title: Effects of injection--drug injury on ankle mobility and chronic venous disorders.
abstract: OBJECTIVE
  To identify potential confounders and test a causal model of injection-site risk, chronic venous disorders (CVD), and ankle mobility. The reliability and validity of goniometry measurements of ankle mobility were also of interest because they are seldom performed in people with a history of injection-drug use.
  
  
  METHODS
  The study was a test-retest design, consisting of 104 participants from a methadone maintenance treatment center.
  
  
  METHODS
  Each participant provided demographic information, health and drug histories, and underwent bilateral ankle goniometric measures of dorsiflexion, plantar flexion, inversion, and eversion. The clinical portion of the Clinical-Etiology-Anatomy-Pathophysiology (CEAP)was used to classify CVD severity.
  
  
  RESULTS
  Reliability of goniometry measurements ranged from .70 to .90. Causal modeling supported hypotheses of increased risk from leg injection and reciprocal effects involving ankle mobility and disease progression. Ankle inversion mobility was the strongest indicator of ankle mobility.
  
  
  CONCLUSIONS
  Injury to the lower extremities from IDU affected CVD and mobility. Further research should include assessment of comorbidity and other potential confounders. Ankle inversion should remain part of the goniometry assessment.
authors.affiliation: College of Nursing, Wayne State University, Detroit, MI 48202, USA. bpieper@wayne.edu
authors.forename: Barbara
authors.initials: B
authors.lastname: Pieper
authors.forename: Thomas N
authors.initials: TN
authors.lastname: Templin
authors.forename: Thomas J
authors.initials: TJ
authors.lastname: Birk
authors.forename: Robert S
authors.initials: RS
authors.lastname: Kirsner
mesh_terms: D000704:Analysis of Variance; D016512:Ankle Injuries / Q000175:diagnosis / Q000209:etiology / Q000503:physiopathology; D053587:Arthrometry, Articular / Q000379:methods* / Q000592:standards; D001696:Biomechanical Phenomena; D015984:Causality; D002908:Chronic Disease; D015986:Confounding Factors, Epidemiologic; D005163:Factor Analysis, Statistical; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007593:Joint Instability / Q000175:diagnosis / Q000209:etiology / Q000503:physiopathology; D016014:Linear Models; D008297:Male; D008875:Middle Aged; D051346:Mobility Limitation; D009730:Nursing Assessment; D016491:Peripheral Vascular Diseases / Q000175:diagnosis / Q000209:etiology / Q000503:physiopathology; D016059:Range of Motion, Articular; D018570:Risk Assessment; D012720:Severity of Illness Index; D015819:Substance Abuse, Intravenous / Q000150:complications*; D011795:Surveys and Questionnaires; D013997:Time Factors