Tendoskopie am Sprunggelenk und Fuß

Ankle arthroscopy is increasingly used as a technique for dealing with a wide range of ankle pathologies. In contrast, extra-articular problems of the ankle still most often demand open surgery. In the recent years, endoscopic procedures for treating various tendon pathologies have been developed. Like arthroscopic surgery, tendoscopy offers the advantages related to any minimally invasive procedure such as fewer wound infections, less blood loss, smaller wounds and less morbidity. This article defines the major indications in which tendoscopy is appropriate and presents current techniques for treatment.     

Évaluation des orthèses de genou et de cheville en pathologie de l’appareil locomoteur. Avis d’experts

A french committee of experts worked to create an assessment methodology for knee and ankle orthoses in order to evaluate the beneficial effects of these devices in current pathologies. It lead to the establishment of a simple evaluation tool for knee and ankle orthoses.     

Cheville et pied douloureux de l’enfant sportif

We realized an exhaustive review of literature concerning traumatic and microtraumatic lesions of the ankle and foot in sporting children. These pathologies are on the increase due to considering the development of sports activities. They are often considered as benign whereas they require an adequate diagnosis followed by adequate treatment. We thus described four groups of pathologies of the ankle and foot in sporting children: osteodystrophies (disease of Sever, Köhler-Mouchet, Renander, Freiberg, Panner and Iselin), talar diseases (osteochondritis dissecans and osteochondral fractures), sprained ankles (benign, medium and serious) and supernumerary ossifications.     

MR imaging of the articular cartilage of the knee and ankle

Cartilage abnormalities in the knee and ankle are a common source of pain and are often difficult to diagnose clinically or radiographically. MR imaging is a valuable tool for diagnosing and characterizing cartilage lesions of both the knee and ankle. An understanding of the appearance of cartilage, and an understanding of how and when to report cartilage injury in the knee and ankle based on current grading systems allows the radiologist to provide the most helpful reports to referring clinicians. This article presents the range of cartilage pathologies in the knee and ankle and provides clinically relevant guidelines.     

Association tendinopathie des fibulaires et fracture de fatigue de la malléole latérale : à propos de trois cas

Among the pathologies of the athlete's ankle, tendon distress and bone stress pathologies may often occur. Through three cases report, we describe the association of the fibular tendinopathies and the presence of stress fractures of the external malleolus. This association is important to detect since the treatment of the tendinopathy can be different if the condition is isolated or if it associated with a bone stress fracture, notably in the presence of correction for static difficulties. We highlight also the interest of the paraclinical exams, in particular MRI which gives evidence for the two pathologies.     

Posterior ankle and subtalar arthroscopy: indications, technique, and results

Over the decades, arthroscopy has grown in popularity for the treatment of many foot and ankle pathologies. While anterior ankle arthroscopy is a widely accepted technique, posterior ankle/subtalar arthroscopy is still a relatively new procedure. The goal of this review is to outline the indications, surgical techniques, and results of posterior ankle/subtalar arthroscopy. The main indications include: 1) osteochondral lesions (of subtalar and posterior ankle joint); 2) posterior soft tissue or bony impingement; 3) os trigonum syndrome; 4) posterior loose bodies; 5) flexor hallucis longus (FHL) tenosynovitis; 6) posterior synovitis; 7) subtalar (or ankle) joint arthritis; 8) posterior tibial, talar, or calcaneal fractures (for arthroscopic reduction and internal fixation). Although posterior ankle/subtalar arthroscopy has shown to be safe and effective in the treatment of many of the above mentioned conditions, thorough knowledge of the anatomy, correct indications, and a precise surgical technique are essential to produce good outcomes.     

The effects of walking speed on forefoot,hindfoot and ankle joint motion

BackgroundFoot and ankle joint kinematic differences have been identified between healthy subjects and subjects with various pathologies suffering from foot and ankle impairments. Changes in temporal factors such as walking speed and double stance time are also found in these pathological conditions. As such, in theory, these factors would also influence the kinematics and hence make it difficult to ascertain the effects of the disease on the kinematics. The aim of this study was to analyse foot and ankle kinematics from gait recordings of healthy subjects walking at comfortable and slower speeds.MethodsGait patterns of 14 healthy subjects were recorded. The subjects were first asked to walk at a comfortable speed and then at predefined speeds of 75% and 50% of their comfortable walking speed respectively. Temporal variables were calculated. Foot and ankle joint kinematics were determined from marker-recordings.FindingsThe subjects walked at mean velocities of 1.28 m/s, 0.97 m/s and 0.65 m/s. With decreasing walking speed the minimum tibio-talar plantar-flexion and maximum hallux dorsi-flexion at toe-off decreased significantly between 3° and 9°. The minimum medial arch at toe-off and minimum midfoot supination at mid-stance were significantly affected by the walking speed. The corresponding individual session differences were small (1°–2°), but the reliability was high and hence the differences were considered clinically relevant.InterpretationWalking speed significantly affected foot and ankle kinematics. Studies aiming to improve the understanding of the effects of foot and ankle pathologies on foot and ankle kinematics should take the walking speed into account.     

