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International Orthopaedics Sep 2021Our aim is to retrospectively review and evaluate the patterns of affection of Charcot arthropathy of foot and ankle.
PURPOSE
Our aim is to retrospectively review and evaluate the patterns of affection of Charcot arthropathy of foot and ankle.
METHODS
Two hundred twenty-eight patients (235 feet) with post-acute Charcot were reviewed and classified anatomically through plain radiographs into type I and type II based on single or multiple regions affected, respectively. Type I included ankle, Lisfranc (tarsometatarsal), naviculocuneiform, forefoot, and hindfoot which includes one of the following: talonavicular joint, calcaneocuboid joint, or calcaneus. Type II included peritalar, perinavicular, mid-tarsal Charcot, or any other combination. Both types were further classified into four stages (A, stable with no deformity; B, stable with deformity; C, unstable; and D, deformity/instability with associated mechanical ulcers).
RESULTS
The most common type was type IIC (27.2%) followed by type IID (18.3%), while types IA and IIA represented the least common types (3.4% and 3.8%, respectively). Types IA and IIA were managed conservatively. All patients in types IC, ID, IIB, IIC, and IID and the majority of type IB received fusion surgery to achieve stability and correction of deformity. Type II D had the highest complication rate (30%). Five patients ended up with amputation, and all were stage IID.
CONCLUSION
Affection of single region has better prognosis than affection of two or more regions. Stage A has the best prognosis and can be managed conservatively provided good diabetes control. Surgery is indicated in all cases of types IC, ID, IIB, IIC, and IID to achieve stability and correction of deformity and prevent complications. Mechanical ulcer (stage D) carries the worst prognosis and highest complication rate.
Topics: Ankle; Ankle Joint; Arthropathy, Neurogenic; Humans; Retrospective Studies; Tarsal Joints
PubMed: 34050383
DOI: 10.1007/s00264-021-05082-6 -
Clinics in Orthopedic Surgery Sep 2020The supramalleolar osteotomy is a joint-preserving surgical procedure. It is a very good treatment option for the asymmetric varus ankle and medial compartment... (Review)
Review
The supramalleolar osteotomy is a joint-preserving surgical procedure. It is a very good treatment option for the asymmetric varus ankle and medial compartment osteoarthritis. The primary objective of the procedure is to shift medial concentration of stress toward the lateral intact articular cartilage to redistribute the joint loads during ambulation. Several studies have shown that deformities of the ankle result in uneven load distribution in the ankle joint, which eventually leads to articular cartilage degeneration. Since the lateral articular cartilage is intact, joint-sacrificing procedures such as total ankle replacement or ankle arthrodesis are not the most appropriate treatment choices for medial compartment arthritis. Results of supramalleolar osteotomies are very promising in terms of functional outcome and pain relief. In younger patients with medial compartment varus ankle osteoarthritis or even with a normal tibial anterior surface angle, supramalleolar osteotomies can be performed to realign the ankle to promote regeneration of the asymmetrically damaged cartilage. In this review article, we will discuss the indications, complications, surgical techniques, and outcomes of the supramalleolar osteotomy reported in the current literature.
Topics: Ankle Joint; Humans; Osteoarthritis; Osteotomy
PubMed: 32904071
DOI: 10.4055/cios20038 -
Seminars in Musculoskeletal Radiology Dec 2022Injuries of the ankle ligaments complexes are very common, and ∼ 20 to 40% of patients can develop chronic ankle instability (CAI). Current concepts in CAI allow a... (Review)
Review
Injuries of the ankle ligaments complexes are very common, and ∼ 20 to 40% of patients can develop chronic ankle instability (CAI). Current concepts in CAI allow a better understanding of the ankle biomechanics needed to repair it. The surgical treatment of CAI has evolved in the last decade, and ankle arthroscopy has become an essential tool in the treatment of instability with promising results. We review the different surgical techniques to treat CAI, both those frequently used and the new approaches, as well as the normal postsurgical appearance of ankle ligaments repair and the most common complications.
Topics: Humans; Ankle; Chronic Disease; Ankle Joint; Ligaments, Articular; Joint Instability; Ankle Injuries
PubMed: 36791734
DOI: 10.1055/s-0042-1760245 -
IEEE Transactions on Bio-medical... Dec 2022Regulating the impedance of our joints is essential for the effective control of posture and movement. The impedance of a joint is governed mainly by the mechanical...
OBJECTIVE
Regulating the impedance of our joints is essential for the effective control of posture and movement. The impedance of a joint is governed mainly by the mechanical properties of the muscle-tendon units spanning it. Many studies have quantified the net impedance of joints but not the specific contributions from the muscles and tendons. The inability to quantify both muscle and tendon impedance limits the ability to determine the causes underlying altered movement control associated with aging, neuromuscular injury, and other conditions that have different effects on muscle and tendon properties. Therefore, we developed a technique to quantify joint, muscle, and tendon impedance simultaneously and evaluated this technique at the human ankle.
