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Gait retraining using haptic biofeedback medially shifts the center of pressure (COP) while walking in orthopedic populations. However, the ideal sensor location needed to effectively shift COP medially has not been identified in people with chronic ankle instability (CAI). Can a heel sensor location feasibly be employed in people with CAI without negatively altering kinematics? Does a heel sensor placement relative to the 5th metatarsal head (5MH) impact COP location while walking in people with CAI? In this exploratory crossover study, 10 participants with CAI walked on a treadmill with vibration feedback for 10 minutes with a plantar pressure sensor under the heel and 5MH. Separate 2×2 repeated measures analyses of covariances (rmANCOVAs) were used to compare the averaged COP location and 3-D lower extremity kinematics from the first 10% of stance before and after training and between sensor locations. Baseline measures served as covariates to adjust for baseline differences. Feedback triggered by a heel sensor resulted in 40% of participants avoiding a heel strike. There were no significant main effects or interactions between time and sensor location on COP location when controlling for baseline COP (p>0.05). However, with the 5MH placement, participants displayed less ankle internal rotation(IR) (5MH/Heel: −4.12±0.00º/ −6.43±0.62º), less forefoot abduction (-4.29±0.00º/ −5.14±1.01º), more knee flexion (3.40±0.32º/ 0.14±0.57º), less knee external rotation (-10.95±0.00º/-11.24±1.48º), less hip extension (-0.20±0.00º/-1.42±1.05º), and less hip external rotation (3.12±0.00º/3.75±1.98º). A 5MH location may be more feasible based on difficulties maintaining heel strike when the sensor was under the heel. While no sensor location was statistically better at changing the COP, the 5MH location decreased proximal transverse plane motions making participants' gait more like controls. Individual response variations support comprehensive lower extremity assessments and the need to identify responder profiles using sensory feedback in people with CAI. • A forefoot sensor to control stimuli is more feasible for gait retraining in CAI. • A forefoot sensor may alter kinematics to be more like controls. • A heel sensor for gait retraining causes unanticipated gait deviations. [ABSTRACT FROM AUTHOR]

Purpose: The aim of the study was to investigate the effect of ankle distortion taping on balance, gait, function, spasticity and quality of life in cerebral palsy cases with varus deformity. Material and Methods: A two-armed randomized controlled trial was carried out in rehabilitation center. A total of 32 children with CP were randomized into taping plus conventional therapy (T+CG) and conventional therapy group (CG). The children in the T+CG group were given distortion taping for 3 days in addition to CG. Participants were assessed before the treatment, in the immediate period after the first session, and in the acute period after the third session. The Timed Up and Go Test (TUG) and Single Leg Stance Test (SLST) were used to assess the physical performance-based function. The Modified Ashworth Scale (MAS) was measured the spasticity degree of individuals. Wisconsin Gait Scale (WGS) and Child Health Questionnaire (CHQ) were used to evaluate the gait and quality-of-life, respectively. Results: The mean ages of the children in CG and T+CG were 9.62±2.50 and 10.0±1.63, respectively. In immediate and acute periods, plantar flexor muscle spasticity decreased significantly in individuals with T+CG (p=0.0001). TUG and SLST scores improved significantly in the T+CG group, both in immediate and acute term (p=0.0001). In acute and immediate term, there was a statistically significant improvement for WGS in both groups (p<0.05). The quality of life of T+CG was improved in the acute period (p<0.05). Conclusion: The results showed the effectiveness of distortion taping in reducing the spasticity of ankle plantar flexor muscles and improving function, balance and gait. However, taping was not superior to control group. [ABSTRACT FROM AUTHOR]

Background: Congenital talipes equinovarus (CTEV), also known as club foot deformity, is a common deformity with an estimated incidence of around 1 in 1000 live births. The deformity consists of four components: Ankle equinus, hindfoot varus, forefoot adductus, and midfoot cavus. Various approaches exist to correct CTEV, with most authorities advocating a conservative closed reduction approach with serial casting. Objective: Pirani scoring has been shown to correlate with the severity of CTEV and has been verified to track response to casting treatment. This study aimed to identify the relationship between initial presenting Pirani scores and other factors on the final Pirani score and the need for surgical intervention for patients managed with Ponseti casting in a single-center observational study design. Methods: A total of 24 patients were followed across the duration of the study and serially assessed with the Pirani scoring system. The scores were charted and studied to determine patterns that predict the success of Ponseti casting in those children. Results: The data showed that tenotomy is most likely corrective of the deformity in those with higher PS. While the age of diagnosis and age of casting were not significantly impactful, careful follow-up and discussion of goals with the family members are essential for expected outcomes, especially for those hesitant to undergo surgical interventions and those with higher Pirani Scores. [ABSTRACT FROM AUTHOR]

Gastrocsoleus lengthening (GSL) is the most common surgical procedure to treat equinus deformity in ambulant children with cerebral palsy (CP). Foot drop, where the ankle remains in plantarflexion during swing phase, can persist in some children post-operatively. There is currently limited understanding of which children will demonstrate persistent foot drop after GSL. Which children develop persistent foot drop after GSL surgery for equinus? We conducted a retrospective cohort study on ambulant children with CP who had GSL surgery for fixed equinus deformity. The aims of the study were: to determine the frequency of persistent foot drop post-operatively and to compare outcome parameters from physical examination and three-dimensional gait analysis for children with hemiplegia or diplegia. One hundred and ten children functioning at GMFCS Levels I/II/III of 28/75/7 met the inclusion criteria for this study. There were 71 boys and mean age was 9.1 years at time of GSL surgery. The overall frequency of persistent foot drop was 25%, with a higher frequency of persistent foot drop in children with hemiplegia (42%) than children with diplegia (19%). There were significant improvements in dorsiflexor strength and in selective motor control in children with diplegia but not in children with hemiplegia. Mean (SD) pre-operative mid-swing ankle dorsiflexion for children with hemiplegia was − 14.0° (9.9°) and improved post-operatively to − 1.6° (5.5°). For children with diplegia, the pre-operative mid-swing ankle dorsiflexion was − 12.1° (12.9°) and improved post-operatively to + 4.2° (6.9°). Foot drop is present following GSL surgery for fixed equinus deformity in a significant number of children with hemiplegia and to a lesser extent in children with diplegia, which may reflect a difference in the central nervous system lesion between these groups. New management approaches are required for this important and unsolved problem. • Foot drop may persist after gastrocsoleus lengthening surgery for equinus deformity. • Higher frequency in children with hemiplegia (42%) than those with diplegia (19%). • Greater dorsiflexor strength and selective motor control in children with diplegia. • This may reflect differences in the underlying central nervous system lesion. • Improved management strategies are required to prevent post-operative foot drop. [ABSTRACT FROM AUTHOR]

BACKGROUND: Only one article described ankle varus as a typical symptom in the late stage of the intra-articular osteoid osteoma of the calcaneus. And the red-brown color of synovial fluid in the affected joint hasn't been reported. This report shows a patient with intra-articular osteoid osteoma of the calcaneus who had the 2 above symptoms. Case presentation: A 39-year-old man had left ankle pain and the diagnosis was delayed for 20 months. At the late stage, the ankle was gradually varus. In our hospital, the withdrawal of the subtalar joint gave a red-brown synovial fluid. Together with the typical lesion on MRI, the diagnosis of intra-articular osteoid osteoma of the calcaneus was made. An open operation was performed for treatment. In the procedure, the red-brown synovial fluid was exuded. A specimen was harvested for biopsy confirming osteoid osteoma. CONCLUSIONS: It is still essential that intra-articular calcaneal osteoid osteoma should be considered in patients with prolonged pain and varus of the ankle. The red-brown synovial may be used as a finding for diagnosis. [ABSTRACT FROM AUTHOR]

