Active Ankle Circumduction to Identify Mobility Deficits in Subacute Ankle Sprain Patients

Assessment of ankle mobility is complex and of clinical relevance after an ankle sprain. This study develops and tests a biomechanical model to assess active ankle circumduction and its reliability. The model was then applied to compare individuals’ ankle mobility between injured and noninjured ankles after a sprain episode. Twenty patients with subacute unilateral ankle sprain were assessed at 4 weeks and 10 weeks after the injury. They underwent a clinical exam and an ankle circumduction test during which the kinematics were recorded with an optoelectronic device. A biomechanical model was applied to explore ankle kinematics. Reliability of the ankle circumduction tests were good to excellent (ICC of 0.55–0.89). Comparison between noninjured and injured ankles showed a mobility deficit of the injured ankle (dorsiflexion = −27.4%, plantar flexion = −25.9%, eversion = −27.2%, and inversion = −11.6%). The model allows a graphical representation of these deficits in 4 quadrants. Active ankle circumduction movement can be reliably assessed with this model. In addition, the graphical representation allows an easy understanding of the mobility deficits which were present in all 4 quadrants in our cohort of patients with subacute ankle sprain.

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Characterization of Ankle Kinematics and Constraint Following Ligament Rupture in a Cadaveric Model

Journal of Biomechanical Engineering ◽

10.1115/1.4044234 ◽

2019 ◽

Vol 141 (11) ◽

Cited By ~ 1

Author(s):

Bardiya Akhbari ◽

Matthew H. Dickinson ◽

Ednah G. Louie ◽

Sami Shalhoub ◽

Lorin P. Maletsky

Keyword(s):

Internal Rotation ◽

External Rotation ◽

Training Data ◽

Ankle Injuries ◽

Ankle Sprains ◽

Ligament Rupture ◽

Ankle Kinematics ◽

Posterior Translation ◽

Ankle Mobility ◽

And Inversion

Ankle sprains are a common injury that may need reconstruction and extensive physical therapy. The purpose of this study was to provide a description of the biomechanics of the ankle joint complex (AJC) after anterior talofibular (ATFL) and calcaneofibular (CFL) ligament rupture to better understand severe ankle injuries. The envelope of motion of ten cadaveric ankles was examined by manual manipulations that served as training data for a radial basis function used to interpolate ankle mobility at flexion angles under load and torque combinations. Moreover, ankle kinematics were examined, while tendons were loaded to identify how their performance is altered by ligament rupture. The increased force required to plantarflex the ankle following ligament rupture was measured by calculating the load through the Achilles. Following ATFL injury, the largest changes were internal rotation (5 deg) in deep plantarflexion and anterior translation (1.5 mm) in early plantarflexion. The combined ATFL and CFL rupture changed the internal/external rotation (3 deg), anterior/posterior translation (1 mm), and inversion (5 deg) throughout flexion relative to the isolated ATFL rupture. Moreover, the Achilles' load increased by 24% after the rupture of ligaments indicating a reduction in its efficiency. This study suggests that if patients demonstrate primarily an increased laxity in internal rotation, the damage has solely occurred to the ATFL; however, if the constraint is reduced across multiple motions, there is likely damage to both ligaments. Higher loads in the Achilles suggest that it is overloaded after the injury; hence, targeting the calf muscles in rehabilitation exercises may reduce patients' pain.

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Evaluation of Ankle Mobility Loss in Patients Undergoing Subtalar Arthrodesis

Foot & Ankle Orthopaedics ◽

10.1177/2473011420s00118 ◽

2020 ◽

Vol 5 (4) ◽

pp. 2473011420S0011

Author(s):

Tiago S. Baumfeld ◽

Roberto Zambelli de A. Pinto ◽

Fernando Araujo S. Lopes ◽

Daniel Baumfeld ◽

Camilo Tavares

Keyword(s):

