Functional ankle instability

NewsBot · Jul 14, 2024

Effects of Chronic Pain on Static and Dynamic Postural Control in Chronic Ankle Instability
Minsub Oh et al
Clin J Sport Med. 2024 Jul 8.

Objective: To identify the effects of chronic pain levels on static and dynamic postural (DP) control in individuals with chronic ankle instability (CAI).

Design: Cross-sectional study.

Setting: Controlled laboratory.

Participants: Sixty participants were divided into the following 3 groups: 20 high pain individuals with CAI (high pain), 20 low pain individuals with CAI (low pain), and 20 healthy controls (control).

Independent variables: Groups (CAI with high pain, CAI with low pain, and control) and visual conditions (eyes open and closed) for single-leg stance.

Main outcome measures: Participants performed single-leg stance with eyes open and closed, the star excursion balance test, and single-leg hop to stabilization.

Results: The high pain group experienced worse self-reported outcomes, including Foot and Ankle Ability Measure activities of daily living and sports, than the low pain and control groups. Regardless of visual condition, both the high and low pain groups exhibited decreased static postural control in mediolateral (ML) compared with the control group. Specifically, the high pain group showed decreased static postural control in ML under closed eyes compared with the low pain and the control groups. The high pain group showed less reach distance than the control group and increased DP control in vertical and overall DP stability index compared with the low and control groups.

Conclusions: Chronic pain can significantly affect both static and DP control in individuals with CAI. Therefore, clinicians should consider chronic pain as one of the factors affecting postural control in individuals with CAI.
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NewsBot · Jul 14, 2024

The Effect of Additional Neuromuscular Training on Peri-Ankle Muscle Morphology and Function in Chronic Ankle Instability Subjects: A Randomized Controlled Trial
Khadijeh Kazemi et al
Sports Health. 2024 Jun 20

Background: Lateral ankle sprain is one of the most common musculoskeletal issues during sports and activities of daily living. This study investigated the effect of combined neuromuscular training and conventional training (including strengthening, range of motion, and balance exercises) on muscle morphology, dynamic balance, perceived ankle instability, and functional capacity in persons with chronic ankle instability (CAI).

Hypothesis: The combination of neuromuscular and conventional training programs might result in additional benefits on the morphology of muscle, dynamic balance, and functional capacity in subjects with CAI.

Study design: A single-blind parallel-arm randomized controlled trial.

Level of evidence: Level 2.

Methods: A total of 34 participants with CAI were divided randomly into experimental (EG) and control groups (CG). The EG received conventional and neuromuscular training, while the CG underwent conventional training. Cross-sectional areas of the peroneus longus and tibialis anterior muscles were measured using ultrasonography. Measurements included reaching direction distance, ankle instability, and the foot and ankle outcome score, all evaluated before and immediately after 12 intervention sessions and 4 weeks later in the follow-up phase.

Results: Repeated-measures analysis of variance (ANOVA) revealed significant improvement in the EG, particularly in the cross-sectional area of the tibialis anterior muscle on the injured side and the posteromedial reaching direction displacement of the Y balance test. Moreover, the EG's foot and ankle outcome scores increased significantly compared with the CG (P < 0.05). However, the group effect size ranged from minor to moderate (Hedges g, 0.40-0.73).

Conclusion: Combining neuromuscular and conventional training programs yields greater benefits than conventional training alone regarding tibialis anterior muscle morphology, posteromedial dynamic balance, and functional capacity in persons with CAI.

Clinical relevance: The combination of neuromuscular and conventional training programs could enhance muscle morphology, dynamic balance, perceived ankle instability, and functional capacity in persons with CAI.
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NewsBot · Jul 15, 2024

Peri‐ankle muscles architecture and performance changes
in patients with chronic ankle instability: A retrospective
cross‐sectional study
Heeju Yu et al
Source

This study aimed to identify changes in the architecture and performance of the peri‐
ankle muscles in patients with chronic ankle instability (CAI) and investigate the relationship between them. In total, 17 subjects were evaluated retrospectively. Each
subject underwent anthropometric and isokinetic test, and peroneus longus (PL) and
brevis (PB), medial gastrocnemius (MGCM), and tibialis anterior (TA) ultrasound imaging were performed at rest and maximum voluntary contraction (MVC) conditions.
Regarding muscle architectural variables, the pennation angle (PA) of the MGCM at
rest and the PA of the TA, MGCM, and PL in MVC were significantly reduced on the
injured side compared to the intact side. There were no significant differences in muscle
thickness of PL, PB, MGCM, and TA observed between intact and injured side during
both rest and MVC. Regarding muscle performance parameters, significant decreased
were observed in the muscle strength for both limbs in all four directions under the two
different conditions. A secondary finding was that the relative PA ratio of the TA
showed moderate correlation with the relative dorsiflexion ratio at 30°/s. These findings can provide opportunities to better understand how injuries in patients with CAI
may be related to changes in ankle and foot function.
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NewsBot · Jul 16, 2024

Effects of Chronic Pain on Static and Dynamic Postural Control in Chronic Ankle Instability
Oh, Minsub et al
Clinical Journal of Sport Medicine ():10.1097/JSM.0000000000001248, July 8, 2024. | DOI: 10.1097/JSM.0000000000001248

Objective:
To identify the effects of chronic pain levels on static and dynamic postural (DP) control in individuals with chronic ankle instability (CAI).

Design:
Cross-sectional study.

Setting:
Controlled laboratory.

Participants:
Sixty participants were divided into the following 3 groups: 20 high pain individuals with CAI (high pain), 20 low pain individuals with CAI (low pain), and 20 healthy controls (control).

Independent Variables:
Groups (CAI with high pain, CAI with low pain, and control) and visual conditions (eyes open and closed) for single-leg stance.

Main Outcome Measures:
Participants performed single-leg stance with eyes open and closed, the star excursion balance test, and single-leg hop to stabilization.

Results:
The high pain group experienced worse self-reported outcomes, including Foot and Ankle Ability Measure activities of daily living and sports, than the low pain and control groups. Regardless of visual condition, both the high and low pain groups exhibited decreased static postural control in mediolateral (ML) compared with the control group. Specifically, the high pain group showed decreased static postural control in ML under closed eyes compared with the low pain and the control groups. The high pain group showed less reach distance than the control group and increased DP control in vertical and overall DP stability index compared with the low and control groups.

Conclusions:
Chronic pain can significantly affect both static and DP control in individuals with CAI. Therefore, clinicians should consider chronic pain as one of the factors affecting postural control in individuals with CAI.
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NewsBot · Jul 27, 2024

Effect of Progressive Balance Control Strategies on Chronic Ankle Instability in Middle-Aged Obese Women
Rutuja S Arulekar et al
Cureus. 2024 Jun 23

Introduction: Chronic ankle instability (CAI) is a disease characterized by persistent feelings of instability in the ankle joint and a propensity for recurrent ankle sprains. It is often caused by ligamentous laxity or neuromuscular deficits. Middle-aged obese females represent a demographic subset at increased risk for CAI due to factors such as reduced proprioception and increased loading on the ankle joint. The gaps in the current evidence suggest that more research is needed on middle-aged obese females, who are particularly vulnerable to CAI due to physiological changes associated with poor balance.

Objectives: This study aims to determine the effect of progressive balance control strategies on CAI in middle-aged obese women.

Method: In this experimental study, 72 patients with CAI in middle-aged women were selected randomly using a simple random sampling method. Females aged 35-45 with a body mass index (BMI) greater than 27 kg/m2 and a history of ankle sprains greater than one and having residual symptoms. The experimental group (Group B) received progressive balance control strategies, and the conventional group (Group A) received conventional balance exercises. Foot and ankle ability measure (FAAM) scale, push-and-release test (PART), single-leg stance test (SLST), evaluations, and star excursion balance test (SEBT) were used for pre- and posttreatment.