Background: The ankle plays a key role in balance, but ankle range of motion decreases with ageing.Research Question: To establish whether a talus mobilization-based manual therapy intervention may be effective for increasing range of motion and balance in older adults with limited ankle mobility due to the ageing process.Methods: Randomized clinical trial in which 42 community-dwelling older adults with limited ankle mobility were allocated to an experimental or a control group. The experimental intervention consisted of six sessions of anteroposterior talus mobilization, whereas the control intervention was a sham treatment. Baseline change in weight and non-weight bearing ankle range of motion (ROM), balance outcome in terms of the Timed up and go (mobility and dynamic balance), Single-leg stand (static balance and stability), Functional reach (margins of stability) and Romberg tests (static balance) were assessed. Analysis of variance based on a mixed-linear model of repeated measures looked for group interactions.Results: Forty participants completed the study. Participants who received six sessions of manual therapy showed greater improvements in the Timed up and go, Functional reach and Single-leg stand tests than participants who received a sham intervention (p < 0.001). Both groups presented similar performance in post-treatment static balance measures (p > 0.05).Significance: An anteroposterior talus mobilization-based manual therapy intervention is effective for increasing ankle ROM, with a positive effect on dynamic balance, mobility and stability in community-dwelling older adults with limited ankle mobility. [ABSTRACT FROM AUTHOR]

Background: The purpose of this study is to report outcomes of transphyseal screw hemi-epiphysiodesis at the medial malleolus for the treatment of valgus ankle deformity. Methods: An institutional review board–approved retrospective review was done of 24 patient charts. Lateral distal tibial angle (LDTA) was measured preoperatively and at final follow-up. Results: The average change in LDTA was 8.3 degrees (SD 4.9 degrees; range 0-19 degrees). The average rate of correction was 0.4 degrees per month (SD 0.3; range 0-1.4). Conclusion: Medial malleolar transphyseal screw hemiepiphysiodesis is a simple, effective, and safe treatment for valgus ankle deformity in skeletally immature children. Level of Evidence: Level IV, case series. [ABSTRACT FROM AUTHOR]

Background: Individuals with chronic ankle instability (CAI) have an increased risk for recurrent injuries. The preventive effects of external ankle supports are not fully understood. This study aimed to examine the effect of elastic ankle support on running ankle kinematics.Methods: 3D running gait analysis of individuals with and without CAI was conducted at three-minute-running trials at 2.78 m/s with and without elastic ankle support in a randomised order. Ankle kinematics and intra-individual standard deviations (variability) were calculated at each percent of the running gait cycle. Group and ankle support effects were calculated using statistical parameter mapping.Results: Twenty-seven individuals were analysed (CAI: n = 14, controls: n = 13). When wearing ankle support, CAI individuals showed significantly decreased plantarflexion angles at 43-47 % (p = 0.033) and 49-51 % (p = 0.043) of the running gait cycle compared to normal running. In healthy controls, no differences in ankle angles between both conditions were found. Comparisons between CAI individuals and healthy controls showed statistically significant differences in the plantar-/dorsiflexion angles at 38-41 % (p = 0.044) with ankle support and at 34-46 % (p = 0.004) without ankle support. Significant ankle angle variability differences were found for ankle in-/eversion between CAI individuals and healthy controls (p = 0.041) at 32-33 % of the running gait cycle.Conclusions: Elastic ankle support reduces the range of sagittal plane running ankle kinematics of CAI individuals but not of healthy controls. Further research is needed to evaluate the association between ankle support effects and the risk for recurrent ankle sprains. [ABSTRACT FROM AUTHOR]

As an effective scale for the condition assessment of patients with chronic ankle instability (CAI), the Cumberland Ankle Instability Tool (CAIT) is the most widely used scale, and its original version is written in English. Therefore, the purpose of our study is to apply the CAIT to Chinese patients and evaluate its responsiveness, reliability, and validity in terms of Chinese patients with CAI. First, we adapted the CAIT into the Chinese edition (CAIT-C), through which cross-cultural adaptation and translation can be carried out in a five-step procedure. Next, recruited patients completed the three periods of the Foot and Ankle Ability Measure (FAAM), CAIT-C, and the Medical Outcomes Study Short-Form 36 (SF-36) scales. Afterward, to assess the responsiveness, reliability, and validity, we calculated the standardized response mean (SRM), effect size (ES), Spearman's correlation coefficient (rs), minimal detectable change (MDC), standard error of measurement (SEM), intraclass correlation coefficient (ICC), and Cronbach's alpha. Generally, in the use of CAI, 131, 119, and 86 patients favorably completed the three periods of the scales. The CAIT-C was proven to have good test–retest reliability (ICC = 0.930) and fine internal consistency (Cronbach's alpha = 0.845–0.878). The low-value of MDC (0.04–2.28) and SEM (1.73) show it is possible to detect clinical changes when we take advantage of CAIT-C. Good or moderate correlations (rs = 0.422–0.738) were gained from the physical subscales of the SF-36 and the subscales of the FAAM and the CAIT-C. Fair or poor correlations (rs = 0.003–0.360) were gained between the mental subscales of the SF-36 and the CAIT-C, which sufficiently indicated that the CAIT-C had good validity. Moreover, good responsiveness was observed in the CAIT-C (ES = 1.316, SRM = 1.418). The CAIT-C scale is an effective, valid, and reliable tool to evaluate Chinese CAI patients. [ABSTRACT FROM AUTHOR]

Purpose: The aim of the present study was to assess the long-term outcomes of the treatment of chronic ankle instability (CAI) with a four-step protocol. Methods: Fifty-four patients with isolated anterior talo-fibular ligament (ATFL) lesion suffering from CAI who underwent surgical treatment between 2000 and 2009 were assessed. All the patients underwent a four-step protocol including synovectomy, debridement of ATFL lesion borders, capsular shrinkage, and 21-day immobilization and nonweightbearing. Median age at surgery was 31.6 years (18–48). Patients were examined preoperatively and at follow-up. Clinical assessment included the American Orthopaedic Foot and Ankle Society (AOFAS) ankle and hindfoot scoring system, Karlsson–Peterson score, Tegner activity level, and objective examination comprehending range of motion (ROM) and manual laxity tests. Results: AOFAS (preoperative, 64.8; postoperative, 92.4; p < 0.001) and Karlsson-Peterson score (preoperative, 62.5; postoperative, 88.8; p < 0.001) significantly improved after a median 11 years follow-up (7–16 years). Similarly median Tegner activity level significantly increased at follow-up compared to pre-operatory status (6.0 and 4.0 respectively, p < 0.001). Objective examination documented a statistically significant improvement in terms of ankle stability compared to pre-operative manual laxity tests, with negative anterior drawer test observed in 48 (88.9%) patients (p < 0.001). Sagittal ROM was full in 50 patients (92%). Nine patients had subsequent ankle sprains (15.6%), two patients required further surgery, while seven were treated conservatively. No major complications were reported. Conclusion: Satisfying subjective and objective clinical outcomes in selected patients with isolated ATFL lesion suffering from CAI were reported with a treatment protocol including arthroscopic synovectomy, debridement of ATFL remnants, capsular shrinkage, and immobilization. These findings are of clinical relevance because they provide a suitable minimally invasive method for the treatment of mild to moderate ankle instability. Level of evidence: Level IV [ABSTRACT FROM AUTHOR]

Purpose: In the athletic population, the prevalence of isolated syndesmotic lesions is high. To detect potential instability of the ankle is crucial to define those lesions in need of surgical management. The aim was to define how the extent of tibio-fibular syndesmotic ligament injury influences the overall stability of the ankle joint in a cadaver model.Methods: Twenty fresh-frozen through knee cadaveric leg specimens were subjected to different simulated syndesmotic ligament lesions. In Group 1 (n = 10), the order of ligament sectioning was: anterior tibio-fibular ligament (ATFL), superficial deltoid ligament (SDL), deep deltoid ligament (DDL), posterior tibio-fibular ligament (PTFL), and progressive sectioning at 10, 50 and 100 mm of the distal interosseous membrane (IOM). In Group 2 (n = 10), the sequence was: ATFL, PITFL, 10 and then 50 mm of the distal IOM, SDL, DDL, and 100 mm of the distal IOM. Diastasis of 4 mm in the coronal or sagittal plane and external rotation of the ankle greater than 20° were considered indicative of instability.Results: Both coronal and sagittal diastasis exceeded 4 mm with injury patterns characterized by IOM lesions extending beyond 5 cm. External rotation of the ankle exceeded 20° with injury patterns characterized by a DDL lesion.Conclusion: Coronal and sagittal plane diastases of the tibio-fibular syndesmosis are particularly affected by sequential lesions involving the IOM, whereas increased external rotation of the ankle most depends on DDL. The identification of the specific syndesmotic and deltoid ligament injuries is crucial to understanding which lesions need operative management. The knowledge of which pattern of tibio-fibular syndesmotic ligament injury influences the ankle joint stability is crucial in defining which lesions need for surgical management. [ABSTRACT FROM AUTHOR]

