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Abstract
Ligament injuries of the ankle are common and troublesome. Management may seem easy, but residual symptoms ae common. Grade III injuries still generate controversy in terms of the best management available, and more studies are needed when it comes to early mobilization, cast immobilization, or surgery. Even the three Cohrane reviews published to date are not conclusive.
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Beynnon BD, Renström PA, Haugh L, Uh BS, Barker H. A prospective, randomized clinical investigation of the treatment of first-time ankle sprains. Am J Sports Med 2006; 34:1401-12. [PMID: 16801691 DOI: 10.1177/0363546506288676] [Citation(s) in RCA: 107] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
BACKGROUND Acute ankle ligament sprains are treated with the use of controlled mobilization with protection provided by external support (eg, functional treatment); however, there is little information regarding the best type of external support to use. HYPOTHESIS There is no difference between elastic wrapping, bracing, bracing combined with elastic wrapping, and casting for treatment of acute, first-time ankle ligament sprains in terms of the time a patient requires to return to normal function. STUDY DESIGN Randomized controlled clinical trial; Level of evidence, 1. METHODS Patients suffering their first ligament injury were stratified by the severity of the sprain (grades I, II, or III) and then randomized to undergo functional treatment with different types of external supports. The patients completed daily logs until they returned to normal function and were followed up at 6 months. RESULTS Treatment of grade I sprains with the Air-Stirrup brace combined with an elastic wrap returned subjects to normal walking and stair climbing in half the time required for those treated with the Air-Stirrup brace alone and in half the time required for those treated with an elastic wrap alone. Treatment of grade II sprains with the Air-Stirrup brace combined with the elastic wrap allowed patients to return to normal walking and stair climbing in the shortest time interval. Treatment of grade III sprains with the Air-Stirrup brace or a walking cast for 10 days followed by bracing returned subjects to normal walking and stair climbing in the same time intervals. The 6-month follow-up of each sprain severity group revealed no difference between the treatments for frequency of reinjury, ankle motion, and function. CONCLUSION Treatment of first-time grade I and II ankle ligament sprains with the Air-Stirrup brace combined with an elastic wrap provides earlier return to preinjury function compared to use of the Air-Stirrup brace alone, an elastic wrap alone, or a walking cast for 10 days.
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Stevens JE, Pathare NC, Tillman SM, Scarborough MT, Gibbs CP, Shah P, Jayaraman A, Walter GA, Vandenborne K. Relative contributions of muscle activation and muscle size to plantarflexor torque during rehabilitation after immobilization. J Orthop Res 2006; 24:1729-36. [PMID: 16779833 DOI: 10.1002/jor.20153] [Citation(s) in RCA: 68] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
Muscle atrophy is clearly related to a loss of muscle torque, but the reduction in muscle size cannot entirely account for the decrease in muscle torque. Reduced neural input to muscle has been proposed to account for much of the remaining torque deficits after disuse or immobilization. The purpose of this investigation was to assess the relative contributions of voluntary muscle activation failure and muscle atrophy to loss of plantarflexor muscle torque after immobilization. Nine subjects (ages 19-23) years with unilateral ankle malleolar fractures were treated by open reduction-internal fixation and 7 weeks of cast immobilization. Subjects participated in 10 weeks of rehabilitation that focused on both strength and endurance of the plantarflexors. Magnetic resonance imaging, isometric plantarflexor muscle torque and activation (interpolated twitch technique) measurements were performed at 0, 5, and 10 weeks of rehabilitation. Following immobilization, voluntary muscle activation (56.8 +/- 16.3%), maximal cross-sectional area (CSA) (35.3 +/- 7.6 cm(2)), and peak torque (26.2 +/- 12.7 N-m) were all significantly decreased ( p < 0.0056) compared to the uninvolved limb (98.0 +/- 2.3%, 48.0 +/- 6.8 cm(2), and 105.2 +/- 27.0 N-m, respectively). During 10 weeks of rehabilitation, muscle activation alone accounted for 56.1% of the variance in torque ( p < 0.01) and muscle CSA alone accounted for 35.5% of the variance in torque ( p < 0.01). Together, CSA and muscle activation accounted for 61.5% of the variance in torque ( p < 0.01). The greatest gains in muscle activation were made during the first 5 weeks of rehabilitation. Both increases in voluntary muscle activation and muscle hypertrophy contributed to the recovery in muscle strength following immobilization, with large gains in activation during the first 5 weeks of rehabilitation. In contrast, muscle CSA showed fairly comparable gains throughout both the early and later phase of rehabilitation.
