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Lateral ankle sprains are among the most common sports injuries, with a prevalence of 25 to 30 % of all injuries. At least one-third of individuals develop long-term complaints and chronic instabilities at the ankle, which in many cases cannot be attributed to mechanical insufficiencies of the joint. This condition is referred to as functional ankle instability (FAI). Impairments of the sensorimotor control system, such as disturbed proprioception and postural control, as well as reduced muscle strength and reflex activity, have been suggested to contribute to the aetiology of FAI. This review summarises the current body of literature regarding sensorimotor control in individuals with FAI. We discuss the results in the context of current neurophysiological models of the development of functional joint instabilities., (Georg Thieme Verlag KG Stuttgart · New York.)

Background: Knowledge of the pathomechanism and the detailed extent of ankle joint lesions determines adequate therapy and success of treatment., Material and Methods: Supination external rotation lesions were induced in 29 human cadavera with a testing apparatus; 27 of these specimens were from elderly women. Bone mineral density was measured. The literature review includes experimental studies of this fracture entity., Results: We induced stage II in 42%; applying an additional lateral force on the fibula raised the incidence. The syndesmosis stayed intact in 50% although the fibula fractured at the level of the tibial plafond. Stage IV lesions were registered in 25%. The overall low bone mineral density showed a positive correlation to the angle at which the fibula fracture occurred., Conclusions: We reproduced supination external rotation lesions according to Lauge-Hansen in osteoporotic ankles. There is a certain discrepancy between the obligatory lesion of the inferior anterior tibiofibular syndesmosis at stage II according to Lauge-Hansen, as we observed an intact syndesmosis in 50% at stage II. Stage IV defining medial malleolar fractures were reproduced after Lauge-Hansen and Michelson et al.

Muscle injuries are common in sports. They are usually caused by either acute (mostly eccentric mechanisms) or chronic overloading with a lack of muscle coordination. They present in clinical practice as bruises and muscle sprains. Due to the rigours of a modern society and the high economic cost of time off work, an effective treatment needs to be employed. The key to an optimised therapy rests in the appropriate timing between immobilisation and mobilisation. The interval to muscle repair might be shortened by certain adjuvant therapies. In doing so, it is important that no physiological phases of wound healing are overlooked. Muscle healing can be accelerated by externally induced higher metabolic turnover. Surgical therapy is sometimes necessary in selected cases and in serious injuries.

Problems: Soccer as a Stop-and-Go-sport goes along with a high level of physical strain on the locomotor system. Compared to similar kinds of sports, soccer is characterized by a high prevalence of overloads/injuries in the pelvic region. Since soccer frequently involves one-sided shot-training, modifications in the pelvic statics are possible., Methods: In a pilot study including 15 football-players-FP (age 26.9 +/- 3.1 yrs; 4.4 +/- 0.4 training units/week+ 1 leaque game) the pelvic statics was measured using the 3-d-recording system CMS70 (Zebris, Germany) directly before and after a defined shot training. The positions of the right and the left posterior superior iliac spines - PSIS were compared. Additionally, the stiffness of selective muscles was analyzed., Results: Before intervention the right PSIS was heightened in 8 FP. In 4 FP the pelvic statics was balanced and in 3 FP the right PSIS was abased. After the shot training, the pelvic statics was balanced in 4 FP. In contrast, 10 FP showed a higher right PSIS and 1 FP had a lower right PSIS. However, modifications of the pelvic statics were detected in all directions., Discussion: Our study demonstrates modification of the pelvic statics by asymmetric soccer-specific strains, but the reactions were individually different. It is possible, that changes in the pelvic statics may lead to changed function or overstrain of advertising muscles.

Chronic ankle instability represents a typical sports injury which can mostly be seen in basketball, soccer, orienteering and other high risk sports. 20 to 40 % of the acute ankle sprains develop into chronic ankle instability. From a sports orthopaedic point of view, chronic ankle instability can be subdivided into a lateral, medial or a combination of both so called rotational ankle instability. From a pathophysiological point of view, chronic ankle instability can be either mechanical with a structural ligament lesion or functional with loss of the neuromuscular control. For the sports physician, the chronic ankle instability is a difficult entity as the diagnosis is usually complex and the therapy usually surgical. This review on chronic ankle instability addresses pathomechanism, diagnostics, indications for conservative and surgical treatments, and possible long-term sequelae, as ligamentous osteoarthritis.

Chronic functional instability is a residual problem after acute ankle sprain. Reasons may be weak ligaments and/or a deficit in the proprioceptive system. Studies have shown that peroneal reaction time (PRT) can be used to quantify proprioceptive performance. To test the influence of anthropometric data on PRT, an experimental study with 120 healthy volunteers was performed. Surface electrodes recorded the activity of the peroneal muscles after a sudden inversion on a tilting platform. It was found that PRT is not influenced by extrinsic or anthropometric data. Furthermore, the results prove a significant slackening in PRT with increasing age. Therefore, the patient's age must to be considered in judging the PRT.

Two questions were investigated: Do ankle devices have any influence on sports performance? Are there any differences between the devices? 31 participants could be included. The average age was 24.5 (+/- 4.1). The participants exercised 5.8 hours/week. We tested 41 ankles without any previous injury. With the Cybex 6000 four parameters were evaluated. Torque maximum for the plantarflexion, range of motion, work in Joule. The ankles were tested with three different ortheses, ankle taping and without any device. The Friedman Test was used to evaluate differences between the five test conditions. All measurements showed significant worse results for the devices and taping. The protective effect of ankle devices is well known. In this investigation we could show a restriction of the performance. Thus it should be decided individually, if an ankle device is useful.

