Four rating systems were developed by the American Orthopaedic Foot and Ankle Society to provide a standard method of reporting clinical status of the ankle and foot. The systems incorporate both subjective and objective factors into numerical scales to describe function, alignment, and pain.

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Weightbearing radiographs and bone scintigrams are sensitive, reproducible, and relatively inexpensive methods of investigation of these injuries. Restoration and maintenance of the anatomic alignment of the Lisfranc joint is the key to appropriate treatment of injury to the midfoot.

By 24 months, ankles treated with STAR ankle replacement (in both the Pivotal and Continued Access Groups) had better function and equivalent pain relief as ankles treated with fusion.

This ad hoc committee was appointed to evaluate the methods of measurement in quantitating pre-and postoperative hallux valgus angles and make recommendations. The previous AOFAS research committee report had also done this in 1984. 37The most commonly used angular measurements to assess the severity of a pre-operative hallux valgus deformity and the magnitude of the postoperative correction are the hallux valgus angle and the 1-2 intermetatarsal angle. The use of these quantitative angular measurements in assessing hallux valgus deformities is based upon the belief that they are reliable, repeatable, and provide a constant value for comparison of different studies." While it has been demonstrated that both of these angles can be reliably measured from both an intra-observer and inter-observer standpolnt,"" there is considerable evidence that these angular measurements are obtained and reported in an inconsistent fashion.In evaluating published reports on hallux valgus correction, the information on angular measurements presented is variable. In few instances, a precise description as well as a consistent diagram and/or representative radiograph is presented,"> but generally there are either no recorded measure-

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BACKGROUND Previous studies have suggested injury to the anterior talofibular ligament may be linked to altered kinematics and the development of osteoarthritis of the ankle joint. However, the effects of ATFL injury on the in vivo kinematics of the ankle joint are unclear. HYPOTHESIS Based on the orientation of the ATFL fibers, we hypothesized that ATFL deficiency would lead to increased anterior translation and increased internal rotation of the talus relative to the tibia. STUDY DESIGN Controlled laboratory study. METHODS The ankles of 9 patients with unilateral ATFL injuries were compared as they stepped onto a level surface. Kinematic measurements were made as a function of increasing load. Using magnetic resonance imaging and orthogonal fluoroscopy, the in vivo kinematics of the tibiotalar joint were measured in the ATFL deficient and intact ankles from the same individuals. RESULTS A statistically significant increase in internal rotation, anterior translation, and superior translation of the talus was measured in ATFL deficient ankles as compared to intact, contralateral controls. For example, at 100% body weight, ATFL deficient ankles demonstrated a statistically significant increase in anterior translation of 0.9 ± 0.5mm (p = 0.008). At 100% body weight, the ATFL deficient ankle was internally rotated relative to the intact ankle by 5.7 ± 3.6° (p = 0.008). There was a slight increase of 0.2 ± 0.2mm in the superior translation of the ATFL deficient ankle compared to the intact ankle at 100% body weight (p = 0.02). CONCLUSIONS ATFL deficiency increases anterior translation, internal rotation, and superior translation of the talus. CLINICAL RELEVANCE Altered kinematics may contribute to the degenerative changes observed with chronic lateral ankle instability. These findings might help to explain the degenerative changes frequently observed on the medial talus in patients with chronic ATFL insufficiency and provide a baseline for improving ankle ligament reconstructions aimed at restoring normal joint motion.

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