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]

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.

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.

Effect of Foot Morphology on Center-of-Pressure Excursion During Barefoot Walking

2008 ◽  
Vol 98 (2) ◽  
pp. 112-117 ◽  
Author(s):  
Lilian Wong ◽  
Adrienne Hunt ◽  
Joshua Burns ◽  
Jack Crosbie
Keyword(s):  
Regional Differences ◽  
Center Of Pressure ◽  
Pressure Data ◽  
Lateral Border ◽  
Foot Posture Index ◽  
Posture Index ◽  
Foot Posture ◽  
Foot Morphology ◽  
The Relationship

Background: The path of the center of pressure during walking varies among individuals by deviating to a greater or lesser extent toward the medial or lateral border of the foot. It is unclear whether this variance is systematic and is affected by foot posture. The aim of this study was to explore the relationship between foot morphology and center-of-pressure excursion during barefoot walking. Methods: Pressure data were collected from 83 participants whose foot type had been classified as supinated, normal, or pronated according to the Foot Posture Index. Three center-of-pressure variables were analyzed: medial excursion area, lateral excursion area, and total excursion area. Results: Across the spectrum of foot types, we found that the more supinated a participant’s foot posture, the larger the area of lateral center-of-pressure excursion, and, conversely, the more pronated the foot posture, the smaller the area of lateral center-of-pressure excursion. Furthermore, the supinated foot type had a relatively larger center-of-pressure total excursion area, and the pronated foot type had a relatively smaller center-of-pressure total excursion area. Conclusions: These results indicate the importance of assessing foot posture when measuring center of pressure and may help explain regional differences in pain and injury location among foot types. (J Am Podiatr Med Assoc 98(2): 112–117, 2008)

scholarly journals The influence of an aquatic exercise program on balance in patients with ankylosing spondylitis

2021 ◽  
Vol 31 (Supplement_2) ◽  
Author(s):  
Margarida Ferreira ◽  
Cristina Mesquita ◽  
Paula Santos ◽  
João Borges ◽  
Maria Graça ◽  
...  
Keyword(s):  
Ankylosing Spondylitis ◽  
Center Of Pressure ◽  
Exercise Program ◽  
Wilcoxon Test ◽  
Aquatic Exercise ◽  
Body Sway ◽  
Mean Velocity ◽  
Assessment Protocol ◽  
Eyes Closed ◽  
Eyes Open

Abstract Background Ankylosing spondylitis (AS) is a chronic inflammatory rheumatic disease that leads to a limitation of mobility, which can cause postural deficits and progressive loss of balance. Aquatic exercise improves this health condition. The objetive is to verify the influence of an aquatic exercise program, on balance and functionality, in individuals with AS. Methods Pre-experimental study carried out on 6 individuals with AS. All individuals were assessed at baseline (M0) and 12 weeks after the intervention (M1) using the Bath indices (BASMI, BASFI and BASDAI) and the balance assessment protocol (‘Body Sway’) by the Physiosensing Platform. Data were analyzed using the Statistical Program Statistical Package for the Social Sciences (SPSS), version 26. Were used descriptive statistics and Wilcoxon test to compare M0 and M1. The significance value was 0.05. Results We verify improvements in BASMI (P = 0.046), BASFI (P = 0.042) and BASDAI (P = 0.027) scores. Through the analysis of the center of pressure variables, there were no statistically significant differences, between moments, in the protocol. However, when assessing balance, in the anteroposterior mean distance in both the protocol (eyes open) and in the protocol (eyes closed), in the root mean square in both protocols and in mediolateral mean velocity, only in the protocol (eyes open), there was a slight decrease in the median value. Conclusions The present study suggests that the specific aquatic exercise program, may influence balance and improve functionality in a population with AS. Therefore, the Bath indices translate improvements in the symptoms and functionalities of these participants.

Examination of the Origin and Branching Direction of the Anterior Medial Malleolar Artery From the Anterior Tibial Artery: A Cadaveric Study

2018 ◽  
Vol 12 (2) ◽  
pp. 167-171 ◽  
Author(s):  
Ichiro Tonogai ◽  
Fumio Hayashi ◽  
Yoshihiro Tsuruo ◽  
Koichi Sairyo
Keyword(s):  
Ankle Joint ◽  
Sagittal Plane ◽  
External Iliac Artery ◽  
Longitudinal Axis ◽  
Cadaveric Study ◽  
Ankle Arthroscopy ◽  
Anterior Tibial Artery ◽  
Tibial Artery ◽  
Anterior Tibial ◽  
Branching Point

Background. This study characterized the anterior medial malleolar artery (AMMA) branching from the anterior tibial artery (ATA) to identify problems in anterior ankle arthroscopy possibly contributing to injury to the AMMA. Methods. Barium was injected into 12 adult cadaveric feet via the external iliac artery and the origin and branching direction of the AMMA were identified on computed tomography. Results. The AMMA originated from the level of the ankle joint and below and above the ankle joint line (AJL) in 4 (33.3%), 6 (50.0%), and 1 (8.3%) specimen, respectively. Mean distance from the AJL to the branching point of the AMMA on the sagittal plane was 2.5 mm distal to the AJL. Mean angle between the distal longitudinal axis of the ATA and AMMA was 83.2°. Conclusions. This study established the origin and branching of the AMMA from the ATA. The AMMA should be examined carefully during ankle arthroscopy. Levels of Evidence: Level IV: Cadaveric study

