Injuries to the ankle and foot
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BACKGROUND: The aim of this study was to investigate the result of the specific conservative treatment of acute lateral ankle ligaments rupture and verify the effect of this therapy by stabilometry. METHODS: 17 young athletes were examined after acute lateral ankle sprain (grade III). Diagnosis was based on musculoskeletal ultrasound examinations. Pressure plate evaluated postural stability after conservative treatment at regular intervals during 1year. RESULTS: There were no significant differences in postural stability in double-leg stance between limbs. In single-leg stance, COP confidence ellipse (p=0,011) and COP excursion in sagittal plane (p=0,000) were significantly higher for the injured leg when compared with the uninjured leg only one week after removing the cast. CONCLUSIONS: After conservative treatment of grade III injuries with STABHA, immobilization with full weight bearing on the injured leg for 6 weeks and rehabilitation, stabilometry results showed that none of the patients had impaired postural stability or were at risk of functional ankle instability in the monitored period.
- Klíčová slova
- Acute lateral ankle ligaments rupture, Cast, STABHA, Stabilometry,
- MeSH
- akutní nemoc MeSH
- dospělí MeSH
- hojení ran MeSH
- imobilizace MeSH
- konzervativní terapie metody MeSH
- kyselina hyaluronová aplikace a dávkování MeSH
- lidé MeSH
- ligamentum laterale articulationis talocruralis zranění MeSH
- mladiství MeSH
- mladý dospělý MeSH
- nestabilita kloubu diagnóza prevence a kontrola rehabilitace terapie MeSH
- poranění kotníku diagnóza diagnostické zobrazování rehabilitace terapie MeSH
- ruptura MeSH
- sádrové obvazy MeSH
- sportovní úrazy diagnóza diagnostické zobrazování rehabilitace terapie MeSH
- ultrasonografie MeSH
- viskosuplementy aplikace a dávkování MeSH
- zatížení muskuloskeletálního systému MeSH
- Check Tag
- dospělí MeSH
- lidé MeSH
- mladiství MeSH
- mladý dospělý MeSH
- mužské pohlaví MeSH
- ženské pohlaví MeSH
- Publikační typ
- časopisecké články MeSH
- Názvy látek
- kyselina hyaluronová MeSH
- viskosuplementy MeSH
BACKGROUND: Foot morphology is associated with altered loading of the ankle-foot complex in adolescent footballers, predisposing to pain and injury. However, usual singular plane clinical assessments do not accurately capture the 3D nature of foot morphology. A new approach is 3D laser scanning, with statistical shape model techniques creating individual-to-group comparison. However, no research exists on the adolescent, football-playing foot. Furthermore, a link between 3D foot morphology, and usual clinical and performance measures would be beneficial for practical implementation. METHODS: Four hundred forty-seven 3D foot scans from 224 elite male footballers (U12-U19) in bilateral stance were collected and further processed with statistical shape model techniques. Weighted shape parameters for individual principal components (Modes) were extracted for each foot. Centre of pressure displacement expressed as total travelled way in millimetres was calculated for bilateral and unilateral postural stability measures. Clinical assessments (Clarke's Angle, Resting Calcaneal Stance Position) were calculated on the 3D foot scans. Differences in weighted shape parameters, postural stability measures, and clinical assessments between age groups were determined by ANOVA. Correlations determined the relationship of Modes and clinical assessments to postural stability measures. Linear regression established if clinical assessments predicted the mode describing foot arch variation. RESULTS: Age groups significantly differed for Mode 1 (foot length), Mode 2 (foot arch), and Mode 5 (tibial rotation relative to the foot) (p < 0.05). Resting Calcaneal Stance Position (r = .663) and Clarke's Angle (r = -.445) were low-to-moderately correlated to Mode 2 (both p < 0.001), and linear regression found they were both significant predictors of Mode 2, though only moderately (R2 = .522). There were low correlations of foot morphology to the postural stability tests. CONCLUSION: This is the first study to describe the 3D foot morphology of male football-playing adolescents, and discover the differences between age groups. This will improve understanding and assessment of foot morphology in male adolescents because 2D techniques, as discovered in this study, do not strongly correlate to, nor predict, the 3D foot arch. Foot morphology was only lowly correlated to postural stability, thus a multifaceted program would be required for improvements.