Loss of proprioception or motor control is not related to functional ankle instability: an observational study

QUESTIONS: Is loss of proprioception or loss of motor control related to functional ankle instability? Are proprioception and motor control related? Is there any difference in proprioception or motor control between ankles with different severity of functional ankle instability? DESIGN: Cross-sectional, observational study. PARTICIPANTS: Twenty people aged between 18 and 40 years with functional ankle instability associated with a history of ankle sprain more than one month prior. Twenty age-matched controls with no functional ankle instability or history of ankle sprain. OUTCOME MEASURES: Functional ankle instability was classified using the Cumberland Ankle Instability Tool, proprioception at the ankle was measured as movement detection at three velocities, and motor control was measured using the Landing Test and the Hopping Test. RESULTS: There was little if any relation between proprioception (r = 0.14 to 0.03, 95% CI 0.40 to 0.25) or motor control (r = 0.08 to 0.07, 95% CI 0.35 to 0.20) and functional ankle instability. There was also little if any relation between proprioception and motor control except for a low correlation between movement detection at 0.1 deg/s and the Landing Test (r = 0.35, 95% CI 0.09 to 0.58). Furthermore, there was no difference between the ankles with or without functional ankle instability in proprioception or motor control. CONCLUSION: By greater than one month after ankle sprain, loss of proprioception does not make a major contribution to functional ankle instability.     

The effect of ankle–foot orthosis plantarflexion stiffness on ankle and knee joint kinematics and kinetics during first and second rockers of gait in individuals with stroke

BackgroundStiffness of an ankle–foot orthosis plays an important role in improving gait in patients with a history of stroke. To address this, the aim of this case series study was to determine the effect of increasing plantarflexion stiffness of an ankle–foot orthosis on the sagittal ankle and knee joint angle and moment during the first and second rockers of gait.MethodsGait data were collected in 5 subjects with stroke at a self-selected walking speed under two plantarflexion stiffness conditions (0.4 Nm/° and 1.3 Nm/°) using a stiffness-adjustable experimental ankle–foot orthosis on a Bertec split-belt fully instrumented treadmill in a 3-dimensional motion analysis laboratory.FindingsBy increasing the plantarflexion stiffness of the ankle–foot orthosis, peak plantarflexion angle of the ankle was reduced and peak dorsiflexion moment was generally increased in the first rocker as hypothesized. Two subjects demonstrated increases in both peak knee flexion angle and peak knee extension moment in the second rocker as hypothesized. The two subjects exhibited minimum contractility during active plantarflexion, while the other three subjects could actively plantarflex their ankle joint.InterpretationIt was suggested that those with the decreased ability to actively plantarflex their ankle could not overcome excessive plantarflexion stiffness at initial contact of gait, and as a result exhibited compensation strategies at the knee joint. Providing excessively stiff ankle–foot orthoses might put added stress on the extensor muscles of the knee joint, potentially creating fatigue and future pathologies in some patients with stroke.     

踝关节本体感觉的测量方法研究与应用

背景:踝关节本体感觉能力的降低可能是踝关节容易反复损伤的一个重要原因,而对于踝关节本体感觉的定量评定方法一直没有一个标准化的测试方法.目的:通过查阅大量资料并进行分析总结,对踝关节本体感觉的测量方法的研究现状进行综述.方法:由作者检索PubMed数据库及维普数据库的相关文章.英文检索词为"joint position sense,muscle force sense;balance capacity;proprioception;ankle joint";中文检索词为"本体感觉,平衡能力,踝关节".共入选53篇文献进行归纳总结.结果与结论:踝关节本体感觉的测量方法包括关节位置觉、肌肉力觉、侦测被动运动变化阈值、关节运动觉、平衡能力等,在实际应用中应根据实际情况需要来确定选用哪种方法作为踝关节本体感觉的测量方法.     

