Search

Background/Objectives: To assess magnetic resonance image (MRI) findings in children and adolescents with atraumatic non-overload ankle pain and to identify potential anatomic risk factors. Methods: In total, 310 MRIs of 6- to 20-year-old patients were evaluated regarding detectable ankle pathologies. A total of 147 patients (68 males; 79 females) suffered from atraumatic non-overload ankle pain. The findings were compared to a control group (163 patients: 89 males; 74 females), including patients with ankle trauma in the 4 weeks prior to MRI examination. A t-test for unpaired samples and a binary logistic regression model were used to identify significant differences between both groups and determine potential anatomic risk factors. Results: In the group with atraumatic ankle pain, 95 patients (64.6%) showed at least one pathology. Anterolateral impingement of the upper ankle joint was found in 29 patients (19.7%). Its occurrence was significantly higher in atraumatic non-overload patients than in the control group (p = 0.043). Moreover, a significant correlation between anterolateral impingement of the upper ankle and the presence of hindfoot valgus malposition (n = 25; 17.0%) could be proven in atraumatic non-overload patients (p = 0.035). Conclusions: Anterolateral impingement of the upper ankle joint is frequently observed in children and adolescents suffering from atraumatic non-overload ankle pain, whereby a hindfoot valgus malposition seems to present an anatomic risk factor. [ABSTRACT FROM AUTHOR]

Abstract This study aimed to establish a risk prediction nomogram model for anterolateral, mediolateral, and posterolateral ankle pain in runners with chronic ankle instability (CAI) and analyse the potential risk factors for pain at different ankle sites. Thirty recreational runners with CAI who reported ankle pain in the anterolateral, mediolateral, or posterolateral regions were recruited for this study. Kinematic, kinetic, and electromyographic data during running were collected using motion capture system, 3-D force platform, and surface electromyography system. These data were used to generate a dynamic nomogram. The results showed that anterolateral ankle pain in runners with CAI may be caused by insufficient gastrocnemius muscle strength (OR 0.85, 95% CI 0.73–0.97), excessive ground reaction force (GRF, OR 2.64, 95% CI 1.25–6.22), and an increased percentage of ankle energy absorption (OR 9.11, 95% CI 1.50–77.79). Mediolateral ankle pain might be contributed by greater ankle inversion angle (OR 1.08, 95% CI 1.01–1.00) and GRF (OR 2.13, 95% CI 1.17–4.31). Moreover, posterolateral ankle pain was predicted by increased ankle adduction angle (OR 1.06, 95% CI 1.00–1.12), increased GRF (OR 2.16, 95% CI 1.07–4.80), and decreased dynamic stability (OR 0.20, 95% CI 0.05–0.68). To prevent ankle pain, runners with CAI should be encouraged to focus on improving the neuroreceptor sensitivity of the gastrocnemius muscles, and retraining their energy absorption patterns.

Clinical Scenario: Pain is a common symptom experienced by individuals who sustain an acute lateral ankle sprain and can continue to persist among those who develop chronic ankle instability. Most rehabilitation protocols for individuals with acute ankle sprains or chronic ankle instability focus on restoring physical impairments and have largely omitted any pain-relieving therapies. This impairment-based focus has led pain to be an understudied symptom among individuals with an ankle sprain history. Overlooking the role of pain has also left clinicians with little insight into whether pain experienced after an ankle sprain is local (i.e., peripheral sensitization) or widespread (i.e., central sensitization). Understanding the pain profiles for those with an ankle sprain history may represent an unexploited area for clinicians and future research to improve health outcomes for this patient population. Clinical Question: Is there evidence to suggest that pain mechanosensitivity levels are different between those with and without a history of lateral ankle sprain? Summary of Key Findings: The literature was systematically searched for Level 4 evidence or higher. The search yielded two cross-sectional case-control studies and one cross-sectional study that met the inclusion and exclusion criteria. Based on the available evidence, pain mechanosensitivity levels are lower across ligamentous stabilizers immediately after an acute ankle sprain and over lower extremity neuromuscular structures among individuals with chronic ankle instability. ClinicalBottom Line: There is weak evidence to support an ankle sprain history can affect local pain mechanosensitivity levels of structures surrounding the ankle but not at distant locations. Strength of Recommendation: Level 4 evidence is available according to the Center for Evidence-Based Medicine. [ABSTRACT FROM AUTHOR]

Background Occupational footwear is intended to provide protection against the risks associated with work activities. The choice of footwear is complex due to the welfare, health and safety conditions of workers. Aims To identify the injuries and problems caused by occupational footwear through a systematic review of the existing literature. Methods A literature search was carried out in the Cumulative Index to Nursing and Allied Health Literature, Dialnet Plus, Pubmed, Scientific Electronic Library Online, Medline, Scopus and Web of Science databases over the period 2000–23, following the PRISMA Declaration guidelines. Results A total of 27 studies were included in the review. The results indicated that there is a wide variety of injuries caused by occupational footwear: from dermal injuries (e.g. calluses) and injuries to the nail apparatus to inflammatory pathologies such as plantar fasciitis or bursitis. In addition, inappropriate footwear can cause pain in the ankle and foot, knees, hips and lower back. Other results include the discomfort derived from the footwear itself. Conclusions Inappropriate footwear can cause injuries to the foot and other related bone structures. Further studies are needed on the detection of foot injuries caused by occupational footwear and the levels of action at this level to improve the worker's health, the adaptability of the footwear to the wearer, and the worker's comfort and adherence to the footwear. [ABSTRACT FROM AUTHOR]

Abstract Purpose Patients with varus knee osteoarthritis usually compensate at the ankle and typically walk with hindfoot valgus alignment. As the neutral weight-bearing axis of the lower limbs is restored with Total Knee Arthroplasty (TKA), ankle and hindfoot biomechanics also acutely change. This study aims to investigate whether any ankle clinical-radiographical changes occur as a result of bilateral mechanical TKA in patients with bilateral Osteoarthritis knee at a minimum follow-up of 6 months. Methods The prospective observational study included 61 patients (122 knees) undergoing simultaneous bilateral TKA (mechanical alignment). Tibio-talar angle(TTA), tibial Anterior Surface angle (TAS), lateral distal tibial angle (LDTA), talar-tilt angle (TT), anatomical talocrural angle (aTC), ground surface and distal tibial plafond angle (GP), ground surface and an upper surface of talus angle (GT)and tibial plateau and tibial plafond angle (PP) were measured on long-film radiographs to look for changes in the ankle, whereas functional assessment was done using American Foot and Ankle Society (AOFAS), Foot and Ankle Disability Index (FADI), and Forgotten Joint (FJS-12) scores. Patients were sub-grouped based on the Hip-Knee-Ankle (HKA) axis, and the effect of the severity of knee varus on the ankles after TKA was also analyzed. The minimum follow-up was 6 months. Results A significant decrease in the tibial plateau-tibial plafond (PP), ground-tibial plafond (GP), and ground-talar dome (GT) angles was noted after TKA (p-value

Background/Objectives: To assess magnetic resonance image (MRI) findings in children and adolescents with atraumatic non-overload ankle pain and to identify potential anatomic risk factors. Methods: In total, 310 MRIs of 6- to 20-year-old patients were evaluated regarding detectable ankle pathologies. A total of 147 patients (68 males; 79 females) suffered from atraumatic non-overload ankle pain. The findings were compared to a control group (163 patients: 89 males; 74 females), including patients with ankle trauma in the 4 weeks prior to MRI examination. A t-test for unpaired samples and a binary logistic regression model were used to identify significant differences between both groups and determine potential anatomic risk factors. Results: In the group with atraumatic ankle pain, 95 patients (64.6%) showed at least one pathology. Anterolateral impingement of the upper ankle joint was found in 29 patients (19.7%). Its occurrence was significantly higher in atraumatic non-overload patients than in the control group (p = 0.043). Moreover, a significant correlation between anterolateral impingement of the upper ankle and the presence of hindfoot valgus malposition (n = 25; 17.0%) could be proven in atraumatic non-overload patients (p = 0.035). Conclusions: Anterolateral impingement of the upper ankle joint is frequently observed in children and adolescents suffering from atraumatic non-overload ankle pain, whereby a hindfoot valgus malposition seems to present an anatomic risk factor.

