Lateral Ankle Research Articles

The painful lateral column of the foot: from back to front.

The purpose of this article is to focus attention on the abnormalities which the radiologist may encounter in patients presenting with lateral ankle or foot pain outside of the context of acute trauma. These include anterolateral impingement, subfibular impingement, subtalar instability and tarsal sinus syndrome, tarsal coalition, sural neuromas, peroneal tendon abnormalities, calcaneocuboid instability and occult cuboid fractures, and painful accessory ossicles. The expected and unexpected findings on radiographs, CT, US, and MRI are discussed.

Is There a Borderline Value in the Radiological Findings of Patients With Calcaneal Malunion That May Help to Select an Appropriate Treatment Option?

Despite the constant evolution of technological support, operative techniques, and rehabilitation techniques after conservative treatment and operative treatment, a considerable number of patients with calcaneal fractures have constant pain, frequently resulting in loss of occupation. There are numerous options for the operative treatment of painful calcaneal malunion; however, very few publications suggest specific radiological measurements for pre- and postoperative planning-even fewer have statistically analyzed how these radiological measurements affect clinical outcomes. We performed a retrospective study of 100 patients after operative treatment of calcaneal malunion to determine the correlation between radiological measurements and clinical outcomes. Data were used to create an algorithm that would help to choose between in situ subtalar arthrodesis and complex reconstructive operations. The algorithm was then used to treat 27 prospective patients. The American Orthopaedic Foot & Ankle Society (AOFAS) hindfoot score and visual analog scale (VAS) were used for clinical assessment, whereas standard weightbearing anteroposterior (AP), lateral (LAT) ankle x-rays, and long axial hindfoot view were used for radiological assessment. The talar declination angle was positively correlated with clinical outcome. Patients with talar declination angles less than 6.5 degrees showed worse results in AOFAS score than patients with a greater angle did (57.3 ± 15.3 and 81 ± 15.6, respectively). The combination of subtalar arthrodesis with distraction bone block or calcaneal osteotomy in patients with calcaneal malunion and a talar declination angle less than 6.5 degrees showed better results than isolated in situ arthrodesis. Level III, retrospective cohort study, case series.

Effects Of Toe-in/ Out Toe-in Gait And Lateral Wedge Orthoses On Lower Extremity Joint Kinetics.

PURPOSE: The aim of the current investigation was to examine the effects of both lateral orthoses and toe-in/ toe-out foot progression angles on lower extremity joint loading during walking using a musculoskeletal simulation approach. METHODS: The current investigation examined 15 healthy males, walking in six different conditions (neutral, lateral orthoses, toe-in, lateral toe-in, toe-out and lateral toe-out). Walking kinematics were collected using an eight-camera motion capture system, and kinetics via an embedded piezoelectric force plate. Lower extremity joint loading was explored using a musculoskeletal simulation approach. RESULTS: This investigation showed that peak patellofemoral joint stress was greater in the neutral (3.96 KPa/BW) and lateral orthoses (4.20 KPa/BW) conditions compared to toe-in (3.33 KPa/BW), lateral toe-in (3.43 KPa/BW), toe-out (3.35 KPa/BW) and lateral toe-out (3.53 KPa/BW) and ankle joint impulse larger in the toe-in (1.65BW·s) and toe-out (1.62BW·s) foot progression angle modalities compared to neutral (1.51BW·s) and lateral orthoses (1.53BW·s). Furthermore, it was also shown that medial tibiofemoral impulse was statistically greater in the toe-in (1.20BW·s) and lateral toe-in (1.15BW·s) conditions compared to neutral (1.07BW·s), lateral orthoses (1.07BW·s), toe-out (1.09BW·s) and lateral toe-out (1.05BW·s). CONCLUSIONS: Therefore, the current investigation provides evidence that altering the foot progression angle may attenuate the risk from patellofemoral disorders whilst simultaneously enhancing the risk from degenerative ankle pathologies. Similarly, adopting a toe-in foot progression angle may also increase the risk from medial tibiofemoral degeneration.

The Agility Total Ankle Arthroplasty: A Concise Follow-up at a Minimum of 20 Years.

