scholarly journals The Effect of CAM Boots on Contact Pressures of the Ankle and Hindfoot Joints

2020 ◽  
Vol 5 (2) ◽  
pp. 2473011420S0001
Author(s):  
Niall A. Smyth ◽  
Pooyan Abbasi ◽  
Cesar de Cesar Netto ◽  
Stuart M. Michnick ◽  
Nicholas Casscells ◽  
...  
Keyword(s):  
Ankle Joint ◽  
Muscle Activation ◽  
Sagittal Plane ◽  
Center Of Pressure ◽  
Pressure Sensors ◽  
Flexor Hallucis Longus ◽  
Neutral Position ◽  
Ankle Motion ◽  
Joint Contact ◽  
Contact Pressures

Category: Basic Sciences/Biologics; Ankle; Hindfoot Introduction/Purpose: The tall Controlled Ankle Motion (CAM) boot and the short CAM boot are commonly used devices to immobilize the foot and ankle. However, the effect of these devices on joint contact pressures is unknown. The objective of this study is to assess the effect of the tall CAM boot and short CAM boot on contact pressures of the ankle, subtalar, talonavicular, and calcaneocuboid joints. We hypothesize that both the tall CAM boot and short CAM boot will reduce contact pressures of the ankle and hindfoot joints, with the tall CAM boot having the greatest effect. Methods: Eight lower extremity cadaver specimens were mounted on a servohydraulic test frame. The specimens were loaded to 700 N at a cyclical frequency of 1 Hz with the posterior tibial, peroneus longus, peroneus brevis, flexor hallucis longus, flexor digitorum longus, and Achilles tendon physiologically tensioned. TekScan (TekScan, Boston, MA) pressure sensors were placed in the ankle, subtalar, talonavicular, and calcaneocuboid joints. In the sagittal plane, the specimens were loaded on a neutral surface, followed by 20o of dorsiflexion. Each specimen served as its own control, with contact pressures measured with no immobilization (control), followed by placement in a short CAM boot and tall CAM boot. In addition, contact pressures in the immobilized limbs were measured at muscle loads both equal to and half of the load applied to the control in order to account for decreased muscle activation during immobilization. Results: There was no difference in the average and peak contact pressures of the ankle, subtalar, talonavicular and calcaneocuboid joints when comparing the short CAM boot to no immobilization at equal tendon loads. The tall CAM boot significantly decreased average and peak contact pressures of the ankle, subtalar, and talonavicular joints when compared to no immobilization. The tall CAM decreased the contact pressures of the talonavicular and subtalar joint to a greater degree than the ankle joint. The reduction in contact pressures was accentuated when the load applied to the tendons was decreased in accordance with diminished muscle activation during immobilization. Neither immobilization device decreased the contact pressures of the calcaneocuboid joint at equal tendon loads. Neither CAM boot changed the center of pressure of any joint. Conclusion: Immobilization in a tall CAM boot decreases contact pressures of the ankle and hindfoot in both a neutral position and in dorsiflexion. A tall CAM boot should be used clinically if the goal of its use is to maximally reduce contact pressures of the ankle and hindfoot. The tall CAM boot is better at reducing the contact pressures of the subtalar and talonavicular joint than the ankle joint.

scholarly journals The Effect of Immobilization Devices on Contact Pressures of the Ankle and Hindfoot

2019 ◽  
Vol 4 (4) ◽  
pp. 2473011419S0040
Author(s):  
Niall A. Smyth ◽  
Pooyan Abbasi ◽  
Cesar de Cesar Netto ◽  
Stuart M. Michnick ◽  
Nicholas D. Casscells ◽  
...  
Keyword(s):  
Muscle Activation ◽  
Sagittal Plane ◽  
Pressure Sensors ◽  
Personal Hygiene ◽  
Flexor Hallucis Longus ◽  
Neutral Position ◽  
Ankle Motion ◽  
Therapeutic Exercises ◽  
Joint Contact ◽  
Contact Pressures

