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The Journal of Bone and Joint Surgery.... Mar 2015Ankle arthrodesis traditionally has been regarded as the treatment of choice for many patients with end-stage ankle arthritis. However, a major reported risk of ankle... (Review)
Review
BACKGROUND
Ankle arthrodesis traditionally has been regarded as the treatment of choice for many patients with end-stage ankle arthritis. However, a major reported risk of ankle arthrodesis is adjacent-joint degeneration. There are conflicting views in the literature as to the causative link between ankle arthrodesis and progression to adjacent-joint arthritis. Recent studies have challenged the causative link between arthrodesis and adjacent-joint arthritis, purporting that preexisting adjacent-joint arthritis is present in many patients. The aim of the present study was to systematically review the available literature to determine if there is sufficient evidence to support either hypothesis.
METHODS
A literature search of the EMBASE and PubMed/MEDLINE databases (1974 to present) was performed. A total of twenty-four studies were included for review. The studies were reviewed, and the relevant information was extracted, including research methodology, postoperative outcomes in the adjacent joints of the foot, and whether pre-arthrodesis radiographs and medical records were available for analysis.
RESULTS
The twenty-four manuscripts included eighteen clinical studies, five biomechanical studies, and one gait-analysis study. The majority of biomechanical studies showed altered biomechanics in the fused ankle; however, there was no clear consensus as to whether these findings were causes of adjacent-joint arthritis. In studies assessing clinical outcomes, the reported prevalence of subtalar joint arthritis ranged from 24% to 100% and the prevalence of talonavicular and calcaneocuboid arthritis ranged from 18% to 77%. Correlation between imaging findings of arthritis in adjacent joints and patient symptoms was not established in a number of the clinical studies reviewed.
CONCLUSIONS
There is no true consensus in the literature as to the effects of ankle arthrodesis on biomechanics or whether ankle arthrodesis leads to adjacent-joint arthritis. Similarly, a correlation between postoperative imaging findings and clinical presentation in this cohort of patients has not been conclusively demonstrated.
Topics: Ankle Joint; Arthritis; Arthrodesis; Humans; Tarsal Joints
PubMed: 25788309
DOI: 10.2106/JBJS.N.00426 -
Injury Oct 2017Ankle dislocation without fracture is rare. We used electronic hospital records to determine the incidence of pure ankle dislocation and performed a systematic review of... (Review)
Review
BACKGROUND
Ankle dislocation without fracture is rare. We used electronic hospital records to determine the incidence of pure ankle dislocation and performed a systematic review of the literature to investigate the occurrence, treatment and outcome of this injury to better inform treating clinicians.
METHODS
A review of electronic medical records at a tertiary referral centre was conducted to estimate in incidence of pure ankle dislocation. Systematic review of the literature was undertaken according to PRISMA guidelines for the reporting of individual patient data. This identified 64 English language articles that included 18 case series, 45 case reports and 1 biomechanical cadaveric study. Data was extracted by standard form independently by 2 of the authors and descriptive statistics were used to describe results.
RESULTS
The estimated incidence of pure ankle dislocation is 0.065% (13/20,000) of presentations with an ankle injury or 0.46% (23/5000) of presentations with an ankle dislocation. Systematic review of English literature identified 154 cases and demonstrated that sporting accidents (31%) and motor vehicle accidents (30%) are the most common cause. 73% (112/154) of the cases occurred in males and 50% (77/154) were open. In 46% (71/154) of patients the direction of dislocation was posteromedial. 46% of patients had nonoperative treatment; ligamentous repair was described in 26% (37 patients). The mean period of immobilisation was just over 6 weeks (range 2-16 weeks). In most patients, good functional outcomes were described. The most common long-term complaint was decreased ankle range of motion (18%) (27/154). Ankle instability was rare (2.6%) (4/154) and not influenced by acute ligament repair (P=0.98).