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79
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Kumar P, Bajracharya S, Pandey S. Medial peritalar dislocation in a volleyball player. JNMA J Nepal Med Assoc 2006; 45:314-5. [PMID: 17334422] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/14/2023] Open
Abstract
We report a medial peritalar dislocation, which was treated with closed reduction and cast for 3 weeks. At follow up 12 months later, there was normal range of motion and mild pain after prolonged walking.
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Vicenzino B, Branjerdporn M, Teys P, Jordan K. Initial changes in posterior talar glide and dorsiflexion of the ankle after mobilization with movement in individuals with recurrent ankle sprain. J Orthop Sports Phys Ther 2006; 36:464-71. [PMID: 16881463 DOI: 10.2519/jospt.2006.2265] [Citation(s) in RCA: 181] [Impact Index Per Article: 10.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
STUDY DESIGN A double-blind randomized crossover experimental study with repeated measures, including a no-treatment control condition. OBJECTIVE To evaluate the initial effect of 2 mobilization with movement (MWM) treatment techniques performed in weight bearing and non-weight bearing on posterior talar glide and talocrural dorsiflexion in individuals with recurrent lateral ankle sprain. BACKGROUND MWM treatment techniques are commonly used in the treatment of musculoskeletal pain, such as lateral ankle sprain. Recent evidence indicates that a lack of posterior talar glide and weight-bearing ankle dorsiflexion are common physical impairments in individuals with recurrent ankle sprains. MWM of the ankle joint involves the application of a combined posterior talar glide mobilization and active dorsiflexion movement. The recurrent ankle sprain injury and the MWM treatment techniques for the ankle seemingly provide an appropriate model to further evaluate the effects and mechanism(s) of action of the MWM treatment techniques in a way that they have not been tested to date. METHODS Sixteen subjects (mean +/- SD age, 19.8 +/- 2.3 years) with a history of recurrent lateral ankle sprain and deficits in posterior talar glide (71%) and weight-bearing dorsiflexion (34%) were studied. A within-subjects study design was used to evaluate the effect of 2 independent variables: treatment conditions (weight-bearing MWM, non-weight-bearing MWM, and a no-treatment control group) and time (pretreatment and posttreatment) on the dependent variables of posterior talar glide and weight-bearing dorsiflexion. RESULTS Both the weight-bearing and non-weight-bearing MWM treatment techniques significantly improved posterior talar glide by 55% and 50% of the preapplication deficit between affected and unaffected sides, respectively, which was significantly greater than that of the control group (P<.001). The weight-bearing and non-weight-bearing MWM treatment techniques improved weight-bearing dorsiflexion by 26% (P<.017), compared to 9% for the control condition. The change in posterior talar glide, expressed as a proportion of pretreatment deficit, was correlated to the change in weight-bearing dorsiflexion (r = .88, P<.001), but only after the weight-bearing MWM technique. CONCLUSION This preliminary study demonstrated an initial ameliorative effect of MWM treatment techniques on posterior talar glide and dorsiflexion range of motion in individuals with recurrent lateral ankle sprain. These results suggest that this technique should be considered in rehabilitation programs following lateral ankle sprain. This study provides justification for follow-up research of the long-term effects of MWM on lateral ankle sprain and proposes further work be conducted on the posterior talar glide test.
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81
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Lin CF, Gross ML, Weinhold P. Ankle syndesmosis injuries: anatomy, biomechanics, mechanism of injury, and clinical guidelines for diagnosis and intervention. J Orthop Sports Phys Ther 2006; 36:372-84. [PMID: 16776487 DOI: 10.2519/jospt.2006.2195] [Citation(s) in RCA: 119] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
Syndesmosis injuries are rare, but very debilitating and frequently misdiagnosed. The purpose of this clinical commentary is to review the mechanisms of syndesmotic injuries, clinical examination methods, diagnosis, and management of the injuries. Cadaveric studies of the syndesmosis and deltoid ligaments are also reviewed for further understanding of stress transmission and the roles of different structures in stabilizing the distal syndesmosis. External rotation and excessive dorsiflexion of the foot on the leg have been reported as the most common mechanisms of injury. The injury is most often incurred by individuals who participate in skiing, football, soccer, and other sport activities played on turf. The external rotation and squeeze tests are reliable tests to detect this injury. The ability of imaging studies to assist in an accurate diagnosis may depend on the severity of the injury. The results of cadaveric studies indicate the importance of the deltoid ligament in maintaining stability of the distal tibiofibular syndesmosis and the congruency of the ankle mortise. Intervention programs with early rigid immobilization and pain relief strategies, followed by strengthening and balance training are recommended. Heel lift and posterior splint intervention can be used to avoid separation of the distal syndesmosis induced by excessive dorsiflexion of the ankle joint. Application of a rigid external device should be used with caution to prevent medial-lateral compression of the leg superior to the ankle mortise, thereby inducing separation of the distal syndesmosis articulation. Surgical intervention is an option when a complete tear of the syndesmotic ligaments is present or when fractures are observed.