Between 1984 and 1994, a single surgeon performed 132 primary cementless total ankle replacements using the Agility total arthroplasty system. The purpose of this study was to report on the 20-year follow-up, which we believe is the first study with this length of follow-up. Living patients were contacted and interviewed to determine the status of their implant (revised or unrevised) and to answer a simple questionnaire concerning overall satisfaction, pain, and functional improvement, as in a previous study. Thirty-three (26.2%) patients with 33 (25%) ankles of the original series were alive at a minimum of 20 years postoperatively, with a median follow-up of 22 years. They were asked to return to the office for standing anteroposterior and lateral ankle and foot radiographs or to send these radiographs if performed elsewhere. Radiographs were evaluated for radiolucencies around the components and subsidence (talar component) or migration (tibial component) of components. Seventeen (13.5%) ankles of the 126 available for follow-up, including 5 (15.2%) ankles in living patients, had undergone revision (n = 10) or arthrodesis (n = 7) for loosening. One additional ankle was revised for infection and 1 for talar component malposition; thus, 19 (15.1%) ankles were revised. These results should provide a 20-year benchmark for newer total ankle arthroplasty designs when a similar length of follow-up becomes available. Level III, retrospective cohort study.

Effects of toe-in/ out toe-in gait and lateral wedge orthoses on lower extremity joint kinetics; an exploration using musculoskeletal simulation and Bayesian contrasts

IntroductionThe aim of the current investigation was to examine the effects of both lateral orthoses and toe-in/ toe-out foot progression angles on lower extremity joint loading during walking using a musculoskeletal simulation approach.MethodsThe current investigation examined 15 healthy males, walking in 6 different conditions (neutral, lateral orthoses, toe-in, lateral toe-in, toe-out and lateral toe-out). Walking kinematics were collected using an eight-camera motion capture system, and kinetics via an embedded piezoelectric force plate. Lower extremity joint loading was explored using a musculoskeletal simulation approach.ResultsThis investigation showed that peak patellofemoral joint stress was greater in the neutral (3.96 kPa/BW) and lateral orthoses (4.20 kPa/BW) conditions compared to toe-in (3.33 kPa/BW), lateral toe-in (3.43 kPa/BW), toe-out (3.35 kPa/BW) and lateral toe-out (3.53 kPa/BW) and ankle joint impulse larger in the toe-in (1.65BW·s) and toe-out (1.62BW·s) foot progression angle modalities compared to neutral (1.51BW·s) and lateral orthoses (1.53BW·s). Furthermore, it was also shown that medial tibiofemoral impulse was statistically greater in the toe-in (1.20BW·s) and lateral toe-in (1.15BW·s) conditions compared to neutral (1.07BW·s), lateral orthoses (1.07BW·s), toe-out (1.09BW·s) and lateral toe-out (1.05BW·s).Conclusions Therefore, the current investigation provides evidence that altering the foot progression angle may attenuate the risk from patellofemoral disorders whilst simultaneously enhancing the risk from degenerative ankle pathologies. Similarly, adopting a toe-in foot progression angle may also increase the risk from medial tibiofemoral degeneration.

Classification of the lymphatic pathways in each lymphosome based on multi-lymphosome indocyanine green lymphography: Saphenous, calf, and thigh (SCaT) classification

The anatomy of the lymphatic vessels in the extremities is not completely understood. The aim of this study was to elucidate the patterns of the lymphatic pathways of each lymphosome in lymphedematous legs. We performed a retrospective study on 630 lymphosomes from 105 patients with leg lymphedema. The mean age of the subjects was 58.9 (range: 20-91) years, and the mean duration of lymphedema was 8.8 (range: 1-91) years. In indocyanine green (ICG) lymphography, we injected ICG into the multi-lymphosome: the first web space of the foot (saphenous lymphosome), lateral ankle (lateral calf lymphosome), and lateral knee (lateral thigh lymphosome). We established the saphenous, calf, and thigh (SCaT) classification based on the lymphatic location: lymphatic vessels on the medial side (type 1) and lymphatic vessels in other locations (type 2). In the saphenous lymphosome, 157 lymphatics (95.5%) were type 1. In the lateral calf lymphosome, 164 lymphatics (29.9%) were type 1. In the lateral thigh lymphosome, 148 lymphatics (16.9%) were type 1. The percentage of type 2 lymphatic vessels increased as the lymphoscintigraphic staging progressed. The lymphatic vessels in the lymphedematous legs shifted from the medial to the lateral side and finally disappeared in all lymphosomes as lymphedema worsened. We propose the SCaT classification to describe the condition of the lymphatic vessels in each lymphosome with the hope that it becomes a common staging system for sharing information on lymphedema severity among interdisciplinary medical professionals.

