scholarly journals Ankle Reconstruction in Charcot's Neuroarthropathy: Challenges and Solutions

2016 ◽  
Vol 3 (2) ◽  
pp. 65-70
Author(s):  
Vinod K Panchbhavi
Keyword(s):  
Weight Bearing ◽  
Late Presentation ◽  
Ankle Injuries ◽  
Asia Pacific ◽  
Medical Attention ◽  
Main Concern ◽  
Ankle Sprains ◽  
True Nature ◽  
Vein Thrombosis ◽  
Stress Modality

ABSTRACT Ankle injuries in the presence of neuropathy have potential to cause deformity in the ankle, which can in turn cause ulcerations and infections leading to significant morbidity including loss of limb or even life. These injuries although devastating can start off innocuously and may not be immediately apparent to the patient because of lack of pain. This can lead to a late presentation. Often, the main concern is swelling, for which the patient seeks attention. And even when medical attention is sought, unless the physician is vigilant, the condition can potentially be missed or misdiagnosed as deep vein thrombosis or cellulitis. A sprain or even a fracture in the ankle is not suspected as the patient retains the ability to walk. This condition and its true nature further escapes detection if, as often is the case, a nonweight-bearing radiograph is obtained. Radiographs obtained without the weight-bearing or other stress modality may not reveal the instability at the ankle joint due to ligament damage. A thorough clinical evaluation including assessment for neuropathy and weight-bearing radiographs are necessary for diagnosis. Stable fractures and ankle sprains can be managed conservatively in a cast or boot. Unstable ankle following ligamentous disruption and/or fractures in the vicinity of the ankle needs internal or external stabilization. The stabilization in the presence of neuropathy should be stronger and the protection from weight bearing last longer and twice that used for patients with similar condition but without neuropathy. How to cite this article Panchbhavi VK. Ankle Reconstruction in Charcot's Neuroarthropathy: Challenges and Solutions. J Foot Ankle Surg (Asia-Pacific) 2016;3(2):65-70.

scholarly journals A Comparison of Kinesiology and Athletic Taping on Ankle Range of Motion

2018 ◽  
Vol 3 (3) ◽  
pp. 2473011418S0022
Author(s):  
Eric Folmar ◽  
Adam Thomas
Keyword(s):  
Range Of Motion ◽  
Repeated Measures ◽  
Weight Bearing ◽  
Ankle Dorsiflexion ◽  
Ankle Injuries ◽  
Ankle Sprains ◽  
Kinetic Chain ◽  
Limited Mobility ◽  
Ankle Inversion ◽  
Athletic Tape

Category: Other Introduction/Purpose: A high prevalence of ankle sprains exists in athletic and non-athletic populations. White athletic tape (WAT), commonly used for prevention and treatment, provides ankle stability while limiting mobility. Athletic taping has demonstrated the ability to limit ROM in all directions, particularly ankle inversion, as inversion injuries represent a vast majority of ankle sprains. Use of kinesiology taping (KT) for the purpose of limiting mobility in the ankle has not been examined. While limiting inversion range of motion may be beneficial in prophylactic management of ankle injuries, limiting ROM in other directions may impact kinematics of other joints in the kinetic chain. To determine the effectiveness of an innovative KT technique for limiting ankle inversion ROM while allowing movement in the other movements of the ankle. Methods: Fifty-three healthy 18-25 year old college students were recruited for this study. Subjects received each of the taping conditions (traditional basket weave WAT, a novel KT method, and no tape) in a randomized order. Manual goniometer measurements were taken in non-weight bearing in the inversion, eversion, dorsiflexion and plantarflexion directions. A handheld inclinometer was used to measure weight bearing ankle dorsiflexion. Measures for each were compared across each taping condition. A repeated measures ANOVA was performed. Results: Significant decreases in ankle ROM (p <.01) were observed in all measures between WAT and no tape. KT demonstrated significant decreases in all ROM compared to no tape (p <.01), except for a minimal decrease in weight bearing ankle dorsiflexion (p>.05). WAT demonstrated significantly greater ROM restriction in all directions than did KT (p<.01), including weight-bearing ankle DF. Conclusion: These results suggest that KT allows for more ankle ROM than traditional WAT in non-weight bearing and weight bearing measures, while still providing significant motion limitation in all motions except weight bearing dorsiflexion (in comparison to no tape). Limiting excessive inversion while simultaneously allowing closer to normal ROM in all other planes may decrease the risk of negatively impacting kinetic chain kinematics associated limited mobility of the ankle.

