ARTHROPATHICA ULCEROSA - A STUDY OF REDUCED ANKLE MOVEMENT IN ASSOCIATION WITH CHRONIC LEG ULCERATION

Objective. To quantify the clinical impression that reduced ankle move ment occurs in association with chronic lower leg ulceration, to obtai n data on the relation between severity and duration, and to assess th e role of other factors such as age, smoking, and lipodermatosclerosis . Methods. Ipsilateral and contralateral passive range of movement (RO M) of the tibiotalar joint were measured in 38 patients with chronic u lceration of the lower leg. Passive ROM in 40 elderly patients without venous ulceration was also measured. Subjects with chronic ulceration had a mean duration of current ulceration of 3.4 years but a mean tot al duration of ulcer disease of 19.2 years. Results. A significant dif ference in passive ROM was noted between ipsilateral and contralateral legs (ROM ipsilateral leg 36.3 +/- 10 degrees; ROM contralateral leg 45.3 +/- 13 degrees, t = -3.27, p = 0.002). No significant difference in equilibrium position at the ankle was observed between normal and a ffected legs. Multiple regression analysis revealed that for every yea r of life the patient lost 0.36 degrees of tibiotalar movement and for every year of active ulceration the patient lost 0.78 degrees of move ment. This restriction of movement was not associated with the presenc e of lipodermatosclerosis nor with smoking history. Conclusion. A redu ction in movement in the dorsovolar plane occurs in the ankle joint ad jacent to chronic ulceration and, the longer the period of ulceration, the greater the restriction of movement.