CONCLUSION
Pure ankle dislocation is a rare injury. The literature reports that most injuries occur in sports and motor vehicle accidents. The majority of injuries treated with early reduction followed by a short period of immobilisation and functional rehabilitation have good clinical outcomes.
Topics: Ankle Injuries; Humans; Immobilization; Incidence; Joint Dislocations; Physical Therapy Modalities; Radiography; Range of Motion, Articular
PubMed: 28826653
DOI: 10.1016/j.injury.2017.08.011 -
Journal of the American Podiatric... 2023Lateral wedges are a common intervention used to alter biomechanical function of the lower limb. Although there is evidence investigating the use and impact of lateral... (Review)
Review
Lateral wedges are a common intervention used to alter biomechanical function of the lower limb. Although there is evidence investigating the use and impact of lateral wedges in individuals with medial knee osteoarthritis, knowledge of how these wedges affect foot function in healthy adults is limited. Therefore, this study intends to investigate how lateral wedging affects foot function in healthy adults and, furthermore, how wedge design influences the outcome. The framework outlined by Arksey and O'Malley was used for this scoping review. To ensure methodologic quality and transparent reporting, the study adheres to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses Extension for Scoping Reviews preferred reporting guidelines. A systematic search was conducted using MEDLINE by means of EBSCO; SPORT Discuss; CINAHL; AMED by means of OVID; and Scopus. The initial search yielded 252 articles in total; 21 studies were included in the final analysis. Significant incongruence exists in descriptions of wedge length among the 21 included studies. Thirteen studies (61%) reported using full-length wedges, five studies did not report wedge length, and only one study analyzed more than one wedge length. Ethylene vinyl acetate was the most common material, and reporting of hardness was inconsistent. A broad range of inclination angles were used, with limited explanation for why these values were selected. All but one study that analyzed ankle/subtalar joint frontal plane moments reported an increase in the external eversion moment. The review identified significant variation in the design of wedges used within this body of work and a lack of investigation into the influence of wedge design. Wedge design appears to be a secondary consideration, with very few studies examining multiple material types or wedge placements. All but one of the included studies reported a significant change in ankle/subtalar joint moments with lateral wedging. Unfortunately, further generalization was not possible because of the inconsistency and variation.
Topics: Adult; Humans; Foot Orthoses; Osteoarthritis, Knee; Foot; Ankle Joint; Sports; Knee Joint; Biomechanical Phenomena
PubMed: 37934589
DOI: 10.7547/21-180 -
Gait & Posture Sep 2021The foot and ankle complex undergoes significant structural and functional changes with advancing age. (Meta-Analysis)
Meta-Analysis Review
BACKGROUND
The foot and ankle complex undergoes significant structural and functional changes with advancing age.
RESEARCH QUESTION
The objective of this systematic review and meta-analysis was to synthesize and critique the research literature pertaining to foot and ankle biomechanics while walking in young and older adults.
METHODS
Electronic databases (Web of Science, PubMed, Scopus and Embase) were searched from inception to April 2019 for cross-sectional studies which compared kinematics, kinetics and plantar pressure differences between young and older adults. Screening and data extraction were performed by two independent assessors, with disagreements resolved by consensus.
RESULTS
A total of 39 articles underwent full-text screening, and 19 articles met the inclusion criteria and were included. Meta-analysis showed that older adults had less ankle joint plantar flexion (5 studies; weighted mean difference [WMD]: -5.15; 95 %CI: -6.47 to -3.83; P < 0.001) and less ankle joint power generation (6 studies; standardized mean difference [SMD]: -0.62; 95 %CI: -0.82 to -0.41; P < 0.001) during propulsion compared to young adults. These differences persisted in subgroup analyses comparing different walking speeds. Plantar pressure findings were highly variable due to differences in data collection protocols and meta-analysis was not possible.
SIGNIFICANCE
Older adults have unique foot and ankle kinematics and kinetics during walking characterized by reduced ankle joint plantarflexion and power generation during propulsion.
