Reliability of two goniometric methods of measuring active inversion and eversion range of motion at the ankle

Background  

Active inversion and eversion ankle range of motion (ROM) is widely used to evaluate treatment effect, however the error associated with the available measurement protocols is unknown. This study aimed to establish the reliability of goniometry as used in clinical practice.     

Inversion/Eversion Strength Dysbalance in Patients With Medial Tibial Stress Syndrome

The main purpose of the study is to investigate the inversion/eversion muscle strength balance of the ankle in patients with medial tibial stress syndrome (MTSS). A dysbalance of these muscles may play a role in the pathophysiology of MTSS. Another aim is to measure the medial longitudinal arch and navicular drop in patients with MTSS. A total of 11 patients diagnosed with MTSS in the outpatient clinic of Ege University School of Medicine Sports Medicine Department were enrolled in this study. The control group consisted of 11 regularly exercising individuals. The mean age of the patient group and the control group was 21. 0 ± 1.9 years (18-23 years) and 23.2 ± 2.9 years (18-27 years), respectively. A detailed exercise questionnaire was administered to all subjects. Isokinetic muscle strength testing was performed at 30°/sec and 120°/sec to assess invertor and evertor muscle strength of the ankle. Photographs of the weight bearing and non-weight bearing foot were taken to measure the medial longitudinal arch deformation and the navicular drop. At 30°/sec, the average eversion concentric strength was significantly higher in the patient group, and the inversion/eversion strength ratio was significantly higher in the control group (p < 0.05). At 120°/sec velocity, average concentric eversion strength was significantly higher in the patient group (p < 0.05). The measurements of pronation indicators did not reveal any statistically significant differences between the two groups (p > 0.05). MTSS may occur without an increase of pronation indicators like medial longitudinal arch deformation or navicular drop. In such cases, one of the predisposing factors may be the strength dysbalance of the invertor/evertor muscles in favour of the evertor muscles. This observation may be of additional value in the prevention and therapy of MTSS.

Key points

• At 30°/sec, the average eversion concentric strength was significantly higher in the MTSS group, and the inversion/eversion strength ratio was significantly higher in the control group.
• At 120°/sec velocity, average concentric eversion strength was significantly higher in the MTSS group.
• MTSS may occur without an increase of pronation indicators like medial longitudinal arch deformation or navicular drop. In such cases, one of the predisposing factors may be the strength dysbalance of the invertor/evertor muscles in favour of the evertor muscles.

Key words: Medial tibial stress syndrome, eversion, inversion, strength dysbalance, pronation, exercise     

The assessment of three-dimensional foot pronation using a principal component analysis method in the stance phase of running

Foot pronation has not been quantified dynamically in three planes of movement in an in-vivo study. The aims of this study were to determine foot pronation through using Principal Component Analysis (PCA) method and to compare it among barefoot, shod and shod with 6° lateral wedge during the stance phase of running. In this method, three-dimension of foot movements were measured and each of these components represents a percentage of foot pronation. These components were derived based on eigenvalues and vectors of covariance matrix of primary variables. The first (PC1), second (PC2) and third (PC3) components explained about (82.5%, 79.1%), (14%, 15.8%) and (3.5%, 5.1%) the foot pronation for barefoot and shod conditions, respectively. These components were mutually independent and the components set had the same information as the primary variables. Foot pronation index and eversion angles were calculated and compared among barefoot, shod and shod with wedge insole (6° lateral wedge insole) conditions in the four phases of stance. Statistical analysis showed that there was no foot conditions effect for foot eversion in four phases (p = 0.72), while this effect was significant for PC1 (p = 0.001). This finding shows that PC1 index could discriminate footwear effect among each phase of stance. Specifically, pronation was reduced in shoe condition as compared to barefoot condition (p = 0.02) from 5 to 50% of stance phase. It has been suggested that the PCA method provides more accurate criteria for investigating effects of footwear interventions on simultaneous three-dimensional foot motion.     

The use of muscle strength assessed with handheld dynamometers as a non-invasive biological marker in myotonic dystrophy type 1 patients: a multicenter study

Background  

Myotonic dystrophy type 1 (DM1) is a multisystem disorder that demonstrates variable symptoms and rates of progression. Muscle weakness is considered one of the main problems with a clinical picture that is characterized by distal weakness of the limbs progressing to proximal weakness. The main objective of this study was to characterize the maximal strength of ankle eversion and dorsiflexion in DM1 patients. Manual and handheld dynamometer (HHD) muscle testing were also compared.     