Results: The experimental group post-intervention for static balance, dynamic balance, and postural control tests showed extremely significant improvement with a p-value of <0.0001. Between groups A and B, the dynamic balance was considered very significant, with a p-value of 0.0001. In the single-leg stance test, Group B's result was significantly greater than that of Group A's (63.4 + 16.1 and 63.4 + 16.1). PART results indicate that Group B is more significant than Group A (0.76 and 0.51, respectively).

Conclusions: The study concluded that progressive balance control strategy training is effective in middle-aged obese women with CAI.
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NewsBot · Jul 30, 2024

Treatment and Prevention of Chronic Ankle Instability: an Umbrella Review of Meta-analyses
Dahai Hu et al
Foot and Ankle Surgery; 30 July 2024

Background
Chronic ankle instability (CAI) is a common and highly disabling condition. Although several studies have evaluated and analyzed prevention and treatment strategies for CAI, an unbiased and systematic synthesis of evidence is required to provide the most powerful and comprehensive evidence-based measures for the its prevention and treatment of CAI. This study aimed to synthesize evidence from the existing literature addressing the treatment and prevention of CAI.

Methods
The PubMed, Embase, Cochrane, and Web of Science databases were systematically searched for relevant studies from inception to December 12, 2023. Data on effect sizes and corresponding 95% confidence intervals for selected intervention measures were extracted. Systematic reviews were assessed for quality of included studies using a measurement tool (i.e., “AMSTAR 2”).

Results
In total, 37 studies were included, among which 21 (57%) were of high or moderate quality. Strong evidence suggested that lower weight (P < 0.001), lower body mass index (P = 0.002), and non-stability defects (P = 0.04) significantly reduced the risk of developing CAI. Strong evidence supported exercise and moderate evidence supported manual therapy, acupuncture, and surgery for improving CAI. Additionally, external support plays an active role in the treatment process of CAI.

Conclusion
This is the first study synthesizing evidence supporting interventions for the treatment and prevention of CAI. Low body weight and body mass index were effective preventive measures against CAI. Exercise, manual therapy, acupuncture, and surgery can improve ankle function in patients with CAI. Plantar sensory treatment and neuromuscular training may be good therapeutic options for patients with CAI.
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NewsBot · Jul 31, 2024

Relationship between Tilt Sensation Ability and Lower Limb Injuries in Junior Athletes
Maki Tanaka et al
Int J Environ Res Public Health. 2024 Jul 19;21(7):947

The purpose of this study was to devise a tilt sensation measurement method to evaluate ankle proprioception and to examine its reliability. It was also used to determine the relationship among tilt sensation abilities, physical development, and lower limb injuries in junior athletes. In this study, a step platform created tilt angles. Participants with eye masks answered "yes" or "no" to sensing a tilt, evaluated over nine or seven trials. Experiment 1 involved 22 university students (20.6 ± 0.9 years). The minimum angle at which a tilt could be sensed while standing on both feet was determined, and measurements were taken again to examine reliability. Experiment 2 involved 40 junior athletes (12.3 ± 2.0 years), where the minimum angle for tilt sensation was obtained, and medical checks were conducted to assess injuries in the knee, lower leg, and foot. Reliability studies showed a moderately significant correlation between the first and second sessions (r = 0.504, p = 0.017), suggesting the reliability of the experimental method. The proportion capable of sensing a tilt of 1.1° and 1.6° was significantly higher in junior high school students than in elementary school students (1.1°; χ2 = 8.839, p = 0.003. 1.6°; χ2 = 4.038, p = 0.044). The group unable to sense a tilt of 1.6° and 2.1° had a significantly higher positive rate of knee injuries compared to the sensed group among junior high school students (1.6°; χ2 = 4.622, p = 0.032. 2.1°; χ2 = 4.622, p = 0.032). Our findings suggested that a reduced tilt sensation ability was associated with knee injuries in junior high school students. Utilizing our devised tilt sensation assessment could play a crucial role in preventing and detecting early injuries in junior high school students.
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NewsBot · Aug 4, 2024

Comparison of Midterm Outcomes between All-Inside Arthroscopic and Open Modified Broström Procedures as Treatment for Chronic Ankle Instability
Sung Hwan Kim et al
Clin Orthop Surg. 2024 Aug;16(4):628-635

Background: Although the all-inside arthroscopic modified Broström operation (AMBO) and open modified Broström operation (OMBO) for chronic lateral ankle instability (CLAI) showed favorable outcomes up to 1-year short-term follow-up, concerns about the long-term stability of AMBO are still present. Therefore, we aimed to compare midterm outcomes between the 2 methods by extending the observation period.

Methods: Fifty-four patients undergoing ankle surgery between August 2013 and July 2017 were included in the AMBO (n = 37) and OMBO (n = 17) groups. The American Orthopaedic Foot and Ankle Society (AOFAS) ankle-hindfoot scale and a visual analog scale (VAS) were used to evaluate the clinical outcomes. Anterior drawer test and talar tilt angle were used to evaluate the radiological outcomes. The mean follow-up duration was 59.69 months.

Results: The 2 groups both showed improved clinical and radiological results statistically. In addition, they did not differ in age, sex, or preoperative AOFAS ankle-hindfoot scale score, VAS score, anterior drawer test, or talar tilt angle. No significant difference in the final follow-up postoperative clinical scores or radiological outcomes was observed.

Conclusions: AMBO and OMBO as treatments for CLAI did not yield differing clinical or radiological outcomes at a mean follow-up time point of 59.69 months.
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NewsBot · Aug 5, 2024

BACKWARD WALKING VERSUS BALANCE TRAINING IN PATIENTS WITH CHRONIC ANKLE INSTABILITY: A
RANDOMIZED CONTROLLED TRIAL
Heba A. ElGayar et al
Source

Background: Ankle instability is a common injury, affecting the quality of life, self-reported function, ankle
proprioception as well as static and dynamic balance. Purpose: to compare the efficacy of backward walking
and Biodex balance training in chronic ankle instability patients. Methods: Sixty subjects participated in this
study; their age ranged from 19 to 35 years. They were randomly allocated into three equal groups. Group A
received a traditional physical therapy treatment in addition to backward walking training, Group B received
a traditional physical therapy treatment in addition to Biodex balance training, and Group C received a
traditional physical therapy treatment only (strength training, short foot exercises, heel raise exercises, and
calf stretch). All groups received treatment protocols three times a week for 6 consecutive weeks. Outcome
measures included the stability indices measured by the Biodex Balance System as well as ankle proprioception
measured by a digital goniometer, and functional limitations by the Foot and Ankle Disability Index. Results:
Post-treatment Within-Group findings revealed a statistically significant balance improvement by a decrease
in the overall, anteroposterior, and medio lateral stability indices, a decrease in ankle proprioception error,
as well as a significant increase in Foot and Ankle Disability Index outcomes of all 3 groups (p < 0.05). On
the other hand, there were no statistically significant differences between groups A, and B related to stability
indices, ankle proprioception, and Foot and Ankle Disability Index, while, there were statistically significant
differences between groups A and B compared with group C. Conclusion: Backward walking training has a
significant effect which appears to be similar to the Biodex balance training in improving balance, risk of fall,
ankle proprioception, and decreasing functional limitations in patients with chronic ankle instability
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NewsBot · Aug 14, 2024

The effect of joint mobilization of Maitland on chronic ankle instability: A randomized trial
Fang Tang et al
Medicine (Baltimore). 2024 Aug 9;103(32)

Background: The aim of study was to observe the therapeutic effect of joint mobilization of Maitland on subjects with chronic ankle instability (CAI).