scholarly journals The epidemiology, evaluation, and assessment of lateral ankle sprains in athletes

2021 ◽  
Vol 6 (2) ◽  
pp. 008-017
Author(s):  
Cavazos Jr. G Javier ◽  
Harkless Lawrence B
Keyword(s):  
Best Practice ◽  
Healthcare Providers ◽  
Treatment Strategies ◽  
The United States ◽  
Ankle Injuries ◽  
Return To Play ◽  
Medical Attention ◽  
Ankle Sprains ◽  
Lateral Ankle ◽  
True Incidence

Approximately 30,000 ankle injuries occur every day in the United States. With the incidence estimated at more than 3 million a year and at a rate of 2.15/1,000 in the U.S. alone, medical specialists and other healthcare providers caring for the foot and ankle must take notice. Despite the millions of ankle injuries sustained annually, the true incidence may be underestimated, as fewer than half of individuals with ankle sprains seek medical attention from healthcare professionals. The economic burden associated with the evaluation, diagnosis, and treatment is close to $4 billion annually. Ankle sprains account for half of all sports injuries and remains a difficult diagnostic and therapeutic challenge in the athlete. Accurate diagnosis is critical as 40% of ankle sprains are misdiagnosed or poorly treated leading to chronic ankle pain and disability. Implementing evidence supported diagnostic and treatment strategies is the goal for ensuring safe and rapid return to play. The Lateral Ankle Sprain (LAS) is among the most common type of ankle sprains suffered during athletic activities. Up to 80% of LAS are of the inversion type, and 75% lead to recurrence and instability. Although most individuals experiencing a LAS return to activity within six weeks, many report continued pain, diminished function, and instability. The purpose of this review is to highlight the epidemiology, pathoetiology, pathoanatomy, and biomechanics of the LAS, enabling sports physicians to implement the best practice guidelines and protocols to manage this common enigma.

scholarly journals Not all ankle injuries are ankle sprains - Case of an isolated cuboid stress fracture

2018 ◽  
Author(s):  
Sidharth Unnithan ◽  
Joe Thomas
Keyword(s):  
Magnetic Resonance Imaging ◽  
Computed Tomography ◽  
Magnetic Resonance ◽  
Stress Fracture ◽  
Weight Bearing ◽  
Stress Fractures ◽  
Ankle Injuries ◽  
Ankle Sprains ◽  
Resonance Imaging ◽  
Left Ankle

A 22-year old lady, had a twisting injury to her left ankle followed by pain on prolonged weight bearing and walking. Magnetic resonance imaging with computed tomography correlation was done which showed an isolated cuboid stress fracture. Isolated cuboid stress fractures are very rare and are usually misdiagnosed as ankle sprains.

Recent Ankle Injury, Sport Participation Level, and Tests of Proprioception

2019 ◽  
Vol 28 (8) ◽  
pp. 824-830 ◽  
Author(s):  
Nili Steinberg ◽  
Roger Adams ◽  
Moshe Ayalon ◽  
Nadav Dotan ◽  
Shiri Bretter ◽  
...  
Keyword(s):  
Sport Participation ◽  
Weight Bearing ◽  
Ankle Injury ◽  
Active Movement ◽  
Ankle Sprains ◽  
Discrimination Test ◽  
Cross Sectional ◽  
Sensitivity Score ◽  
Participation Level ◽  
Proprioceptive Sensitivity

