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Motoneuronal persistent inward currents (PICs) are facilitated by neuromodulatory inputs but are highly sensitive to local inhibitory circuits. Estimates of PICs are reduced by group Ia reciprocal inhibition, and increased with the diffuse actions of neuromodulators released during remote muscle contraction. However, it remains unknown how motoneurons function in the presence of simultaneous excitatory and inhibitory commands. To probe this topic, we investigated motor unit discharge patterns and estimated PICs during voluntary co‐contraction of ankle muscles, which simultaneously demands the contraction of agonist–antagonist pairs. Twenty participants performed triangular ramps of both co‐contraction (simultaneous dorsiflexion and plantar flexion) and isometric dorsiflexion to a peak of 30% of their maximum muscle activity from a maximal voluntary contraction. Motor unit spike trains were decomposed from high‐density surface EMG activity recorded from tibialis anterior using blind source separation algorithms. Voluntary co‐contraction altered motor unit discharge rate characteristics. Discharge rate at recruitment and peak discharge rate were modestly reduced (∼6% change; P < 0.001; d = 0.22) and increased (∼2% change; P = 0.001, d = −0.19), respectively, in the entire dataset but no changes were observed when motor units were tracked across conditions. The largest effects during co‐contraction were that estimates of PICs (ΔF) were reduced by ∼20% (4.47 vs. 5.57 pulses per second during isometric dorsiflexion; P < 0.001, d = 0.641). These findings suggest that, during voluntary co‐contraction, the inhibitory input from the antagonist muscle overcomes the additional excitatory and neuromodulatory drive that may occur due to the co‐contraction of the antagonist muscle, which constrains PIC behaviour. Key points: Voluntary co‐contraction is a unique motor behaviour that concurrently provides excitatory and inhibitory synaptic input to motoneurons.Co‐contraction of agonist–antagonist pairs alters agonist motor unit discharge characteristics, consistent with reductions in persistent inward current magnitude. [ABSTRACT FROM AUTHOR]

Purpose: Static stretching (SS) improves flexibility but may impair the accuracy of joint position sense. Therefore, this study aimed to investigate the acute effects and time course of SS on the accuracy of joint position sense, range of motion (ROM), and muscle–tendon unit (MTU) stiffness. Methods: This study randomly assigned 16 healthy, young males to the SS and control conditions. SS intervention in the SS condition was performed on the plantar flexors of the dominant leg for three sets of 60 s. The participants were instructed to sit for 240 s in the control condition. The ankle dorsiflexion (DF) ROM, passive torque at DF ROM, MTU stiffness, and joint position sense on the dominant leg side were measured before (PRE) and immediately (POST) and at 5, 10, and 20 min postintervention. Results: A significant interaction effect was observed in the relative error in the joint position sense, and significant increases were noted in POST compared to PRE in the SS condition. Further, significant interactions were observed in DF ROM, passive torque at DF ROM, and MTU stiffness. The SS condition demonstrated significant increases in DF ROM and passive torque at DF ROM compared to PRE with POST, 5 min, and 10 min, and MTU stiffness significantly decreased in POST compared with PRE. Conclusion: Our results indicated that the accuracy of the joint position sense decreased immediately after SS, but returned to baseline in a very short time. [ABSTRACT FROM AUTHOR]

Purpose: Musculotendinous stiffness (MTS) measurement is valuable for assessing stretch-induced effects for sports injury prevention. There is no consensus on whether there are sex-related differences in MTS reduction by stretching, and no effective stretching protocol exists. We aimed to investigate the sex-related differences in stretch-induced MTS changes. Methods: Fifteen healthy men (22.0 ± 1.0 years) and fifteen healthy women (22.3 ± 1.1 years) performed stretching of the ankle plantar flexors for four sets of 30 s each. MTS was measured before and after each set of stretching. Results: A significant two-way interaction (time × sex) was found for MTS (p = 0.021). MTS significantly decreased after one set of stretching in men (p = 0.024) and after three sets in women (p = 0.001). MTS after one and four sets of stretching was significantly higher in men than in women (p = 0.038 and p = 0.019, respectively). Conclusion: Fewer stretching sets are needed for men compared with that required for women to decrease MTS, and the MTS change is greater for men. Thus, the patient's sex should be considered when designing an optimum stretching protocol. [ABSTRACT FROM AUTHOR]

This study investigates the impact of chronic ankle instability (CAI) on athletes’ lower extremity mechanics during bounce drop-jump landings with divided attention. Thirty Division I physical education voluntarily participated in the study. They performed two sets of bounce drop jumps: one set with a divided attention task and the other without. The obtained data were analysed using a paired t-test to compare the outcomes between the divided attention (DA) and non-divided attention (NDA) tasks. Athletes with CAI, during the DA task, displayed higher vertical landing forces, increased ankle inversion velocity, and greater range of motion of the ankle, knee, and hip in the frontal and transverse planes. They also exhibited insufficient neuromuscular preparation of the rectus femoris muscle. Notably, distinct kinematic alterations were observed in the ankle, knee, and hip joints regarding frontal and transverse lower-extremity kinematics. The findings suggest that athletes with CAI experience decreased activation of the rectus femoris muscle, which may impact their dynamic postural stability from pre-landing to ascending phases. Furthermore, the results indicate that individuals with CAI closely replicate the injury mechanisms encountered during a drop-jump landing task with divided attention. These insights offer valuable information about the real-time challenges faced by athletes with CAI. [ABSTRACT FROM AUTHOR]

Copyright of Cultura, Ciencia y Deporte is the property of Cultura, Ciencia y Deporte and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Background: Subtle chronic or latent instabilities are difficult to delineate with currently available diagnostic modalities and do not allow assessment of ligamentous functionality. The noninvasive bilateral external torque computed tomography (CT) was able to reliably detect syndesmotic lesions in a cadaveric study. The aim of the study was to test the external torque device in young, healthy subjects at 3 different torque levels and to demonstrate comparability with the contralateral side. Methods: Ten healthy subjects without history of injury or surgery to the ankle joint were enrolled in this cross-sectional study. Four CT scans were performed. During the scans, the lower legs and feet were placed in an external torque device with predefined external rotation torques of 0, 2.5, 5, and 7.5 Nm. Five different radiographic measures of syndesmotic stability were measured: anterior distance (AD), tibiofibular clear space (TCS), posterior distance (PD), external rotation (ER), and β angle. Results: With increasing external torque, slight increases in AD, ER, and β angle were observed, whereas TCS and PD decreased slightly. Large absolute differences were found between the healthy subjects for all measured parameters, regardless of the external torque applied. Differences from the contralateral side using the same external torque were minimal for all parameters, but smallest for AD with a maximum difference of 0.5 mm. Conclusion: Using the healthy contralateral ankle joint is appropriate for assessing syndesmotic stability based on minimal intraindividual side differences using the external torque device. Side differences >0.5 mm in AD and >0.9 mm in PD may be considered abnormal and may indicate significant instability of the syndesmosis. However, future studies are needed to define definitive cutoff values for relevant side differences in acute and chronic syndesmotic instability to guide clinicians in their treatment decisions. [ABSTRACT FROM AUTHOR]

