Kinematics Analysis of Ankle Inversion Ligamentous Sprain Injuries in Sports

Background: Ankle ligamentous sprain is common in sports. The most direct way to study the mechanism quantitatively is to study real injury cases; however, it is unethical and impractical to produce an injury in the laboratory. A recently developed, model-based image-matching motion analysis technique allows quantitative analysis of real injury incidents captured in televised events and gives important knowledge for the development of injury prevention protocols and equipment. To date, there have been only 4 reported cases, and there is a need to conduct more studies for a better understanding of the mechanism of ankle ligamentous sprain injury. Purpose: This study presents 5 cases in tennis and a comparison with 4 previous cases for a better understanding of the mechanism of ankle ligamentous sprain injury. Study Design: Case series; level of evidence, 4. Methods: Five sets of videos showing ankle sprain injuries in televised tennis competition with 2 camera views were collected. The videos were transformed, synchronized, and rendered to a 3-dimensional animation software. The dimensions of the tennis court in each case were obtained to build a virtual environment, and a skeleton model scaled to the injured athlete’s height was used for the skeleton matching. Foot strike was determined visually, and the profiles of the ankle joint kinematics were individually presented. Results: There was a pattern of sudden inversion and internal rotation at the ankle joint, with the peak values ranging from 48°-126° and 35°-99°, respectively. In the sagittal plane, the ankle joint fluctuated between plantar flexion and dorsiflexion within the first 0.50 seconds after foot strike. The peak inversion velocity ranged from 509 to 1488 deg/sec. Conclusion: Internal rotation at the ankle joint could be one of the causes of ankle inversion sprain injury, with a slightly inverted ankle joint orientation at landing as the inciting event. To prevent the foot from rolling over the edge to cause a sprain injury, tennis players who do lots of sideward cutting motions should try to land with a neutral ankle orientation and keep the center of pressure from shifting laterally.

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Operative Outcome of Side-Locking Loop Suture Technique Accompanied by Autologous Semitendinosus Tendon Grafting for Chronic Rupture of Achilles Tendon

Foot & Ankle Orthopaedics ◽

10.1177/24730114211003541 ◽

2021 ◽

Vol 6 (2) ◽

pp. 247301142110035

Author(s):

Keisuke Tsukada ◽

Youichi Yasui ◽

Maya Kubo ◽

Shinya Miki ◽

Kentaro Matsui ◽

...

Keyword(s):

Achilles Tendon ◽

Scale Score ◽

Tendon Rupture ◽

Plantar Flexion ◽

Achilles Tendon Rupture ◽

Case Series ◽

Semitendinosus Tendon ◽

Level Of Evidence ◽

Operative Outcomes

Background: The purpose of this retrospective study was to clarify the operative outcomes of the side-locking loop suture (SLLS) technique accompanied by autologous semitendinosus tendon grafting for chronic Achilles tendon rupture. Methods: A chart review was conducted of consecutive patients treated with the SLLS technique at our department from 2012 to 2017. Postoperatively, a below-knee splint was applied for 2 weeks in 20 degrees of plantar flexion and then active range of motion exercise was started. Partial weightbearing exercise was allowed at 4 weeks according to patient tolerance, and full weightbearing without crutches was allowed at 8 weeks. The American Orthopaedic Foot & Ankle Society (AOFAS) ankle-hindfoot scale score and the Achilles tendon rupture score (ATRS) were used to evaluate clinical outcomes preoperatively and at the final follow-up. Results: Ten patients (6 men, 4 women) were included in the analysis. Mean AOFAS ankle-hindfoot scale score increased significantly from 64.2 ± 5.6 points preoperatively to 95.0 ± 5.3 points at the final follow-up ( P < .001). The mean ATRS also increased significantly from 29.8 ± 4.4 points to 86.2 ± 7.7 points, respectively ( P < .001). Mean time between surgery and ability to perform 20 continuous double-leg heel raises of the operated foot was 13.5 ± 3.4 (range 10-18) weeks. One patient complained of postoperative hypoesthesia in the foot, which had spontaneously resolved by 3 months after surgery. Conclusion: The SLLS technique accompanied by autologous semitendinosus tendon grafting provided successful operative outcomes for patients with chronic Achilles tendon rupture regardless of the size of the defect, and thus long-term orthotic use was not needed after surgery. Level of Evidence: Level IV, retrospective case series.

