title: Hindfoot joint pressure in supination sprains.
abstract: BACKGROUND
  Hindfoot trauma including ankle and subtalar sprains may be followed by osteochondral lesions and persisting pain originating from posttraumatic arthritis.
  
  
  OBJECTIVE
  "Acute severe" supination sprains and "mild supination sprains with increasing ligamentous incompetence" of the hindfoot lead to medial ankle and subtalar stress concentrations that may contribute to osteochondral lesions (OCLs) and subsequent arthritis.
  
  
  METHODS
  Controlled laboratory study.
  
  
  METHODS
  "Acute severe" sprains and "mild sprains with increasing ligamentous incompetence" (consecutive anterior talofibular ligament [ATFL], calcaneofibular ligament [CFL], and lateral talocalcaneal ligament [LTCL] transections) were simulated in human lower leg specimens (7 different specimens for each condition). The effect on the migration of the center of force (COF) and on the tibiotalar and subtalar pressures at 700-N (acute severe) and 150-N (mild sprain with increasing ligamentous incompetence) axial static and dynamic loads, respectively, was recorded using pressure sensors.
  
  
  RESULTS
  In the "acute severe" sprain, the peak pressure increase reached the level of significance in the ankle (P = .042) and in the subtalar medial facet (P = .046). The ankle COF migrated significantly toward the medial (P = .001) and posterior (P = .023) directions. In the "mild sprain with increasing ligamentous incompetence" condition, the ankle (P = .018) and subtalar (medial facet, P = .022) peak pressure increased significantly with intact ligaments and with all ligaments cut. The ankle COF migrated significantly toward the medial direction when the ATFL and CFL or when all 3 ligaments were severed. The anteroposterior ankle COF migration was anterior when all ligaments were intact or when only the ATFL was severed but posterior when the CFL or when the CFL and the LTCL were severed in addition.
  
  
  CONCLUSIONS
  Next to chronic inhomogeneous load distribution in the unstable hindfoot and shear stress during sprains, intra-articular pressure elevation (impact) in the ankle and subtalar joint during hindfoot supination sprains with intact ligaments or incompetent ligaments likely contributes to OCLs of the medial talar dome and the medial subtalar facet.
  
  
  CONCLUSIONS
  Intra-articular hindfoot pressure elevation (impact) in "acute severe" and in "mild hindfoot supination sprains with increasing ligamentous incompetence" is substantial for the development of OCLs at the medial midtalar dome and the medial facet of the subtalar joint.
authors.affiliation: Department of Orthopaedic Surgery, Inselspital, University of Berne, Berne, Switzerland. fabian.krause@insel.ch
authors.forename: Fabian
authors.initials: F
authors.lastname: Krause
authors.forename: Stefanie
authors.initials: S
authors.lastname: Blatter
authors.forename: Dirk
authors.initials: D
authors.lastname: Waehnert
authors.forename: Markus
authors.initials: M
authors.lastname: Windolf
authors.forename: Martin
authors.initials: M
authors.lastname: Weber
mesh_terms: D000368:Aged; D000843:Ankle Joint / Q000502:physiology*; D002102:Cadaver; D006801:Humans; D008875:Middle Aged; D013180:Sprains and Strains / Q000473:pathology*; D013484:Supination / Q000502:physiology*