The aim was to provide an update on anatomy and function of the medial ankle ligaments, diagnosis of their injuries and treatment of medial ankle instability. Literature search on PubMed. Injuries to the deltoid ligament are not uncommon in relation to malleolar fractures and ankle sprains. Chronic instability may lead to ankle osteoarthritis. However, there is no consensus on diagnostic criteria (clinically, by imaging and by arthroscopy), on indications for non-operative and operative treatment, and on standards for repair and reconstruction of the ligament complex. There is no current evidence to support acute repair of deltoid ligament injury. Reports on the effect of isolated deltoid ligament reconstruction are very sparse. There is a need for a focused effort to establish evidence for all aspects of deltoid ligament injury. [ABSTRACT FROM AUTHOR]

This study aimed to investigate the dimensions and types of the os trigonum and evaluate their relationship with various pathologic conditions on the posterior ankle using ankle MRI images. A total of 124 non-contrast-enhanced ankle and foot MR images of 123 consecutive patients were included in this retrospective study. The images were presented randomly, and they contained no patient information. The MR images were retrospectively and independently reviewed by two reviewers with a fellowship-trained musculoskeletal radiologist. The images were classified as type I and II based on the ossicle's medial border overlying the talus's posterior process and the groove for the flexor hallucis longus tendon (FHL). The study revealed that patients with type II os trigonum had a longer transverse diameter of the ossicle than type I, and there were statistically significant differences. Detachment status tended to be less in type I than in type II os trigonum, and the differences between the groups were statistically significant. There were no significant differences between type I and II os trigonum regarding posterior talofibular ligament (PTFL) abnormality, bone marrow edema, FHL tenosynovitis, and posterior synovitis. The study concluded that the os trigonum is a common cause of posterior ankle impingement, and type II os trigonum has a longer transverse diameter of the ossicle than type I. [ABSTRACT FROM AUTHOR]

Purpose: Patients with varus knee osteoarthritis usually compensate at the ankle and typically walk with hindfoot valgus alignment. As the neutral weight-bearing axis of the lower limbs is restored with Total Knee Arthroplasty (TKA), ankle and hindfoot biomechanics also acutely change. This study aims to investigate whether any ankle clinical-radiographical changes occur as a result of bilateral mechanical TKA in patients with bilateral Osteoarthritis knee at a minimum follow-up of 6 months. Methods: The prospective observational study included 61 patients (122 knees) undergoing simultaneous bilateral TKA (mechanical alignment). Tibio-talar angle(TTA), tibial Anterior Surface angle (TAS), lateral distal tibial angle (LDTA), talar-tilt angle (TT), anatomical talocrural angle (aTC), ground surface and distal tibial plafond angle (GP), ground surface and an upper surface of talus angle (GT)and tibial plateau and tibial plafond angle (PP) were measured on long-film radiographs to look for changes in the ankle, whereas functional assessment was done using American Foot and Ankle Society (AOFAS), Foot and Ankle Disability Index (FADI), and Forgotten Joint (FJS-12) scores. Patients were sub-grouped based on the Hip-Knee-Ankle (HKA) axis, and the effect of the severity of knee varus on the ankles after TKA was also analyzed. The minimum follow-up was 6 months. Results: A significant decrease in the tibial plateau-tibial plafond (PP), ground-tibial plafond (GP), and ground-talar dome (GT) angles was noted after TKA (p-value < 0.05). Postoperative functional parameters were comparable to the preoperative status except for FADI, which significantly improved (p-value-0.03). Sub-group analysis based on the severity of knee varus (HKA) revealed GT to be most significantly reduced (p-value-0.036), while the talar tilt (TT) increased (p-value-0.044). Functional outcomes of the ankles clinically improved with the correction of severe knee varus after TKA. At a mean follow-up of 13.2 months post-TKA, 7 out of 61 (11.4%) patients complained of post-TKA ipsilateral ankle pain. Conclusion: Mechanically aligned bilateral TKA in severe varus deformity of the knee significantly decreases the GT angle but increases the varus tilt of the talus with lateral talar incongruency and under-coverage. Although the acute correction of severe knee varus deformity aligns the tibia more neutrally, resulting in an overall clinically evident improvement in ankle functional outcome, the increased varus talar tilt remains a deep concern. Level of Evidence: Prospective, observational, comparative study Level II. [ABSTRACT FROM AUTHOR]

Foot pain is one of the most common presenting complaints in orthopaedic clinical practice and can be attributed to a multitude of pathologies in the various osseous structures, ligaments, and tendons of the foot. The spring ligament complex (SLC) between the calcaneum and navicular supports the talus and plays a major role in the static stability of the medial longitudinal arch of the foot. Although calcific ligamentous enthesopathy around the ankle has been described in the literature, we report the first case of its kind affecting the SLC in a 51-year-old male with medial foot pain and no history of trauma. We highlight the role of radiological interventions in the diagnosis and effective management using ultrasound (US)-guided barbotage. [ABSTRACT FROM AUTHOR]

Background: Falls are a major public health concern globally. While falls are associated with osteoarthritis and persistent pain at the hip and knee, falls have not been investigated in people with chronic ankle symptoms. This study aimed to compare self-reported history of falls between adults with and without chronic ankle symptoms. Secondary aims were to compare concern about falling and balance confidence between groups, and to identify factors associated with falling. Methods: A total of 226 participants (134 with chronic ankle pain and/or stiffness and 92 controls) participated in this cross-sectional case–control study. Participants completed an online questionnaire about falls in the past 12 months, injuries associated with falling, concern about falling, balance confidence, function, pain and multimorbidity. Results: Eighty-six (64%) participants with chronic ankle symptoms and 24 (26%) controls reported at least one fall in the last 12 months (p < 0.001). Participants with chronic ankle symptoms reported more falls, more injurious falls, and more hospitalisations because of a fall than controls (p > 0.002). There was a small effect for lower balance confidence and higher concern about falling in symptomatic participants (standardised mean difference: 0.39–0.49; p > 0.017). Logistic regression analysis identified that falling was associated with the presence of ankle symptoms (3.08 (1.20, 7.92); p = 0.02) and concern about falling (odds ratio (95% confidence intervals): 1.13 (1.05, 1.23); p = 0.002). Conclusions: Falls and falls-related injuries are a problem in individuals with chronic ankle symptoms. The high falls occurrence and concern about falling in individuals with chronic ankle symptoms suggest the need for clinicians to assess these factors in this population. [ABSTRACT FROM AUTHOR]

Alaa Abd-Elsayed,1 Robert Moghim2 1Anesthesiology Department, University of Wisconsin School of Medicine and Public Health, Madison, WI, USA; 2Colorado Pain Care, Denver, CO, USACorrespondence: Alaa Abd-Elsayed, Department of Anesthesiology and Pain Management, University of Wisconsin School of Medicine and Public Health, 600 Highland Avenue, Madison, WI, 53792-3272, USA, Email alaaawny@hotmail.comIntroduction: Chronic pain is a significant global public health problem. Peripheral nerve stimulation (PNS) has been gaining popularity in recent years as it is effective, safe and less invasive than surgery for the treatment of chronic pain. The authors aimed to document and share a collection of patient-reported pain scores before and after implanting a percutaneous PNS lead/s with an external wireless generator at various target nerves.Methods: The authors designed a retrospective study, reviewing electronic medical records. Statistical analysis was performed using SPSS 26; p-value ≤ 0.05 was considered significant.Results: The mean baseline pain scores of 57 patients have reduced significantly after the procedure at different follow-up durations. Target nerves included genicular nerves, superior cluneal nerves, posterior tibial nerve ± sural nerve, middle cluneal nerves, radial and ulnar nerves and right common peroneal nerve. In the one-month follow-up group, mean pain score was reduced from 7.44 ± 1.48 pre-procedure to 1.6 ± 1.49, from 7.42 ± 1.5 pre-procedure to 1.6 ± 1.5 7.42 at 3 months, from 7.52 ± 1.5 to 1.72 ± 1.57 at 6 months, from 7.41 ± 1.53 to 1.7 ± 1.55 at 9 months, from 7.41 ± 1.58 to 1.76 ± 1.63 at 12 months, from 7.38 ± 1.59 to 1.69 ± 1.56 at 15 months and from 7.5 ± 1.7 to 1.45 ± 1.57 at 24 months (p ≤ 0.001). Patients also reported significant reduction in morphine milliequivalent, pre-procedure MME 47.75 ± 452.5 to 37.92 ± 43.51 at 6 months (p = 0.002, N = 57), pre-procedure MME 42.72 ± 43.19 to 30.38 ± 41.62 at 12 months (p = 0.003, N = 42), and pre-procedure MME 41.2 ± 46.12 to 21.19 ± 40.88 at 24 months (p ≤ 0.001, N = 27). The only complications occurred post procedure with 2 patients receiving an explant and 1 patient receiving a lead migration.Conclusion: PNS has been shown to be safe and effective in treating chronic pain at different sites with sustained pain relief for up to 24 months. This study is unique in providing long-term follow-up data.Keywords: peripheral nerve stimulation, external generator, peripheral nerves, superior cluneal nerves, middle cluneal nerves, ankle pain, knee pain, genicular nerves, low back pain

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This study aimed to investigate the dimensions and types of the os trigonum and evaluate their relationship with various pathologic conditions on the posterior ankle using ankle MRI images. A total of 124 non-contrast-enhanced ankle and foot MR images of 123 consecutive patients were included in this retrospective study. The images were presented randomly, and they contained no patient information. The MR images were retrospectively and independently reviewed by two reviewers with a fellowship-trained musculoskeletal radiologist. The images were classified as type I and II based on the ossicle’s medial border overlying the talus’s posterior process and the groove for the flexor hallucis longus tendon (FHL). The study revealed that patients with type II os trigonum had a longer transverse diameter of the ossicle than type I, and there were statistically significant differences. Detachment status tended to be less in type I than in type II os trigonum, and the differences between the groups were statistically significant. There were no significant differences between type I and II os trigonum regarding posterior talofibular ligament (PTFL) abnormality, bone marrow edema, FHL tenosynovitis, and posterior synovitis. The study concluded that the os trigonum is a common cause of posterior ankle impingement, and type II os trigonum has a longer transverse diameter of the ossicle than type I.