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BIOMECHANICS OF SHOD AND BAREFOOT RUNNING: A LITERATURE REVIEW

Revista Brasileira de Medicina do Esporte ◽

10.1590/1517-869220202606219320 ◽

2020 ◽

Vol 26 (6) ◽

pp. 551-557

Author(s):

Vitória da Silveira Jahn ◽

Clara Knierim Correia ◽

Elisa Dell’Antonio ◽

Luis Mochizuki ◽

Caroline Ruschel

Keyword(s):

Literature Review ◽

Plantar Flexion ◽

Reaction Force ◽

Individual Characteristics ◽

Medial Gastrocnemius ◽

Vertical Ground Reaction Force ◽

Level Of Evidence ◽

Barefoot Running ◽

Foot Strike ◽

General Studies

ABSTRACT This study aims to analyze and summarize the biomechanical (kinematics, kinetics and neuromuscular) differences between shod and barefoot running, through a literature review. Searches were conducted for complete articles published between 2013 and November 2018 in the Web of Science, PubMed, Scopus and SPORTdiscus databases. The search terms used were Biomechanics, Kinetics, Kinematics, Electromyography, “Surface Electromyography”; and Unshod, Barefoot, Barefeet and Running. The search resulted in 687 articles; after excluding duplicates and selecting by title, abstract and full text, 40 articles were included in the review. The results show that there are important differences in the biomechanics of running when shod or barefoot. In general, studies indicate that in barefoot running: a) individuals present forefoot or midfoot foot strike patterns, while in shod running the typical pattern is the rearfoot strike; (b) greater cadence and shorter stride length are observed; and (c) there is greater knee flexion, lower peak vertical ground reaction force and greater activation of the medial gastrocnemius. In addition, barefoot runners contact the ground with greater plantar flexion, possibly as a strategy to reduce impact when stepping without footwear. These differences, as well as runners’ individual characteristics, should be considered in the prescription of the barefoot running, in order to minimize injuries resulting from the practice. Level of Evidence II; Review.

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Congenital internal rotation deformity of the distal femur presenting as patellofemoral instability and pain

Journal of ISAKOS Joint Disorders & Orthopaedic Sports Medicine ◽

10.1136/jisakos-2018-000260 ◽

2019 ◽

Vol 4 (2) ◽

pp. 93-97 ◽

Cited By ~ 2

Author(s):

Xinyuan Zhang ◽

John Attenello ◽

Marc R Safran ◽

David W Lowenberg

Keyword(s):

Internal Rotation ◽

Knee Pain ◽

Anterior Knee Pain ◽

Distal Femur ◽

Case Series ◽

Patellofemoral Instability ◽

Level Of Evidence ◽

Femoral Antetorsion ◽

Derotational Osteotomy ◽

Anterior Knee

ObjectivesFemoral antetorsion, defined as the angle of rotation of the femoral head and neck axis in relation to the transcondylar axis of the distal femur, is a cause for patellofemoral instability and anterior knee pain. Most clinical reports do not distinguish between antetorsion of the femur distal to the isthmus and anteversion of the proximal femur, which is another cause of femoral internal rotational deformity.MethodsThis retrospective observational case series evaluated four cases in three female patients who underwent evaluation of surgical intervention for chronic anterior knee pain since childhood. Physical examination and radiographic images supported the diagnosis of internal rotation deformity at the distal femora in all four cases. Distal femoral derotational osteotomy of 45°, 60° and 30° were performed, respectively. Kujala scoring system for patellofemoral pathology was used to assess the change in knee symptoms before and after the osteotomies.ResultsThis study demonstrated successful treatment of the resultant knee symptoms from femoral antetorsion with distal femur derotational osteotomy in all three patients.ConclusionsPatellofemoral syndrome is multifactorial, and the true anatomic reason for each patient’s individual pathology must be determined before surgery proceeds.Level of evidenceLevel V.

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A Model to Predict the Effect of Ankle Joint Misalignment on Calf Band Movement in Ankle-Foot Orthoses

Prosthetics and Orthotics International ◽

10.1080/03093640600983873 ◽

2007 ◽

Vol 31 (1) ◽

pp. 76-87 ◽

Cited By ~ 10

Author(s):

Stefania Fatone ◽

Andrew H. Hansen

Keyword(s):