Background: There are limited data regarding risk factors associated with periprosthetic medial malleolar fractures in total ankle arthroplasty (TAA). This case-control study aimed to identify the risk factors and analyze the effect of prophylactic screw fixation in preventing a medial malleolar fracture after TAA. Methods: A case-control study was conducted on 149 patients who underwent primary TAA. Twenty patients with postoperative medial malleolar fractures >4 weeks postoperatively (cases) were identified. An additional 129 patients (controls) were randomly selected from the TAA database. Radiographic evaluation included tibial component coronal alignment and postoperative medial malleolar width. Demographics and radiographic variables were compared between cohorts. Logistic regression was used to investigate the association between medial malleolar fracture and postoperative coronal alignment, medial malleolar width, and prophylactic fixation of the medial malleolus. Results: Mean (SD) medial malleolar width was significantly smaller in the fracture cohort (8.52 mm [1.6]) than in the control group (11.78 mm [1.74]) (P <.001). Mean (SD) tibial component coronal alignment was 92.17 degrees (2.77) in the fracture cohort and 90.21 degrees (1.66) in the control group (P =.002). Regression analysis identified a significant negative association between postoperative medial malleolar width and the probability of fracture (OR = 0.06, 95% CI 0.01, 0.26, P <.001). Varus malalignment of the tibial component was positively associated with the probability of fracture (OR = 1.90, 95% CI 1.27, 2.86, P =.002). Prophylactic screw fixation resulted in more than 90% reduction in the odds of a fracture (OR = 0.04, 95% CI 0.01, 0.45, P =.01). ROC curve analysis determined a medial malleolar width of 10.3 mm as a potential threshold for predicting fracture. Conclusion: Decreased medial malleolar width and postoperative varus malalignment were associated with an increased risk of postoperative medial malleolar fracture. Therefore, surgeons should consider prophylactic screw fixation in patients with a medial malleolar width <10.3 mm or at risk of postoperative varus deformity. [ABSTRACT FROM AUTHOR]

To undertake a systematic analysis of 17 medical attention and time-loss lateral ankle ligament sprain (LALS) events from televised Australian professional netball games during the 2020–2023 seasons. Case series. Three analysts independently assessed the video footage and then convened to review and discuss each case until a consensus was reached. When in possession (7 cases) a player was commonly performing an agility-based manoeuvre to break free from an opponent and reposition themselves to be a passing option (5/7 cases). When out of possession (10 cases) a player was either attempting to intercept a pass (6 cases) or marking an opponent (4 cases). Players tended to land on the anterior one-third of the plantar surface of the foot - forefoot or shoe tip (7 cases). Players often landed on either the ground (7 cases) or the opponent's shoe then the ground (8 cases). In 9 cases the ankle-foot was considered to be in a neutral alignment in the frontal plane at landing. At the estimated index frame the players' weight tended to be all on the foot on the injured side (11 cases) or favouring the foot on the injured side (5 cases). Inversion and adduction was a common injury mechanism. Plantar-flexion was rarely involved. Landing on the anterior one-third of the plantar surface of the foot and subsequent weight transference onto the injured limb side was more important than ankle-foot inversion at initial ground contact. Exercises involving external perturbations that challenge the control of frontal and transverse plane ankle-foot motion and improve proprioception, neuromuscular control, and dynamic balance are warranted. • In 59% of cases, players were involved in a collision of some type with an opponent. • The foot of the injured player contacted the foot of an opponent in 59% of cases. • Injured players tended to land on the forefoot (41% of cases) and transfer weight onto the injured limb side (94% of cases). • Inversion and adduction was common (42% of cases) while plantar-flexion was rarely involved. [ABSTRACT FROM AUTHOR]

The distal tibiofibular joint is described as a syndesmosis. The syndesmosis is important to the structural integrity of the ankle joint by maintaining the proximity of the tibia, fibula, and talus. Syndesmotic or high ankle sprains, involving the syndesmotic ligaments, pose a significant rehabilitative challenge due to their intricate anatomy, prolonged recovery periods following injury, and high susceptibility to persistent disability. Traditional management strategies have often been conservative, marked by lengthy periods of immobilization and a gradual return to activity. Severe syndesmotic injuries with diastasis have been treated surgically with screw fixation which may require a second intervention to remove the hardware and carries an inherent risk of breaking the screw during rehabilitation. Another fixation technique, the Tightrope™, has gained popularity in treating ankle syndesmosis injuries. The TightRope™ involves inserting Fiberwire® through the tibia and fibula, which allows for stabilization of the ankle mortise and normal range of motion. The accelerated rehabilitation protocol promotes early weight-bearing and has been shown to expedite the return to sport. This emerging strategy has shown promise in reducing recovery time as it is now possible to return to sport in less than 2 months after a tightrope repair and accelerated rehabilitation, compared with 3-6 months post screw fixation. This clinical commentary delves into this novel approach, highlighting the procedure, rehabilitation protocols, and the implications for physical therapy practice. [ABSTRACT FROM AUTHOR]

Purpose: Shear wave elastography (SWE) has seen many advancements in Achilles tendon evaluation in recent years, yet standardization of this technique is still problematic due to the lack of knowledge regarding the optimal way to perform the examination. The purpose of this study was to evaluate the effects of ankle position, probe frequency and physical effort on the shear modulus of the Achilles tendon, but also to determine the intra and inter-observer reliability of the technique. Methods: 37 healthy volunteers were included; SWE protocol was performed by two examiners. We analyzed the shear modulus of the tendon with the ankle in neutral, maximum dorsiflexion and maximum plantar flexion using two different high frequency probes. Afterwards, the subjects performed a brief physical exercise and SWE measurements were repeated. Results: The L18-5 probe showed the highest ICC values (ICC = 0.798, 95% CI 0.660–0.880, p < 0.001) when positioned at 2 cm from the calcaneal insertion with the ankle in a neutral state. Conversely, utilizing the same L18-5 probe at 1 cm from the insertion during maximum plantar flexion of the ankle resulted in the lowest ICC (ICC = 0.422, 95% CI 0.032–0.655, p = 0.019). Significant variations in elasticity values were noted among different ankle positions and probe types, while no significant changes in elasticity were observed post-physical exercise. Conclusion: Ankle position and probe frequency are factors that influence elasticity values of the Achilles tendon. An ankle position between 10 and 20 degrees of plantar flexion is the most suitable for SWE evaluation. However, more research focusing on Achilles tendon SWE is essential due to the challenges encountered in standardizing this region. [ABSTRACT FROM AUTHOR]