Purpose: Ligamento-muscular reflex pattern following stimulation of the anterior talofibular ligament (ATFL) was examined. Methods: The peroneus longus (PL), the tibialis anterior (TA), and tibialis posterior (TP) muscles were investigated in sixteen patients with functional ankle instability (FAI) and 16 age- and gender-matched controls. The ATFL was stimulated with a fine wire electrode while electromyographic (EMG) activities were recorded during isometric foot contraction of 20% maximal force in plantarflexion, dorsiflexion, supination and pronation. The complete measurement was repeated after a peroneal block anesthesia. Results: Statistically significant changes in post-stimulus EMG activity were observed in all three muscles and all four tested foot positions. In supination, the PL showed no reactions in both groups before and after anesthesia. The post-stimulus inhibition of the TA seen after 80 and 180 ms disappeared in controls after anesthesia. The TP had similar inhibitory responses in both groups. Conclusion: Ligamento-muscular reflex pattern is alterated in FAI. While early reactions are essential in protecting the ankle joint in sudden movements, the later responses indicate a supraspinal control of neuromuscular stability of the ankle joint. Proprioceptive rehabilitation of the PL, TA, and TP is crucial in FAI to compensate for post-traumatic ligamentomuscular reflex deficiencies. Level of evidence: II. [ABSTRACT FROM AUTHOR]

Purpose: Arthroscopic all-inside anterior talofibular ligament (ATFL) repair is a common surgical technique for chronic ankle instability (CAI), and the condition of the ATFL remnants is associated with its reparability. ATFL reparability can affect the clinical course, but the relationship between magnetic resonance imaging (MRI) findings and the intraoperative ATFL reparability is still unclear. The purpose of this study was to investigate the relationship between ATFL signal intensities according to MRI and intraoperative ATFL reparability. Methods: This study included 55 cases of CAI (n = 37) and osteochondral lesion of the talus (n = 18) that underwent MRI followed by subsequent arthroscopy. MRI signal intensity was measured preoperatively to calculate the signal to noise ratio (SNR). During arthroscopy, the presence of an ATFL tear was checked and the ATFL tension was classified as taut, mild laxity, or laxity; ATFL quality was classified as excellent (normal), moderate (abnormal but reparable), or poor (irreparable). It was then analyzed whether there was a relationship between the intraoperative findings and the SNR. Results: The mean SNR was 23.4 ± 21.6. The SNR was significantly different according to the presence of an ATFL tear and ATFL tension and quality (all P = 0.001). The SNR was better correlated with ATFL quality (r = 0.708) than the presence of a tear (r = 0.545) or degree of tension (r = 0.653). The diagnostic SNR cutoff point to distinguish a normal ATFL from an abnormal but reparable ATFL was 11.2, and that to distinguish between an irreparable and reparable ATFL, was 32.3. Conclusion: The SNR, representing MRI signal intensities, is highly correlated with the intraoperative measures of the ATFL. Therefore, the SNR had predictive value for determining the arthroscopic reparability of the ATFL. Level of evidence: Level III. [ABSTRACT FROM AUTHOR]

Background: Osteochondral lesion of the talus (OLT) is commonly found as a concomitant pathologic lesion in a large proportion of patients with chronic lateral ankle instability (CLAI). This study investigated which characteristics in a patient with CLAI increase the risk for OLT. Methods: Three hundred sixty-four patients who underwent a modified Brostrom operation for their CLAI were reviewed retrospectively. The characteristics of each patient and variables associated with OLTs were investigated. Statistical analyses were performed to determine the effect of each potential predictor on the incidence of OLT, and to evaluate the associations between the patient characteristics and variables associated with OLTs. Results: Patients with OLTs were more frequently female (female vs male: 63.1% vs 43.9%, P = .003). In addition, the lesion sizes were larger in female patients (female vs male: 113.9+24.9 mm² vs 100.7 + 18.0 mm², P = .002), and medial lesions were more common in female patients (female vs male; 93.3% vs 81.8%, P = .036). The lesion sizes were larger in patients with a wider talar tilt angle (P < .001), and patients with a medial OLT showed a wider talar tilt angle (12.0+2.0 degrees vs 10.3 + 2.2 degrees, P = .002). Conclusion: In this CLAI patient cohort, we found female patients to be at greater risk for OLTs than male patients. Furthermore, CLAI female patients with concomitant OLT had on average a larger lesion size, more frequent OLT medial position, and were associated with wider talar tilt angles, suggesting that females had more intrinsic ankle instability than males. [ABSTRACT FROM AUTHOR]

The relationship between ankle joint function and throwing-related injuries has not been demonstrated. We hypothesized that limited ankle joint range of motion (ROM) was related to risk factors for shoulder and elbow injuries in young baseball players. This 12-month prospective cohort study evaluated the age, height, weight, playing position, shoulder, elbow, and ankle function of 228 enrolled baseball players. Shoulder and elbow injuries were tracked during the season. Univariate and multivariate analyses were performed to identify risk factors for shoulder and elbow injuries among participants divided into non-injured and injured groups. Univariate analysis showed that age, height, weight, ROM of elbow flexion in the dominant arm, muscle strength ratio of shoulder abduction, and the likelihood of being a pitcher or a catcher were significantly greater in the injured group than in the non-injured group. ROM of shoulder abduction-external/internal rotation, shoulder total arc on the dominant arm, ankle joint dorsiflexion, and plantar flexion on the back (non-lead) and front (lead) legs were significantly less in the injured group than in the non-injured group. In conclusion, ROM dorsiflexion deficits in the back leg, shoulder abduction-external rotation in the dominant arm, ROM increase in elbow flexion on the dominant side, older age, and being a pitcher were significant independent risk factors for injury. [ABSTRACT FROM AUTHOR]

Background: People with chronic ankle instability (CAI) exhibit neuromuscular deficits. Previous studies, however, only investigated magnitudes of muscle activation and not the time-frequency domain.Research Question: Do people with CAI exhibit differences in muscle activation patterns in the time-frequency domain during landing, anticipated cutting, and unanticipated cutting compared to matched controls?Methods: Eleven people with CAI and eleven healthy matched controls (CON) performed landing, anticipated cutting, and unanticipated cutting as surface EMG of the lateral gastrocnemius, medial gastrocnemius, fibularis longus, soleus, and tibialis anterior were recorded. The time-frequency domain of surface EMG data was analyzed with wavelet transformations and principal component analysis (PCA), PC scores were compared across group, task, and muscle with three-way ANOVAs.Results: The PCA extracted two PCs that captured the overall magnitude (PC1) of wavelet intensities across the time-frequency domain and a shift among the range of frequencies (PC2) where wavelet intensities were most prominent. A main effect for group indicated that people with CAI demonstrated smaller (p = 0.009) PC1 scores than people in the CON group across all muscles and tasks. An interaction between group and task indicated that people in the CAI group exhibited smaller (p = 0.041) PC2 scores than people in the CON group during only anticipated cutting.Significance: People with CAI exhibited neuromuscular deficits in the time-frequency domain of EMG during dynamic tasks. These deficits appear to reflect a neuromuscular strategy characterized by the recruitment of fewer motor units in ankle muscles regardless of task, and an inability to scale the recruitment of motor units in the frequency domain in response to different task demands. Rehabilitation for people with CAI should consider that this population exhibits differences in neuromuscular control that exist not only in the overall magnitudes, but also in the time-frequency domain, of muscle activation patterns. [ABSTRACT FROM AUTHOR]

