A pilot investigation into the relationship between static diagnosis of ankle equinus and dynamic ankle and foot dorsiflexion during stance phase of gait: Time to revisit theory?

BackgroundAlthough the clinical assessment of ankle dorsiflexion has traditionally been measured utilising various goniometric means, the validity of this static examination has never been investigated. Since any impairment in ankle flexibility is likely to result in injuries, it is imperative that the correct examination technique is conducted.Hypothesis/PurposeTo determine whether a clinical diagnosis of ankle equinus, or limited ankle dorsiflexion, correlates with a decreased dorsiflexion range of movement of the foot and ankle during gait.MethodsTwenty participants with a clinical diagnosis of ankle equinus underwent optoelectronic motion capture utilising the Rizzoli foot model. Participants were divided into two groups, Group A with <−5° of dorsiflexion and Group B with −5° to 0° of ankle dorsiflexion.ResultsParticipants in Group B had a mean dynamic ankle dorsiflexion angle of 13.9°, while those in Group A had a mean dorsiflexion angle of 4.4°, resulting in a significant difference (p = 0.004) between the two groups. Likewise, foot mean dynamic dorsiflexion angle of Group B was 17.13° and Group A 8.6° (p = 0.006).ConclusionThere is no relationship between a static diagnosis of ankle dorsiflexion at 0° with dorsiflexion during gait. On the other hand, those subjects with less than −5° of dorsiflexion during static examination did exhibit reduced ankle range of motion during gait.     

Orthotic configuration and its effect on clubfoot: A bench research with modifications of orthotic bar length,dorsiflexion and abduction

PurposeWe determined the effect of changes in abduction orthosis for clubfoot (bar width, dorsiflexion and abduction) on ankle dorsiflexion and foot abduction.MethodsThe study included 31 children with clubfoot. An adjustable Steenbeek foot abduction orthosis permitting variations of bar width [distance between anterior superior iliac spines, shoulders and 'standard'], dorsiflexion (0, 15 and 30°) and abduction (30, 45 and 70°) was used for measurements. Ankle dorsiflexion and foot abduction were measured with and without orthosis and compared using repeated measures analysis of variance (ANOVA).ResultsFoot abduction was same as orthotic abduction in all configurations. A better ankle dorsiflexion was found with a shorter bar width, larger orthotic dorsiflexion and abduction. Contrarily, the arc increased with a wider bar. A 30° inbuilt orthotic dorsiflexion and 70° abduction produced better foot dynamics.ConclusionsA foot abduction orthosis with modifications of shorter bar length, 30° dorsiflexion and 70° abduction may offer better soft tissue stretch and foot motion in clubfoot.     

Evaluation of the uninjured anterior talofibular ligament by ultrasound for assessing generalized joint hypermobility

BackgroundMost clinicians use the Beighton score to assess generalized joint hypermobility (GJH) when deciding on the treatment of chronic lateral ankle instability (CLAI). The purpose of the study was to evaluate anterior talofibular ligament (ATFL) status by ultrasound and correlate these values with Beighton scores and the manual anterior drawer test (ADT).MethodsThe participants were divided into two groups, those without GJH (24 ankles) and with GJH (20 ankles). For the investigation of ATFL, resting and stress ultrasonography was performed to assess the length, height (degree of loosening) and thickness. Beighton scores, manual ADT grades and ultrasound parameters of participants with and without GJH were compared. The correlation coefficients among those values were analyzed.ResultsThe mean ATFL length, resting height, stress height and mean difference in height between resting and stress ATFL were all significantly different between the two groups (P < .05). The resting and stress ATFL length, height, and difference in height between resting and stress ATFL showed a positive linear relationship with Beighton scores and manual ADT grades (P < .05).ConclusionsThe ATFL stress ultrasound parameters showed significant differences between participants with high and low Beighton scores and were correlated with Beighton scores and manual ADT grades.Level of EvidenceCross-sectional cohort study; Level of evidence IV.     

