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Hello!
He would like to know me your opinion with respect to a type of patient who suffers a chronic instability of ankle associated to the presence of a lateral STJA (predominance of supination moments), I believe that peroneal type is a foot, in relation to the classification of the types of feet that describes the Dr. Fuller and Dr. Kirby, based on the location of the space location of STJA and centre of pressure of the foot . Today in class, a student has realised me a suggestion on a debate that we had open during the class the cavus foot and her mechanics… Its question went directed to the following reflection: in the cases of dysfunction of the tendon of posterior tibial muscle, one of clinical it maneuvers of which we arrange to see the mechanical behavior of the tendon in activiades of load is the Single Heel Rise Test… by means of this test we can infer in the knowledge of the degree of integrity of the tendon of this muscle, for example…etc.
Exists some clinical test that evaluates the state or integrity to you of the tendon of muscle PLC in feet with lateralizados axes? When we asked to him the patient who reproduces the test of maximum pronation and knowing that this moment of pronador force that is generated, is through the contraction of this muscle, mainly, how we interpreted this test? Said this, the roll instability of ankle is cause or consequence? A foot is laterally unstable when for example this muscular group gets tired itself? One is sndrome whose patomechanics is similar to the dysfunction of the tendon of posterior tibial muscle? What is your opinion?
I feel my level of English....Sorry...
Thank you very much
Cheers
Fran Monzó
University Miguel Hernández. San Juan. Alicante. Spain
__________________
El Raciocinio... una maravilla de la naturaleza humana capaz de conseguir el mayor triunfo personal.
Just by coincidence I have a patient with very painful ankle instability due to improperly rehabilitated ankle sprains and tibial fracture over several years (see X Rays attachments below). Orthoses do not stabilise the joint and I have prescribed a laced ankle brace and referred to orthopaedics. I wondered what your opinion might be (anyone) as to the successful surgical outcome for this type of trauma.
Hmm? don't know why the AP view doesn't fully load, well you can see the relevant bit tho.
PS Please move this to a new thread if not relevant
Cheers Dave
__________________
Descartes seems to consider here that beliefs formed by pure reasoning are less doubtful than those formed through perception.
Hello!
He would like to know me your opinion with respect to a type of patient who suffers a chronic instability of ankle associated to the presence of a lateral STJA (predominance of supination moments), I believe that peroneal type is a foot, in relation to the classification of the types of feet that describes the Dr. Fuller and Dr. Kirby, based on the location of the space location of STJA and centre of pressure of the foot . Today in class, a student has realised me a suggestion on a debate that we had open during the class the cavus foot and her mechanics… Its question went directed to the following reflection: in the cases of dysfunction of the tendon of posterior tibial muscle, one of clinical it maneuvers of which we arrange to see the mechanical behavior of the tendon in activiades of load is the Single Heel Rise Test… by means of this test we can infer in the knowledge of the degree of integrity of the tendon of this muscle, for example…etc.
Exists some clinical test that evaluates the state or integrity to you of the tendon of muscle PLC in feet with lateralizados axes? When we asked to him the patient who reproduces the test of maximum pronation and knowing that this moment of pronador force that is generated, is through the contraction of this muscle, mainly, how we interpreted this test? Said this, the roll instability of ankle is cause or consequence? A foot is laterally unstable when for example this muscular group gets tired itself? One is sndrome whose patomechanics is similar to the dysfunction of the tendon of posterior tibial muscle? What is your opinion?
I feel my level of English....Sorry...
Thank you very much
Cheers
Fran Monzó
University Miguel Hernández. San Juan. Alicante. Spain
Fran,
Your English is better than my Spanish. Use passive, active and resisted eversion. Then maybe look at maximum eversion height in standing.
Just by coincidence I have a patient with very painful ankle instability due to improperly rehabilitated ankle sprains and tibial fracture over several years (see X Rays attachments below). Orthoses do not stabilise the joint and I have prescribed a laced ankle brace and referred to orthopaedics. I wondered what your opinion might be (anyone) as to the successful surgical outcome for this type of trauma.
Hmm? don't know why the AP view doesn't fully load, well you can see the relevant bit tho.
PS Please move this to a new thread if not relevant
Cheers Dave
Thank you very much Dave. Your clinical case is very interesting.