Backward walking offers a unique challenge to balance and ambulation. This study investigated the characteristics of spatiotemporal gait factors and ankle kinematics during backward walking in people with chronic ankle instability. Sixteen subjects with chronic ankle instability and 16 able-bodied controls walked on a treadmill at their self-selected speed under backward and forward walking conditions. Gait speed, cadence, double limb support percentage, stride time variability, and three-dimensional ankle kinematics were compared between groups and conditions. During backward walking, both groups had significantly slower gait speed, lower cadence, and greater stride time variability. In addition, under backward walking condition, subjects in both groups demonstrated significant sagittal and frontal kinematic alternations, such as greater dorsiflexion and inversion following initial contact (0–27.7%, 0–25.0% of gait cycle respectively, p < 0.001). However, there were no significant differences between groups in any of the measured outcomes. This indicates that subjects with chronic ankle instability adapt to self-selected speed backward walking similarly to healthy controls. Assessments with more challenging tasks, such as backward walking with dual task and backward walking at fast speed, may be more appropriate for testing gait impairments related to chronic ankle instability. [ABSTRACT FROM AUTHOR]

Background. The retinacula are important dynamic stabilizers around the ankle joint and are susceptible to potential injury in high-level footballers. Aim. The purpose of this study was to evaluate the prevalence of retinacula injury in asymptomatic professional football players and for the presence of associated ankle tendon or ligament abnormalities. Methods. Seventeen professional football players from one English premier league club underwent ultrasound examination of both ankles. The retinacula around the ankle were measured for thickness and compared with normal values. Ankle tendons were evaluated for the presence of abnormal vascularity or tendinopathy, tendon sheath effusions, and for peroneal tendon subluxation. Lateral ankle ligaments were also examined. Results. The results indicated increased thickness of the retinacula at the following sites: superior extensor retinaculum on the medial side (1.5 mm, normal 0.9 mm) ; superior peroneal retinaculum at the anterior insertion (2.16 mm, normal 1 mm); and flexor retinaculum at the anterior insertion into the tibia (1.78 mm, normal.0.9 mm). Fluid around the tibialis posterior tendon was a frequent finding representing 74%, whilst over 25% revealed fluid within the peroneal tendon sheaths. Over 50% of the scans revealed thickened and abnormal lateral ligament complexes. Conclusions. The thickening of the retinacula may indicate scarring from previous injury or repetitive micro-trauma, attributable to the ball kicking biomechanics, kinematics and contact injuries during tackles. Furthermore tendon sheath fluid was commonly seen on both the medial and lateral side of the ankle. We conclude that chronic scarring and thickening of these structures should be recognized as a common and often incidental finding and the significance in asymptomatic professional footballers is minimal. [ABSTRACT FROM AUTHOR]

Background: Cavovarus foot constitutes a complex 3-dimensional deformity. The Coleman block test has traditionally been used to distinguish between forefoot- and hindfoot-driven deformity. However, there has been no objective evaluation of the Coleman block test using radiographs or weightbearing computed tomography (WBCT). The purpose of this study was to compare hindfoot alignment in adult cavovarus feet with and without the Coleman block using clinical examination, radiography, and WBCT. Methods: Six feet in 6 patients with a clinical diagnosis of cavovarus foot deformity were prospectively enrolled. All feet underwent clinical photography with the camera positioned at 0 degrees to the heel, hindfoot alignment view radiography with the beam positioned 20 degrees off the ground, and WBCT, both with and without the Coleman block in place. Clinical photos were characterized using the standing talocalcaneal angle (STCA), radiographs were characterized using the hindfoot alignment angle (HAA), and WBCTs were characterized using manual and automated hindfoot alignment angle (HAA) and foot and ankle offset (FAO). Using paired analyses, measurements taken with the Coleman block in place were compared to those taken without the Coleman block. Finally, the different methods of measuring hindfoot alignment were tested for correlation with each other. Mean age was 56 years (range 38-69). Results: On clinical photography, the STCA decreased by 3.8 degrees with addition of the block (from 10.0+6.6 degrees varus without block to 6.2+7.1 degrees varus with block; P = .001). On radiograph, HAA decreased by 9.0 degrees with addition of the block (from 16.8+8.4 degrees varus without block to 7.5+6.3 degrees varus with block; P = .07). On WBCT, hindfoot alignment angle changed an average of 3.2 degrees (33.4 degrees varus without block, 30.2 degrees varus with block; P = .008). On WBCT, FAO decreased by 1.4% (from 11.3% varus without block to 10.1% varus with block; P = .003). Clinical examination and automated WBCT measurements were strongly correlated with each other. Conclusion: Clinical examination, radiograph, and WBCT demonstrated improvements in hindfoot varus using the Coleman block test in adults, but no patient demonstrated complete resolution of deformity regardless of the measurement modality. Clinical examination correlated strongly with automated WBCT measurements. [ABSTRACT FROM AUTHOR]

Purpose: Foot and ankle problems in children are a common cause for paediatric orthopaedic referrals. There is a variation in the reported epidemiology of foot and ankle abnormalities across the globe. The prevalence in our locality was unknown. The objective of this study was to determine the prevalence pattern of foot and ankle problems in our locality as well as compare with patterns from other geographical locations to determine the presence or otherwise, of differences among varying populations.Methods: One thousand seven hundred and fifty-eight Nigerian primary school children aged between five and 13 years were clinically evaluated, checking for weight, height and calculation of BMI. The heel axis angle and hallux angle were measured clinically while determination of flatfeet or high arched feet was made from analysis of foot imprints.Results: Hindfoot valgus was the commonest abnormality of the foot and ankle in this population with a prevalence of 34.2% and predominantly in females and older children, while hallux valgus and a high arched foot were the least common abnormalities at 0.6 and 0.7% prevalence rates, respectively. We found no statistically significant relationship between BMI and hindfoot valgus.Conclusion: Hindfoot valgus is the commonest foot and ankle abnormality among primary school children in our locality. [ABSTRACT FROM AUTHOR]

Background: Ankle sprains are one of the most common musculoskeletal injuries, and can lead to chronic ankle instability (CAI). The Cumberland Ankle Instability Tool (CAIT) measures a subset of CAI, functional ankle instability (FAI). Because no French version existed, we set out to translate and validate the CAIT in French.Methods: The CAIT was translated using a forward-backward methodology. We examined its psychometric properties and calculated a cut-off score for FAI in a sample of 102 subjects (median age 22 years).Results: The CAIT was translated without significant problems. The CAIT-F can discriminate between those with and without FAI (p < 0.001), with a cut-off score of ≤ 23 points. The test-retest reliability is excellent (ICC = 0.960), as is the internal consistency (α = 0.885). Construct validity was confirmed. No floor or ceiling effects were detected among subjects with FAI.Conclusions: The CAIT is now available in French, and is a valid and reliable instrument. [ABSTRACT FROM AUTHOR]

As a basic osteotomy technique, U osteotomy can be applied for certain complex foot and ankle deformities. Gradual correction cases using Ilizarov apparatus and Taylor Spatial Frame have been reported. This paper proposes a novel parallel distraction apparatus for U osteotomy (PDA-Uos) to supplement the correction equipment for surgeon. Designed with an adjustable structure, the PDA-Uos can adopt different assembly shapes (joint connection points). However, the influence of the change in assembly shape on interference-free workspace and self-structural performance of the external fixator have received little attention. To address this issue and enhance the selection of the most suitable assembly shape for patient, an algorithm to obtain the interference-free workspace of different assembly shapes is proposed based on the inverse position solution of the PDA-Uos. Additionally, correction ability indices are defined according to the requirements of accurately controlled motion and high structural stiffness of the external fixator along the correction path. The results of simulation cases indicate that the interference-free workspace and the correction ability vary according to the assembly shape and thus the proposed method can be used to select an assembly shape with sufficient workspace and the best correction ability before performing correction for a given patient. Graphical abstract. [ABSTRACT FROM AUTHOR]

