Functional ankle instability

NewsBot · Feb 16, 2025

Application of Smart Insoles in Assessing Dynamic Stability in Patients with Chronic Ankle Instability: A Comparative Study
Seonghyun Kang et al
Sensors (Basel). 2025 Jan 22;25(3):646.

Chronic ankle instability (CAI), due to its chronic nature and biomechanical complexity, is well-suited for continuous monitoring and tele-rehabilitation using wearable sensor technology. This study assessed whether a smart insole system, equipped with 4 force-sensing resistor sensors and an inertial measurement unit, combined with functional tests and biomechanical indices, could distinguish CAI patients from healthy controls. A total of 21 CAI patients (23.8 ± 5.1 years) and 16 controls (22.62 ± 2.60 years) completed a battery of functional performance tests while wearing the smart insole system. The results showed an increased medial-lateral pressure ratio in the CAI during heel raise (p = 0.031, effect size = 0.82) and hop tests, suggesting an everted foot position. Significant deviations in center-of-pressure trajectory during double-leg heel raises (p = 0.005, effect size = 1.10) suggested asymmetric motion coordination, while compensatory fluctuations of the lifted limb during single-leg balance tests (p = 0.011, effect size = 1.03) were greater in CAI patients. These findings facilitated the development of features to characterize CAI-specific movement patterns. Together, this system shows promise as a quantitative assessment tool for CAI, supporting improved treatment outcomes through tele-rehabilitation.
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NewsBot · Feb 16, 2025

Factors Associated with the Clinical Outcomes of Ankle Instability Surgery
Yashar Shahbaz, Mahla Daliri, Mohammad H Ebrahimzadeh, Sayyed Hadi Sayyed Hosseinian
Arch Bone Jt Surg. 2025;13(1):30-38.

Objectives: More than 20% of patients experience chronic lateral ligamentous instability of the ankle (CLLIOTA) following the appropriate management of an ankle sprain. The modified Broström-Gould (MBG) procedure has become the standard treatment for the anatomic repair of symptomatic CLLIOTA.

Methods: This retrospective, single-group study included all patients with CLLIOTA who underwent surgery using the MBG technique in Shahid Kamyab Hospital, Mashhad, Iran, between July 2015 and August 2020. The American Orthopedic Foot and Ankle Score (AOFAS), Manchester-Oxford Foot Questionnaire (MOXFQ), and Pain Visual Analog Scale (VAS) were used to evaluate the outcome. The correlation between patient-related factors and each outcome measure was also analyzed.

Results: In total, 38 patients underwent the MBG procedure. The mean follow-up was 40.1 (18-67) months. Overall, 15 patients (39.47%) had a history of sports-related ankle sprains, and 15 (39.47%) had ankle osteochondral lesions. The AOFAS score improved significantly (51.23±13.49 to 91.92±12.077, P<0.001), while MOXFQ and VAS scores decreased significantly in the follow-up evaluation (50.28±9.33 to 27.5±13.35, P<0.001, and 6.2±1.47 to 2.18±1.86, P<0.001, respectively). No significant correlation was found between pre-operative ankle osteoarthritis, talus osteochondral lesion, duration of the follow-up, ankle sprain etiology (sports vs. non-sports), age, body mass index, gender, and the interval between the first sprain and surgery on the one hand, and post-operative outcomes, on the other hand. The more time passed after the surgery, the less painful the ankle of the patient was (P=0.038). No failure was observed among the patients.

Conclusion: This study showed that the open MBG technique for CLLIOTA can improve clinical outcomes with no major complications following surgery in the Iranian population.
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NewsBot · Feb 18, 2025

Analyzing Lower Limb Muscle Imbalance Patterns Associated With Chronic Ankle Instability
Sonam Jagadale et al
Cureus. 2025 Jan 16;17(1):e77529.

Objectives: Our main objective was to find a complex relationship between chronic ankle instability (CAI) and factors contributing to lower limb proximal-distal muscle imbalance.

Methods: This cross-sectional study, conducted in the physiotherapy department of Krishna Vishwa Vidyapeeth, Karad, included 111 volunteers selected through simple random sampling. Outcome assessments involved manual muscle testing, range of motion evaluation, and gait pattern analysis based on specific inclusion and exclusion criteria.

Results: The study interpreted that individuals with CAI exhibited significant muscle imbalances on the affected side compared to the unaffected side. Core muscle weakness was present in 97 (87.2%) of patients involving multifidus and rectus abdominals majorly, while 90 (84.6%) experienced lower limb muscle weakness. The ankle joint's range of motion was the most affected, with ankle plantar flexors and evertors showing the greatest weakness. Abnormalities in gait were also noted, with cautious gait observed in 83 (75%) patients, knee hyperextension in 24 (22%), and foot slap in four (3%).