- Klíčová slova
- Adolescents, Foot morphology, Football, Postural stability, Principal component analysis, Three-dimensional shape,
- MeSH
- dolní končetina * MeSH
- hlezenní kloub MeSH
- lidé MeSH
- lineární modely MeSH
- mladiství MeSH
- patní kost * MeSH
- tibie MeSH
- Check Tag
- lidé MeSH
- mladiství MeSH
- mužské pohlaví MeSH
- Publikační typ
- časopisecké články MeSH
This guide to ultrasound imaging of the ankle and foot describes the basic scanning planes and contains corresponding high-resolution ultrasound images. The patient and probe positionings are explained in a simplified step-by-step manner using schematic drawings. This standard and simple examination technique seems to be an appropriate way to improve the learning curve of novice musculoskeletal sonographers. In this manuscript, an emphasis is placed on joint effusion detection, plantar fasciitis, Achilles tendinopathy, and ligamentous injuries around the ankle. Key words: tendons, ankle joint, tendinopathy, Achilles tendon, fasciitis, plantar, anterior talofibular ligament, musculoskeletal, protocol, ultrasound.
- Klíčová slova
- FOOT/fractures *,
- MeSH
- fraktury kostí * MeSH
- lidé MeSH
- noha (od hlezna dolů) * MeSH
- patní kost * MeSH
- poranění kotníku * MeSH
- talus * MeSH
- Check Tag
- lidé MeSH
- Publikační typ
- časopisecké články MeSH
BACKGROUND: Biological maturity (BM) and foot morphology (FM) can independently alter neuromuscular loading on the ankle-foot complex, potentially causing stability deficits and injury predisposition. However, the influence of BM on FM, and how much both explain neuromuscular performance in postural stability (PS) tests, has been understudied. This study aimed to investigate the effect of BM on FM, and then discover to what extent both factors explain the variance in PS performance in adolescent footballers. METHODS: Over one season, 399 three-dimensional foot scans were gathered from 72 footballers (U12-U15). PS was measured by center of pressure (COP) displacement in bilateral and unilateral stance. The Khamis and Roche equation determined maturity status (MS), while formulae from Mirwald and Khamis and Roche estimated timing of biological maturation (TBM). Principal component analysis determined nine principal components that explained the most variance in FM. An ANCOVA determined the effect of TBM on FM principal components, with covariates of age, height, weight, playing position, and foot preference. Step-wise linear regression determined the explanation of COP displacement by the above-mentioned predictors. RESULTS: There was significantly increased foot pronation during and after peak height velocity/puberty. MS and four foot principal components (foot arch and width, great toe width and length) were significant predictors in all PS tests (R2: 0.105-0.180). CONCLUSIONS: TBM had a significant effect on FM presentation, and should be a part of adolescent foot assessment. While they only explained a small amount of variance, determining MS and FM may identify those requiring additional PS attention.