Background: Medial opening-wedge high tibial osteotomy (MOWHTO) in patients with varus knee osteoarthritis (OA) causes changes to ankle and hindfoot alignment. However, the compensatory ability of the ankle and hindfoot varies according to the severity of ankle OA. Purpose: To investigate whether the changes in ankle symptoms and ankle and hindfoot alignments differ after MOWHTO according to the severity of preoperative ankle OA. Study design: Case-control study; Level of evidence, 3. Methods: The data of 130 patients who were followed for ≥4 years were reviewed. Patients were classified into 2 groups according to their severity of ankle OA: group 1, modified Kellgren-Lawrence grade 0 and 1; group 2, grade ≥2. Four radiographic parameters were examined to evaluate ankle alignment: tibial plafond inclination, talar tilt, talar inclination, and tibial surface angle. The hindfoot alignment was evaluated using the varus-valgus angle (VVA) of the calcaneus. A visual analog scale (VAS) was used to evaluate ankle pain. The patient-reported outcome measure of the knee joint was the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) score. Results: There were 110 patients in group 1 and 20 patients in group 2. In group 2, the change in talar inclination after MOWHTO was significantly greater and the changes in tibial plafond inclination, talar tilt, and VVA were significantly smaller compared with in group 1 (all P <.05). Ankle pain VAS scores were more severe in group 2 than in group 1 pre- and postoperatively (all P <.05), and group 2 reported that ankle pain worsened postoperatively (P <.05). In both groups, knee WOMAC scores improved, and there were no differences between groups pre- or postoperatively (all P >.05). A multivariate regression analysis demonstrated that a small VVA change (odds ratio, 0.775; P =.027) and severe OA grade of the ankle joint preoperatively (Kellgren-Lawrence grades 2-4 vs 0 and 1; odds ratio, 4.241 [ P =.046]) predicted increased ankle pain VAS scores after MOWHTO. Conclusion: Although the patient-reported outcome measures for the knee joint improved irrespective of the presence of ankle OA, ankle pain worsened after MOWHTO in patients with ankle OA. Inadequate compensatory change in hindfoot alignment increased ankle pain in these patients. [ABSTRACT FROM AUTHOR]

Abstract Background Falls are a major public health concern globally. While falls are associated with osteoarthritis and persistent pain at the hip and knee, falls have not been investigated in people with chronic ankle symptoms. This study aimed to compare self‐reported history of falls between adults with and without chronic ankle symptoms. Secondary aims were to compare concern about falling and balance confidence between groups, and to identify factors associated with falling. Methods A total of 226 participants (134 with chronic ankle pain and/or stiffness and 92 controls) participated in this cross‐sectional case–control study. Participants completed an online questionnaire about falls in the past 12 months, injuries associated with falling, concern about falling, balance confidence, function, pain and multimorbidity. Results Eighty‐six (64%) participants with chronic ankle symptoms and 24 (26%) controls reported at least one fall in the last 12 months (p 0.002). There was a small effect for lower balance confidence and higher concern about falling in symptomatic participants (standardised mean difference: 0.39–0.49; p > 0.017). Logistic regression analysis identified that falling was associated with the presence of ankle symptoms (3.08 (1.20, 7.92); p = 0.02) and concern about falling (odds ratio (95% confidence intervals): 1.13 (1.05, 1.23); p = 0.002). Conclusions Falls and falls‐related injuries are a problem in individuals with chronic ankle symptoms. The high falls occurrence and concern about falling in individuals with chronic ankle symptoms suggest the need for clinicians to assess these factors in this population.

Clinical Scenario: Osteochondral lesions (OCLs) of the talus can result from ankle sprains which are the most common injury in the physically active. Recently, platelet-rich plasma (PRP) has been used to develop an innovate treatment for OCLs of the talus. Clinical Question: Do PRP injections improve self-reported pain and ankle function in patients with OCL of the talus? Summary of Key Findings: 3 randomized controlled trials were included. One of the studies compared a single dose of PRP to a single dose of hyaluronic acid (HA) or saline when added as an adjunct to microfracture surgery. Another study compared a group receiving a single dose of PRP after microfracture surgery to a group that only received microfracture surgery. The last study compared a series of 3 PRP injections to a series of 3 HA injections. In all 3 studies PRP appeared to be more effective in pain and function outcomes than comparison treatments. The superior outcomes of PRP were demonstrated at times as short as 4 weeks and as long as 25 months. Clinical Bottom Line: There is moderate to strong evidence that PRP produces favorable, short-term, pain and function results compared to HA, saline, and/or microfracture surgery alone. Strength of Recommendation: Level 2. [ABSTRACT FROM AUTHOR]

Ankle pain can present a clinical dilemma to the foot and ankle surgeons, with a multitude of entities to which the symptoms could potentially be attributed. Enthesopathy around the ankle joint could be due to overuse, injury, inflammation or infection. Calcific ligamentous enthesopathy around the ankle is a well-recognised condition with a spectrum of causes. To our knowledge, a clinically symptomatic presentation of calcific enthesopathy specifically affecting the entheses of the superior extensor retinaculum has not been described in the literature. We report the first case of symptomatic calcific enthesopathy of the superior extensor retinaculum in a healthy young female, and highlight the role of radiological interventions in its diagnosis. The condition was managed successfully by ultrasound-guided barbotage. Calcific enthesopathy of the attachment of the superior extensor retinaculum is a rare condition that should be considered in the differential diagnosis of patients with medial ankle pain. [ABSTRACT FROM AUTHOR]

Background & Aims: Following a serious injury, microtrauma and as a result of microscopic damage in joint surfaces, pain disorders in the skeletal and muscular system develop over time. Pain in the musculoskeletal system, in addition to injury, causes secretion and fatigue in the pastoral structure, which leads to disruption of the neuromuscular system. Although the foot is the last part of the lower limb chain and resists the incoming forces, it is expected to cause movement pathology, pathokinesiology and increased stress and thus injury due to improper distribution of forces. It reaches the tissues and muscles of the leg, and as a result, the risk of joint pain increases. In futsal, which is one of the vulnerable sports, most of the injuries of the lower limbs are assigned to the wrist and knee, According to the report of the National Association of American Sports Science Colleges, ankle injuries compared to other body joints in disciplines such as; It has basketball, volleyball, futsal, etc. Ankle pain can be caused by aspirin, instability, arthritis, gout, tendonitis, fracture, nerve compression and infection in this joint. In this popular field, due to the fact that players have to withdraw from this sport due to pain and injury in their basic ages, and as a result, talents are not lost, attention was paid to movement sciences and rehabilitation. Familiarity with biomechanical principles in injury or disease is a very important part of air and treatment activity. If we can provide a targeted ability in ankle pain and evaluate and perform the tasks they do in static and dynamic conditions, it will allow athletes and even non-athletes to return to sports faster and more confidently. And they do everyday, was a witness The first step in this field is to know the rehabilitation method that optimally minimizes the frequency of pain and re-injury. As a result, biomechanical principles and evaluations become reliable in treatment and help to increase better performance. Research shows that mechanical proprioception movements with ultrasound supplements improve and increase neuromuscular function and balance of the plantar pressure center, as well as a significant reduction in pain, in the same direction, from existing changes and the degree of impact on foot posture or position. in which the patient is located, by using biomechanical evaluations in the initial or final stages of the rehabilitation period, it helps the treatment to increase the effectiveness of the methods used with higher validity and to use better methods with higher effectiveness. take. Take, Therapeutic strategies to prevent and increase the return to daily and sports activities include: external supporters, manual therapy, and deep sensory exercises, which generally divide rehabilitation into two types, mechanical and physical. Studies have shown that deep sensory exercises and orthoses and tapings reduce the amount of damage by 50%. In addition, the postural changes or the condition in which the patient or the injured person is located, recovery during the rehabilitation phase helps the specialists to take appropriate actions to have a better effect. In the meantime, examining the amount of electrical muscle activity and the pressures on the person in the biomechanical analysis of the person will give valuable information about treatment and rehabilitation strategies. According to the available documents, foot and ankle problems even cause pain in the upper limb areas such as the back due to its effects on the posture and the way the forces interact in walking over time. Considering the increasing trend of basic ages in futsal, in order to avoid re-injury or to prevent it, it is necessary to take preventive measures. In this approach, the use of proprioception exercises and the use of ultrasound waves on the injured area of the ankle have a significant effect on the walking process, the sense of the position of the ankle joint, and the function of the muscles around the joint. Failure to use proprioception exercises reduces performance and ankle sprains, which is the result of instability followed by chronic ankle pain. is looking for To get a better result, the use of ultrasound therapy modality by applying a length of heat in the ankle along with deep sensory exercises will be useful in controlling and improving the function of the device and foot posture. In rehabilitation planning, understanding the mechanism of applied forces will help professionals to provide the appropriate protocol to increase the function of the device and joints. Because a period of rehabilitation before and after the changes in the posture or the condition in which the patient or athlete is located, can have a great help in the therapeutic methods of care and treatment of its effectiveness in the treatment protocol. it shows. In most cases, in the field of rehabilitation, the therapist is unwilling and according to the conditions of the teams and the pressure of the coaches and sports managers upon the player's return, he trains and competes with the speed of action of the fields. But this athlete's return is mostly temporary and causes joint injuries and choices in the future. Therefore, in the evaluations and screenings at the beginning and end of the season, as in the field of football, in this field as well, the amount of injuries can be minimized by taking into account clinical evaluation tests. In this study, our aim was to investigate the effects of deep sensory training with ultrasound therapy on the chronic ankle pain of young players along with the evaluation of the center of pressure and the changes in the activities of the 2 specialized muscles, tibialis anterior and peroneus longus during walking, in response to changes in their activity can help people with ankle injuries. Methods: The statistical sample of this study included 24 people (12 people in the experimental group and 12 people in the control group). Pain intensity in both groups was assessed through the standard Visual analogue scale form, which is characterized by a pain scale of 1 to 10, and the selection criterion was a score of 7 (high pain intensity). Also, for analysis and evaluation of electrical muscle function by electromyography system of anterior tibialis and peroneus longus muscles, subjects of both groups were recorded using UK Biometrics system in stance phase in 14-meter path of both groups (pre-test). The experimental group then received a deep sensory training protocol with 3 MHz ultrasound for three weeks. The control group performed its normal activities during this period. After the treatment period, both groups re-tested and checked the pain and recorded the electrical activity of the muscles as a pre-test (post-test). For statistical analysis, correlated T-test was used for intra-group comparison and independent for inter-group comparison (p<0.05). Results: The results showed a significant difference only in the activity of Peroneus longus muscle in comparison with pre- and post-test of the experimental group. Also, a significant difference in the amount of pain in the experimental group before and after rehabilitation interventions was observed in the comparison within the group. Conclusion: Based on the results of this study, it can be mentioned that the use of deep sensory exercises with ultrasound waves as an effective method in the rehabilitation of the musculoskeletal system in chronic pain can be used by physiotherapists and other sports rehabilitation specialists. Because its effectiveness was effective in reducing the amount of pain and normal function of selected muscles in static and dynamic positions (walking). [ABSTRACT FROM AUTHOR]