Context: Functional rehabilitation is often employed for ankle instability, but there is little evidence to support its efficacy, especially in those with chronic ankle instability (CAI). Objective: To review studies using both functional rehabilitation interventions and functional measurements to establish the effectiveness of functional rehabilitation for both postural control and self-reported outcomes in those with CAI. Evidence Acquisition: The databases of Medline, SPORTDiscus, and PubMed were searched between the years 1988 and 2008. Inclusion criteria required articles to have used a clinical research trial involving at least 1 functional rehabilitation intervention, have at least 1 outcome measure of function and/or functional performance, and to have used at least 1 group of subjects who reported either repeated lateral ankle sprains or episodes of "giving way." The term functional was operationally defined as dynamic, closed-kinetic-chain activity other than quiet standing. Evidence Synthesis: Six articles met the inclusion criteria. The articles reviewed used multiple functional means for assessment and training, with a wobble board or similar device being the most common. Despite effect sizes being inconsistent for measures of dynamic postural control, all interventions resulted in improvements. Significant improvements and strong effect sizes were demonstrated for self-reported outcomes. Conclusions: The reviewed studies using functional rehabilitation interventions and functional assessment tools were associated with improved ankle stability for both postural control and self-reported function, but more studies may be needed with more consistent effect sizes and confidence intervals to make a definitive conclusion. [ABSTRACT FROM AUTHOR]

Background: Treatment of complex foot deformities in growing children and young adult patients is challenging. The traditional approach consists of extensive soft tissues releases, osteotomies and/or arthrodesis. More recently, distraction osteogenesis has been proposed as an alternative strategy. The aim of this study was to describe our treatment strategy and report clinical outcomes of the patients affected from complex foot deformities treated by distraction osteogenesis and hexapod external fixator.Materials and Methods: We retrospectively reviewed 10 consecutive patients with complex foot and ankle deformities treated from 2014 to 2016 at our unit. A TrueLok external fixator system was used in all patients. Final outcome was classified as good, fair and poor according to the criteria indicated by Paley and Ferreira. The results were also evaluated by the pre-operative and post operative American Orthopedic Foot and Ankle Score (AOFAS) and The Manchester-Oxford Foot Questionnaire (MOXFQ).Results: A plantigrade foot was obtained in eight patients at the end of treatment, while in two patients a recurrence of the deformity was noted. Result was classified as good in 6 patients, fair in 2 patients, and poor in 2 patients. The AOFAS score improved from 33.9±21.2 pre-operatively to 67.25±15.1 post-operatively (p=0.005). A statistically significant improvement was observed for the MOXFQ score as well (from 60.6±23.3 to 33.0±25.2, p=0.020).Conclusions: Our study shows that the TrueLok hexapod external fixator is a safe and effective tool in treatment of complex rigid foot deformities. Nevertheless, deformity recurrence can be observed in some cases and treatment remains challenging. Distraction osteogenesis should be reserved as a salvage solution for particularly complex cases and should be performed at dedicated specialized centers. [ABSTRACT FROM AUTHOR]

Background: As in vivo tibiotalar and subtalar joint kinematics are not currently known following the application of an ankle brace, an investigation of these kinematics may provide insight into the mechanisms of ankle braces.Research Question: This study aimed to determine the effect of an ankle brace on in vivo kinematics of patients with chronic ankle instability.Methods: Eleven patients with chronic ankle instability were recruited in this study. A dual fluoroscopic imaging system and a solid modeling software were utilized to calculate the joint positions of the participants as they walked barefooted on a level platform, walked barefooted on a 15° inversion platform, and walked with an ankle brace on a 15° inversion platform. The joint positions during the three walking conditions were compared.Results: Tibiotalar joints were more inverted (pose 2, p = .004), and subtalar joints were more anteriorly translated (pose 2-6, p = .003), more plantarflexed (pose 2, p = .008; pose 3, p = .013; pose 5, p = .008; pose 6, p = .016) and more inverted (pose 1-5, p = .003; pose 6, p = .013) during barefooted walking on the inversion platform than during walking on the level platform. The inversion of subtalar joints was decreased after the brace application (pose 2-4, p = .003; pose 5, p = .004; pose 7, p = .016).Significance: Brace application reduced the increased subtalar inversion induced by the inversion platform. Nevertheless, increased subtalar anterior translation and plantarflexion persisted after brace application. The ankle brace might be beneficial for clinical populations with increased subtalar inversion. [ABSTRACT FROM AUTHOR]

Accurate measurement of knee alignment, quantified by the hip-knee-ankle (HKA) angle (varus-valgus), serves as an essential biomarker in the diagnosis of various orthopaedic conditions and selection of appropriate therapies. Such angular deformities are assessed from standing X-ray panoramas. However, the limited field-of-view of traditional X-ray imaging systems necessitates the acquisition of several sector images to capture an individual's standing posture, and their subsequent 'stitching' to reconstruct a panoramic image. Such panoramas are typically constructed manually by an X-ray imaging technician, often using various external markers attached to the individual's clothing and visible in two adjacent sector images. To eliminate human error, user-induced variability, improve consistency and reproducibility, and reduce the time associated with the traditional manual 'stitching' protocol, here we propose an automatic panorama construction method that only relies on anatomical features reliably detected in the images, eliminating the need for any external markers or manual input from the technician. The method first performs a rough segmentation of the femur and the tibia, then the sector images are registered by evaluating a distance metric between the corresponding bones along their medial edge. The identified translations are then used to generate the standing panorama image. The method was evaluated on 95 patient image datasets from a database of X-ray images acquired across 10 clinical sites as part of the screening process for a multi-site clinical trial. The panorama reconstruction parameters yielded by the proposed method were compared to those used for the manual panorama construction, which served as gold-standard. The horizontal translation differences were mm mm for the femur and tibia respectively, while the vertical translation differences were mm and mm for the femur and tibia, respectively. Our results showed no statistically significant differences between the HKA angles measured using the automated vs. the manually generated panoramas, and also led to similar decisions with regards to the patient inclusion/exclusion in the clinical trial. Thus, the proposed method was shown to provide comparable performance to manual panorama construction, with increased efficiency, consistency and robustness. [ABSTRACT FROM AUTHOR]

Background: The purpose of this study was to assess the outcomes of distal tibial structural allograft to obtain a stable TTC fusion.Methods: Retrospectively, ten patients were carried out with a minimum one year follow-up. The median age was 72 (33-81). The median BMI was 28 (24-33). Indications for TTC arthrodesis included failed total ankle arthroplasty (n=7 patients), prior nonunion (n=2 patients), and a trauma injury.Results: Union rate was 80%. The median initial height of the distal tibial allograft was 19mm (14-24mm). In seven cases the allograft did not lose height. The AOFAS score median was 69 (31-84). SF-12 median physical component was 39 (30-53), and 59 (23-62) for mental component. The VAS median was 2 (0-8).Conclusions: TTC using distal tibial allograft shows a lower rate of collapse than other structural grafts and provides a fusion rate higher or in accordance with the literature.Level Of Evidence: Level IV, retrospective case series. [ABSTRACT FROM AUTHOR]

Background: It is estimated that nearly 2 million individuals sprain their ankle each year in the US. A majority of these are recurrent injuries, which often results in chronic ankle instability. To better understand the cause of instability, previous research has looked at the coupling or coordination between leg and foot motion during locomotion.Research Question: Determine the coupling between the tibia and the calcaneus during the stance phase of walking in those without a history of ankle instability compared to those with either moderate or severe instability.Methods: Fifty-four individuals between the age of 18-30 years (15 males; 39 females) participated in this study. Each participant's history of ankle sprains and score on the Cumberland Ankle Instability survey was used to assign them to either a no, moderate or severe instability group. Electromagnetic sensors attached to the tibia and calcaneus recorded three-dimensional movement of their tibia and calcaneus during the stance phase of barefoot over ground walking. The kinematic data was referenced to the subject's standing position and time normalized to each subject's stance phase duration. The relative phase (RP) angle and RP variability between tibia internal/external rotation and calcaneal inversion/eversion motion was then calculated. A one-way analysis of variance test was used to determine if significant differences existed between the three groups of subjects on mean RP angle or variability. An alpha level of .05 was used to determine statistical significance.Results: A significant increase in RP angle and variability was found during the mid-stance phase of walking for those with severe ankle joint instability compared to those with moderate or no instability.Significance: The observed decreased coordination and increased coupling variability observed for those with severe ankle instability suggests either residual ligamentous damage, inadequate sensorimotor control, or both. [ABSTRACT FROM AUTHOR]