Methods: 76 subjects with CAI were recruited for this randomized, single-blinded trial and randomized divided into experimental group (EG) and control group (CG). The CG was received conventional rehabilitation, and the EG added 8-weeks treatment of Maitland technology based on the CG. The visual analogue scale, ankle range of motion, Y-balance test, and Foot and Ankle Ability Measure scores (the daily living part of Foot and Ankle Ability Measure scores and the sport part of Foot and Ankle Ability Measure scores) were measured before and 8 weeks after the intervention respectively.

Results: There was no significant difference on outcomes between the 2 groups before treatment (P > .05). After 8 weeks of intervention, the visual analogue scale, ankle range of motion (dorsiflexion, plantar flexion, and varus), the value of Y-balance test (forward extension distance, inner extension distance, and posterior extension distance), the daily living part of Foot and Ankle Ability Measure scores, and the sport part of Foot and Ankle Ability Measure scores of the 2 groups were significantly improved (P < .01), and the improvement of the EG showed remarkable than CG (P < .01).

Conclusion: Maitland therapy is effective in the treatment of CAI. Conventional rehabilitation assisted by Maitland therapy were beneficial to improve pain and functional state in patients with CAI than only routine rehabilitation.
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NewsBot · Aug 14, 2024

Effect of a semirigid ankle brace on the in vivo kinematics and muscle activity of patients with functional ankle instability during simulated ankle sprain
Gonghao Zhang et al
Medicine (Baltimore). 2024 Aug 9;103(32)

Introduction: Ankle braces can effectively decrease the incidence of recurrent ankle sprain; however, whether the brace can decrease the severity of sprain and its related mechanism during sprain remain unknown.

Methods: Twenty-two patients with functional ankle instability (FAI) (12 males and 10 females) and 16 healthy subjects (8 males and 8 females) were enrolled in this study. All of the subjects walked on a custom-built tilting platform that offered a 30° inversion (IV) to mimic the IV of ankle sprain. We collected the kinematic and surface electromyography data of patients with FAI with or without ankle brace and normal controls 6 times.

Results: The FAI without brace group showed significantly higher maximum IV angles and average IV velocities than the control group (P < .001). The FAI with brace group revealed significantly lower maximum IV angles and average IV velocities than the FAI without brace group (P < .001); this group also showed significantly higher maximum external rotation (ER) angle and average ER velocities than the FAI with brace (P < .001) and control (P < .001) groups. The FAI with brace group indicated significantly lower average EMGPrep (P = .047), EMGTilt (P = .037), and EMGafterTilt (P = .004) of the peroneus longus than the FAI without brace group.

Conclusions: The ankle brace could effectively decrease IV angles and their velocities and increase ER angles and their corresponding velocities during ankle sprain in patients with FAI. It could also decrease the activity of the peroneus longus muscle during ankle sprain.
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NewsBot · Aug 16, 2024

Gait Training Interventions for Individuals with Chronic Ankle Instability: A Systematic Review & Meta-Analysis
Christine Ortega et al
J Athl Train. 2024 Aug 13

Objective: This review aimed to determine if gait training interventions influence lower extremity biomechanics during walking in individuals with chronic ankle instability (CAI).

Methods: A literature search was conducted in PubMed, CINAHL, SPORTDiscus, and MEDLINE to identify English-language studies from inception through September 2022. Eligible studies included randomized control trials, repeated measures design, and descriptive laboratory studies measuring the effects during or following a gait training intervention on biomechanical outcomes (kinematics, kinetics, electromyography) during walking in individuals with CAI. Gait training interventions were broadly categorized into devices (destabilization devices, novel gait training device) and biofeedback (visual, auditory, and haptic delivery modes). Meta-analyses were conducted when appropriate using random-effects to compare pre-and post- gait training intervention mean differences and standard deviations.

Results: Thirteen studies were included. Meta-analyses were conducted for single session gait training studies only. Eleven studies reported kinetic outcomes. Our meta-analyses showed location of center of pressure (COP) was shifted medially from 0-90% (Effect Size [ES] range=0.35-0.82) of stance, contact time was decreased in medial forefoot (ES=0.43), peak pressure was decreased for lateral midfoot (ES=1.18) and increased for hallux (ES=0.59), pressure time integral was decreased for lateral heel (ES=0.33) and lateral midfoot (ES=1.22) and increased for hallux (ES=0.63). Three studies reported kinematic outcomes. Seven studies reported electromyography outcomes. Our meta-analyses revealed increased activity following initial contact (IC) for fibularis longus (ES=0.83).

Conclusions: Gait training protocols improved some lower extremity biomechanical outcomes in individuals with CAI. Plantar pressure outcome measures seem to be most impacted by gait training programs with improvements in decreasing lateral pressure associated with increased risk for lateral ankle sprains. Gait training increased EMG activity post-IC for the fibularis longus. Few studies have assessed the impact of multi-session gait training on biomechanical outcome measures. Targeted gait trainning should be considered when treating patients with CAI.
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NewsBot · Sep 3, 2024

The Influence of Hip-Strengthening Program on Patients with Chronic Ankle Instability
Woo-Jin Yeum et al
Medicina (Kaunas). 2024 Jul 24;60(8):1199.

Background and Objectives: Repetitive ankle sprains lead to mechanical instability of the ankle. Patients with chronic ankle instability may experience decreased muscle strength and limited postural control. This study investigated the effects of a hip-strengthening exercise program on muscle strength, balance, and function in patients with chronic ankle instability. Materials and Methods: A total of 30 patients participated in the study and were randomly assigned to the two groups. Among the 30 participants, 14 were assigned to the hip joint-strengthening exercise group and 16 to the control group. The experimental group underwent a hip-strengthening exercise program and received training for 40 min per session twice a week for four weeks. The control group received the same frequency, duration, and number of sessions. Measurements were performed before and after the training period to assess changes in hip strength, balance, and function. Results: In the within-group and between-group comparisons, both groups showed significant differences in hip joint strength, static balance, dynamic balance, and function (FAAM; foot and ankle ability measures) (p < 0.05). Statistically significant differences were observed in the time × group interaction effects among the hip abductors and external rotation in hip joint strength, path length in static balance, posterolateral and posteromedial in dynamic balance, and FAAM-ADL and FAAM-SPORT functions (p < 0.05). Conclusions: Accordingly, this study confirmed that hip joint-strengthening exercises have a positive effect on the strength, balance, and function of patients with chronic ankle instability, and we believe that hip joint-strengthening exercises will be recommended as an effective intervention method for patients suffering from chronic ankle instability.
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NewsBot · Sep 3, 2024

Low Back Pain Caused by Traction Peripheral Neuropathy Due to Chronic Ankle Instability: Three Clinical Cases
Yusuke Hagiwara et al
Cureus. 2024 Jul 26;16(7):e65405