Ankle Evaluation in Active Rheumatoid Arthritis by Ultrasound: A Cross-Sectional Study

Ankle joint evaluation is underestimated in many clinical and sonographic scores used for evaluation and follow-up of rheumatoid arthritis (RA) patients. Agreement on examination parameters is poor among sonographic scores that include the ankle joint. More effort is needed to detect the value of ankle joint examination in RA and assessment of ultrasonographic signs according to frequency, disease duration and activity. The objective of this study was to use ultrasound (US) to detect ankle involvement in active RA and to compare findings with disease duration, disease activity and assessment of ankle bone erosion. A total of 63 RA patients with active disease and 20 controls were included in the study. The tibiotalar and talonavicular joints were examined by US for synovitis and/or effusion in gray-scale and power Doppler modes. The anterior, lateral and posterior ankle tendons were examined for tenosynovitis and tendinosis. Mean age was 35.1?±?8.3 y, mean disease duration was 22.7?±?9.6?mo and the mean 28-joint Disease Activity Score–erythrocyte sedimentation rate was 3.05?±?0.66. Ankle involvement was seen in 28 patients (44.4%). The most frequent pathologies detected were tenosynovitis (30.2%), followed by synovitis (18.3%), erosion (8.7%) and tendinosis (4%). The earliest sonographic signs were tenosynovitis, followed by synovitis, erosion and tendinosis. The right ankle exhibited greater involvement than the left ankle, which was significant with respect to erosions (p?=?0.009). The most common tendon affected by tenosynovitis was the tibialis anterior (22.2%), followed by the tibialis posterior (20.6%). Tenosynovitis, especially of the tibialis anterior and posterior, tibiotalar synovitis and erosions should be considered in future US ankle scores for the assessment of RA.     

Arthroskopische laterale OSG-Stabilisierung in modifizierter Brostr?m-Gould-Technik

The Brostrom-Gould procedure is an established method for anatomic ligamentous reconstruction of the lateral ankle joint. This article presents the arthroscopic technique and the first results of this procedure. From August 2009 to February 2011 a total of 17 patients (6 male, 11 female) with isolated chronic lateral ankle instability were treated using this technique. Patients with concomitant pathologies were excluded from this investigation. The mean follow-up was 12.5 months (range 6?C26 months). The postoperative American Orthopaedic Foot and Ankle Society (AOFAS) hindfoot score was 92.6 (range 61?C100) and the mean Karlsson score was 86.2 (range 42?C100). In one patient the mechanical instability persisted (5.8%) but the other 16 patients (94.0%) were satisfied with the postoperative result and would undergo the same operation again. No postoperative complications occurred.     

History of ankle sprain as a risk factor of future lateral ankle sprain in athletes

Despite the attention and focus lateral ankle sprains receive in athletic training practice and research, they remain the most common injury in many sports. Whereas the functional limitations and time loss from lateral ankle sprains are apparent, consistently reducing their incidence is less certain. One important step in preventing lateral ankle sprains is identifying their risk factors. Although previous literature summaries suggest that specific risk factors are inconclusive in predicting lateral ankle sprains, recent literature investigating the predictors of ankle sprains should be included as evidence. Determining the primary risk factors for lateral ankle sprains may lead to good prevention programs, which in turn may decrease time lost because of injury.     

Movement detection at the ankle following stroke is poor

This study assessed whether sense of movement is impaired at the ankle in persons post-stroke who are able to walk independently. Eleven chronic post-stroke subjects (> 4 months post stroke) who were ambulatory with or without walking aids and living within the community, and 10 healthy age-matched control subjects volunteered to participate. Proprioceptive acuity at the ankle, measured by sense of movement, was tested at three velocities, 0.1, 0.5, and 2.5 deg/sec, in random order. In addition, ankle range of motion and the distance that subjects walked in 6 minutes were assessed. Stroke subjects were significantly poorer (p < 0.001) at detecting movement at the affected ankle compared with either the unaffected ankle or with the control group at each of the velocities tested. Six out of 11 stroke subjects demonstrated significant impairment in movement detection compared to controls. The usual primary impairments following stroke are loss of strength and loss of co-ordination. However, reduced proprioceptive acuity at the affected ankle may also contribute to a person's ability to position and load the foot during walking. This could explain the moderate relationship found between proprioceptive acuity and walking endurance in persons following stroke (Spearman's rho = 0.63 to 0.77).     

踝关节本体感觉的测量方法研究与应用

背景：踝关节本体感觉能力的降低可能是踝关节容易反复损伤的一个重要原因,而对于踝关节本体感觉的定量评定方法一直没有一个标准化的测试方法。目的：通过查阅大量资料并进行分析总结,对踝关节本体感觉的测量方法的研究现状进行综述。方法：由作者检索PubMed数据库及维普数据库的相关文章。英文检索词为＂jointposition sense,muscle forcesense;balance capacity;proprioception;ankle joint＂;中文检索词为＂本体感觉,平衡能力,踝关节＂。共入选53篇文献进行归纳总结。结果与结论：踝关节本体感觉的测量方法包括关节位置觉、肌肉力觉、侦测被动运动变化阈值、关节运动觉、平衡能力等,在实际应用中应根据实际情况需要来确定选用哪种方法作为踝关节本体感觉的测量方法。     