Conclusion: The present study concluded that CAI could cause abnormal gait patterns due to weak muscle strength, impaired muscle length-tension relationships, and reduced range of motion. An efficient core gives optimal efficiency in the entire kinetic chain during movements like acceleration, deceleration, and dynamic stabilization and provides proximal stability to the lower extremities. In the study, lower limb muscle imbalance and core muscle weakness are significant contributors to CAI, impacting both stability and functional performance. Considering the study findings as an important part of patient assessment, it will be used to customize the rehabilitation programs as per the patient's requirement and, thus, enhance positive outcomes.
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NewsBot · Feb 23, 2025

Kinesiophobia in Collegiate Athletes and Nonathletes With and Without Chronic Ankle Instability
Nadia M Perez et al
J Sport Rehabil. 2025 Feb 21:1-7.

Context: Kinesiophobia is a substantial psychological factor that may impact sport performance and activities of daily living for individuals with chronic ankle instability (CAI). The purpose of this study was to determine the levels of kinesiophobia between collegiate athletes and nonathletes with and without CAI using quantitative and qualitative analyses.

Design: Cross-sectional survey.

Methods: A Qualtrics survey was distributed to college students. Ankle health status was evaluated using the Foot and Ankle Ability Measure Sport subscale, Identification of Functional Ankle Instability, and history questions. Kinesiophobia was assessed using the Tampa Scale of Kinesiophobia-11. A 4 × 2 analysis of variance was used to assess differences in athlete status (NCAA Division 1, intramural, club, and nonathlete) and ankle health status (CAI and healthy). An open-ended question was added to understand how kinesiophobia impacts individuals CAI. Data were analyzed via content analysis.

Results: Of the 531 respondents who completed the survey, 140 (116 = CAI and 24 = healthy) met the inclusion criteria for the study. There was a significant main effect for ankle health status for the Foot and Ankle Ability Measure Sport (CAI = 62.68 [15.11]%, healthy = 99.57 [0.01]%), Identification of Functional Ankle Instability (CAI = 21.63 [5.34], healthy = 2.42 [2.93]), and Tampa Scale of Kinesiophobia-11 (CAI = 26.04 [6.22], healthy = 16.75 [5.50]). There were no significant main effects for athlete status or interactions for any variables. Perceptual and behavioral responses were to major categories identified with the qualitative analysis. Fear, pain, and instability were higher order themes within perceptual responses. Activity avoidance and bracing were higher order themes within behavioral responses.

Conclusion: This study highlights the significant role of kinesiophobia in individuals with CAI, with those affected reporting higher levels of fear, pain, and instability compared with healthy individuals. Behavioral adaptations such as activity avoidance and bracing were common among qualitative responses. While no differences were observed across athlete statuses, these findings underscore the need for tailored interventions addressing both physical and psychological factors to improve outcomes for individuals with CAI.
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NewsBot · Apr 4, 2025

Effects of kinesio taping on lower limb biomechanical characteristics during dynamic postural control tasks in individuals with chronic ankle instability
Tao Yuan et al
PLoS One. 2025 Jan 10;20(1):e0317357

Purpose: Previous studies have demonstrated significant biomechanical differences between individuals with chronic ankle instability (CAI) and healthy controls during the Y-balance test. This study aimed to examine the effects of kinesio taping (KT) on lower limb biomechanical characteristics during the Y-balance anterior reach task in individuals with CAI.

Methods: A total of 30 participants were recruited, comprising 15 individuals with CAI and 15 healthy controls. All participants were randomly assigned three taping conditions: no taping (NT), placebo taping (PT), and KT, followed by the Y-balance anterior reach task. Each condition was separated by one-week intervals. Kinematic and kinetic data of the lower limbs during the movement phase were collected using the Vicon motion capture system (Vicon, T40, 200 Hz) and two Kistler force platforms (Kistler, 1000 Hz).

Results: KT significantly improved the Y-balance anterior reach distance (P = 0.003) and peak ankle eversion angle (P = 0.019) compared to NT. Additionally, KT resulted in increased peak knee flexion angle (P = 0.002, P = 0.011) and peak ankle dorsiflexion angle (P <0.001, P = 0.005) relative to both NT and PT. KT also significantly reduced mediolateral center of pressure (COP) displacement (P = 0.001) and average velocity of mediolateral COP displacement (P = 0.033) in comparison to NT. Furthermore, KT decreased mediolateral center of gravity displacement (P = 0.002, P = 0.003) relative to both NT and PT.