Higher stature and lower weight are associated with increased risk of fracture. However, the pathophysiology for the associations of height and weight with bone microarchitecture and geometry is unclear. We examined whether these associations were consistent with causation and/or with shared familial factors. In this cross-sectional study of 566 female twins aged 26-76 yr, a regression analysis for twin data, Inference about Causation by Examination of FAmilial CONfounding (ICE FALCON), was used for testing causation. The bone microarchitecture and geometry of the distal tibia was assessed using HR-pQCT and the StrAx1.0 software. Higher stature was associated with larger total bone cross-sectional area (CSA), lower total bone volumetric bone mineral density (vBMD), larger cortical CSA, thinner cortices, higher porosity of the total cortex, compact cortex, outer and inner transitional zone (TZ), lower cortical vBMD, and larger medullary CSA (regression coefficients (β) ranging from −.37 to.60, all p<.05). Using ICE FALCON, the cross-pair cross-trait associations attenuated toward zero after adjusting for the within-individual association (absolute values of β ranging from.05 to.31, all p<.001). Higher weight was associated with higher total bone vBMD, larger cortical CSA and thicker cortices, lower porosity of the total cortex and inner TZ, and higher cortical vBMD (β ranging from −.23 to.34, all p<.001), and thinner trabeculae, higher trabecular number, lower trabecular separation, and higher trabecular vBMD (β ranging from −.31 to.39, all p<.05). Only cortical CSA attenuated toward zero after adjusting for the within-individual association between weight and bone microarchitecture (β = .042, p=.046). Higher stature was associated with a weaker cortical, not trabecular bone traits, whereas higher weight was associated with stronger cortical and trabecular bone traits. The results were consistent with height having a causal effect on weaker cortical bone structure, whereas weight had a casual effect on the larger cortical CSA. Lay Summary: Height and weight are associated with the bone structure and the likelihood of suffering a fragility fracture. Taller women have an increased risk of hip, wrist, and spine fracture, while heavier women have a lower risk of hip fracture and a higher risk of fractures in the ankle, leg, or upper arm. To give patients better advice regarding bone health, we need to know more about how height and weight are related to the bone structure. We examined measurements from high-resolution radiological investigation of the distal tibia obtained from 566 female Australian twins aged 26-76 yr. We used a statistical method (ICE-FALCON) that can detect whether the results are likely to be causal by using cross sectional twin data. The analysis showed that taller women had a weaker architecture in the outer part of their wider bone, while heavier women had a stronger architecture in both the outer and inner porous part of the bone. The ICE-FALCON analysis showed that the height itself is likely to have a causal relationship with most of the bone structure of the distal tibia, while weight was unlikely to have a causal relationship with most of the bone traits measures. Graphical Abstract [ABSTRACT FROM AUTHOR]

Copyright of Journal of South China University of Technology (Natural Science Edition) is the property of South China University of Technology and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Purpose: This study aims to evaluate how the structure of medical compression stockings, including three compression levels and five cross-sections from the ankle to the thigh part, will be changed after washing in different conditions and further investigate the effect of the washing parameters on the medical compression stockings. Design/methodology/approach: By washing medical compression stockings in different conditions and measuring the structures (including the density, the girth, the transversal and lengthwise dimension, the weight per unit area and the thickness) of medical compression stockings from the knee to the thigh part. Findings: It was concluded that the density, the weight per unit and the thickness increase and the girth, the transversal and lengthwise dimension, the weight per unit and the thickness decrease. The change degree of Class one and Class two is greater than Class 3. Moreover, the washing temperature is the most significant factor affecting all the structures of medical compression stockings. Meanwhile, the mechanical actions of the washing machine, like drum speed and washing time, also influence different medical compression stockings structures to different degrees. Research limitations/implications: The washing parameter not only includes the temperature and washing cycles but also has other factors, such as the drum speed and washing time. In addition, different kinds of factors will be influenced by each other. Originality/value: This study can provide consumers advices on the washing of medical compression stockings, and attribute to the optimization of materials and structures to maintain its properties for manufacturers. [ABSTRACT FROM AUTHOR]

Functional Ankle Instability (FAI) is the subject of extensive research in sports and other environments. Given the importance of accurately measuring this latent construct, it is imperative to carry out a careful assessment of the available tools. In this context, the aim of this review was to take an in-depth look at the six most cited measurement tools to assess FAI, with a specific focus on patient-reported outcome measures related to ankle and foot. Four electronic databases (Web of Science, Scopus, Pubmed, and SportDiscus) were searched (up to November 2022) to identify the six most cited questionnaires for assessing FAI. Our analysis showed that the most cited questionnaires are the following: the Lower Extremity Functional Scale (LEFS), the Foot Function Index (FFI), the Foot and Ankle Ability Measure (FAAM), the Foot and Ankle Outcome Score (FAOS), the Olerud and Molander Ankle Score (OMAS), and the Cumberland Ankle Instability Tool (CAIT). Each questionnaire was thoroughly assessed and discussed in three sections: Development, Reliability, and Summaries. In addition, bibliometric data were calculated to analyze the relevance of each questionnaire. Despite variations in terms of validity and reliability, conceptualization, structure, and usefulness, the six questionnaires proved to be robust from a psychometric point of view, being widely supported in the literature. The bibliometric analyses suggested that the FAOS ranks first and the FFI ranks sixth in the weighted average of the impact factors of their original publications. [ABSTRACT FROM AUTHOR]

The normal physiology of wound healing is impacted by sickle cell disease (SCD). With SCD, the red blood cells are misshapen due to an abnormality of haemoglobin S. Sickle cell leg ulcers usually occur around the ankle and have very poor healing rates, with a detrimental impact on quality of life, particularly as they usually develop in patients who are in their 20s (Marti-Carvajal et al, 2021). This article looks at some of the treatment options for SCD and whether these treatments have an impact, either positively or to the detriment of leg ulcer/wound healing. There are multiple physiological factors influencing the development of sickle cell leg ulcers, and their [ABSTRACT FROM AUTHOR]

Copyright of Journal of Clinical Nursing in Practice is the property of Journal of Clinical Nursing in Practice (Editorial Board, Shanghai Jiao Tong University Press) and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Practicing physical activities or sports that involve frequent jumping and landing can strain the muscles and joints of the lower limbs, especially in those who do not have adequate physical preparation. The objective of this study was to (a) determine the correlation between ankle range of motion (ROM) and landing stability following jumps; (b) assess the association between the jump height in a counter-movement jump (CMJ) test and ankle ROM; and (c) examine the connection between stabilometry during specific jumps movements present in many sports and in ankle stabilization. Sixty-two healthy amateur volleyball players participated in the study (age: thirty-seven females and twenty-five males; age (years): 16.5 ± 4.25; height (cm): 166 ± 11.4; weight (Kg): 61.6 ± 13.7). Participants were recruited for the study in collaboration with student sports associations. The evaluations encompassed the measurement of ankle joint mobility for both lower limbs using an inertial sensor, a static baropodometric and stabilometric analysis using a pressure platform, and the CMJ test using the Microgate system. After the assessments, participants performed a "specific jump landing task". Significant correlations were found between foot range of motion (ROM) and counter-movement jump (CMJ) performance. Specifically, the ROM of the right foot had a strong correlation with the CMJ (r = 0.81, p < 0.001), while the left foot ROM showed a moderate correlation (r = 0.46, p < 0.001). The specific jump task revealed substantial changes in stabilometry parameters, particularly during forward hops compared to lateral jumps. Dorsiflexion ROM significantly impacts jumping ability. Evaluating landing patterns and stabilometry during targeted activities can help optimize training, improve dynamic balance, and reduce ankle injury risk. [ABSTRACT FROM AUTHOR]

Balance is important in lifesaving competitions. We aimed to investigate the relationship between dynamic balance and physical characteristics and functions in elite lifesavers by measuring the foot muscle cross-sectional area, ankle joint muscle strength, toe grasp strength, plantar superficial sensation, and dynamic balance (Y-balance test). In this observational study, we measured the foot muscle cross-sectional area, ankle dorsiflexion, plantar flexion, external flexion, isometric muscle strength, toe grasp strength, and superficial foot sensation of 15 adult lifesavers (12 males). The results show that toe grasp strength and ankle plantar flexion isometric muscle strength are particularly important for the dynamic balance of elite lifesavers working on sandy surfaces. Sand training improves intrinsic muscle strength and dynamic balance function. However, high training intensity may reduce plantar surface sensation; this needs to be verified through sand training interventions in the future. [ABSTRACT FROM AUTHOR]