Objective: Assessing the effects of ankle injury and sport participation level on ankle proprioceptive sensitivity using a joint position reproduction (JPR) test and an inversion movement extent discrimination test. Design: Cross-sectional. Setting: Biomechanics lab. Participants: Forty-five student athletes ages 21–30 (mean = 24.8 y). Main Outcome Measures: Participants were tested for ankle inversion sensitivity using 2 devices; movement reproduction error was obtained from JPR in a non-weight-bearing (N-WB) state at 10° and 15° of inversion, and an ankle proprioceptive sensitivity score was obtained from the active movement extent discrimination apparatus (AMEDA), representing the ability to differentiate 5 inversion movement extents between 10.5° and 14.5°, with testing in both N-WB and weight-bearing (WB) states. Results: For the 34 athletes with no ankle injury in the previous 12 months, the sensitivity scores achieved on the AMEDA were significantly higher (P < .01) than those for the 11 athletes with ankle injury, and the injury effect was significantly greater in WB (P = .01). In JPR testing, the 2.96° error of reproduction for athletes with no recent ankle injury was not significantly different from the 3.36° error for those with ankle injury (P = .46). Correlation of current sport participation level with JPR showed less error for higher-level performers (r = .49, P = .001) but no significant relationship to WB or N-WB AMEDA scores (both P > .61). WB AMEDA scores were significantly higher for athletes who had competed at a higher level of sport competition when <18 years old (r = −.57, P < .001). Conclusions: Previous ankle sprains affected proprioceptive scores on the WB AMEDA and N-WB AMEDA tests, indicating the sensitivity of the AMEDA movement discrimination test to the effects of ankle injury. The correlation between JPR scores and current level of sport participation suggests the sensitivity of the JPR test to current ankle use.

scholarly journals POSTERIOR TIBIAL TENDON INJURY - IS MISSED DIAGNOSIS, A POSSIBILITY? SHOULD IT BE SUSPECTED IN ALLANKLE EVERSION SPRAINS? - A CASE REPORT

2020 ◽  
pp. 1-2
Author(s):  
Chavda Sumant ◽  
Garg Chaitanya ◽  
George, Biji Thomas ◽  
Jad Allah, Bader
Keyword(s):  
Physical Examination ◽  
Ankle Sprain ◽  
Weight Bearing ◽  
Ankle Injuries ◽  
Radiographic Evaluation ◽  
Tibialis Posterior ◽  
Posterior Tibial Tendon ◽  
Persistent Symptoms ◽  
Posterior Tibial ◽  
Ankle Brace

Ankle sprains are one of the most common injuries that occur among people of all ages and accounts for 75% of ankle injuries and for 10 to 30 percent of sports-related injuries in young athletes. Inversion sprain is more common than eversion ankle sprain, to result in injury to the lateral ligament complex. Though injury to the posterior tibial tendon is not a very common injury associated with eversion ankle sprain, it often can be overlooked and missed in the initial physical examination. We present a case of a college student who sustained a twisting injury to his left ankle while playing football. After initial history, physical examination and plain radiographic evaluation, a diagnosis of eversion ankle sprain was made by a general practitioner and treated conservatively. Due to persistent symptoms and local signs, subsequent evaluation with an MRI study revealed tibialis posterior (TP) tendon strain with diffuse soft tissue swelling extending up to lower third of the leg and associated Grade I osteochondral injury to the posterolateral aspect of talus. The injury was successfully treated with medial arch support ankle brace, analgesics, guarded weight bearing and physiotherapy with full functional recovery in 12 weeks.

scholarly journals Role of magnetic resonance imaging in ankle sprains

2021 ◽  
Vol 25 (1) ◽  
pp. 438-445
Author(s):  
Nawroz Othman ◽  
Salwa AL-Najjar
Keyword(s):  
Magnetic Resonance Imaging ◽  
Magnetic Resonance ◽  
Clinical Evaluation ◽  
Ankle Sprain ◽  
Soft Tissues ◽  
Ankle Injuries ◽  
Bone Lesions ◽  
Ankle Sprains ◽  
Resonance Imaging ◽  
Imaging Results