Pathologic complete response with radiation and vismodegib in a patient with advanced basal cell carcinoma: A case report.

In locally advanced basal cell carcinoma (BCC) patients who are not surgical candidates and where radiation therapy (RT) alone would offer lower control rates, the combination of vismodegib and RT delivered concurrently may potentially improve outcomes compared to single modality treatment. The current study presents a case of very advanced, multifocal BCC who received concurrent vismodegib and RT. The patient initially came in with four large primary areas of disease including the left preauriculum, right shoulder, chest wall and right lateral ankle. All sites achieved a clinical complete response, with a pathologic complete response at the right shoulder. The ankle lesion did not require RT and continues to have a clinical complete response. The findings from our case report support several other cases with similar efficacy when vismodegib and RT are combined.

Injuries in Collegiate Track and Field Jumping: A 2-Year Prospective Surveillance Study.

Background:Athletes participating in track and field jumping events (long jump, triple jump, high jump, and pole vault) are exposed to ground-reaction forces on the takeoff leg that are several times their body weight. This can cause injuries specific to such activities.Purpose:To determine the incidence of injuries in collegiate jumpers using the guidelines set forth by a 2014 consensus statement on injury surveillance during track and field events.Study Design:Descriptive epidemiology study.Methods:A total of 51 jumpers between April 2016 and March 2017 and 54 jumpers between April 2017 and March 2018 participated in this study. All athletes were from a single college in Japan. Baseline information on athletes participating in the long jump, triple jump, high jump, and pole vault was collected at study enrollment. Practice and competition exposures were reported by the team trainer. Injury incidence was calculated as the number of injuries per 1000 athlete-exposures (AEs).Results:A total of 147 injuries were reported among 16,998 exposures (8.65 injuries per 1000 AEs). The most common injury locations were the posterior thigh and lateral ankle (17.0%), followed by the posterior foot or toe (12.9%); the most frequent type of injury was strain/muscle rupture/tear (21.1%). The most common injury for long jumpers was ankle sprain (23.3%); for high jumpers, flexor hallucis longus tendinosis (15.8%); and for pole vaulters, hamstring strain (13.2%).Conclusion:The overall characteristics are different for each event; therefore, injuries for each event need to be investigated.

Relationship Between Peroneal Tendons and Anterior Talofibular Ligament

Background: Anterior talofibular ligament (ATFL) injuries are the most common in ankle torsional injuries. ATFL and peroneal tendons are both important stabilizers of lateral ankle joint. We aimed to evaluate peroneal tendons and ATFL. Methods: Fifteen nonpaired leg of fresh frozen cadavers were assessed in this study. After harvesting, ATFL diameters were measured at three points by calipers, these are fibular side, intermediate side and talar side. The mean of these three measurements were assessed and tissue a 15 lb load was applied to the peroneal tendons for 10 minutes, and the transverse diameters were measured by folding the thickest part of the tendon in a double-strand. Results: 5 single bundle, 8 double-bundle and 2 three bundles of ATFL were obtained after dissection. . There was no correlation between ATFL diameter, peroneus longus, peroneus brevis and total tendon diameters of peroneus longus and peroneus brevis in women (p> 0.05). A strong correlation was found between ATFL diameter, peroneus longus (r: 0.95), peroneus brevis (r: 0.81) and total tendon diameters of peroneus longus and peroneus brevis (r: 0.92) in men. Conclusion: Relationship between the diameter of the ATFL and peroneal tendons diameters were evaluated and a correlation was observed in males, while no correlation was observed in females.

