both intra-articular and extra-articular components of diffuse-type PVNS is feasible.

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.

Outcomes of Surgical Treatment for Symptomatic Superficial Peroneal Neuromas

Category: Ankle; Midfoot/Forefoot; Trauma; Other Introduction/Purpose: Peripheral nerve injury or entrapment is a common complication following surgery in the foot and ankle region. The superficial peroneal nerve is particularly at risk following ankle arthroscopy and lateral approaches to the ankle or fibula. Symptoms can result in intense pain and significant disability for patients. The purpose of this study is to investigate the outcomes of superficial peroneal nerve neurolysis and neurectomy. Methods: All patients were identified who underwent operative treatment by two foot and ankle specialists for superficial peroneal nerve related pain. Exclusion criteria included patients under the age of 18, prisoners, those who underwent concomitant osseous procedures, and less than 6-week follow-up. Demographic data, baseline outcomes including FFI, SF-36, FAAM, and VAS were recorded. Final follow-up questionnaires using PROMIS measures and FAAM were administered using REDCap. Results: 55 patients were included in this study with a mean age of 43.0 years (IQR, 33.0-48.0). At a median follow-upof 6.8 months (IQR 1.2-20.2 months), VAS improved from a median of 9.0 (IQR 6.0-9.0) preoperatively to 2.0 (IQR 0.00-5.0) after surgery, p &lt; 0.05. Patients reported a median VAS improvement of 4.0 (IQR 2.0-7.0). At final follow-up patients reported PROMIS lower extremity function score median of 58.6 (IQR 45.2-58.6), PROMIS neuropathic pain quality score of 42.9 (IQR 37.2-55.5), and PROMIS pain interference of 50.5 (IQR 41.1-57.0). Worker's compensation claims were independently associated with significantly poorer post-operative function measured using FAAM ADL (58.58 WC vs 74.86 non-WC, p&lt;0.02) and higher post- operative VAS scores (4.46 WC vs 2.36 non-WC, p&lt;0.01). ). Patients with current or recent tobacco use within 3 months leading up to surgery reported significantly higher post-operative VAS pain scores compared to nonsmokers (4.54 vs 2.47, p&lt;0.02). Conclusion: Neurectomy or neurolysis has potential to significantly improve somatic pain for entrapment or neuroma formation of the superficial peroneal nerve. Tobacco use as well as worker's compensation claims were associated with significantly poorer outcomes. Further studies are needed to optimize perioperative management and surgical techniques for these patients.