Purpose: This study aims to evaluate bilateral ankle antagonist co-activation during compensatory postural responses, including short latency responses (SLR) and medium latency responses (MLR), in response to a unilateral sudden ankle inversion in subjects with chronic ankle instability (CAI).Methods: Twenty-four participants with CAI and 20 controls participated in the present study. Bilateral eletromyography of peroneus longus (PL), peroneus brevis (PB), tibialis anterior (TA) and soleus (SOL) muscles was collected during a unilateral sudden inversion perturbation (30°) to assess antagonist co-activation of SOL/TA and TA/P pairs during SLR and MLR in both support and perturbed positions.Results: Compared to control group, participants with CAI presented: (1) bilateral increased antagonist co-activation of SOL/TA MLR in the support position; and (2) decreased antagonist co-activation of TA/P MLR of uninjured limb in the support position and of injured limb in the perturbed position.Conclusions: CAI involves deregulation of ankle antagonist co-activation of MLR in both injured and uninjured limbs. [ABSTRACT FROM AUTHOR]

The use of standard anterolateral and anteromedial portals in ankle arthroscopy results in reduced risk of vascular complications. Anatomical variations of the arterial network of the foot and ankle might render the vessels more susceptible to injury during procedures involving the anterior ankle joint. The literature, to our knowledge, reports only one case of a pseudoaneurysm involving the peroneal artery after ankle arthroscopy. Here, we report the unusual case of a 48-year-old man in general good health with the absence of the anterior tibial artery and posterior tibial artery. The patient presented with a pseudoaneurysm of the perforating peroneal artery following ankle arthroscopy for traumatic osteoarthritis associated with nonunion of the medial malleolus. The perforating peroneal artery injury was repaired by performing end-to-end anastomosis. The perforating peroneal artery is at higher risk for iatrogenic injury during ankle arthroscopy in the presence of abnormal arterial variations of the foot and ankle, particularly the absence of the anterior tibial artery and posterior tibial artery. Before ankle arthroscopy, surgeons should therefore carefully observe the course of the perforating peroneal artery on enhanced 3-dimensional computed tomography, especially in patients with a history of trauma to the ankle joint. [ABSTRACT FROM AUTHOR]

Summary Objectives The purpose of the study was to investigate the effect of an exercise program using elastic tubing as a perturbation force on balance and functional performance in athletes with chronic ankle instability. Equipment and methods Thirty young university-level competitive athletes with chronic ankle instability participated in this pre–post experimental study. The star excursion balance test and single leg hop test were used to measure balance and functional ankle performance. Participants were randomly divided into two groups. The experimental group performed elastic tubing exercises four times a week for 4 consecutive weeks. Results A paired t -test analysis of the experimental group showed a significant difference (P < 0.05) between the pre- and post-treatment measurements of the three components of the star excursion balance test (anteromedial, medial, posteromedial) as well as the single leg hop test, while the same test of the control group showed an insignificant difference (P > 0.05). The changes in the experimental group were significantly greater (P < 0.05) with a large effect size for the three components of the star excursion balance test and the single leg hop test, suggesting a large practical difference. Conclusion The elastic tubing exercise program resulted in a significant positive difference in the balance and functional performance of athletes with chronic ankle instability. [ABSTRACT FROM AUTHOR]

Background: Corrective fusion for the unstable deformed hind foot and mid foot in Charcot Neuroarthropathy (CN) is quite challenging and is best done in tertiary centres under the supervision of multidisciplinary teams.Methods: We present a follow up to our initial report with a series of 42 hind foot corrections in 40 patients from a tertiary level teaching hospital in the United Kingdom. The mean patient age was 59 (33-82). 17 patients had type1diabetes mellitus, 23 had type 2. 23 feet in 22 patients had chronic ulceration despite offloading. 17 patients were ASA 2 and 23 were ASA grade 3. All patients had hind foot nail fusion performed through a standard technique by the senior author and managed perioperatively by the multidisciplinary team.Results: At a mean follow up of 42 months (12-99) we achieved 100% limb salvage initially and a 97% fusion rate. One patient with persisting non-union of ankle and subtalar joint with difficulty in bracing has been offered below-knee amputation. We achieved deformity correction in 100% and ulcer healing in 83%. 83% patients are able to mobilize and manage independent activities of daily living. There were 11 patients with one or more complications including metal work failure, infection and ulcer reactivation. There have been nine repeat procedures including one revision fixation and one vascular procedure.Conclusion: Single stage corrective fusion for hind foot deformity in CN is an effective procedure when delivered by a skilled multidisciplinary team. [ABSTRACT FROM AUTHOR]

Background: Many studies of total ankle arthroplasty (TAA) have focused on the range of motion and functional outcomes at the time of intermediate-term follow-up. The purpose of our study was to analyze the progression of ankle hindfoot range of motion and patient-reported measures through the first 2 years following TAA.Methods: The charts of 134 patients who had been treated with a TAA by a single surgeon were retrospectively reviewed, and 107 (109 TAAs) were included in the study. The overall range of motion in the sagittal plane was measured as the change in the position of the tibia relative to the floor on dedicated weight-bearing lateral radiographs made with the ankle in maximum plantar flexion and dorsiflexion preoperatively and at 3 months, 6 months, 1 year, and 2 years postoperatively. In addition, patients completed a visual analogue scale (VAS) for pain, the Foot and Ankle Ability Measure (FAAM) Activities of Daily Living (ADL) and Sports Subscales, and the Short Form-12 (SF-12) Physical (PCS) and Mental (MCS) Component Summary scores at each time interval.Results: The mean overall range of motion in the sagittal plane was 20.7° preoperatively and improved to 28.3°, 34.3°, 33.3°, and 33.3° at 3 months, 6 months, 1 year, and 2 years, respectively (p < 0.001). At each postoperative time point, the median VAS score was improved (p < 0.001) compared with the preoperative VAS score. Similarly, the FAAM and SF-12 scores were improved, compared with the preoperative score, at 6 months and later (p < 0.001). An increased range of motion correlated with a lower VAS score preoperatively (ρ = -0.31, p = 0.035) and at 1 year (ρ = -0.36, p = 0.003) postoperatively. An increased range of motion correlated with a higher FAAM ADL score at 3 months (ρ = 0.50, p = 0.012), 1 year (ρ = 0.26, p = 0.040), and 2 years (ρ = 0.39, p = 0.003) postoperatively.Conclusions: Patients who underwent TAA had improvement, compared with preoperatively, in the overall sagittal plane range of motion up to 6 months and maintained improvement in pain and function scores up to 2 years. Pain scores remained improved throughout the 2-year follow-up period. A better range of motion was correlated with less pain as measured with the VAS. An increased range of motion postoperatively was correlated with better function as measured with the FAAM.Level Of Evidence: Therapeutic Level IV. See Instructions for Authors for a complete description of levels of evidence. [ABSTRACT FROM AUTHOR]

Background: The effects of ankle osteoarthritis on gait are noticeable in the clinic, but are difficult to quantify and score without detailed kinematic and kinetic analysis. Evaluationof temporal gait parameters and gait variability is a potential alternative.Research Question: This study aimed to determine associations between limb and gender with temporal gait parameters and gait variability in ankle OA patients to evaluate the utility of these parameters for gait assessment in a clinical setting.Methods: Following informed consent, 242 end-stage unilateral ankle OA patients walked at self-selected speed across force plates. Means and stride-to-stride standard deviations (SD) of stride, swing, stance, and double support times were determined for each patient. Limb x Gender ANCOVA models co-varying for walking speed were run for swing and stance times, while stride and double support times were only compared between genders. Statistical analysis was performed in SPSS (α = 0.05).Results: Walking speed affected all measures of interest. After adjusting for walking speed, mean stride time, stride time SD, and stance time SD were 3.5%, 67% and 29% higher among women than men (p = 0.002, 0.035 and 0.02 respectively). Swing time was 12% higher and stance time was 6% lower on the affected side compared to the unaffected side (p < 0.001 for both).Significance: Women have longer stride times and higher variability, which may indicate higher fall risk. Both genders minimized loading on the affected limb by increasing swing time and reducing stance time on the affected side. Simple, easy to record temporal gait patterns can provide useful insight into gait abnormalities in patients with ankle OA. [ABSTRACT FROM AUTHOR]

