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Medicina (Kaunas, Lithuania) Mar 2022: Ambulant children with cerebral palsy can demonstrate persistent "foot drop" after successful gastrocsoleus lengthening (GSL) surgery for equinus deformity. This may... (Review)
Review
: Ambulant children with cerebral palsy can demonstrate persistent "foot drop" after successful gastrocsoleus lengthening (GSL) surgery for equinus deformity. This may be due to inadequate strength and/or selective motor control of the ankle dorsiflexor muscles. A procedure has been developed to reduce foot drop-Tibialis Anterior Tendon Shortening (TATS), to be performed in conjunction with GSL. However, it is currently unclear how ankle dorsiflexor function changes after surgery and which children could benefit from TATS. This review summarises changes in ankle dorsiflexor function after GSL for equinus, as reported in the literature. : A search was performed of the Medline, Embase and PubMed databases from 1980 to 5 March 2021. Keywords included "cerebral palsy", "equinus deformity", "orthopedic procedures" and "gait analysis". The search identified 1974 studies. Thirty-three cohort studies met the inclusion criteria for this review. : Twenty-two studies reported improvement in swing phase ankle dorsiflexion kinematics, after GSL. There was also evidence that clinical measures of ankle dorsiflexor strength improved after surgery. Four studies reported changes in selective motor control, with mixed results across the studies. : There is good evidence that swing phase ankle dorsiflexion improves after GSL surgery. Although, there is limited evidence that this correlates with reduced foot drop or diminished need for an ankle-foot orthosis. Future research should be prospective, randomised, include a large sample size, and should focus on identifying the optimal candidates for TATS.
Topics: Ankle; Ankle Joint; Cerebral Palsy; Child; Gait; Humans; Prospective Studies
PubMed: 35334551
DOI: 10.3390/medicina58030375 -
Annals of the Royal College of Surgeons... Apr 2011Arthroscopy of the ankle has gained acceptance as a procedure for diagnosing and treating chronic and post-traumatic ankle problems. The senior author's perception is... (Comparative Study)
Comparative Study
INTRODUCTION
Arthroscopy of the ankle has gained acceptance as a procedure for diagnosing and treating chronic and post-traumatic ankle problems. The senior author's perception is that magnetic resonance imaging (MRI) under-diagnoses anterior soft tissue impingement lesions in children. The purpose of this study was retrospectively to analyse the outcome of ankle arthroscopy in the paediatric age group.
PATIENTS AND METHODS
Between March 2005 and September 2007, 23 children underwent ankle arthroscopy for post-traumatic pathology. The indications for arthroscopy were failure of non-operative treatment for at least 12 weeks or a grade 3 or 4 osteochondral defect (OCD) on imaging.
RESULTS
At arthroscopy, OCDs were visualised in 12 cases and impingement lesions were seen in 17 ankles. MRI was performed in 8 of these 12 cases and only 1 suggested the possibility of an impingement lesion. Of the 17 cases of impingement seen on arthroscopy, 12 reported mechanical symptoms preoperatively and 4 were unstable on examination under anaesthetic. Eighteen of the twenty-three patients had complete relief of symptoms at 3 months. Eighteen children who were evaluated at one-year follow up had a mean American Orthopaedic Foot and Ankle Society score of 87. 5 (range: 49-100).
CONCLUSIONS
Ankle arthroscopy has a successful outcome in paediatric patients and the results are comparable with those reported in adult series. MRI was found to be insensitive for the diagnosis of soft tissue impingement of the ankle.
Topics: Adolescent; Ankle Injuries; Ankle Joint; Arthroscopy; Child; Debridement; Epidemiologic Methods; Female; Humans; Magnetic Resonance Imaging; Male; Radiography
PubMed: 21477438
DOI: 10.1308/003588411X564005 -
Osteoarthritis and Cartilage Apr 2001Reliable evaluation of joint space width and subchondral sclerosis of osteoarthritic joints is difficult. The present study describes a new digital method to analyse...
OBJECTIVE
Reliable evaluation of joint space width and subchondral sclerosis of osteoarthritic joints is difficult. The present study describes a new digital method to analyse standard radiographs of the ankle.
DESIGN
Standardized radiographs were taken of the ankle of 12 patients with severe osteoarthritis (OA) under full weight-bearing conditions, before treatment and 1 year after initiation of treatment. Treatment consisted of 3 months distraction of the tibio-talar joint, for which clinical benefit has been shown previously. The width of the joint space was measured on digitized images of the radiographs by means of the newly developed semi-automatic digital technique called AIDA (Ankle Images Digital Analysis) and by means of the most widely used conventional analogue measurements. In addition, AIDA was used to assess subchondral sclerosis by measuring the intensity of the radiograph at fixed positions at the bone-cartilage interface.