Fodder that before a patient with chronic instability of ankle, associate pain and little effectiveness of the orthopaedic treatment, we must look for the presence of an underlying associate injury as some type of tibial fracture of stress, osteocondrales injuries, impigment anterolateral… Dave.... Do you think that the syndrome of dysfunction of the tendon of the PLC is a manifestation of the foot peroneal type (Fuller, 1999)?
Cheers
__________________
El Raciocinio... una maravilla de la naturaleza humana capaz de conseguir el mayor triunfo personal.
Your English is better than my Spanish. Use passive, active and resisted eversion. Then maybe look at maximum eversion height in standing.
OK Simon. Thanks!!!
A question Dr. Spooner: The repetition (5-10 repetitions) on the part of the patient of the test maximum pronation… could resemble the accomplishment of single heel rise test in the posterior tibial foot? (Fuller, 1999). (Your you are not a bad boy… , round table in a course of therapeutic applications that you distributed in Madrid 2002.)
Cheers
__________________
El Raciocinio... una maravilla de la naturaleza humana capaz de conseguir el mayor triunfo personal.
Can you be more specific with the reference of the paper by Fuller 1999.
Is this one useful?
Peroneal Activation Deficits in Persons With Functional Ankle Instability
1. Riann M. Palmieri-Smith, PhD, ATC†‡,§,*,
2. J. Ty Hopkins, PhD, ATC|| and
3. Tyler N. Brown, MS†
+ Author Affiliations
+ Author Affiliations
1.
† School of Kinesiology, the
2.
‡ Department of Orthopaedic Surgery, and the
3.
§ Bone & Joint Injury Prevention & Rehabilitation Center, University of Michigan, Ann Arbor, Michigan, and the
4.
|| Department of Exercise Sciences, Brigham Young University, Provo, Utah
1. *Address correspondence to Riann M. Palmieri-Smith, PhD, ATC, University of Michigan, School of Kinesiology, 4745G CCRB, 401 Washtenaw Avenue, Ann Arbor, MI 48109 (e-mail: riannp@umich.edu).
Abstract
Background Functional ankle instability (FAI) may be prevalent in as many as 40% of patients after acute lateral ankle sprain. Altered afference resulting from damaged mechanoreceptors after an ankle sprain may lead to reflex inhibition of surrounding joint musculature. This activation deficit, referred to as arthrogenic muscle inhibition (AMI), may be the underlying cause of FAI. Incomplete activation could prevent adequate control of the ankle joint, leading to repeated episodes of instability.
Hypothesis Arthrogenic muscle inhibition is present in the peroneal musculature of functionally unstable ankles and is related to dynamic peroneal muscle activity.
Study Design Cross-sectional study; Level of evidence, 3.
Methods Twenty-one (18 female, 3 male) patients with unilateral FAI and 21 (18 female, 3 male) uninjured, matched controls participated in this study. Peroneal maximum H-reflexes and M-waves were recorded bilaterally to establish the presence or absence of AMI, while electromyography (EMG) recorded as patients underwent a sudden ankle inversion perturbation during walking was used to quantify dynamic activation. The H:M ratio and average EMG amplitudes were calculated and used in data analyses. Two-way analyses of variance were used to compare limbs and groups. A regression analysis was conducted to examine the association between the H:M ratio and the EMG amplitudes.
Results The FAI patients had larger peroneal H:M ratios in their nonpathological ankle (0.399 ± 0.185) than in their pathological ankle (0.323 ± 0.161) (P = .036), while no differences were noted between the ankles of the controls (0.442 ± 0.176 and 0.425 ± 0.180). The FAI patients also exhibited lower EMG after inversion perturbation in their pathological ankle (1.7 ± 1.3) than in their uninjured ankle (EMG, 3.3 ± 3.1) (P < .001), while no differences between legs were noted for controls (P > .05). No significant relationship was found between the peroneal H:M ratio and peroneal EMG (P > .05).
Conclusion Arthrogenic muscle inhibition is present in the peroneal musculature of persons with FAI but is not related to dynamic muscle activation as measured by peroneal EMG amplitude. Reversing AMI may not assist in protecting the ankle from further episodes of instability; however dynamic muscle activation (as measured by peroneal EMG amplitude) should be restored to maximize ankle stabilization. Dynamic peroneal activity is impaired in functionally unstable ankles, which may contribute to recurrent joint instability and may leave the ankle vulnerable to injurious loads.