Category: Ankle, Hindfoot Introduction/Purpose: The tall Controlled Ankle Motion (CAM) boot and the short CAM boot are commonly used devices to immobilize the foot and ankle. These devices are preferably used instead of casts and splints as they are easily removed, allowing possible wound examination, personal hygiene, and therapeutic exercises. However, the effect of these devices on joint contact pressures is unknown. The aim of this study is to assess the effect of the tall CAM boot and short CAM boot on contact pressures of the ankle, subtalar, talonavicular, and calcaneocuboid joints. We hypothesize that both the tall CAM boot and short CAM boot will reduce contact pressures of the ankle and hindfoot joints, with the tall CAM boot having the greatest effect. Methods: Eight lower extremity cadaver specimens were mounted on a servohydraulic test frame. The specimens were loaded to 700 N at a cyclical frequency of 1 Hz with the posterior tibial, peroneus longus, peroneus brevis, flexor hallucis longus, flexor digitorum longus, and Achilles tendon physiologically tensioned. TekScan (TekScan, Boston, MA) pressure sensors were placed in the ankle, subtalar, talonavicular, and calcaneocuboid joints. In the sagittal plane, the specimens were loaded on a neutral surface, followed by 20o of dorsiflexion. Each specimen served as its own control, with contact pressures measured with no immobilization (control), followed by placement in a short CAM boot and tall CAM boot. In addition, contact pressures in the immobilized limbs were measured at muscle loads both equal to and half of the load applied to the control in order to account for decreased muscle activation during immobilization. Results: There was no difference in the average and peak contact pressures of the ankle, subtalar, talonavicular and calcaneocuboid joints when comparing the short CAM boot to no immobilization at equal tendon loads. The tall CAM boot significantly decreased average and peak contact pressures of the ankle, subtalar, and talonavicular joints when compared to no immobilization. The reduction in contact pressures was accentuated when the load applied to the tendons was decreased in accordance with diminished muscle activation during immobilization. Neither immobilization device decreased the contact pressures of the calcaneocuboid joint at equal tendon loads. Conclusion: Immobilization in a tall CAM boot decreases contact pressures of the ankle and hindfoot in both a neutral position and in dorsiflexion. A tall CAM boot should be used clinically if the goal of its use is to maximally reduce contact pressures of the ankle and hindfoot.

The Effect of Tibiotalar Fixation on Foot Biomechanics

1997 ◽  
Vol 18 (12) ◽  
pp. 792-797 ◽  
Author(s):  
Jennifer S. Wayne ◽  
Keith W. Lawhorn ◽  
Kenneth E. Davis ◽  
Karanvir Prakash ◽  
Robert S. Adelaar
Keyword(s):  
Subtalar Joint ◽  
Sagittal Plane ◽  
Lower Limbs ◽  
Coronal Plane ◽  
Neutral Position ◽  
Talonavicular Joint ◽  
Tibiotalar Joint ◽  
Contact Areas ◽  
Joint Contact ◽  
Peak Pressures

Contact areas and peak pressures in the posterior facet of the subtalar and the talonavicular joints were measured in cadaver lower limbs for both the normal limb and after fixation of the tibiotalar joint. Six joints were fixed in neutral, in 5–7° of varus and of valgus. Ten degrees of equinus angulation was also studied. Each position of fixation was tested independently. Neutral was defined as fixation without coronal or sagittal plane angulation compared with prefixation alignment of the specimen. When compared with normal unfused condition, peak pressures increased, and contact areas decreased in the subtalar joint for specimens fixed in neutral, varus, and valgus. However, the change in peak pressure for neutral fusion compared with normal control was not statistically significant ( P > 0.07). Peak pressures for varus and valgus fixation were significantly different from normal ( P < 0.001). Contact areas for all positions of fixation were significantly different from normal ( P < 0.001). Coronal plane angulation, however, also resulted in significantly lower contact areas compared with neutral fixation ( P < 0.001). Contact areas and peak pressures in the talonavicular joint did not appear to be substantially affected by tibiotalar fixation with coronal plane angulation. Equinus fixation qualitatively increased contact areas and peak pressures in the talonavicular and posterior facet of the subtalar joint. Neutral alignment of the tibiotalar joint in the coronal and sagittal planes altered subtalar and talonavicular joint contact characteristics the least compared with normal controls. Therefore, ankle fusion in the neutral position would be expected to most closely preserve normal joint biomechanics and may limit the progression of degenerative arthrosis of the subtalar joint.