Objective Diffuse‐type tenosynovial giant cell tumors (Dt‐TGCTs) commonly occur in the knee joint and tend to recur postoperatively. However, limited clinical data are available on ankle joint involvement especially associated multiportal arthroscopic treatment outcomes. The purpose of this study was to report the clinical results of multiportal arthroscopy‐assisted resection of Dt‐TGCTs of the ankle. Methods We retrospectively reviewed the clinical data of 33 patients with Dt‐TGCT of the ankle who underwent multiportal arthroscopic treatment between August 2011 and December 2020. Clinical follow‐up included the visual analogue scale (VAS) score, American Orthopedic Foot and Ankle Society (AOFAS) score, Kofoed score, and recurrence rate to assess surgical outcomes. The number of patients who achieved the patient acceptable symptom state (PASS) based on the AOFAS score was also examined. Additionally, the patients were categorized into two groups based on the final surgical approach: Group A who underwent multiportal arthroscopic synovectomy and Group AO who underwent combined arthroscopic and open surgical excision. Intergroup comparisons were conducted. Intraoperative characteristics, such as the number of patients with involvement of the tarsal tunnel and fibularis tendon and the Outerbridge grading of cartilage damage, were recorded to assess the selection of surgical procedures. Results Among the 33 patients, 15 were assigned to Group A, and 18 were in Group AO. The median follow‐up duration for the 33 patients was 77 months (range, 28–142 months). The median VAS score was 1 (range, 0–4), the AOFAS score was 96 (range, 65–100), and the Kofoed score was 96 (range, 67–100). A total of 27 patients (82%) achieved PASS based on AOFAS scores, while five patients (15%) had recurrence. No statistically significant difference was observed between the two groups in recurrence rate, follow‐up VAS score, AOFAS score, Kofoed score, or number of patients who reached the PASS (p > 0.05). In the AO group, 16 cases of Dt‐TGCT involved the tarsal tunnel, and 11 cases involved the fibularis tendon. All these patients exhibited extension beyond the joint. In contrast, only one patient in Group A had involvement of the tarsal tunnel. Statistically significant differences were observed between the groups (p

BACKGROUND: Distraction arthroplasty of the ankle joint is the treatment method used for the cases of terminal osteoarthritis of the ankle joint that allows for delaying the arthrodesis or the total endoprosthesis replacement. The therapeutic effect is being achieved due to the separation of the articular surfaces (arthrodiastasis) with using the Ilizarov frame (or other devices for external fixation) for a period of 8–12 weeks. Only one research was described with the patients undergoing repeated arthroscopy of the ankle joint after the distraction arthroplasty in a combination with microfracturing of the cartilage defects, or repeated arthroscopy at the moment of removing the external fixation device (after 3 months). АIM: To study the changes in the articular surfaces according to the Outerbridge before and after the distraction arthroplasty of the ankle joint using the repeated arthroscopy of the ankle joint. METHODS: A total of 17 distraction arthroplasty surgical interventions of the ankle joint were performed (7 [41.2%] females and 10 [58.8%] males; the mean age of the patients was 48.5±13.57 years). Repeated arthroscopy of the ankle joint due to the recurrence of anterior impingement-syndrome after the distraction arthroplasty of the ankle joint within up to 12 months from the moment of removing the Ilizarov frame was carried out in 4 patients. For the evaluation of the treatment results, the Foot and Ankle Ability Measure (FAAM) scales were used, with an evaluation of pain, functions, deformity and the alignment of the foot and of the ankle joint (АОFAS Ankle-hindfoot scale), with subjective evaluation of pain (VAS); the status of the cartilage tissue in the ankle joint was evaluated using the modified Outerbridge scale. RESULTS: In all the patients, a statistically significant improvement of the functional result was found in 12 months from the moment of surgery when using the FAAM (р=0.0006) and АОFAS Ankle-hindfoot scales, as well as after removing the Ilizarov frame in 1, 3 and 6 months. The pain intensity according to the VAS scale has decreased from 6.17±1.32 cm before surgery to 2 cm (1.4; 2.1) (p=0.00002) in 12 months. The arthroscopic findings upon the repeated interventions demonstrate the development of the massive arthrofibrosis with its further degradation to the end of 6 months, also showing the restoration of the cartilage defects from Outerbridge grade IV to grade II–III. CONCLUSION: Upon the repeated arthroscopy, including the one performed at the end of 12 months after the distraction arthroplasty of the ankle joint, signs of regeneration were observed in the cartilage tissue defects with further defect coverage with a cartilage-like tissue, which, probably, determines the analgesic effect of the distraction arthroplasty of the ankle joint.

Abstract Our hypothesis is that the peroneus longus (PL) is a great option for ligament reconstruction in the knee, and therefore the objective of the study is to determine if the use of this graft is safe and does not cause secondary damage to the harvested area. A prospective study was conducted between April 2019 and September 2022. Patients who underwent any type of knee ligament reconstruction using the PL or just the anterior half (AHPL) as grafts were followed up. These patients were evaluated according to the Tegner–Lysholm score and the International Knee Documentation Committee (IKDC) guidelines for functional evaluation of the knee and the American Orthopedic Foot and Ankle Score (AOFAS) and the Foot and Ankle Disability Index (FADI) for the functional evaluation of the ankle. Most patients had an increase in the IKDC score, Tegner–Lysholm score, AOFAS and FADI regardless of the graft used in the surgical procedure, with mean values at the 24-month follow-up of, respectively, 99.02± 0.02, 98.69± 0.08, 99.92± 0.07, and 99.92± 0.07 for those with PL grafts and 99.31± 0.54, 98.88± 0.95, 100± 0.00, and 100± 0.00 for those with AHPL grafts. The differences in the scores between the two graft groups during each of the follow-up periods were significant (P = 0.001). The use of the peroneus longus tendon as a graft in knee surgeries was shown to be adequate for achieving good knee functional results.