Keywords:
Dave
__________________
Descartes seems to consider here that beliefs formed by pure reasoning are less doubtful than those formed through perception.
Can you be more specific with the reference of the paper by Fuller 1999.
Is this one useful?
Peroneal Activation Deficits in Persons With Functional Ankle Instability
1. Riann M. Palmieri-Smith, PhD, ATC†‡,§,*,
2. J. Ty Hopkins, PhD, ATC|| and
3. Tyler N. Brown, MS†
+ Author Affiliations
+ Author Affiliations
1.
† School of Kinesiology, the
2.
‡ Department of Orthopaedic Surgery, and the
3.
§ Bone & Joint Injury Prevention & Rehabilitation Center, University of Michigan, Ann Arbor, Michigan, and the
4.
|| Department of Exercise Sciences, Brigham Young University, Provo, Utah
1. *Address correspondence to Riann M. Palmieri-Smith, PhD, ATC, University of Michigan, School of Kinesiology, 4745G CCRB, 401 Washtenaw Avenue, Ann Arbor, MI 48109 (e-mail: riannp@umich.edu).
Abstract
Background Functional ankle instability (FAI) may be prevalent in as many as 40% of patients after acute lateral ankle sprain. Altered afference resulting from damaged mechanoreceptors after an ankle sprain may lead to reflex inhibition of surrounding joint musculature. This activation deficit, referred to as arthrogenic muscle inhibition (AMI), may be the underlying cause of FAI. Incomplete activation could prevent adequate control of the ankle joint, leading to repeated episodes of instability.
Hypothesis Arthrogenic muscle inhibition is present in the peroneal musculature of functionally unstable ankles and is related to dynamic peroneal muscle activity.
Study Design Cross-sectional study; Level of evidence, 3.
Methods Twenty-one (18 female, 3 male) patients with unilateral FAI and 21 (18 female, 3 male) uninjured, matched controls participated in this study. Peroneal maximum H-reflexes and M-waves were recorded bilaterally to establish the presence or absence of AMI, while electromyography (EMG) recorded as patients underwent a sudden ankle inversion perturbation during walking was used to quantify dynamic activation. The H:M ratio and average EMG amplitudes were calculated and used in data analyses. Two-way analyses of variance were used to compare limbs and groups. A regression analysis was conducted to examine the association between the H:M ratio and the EMG amplitudes.
Results The FAI patients had larger peroneal H:M ratios in their nonpathological ankle (0.399 ± 0.185) than in their pathological ankle (0.323 ± 0.161) (P = .036), while no differences were noted between the ankles of the controls (0.442 ± 0.176 and 0.425 ± 0.180). The FAI patients also exhibited lower EMG after inversion perturbation in their pathological ankle (1.7 ± 1.3) than in their uninjured ankle (EMG, 3.3 ± 3.1) (P < .001), while no differences between legs were noted for controls (P > .05). No significant relationship was found between the peroneal H:M ratio and peroneal EMG (P > .05).
Conclusion Arthrogenic muscle inhibition is present in the peroneal musculature of persons with FAI but is not related to dynamic muscle activation as measured by peroneal EMG amplitude. Reversing AMI may not assist in protecting the ankle from further episodes of instability; however dynamic muscle activation (as measured by peroneal EMG amplitude) should be restored to maximize ankle stabilization. Dynamic peroneal activity is impaired in functionally unstable ankles, which may contribute to recurrent joint instability and may leave the ankle vulnerable to injurious loads.
Keywords:
Dave
Thank you very much Dave by the reference of the study. I am going to throw a look to him.
With respect to Fuller 1999, it referred simply me to the article of the Dr. Fuller: " Center of Pressure and its relationship to foot pathology" … I do not know if I do well in denominating standing up to the type with STJA laterally and increase of the muscle tension PLC, how one of the estruturas that with but emphasis pronador moment generates on the STJA… PERONEAL FOOT?
Cheers
__________________
El Raciocinio... una maravilla de la naturaleza humana capaz de conseguir el mayor triunfo personal.
Thank you very much Dave by the reference of the study. I am going to throw a look to him.
With respect to Fuller 1999, it referred simply me to the article of the Dr. Fuller: " Center of Pressure and its relationship to foot pathology" … I do not know if I do well in denominating standing up to the type with STJA laterally and increase of the muscle tension PLC, how one of the estruturas that with but emphasis pronador moment generates on the STJA… PERONEAL FOOT?
