Showing papers on "Ankle published in 1982"

Myofascial pain and dysfunction : the trigger point manual

Abstract: Lower torso pain and muscle guide hip, thigh and knee pain and muscle leg, ankle and foot pain and muscle guide

Kinaesthetic role of muscle afferents in man, studied by tendon vibration and microneurography

Abstract: The characteristics of vibration-induced illusory joint movements were studied in healthy human subjects. Unseen by the subject, constant frequency vibration trains applied to the distal tendon of the Triceps or Biceps induced an almost constant velocity illusory movement of the elbow whose direction corresponded to that of a joint rotation stretching the vibrated muscle. Vibration trains of the same duration and frequency applied alternatively to the Biceps and Triceps evoked alternating flexion-extension illusory movements. During successive application of vibration trains at frequencies from 10 to 120 Hz, the perceived velocity of the illustory movements increased progressively from 10 to 70-80 Hz, then decreased from 80 to 120 Hz. The maximal perceived velocity was three times higher during alternating vibration of the Biceps and Triceps than during single muscle stimulation. Unit activity from 15 muscle spindle primary endings and five secondary endings located in Tibialis anterior and Extensor digitorum longus muscles were recorded using microneurography in order to study their responses to tendon vibration and passive and active movements of the ankle. Primary endings were all activated by low amplitude tendon vibration (0.2-0.5 mm) previously used to induce illusory movements of the elbow. The discharge of some was phase-locked with the vibration cycle up to 120 Hz, while others responded one-to-one to the vibration cycle up to 30-50 Hz, then fired in a sub-harmonic manner at higher frequencies. Secondary endings were much less sensitive to low amplitude tendon vibration. Primary and secondary ending responses to ramp and sinusoidal movements of the ankle joint were compared. During the movement, the primary ending discharge frequency was almost constant, while the secondary ending activity progressively increased. During ankle movements the primary ending discharge appeared mainly related to velocity, while some secondary activities seemed related to both movement velocity and joint angle position. Muscle spindle sensory ending responses to active and passive ankle movements stretching the receptor-bearing muscle (plantar flexion) were qualitatively and quantitatively similar. During passive reverse movements (dorsiflexion) most of the sensory endings stopped firing when their muscle shortened. Active muscle shortening (isotonic contraction) modulated differently the muscle spindle sensory ending discharge, which could stop completely, decrease or some times increase during active ankle dorsiflexion. During isometric contraction most of the muscle spindle sensory endings were activated. The characteristics of the vibration-induced illusory movements and the muscle spindle responses to tendon vibration and to active and passive joint movements strengthened the possibility of the contribution of primary endings to kinesthesia, as suggested by several previous works...

Influence of joint position on ankle plantarflexion in humans

Abstract: The contractile properties of the triceps surae (medial and lateral gastrocnemii and soleus) have been studied in humans. In comparison with most other human muscles, the triceps complex had a slow twitch (mean contraction and half-relaxation times 112.4 +/- 11.1 and 99.6 +/- 14.4 ms, respectively) and a low tetanus fusion frequency (60 Hz). Stretching the muscle caused both the contraction and half-relaxation times to become longer. With the knee bent, the optimum length for torque development corresponded to almost full dorsiflexion of the ankle. Similar results were obtained with the knee extended. The optimum position of the ankle differed considerably from the position of the joint when the leg was at rest. Although the position of the ankle joint affected electromyographic (EMG) activity recorded during maximal voluntary contraction, there was little change in the EMG-to-M wave ratio.

Normal Range of Motion of the Hip, Knee and Ankle Joints in Male Subjects, 30–40 Years of Age

Abstract: Studies of the normal range of joint motion in human adults are uncommon, and frequently used references are based on materials not immediately accessible. The present paper reports on ranges of motion in healthy male subjects, 30–40 years old, in a randomized sample from the population in the city of Goteborg. It is based on 210 hips, 180 knees and 192 ankle joints. Arcs of passive motion were measured by techniques suggested by the American Academy of Orthopaedic Surgeons. Significant differences were found between the obtained measurements and previous referenced studies. The differences can be due to the measurement procedure, difficulties in measurement technique, the patient material, and inter-individual variations. There was no statistically significant difference between the motions of the right and left side, and it is therefore suggested that a patient's healthy limb can be used for comparison with the affected side in the presence of disease or a lesion.

The Cincinnati incision: a comprehensive approach for surgical procedures of the foot and ankle in childhood.