Effect of prosthetic ankle units on the gait of persons with bilateral trans-femoral amputations

2008 ◽  
Vol 32 (1) ◽  
pp. 111-126 ◽  
Author(s):  
Lexyne L. McNealy ◽  
Steven A. Gard
Keyword(s):  
Power Generation ◽  
Range Of Motion ◽  
Ankle Joint ◽  
Lower Limb ◽  
Stance Phase ◽  
Sagittal Plane ◽  
The Body ◽  
Control Group ◽  
Initial Contact ◽  
Ankle Motion

In able-bodied individuals, the ankle joint functions to provide shock absorption, aid in foot clearance during the swing phase, and provides a rocker mechanism during stance phase to facilitate forward progression of the body. Prosthetic ankles currently used by persons with lower limb amputations provide considerably less function than their anatomical counterparts. However, increased ankle motion in the sagittal plane may improve the gait of persons with lower limb amputations while providing a more versatile prosthesis. The primary aim of this study was to examine and quantify temporal-spatial, kinematic, and kinetic changes in the gait of four male subjects with bilateral trans-femoral amputations who walked with and without prosthetic ankle units. Two prosthesis configurations were examined: (i) Baseline with only two Seattle LightFoot2 prosthetic feet, and (ii) with the addition of Endolite Multiflex Ankle units. Data from the gait analyses were compared between prosthetic configurations and with a control group of able-bodied subjects. The amputee subjects' freely-selected walking speeds, 0.74 ± 0.19 m/s for the Baseline condition and 0.81 ± 0.15 m/s with the ankle units, were much less than that of the control subjects (1.35 ± 0.10 m/s). The amputee subjects demonstrated no difference in walking speed, step length, cadence, or ankle, knee, and hip joint moments and powers between the two prosthesis configurations. Sagittal plane ankle range of motion, however, increased by 3–8° with the addition of the prosthetic ankle units. Compared to the control group, following initial contact the amputee subjects passively increased the rate of energy storage or dissipation at the prosthetic ankle joint, actively increased the power generation at the hip, and increased the extension moment at the hip while wearing the prosthetic ankle configuration. The amputee subjects increased the power generation at their hips, possibly as compensation for the reduced rate of energy return at their prosthetic ankles. Results from subject questionnaires administered following the gait analyses revealed that the prosthetic ankle units provided more comfort during gait and did not increase the perceived effort to walk. The subjects also indicated that they preferred walking with the prosthetic ankle units compared to the Baseline configuration. The results of the study showed that the prosthetic ankle units improved sagittal plane ankle range of motion and increased the comfort and functionality of the amputee subjects’ prostheses by restoring a significant portion of the ankle rocker mechanism during stance phase. Therefore, prosthetic ankle mechanisms should be considered a worthwhile option when prostheses are prescribed for persons with trans-femoral amputations.

scholarly journals The Influence of Calcaneal and First Ray Osteotomies on the Contact Pressures of the Ankle Joint

2019 ◽  
Vol 4 (4) ◽  
pp. 2473011419S0015
Author(s):  
Cesar de Cesar Netto ◽  
Gao Zhengyu ◽  
Pooyan Abbasi ◽  
Niall Smyth ◽  
Nicholas D Casscells ◽  
...  
Keyword(s):  
Ankle Joint ◽  
Center Of Pressure ◽  
Maximum Pressure ◽  
Significant Shift ◽  
Pressure Data ◽  
Lateral Aspect ◽  
First Ray ◽  
Load Frame ◽  
Ankle Valgus ◽  
Contact Pressures