Range Of Motion ◽

Plantar Flexion ◽

Contralateral Side ◽

Foot And Ankle ◽

Lower Range ◽

Open Chain ◽

Subtalar Arthrodesis ◽

Closed Chain ◽

Ankle Mobility ◽

Dorsal Flexion

Category: Hindfoot Introduction/Purpose: Objective: To evaluate and quantify the loss of ankle mobility in patients undergoing subtalar arthrodesis compared to the contralateral side, through physical examination. Methods: A total of 12 patients who had only the subtalar arthrodesis procedure from various causes in one foot were selected. The same foot and ankle surgeon performed all measurements of bilateral tibiotarsal range of motion, with loaded closed-chain and unloaded open-chain tests. Then, to assess whether there was a difference between the operated and the non-operated side, statistical analysis was performed with the Mann-Whitney test (Hollander and Wolfe 1999). Results: On the loaded closed-chain test, the operated side had a significantly lower range of motion than the contralateral side, with a mean difference of 5.4 degrees for dorsal flexion and 7.6 degrees for plantar flexion. The open-chain tests showed non- significant differences of 3 degrees for dorsal flexion and 5.3 degrees for plantar flexion. Conclusion: Subtalar joint arthrodesis was shown to cause a loss of mobility in the ipsilateral ankle, which is greater in plantar flexion movement.

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Ankle Bracing, Plantar-Flexion Angle, and Ankle Muscle Latencies During Inversion Stress in Healthy Participants

Journal of Athletic Training ◽

10.4085/1062-6050-43.1.37 ◽

2008 ◽

Vol 43 (1) ◽

pp. 37-43 ◽

Cited By ~ 12

Author(s):

Thomas Kernozek ◽

Christopher J. Durall ◽

Allison Friske ◽

Matthew Mussallem

Keyword(s):

Repeated Measures ◽

Plantar Flexion ◽

Ankle Injuries ◽

Flexion Angle ◽

Electromyographic Activity ◽

Custom Made ◽

Ankle Muscle ◽

Main Effects ◽

And Inversion ◽

Healthy Females

Abstract Context: Ankle braces may enhance ankle joint proprioception, which in turn may affect reflexive ankle muscle activity during a perturbation. Despite the common occurrence of plantar-flexion inversion ankle injuries, authors of previous studies of ankle muscle latencies have focused on inversion stresses only. Objective: To examine the latency of the peroneus longus (PL), peroneus brevis (PB), and tibialis anterior (TA) muscles in response to various degrees of combined plantar-flexion and inversion stresses in braced and unbraced asymptomatic ankles. Design: Repeated measures. Setting: University biomechanics laboratory. Patients or Other Participants: Twenty-eight healthy females and 12 healthy males (n = 40: mean age = 23.63 years, range = 19 to 30 years; height = 172.75 ± 7.96 cm; mass = 65.53 ± 12.0 kg). Intervention(s): Participants were tested under 2 conditions: wearing and not wearing an Active Ankle T1 brace while dropping from a custom-made platform into 10°, 20°, and 30° of plantar flexion and 30° of inversion. Main Outcome Measure(s): The time between platform drop and the onset of PL, PB, and TA electromyographic activity was measured to determine latencies. We calculated a series of 2-way analyses of variance to determine if latencies were different between the conditions (braced and unbraced) and among the plantar-flexion angles (α = .05). Results: No interaction was found between condition and plantar-flexion angle. No significant main effects were found for condition or plantar-flexion angle. Overall means for braced and unbraced conditions were not significantly different for each muscle tested. Overall means for angle for the PL, PB, and TA were not significantly different. Conclusions: Reflexive activity of the PL, PB, or TA was unaffected by the amount of plantar flexion or by wearing an Active Ankle T1 brace during an unanticipated plantar-flexion inversion perturbation.

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Development of a Rehabilitation and Training Device Considering the Ankle Degree of Freedom

Journal of Robotics and Mechatronics ◽

10.20965/jrm.2020.p0673 ◽

2020 ◽

Vol 32 (3) ◽

pp. 673-682

Author(s):

Asaki Akagi ◽

Satoki Tsuichihara ◽

Shinichi Kosugi ◽

Hiroshi Takemura ◽

◽

...