Conclusion: KT significantly improved abnormal ankle posture by promoting greater ankle dorsiflexion and eversion angles. Additionally, KT reduced mediolateral COP displacement and average velocity to improve postural stability. These changes may contribute to reduced risk of ankle sprains. Therefore, KT may serve as an effective tool for managing recurrent ankle sprains in individuals with CAI.
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NewsBot · Apr 4, 2025

Exploratory Analysis of Unstable Surface Training: A Systematic Review and Meta-Analysis for Chronic Ankle Instability
Shuang Liu et al
Arch Rehabil Res Clin Transl. 2024 Aug 17;6(4):100365

Objective: To conduct an exploratory systematic review and meta-analysis to evaluate the effect of unstable surface training on balance and hop function in individuals with chronic ankle instability (CAI).

Data sources: Four major electronic databases were searched, including Cochrane Library, PubMed, Embase, and Web of Science, from January 1, 2000 to June 20, 2024.

Study selection: Randomized controlled trials that compare unstable surface training with either general intervention or no intervention in individuals with CAI were included.

Data extraction: The physical therapy evidence database scale was used to assess the risk of bias and methodological quality of included studies. The mean differences (MDs) with 95% confidence intervals (CIs) were calculated using Review Manager 5.4 software.

Data synthesis: The review ultimately included 9 studies involving 308 participants. Compared with the other exercises or no exercise, unstable surface training could improve the significant effects of the star excursion balance test (SEBT) in the direction of posterolateral (MD=5.80; 95% CI, 1.60-9.99; P=.007), posteromedial (MD=6.24; 95% CI, 2.32-10.16; P=.002), medial (MD=9.11; 95% CI, 6.42-11.80; P<.00001), anteromedial (MD=7.25; 95% CI, 2.33-12.17; P=.004), the time-in-balance test (MD=8.45; 95% CI, 1.50-15.40; P=.02), the foot-lift test (MD=-1.39; 95% CI, -2.49 to -0.28; P=.01). However, there was no significant difference in the anterior direction of the SEBT (MD=3.22; 95% CI, -0.66 to 7.10; P=.10), the side-hop test (MD=-1.94; 95% CI, -4.82 to 0.95; P=.19), and the figure-of-8 hop test (MD=-0.97; 95% CI, -2.39 to 0.46; P=.18) between groups.

Conclusions: Compared with the other exercises or no exercise, unstable surface training has potential benefits in improving balance in people with CAI but has no significant effect on hop function. However, the exploratory nature of this study highlights the need for further research to confirm these findings.
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NewsBot · Apr 9, 2025

Comparison of the efficacy of the modified internal brace and the arthroscopic Broström-Gould procedure for chronic lateral ankle instability
Zhi-Qi Zhang et al
Int Orthop. 2025 Mar;49(3):713-720

Purpose: To compare the efficacy of an internal brace and the arthroscopic Broström-Gould procedure for chronic lateral ankle instability (CLAI).

Methods: The clinical data of 71 patients who were diagnosed with chronic lateral ankle instability between May 2020 and May 2022 were retrospectively analyzed. The American Orthopedic Foot and Ankle Society (AOFAS) scale, Foot and Ankle Ability Measure (FAAM), and Visual Analogue Scale (VAS) were used to assess clinical outcomes.

Results: A total of 59 patients were followed up for a mean of 21 months (range, 16-24 months). Thirty-seven patients underwent the modified Broström-Gould (IB) procedure, and twenty-two patients underwent the arthroscopic Broström-Gould (ABG) procedure. The mean postoperative VAS score (P = 0.790), AOFAS score (P = 0.252), FAAM daily activity score (P = 0.983), and FAAM for sports activity score (P = 0.379) were not significantly different between the ABG and IB groups at the final follow-up. However, the FAAM sports score was better in the internal brace group than in the arthroscopy group at the 1-year postoperative follow-up (P = 0.025).

Conclusion: Patients treated with an internal brace recovered faster than those who underwent the arthroscopic ABG procedure. However, no other significant differences were observed between the two methods.
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NewsBot · May 24, 2025

Clinical practice guidelines for rehabilitation following surgical management of chronic lateral ankle instability: enhancing recovery based on available evidence
Shi-Ming Feng , Xin Luo , Nicola Maffulli , C Niek van Dijk , Francesco Oliva , Kai Fehske , Christian Plaass , Thomas Karius , Amol Saxena , Shun-Hong Gao .et al
British Medical Bulletin, Volume 154, Issue 1, June 2025, ldaf002, https://doi.org/10.1093/bmb/ldaf002

Background
Rehabilitation is a crucial component of comprehensive disease management and functional recovery. Despite advancements in surgical techniques for chronic lateral ankle instability (CLAI), there is still a lack of standardized, evidence-based rehabilitation protocols.

Source of data
After nine clinical questions were proposed by the guidance steering group, an independent search strategy was conducted for all clinical questions, encompassing the PubMed, MEDLINE, Web of Science, EMBASE, and Cochrane databases.