Background: Osteoarthritis frequently affects multiple joints through the lower limbs. This study sought to examine the incidence of foot pain in subjects undergoing total knee arthroplasty (TKA) and determine if foot symptoms improved following surgery.Methods: Six hundred ten subjects undergoing TKA completed patient-reported outcome measures preoperatively, and at 6 and/or 12 months after surgery including the incidence and severity of foot or ankle pain, Knee Injury and Osteoarthritis Outcome Scores (KOOS) Joint Replacement, Oxford Knee Scores (OKS), EQ5D, and satisfaction.Results: Foot or ankle pain was reported in 45% before, 32% at 6 months, and 36% at 12 months after TKA. Of those with preoperative foot pain, 42% at 6 months and 50% at 12 months reported no foot pain after TKA, and the Visual Analog Scale severity reduced from a mean of 4.0 before to 1.7 after surgery. Those with preoperative foot pain had lower baseline KOOS (P = .001), OKS (P = .001), and more depression/anxiety (P = .010), but experienced equivalent postoperative KOOS, OKS, and satisfaction with surgery, compared to those without foot pain.Conclusion: Foot or ankle pain was reported by nearly half of TKA subjects, but resolved after surgery in 50%. Those with preoperative foot pain experienced at least equivalent improvement in knee-related symptoms and mobility compared to those without foot pain. The presence of foot pain should not be a deterrent to TKA. [ABSTRACT FROM AUTHOR]

Background: Ankle pain is common in clinical practice. Various lesions including trauma, impingement syndromes, inflammatory arthritis, soft tissue, and bony lesions affect the ankle joint. Imaging is crucial in the determination of the pain cause and management. Objectives: This study aimed to evaluate the role of high-resolution musculoskeletal ultrasonography (MSK US) compared to the role of magnetic resonance imaging (MRI) in ankle pain. Patients and Methods: This studyconducted on 29 patients who presented with ankle pain during the period from September 2018 until September 2019 at Qena University Hospitals, South Valley University, Egypt and evaluated by plain radiographs, US and MRI. Comparative analysis was done between US and MRI. Results: The US was able to detect various lesions affecting the ankle ( tendinous and ligamentous injury, plantar fasciitis, joint effusion, bursitis, ganglion cysts, tarsal tunnel syndrome) with sensitivity and specificity of 100% regarding tendons pathology and sensitivity 80 %, specificity 100 % regarding ligamentous injuries with overall accuracy 95 % compared to MRI. US was negative in all MRI positive bony lesions. Conclusion: The US is a useful imaging modality in identifying a large spectrum of causes of ankle pain and should be considered a first step diagnostic tool when an osseous lesion is not suspected.

Purpose: Many etiologies are known to lead to a tarsal tunnel syndrome (TTS). One rare cause is mass-occupying lesions, and particularly accessory or variant muscles (AVM). This study aimed to systematically collect published clinical cases of TTS caused by AVM. Methods: An electronic literature search was conducted from inception to April 2021. The diagnosis of AVM should be reported in one of the following methods: ultrasonography, magnetic resonance imaging (MRI), or per-operatively. Data extraction included types and prevalence of accessory muscles, clinical presentation and diagnosis, and treatment modalities. Twenty-five studies were identified with a total 39 patients (47 ankles). Results: The prevalence of TTS was reported in only two studies (9%). Forty-nine AVM were identified with the accessory flexor digitorum longus being the most common (52%). The most common sign/symptoms were tenderness (78.7%), pain (82.9%), dysesthesia (57.4%), Tinel sign (44.6%), and a swelling (25.5%). Decompression and excision were the most commonly performed procedures. Four accessory/variant muscles in the ankle have the potential to induce a tarsal tunnel syndrome. Conclusion: This review highlights the clinical and imagery specificities of TTS secondary to accessory or variant muscles. Mass-occupying etiology should be included in the list of differential diagnoses whenever a posterior tibial nerve compression is suspected. [ABSTRACT FROM AUTHOR]

Background: The effect of total knee arthroplasty (TKA) on the ankle joint is not entirely clear. The purpose of this study is to assess postoperative changes in the coronal alignment of the ankle joint in patients undergoing TKA for various degrees of knee deformity.Methods: This retrospective study included 107 patients who had undergone TKA for primary osteoarthritis. In all cases, preoperative coronal alignment deformity of the knee was corrected in an attempt to restore the native mechanical axis of the knee. Patients were stratified into 3 groups according to the degree of knee coronal alignment correction achieved intraoperatively: group 1 (<10° varus/valgus correction, n = 60), group 2 (≥10° varus correction, n = 30), and group 3 (≥10° valgus correction, n = 17). Knee/ankle alignment angles were measured on full-length, standing anteroposterior imaging preoperatively and postoperatively and included the following: hip-knee-ankle angle, tibial plafond inclination (TPI), talar inclination (TI), and tibiotalar tilt angle.Results: Significant changes in ankle alignment, specifically with regard to TPI (9.5° ± 6.9°, P < .01) and TI (8.8° ± 8.8°, P = .03) were noted in the ≥10° valgus correction group compared to the other 2 groups. Regardless of the degree of knee deformity correction, TKA did not lead to significant changes in the tibiotalar tilt angle.Conclusion: A correction of ≥10° in a genu valgum deformity can affect ankle joint alignment, leading to alterations in TPI and TI. These findings need to be taken into consideration in assessing candidates for TKA as a possible cause of postoperative ankle pain. [ABSTRACT FROM AUTHOR]

Purpose: Calcaneonavicular coalition accounts for more than half of all tarsal coalitions. Resection of calcaneonavicular coalition by an open approach is the standard treatment. Treatment of calcaneonavicular coalition by an arthroscopic approach appears promising. The objective of our study was to compare the clinical outcomes of calcaneonavicular coalition resection by open approach versus arthroscopic approach. Methods: A retrospective cohort study was conducted to evaluate 127 patients who underwent a resection of calcaneonavicular coalition from 2009 to 2017. Patients were divided into two groups according to whether an arthroscopic approach or an open approach was used. Demographics, operative parameters, and clinical outcomes (foot and ankle ability measure score, subjective score, and global ankle estimation) were assessed. Results: Arthroscopic approach was used for 81 patients and open approach for 46 patients. Treatment with arthroscopic approach resulted in a shorter hospital stay (2.6±0.6days vs 3.0±0.7; p=0.02) and a longer operative time (24.5±8.1min vs 20.5±4.2; p<0.01) than with open approach. The foot and ankle ability measure sports subscale scored significantly higher in the arthroscopic approach group (90.9 vs 77.3; p=0.003). Revision rate was significantly higher in the arthroscopic approach group (12 (15%)) versus the open approach group (1 (2%)) (p=0.024). Persistent symptoms (n=12) were the main reason for revision. Conclusions: Arthroscopic treatment of calcaneonavicular coalition is associated with a higher revision rate than the open approach. [ABSTRACT FROM AUTHOR]

