Weight-bearing Ankle Research Articles

Predictors of response to foot orthoses and corticosteroid injection for plantar heel pain

BackgroundFoot orthoses and corticosteroid injection are common interventions used for plantar heel pain, however few studies have investigated the variables that predict response to these interventions.MethodsBaseline variables (age, weight, height, body mass index (BMI), sex, education, foot pain, foot function, fear-avoidance beliefs and feelings, foot posture, weightbearing ankle dorsiflexion, plantar fascia thickness, and treatment preference) from a randomised trial in which participants received either foot orthoses or corticosteroid injection were used to predict change in the Foot Health Status Questionnaire foot pain and foot function subscales, and first-step pain measured using a visual analogue scale. Multivariable linear regression models were generated for different dependent variables (i.e. foot pain, foot function and first-step pain), for each intervention (i.e. foot orthoses and corticosteroid injection), and at different timepoints (i.e. weeks 4 and 12).ResultsFor foot orthoses at week 4, greater ankle dorsiflexion with the knee extended predicted reduction in foot pain (adjusted R2 = 0.16, p = 0.034), and lower fear-avoidance beliefs and feelings predicted improvement in foot function (adjusted R2 = 0.43, p = 0.001). At week 12, lower BMI predicted reduction in foot pain (adjusted R2 = 0.33, p < 0.001), improvement in foot function (adjusted R2 = 0.37, p < 0.001) and reduction in first-step pain (adjusted R2 0.19, p = 0.011). For corticosteroid injection at week 4, there were no significant predictors for change in foot pain or foot function. At week 12, less weightbearing hours predicted reduction in foot pain (adjusted R2 = 0.25, p = 0.004) and lower baseline foot pain predicted improvement in foot function (adjusted R2 = 0.38, p < 0.001).ConclusionsPeople with plantar heel pain who use foot orthoses experience reduced foot pain if they have greater ankle dorsiflexion and lower BMI, while they experience improved foot function if they have lower fear-avoidance beliefs and lower BMI. People who receive a corticosteroid injection experience reduced foot pain if they weightbear for fewer hours, while they experience improved foot function if they have less baseline foot pain.

Supramalleolar osteotomy combined with lateral ligament reconstruction and talofibular immobilization for varus ankle osteoarthritis with excessive talar tilt angle

BackgroundAlthough supramalleolar osteotomy is the main joint-preserving method for the treatment of varus ankle osteoarthritis, it tends to be ineffective when ankle osteoarthritis presents in combination with an excessive talar tilt angle. The purpose of this study was to present a new surgical technique, supramalleolar osteotomy combined with lateral ligament reconstruction and talofibular immobilization, for the treatment of varus ankle osteoarthritis with an excessive talus tilt angle and to evaluate the clinical and radiological results.MethodsFrom January 2013 to October 2016, a total of 17 patients with 17 cases of varus ankle arthritis with excessive talar tilt angles (larger than 7.3°) underwent surgical treatment using our new technique. The American Orthopaedic Foot and Ankle Society (AOFAS) clinical ankle-hindfoot scale and a visual analogue scale (VAS) were used to evaluate ankle function and pain before surgery and at the last follow-up. The medial distal tibial angle (MDTA), anterior distal tibial angle (ADTA), talar tilt angle (TTA), and hindfoot moment arm values (HMAVs) were evaluated on weight-bearing radiographs acquired preoperatively and at the last follow-up.ResultsThe AOFAS score improved significantly from 45.8 ± 2.1 before surgery to 84.8 ± 1.8 after surgery (p < 0.001), and the VAS score decreased from 4.9 ± 0.4 to 1.1 ± 0.2 (p < 0.001). The MDTA, TTA, and HMAV changed from 80.9° ± 0.4° to 90.1° ± 0.4°, 11.7° ± 0.6° to 1.4° ± 0.3°, and 12.6 mm ± 0.8 mm to 4.2 mm ± 0.6 mm, respectively (each p < 0.001). The ADTA showed no obvious change (p = 0.370). The staging of 11 cases (65%) improved. Intramuscular vein thrombosis of the lower limbs occurred in 1 patient 1 week after surgery, and superficial infection occurred in 1 patient.ConclusionsSupramalleolar osteotomy combined with lateral ligament reconstruction and talofibular immobilization can correct the load of the weight-bearing ankle and effectively improve the ankle function. As the talar tilt angle can be significantly improved after surgery, this technique can be used for the treatment of varus ankle osteoarthritis with an excessive TTA.

