Prevention of ankle sprains

Biomechanics of the first ray part V: The effect of equinus deformity. A 3-dimensional kinematic study on a cadaver model

The positional change of the medial column of the foot in closed kinetic chain with variable Achilles tendon tension was investigated in seven fresh frozen cadaver specimens using a 3-dimensional radio wave tracking system. The distal tibia and fibula and the intact ankle and foot and were mounted on a non-metallic loading frame. The frame allowed positioning of the foot to simulate midstance phase of gait while the tibia and fibula were axially loaded to 400 N. To record osseous motion, receiving transducers were attached to the first metatarsal, medial cuneiform, navicular, and talus. Movements of these bones in 3-dimensional space were measured as specimens were axially loaded and midstance motor function was simulated using pneumatic actuators. To simulate a progressive equinus influence, force was applied to the Achilles tendon at tensile loads of 0%, 30%, and 60% of predicted maximum strength during each test trial. Osseous positions and orientations were collected and analyzed in all three cardinal planes utilizing data recorded. As Achilles load increased, the position of the first metatarsal became significantly more inverted ( P < .05). Although not statistically significant, remarkable trends of arch flattening motion were detected in the distal segments of the medial column with varied Achilles load. Increased Achilles load reduced the influence of peroneus longus on the medial column.

Risk factors for ankle fracture requiring operative fixation

BACKGROUND

Ankle fractures are common and expensive injuries, particularly the injuries that require operative intervention. However, epidemiological research on the causative factors is sparse. This study aims to identify the groups at risk of ankle fracture requiring operative fixation, and to suggest directions for further study.

METHODS

The clinical data on 336 patients with ankle fractures admitted to an urban hospital in New Zealand in 1994 were reviewed. Statistical analysis was carried out on the 252 patients with ankle fractures requiring operative fixation.

RESULTS

Those at highest risk of ankle fracture are young male rugby players and middle-aged women who sustain injury while walking. Young males have a similar incidence of AO Type B and C fractures, while Type B fractures predominate strongly in older women.

CONCLUSIONS

The groups at risk of ankle fracture requiring operative fixation, and the activities predisposing these groups to injury have been identified. More work is required to define the specific risk factors and biomechanical mechanisms that lead to these debilitating injuries.

Effect of the Swede-O Ankle Brace on Talar Tilt in Subjects with Unstable Ankles

This study examined the effect of the Swede-O ankle brace on talar tilt in subjects with unstable ankle joints. Six college-age females with talar tilts greater than 9.5° at 15 decaNewtons (daN) of force on a Telos stress test device participated in the study. Each subject was X-rayed at five levels of force (0,6,9, 12, and 15 daN), first with a bare ankle then wearing a Swede-O ankle brace. A two-factor (Brace × Force) analysis of variance revealed a main effect for force, but no main effect for brace and no Brace × Force interaction. For the unbraced ankles, mean displacements were 8.2, 10.4, 11.9, and 13.1° at the four levels of force, respectively. After application of the brace, the talar tilts were 5.7, 8.5, 11.1, and 12.8°, respectively. These findings suggest that the Swede-O ankle brace was not effective in reducing talar tilt in subjects with unstable ankles. Any efficacy of the brace may be due to other factors, such as proprioceptive feedback during inversion.

Comparison of Three Treatment Approaches for Grade I and II Ankle Sprains in Active Duty Soldiers

The opinions or assertions contained herein are the private views of the author and are not to be construed as official or as reflecting the views of the Department of the Army or the Department of Defense. Return to full occupational function is a primary concern for the injured, including those with ankle sprains. This study compared the effectiveness of three different types of treatment for Grade I and Grade II ankle sprains. The effectiveness was determined by how quickly the patient returned to full duty and if the patient had a recurrence of the injury within one month. A total of 184 subjects (60 in Groups 1 and 3; 64 in Group 2) participated in this study. The treatment groups were: 1) strapping with athletic tape for three days, 2) application of gel cast for three days, and 3) daily strapping for three days. All three groups underwent the same physical therapy program before and after strapping or wrapping. All treatment protocols resulted in a better than 50 percent return to full duty in less than 14 days, with Group 3 showing a return rate of 60 percent in three days or less. The study showed (using log linear analysis) a significant difference at the p < 0.01 level between Groups 1 and 3 and Groups 2 and 3. These results suggest that daily strapping can help reduce lost work time due to ankle sprains. J Orthop Sports Phys Ther 1992;15(1):19-23.

