Unilateral Ankle Research Articles

Immediate Effect of a Single Anteroposterior Talus Mobilization on Dorsiflexion Range of Motion in Participants With Orthopedic Dysfunction of the Ankle and Foot

ObjectiveThe purpose of this study was to determine the immediate effects of a single anteroposterior mobilization of the talus on the active dorsiflexion range of motion (ROM) in participants with different orthopedic foot and ankle injuries. MethodsThis study included 30 male and female participants aged 18 to 50 years with unilateral orthopedic foot and ankle dysfunction. All participants underwent 3 sets of active dorsiflexion ROM measurement in both ankles. Measurements included baseline, post–first treatment, and post–second treatment values. Participants received either joint mobilization or manual contact (control) on the affected ankle. Active dorsiflexion ROM was assessed using a biplanar goniometer with participants in the prone position and 90° of knee flexion. ResultsBoth groups (joint mobilization and manual contact) showed increased active dorsiflexion ROM. However, the mean difference of dorsiflexion measurements before and after mobilization was greater than before and after control treatment. ConclusionA single session of articular mobilization of the talus did not significantly increase dorsiflexion ROM in participants with orthopedic dysfunctions of the ankle and foot compared with a manual contact procedure.

Effect of soft and semirigid ankle orthoses on Star Excursion Balance Test performance in patients with functional ankle instability

To evaluate the effect of soft and semirigid ankle orthoses on dynamic balance assessed using Star Excursion Balance Test in patients with functional ankle instability compared with healthy individuals. Non-experimental, observational study with multiple-factor design, including group (functional ankle instability and healthy) as the between-subjects factor and orthotics condition (no orthosis, soft orthosis and semirigid orthosis) as the within-subjects factor. Sixteen unilateral functional ankle instability patients and a group of 16 healthy control individuals, matched for age, height and weight, participated in the study. Dynamic balance was tested with and without wearing ankle orthosis. Reach distance of participants in 3 bracing conditions were measured in anteromedial, medial and posteromedial directions of Star Excursion Balance Test. Average of 3 trials in 3 measured directions, normalized to leg length of each participant, was used for statistical analysis. There were no differences among orthotics conditions in healthy people. However, normalized reach distance increased from no-orthosis to semirigid to soft orthoses in FAI patients. Differences were significant between soft and no-orthosis (13% in anteromedial, 14% in medial and 15% in posteromedial direction p=0.01) and between semirigid and no-orthosis (10% in anteromedial, 8.5% in medial and 8.5% in posteromedial direction, p=0.01) conditions in all 3 measured directions. The difference between soft and semirigid orthoses was significant (6% difference, p<0.05) only in PM direction. Ankle orthoses improve reach distance in functional ankle instability patients in various reach directions. Soft orthosis has a more pronounced effect on dynamic balance, especially in posteromedial direction, compared with semirigid orthosis.

SAT0423 A randomized, controlled, multicenter study on the effectiveness of traumeel (ointment and gel) in terms of pain reduction and function improvement compared with diclofenac gel in acute ankle sprain

BackgroundAcute lateral ankle sprain is generally accepted as the most common ligamentous sports and daily exercise injury associated with acute inflammation. When left untreated, these injuries can lead to joint...

SAT0080 Ankle synovitis and its prognostic implications in a very early arthritis cohort

BackgroundAnkle synovitis occurs in over a third of early inflammatory arthritis patients and may be present in isolation. However, the clinical outcomes associated with ankle involvement in this population are...