Non-specific low back pain without identifiable causes on imaging is a common and frustrating problem for both patients and physicians. While proximal symptoms such as shoulder pain from distal upper extremity neuropathies such as carpal tunnel syndrome are well-known, peripheral neuropathy of the foot or ankle is rarely considered in the differential diagnosis for low back pain. This study aims to highlight the potential link between chronic ankle instability (CAI) and low back pain. We present three cases: a 32-year-old woman with chronic low back pain for over 10 years, a 59-year-old woman with transient low back pain after long drives, and a 42-year-old woman with acute low back pain while gardening. All patients had normal imaging studies but exhibited CAI on examination. Diagnostic modalities included the ankle anterior drawer test, application of ankle brace, superficial peroneal nerve (SPN) blocks, and assessment of the active straight leg raise (aSLR) angle. In the first case, low back pain disappeared after SPN neurolysis and ankle ligament reconstruction. The second case showed significant improvement in aSLR and pain reduction with SPN block and ankle brace. The third case experienced substantial pain relief with the use of an ankle brace. These findings suggest that addressing ankle instability and associated traction neuropathy can significantly alleviate low back pain symptoms. CAI may be an underrecognized cause of non-specific low back pain. Interventions such as ankle brace, SPN blocks, SPN decompression, and ankle ligament reconstruction can be effective for diagnosis and treatment, potentially offering relief for patients with chronic low back pain.
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NewsBot · Sep 4, 2024

Do individuals with ankle instability show altered lower extremity kinematics and kinetics during walking? A systematic review and meta-analysis
Lijiang Luan et al
Source

Objective
To determine if individuals with chronic ankle instability (CAI) demonstrate altered lower extremity kinematics and kinetics during walking.
Data sources
Relevant studies were sourced from PubMed, Embase, Cochrane Library, Web of Science, EBSCO and PEDro.
Study selection
Kinematic and kinetic studies involving joint angle and/or joint moment measured in individuals with CAI were included.
Study appraisal and synthesis methods
The Risk of Bias in Non-randomised Studies - of Interventions (ROBINS-I) tool was used to assess literature quality. Weighted mean differences (WMDs) in joint angles and moments between CAI and controls were analyzed as continuous variables.
Results
1261 articles were screened, with a final selection of 13 studies involving 729 participants. Compared to non-CAI controls, CAI participants showed significantly greater ankle inversion angle (degree) (WMD: 3.71, 95% CI: 3.15 to 4.27, p < 0.001), hip adduction angle (degree) (WMD: 1.60, 95% CI: 0.09 to 3.11, p = 0.04), and knee valgus moment (Nm/kg) (WMD: 0.07, 95% CI: 0.01 to 0.13, p = 0.02) during walking. Additionally, there were no consistent findings or specific altered patterns in other lower extremity joint angles, or moment changes, regardless of the motion plane (sagittal, coronal, horizontal), for CAI compared with controls.
Conclusions
This review provides further evidence of altered lower limb kinematics and kinetics in the frontal plane in CAI participants during certain walking phases, which may partially explain the high level of recurrent ankle sprains observed in the CAI population, and support hip abduction and ankle eversion motor control exercises for CAI rehabilitation.
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NewsBot · Sep 9, 2024

Noninstrumented Clinical Assessment of Static Postural Stability in Chronic Ankle Instability: A Systematic Review and Meta-Analysis
Yuta Koshino, Takumi Kobayashi
J Sport Rehabil. 2024 Aug 19:1-11

Context: Several clinical tests are available to assess static postural stability in individuals with chronic ankle instability (CAI); however, it is unclear which test should be used.

Objective: To determine which noninstrumented clinical tests should be used to detect static postural stability deficits in individuals with CAI.

Evidence acquisition: We searched 4 databases from their inception to February 2023, and included studies comparing static postural stability in individuals with CAI and healthy controls using noninstrumented assessments. Two reviewers independently extracted study characteristics, participant information, static postural stability assessment methods, and results. We calculated the pooled standardized mean difference (SMD) and 95% confidence interval using a random effects meta-analysis and assessed the certainty of the evidence.

Evidence synthesis: Fourteen cross-sectional studies (293 participants with CAI and 284 healthy controls) were included. The meta-analysis showed no significant differences between the CAI and healthy groups in the double-leg stance condition of the Balance Error Scoring System (BESS) (SMD, -0.03; low-certainty evidence). Significant group differences were found in the BESS single-leg stance (SLS) on firm and foam surfaces (SLS firm: SMD, 0.47, very low-certainty evidence; SLS foam: SMD, 0.80, very low-certainty evidence), the tandem stance (TS) on firm and foam surfaces (TS firm: SMD, 0.39, low-certainty evidence; TS foam: SMD, 0.76, low-certainty evidence), and the total BESS in the foam conditions (SMD, 1.12, very low certainty evidence). Significant differences were also found between the CAI and healthy groups in the foot-lift (SMD, 1.24; very low certainty evidence) and time-in-balance tests (SMD, -0.94; very low certainty evidence).

Conclusions: Due to the large magnitude of the differences, the SLS foam, TS foam, and the total BESS in the foam conditions, as well as the foot-lift test or time-in-balance test, may be the most appropriate to clinically identify static postural stability impairment in individuals with CAI.
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NewsBot · Sep 24, 2024

Different strategies for landing from different heights among people with chronic ankle instability
Teng Zhang et al
Gait Posture. 2024 Sep 15:114:90-94

Background: Lateral ankle sprain (LAS) usually occurs during landing from heights among people with chronic ankle instability (CAI). Although the kinematics when landing on the flat surface has been reported, no studies have explored the effect of different heights on the landing strategies using a trapdoor device among people with CAI.

Research question: Do people with CAI adopt different landing strategies when drop-landing on the trapdoor device from three heights?

Methods: Thirty-one participants with CAI (24 males and 7 females, age=21.1±1.8 years, height=176.9±7.4 cm, body mass=71.9±9.2 kg, injured side=18 R&13 L) were recruited. They dropped from three different heights (low height (16 cm), medium height (23 cm), high height (30 cm)) with their affected foot landing on a movable surface of a trapdoor device, which was tilted 24° inward and 15° forward to simulate LAS. Kinematic data was collected using a twelve-camera motion capture system. One-way analysis of variance with repeated measures was used to compare the differences between the three heights.

Results: Significant height effects were detected in the peak ankle inversion angle (p=0.009, η2p=0.280) and angular velocity (p<0.001, η2p=0.444), and the peak ankle plantarflexion (p=0.002, η2p=0.360), knee flexion (p<0.001, η2p=0.555), and hip flexion (p=0.030, η2p=0.215) angles at the time of peak ankle inversion. Post-hoc tests showed that all the angles and velocities were higher at a low height than at medium (p: 0.001-0.045, d: 0.14-0.44) and high heights (p: 0.001-0.023, d: 0.28-0.66), except for the ankle plantarflexion angle, which was lower at a low height than at medium (p<0.001, d=0.44) and high (p=0.021, d=0.38) heights.

Significance: People with CAI adopt a protective strategy during drop-landing at medium and high heights compared to a low height. This strategy involves increased ankle dorsiflexion angle as well as knee and hip flexion angles.
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NewsBot · Sep 27, 2024

Assessing Functional Ankle Instability in Sport: A Critical Review and Bibliometric Analysis
Élio Alexandre et al
Healthcare (Basel). 2024 Aug 30;12(17):1733.