Changes in Rearfoot Alignment in Chronic Plantar Heel Pain

Plantar heel pain is a common disabling condition in adults. Biomechanical factors are important in the development of plantar heel pain. Quantitative changes in rearfoot alignment in patients with plantar heel pain have not been previously investigated. From April 2016 to March 2017, 100 patients with plantar heel pain and 100 healthy individuals were recruited. The foot posture index was used for the measurement of foot alignment. The generalized joint hypermobility condition was assessed using the Beighton scale. The transverse plane talocalcaneal angle, calcaneocuboid angle, talonavicular uncovering angle, calcaneal inclination angle (CIA), talar declination angle, talar–first metatarsal angle, and sagittal talocalcaneal angle were measured on standard weightbearing anteroposterior and lateral foot radiographs. The body mass index was recorded electronically. The distribution of sex, age, weight, body mass index, side, foot posture index score, and Beighton scale were comparable between groups (p?>?.05). The mean calcaneocuboid angle (p?=?.009), talonavicular uncovering angle (p?=?.000), CIA (p?=?.000), talar declination angle (p?=?.039), and talar–first metatarsal angle (p?=?.000) were significantly higher in the plantar heel pain group. In conclusion, our study has demonstrated a relationship between chronic plantar heel pain and the CIA.     

The effect of uncontrolled moment and short-term,repeated passive stretching on maximum ankle joint dorsiflexion angle

BackgroundTrials investigating ankle joint measurement normally apply a known moment. Maximum ankle angle is affected by foot posture and stretching characteristics of the calf muscles.ObjectivesTo investigate whether consistent maximum ankle angles could be achieved without applying a constant moment to all subjects, and whether short, repetitive stretching of the calf muscle tendon unit would produce a difference in the maximum ankle angle.MethodPassive dorsiflexion in 14 healthy participants was captured using an optoelectronic motion analysis system, with the foot placed in 3 postures.ResultsThe maximum ankle angles for both the neutral and supinated positions did not differ significantly. In general, the majority of subjects (92.8%) showed no increase in the maximum ankle dorsiflexion angle following repetitive brief passive stretching. Only one subject exhibited a significant increase in maximum ankle angle at the neutral position.ConclusionSince the range of motion of the ankle joint is clearly determined by other physical factors, the maximum ankle dorsiflexion angle can be assessed at both neutral and supinated positions without moment being controlled.     

Reliability of radiographic measures in infants with clubfoot treated with the Ponseti method

PurposeThe aim of this study was two-fold: (1) to determine if radiographic measures can be reliably made in infants being treated with the Ponseti method and (2) to document radiographic changes before and after Achilles tenotomy.MethodsA retrospective radiographic and chart review was performed on children with clubfoot treated by the Ponseti method at a single institution over a 10-year period. Five independent reviewers measured a series of angles from a lateral forced dorsiflexion radiograph taken prior to and following Achilles tenotomy. These measures were taken in triplicate to determine the intra- and inter-reader reliability of dorsiflexion, tibio-calcaneal, talo-calcaneal, and talo-first metatarsal angles.ResultsThirty-six subjects (56 feet) were treated with the Ponseti method and met the inclusion criteria. The median (range) age of patients at the time of tenotomy was 52 (34–147) days. The intra-reader reliability [intra-rater correlation coefficient (ICC)] for each of the measured angles pre- and post-tenotomy ranged from 0.933 to 0.995 and 0.864 to 0.995, respectively. Similarly, the inter-reader reliabilities (ICC) ranged from 0.727 for the pre-tenotomy (talo-calcaneal) to 0.950 for the post-tenotomy (talo-first metatarsal) angles. The mean differences between pre- and post-tenotomy radiographs were: dorsiflexion increase of 17°, tibio-calcaneal angle increase of 19°, talo-calcaneal angle increase of 9°, and talo-first metatarsal angle increase of 10° (p-value ≤0.001 for all measurements except the talo-first metatarsal angle, with a p-value of 0.001).ConclusionsReliable radiographic measures can be made from lateral dorsiflexion radiographs of clubfeet treated with the Ponseti method before and after Achilles tenotomy.     