RESULTS
AIDA appeared to be a reliable method for measuring small changes in joint space width and subchondral sclerosis because the intra- and interobserver variation was small. Mean JSW for two observers was 1.96 and 2.00 mm, with mean differences between two observations of 0.05 and -0.01, respectively. Mean subchondral sclerosis in the tibia was 1.52 and 1.61 with mean differences between two observations of, respectively, 0.00 and 0.03. In addition to conventional measurements, AIDA could demonstrate a decrease in subchondral sclerosis as a result of joint distraction of 71% and 69% after 1 year for talus and tibia, respectively.
CONCLUSION
The use of AIDA is preferable to the conventional analogue method for evaluating the severity of ankle OA, because the method provides quantitative data not only for the joint space width but also for subchondral sclerosis.
Topics: Ankle Joint; Humans; Image Processing, Computer-Assisted; Osteoarthritis; Radiographic Image Enhancement; Reference Standards; Reproducibility of Results; Sclerosis
PubMed: 11300750
DOI: 10.1053/joca.2000.0384 -
PloS One 2023The effects of foot deformities and corrections on the ankle joint without osteoarthritis has received little attention. This study aimed to investigate the effect of...
OBJECTIVES
The effects of foot deformities and corrections on the ankle joint without osteoarthritis has received little attention. This study aimed to investigate the effect of flatfoot correction on the ankle joint of patients without osteoarthritis.
METHODS
Thirty-five patients (24 men and 11 women; mean age 17.5 years) who underwent lateral column lengthening for flatfoot deformities were included. The mean postoperative follow-up period was 20.5 months (standard deviation [SD]: 15.7 months). Radiographic indices were measured pre- and postoperatively, including anteroposterior (AP) and lateral talo-first metatarsal angles, naviculocuboid overlap, position of the articulating talar surface, and lateral talar center migration. Postoperative changes in the radiographic indices were statistically analyzed.
RESULTS
There was significant postoperative improvement in flatfoot deformity in terms of AP and lateral talo-first metatarsal angles (p<0.001 and p<0.001, respectively) and naviculocuboid overlap (p<0.001). On lateral radiographs, the talar articulating surface dorsiflexed by 7.3% (p<0.001), and the center of the talar body shifted anteriorly by 0.85 mm (p<0.001) postoperatively.
CONCLUSIONS
Flatfoot correction using lateral column and Achilles tendon lengthening caused dorsiflexion and an anterior shift of the articular talar body in patients without osteoarthritis. Correction of flatfoot deformity might affect the articular contact area at the ankle joint. The biomechanical effects of this change need to be investigated further.
Topics: Male; Humans; Female; Adolescent; Flatfoot; Ankle Joint; Retrospective Studies; Tendon Transfer; Osteoarthritis
PubMed: 37917738
DOI: 10.1371/journal.pone.0286013 -
Orthopaedic Surgery Dec 2021To investigate the efficacy of modified percutaneous Achilles tendon lengthening for severe ankle joint deformity.
OBJECTIVE
To investigate the efficacy of modified percutaneous Achilles tendon lengthening for severe ankle joint deformity.
METHODS
This retrospective case series study included 33 patients with an average age of 25.2 years who underwent surgery in our hospital from April 1, 2010 to March 1, 2018. Triple hemisection percutaneous Achilles tendon lengthening was performed. One stage surgery, other soft tissue surgery or bone correction surgery could be performed. After surgery, a plaster cast was used to fix the functional position, and rehabilitation training was carried out as planned. Complications during the perioperative period were recorded. Statistical analysis of the patients' visual analogue scale (VAS) and American Orthopedic Foot and Ankle Society (AOFAS) score before and at the last follow-up was performed. The recurrence rate of Achilles tendon contracture at the last follow-up and the patients' satisfaction rate were investigated.
RESULTS
All patients were followed up, with an average follow-up period of 56.31 months (8-104 months). All achieved good ankle joint function and appearance improvement And there were no infection or skin necrosis complications. In two cases, the incision was poorly healed at non-Achilles tendon site and was cured by change of dressing. The average VAS score at the last follow-up was reduced from (2 ± 1.48) points before surgery to (0.26 ± 0.51) points (P = 0.001), and the average AOFAS score was increased from (64.97 ± 13.56) points before surgery to (90.06 ± 10.06) points (P = 0.001). During the follow-up period, there was no chronic rupture of Achilles tendon. There were two cases of recurrence of foot drop (5.7%), and the patients' satisfaction rate was 93.9%.