Abstract: We are describing a transverse incision that we have found useful in performing surgical procedures involving extensive dissection of the posterior, medical, and lateral aspects of the foot and ankle. Operative procedures using this incision have been performed on 154 feet in ninety-nine patients who were less than fifteen years old and who had an average follow-up of eighteen months. The incision is transverse and extends from the anteromedial to the anterolateral aspect of the foot over the back of the ankle at the level of the tibiotaler joint. Depending on the requirements of the procedure, either the anteromedial or posterolateral portion of the incision, or the complete incision, may be used. The incision improves visualization of the medial, posterior, and lateral aspects of the foot and ankle, while at the same time resulting in excellent healing of the wound and an improved cosmetic appearance compared with the more commonly used vertical incisions.

Total ankle arthroplasty. Clinical study of fifty cases.

Abstract: A prosthesis for the ankle joint that I designed in 1973 was implanted in fifty patients who otherwise would have required fusion of the ankle to relieve severe pain. The design of the device allows about as much motion as in the normal ankle. During implantation of the prosthesis the dome of the talus is not resected and only one centimeter of the distal end of the tibia is removed. If the prosthetic replacement is unsuccessful, fusion of the ankle can more easily be achieved secondarily if it should become necessary. Review of the cases of these fifty patients showed that the best results were obtained in the patients with degenerative arthritis whose ankles were stable and not unduly deformed. A few patients with rheumatoid arthritis (four of ten) who were not on long-term steroid therapy also did well. Contraindications revealed by my experience include avascular necrosis of the talus, pseudarthrosis at the site of a previously attempted ankle fusion, and conditions causing talar tilt of 20 degrees or more.

Forces predicted at the ankle during running.

Abstract: A biomechanical model of the ankle joint was developed and was used to predict the forces at the ankle during the stance phase of running. Measurements from five cadavers were averaged to obtain insertion points and directions of pull of equivalent tendons with respect to the assumed center of the ankle joint. A minimum joint force solution was obtained by assuming that only two equivalent muscle groups could exert force at one time. Three subjects ran at 4.47 m/s across a force platform that recorded the external forces and moments acting on the foot. Cinematography was used to measure the foot and leg positions during stance. Peak resultant joint forces ranging from 9.0 to 13.3 times body weight and peak Achilles tendon forces ranging from 5.3 to 10.0 times body weight were predicted. Small variations in some cases resulted in large differences in predicted forces. The highest tendon forces predicted exceeded those reported to cause damage to cadaver tendons in other studies.

The relation between discomfort and postural loading at the joints

Abstract: An investigation to identify the relation between torques at hip, knee and ankle, posture holding time, and perceived discomfort was carried out. Subjects held four different extents of straight-legged forward bend as long as they could whilst reporting perceived overall and body-part discomforts at regular intervals. The results indicated that changes in postures correlated significantly with changes in holding time and in discomfort. Averaged results showed that discomfort levels in the body segment immediately superior to the joints studied were significantly related to torque at the joint. The relation was strongest for the ankle joint, where the location of the muscles producing the resisting torque could be associated most clearly with the body segment concerned.

Doppler Ankle Pressure: An Evaluation of Three Methods of Expression

Abstract: • We studied 133 patients with arteriographic evidence of lower limb arterial disease and 34 normal volunteers to determine the most useful means of expressing ankle pressure. Representative ranges were determined for each of six symptomatic categories. Receiver operating characteristic curve analysis showed that ankle index (ankle to brachial pressure ratio) and brachial-ankle pressure gradient were more valuable than absolute pressure in discriminating between normal and diseased extremities. In contrast, absolute ankle pressure was the best predictor of nonviability (limb requiring bypass for salvage or amputation). An absolute pressure cutoff of 60 mm Hg correctly identified 86% of viable limbs and 77% of nonviable limbs. Thus, the diagnostic accuracy of the three methods of expressing ankle pressure depends on the context in which they are to be used, and it appears that ankle index and gradient are most appropriate for defining the presence of disease, while absolute pressure correlates best with viability. ( Arch Surg 1982;117:1297-1300)

Rheumatoid Arthritis in the Foot and Ankle—Diagnosis, Pathology, and Treatment: THE RELATIONSHIP BETWEEN FOOT AND ANKLE DEFORMITY AND DISEASE DURATION IN 50 PATIENTS

Abstract: Rheumatoid arthritis frequently results in synovitis and deformity of the ankle and foot. Rheumatoid vasculitis presents with skin ulceration, digital ischemia, nodules, and mononeuritis multiplex. The relationship of disease duration and deformity is discussed in 50 patients with rheumatoid arthritis.