Plantar forces mid-term after hemiarthroplasty with HemiCAP for hallux rigidus

BackgroundThe aim of this study was to examine the biomechanical gait effects and range of motion following a proximal hemiarthroplasty with a HemiCap®.MethodsForty-one HemiCAP-operated participants with a mean follow-up time of 5 years had plantar force variables (PFVs) examined and compared with their non-operated foot and a control group. PFVs were compared to the MTPJ1 range of motion (ROM), and pain measured by Visual Analog Scale (VAS).ResultsThe HemiCAP participants’ operated feet had higher PFVs laterally on the foot and lower PFVs under the hallux.Dorsal ROM of the operated feet was a median 45° (range 10–75) by goniometer and 41.5 (range 16–80) by X-ray. An increase in ROM decreased the forces under the hallux. Most participants were pain-free. No correlation between pain and PFVs was found.ConclusionsIncreased dorsiflexion decreased the maximum force under the hallux. A mid-term HemiCAP maintains some motion. The decreased PFVs under the hallux may reflect a patient reluctance to load the first ray, although no correlation between plantar forces and pain was found.     

Muscular activity and torque of the foot dorsiflexor muscles during decremental isometric test: A cross-sectional study

PurposeTo analyse the torque variation level that could be explained by the muscle activation (EMG) amplitude of the three major foot dorsiflexor muscles (tibialis anterior (TA), extensor digitorum longus (EDL), extensor hallucis longus (EHL)) during isometric foot dorsiflexion at different intensities.MethodsIn a cross-sectional study, forty-one subjects performed foot dorsiflexion at 100%, 75%, 50% and 25% of maximal voluntary contractions (MVC) with the hip and knee flexed 90° and the ankle in neutral position (90° between leg and foot). Three foot dorsiflexions were performed for each intensity. Outcome variables were: maximum (100% MVC) and relative torque (75%, 50%, 25% MVC), maximum and relative EMG amplitude. A linear regression analysis was calculated for each intensity of the isometric foot dorsiflexion.ResultsThe degree of torque variation (dependent variable) from the independent variables explain (EMG amplitude of the three major foot dorsiflexor muscles) the increases when the foot dorsiflexion intensity is increased, with values of R² that range from 0.194 (during 25% MVC) to 0.753 (during 100% MVC). The reliability of the outcome variables was excellent.ConclusionThe EMG amplitude of the three main foot dorsiflexors exhibited more variance in the dependent variable (torque) when foot dorsiflexion intensity increases.     

Correlation of first metatarsal sagittal alignment with clinical and functional outcomes following the Lapidus procedure

BackgroundThe purpose of this study was to evaluate the effect of the variation of the first metatarsal (M1) sagittal alignment after the Lapidus procedure (LP) on clinical and functional outcomes, and transfer metatarsalgia.MethodsTwenty-nine patients who underwent a LP, with a mean follow-up of 20 months, were reviewed. Radiographic, clinical and functional measurements were compared. Clinical and functional questionnaires applied were the visual analogue scale (VAS), American Orthopaedic Foot and Ankle Society (AOFAS) scale, lower extremity functional scale (LEFS) and SF-12, which is divided in physical (PCS-12) and mental-health (MCS-12) scales. Radiographic analysis of M1 sagittal alignment was based on the first metatarsal declination angle (FMDA) and Meary Angle (MA). Intermetatarsal angle (IMA) and hallux valgus angle (HVA) were also measured.ResultsFMDA, IMA and HVA showed significant variation, but MA did not. Clinical and functional improvements were observed, except in MCS-12. No patient developed transfer metatarsalgia. A direct correlation was found between Δ-FMDA with Δ-PCS-12 and Δ-LEFS, meaning that excessive M1 dorsiflexion as measured by FMDA led to a decrease in PCS-12 and LEFS. Patients with Δ-FMDA of up to 3.2° of dorsiflexion were those who had significant improvements.ConclusionDorsiflexion of M1 can lead to decreased outcomes as measured by PCS-12 and LEFS. However, satisfactory outcomes can be obtained even with some dorsal deviation of the M1.Level of EvidenceIV, retrospective case series.     