Brain Regulation of Muscle Tone in Healthy and Functionally Unstable Ankles

Current research into the etiology of joint instability has yielded inconsistent results, limiting our understanding of how to prevent and treat ligamentous injury effectively. Recently, cortical reorganization was demonstrated in patients with ligamentous injury; however, these neural changes have not been assessed relative to joint laxity. The purpose of the current study was to determine if changes in cortical excitability and inhibition occur in subjects with functional ankle instability, as well as to investigate the relationship between these measures and joint laxity. Posttest only with control group. University laboratory. 12 subjects with no history of ankle sprain (CON) and 12 subjects with a history of unilateral functional ankle instability (UNS). Subjects were tested for joint laxity using an instrumented ankle arthrometer. Cortical excitability and inhibition were assessed using transcranial magnetic stimulation (TMS) to obtain motor-evoked potentials and the cortical silent period from the lower leg muscles. Joint laxity was quantified as peak anterior displacement and inversion rotation. Active motor threshold, slope, and intensity at 50% of peak slope of TMS-derived recruitment curves were used to quantify cortical excitability from lower leg muscles, while the cortical silent period from the peroneus longus was used to represent intracortical inhibition. No significant differences were observed between groups for laxity or cortical measures. CON demonstrated a significant relationship between laxity and tibialis anterior excitability, as well as laxity and silent period, while UNS ankles demonstrated significant relationships between peroneal and soleus excitability and laxity measures. Our results support relationships between laxity and measures of excitability and inhibition that differ between healthy and unstable subjects. Future research should further investigate the mechanisms behind these findings and consider cortical influences when investigating altered joint laxity.

The Effect of Isokinetic Testing Speed on the Reliability of Muscle Fatigue Indicators During a Hip Abductor-Adductor Fatigue Protocol

The aim of this study was to investigate the reliability of fatigue indicators calculated from peak torque and total work during isokinetic speeds of 60, 90, 120 and 180° · s-1 during a hip fatigue protocol. 10 males suffering from a history of unilateral functional ankle instability and 10 male healthy controls performed 5 maximal concentric contractions on an isokinetic dynamometer. Following a 4 min rest period subjects were instructed to perform repeated maximal concentric contractions to fatigue, which was defined as 3 consecutive repetitions below 50% of the maximum peak torque value. Each testing speed was randomised with 24 h between speeds. The subjects were asked to return to the laboratory 7 days later to repeat the 4 speeds, with 24 h between speeds. Muscle fatigue was determined for each testing speed by the fatigue index, the percent decrease in performance and the slope of the regression equation. The most reliable fatigue determination method was the slope of the regression equation, when testing at a speed of 120° · s-1. It is recommended that future investigators examine and plot their data before choosing the slope of the regression equation as their fatigue indicator, as a linear model is required.

The Eccentric Torque Production Capacity of the Ankle, Knee, and Hip Muscle Groups in Patients with Unilateral Chronic Ankle Instability

The aim of this study was to investigate eccentric torque production capacity of the ankle, knee and hip muscle groups in patients with unilateral chronic ankle instability (CAI) as compared to healthy matched controls. In this case-control study, 40 participants (20 with CAI and 20 controls) were recruited based on convenient non-probability sampling. The average peak torque to body weight (APT/BW) ratio of reciprocal eccentric contraction of ankle dorsi flexor/plantar flexor, ankle evertor/invertor, knee flexor/extensor, hip flexor/extensor and hip abductor/adductor was determined using an isokinetic dynamometer. All subjects participated in two separate sessions with a rest interval of 48 to 72 hours. In each testing session, the torque production capacity of the ankle, knee, and hip muscle groups of only one lower limb was measured. At first, 3 repetitions of maximal eccentric-eccentric contraction were performed for the reciprocal muscles of a joint in a given movement direction. Then, the same procedure of practice and testing trials was repeated for the next randomly-ordered muscle group or joint of the same limb. There was no significant interaction of group (CAI and healthy controls) by limb (injured and non-injured) for any muscle groups. Main effect of limb was not significant. Main effect of group was only significant for eccentric torque production capacity of ankle dorsi flexor and hip flexor muscle groups. The APT/BW ratio of these muscles was significantly lower in the CAI group than the healthy controls (P<0.05). CAI is associated with eccentric strength deficit of ankle dorsi flexor and hip flexor muscles as indicated by reduction in torque production capacity of these muscles compared to healthy controls. This strength deficit appeared to exist in both the injured and non-injured limbs of the patients.

