Diagnostic research
Nicholas Summerton in Primary Care Diagnostics, 2018
In assessing the applicability of clinical indicants one sequence is illustrated by the development of the ‘Ottawa ankle rules’ for acute ankle injuries. In 1992 Stiell et al. undertook a study of 750 emergency department patients over a 5-month period. They surveyed for 32 standardised clinical variables that were compared against a radiographic gold standard in order to develop clinical indicants for malleolar fractures. Such fractures were more likely to be identified among people who had pain near the malleoli and who were aged 55 years or more, had localised bone tenderness of the posterior edge or tip of either malleolus, or were unable to bear weight both immediately after the injury and in the emergency department.23
Trauma
Harry Griffiths in Musculoskeletal Radiology, 2008
The ankle has been described as a “mortise” joint, with the lateral malleolus, medial malleolus, and posterior malleolus holding the talus in place. Between the tibia and fibula is an intraosseous membrane that holds the two bones roughly parallel and ends in a syndesmosis just above the ankle joint. This should be no greater than 4-mm wide and is best seen on a 15° oblique AP view of the ankle called a mortise view. The joint space between the three malleoli and the talus should be approximately equidistant, measuring from 2 to 3 mm in the average normal patient. Thus, the talus has articulating surfaces on its sides, as well as a curved superior surface that has two “domes” with a slight depression centrally on the AP view.
The lower limb
Ffion Davies, Colin E. Bruce, Kate Taylor-Robinson in Emergency Care of Minor Trauma in Children, 2017
Look for small avulsion fractures of the lateral malleolus, which are the commonest fracture pattern. In larger fractures it is important to look for signs of instability by checking that the gap between the talus and tibia and fibula is parallel, as it is when stable. In Figure 9.16 you can see that the gap between the talus and the articular surfaces of the tibia and fibula measures the same all the way around. This view is called a mortise view, and is a modified AP view to help you assess the joint congruity. Disruption of the articular surfaces or ligaments will result in movement called ‘talar shift’. Medial malleolus fractures are less common and tend to be bigger (Figure 9.17).
Effects of range of motion exercise of the metatarsophalangeal joint from 2-weeks after joint-preserving rheumatoid forefoot surgery
Published in Modern Rheumatology, 2020
Makoto Hirao, Hideki Tsuboi, Naotaka Tazaki, Kohei Kushimoto, Kosuke Ebina, Hideki Yoshikawa, Jun Hashimoto
The subjects walked on a 10-m walkway with 5 1.4-cm-diameter reflective markers placed at specific landmarks of the foot (1. medial malleolus, 2. lateral malleolus, 3. 3 cm proximal of the insertion of the Achilles tendon, 4. second metatarsal head, and 5. second distal phalanx) (Figure 2(a1–3)). Gait motion was recorded in three dimensions using a 12-Raptor camera infrared motion analysis system (MAC 3D system, Motion Analysis, Corp., Rohnert Park, CA, USA) at a sampling frequency of 500 Hz. The captured data were analyzed using a toolkit: Software for Interactive Musculoskeletal Modeling (SIMM, Motion Analysis, Corp.). In the analysis of gait motion, the extension angle of the second MTP joint at the terminal stance phase (when the heel was most elevated) was measured (Figure 2(a-3,b-1.2)). The difference between the terminal stance phase and the standing still phase in the angle created by the longitudinal axis of the second metatarsal bone and the basal phalanx bone was defined as the extension angle of the second MTP joint at the terminal stance phase (Figure 2(b-2)). As healthy controls, the analysis was also performed in healthy subjects (N = 5, age: 26–35 years, no rheumatoid arthritis, no disorder of the lower extremities including the feet and ankles) (Table 2).
Accuracy and kinematics consistency of marker-based scaling approaches on a lower limb model: a comparative study with imagery data
Published in Computer Methods in Biomechanics and Biomedical Engineering, 2020
P. Puchaud, C. Sauret, A. Muller, N. Bideau, G. Dumont, H. Pillet, C. Pontonnier
An image-based scaling method was applied with EOS data. An EOS-based model (EB) was built and considered as a reference for each subject (Melhem et al. 2016). The 3D reconstructions of the lower limb bones were extracted from the biplanar radiographs. Femurs, tibiae and fibulae were reconstructed based on a parametric model and on statistical inferences (Chaibi et al. 2012). Regions were then automatically segmented on the bones. The HJCs were identified with a least-squares sphere fitting on the femoral heads regions of the 3 D mesh (Pillet et al. 2014). Spheres were least-squares fitted on medial and lateral posterior aspects of femoral condyles. The KJCs were defined as the mid-points between the two spheres centres and the knee joint axis by the line passing through them (Sauret et al. 2016). Finally, malleoli regions of the fibulae and the tibiae were selected on the parametric bone models. Their barycentres were used to create middle points which were considered as the AJCs.
Measurement of instantaneous Achilles tendon moment arm and force during the stance phase of running
Published in Computer Methods in Biomechanics and Biomedical Engineering, 2021
Giorgos Krikelis, Matthew T. G. Pain, Laura-Anne M. Furlong
The ATMA curve across the ankle range of motion from the motion analysis/ultrasound data relative to the FHAm intersected with the ATMA profile during walking reported by Rasske et al. (2017) that was measured with a similar method (Figure 6). However, in that study the moment arm was measured relative to the midpoint of the malleoli markers. In contrast to the results from Wade et al. (2019), ATMA relative to the ankle ‘functional’ axis were lower than when calculated relative to the malleoli midpoint in this study. The reasons for such difference are not clear, since the methods used in this study and in Wade et al. (2019) were similar. Part of it could be explained by the fact that the loading conditions were different (running vs. toe raises), as well as subject anatomical variation.
Related Knowledge Centers
- Ankle
- Fibula
- Flexor Digitorum Longus Muscle
- Tibia
- Tibialis Posterior Muscle
- Process
- Talus Bone
- Malleolar Sulcus
- Deltoid Ligament
- Flexor Retinaculum of Foot