Areas of agreement
Rehabilitation is crucial to optimize surgical outcomes and patient recovery. An appropriate and well-structured rehabilitation plan can optimize a safe return to sports and daily activities.

Areas of controversy
Rehabilitation for surgical management of CLAI poses significant challenges, especially in the areas of preoperative preparation, control of postoperative swelling and pain, early-stage rehabilitation, advanced rehabilitation, and return to exercise.

Growing points
Given the lack of established guidelines for rehabilitation following surgical management of CLAI, this clinical practice guideline presents nine key recommendations aimed at addressing the existing controversies in this area. For CLAI patients undergoing surgery, preoperative rehabilitation should include exercise and education, followed by postoperative focus on pain and swelling management. Early rehabilitation emphasizes nonweight-bearing functional training, with gradual progression to weight-bearing exercises, dynamic balance, and strength training over the first 18 weeks. Regular follow-up visits are essential to monitor recovery and promote functional restoration.

Areas timely for developing research
In patients undergoing surgery for CLAI, there is a pressing need for comparative studies to assess the necessity of immobilization and to determine the optimal selection of braces.
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NewsBot · May 25, 2025

Dynamic neuromuscular stabilization training for chronic ankle instability: A randomized controlled trial in amateur athletes
Sevval Yesilkir, Gizem Ergezen Sahin
J Back Musculoskelet Rehabil. 2025 May 11

BackgroundChronic ankle instability (CAI) is a widespread condition in athletes, characterized by recurrent episodes of ankle "giving way," diminished neuromuscular control and balance deficits. Traditional rehabilitation programmes typically emphasize strength and posture control, while more effective strategies incorporate balance training, including open chain exercises, vestibular training and multi-planar movements. In addition, novel approaches such as Dynamic Neuromuscular Stabilization (DNS) present an innovative method that aims to restore functional stability by activating the brain's natural movement control mechanisms.ObjectiveThis study aimed to determine and compare the impacts of balance and DNS training on functionality, instability severity, stabilization, balance, reaction time and performance in amateur athletes with CAI.MethodsThis single-blind randomized controlled trial was conducted with 36 amateur athletes (DNS training group: n = 12, balance training group: n = 12, conventional training group: n = 12) over a 6-week period. The DNS training group participated in exercises based on DNS principles, while the balance training group focused on training to enhance postural stability and vestibular function, and the conventional training group underwent conventional rehabilitation. The primary outcomes were measured using the Cumberland Ankle Instability Tool (CAIT) and Y Balance Test (YBT). Secondary measures were assessed through the Foot and Ankle Ability Measure (FAAM), Foot Lift Test (FLT), Balance Error Scoring System (BESS) and BlazePod™ Reaction Time (RT) Test. Assessments were carried out at three distinct time points: at baseline (pre-test), following 6 weeks of training (post-test), and at 12 weeks (follow-up test).ResultsDNS and balance training significantly improved all measures compared to conventional therapy (p < 0.05). DNS training showed significant superiority in FLT score, while balance training demonstrated significant performance increase in foam surface single-leg stance and foam surface tandem stance subscales of the BESS, with the high effect sizes (ranging from 0.95 to 1.00).ConclusionInnovative and effective interventions, such as DNS and balance training, play a crucial role in the rehabilitation processes of amateur athletes with CAI, with these effects being sustained in the long term.
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NewsBot · May 25, 2025

New insights into chronic ankle instability: an in vivo evaluation of three-dimensional motion and stability of the ankle joint complex
Shengli Wang et al
Front Bioeng Biotechnol. 2025 Mar 26:13:1556291

Introduction: Chronic ankle instability (CAI) is generally associated with repetitive ankle sprains with concomitant ligament injuries and abnormal joint motion, which affects the stability of the joint. This study aims to quantify and compare the 3D motion differences in the ankle joint complex (AJC) during walking between CAI patients and healthy controls and to analyze the effect of CAI on the vertical ground reaction force (vGRF) and center of pressure (COP) distribution.

Methods: Fifteen CAI patients (6 males, 9 females; height 165 ± 3.8 cm; weight 68.5 ± 10.2 kg; BMI 21.6 ± 3.5 kg/m2) with anterior talofibular and calcaneofibular ligament sprains and fifteen healthy participants (8 males, 7 females; height 168 ± 4.2 cm; weight 74.5 ± 12.6 kg; BMI 22.3 ± 4.2 kg/m2) participated in this study. Dynamic biplanar radiography were used to analyze the 3D motion and stability of the ankle joint complex during the stance phase. Synchronous force plate data were used to assess vGRF and COP trajectories.