Functional Ankle Instability (FAI) is the subject of extensive research in sports and other environments. Given the importance of accurately measuring this latent construct, it is imperative to carry out a careful assessment of the available tools. In this context, the aim of this review was to take an in-depth look at the six most cited measurement tools to assess FAI, with a specific focus on patient-reported outcome measures related to ankle and foot. Four electronic databases (Web of Science, Scopus, Pubmed, and SportDiscus) were searched (up to November 2022) to identify the six most cited questionnaires for assessing FAI. Our analysis showed that the most cited questionnaires are the following: the Lower Extremity Functional Scale (LEFS), the Foot Function Index (FFI), the Foot and Ankle Ability Measure (FAAM), the Foot and Ankle Outcome Score (FAOS), the Olerud and Molander Ankle Score (OMAS), and the Cumberland Ankle Instability Tool (CAIT). Each questionnaire was thoroughly assessed and discussed in three sections: Development, Reliability, and Summaries. In addition, bibliometric data were calculated to analyze the relevance of each questionnaire. Despite variations in terms of validity and reliability, conceptualization, structure, and usefulness, the six questionnaires proved to be robust from a psychometric point of view, being widely supported in the literature. The bibliometric analyses suggested that the FAOS ranks first and the FFI ranks sixth in the weighted average of the impact factors of their original publications.
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NewsBot · Oct 7, 2024

Randomized controlled trial on ankle biomechanics in the treatment of functional ankle instability with joint mobilization
YiKun Yin, Qihan Lin & Jialin Wang
Scientific Reports volume 14, Article number: 22095 (2024)

Functional ankle instability (FAI) patients often experience restricted ankle dorsiflexion, increased inversion angle, and elevated ground reaction forces during walking, all related to altered kinematics of the talocrural and subtalar joints. This study aimed to investigate the potential positive impact of joint mobilization on FAI patients from a biomechanical perspective. The experimental group (EG, n = 17; Age: 20.06 ± 1.34 years; Height: 1.74 ± 0.07 m; Weight: 69.79 ± 11.20 kg; BMI:22.88 ± 2.63 kg/m2; CAIT:15.59 ± 2.58; M/F: 15/2) received joint mobilization + routine rehabilitation training, while the control group (CG, n = 16; Age: 20.50 ± 0.73 years; Height: 1.73 ± 0.09 m; Weight: 64.59 ± 7.21 kg; BMI: 21.65 ± 2.47 kg/m2; CAIT: 16.75 ± 2.21; M/F: 14/2) only received regular rehabilitation training. Biomechanical tests were performed in both groups after the 4-week intervention. The spatial parameters during walking (including step length, stride length, step width, step time, cadence, step speed, support time, and swing time), ankle flexion and dorsiflexion angle, inversion, and eversion angles, internal and external rotation angles, ankle torque, as well as the vertical ground reaction force were measured before and after the intervention. The results of the two-way ANOVA showed that the main effect of time was significant for step length (P < 0.001), stride length (P = 0.008), step speed (P < 0.001), the sagittal plane angle at touchdown (P < 0.001), maximum dorsiflexion angle (P = 0.005), sagittal plane toe off-ground angle (P < 0.001), peak flexion-dorsiflexion torque (P = 0.033), the first peak vGRF (P = 0.013), and second peak vGRF (P = 0.011). The main effect of Time * Group was significant for step speed (P = 0.044). The EG demonstrated significant improvements in step speed (P = 0.047), maximum dorsiflexion angle (P = 0.047), and the first peak vGRF (P = 0.028) compared to the CG. This study reveals that joint mobilization intervention enhances gait spatiotemporal parameters, kinematics, and kinetics, particularly in step speed, maximum dorsiflexion angle, and the first vGRF peak for the EG compared to the CG. Therefore, the rehabilitation strategy for patients with functional ankle instability should appropriately increase the use of joint movement to promote the functional recovery of FAI patients.
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NewsBot · Oct 11, 2024

Is Achilles tendon structure associated with functional ability and chronic ankle instability in military recruits?
Gali Dar et al
Musculoskelet Sci Pract. 2024 Sep 27

Objective: To determine the relationship between Achilles tendon (AT) structure, functional ability and chronic ankle instability (CAI) in military recruits.

Methods: Three hundred and sixty newly recruited infantry male soldiers recruited in April 2022 were assessed for AT structure by Ultrasound Tissue Characterization (UTC), for functional abilities (included proprioception ability, heel-raise test, dynamic postural balance, and hopping agility ability) and for CAI (recurrent sprains and a positive perceived instability).

Results: Soldiers that were identified with disorganized tendon had significantly lower heel-raise and agility scores compared to those with organized tendon structures (33.6 ± 18.1(n) vs. 49.9 ± 28.9(n), p < 0.001; and 5.39 ± 2.12(n) vs. 6.16 ± 1.90(n), p = 0.002, respectively). The best discriminator between soldiers with organized vs. disorganized structure, was heel-raise test (AUC = 0.741). Moreover, soldiers with disorganized AT structure had a higher prevalence of CAI compared with those with organized tendon structures (p < 0.05).

Conclusion: Recruits with disorganized tendon structures displayed reduced heel-raise score, agility ability and dynamic postural-balance and greater ankle instability. Inferior tendon quality at the onset of military service is an important physical indicator to consider when seeking to manage future injuries and potential for physical performance. Pre-recruitment screening of the AT structure, CAI, and functional abilities, especially in high-intensity infantry programs, needs to be considered.
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NewsBot · Oct 12, 2024

Modified Broström vs Suture Tape Augmentation: A Systematic Review
Sara E. Kubick et al
Source

Ankle sprains are common musculoskeletal injuries which can develop into residual chronic lateral ankle instability. When non-surgical treatments fail, surgical intervention is often indicated. We performed a systematic review of the literature comparing outcome measures of modified Broström repair to suture tape augmentation for lateral ankle stabilization. All studies available in PubMed up to July 2023 were screened. Three randomized controlled trials involving 235 patients met inclusion criteria. All the studies reported on Foot and Ankle Ability Measure, two of the three studies found higher postoperative Sports Activity scores in the suture tape group. Two of the studies reported Foot and Ankle Outcome Score, neither were found to be significantly different. The third study analyzed return to pre-injury level of activity between the two surgical techniques and found a faster return to activity for suture tape compared to modified Broström procedure. Overall, outcome measures show no significant difference between modified Broström and suture tape augmentation.
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NewsBot · Oct 13, 2024

Plantar massage or ankle mobilization do not alter gait biomechanics in those with chronic ankle instability: a randomized controlled trial
Raed Alamri et al
J Man Manip Ther. 2024 Oct 11:1-8

Objectives: Chronic ankle instability (CAI) is characterized by persistent neuromechanical impairments following an initial lateral ankle sprain. Ankle joint mobilization and plantar massage have improved the range of motion and static postural control in those with CAI. This study aimed to determine the impact of two-week joint mobilization and plantar massage interventions on gait kinematics and kinetics in individuals with CAI.

Methods: A single-blind randomized trial was conducted with 60 participants with CAI, randomized into three groups: joint mobilization (n = 20), plantar massage (n = 20), and control (n = 20). The two treatment groups received six 5-min sessions manual therapy over a 2-week, while the control group received no intervention. Gait biomechanics were assessed on an instrumented treadmill before and after the intervention using 3D kinematics and kinetics analysis. Analyses compared biomechanical outcomes from each treatment group to the control group individually using a 1-dimensional statistical parametric mapping. The alpha level was set at p < 0.05.

Results: Eighteen participants per group were part of the final analysis. No significant main or interactions effects were found for ankle sagittal or frontal plane positions following either intervention (p > 0.05 for all comparisons). COP location relative to the lateral border of the foot also did not change (p > 0.05).

Conclusion: The findings suggest that two-week joint mobilization and plantar massage interventions do not significantly alter gait biomechanics in individuals with CAI. These results support the need for gait-specific interventions to modify biomechanics in this population.
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NewsBot · Oct 14, 2024

Ultrasonography assessments of talar cartilage and ATFL after running in chronically unstable, coper, and healthy ankles: a case-control study
Dongkyun Seo, Jihong Park
Physiother Theory Pract. 2024 Oct 1:1-11

Background: Comparisons of talar cartilage and the anterior talofibular ligament (ATFL) profiles in individuals with different levels of chronic ankle instability (CAI) provide insight into early adaptation of tissue morphology.