Category: Ankle, Hindfoot Introduction/Purpose: Medial displacement calcaneal osteotomies (MDCO) and first ray plantarflexion osteotomies, such as a Cotton osteotomy, are frequently used realignment procedures for hindfoot and ankle joint valgus malalignment. Multiple studies demonstrated the effects of calcaneal osteotomies on the contact pressures of the ankle joint (CPAJ), with slight medial displacement of the center of pressure and lateral unloading of the ankle joint. However, the influence of a first ray plantarflexion osteotomy on the CPAJ is yet to be determined. In this cadaveric study we compared the effects of calcaneal and first ray osteotomies in the CPAJ. Methods: Fifteen bellow-knee cadaveric specimens were dissected to expose the ankle joint and isolate the flexor and peroneal tendons. Tekscan 5033 sensors were placed in the ankle joint and held in place with cyanoacrylate. Specimens were loaded in a servohydraulic load frame. The following loads were applied to the tendons: Achilles (200 N), PTT (40 N), peroneals combined (44 N), FHL/FDL combined (35 N). Ankles were tested in an intact position, after isolated MDCO (6, 8, 10 and 12 mm), isolated Cotton osteotomies (4, 8 and 12 mm) as well as combined osteotomies (10 mm and 12 mm, respectively). Specimens were then cyclically load from 100N-700 N at a rate of 0.5 Hz for 30 cycles while CPAJ data was collected at a rate of 20 Hz. Average and maximum pressure data were extracted as well as the center of pressure (CoP) movement in the AP and ML directions. Results: There was a significant (p<0.05) and progressive decrease in respective maximum and average contact pressures of the ankle joint when comparing intact ankle (1608 and 1312kPa), calcaneal osteotomy (1291 and 1034 kPa), Cotton osteotomy (1165 and 962 kPa) and combined osteotomies (1134 and 903 kPa). Cotton osteotomy and combined osteotomies showed similar contact pressures. Regarding CoP measurements of the ankle joint, native ankle and MDCO demonstrated similar positionings in the sagittal and coronal planes. Cotton and combined osteotomies caused a significant shift of the CoP anteriorly and laterally when compared respectively to the intact/MDCO and MDCO ankles. Conclusion: The results of this study demonstrate that the Cotton osteotomy has a greater effect on the contact pressures of the ankle when compared to the MDCO. There is an overall decrease in the maximum and average pressures as well as a deviation of the center of pressure toward the anterior and lateral aspect of the ankle joint. These findings should guide surgeons when deciding between first ray and calcaneal osteotomies as realignment procedures for hindfoot and ankle valgus deformities.

The Effect of Subtalar Arthrodesis Alignment on Ankle Biomechanics

2012 ◽  
Author(s):  
James R. Jastifer ◽  
Peter A. Gustafson ◽  
Robert R. Gorman
Keyword(s):  
Lower Extremity ◽  
Range Of Motion ◽  
Ankle Joint ◽  
Sagittal Plane ◽  
Three Dimensional ◽  
Neutral Position ◽  
Moment Arms ◽  
Subtalar Arthrodesis ◽  
Force Moment ◽  
Ankle Biomechanics

Background: The position, axis, and control of each lower extremity joint intimately affects adjacent joint function as well as whole limb performance. There is little describing the biomechanics of subtalar arthrodesis and none describing the effect that subtalar arthrodesis position has on ankle biomechanics. The purpose of the current study is to establish this effect on sagittal plane ankle biomechanics. Methods: A study was performed utilizing a three-dimensional, validated, computational model of the lower extremity. A subtalar arthrodesis was simulated from 20 degrees of varus to 20 degrees of valgus. For each of these subtalar arthrodesis positions, the ankle dorsiflexor and plantarflexor muscles’ fiber force, moment arm, and moments were calculated throughout a physiologic range of motion. Results: Throughout ankle range of motion, plantarflexion and dorsiflexion strength varies with subtalar arthrodesis position. When the ankle joint is in neutral position, plantarflexion strength is maximized in 10 degrees of subtalar valgus and strength varies by a maximum of 2.6% from the peak 221 Nm. In a similar manner, with the ankle joint in neutral position, dorsiflexion strength is maximized with a subtalar joint arthrodesis in 5 degrees of valgus and strength varies by a maximum of 7.5% from the peak 46.8 Nm. The change in strength is due to affected muscle fiber force generating capacities and muscle moment arms. Conclusion: The clinical significance of this study is that subtalar arthrodesis in a position of 5–10 degrees subtalar valgus has biomechanical advantage. This supports previous clinical outcome studies and offers biomechanical rationale for their generally favorable outcomes.