Results: Compared to controls, CAI patients showed increased plantarflexion (1.3°), internal rotation (2.0°), and medial translation (0.6 mm) in the tibiotalar joint, along with decreased dorsiflexion (3.0°). For the subtalar joint, plantarflexion decreased (1.8°), and external rotation increased (0.9°). The tibio-calcaneal joint showed increased internal rotation (1.9°) and posterior translation (0.5 mm). Stability differences included more dispersed axes of rotation and greater spatial motion volumes of landmarks in the CAI group. Additionally, CAI patients exhibited greater peak vGRF with earlier peaks, higher loading rates, and more lateral and unstable COP trajectories.

Conclusion: These findings reveal that CAI not only alters the 3D motion and stability of the AJC but also affects foot-ground interaction forces, such as vGRF and COP distribution, during walking. This study provides critical insights into the altered biomechanics of the AJC in CAI patients and contributes to the clinical diagnosis of CAI and evaluation of results from surgical or conservative intervention
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NewsBot · May 25, 2025

New insights into chronic ankle instability: an in vivo evaluation of three-dimensional motion and stability of the ankle joint complex
Shengli Wang et al
Front Bioeng Biotechnol. 2025 Mar 26:13:1556291

Introduction: Chronic ankle instability (CAI) is generally associated with repetitive ankle sprains with concomitant ligament injuries and abnormal joint motion, which affects the stability of the joint. This study aims to quantify and compare the 3D motion differences in the ankle joint complex (AJC) during walking between CAI patients and healthy controls and to analyze the effect of CAI on the vertical ground reaction force (vGRF) and center of pressure (COP) distribution.

Methods: Fifteen CAI patients (6 males, 9 females; height 165 ± 3.8 cm; weight 68.5 ± 10.2 kg; BMI 21.6 ± 3.5 kg/m2) with anterior talofibular and calcaneofibular ligament sprains and fifteen healthy participants (8 males, 7 females; height 168 ± 4.2 cm; weight 74.5 ± 12.6 kg; BMI 22.3 ± 4.2 kg/m2) participated in this study. Dynamic biplanar radiography were used to analyze the 3D motion and stability of the ankle joint complex during the stance phase. Synchronous force plate data were used to assess vGRF and COP trajectories.

Results: Compared to controls, CAI patients showed increased plantarflexion (1.3°), internal rotation (2.0°), and medial translation (0.6 mm) in the tibiotalar joint, along with decreased dorsiflexion (3.0°). For the subtalar joint, plantarflexion decreased (1.8°), and external rotation increased (0.9°). The tibio-calcaneal joint showed increased internal rotation (1.9°) and posterior translation (0.5 mm). Stability differences included more dispersed axes of rotation and greater spatial motion volumes of landmarks in the CAI group. Additionally, CAI patients exhibited greater peak vGRF with earlier peaks, higher loading rates, and more lateral and unstable COP trajectories.

Conclusion: These findings reveal that CAI not only alters the 3D motion and stability of the AJC but also affects foot-ground interaction forces, such as vGRF and COP distribution, during walking. This study provides critical insights into the altered biomechanics of the AJC in CAI patients and contributes to the clinical diagnosis of CAI and evaluation of results from surgical or conservative intervention
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NewsBot · May 25, 2025

Tapping and Task Switching Activation in Individuals With and Without Chronic Ankle Instability: fMRI Pilot Study
Danielle M Torp et al
J Neuroimaging. 2025 May-Jun;35(3):e70053. doi: 10.1111/jon.70053.

Background and purpose: Chronic ankle instability (CAI) disrupts mechanoreceptors at the talocrural joint, which requires reliance on other forms of sensory information to maintain normal physical function. Understanding central nervous system activation patterns in individuals with CAI may lead to the development of interventions aimed at preventing long-term dysfunction. The primary objective of this study was to explore cortical activation patterns between individuals with CAI and uninjured controls during foot tapping and task switching.

Methods: Twenty-six adults (13 CAI) completed a functional MRI protocol. The foot tapping task required participants to tap a response button under their metatarsal heads by plantarflexing their foot in sync with a visual stimulus. The switching task required participants to make a decision about a single stimulus feature (e.g., color or shape) during single and mixed task blocks. Single blocks required attention to either the shape or color of the stimulus, while mixed blocks required participants to switch between features (color and shape). Participants responded to stimuli via a plantarflexion button press. Between and within group voxelwise analyses were then conducted to determine cortical activation patterns.

Results: The CAI group demonstrated greater activation in regions of visual processing and sensorimotor integration during foot tapping when compared to the uninjured controls. During task switching, the uninjured group demonstrated more activation in regions of cognitive flexibility, while CAI participants demonstrated more activation in an area of emotional processing.

