-- Most lesions are best identified with an MRI. -- Pure cartilage injuries will not typically be picked up by a routine x- ray. -- Patients often complain of clicking, or locking of the ankle joint from the loose piece of cartilage."Fibrous tarsal coalitions A fibrous tarsal coalition is an abnormal connection between two bones in the foot which is present since birth. This connection limits the motion of the two connected bones and causes stiffness of the foot, especially the side-to-side motion of the heel. Jeffrey E. Johnson, MD, of Washington University Department of Orthopedic Surgery said, "Although this is a relatively uncommon cause of persistent pain following an 'ankle sprain,' it is often overlooked and the diagnosis may be delayed. The two common scenarios in which a tarsal coalition present are: 1) the active adolescent with a complaint of recurrent sprains and a stiff painful hind foot (the patient may not remember a significant ankle injury); and 2) the adult with lingering pain over the outside of the hind foot after a sprain due to a previously painless tarsal coalition that becomes painful after an injury." Dr. Johnson continued, "The key to making the diagnosis of this condition after a sprain is to perform a careful examination of the ankle to determine if the location of tenderness is over the ankle ligaments (as in a sprain) or over the typical locations for a tarsal coalition, which are slightly lower on the side of the hind foot. In addition, the physical exam will demonstrate limited side-to-side range of motion of the foot. Careful scrutiny of the x-ray will often identify the abnormal bone formation indicating a tarsal coalition; however, a CT scan is often obtained to confirm the diagnosis. If the pain does not resolve with ankle rehabilitation and immobilization, surgical excision of the painful connection between the calcaneus and navicular bones is recommended. This will not significantly improve the range of motion of the foot, but it will relieve pain." Ankle rehabilitation D. Rod Walters, PhD, a consultant in sports medicine, said his approach to ankle rehabilitation includes restoration of range of motion, strength, ankle function, and sport specific conditioning. "Failure to do these things results in chronic ankle dysfunction, an anomaly affecting some 20-50% of lateral ankle sprain patients. Ankle dysfunction is characterized by pain, inflammation, and loss of motion and may produce long-term disability and function, leading to increased treatment costs and time loss for patients." He continued, "For injury prevention, strengthening of the muscles of the ankle should include all appropriate motions -- and include exercise of concentric (shortening) and eccentric (lengthening) contractions. The eccentric mode is so important, especially in sport activity, and is often overlooked due to the difficulty associated with determining the actual deficit. When approaching bracing and /or taping options for the ankle, the focus needs to be on control of the calcaneous (heel bone) to minimize motions associated with the subtalar joint (true ankle motion of inversion and eversion) while syndesmosis (high ankle sprain) injuries indicate attention to the first ray (great toe and the area it articulates within the foot) and the corresponding motions of pronation and supination. Brace options for these two injuries should address these needs." This symposium makes it easy to understand the various types of conditions that comprise the term "ankle sprain." From the simple to the complex, from the short-term injury to long-lasting condition, this seminar illustrates the many different aspects to what otherwise might be thought of as a simple ankle sprain. About AOFAS The AOFAS promotes quality, ethical and cost-effective patient care through education, research and training of orthopaedic surgeons and other health care providers. It creates public awareness for the prevention and treatment of foot and ankle disorders, provides leadership, and serves as a resource for government, industry and the national and international health care community. About Orthopaedic Foot and Ankle Surgeons Orthopaedic foot and ankle surgeons are medical doctors (MD and DO) who specialize in the diagnosis, care, and treatment of patients with disorders of the musculoskeletal system of the foot and ankle. This includes the bones, joints, ligaments, muscles tendons, nerves, and skin. Orthopaedic foot and ankle surgeons use medical, physical, and rehabilitative methods as well as surgery to treat patients of all ages. They perform reconstructive procedures, treat sports injuries, and manage and treat trauma of the foot and ankle. Orthopaedic foot and ankle surgeons work with physicians of many other specialties, including internal medicine, pediatrics, vascular surgery, endocrinology, radiology, anesthesiology, and others. Medical school curriculum and post-graduate training provides the solid clinical background necessary to recognize medical problems, admit patients to a hospital when necessary, and contribute significantly to the coordination of care appropriate for each patient. To visit a multi-media version of this release visit: http://www.pwrnewmedia.com/2009/aofas90312/index.html
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