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van der Wees PJ, Lenssen AF, Hendriks EJM, Stomp DJ, Dekker J, de Bie RA. Effectiveness of exercise therapy and manual mobilisation in ankle sprain and functional instability: a systematic review. ACTA ACUST UNITED AC 2006; 52:27-37. [PMID: 16515420 DOI: 10.1016/s0004-9514(06)70059-9] [Citation(s) in RCA: 89] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
This study critically reviews the effectiveness of exercise therapy and manual mobilisation in acute ankle sprains and functional instability by conducting a systematic review of randomised controlled trials. Trials were searched electronically and manually from 1966 to March 2005. Randomised controlled trials that evaluated exercise therapy or manual mobilisation of the ankle joint with at least one clinically relevant outcome measure were included. Internal validity of the studies was independently assessed by two reviewers. When applicable, relative risk (RR) or standardised mean differences (SMD) were calculated for individual and pooled data. In total 17 studies were included. In thirteen studies the intervention included exercise therapy and in four studies the effects of manual mobilisation of the ankle joint was evaluated. Average internal validity score of the studies was 3.1 (range 1 to 7) on a 10-point scale. Exercise therapy was effective in reducing the risk of recurrent sprains after acute ankle sprain: RR 0.37 (95% CI 0.18 to 0.74), and with functional instability: RR 0.38 (95% CI 0.23 to 0.62). No effects of exercise therapy were found on postural sway in patients with functional instability: SMD: 0.38 (95% CI -0.15 to 0.91). Four studies demonstrated an initial positive effect of different modes of manual mobilisation on dorsiflexion range of motion. It is likely that exercise therapy, including the use of a wobble board, is effective in the prevention of recurrent ankle sprains. Manual mobilisation has an (initial) effect on dorsiflexion range of motion, but the clinical relevance of these findings for physiotherapy practice may be limited.
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Nilsson G, Ageberg E, Ekdahl C, Eneroth M. Balance in single-limb stance after surgically treated ankle fractures: a 14-month follow-up. BMC Musculoskelet Disord 2006; 7:35. [PMID: 16597332 PMCID: PMC1450283 DOI: 10.1186/1471-2474-7-35] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/15/2005] [Accepted: 04/05/2006] [Indexed: 12/26/2022] Open
Abstract
Background The maintenance of postural control is fundamental for different types of physical activity. This can be measured by having subjects stand on one leg on a force plate. Many studies assessing standing balance have previously been carried out in patients with ankle ligament injuries but not in patients with ankle fractures. The aim of this study was to evaluate whether patients operated on because of an ankle fracture had impaired postural control compared to an uninjured age- and gender-matched control group. Methods Fifty-four individuals (patients) operated on because of an ankle fracture were examined 14 months postoperatively. Muscle strength, ankle mobility, and single-limb stance on a force-platform were measured. Average speed of centre of pressure movements and number of movements exceeding 10 mm from the mean value of centre of pressure were registered in the frontal and sagittal planes on a force-platform. Fifty-four age- and gender-matched uninjured individuals (controls) were examined in the single-limb stance test only. The paired Student t-test was used for comparisons between patients' injured and uninjured legs and between side-matched legs within the controls. The independent Student t-test was used for comparisons between patients and controls. The Chi-square test, and when applicable, Fisher's exact test were used for comparisons between groups. Multiple logistic regression was performed to identify factors associated with belonging to the group unable to complete the single-limb stance test on the force-platform. Results Fourteen of the 54 patients (26%) did not manage to complete the single-limb stance test on the force-platform, whereas all controls managed this (p < 0.001). Age over 45 years was the only factor significantly associated with not managing the test. When not adjusted for age, decreased strength in the ankle plantar flexors and dorsiflexors was significantly associated with not managing the test. In the 40 patients who managed to complete the single-limb stance test no differences were found between the results of patients' injured leg and the side-matched leg of the controls regarding average speed and the number of centre of pressure movements. Conclusion One in four patients operated on because of an ankle fracture had impaired postural control compared to an age- and gender-matched control group. Age over 45 years and decreased strength in the ankle plantar flexors and dorsiflexors were found to be associated with decreased balance performance. Further, longitudinal studies are required to evaluate whether muscle and balance training in the rehabilitation phase may improve postural control.