Conclusions: Individuals with CAI and uninjured controls demonstrate different activation patterns during foot tapping and task switching.
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NewsBot · Jun 1, 2025

The effect of visual feedback on balance rehabilitation in people with impaired ankle instability: a systematic review and meta-analysis
Chuan Qiu Shui Wang et al
BMC Sports Sci Med Rehabil. 2025 Apr 10;17(1):77

Background: Ankle instability is a consequence of ankle injuries that can impair balance and affect an individual's ability to perform activities of daily living. Consequently, visual feedback is frequently employed in rehabilitation to enhance training outcomes. However, inconsistencies exist in the scientific literature regarding the effect size of visual feedback and the optimal method of delivery.

Aim: The objective of this systematic review and meta-analysis was twofold: firstly, to conduct a comprehensive assessment of the potential impact of visual feedback on balance exercises for individuals with ankle instability; secondly, to quantify the effects of visual feedback on balance in this population.

Methods: A total of 10 studies were included in this systematic review and meta-analysis. The review was conducted in accordance with the PERSiST (Implementing Prisma in Exercise, Rehabilitation, Sport Medicine, and Sports Science) guidance. The research was conducted using four databases and was required to be written in English. Additionally, the studies had to involve the provision of visual feedback during balanced rehabilitation.

Results: The provision of visual feedback has been demonstrated to enhance the efficacy of rehabilitation programs designed to improve balance. Improvement in static, dynamic, and perceptual balance during balance training. The provision of visual feedback was found to simultaneously increase the subjects' subjective motivation to train and their satisfaction and enjoyment of the rehabilitation training. The results demonstrated that visual feedback improved the Foot and Ankle Ability Measure by approximately 17% (MD = 2.42, 95%CI = 0.72 to 4.12, I²[total] = 0%). Additionally, the provision of visual feedback during the training cycle may positively affect the star excursion balance test (SEBT) (MD = 4.83, 95%CI = 3.09 to 6.56, I²[total] = 21%). Moreover, the Biodex system is expected to demonstrate notable improvements in measures of balance (MD = 0.14, 95% CI = 0.01 to 0.28, I²[total] = 24%).

Conclusion: The provision of visual feedback in the context of balance rehabilitation has been demonstrated to facilitate beneficial adaptations to balance in individuals presenting with ankle instability. The research included in our analysis demonstrates the positive impact of visual feedback, with nearly all results exhibiting superior outcomes relative to those observed in the absence of visual feedback. Visual feedback can be employed as an "additive" or alternative to conventional rehabilitation for individuals with ankle instability.
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NewsBot · Jun 2, 2025

Intrinsic foot muscles size and quality changes after impairment-based rehabilitation in patients with chronic ankle instability
Abbis Jaffri et al
Phys Ther Sport. 2025 May 17:74:51-57. doi: 10.1016/j.ptsp.2025.05.008

Objective: To determine IFMs size and quality using US imaging following rehabilitation in patients with CAI.

Design: Prospective cohort study.

Settings: University Laboratory.

Participants: 26 patients with CAI (age:21.9 ± 3.5 yrs; 18F, 8M) completed 8 clinician-supervised rehabilitation sessions over a 4-week period.

Main outcome measures: US imaging assessed IFM cross-sectional area (CSA) in seated and standing positions for both trained and untrained legs before and after the intervention. Muscle quality was evaluated using grey scale analysis for echogenicity.

Results: Significant (P < 0.01) increases in normalized CSA were observed for AbH and FDB in both seated and standing positions. Significant improvements (P < 0.05) were also seen in the untrained leg during standing. No significant changes were found in seated positions or in echogenicity for AbH (P = 0.26) and FDB (P = 0.052) for the trained leg.

Conclusion: IFM CSA increased post-rehabilitation, with some cross-over effects in the untrained leg. There was a certain cross-over effect observed. The muscle quality measures didn't change for the IFMs before and after rehabilitation. The IFMs strengthening should be included in CAI rehabilitation programs. There is a definite increase in size after rehabilitation. However, for quality changes there may be a need of longer rehabilitation programs.
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NewsBot · Jun 2, 2025

Kinesiology taping length and dynamic balance control in individuals with chronic ankle instability
Ruoni Yu et al
Sci Rep. 2025 Apr 1;15(1):11030