Abstract Background Various treatment approaches for individuals with ankle sprains can reduce treatment costs and enhance recovery. This study aimed to compare the efficacy of spring ankle braces with splints and casts in treating ankle sprains. Materials and methods This cross-sectional study involved 60 patients diagnosed with ankle sprains at the orthopedic clinic of Imam Khomeini Hospital in Jiroft in 2022. Following diagnosis confirmation through additional examinations and imaging, patients with ankle sprains not requiring surgery were selected and placed in two groups: one treated with spring ankle braces and the other with splints or casts. Both groups underwent a 4-week treatment regimen, comprising 30 individuals each. Data were collected and analyzed using SPSS version 26. Results The average age of patients was 32.5 ± 13.4 years. Of the ankle sprain patients, 56.7% were male. Patients reported the highest satisfaction levels with the plaster cast treatment method. A statistically significant relationship was found between patient satisfaction and the treatment methods of spring ankle braces and plaster casting (P

Abstract Background Advances in medical imaging have made it possible to classify ankle fractures using Artificial Intelligence (AI). Recent studies have demonstrated good internal validity for machine learning algorithms using the AO/OTA 2018 classification. This study aimed to externally validate one such model for ankle fracture classification and ways to improve external validity. Methods In this retrospective observation study, we trained a deep-learning neural network (7,500 ankle studies) to classify traumatic malleolar fractures according to the AO/OTA classification. Our internal validation dataset (IVD) contained 409 studies collected from Danderyd Hospital in Stockholm, Sweden, between 2002 and 2016. The external validation dataset (EVD) contained 399 studies collected from Flinders Medical Centre, Adelaide, Australia, between 2016 and 2020. Our primary outcome measures were the area under the receiver operating characteristic (AUC) and the area under the precision-recall curve (AUPR) for fracture classification of AO/OTA malleolar (44) fractures. Secondary outcomes were performance on other fractures visible on ankle radiographs and inter-observer reliability of reviewers. Results Compared to the weighted mean AUC (wAUC) 0.86 (95%CI 0.82–0.89) for fracture detection in the EVD, the network attained wAUC 0.95 (95%CI 0.94–0.97) for the IVD. The area under the precision-recall curve (AUPR) was 0.93 vs. 0.96. The wAUC for individual outcomes (type 44A-C, group 44A1-C3, and subgroup 44A1.1-C3.3) was 0.82 for the EVD and 0.93 for the IVD. The weighted mean AUPR (wAUPR) was 0.59 vs 0.63. Throughout, the performance was superior to that of a random classifier for the EVD. Conclusion Although the two datasets had considerable differences, the model transferred well to the EVD and the alternative clinical scenario it represents. The direct clinical implications of this study are that algorithms developed elsewhere need local validation and that discrepancies can be rectified using targeted training. In a wider sense, we believe this opens up possibilities for building advanced treatment recommendations based on exact fracture types that are more objective than current clinical decisions, often influenced by who is present during rounds.

Abstract Introduction Posterior tibial nerve (PTN) cross‐sectional area (CSA) reference values for the diagnosis of tarsal tunnel syndrome (TTS) using ultrasound imaging exist in several countries but not in South Africa (SA). Therefore, the objective was to measure the CSA reference values for PTN in SA. Methods Ultrasound CSA measurements of PTN in both ankles on 112 participants were performed, the mean measurement was recorded, and the effect of race, age, gender, and body mass index (BMI) were recorded. Results In this study, the primary variables age and BMI affect the CSA measurement of the PTN. A positive correlation was found between PTN asymptomatic size and age (r = 0.196, P

Dysplasia epiphysealis hemimelica (DEH), also known as Trevor’s disease, is a rare disease which is skeletal developmental disorder characterized by asymmetrical growth of epiphyseal cartilage. It most frequently affects the ankle joint. Surgical treatment with complete resection is recommended before irreversible joint damage and deformity occurs. Multiple surgeries may be required if resected at an early age because recurrences are common until skeletal maturity. We present a case of DEH at the anteromedial aspect of a left ankle joint and a review of the literature.

Chronic lateral ankle instability is a relatively frequent consequence after acute ankle sprain. In case of unsuccessful conservative treatment, surgical therapy is recommended to prevent osteoarthritis of the ankle joint. To date, different surgical methods have evolved. Yet, it remains unclear which approach reveals the best results. We hypothesized that the modified Broström–Gould procedure with suture anchor ligament fixation leads to superior postoperative results compared to the Broström–Gould procedure or the periosteal flap technique.

Abstract Background The relationship between ankle blood pressure (BP) and cardiovascular disease remains unclear. We examined the relationships between known and new ankle BP indices and major cardiovascular outcomes in people with and without type 2 diabetes. Methods We used data from 3 large trials with measurements of ankle systolic BP (SBP), ankle-brachial index (ABI, ankle SBP divided by arm SBP), and ankle-pulse pressure difference (APPD, ankle SBP minus arm pulse pressure). The primary outcome was a composite of cardiovascular mortality, myocardial infarction, hospitalization for heart failure, or stroke. Secondary outcomes included death from cardiovascular causes, total (fatal and non-fatal) myocardial infarction, hospitalization for heart failure, and total stroke. Results Among 42,929 participants (age 65.6 years, females 31.3%, type 2 diabetes 50.1%, 53 countries), the primary outcome occurred in 7230 (16.8%) participants during 5 years of follow-up (19.4% in people with diabetes, 14.3% in those without diabetes). The incidence of the outcome increased with lower ankle BP indices. Compared with people whose ankle BP indices were in the highest fourth, multivariable-adjusted hazard ratios (HRs, 95% CI) of the outcome for each lower fourth were 1.05 (0.98–1.12), 1.17 (1.08–1.25), and 1.54 (1.54–1.65) for ankle SBP; HR 1.06 (0.99–1.14), 1.26 (1.17–1.35), and 1.48 (1.38–1.58) for ABI; and HR 1.02 (0.95–1.10), 1.15 (1.07–1.23), and 1.48 (1.38–1.58) for APPD. The largest effect size was noted for ankle SBP (HRs 1.05 [0.90–1.21], 1.21 [1.05–1.40], and 1.93 [1.68–2.22]), and APPD (HRs 1.08 [0.93–1.26], 1.30 [1.12–1.50], and 1.97 [1.72–2.25]) with respect to hospitalization for heart failure, while only a marginal association was observed for stroke. The relationships were similar in people with and without diabetes (all p for interaction > 0.05). Conclusions Inverse and independent associations were observed between ankle BP and cardiovascular events, similarly in people with and without type 2 diabetes. The largest associations were observed for heart failure and the smallest for stroke. Including ankle BP indices in routine clinical assessments may help to identify people at highest risk of cardiovascular outcomes. Graphical abstract Ankle blood pressure indices and incidence of major cardiovascular outcomes. Expanded MACE, a composite of death from cardiovascular causes, myocardial infarction,hospitalization for heart failure, or stroke. BP, blood pressure; CV, cardiovascular; HHF, hospitalization for heart failure; HR, Hazard ratio (for the lowest fourth of blood pressure indice compared to the highest); MACE, major adverse cardiovascular events; MI, myocardial infarction; Total, fatal and non-fatal MI or stroke.

Background: Plantar sensation and ankle proprioception occur in a stage-like variance across the life span. However, changes in adolescents, young adults, middle-aged adults, and older adults remain unclear. The aim of this study was to investigate the differences of plantar sensation and ankle proprioception in adolescents to older adults. Methods: A total of 212 participants were recruited in the study and were divided into four groups, including adolescents (n = 46), young adults (n = 55), middle-aged adults (n = 47), and older adults (n = 54). Plantar tactile sensitivity/tactile acuity/vibration threshold and ankle movement threshold/joint position sense/force sense were assessed in all groups. The Kruskal–Wallis H test was used to analyze the differences in Semmes–Weinstein monofilaments between different age groups in different plantar positions. One-way analysis of variance was used to determine differences in foot vibration threshold, two-point discrimination, and ankle proprioception between different age groups. Results: Significant differences were found in the Semmes–Weinstein monofilament test (p <.001), the two-point discrimination test (p <.05), and the vibration threshold test (p <.05) in the six tested plantar positions among adolescents, young adults, middle-aged adults, and older adults. For ankle proprioception, significant differences were found in movement thresholds in ankle plantar flexion (p =.01), ankle dorsiflexion (p <.001), ankle inversion (p <.001), and ankle eversion (p <.001), as well as relative absolute errors in the ankle force senses of ankle plantar flexion (p =.02) and ankle dorsiflexion (p =.02) across the four age groups. Conclusion: Plantar sensation and ankle proprioception were sensitive in adolescents and young adults than in middle-aged adults and older adults. [ABSTRACT FROM AUTHOR]