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Abstract
PURPOSE The purpose of this study was to evaluate a combined anterior and posterior arthroscopic approach in the treatment of frozen ankle. TYPE OF STUDY Retrospective case series. METHODS Five patients with post-traumatic frozen ankle were evaluated. RESULTS After an average follow-up of 32.6 months (range, 24 to 42 months), the average American Orthopaedic Foot and Ankle Society hindfoot-ankle score was improved from 63.8 point (range, 55-74) to 88.6 point (range, 81-100). The average ankle dorsiflexion improved from 1 degrees (range, 0 degrees to 5 degrees) to 19 degrees (range, 15 degrees to 25 degrees). The average ankle plantarflexion improved from 16 degrees (range 10 degrees to 20 degrees) to 39 degrees (range, 30 degrees to 45 degrees). CONCLUSIONS Combined posterior ankle endoscopy and anterior ankle arthroscopy is effective in the treatment of post-traumatic frozen ankle. LEVEL OF EVIDENCE Level 4.
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Simanski CJP, Maegele MG, Lefering R, Lehnen DM, Kawel N, Riess P, Yücel N, Tiling T, Bouillon B. Functional treatment and early weightbearing after an ankle fracture: a prospective study. J Orthop Trauma 2006; 20:108-14. [PMID: 16462563 DOI: 10.1097/01.bot.0000197701.96954.8c] [Citation(s) in RCA: 77] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
OBJECTIVE Postoperative care for ankle fractures is generally 1 of 2 regimens: 1) functional treatment combined with early weightbearing (EWB), or 2) immobilization in a cast/orthosis for 6 weeks without weightbearing (6WC). The objective of this study was 2-fold: 1) to follow a prospective group treated with EWB as to long-term subjective and objective outcomes, and 2) to compare a subset of this group with a matched group of historic controls treated with 6WC. DESIGN Prospective, clinical, cohort observation, and retrospective matched pair analysis. SETTING University hospital, level 1 trauma center. PATIENTS Forty-three patients (20 males; mean age, 49 +/- 14 years) with operated Weber B/C fractures underwent EWB. For comparison, 23 patients of this group were matched to a same number of historic controls with respect to age, gender, body mass index, and fracture type. INTERVENTION Open reduction and internal fixation (ORIF) using a 1/3-tubular-fibula-plate for the fibula, and malleolar screws for the medial malleolus fracture (in cases with a bimalleolar ankle fracture) followed by EWB or 6WC. MAIN OUTCOME MEASUREMENTS Olerud and Tegner scores at follow-up (at least 12 months after surgery), time to full weightbearing, return to work, pain intensity (numerical rating scale (NRS)), and hospital stay. Statistical comparisons were performed by using the Mann-Whitney U test or Fisher exact test (P < 0.05). RESULTS Patients with EWB were full weightbearing at 7 +/- 3 weeks and returned to work at 8 +/- 5 weeks after surgery. At follow-up (mean, 20 +/- 11 months after surgery), all EWB patients showed good results in the Olerud score (90 +/- 13 points). Matched-pair analysis in 23 patients in each group revealed differences between EWB and 6WC groups for hospital stay (mean, 10.8 +/- 4.7 vs. 13.6 +/- 6 days; P = 0.12), time to full weightbearing (mean, 7.7 +/- 3.1 vs. 13.5 +/- 9.4 weeks; P = 0.01), and time until return to work (mean 9.2 +/- 5.5 vs. 10.8 +/- 7 weeks; P = 0.63). No differences concerning pain intensities were observed (EWB vs. 6WC: NRS = 1.9 vs. 1.7; P = 0.12). At follow-up, Olerud scores were generally considered good for both groups; however, mean values in EWB patients were slightly higher (87 +/- 14 vs. 79 +/- 19 points; P = 0.25). In both groups, the majority of patients reached their preinjury level of activity as demonstrated by Tegner scores. CONCLUSIONS EWB patients tolerated earlier full weightbearing compared with 6WC patients, and there were no disadvantages with EWB compared with 6WC concerning hospital stay, pain intensities, time until return to work, and Olerud/Tegner Scores. Potential candidates for EWB are patients with a stable osteosynthesis of their fractured ankles as judged by the responsible surgeon, compliance, and high motivation.