Abstract Background Low back pain (LBP) is a common problem among young basketball players in addition to lower extremity injuries. However, studies that focus on LBP with lower extremity pain are limited. From the perspective of the kinematic chain, disrupted lower extremity function can lead to LBP. The association between these two symptoms in basketball players, however, has not been reported. Therefore, this study aimed to clarify the association between lower extremity pain and LBP among young basketball players. Methods This cross-sectional study was conducted on school-aged basketball players (n = 592). Information regarding their sporting activities was collected using a self-reported questionnaire. Musculoskeletal pain such as low back, knee, and ankle pain was assessed. The sports players with knee and/or ankle pain were defined as having lower extremity pain. Multivariate logistic regression analysis was used to assess the association between lower extremity pain and LBP. Odds ratios (OR) and 95% confidence intervals (95% CI) were calculated. The associations of knee or ankle pain with LBP were similarly assessed. Results School-aged basketball players had a point prevalence of 12.8% for LBP. Compared with the players without lower extremity pain, the players with lower extremity pain had higher rates of LBP, with an adjusted OR (95% CI) of 6.21 (3.57–10.80). There was also a significant association of knee and ankle pain with LBP. Compared with the players without knee or ankle pain, the adjusted ORs (95% CI) for LBP were 4.25 (2.55–7.07) in the players with knee pain and 3.79 (2.26–6.36) in the players with ankle pain. Conclusions Lower extremity pain was associated with LBP among school-aged basketball players. Further research is needed to clarify the mechanism of this association, which will provide useful information for prevention and treatment of LBP among young basketball players.

Objective: To analyze the characteristics of injuries sustained by young figure skaters who were evaluated at regional pediatric sports medicine clinics. Design: Retrospective chart review (2003-2017). Setting: Sports medicine clinics at a tertiary-level pediatric medical center. Patients: Two hundred ninety-four figure skaters (271 female and 23 male). Age rage: 9 to 19 years. Mean age: 14.2 ± 2.3 years. Interventions: None. Main outcome measures: Mechanism of injury (acute vs overuse), injured body areas, diagnoses for most commonly injured body areas, and distribution of bone stress injuries. Results: Eight hundred sixty-four figure skating-related injuries were identified. Approximately 68.9% were overuse and 31.1% were acute. In female figure skaters, the most frequently injured body areas were foot/ankle (29.6%), knee (19.3%), and back (15.8%). In male figure skaters, they were foot/ankle (25.4%), hip (16.4%), and knee (14.9%). Most common diagnoses at these body areas were tendinopathy (foot/ankle), extensor mechanism (knee), and posterior column bone stress injuries (back). All injuries to anterior knee structures, excluding bone contusions, were categorized as extensor mechanism injuries. About 11.8% of all injuries were bone stress reactions/fractures with the majority occurring at the back (42.2%), foot/ankle (32.4%), and lower leg (15.7%). Conclusion: Most injuries sustained by figure skaters were overuse and occurred most commonly at the foot/ankle (29.6%), knee (19.3%), and back (15.8%). Approximately 1 in 10 injuries were bone stress reactions/fractures, and nearly 1 in every 3 skaters who presented with back pain was diagnosed with a posterior column bone stress injury. Health care providers who take care of young figure skaters need to maintain a high index of suspicion for overuse injuries, especially bone stress reactions/fractures. [ABSTRACT FROM AUTHOR]

Background  Injury or compression of a sensory nerve is an under-reported source of disabling pain in the lower limb. It is known that peripheral nerve microsurgeons can reconstruct and rewire injured nerves to relieve chronic pain but this option remains not completely understood and ignored by most orthopaedic surgeons, neurologists, and pain therapists. In this paper, we describe our experience with knee and ankle peripheral nerve surgery to improve the condition of patients suffering from chronic, posttraumatic lower limb pain. Patients and Methods  Between 2015 and 2018, a retrospective investigation was performed including patients who underwent ankle and knee nerve surgery for posttraumatic chronic pain with at least 1 year of follow-up. Previous surgeries or type of trauma, pain location and characteristics, type of operation (reconstruction, decompression, or denervation), and number of nerves operated were listed. Selective neuropathy was confirmed by ultrasound-guided nerve blocks. Outcome was assessed combining the visual analogue scale (VAS) score at rest and during movement, functional indexes, drug use, and ability to work. Results  A total of 34 patients (14 knee and 20 ankle) were included in this study. A statistically significant difference (p  < 0.05%) in postoperative pain at rest and during activity was seen in both groups of patients. Good to excellent outcomes were recorded in 92 and 80% of patients treated, respectively, at the knee and the ankle levels. No major complications occurred, while a secondary procedure due to neuroma recurrence was necessary in seven patients (three knees and four ankles). Conclusion  Peripheral nerve microsurgery is a useful and minimally invasive tool to be added in the algorithm of treatment of chronic knee and ankle pain. Physicians should be trained to suspect a neuropathic origin of pain in absence of musculoskeletal signs of pathology, especially following trauma or surgeries. [ABSTRACT FROM AUTHOR]

A 65-year-old female with 18 months of left ankle pain after a traumatic injury underwent nano arthroscopy of her left ankle with identification and removal of a loose osseous body annealed to her tibiotalar joint not seen on advanced imaging. The arrival of nano arthroscopy has provided foot and ankle surgeons with the necessary tools to now locate sources of pain and dysfunction not necessarily observed on advanced imaging and directly intervene on these disorders in the office setting. This case report describes one of the first patients treated with an innovative nano arthroscopy device.

The purpose of this case report is to present an osseous foot lesion as the initial presentation of advanced metastatic adenocarcinoma. A 65-year-old female presented with 5 months of atraumatic left ankle pain. Initial radiographs and computed tomography scan showed a lytic lesion in the talar dome and calcaneus. Further workup and evaluation revealed diffuse metastatic disease in the lung, abdomen, and brain. A biopsy of the talar lesion demonstrated metastatic adenocarcinoma, and the patient elected to transition to hospice care less than 2 months after initial diagnosis. Although exceedingly rare, metastatic disease should be included in the differential for any lesion in the distal extremities including the foot and ankle. Unfortunately, these patients may have widespread metastases and poor prognosis at the time of initial presentation. This case report describes an acrometastasis of a primary adenocarcinoma and highlights the importance of considering metastatic disease in the differential of foot and ankle lesions. Delay in recognition and diagnosis of metastatic disease may have devastating consequences, and physicians could benefit from a high index of suspicion when treating these patients. [ABSTRACT FROM AUTHOR]

Abstract Background Soccer is a high-intensity sport with a high injury rate. Among youth soccer players, lower extremity pain is a major problem that could be associated with trunk function. This study investigated the association between lower extremity pain and trunk pain among youth soccer players. Methods A cross-sectional study involving youth soccer players participating in the Miyagi Amateur Sports Association was conducted using a self-reported questionnaire. A multiple logistic regression analysis was used to examine the association between trunk pain and lower extremity pain. Covariates were sex, age, body mass index, height increase, number of days of training per week, practice time per day on weekdays or weekends, competition levels, frequency of participation in games, and previous injuries. Results The final study population comprised 1139 youth soccer players (age, 6–15 years; male, 94.2%). Lower extremity pain with concomitant trunk pain occurred in 61.8% (42/68). Trunk pain was significantly associated with lower extremity pain (adjusted odds ratio [OR], 6.82; 95% confidence interval [CI], 3.99–11.67). Back pain and hip pain were significantly associated with knee pain (adjusted OR [95% CI]: 7.63 [3.70–15.76] and 3.84 [1.89–7.83], respectively), ankle pain (adjusted OR [95% CI]: 9.03 [4.42–18.44] and 5.43 [2.77–10.62], respectively), and both knee and ankle pain (adjusted OR [95% CI]: 13.67 [6.01–31.09] and 5.98 [2.56–13.97], respectively). Conclusions Trunk pain was associated with lower extremity pain among youth soccer players. Clinicians and coaches should consider comorbidities while treating those players.