scholarly journals The Effect of Achilles Tendon Loading on Ankle Joint Contact Area and Peak Pressure

2018 ◽  
Vol 3 (3) ◽  
pp. 2473011418S0030
Author(s):  
L. Daniel Latt ◽  
Alfonso Ayala ◽  
Samuel Kim ◽  
Jesus Lopez
Keyword(s):  
Achilles Tendon ◽  
Ankle Joint ◽  
Contact Area ◽  
Axial Load ◽  
Peak Pressure ◽  
The Body ◽  
Neutral Position ◽  
Joint Contact ◽  
Axially Loaded ◽  
The Impact

Category: Ankle Introduction/Purpose: Increased tibiotalar peak pressure (PP) and decreased contact area (CA) following ankle fracture are associated with the development of post-traumatic osteoarthtritis. Lateral talar translation of just 1 mm has been shown to decrease CA by 42%. The impact of talar malalignment in other directions on ankle joint contact pressures (AJCP) are not well understood. The majority of research on AJCP has utilized cadaveric models in which body weight is simulated with an axial load applied through the tibia. This model does not account for Achilles tendon - which transmits the largest tendon force in the body during weight bearing. This study aimed to determine the effects of Achilles tendon loading on tibiotalar CA and PP in an axially loaded cadaver model at different ankle flexion angles. Methods: Ten fresh frozen cadaveric lower extremity specimens transected mid-tibia were dissected free of soft tissues surrounding the ankle, sparing the ligaments. The proximal tibia and fibula were potted in quick drying cement for rigid mounting on a MTS machine. A pressure sensing element (TekScan KScan model 5033) was inserted into the tibiotalar joint and used to measure CA (cm2) and PP (MPa). An axial load of 686 N was applied through the tibia and fibula, followed by a 350 N load via the Achilles tendon to simulate mid-stance conditions. Measurements were taken at neutral position, 15 degrees of dorsiflexion and 15 degrees of plantarflexion, with and without Achilles load. The effects of Achilles load and ankle flexion angle on CA and PP were analyzed using a 2x3 ANOVA. Bonferroni post-hoc adjustments were used for multiple comparisons. Level of statistical significance was set at p < 0.05. Results: ANOVA revealed significant main effects of ankle flexion on contact area and peak pressures (Table 1). Contact area was significantly lower for 15 degrees of plantarflexion than neutral and 15 degrees of dorsiflexion (p < 0.001). In addition, peak pressure was significantly higher for 15 degrees of plantarflexion than neutral and 15 degrees of dorsiflexion. ANOVA also indicated that contact area and peak pressure were significantly higher with Achilles load than without (p < 0.001). No interaction effects were found. Conclusion: The applied Achilles tendon load significantly altered tibiotalar PP in an axially loaded cadaver model. On the other hand, changes in CA with Achilles load were found to be minimal (~1.8%). We also found that the greatest PP and smallest CA occured during plantar flexion. This observation can be explained by a difference in width between the anterior and posterior talus. While the results of this study demonstrate the importance of Achilles tendon load on tibiotalar measurements, further studies investigating the effects of additional factors such as loading techniques are warranted to improve the physiological accuracy of cadaver models.

scholarly journals The Influence of Calcaneal and First Ray Osteotomies in the Contact Pressures of the Ankle Joint

2020 ◽  
Vol 5 (4) ◽  
pp. 2473011420S0003
Author(s):  
Cesar de Cesar Netto ◽  
Pooyan Abbasi ◽  
Niall A. Smyth ◽  
Stuart Michnick ◽  
Nicholas Casscells ◽  
...  
Keyword(s):  
Ankle Joint ◽  
Center Of Pressure ◽  
Cadaveric Study ◽  
Wilcoxon Test ◽  
Pressure Data ◽  
Ankle Arthritis ◽  
Lateral Aspect ◽  
First Ray ◽  
Ankle Valgus ◽  
Contact Pressures