Background and objective: Musculoskeletal injuries frequently occur in the ankle in both the athletic and general population. Ankle sprains are among the most frequent types of ankle injuries, which are conventionally diagnosed through clinical examinations. However, magnetic resonance imaging can provide a more precise diagnosis, leading to better injury management and prevention of consequent chronic complications. The present study aimed to examine the significance of magnetic resonance imaging in detecting and assessing changes that occur in ligaments and soft tissues in patients with ankle sprains. Methods: In a prospective study, 50 patients with ankle sprain referred to Rizgary and Erbil Teaching hospitals in Erbil city, Iraqi Kurdistan Region, from March 2018 to April 2019, were included in the study. They underwent clinical evaluation and MRI (GE general electric 1.5 Tesla). Two expert radiologists analyzed the magnetic resonance imaging images, and the results were compared. The collected data were analyzed using SPSS version 23 through descriptive statistics. Results: Most patients (64%) belonged to the age groups of 30-49 years old. Most of them (64%) were males. Most events of ankle sprain (66%) were because of sports and accidents. The clinical evaluation proved 82% of the ankle sprains. Regarding the laterality of the lesions, 60% were spotted in the right ankles and 40% in the left. According to magnetic resonance imaging results, both radiologists diagnosed that the ankle sprains included bone lesions, ligament injury, tendon injury, and effusion. There was an agreement of ≥ 96% between the two radiologists in this regard. The two radiologists were not significantly different in terms of diagnosing the ligament side. As reported by the radiologists based on the magnetic resonance imaging images, the anterior, lateral, and medial tendons were normal in most cases. Conclusion: Magnetic resonance imaging is a vitally important tool that can be utilized reliably and accurately to diagnose and evaluate changes in ligaments and soft tissues in patients with ankle sprains. Keywords: Magnetic resonance imaging (MRI); Ankle sprain; Ligaments; Injuries.

Evaluation of the Sports Ankle Rating System in Young, Athletic Individuals with Acute Lateral Ankle Sprains

2003 ◽  
Vol 24 (3) ◽  
pp. 274-282 ◽  
Author(s):  
Glenn N. Williams ◽  
Joseph M. Molloy ◽  
Thomas M. DeBerardino ◽  
Robert A. Arciero ◽  
Dean C. Taylor
Keyword(s):  
Ankle Injuries ◽  
Rating System ◽  
Ankle Sprains ◽  
Rating Score ◽  
Lateral Ankle ◽  
Life Measure ◽  
Initial Validation ◽  
Unique System ◽  
The Impact

The purpose of this paper is to introduce the Sports Ankle Rating System and provide the initial validation for its use. As its name implies, this outcomes measurement system is intended for use in assessing the functional outcomes of athletes with ankle injuries. This unique system consists of three distinct instruments: the Quality of Life Measure, the Clinical Rating Score, and the Single Assessment Numeric Evaluation. We began the validation process of the Sports Ankle Rating System with subjects who had sustained lateral ankle sprains because this is the most common injury in sports. The results of this study indicate that the Sports Ankle Rating System is: effective at assessing the impact that an ankle sprain has on an athlete's functional and psychosocial status responsive to changes in an athlete's ankle-related health status, and valid and reliable as tested.

The Snowboarder's Foot and Ankle

1998 ◽  
Vol 26 (2) ◽  
pp. 271-277 ◽  
Author(s):  
Douglas P. Kirkpatrick ◽  
Robert E. Hunter ◽  
Peter C. Janes ◽  
Jackie Mastrangelo ◽  
Richard A. Nicholas
Keyword(s):  
Injury Rate ◽  
Soft Tissue Injuries ◽  
Fracture Pattern ◽  
Ankle Injuries ◽  
Anterior Talofibular Ligament ◽  
Ankle Sprains ◽  
Foot And Ankle ◽  
Foot Injuries ◽  
Lateral Process ◽  
Ski Resorts

We undertook a prospective study to determine the type and distribution of foot and ankle snowboarding injuries. Reports of 3213 snowboarding injuries were collected from 12 Colorado ski resorts between 1988 and 1995. Of these, 491 (15.3%) were ankle injuries and 58 (1.8%) were foot injuries. Ankle injuries included 216 (44%) fractures and 255 (52%) sprains. Thirty-three (57%) of the foot injuries were fractures and 16 (28%) were sprains. The remaining injuries were soft tissue injuries, contusions, or abrasions. There was no significant correlation between boot type (soft, hybrid, or hard) and overall foot or ankle injury rate. There were significantly fewer ankle sprains in patients wearing hybrid boots and fewer fractures of the lateral process of the talus in patients wearing soft boots. An unexpectedly high number of fractures of the lateral process of the talus were noted. These 74 fractures represented 2.3% of all snowboarding injuries, 15% of all ankle injuries, and 34% of the ankle fractures. Many of these fractures are not visible on plain radiographs and require computed tomography imaging to be diagnosed. Diagnosis of this fracture pattern is paramount; the physician should be very suspicious of anterolateral ankle pain in the snowboarder, where subtle fractures that may require surgical intervention can be confused with anterior talofibular ligament sprains.