The injury rate in professional basketball

Abstract: The purpose of this study is to review seven years of medical experience with injuries to players of a profes sional basketball club. One of the authors was in volved with all injuries occurring during this period of time. All 71 athletes participating with this club were evaluated, and their specific injuries were studied with regard to incidence, time loss due to injury, and treat ment.Foot, ankle, knee, back, and hand injuries were found to occur most often. The most common as well as the most severe injuries were those of the ankle and knee. The average time loss from play due to injury was amazingly consistent for each specific in jury. Rehabilitation of injuries varied from no playing time loss to two years. Even though knee injuries carry a poor prognosis, the authors conclude that the inci dence of severe injury in professional basketball is low. This study will hopefully serve as useful informa tion for those involved with the care of basketball players.

A Review of Lateral Ankle Ligamentous Reconstructions

Abstract: We have performed on ongoing retrospective and prospective multi-institutional review of 50 patients who underwent 53 lateral ligamentous reconstructive procedures of the ankle. The point grading system used for postoperative evaluation of our patients allowed for classification of functional activity. The grading system included evaluation of the patient's return to preinjury activities and athletics, degree of pain, degree of swelling, number of recurrent sprains, and any disability that the patient incurred secondary to the tendon transfer. Preoperative and postoperative stress radiographs were obtained to evaluate the talar tilt angle. Of our 53 lateral ankle ligamentous reconstructions, we consider 45 to be excellent, with the patients returning to full activity and athletics. Our results show no statistically significant difference in long-term function among the five ligamentous repairs employed in this series (Pearson Chi-square test; chi 2 = 2.30, df = 4, P = 0.68). No correlation could be made between the long-term clinical response of the various procedures and the postoperative talar tilt angle. We conclude that lateral ligamentous reconstructive repairs of the ankle are indicated, and that good or excellent clinical results, greater than 91%, can be obtained with any of the five reconstructive procedures, performed correctly.

Salvage of painful total ankle arthroplasty.

Abstract: Revision of painful total ankle arthroplasties with reinsertion of a prosthetic device has been unsatisfactory After removal of the prosthetic components, generally, the remaining bony stock is insufficient to allow adequate fixation with methylmethacrylate Revision with arthrodesis by the modified Chuinard compression technique has been successful Ankle arthrodesis is the only available surgical alternative to prosthetic ankle arthroplasty Consequently, should a total ankle arthroplasty fail, a reliable salvage procedure is available that leaves the patient with minor, if any, additional functional impairment compared to that with an ankle arthrodesis done initially

Posterior Block of the Ankle Joint in Dancers

Abstract: A posterior block of the ankle joint caused by an os trigonum, a large posterior tubercle of the talus, or prominence on the dorsum of the posterior part of the os calcis is described. The presenti...

Control of soleus motoneuron excitability during muscle stretch in man.

Abstract: The relative contributions of intramuscular and extramuscular receptors to changes in the reflex excitability of soleus motoneurons, following muscle stretch, have been studied in man. It was found that reflex excitability was decreased by muscle stretch. The extent of the decrease was related to the amount of stretch, irrespective of whether the latter was produced by dorsiflexion of the ankle or by depression of the Achilles tendon with the ankle joint fixed. The results were unaffected by anaesthesia of the skin. It would appear that neither joint receptors nor cutaneous mechanoreceptors contribute significantly to the decrease in reflex excitability during ankle dorsiflexion and that the intramuscular receptors are mainly responsible for the effects observed.

Graphing the adult foot and ankle.

Abstract: When the patient appears in your office with foot and/or ankle complaints, what will be your standard routine X-rays for those areas and what information can you glean from your careful study of these films? What views portray the areas in question and what are suggestive pathognomonic signs? The author has attempted to outline some of the roentgenological approaches to diagnosis of ailments of the foot and ankle and to point out some of the clues that can be found with their interpretations. Many of the signs have, hitherto, not been recognized or are buried in the voluminous orthopaedic literature.

Sprained ankles in ballet dancers.

Abstract: Ankle sprains are common in dancers. They result from working in the positions which allow increased risk of sprain on the lateral side of the ankle for many hours a day. One hundred ankle injuries were evaluated. The mechanisms of injury are presented, as well as a classification of these injuries. The recommended treatment and rehabilitation are discussed. Leg muscle strength must be restored before rehabilitation is considered complete.

Late revision of fibular malunion in ankle fractures.