Category: Ankle Arthritis; Ankle; Hindfoot; Midfoot/Forefoot Introduction/Purpose: Medial displacement calcaneal osteotomies (MDCO) and first ray plantarflexion osteotomies, such as a Cotton osteotomy, are frequently used realignment procedures for hindfoot and ankle joint valgus malalignment. Multiple studies demonstrated the effects of calcaneal osteotomies on the contact pressures of the ankle joint (CPAJ), with slight medial displacement of the center of pressure and lateral unloading of the ankle joint. However, the influence of a first ray plantarflexion osteotomy on the CPAJ is yet to be determined. In this cadaveric study, we compared the effects of calcaneal and first ray osteotomies in the CPAJ. Methods: Fifteen bellow-knee cadaveric specimens were used. Tekscan 5033 sensors were placed in the ankle joint and held with cyanoacrylate. Specimens were loaded in a servohydraulic load frame. Tension loads applied to tendons: Achilles (200N), PTT (40N), peroneals combined (44N), FHL/FDL combined (35N). Specimens were tested in intact position, isolated MDCO (6 and 10mm), isolated Cotton osteotomies (4 and 8mm) and combined MDCO/Cotton osteotomies (10mm and 8mm, respectively). Specimens were then cyclically loaded from 100N-1000N at a rate of 0.5Hz for 30 cycles while CPAJ data was collected at a rate of 20Hz. Average and maximum overall pressure data were extracted as well as the center of pressure (CoP) movement in the anteroposterior (AP) and medial to lateral (ML) directions. Data was also analyzed when divided into lateral, central, and medial areas of the contact pressure map. Groups were compared by the Wilcoxon test. P-values <0.05 were considered significant. Results: We found significant (p<0.05) and progressive decrease in the average and maximum CPAJ when comparing intact ankle (1624 and 1964kPa), MDCO (1526 and 1891 kPa), Cotton osteotomy (1370 and 1642 kPa) and combined osteotomies (1292 and 1599 kPa). Cotton (4 and 8mm) and combined osteotomies showed similar contact pressures, that were significantly lower than intact specimens, emphasizing the power of first ray osteotomies in changing the contact pressures of the ankle joint. When accounting for medial, central and lateral aspects of the joint, we found that the decrease in the pressures was only significant in the central (cotton and combined osteotomies) and lateral aspects (combined osteotomy only).No significant differences were found in CoP measurements (both AP ad ML directions). Conclusion: The results of this cadaveric study demonstrate the power of Cotton osteotomies, in isolation or combined with MDCO, in decreasing the overall CPAJ, especially on its central and lateral aspects. MDCO in isolation did not differ from intact specimens. No significant changes in the center of pressure of the ankle joint were noted following any of the performed osteotomies (combined or isolated). Our findings should guide surgeons when deciding between first ray and calcaneal osteotomies as realignment procedures for hindfoot and ankle valgus deformities, when aiming to unload the lateral aspect of the ankle joint. [Figure: see text]

Talar Dome Access Through Posteromedial Surgical Intervals for Fracture Care

2021 ◽  
pp. 107110072110367
Author(s):  
Graham J. DeKeyser ◽  
Dillon C. O’Neill ◽  
Yantarat Sripanich ◽  
Amy L. Lenz ◽  
Charles L. Saltzman ◽  
...  
Keyword(s):  
Achilles Tendon ◽  
Sagittal Plane ◽  
Kirschner Wire ◽  
Posterior Tibial Artery ◽  
Flexor Hallucis Longus ◽  
Neutral Position ◽  
Micro Computed Tomography ◽  
Talar Dome ◽  
Level Of Evidence ◽  
Dimensional Reconstruction