CONCLUSION
In the surgical treatment of severe ankle joint deformity, the application of triple hemisection percutaneous Achilles tendon lengthening for Achilles tendon contracture has the advantages of less trauma, beautiful incision, and reliable efficacy. The satisfaction rate of patients with this treatment is high, and it is worth promoting in the clinic.
Topics: Achilles Tendon; Adolescent; Adult; Ankle Joint; Casts, Surgical; Female; Humans; Male; Pain Measurement; Plastic Surgery Procedures; Retrospective Studies; Surveys and Questionnaires; Tenotomy; Young Adult
PubMed: 34806335
DOI: 10.1111/os.13096 -
International Biomechanics Dec 2020Lower extremity multi-joint strength curves tend not to evaluate individual joint contributions to endpoint force in maximum effort isometric whole limb extension....
Lower extremity multi-joint strength curves tend not to evaluate individual joint contributions to endpoint force in maximum effort isometric whole limb extension. Therefore, the purpose of this study was to measure the contribution of the hip, knee, and ankle to vertical ground reaction force in maximum effort isometric whole limb extension at various postures. An effect of posture on the contributions of the hip, knee, and ankle to vertical ground reaction force was found ( = 85.31, < 0.0001; = 21.32, < 0.0001; = 130.61, < 0.0001 for the hip, knee, and ankle, respectively). The hip and knee contributed most to vertical endpoint force when the lower limb was in a flexed posture, and their contributions decreased when posture was extended. Conversely, the ankle contributed least when the limb was flexed, but its contribution increased as posture was changed from flexed to more extended. In comparison to recent research involving induced acceleration analysis, it appears that the hip, knee, and ankle utilize the same force allocation strategy in multi-joint maximum effort isometric leg extensions and activities of daily living.
Topics: Activities of Daily Living; Adult; Ankle Joint; Biomechanical Phenomena; Female; Hip Joint; Humans; Knee Joint; Leg; Male; Muscle Stretching Exercises; Posture; Range of Motion, Articular
PubMed: 33998385
DOI: 10.1080/23335432.2019.1695540 -
Journal of Orthopaedic Science :... Jul 2015This study aimed to evaluate the clinical outcome of simultaneous less-invasive ankle arthroscopy and hindfoot endoscopy for combined anterior ankle impingement syndrome...
INTRODUCTION
This study aimed to evaluate the clinical outcome of simultaneous less-invasive ankle arthroscopy and hindfoot endoscopy for combined anterior ankle impingement syndrome (AAIS) and posterior ankle impingement syndrome (PAIS) in professional athletes.
MATERIALS AND METHODS
Between October 2009 and October 2011, 12 feet of 9 professional athletes (8 men, 1 woman; mean age 25 years; range 19-34 years) with combined AAIS and PAIS underwent simultaneous ankle arthroscopy and hindfoot endoscopy. Radiography, computed tomography, and magnetic resonance imaging were performed in all patients. Ultrasound-guided anesthetic injection was administered for the diagnosis of PAIS. Active plantar and dorsal flexion angles of the ankle before and after surgery, occurrence of complications, and time to return to competitive sports were evaluated.
RESULTS
All feet had osteophytes in the anterior ankle joint. Ostrigonum and a large posterior talar process were found in 8 and 4 feet, respectively. Combined disorders that were noted were lateral ankle instability in 6 feet and an osteochondral lesion of the talus in 4 feet. Median JSSF and VAS scores improved significantly from 63 (range 55-69) points preoperatively to 82 (range 77-100) points postoperatively (p < 0.01), and from 85 (range 70-95) points preoperatively to 8 (range 3-15) points postoperatively (p < 0.01), respectively. Median active plantar and dorsal flexion angles improved significantly from 40° (range, 30°-50°) and 10° (range 5°-20°) preoperatively to 50° (range 40°-55°) and 15° (range 10°-20°) postoperatively, respectively (p < 0.01 and p < 0.05, respectively). One patient complained of numbness in the vicinity of the sural nerve, which resolved spontaneously by the 4th week after surgery. Median time to return to competitive sports was 12 (range 12-15) weeks.
CONCLUSION
Simultaneous ankle arthroscopy and hindfoot endoscopy for combined AAIS and PAIS enables professional athletes to return to athletic activity.