Study protocol: the effect of whole body vibration on acute unilateral unstable lateral ankle sprain- a biphasic randomized controlled trial

BackgroundAnkle sprains often result in ankle instability, which is most likely caused by damage to passive structures and neuromuscular impairment. Whole body vibration (WBV) is a neuromuscular training method improving those impaired neurologic parameters. The aim of this study is to compare the current gold standard functional treatment to functional treatment plus WBV in patients with acute unilateral unstable inversion ankle sprains.Methods/Design60 patients, aged 18–40 years, presenting with an isolated, unilateral, acute unstable inversion ankle sprain will be included in this bicentric, biphasic, randomized controlled trial. Samples will be randomized by envelope drawing. All patients will be allowed early mobilization and pain-dependent weight bearing, limited functional immobilization by orthosis, PRICE, NSARDs as well as home and supervised physiotherapy. Supervised physical therapy will take place twice a week, for 30 minutes for a period of 6 weeks, following a standardized intervention protocol. During supervised physical therapy, the intervention group will perform exercises similar to those of the control group, on a side-alternating sinusoidal vibration platform. Two time-dependent primary outcome parameters will be assessed: short-term outcome after six weeks will be postural control quantified by the sway index; mid-term outcome after one year will be assessed by subjective instability, defined by the presence of giving-way attacks. Secondary outcome parameters include: return to pre-injury level of activities, residual pain, recurrence, objective instability, energy/coordination, Foot and Ankle Disability Index and EQ 5D.DiscussionThis is the first trial investigating the effects of WBV in patients with acute soft tissue injury. Inversion ankle sprains often result in ankle instability, which is most likely due to damage of neurological structures. Due to its unique, frequency dependent, influence on various neuromuscular parameters, WBV is a promising treatment method for patients with acute unstable inversion ankle sprains.Trial registrationNCT01702597

Influence of Isokinetic Strength Training of Unilateral Ankle on Ipsilateral One-legged Standing Balance of Adults

[Purpose] The purpose of the current study was to investigate the changes in one-legged standing balance of the ipsilateral lower limb following unilateral isokinetic strength training. [Subjects and Methods] Thirty healthy adult volunteers were randomly assigned to either a training group or a control group, so that each group included 15 subjects. Subjects in the training group performed unilateral ankle isokinetic exercises of the dominant leg using the Biodex 3 PRO System for a period of four weeks. Ipsilateral one-legged standing balance was evaluated before and after the intervention with three stability indexes of balance using the Biodex System: Anterior-Posterior Stability Index (APSI), Medial-Lateral Stability Index (MLSI), and Overall Stability Index (OSI). [Results] Comparison of pre- and post-test data revealed significant improvements in strength values (dorsiflexion, plantarflexion, eversion, and inversion) and stability indexes (APSI, MLSI, OSI). [Conclusion] These results suggest that ankle strengthening exercise can be considered as a form of exercise that may assist individuals with improvement of balance.

Active Weight Bearing Tibio-talar Motion and Meniscal Translation in the S.T.A.R Prosthesis-A Radiographic Comparative Study of the S.T.A.R. Toward the Opposite Normal Ankle Joint

Background: The kinematics of meniscal bearing artificial ankle joints is not well documented after the implantation of the prosthesis. Purpose of the study To investigate the active weight-bearing tibio-talar motion and the translation of the meniscus radiographically after mean 36 months in patients with unilateral traumatic ankle osteoarthritis. Methods: Straight lateral radiographic views under image intensification of the replaced ankle and the opposite normal ankle were performed during active weight-bearing. The tibio-talar motion of both ankles, as well as the translation/rotation of the meniscus in the replaced ankles was measured. Results: The total range of motion in normal ankles was mean 59° (33.7–68.7). The motion in the replaced ankles was mean 37.2° (16.7–53.3), p<0.02. Normal extension was mean 24° (3.7–37.7). Replaced ankle extension was mean 14.7° (2-26.7), p<0.02. Normal plantarflexion was mean 31° (19.7–51), in replaced ankles plantar flexion was mean 22.3° (12.3–34), p<0.02. The translation of the meniscus was 0.7 mm (-1.5 to 1.2). This could also be calculated to be a rotation of 3.9°. The translation of the meniscus is most probably a combination of gliding and rotation. Conclusions: The active weight-bearing motion of the replaced ankle is about 2/3 of the normal ankle motion. Functionally this is a satisfactory result. After 36 months the translation of the meniscus is rather small suggestion that the replaced ankle has reached a steady state of conformity.