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Leemrijse CJ, Plas GM, Hofhuis H, van den Ende CHM. Compliance with the guidelines for acute ankle sprain for physiotherapists is moderate in the Netherlands: an observational study. ACTA ACUST UNITED AC 2006; 52:293-9. [PMID: 17132125 DOI: 10.1016/s0004-9514(06)70010-1] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
QUESTION What is the compliance with guidelines for acute ankle sprain for physiotherapists? DESIGN Survey of random sample of physiotherapists. PARTICIPANTS 400 physiotherapists working in extramural health care in the Netherlands. OUTCOME MEASURES Questions covered attitude towards guidelines in general, familiarity with the guidelines for acute ankle sprain,compliance with the guidelines, advantages and disadvantages of the guidelines, and factors relating to compliance with the guidelines. RESULTS The majority of the physiotherapists were familiar with the content of the guidelines to some degree and 66%applied it to more than half of their patients with acute ankle sprain. The recommendations to determine both the prognosis and the necessity of treatment by using the function score were the least followed. Some physiotherapists thought the function score was not completely clear, which may have been a barrier for implementation. Factors relating positively to compliance were a positive attitude towards guidelines in general, and having colleagues who implemented the guidelines for acute ankle sprain. CONCLUSION Although compliance with the guidelines for acute ankle sprain was fair/moderate, compliance may be enhanced by improving clarity of the function score, including it in the short version and improving the attitude of physiotherapists towards guidelines in general.
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Wikstrom EA, Tillman MD, Chmielewski TL, Borsa PA. Measurement and Evaluation of Dynamic Joint Stability of the Knee and Ankle After Injury. Sports Med 2006; 36:393-410. [PMID: 16646628 DOI: 10.2165/00007256-200636050-00003] [Citation(s) in RCA: 67] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
Injuries to the lower extremity, specifically the knee and ankle joints of the human body can occur in any athletic event and are most prevalent in sports requiring cutting and jumping manoeuvres. These joints are forced to rely on the dynamic restraints to maintain joint stability, due to the lack of bony congruence and the inability of the static restraints to handle the forces generated during functional tasks. Numerous variables (proprioception, postural control, electromyography, kinetics/kinematics, dynamic stability protocols) have been measured to better understand how the body maintains joint stability during a wide range of activities from static standing to dynamic cutting or landing from a jump. While the importance of dynamic restraints is not questioned, a recent impetus to conduct more functional or sport-specific testing has emerged and placed a great deal of emphasis on dynamic joint stability and how it is affected by lower extremity injuries. Evidence suggests that surgery and aggressive rehabilitation will not necessarily restore the deficits in dynamic joint stability caused by injury to the anterior cruciate ligament or lateral ankle ligaments. In today's athletic society, there is a major push to return athletes to play as quickly as possible. However, the ramifications of those decisions have not been fully grasped. If an athlete is not fully recovered, a quick return to play could start a vicious cycle of chronic injuries or permanent disability.
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88
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[Fractures of the ankle]. DUODECIM; LAAKETIETEELLINEN AIKAKAUSKIRJA 2006; 122:285-6. [PMID: 16619885] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/08/2023]
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Chaiwanichsiri D, Lorprayoon E, Noomanoch L. Star excursion balance training: effects on ankle functional stability after ankle sprain. JOURNAL OF THE MEDICAL ASSOCIATION OF THAILAND = CHOTMAIHET THANGPHAET 2005; 88 Suppl 4:S90-4. [PMID: 16623010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/08/2023]
Abstract
OBJECTIVES To study the effects of Star Excursion Balance training on functional stability of athletes with ankle sprain. MATERIAL AND METHOD Thirty-two male athletes with grade 2 ankle sprain, aged 15-22 years old were enrolled. They were random sampling into training group (n=15) and control group (n=17). All received conventional physical therapy program for 4 weeks. The training group also underwent the Star Excursion Balance training 3 days per week for 4 weeks. Single leg stance time (SLST) was assessed at pre- and post-training. Re-injuries were recorded during 3 months follow-up. RESULTS After the program, subjects from both groups demonstrated significant improvement in SLST The training group gained SLST of the injured sides 2 times more than the control group (p = 0.002 tested with eyes closed, p = 0. 007 tested with eyes open), and also improved the SLST during eyes closed of the normal sides (p = 0.015). Re-injuries were found in 1/15 of the training group and 2/17 of the control group. CONCLUSION Star Excursion Balance training is more effective than the conventional therapy program in improving functional stability of the sprained ankle.