The peroneal strength deficits in patients with chronic ankle instability compared to ankle sprain copers and normal individuals

Background

Despite a consensus regarding the correlation of peroneal strength deficit with chronic ankle instability (CAI), there are conflicting reports in regards to peroneal strength as assessed by isokinetic dynamometer in patients with CAI. The purpose of this study was to evaluate the changes of isokinetic strength in patients with CAI compared to ankle sprain copers and normal individuals.

The Biomechanical Influence of Defected Cartilage on the Progression of Osteochondral Lesions of the Talus: A Three-dimensional Finite Element Analysis

Objectives

Osteochondral lesions of the talus (OLTs) are common injuries in the general population. Abnormal mechanical conditions applied to defected cartilage are believed to be the culprits to deteriorating OLTs. This study aims to investigate the biomechanical effects of defect size of talar cartilage on OLTs during ankle movements.

Methods

A finite element model of the ankle joint was created based on the computed tomography images of a healthy male volunteer. Different defect sizes (S = 0.25, 0.5, 0.75, 1.0, 1.25, 1.5, 1.75, and 2.0 cm²) of talar cartilage were modeled to simulate the progression of OLTs. Mechanical moments were applied to the model to generate different ankle movements, including dorsiflexion, plantarflexion, inversion, and eversion. The effects of varying defect sizes on peak stress and its location were evaluated.

Results

The maximum stress on the talar cartilage increased as the area of the defect enlarged. Additionally, as the defect size of OLTs increased, the areas with peak stress on talar cartilage tended to move closer to where the injury was located. High stresses were present in the medial and lateral areas of the talus at the neutral position of the ankle joint. The concentrated stresses were mainly located in the anterior and posterior defect areas. The peak stress in the medial region was higher than on the lateral side. The order of peak stress from highest to lowest was dorsiflexion, internal rotation, inversion, external rotation, plantar flexion, and eversion.

Conclusions

Osteochondral defect size and ankle joint movements significantly modulate the biomechanical features of the articular cartilage in osteochondral lesions of the talus. The progression of osteochondral lesions in a talus deteriorates the biomechanical well-being of the bone tissues of the talus.     

Posttraumatic proximal radioulnar synostosis: Technique for operative resection

Objectives  

Resection of a posttraumatic proximal radioulnar synostosis to gain pronation and supination of the forearm.     

Proposed novel unified nomenclature for range of joint motion: method for measuring and recording for the ankles, feet, and toes

The Ad Hoc Committee of Terminology of the Japanese Society for Surgery of the Foot (JSSF) proposes novel terminology for motion of the ankle, foot, and toe because there are some ambiguities in the current terminology. Articles were identified by searching the electronic databases of PubMed that compared definitions of American Orthopaedic Foot and Ankle Society (AOFAS), International Society of Biomechanics (ISB), and in the textbook of Kapandji as well as the American Academy of Orthopaedic Surgeons (AAOS). A total of 11 articles described the transverse (horizontal) plane motion in the hindfoot as external rotation/internal rotation and 10 as abduction/adduction. In all, 2 articles described the transverse (horizontal) plane motion in midfoot as external rotation/internal rotation and 10 as abduction/adduction. Another 4 articles described the transverse (horizontal) plane motion in the forefoot as external rotation/internal rotation and 8 as abduction/adduction. Altogether, 109 articles described the sagittal plane motion of the foot/ankle as dorsiflexion/plantarflexion and 20 as extension/flexion. In all, 99 articles described the frontal (coronal) plane motion of the foot/ankle as inversion/eversion and 4 as supination/pronation. Furthermore, 12 articles described the sagittal plane motion of toes as dorsiflexion/plantarflexion and 15 as extension/flexion. Another 16 articles described the frontal (coronal) plane motion of toes as supination/pronation and 1 as inversion/eversion. The transverse (horizontal) plane motion of the foot/ankle was defined as abduction/adduction in the hindfoot, midfoot, and forefoot; the sagittal plane motion of the foot/ankle was defined as dorsiflexion/plantarflexion; and the frontal (coronal) plane motion of the foot/ankle as inversion/eversion. The transverse (horizontal) plane motion of toes was defined as abduction/adduction; the sagittal plane motion of toes was defined as extension/flexion; and the frontal (coronal) plane motion of toes was defined as supination/pronation.     