Topics: Adult; Ankle Injuries; Ankle Joint; Arthroscopy; Athletes; Female; Follow-Up Studies; Humans; Joint Instability; Magnetic Resonance Imaging; Male; Range of Motion, Articular; Recovery of Function; Syndrome; Tomography, X-Ray Computed; Treatment Outcome; Young Adult
PubMed: 25797332
DOI: 10.1007/s00776-015-0712-x -
Canadian Association of Radiologists... Aug 2018The distal insertions of the tendons crossing the ankle as well as the tendons originating in the foot are less well known by radiologists. We review the anatomy and... (Review)
Review
The distal insertions of the tendons crossing the ankle as well as the tendons originating in the foot are less well known by radiologists. We review the anatomy and ultrasound appearance of these insertions using our own cadaveric sectioning and dissection. The ultrasound images were correlated with anatomical slices. Occasionally magnetic resonance images were also used for better understanding. Understanding the normal appearance of these tendon insertions is important for diagnosing pathology in this region.
Topics: Ankle; Ankle Joint; Foot; Humans; Tendons; Ultrasonography
PubMed: 29773337
DOI: 10.1016/j.carj.2017.11.005 -
BMC Musculoskeletal Disorders Sep 2017Malalignment of the ankle joint has been found after trauma, by neurological disorders, genetic predisposition and other unidentified factors, and results in...
BACKGROUND
Malalignment of the ankle joint has been found after trauma, by neurological disorders, genetic predisposition and other unidentified factors, and results in asymmetrical joint loading. For a medial open wedge supramalleolar osteotomy(SMO), there are some debates as to whether concurrent fibular osteotomy should be performed. We assessed the changes in motion of ankle joint and plantar pressure after supramalleolar osteotomy without fibular osteotomy.
METHODS
Ten lower leg specimens below the knee were prepared from fresh-frozen human cadavers. They were harvested from five males (10 ankles)whose average age was 70 years. We assessed the motion of ankle joint as well as plantar pressure for SS(supra-syndesmotic) SMO and IS(intra-syndesmotic) SMO. After the osteotomy, each specimen was subjected to axial compression from 20 N preload to 350 N representing half-body weight. For the measurement of the motion of ankle joint, the changes in gap and point, angles in ankle joint were measured. The plantar pressure were also recorded using TekScan sensors.
RESULTS
The changes in the various gap, point, and angles movements on SS-SMO and IS-SMO showed no statistically significant differences between the two groups. Regarding the shift of plantar center of force (COF) were noted in the anterolateral direction, but not statistically significant.
CONCLUSIONS
SS-SMO and IS-SMO with intact fibula showed similar biomechanical effect on the ankle joint. We propose that IS-SMO should be considered carefully for the treatment of osteoarthrosis when fibular osteotomy is not performed because lateral cortex fracture was less likely using the intrasyndesmosis plane because of soft tissue support.
Topics: Aged; Ankle Joint; Biomechanical Phenomena; Cadaver; Humans; Imaging, Three-Dimensional; Male; Models, Biological; Osteotomy; Range of Motion, Articular
PubMed: 28888229
DOI: 10.1186/s12891-017-1749-0 -
Annals of Biomedical Engineering Feb 2019In this combined in vivo and computational modeling study, we tested the central hypothesis that ankle joint rotation and triceps surae muscle loading have independent... (Clinical Trial)
Clinical Trial
In this combined in vivo and computational modeling study, we tested the central hypothesis that ankle joint rotation and triceps surae muscle loading have independent and combinatory effects on the calcaneal (i.e., Achilles) tendon moment arm (CTma) that are not fully captured in contemporary musculoskeletal models of human movement. We used motion capture guided ultrasound imaging to estimate instantaneous variations in the CTma during a series of isometric and isotonic contractions compared to predictions from scaled, lower extremity computational models. As hypothesized, we found that muscle loading: (i) independently increased the CTma by up to 8% and (ii) attenuated the effects of ankle joint rotation, the latter likely through changes in tendon slack and tendon curvature. Neglecting the effects of triceps surae muscle loading in lower extremity models led to an underestimation of the CTma, on average, particularly in plantarflexion when those effects were most prominent. We also found little agreement between in vivo estimates and model predictions on an individual subject by subject basis, alluding to unaccounted for variation in anatomical morphology and thus fundamental limitations in model scaling. Together, these findings contribute to improving our understanding of the physiology of ankle moment and power generation and novel opportunities for model development.
Topics: Achilles Tendon; Adult; Ankle Joint; Diagnostic Imaging; Female; Humans; Isometric Contraction; Isotonic Contraction; Male; Models, Biological; Movement; Muscle, Skeletal; Rotation; Weight-Bearing
PubMed: 30386951
DOI: 10.1007/s10439-018-02162-4