Comparison of the effect of selected muscle groups fatigue on postural control during bipedal stance in healthy young women

Background:The maintenance of balance is an essential requirement for the performance of daily tasks and sporting activities and muscular fatigue is a factor to impair postural control, so this study was done to compare the effect of selected muscle groups fatigue on postural control during bipedal stance in healthy subjects.Materials and Methods:Fifteen healthy female students (24.3 ± 2.6 years) completed three testing session with a break period of at least 2 days. During each session, postural control was assessed during two 30-s trials of bipedal stance with eyes close before and after the fatigue protocol. Fatigue protocols were performed by 60% of their unfatigued Maximum Voluntary Contraction of unilateral ankle plantar flexors, bilateral lumbar extensors and bilateral neck extensors. One of the three fatigue protocols was performed on each session.Results:The result showed that fatigue had a significant effect on COP velocity and it increase COP velocity but there was not found any difference in postural sway between muscle groups.Conclusion:Localized muscle fatigue caused deficits in postural control regardless of the location of fatigue. Authors suggest the possibility of the contributions of central mechanisms to postural deficits due to fatigue and it seems that difference was not between muscle groups due to central fatigue.

Clinical Reasoning and Sports Medicine-Application of Hypothetico- Deductive Model

Hypothetico-deductive model of clinical reasoning was proposed by Mark Jones and it involves the self-reflection and informed clinical decision making process of generating and testing hypotheses in association with the patient’s presenting symptoms and signs. Sports medicine is a dynamic field with an ever-changing wealth of evidence-based information from practice, education and research. The objective of this editorial is to illustrate the application of clinical reasoning in sports medicine explained via the hypothetico-deductive model for a 23-year old female basketball player who presents with unilateral ankle pain after a twisting injury while landing on the foot. The eight hypotheses categories of dysfunction, pathobiological mechanism, and source of symptoms, contributing factors, precautions, management, prognosis and mechanisms of pain were described to illustrate the case example with emphasis on hypotheses generation and testing as an ongoing process in reflective thinking and individualized decision making in sports medicine.

Cross-cultural adaptation and validation of the Spanish version of the Cumberland Ankle Instability Tool (CAIT): an instrument to assess unilateral chronic ankle instability

The Cumberland Ankle Instability Tool (CAIT) is a valid instrument to determine the presence of chronic ankle instability (CAI) and to assess its severity. Self-report test is very useful for researchers and clinical practice, and CAI is a widespread tool. Nevertheless, there is lack of measurement instruments validated into Spanish, which represents a major difficulty for research dealing with a Spanish-speaking population. The questionnaire was cross-culturally adapted into Spanish. The psychometric properties tested in the Spanish version of the CAIT were measured for internal consistency, test-retest reliability, construct validity, criterion validity, and responsiveness in 108 participants who were recruited from several fitness centers. The Spanish version of the CAIT had high internal consistency (Cronbach's α = 0.766) and reliability (intraclass correlation coefficient = 0.979, 95% confidence interval (CI) = 0.958-0.990). Correlation with the 36-item Short-Form Health Survey (SF-36) physical component summary score (rho = 0.241, p = 0.012) was greater than the SF-36 mental component summary score (rho = -0.162, p = 0.094). The construct validity shows three different factors in the questionnaire and good responsiveness with a mean change of -2.43 (95% CI = -3.12 to 1.73, p < 0.0001) and a size effect of Cohen's d = 1.07. The Spanish version of the CAIT has been shown to be a valid and reliable instrument for measuring chronic ankle instability and constitutes a useful instrument for the measurement of CAI in the clinical setting in Spain.

Levodopa changes brain motor network function during ankle movements in Parkinson’s disease

Bradykinesia-the cardinal symptom in Parkinson's disease (PD)-affects both upper and lower limbs. While several functional imaging studies investigated the impact of levodopa on movement-related neural activity in Parkinson's disease during upper limb movements, analogue studies on lower limb movements are rare. We studied 20 patients with PD (mean age 66.8±7.2years) after at least 12h drug withdrawal (OFF-state) and a second time approximately 40min after oral administration of 200mg levodopa (ON-state) behaviourally and by functional magnetic resonance imaging (fMRI) at 3T during externally cued active ankle movements of the more affected foot at fixed rate. Results were compared with that obtained in ten healthy controls (HC) to separate pure pharmacological from disease-related levodopa-induced effects and to allow for interaction analyses. Behaviourally, all patients improved by at least 20% regarding the motor score of the Unified Parkinson's disease rating scale after levodopa-challenge (mean scores OFF-state: 38.4±10.1; ON-state: 25.5±8.1). On fMRI, levodopa application elicited increased activity in subcortical structures (contralateral putamen and thalamus) in the patients. In contrast, no significant levodopa-induced activation changes were found in HC. The interaction between "PD/HC group factor" and "levodopa OFF/ON" did not show significant results. Given the levodopa-induced activation increases in the putamen and thalamus with unilateral ankle movements in patients with PD but not in HC, we speculate that these regions show the most prominent response to levodopa within the cortico-subcortical motor-circuit in the context of nigrostriatal dysfunction.