Purpose: This study compared morphologic response and recovery of the talar cartilage and ATFL before and after 30-min of self-paced treadmill running between individuals with CAI, coper (full recovery from a first-time ankle sprain), and healthy controls.

Methods: Sixty young males (24.8 years, 176.9 cm, 75.7 kg) were allocated into the CAI, coper, and healthy control group by their number of ankle sprains and scores on the self-reported ankle instability questionnaires (Cumberland Ankle Instability Tool, and Foot and Ankle Ability Measure-Activities of Daily Living). Ultrasonographic images in the cross-sectional area (CSA; overall, lateral, and medial) and ATFL length (unstressed and stressed and position) before and after treadmill running were recorded and analyzed.

Results: There were no group by time interactions in the talar cartilage CSA (F14,399 <1.09, p > .36 for all tests) and ATFL length (F14,399< .69, p > .79 for all tests). Regardless of time, CAIs had the largest overall (F2,399 = 42.68, p < .001), lateral (F2,399 = 37.16, p < .001), and medial (F2,399 = 36.57, p < .001) CSA of talar cartilage and the longest stressed-ATFL length (F2,399 = 54.42, p < .001), followed by copers and healthy controls.

Conclusion: Morphologic features of the talar cartilage and ATFL appear to depend on the level of ankle instability (e.g. a history of recurrent ankle sprain).
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NewsBot · Oct 15, 2024

Effects of custom mold with peripheral textured surface foot orthosis on balance and physical function in subjects with
chronic ankle instability
Hanieh KHALILIYAN et al
Source

Introduction: Currently, healthcare professionals recommend an initial conservative approach consisting of non-pharmacological approaches for chronic ankle instability. We developed a foot orthosis targeting both mechanical and functional instability in these patients,
aiming to investigate its effects on balance and physical function.
Methods: This research is a randomized controlled trial that included 45 young individuals
who are active and have chronic ankle instability. The participants were recruited from sports
clubs. The participants were separated into three groups: a control group without any intervention, a group prescribed with a custom mold foot orthosis, and a group prescribed with a
custom mold with peripheral textured surface foot orthosis. Balance was assessed using single-leg balance and single-leg hop tests, while physical function was evaluated using the
FAAM questionnaire. Data analysis was performed using one-way analysis of covariance statistical test.
Results: Both types of foot orthoses were found to enhance balance and physical function.
The foot orthosis with peripheral textured surface exhibited superior results compared to
custom mold foot orthosis, as it significantly increased the score of the single leg hop test
(p=0.01) and the FAMM-sport section (p=0.002).
Discussion: The foot orthosis with peripheral textured surface can potentially optimize the
subtalar joint alignment and modify the sensory input generated by the activation of mechanoreceptors located in the sole region of the foot. This alteration may further enhance balance
and physical function.
Take-home message: Foot orthoses, designed to change the action of the sensorimotor
mechanism in the human body, have demonstrated favorable outcomes in improving balance
and physical function among chronic ankle instability subjects.
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NewsBot · Oct 20, 2024

Impact of chronic ankle instability on gait loading strategy in individuals with chronic ankle instability: a comparative study
Omar M Elabd et al
J Neuroeng Rehabil. 2024 Oct 18;21(1):185

Background: Lateral ankle sprains rank among the most prevalent musculoskeletal injuries, while chronic ankle instability (CAI) is its most common cascade. In addition to the conflicting results of the previous studies and their methodological flaws, the specific gait loading strategy is still not well studied.

Purpose: The study aimed to investigate the fluctuations in gait loading strategy in people with chronic ankle instability compared to health control.

Methods: A total of 56 male subjects participated in this study and were allocated into two groups: (A) CAI group: 28 subjects with unilateral CAI (age 24.79 ± 2.64 and BMI 26.25 ± 3.50); and (B) control group: 28 subjects without a history of ankle sprains (age 24.57 ± 1.17 and BMI 26.46 ± 2.597). Stance time, weight acceptance time, and load distribution were measured to investigate gait loading strategy.

Results: The study findings revealed that the CAI group had a significant higher load over the lateral rearfoot. However, MANOVA indicates that there was no overall significant difference in gait loading strategy between the CAI and control groups. Furthermore, in terms of stance time, time of weight acceptance phase, load over medial foot, and load over lateral foot, CAI and healthy controls seemed to walk similarly.

Conclusions: The findings revealed that individuals with CAI had the significant alteration in the lateral rearfoot loading, suggesting a potential compensatory mechanism to address instability during the weight acceptance phase. This could manifest a laterally deviated center of pressure and increased frontal plane inversion during the early stance phase. However, it is acknowledged that these alterations could be both the result and the origin of CAI. The study highlights the vulnerability of CAI during the early stance phase, emphasizing the need for gait reeducation as individuals return to walking as healthcare clinicians should focus on treatment modalities aimed at reducing rearfoot inversion in individuals with CAI.
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NewsBot · Oct 24, 2024

Bibliometric Analysis of Chronic Lateral Ankle Instability Research: Mapping the Landscape of Influential Publications
Lercan Aslan et al
Source

Objective: We aimed to conduct a comprehensive bibliometric analysis of the top 100 most-cited publications in the field of Chronic Lateral Ankle Instability (CLAI). We sought to identify key research themes, trends, and the collaborative network among scholars, institutions, and countries within the CLAI domain, and to offer insights into the evolution of CLAI research and its impact on clinical practice and patient care in the context of evidence-based medicine. Submitted: 30.05.2024 Revised: 03.07.2024 Accepted: 15.07.2024 Correspondence: Lercan Aslan, Department of Orthopaedic Surgery, Foot & Ankle Research and Innovation Laboratory, Massachusetts General Hospital, Harvard Medical School, Boston, USA E-mail: laslan@mgh.harvard.edu.tr Keywords: Bibliometric study; chronic lateral ankle instability; citation count; citation density. This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License. INTRODUCTION Methods: We conducted a bibliometric analysis of the 100 most-cited articles on CLAI using the Web of Science database up to the end of 2023. The mean citation count and citation density were calculated. Additionally, we classified studies by evidence level, design, and subject matter, and investigated correlations with citation metrics, including evidence level, publication decade, and journal title. Additional analyses examined the influence of author specialty, inter-institutional collaborations, and quantitative aspects such as the number of authors, institutions, page count, and references on citation numbers. Results: The analysis of the top 100 cited articles on CLAI revealed a maximum citation count of 1,074 and an average of 166.15±127.05 across articles, with citation density ranging from 2.50 to 60.60. The research was predominantly from the United States (52 studies), involved an average of 4.42±4.32 authors per article, and spanned 2 to 18 pages with 10 to 260 references. The University of North Carolina emerged as a leading institution with eight articles, and Hertel was noted as a key contributor with contributions to 15 papers. Conclusion: This bibliometric analysis on CLAI underscores the evolving interest in recent studies, particularly from 2011-2020, and highlights the importance of multicenter research and the need for higher-level evidence. It reveals the United States, Sweden, and the United Kingdom as key contributors, suggesting a potential for global collaboration.
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NewsBot · Oct 26, 2024

Rebuilding Stability: Exploring the Best Rehabilitation Methods for Chronic Ankle Instability
Roberto Tedeschi et al
Sports (Basel). 2024 Oct 17;12(10):282