Mobility declines in older adults can be determined through monitoring longitudinal changes in gait speed. We examined longitudinal changes [in] ankle proprioception among those with and without baseline lower extremity numbness to develop a better understanding of mobility declines in healthy older adults. Participants included 568 adults (52.8% women) aged 60–98 years from the Baltimore Longitudinal Study of Aging. Larger ankle proprioception decreases during plantar flexion were found in the participants with lower extremity numbness compared with those without numbness (p =.034). Among participants with lower extremity numbness, slower baseline speeds from both usual and fast pace gait were associated with performance decline in ankle proprioception measured during ankle dorsiflexion (p =.039 and p =.004, respectively). Assisting older adults, especially those with lower extremity numbness, to maintain and improve ankle proprioception may help prevent mobility declines that have previously been considered age related. [ABSTRACT FROM AUTHOR]

BACKGROUND: Stroboscopic visual training can force sensory reweighting to restore the original weights by increasing sensitivity to proprioceptive information, which may be an effective method to improve proprioception. OBJECTIVE: To determine the effects of balance training in three conditions, low frequency, high frequency and normal vision, on ankle proprioception in patients with chronic ankle instability. METHODS: Thirty-six patients with chronic ankle instability recruited from the students of Southwest Medical University were randomly assigned to a low- frequency vision training group, a high-frequency vision training group, and a normal vision training group, with 12 subjects in each group. Subjects in the three groups underwent progressive hop stabilization and balance training, in which the low-frequency vision training group and the high-frequency vision training group wore stroboscopic spectacles during the training, with a stroboscopic frequency of 1.75 and 5 Hz, respectively. The training in each group was performed three times a week for 4 consecutive weeks. Assessments, including ankle proprioception, ankle stability self-assessment and dynamic postural stability, were performed before training and within 1 week after the completion of training. RESULTS AND CONCLUSION: There was a significant main effect of time factor in ankle proprioception (P < 0.05). Compared with the pre-training period, subjects in the low-frequency vision training group and the high-frequency vision training group showed significant improvement in ankle proprioception after 4 weeks of training (P < 0.05); and subjects in the low-frequency vision training group showed a significant improvement in ankle proprioception compared with that of the normal vision training group after 4 weeks of training (P < 0.05). There were significant main effects of time factor and group × time interaction in ankle proprioception (P < 0.05). Compared with the pre-training period, the ankle stability self-assessment in all three groups was improved after 4 weeks of training (P < 0.05). And the ankle stability self-assessment in high-frequency visual training group was higher than that in normal vision training group after 4 weeks of training (P < 0.05). Compared with the pre-training period, subjects in the low-frequency vision training group and the high-frequency vision training group showed significant improvements in forward dynamic postural stability, posteromedial dynamic postural stability, and posterolateral dynamic postural stability after 4 weeks of training (P < 0.05), while in the normal vision training group, forward dynamic postural stability and posterolateral dynamic postural stability were significantly improved after 4 weeks of training (P ≤ 0.05). To conclude, balance training under stroboscopic visual conditioning improves proprioception, ankle stability self-assessment, and dynamic postural stability in patients with chronic ankle instability regardless of frequency. [ABSTRACT FROM AUTHOR]

Surgical repair or reconstruction of lateral ankle ligaments is indicated in patients with persistent ankle instability, with arthroscopic/endoscopic treatment becoming more frequent. Although presurgical imaging of the ankle is always standard procedure, more is needed to understand the evolution of the repaired ligament or the tendinous graft to help improve length of postoperative time and functional results. This review describes the normal ultrasound aspects and possible complications of repaired/reconstructed ankle ligaments after an all-inside endoscopic repair/reconstruction of the anterior talofibular ligament and the calcaneofibular ligament. [ABSTRACT FROM AUTHOR]

The ankle infrequently develops primary osteoarthritis (OA), especially when compared to the hip and the knee. Ankle OA instead generally develops only after trauma. The consequences of end‐stage ankle OA can nonetheless be extremely debilitating, with impairment comparable to that of end‐stage kidney disease or congestive heart failure. Disconcertingly, evidence suggests that ankle OA can develop more often than is generally appreciated after even low‐energy rotational ankle fractures and chronic instability associated with recurrent ankle sprains, albeit at a slower rate than after more severe trauma. The mechanisms whereby ankle OA develops after trauma are poorly understood, but mechanical factors are implicated. A better understanding of the prevalence and mechanical etiology of post‐traumatic ankle OA can lead to better prevention and mitigation. New surgical and conservative interventions, including improved ligamentous repair strategies and custom carbon fiber bracing, hold promise for advancing treatment that may prevent residual ankle instability and the development of ankle OA. Studies are needed to fill in key knowledge gaps here related to etiology so that the interventions can target key factors. New technologies, including weight bearing CT and biplane fluoroscopy, offer fresh opportunities to better understand the relationships between trauma, ankle alignment, residual ankle instability, OA development, and foot/ankle function. This paper begins by reviewing the epidemiology of post‐traumatic ankle OA, presents evidence suggesting that new treatment options might be successful at preventing ankle OA, and then highlights recent technical advances in understanding of the origins of ankle OA to identify directions for future research. [ABSTRACT FROM AUTHOR]

Seventy‐eight parameters are theoretically needed to describe the relative position and orientation of all the 14 bones in the foot and ankle with respect to a reference bone (foot posture). However, articular contacts and soft tissues introduce kinematic coupling, reducing the number of the foot degrees‐of‐freedom (DOF). This study aims at providing quantification and definition of these couplings. The foot posture was measured in vitro through a series of computed tomography scans, spanning the whole range of foot dorsi/plantar flexion and pronation/supination, also considering the effect of weightbearing. The envelope of foot postures was investigated by means of principal component analysis. The foot and ankle motion were well described with four principal sets of kinematic couplings, that is, synergies. One synergy covers the independent motion of the ankle, while three synergies describe the foot motion. The first foot synergy shows all the bones rotating approximatively about a common axis, mapping the foot abduction/adduction about the Chopart joint. The second foot synergy results in a spherical motion, whose center is located between lateral cuneiform and navicular bone, mapping the foot pronation/supination. The third foot synergy maps the opening of the foot arches during the load acceptance. The foot and ankle complex can thus be described as a four DOF system, whose motion is the result of the linear combination of four synergies. Significance: Synergies reveal the contribution of each bone to the three‐dimensional foot posture, providing a compact representation of the motion of the foot and ankle complex, improving the comprehension of its physiology. [ABSTRACT FROM AUTHOR]