Simultaneous ossicle resection and lateral ligament repair give excellent clinical results with an early return to physical activity in pediatric and adolescent patients with chronic lateral ankle instability and os subfibulare.

To elucidate surgical outcomes in pediatric/adolescent patients with chronic lateral ankle instability and os subfibulare. A retrospective chart review was conducted of pediatric/adolescent patients with chronic lateral ankle instability and os subfibulare following simultaneous ossicle resection and lateral ligament repair using suture anchors with subsequent immediate full weightbearing and active range of motion exercises for the ankle in our department between 2013 and 2017. Clinical outcomes were evaluated by comparing preoperative and final follow-up American Orthopaedic Foot and Ankle Society Ankle-Hindfoot Scale (AOFAS) and Karlsson-Peterson ankle function scores. Intervals between surgery and return to physical education in school were determined. 31 feet of 15 male and 16 female patients were examined. Mean postoperative follow-up duration was 40.7 ± 12.7 (range 24-66) months. Mean AOFAS score increased significantly from 66.3 ± 2.5 (range 62-77) preoperatively to 96.5 ± 4.9 (range 87-100) at final follow-up (p < 0.001). Mean Karlsson-Peterson score increased significantly from 51.7 ± 4.0 (range 47-70) preoperatively to 95.3 ± 6.7 (range 80-100) at final follow-up (p < 0.001). Mean interval between surgery and return to physical education in school was 11.4 ± 1.6 (range 10-18) weeks. Simultaneous ossicle resection and lateral ligament repair using suture anchors with subsequent immediate full weightbearing and active ankle range of motion exercises may give excellent clinical outcomes with early return to physical activity for chronic lateral ankle instability with os subfibulare in pediatric/adolescent patients desiring an early return to physical activity. Level of evidence III.

Relationship between the architecture and function of ankle plantar flexors with Achilles tendon morphology in ballet dancers

Achilles tendinopathy is the most frequent foot overuse injury in ballet dancers and knowledge of clinically modifiable factors related to tendon structure in a population at risk, such as ballet dancers, would be important for the development of preventive programs. Therefore, the present study aimed to assess relationships of gastrocnemius muscle architecture and ankle plantar flexors function with Achilles tendon morphology in ballet dancers. Fifty-four measures from 27 ballet dancers were collected. Tendon morphology (thickness, echogenicity, hypoechoic areas and neovascularisation) and muscle architecture (thickness, pennation angle and fascicle length) were evaluated using ultrasonography; ankle plantar flexors torque was evaluated using hand-held dynamometry, flexibility was evaluated in maximal weight-bearing ankle dorsiflexion position using inclinometer, and endurance was evaluated using the heel rise test. Ankle plantar flexors torque and medial gastrocnemius muscle architecture (thickness, pennation angle and fascicle length) are associated with Achilles tendon thickness in ballet dancers (r2 = 0.24, p = 0.008). Ankle plantar flexors torque and medial gastrocnemius muscle fascicle length are also associated with the echogenicity of the Achilles tendon (r2 = 0.13, p = 0.03). These findings call attention to the potential importance of ankle plantar flexors muscle force in healthy ballet dancers for the prevention of alterations in Achilles tendon structure.

Calf muscle stretching is ineffective in increasing ankle range of motion or reducing plantar pressures in people with diabetes and ankle equinus: A randomised controlled trial

BackgroundLimited ankle dorsiflexion, or equinus, is associated with elevated plantar pressures, which have been implicated in the development and non-healing of foot ulcer. A stretching intervention may increase ankle dorsiflexion and reduce plantar pressures in people with diabetes. MethodsTwo arm parallel randomised controlled trial from September 2016 to October 2017. Adults with diabetes and ankle equinus (≤5° dorsiflexion) were randomly allocated to receive an 8 week static calf stretching intervention or continue with their normal activities. Primary outcome measures were change in weight bearing and non-weight bearing ankle dorsiflexion and forefoot peak plantar pressure. Secondary outcome measures were forefoot pressure time integrals and adherence to the stretching intervention. Findings68 adults (mean (standard deviation) age and diabetes duration 67.4 (10.9) years and 14.0 (10.8) years, 64.7% male) were randomised to stretch (n = 34) or usual activity (n = 34). At follow up, no significant differences were seen between groups (adjusted mean difference) for non-weight (+1.3°, 95% CI:−0.3 to 2.9, p = 0.101) and weight bearing ankle dorsiflexion (+0.5°, 95% CI:−2.6 to 3.6, p = 0.743) or forefoot in-shoe (+1.5 kPa, 95% CI:−10.0 to 12.9, p = 0.803) or barefoot peak pressures (−19.1 kPa, 95% CI:−96.4 to 58.1, p = 0.628). Seven of the intervention group and two of the control group were lost to follow up. InterpretationOur data failed to show a statistically significant or clinically meaningful effect of static calf muscle stretching on ankle range of motion, or plantar pressures, in people with diabetes and ankle equinus.