Background: Chronic Ankle Instability (CAI) is a common condition characterized by repeated episodes of ankle "giving way" and impaired balance, leading to functional limitations. Various rehabilitation techniques, including balance training, proprioceptive exercises, whole-body vibration (WBV), and novel approaches like stroboscopic vision, are used to address these deficits. This review evaluates the effectiveness of different rehabilitation interventions for CAI management. Methods: A review was conducted by analyzing 11 randomized controlled trials that investigated the impact of balance and proprioceptive training programs on CAI. The primary outcomes assessed were the Star Excursion Balance Test (SEBT), Cumberland Ankle Instability Tool (CAIT), and Foot and Ankle Ability Measure (FAAM). Methodological quality was assessed using the PEDro scale, and the risk of bias was evaluated with the ROB 2 tool. Results: All rehabilitation interventions demonstrated significant improvements in SEBT, CAIT, and FAAM scores. However, no single intervention was found to be consistently superior. Traditional balance training, strength exercises, BAPS, and WBV all provided meaningful functional gains. Stroboscopic vision training showed similar effectiveness compared to conventional approaches. The evidence supports a combination of balance and strength training for optimal recovery. Conclusions: Balance and proprioceptive exercises are effective in managing CAI, with improvements in both dynamic stability and subjective outcomes. No intervention stands out as the best, but personalized programs incorporating various methods are recommended. Future research should explore the long-term effects and potential synergies of combined interventions.
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NewsBot · Oct 27, 2024

Impact of subtalar joint mobilization on walking ability in patients with intra-articular varus of the hindfoot joint with chronic ankle instability
Yu-Juan Han et al
J Orthop Surg Res. 2024 Oct 26;19(1):692

Background: Patients with chronic ankle instability (CAI) often experience recurrent swelling and pain, which hinder their ability to walk long distances. Emerging evidence suggests that joint mobilization can enhance ankle function in patients with CAI.

Objective: The aim of this study is to investigate the effects of subtalar joint mobilization on enhancing ankle stability, alleviating ankle pain, and improving the walking ability of patients diagnosed with CAI.

Methods: A retrospective analysis was conducted on 46 patients who were treated between April 2022 and October 2023. They were randomly divided into two groups: a treatment group with 23 cases receiving conventional treatment along with subtalar joint mobilization treatment, and a control group with 23 cases receiving only conventional treatment. The treatment duration was eight weeks. Pain levels and walking ability were assessed before and after the treatment period.

Results: After eight weeks of treatment, the treatment group showed significant increases in the number of heel raises on the affected leg (NLHSL), improvements in the star excursion balance test (SEBT), and higher American Orthopedic Foot and Ankle Society (AOFAS) scores compared to the control group. Additionally, resting pain (RVAS) and walking pain (WVAS) scores were significantly lower in the treatment group. However, there was no statistically significant difference in single-leg standing time (SLT) between the two groups. Within the control group, post-treatment assessments indicated significant improvements in dynamic balance and control measures (SLT, NLHSL, SEBT), but no significant changes were observed in pain levels (RVAS, WVAS) or rear foot function (AOFAS). In contrast, the treatment group showed significant improvements across all measured parameters (RVAS, WVAS, SLT, NLHSL, SEBT, and AOFAS) following treatment.

Conclusion: Subtalar joint mobilization effectively reduces ankle pain and enhances walking ability among patients with CAI by improving ankle stability. The observed improvements in walking ability may stem from mitigating compensatory mechanisms associated with varus of the calcaneus and ankle instability.
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NewsBot · Nov 4, 2024

Comparing the Effects of Progressive Balance and Hip Strengthening Rehabilitation in Individuals With Chronic Ankle Instability
Ashley M B Suttmiller et al
J Sport Rehabil. 2024 Oct 28:1-10

Context: Chronic ankle instability (CAI) is associated with motor-behavioral and sensory-perceptual impairments, including reduced balance performance, hip strength, and ankle function, and increased disablement, and injury-related fear. Progressive balance training (BAL) and hip strengthening (HIP) can both improve balance and function, but their comparative effects are unknown. Our objective was to compare the effects of progressive BAL and HIP on balance, hip strength, and patient-reported outcomes in those with CAI.

Methods: Forty-five individuals with CAI volunteered for this randomized control study. Participants were randomly allocated to BAL, HIP, and control (CON) groups (n = 15 per group). BAL and HIP each participated in 8-week interventions while CON did not. Participants' involved limbs underwent testing of patient-reported outcomes (Foot and Ankle Ability Measure [FAAM-ADL, FAAM-S], modified Disablement in the Physically Active Scale [mDPA], Tampa Scale of Kinesiophobia-11 [TSK-11], Fear-Avoidance Beliefs Questionnaire [FABQ], and Self-Efficacy of Balance Scale [SEBS]), Star Excursion Balance Test (SEBT), and isometric hip strength (extension [EXT], abduction [ABD], and external rotation [ER]) before and after the intervention. Multiple imputation was used for missing data. Multivariate repeated-measures analyses of variance analyzed effects of the interventions.

Results: A significant group × time interaction existed for psychosocial outcomes (P = .008), but not for balance (P = .159), strength (P = .492), or ankle function and disability (P = .128). Time main effects existed for balance (P = .003), strength (P < .001), function and disability (P < .001), and psychosocial outcomes (P = .006). BAL significantly improved in SEBT, EXT, ABD, and all patient-reported outcomes. HIP significantly improved in EXT, ABD, ER, FAAM-S, mDPA, FABQ, and SEBS.

Conclusions: Balance training and hip strengthening can both improve motor-behavioral and sensory-perceptual impairments in individuals with CAI; however, balance training remains the most effective option for clinicians.
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NewsBot · Nov 9, 2024

Ultrasound Imaging for the Evaluation of Anterior Talofibular Ligament Remnants in 547 Ankles With Chronic Lateral Ankle Instability
Masato Takao, et al
Source

Background:
There are few reports on the intra- and interobserver agreement and parameters for the diagnostic accuracy of ultrasound (US) imaging for chronic lateral ankle instability (LAI). The purpose of this study was to investigate the reliability and validity of US imaging for identifying anterior talofibular ligament (ATFL) remnants in patients with LAI.
Methods:
A total of 547 ankles from 406 patients underwent surgery for LAI between 2019 and 2022. If ligament fibers remained in US images, they were evaluated as positive. If the ligament was not visualized, it was evaluated as negative. Two observers performed repeated measurements. Arthroscopic findings were considered the “gold standard” for validity and diagnostic test accuracy purposes. The intra- and interobserver agreements and parameters for diagnostic accuracy, including sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) of preoperative US imaging as intraoperative arthroscopic findings were used as reference standards.
Results:
The intraobserver agreement was substantial, with an agreement of 98.54% and a kappa coefficient of 0.76. The interobserver agreement was also substantial, with an agreement of 98.72% and a kappa coefficient of 0.75. The sensitivity, specificity, and accuracy of preoperative US imaging were 98.7%, 100%, and 98.7%, respectively. The PPV and NPV of US imaging were 100% and 61.1%, respectively. In the arthroscopic evaluation of the 7 cases in which US imaging showed false negative results, the ATFL ruptured at the fibular attachment and ran in contact with the talus.
Conclusion:
A US examination finding of an intact ATFL is highly likely to be correct. An US examination finding of a ruptured ATFL can be false and may require arthroscopic confirmation.
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NewsBot · Nov 10, 2024

Comparison of the distance between the talus and lateral malleolus during the stance phase with and without chronic ankle instability
Satoshi Onoue, Noriaki Maeda, Yasunari Ikuta, Tsubasa Tashiro, Satoshi Arima, Honoka Ishihara, Ayano Ishida, Andreas Brand, Tomoyuki Nakasa, Nobuo Adachi, Shogo Tsutsumi, Makoto Komiya & Yukio Urabe
Scientific Reports volume 14, Article number: 27055 (2024)