Background: Posterior talar body fractures are rare injuries without a consensus surgical approach. This study evaluates the accessible area of the talar dome through 2 posteromedial approach intervals (posteromedial [PM] and modified posteromedial [mPM]) both with and without distraction. Methods: Ten male cadaveric legs (5 matched pairs) were included. A PM approach, between flexor hallucis longus (FHL) and the tibial neurovascular bundle, and an mPM approach, between FHL and Achilles tendon, was performed on each pair. In total, 4 mm of distraction across the tibiotalar joint was applied with the foot held in neutral position. Accessible dome surface area (DSA) was outlined by drilling with a 1.6-mm Kirschner wire with and without distraction. Specimens were explanted and analyzed by micro–computed tomography with 3-dimensional reconstruction. Primary outcomes were total accessible DSA and sagittal plane access at predetermined intervals. Results: The PM approach allowed access to 19.1% of the talar DSA without distraction and 33.1% of the talar dome with distraction ( P < .001). The mPM approach provided access to 20.4% and 35.6% of the talar DSA without and with distraction ( P < .001). Both approaches demonstrated similar sagittal plane access at all intervals except the lateral border of the talus, where the mPM approach provided greater access both without distraction (20.5% vs 4.38%, P = .002) and with distraction (34.3% vs 17.8%, P = .02). Conclusion: The mPM approach, using an interval between FHL and Achilles tendon, provides similar access to the posterior surface of talar dome and better sagittal plane access to the most lateral portion of the dome. The mPM interval provides the advantage of avoiding direct dissection of the tibial nerve or posterior tibial artery. Using an external fixator for distraction can improve talar dome visualization substantially. Level of Evidence: Level V, Cadaveric Study.

scholarly journals Dynamic Postural-Stability Deficits After Cryotherapy to the Ankle Joint

2015 ◽  
Vol 50 (9) ◽  
pp. 893-904 ◽  
Author(s):  
Karl Fullam ◽  
Brian Caulfield ◽  
Garrett F. Coughlan ◽  
Mark McGroarty ◽  
Eamonn Delahunt
Keyword(s):  
Ankle Joint ◽  
Postural Stability ◽  
Sagittal Plane ◽  
Center Of Pressure ◽  
Mean Velocity ◽  
Balance Test ◽  
Before And After ◽  
Elite Level ◽  
Star Excursion Balance Test ◽  
Dynamic Postural Stability

Context  Decreased postural stability is a primary risk factor for lower limb musculoskeletal injuries. During athletic competitions, cryotherapy may be applied during short breaks in play or during half-time; however, its effects on postural stability remain unclear. Objective  To investigate the acute effects of a 15-minute ankle-joint cryotherapy application on dynamic postural stability. Design  Controlled laboratory study. Setting  University biomechanics laboratory. Patients or Other Participants  A total of 29 elite-level collegiate male field-sport athletes (age = 20.8 ± 1.12 years, height = 1.80 ± 0.06 m, mass = 81.89 ± 8.59 kg) participated. Intervention(s)  Participants were tested on the anterior (ANT), posterolateral (PL), and posteromedial (PM) reach directions of the Star Excursion Balance Test before and after a 15-minute ankle-joint cryotherapy application. Main Outcome Measure(s)  Normalized reach distances; sagittal-plane kinematics of the hip, knee, and ankle joints; and associated mean velocity of the center-of-pressure path during performance of the ANT, PL, and PM reach directions of the Star Excursion Balance Test. Results  We observed a decrease in reach-distance scores for the ANT, PL, and PM reach directions from precryotherapy to postcryotherapy (P &lt; .05). No differences were observed in hip-, knee-, or ankle-joint sagittal-plane kinematics (P &gt; .05). We noted a decrease in mean velocity of the center-of-pressure path from precryotherapy to postcryotherapy (P &lt; .05) in all reach directions. Conclusions  Dynamic postural stability was adversely affected immediately after cryotherapy to the ankle joint.

scholarly journals Kinematics Analysis of Ankle Inversion Ligamentous Sprain Injuries in Sports

2012 ◽  
Vol 40 (11) ◽  
pp. 2627-2632 ◽  
Author(s):  
Daniel Tik-Pui Fong ◽  
Sophia Chui-Wai Ha ◽  
Kam-Ming Mok ◽  
Christie Wing-Long Chan ◽  
Kai-Ming Chan
Keyword(s):  
Internal Rotation ◽  
Ankle Joint ◽  
Sagittal Plane ◽  
Center Of Pressure ◽  
Plantar Flexion ◽  
Case Series ◽  
Level Of Evidence ◽  
Skeleton Model ◽  
Ankle Inversion ◽  
Foot Strike

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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