The effect of different skin-ankle brace application pressures on quiet single-limb balance and electromyographic activation onset of lower limb muscles

Background  

Several studies have been carried out in order to investigate the effect of ankle bracing on ankle joint function and performance. However, no study so far has examined the role of skin-brace interface pressure in neuromuscular control. The aim of this study was to investigate the effect of different skin-ankle brace interface pressures on quiet single limb balance and the electromyographic (EMG) activation sequence of four lower limb muscles.     

False negative rate of syndesmotic injury in pronation-external rotation stage IV ankle fractures

Background:

To investigate false negative rate in the diagnosis of diastasis on initial static anteroposterior radiograph and reliability of intraoperative external rotational stress test for detection of concealed disruption of syndesmosis in pronation external rotation (PER) stage IV (Lauge-Hansen) ankle fractures.

Materials and Methods:

We prospectively studied 34 PER stage IV ankle fractures between September 2001 and September 2008. Twenty (59%) patients show syndesmotic injury on initial anteroposterior radiographs. We performed an intraoperative external rotation stress test in other 14 patients with suspicious PER stage IV ankle fractures, which showed no defined syndesmotic injury on anteroposterior radiographs inspite of a medial malleolar fracture, an oblique fibular fracture above the syndesmosis and fracture of the posterior tubercle of the tibia.

Results:

All 14 fractures showed different degrees of tibiofibular clear space (TFCS) and tibiofibular overlapping (TFO) on the external rotation stress test radiograph compared to the initial plain anteroposterior radiograph. It is important to understand the fracture pattern characterstic of PER stage IV ankle fractures even though it appears normal on anteroposterior radiographs, it is to be confirmed for the concealed syndesmotic injury through a routine intraoperative external rotational stress radiograph.     

Controlling excessive pronation: a comparison of casted and non-casted orthoses

Casted and plate orthoses were compared for their effectiveness in controlling excessive pronation and providing associated symptom relief. Two subject groups (n=30) matched for sex, age, sport involvement and injury type were prescribed either a casted or plate orthosis and were evaluated over a 3 month period. Pronation during treadmill running trials, with and without orthotic intervention, was determined by using two-dimentional video analysis. Symptom improvement was evaluated via questionnaire analysis. Two way analysis of variance demonstrated that both types of orthosis effectively reduced total pronation, maximum velocity of pronation, total calcaneal eversion and maximum velocity of calcaneal eversion (P<0.05), with no significant difference between orthotic types. Questionnaire analysis indicated that symptoms improved (to some extent) in 92% of all subjects after one month, with little difference between orthotic type. Considering the cost difference of the two types of orthotics (casted costing 2.5 times more), plate orthoses provide satisfactory treatment.     

Rupture of the tibiofibular syndesmosis without osseous fibular injury

Within 3 years 12 injuries of the anterior fibulo-tibial ligament without fracture of the fibula were recorded prospectively. In relation to the total number of the ankle joint fractures during the same period the incidence is 3.3%. The rupture of the ligament arose in all cases from a forced eversion combined with supination or pronation of the foot. Clinical characteristics are the circumscribed painful palpation of the area of the ligament together with eversion pain of the foot. Arthrography is the most sensitive diagnostic procedure, which, however, may be avoided if the clinical situation is absolutely clear. Differential diagnosis consists mainly in the rupture of the fibulo-talar ligament including a tear of the anterior capsule of the ankle joint. Treatment should always be surgical - suture of the ligament, reinforcement of the syndesmosis by means of a positioning screw. Aftercare is functional without external fixation.     

A case-series study to explore the efficacy of foot orthoses in treating first metatarsophalangeal joint pain

Background

First metatarsophalangeal (MTP) joint pain is a common foot complaint which is often considered to be a consequence of altered mechanics. Foot orthoses are often prescribed to reduce 1^st MTP joint pain with the aim of altering dorsiflexion at propulsion. This study explores changes in 1^st MTP joint pain and kinematics following the use of foot orthoses.

Methods

The effect of modified, pre-fabricated foot orthoses (X-line^®) were evaluated in thirty-two patients with 1^st MTP joint pain of mechanical origin. The primary outcome was pain measured at baseline and 24 weeks using the pain subscale of the foot function index (FFI). In a small sub-group of patients (n = 9), the relationship between pain and kinematic variables was explored with and without their orthoses, using an electromagnetic motion tracking (EMT) system.