The level of dynamic mechanical instability between the bony parts of the ankle joint provides important information on biomechanical function. However, the dynamics of the distance between the talus and lateral malleolus during gait remain unclear. This study aimed to compare the distance between the talus and lateral malleolus and the ankle joint angles during the stance phase of gait between individuals with chronic ankle instability (CAI) and healthy adults. The comparison was conducted using a synchronized ultrasound (US) imaging with a three-dimensional motion analysis (MA) system. This cross-sectional study included 12 participants (5 males, 7 females; age, 20.5 ± 1.8 years; height, 166.6 ± 9.4 cm; body weight, 60.2 ± 5.3 kg; body mass index, 21.7 ± 2.0 kg/m2; 16 feet) with CAI and 10 healthy controls (4 males, 6 females; age, 21.2 ± 1.6 years; height, 164.6 ± 10.5 cm; body weight, 56.8 ± 11.3 kg; body mass index, 20.8 ± 2.6 kg/m2; 20 feet). The distance between the talus and lateral malleolus during gait was significantly increased in the CAI group compared with that in the control group throughout the stance phase. The ankle dorsiflexion angle was smaller in the CAI group during the middle and terminal stance phases. Additionally, the ankle inversion angle was greater in the CAI group than in the control group. Our findings show the application of the synchronized US and MA system in the assessment of mechanical instability in CAI group, which may be used to determine treatment efficacy.
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NewsBot · Nov 11, 2024

Uphill Treadmill Running and Joint Mobilization Improve Dynamic Stability and Ankle Dorsiflexion Range of Motion in Young Adults With Chronic Ankle Instability: A Four-Arm Randomized Controlled Trial
Yongjie Lao et al
Archives of Physical Medicine and Rehabilitation 19 September 2024

Objective
To observe the effect of uphill running and the combined effect of uphill running plus joint mobilizations on dynamic stability and ankle dorsiflexion in young adults with chronic ankle instability (CAI).
Design
Four-arm randomized controlled trial.
Setting
A college rehabilitation center.
Participants
Individuals with CAI (N=73).
Interventions
Participants were randomly assigned to 4 groups: combined uphill running and joint mobilization (URJM), uphill running alone (UR), joint mobilization alone (JM), and control group. The URJM and UR groups received 20-minute running sessions, and the URJM and JM groups received ankle joint mobilizations, all 3 times a week for 4 weeks.
Main Outcome Measures
Cumberland Ankle Instability Tool (CAIT) and Y-balance test (YBT) in anterior, posteromedial (PM), and posterolateral (PL) directions for dynamic stability; weight-bearing lunge test and non-weight-bearing ankle dorsiflexion degree using a goniometer (NWBG) for dorsiflexion.
Results
The UR group showed significant improvements in CAIT, YBT-PL, YBT-PM, and NWBG compared to the control group. The URJM group demonstrated large treatment effects in NWBG compared to both UR and JM groups. Responder analysis indicated that the UR, JM, and URJM groups had a higher likelihood of achieving clinically significant changes (exceeding minimal detectable change or minimal clinically important difference) in CAIT, YBT-PM, YBT-PL, and NWBG compared with the control group. Additionally, the combination of UR and JM was superior to either intervention alone for NWBG, with success rates 1.55 times greater than UR alone and 2.08 times greater than JM alone.
Conclusions
A 4-week UR program improves the subjective feeling of instability, dynamic postural control, and ankle dorsiflexion in young adults with CAI. Compared to UR or JM alone, their combined application can better improve the non-weight-bearing ankle dorsiflexion range of motion.
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NewsBot · Nov 12, 2024

Open and all-inside arthroscopic Brostrom-Gould for chronic lateral ankle instability: a comparative analysis of surgical outcomes and learning curves
Yanrui Zhao, et al
Foot and Ankle Surgery 10 November 2024

Objective
The purpose of this study was to investigate and compare the learning curve and clinical outcomes of all-inside arthroscopic and open techniques in the treatment of chronic lateral ankle instability (CLAI).
Method
This was a retrospective cohort analysis of 100 consecutive patients who received all-inside arthroscopic or open Brostrom-Gould surgery. These patients with CLAI were all surgically treated by the same surgeon. We applied the CUSUM analysis to assess the surgeons' learning curves, determine the cut-off point, and subsequently divide the patients into learning and proficiency groups. We recorded and compared baseline data, the preoperative and postoperative clinical function scores (AOFAS, K-P, and Tegner scores), VAS scores, time to full weight-bearing, surgery-related parameters (operation time, and postoperative hospital stays), and complications for both surgical methods during their learning and proficiency phases.
Result
The CUSUM analysis identified a learning curve cutoff at 12 cases for open surgery and 22 cases for arthroscopic surgery. In the open surgery group, significant differences were observed in operation time between the learning and proficiency phases (P<0.05). However, no significant differences were found in clinical function scores and postoperative full weight-bearing time. Similar trends were seen in the arthroscopic surgery group, with significant improvements in operation timeand postoperative hospitalization time in the proficiency phase compared to the learning phase (P<0.05). However, no significant differences were found in clinical function scores between either surgical method's learning and proficiency stages. Additionally, when comparing the two surgical approaches at the same stage, significant differences emerged in VAS scores, postoperative full weight-bearing time, operation timeand postoperative hospitalization time (P<0.05), with the arthroscopic technique showing advantages in reduced postoperative discomfort and faster recovery times.
Conclusion
Although arthroscopic surgery takes longer to achieve proficiency, it offers the advantages of reduced postoperative discomfort and faster recovery times during both the learning and proficiency phases while achieving comparable clinical outcomes.
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NewsBot · Dec 7, 2024 at 10:58 PM

Proprioception Deficits in Chronic Ankle Instability Associated with Structural and Functional Alternations in Cerebellar Vermis.
Xiao’ao Xue et al
Sports Medicine and Health Science 7 December 2024

Highlights
•Patients with CAI showed vermis atrophy and increased intrinsic activity.
•Changes of vermal structure and function relate to ankle proprioception deficits.
•Cerebellum-focused interventions are needed in ankle sprain rehab strategies.
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Purpose
Ankle proprioception deficits have been widely reported in patients with chronic ankle instability (CAI), but their central neuropathological mechanisms have not been fully discussed. So, we aimed to figure out whether the structural and functional features of the cerebellar vermis differed between patients with CAI and healthy controls, and are associated with proprioception deficits in patients.
Methods
Twenty-two patients and 25 control individuals were enrolled in a cross-sectional investigation. All participants underwent structural and resting-state functional magnetic resonance imaging scanning to calculate voxel-based morphometry (VBM) and fractional amplitude of low-frequency fluctuation (fALFF) of the vermis. Between-group comparisons of the ankle instability-related subregions of the vermis were performed. Correlation analyses were performed between the outcomes of the surviving subregions and the proprioceptive scores of the ankle inversion discrimination apparatus for landing test.
Results
The subregion of vermis IV/V survived the multiple comparison correction to reveal a lower VBM value in patients than in healthy controls (Cohen’s d = -0.968). The patients also showed significantly higher fALFF (Cohen’s d = 0.666) in this subregion. After controlling the demographic features, the proprioceptive scores were significantly correlated with VBM (r = 0.622) and fALFF values (r = −0.512) in the group of patients.
Conclusions
Patients with CAI have lower gray matter volume and higher activity intensity in the cerebellar vermis than healthy control. The more severe proprioception deficits were significantly associated with the vermal volume and activity, which might be able to facilitate future diagnoses and treatments for CAI.
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Functional ankle instability

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