Keyword(s):

Degrees Of Freedom ◽

Physical Therapists ◽

Plantar Flexion ◽

Muscular Activity ◽

Isokinetic Contraction ◽

Peroneus Longus ◽

Anterior Tibial ◽

Gastrocnemius Muscles ◽

And Control ◽

And Inversion

While the number of people who need rehabilitation has been increasing because of the aging population, there are only a limited number of physical therapists engaged in rehabilitation, making it difficult to perform rehabilitation at a sufficient level. In this situation, various devices have been developed to replace physical therapists. However, no rehabilitation devices that can respond to the complicated degrees of freedom of an ankle joint complex (AJC) are commercially available. In the present study, we developed an AJC rehabilitation device using a Stewart platform parallel link mechanism. Using the device, we aim to measure and control the AJC with six degrees of freedom so that complicated composite motions of the AJC can be realized. To evaluate the device’s usefulness, we investigated how the composite motion generated by moving the AJC along the trajectory the device reproduced could influence a crural muscle. Muscular activities of the anterior tibial, soleus, and gastrocnemius muscles, generated by a composite motion of plantar flexion and inversion, had a similar feature to those generated by plantar flexion. However, the muscular activity of the peroneus longus muscle generated in the composite motion was significantly different from that generated only in plantar flexion. In the composite motion of plantar flexion and inversion, based on the knowledge that activity to develop only back muscles while suppressing muscular activities of the anterior tibial and peroneus longus muscles is possible. Based on the knowledge, the device was used to perform isokinetic contraction for evaluating the device’s usefulness for muscular training. We found a difference between the combination of active muscles during the composite motion and that during plantar flexion. A load can be applied to different muscles depending on the composite motion, which indicates that the device can be suitable for rehabilitation or training with high degrees of freedom.

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Arthroscopically assisted resection of overlooked fracture of posterior talar procesus

Srpski arhiv za celokupno lekarstvo ◽

10.2298/sarh210131050k ◽

2021 ◽

pp. 50-50

Author(s):

Branislav Krivokapic ◽

Bojan Bukva ◽

Danilo Jeremic ◽

Nemanja Jovanovic ◽

Filip Maljkovic

Keyword(s):

Plantar Flexion ◽

Quick Recovery ◽

Posterior Process ◽

Professional Soccer ◽

Arthroscopic Excision ◽

Arthroscopically Assisted ◽

History Of ◽

And Inversion ◽

Professional Soccer Player

Introduction. The fractures of the posterior process of talus are relatively rare injuries of the ankle. They most frequently occur via the mechanism of the forced hyper plantar flexion and inversion. Sometimes they are not initially diagnosed, since over 40% of cases of the fractures of the posterior process of talus are not seen in the initial radiography. The objective of this work is the review of the case study of the arthroscopically treated unhealed fracture of the posterior process of talus. Case outline. In our case report we have presented the 30-year-old male, professional soccer player, with a three-month-long history of chronic pain in the region of the left ankle and heel and the fracture of the posterior process of talus. Conclusion. The work shows all the advantages of minimally invasive surgery - arthroscopic excision of the fragment, quick recovery and returning to physical activities.

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Biomechanical model of the ankle to estimate the musculotendinous forces during an isometric plantar flexion

Computer Methods in Biomechanics & Biomedical Engineering ◽

10.1080/10255842.2012.713692 ◽

2012 ◽

Vol 15 (sup1) ◽

pp. 167-170 ◽

Cited By ~ 1

Author(s):

S. Bennour ◽

N. Zarrouk ◽

M. Dogui ◽

L. Romdhane ◽

J.-P. Merlet

Keyword(s):

Plantar Flexion ◽

Biomechanical Model

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Acute Paraplegia

Pediatrics in Review ◽

10.1542/pir.6.10.303 ◽

1985 ◽

Vol 6 (10) ◽

pp. 303-304

Keyword(s):