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Lemon M, Somayaji HS, Khaleel A, Elliott DS. Fragility fractures of the ankle: stabilisation with an expandable calcaneotalotibial nail. ACTA ACUST UNITED AC 2005; 87:809-13. [PMID: 15911664 DOI: 10.1302/0301-620x.87b6.16146] [Citation(s) in RCA: 60] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Fragility fractures of the ankle occur mainly in elderly osteoporotic women. They are inherently unstable and difficult to manage. There is a high incidence of complications with both non-operative and operative treatment. We treated 12 such fractures by closed reduction and stabilisation using a retrograde calcaneotalotibial expandable nail. The mean age of patients was 84 years (75 to 95). All were women and were able to walk fully weight-bearing after surgery. There were no wound complications. One patient died from a myocardial infarction 24 days after surgery. The 11 other patients were followed up for a mean of 67 weeks (39 to 104). All the fractures maintained satisfactory alignment and healed without delay. Six patients refused removal of the nail after union of the fracture. The functional rating using the scale of Olerud and Molander gave a mean score at follow-up of 61, compared with a pre-injury value of 70.
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Abstract
OBJECTIVES (1) To describe the incidence of inclusion of early mobilization components in emergency department (ED) discharge instructions; (2) to describe the prescribed follow-up appointments; and (3) to analyze the differences between the treatment of pediatric and adult patients. METHODS A 1-year retrospective chart review of ED records of a large urban hospital was performed. Medical records of 374 (95%) of the 397 adult and pediatric patients with ICD-9 code for ankle sprains were reviewed (213 males and 171 females, mean age 28.4 +/- 14.5; 291 adults, 93 pediatric). RESULTS Sixteen percent of records contained discharge instructions that included rest, ice, compression, elevation, and medications (RICEM). Twenty percent included RICE. Pediatricians (33.7%) were more likely than adult physicians (10.3%) to have given RICEM (P < 0.0001) and RICE (P = 0.05, pedi = 45.8%, adult = 13.1%). Follow-up referrals were recommended as needed 50% of the time. Follow-up referrals were made to community clinics (59%), orthopedic clinic (23%), the ED (14%), and others (4%). Pediatricians were more likely to recommend routine scheduled follow up (pedi = 62%, adult = 47%, P = 0.018), suggest follow-up in a community clinic or doctors office (pedi = 68.6%, adult = 51.2%, P < 0.0001), and to recommend earlier follow up (pedi = 1.6 weeks +/- 1.1, adult = 2.0 weeks +/- 1.1, P = 0.002) than adult physicians. CONCLUSIONS Programs that train physicians who work in the ED need to include education on the proper treatment, rehabilitation, and follow up of patients with acute ankle sprains. Providing easy-to-complete discharge instruction templates can help providers give patients discharge instructions that may help patients minimize the risk of long-term sequelae.
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Abstract
OBJECTIVE To evaluate whether rock climbing type exercise would be of value in rehabilitating ankle injuries to improve ankle stability and coordination. [figure: see text] METHODS A group of 25 rock climbers was compared with a group of 26 soccer players. All were male, uninjured, and exercised three to four times a week. Active ankle stability was evaluated by one leg stand stabilometry (measurement of migration of the centre of gravity) and measurements of maximum strength of ankle isokinetic concentric flexion and extension (Cybex). RESULTS The rock climbers showed significantly better results in the stabilometry and greater absolute and relative maximum strength of flexion in the ankle. The soccer players showed greater absolute but not relative strength in extension. CONCLUSION Rock climbing, because of its slow and controlled near static movements, may be of value in the treatment of functional ankle instability. However, it has still to be confirmed whether it is superior to the usual rehabilitation exercises such as use of the wobble board.
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Abstract
STUDY DESIGN Case series. BACKGROUND Plantar flexion/inversion ankle sprains are one of the most frequently occurring sports injuries. Cuboid syndrome, which is difficult to diagnose, may result from a plantar flexion/ inversion ankle injury and could become the source of lateral ankle/midfoot pain. The objective of this case series is to describe the examination, evaluation, and treatment of the cuboid syndrome following a lateral ankle sprain. CASE DESCRIPTION Seven patients were seen in our clinic 1 to 8 weeks following a lateral ankle sprain with a chief complaint of lateral ankle/midfoot pain. In these 7 patients, the presence of cuboid syndrome was identified independently by 2 examiners. Treatment consisted of a cuboid manipulation. OUTCOMES All 7 patients returned to sports activities following 1 to 2 treatments consisting of the "cuboid whip" manipulation. No recurrence of symptoms was reported upon immediate return to competition or during the remainder of the season (mean follow-up, 5.7 months; range, 2 to 8 months). DISCUSSION Based on those 7 patients, our results suggest that patients who are properly diagnosed with cuboid syndrome and receive the cuboid manipulation can return to competitive activity within 1 or 2 visits without injury recurrence.