Ankle Joint ◽

Walking Speed ◽

Sagittal Plane ◽

Plantar Flexion ◽

Dimensional Model ◽

Ankle Foot Orthosis ◽

Ankle Joints ◽

Ankle Foot Orthoses ◽

Foot Orthosis ◽

Anterior Posterior

Accurate alignment of anatomical and mechanical joint axes is one of the major biomechanical principles pertaining to articulated orthoses, yet knowledge of the potential effects of axis misalignment is limited. The purpose of this project was to model the effects of systematic linear (proximal-distal and anterior-posterior) misalignments of single axis mechanical ankle joints in an ankle-foot orthosis (AFO) in order to determine the degree and direction of calf band travel that would occur over a functional range of motion. Sagittal plane misalignments of the ankle joint centres of an AFO were simulated using a simple two-dimensional model for both a range of ankle angles and a typical able-bodied ankle kinematic curve for self-selected normal walking speed. The model assumed that no movement occurred between the foot and the foot-plate of the AFO. The model predicted that for anterior (positive horizontal) misalignments, dorsiflexion movements would cause the calf band to travel proximally (i.e., up the leg) and plantar flexion movements would cause the calf band to travel distally (i.e., down the leg). The opposite was predicted for posterior (negative horizontal) misalignments. Proximal (positive vertical) misalignments would cause only distal movements of the calf band while distal (negative vertical) misalignments would cause only proximal movements of the calf band. Anterior-posterior misalignments were found to have a much larger effect on the amount of calf band travel than proximal-distal misalignments.

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Proximal Spherical Metatarsal Osteotomy for the Foot with Severe Hallux Valgus

Foot & Ankle International ◽

10.3113/fai.2008.1025 ◽

2008 ◽

Vol 29 (10) ◽

pp. 1025-1030 ◽

Cited By ~ 16

Author(s):

Yasuhito Tanaka ◽

Yoshinori Takakura ◽

Tsukasa Kumai ◽

Kazuya Sugimoto ◽

Akira Taniguchi ◽

...

Keyword(s):

Hallux Valgus ◽

Plantar Flexion ◽

Case Series ◽

Osteotomy Site ◽

Metatarsal Osteotomy ◽

Retrospective Case ◽

Level Of Evidence ◽

Tarsometatarsal Joint ◽

Combined Operations ◽

Severe Hallux Valgus

Background: A proximal spherical metatarsal osteotomy was devised to correct not only varus deviation of the first metatarsal, but also dorsiflexion. We expected to increase the medial longitudinal arch by adding plantar flexion at the osteotomy site. To investigate the limitations of this procedure for feet with severe hallux valgus, a followup study was performed on patients with preoperative hallux valgus angles greater than or equal to 40 degrees. Materials and Methods: Forty-eight feet in 37 patients (10 male, 27 female) (60 years; range, 20 to 84 years) were investigated. Mean followup was 4 years and 1 month, ranging from 2 to 8 years. The spherical osteotomy was performed using a curved chisel. A distal soft tissue procedure was done at the same time. Twenty feet received combined operations for their combined deformities. Results: While 81% of patients were satisfied with the results, 50% of those with preoperative hallux valgus angles greater than or equal to 50 degrees had postoperative hallux valgus angle greater than or equal to 20 degrees. In these patients, correction of metatarsus primus varus was good, but correction of valgus deviation of the hallux was fair. Mean correction toward plantar flexion was 1.5 degrees and no increase in arch height was achieved. Conclusion: The proximal spherical osteotomy could consistently achieve satisfactory results for the patients with hallux valgus angles less than 50 degrees. However, the corrections were worse in feet with more severe deformities. Furthermore, plantarflexion at the osteotomy site was offset by displacement at the first tarsometatarsal joint. If plantarflexion is indispensable, arthrodesis of the tarsometatarsal joint is recommended. Level of Evidence: IV, Retrospective Case Series

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Kinetics Study in Parachute Landing Fall Technique by Comparing Professional and Amateur Malaysian Army Parachutists Using Kane’s Method

Mathematics ◽

10.3390/math8060917 ◽

2020 ◽

Vol 8 (6) ◽

pp. 917 ◽

Cited By ~ 1

Author(s):

Syazwana Aziz ◽

Azmin Sham Rambely ◽

Kok Beng Gan ◽

Wan Rozita Wan Din

Keyword(s):

Sagittal Plane ◽

Dimensional Space ◽

Plantar Flexion ◽

P Value ◽

Open Chain ◽

Kane’S Method ◽

Kane's Method ◽

Foot Strike ◽

The Mathematical Model ◽

Flexion And Extension

This paper discusses the torque data during Parachute Landing Fall (PLF) activity on the sagittal plane by applying Kane’s method. The value of torque is determined in order to identify the movement of extension and flexion at every joint-segment on the parachutist during landing. Data were obtained from three professional and eighteen amateur parachutists, each with three consecutive landings. Quintic Biomechanics Software v26 was selected to capture motion analysis. The mathematical model for the PLF technique was presented based on a two-link kinematics open chain in a two-dimensional space using Kane’s method. The t-test result showed the p-value of torque at each joint between professionals and amateurs (p ≤ 0.05). According to the torque result, the professional parachutists extended their arm then flexion their elbow, shoulder, hip, knee and the ankle plantar flexion during the foot strike phase. The professional demonstrated a perfect PLF technique by identifying the flexion and extension on each joint segment that was involved during landing activity. The value of torque at each joint segment from professional parachutists may be used as a guideline for amateurs to perform optimal landing and minimise the injury.