Successful reconstruction of distal peroneus longus tendon dislocation associated with a split lesion \u2013 a case report

BackgroundPeroneal tendon injuries are one of the differential diagnoses in lateral ankle and rearfoot pain. While partial tears are not uncommon, peroneal tendon dislocation at the peroneal tubercle is very rare. Until now, only three papers have been published, presenting five cases of peroneus longus tendon dislocation over the peroneal tubercle. This report adds a previously undescribed case of a peroneus longus tendon split tear that was partially dislocated and entrapped over the peroneal tubercle. The respective operative approach and the outcome are described.Case presentationA 25-year-old international top-level speed skater developed a painful mass over the lateral calcaneal wall. There was no specific inducing injury in his medical history. In contrast to previous reports, according to the patient’s history, a snapping phenomenon was not present. Conservative treatment was not effective. By inspection and palpation an enlarged peroneal tubercle was assumed. During operative exploration, we found an incomplete longitudinal split tear of the peroneus longus tendon, which was partially dislocated and entrapped over the peroneal tubercle. This mimicked an enlarged peroneal tubercle. A portion of the split tendon was resected. A deepening procedure of the flat groove of the peroneus longus tendon below the peroneal tubercle and a transosseous reconstruction of the avulsed inferior peroneal retinaculum were performed. After six months, the patient had completely reintegrated into his elite sport and has been free of symptoms since then.ConclusionsFrom the presented case it can be speculated that the inferior peroneal retinaculum was overused, worn out, detached, or ruptured due to overpronation and friction the lateral edge of the low-cut speed skating shoe. Then the peroneus longus tendon experienced substantial friction with the peroneal tubercle with possible dislocation during ankle motion. This frictional contact may have finally led to further degeneration and a longitudinal tear of the tendon. Obviously, dislocations can develop insidiously resulting in lesions of the peroneus longus tendon at the peroneal tubercle, ultimately leading to a tendon entrapment. This mimics an enlarged tubercle. The pathology is very rare and can be successfully addressed surgically.

Magnetic resonance imaging of a sports injury of the lower extremities in children

Introduction. The number of acute and stressful injuries has been increasing in recent years. Injuries of the musculoskeletal system in children seeking emergency care account for 41%, while children aged from 5 to 17 years with chronic sports injuries account for 53% who need medical attention. The lower extremity is the most frequently affected part of patients aged from 5 to 18 years, which is about 60% of all injuries. Aim of the study. To show the possibilities of magnetic resonance imaging in the diagnosis of sports injuries of lower extremities in children. Materials and methods. MRI was performed on a scanner with a magnetic field strength of 3 T to obtain multi-planar STIR, T1-, T2- and PD-weighted images (WI) SE and GE in axial, oblique frontal and sagittal projections with a slice thickness of 4 mm, as well as 2D and 3D isotropic images that were used to obtain images with contrast gain. Specialized coils were used for MRI. MRI was performed in case of damage to the hip (n = 19), knee (n = 329), and ankle joints (n = 32). Results. Studies of the hip were limited to sports muscle injury - muscle strain due to forced contractile load (75.8%) and muscle bruises (24.2%). According to the MRI results, 320 children with knee injury were diagnosed with ACL ruptures, in 67% - complete (n = 214), 33% (n = 106) - partial. Eight (3.7%) of 214 athletes had isolated full breaks in ACL; the remaining 206 were associated with damage to other structures of the knee joint. ACL ruptures were accompanied in all 320 cases of hemarthrosis. Of 30 patients with an ankle injury, 17 had an anterior talofibular ligament (56.7%), in 8 cases with an avulsion of bone fragments from the lateral ankle. Partial deltoid ligament injuries were detected in 9 patients (30.0%); complete ruptures were rare and were observed in only two patients (6.7%). Conclusion. Among imaging methods, MRI plays a decisive role in the diagnosis of sports injuries in children.

Safety of medical compression stockings in patients with diabetes mellitus or peripheral arterial disease

IntroductionCompression therapy is highly effective in the treatment of many venous diseases, including leg edema. However, its relevance in patients with peripheral arterial disease (PAD) or diabetes mellitus is critically...

Minimally Invasive Treatment of Chronic Ankle Instability: a Comprehensive Review.