Effect of various parameters on Quadriceps angle in adult Indian population

BackgroundThe purpose of this study was to compare the values of quadriceps angle (Q angle) in relation to age, weight, height, gender, bilateral and postural variations, and strenuous activities on the weight bearing limbs in order to observe its variability.Materials and methodsA total of 450 adult healthy volunteers (150 male students, 150 female students and 150 male labourers) were enrolled in this cross sectional study. Each volunteer had its height, weight and Q angles measured. Q angle was measured in all subjects bilaterally in both supine and standing position with the same goniometer. Comparison of Q angles and various parameters and groups were studied and tabulated. Correlation between age, weight, height and Q angles was determined by Karl Pearson's correlation coefficient.ResultsFemales had statistically significant higher Q angles in both knees than males of either group, and difference between males of two groups was insignificant. It was more often greater on left side (42.36%) as compared to right, both in males and females. Majority of subjects showed an increase in angle from supine to standing position. There was negative correlation between height and Q angle with both standing and supine position all three groups. Weight and age did not show significant correlation with Q angle. Physical activity did not show any significant effect on the angle.ConclusionQ angle is an important parameter to assess quadriceps muscle’s function and its effect on knee. An increase in the angle is clearly associated with patellofemoral problems. Higher Q angle among females may predispose them to sports related injuries. It is important to take into consideration of such factors like sex, height, posture, side, foot rotation and muscle’s relaxation while measuring and comparing the angle.     

In vivo Sonographic Characterization of The Achilles Tendons in Healthy Young Collegiate Athletes as a Function of Ankle Position

This study aims to describe the normative Achilles tendon properties in a collegiate subject cohort. Achilles tendon evaluations in 65 asymptomatic college-level athletes by ultrasound B mode on two tendon positions (neutral state and active maximum dorsiflexion). Correlation was made to BMI, tibial/foot length, maximal calf circumference, type of sports, resting/maximal dorsiflexion-plantar flexion angles among other factors. The mean Achilles tendon length was found to be 14.9 cm, mean transverse dimension of 1.38 cm, thickness of 0.49 cm and cross-sectional area of 0.61 cm² in the relaxed state. Males had greater tendon length than the female athletes (15.5 (M) vs 14.3cm (F) in the relaxed position and 16.1 (M) vs 15.2cm (F) in the stretched position), tendon width (1.4 vs 1.3 cm), tendon thickness (0.51 vs 0.46 cm), tendon cross-sectional area (0.65 vs 0.57 cm²) and foot length (27.6 cm vs 26.6 cm). The Achilles tendon parameters such as length in the relaxed state had a statistically significant correlation with the height, weight, and foot length, while the tendon length in the dorsiflexed-stretched position had a statistically significant relationship to foot length, tibia length, calf circumference and range of motion (both in maximum dorsiflexion and plantar flexion positions; p < .05 for all comparison). Differences in the correlation between the Achilles tendon parameters and body habitus was recorded as a function of ankle position. Tendon dimensions and cross-sectional areas were larger in male vs female athletes. Calf circumferences and Achilles tendon resting angle were outlined. No significant difference was found in the Achilles tendon dimensions regardless of the leg dominance with similar range of motion regardless of athlete gender.     

Range of motion measures under anesthesia compared with clinical measures for children with cerebral palsy

The purpose of this study was to determine whether there is a difference in range of motion at the ankle and knee when measured in the clinic versus under anesthesia for ambulatory children with cerebral palsy. Dorsiflexion and popliteal angle were measured on 70 limbs in the clinic and under surgical anesthesia with the assessor blinded. For the group of patients under 11 years of age, dorsiflexion with the knee flexed significantly increased a mean of 9.5 degrees (P<0.05) and with the knee extended significantly increased 8.5 degrees when patients were under anesthesia compared with the clinical measures. Dorsiflexion angles did not change significantly between the two conditions for the group of patients older than 11 years of age. Mean popliteal angle did not change significantly between the two conditions for either age group.     