scholarly journals Stress vs. Non-Stress Radiographs in Subtle Syndesmotic Injuries

2018 ◽  
Vol 3 (3) ◽  
pp. 2473011418S0029
Author(s):  
Nicola Krähenbühl ◽  
Travis Bailey ◽  
Nathan Davidson ◽  
Heath Henninger ◽  
Charles Saltzman ◽  
...  
Keyword(s):  
Ankle Instability ◽  
External Rotation ◽  
Paired Comparison ◽  
Weight Bearing ◽  
Deltoid Ligament ◽  
Ankle Sprains ◽  
X Rays ◽  
Syndesmotic Injury ◽  
Stress Radiographs ◽  
Clear Space

Category: Sports Introduction/Purpose: Between 1-18% of all ankle sprains and 23% of all ankle fractures involve injury to the distal tibio-fibular syndesmosis. Syndesmotic injuries can create a substantial diagnostic and therapeutic challenge for orthopaedic surgeons. While acute injuries can be assessed using conventional radiographs, subtle syndesmotic injuries may be misdiagnosed using X-rays. Misdiagnoses may result in chronic ankle instability, pain and post-traumatic osteoarthritis of the tibio-talar joint. The purpose of this study was to investigate whether syndesmotic injury was more easily diagnosed with stress vs. non-stress radiographs.radiographs.sed with stress vs. non-stress radiographs. Methods: Five pairs of cadavers (tibia plateau to toe-tip, mean 61 years, range 52-70 years) were scanned with weight-bearing CT (170 lb, w/ and w/o 10 Nm static external rotation torque). Digitally reconstructed radiographs (DRRs), which are comparable to conventional radiographs, were reconstructed from the 3D CT data. The following conditions were tested: First, intact ankles (Native) were tested. Second, one specimen from each pair underwent AITFL resection, while the contralateral underwent deltoid resection (Condition 1). Third, the remaining intact deltoid ligament or AITFL was resected in each ankle (Condition 2). Finally, the interosseous membrane (IOM) was resected in all ankles (Condition 3). Condition 3 was defined as acute syndesmotic injury. Using antero-posterior (AP) views, the tibio-fibular clear space (TFCS), tibiofibular overlap (TFO) and medial clear space (MCS) were assessed. Statistical analysis was performed using paired (comparison within groups) and unpaired (comparison between groups) t-test where p=0.05 was considered significant. Results: Regarding the TFCS, Native vs. Condition 3 in 10 Nm stress radiographs was significantly different in the deltoid group (p=0.021). Using TFO in stress and non-stressed radiographs, Native vs. Condition 2 and 3 was significantly different for the deltoid group (p=0.043), and Native vs. Condition 3 in the syndesmotic group (p=0.027). Regarding the MCS in non-stress radiographs, Native vs. Condition 3 was significantly different in the deltoid group (p=0.007), while in stress views, Native vs. Condition 2 was significant different in the syndesmotic (p=0.026) and Native vs. Condition 3 in the deltoid group (p=0.030). No differences were found comparing the conditions of the AITFL with the same conditions of the deltoid group. Conclusion: The TFCS cannot be used to assess subtle or acute syndesmotic injuries in stress and non-stress radiographs. The TFO can be used to assess a combined injury to the AITFL and deltoid ligament in stress and non-stress radiographs. The MCS can be used to assess acute syndesmotic injuries in stress and non-stress radiographs. Radiographs (stress or non-stress) cannot be used to distinguish between injuries to the AITFL or deltoid ligament. Therefore, stress and non-stress radiographs are not useful in assessment of subtle syndesmotic injuries. Stress-radiographs are not superior compared to non-stress radiographs in assessment of acute syndesmotic injuries.

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