The Effect of Modified Broström-Gould Repair for Lateral Ankle Instability on In Vivo Tibiotalar Kinematics

Background: Lateral ankle instability leads to an increased risk of tibiotalar joint osteoarthritis. Previous studies have found abnormal tibiotalar joint motions with lateral ankle instability that may contribute to this increased incidence of osteoarthritis, including increased anterior translation and internal rotation of the talus under weightbearing loading. Surgical repairs for lateral ankle instability have shown good clinical results, but the effects of repair on in vivo ankle motion are not well understood. Hypothesis: The modified Broström-Gould lateral ligament reconstruction decreases anterior translation and internal rotation of the talus under in vivo weightbearing loading conditions. Study Design: Controlled laboratory study. Methods: Seven patients underwent modified Broström-Gould repair for unilateral lateral ankle instability. Ankle joint kinematics as a function of increasing body weight was studied with magnetic resonance imaging and biplanar fluoroscopy. Tibiotalar kinematics was measured in unstable ankles preoperatively and postoperatively at a mean follow-up of 12 months as well as in the uninjured contralateral ankles of the same patients. Results: Surgical repair resulted in statistically significant decreases (expressed as mean ± standard error of the mean) in anterior translation of the talus (0.9 ± 0.3 mm; P = .018) at 100% body weight and internal rotation of the talus at 75% (2.6° ± 0.8°; P = .019) and 100% (2.7° ± 0.8°; P = .013) body weight compared with ankle kinematics measured before repair. No statistically significant differences were detected between repaired ankles and contralateral normal ankles. Conclusion: The modified Broström-Gould repair improved the abnormal joint motion observed in patients with lateral ankle instability, decreasing anterior translation and internal rotation of the talus. Clinical Relevance: Altered kinematics may contribute to the tibiotalar joint degeneration that occurs with chronic lateral ankle instability. The findings of the current study support the efficacy of this repair in improving the abnormal ankle motion observed in these patients.

Alterations in Gait Initiation Are Present in Those With Posttraumatic Ankle Osteoarthritis: A Pilot Study

The purpose of this investigation was to determine if stereotypical patterns of gait initiation are altered in those with posttraumatic ankle osteoarthritis. Ten subjects, five with unilateral ankle osteoarthritis and five uninjured controls, participated. Subjects completed the SF-36 and Ankle Osteoarthritis Scale to quantify self-reported disability as well as 10 dual-limb static stance trials and 10 gait initiation trials with each leg. Center of pressure outcomes were calculated for static balance trials while the peak center of pressure excursions were calculated for each phase of gait initiation. The results indicate greater self-reported disability (P < .05) and worse static postural control (P < .05) in the ankle osteoarthritis group. Nonstereotypical patterns were also observed during the first and third phases of gait initiation in those with ankle osteoarthritis. The results of this pilot study suggest that supraspinal motor control mechanisms may have changed in those with posttraumatic ankle osteoarthritis.

Visualization of painful process in peripheral tissue using positron emission tomography and [11C]-d-deprenyl

Abstract Background/aims An objective correlate of ongoing painful process in peripheral tissue would represent a progress in the analysis of pain. The aim of this study was to investigate if the extent of the injury and inflammation in musculoskeletal injuries can be visualized, quantified and followed over time using positron emission tomography (PET) with the radioligand [11C]-D-deprenyl. Methods Eight otherwise healthy patients with unilateral ankle sprain were PET-imaged acutely and followed up twice, first a month and then up to over one year after injury. Results Acutely [11C]-D-deprenyl uptake was significantly increased by a factor 10.7 (range 2.9–37.3) in the injury sites as compared to the intact ankle. During healing [11C]-D-deprenyl uptake was reduced, but not normalized until after 11 months. Conclusions Patients experiencing persistent pain showed prolonged [11C]-D-deprenyl uptake in the injury sites. Thus, PET can be used to visualize, quantify and follow painful processes in peripheral tissue.