Tibialis posterior tendinopathy is a common debilitating condition seen by foot and ankle providers. Non-operative management is difficult as patients often present in later stages of the disease. This case series evaluated the combination of radial shockwave therapy and a foot core progression exercise regimen on 10 patients who had failed standard conservative treatment techniques. Median follow-up time was 4 months. Clinically important differences in the Foot and Ankle Ability Measure were met in 9 (90%) and 8 (80%) of patients for activities of daily living and sport sub-scores, respectively. No adverse effects were observed. [ABSTRACT FROM AUTHOR]

Background: Low back pain (LBP) is a common problem among young basketball players in addition to lower extremity injuries. However, studies that focus on LBP with lower extremity pain are limited. From the perspective of the kinematic chain, disrupted lower extremity function can lead to LBP. The association between these two symptoms in basketball players, however, has not been reported. Therefore, this study aimed to clarify the association between lower extremity pain and LBP among young basketball players. Methods: This cross-sectional study was conducted on school-aged basketball players (n = 592). Information regarding their sporting activities was collected using a self-reported questionnaire. Musculoskeletal pain such as low back, knee, and ankle pain was assessed. The sports players with knee and/or ankle pain were defined as having lower extremity pain. Multivariate logistic regression analysis was used to assess the association between lower extremity pain and LBP. Odds ratios (OR) and 95% confidence intervals (95% CI) were calculated. The associations of knee or ankle pain with LBP were similarly assessed. Results: School-aged basketball players had a point prevalence of 12.8% for LBP. Compared with the players without lower extremity pain, the players with lower extremity pain had higher rates of LBP, with an adjusted OR (95% CI) of 6.21 (3.57–10.80). There was also a significant association of knee and ankle pain with LBP. Compared with the players without knee or ankle pain, the adjusted ORs (95% CI) for LBP were 4.25 (2.55–7.07) in the players with knee pain and 3.79 (2.26–6.36) in the players with ankle pain. Conclusions: Lower extremity pain was associated with LBP among school-aged basketball players. Further research is needed to clarify the mechanism of this association, which will provide useful information for prevention and treatment of LBP among young basketball players. [ABSTRACT FROM AUTHOR]

To describe the prevalence and distribution of clinical and ultrasound (US) pathological findings at ankle level and to compare them, in patients with rheumatoid arthritis (RA). This is a descriptive, cross-sectional study assessing patients diagnosed with RA according to the 2010 ACR criteria, who were recruited consecutively and independently of disease status or treatment and of the presence of pain at ankle level. Clinical and US findings were acquired by two independent rheumatologists. US assessments were performed according to the EULAR and OMERACT indications. A total of 224 ankles of 112 RA patients were examined. One hundred (89.3%) patients were women and 12 (10.7%) were men, with a mean age of 51 years. RA mean disease duration was 72 months. Ankle spontaneous pain was found in 56.2% of the patients. In 65.2% of the patients, US found at least one pathologic sign indicative of joint and/or tendon pathology. Using grayscale US, joint involvement was more frequently found than tendon pathology (37.5% vs 22.3%). Conversely, no substantial difference was found between the prevalence of power Doppler signal at joint and tendon level. There was a significant correlation between clinical findings and US findings indicative of tibiotalar joint synovitis and peroneal tenosynovitis. In the present study, pain and US pathologic findings at ankle level were described and compared in a cohort of RA patients. Spontaneous pain was found in more than half of the patients and US found joint involvement more prevalent than tendon pathology. [ABSTRACT FROM AUTHOR]

Lateral ankle sprains are common injuries seen by primary care and podiatric specialties. However, lateral ankle pain from a suspected inversion injury of the ankle may be more than a Grades I, II, or III ankle sprain. This case report illustrates a 30-year-old U.S. Navy Active Duty Service Member that was initially diagnosed with a "lateral ankle sprain". Upon subsequent follow-up with a podiatric foot and ankle surgeon, he was diagnosed with a 3-month-old chronic and neglected Achilles tendon rupture. The purpose of this manuscript is to present an uncommon and unique presentation of lateral ankle pain after injury, subsequent surgical treatment, as well as a review of the common differential diagnoses of "lateral ankle pain." [ABSTRACT FROM AUTHOR]

An os subtibiale is a rare accessory bone located below or behind the medial malleolus. Herein we present a rare case of a painful os subtibiale in a young triathlete who presented with pain, redness and swelling below his left medial malleolus. Plain radiographs and three-dimensional computed tomography revealed a well-defined oval bone distal to the left medial malleolus. After conservative treatment failed, the ossicle was excised in an open surgery with complete resolution of symptoms. This case report emphasizes the need for clinical awareness of different anatomical variations of the bones of the foot.

Objective: To assess the reliability and validity of Foot Function Index Thai version [FFI-TH]. Materials and Methods: The cross-sectional descriptive study was conducted in patients with painful foot/ankle problems at Department of Rehabilitation Medicine, King Chulalongkorn Memorial Hospital, Bangkok, Thailand. Foot Function Index [FFI] is a self-administered patient-reported outcomes [PRO] measure for evaluating foot/ankle problems. It comprises three domains including pain, disability, and activity limitation. It was translated into Thai language using internationally recognized translation standards. Internal consistency reliability coefficients and coefficient of stability were calculated to test for reliability. The average test-retest interval was 3.90 days. Construct validity was evaluated by the Pain Visual Analogue Score [VAS-pain], the Visual Analogue Scale Foot and Ankle Thai version [VASFA-TH], and the Medical Outcomes Study [MOS] 3 6-item short form Thai version [SF3 6-TH]. Results: Ninety-seven patients were enrolled. Most participants were female (80.47%), with an average age of 45.74 years and an education level of at least bachelor's degree (81.40%). The most common diagnoses were plantar fasciitis, ankle sprain, and hallux valgus. Median time to onset of problem was 5.5 months. Three domains revealed Cronbach's alpha coefficient values, as follows, pain subscale (0.94), disability subscale (0.96), and activity limitation subscale (0.72). Intraclass correlation coefficient as 0.92 indicated high stability. Construct validity demonstrated significant correlation between the total and subscale of FFI-TH scores when compared to VAS-pain and SF36-TH for bodily pain, as determined by moderate correlation from Pearson's correlation coefficients that ranged from 0.5 to 0.7. Average time to complete the FFI-TH was 4.67 minutes. A higher level of impairment will correspond with and result in a higher FFI score. Conclusion: FFI-TH demonstrated good reliability and validity with appropriate completing time. FFI-TH is suitable to be one of the Thai PRO measures that provide clinical benefit for patients with painful foot/ankle problems. [ABSTRACT FROM AUTHOR]

Objective: To assess the reliability and validity of Foot Function Index Thai version (FFI-TH). Material and Method: The cross-sectional descriptive study was conducted in patients with painful foot/ankle problems at Department of Rehabilitation Medicine, King Chulalongkorn Memorial Hospital, Bangkok, Thailand. Foot Function Index (FFI) is a self-administered patient-reported outcomes (PRO) measure for evaluating foot/ankle problems. It comprises three domains including pain, disability, and activity limitation. It was translated into Thai language using internationally recognized translation standards. Internal consistency reliability coefficients and coefficient of stability were calculated to test for reliability. The average test-retest interval was 3.90 days. Construct validity was evaluated by the Pain Visual Analogue Score (VAS-pain), the Visual Analogue Scale Foot and Ankle Thai version (VASFA-TH), and the Medical Outcomes Study (MOS) 36-item short form Thai version (SF36-TH). Results: Ninety-seven patients were enrolled. Most participants were female (80.47%), with an average age of 45.74 years and an education level of at least bachelor's degree (81.40%). The most common diagnoses were plantar fasciitis, ankle sprain, and hallux valgus. Median time to onset of problem was 5.5 months. Three domains revealed Cronbach's alpha coefficient values, as follows, pain subscale (0.94), disability subscale (0.96), and activity limitation subscale (0.72). Intraclass correlation coefficient as 0.92 indicated high stability. Construct validity demonstrated significant correlation between the total and subscale of FFI-TH scores when compared to VAS-pain and SF36-TH for bodily pain, as determined by moderate correlation from Pearson's correlation coefficients that ranged from 0.5 to 0.7. Average time to complete the FFI-TH was 4.67 minutes. A higher level of impairment will correspond with and result in a higher FFI score. Conclusion: FFI-TH demonstrated good reliability and validity with appropriate completing time. FFI-TH is suitable to be one of the Thai PRO measures that provide clinical benefit for patients with painful foot/ankle problems. [ABSTRACT FROM AUTHOR]