Cheers
David looks like you did an edit as I posted it up. Now people can read it twice if they want. Maybe admin can remove the posts to clean up the Thread.
David looks like you did an edit as I posted it up. Now people can read it twice if they want. Maybe admin can remove the posts to clean up the Thread.
BOGOFF that's buty one get one free - always good value eh Mike!
Rearguards Dave
__________________
Descartes seems to consider here that beliefs formed by pure reasoning are less doubtful than those formed through perception.
Thank you very much Dave by the reference of the study. I am going to throw a look to him.
With respect to Fuller 1999, it referred simply me to the article of the Dr. Fuller: " Center of Pressure and its relationship to foot pathology" … I do not know if I do well in denominating standing up to the type with STJA laterally and increase of the muscle tension PLC, how one of the estruturas that with but emphasis pronador moment generates on the STJA… PERONEAL FOOT?
Cheers
Does anyone have a copy of this paper too?
Peroneal Activation Deficits in Persons With Functional Ankle Instability
thanks!
Bruce
Hello!
He would like to know me your opinion with respect to a type of patient who suffers a chronic instability of ankle associated to the presence of a lateral STJA (predominance of supination moments), I believe that peroneal type is a foot, in relation to the classification of the types of feet that describes the Dr. Fuller and Dr. Kirby, based on the location of the space location of STJA and centre of pressure of the foot . Today in class, a student has realised me a suggestion on a debate that we had open during the class the cavus foot and her mechanics… Its question went directed to the following reflection: in the cases of dysfunction of the tendon of posterior tibial muscle, one of clinical it maneuvers of which we arrange to see the mechanical behavior of the tendon in activiades of load is the Single Heel Rise Test… by means of this test we can infer in the knowledge of the degree of integrity of the tendon of this muscle, for example…etc.
Exists some clinical test that evaluates the state or integrity to you of the tendon of muscle PLC in feet with lateralizados axes? When we asked to him the patient who reproduces the test of maximum pronation and knowing that this moment of pronador force that is generated, is through the contraction of this muscle, mainly, how we interpreted this test? Said this, the roll instability of ankle is cause or consequence? A foot is laterally unstable when for example this muscular group gets tired itself? One is sndrome whose patomechanics is similar to the dysfunction of the tendon of posterior tibial muscle? What is your opinion?
I feel my level of English....Sorry...
Thank you very much
Cheers
Fran Monzó
University Miguel Hernández. San Juan. Alicante. Spain
Fran:
Dr. Fuller and I have both written papers where we describe how the peroneals have increased contractile activity when the subtalar joint (STJ) is laterally deviated. This is essentially a central nervous system (CNS) effect where the CNS "recognizes", through afferent input, that the foot has too much subtalar joint (STJ) supination moment acting on it and then "compensates" for this increase in STJ supination moment by sending increased efferent output to the peroneal muscles to increase the internal STJ pronation moment during weightbearing activities. I have attached my most recent paper (Kirby KA: Subtalar joint axis location and rotational equilibrium theory of foot function. JAPMA, 91:465-488, 2001) which proposes a theory as to how the foot functions using STJ axis location as the frame of reference. This paper goes into great detail about how STJ axis spatial location affects the kinetics of the foot. In addition, the paper reviews how the peroneals are the only extrinsic muscles of the foot that can generate significant STJ pronation moment and, therefore, are the only significant extrinsic muscles of the foot which are effective at reducing excessive external STJ supination moments that may arise from a patient with a laterally deviated STJ axis. The following papers may also be of benefit in helping you further understand these concepts and see how my thought processes moved over time as the theory was developed (Kirby KA: Methods for determination of positional variations in the subtalar joint axis. JAPMA, 77: 228-234, 1987; Kirby KA: Rotational equilibrium across the subtalar joint axis. JAPMA, 79: 1-14, 1989; Kirby KA: Biomechanics of the normal and abnormal foot. JAPMA, 90:30-34, 2000;.) Dr. Fuller's paper has already been mentioned, it is a very good one and I highly recommend it also (Fuller EA: Center of pressure and its theoretical relationship to foot pathology. JAPMA, 89 (6):278-291, 1999).