Acute lateral ankle ligament injuries: a literature review

The average general orthopaedic surgeon examines and treats a considerable number of acute lateral ankle ligament sprains in a busy office practice. A cursory review of recent articles published on this subject will present a confusing picture regarding diagnosis and treatment of Grade III injuries. An air of controversy surrounds the interpretation of diagnostic x-rays, and the management of these common ankle problems. This review article is presented to summarize current thoughts on the anatomy, biomechanics, diagnosis, and treatment of acute lateral ankle ligament sprains.

Retrospective comparison of taping and ankle stabilizers in preventing ankle injuries

The effectiveness of taping and the effectiveness of wearing a laced stabilizer in preventing ankle injuries and reinjuries over six seasons of collegiate football practices and games were assessed retrospectively. For 1 1/2 years the players all had taped ankles, and for the remaining 4 1/2 years the players chose their type of ankle support. Over the entire period, the players chose high-top or low-top shoes as preferred. During 51,931 exposures to injury (46,789 practice-exposures and 5,142 game-exposures), the 297 players sustained 224 ankle injuries and 24 reinjuries. Tape was worn during 38,658 exposures to injury (233 players), stabilizers during 13,273 exposures (127 players). Tape had been worn when 159 of the injuries and 23 of the reinjuries occurred; a stabilizer had been worn when 37 of the injuries (P = 0.003) and one of the reinjuries occurred. The combination allowing the fewest injuries overall was low-top shoes and laced ankle stabilizers.

The sprained ankle: current therapy

The sprained ankle is one of the most common musculoskeletal injuries. Three treatments for severe acute sprain are advocated: immobilization, protected mobilization, and primary surgical repair. These injuries are cared for by different medical and paramedical specialties, each with varying skills and interests. In order to define the current preferred treatment, a survey was randomly distributed to 500 physicians. These data indicate that the treatment is generally conservative: cast immobilization was the preferred treatment for the moderate and severe sprain. These data also demonstrated that basic care (e.g., ice and elevation) and rehabilitation were often neglected. Significant differences were noted between the specialties of orthopaedic surgery, family practice, and emergency medicine.

An epidemiologic study of squash injuries

A retrospective investigation of squash-related injuries incurred at a private and a public club in New York was undertaken to gain insight into the incidence and nature of such injuries. Telephone interviews were conducted with 200 randomly selected individuals to obtain their entire injury history. Sixty-nine of the 155 squash players contacted sustained injuries during their participation. Some had multiple injuries. This resulted in an overall injury rate of 44.5%. Strains and sprains accounted for over one-third of the injuries. Nearly one-half of the injuries involved the lower extremity, with the ankle and lower leg being injured most often. Forty-seven percent of the injuries seen were considered disabling because the patients were out of action for more than two weeks after injury. Players over the age of 40 are at increased risk for injury, as are newcomers to the game. Increased injury rates were also associated with an increased frequency of play among females. Only rarely will an injured squash player become permanently impaired.

Three-dimensional kinematics of the taped ankle before and after exercise

The practice of prophylactic ankle taping or wrapping to reduce the incidence of inversion ankle sprains in athletes has come under attack. The purpose of this study was to measure objectively one ankle taping technique's ability to withstand the stresses placed upon it by a standardized exercise routine. Electrogoniometers were used to measure the three-dimensional ankle motion of 20 subjects walking on a level surface and a 10 degrees sideslope. The evaluations were carried out under these three conditions: (1) both ankles untaped, (2) both ankles taped before exercises, and (3) both ankles taped after exercise. The results from this study indicate that the tape does indeed restrict those motions associated with inversion ankle sprain. Methods similar to those described in this study could be used in the evaluation of many current training room practices and thereby provide an objective rationale for their application.