To explore the effect of different lengths of kinesiology taping (KT) on dynamic balance control in individuals with and without chronic ankle instability (CAI). Thirty-one participants (16 CAI, 15 non-CAI) volunteered, and all of them were tested for dynamic balance with KT taping of varied strip lengths, in a random sequence, with taping conditions being: above-ankle taping (short taping), below-knee taping (mid taping), and above-knee taping (long taping). Dynamic balance was measured by the Y-Balance test (YBT) with three reaching directions; anterior (YBT-A), posteromedial (YBT-PM), posterolateral (YBT-PL), untaped at enrolment and immediately after each taping condition. Non-CAI participants consistently outperformed CAI all YBT measures made in the untaped condition (all p<0.05). Linear mixed model (LMM) analysis suggested there were significant KT-Group interactions reflecting reducing inter-group difference as tape length increased for YBT-C (F(3, 29) = 5.599, p = 0.016, ES = 0.104), YBT-PM (F (3, 29) = 3.53, p = 0.018, ES = 0.102) and YBT-PL (F (3, 29) = 2.72, p = 0.049, ES = 0.008), but not YBT-A (F (3, 29) = 1.44, p = 0.236). Paired t-tests suggested that in the CAI group, compared to the untaped condition, YBT-PM scores increased in all taping conditions, with mean difference (MD) from 3.5 to 7.0% (t = 2.17-5.17, p = 0.00-0.046, 95%CI = -9.83, -0.07), whereas YBT-C (MD = 4.2%, t = 1.03, p = 0.001, 95%CI = -6.36, -1.97) and YBT-PL scores (MD = 5.3%, t = 3.9, p = 0.001, 95%CI = -8.18, -2.41) increased only in the long-taping condition. KT taping can improve dynamic balance for individuals with CAI to a level of those without CAI. Longer KT taping seems to show superior effects. However, individuals without CAI may not benefit from KT taping when performing a dynamic balance task.
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NewsBot · Jun 2, 2025

Effects of differing platform orientations on forefoot and hindfoot kinematics in chronic ankle instability during single leg landing
Anthony Laigo, et al
Physical Therapy in Sport Volume 73, May 2025, Pages 114-120

Highlights
•Examined forefoot and hindfoot kinematics in CAI during single-leg landings.
•Modifiable platforms highlight various landing kinematics in studies on single-leg landings.
•Segment-specific analysis offers insights into intra-foot biomechanics in CAI.
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Objectives
To investigate how modifiable landing platforms influence intra-foot movement during single-leg landings, comparing forefoot and hindfoot kinematics between individuals with chronic ankle instability (CAI) and controls to inform segment-focused rehabilitation strategies.
Design
Cross-sectional.
Setting
Biomechanics laboratory.
Participants
20 university students, 12 with CAI, 8 controls.
Main outcome measures
Participants performed single-leg landing on platforms with three orientations (inverted, plantarflexed-everted-abducted and dorsiflexed-inverted-adducted), and four inclinations (10°, 12°, 14°, 16°). These configurations were based on prior studies and safety limits. Net frontal-plane movement of the forefoot and hindfoot was calculated across a 400ms window.
Results
The CAI group showed significantly greater forefoot inversion (η2 = 0.32; p < 0.01) and non-significant group difference in hindfoot eversion (ƞ2 = 0.183; p = 0.06). Orientation and inclination had large effects on forefoot motion (η2 = 0.56 and 0.80, respectively; p < 0.001). A significant group × segment interaction (η2 = 0.24; p < 0.001) indicated contrasting movement between the forefoot and hindfoot in CAI, not observed in controls.
Conclusion
Individuals with CAI demonstrated a less adaptive, segment-specific landing strategy. Findings support the use of modifiable platforms and multi-segment foot models to guide targeted interventions addressing forefoot compensation and improving segmental control during landing.
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NewsBot · Jun 2, 2025

Hop Stabilization Training Improves Functional Movement Patterns and Quality of Life in Female Athletes With Chronic Ankle Instability
Lale Pooryamanesh et al
J Sport Rehabil. 2025 Apr 1:1-7

Context: Chronic ankle instability (CAI) is a common consequence of a lateral ankle sprain. Sex differences in functional outcomes exist, but there is a lack of female-specific intervention studies. Hop stabilization training is effective in male athletes with CAI but has not been investigated in female athletes. Therefore, the purpose of this investigation was to describe the effect of hop stabilization exercises on functional movement patterns and patient-reported outcomes in female athletes with CAI. We also compared the current effect sizes with those observed in an all-male cohort following an identical intervention.

Design: Randomized controlled trial.

Methods: Fourteen female CAI participants completed hop stabilization training (age = 25.29 [5.86] y), and 14 female CAI participants were in the control group (age = 24.73 [6.97] y). Inclusion criteria were consistent with the International Ankle Consortium recommendations. The hop stabilization program consisted of three 20-minute sessions per week for 6 weeks. Sessions consisted of increasing foot-to-ground contacts each week until a taper in the final week. Exercise difficulty was also modified throughout the program. Functional movement patterns via the Functional Movement Screen and Fusionetics Scores, dorsiflexion range of motion, and select region-specific patient-reported outcomes were captured.

Results: The hop training group (pre: 12.68 [1.32] cm, post: 13.42 [1.35] cm) had a significant improvement (P< .001) in dorsiflexion range of motion relative to the control group (pre: 13.62 [1.22] cm, post: 13.68 [1.16] cm). Hop training also significantly improved (P,<0.01) functional movement patterns and all patient-reported outcomes. Relative to an all-male cohort who previously underwent the same hop stabilization program, the current female cohort demonstrated larger effect sizes, but all 95% CIs overlapped.