I prefer to do manual muscle testing of both the peroneus brevis and pereoneus longus muscles to assess their strength and/or level of pain with contractile activity. In addition, another clinical note that I make is, during relaxed bipedal stance, I will observe the patient's foot from posterior and lateral, and will often notice that the peroneal tendons are "bowstrung", indicating tonic peroneal muscle activity during standing. This tonic peroneal muscle contactile activity during relaxed bipedal stance is caused by the individual's involuntary (i.e. CNS mediated) attempt to keep the forefoot in a plantigrade position (i.e. keep the forefoot from being inverted to the ground) via increased peroneal muscle contractile activity to generate an internal STJ pronation moment. These feet with tonic peroneal muscle activity during relaxed bipedal stance are often also the patients that develop peroneal tendinopathy and may, in addition, have chronic lateral ankle instability.
Chronic lateral ankle instability, or, in other words, a tendency for an individual to frequently suffer inversion ankle sprains, often occurs in patients with laterally deviated STJ axes since these feet will have increased magnitudes of external STJ supination moment (due to the lateral STJ axis position relative to the plantar foot) acting on them during weightbearing activities. Of course, other influences may also cause chronic lateral ankle instability including improper or worn shoes, weak peroneal muscles, certain sports activities, chronic weightbearing on uneven surfaces or overly compliant lateral ankle ligaments (i.e decreased passive internal rearfoot eversion moments from lateral ankle/STJ ligamentous tensile force).
With all the above in mind, a logical question follow-up question may be: What type of Root et al "foot deformities" can cause lateral STJ axis deviation? Here is the answer:
All of these "foot deformities" will cause a lateral spatial location of the STJ axis in relation to the plantar foot and thus cause the foot to have a "laterally deviated STJ axis" by the definitions I first proposed in my paper from 22 years ago (Kirby KA: Methods for determination of positional variations in the subtalar joint axis. JAPMA, 77: 228-234, 1987). Therefore, the Root et al system of "foot and lower extremity deformities" and the system of STJ axis spatial location classification that I have proposed can be directly related to each other by simply changing the frame of reference from the STJ neutral position to the spatial location of the STJ axis relative to the plantar foot during weightbearing activities.
Hope this helps.
__________________
Sincerely,
Kevin
**************************************************
Kevin A. Kirby, DPM
Adjunct Associate Professor
Department of Applied Biomechanics
California School of Podiatric Medicine at Samuel Merritt College
Originally Posted by Fran Monzó
Thank you very much Dave by the reference of the study. I am going to throw a look to him.
With respect to Fuller 1999, it referred simply me to the article of the Dr. Fuller: " Center of Pressure and its relationship to foot pathology" … I do not know if I do well in denominating standing up to the type with STJA laterally and increase of the muscle tension PLC, how one of the estruturas that with but emphasis pronador moment generates on the STJA… PERONEAL FOOT?
Fran
You seem to be asking about a test to examine the strength and efficiency of the Peroneal complex in STJ eversion. Also how CoP and stj axis location are relevant to this Peroneal action. I think That the two papers attached earlier and Simon's reply seem to answer your question. Is this assumption correct?
I was curious to know what you meant by the term 'Peroneal Foot' I thought it might be something Eric Fuller (Fuller 1999) had used but I have read through his paper and it does not appear.
Here are some more papers that might be of interest
Regards D Smith
__________________
Descartes seems to consider here that beliefs formed by pure reasoning are less doubtful than those formed through perception.
Dr. Fuller and I have both written papers where we describe how the peroneals have increased contractile activity when the subtalar joint (STJ) is laterally deviated. This is essentially a central nervous system (CNS) effect where the CNS "recognizes", through afferent input, that the foot has too much subtalar joint (STJ) supination moment acting on it and then "compensates" for this increase in STJ supination moment by sending increased efferent output to the peroneal muscles to increase the internal STJ pronation moment during weightbearing activities. I have attached my most recent paper (Kirby KA: Subtalar joint axis location and rotational equilibrium theory of foot function. JAPMA, 91:465-488, 2001) which proposes a theory as to how the foot functions using STJ axis location as the frame of reference. This paper goes into great detail about how STJ axis spatial location affects the kinetics of the foot. In addition, the paper reviews how the peroneals are the only extrinsic muscles of the foot that can generate significant STJ pronation moment and, therefore, are the only significant extrinsic muscles of the foot which are effective at reducing excessive external STJ supination moments that may arise from a patient with a laterally deviated STJ axis. The following papers may also be of benefit in helping you further understand these concepts and see how my thought processes moved over time as the theory was developed (Kirby KA: Methods for determination of positional variations in the subtalar joint axis. JAPMA, 77: 228-234, 1987; Kirby KA: Rotational equilibrium across the subtalar joint axis. JAPMA, 79: 1-14, 1989; Kirby KA: Biomechanics of the normal and abnormal foot. JAPMA, 90:30-34, 2000;.) Dr. Fuller's paper has already been mentioned, it is a very good one and I highly recommend it also (Fuller EA: Center of pressure and its theoretical relationship to foot pathology. JAPMA, 89 (6):278-291, 1999).