Introduction/Purpose: Opioid pain medications are frequently prescribed after orthopedic surgery as effective tools for pain relief, but with adverse consequences such as addiction and overdose. Postoperative pain control can vary depending on patient opioid prescription history and pain expectations. There are limited studies regarding pain and anxiety levels following orthopedic foot and ankle trauma surgery, with a lack of formal guidelines in prescribing opioid medications to this patient population. The overall purpose of this study was to gain an understanding of postoperative pain and anxiety in patients undergoing outpatient foot and ankle trauma surgery. This study additionally sought to identify any risk factors that may predispose a patient to increased postoperative pain and anxiety, resulting in a potentially increased pain medication requirement. Methods: A subanalysis of 50 patients from a prospective, observational study was performed, examining adult patients undergoing outpatient foot and ankle trauma surgery performed by trauma fellowship-trained senior investigators. Patients were enrolled and given pertinent reference materials including access to an automated texting survey platform to collect data regarding their postoperative pain, anxiety, and opioid medication use. Patients were stratified by procedure type (irrigation & debridement/hardware removal, foot/syndesmosis ORIF, ankle ORIF, pilon ORIF) and by receiving perioperative regional anesthetic block versus local anesthetic. Pain and anxiety were measured with the Numeric Rating Scale for Pain (scale of 1-10) and the Visual Facial Anxiety Scale (scale of 1-5), respectively. The primary outcome measured was the number of days on average for a patient to discontinue opioid medication. Secondary endpoints consisted of pain level < 4, anxiety level < 2, patient-specific and surgery-related factors that may affect these variables. Results: Postoperatively, it took an average of 9.6 days until opioids were discontinued, 8.2 days for pain to subside below 4, and 6.6 days until anxiety reduced under 2. Foot/syndesmosis ORIF and older age were associated with prolonged pain medication use (p<0.05). Drug use and older age limited the chance of obtaining a pain score under 4 (p<0.05). Psychiatric history and older age decreased the odds of obtaining an anxiety score under 2 (p<0.05). White race improved the chance of obtaining an anxiety score under 2 and tapering off pain medications (p<0.05). When stratified by procedure type or analgesic adjuvants (regional block vs local), there were no significant differences in pain and anxiety scores. Conclusion: Our study shows that regardless of procedure type or analgesic adjuvant used, it takes approximately eight days for postoperative pain levels to decrease to 4 out of 10 and six days for anxiety levels to decrease to 2 out of 5, with patients requiring opioid pain medications for an average of 10 days. Risk factors such as older age, prior drug use, and psychiatric history increased postoperative pain, anxiety, and use of opioid pain medications. This data may be utilized by orthopedic surgeons in providing safe, effective, and evidence-based pain management prescribing practices in anticipating postoperative pain and anxiety. [ABSTRACT FROM AUTHOR]

Introduction/Purpose: Tarsal tunnel syndrome (TTS) is typically caused by an anatomical variant or mechanical compression of the tibial nerve (TN). It is critical then to understand the anatomy of the TN in relation to the tarsal tunnel to understand this condition more fully. Methods: 40 lower-leg specimens were obtained. Dissection started 20 centimeters proximal to the DellonMcKinnon (DM) line towards the medial aspect of the naviculo-cuneiform joint distally. Anteriorly, dissection began at the tibio-talar medial gutter until the medial aspect of the Achilles tendon posteriorly. The plantar aspect extended from medial to lateral within the parameters previously described, ending at the level of the second metatarsal. Results: The flexor retinaculum had a denser consistency in 22.5% of the cases and the average length was 51.9 mm. The flexor retinaculum as an independent structure was absent and 77.2% of cases as an undistinguished extension of the crural fascia. The lateral plantar nerve (LPN) and abductor digiti minimi (ADM) nerve shared the same origin in 80% of cases, 34.5% bifurcated proximal to the DM line, 31.2% distally and 34.3% at the same level. The medial calcaneal nerve (MCN) emerged proximal to the DM line in 100% of specimens. The medial plantar nerve (MPN) has its origin proximal to the DM line in 95% of cases. Conclusion: The flexor retinaculum is an extension of the crural fascia and not an independent structure. The LPN and ADM have the same origin in most cases and this presents as an important finding that must be studied in detail for clinical correlations between the motor ADM and sensory LPN affections. Finally, the branches of the MCN and MPN are the most constant in their distribution and proximal origin in relation to the DellonMcKinnon line. [ABSTRACT FROM AUTHOR]

Introduction/Purpose: Osteochondral lesions of the Talus are defined as any damage involving both articular cartilage and subchondral bone of the talar dome, and this condition is associated with persistent ankle pain and disability. The incidence of osteochondral lesions of the talus is increasing in the pediatric and adolescent population. There are a few studies regarding surgical treatment. The aim of this study is to report that need for surgical treatment is higher than expected in aforementioned lesions. Methods: Osteochondral lesions of the Talus are defined as any damage involving both articular cartilage and subchondral bone of the talar dome, and this condition is associated with persistent ankle pain and disability. The incidence of osteochondral lesions of the talus is increasing in the pediatric and adolescent population. There are a few studies regarding surgical treatment. The aim of this study is to report that need for surgical treatment is higher than expected in aforementioned lesions. Results: Average age was 14,5 (10-18) at beginning of the treatment. 69,2% of our patients were female. Foundation of conservative treatment was activity modification. 9 of our 13 patients were treated surgically. Arthroscopic debridement and microfracture surgery as well as various techniques were applied to all operated patients. In 7 of the operated patients (n=9), the lesion was on the right side and there was a history of trauma before the complaints started. While the mean AOFAS scores of the operated patients were 47 (24-75) before the operation, it was 83.8 in the last follow-up. While the mean AOFAS scores of our conservatively treated patients were 38.2 (21-74) before treatment, the mean AOFAS scores at the last follow-up after treatment (mean follow-up 2 years) were 70 (17-100). There were no minor and major postoperative complications and no need of reoperation. At the final follow up there was significant improvement in clinical results in all patients treated surgically and conservatively. Conclusion: Talus osteochondral lesions at younger ages is an increasing problem. Conservative management with close follow up is the mainstay of the treatment. However, need of surgical treatment may be higher than expected and the short-term results of surgical with various techniques are successful [ABSTRACT FROM AUTHOR]

Introduction Adults with haemophilia frequently have a painful and disordered gait due to ankle arthropathy. Aim The aim of this study was to determine if pain and gait parameters were affected by the use of different types of ankle bracing. Methods We investigated the gait patterns of 17 men with severe haemophilia without bracing, using a fracture boot ( FB) and a carbon fibre floor reaction ankle foot orthosis (CF-AFO). Pain relief was determined in each condition. Gait parameters were measured by means of an electronic, pressure sensitive mat. Results Both brace types relieved pain. Use of a FB altered gait parameters that are associated with movement of the involved and the uninvolved limb during the gait cycle, whereas the use of a CF-AFO did not affect the gait cycle. Conclusion This study suggests that pain relief from both types of braces is identical but use of a CF-AFO does not alter gait patterns. [ABSTRACT FROM AUTHOR]

HPI: A 26-year old male presented to the emergency department after experiencing the acute onset of left ankle pain while playing basketball. Upon jumping, he felt a “pop” in his left posterior ankle, followed by pain and difficulty ambulating. His exam was notable for a defect at the left Achilles tendon on palpation. The practitioner performed a Thompson test, which was positive (abnormal) on the left. Significant Findings: The left Achilles tendon had a defect on palpation, while the right Achilles tendon was intact. When squeezing the right (unaffected) calf, the ankle spontaneously plantar flexed, indicating a negative (normal) Thompson test. Upon squeeze of the left (affected) calf, the ankle did not plantar flex, signifying a positive (abnormal) Thompson test. The diagnosis of left Achilles tendon rupture was confirmed intraoperatively one week later. Discussion: The Achilles tendon (also: calcaneal tendon or heel cord) is derived from the medial and lateral heads of the gastrocnemius muscle, as well as the soleus muscle. Rupture of the Achilles tendon most commonly occurs in the distal tendon, approximately 2-6 cm from its attachment to the calcaneal tuberosity, in an area of hypovascularity known as the “watershed” or “critical” zone.1-3 The Thompson test (also: Simmonds-Thompson test), described by Simmonds in 1957 and Thompson in 1962, is done while the patient is in the prone position, with feet hanging over the end of a table/gurney, or with the patient kneeling on a stool or chair.4-5 Squeezing the calf of an unaffected limb will cause the ankle to plantar flex, but squeezing the calf of a limb with an Achilles tendon rupture will cause no motion. The sensitivity of the Thompson’s test for the diagnosis of a complete Achilles tendon rupture is 96-100% and the specificity is 93-100%, but data is limited.6-8

Abstract Background The analysis of internet search traffic may present the opportunity to gain insights into general trends and patterns in information seeking behaviour related to medical conditions at a population level. For prevalent and widespread problems such as foot and ankle pain, this information has the potential to improve our understanding of seasonality and trends within these conditions and their treatments, and may act as a useful proxy for their true incidence/prevalence characteristics. This study aimed to explore seasonal effects, general trends and relative popularity of internet search terms related to foot and ankle pain over the past decade. Methods We used the Google Trends tool to obtain relative search engine traffic for terms relating to foot and ankle pain and common treatments from Google search and affiliated pages for major northern and southern hemisphere English speaking nations. Analysis of overall trends and seasonality including summer/winter differences was carried out on these terms. Results Searches relating to general foot pain were on average 3.4 times more common than those relating to ankle pain, and twice as common as searches relating to heel pain. Distinct seasonal effects were seen in the northern hemisphere, with large increases in search volumes in the summer months compared to winter for foot (p = 0.004, 95 % CI [22.2–32.1]), ankle (p = 0.0078, 95 % CI [20.9–35.5]), and heel pain (p = 0.004, 95 % CI [29.1–45.6]). These seasonal effects were reflected by data from Australia, with the exception of ankle pain. Annual seasonal effects for treatment options were limited to terms related to foot surgery and ankle orthoses (p = 0.031, 95 % CI [3.5–20.9]; p = 0.004, 95 % CI [7.6–25.2] respectively), again increasing in the summer months. Conclusions A number of general trends and annual seasonal effects were found in time series internet search data for terms relating to foot and ankle pain. This data may provide insights into these conditions at population levels.