Topics: Aged; Ankle; Ankle Joint; Biomechanical Phenomena; Cross-Sectional Studies; Humans; Walking; Young Adult
PubMed: 34217001
DOI: 10.1016/j.gaitpost.2021.06.018 -
International Orthopaedics Feb 2021To evaluate the evidence supporting safety and effectiveness of intra-articular injective treatments for ankle lesions ranging from osteochondral lesions of the talus... (Meta-Analysis)
Meta-Analysis Review
PURPOSE
To evaluate the evidence supporting safety and effectiveness of intra-articular injective treatments for ankle lesions ranging from osteochondral lesions of the talus (OLT) to osteoarthritis (OA).
METHODS
A systematic review and a meta-analysis were performed on PubMed, Embase, and Cochrane Library in March 2020. Safety was evaluated through the reported side effects and effectiveness through the scores used. The quality of the studies was assessed using the Cochrane Collaboration Risk of Bias 2.0 tool and the Downs and Black checklist. For each outcome, the quality of evidence was graded according to GRADE guidelines.
RESULTS
Twenty-four studies (21 for OA, 3 for OLT) were included on hyaluronic acid (HA), platelet-rich plasma (PRP), saline, methylprednisolone, botulinum toxin type A (BoNT-A), mesenchymal stem cells (MSCs), and prolotherapy. No severe adverse events were reported. For OLT, a comparison was possible between HA and PRP showing no significant difference. For ankle OA, a significant difference favouring HA versus saline was documented at six months (p < 0.001). The GRADE level of evidence was very low.
CONCLUSION
This meta-analysis supports the safety of intra-articular treatment for ankle OA and OLT, while only a very low evidence supports the efficacy of HA in terms of better results versus placebo for the treatment of ankle OA, and other conclusions are hindered by the scarcity of the available literature. This urges further and stronger trials to specifically investigate potential and limitations of these different injective approaches for the treatment of OLT and ankle OA.
Topics: Ankle; Ankle Joint; Humans; Hyaluronic Acid; Injections, Intra-Articular; Osteoarthritis; Osteoarthritis, Knee; Platelet-Rich Plasma; Treatment Outcome
PubMed: 32647968
DOI: 10.1007/s00264-020-04689-5 -
Foot & Ankle International Nov 2023Foot and ankle soft tissue sarcomas (STSs) are rare neoplasms associated with a high risk of local recurrence and metastasis. Although amputation is often performed, its...
BACKGROUND
Foot and ankle soft tissue sarcomas (STSs) are rare neoplasms associated with a high risk of local recurrence and metastasis. Although amputation is often performed, its impact on prognosis remains unknown. The aims of our systematic review were identifying risk factors for (1) disease-specific death, (2) local recurrence, (3) metastasis, and assessing (4) whether the type of surgery (amputation or limb-salvage) affected disease-specific survival.
METHODS
This systematic review was conducted following PRISMA guidelines. The PubMed, Embase, and Scopus databases were searched. Our study was registered in PROSPERO (ID: 415624). Quality appraisal was done using STROBE guidelines.
RESULTS
A total of 7 studies and 123 patients were included. Metastasis was the only risk factor for disease-specific death (OR = 107.85, < .001). Previous unplanned excision (OR = 22.29, .009) and positive margins (OR = 64.48, .011) were associated with higher risk of local recurrence. Patients with high-grade tumors (OR = 13.22, .023) and tumors ≥6 cm (OR = 7.40, .022) were more likely to develop metastases. After adjusting for confounders (age, sex, and presence of metastasis), amputation was not associated with poorer disease-specific survival.
CONCLUSION
Metastasis was the single most important risk factor for death with foot and ankle soft tissue sarcoma. Positive margins and history of previous unplanned excision are risk factors for local recurrence. The most important risk factors for metastasis are tumor grade and size ≥6 cm. Amputation was not associated with poorer disease-specific survival.
