Arthropathica ulcerosa: a study of reduced ankle movement in association with chronic leg ulceration.

OBJECTIVE

To quantify the clinical impression that reduced ankle movement occurs in association with chronic lower leg ulceration, to obtain data on the relation between severity and duration, and to assess the role of other factors such as age, smoking, and lipodermatosclerosis.

METHODS

Ipsilateral and contralateral passive range of movement (ROM) of the tibiotalar joint were measured in 38 patients with chronic ulceration 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 total duration of ulcer disease of 19.2 years.

RESULTS

A significant difference 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 affected legs. Multiple regression analysis revealed that for every year of life the patient lost 0.36 degree of tibiotalar movement and for every year of active ulceration the patient lost 0.78 degree of movement. This restriction of movement was not associated with the presence of lipodermatosclerosis nor with smoking history.

CONCLUSION

A reduction in movement in the dorsovolar plane occurs in the ankle joint adjacent to chronic ulceration and, the longer the period of ulceration, the greater the restriction of movement.