Muscular atrophy of the lower leg in unilateral post traumatic osteoarthritis of the ankle joint

Muscle atrophy is a commonly encountered problem in osteoarthritis (OA). The aim of this study was to estimate the amount of muscle atrophy and fatty degeneration of the lower leg muscles related to ankle OA by magnetic resonance imaging (MRI). Twenty-one patients with unilateral ankle OA were included in this cohort study. Calf circumference of the affected and healthy lower leg was documented. The degree of OA was classified in conventional radiographs. The cross-sectional areas and fatty degeneration of the muscles of the lower leg were measured in bilateral MRI. We found a significantly reduced calf circumference of the affected vs. healthy leg (p = 0.016). MRI showed a significantly lower cross-sectional area of the entire lower leg musculature in OA (p = 0.013). Sub-analysis of muscle groups revealed that only the M. soleus had a significant cross-sectional area decrease (p < 0.01). All muscles showed a significant fatty degeneration (p < 0.01). We conclude that unilateral ankle joint osteoarthritis leads to an overall lower leg muscle atrophy, but significant atrophy of the M. soleus. All muscles of the affected leg undergo a fatty degeneration.

Long-term Follow-up of Tibiocalcaneal Arthrodesis in Diabetic Patients with Early Chronic Charcot Osteoarthropathy

Charcot osteoarthropathy with severe ankle instability and deformity is often managed with below-the-knee amputation if deformity and cutaneous compromise result in osteomyelitis. Recently, some surgeons have reported satisfactory outcomes with ankle arthrodesis in the coalescence or remodeling (subacute and chronic) stages of the disease before the onset of joint instability, severe deformity, and ulcer formation. This observational study describes the clinical outcomes of ankle arthrodesis in a cohort of 45 diabetic patients who underwent unilateral ankle arthrodesis for Charcot neuroarthropathic ankle deformity before the development of ulceration and bone infection. Two (4.44%) of the patients were lost to follow-up, whereas 2 (4.44%) others underwent below-the-knee amputation shortly after the ankle arthrodesis because of postoperative infection. After a mean follow-up duration of 5 ± 2.85 years, 39 (86.67%) patients returned to independent ambulation wearing custom-made shoes with molded insoles, whereas 2 (4.44%) others required pneumatic casts for ambulation.

Deep Tissue Hypersensitivity to Pressure Pain in Individuals with Unilateral Acute Inversion Ankle Sprain

The objective of this study was to investigate whether pressure hypersensitivity over deep tissues is a feature of acute inversion ankle sprain. This is a cross-sectional study. No study has previously investigated peripheral and central sensitization mechanisms in a clinical acute pain model such as inversion ankle sprain. Twenty individuals with unilateral inversion ankle sprain (10 women/10 men, age: 31 ± 7 years) and 19 comparable healthy controls (11 women/8 men, age: 30 ± 6 years) participated in this study. Pressure pain thresholds (PPTs) over anterior talofibular, calcaneofibular, and deltoid ligaments; the lateral and medial malleolus; the tibialis anterior muscle; second metacarpal; and median, radial, and ulnar nerves were bilaterally assessed. The analysis of variance (ANOVA) revealed that PPT levels over the affected anterior talofibular (P = 0.048) and calcaneofibular (P = 0.002) ligaments, and over the affected lateral malleolus (P < 0.001) were lower compared with the non-affected side within patients and both sides in controls. The patients also showed bilateral lower PPT levels over the deltoid ligament than controls (P < 0.05). No significant differences for PPT over the medial malleolus; the second metacarpal; the tibialis anterior muscle; and the median, ulnar, radial nerves were found. Significant negative correlations between intensity of ongoing pain and PPT over the anterior talofibular and deltoid ligaments were found: the higher the pain intensity, the lower the PPT. This study showed the presence of localized pressure pain hypersensitivity over ankle ligaments in patients with unilateral acute inversion ankle sprain, confirming the presence of localized peripheral sensitization.