METHODS
We used a single degree of freedom actuator to deliver pseudorandom rotations to the ankle while measuring the corresponding torques. We simultaneously measured the displacement of the medial gastrocnemius muscle-tendon junction with B-mode ultrasound. From these experimental measurements, we were able to estimate ankle, muscle, and tendon impedance using non-parametric system identification.
RESULTS
We validated our estimates by comparing them to previously reported measurements of muscle and tendon stiffness, the position-dependent component of impedance, to demonstrate that our technique generates reliable estimates of these properties.
CONCLUSION
Our approach can be used to clarify the respective contributions from the muscle and tendon to the net mechanics of a joint.
SIGNIFICANCE
This is a critical step forward in the ultimate goal of understanding how muscles and tendons govern ankle impedance during posture and movement.
Topics: Humans; Ankle; Electric Impedance; Ankle Joint; Tendons; Muscle, Skeletal; Biomechanical Phenomena
PubMed: 35594215
DOI: 10.1109/TBME.2022.3175646 -
Zeitschrift Fur Orthopadie Und... Jun 2021Arthrodesis of the upper ankle and subtalar joint are still frequently used and at the moment the gold standard in the therapy of severe arthritis and deformity of the...
Arthrodesis of the upper ankle and subtalar joint are still frequently used and at the moment the gold standard in the therapy of severe arthritis and deformity of the ankle joint and hindfoot. The spectrum of indications is wide, beginning from posttraumatic or degenerative changes to postinfectious, rheumatoid and diabetic causes of arthritis and as a salvage procedure after failed ankle arthroplasty. The types of arthrodesis have to be differentiated from each other: tibiotalar, subtalar and tibiotalcalcaneal fusion. Soft tissue conditions have to be taken into account; these and individual factors like comorbidities and osseous conditions require an individual planning of the approaches and types of fixation.
Topics: Ankle; Ankle Joint; Arthritis; Arthrodesis; Humans; Subtalar Joint
PubMed: 33003234
DOI: 10.1055/a-0968-9672 -
Radiologic Clinics of North America Mar 2023The anatomy of the ankle and foot is complex, allowing for a wide range of functionality. The movements of the joints represent a complex dynamic interaction. A solid... (Review)
Review
The anatomy of the ankle and foot is complex, allowing for a wide range of functionality. The movements of the joints represent a complex dynamic interaction. A solid understanding of the characteristics and actions of the anatomic elements helps explain the mechanisms and patterns of injury. This article reviews the anatomy, with special focus on concepts that are the object of recent study and the features that favor the development of symptoms. Good understanding of the surgical procedures helps in providing information to guarantee a favorable outcome. We review the commonly expected postsurgical appearances and the most common postsurgical complications.
Topics: Humans; Ankle; Ankle Joint; Magnetic Resonance Imaging
PubMed: 36739146
DOI: 10.1016/j.rcl.2022.10.013 -
Medicine Aug 2022The involvement of ankles in systemic lupus erythematosus (SLE) has not been widely studied. The aim of our prospective study was to determine the characteristics of the...
The involvement of ankles in systemic lupus erythematosus (SLE) has not been widely studied. The aim of our prospective study was to determine the characteristics of the ankle joint and tendon involvement in SLE using ultrasound (US) as an imaging modality. Sixty consecutive patients with SLE underwent a detailed clinical evaluation and US examination. Gray-scale and power Doppler US of the bilateral tibiotalar (TT) joints, subtalar (ST) joints, and ankle tendons were performed using a multiplanar scanning technique. Joint effusion, synovitis, tenosynovitis, enthesitis, and vascularization were assessed according to the OMERACT recommendations. The Total Ankle Ultrasound Score (TAUSS) was calculated as the sum of the grades of joint effusion and synovial hypertrophy for both TT and ST joints bilaterally (ranging from 0-24) and power Doppler activity was assessed separately. Finally, US findings were correlated with physical evaluation, laboratory parameters, and SLE activity scores. US ankle joint involvement was present in 32/60 (53.3%) patients. TT joints were affected in 26 (43.3%) and ST joints in 16 (26.7%) patients. Thirteen (21.7%) patients had US tendons and/or enthesal involvement. TT joint effusion was the most frequent finding, present in 55/240 (22.9%) examined joints, followed by synovial hypertrophy detected in 18/240 (7.5%) joints. The median (interquartile range; range) TAUSS of the US-affected joints was 1 (0-2; range 1-10). There were no significant correlations between US findings and inflammatory parameters or serological parameters of disease activity, but we found a weak positive correlation between TAUSS and the European Consensus Lupus Activity Measurement (r = 0.281, P = .029). This study revealed a high prevalence of pathological US ankle changes in patients with SLE and a positive correlation between ankle US involvement and disease activity score (European Consensus Lupus Activity Measurement).
