11/25. achilles tendon rupture. Occurrence with a closed ankle fracture.A 61-year-old man, involved in an automobile accident, sustained a complete achilles tendon rupture with an ipsilateral, closed slightly displaced medial malleolus ankle fracture. The tendon rupture was not diagnosed before operation but was recognized at the time of open reduction of the ankle. This rare combination of injuries was apparently secondary to hyperdorsiflexion of the foot. The tendon rupture would have been missed had surgical treatment not been required. Unrecognized tendon ruptures associated with closed ankle fractures may be a cause of residual ankle-foot weakness, pain, loss of motion, or a combination thereof.- - - - - - - - - - ranking = 1keywords = motion (Clic here for more details about this article) |
12/25. Post-fracture, late debridement resection arthroplasty of the ankle.Seven patients (three male and four female), aged 10 to 45 years (average, 36 years), who suffered fractures at the ankle (three right and four left) from 6 months to 20 years ago (average, 7.6 years), underwent late debridement resection arthroplasty. Follow-up ranged from 3.5 to 7 years (average, 5 years). Six patients improved in range of motion, endurance, and freedom from pain and swelling and were able to engage thereafter in increased activities, including sports. The oldest female (aged 45), because of continual pain 15 months later, had an ankle arthrodesis. No "normal" ankles resulted, but final rating determinations based on range of motion, endurance, swelling, pain, and subjective analyses were: excellent (1), good (3), fair (2), poor (1) (arthrodesis patient). Results of the 5-year follow-ups suggest that this type of surgery in selected cases is a feasible, at least interim, alternative to more radical total ankle arthroplasty or ankle arthrodesis.- - - - - - - - - - ranking = 2keywords = motion (Clic here for more details about this article) |
13/25. Tibiofibular synostosis and recurrent ankle sprains in high performance athletes.Recent evidence points toward a weight bearing and dynamic stabilizing function of the distal fibula in ankle joint mechanics. When fibular rotation and translation are restricted, ankle pain during weight bearing and push off often (but not always) results. The case histories of six professional athletes with distal tibial synostosis resulting from internal rotation-inversion injury confirm recent reports of ankle disability resulting from restriction of fibular motion, but suggest that there may be many patients with this lesion who are not disabled. Two patients with incomplete synostosis were asymptomatic, and one with complete synostosis had only occasional pain after vigorous exercise.- - - - - - - - - - ranking = 1keywords = motion (Clic here for more details about this article) |
14/25. The anterior impingement syndrome of the ankle.Four cases in professional athletes and a ballet dancer of what we would like to term the anterior impingement syndrome of the ankle are described. A brief review of the very sparse literature is presented. The cause is felt to be the repeated pull of the anterior ankle joint capsule and the impingement of the talus against the tibia in running and jumping leading to calcific deposits along the lines of the capsular fibers. We feel that any athlete who has pain or limitation of motion secondary to the anterior impingement syndrome should be considered for surgical removal of the offending spurs. The four patients were able to return to their previous activity levels.- - - - - - - - - - ranking = 1keywords = motion (Clic here for more details about this article) |
15/25. Simultaneous fracture of the ankle and talus associated with ruptured tibialis posterior tendon.A 45-year-old woman involved in a motor vehicle accident sustained a fracture of the medial malleolus and a fracture of the neck of the talus. Open reduction and internal fixation of the fractures were achieved through an anteromedial approach. Intraoperatively, the tibialis posterior tendon was found to be ruptured and retracted. The tendon was reapproximated and repaired. The patient developed an inversion deformity of the ankle, which required release of the tibialis posterior tendon and correction of the deformity using the Ilizarov fixation device. Twelve months after the injury, the patient had 45 degrees of plantar flexion and 15 degrees of dorsiflexion of the ankle; subtalar motion was 25 degrees of eversion and 35 degrees of inversion. Radiographs showed healing of all fractures with minimal degenerative changes of the ankle joint and absence of avascular necrosis of the talus.- - - - - - - - - - ranking = 1keywords = motion (Clic here for more details about this article) |
16/25. Tibiofibular synostosis: a cause of ankle disability.A syndrome of ankle pain on weight-bearing while running due to post-traumatic ossification of the tibiofibular ligament is described. pain is caused by failure of normal downward and lateral motion of the fibula. Treatment consists of complete excision of the synostosis, followed by cast immobilization for 3 weeks.- - - - - - - - - - ranking = 1keywords = motion (Clic here for more details about this article) |
17/25. Spontaneous atraumatic rupture of the flexor hallucis longus tendon under the sustentaculum tali: case report, review of the literature, and treatment options.A case of spontaneous rupture of the flexor hallucis longus tendon within the hind part of the foot is reported in a middle-aged woman who had no trauma or systemic disease. Repair was effected by tenodesis to the flexor digitorum longus tendon above and below the fibro-osseous tunnel. Hyperextension of the interphalangeal joint which most troubled the patient was corrected postoperatively. Active range of motion was equal in extension. Flexion at the IP joint was present, but significantly less than the unaffected side.- - - - - - - - - - ranking = 1keywords = motion (Clic here for more details about this article) |
18/25. Accessory calcaneus: a case report and literature review.A case of bilateral accessory calcanii is presented in which the accessory ossicle articulated with the talus and calcaneus at the lateral aspect of the posterior facet of the subtalar joint, causing premature subtalar degenerative changes in a 19-year-old man. Although rare and usually asymptomatic, accessory ossicles around the foot may need surgical excision if painful or if sufficient size is obtained to cause deformity and/or limitations in range of motion.- - - - - - - - - - ranking = 1keywords = motion (Clic here for more details about this article) |
19/25. Successful revascularization of a partially avulsed foot in a 6-year-old child.The foot of a 6-year-old child was revascularized successfully following an avulsion and partial amputation through the tibiotalar joint. Partial degloving had disrupted the anterior and posterior tibial arteries with resultant ischemia. We excised the entire damaged segment of the posterior tibial artery and performed a reverse saphenous vein graft, end-to-end reconstruction of the defect. Peroneal and tibial nerve function returned within 5 months. Four years later, the patient has regained full, painless range of motion and normal strength and sensibility with no evidence of premature growth plate closure or avascular necrosis of the talus.- - - - - - - - - - ranking = 1keywords = motion (Clic here for more details about this article) |
20/25. Open total talus dislocation: case report and review of the literature.An open pure total lateral dislocation of the right talus with extrusion of the whole talar body is reported. Immediately surgical debridement, reduction, and primary closure were accomplished under antibiotic coverage. The ankle was immobilized for 6 weeks, and weight-bearing was restricted for 6 more weeks. Neither avascular necrosis (AVN) of the talus nor infection developed. Both ankle and foot regained full pain-free range of motion at 16 weeks, except for a mild restriction of the last 5 degrees of supination. Four years postinjury, the patient continues in the same preinjury occupation. A thorough review of the literature suggested that (a) immediate closed or open reduction is preferable; (b) if AVN develops, it can be treated in most cases by weight-bearing restrictions; and (c) talectomy, alone or associated with a tibiocalcaneal arthrodesis, should be reserved for an eventual reconstructive procedure, particularly in the event of talus infection.- - - - - - - - - - ranking = 1keywords = motion (Clic here for more details about this article) |
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