Introduction: Chronic ankle instability can impair balance, ankle range of motion, and strength. Neurofeedback training was recently used to rehabilitate musculoskeletal injuries. This study investigated the effectiveness of adding neurofeedback training to neuromuscular training on the balance, limit of stability, ankle range of motion, and strength of athletes with chronic ankle instability. Methods: This study was three arms and a single-blind randomized control trial. Participants were 62 young male athletes with chronic ankle instability who were randomly divided into 3 groups; combination group, neuromuscular group, and control group. Eight weeks of intervention were carried out in training groups. Outcome measures were balance control, the limit of stability, ankle range of motion, and strength. Results: The study results indicated that neurofeedback training + neuromuscular training and neuromuscular training alone improved balance, the limit of stability, ankle range of motion, and strength. Also, neurofeedback training + neuromuscular training was more effective than neuromuscular training alone in variables of dynamic balance in anterior–posterior (p = 0.031), the limit of stability in the left (p = 0.003), forward-left (p = 0.045), and backward-right (p = 0.048). Conclusion: Considering that the improvement in dynamic balance in anterior–posterior, the limit of stability in the left, forward-left, and backward-right was greater in the combined (neurofeedback training + neuromuscular training) group compared to neuromuscular training alone, neurofeedback training can be considered as a complementary program to rehabilitation protocols for chronic ankle instability. Trial registration: IRCTID, IRCT20211018052799N1. Registered 1 December 2021 [ABSTRACT FROM AUTHOR]

Purpose: There is no consensus about the best fixation method for medial malleolar fractures. This study was conducted to compare the clinical and radiological results of positional (fully threaded) screws and lag (partially threaded) screws when used to fix medial malleolar fractures. Methods: This prospective, randomized clinical trial included 68 patients with closed isolated medial malleolar fractures. Each study arm included 34 patients who were randomly treated with either fully threaded screws (FT group) or partially threaded screws (PT group). Patients were evaluated radiologically for union and clinically using the American Orthopaedic Foot and Ankle Society (AOFAS) ankle hindfoot score. Results: After a 12-month follow-up, the mean AOFAS ankle hindfoot score was 92.1 ± 3.5 in the FT group and 91.8 ± 5.4 in the PT group. Union was achieved in the FT group after a mean of 6.2 ± 1.3 weeks and after a mean of 6.5 ± 1.5 weeks in the PT group. Conclusion: Both fully threaded and partially threaded screws yielded good comparable clinical and radiological outcomes when used to fix isolated medial malleolar fractures. [ABSTRACT FROM AUTHOR]

The objectives of this network meta-analysis were: (a) to estimate and compare the pooled effects of some injury prevention programs (IPPs) whose exercise-based components were categorized using a movement pattern-specific taxonomy on reducing overall and some specific body regions (lower extremity, thigh, knee, and ankle) injury incidences in youth team sport athletes and (b) to explore the individual effects of these components on the injury incidence rates (IIRs) previously mentioned. Searches were performed in PubMed, Web of Science, SPORTDiscus, and Cochrane Library. Eligible criteria were: exercise-based interventions comprised of exercises involving athletic motor skill competencies and evaluated against a control group, overall IIRs were reported, and youth (≤19 years old) team sport players. For the current analysis, a taxonomy based on movement patterns was employed for exercise component identification (upper body pushing and pulling; lower body concentric and eccentric; core; mechanics; acceleration; and lower body stability). Pooled effects were calculated by frequentist random effects pairwise and network meta-analyses. Nineteen studies were included. Most of the IPPs exhibit risk reduction when compared to their control groups on overall, lower extremity, and ankle injuries. Interventions comprised of lower body concentric and eccentric, core, mechanics, and lower body stability exercises were the most effective measures for reducing these injuries. None of the IPPs demonstrated to be effective for reducing thigh injuries, and contradictory results were found for knee injuries. Individual analysis at component level revealed that the lower body (bilateral and unilateral, concentric, and eccentric) component was the only one associated with a significant reduction on overall injuries. Indirect evidence suggests that interventions incorporating lower body concentric and eccentric, core, mechanics, and lower body stability exercises might be the most effective for reducing overall, lower extremity, and ankle injuries in youth team sports. [ABSTRACT FROM AUTHOR]

Objectives: The whole-body vibration (WBV) effects on muscle strength show inconsistent results. Moreover, there is no study about the WBV effect on stiffness, elasticity, and muscle strength. Therefore, the study aimed to examine the effect of WBV exposure with static squat posture on the stiffness, elasticity, and strength of the lower-limb extensor muscles. Material and methods: Forty healthy untrained young adults were divided into WBV and control groups. The experimental group received WBV exposure on 2 nonconsecutive days of the week, for 6 weeks. The MyotonPRO device was used for the assessment of the knee extensor and the ankle dorsiflexors' stiffness and elasticity. Isometric muscle strength was evaluated with a hand-held dynamometer. All measurements were done by the same assessor at baseline, and the following 6 weeks. Results: Significant group-by-time interactions were found for the elasticity scores of the right (d = 0.84, P = .01) and left (d = 0.77, P = .02) ankle dorsiflexors. Similar to the elasticity measurements, significant group-by-time interactions were observed in the muscle strength scores of the right (d = 0.45, P = .046) and left (d = 1.25, P < .001) ankle dorsiflexors. No significant effects were observed in any of the evaluated muscle stiffness measurements (P > .05), and there was no significant group-by-time interaction in knee-extensor muscle strength and elasticity scores (P > .05). Conclusions: The study results indicate that if the ankle dorsiflexor strength and elasticity are desired to be increased, the 6-week WBV exposure in a static squat posture can be used in healthy individuals. [ABSTRACT FROM AUTHOR]

Balance control is essential for postural adjustment in physical activities. This study investigates the behavior of human postural control and the coordination and adaptation strategy of hip, knee, and ankle when standing on an unstable surface. Twenty participants were recruited. Four different conditions were investigated: a quiet bipedal stance with eyes open and eyes closed, and standing on an unstable surface with eyes open and eyes closed. Other than the joint angle, the standard body sway measures, such as sway area and sway velocity. were computed. A nonlinear time series measure, that is, sample entropy, was used to determine the regularity of the time series and body adaptability to change and perturbation. The results show that the body sway increases as the difficulty increases. This study also confirms the coordination of the hip. knee, and ankle to maintain body balance on the unstable surface by decreasing the joint angle and adopting a lower posture. Even though the individual joint has lower sample entropy value and is deemed to be rigid and less adaptive to perturbation, the postural control exhibits higher sample entropy value, particularly in the anteriorposterior direction, and has the ability to stabilize the body by manipulating the joints simultaneously. These outcomes suggest that an unstable surface not only challenges the human postural control. but also reduces the hip. knee, and ankle adaptability to perturbation, thus making it a great tool to train body balance. [ABSTRACT FROM AUTHOR]

