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Increased subtalar rotational motion in patients with symptomatic ankle instability under load and stress conditions

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Knee Surgery, Sports Traumatology, Arthroscopy Aims and scope

Abstract

Purpose

Differentiating subtalar and ankle instability in the clinical setting is challenging. This study aims to analyze the rotational laxity of the subtalar joint bilaterally in patients with asymptomatic and symptomatic ankle instability under simulated load and stress-induced position of the subtalar joint.

Methods

A case–control study was conducted using an adjustable load device (ALD). Patients with chronic ankle instability and healthy volunteers were included. Each subject underwent a CT scan under mechanical stress and simulated weight-bearing conditions, maintaining maximum eversion and inversion hindfoot positions. The images were obtained in a single model, allowing calculations of the motion vector as well as the helical axis. The helical axis was defined by a rotation angle and a translation distance.

Results

A total of 72 feet were included in the study. Thirty-one patients with unilateral symptoms and five healthy controls were selected, defining two groups: symptomatic (n = 31) and asymptomatic (n = 41). An absolute difference of 4.6º (95%CI 2–11.1) rotation angle was found on the helical axis of the symptomatic vs. asymptomatic group (p = 0.001). No significant differences were detected in the translation distance (n.s.) between the groups. Additionally, a significant positive correlation was found between the rotation angle and translation distance through the helical axis in the asymptomatic group (r = 0.397, p = 0.027).

Conclusion

Patients with chronic ankle instability suspected of having subtalar joint instability showed a wider subtalar range of laxity in terms of rotation about the helical axis. Furthermore, differences in kinematics between symptomatic and asymptomatic hindfeet was demonstrated when both feet were compared.

Level of evidence

III.

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Data availability

Not applicable.

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Acknowledgements

The authors would like to thank Eloisa Rubio Pérez (Methodological and Statistical Management Unit - Hospital Universitario Virgen del Rocío) her invaluable assistance in the methodology and statistical analysis of this work.

Funding

None.

Author information

Authors and Affiliations

  1. University Hospital Virgen del Rocío, Sevilla, Spain

    María Reyes Fernández-Marín

  2. Orthopedic Surgery and Traumatology Deparment, Origen, Grupo Recoletas, C. Paulina Harriet, 4-6, 47006, Valladolid, Spain

    David González-Martín

  3. Universidad Europea Miguel de Cervantes, Valladolid, Spain

    David González-Martín

  4. Universidad de La Laguna, La Laguna, Spain

    Mario Herrera-Pérez

  5. Foot and Ankle Unit, Orthopedic Surgery and Traumatology Department, Hospital Universitario de Canarias, La Laguna, Spain

    Mario Herrera-Pérez

  6. Engineering Deparment, HT Médica, Granada, Spain

    Félix Paulano-Godino

  7. University Hospital 12 de Octubre, Madrid, Spain

    Jesús Vilá-Rico

  8. Universidad Complutense de Madrid, Madrid, Spain

    Jesús Vilá-Rico

  9. Head Foot Ankle Unit, University Hospital Virgen del Rocío, Sevilla, Spain

    Sergio Tejero

  10. University of Sevilla, Sevilla, Spain

    Sergio Tejero

Authors
  1. María Reyes Fernández-Marín
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  2. David González-Martín
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  4. Félix Paulano-Godino
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  5. Jesús Vilá-Rico
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Contributions

All authors were equally involved in the development of the article.

Corresponding author

Correspondence to David González-Martín.

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Ethical approval

The study received ethical approval from the Virgen del Rocío’s Centre for Investigation Ethics Comitee (2012PI/060) and all methods were performed according to the regulations.

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All patients signed the informed consent form.

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Cite this article

Fernández-Marín, M.R., González-Martín, D., Herrera-Pérez, M. et al. Increased subtalar rotational motion in patients with symptomatic ankle instability under load and stress conditions. Knee Surg Sports Traumatol Arthrosc 31, 5214–5221 (2023). https://doi.org/10.1007/s00167-023-07553-2

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  • DOI: https://doi.org/10.1007/s00167-023-07553-2

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