A CONCEPTUAL STUDY OF GULPHA MARMA WITH SPECIAL REFERENCE TO ANKLE JOINT AND CONCEPT OF MARMA CHIKITSA

2019 ◽  
Vol 7 (06) ◽  
Author(s):  
Isha Pradeep Wasu ◽  
Vinod M Choudhari
Keyword(s):  
Special Reference ◽  
Ankle Joint ◽  
Lateral Aspect ◽  
Pain Reliever ◽  
Joint Injury ◽  
Exact Location ◽  
Conceptual Study ◽  
A Site

Aim- Study of Gulpha Marma and ankle joint. Objective- 1. Exact location of Gulpha Marma in limbs 2. Effect of injury to Gulpha Marma 3. Contemperory concept of Gulpha Marma and ankle joint 4. Concept of marma chikitsa in pain related to Gulpha Marma. Observation- Gulpha Marma is sandhi marma and rujakar marma. It is predominantly made up of sandhi i.e. the joint or components making the ankle joint. Injury to it causes stabhdata & khanjata. The location of Gulpha Marma is nothing but the joint between tibia, fibula and talus and other structures related to lateral aspect of ankle joint. Marma chikitsa gives tridosha triguna samanya as there is a site of prana at these points. This chikitsa acts as the pain reliever or preventional aspect of these vital sites or Marma. Conclusion- On dissection of ankle joint various structures were studied and were compared with Gulpha Marma. The injuries related to these marma’s can be studied under tendons, ligaments, vessels and bones. These can be considered as siravedhya and vatavyadhi and treated accordingly. Based upon the above observations and study we can conclude the exact location, effect of injury, relation with ankle joint of Gulpha Marma.  Keywords- Marma, Gulpha Marma, Ankle Joint, Marma Chikitsa

Contact patterns in the ankle joint after lateral ligamentous injury during internal rotation: A computational study

2020 ◽  
Vol 235 (1) ◽  
pp. 82-88
Author(s):  
G Marta ◽  
C Quental ◽  
J Folgado ◽  
F Guerra-Pinto
Keyword(s):  
Finite Element ◽  
Contact Mechanics ◽  
Internal Rotation ◽  
Ankle Joint ◽  
Ankle Instability ◽  
Computational Study ◽  
Rotational Instability ◽  
Anterior Talofibular Ligament ◽  
Maximum Contact ◽  
Contact Pressures

Lateral ankle instability, resulting from the inability of ankle ligaments to heal after injury, is believed to cause a change in the articular contact mechanics that may promote cartilage degeneration. Considering that lateral ligaments’ insufficiency has been related to rotational instability of the talus, and that few studies have addressed the contact mechanics under this condition, the aim of this work was to evaluate if a purely rotational ankle instability could cause non-physiological changes in contact pressures in the ankle joint cartilages using the finite element method. A finite element model of a healthy ankle joint, including bones, cartilages and nine ligaments, was developed. Pure internal talus rotations of 3.67°, 9.6° and 13.43°, measured experimentally for three ligamentous configurations, were applied. The ligamentous configurations consisted in a healthy condition, an injured condition in which the anterior talofibular ligament was cut, and an injured condition in which the anterior talofibular and calcaneofibular ligaments were cut. For all simulations, the contact areas and maximum contact pressures were evaluated for each cartilage. The results showed not only an increase of the maximum contact pressures in the ankle cartilages, but also novel contact regions at the anteromedial and posterolateral sections of the talar cartilage with increasing internal rotation. The anteromedial and posterolateral contact regions observed due to pathological internal rotations of the talus are a computational evidence that supports the link between a pure rotational instability and the pattern of pathological cartilaginous load seen in patients with long-term lateral chronic ankle instability.

scholarly journals 20 Degree Post Traumatic Ankle Valgus and Distal Lateral Tibial Osteonecrosis Treated with Staged Deformity Correction and Total Ankle Arthroplasty

2017 ◽  
Vol 2 (3) ◽  
pp. 2473011417S0001
Author(s):  
Lawrence DiDomenico ◽  
Danielle Butto
Keyword(s):  
Ankle Joint ◽  
Deformity Correction ◽  
Total Ankle Arthroplasty ◽  
Wedge Osteotomy ◽  
Tibial Osteotomy ◽  
Opening Wedge ◽  
Ankle Arthroplasty ◽  
Initial Surgery ◽  
Post Traumatic ◽  
Ankle Valgus

Category: Ankle, Ankle Arthritis Introduction/Purpose: The purpose of this review is to present a case of post-traumatic ankle valgus and distal lateral tibial osteonecrosis successfully treated with staged deltoid repair, opening wedge tibial osteotomy, fibular lengthening, syndesmotic fusion and total ankle arthroplasty. Methods: Initial surgery consisted of ankle joint arthrotomy and deltoid imbrication. The second surgery consisted of a tibial opening wedge osteotomy with autogenous cortical fibular bone graft superior to the area of osteonecrosis to correct the 20 degree ankle valgus. Fibular lengthening osteotomy and fusion of the distal syndesmosis were also performed. CT scan confirmed bony consolidation at the distal tibiofibular syndesmosis as well as union of the allograft opening wedge. The final surgery was total ankle joint replacement with bone grafting of the area of osteonecrosis. Results: After 5 years of follow up the patient has progressed out of his AFO to full weightbearing. He reports no ankle pain, improved function and range of motion and is ambulating independently with no assistive devices. Conclusion: We successfully treated a case of distal lateral tibial osteonecrosis, and a 20 degree ankle valgus with staged deformity correction and ankle replacement. Radiographs demonstrate a well seated and positioned implant. We believe that with proper alignment that total ankle arthroplasty is a safe treatment option in the face of bone infarction.

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