髓内钉结合阻挡钉与经皮锁定钢板固定胫骨远侧干骺端骨折的比较

目的比较髓内钉结合阻挡螺钉与锁定钢板治疗胫骨远侧干骺端骨折的疗效。方法将52例胫骨远侧干骺端骨折患者按随机数字表法分为2组,分别采用经皮锁定钢板（钢板组,n=26）和髓内钉结合阻挡螺钉技术（髓内钉组,n=26）行骨折内固定治疗。对2组手术时间、透视次数、术中出血量、术后感染率、踝关节前后及内外翻成角、完全负重时间、骨折愈合率、内植物松动断裂率、踝关节活动度及Olerud-Molander踝关节评分进行比较。结果 2组均获15～21（19.0±3.4）个月随访,均显示良好踝关节功能,且手术时间、透视次数、术后感染率、踝关节前后及内外翻成角、完全负重时间、骨折愈合率、内植物松动断裂率、踝关节活动度及Olerud-Molander踝关节评分等差异无统计学意义（P〉0.05）。髓内钉组较钢板组出血量多（P〈0.05）,钢板组有2例发生软组织并发症。结论在胫骨远端骨折治疗中,交锁髓内钉结合阻挡螺钉和经皮锁定钢板都是有效的固定方式,但对于伴有局部软组织条件损伤的患者,前者是更好的选择。     

Platelet-rich plasma in the foot and ankle

Purpose of review

Platelet-rich plasma has become an increasingly popular treatment option within the orthopedic community to biologically enhance and stimulate difficult-to-heal musculoskeletal tissues. This review evaluates the recent literature on platelet-rich plasma use in the treatment of foot and ankle pathologies.

Recent findings

Recent literature has demonstrated platelet-rich plasma to have a possible benefit in the treatment of Achilles pathology, chronic plantar fasciitis, osteochondral lesions of the talus, ankle osteoarthritis, and diabetic foot ulcers. However, given the lack of standardization of platelet-rich plasma preparations and protocols and the predominance of low-quality studies, no definitive treatment indications exist.

Summary

Platelet-rich plasma is a promising treatment option, but at present, there is only limited clinical evidence supporting its use in foot and ankle applications.

     

A pneumatic power harvesting ankle-foot orthosis to prevent foot-drop

Background  

A self-contained, self-controlled, pneumatic power harvesting ankle-foot orthosis (PhAFO) to manage foot-drop was developed and tested. Foot-drop is due to a disruption of the motor control pathway and may occur in numerous pathologies such as stroke, spinal cord injury, multiple sclerosis, and cerebral palsy. The objectives for the prototype PhAFO are to provide toe clearance during swing, permit free ankle motion during stance, and harvest the needed power with an underfoot bellow pump pressurized during the stance phase of walking.     

Effect of immobilization on ankle dorsiflexion strength

This study was performed in order to determine the loss of strength of the dorsiflexors in healthy persons after immobilization of the ankle, and the ability of these muscles to regain strength. First, isometric ankle dorsiflexion strength was measured in 33 healthy male and 39 female subjects in age categories 20-40 and 40-80 years, in order to obtain reference data and to determine the reproducibility of the measurement protocol. Gender, age and ankle position had a significant influence on the ankle dorsiflexion torque. Secondly, torque was measured in 15 patients after 4-6 weeks' immobilization of the ankle due to a fracture. A 28% decrease in dorsiflexion torque was seen. Strength reduction in neutral position and in 30 degrees plantar flexion was not significantly different. Without specific therapy restoration of torque was almost complete 6 weeks after cast removal.     

Effects of barefoot and barefoot inspired footwear on knee and ankle loading during running

Background

Recreational runners frequently suffer from chronic pathologies. The knee and ankle have been highlighted as common injury sites. Barefoot and barefoot inspired footwear have been cited as treatment modalities for running injuries as opposed to more conventional running shoes. This investigation examined knee and ankle loading in barefoot and barefoot inspired footwear in relation to conventional running shoes.

Method

Thirty recreational male runners underwent 3D running analysis at 4.0 m·s^− 1. Joint moments, patellofemoral contact force and pressure and Achilles tendon forces were compared between footwear.

Findings

At the knee the results show that barefoot and barefoot inspired footwear were associated with significant reductions in patellofemoral kinetic parameters. The ankle kinetics indicate that barefoot and barefoot inspired footwear were associated with significant increases in Achilles tendon force compared to conventional shoes.

Interpretation

Barefoot and barefoot inspired footwear may serve to reduce the incidence of knee injuries in runners although corresponding increases in Achilles tendon loading may induce an injury risk at this tendon.