Background: Foot orthoses are used to treat many disorders that affect the lower limb. These assistive devices have the potential to alter the forces, load distribution, and orientation within various joints in the foot and ankle. This study attempts to quantify the effects of orthoses on the intra-articular force distribution of the ankle and subtalar joint using a cadaveric testing jig to simulate weight bearing. Methods: Five lower-limb cadaveric specimens were placed on a custom jig, where a 334-N (75-lb) load was applied at the femoral head, and the foot was supported against a plate to simulate double-leg stance. Pressure-mapping sensors were inserted into the ankle and subtalar joint. Mean pressure, peak pressure, contact area, and center of force were measured in both the ankle and subtalar joints for barefoot and 2 medial foot orthosis conditions. The 2 orthosis conditions were performed using (1) a 1.5-cm-height wedge to simulate normal orthoses and (2) a 3-cm-height wedge to simulate oversized orthoses. Results: The contact area experienced in the subtalar joint significantly decreased during 3-cm orthotic posting of the medial arch, but neither orthosis had a significant effect on the spatial mean pressure or peak pressure experienced in either joint. Conclusion: The use of an oversized orthosis could lead to a decrease in the contact area and alterations in the distribution of pressure within the subtalar joint. Clinical Relevance: The use of inappropriate orthoses could negatively impact the force distribution in the lower limb. [ABSTRACT FROM AUTHOR]

Background/Purpose: Ankle sprains are common and potentially disabling musculoskeletal injuries that often lead to chronic ankle instability (CAI). CAI has been linked to impairments in postural and neuromuscular control; however, inconsistent findings have been reported. Individuals who experience a lateral ankle sprain, but do not develop instability, termed copers, may adapt different neuromuscular control strategies after injury. This study aimed to compare postural control and electromyographic (EMG) activity of hip and ankle muscles during the performance of the Star Excursion Balance Test (SEBT) in subjects with and without CAI. Method: 48 participants were classified into three groups (16 control, 16 copers, 16 CAI) based on ankle sprain history and Cumberland Ankle Instability Tool score. Outcome measures included normalized reach distance, center of pressure (COP), and integrated EMG activation of gluteus medius (Gmed), gluteus maximus (Gmax), tibialis anterior (TA), and peroneus longus (PL) during each reach direction of SEBT. Results: Compared to copers and controls, CAI group demonstrated significantly diminished postural control (reach distance and COP measures, p< 0.05) and less EMG activity of TA during the anterior direction (CAI: 33.1% ± 10.1% versus copers: 44.8% ± 12.7% versus controls: 51.7% ± 8.4%, p<0.01) and Gmax in the posterolateral direction (CAI: 25.6% ± 9.4% versus copers: 37.5% ± 13.8% versus controls: 40.2% ± 17.2%, p = 0.011). Conclusion: Alteration in proximal and distal muscle activity appears to negatively affect postural control and quality of movement, which may lead to prolonged functional impairments. Hence, implementing hip and ankle muscle exercises in the rehabilitation of ankle instability might benefit these patients. [ABSTRACT FROM AUTHOR]

People with diseases such as stroke, spinal cord injury, and trauma usually have paretic ankle involvement because of the plantar flexor and dorsiflexor muscle weakness. Individuals with paretic ankle normally have the drop-foot gait, which has the complications of foot-slap after heel contact and toe-drag during the swing phase of a gait cycle. This could cause slow walking speed, short step-length, high metabolic cost, and high risk of tripping. Ankle-foot orthotic intervention is mostly prescribed to treat paretic ankle impairments. In addition, ankle-foot orthoses (AFOs) have been developed to assist human walking, which can reduce the wearer's metabolic cost of walking. To date, three kinds of AFOs have been developed, including the passive AFOs, semi-active AFOs, and active AFOs. This paper provides a systematic review on these three types of AFOs, where the biomechanics of normal and pathological gaits of human, the design concepts of the AFOs, and motion data collection of the human-machine system in human trials are described. The limitations of the currently developed AFOs and future research and development directions of AFOs are discussed, which would provide useful information for researchers to develop suitable AFOs. [ABSTRACT FROM AUTHOR]

Gas or air bubbles in a joint space are most commonly associated with the "vacuum phenomenon," a collection of gas that has precipitated out of solution to take up a gaseous state within a joint. This phenomenon was unbeknown to us upon a patient presentation, seen on computed tomography scan, and so further academic investigation was performed to define this pathology. Because of this lack of awareness, a PubMed® literature review was performed to analyze the rate of incidence in foot and ankle. Additionally, we present a case example of the vacuum phenomenon in the ankle joint of a 50-year old patient presenting with degenerative ankle joint pain symptoms. Further, a review of the condition as well as differentials is discussed in an attempt to raise awareness of this differential diagnosis for gas bubbles within a joint. [ABSTRACT FROM AUTHOR]

Background: To determine the outcome of locking compression plate (LCP) by minimally invasive percutaneous plate osteosynthesis (MIPPO) in closed diaphyseal fracture of distal tibia Methods: In this descriptive study patients (n=80)of either gender, 20-45 years of age with diaphyseal fractures of distal tibia were included. While patients having open, pathological, old (>3 wks), infected and fractures associated with compartment syndrome were excluded. All the patients were treated with LCP through MIPPO technique. All patients were discharged 3 days after surgery. The follow up of the patients was done at 2nd, 6th, 8th and 12th week interval. The patients were assessed for the outcome parameters (complications) i.e. delayed radiological union, palpable implant, and ankle stiffness. Results : Mean age of male and female patients was 33.89±7.49 and 31.63±8.55 years respectively. Majority (77.2%) were male. Delayed union was observed in 9.4%. There were 12.2% patients who had palpable hardware. Ankle stiffness was observed in 7.2%. Conclusion: Management of closed distal diaphyseal fractures of tibia with LCP through MIPPO technique is an excellent treatment method as it have increased union rate and decreased complications (Palpable implant and ankle stiffness). [ABSTRACT FROM AUTHOR]

This paper investigates deteriorations in knee and ankle dynamics during running. Changes in lower limb accelerations are analyzed by a wearable musculoskeletal monitoring system. The system employs a machine-learning technique to classify joint stiffness. A maximum-entropy-rate method is developed to select the most relevant features. Experimental results demonstrate that distance travelled and energy expended can be estimated from observed changes in knee and ankle motions during 5-km runs. [ABSTRACT FROM AUTHOR]

ABSTRACT: Degenerative joint disease (DJD) of the ankle is a debilitating chronic disease associated with severe pain and dysfunction resulting in antalgic gait alteration. Little information is available about segmental foot and ankle motion distribution during gait in ankle osteoarthritis. The aim of the current study was to dynamically characterize segmental foot and ankle kinematics of patients with severe ankle arthrosis requiring total ankle replacement. This was a prospective study involving 36 (19 M, 17 F) adult patients with a clinical diagnosis of ankle arthrosis (“DJD” group) and 36 (23 M, 13 F) healthy subjects (“Control” group). Motion data were collected at 120 Hz using a 3‐D motion camera system at self‐selected speed along a 6‐m walkway and processed using the Milwaukee Foot Model (MFM). The SF‐36 Health Survey and Orthopaedic Foot and Ankle Society (AOFAS) ankle‐hindfoot scale were administered to evaluate functional levels. Findings include decreases in walking speed, cadence, stride length and swing phase, and reduced outcomes scores (SF‐36 and AOFAS). Multisegemental motion in patients with ankle DJD demonstrates significant changes in foot mechanics characterized by altered segment kinematics and significant reduction in dynamic ROM at the tibia, hindfoot, forefoot, and hallux when compared to controls. The results demonstrate decreased temporal‐spatial parameters and low outcomes scores indicative of functional limitations. Statement of clinical significance: Altered segment kinematics and reduced overall range of motion demonstrate how a single joint pathology affects kinematic distribution in the other segments of the foot and ankle and alters patients’ overall gait. © 2017 Orthopaedic Research Society. Published by Wiley Periodicals, Inc. J Orthop Res 36:1739–1746, 2018. [ABSTRACT FROM AUTHOR]