- MeSH
- dolní končetina * MeSH
- hlezenní kloub MeSH
- kotník MeSH
- lidé MeSH
- mladiství MeSH
- posturální rovnováha * MeSH
- Check Tag
- lidé MeSH
- mladiství MeSH
- mužské pohlaví MeSH
- Publikační typ
- časopisecké články MeSH
The authors describe an atypical case of the so called Bosworth fracture of ankle. A woman, 26 years suffered a fracture of fibula in the proximal third of the shaft, the distal fibular fragment was displaced from the fibular insicure of distal tibia posteromedially where it remained locked behind posterior tibial tubercle, and a fracture of medial malleolus and fracture of the posterolateral fragment of distal tibia. Thus it was a fracture-dislocation of ankle of Weber C type. The primary examination showed an evident external rotation deformity of the foot with regard to tibia. Conservative reduction was performed with a subsequent surgical revision, fixation of medial malleolus, suture of anterior tibiofibular ligament and stabilization of the reduced fibula in the fibular insicure of distal tibia by a suprasyndesmal screw. At present, four years after the surgery the patient is fully satisfied. Objectively there occurred only a limitation of dorsiflexion in ankle by 10 degrees as compared to the contralateral joint. Radiograph shows healing of the fracture in the anatomical position, without sings of post-traumatic osteoarthritis. Analysis of literature has showed that only approximately 40 cases with various sub-types of this fracture have been so far described. Typical of all fractures is a marked external rotation of the foot with regard to tibia, radiograph shows posterior subluxation of talus with regard to distal tibia and posteromedial dislocation of distal fibula from the fibula insicure of distal tibia and its locking behind its posterior tubercle. Apart from the above mentioned, associated with the injury is always a rupture of anterior tibiofibular ligament and partial rupture or distension of posterior tibiofibular ligament. In a typical Bosworth fracture it is associated with fracture of lateral malleolus of Weber B fracture. Very frequent is also a minor avulsion of the posterolateral fragment of distal tibia. In atypical cases fibula breaks in its proximal third (this Weber C type of fracture is described only by Hamilton) or there is no fracture of fibula. In children or young adults fibula does not break, it only dislocates and in adolescents there may simultaneously occur epiphysiolysis of distal tibia. On the medial side there usually occurs a fracture of medial malleolus or rupture of deltoid ligament or there is no lesion on the medial side. Conservative reduction is successful only exceptionally, i.e. only in case of intact fibula or its high fracture (Weber C), the method of choice is open reduction and internal fixation.
- MeSH
- dospělí MeSH
- fibula zranění chirurgie MeSH
- fraktury kostí * komplikace diagnóza chirurgie MeSH
- lidé MeSH
- poranění kotníku * diagnóza chirurgie MeSH
- Check Tag
- dospělí MeSH
- lidé MeSH
- ženské pohlaví MeSH
- Publikační typ
- anglický abstrakt MeSH
- časopisecké články MeSH
- kazuistiky MeSH
INTRODUCTION: The aim of this study was to analyze the pathoanatomy of the posterior fragment on the basis of a comprehensive CT examination, including 3D reconstructions, in a large patient cohort. MATERIALS AND METHODS: One hundred and forty one consecutive individuals with an ankle fracture or fracture-dislocation of types Weber B or Weber C and evidence of a posterior tibial fragment in standard radiographs were included in the study. The mean patient age was 49 years (range 19-83 years). The exclusion criteria were patients below 18 years of age, inability to provide written consent, fractures of the tibial pilon, posttraumatic arthritis and pre-existing deformities. In all patients, post-injury radiographs were obtained in anteroposterior, mortise and lateral views. All patients underwent CT scanning in transverse, sagittal and frontal planes. 3D CT reconstruction was performed in 91 patients. RESULTS: We were able to classify 137 cases into one of the following four types with constant pathoanatomic features: type 1: extraincisural fragment with an intact fibular notch, type 2: posterolateral fragment extending into the fibular notch, type 3: posteromedial two-part fragment involving the medial malleolus, type 4: large posterolateral triangular fragment. In the 4 cases it was not possible to classify the type of the posterior tibial fragment. These were collectively termed type 5 (irregular, osteoporotic fragments). CONCLUSION: It is impossible to assess the shape and size of the posterior malleolar fragment, involvement of the fibular notch, or the medial malleolus, on the basis of plain radiographs. The system that we propose for classification of fractures of the posterior malleolus is based on CT examination and takes into account the size, shape and location of the fragment, stability of the tibio-talar joint and the integrity of the fibular notch. It may be a useful indication for surgery and defining the most useful approach to these injuries.
- MeSH
- dospělí MeSH
- fraktury kotníku klasifikace diagnostické zobrazování MeSH
- fraktury tibie klasifikace diagnostické zobrazování MeSH
- lidé středního věku MeSH
- lidé MeSH
- mladý dospělý MeSH
- počítačová rentgenová tomografie metody MeSH
- senioři nad 80 let MeSH
- senioři MeSH
- tarzální kosti anatomie a histologie MeSH
- tibie anatomie a histologie MeSH
- zobrazování trojrozměrné * MeSH
- Check Tag
- dospělí MeSH
- lidé středního věku MeSH
- lidé MeSH
- mladý dospělý MeSH
- mužské pohlaví MeSH
- senioři nad 80 let MeSH
- senioři MeSH
- ženské pohlaví MeSH
- Publikační typ
- časopisecké články MeSH
To eliminate drawbacks of the standard clinical examination technique of the ligamentous lesions of the ankle the author has developed his own method. The position of the patient is prone with bent knee. In evaluating the drawer sign manoeuvres rendering both, the full anterior shift of the foot and palpation of the talus, are used. During x-ray examination the same principles should be observed.