Correlation between Evoked Motor Response of the Sciatic Nerve and Sensory Blockade

Background: Incomplete sensory blockade of the foot after sciatic nerve block in the popliteal fossa may be related to the motor response that was elicited when the block was performed. We investigated the appropriate motor response when a nerve stimulator is used in sciatic nerve block at the popliteal fossa.

Methods: Six volunteers classified as American Society of Anesthesiologists' physical status I underwent 24 sciatic nerve blocks. Each volunteer had four sciatic nerve blocks. During each block, the needle was placed to evoke one of the following motor responses of the foot: eversion, inversion, plantar flexion, or dorsiflexion. Forty milliliters 1.5% lidocaine was injected after the motor response was elicited at < 1 mA intensity. Sensory blockade of the areas of the foot innervated by the posterior tibial, deep peroneal, superficial peroneal, and sural nerves was checked in a blinded manner. Motor blockade was graded on a three-point scale. The width of the sciatic nerve and the orientation of the tibial and common peroneal nerves were also examined in 10 cadavers.

Results: A significantly greater number of posterior tibial, deep peroneal, superficial peroneal, and sural nerves were blocked when inversion or dorsiflexion was seen before injection than after eversion or plantar flexion (P < 0.05). Motor blockade of the foot was significantly greater after inversion. Anatomically, the tibial and common peroneal nerves may be separate from each other throughout their course. The sciatic nerve ranged from 0.9-1.5 cm in width and was divided into the tibial and common peroneal nerves at 8 +/- 3 (range, 4-13) cm above the popliteal crease.     

Tibialis posterior (TP) tendon transfer for foot drop: A single center experience

BackgroundFoot drop defined as a significant weakness of ankle and toe dorsiflexion. It leads to high stepping gait, functional impairment and deformity of the foot. Objective of this study was to assess the functional outcome of tibialis posterior (TP) transfer for patient with foot drop in a single center.MethodsThis is a retrospective study included 20 patients operated for foot drop of >1 year duration in the last 5 years. Preoperative assessment of muscles of all the three compartment of leg along with radiological assessment of ankle to rule out tarsal disintegration and ankle instability was done. Postoperatively gait, active dorsi/plantar flexion and the range of movement of the ankle and toes were assessed.ResultsTibialis posterior transfer was performed on 20 patients (16 males and 4 females, mean age 31.4 years). Commonest cause of foot drop was Hansen’s disease followed by post traumatic peroneal nerve damage and post injection sciatic neuropathy. At mean follow-up of 2 years, all patients, except one, could walk with heel-toe gait without any orthotic support. There was no pain, ruptures or infections of the transferred tendons. 19 of the 20 operated ankles had mean active dorsiflexion of 7.5°, the active plantar flexion of 36.25°, and the total range of movement 43.75°. The active dorsiflexion of the toes ranged from 5-20°.ConclusionDynamic tibialis posterior transfer gives good results in terms of normal gait, high patients’ satisfaction with minimal donor site morbidity and low complication rate.     

Prevalence,frontal plane knee alignment,and lower limb joint pain and injury in generalized joint hypermobility in Thai physical therapy students

ObjectivesThe primary aim was to study the prevalence of generalized joint hypermobility (GJH) among Thai physical therapy (PT) students. The secondary aims were to compare the lower limb alignments and lower limb joint pain and injury between GJH and non-GJH individuals. Furthermore, the association between GJH, lower limb alignment, and joint pain and injury were also evaluated.Material and methodsGeneralized joint hypermobility was assessed using the Beighton score with a cut-off of 4/9 in 255 PT students. The lower limb alignments measured in the study included pelvic tilt angle, tibiofemoral angle, quadriceps angle (QA), and navicular drop. Tibiofemoral angle and QA were measured with and without quadriceps contraction. The history of lower limb joint pain and injury was recorded with a simple questionnaire. Lastly, logistic regression analysis was used to study the association between GJH, lower limb alignment, and joint pain and injury.ResultsThe prevalence of GJH was 21.18% among the studied population. Quadriceps angle during quadriceps relaxation of the non-dominant leg of the GJH group was the only lower limb alignment found greater than those of the non-GJH group. The rate of lower limb joint pain and injury was not different between the two groups. Furthermore, no significant association between GJH, lower limb alignment, and lower limb joint pain and injury was found.ConclusionsGJH is not uncommon among Thai PT students. Only the non-dominant QA was found different between groups. Generalized joint hypermobility neither increase risk nor is it associated with lower limb joint pain and injury among Thai PT students.     