Peripheral nerve entrapment of the ankle and foot is relatively uncommon and often underdiagnosed because electrophysiologic studies may not contribute to the diagnosis. Anatomy of the peripheral nerves is variable and complex, and along with a comprehensive physical examination, a thorough understanding of the applied anatomy is essential. Several studies have helped identify specific areas in which nerves are commonly compressed. Identified secondary causes of nerve compression include previous trauma, osteophytes, ganglion cysts, edema, accessory muscles, tenosynovitis, vascular lesions, and a primary nerve tumor. Imaging plays a key role in identifying primary and secondary causes of nerve entrapment, specifically ultrasound (US) and magnetic resonance imaging. US is a dynamic imaging modality that is cost effective and offers excellent resolution. Symptoms of nerve entrapment may mimic other common foot and ankle conditions such as plantar fasciitis. [ABSTRACT FROM AUTHOR]

Objective: To present our experience of treating the club foot with the Ponseti way of conservative management. Study Design: Cross-sectional prospective study. Place and Duration of Study: Study was carried out at CMH Sialkot and CMH Rawalpindi, from Jun 2012 to Jun 2015. Material and Methods: A total of 39 children were treated by the same surgeon and 35 cases were included in this study. Ponseti method involves the non-surgical management of clubfoot, involving manipulation and casting techniques. The foot is systematically stretched as per Ponseti method into the normal shape and repeated casts are applied. Equinus is later treated by percutaneous tendoachilles tenotomy if required. Results: Our aim was over correction of the deformity before advising for foot abduction brace. Thirty one (88.57%) cases showed excellent results while we faced difficulty in achieving the required aim in 4 (11.43%) cases. Conclusion: Ponseti clubfoot management technique has reduced the need for extensive soft tissue release and major clubfoot surgery. This technique has been successful in our setup too. We recommend that it may be adopted as the gold standard for clubfoot treatment throughout the country and primary health care physicians should also be trained in this technique so that maximum people may benefit from this. [ABSTRACT FROM AUTHOR]

Background: Despite advances in surgical skills, adipofascial flaps are still less preferred option for coverage of leg defect. We evaluate the use of perforator-based adipofascial flap in small-to-medium-sized soft-tissue defects in the lower limb. Patients and Methods: After localisation of perforators along the major axial vessels in the lower limb using handheld Doppler, adipofascial flap based on the nearest best perforator of anterior tibial artery, posterior tibial artery and peroneal artery was raised to cover soft-tissue defect in 21 patients. The flap was transposed over the defect and covered by split-skin graft. Donor site was primarily closed. Flap complications, functional and aesthetic outcomes are noted in follow-up. Results: There was partial loss of flap in five patients. After debridement and dressings, split-skin grafting was done for four patients and one patient was managed with local flap. Scar over the flap was stable with no reports of recurrent ulceration or breakdown of wound in 6-month follow-up. Four of five patients reported adequate healing of the fractured bone. Average visual analogue score was 8.24/10 for appearance of donor site as evaluated by the patient. Conclusions: Perforator-based adipofascial flap is a good alternative for coverage of small-to-medium-sized soft-tissue defect of the leg, particularly over the malleolus and lower part of the leg. Use of adipofascial tissue and primary closure of the donor site causes minimal donor-site morbidity. Adipofascial perforator flap provides aesthetically superior recipient-site scar with satisfactory functional outcome. [ABSTRACT FROM AUTHOR]

This paper presents a control system for a powered transtibial prosthesis that provides stair ascent and descent capability, as well as ability for user-controlled transitions between walking, standing, stair ascent, and stair descent. The control system was implemented on a powered prosthesis and evaluated on a single unilateral transtibial amputee subject. The ability of the prosthesis to provide appropriate functionality during stair ascent and descent was assessed by comparing gait kinematics and kinetics of the prosthesis to those of a passive dynamic elastic response prosthesis and those of a set of non-amputee subjects. Data from the assessment indicates that the powered prosthesis is able to provide some desirable stair ascent and stair descent characteristics, relative to the passive prosthesis. [ABSTRACT FROM PUBLISHER]

Aging is accompanied by impaired motor function, but age-related changes in neural networks responsible for generating movement are not well understood. We aimed to investigate the functional oscillatory coupling between activity in the sensorimotor cortex and ankle muscles during static contraction. Fifteen young (20–26 yr) and fifteen older (65–73 yr) subjects were instructed to match a target force by performing static ankle dorsi- or plantar flexion, while electroencephalographic (EEG) activity was recorded from the cortex and electromyographic (EMG) activity was recorded from dorsi- (proximal and distal anterior tibia) and plantar (soleus and medial gastrocnemius) flexor muscles. EEG-EMG and EMG-EMG beta band (15–35 Hz) coherence was analyzed as an index of corticospinal activity. Our results demonstrated that beta cortico-, intra-, and intermuscular coherence was reduced in old versus young subjects during static contractions. Old subjects demonstrated significantly greater error than young subjects while matching target forces, but force precision was not related to beta coherence. We interpret this as an age-related decrease in effective oscillatory corticospinal activity during steady-state motor output. Additionally, our data indicate a potential effect of alpha coherence and tremor on performance. These results may be instrumental in developing new interventions to strengthen sensorimotor control in elderly subjects. [ABSTRACT FROM AUTHOR]

Background: it has been well established that chronic ankle pain negatively affects the lives of patients. Surgical techniques for ankle pain have evolved dramatically over the past decade, as arthroscopic equipment has improved to allow excellent exposure to the ankle joint and surrounding anatomic areas. Softtissue and osseous impingement syndromes are now increasingly recognized as a significant cause of chronic ankle pain, The exact cause of this condition is debated but seems to involve osteophyte formation due to either repetitive microtrauma or macrotrauma associated with major injuries. Careful analyses of patient history and signs and symptoms at physical examination can suggest a specific diagnosis in most patients. Aim of the work: this systematic review aimed to assess the outcome of ankle arthroscopy versus conservative modalities in management of ankle impingement syndrome. Methods: a systematic literature search of the PubMed, Embase (classic), and Chochrane library databases, for articles that published from January 1990 to June 2017 was performed using the following inclusion criteria English language puplications, human clinical trials, studies that reported on at least one of the chosen outcome measures which are patient satisfaction, time to return to full activity, AOFAS score, visual analog scale (VAS) score for pain, and complications, we found 9 studies met our inclusion criteria, data extraction was done which is consisted of population characteristics, in addition to the outcome measures. Results: nine articles were included in this systematic review. Overall, good results were found for arthroscopic treatment in patients with ankle impingement syndrome, patient satisfaction rates was reported in 5 studies, we reported high percentages of good to excellent satisfaction rates, ranging 74% to 94%, especially in patients treated with arthroscopy, Complication rates were 14.1%, as regard to patients treated with arthroscopy the rate was 13.2%, on the other hand the rate was 17.6% in those patients treated with injection therapy technique, conventional conservative modalities reported to be ineffective in treating ankle impingement except injection therapy technique in case of ankle soft tissue impingement. Conclusion: our systematic review showed that Patients may respond to conservative treatment modalities, especially ultra-sound guided injection mainly in soft tissue impingement type, arthroscopic debridement is the treatment of choice for patients of ankle impingement syndrome of both osseous and soft tissue nature with least morbidity and early return to function, and also it is noted to be superior to conservative modalities. [ABSTRACT FROM AUTHOR]

The purpose of this study was to justify the algorithm of rational choice of surgical treatment in patients with arthrosis of the ankle joint, based on a comparative analysis of risk factors for poor results after surgery involving ankle fusion and ankle arthroplasty. We evaluated the efficiency of ankle fusion (63 patients) and ankle joint replacement (71 patients). All patients were divided into 2 groups - prospective (6, 12 and 24 months) and retrospective (3, 5, 7 and 10 years) . The results were evaluated with the help of a visual analogue scale (VAS) and the 100-point AOFAS scale; we also performed X-ray examinations. The longest follow-up period was 10 years. We found that the desirable angles of ankle fusion ranging from 90° - 95° could reduce the chance of the rapid progression of arthritis in the joints of the middle part of the foot. For ankle joint replacement we identified a significant risk factor for the most frequent complication, which was aseptic instability of the implant components. From the results of our analysis we suggest an algorithm of surgical treatment in patients with terminal stage arthrosis of the ankle joint. [ABSTRACT FROM AUTHOR]