Sex differences in lower extremity musculoskeletal and neuromuscular characteristics in intercollegiate soccer athletes

ABSTRACTPurpose: Establishing sex-specific musculoskeletal characteristics promotes specific and effective injury prevention. The purpose was to identify sex differences in musculoskeletal characteristics in soccer athletes.Methods: 80 collegiate male and female soccer athletes participated. Flexibility included: weight-bearing ankle dorsiflexion mobility (DFM), active ankle dorsiflexion (ADF), active knee extension (AKE), and passive hip flexion (PHF). Strength tests included: ankle dorsiflexion/inversion/eversion, knee flexion/extension, hip abduction/adduction/internal/external rotation. LE dynamic postural stability (DPS) was assessed with an accelerometer. DPS was expressed as the Dynamic Postural Stability Index composite (DPSIC) and component scores in the anterior/posterior (APSI), medial/lateral (MLSI), and vertical (VSI) directions. If normally distributed, differences were calculated using a Student’s T-test; if non-normal, a Mann–Whitney U test was utilized.Results: Flexibility tests yielded significant differences for AKE (Dominant:p = 0.008, Non-Dominant:p = 0.040) and PHF (Dominant:p < 0.000,Non-Dominant:p = 0.001). Strength tests yielded significant differences for non-dominant hip internal rotation (p = 0.002). Dynamic postural stability tests yielded significant differences for DPSIC (p = 0.0160) and APSI (p = 0.014).Conclusion: These results implicate that flexibility and DPS may be better linked to sex than strength, suggesting that they may sex-specific musculoskeletal characteristics for the purpose of effective injury prevention.

Acute Effects of Gastrocnemius/Soleus Self-Myofascial Release Versus Dynamic Stretching on Closed-Chain Dorsiflexion.

Limited ankle dorsiflexion (DF) range of motion has been correlated with decreased flexibility of the gastrocnemius/soleus complex. Decreased ankle DF range of motion can lead to an increase in lower-extremity injuries, for example, acute ankle sprains, Achilles tendinopathy. The purpose of this study was to determine whether a single application of the intervention to the gastrocnemius/soleus complex via multidirectional self-myofascial release using a foam roller, multiplanar dynamic stretch performed in downward dog, or a combination of both techniques acutely improved ankle DF. Subjects were assigned to groups via random card selection. Investigators provided verbal cues as needed to yield correct performance of interventions. Both interventions were performed twice for 1 minute using a dynamic walking rest of 30.48 m at a self-selected pace between interventions. Statistical analyses were completed using a 1-way analysis of variance, at α level ≤ .05. A convenience sample study. A total of 42 asymptomatic physical therapy students (18 females and 24 males) with mean age of 26.12 (4.03) years volunteered to participate. Multidirectional self-myofascial release using a foam roller, multiplanar dynamic stretch performed in downward dog, or a combination of both techniques. Weight-bearing right ankle DF measurements were recorded in centimeters using a forward lunge technique (intraclass correlation coefficient = .98, .97, and .96). Data analysis revealed no significant difference between the 3 groups in all pre-post measurements (P = .82). Mean (SD) measurements from pretest to posttest for myofascial release, dynamic stretching, and combination interventions were 0.479 (0.7)cm, 0.700 (0.7)cm, and 0.907 (1.4)cm, respectively. Until further studies are conducted, the selection of technique to increase ankle DF range of motion should be based on each individual patient's ability, preference, and response to treatment.