Influence of foot characteristics on the site of lower limb osteoarthritis

BACKGROUND: Foot structure and range of motion have been linked to lower limb musculoskeletal injuries in sports medicine,(11,14,41) and recently there have been attempts to establish a connection between the foot and lower limb osteoarthritis (OA)(19,13). Considering the fact that OA of the knee and hip are the most important causes of pain and disability in older people,(12,25) it is surprising that there has been no research comparing the foot types of those with knee OA and those with hip OA. To evaluate an apparent difference in the feet and gaits of patients with hip OA and medial compartment OA of the knee that was noted during routine clinical assessment, a prospective observation study was undertaken. METHODS: The study included patients with OA either of the hip or the medial compartment of the knee and a control group of healthy subjects. There were 60 in each group determined by sample size calculation. The groups were matched for age and gender. Dorsiflexion and plantarflexion of the ankle, calcaneal angle, and navicular height in both sitting and standing were measured. Results were analyzed by ANOVA and linear regression analysis. RESULTS: There were significant differences among all three groups, particularly in ankle dorsiflexion (p < 0.001) and calcaneal angle (p < 0.001). CONCLUSIONS: Differences in foot type between patients with OA of hip and knee were confirmed. These two groups also were different from the control group of healthy subjects. The lack of ankle dorsiflexion and high arches of patients with OA of the hip contrasted with the ample dorsiflexion and flatfeet of patients with OA of the knee.     

Test-retest reliability of a clinical foot assessment device for measuring first metatarsophalangeal joint quasi-stiffness

BackgroundThe stiffness of the first metatarsophalangeal joint (MTPJ) is of interest in cases such as hallux rigidus and apropulsive gait. Subjective rating of joint mobility as ‘hypermobile, normal, or stiff’ is an unreliable method. Previous instruments for the assessment of first MTPJ stiffness can be too hard and uncomfortable for test subjects. Recently, a new device using a load cell and optical fiber with fiber Bragg grating (FBG) sensors was developed to provide a comfortable means of clinical foot assessment. This study aimed to evaluate the test-retest reliability of this FBG-load cell device in measuring the first MTPJ quasi-stiffness.MethodsThe left foot of 13 female subjects were measured twice for their first MTPJ quasi-stiffness, approximately seven days apart. The FBG-load cell device measured the MTPJ range of motion from a resting position to maximum dorsiflexion and then returning to the resting start-position. The force applied by a clinician to displace the toe was simultaneously recorded using the load cell. The quasi-stiffness over the “working range” in loading and unloading directions were determined from the slope of the torque-angular displacement graph. The test-retest reliability of the MTPJ quasi-stiffness was evaluated using intra-class correlation coefficient [ICC (2,1)].ResultsThe reliability was almost perfect for MTPJ quasi-stiffness over the loading phase (ICC = 0.814), moderate for MTPJ quasi-stiffness over the unloading phase (ICC = 0.477) and moderate for MTPJ maximum range (ICC = 0.486).ConclusionThe foot assessment device comprising FBG and load cell was able to reliably measure the first MTPJ quasi-stiffness in a clinical setting. The measurement reliability was higher during the loading phase than the unloading phase.     