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Gait Function and Postural Control 4.5 Years After Nonoperative Dynamic Treatment of Acute Achilles Tendon Ruptures

Orthopaedic Journal of Sports Medicine ◽

10.1177/2325967119854324 ◽

2019 ◽

Vol 7 (6) ◽

pp. 232596711985432 ◽

Cited By ~ 4

Author(s):

Merete B. Speedtsberg ◽

Rasmus Kastoft ◽

Kristoffer W. Barfod ◽

Jeanette Ø. Penny ◽

Jesper Bencke

Keyword(s):

Achilles Tendon ◽

Center Of Pressure ◽

Dynamic Stiffness ◽

Plantar Flexion ◽

Achilles Tendon Rupture ◽

Case Series ◽

Tendon Length ◽

Balance Task ◽

Achilles Tendon Length

Background: An Achilles tendon rupture (ATR) is known to cause persistent biomechanical deficits such as decreased muscle strength in end-range plantar flexion and reduced tendon stiffness. Purpose/Hypothesis: This study aimed to examine whether sustained asymmetries were present in dynamic stiffness and kinematic and kinetic variables in gait and single-leg balance at 4.5-year follow-up in conservatively treated patients recovering from an ATR. We hypothesized that patients who had recovered from ATRs exhibit a midterm increase in peak ankle dorsiflexion, a decrease in concentric work, and decreased dynamic stiffness during the stance phase of gait, along with increased single-leg standing sway in the injured leg compared with the uninjured leg. Study Design: Case series; Level of evidence, 4. Methods: This study was a cross-sectional medium-term follow-up of conservatively treated patients recovering from ATRs. A total of 34 patients who underwent nonoperative treatment were included for testing 4.5 years after a rupture. The Achilles tendon length was measured using ultrasound. Standard instrumented 3-dimensional (3D) gait analysis and single-leg standing balance were performed using 3D motion capture. Kinematic and kinetic ankle parameters were calculated during gait, and quasi-stiffness was calculated as the moment change per the change in the degree of dorsiflexion during the second (ankle) rocker of the gait cycle. Center of pressure displacement (sway length), along with rambling and trembling, was calculated for the single-leg balance task. Results: Peak dorsiflexion in stance was 13.4% larger in the injured leg than the uninjured leg (16.9° ± 3.1° vs 14.9° ± 0.4°, respectively; P ≤ .001). Peak dorsiflexion was not associated with the normalized Achilles tendon length (B = 0.052; P = .775). Total positive work in the plantar flexors was 23.9% greater in the uninjured leg than the injured leg (4.71 ± 1.60 vs 3.80 ± 0.79 J/kg, respectively; P = .001). Quasi-stiffness was greater in the uninjured leg than the injured leg during the initial (0.053 ± 0.022 vs 0.046 ± 0.020 N·m/kg/deg, respectively; P = .009) and late (0.162 ± 0.110 vs 0.139 ± 0.041 N·m/kg/deg, respectively; P = .005) phases of eccentric loading. No difference was found in sway length during single-leg stance between the injured and uninjured legs (1.45 ± 0.4 vs 1.44 ± 0.4 m, respectively; P = .955). Conclusion: Patients treated conservatively have a small increase in peak dorsiflexion, decreased total concentric plantar flexor power, and decreased quasi-stiffness in initial and end-range dorsiflexion in the injured leg. These deviations could not be directly associated with the measured tendon elongation. Registration: NCT02760784 ( ClinicalTrials.gov ).