Plantar Flexion ◽

Tibialis Posterior ◽

Peroneus Longus ◽

Posterior Tibial ◽

Acute Paraplegia ◽

And Inversion

With regard to the article "Diagnosis and Evaluation of Acute Paraplegia" by J. M. Freeman in the April 1983 issue (PIR 1983;4:327), a reader has noted that Table 2 (page 328) lists the anterior and posterior tibial muscles as responsible for `dorsiflexion inversion.' In the same table, the peroneals were listed as being responsible for `dorsiflexion eversion.' However, the action of the tibialis posterior is plantar flexion and inversion. In addition, the action of the peroneus longus is plantar flexion and eversion. Dr Freeman answers: The reader is indeed correct. In an effort to condense the table, I did lump dorsiflexion and eversion together.

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Athletes at late stage rehabilitation have persisting deficits in plantar- and dorsiflexion, and inversion (but not eversion) after ankle sprain

Physical Therapy in Sport ◽

10.1016/j.ptsp.2019.04.015 ◽

2019 ◽

Vol 38 ◽

pp. 30-35 ◽

Cited By ~ 1

Author(s):

Mohsen Abassi ◽

Chris Bleakley ◽

Rod Whiteley

Keyword(s):

Ankle Sprain ◽

Late Stage ◽

And Inversion

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The Effect of Ankle Bracing on Kinematics in Simulated Sprain and Drop Landings: A Double-Blind, Placebo-Controlled Study

The American Journal of Sports Medicine ◽

10.1177/0363546519837695 ◽

2019 ◽

Vol 47 (6) ◽

pp. 1480-1487

Author(s):

Alison N. Agres ◽

Marios Chrysanthou ◽

Peter C. Raffalt

Keyword(s):

Ankle Sprain ◽

Sagittal Plane ◽

Ankle Instability ◽

Lateral Ankle Sprain ◽

Lateral Ankle ◽

Ankle Inversion ◽

Ankle Kinematics ◽

Ankle Brace ◽

History Of ◽

Drop Landings

Background: The efficacy of external ankle braces to protect against sudden inversion sprain has yet to be determined while taking into account the possible placebo effect of brace application. Purpose: To assess the protective effect of an external ankle brace on ankle kinematics during simulated inversion sprain and single-legged drop landings among individuals with a history of unilateral lateral ankle sprain. Hypothesis: The primary hypothesis was that active and placebo external braces would reduce inversion angle during simulated inversion sprain. Study Design: Controlled laboratory study. Methods: Sixteen participants with ankle instability and previous sprain performed single-legged drop landings and sudden inversion tilt perturbations. Kinematics of the affected limb were assessed in 3 conditions (active bracing, passive placebo bracing, and unbraced) across 2 measurement days. Participators and investigators were blinded to the brace type tested. The effect of bracing on kinematics was assessed with repeated measures analysis of variance with statistical parametric mapping, with post hoc tests performed for significant interactions. Results: Only active bracing reduced inversion angles during a sudden ankle inversion when compared with the unbraced condition. This reduction was apparent between 65 and 140 milliseconds after the initial fall. No significant differences in inversion angle were found between the passive placebo brace and unbraced conditions during sudden ankle inversion. Furthermore, no significant differences were found among all tested conditions in the sagittal plane kinematics at the knee and ankle. Conclusion: During an inversion sprain, only the actively protecting ankle brace limited inversion angles among participants. These results do not indicate a placebo effect of external bracing for patients with ankle instability and a history of unilateral ankle sprain. Furthermore, sagittal plane knee kinematics appear to remain unaffected by bracing during single-legged landing, owing to the limited effects of bracing on sagittal ankle kinematics. These results highlight the role of brace design on biomechanical function during sports-related and injury-prone movements. Clinical Relevance: Athletes prone to reinjury after lateral ankle sprain may benefit from brace designs that allow for full sagittal range of motion but restrict only frontal plane motion.

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