Avascular necrosis (AVN) of the talus in a posttraumatic setting describes a condition of temporary or permanent bone death of a different extent, initiated by a circulatory disturbance. It is estimated that about 75% of all talar AVNs are caused by a prior trauma. The incidence of posttraumatic AVN rises with higher energy of injury, severity of talar body or neck displacement, fracture comminution, and injury to the soft tissues and major vessels in the lower leg and ankle region. These conditions are often seen in open fractures, fracture dislocations, and pure dislocations.
- Klíčová slova
- Fracture, Fusion, Malunion, Necrosis, Nonunion, Replacement, Talus, Vascularized bone graft,
- MeSH
- lidé MeSH
- osteonekróza * prevence a kontrola etiologie terapie diagnóza MeSH
- poranění kotníku * komplikace MeSH
- talus * zranění chirurgie patologie MeSH
- Check Tag
- lidé MeSH
- Publikační typ
- časopisecké články MeSH
- přehledy MeSH
BACKGROUND: The foot is often affected in patients with rheumatoid arthritis. Subtalar joints are involved more frequently than ankle joints. Deformities of subtalar joints often lead to painful flatfoot and valgus deformity of the heel. Major contributors to the early development of foot deformities include talonavicular joint destruction and tibialis posterior tendon dysfunction, mainly due to its rupture. METHODS: Between 2002 and 2005 we performed isolated talonavicular arthrodesis in 26 patients; twenty women and six men. Tibialis posterior tendon dysfunction was diagnosed preoperatively by physical examination and by MRI. Talonavicular fusion was achieved via screws in eight patients, memory staples in twelve patients and a combination of screws and memory staples in six cases. The average duration of immobilization after the surgery was four weeks, followed by rehabilitation. Full weight bearing was allowed two to three months after surgery. RESULTS: The mean age of the group at the time of the surgery was 43.6 years. MRI examination revealed a torn tendon in nine cases with no significant destruction of the talonavicular joint seen on X-rays. Mean of postoperative followup was 4.5 years (3 to 7 years). The mean of AOFAS Hindfoot score improved from 48.2 preoperatively to 88.6 points at the last postoperative followup. Eighteen patients had excellent results (none, mild occasional pain), six patients had moderate pain of the foot and two patients had severe pain in evaluation with the score. Complications included superficial wound infections in two patients and a nonunion developed in one case. CONCLUSIONS: Early isolated talonavicular arthrodesis provides excellent pain relief and prevents further progression of the foot deformities in patients with rheumatoid arthritis and tibialis posterior tendon dysfunction.
- MeSH
- artrodéza metody MeSH
- disekce MeSH
- dislokace kloubu patologie patofyziologie chirurgie MeSH
- dospělí MeSH
- dysfunkce zadní holenní šlachy patologie patofyziologie chirurgie MeSH
- kostní šrouby MeSH
- lidé středního věku MeSH
- lidé MeSH
- mrtvola MeSH
- ortopedické výkony metody MeSH
- plochá noha patologie patofyziologie chirurgie MeSH
- poranění šlachy patologie patofyziologie chirurgie MeSH
- radiografie MeSH
- revmatoidní artritida patologie patofyziologie chirurgie MeSH
- ruptura patologie patofyziologie chirurgie MeSH
- subtalární kloub diagnostické zobrazování patologie chirurgie MeSH
- sutura MeSH
- výsledek terapie MeSH
- Check Tag
- dospělí MeSH
- lidé středního věku MeSH
- lidé MeSH
- mužské pohlaví MeSH
- ženské pohlaví MeSH
- Publikační typ
- časopisecké články MeSH