Chronic ankle pain is a prevalent and significant cause of chronic pain. While the definition of chronic ankle pain is heterogeneous and poorly defined in the literature, systematic reviews and meta-analyses have estimated this condition to be a prevalent and debilitating source of chronic pain. The most identifiable and prominent cause of chronic ankle pain is chronic ankle instability (CAI), a condition defined by instability of the ankle-joint complex. It is a common consequence of lateral ankle sprains or ligamentous injuries and can be described as a failure of the lateral ankle joint complex after an acute, or recurring, ankle injury. The objective of this manuscript is to provide a comprehensive review of CAI diagnosis and our current understanding of minimally invasive treatment options. First-line treatment is conservative management, some of which includes neuromuscular rehabilitation, balance training, nonsteroidal anti-inflammatory drugs (NSAIDs), manual mobilization, ice therapy, and compression. While conservative management is effective, additional treatments for those who fail conservative management, or who seek alternative options also have been explored. Recent advances and modern techniques have expanded available treatment options, many of which are becoming less invasive, and have shown improving functionality, recovery, and patient satisfaction. Minimally invasive treatments highlighted in this review include: arthroscopic surgery, steroid injections, plasma-rich plasma injections, hyaluronic acid (HA) injections, medicinal signaling cell injections, radiofrequency therapies, and shockwave therapies. This review will discuss some of these current treatments for minimally invasive treatment of CAI, as well as suggest novel treatments for clinical trials and further investigation.

Calf Reduction by Partial Resection of Gastrocnemius Using a Suction-Assisted Cartilage Shaver.

Long-term aesthetic reduction of the legs in Asians is gaining increasing popularity among cosmetic patients. Current treatment options include botulinum toxin injection, radiofrequency, neurectomy, and total, subtotal, or partial muscle resection of the gastrocnemius. Partial resection using Kelly forceps was introduced in 2000. This article presents the use of a suction-assisted cartilage shaver to perform partial resection, describing the procedures and shaver modifications and evaluating its use. A retrospective review of 71 cases with a minimum 6-month follow-up (average, 36.5 months; range, 6 to 160 months) was performed. Twenty partial calf reductions were performed with a short shaver, 27 with a long shaver, and 24 with an endoscope-guided long shaver. Mean reduction of calf circumference was 2 cm (range, -1 to 6 cm); the mean preoperative and postoperative calf circumferences were 35.8 cm and 33.8 cm, respectively. Mean tissue reduction per calf was 110 g (range, 25 to 300 g).Two patients developed larger calves after surgery, one because of weight gain and the other because of weight training. Complications included surface irregularity (n = 4, 5.6 percent), numbness over the lateral ankle or lateral foot (n = 9, 12.7 percent), hematoma clot requiring surgical evacuation (n = 11, 15.5 percent), prolonged seroma (n = 2, 2.8 percent), and left ankle plantar-flexion contracture due to tight, sustained postsurgery bandaging (n = 1, 1.5 percent). Scar-related complications were hyperpigmentation (n = 6, 8.5 percent), depressed scars (n = 5, 7 percent), and hypertrophic scars (n = 2, 2.8 percent). Short, long, and endoscope-guided long suction-assisted cartilage shavers for partial resection of calf muscles can be used effectively to reduce the calf. Several mostly treatable complications were noted. Therapeutic, IV.

Relationship between chronic ankle sprain instability and ultrasonographic evaluation of the peroneus during a single-leg standing task.

[Purpose] This study aimed to examine the relationship between chronic ankle sprain instability and ultrasonography of the peroneus muscles during a single-leg standing task. [Participants and Methods] We examined nine college-aged students with a history of lateral ankle joint sprain with chronic ankle sprain instability scores less than 24. Participants underwent ultrasonographic measurement of the pennation angle and muscle thickness of the peroneal and gastrocnemius muscle groups of both legs. In addition, participants were evaluated for fluctuation by the root mean square calculated from accelerations in the anteroposterior, lateral-horizontal, and vertical directions during the single-leg standing position by affixing the accelerometer to their waist. Measurement results were compared between sprain and non-sprain sides. [Results] Ultrasonography revealed a significant reduction in the feathered pennation angle of the long peroneal muscle on the side of the sprain, but no other significant differences. Also, significant extension was observed on the side of the sprain in the anteroposterior and vertical directions during single-leg standing; however, no significant differences were found in the lateral-horizontal direction. [Conclusion] Participants with chronic ankle sprain instability exhibited greater fluctuation in the anteroposterior and vertical directions. Such fluctuations are believed to be compensatory in nature because the feathered horn of the long peroneal muscle is decreased, and pronation of the forefoot is difficult during one-leg standing.