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Atkinson JJ, Woods MJ, Lovell ME. Extra help required by litigants after simple fractures--a questionnaire based study. Injury 2005; 36:775-7. [PMID: 15910832 DOI: 10.1016/j.injury.2004.12.027] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/26/2004] [Revised: 12/01/2004] [Accepted: 12/01/2004] [Indexed: 02/02/2023]
Abstract
A questionnaire based interview of 100 patients under fracture clinic review was undertaken to assess the help required with the activities of daily living (ADL) in the first 2 weeks following fractures of the hand, wrist, neck of humerus, foot or ankle. The amount of help patients required was correlated with whether or not the patients were claiming compensation for their injuries. Twenty-five percent were litigating and this was shown to influence the amount of help a patient reported having received with dressing, shopping, cooking, housework, personal hygiene and travelling (p<0.0001) and feeding (p<0.0022), but not with getting in/out of bed (p=0.52). Complications of the fracture were not shown to increase litigation. On average litigants required over 3 h extra help per day compared with non-litigants (6.4 h versus 2.75 h).
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Swanson J. The missing link. REHAB MANAGEMENT 2005; 18:20, 22-3. [PMID: 15786665] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/02/2023]
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van Os AG, Bierma-Zeinstra SMA, Verhagen AP, de Bie RA, Luijsterburg PAJ, Koes BW. Comparison of conventional treatment and supervised rehabilitation for treatment of acute lateral ankle sprains: a systematic review of the literature. J Orthop Sports Phys Ther 2005; 35:95-105. [PMID: 15773567 DOI: 10.2519/jospt.2005.35.2.95] [Citation(s) in RCA: 45] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
STUDY DESIGN Systematic literature review. OBJECTIVE To compare the effectiveness of conventional treatment complemented by supervised rehabilitation training (supervised exercises) with conventional treatment alone for the rehabilitation of acute lateral ankle sprains. BACKGROUND Conventional treatment is advocated as a preferable treatment strategy. Whether supervised exercises should complement conventional treatment is unclear. METHODS AND MEASURES We searched 5 computerized databases from 1966 to March 2004, checked the reference lists of all studies that fulfilled our eligibility criteria, and searched for nonindexed journals available on the Internet. Three reviewers independently selected randomized controlled trials (RCTs), and controlled clinical trials (CCTs), comparing conventional treatment alone with conventional treatment combined with supervised exercises for treating patients with an acute lateral ankle sprain. Two reviewers independently assessed the methodological quality of each included study. Two reviewers extracted data regarding outcomes, interventions, and results. Follow-up measurements were grouped as (a) immediate term, (b) short term, (c) intermediate term, and (d) long term. A best-evidence synthesis was conducted, weighting the studies with respect to their internal validity and statistical significance of the outcomes. RESULTS Seven RCTs were included. The quality assessment resulted in 1 high-quality and 6 low-quality studies. There is limited evidence that the addition of supervised exercises to a conventional treatment approach results in greater reduction in swelling and faster return to work. Studies reporting a lack of difference between treatment approach did not report statistical power, making interpretation of those results difficult. CONCLUSIONS The retrieved data failed to demonstrate a clearly superior treatment approach, although preliminary support exists for supervised exercises. Additional high-quality RCTs are needed that are appropriately designed and reported.
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Braund M, Kroontje D, Brooks J, Self B, Aaron G, Bearden K. Analysis of stiffness reduction in varying curvature ankle foot orthoses. BIOMEDICAL SCIENCES INSTRUMENTATION 2005; 41:19-24. [PMID: 15850076] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/02/2023]
Abstract
Ankle foot orthoses (AFO) are often used for patients who cannot generate a strong enough extension moment at the knee to allow functional gait. Orthotists often cut out portions of the AFO around the malleoli in order to improve comfort. There has been some question as to how this affects the stress distribution around the orthosis, the fatigue performance of the device, and the AFOs stiffness. To examine this, three orthoses were constructed with differing curvatures cut out of the malleolar regions. Photoelastic coatings were placed on the most stiff and least stiff orthoses, and the stress distributions while wearing the device were examined. A fixture was created to test the orthosis, and the stress distribution while loaded in the fixture closely matched the distribution with actual wear. These orthoses were then tested in fatigue for 500,000 cycles at 5 Hz in displacement control. Initial displacements were set to provide maximum loads of 45 lbs. The displacement settings for the stiffest orthosis were 0.4 to 0.6 inches of deflection; the load decreased from 44 lbs to 28 lbs after the final cycle. The least stiff displacement varied from 1.3 to 1.5 inches, and the load value changed from 46 lbs to 35 lbs. The data will be useful in guiding orthotists in building AFOs, particularly when shaving portions of the AFO for comfort. Excessive shaving may seriously degrade the performance of the device, especially after longer life cycles.
