Influence of kinematic analysis methods on detecting ankle and subtalar joint instability

mike weber · Dec 15, 2011

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Influence of kinematic analysis methods on detecting ankle and subtalar joint instability

Julie Choisne, Stacie I. Ringleb, Michael A. Samaan, Sebastian Y. Bawab, Dayanand Naik, Claude D. Anderson

Abstract
Patients with subtalar joint instability may be misdiagnosed with ankle instability, which may lead to chronic instability at the subtalar joint. Therefore, it is important to understand the difference in kinematics after ligament sectioning and differentiate the changes in kinematics between ankle and subtalar instability. Three methods may be used to determine the joint kinematics; the Euler angles, the Joint Coordinate System (JCS) and the helical axis (HA). The purpose of this study was to investigate the influence of using either method to detect subtalar and ankle joints instability. 3D kinematics at the ankle and subtalar joint were analyzed on 8 cadaveric specimens while the foot was intact and after sequentially sectioning the anterior talofibular ligament (ATFL), the calcaneofibular ligament (CFL), the cervical ligament and the interosseous talocalcaneal ligament (ITCL). Comparison in kinematics calculated from sensor and anatomical landmarks was conducted as well as the influence of Euler angles and JCS rotation sequence (between ISB recommendation and previous research) on the subtalar joint. All data showed a significant increase in inversion when the ITCL was sectioned. There were differences in the data calculated using sensors coordinate systems vs. anatomic coordinate systems. Anatomic coordinate systems were recommended for these calculations. The Euler angle and JCS gave similar results. Differences in Euler angles and JCS sequence lead to the same conclusion in detecting instability at the ankle and subtalar joint. As expected, the HA detected instability in plantarflexion at the ankle joint and in inversion at the subtalar joint.
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DrBob · Dec 29, 2011

Hi Mike,
Can you supply the reference details, please?
DrBob

efuller · Dec 29, 2011

Abstract
Patients with subtalar joint instability may be misdiagnosed with ankle instability, which may lead to chronic instability at the subtalar joint. Therefore, it is important to understand the difference in kinematics after ligament sectioning and differentiate the changes in kinematics between ankle and subtalar instability.

some cut

The Euler angle and JCS gave similar results. Differences in Euler angles and JCS sequence lead to the same conclusion in detecting instability at the ankle and subtalar joint. As expected, the HA detected instability in plantarflexion at the ankle joint
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This is one where the experiment may be flawless, but the research question is wrong. When patients come in complaining of ankle instability they probably don't know the difference between the ankle and subtalar joint. The instability starts when the foot is close to its relaxed stance position and not when it's at the end of range of motion, which is where the function of the ligaments matters. If the patient complains of frequent sprains the initial problem is unlikely to be with the ligaments. The ligaments may become a problem after several sprains, but it is not the initial problem. Are there weak peroneal muscles or a laterally deviated STJ axis causing the frequent sprains? What is the problem when a patient says their ankle is unstable?

Eric

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