I prefer to do manual muscle testing of both the peroneus brevis and pereoneus longus muscles to assess their strength and/or level of pain with contractile activity. In addition, another clinical note that I make is, during relaxed bipedal stance, I will observe the patient's foot from posterior and lateral, and will often notice that the peroneal tendons are "bowstrung", indicating tonic peroneal muscle activity during standing. This tonic peroneal muscle contactile activity during relaxed bipedal stance is caused by the individual's involuntary (i.e. CNS mediated) attempt to keep the forefoot in a plantigrade position (i.e. keep the forefoot from being inverted to the ground) via increased peroneal muscle contractile activity to generate an internal STJ pronation moment. These feet with tonic peroneal muscle activity during relaxed bipedal stance are often also the patients that develop peroneal tendinopathy and may, in addition, have chronic lateral ankle instability.
Chronic lateral ankle instability, or, in other words, a tendency for an individual to frequently suffer inversion ankle sprains, often occurs in patients with laterally deviated STJ axes since these feet will have increased magnitudes of external STJ supination moment (due to the lateral STJ axis position relative to the plantar foot) acting on them during weightbearing activities. Of course, other influences may also cause chronic lateral ankle instability including improper or worn shoes, weak peroneal muscles, certain sports activities, chronic weightbearing on uneven surfaces or overly compliant lateral ankle ligaments (i.e decreased passive internal rearfoot eversion moments from lateral ankle/STJ ligamentous tensile force).
With all the above in mind, a logical question follow-up question may be: What type of Root et al "foot deformities" can cause lateral STJ axis deviation? Here is the answer:
All of these "foot deformities" will cause a lateral spatial location of the STJ axis in relation to the plantar foot and thus cause the foot to have a "laterally deviated STJ axis" by the definitions I first proposed in my paper from 22 years ago (Kirby KA: Methods for determination of positional variations in the subtalar joint axis. JAPMA, 77: 228-234, 1987). Therefore, the Root et al system of "foot and lower extremity deformities" and the system of STJ axis spatial location classification that I have proposed can be directly related to each other by simply changing the frame of reference from the STJ neutral position to the spatial location of the STJ axis relative to the plantar foot during weightbearing activities.
Hope this helps.
Thank you very much by the observations Dr. Kirby. Its theory gets passionate to me and each dez that I see a patient with some syntomatologic problem, attempt to apply these concepts, the theory of stress of tissue and its clinical application continues contributing great satisfactions. Totally in agreement .
Thanks Dr. Kirby!
Cheers
__________________
El Raciocinio... una maravilla de la naturaleza humana capaz de conseguir el mayor triunfo personal.
Originally Posted by Fran Monzó
Thank you very much Dave by the reference of the study. I am going to throw a look to him.
With respect to Fuller 1999, it referred simply me to the article of the Dr. Fuller: " Center of Pressure and its relationship to foot pathology" … I do not know if I do well in denominating standing up to the type with STJA laterally and increase of the muscle tension PLC, how one of the estruturas that with but emphasis pronador moment generates on the STJA… PERONEAL FOOT?
Fran
You seem to be asking about a test to examine the strength and efficiency of the Peroneal complex in STJ eversion. Also how CoP and stj axis location are relevant to this Peroneal action. I think That the two papers attached earlier and Simon's reply seem to answer your question. Is this assumption correct?
I was curious to know what you meant by the term 'Peroneal Foot' I thought it might be something Eric Fuller (Fuller 1999) had used but I have read through his paper and it does not appear.
Here are some more papers that might be of interest
Regards D Smith
Thanks for the bibliography David!