Athletes at late stage rehabilitation have persisting deficits in plantar- and dorsiflexion, and inversion (but not eversion) after ankle sprain

ObjectivesDocument reliability and normative data for a novel device measuring weight-bearing ankle range of motion after ankle injury. DesignCross-sectional Cohort, two occasions one day apart. SettingSports medicine hospital. Participants87 ankle-injured male athletes at a late stage of their rehabilitation and 25 uninjured subjects. The injured athletes had met all criteria to return to functional, on-field rehabilitation. Main outcome measuresReliability (Intra-Class correlation Coefficient (ICC), and Minimum Detectable Change as a percent of the grand mean), weight-bearing range of motion (degrees) of dorsiflexion, plantarflexion, inversion, and eversion. ResultsGood (dorsiflexion = 0.82[0.76–0.87] and inversion = 0.81[0.75–0.86]) and excellent (plantarflexion = 0.93[0.90–0.95]) reliability was documented, however reliability for the eversion measure showed only fair reliability (0.61[0.49–0.70]). Reduced range of motion in the injured leg was seen in all 4 directions, however with different magnitudes: Large differences were plantarflexion (−8.5°, ES = 0.80), medium for dorsiflexion (−5.2°, 0.57), small for inversion (−4.8°, 0.36), and trivial for eversion (−1.7°, 0.15). ConclusionThe device demonstrated clinically useful reliability for measuring these ranges of motion in a functional, weight-bearing position. PF ROM showed the greatest reduction in range in these athletes at a late stage of their rehabilitation.

THE EFFECT OF NOVEL ANKLE-REALIGNING SOCKS ON DYNAMIC POSTURAL STABILITY IN INDIVIDUALS WITH CHRONIC ANKLE INSTABILITY

A dynamic postural stability deficit has been suggested to be present in individuals with chronic ankle instability (CAI). Interventions to improve postural control in individuals with CAI have been reported, but they required a long period of and compliance with interventions. To examine the effect of novel ankle-realigning socks on dynamic postural stability in individuals with CAI using the star excursion balance test (SEBT). Case-control study. Twenty-eight control and 22 subjects with CAI (who were tested in both barefoot and with socks) were enrolled. The weight-bearing ankle dorsiflexion range of motion (DF-ROM) and SEBT were measured in the control group, the barefoot CAI group, and the CAI with socks group. In addition, subjective ankle instability during SEBT was measured using a visual analog scale (0 - 100). DF-ROM was 48.3 ± 7.4 º in the control group, 43.3 ± 8.0 º in the barefoot CAI group, and 45.7 ± 6.8 º in the CAI with socks group. DF-ROM was significantly less in the barefoot CAI group than in the control group. The SEBT scores were significantly less in the barefoot CAI group than in the control group in all directions. The SEBT score was significantly larger in the CAI with socks group than in the barefoot CAI group in the posteromedial, posterior, and posterolateral directions. In addition, there were no significant differences between the control group and the CAI with socks group in six directions. Wearing the novel ankle-realigning socks immediately improved dynamic postural stability as measured by the SEBT and subjective ankle instability in individuals with CAI. Level 3b.

Early clinical and radiological evaluation in patients with total ankle replacement performed by lateral approach and peroneal osteotomy

BackgroundThe Zimmer Trabecular Metal Total Ankle Replacement (Zimmer TM TAR) is a recent ankle arthroplasty approved for use in the United States and Europe. Many of the studies reporting the results of this implant are provided by surgeons involved at least in the initial design of the implant under study.The aim of this study is to describe the early clinical and radiological outcomes in patients who underwent this procedure performed by non-designer surgeons.MethodsA total of thirty consecutive patients underwent total ankle replacement with a Zimmer TM TAR surgery between July 2013 to January 2016.All clinical assessments were collected pre- and post-operatively with minimum follow-up of 12 months for each patient using the American Orthopedic Foot and Ankle (AOFAS) score, the Foot Function Index (FFI) and a visual analogue scale (VAS) for pain. Radiographic outcomes included ankle orientation assessed with angle “α”,“β” and “γ” according to Wood. Furthermore, the anteroposterior offset ratio was measured in weight-bearing lateral ankle radiographs at the last follow-up.ResultsThe mean preoperative FFI-pain (FFI-P) value was 53.67, the FFI-disability (FFI-D) was 64.19. At the last follow-up visit, the FFI-P and FFI-D was 16.95 and 20.76 respectively (p<0.01 for the both scales). Preoperatively, the mean VAS for pain and AOFAS score was 7.81 and 40.95 respectively, and at the last follow-up 2.29 and 86.38 (p<0.01 for the both scales). The mean angle calculated using Wood and Deakin’s method were “α”= 89.02°, “β”= 85.11 and “γ”= 27.54 post-operatively. At the last follow-up the same values were respectively 89.43, 85.18 and 29.94. At the last follow-up, the mean offset ratio was 0.06 (range 0.003/-0.17).ConclusionsThese early results show high levels of patient satisfaction, and we are encouraged to continue with lateral approach total ankle arthroplasty.