Improvements of the shoe design to increase ankle stability have been discussed for a number of years. This accounts also for floorball where the incidence of ankle injuries is very high. The purpose of the present study was to describe the influence of the shoe upper on a typical floorball sideward cutting movement. A film analysis was conducted (200 Hz) where the achilles tendon angle beta was measured on the shoe as well as within the shoe. Subjects were twelve active floorball players who performed a defined sideward cutting movement with a low-cut and high-cut shoe as well as in the barefoot condition. The results of part 1 of the study showed the stabilizing effect of the shoe upper with respect to supination. The range of supination of the barefoot inside the shoe (between touchdown and maximum) of the low-cut shoe (23.7 degrees +/- 5.7 degrees) was decreased when using the high-cut shoe (12.3 degrees +/- 4.6 degrees). In addition, a reduced shoe sole thickness and an anisotropic shoe sole design showed reducing effects on supination. Part 2 of the study showed significant differences in supination between two different touchdown techniques. With a forefoot touchdown supination was much less (12.0 degrees +/- 4.8 degrees) than with a touchdown in the neutral position (31.7 degrees +/- 4.2 degrees; p < 0.001). Furthermore, possibilities to improve the design of future floorball shoes are discussed.

For functional treatment of acute ankle sprain after surgical or nonsurgical management various special shoes and braces are in use. For a comparison under functional conditions we applied controlled inversion movements of 20 and 30 degrees to 13 subjects. The reduction of angular displacement was measured for the following orthosis: Aircast, Adimed Stabil 2, Adipromed Stabil Super, Mikros Ankle Brace, MHH-Splint Caligamed, Puschbrace and Tape. For evaluation of the neuromuscular activation surface EMGs of selected leg muscles were analyzed. A significant reduction of the induced inversion displacement was observed in all devices, although a complete inhibition of this movement was not possible. EMG activation was comparable to physiological conditions and is not correlated to the displacement characteristics. It is concluded that functional evaluation must take into consideration both the optimal reduction of the inversion and the high functional innervation.

Traumatic carpal instability implies that the normal relationships of the radiocarpal and mid carpal joint are distorted either statically or during dynamic stress. Normal kinematics of the carpus are dysfunctional. The causes of carpal instability are dissociation of the intercarpal ligaments on either side of the lunate, a so-called scapholunate dissociation or a luno-triquetral dissociation. Carpal instability nondissociative is generally due to a laxity or attenuation of the intrinsic ligaments of the carpus and are associated with deformity of the distal radius. Ulnar translation of the carpus on the distal radioulnar articular surfaces occurs with shear stretching of the origins of the radiocarpal ligaments. The radial styloid attenuation of the ligaments may result in abnormal motions of the carpal bones going from ulnar to radial deviation at which time a catch-up click may occur. Carpal instabilities are usually associated with malalignment of the lunate with respect to the longitudinal axes of the radius and capitate and tends to assume an extended position with scaphoid fractures or injuries to the scapholunate ligament, a palmar flexed position with injuries to the luno-triquetral area or the ulnar capsule.

Measurements with polarographic needle probes in fibromyalgic muscles (mm. erectores spinae) revealed an elevated mean tissue-pO2. The total mean tissue-pO2 in the patient group was significantly higher than that in the control group. Greater pathological tension in fibromyalgic muscles increases the mean tissue-pO2. The distribution of local tissue-pO2 values was normal; there was no evidence of small hypoxic areas in the muscle. The elevated tissue-pO2 in fibromyalgic muscles could either be explained by an increase in local blood flow or by disturbance of oxygen-utilization of the muscle cells. The mean tissue-pO2 in patients treated with NSAD was lower than in patients without this treatment. Myogelosises (i.e., circumscript tautness in muscles, that, contrary to fibromyalgic muscles, do not relax under general anesthesia) showed low tissue-pO2 values and even hypoxia in the core. In myogelosises, pain could be hypoxic in nature. However, in fibromyalgic muscles no evidence for hypoxia or hypoxia-related pain could be found.

The lower ankle joint is highly variable in ligamental guidance. It has to be considered in unity with the upper ankle joint. Biomechanical investigations have shown the posterior lower ankle joint to be relatively unstable primarily in supination position. Radiological techniques are available to procedure radiographic evidence to that clinical instability of the lower ankle joint. A surgical approach to instability of both upper and lower ankle joints is proposed in this paper and is discussed in some detail.

The efficacy of Mobilat ointment (100 g contain: Extract. suprarenale 1.0 g, Mucopolysaccharide-polysulfate 0.2 g, salicylic acid 2.0 g) in the treatment of acute lateral distortions of the ankle was tested in a randomised, placebo-controlled, double blind study. The criteria used for the assessment of the progress of healing were the pressure distribution during walking, the swelling of the injured region and the evaluation of pain using a visual analogue scale. During the period of treatment and observation lasting 2 weeks, all the assessment criteria showed a more rapid regression in the symptoms and signs of the disorder on treatment with the active product. The differences were statistically significant for all the criteria assessed.