Abstract: Eleven patients with fibular malunion after ankle fracture healed with stiff, painful joints and radiographic evidence of fibular malunion, diastasis of the ankle mortice, and talar tilt. Reconstruction was performed by mobilizing the fibula (by osteotomy or through the old fracture site), lengthening the fibula, and restoring the ankle mortice anatomically. The operation was done three months to three years after the initial fracture in patients ranging in age from 26 to 52 years. The average follow-up period was 3.3 years. Radiographically, seven patients had the ankle joint restored anatomically. Four patients had residual talar tilt. On clinical assessment, eight patients were rated as good, two fair and improving, and one poor resulting in fusion. Good functional results were maintained at long-term follow-up examination. The factors that determined the success of the revision were the duration of the malunion, the quality of the reduction achieved, and the condition of the articular cartilage at the time of revision. Late correction of the malunited fibula with diastasis of the ankle mortice is an effective means of salvaging function in a joint otherwise destined to be stiff and painful.

Endoprosthetic arthroplasty of the ankle joint. A clinical and radiological follow-up.

Abstract: Eighteen ICLH ankle arthroplasties in 16 patients were followed up 15 to 52 months postoperatively (mean 36 months) by a review of the records, and clinical and radiological examinations. Five arthroplasties were performed for osteoarthrosis, 13 for rheumatoid arthritis. The overall clinical result was rated excellent in 2, good in 8, fair in 6, and poor in 2 joints. In osteoarthritic joints the results were somewhat poorer, no patient obtaining a rating of excellent but 2 of good, 2 of fair, and one of poor. Radiolucent zones greater than 2 millimeters were seen around the tibial component in 7 cases. Loosening defined as radiographic signs of movement between the prosthetic components and bone was present in 4 cases. The high occurrence of obvious loosening and large radiolucent zones indicates that mechanical problems will be encountered frequently in the future. From the results of this study it is concluded that ankle arthroplasty has a definite place in the treatment of severe arthritis in rheumatoi...

Displaced unstable ankle fractures : classification, incidence and management of a consecutive series

Abstract: A review of 157 displaced, unstable ankle fractures has suggested that external rotation injuries cause most ankle fractures, with pronation type injuries being six times more common than supination type injuries. Accurate, rigid fixation of displaced unstable ankle fractures tends to prevent talar tilt and lessens the tendency for arthrosis. If the fibula is not fixed, it tends to shorten and allows talar tilt or spread of the syndesmosis with resulting arthrosis. Minimal external fixation is desirable, and rapid restoration of motion is needed.

Nonoperative treatment of double lateral ligament tears of the ankle.

Abstract: In this article the objective evaluation of 39 cases of double lateral ligament tears of the ankle treated by cast immobilization is described. Such treatment resulted in a 79.5% success rate as determined by repeat stress roentgenograms. In addition, a statistical method which may aid the orthopaedist in deciding whether to use nonoperative or operative treatment is presented.

Mobility of the ankle joint: recording of rotatory movements in the talocrural joint in vitro with and without the lateral collateral ligaments of the ankle.

Abstract: A method for graphic recording of rotatory movements in osteoligamentous ankle preparations is described. By this method it is possible to record characteristic mobility patterns in two planes at the same time. The ankle is affected by a known torque, so that the individual mobility patterns are reproducible with unchanged condition of the ligaments. Six amputated legs were investigated in the sagittal and horizontal planes and another six in the sagittal and frontal planes. Mobility patterns were recorded with intact ligaments and after successive cutting of the lateral collateral ligaments of the ankle in the anteroposterior direction. In the sagittal plane increased dorsiflexion was observed after total cutting of the lateral ligaments, while plantar flexion remained unchanged. In the horizontal plane the internal rotation of the talus increased in step with increasing injury to the ligament, particularly when the ankle was plantar flexed. When all collateral ligaments had been cut, an increase in external rotation occurred, especially in dorsiflexion. In the frontal plane the talar tilt increased gradually with increasing injury to the ligaments. Talar tilt was at a maximum in the neutral position of the ankle or in plantar flexion. After total severing of the collateral ligaments, however, talar tilt was most marked in dorsiflexion of the ankle.

Bone grafting for nonunion of fractures of the tibia: a critical review.

Abstract: This study concerns the results of treatment of 39 patients with 40 tibial fractures which had progressed to nonunion and which subsequently were treated by autogenous bone grafting and cast immobilization. Thirty-one fractures were initially open and nine of these became infected nonunions. Thirty-four fractures united after bone grafting, four other patients finally required amputations, and two tibiae healed after subsequent internal fixation. The functional results, especially as related to the ankle and subtalar joints, the residual tibial deformities, shortening and cosmetic results, were less than optimal. The difficulty with correcting and maintaining correction of the initial deformity and long periods of joint immobilization contributed to these results. Each patient with a nonunion of the tibia should be assessed so that a recommendation as to the need for immobilization, its type, and the necessity for bone grafting or not can be made.