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An inverted ankle joint orientation at foot strike could incite ankle inversion sprain: Comparison between injury and non-injured cutting motions of a tennis player

The Foot ◽

10.1016/j.foot.2021.101853 ◽

2021 ◽

pp. 101853

Author(s):

Kam-Ming Mok ◽

Sophia Chui-Wai Ha ◽

Zoe Yau-Shan Chan ◽

Patrick Shu-Hang Yung ◽

Daniel Tik-Pui Fong

Keyword(s):

Ankle Joint ◽

Tennis Player ◽

Joint Orientation ◽

Ankle Inversion ◽

Foot Strike

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Radiographic Assessment of Relative First Metatarsal Length Following Modified Lapidus Procedure

Foot & Ankle International ◽

10.1177/1071100720924016 ◽

2020 ◽

Vol 41 (8) ◽

pp. 972-977 ◽

Cited By ~ 1

Author(s):

Wessel Greeff ◽

Andrew Strydom ◽

Nikiforos Pandelis Saragas ◽

Paulo Norberto Faria Ferrao

Keyword(s):

Hallux Valgus ◽

Sagittal Plane ◽

Case Series ◽

Relative Length ◽

Long Term Results ◽

Retrospective Case ◽

Level Of Evidence ◽

First Metatarsal ◽

Patient Reported ◽

The Mean

Background: The modified Lapidus is a surgical procedure for managing moderate to severe hallux valgus, especially in the presence of first tarsometatarsal joint arthritis or hypermobility. It has good long-term results but reportedly can lead to transfer metatarsalgia due to inherent shortening of the first metatarsal. Methods: A retrospective analysis of all adult patients who underwent a modified Lapidus procedure during a 3-year period was performed. Clinical notes were evaluated to look for nonunion or any other complications related to the surgery. Pre- and postoperative standard weightbearing radiographs were used to establish the relative metatarsal length (RML), intermetatarsal angle (IMA), hallux valgus angle (HVA), and distal metatarsal articular angle (DMMA). A total of 69 modified Lapidus procedures were identified, with 32 included in the study. Results: The mean pre- and postoperative RMLs were −0.8 and −4.9 mm, respectively. The average RML shortening due to the procedure was −4.1 ( P < .0001). The mean pre- and postoperative IMAs were 15 and 5 degrees, respectively ( P < .0001). The mean pre- and postoperative HVAs were 33 and 9 degrees, respectively ( P < .0001). One patient reported transfer metatarsalgia, which was attributed to elevation of the first metatarsal. Conclusion: We found a statistically significant degree of shortening of the relative length of the first metatarsal without any clinically significant metatarsalgia. The low rate of transfer metatarsalgia following the modified Lapidus procedure could be attributed to the sagittal plane correction and stability obtained by performing a first tarsometatarsal fusion. Level of Evidence: Level IV, retrospective case series.

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Assessment of the ankle joint in clubfeet and normal feet to the age of four years by ultrasonography

Journal of Children s Orthopaedics ◽

10.1302/1863-2548.12.170217 ◽

2018 ◽

Vol 12 (3) ◽

pp. 262-272 ◽

Cited By ~ 1

Author(s):

A. Johansson ◽

Y. Aurell ◽

B. Romanus

Keyword(s):

Ankle Joint ◽

Interobserver Reliability ◽

Plantar Flexion ◽

Intraclass Correlation ◽

Neutral Position ◽

Healthy Children ◽

Level Of Evidence ◽

Posterior Aspect ◽

Talocrural Joint ◽

Interexaminer Reliability

Purpose To establish reproducible posterior ultrasonographic projections for evaluation of the movement in the talocrural joint in clubfeet and normal feet from the perinatal period up to the age of four years. Methods The feet in 105 healthy children and 46 patients (71 clubfeet and 21 normal feet) were examined. In all, 14 feet in seven patients were examined twice by two examiners independently to evaluate the repeatability of the ultrasonography scans. A posterior sagittal projection was used. The distance from the posterior aspect of the tibial physis to the posterior border of the talocalcaneal joint (Tib. phys – TCJ) was measured with the foot in neutral position and dorsiflexion. In plantar flexion the shortest distance between the tibial physis and the calcaneus was measured. The distance from the skin to the tibial epiphyses and the talus was measured in neutral position. The intraclass correlation coefficient (ICC) was calculated to evaluate the repeatability of the measurements. Results The interexaminer reliability was 0.71 to 0.89 ICC. The intra- and interobserver reliability measured as ICC was 0.68 to 0.99 for all measurements. The correlation between Tib. phys. – TCJ and clinical dorsiflexion varied much between the age groups. Conclusion Ultrasonography of the posterior aspect of the ankle joint can be done with high interexaminer reliability. The repeatability of image evaluation was high. Correlation to clinical measurements varied, therefore dynamic ultrasound in real time is clinically more useful than single measurements on frozen ultrasound images. Level of Evidence III

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