The purpose of this article is to report 3 cases of Kager's fat pad scarring and tethering to the deep surface of the Achilles tendon in patients with Achilles tendinosis symptomatology. The 3 patients were diagnosed sonographically by the use of a dynamic maneuver we described and named the "Kager's squeeze" technique. The key finding for diagnosis is the deformation and bowing of the deep fibers of the Achilles tendon during dynamic squeezing of Kager's fat pad. After diagnosis, the patients were treated with ultrasound-guided hydrodissection and scar release to restore normal motion between Kager's fat pad and the Achilles tendon. All 3 patients experienced significant clinical improvement shortly after treatment. Therefore, we suspect that Kager's fat pad scarring with Achilles tendon tethering may mimic or exacerbate Achilles tendinosis symptomatology and should be considered a possible diagnosis when conservative treatments for Achilles tendinosis fail. We demonstrate that Kager's fat pad scarring with Achilles tendon tethering can be diagnosed and treated with a simple in-office hydrodissection technique, leading to improved patient outcomes. [ABSTRACT FROM AUTHOR]

Fatigue stress fractures of the talus are rare and usually involve the head of the talus in military recruits. We report an uncommon cause of ankle pain due to a fatigue stress fracture of the body of the talus in a 32-year-old male social soccer player. Healing was achieved after weightbearing suppression for 6 weeks. Although rare, a stress fracture of the body of the talus should be considered in an athlete with a gradual onset of chronic ankle pain. Magnetic resonance imaging and bone scan are useful tools for early diagnosis. [ABSTRACT FROM AUTHOR]

Background: Total ankle arthroplasty (TAA) has become a successful treatment for end-stage ankle arthritis. Some patients may still have pain or may present with new pain. Suggested sources of medial pain include tibialis posterior tendonitis, impingement, or medial malleolar stress fracture. Etiology and treatment remain unclear. The objective of our study was to evaluate patients with delayed-onset medial malleolar pain following TAA who underwent treatment with percutaneous medial malleolar screw placement and propose an etiology. Materials and Methods: Patients who had undergone TAA at our institution were reviewed and those with medial malleolar pain were identified. Clinical and radiographic examinations were performed pre- and postoperatively. Radiographs were compared with those from a cohort of controls without a history of medial pain. All affected patients failed conservative therapy and were treated with percutaneous placement of medial malleolar screws positioned from the malleolar tip and extending proximally beyond the tibial component. Postoperatively, patients were placed in an ace wrap and allowed to be weightbearing to tolerance, except for 1 patient initially restricted to partial weightbearing. Visual analog scale (VAS) scores were recorded. Seventy-four (74) patients underwent TAA by the corresponding author. All (100%) were female with an average age of 66 (range, 57-73) years. Average follow-up since screw placement was 21.4 (range, 10-41) months. Results: Six (8.1%) underwent placement of 2 percutaneous medial malleolar screws. Patients presented with pain an average of 12 (range, 4-24) months postoperatively and underwent screw placement an average of 2.8 (range, 1-6) months after presentation. At the time of TAA, none had a coronal plane deformity and none underwent a deltoid ligament release as part of balancing. All (100%) patients had pain and swelling directly over the medial malleolus prior to screw placement. Postoperatively, 1 (17%) had mild pain clinically at this site and 2 (33%) had occasional pain medially with activity. Average VAS scores improved from 5.7 (range, 4-6) preoperatively to 1.3 (range, 0-3) postoperatively (P < .05). Three (50%) patients had a bone density test and all were normal. Prior to screw placement, radiographs demonstrated no signs of stress fracture or misalignment. Average minimum width of the medial malleolus at the level of the tibial component was 10.2 mm (range, 9.2-11.0), which was significantly less (P < .05) than the control group of 19 patients whose distance measured 12.2 mm (range, 8.5-14.8). Discussion: Patients who present with new-onset medial malleolar pain with normal radiographs following TAA may have medial malleolar insufficiency fracture. These patients can be treated successfully with minimal morbidity by placement of percutaneous medial malleolar screws. Etiology may be related to deltoid traction, subacute stress fracture, and/or impingement of the talus component on the medial malleolus. Medial malleolar pain may be misdiagnosed as tibialis posterior tendonitis, impingement, or implant failure. This diagnosis should be considered in patients who have pain at the medial malleolus, particularly if they are female or have medial malleolus thickness less than 11 mm at the level of the tibial implant. Placement of prophylactic medial malleolar screws may be considered at the time of TAA when these conditions exist. Level of Evidence: Level IV, case series. [ABSTRACT FROM AUTHOR]

Introduction/Purpose: Ankle fractures are among the most commonly surgically treated orthopaedic injuries, with debate regarding their long-term outcomes and the clinical benefit of contemporary fixation strategies. The purpose of this study was to retrospectively evaluate the functional outcomes of patients following surgical management of ankle fractures, and to determine what, if any, limitations and effects their injury has on their daily lives. The authors of this study hypothesized that despite patients having some degree of measurable impairments, these did not cause meaningful disruption in their everyday lives. Methods: We retrospectively reviewed a total of 259 patients who underwent surgical management of their ankle fractures between 2004 and 2012. Two separate patient reported outcome measures, the Foot Function Index (FFI) and Short Musculoskeletal Function Assessment (SMFA) were obtained at a minimum of 5 years following time of surgery. Multivariate linear regression analysis was performed to compare FFI and SMFA against several patient and injury specific variables. Results: A total of 259 patients with ankle fractures were included in the study population. 7 of the demographic and injuryrelated variables were found to have a statistically significant relationship to both the FFI and SMFA scores. The multivariate linear regression analysis using these 7 variables in addition to both sub-group components of the SMFA to predict the total FFI score yielded an output adjusted-r2 = 0.78. The SMFA dysfunction sub-category was found to correlate with FFI (standardized beta 0.85, p<0.001), but the SMFA bothersome sub-category did not (p=0.866). Ankle pain limiting function and Medicaid insurance status were also predictive of higher FFI scores. Conclusion: Despite patients, at times, experiencing persistent issues with pain and mild activity limitations following surgical management of ankle fractures, these did not lead to measured burdens in daily activities. At a moderate-length follow-up, patients overall do well from a functional standpoint after sustaining ankle fractures treated surgically. [ABSTRACT FROM AUTHOR]

Introduction/Purpose: The decision regarding total ankle replacement is challenging in inflammatory arthritis patients regarding more inferior bone quality, large bone cysts, and increased risk for infections. This systematic review aimed to compare the short and long-term results of total ankle replacement, including the revision rate and the patient-reported outcomes between inflammatory rheumatoid arthritis (RA) versus non-inflammatory ankle osteoarthritis (OA). Methods: All published clinical studies on total ankle arthroplasty were searched in the databases. We extracted the data, specifically the American Orthopaedic Foot & Ankle Society (AOFAS) improvement, complication rate, and the reoperation rate. The results were also analyzed based on the prosthesis type. Results: In total, 34 trials were included in our study. Out of 5,078 patients, the underlying condition was rheumatoid arthritis in 1,327 patients and was non-inflammatory osteoarthritis in 2,849 patients. There was statistically significant higher AOFAS improvement in the patients with RA vs. OA with a mean follow-up of 63 months (P=0.009). The rates of TAA removal or revision were estimated at 16% (95% CI, 10%-23%) in the OA and 13% (95% CI, 9%-18%) in the RA group. Overlapping confidence intervals showed no significant difference in the rate of failure between RA and OA. The survival rate was 66% in the OA group and 88% in the RA group during a 63-month follow-up. Conclusion: Total ankle replacement is a safe procedure in RA patients with fewer minor and major complications relative to other reasons for ankle osteoarthritis. [ABSTRACT FROM AUTHOR]

Os trigonum is a congenital condition in which a bone ossicle fails to fuse to a secondary ossification center in the posterior aspect of the talar bone. Repetitive plantar flexion of the foot may elicit inflammation of the ossicles fibrous connective band, subsequently causing pain. It is common to misdiagnose os trigonum as an avulsion fracture. We report a case of a 23.year.old male with symptomatic os trigonum diagnosed on Tc.99m hydroxymethylene diphosphonate single.photon emission computed tomography.computed tomography (SPECT.CT). We also wish to emphasize on the use of SPECT/CT in not only allocating the ossicle anatomically but also for the purpose of evaluation an active source of pain in a region of multiple complex small bones. [ABSTRACT FROM AUTHOR]