The iPhone Measure app level function as a measuring device for the weight bearing lunge test in adults: a reliability study

BackgroundAnkle joint range of motion is a frequently assessed measure used by health care clinicians who manage lower limb pathologies to identify ankle equinus and/or other joint motion concerns that may negatively impact on function. The purpose of this study was to assess a new iPhone application (the level function of the ‘Measure application’), for measuring the weightbearing ankle lunge test in a healthy adult population (reliability) and measuring known angles (validity) when compared to a digital inclinometer.MethodsTo determine intra-rater reliability, inter-rater reliability and concurrent validity, 168 measures were conducted on 21 participants. Participants were preconditioned prior to assessment, and two experienced raters measured ankle dorsiflexion range of motion in the knee extended and knee flexed positions of the weight bearing lunge test, using an iPhone level function (of the Measure application) and a digital inclinometer in a randomised order, over two timepoints. Concurrent validity was also determined by comparison of measures of the two devices at known surface angles (0 and 15 degrees) in multiple planes. Reliability and validity were determined with intraclass correlation coefficients, concurrent validity was explored with the Bland Altman plot and an intraclass correlation coefficient. The Standard Error of the Mean and the minimal detectable change were also explored.ResultsThe intra-rater reliability using the iPhone and inter-rater reliability using the digital inclinometer, in the knee extended position, were ICC 0.85 respectively, indicating good reliability. All other intra-rater reliability and inter-rater reliability for both devices and both leg positions were over ICC 0.90, indicating excellent reliability. Concurrent validity between the two devices on a flat and known angle surface were ICC 1.0 (Limits of Agreement − 1.0 to 0.61), indicating excellent validity, with good validity demonstrated by a Bland Altman plot of all measures in all positions (ICC of 0.84 (Limits of agreement = − 4.51 to 6.49)).ConclusionThe use of the iPhone level measure, within the Measurement App has demonstrated to be an easy and reliable measurement tool to determine ankle joint dorsiflexion during the weightbearing lunge test in healthy adults.

Radiographic parameters in gravity stress view of the ankle: Normative data

BackgroundIn rotational ankle injury with isolated fibular fracture, deltoid integrity is important for determining stability of ankle. Medial clear space and superior clear space in gravity stress view are parameters widely used to predict deltoid ligament tear. The purpose of this study is to report radiographic parameters in gravity stress view in normal population. Methods120 persons were enrolled. Non weight-bearing ankle mortise and gravity stress view were obtained. Radiographic measurements were made by 2 investigators, including medial clear space (MCS), superior clear space (SCS), tibiofibular overlaps, tibiofibular clear space and talocrural angle. Statistical analysis included mean, mean difference, SD, 95%CI, paired T-test were calculated and subgroup analysis by foot length. Intraclass correlation coefficients were used to determine intra/interobserver reliability of measurement. ResultsMean MCS in gravity stress view was 3.19mm (95%CI 3.1–3.31). This compared to mean MCS of 3.01mm (95%CI 2.9–3.12) in mortise view which was statistically significant (P=0.02). Mean difference was 0.18mm (95%CI 0.07–0.3). SCS in gravity stress view was 3.29mm (95%CI 3.19–3.39) and when compared to MCS in gravity stress view, no statistical significance was found (P=0.158). Mean difference was 0.1mm (95%CI 0.03–0.21). In subgroup analysis by foot length, no significant difference was found in any parameters. ConclusionsThis study provides normative radiographic data for a gravity stress radiograph and supports that if measurable MCS >4mm on gravity stress view, it should be aware of an unstable ankle in supination-external rotation injury.

Weightbearing Digital Tomosynthesis of Foot and Ankle Arthritis: Comparison With Radiography and Simulated Weightbearing CT in a Prospective Study.