Topics: Ankle; Ankle Joint; Cross-Sectional Studies; Humans; Lupus Erythematosus, Systemic; Prospective Studies; Synovitis; Ultrasonography, Doppler
PubMed: 35945784
DOI: 10.1097/MD.0000000000029196 -
Foot and Ankle Surgery : Official... Oct 2019Thorough understanding of the morphometry of the ankle joint is crucial to optimize conservative and operative therapy of ankle joint disorders. Despite recent...
BACKGROUND
Thorough understanding of the morphometry of the ankle joint is crucial to optimize conservative and operative therapy of ankle joint disorders. Despite recent improvements, basic anatomic and biomechanical correlations of the ankle joint including the orientation of the ankle joint axis and joint morphology as its key biomechanical features are not sufficiently recorded to date. The aim of this study was the evaluation of the ankle morphometry to gain information about the ankle joint axis.
MATERIAL AND METHODS
In this study 98 high-resolution CT-scans of complete Caucasian cadaver legs were analysed. Using the software Mimics and 3-Matic (Materialize) 22 anatomic parameters of the talocrural joint were assessed, including the length, width and surface area of the tibial and talar articular areas. Additionally, the radii of the articular areas, the medial distal tibial angle and the height of the talar dome were determined.
RESULTS
The radius of the central trochlea tali was 44.6±4.1mm (mean±SD). The central trochlea tali arc length was 40.8±3.0mm and its width was 27.4±2.5mm. Additionally we determined 47.0±4.4mm for the tibial sagittal radius, 27.6±3.0mm for the tibial arc length and 27.4±2.5mm for the central tibial width.
CONCLUSION
The present study describes the three-dimensional morphometry of Caucasian ankle joints in detail. This dimensional analysis of the ankle joint will inform the development and placements of implants and prostheses.
Topics: Adult; Aged; Aged, 80 and over; Ankle Joint; Cadaver; Female; Humans; Image Processing, Computer-Assisted; Male; Middle Aged; Talus; Tibia; Tomography, X-Ray Computed; White People
PubMed: 30306892
DOI: 10.1016/j.fas.2018.08.002 -
Foot & Ankle International Sep 2023Hindfoot varus deformity is a known risk factor for chronic lateral ankle instability (CLAI). The impact of this deformity on clinical results following arthroscopic...
BACKGROUND
Hindfoot varus deformity is a known risk factor for chronic lateral ankle instability (CLAI). The impact of this deformity on clinical results following arthroscopic lateral ankle ligament repair (ALLR) for CLAI has not been studied.
METHODS
Sixty-three ankles from 62 patients who received ALLR for CLAI were retrospectively examined. Preoperative plain radiographs were used to measure tibial articular surface (TAS) angles, and long axial hindfoot alignment radiographs were used to measure tibiocalcaneal angles (TCAs) pre- and postoperatively. Results included ratings on the Self-Administered Foot Evaluation Questionnaire (SAFE-Q) and recurrent ankle instability (respraining of the operated ankle following surgery).
RESULTS
Recurrent ankle instability, defined as incidence of any new ankle sprain after surgery reported in the follow-up period, occurred in 13 ankles. The TAS angles of these patients were significantly low, and their preoperative TCA was significantly high. Multivariate analysis showed that preoperative TCA was an independent risk factor for recurrent ankle instability. The threshold values for preoperative TCA for recurrent instability were determined via the receiver operating characteristic curve analysis to be 3.4 degrees. Patients were assigned to a low- or high-TCA group based on the reported average TCA (2.7 degrees) of healthy patients. In the high-TCA group, recurrent instability was significantly more frequent, and the scores on the pain subscale of the postoperative SAFE-Q were significantly lower.
CONCLUSION
Hindfoot varus alignment was associated with pooreroutcomes after ALLR.
LEVEL OF EVIDENCE
Level III, retrospective comparative study.
Topics: Humans; Ankle; Retrospective Studies; Lateral Ligament, Ankle; Ankle Joint; Foot; Joint Instability; Arthroscopy
PubMed: 37391997
DOI: 10.1177/10711007231181123 -
Clinics in Podiatric Medicine and... Oct 2022Hindfoot and ankle Charcot neuroarthropathy is a challenging condition to treat, specifically with segmental bone defects secondary to avascular necrosis or infection.... (Review)
Review
Hindfoot and ankle Charcot neuroarthropathy is a challenging condition to treat, specifically with segmental bone defects secondary to avascular necrosis or infection. Several techniques exist alongside continued challenges of nonunion and complication rates. The authors assert that combining distal tibial distraction osteogenesis with external fixation in tibiocalcaneal or tibiotalocalcaneal arthrodesis should be considered an effective method for management of complex Charcot neuroarthropathy conditions of the ankle. This staged procedure technique resulted in a high rate of union in patients who are often considered a high risk for nonunion, as well as eradication of infection, minimal soft tissue disruption, and improvement in limb length.
Topics: Ankle Joint; Arthrodesis; Bone Nails; Foot; Humans; Retrospective Studies; Tibia
PubMed: 36180195
DOI: 10.1016/j.cpm.2022.05.011