Application of different turnover intervals in preventing stress injury to patients in rescue room

Objective To investigate the effect of different turnover intervals in preventing stress injury to patients in emergency room. Methods The 200 eligible patients from July 2016 to July 2017 were divided into 4 groups by random number table method, 50 patients per group, named as the conventional group, test group 1, test group 2 and test group 3. Turning frequency was used for 2.0 h in the conventional group, and 2.5 h, 3.0 h and 3.5 h in the first, second and third groups, respectively. The average body pressure of the shoulder blade, left and right lateral ankle and sacral tail between the four groups at different turning time, the incidence of stress injuries, the comprehensive satisfaction of patients with turn-over nursing were compared. Results There was no statistically significant difference in the body pressure value of the main compression site between the four groups (P>0.05), and the incidence of stress injury was 2.0% (1/50), 2.0% (1/50), 2.0% (1/50), and 4.0% (2/50), respectively (P>0.05). The comprehensive satisfaction degree of the patients in the four groups was 71.0%(71/100), 75.0%(81/108), 79.8% (83/104), and 86.6% (97/112), respectively, with statistically significant differences (χ2=8.517, P< 0.05). For each of the two groups, only the general group and the experimental group showed statistically significant differences in the comprehensive satisfaction degree of the patients in the three groups (χ2=7.824, P< 0.01). Conclusions It shows that the 3.5 h turning-over interval can effectively prevent stress injuries, improve patient satisfaction, and reduce the workload of nursing staff without affecting patient treatment, nursing, and stress injury prevention. Key words: Emergency room; Pressure-induced injury; Average body pressure; Patients′ satisfaction

1419. A Rare Case of Clostridium beijerinckii Traumatic Osteomyelitis

BackgroundWe present a case of Clostridium beijerinckii osteomyelitis in the presence of retained foreign bodies not seen on MRI.MethodsA 45-year-old female with type 2 diabetes sustained multiple open right leg injuries, grossly contaminated with gravel, after a motor vehicle collision. She underwent external fixation (ex-fix) and 5 irrigations and debridements (I&D) initially. Polymicrobial intraoperative cultures (Cx) were treated with vancomycin and ertapenem for 6 weeks. One month post-antibiotic completion, pain, and swelling developed in ankle; contrast MRI revealed avascular necrosis and osteomyelitis (OM) of talus. Cx from repeat I&D grew same organisms; meropenem was recommended for 6 weeks. During meropenem week 6, pain was minimal and wound was closed. During attempt to implant hardware, pus was seen around peroneal tendon. Cx grew Clostridium species and Bacteroides from tibia, calcaneus, talus, and peroneal tendon sheath; meropenem was continued. Pain worsened 3 weeks later; I&D revealed pus in lateral ankle. To better access the medial ankle, a longitudinal incision was made along posterior tibial tendon, perpendicular to prior surgical incision. Immediate purulence, grass blades, and rocks were seen. Brucella agar had a rare gray colony at 48 hours and was subbed to blood and Brucella agar; it grew on Brucella agar with aero tolerance test. Gram stain showed Gram-positive rods with subterminal spores. Rapid ANA panel identified isolate as Clostridium beijerinckii (Cb) with > 99.9% probability and bioscore 1/24.ResultsCb is a strict anaerobic gram-positive rod with oval subterminal spores. Found in soil and water, its main use is industrial solvent production. Infection by Cb is rare; only 2 cases of OM, 1 traumatic endophthalmitis, and 1 mitral valve endocarditis have been reported. While uncommon, Clostridial osteomyelitis is associated with contaminated open traumatic injuries. It can be difficult to eradicate, despite aggressive surgical intervention and appropriate antibiotics.ConclusionThis is the third case of Cb OM described. Anaerobic cultures should be collected during I&D of open traumatic wounds. If infection persists, careful intraoperative evaluation of wound for residual foreign bodies, even if not seen radiologically, should be performed. Disclosures All authors: No reported disclosures.