It has been to me clear. Solved doubts give rise to new caused questions… Cheers
__________________
El Raciocinio... una maravilla de la naturaleza humana capaz de conseguir el mayor triunfo personal.
Michael;
thank you, but no. I was looking for the reference posted above my query, one on Peroneal Activation Deficits in Persons With Functional Ankle Instability
1. Riann M. Palmieri-Smith, PhD, ATC†‡,§,*,
2. J. Ty Hopkins, PhD, ATC|| and
3. Tyler N. Brown, MS†
Anyone else have that paper available?
thanks again!
Bruce
Thank you very much by the observations Dr. Kirby. Its theory gets passionate to me and each dez that I see a patient with some syntomatologic problem, attempt to apply these concepts, the theory of stress of tissue and its clinical application continues contributing great satisfactions. Totally in agreement .
Thanks Dr. Kirby!
Cheers
Fran:
De nada!!
Feliz Navidad.
__________________
Sincerely,
Kevin
**************************************************
Kevin A. Kirby, DPM
Adjunct Associate Professor
Department of Applied Biomechanics
California School of Podiatric Medicine at Samuel Merritt College
Michael;
thank you, but no. I was looking for the reference posted above my query, one on Peroneal Activation Deficits in Persons With Functional Ankle Instability
1. Riann M. Palmieri-Smith, PhD, ATC†‡,§,*,
2. J. Ty Hopkins, PhD, ATC|| and
3. Tyler N. Brown, MS†
Anyone else have that paper available?
thanks again!
Bruce
Bruce:
Merry Christmas!
__________________
Sincerely,
Kevin
**************************************************
Kevin A. Kirby, DPM
Adjunct Associate Professor
Department of Applied Biomechanics
California School of Podiatric Medicine at Samuel Merritt College
Just by coincidence I have a patient with very painful ankle instability due to improperly rehabilitated ankle sprains and tibial fracture over several years (see X Rays attachments below). Orthoses do not stabilise the joint and I have prescribed a laced ankle brace and referred to orthopaedics. I wondered what your opinion might be (anyone) as to the successful surgical outcome for this type of trauma.
I believe there are different reasons for ankle instability. The laterally deviated STJ axis is one in that the center of pressure is much more likely to be very near or medial to the axis so there will be a small pronation moment from the ground, or even a supination moment from ground reaction force. Feet with laterally positioned STJ axes may. or may not, have a history of ankle sprains. It is possible for people with this kind of foot may be so attuned to any unexpected supination moment and have very active peroneal muscles that prevent any inversion. As Kevin mentioned you may see the peroneal muscles active when the patients are in "relaxed" stance position. There was a thread asking about the therapeutic effect of wedging. The effect that I find about 100% effective is the patient who complains of peroneal tendonitis / fatigue and is given a forefoot valgus wedge. They often feel the difference the instant they stand on the wedge.
Dave's radiographs represent a different kind of ankle instability. The ligaments have torn and appear to have healed in a configuration where the ligaments are longer. These longer ligaments allow more motion than is optimal. There will be some overlap between these two types of instability. Those with laterally positioned STJ axes will probably be more likely to have had an ankle injury where the ankle collateral ligaments are injured. The laterally positioned axis and the ligamentous laxity will create different symptoms. The lax ligaments are probably more likely to lead to ankle arthritis and I would bet more difficulty in starting and stopping sports. The laterally positioned axis will still tend to invert in the presence of uneven ground and unexpected locations of center of pressure. These are different complaints and should be treated differently. In the surgery courses in podiatry school, they taught that the ankle instability was caused by the lax ligaments without differentiating what kind of stability was present. Lax ligaments won't cause an inversion motion. A supination moment has to cause an inversion motion.
One story that I heard in school has stuck with me. James Garrick an orthopedic surgeon in San Francisco was telling us about a study he was going to on lateral ankle stabilization surgical procedures. He wanted for everyone to be at the same starting point prior to surgery so he had all the potential study participants go to physical therapy for proprioceptive training. He said that all the people who got the proprioceptive training declined to have the surgery because they felt more stable. It was an influential moment for me in that it really illustrates how important it is to take into account the brain that is attached to the foot. Things are not just purely mechanical and you do have to at least think about variation in muscle moments across steps and across individuals.
Regards,
Eric
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Ankle Lateral Instability VS Syndrome Disfunction Peroneal Lateral Brevis Muscle
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