Context: The performance of sprints during male soccer matches usually is slow medium paced, where the soleus and gastrocnemius (ankle plantar flexors) play a very important role. As in male soccer, soleus injuries should be considered in female soccer; but the scientific evidence is very limited in this case. Design: Pilot clinical trial study. Objective: To determine whether adding an ultrasound-guided percutaneous needle electrolysis (US-guided PNE) technique to a specific exercise program improved perceived pain at stretching and at palpation, ankle dorsiflexion range of motion, muscle fatigue, and sport performance in women soccer players with soleus injury. Methods: This pilot study recruited 20 female players with chronic soleus injury (type 1, characterized by hypoechoic image) who were assigned to one of 2 groups: an experimental group (exercise program + US-guided PNE; n = 10) or a control group (exercise program + sham stimulation; n = 10). Pain intensity, dorsiflexion range of motion, knee-flexion heel raise test, curve sprint test, and the global rating of change scale were analyzed at baseline and after treatment (4 wk) and there was no further follow-up. Results: Pain intensity at palpation and at stretching, dorsiflexion range of motion, and heel raise test values showed significant improvements (P < .05) between pretreatment and posttreatment for both groups, however, no significant differences were observed between groups. Curve sprint tests did not show significant differences between pretreatment and posttreatment for either group or between groups. However, the percentage of changes always revealed better values in favor of the PNE group. Both groups showed good player satisfaction with the therapies. Conclusion: The application of the US-guided PNE combined with a specific exercise program may cause clinical benefits in the treatment of female soccer players with soleus injury. [ABSTRACT FROM AUTHOR]

Aims: Our primary aim was to establish the proportion of female orthopaedic consultants who perform arthroplasty via cases submitted to the National Joint Registry (NJR), which covers England, Wales, Northern Ireland, the Isle of Man, and Guernsey. Secondary aims included comparing time since specialist registration, private practice participation, and number of hospitals worked in between male and female surgeons. Methods: Publicly available data from the NJR was extracted on the types of arthroplasty performed by each surgeon, and the number of procedures of each type undertaken. Each surgeon was cross-referenced with the General Medical Council (GMC) website, using GMC number to extract surgeon demographic data. These included sex, region of practice, and dates of full and specialist registration. Results: Of 2,895 surgeons contributing to the NJR in 2023, 102 (4%) were female. The highest proportions of female surgeons were among those who performed elbow (n = 25; 5%), shoulder (n = 24; 4%), and ankle (n = 8; 4%) arthroplasty. Hip (n = 66; 3%) and knee arthroplasty (n = 39; 2%) had the lowest female representation. Female surgeons had been practising for a median of 10.4 years since specialist registration compared to 13.7 years for males (p < 0.001). Northern Ireland was the region with the highest proportion of female arthroplasty surgeons (8%). A greater proportion of male surgeons worked in private practice (63% vs 24%; p < 0.001) and in multiple hospitals (74% vs 40%; p < 0.001). Conclusion: Only 4% of surgeons currently contributing cases to the NJR are female, with the highest proportion performing elbow arthroplasty (5%). Female orthopaedic surgeons in the NJR are earlier in their careers than male surgeons, and are less involved in private practice. There is a wide geographical variation in the proportion of female arthroplasty surgeons. Cite this article: Bone Jt Open 2024;5(8):637–643.

The retinacula of the ankle are specialized anatomical structures characterized by localized thickenings of the crural fascia that envelop the deep components of the lower leg, ankle and foot. The ankle retinacula include the extensor retinacula, the peroneal retinacula and flexor retinaculum. Despite their potential to explain persistent and unexplained pain following an injury, these structures are often overlooked or incorrectly diagnosed. Hence, this comprehensive review was performed aiming to investigate the use and the methodology of US imaging to assess ankle retinacula. The search was performed on PubMed and Web of Science databases from inception to May 2024. The MeSH keywords used were as follows: “Ankle Retinacula”, “Foot Retinacula”, “Superior extensor retinaculum”, “Inferior extensor retinaculum”, “peroneal retinaculum”, “superior peroneal retinaculum”, “inferior peroneal retinaculum”, “flexor retinaculum”, “Ultrasound Imaging”, “Ultrasound”, “Ultrasonography” and “Ultrasound examination”. In total, 257 records underwent screening, resulting in 22 studies meeting the criteria for inclusion after the process of revision. Data heterogeneity prevents synthesis and consistent conclusions. The results showed that advanced US imaging holds promise as a crucial tool to perform an US examination of ankle retinacula, offering static and dynamic insights into ankle retinacula pathology. Understanding normal anatomy and US imaging is essential for accurately identifying injuries. Future research should focus on clinical trials to validate parameters and ensure their reliability in clinical practice.

Synovial chondromatosis is a rare benign condition defined by the presence of cartilaginous lesions in the synovium of joints, tendon sheaths, and bursae. It most typically affects large joints, such as the knee, hip, and shoulder, but it is also reported in smaller joints. Nonetheless, ankle involvement is relatively uncommon. A complete history and clinical, physical, and radiographic examinations are usually used to determine the diagnosis. Hence, we reported a case of a young patient with left ankle primary synovial chondromatosis who presented with a left ankle mass and chronic pain.

Introduction Despite the fact that ultrasound (US) therapy is not advised for acute ankle sprains, its therapeutic effects may be beneficial for other stages of ankle sprains, such as a subacute ankle sprain. There is, however, a lack of evidence regarding the effects of US on pain relief and functional improvement in subacute ankle sprains. Therefore, this study aimed to determine the immediate effects of US on pain and plantar pressure in individuals with unilateral subacute ankle sprains. Methods Fifty-four participants with unilateral subacute ankle sprains (aged 16–55 years) were recruited and randomly allocated into a treatment group ( n = 27) and a control group ( n = 27). The treatment and control groups received a single intervention session of US and an ineffectual US, respectively. Pain intensity during weight-bearing and static and dynamic plantar pressures were assessed before and after receiving the intervention. Results In both groups, pain intensity was statistically reduced ( p < 0.05) and clinically relevant. Although the maximum plantar pressure in the hindfoot during static conditions was statistically higher in the control group ( p = 0.024), the values were still lower than MDC95. Conclusions A single treatment of US could clinically reduce pain, but it had no effect on altering plantar pressure in individuals with unilateral subacute ankle sprains.

Abstract Background Acute ankle injuries are commonly seen in emergency rooms, with significant social impact and potentially devastating consequences. While several clinical practice guidelines (CPGs) related to ankle injuries have been developed by various organizations, there is a lack of critical appraisal of them. The purpose of this systematic review is to identify and critically appraise evidence-based clinical practice guidelines (EB-CPGs) related to acute ankle injuries in adults. Method We conducted searches in the Cochrane Library, MEDLINE, EMBASE databases, WHO, and reviewed 98 worldwide orthopedic association websites up until early 2023. Two authors independently applied the inclusion and exclusion criteria, and each evidence-based clinical practice guideline (EB-CPG) underwent independent critical appraisal of its content by all four authors using the Appraisal of Guidelines for REsearch and Evaluation (AGREE II) instrument. AGREE II scores for each domain were then calculated. Results This review included five evidence-based clinical practice guidelines. The mean scores for all six domains were as follows: Scope and Purpose (87.8%), Stakeholder Involvement (69.2%), Rigour of Development (72.5%), Clarity of Presentation (86.9%), Applicability (45.6%), and Editorial Independence (53.3%). Conclusion The number of EB-CPGs related to ankle injuries are limited and the overall quality of the existing evidence-based clinical practice guidelines (EB-CPGs) for ankle injuries is not strong, with three of them being outdated. However, valuable guidance related to Ottawa rules, manual therapy, cryotherapy, functional supports, early ambulation, and rehabilitation has been highlighted. Challenges remain in areas such as monitoring and/or auditing criteria, consideration of the target population’s views and preferences, and ensuring editorial independence. Future guidelines should prioritize improvements in these domains to enhance the quality and relevance of ankle injury management. Systematic review Systematic review.