Foot and ankle arthritis is common and debilitating. Weightbearing radiography is the reference standard for evaluating alignment, but overlapping bones and hardware limit evaluation for osteoarthritic bony detail. The purpose of this study was to evaluate whether digital tomosynthesis (DTS) can yield reliable quantitative alignment values, as radiography does with its weightbearing capability, and good qualitative osteoarthritic detail, as CT does. Adults with foot or ankle arthritis referred for simulated weightbearing CT were recruited to undergo weightbearing radiography and DTS. Four readers independently evaluated radiographs and DTS images for foot and ankle alignment and severity of osteoarthritis in each joint. Two readers performed consensus readings of CT images. Agreement between modalities was assessed by intraclass correlation coefficient (ICC) and Cohen kappa statistics. Ninety-one ankles were analyzed. Most joints were significantly less obscured by overlapping bone when seen with DTS (11.2%) or CT (4.3%) compared with radiography (30.4%). For quantitative foot alignment measurements, DTS had good to excellent agreement with weightbearing radiography (ICC, 0.65-0.93), which performed significantly better than CT (ICC, 0.39-0.87). For qualitative osteoarthritic details of each joint, DTS had significantly better agreement with weightbearing radiography on joint space narrowing (κ = 0.38-0.67) than did CT (κ = 0.08-0.62). Weightbearing radiography and DTS had similar levels of agreement with CT on grading of osteophytes, subchondral cysts, and loose bodies. DTS is associated with less obscuration of joints than radiography and yields more reliable weightbearing quantitative foot and ankle alignment values than radiography does and more reliable osteoarthritic bony details than CT does.

Relationship of hip and ankle range of motion, trunk muscle endurance with knee valgus and dynamic balance in males

ObjectivesInvestigate the relationship of hip internal rotation (IR) and ankle dorsiflexion (DF) range of motion (ROM), trunk flexor, extensor, and lateral flexor muscle endurance with frontal plane knee projection angle (FPKPA) and Y-balance test (YBT). Study designCross-sectional study. SettingArmed Force training site. Participants121 healthy male militaries with no history of musculoskeletal injury in the last 6 months. Main outcomesFPKPA was evaluated during single-leg squat. YBT was assessed on the anterior, posterolateral and posteromedial directions. Passive hip IR ROM and weight-bearing ankle DF ROM were measured with a digital inclinometer. Trunk muscle endurance was measured as the time the participant could hold the positions. ResultsFPKPA was predicted by ankle DF ROM and hip IR ROM (r2 = 0.340; P = 0.009). For YBT anterior, ankle DF ROM was the only predictor (r2 = 0.32; P < 0.001); whereas trunk extensor endurance predicted YBT posterolateral (r2 = 0.273; P < 0.001) and YBT posteromedial (r2 = 0.033; P = 0.045). ConclusionThe results suggest that increasing hip stiffness and ankle mobility might help to control dynamic knee alignment. In addition, the dynamic balance could be improved increasing ankle DF ROM and trunk extensor endurance.

Immediate Weight-Bearing Protocol for the Determination of Ankle Stability in Patients With Isolated Distal Fibular Fractures.

To evaluate an alternative protocol for allowing immediate weight-bearing (WB) as tolerated in a functional walking boot in patients with a medial clear space (MCS) of less than 4 mm on nonstressed initial radiographs with subsequent WB radiographs at 1-week follow-up to determine if this can differentiate stable from unstable distal fibular fractures. Retrospective case series. Level 1 trauma center. Seventy-nine patients who sustained an isolated distal fibular fracture with an MCS less than 4 mm on initial non-weight-bearing radiographs during a 6-year period. Patients with MCS less than 4 mm on 1-week radiographs were treated nonoperatively. Patients with MCS greater than or equal to 4 mm were treated operatively. Medial clear space measurements on WB ankle radiographs at the time of radiographic bony union. Two of the 79 (2.5%) patients had an MCS greater than 4 mm at 1-week follow-up with WB radiographs and underwent operative fixation. The remaining 77 patients were treated nonoperatively. All 77 patients had an MCS less than 4 mm on WB radiographs at the time of radiographic healing. These results suggest that our immediate weight-bearing protocol may be an effective method for determination of functional ankle stability only in the setting of an isolated distal fibula fracture with MCS less than 4 mm. However, it should be cautioned that careful evaluation of WB radiographs for joint asymmetry and/or MCS widening is mandatory to avoid poor outcomes. Therapeutic Level IV. See Instructions for Authors for a complete description of levels of evidence.