Topics: Humans; Ankle; Prognosis; Sarcoma; Risk Factors; Ankle Joint; Soft Tissue Neoplasms; Retrospective Studies
PubMed: 37750365
DOI: 10.1177/10711007231198516 -
Diagnostics (Basel, Switzerland) Jan 2022(1) Background: Ankle fracture results in pain, swelling, stiffness and strength reduction, leading to an altered biomechanical behavior of the joint during the gait... (Review)
Review
(1) Background: Ankle fracture results in pain, swelling, stiffness and strength reduction, leading to an altered biomechanical behavior of the joint during the gait cycle. Nevertheless, a common pattern of kinematic alterations has still not been defined. To this end, we analyzed the literature on instrumental gait assessment after ankle fracture, and its correlation with evaluator-based and patient-reported outcome measures. (2) Methods: We conducted a systematic search, according to the Preferred Reporting Items for Systematic Reviews and Meta-analyses guidelines, of articles published from January 2000 to June 2021 in PubMed, Embase and PEDro on instrumental gait assessment after ankle fracture. (3) Results: Several changes in gait occur after ankle fracture, including a reduction in step length, swing time, single support time, stride length, cadence, speed and an earlier foot-off time in the affected side. Additionally, trunk movement symmetry (especially vertical) is significantly reduced after ankle fracture. The instrumental assessments correlate with different clinical outcome measures. (4) Conclusions: Instrumental gait assessment can provide an objective characterization of the gait alterations after ankle fracture. Such assessment is important not only in clinical practice to assess patients' performance but also in clinical research as a reference point to evaluate existing or new rehabilitative interventions.
PubMed: 35054366
DOI: 10.3390/diagnostics12010199 -
PM & R : the Journal of Injury,... Jun 2023Patients with chronic ankle instability (CAI) may experience ankle force sense deficits due to mechanoreceptor injury and proprioceptive deafferentation in the affected... (Meta-Analysis)
Meta-Analysis Review
OBJECTIVE
Patients with chronic ankle instability (CAI) may experience ankle force sense deficits due to mechanoreceptor injury and proprioceptive deafferentation in the affected ankles. This study aimed to systematically review the literature and investigate (1) whether patients with CAI have impaired force sense when compared with uninjured contralateral sides or healthy controls, and (2) which characteristics of CAI (e.g., any measurement of CAI symptoms, clinical questionnaires, or functional tests on the injured ankles) are correlated with force sense deficits. TYPE: Systematic review and meta-analysis.
LITERATURE SURVEY
PubMed, Embase, Web of Science, Cochrane Library, Scopus, CINAHL, and SPORTDiscus were searched for ankle-related, injury-related, and force sense-related terms from inception to February 2, 2022.
METHODOLOGY
The following information was extracted from included articles: demographic data, sample size, selection criteria, methodology, force reproduction test outcomes, and correlations between force sense and other characteristics of CAI. Meta-analyses were conducted for the force sense outcomes, and a narrative review was undertaken for the correlation between force sense deficits and other characteristics of CAI.
SYNTHESIS
Eight studies were included. The meta-analyses revealed eversion force sense deficits of the injured ankles in absolute error (magnitude of force reproduction error) at 20% maximal voluntary isometric contractions (MVIC) (standardized mean difference [SMD] = 0.67, 95% confidence interval [CI] 0.23-1.11) and variable error (consistency of force reproduction) at 30% MVIC (SMD = 0.46, 95% CI 0.07-0.85), as compared with healthy controls. None of the included studies reported a significant correlation between these two deficits and other characteristics of CAI.
CONCLUSIONS
Patients with CAI have eversion force sense deficits in the magnitude of force reproduction error at 20% MVIC and the consistency of force reproduction at 30% MVIC.