Results

A significant reduction in pain was observed between baseline (median = 48 mm) and the 24 week endpoint (median = 14.50 mm, z = -4.88, p < 0.001). In the sub-group analysis, we found no relationship between pain reduction and 1^st MTP joint motion, and no significant differences were found between the 1^st MTP joint maximum dorsiflexion or ankle/subtalar complex maximum eversion, with and without the orthoses.

Conclusions

This observational study demonstrated a significant decrease in 1^st MTP joint pain associated with the use of foot orthoses. Change in pain was not shown to be associated with 1^st MTP joint dorsiflexion nor with altered ankle/subtalar complex eversion. Further research into the effect of foot orthoses on foot function is indicated.

     

The relationship between excessive pronation as measured by navicular drop and isokinetic strength of the ankle musculature

EMG research has shown that excessive pronation affects the timing and magnitude of extrinsic muscle activity. This study was designed to investigate the relationship between excessive pronation and isokinetic strength of the ankle. The following measures were performed on 24 subjects (12 pronators, 12 normals) matched for gender and weight: 1) plantarflexion, dorsiflexion, inversion and eversion strength, both eccentrically and concentrically, determined by isokinetic peak torque at 30 degrees/sec; and 2) excessive pronation determined by navicular drop. Subjects with excessive pronation were found to have no difference in invertor strength, but decreased concentric plantarflexion strength when compared to normals. This finding agrees with biomechanical theory suggesting that a pronated foot is less rigid and generates less torque. Differences in strength ratios in excessive pronators were also observed and attributed to the decrease in plantarflexion strength.     

Modified Rerouting Procedure for Failed Peroneal Tendon Dislocation Surgery

Abstract  

Recurrent dislocation of the peroneal tendons following operative treatment is relatively uncommon, but can be difficult to treat. We asked whether subligamental transposition of the peroneus brevis tendon, fibular grooving, and reattachment of the superior peroneal retinaculum for failed peroneal tendon dislocation surgery would achieve a stable fixation of the peroneal tendons and whether there would be restrictions of ROM or instability of the hindfoot. We reviewed six female patients (mean age, 24.5 years) with general laxity of joints preoperatively and at 6 weeks and 3, 6, and 12 months postoperatively. Within 1 year postoperatively no recurrence was found. In two ankles the extension was restricted 5° to 10°. In another pronation and supination was restricted 5° each. Stability of the ankle increased in four patients and stayed unchanged in two. AOFAS score increased from a mean value of 36 ± 20.6 preoperatively to 90 ± 7 postoperatively at 1 year. We conclude transposition of the peroneus brevis tendon is a reasonable treatment for failed peroneal tendon dislocation surgery.     

Sevoflurane requirement during elective ankle day surgery: the effects of etirocoxib premedication,a prospective randomised study

Background  

Anti-inflammatory drugs, NSAIDs, have become an important part of the pain management in day surgery. The aim of the present study was to evaluate the effect of Coxib premedication on the intra-operative anaesthetic requirements in patients undergoing elective ankle surgery in general anaesthesia.     

Arthroplasty versus arthrodesis for end-stage ankle arthritis: decision analysis using Markov model

Background  

Total ankle arthroplasty and arthrodesis are the two mainstreams of treatment for end-stage ankle arthritis. This study was performed to determine which is a better choice for ankle arthritis, using a decision analysis and Markov model to reflect the repetitive nature of revision arthroplasty.     

Evaluation of the ankle function following reconstruction of the donor defect with a split fibular bone after a vascularized fibular flap transfer

Introduction  

To validate the hypothesis that the reconstruction of the missing segment of the fibula using a redundant split fibular graft after a vascularized fibular flap transfer may have a better effect on ankle function.     

Are venotonic drugs effective for decreasing acute posttraumatic oedema following ankle sprain? A prospective randomized clinical trial

Objective  

Lower leg oedema after trauma may cause various degrees of pain, disability and delay in patient recovery. In this prospective randomized study, we hypothesized that venotonic drugs had no effect in clinical outcome of patients with ankle sprain.     

High revision and reoperation rates using the Agility™ Total Ankle System

Background  

Total ankle arthroplasty (TAA) is an evolving treatment for end-stage ankle arthritis, however, there is controversy regarding its longevity.