Relationship of Ankle Dorsiflexion and Gastrocnemius Tightness and Posterior Talar Glide

It has been reported that gastrocnemius tightness and posterior talar glide are crucial factors influencing ankle dorsiflexion. However, the relationship of ankle dorsiflexion and these factors is not identified in previous studies. The purpose of this study was to identify the relationship of ankle dorsiflexion passive range of motion and gastrocnemius tightness and posterior talar glide. Twenty-five male subjects participated in this study. Bilateral weight-bearing ankle dorsiflexion passive range of motion and amount posterior talar glide of participants were measured using an inclinometer. Change in myotendinous junction of medial gastrocnemius was measured using ultrasonography to identify gastrocnemius tightness. Pearson product moment correlations were performed to examine correlations between ankle dorsiflexion passive range of motion and gastrocnemius tightness and posterior talar glide. Present findings revealed significant correlation between ankle dorsiflexion passive range of motion and gastrocnemius tightness (p=0.017, r=0.336). Also, ankle dorsiflexion passive range of motion was correlated with posterior talar glide (p=0.001, r=0.470). The present findings provide experimental evidence for factors influencing weight-bearing ankle dorsiflexion.

Inter-rater reliability and validity of angle measurements using smartphone applications for weight-bearing ankle dorsiflexion range of motion measurements

ObjectivesThe purpose of this study was to examine the inter-rater reliability, validity, and error of angle measurements for ankle dorsiflexion range of motion while in the weight-bearing position using a smartphone application. DesignReliability and validity study. SettingMeasurement positions were performed by one experienced examiner. ParticipantsEighteen volunteers participated in the study. Three examiners (examiner 1 and examiner 2 had completed the course to become qualified certified athletic trainers and examiner 3 did not belong to the course) performed smartphone application measurements. Main outcome measuresAnkle dorsiflexion range of motion was measured in the lunge position. Radiographic measurements were performed using a bony landmark. The markerless method for application measurements was used, using a body part as a landmark. ResultsUsing the markerless method for application measurements, the intra-class correlation coefficients were 0.945. Using Pearson's correlation coefficient and intra-class correlation coefficients to compare the radiographic measurements and markerless method for application measurements, three examiners showed very high correlation (r > 0.9) and almost perfect (>0.81) intra-class correlation coefficient. Error values were less than 5° according to examiner 1 and examiner 2. ConclusionSmartphone application measurements using the markerless method of ankle dorsiflexion range of motion exhibited inter-rater reliability and high validity.

Concurrent validity and reliability of an iPhone app for the measurement of ankle dorsiflexion and inter-limb asymmetries

ABSTRACTThe purpose of this investigation was to analyze the validity and reliability of an iPhone app (named: Dorsiflex) for the measurement of weight-bearing ankle dorsiflexion. To do this, twelve healthy participants (age=28.6±2.3 years) performed a weight-bearing lunge test with each leg in five separate occasions, while dorsiflexion angle was simultaneously registered using a professional digital inclinometer and the Dorsiflex iPhone app, which was specifically developed for this study. A total of 120 angles measured both with the digital inclinometer and the app were then compared for validity, reliability and accuracy purposes using several statistical tests. There was an almost perfect correlation between the digital inclinometer and the Dorsiflex app for the measurement of ankle dorsiflexion (r=0.989, 95% CI=0.986-0.993, SEE=0.48º), with trivial, non-significant differences between devices (SMD=0.17, p=0.10). When analyzing the reliability of the app for the measurement of five different trials for each participant, similar coefficients of variation (CV) were observed in comparison with those obtained with the digital inclinometer (Dorsiflex app: CV=5.1±2.3 %; Digital inclinometer: CV=4.9±2.5 %). The results of the present study show that weight-bearing ankle dorsiflexion can be easily, accurately, and reliably evaluated using the Dorsiflex iPhone app.