Topics: Humans; Ankle; Ankle Joint; Proprioception; Isometric Contraction; Joint Instability; Ankle Injuries; Chronic Disease
PubMed: 35532066
DOI: 10.1002/pmrj.12833 -
European Journal of Trauma and... Aug 2017The main purpose of this systematic review was to investigate the effect of compression treatment on the perioperative course of ankle fractures and describe its effect... (Review)
Review
PURPOSE
The main purpose of this systematic review was to investigate the effect of compression treatment on the perioperative course of ankle fractures and describe its effect on edema, pain, ankle joint mobility, wound healing complication, length of stay (LOS) and time to surgery (TTS). The aim was to suggest a recommendation to clinicians considering implementing compression therapy in the standard care of the ankle fracture patient, based on the existing literature.
METHODS
We conducted a systematic search of literature including studies concerning adult patients with unstable ankle fractures undergoing surgery, testing either intermittent pneumatic compression, compression bandage and/or compression stocking and reporting its effect on edema, pain, ankle joint mobility, wound healing complication, LOS and TTS. To conclude on data a narrative synthesis was performed.
RESULTS
The review included eight studies (451 patients). Seven studies found a significant effect on edema, two studies described a significant reduction in pain, one a positive effect on ankle movement, two a positive effect on wound healing, one a reduction in LOS and finally two studies reported reduction in TTS. A systematic bias assessment showed that the included studies had methodological limitations influencing the confidence in the effect estimate.
CONCLUSIONS
Compression therapy has a beneficial effect on edema reduction and probably a positive effect on pain and ankle joint mobility, but with the methodological limitations in the included studies it is not possible to make a solid conclusion on the effect on wound healing, LOS and TTS.
Topics: Ankle Fractures; Compression Bandages; Edema; Humans; Intermittent Pneumatic Compression Devices; Length of Stay; Pain Measurement; Postoperative Complications; Wound Healing
PubMed: 28624992
DOI: 10.1007/s00068-017-0801-y -
Healthcare (Basel, Switzerland) Sep 2023Chronic ankle instability (CAI) is a prevalent condition characterized by recurring instances of the ankle giving way and persistent symptoms, including pain and... (Review)
Review
Chronic ankle instability (CAI) is a prevalent condition characterized by recurring instances of the ankle giving way and persistent symptoms, including pain and diminished function. Foot and ankle external supports are commonly used in clinical practice and research for treating CAI. This systematic review aimed to assess the effects of foot and ankle external supports on the postural stability of individuals with CAI to guide clinical practice and inform future research. A comprehensive search was conducted in PubMed, Web of Science, Scopus, and Google Scholar databases from 1 January 2012 to 1 November 2022. Eighteen studies involving individuals with CAI were chosen in this systematic review. The quality of the included studies and risk of bias were assessed using Cochrane Collaboration's tool for randomized controlled trials, the Newcastle-Ottawa Scale for case-control studies, and the DELPHl-list for crossover trial studies. The external supports included in this review were ankle orthoses (elastic, semi-rigid, and active orthoses), taping (kinesiotaping and fibular reposition taping), and insoles (textured and supportive insoles). The outcome measures included static and dynamic postural stability tests, such as the single-leg stance test, star excursion balance test, Y-balance test, single-leg landing test, lateral jump test, walking test, and running test. The results showed that elastic orthoses, Kinesiotaping, and textured insoles demonstrated potential benefits in improving postural stability in individuals with CAI. Elastic orthoses decreased ankle joint motion variability, kinesiotaping facilitated cutaneous receptors and proprioceptive feedback, while textured insoles increased tactile stimulation and foot position awareness. However, the effects of semi-rigid orthoses, fibular reposition taping, and arch support insoles were inconsistent across studies. Future research should explore the long-term effects of these external supports, analyze the effects of different characteristics and combinations of supports, and employ standardized outcome measures and testing protocols for assessing postural stability.
PubMed: 37761767
DOI: 10.3390/healthcare11182570