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Stevens JE, Walter GA, Okereke E, Scarborough MT, Esterhai JL, George SZ, Kelley MJ, Tillman SM, Gibbs JD, Elliott MA, Frimel TN, Gibbs CP, Vandenborne K. Muscle Adaptations with Immobilization and Rehabilitation after Ankle Fracture. Med Sci Sports Exerc 2004; 36:1695-701. [PMID: 15595289 DOI: 10.1249/01.mss.0000142407.25188.05] [Citation(s) in RCA: 93] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
UNLABELLED INTRODUCTION/ PURPOSE: The widespread occurrence of muscular atrophy during immobilization and its reversal presents an important challenge to rehabilitation medicine. We used 3D-magnetic resonance imaging (MRI) in patients with surgically-stabilized ankle mortise fractures to quantify changes in plantarflexor and dorsiflexor muscle size during immobilization and rehabilitation, as well as to evaluate changes in force generating capacity (specific torque). METHODS Twenty-individuals participated in a 10 wk rehabilitation program after 7 wk of immobilization. MRIs were acquired at baseline, 2, and 7 wk of immobilization, and at 5 and 10 wk of rehabilitation. Isometric plantarflexor muscle strength testing was performed at 0, 5, and 10 wk of rehabilitation. RESULTS Dorsiflexors and plantarflexors atrophied 18.9% and 24.4% respectively, the majority of which occurred during the first 2 wk of immobilization (dorsiflexors: 9.6%; plantarflexors: 14.1%). Likewise, more than 50% of hypertrophy during rehabilitation occurred within the first 5 wk of rehabilitation for both the dorsiflexors (12.9%) and plantarflexors (13.2%), when compared to the total amount of hypertrophy over 10 wk of rehabilitation (dorsiflexors: 17.6%, plantarflexors: 22.5%). There were no significant differences in hypertrophy or atrophy of the dorsiflexor or plantarflexor muscles, despite a rehabilitation emphasis on the plantarflexors. Patients had significantly lower plantarflexor specific torque (torque/CSA) than healthy, control subjects immediately after cast immobilization, which did not return to normal after 10 wk of rehabilitation (P < 0.05). CONCLUSION Our investigation of the consequences of limb immobilization on rehabilitation outcomes in patients can be applied directly to optimizing rehabilitation programs. Although muscle hypertrophy occurred early during rehabilitation, plantarflexor muscle function (specific torque) should remain the focus of rehabilitation programs because although CSA recovered quickly, specific torque still lagged behind that of control subjects.
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Garofalo R, Mouhsine E, Borens O, Wettstein M. Nonoperative treatment of acute rupture of the Achilles tendon: results of a new protocol and comparison with operative treatment. Am J Sports Med 2004; 32:1776-7; author reply 1777. [PMID: 15517698 DOI: 10.1177/0363546503262647] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
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Kelm J, Anagnostakos K, Deubel G, Schliessing P, Schmitt E. Ruptur der Sehne des Musculus tibialis anterior bei einem Seniorenfechter der Weltklasse. SPORTVERLETZUNG-SPORTSCHADEN 2004; 18:148-52. [PMID: 15375720 DOI: 10.1055/s-2004-813362] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
The rupture of the tendon of the M. tibialis ant. is a rare sport injury and has not been yet described in fencing. The lunge, the most common offensive movement in fencing, displays a high stress on the spanned tendons and ligaments over the ankle joint and led to the rupture of the pre-damaged tendon of our patient. Pain over the inner side of the foot should be assessed as knells of this tendon injury. The exact patient's history and the precise clinical investigation are adequate for diagnosing the rupture. Hereby, an absence of the tendon shape over the ankle joint and a distinct active deficit of the extension are presented in comparison to the other side where a gap in the tendon course is palpable. An x-ray is obligate, a sonography and a MRI are helpful for the operative planning. The surgical treatment is necessary for athletes. If possible, a primary tendon suture should be aimed, in case of a distal torn an osseous reinsertion should occur. An early functional, postoperative treatment with an orthesis should be rather preferred for athletes than an immobilization.
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