Staples and locking plates provide comparable outcomes for fixation of first metatarsal dorsiflexion osteotomies in pes cavovarus

BackgroundOne commonly encountered deformity within the cavovarus foot is plantarflexion of the first metatarsal which may be a primary or secondary deformity. Correcting the plantarflexion may be achieved through a dorsiflexion osteotomy although the optimal fixation device for this osteotomy has not been determined. This clinical study compared the outcomes using staples and locking plates.MethodsA retrospective evaluation was performed of 52 feet that had undergone dorsiflexion osteotomy of the first metatarsal as part of a cavovarus foot correction with a minimum follow-up of two years. Data was collected on deformity correction, complications and cost-analysis.ResultsAs a cohort, Meary’s angle improved from 13.4° to 7.72° (p < 0.001), Hibbs’ angle improved from 117.1° to 124.2° (p < 0.001) and navicular height dropped from 52.7 mm to 47.7 mm (p < 0.001) while calcaneal inclination changed from 20.9° to 21.2° but this did not reach significance (p = 0.66). These indices and the number of complications were not significantly different between the staple and locking plate group. The overall cost of using staples was less than using locking plates.ConclusionsBoth staples and locking plates are effective devices for fixation of the first metatarsal after a dorsiflexion osteotomy in cavovarus foot surgery. They were both able to provide comparable fixation, although staples were less expensive to use in our study.     

Comparison of clinical with CT based evaluation for tibial torsion

PurposeTibial torsion is important to be factored in during calculations of angular deformities of the lower extremity. Three methods are commonly used, thigh foot angle, measurement of transmalleolar axis with proximal tibia or knee as a reference, and Computerized tomography. The purpose of the current study was to find out the effectiveness of clinical methods and compare CT based method for tibial torsion.MethodsA total of 68 limbs (34 subjects) were included. Tibial torsion was measured using thigh foot angle, transmalleolar axis in relation to knee forward position (Knee ankle axis) and CT based evaluation using Jend method.ResultsPearson correlation coefficient showed strong correlation between CT values and thigh foot angle (r = 0.848) as well as between CT values and Knee ankle axis (r = 0.889). Scatter plots also showed a linear distribution.ConclusionBoth thigh foot angle and Knee ankle axis provide reliable alternative to ionizing CT in measuring tibial torsion.     

踝关节跖屈、背屈运动的研究

目的:研究Pilon骨折在治疗中评价踝关节功能,诊断下胫腓联合分离、踝关节前后脱位的影像学依据。方法:35例正常成人,男21例(42踝),女14例(28踝);年龄21-48岁,平均31.6岁。踝关节常规摄正、侧位X线片;测量踝关节主动跖屈、背屈运动的最大角度,下胫腓联合间隙的宽度,胫骨外侧与腓骨的胫侧重叠影宽度,距骨踝关节面几何中心偏离胫骨中轴线的距离。结果:跖屈主动运动的最大角度,男(40.8°±3.1°),女(43.9°±4.8°);背屈主动运动的最大角度,男(27.6°±5.2°),女(26.5°±6.1°)。下胫腓联合间隙的宽度平均(3.2±0.5)mm。胫骨外侧与腓骨的胫侧重叠影宽度平均(6.9±2.2)mm。踝关节的跖屈下胫腓联合有逐渐变窄的变化,平均2 mm。距骨中心中轴距:男性跖屈最大值2.4 mm、背屈2.5 mm,女性跖屈最大值1.9 mm、背屈2.0 mm,最小值均为0 mm。结论:男女之间无论是背屈还是跖屈均无显著性差异(P>0.05),即踝关节在运动灵活性上无性别差异。踝关节主动跖屈、背屈运动的最大角度为Pilon骨折术中踝关节功能评定提供参考,下胫腓联合宽度>3.5 mm为下胫腓联合分离,胫骨外侧与腓骨的胫侧重叠影宽度<5.5 mm时,有下胫腓联合分离的可能。距骨中心中轴距>2 mm提示踝关节前后脱位。Pilon骨折在恢复骨折解剖复位的同时要注意这两个指标,对于恢复踝关节的侧方稳定、前后方向稳定有重要意义,能指导踝关节骨折治疗和康复。