A Comparison of Kinesiology and Athletic Taping on Ankle Range of Motion

Category: Other Introduction/Purpose: A high prevalence of ankle sprains exists in athletic and non-athletic populations. White athletic tape (WAT), commonly used for prevention and treatment, provides ankle stability while limiting mobility. Athletic taping has demonstrated the ability to limit ROM in all directions, particularly ankle inversion, as inversion injuries represent a vast majority of ankle sprains. Use of kinesiology taping (KT) for the purpose of limiting mobility in the ankle has not been examined. While limiting inversion range of motion may be beneficial in prophylactic management of ankle injuries, limiting ROM in other directions may impact kinematics of other joints in the kinetic chain. To determine the effectiveness of an innovative KT technique for limiting ankle inversion ROM while allowing movement in the other movements of the ankle. Methods: Fifty-three healthy 18-25 year old college students were recruited for this study. Subjects received each of the taping conditions (traditional basket weave WAT, a novel KT method, and no tape) in a randomized order. Manual goniometer measurements were taken in non-weight bearing in the inversion, eversion, dorsiflexion and plantarflexion directions. A handheld inclinometer was used to measure weight bearing ankle dorsiflexion. Measures for each were compared across each taping condition. A repeated measures ANOVA was performed. Results: Significant decreases in ankle ROM (p &lt;.01) were observed in all measures between WAT and no tape. KT demonstrated significant decreases in all ROM compared to no tape (p &lt;.01), except for a minimal decrease in weight bearing ankle dorsiflexion (p&gt;.05). WAT demonstrated significantly greater ROM restriction in all directions than did KT (p&lt;.01), including weight-bearing ankle DF. Conclusion: These results suggest that KT allows for more ankle ROM than traditional WAT in non-weight bearing and weight bearing measures, while still providing significant motion limitation in all motions except weight bearing dorsiflexion (in comparison to no tape). Limiting excessive inversion while simultaneously allowing closer to normal ROM in all other planes may decrease the risk of negatively impacting kinetic chain kinematics associated limited mobility of the ankle.

Weight-bearing anteroposterior radiograph of the ankle underestimates the severity of osteoarthritis when there is anterior subluxation of the talus

Category: Ankle Arthritis Introduction/Purpose: On weight-bearing lateral radiograph, anterior aspect of the ankle shows more narrowing than posterior aspect in the ankle osteoarthritis with anterior subluxation of the talus. However, weight-bearing anteroposterior radiograph of the ankle osteoarthritis with anterior subluxation of the talus often shows less severe joint space narrowing than the joint space in the narrowest anterior aspect of the ankle joint. (Fig.1). The purposes of this study were to compare the degree and shape of joint space narrowing in the anterior, middle and posterior aspect of the ankle by using weight-bearing CT and to investigate which area of the ankle was shown on plain weight-bearing ankle anteroposterior radiograph in the ankle osteoarthritis with anterior subluxation of the talus. Methods: We retrospectively evaluated patients who underwent surgery for ankle osteoarthritis in our clinic from January, 2017 to May, 2017. We included patients who showed ankle osteoarthritis with anterior subluxation of the talus in weight-bearing lateral radiograph. We determined anterior, posterior and middle coronal images in sagittal image of the weight-bearing CT.(Fig.1) Talar tilt, medial width of superior clear space(SCS), lateral width of SCS, width of medial clear space and obliteration ratio were measured on plain weight-bearing anteroposterior ankle radiograph, and the three coronal images. The obliteration ratio was obtained by obliteration-width / talus-width * 100.(Fig.1) The radiographic parameters of the anterior coronal image were compared with those on the middle and the posterior coronal image by using paired T-test. The intraclass coefficient was used to investigate which of the three coronal images showed best match with degree and shape of ankle osteoarthritis on the plain weight-bearing ankle anteroposterior radiograph Results: Seventy-one ankles from 71 patients were included in this study. The average age of patients in this study was 62.6 years (range: 19-82). The talar tilt on the anterior coronal image was significantly lower than that on the middle and posterior coronal images. The lateral width of SCS and the width of medial clear space on the anterior coronal image was significantly narrower than those on the middle and the posterior coronal image. The obliteration ratio on the anterior coronal image was significantly higher than that of the middle and the posterior coronal images (Fig.2). The intraclass coefficients indicated that the radiographic parameters on plain weight-bearing anteroposterior radiograph was most reliable with those on the middle coronal image among the three coronal images. Conclusion: Anterior area of ankle shows the most severe osteoarthritis and plain weight-bearing anteroposterior radiograph shows the best match to the middle portion of the ankle, when ankle osteoarthritis has anterior subluxation of the talus. Because middle area of ankle has less severe ankle osteoarthritis than anterior area of ankle in that kind of ankle osteoarthritis, plain weight-bearing radiograph may underestimate the severity of ankle osteoarthritis.