Detection of inefficiency compensatory mechanism during gait in individual with functional ankle instability by use of inversion perturbation

To explore and identify the predictors of ankle sprain after an index (first) lateral ankle sprain.Prospective cohort study, Level of evidence II.Musculoskeletal research laboratory at the University of Sydney.A sample of convenience (70 controls, 30 with an index sprain) was recruited.Potential predictors of ankle sprain were measured including: demographic measures, perceived ankle instability, ankle joint ligamentous laxity, passive range of ankle motion, balance, proprioception, motor planning and control, and inversion/eversion peak power. Participants were followed up monthly and the number of ankle sprains was recorded over 12 months.Ninety-six participants completed the study; 10 participants sustained an ankle sprain. A combination of 10 predictors including: a recent index sprain, younger age, greater height and weight, perceived instability, increased laxity, impaired balance, and greater inversion/eversion peak power explained 27 to 56% of the variance in occurrence of ankle sprain (χ211,95 = 30.67, p = 0.001). The regression model correctly classified 90% of cases. The strongest independent predictors were history of an index sprain (odds ratio (OR) = 8.23, 95% confidence interval (CI) = 1.66 to 40.72) and younger age (OR = 8.41, 95%CI = 1.48 to 47.96).A recent index ankle sprain and younger age were the only independent predictors of ankle sprain. The combination of greater height or weight, feeling of instability, peak power and impaired balance predicted the occurrence of ankle sprain in almost 90% of participants. These findings could form the basis for intervention targeted at reducing recurrence of sprain after an index sprain.

Differential Effects of Sustained Manual Pressure Stimulation According to Site of Action.

Sustained pressure stimulation of the body surface has been used in several physiotherapeutic techniques, such as reflex locomotion therapy. Clinical observations of global motor responses and subsequent motor behavioral changes after stimulation in certain sites suggest modulation of central sensorimotor control, however, the neuroanatomical correlates remain undescribed. We hypothesized that different body sites would specifically influence the sensorimotor system during the stimulation. We tested the hypothesis using functional magnetic resonance imaging (fMRI) in thirty healthy volunteers (mean age 24.2) scanned twice during intermittent manual pressure stimulation, once at the right lateral heel according to reflex locomotion therapy, and once at the right lateral ankle (control site). A flexible modeling approach with finite impulse response basis functions was employed since non-canonical hemodynamic response was expected. Subsequently, a clustering algorithm was used to separate areas with differential timecourses. Stimulation at both sites induced responses throughout the sensorimotor system that could be mostly separated into two anti-correlated subsystems with transient positive or negative signal change and rapid adaptation, although in heel stimulation, insulo-opercular cortices and pons showed sustained activation. In direct voxel-wise comparison, heel stimulation was associated with significantly higher activation levels in the contralateral primary motor cortex and decreased activation in the posterior parietal cortex. Thus, we demonstrate that the manual pressure stimulation affects multiple brain structures involved in motor control and the choice of stimulation site impacts the shape and amplitude of the blood oxygenation level-dependent response. We further discuss the relationship between the affected structures and behavioral changes after reflex locomotion therapy.

The peroneus longus muscle and tendon: a review of its anatomy and pathology.

This article will review the anatomy and common pathologies affecting the peroneus longus muscle and tendon. The anatomy of the peroneus longus is complex and its long course can result in symptomatology referable to the lower leg, ankle, hindfoot, and plantar foot. Proximally, the peroneus longus muscle lies within the lateral compartment of the lower leg with its distal myotendinous junction arising just above the level of the ankle. The distal peroneus longus tendon has a long course and makes two sharp turns at the lateral ankle and hindfoot before inserting at the medial plantar foot. A spectrum of pathology can occur in these regions. At the lower leg, peroneus longus muscle injuries (e.g., denervation) along with retromalleolar tendon instability/subluxation will be discussed. More distally, along the lateral calcaneus and cuboid tunnel, peroneus longus tendinosis and tears, tenosynovitis, and painful os peroneum syndrome (POPS) will be covered. Pathology of the peroneus longus will be illustrated using clinical case examples along its entire length; these will help the radiologist understand and interpret common peroneus longus disorders.