Conclusions: A 6-week hop training program significantly improves patient-reported outcomes, dorsiflexion range of motion, and functional movement patterns in female athletes with CAI .
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NewsBot · Jun 5, 2025

Transcranial Direct Current Stimulation over the Motor or Frontal Cortex in Patients with Chronic Ankle Instability
Alan R Needle et al
J Athl Train. 2025 Apr 15 https://pubmed.ncbi.nlm.nih.gov/40231399/
Objective: Growing evidence has suggested clinical efficacy for the use of anodal transcranial direct current stimulation (atDCS) when combined with motor interventions in patients with chronic ankle instability (CAI). However, no studies have compared multiple approaches for improving motor function with atDCS in patients with CAI. We therefore aimed to determine the efficacy of atDCS over the motor or frontal cortex when combined with a four-week motor planning intervention on neural function, performance, and patient-reported outcomes in patients with CAI.

Design: Double-blind, sham-controlled, parallel randomized control trial.

Methods: Participants (n=44, 15 males, 29 females, 23.6±6.1 yrs) were assessed for outcome measures of cortical and reflexive excitability; performance measures of dynamic balance, muscle activation, reaction times, and cognitive performance on a dual-task balance test; and patient-reported outcome measures at baseline, mid-training (week 2), post-training (week 4), and retention (week 6). After baseline testing, participants were randomized to receive atDCS over the motor cortex, frontal cortex, or a sham current during rehabilitation exercises over four weeks. Participants reported for eight training sessions where they were instrumented for atDCS while performing obstacle walking, dual-task balance, and agility exercises. Analyses between groups and time points were performed with mixed linear models (α=0.05).

Results: Forty-six individuals were recruited & randomized with 37 completing the investigation (motor=14, frontal=11, sham=12). No differences across groups or times were observed in neural excitability or muscle activation variables (P>0.05). Significant improvements in dynamic postural stability indices were observed from baseline across all groups (P<0.05). Improvements were observed for foot & ankle function, perceived disablement, and the Global Rating of Change at post-training and retention (p<0.001).

Conclusions: Improvements in patient function were observed across all groups, suggesting the motor planning intervention improved function, regardless of atDCS application. Observing benefits from atDCS may be dependent on proper pairing of rehabilitation exercise with electrode location.

NewsBot · Jun 12, 2025

Activities of the intrinsic muscles of the foot and lower leg during a single-leg stance and drop landing in individuals with chronic ankle instability
Takumi Okunuki et al
Phys Ther Sport. 2025 May 8:74:32-38

Objectives: The aim of this study was to compare intrinsic foot muscle activity during single-leg standing and single-leg drop landing between participants with and without chronic ankle instability.

Design: A cross-sectional study.

Setting: Laboratory.

Participants: Twelve participants with chronic ankle instability and eleven control participants.

Main outcome measures: The main outcomes were the muscle activities of the abductor hallucis, abductor digiti minimi, peroneus longus, and soleus muscles and the center of pressure during single-leg standing and single-leg drop landing.

Results: Participants with chronic ankle stability showed increased soleus muscle activity during single-leg standing with eyes closed and after single-led drop landing compared with that of controls. In the chronic ankle instability group, lower Cumberland Ankle Instability Tool scores were associated with reduced abductor digit minimi muscle activity during landing. No significant differences were found in other outcomes.

Conclusions: Reduced abductor digit minimi muscle activity may be associated with greater severity of chronic ankle instability. Increased soleus muscle activity in individuals with chronic ankle instability may serve as a compensatory mechanism for other impairments during single-leg standing with eyes closed and single-leg drop landing tasks.
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NewsBot · Jun 13, 2025

Foot tissue stress in chronic ankle instability during the stance phase of cutting
Peimin Yu, Xuanzhen Cen, Liangliang Xiang, Alan Wang, Yaodong Gu & Justin Fernandez
Medical & Biological Engineering & Computing

Lower limb biomechanics of chronic ankle instability (CAI) individuals has been widely investigated, but few have evaluated the internal foot mechanics in CAI. This study evaluated bone and soft tissue stress in CAI contrasted with copers and non-injured participants during a cutting task. Integrating scanned 3D foot shapes and free-form deformation, sixty-six personalized finite element foot models were developed. Computed Achilles tendon forces and measured regional plantar pressure were applied as boundary loading conditions for simulation. It was observed that the primary group differences in foot stress occurred during midstance and heel-off phases of the cutting task. Specifically, healthy individuals had significantly higher stress in the talus and soft tissue around the talus compared to CAI participants. In contrast, CAI participants had significantly higher stress in the cuneiforms and lateral forefoot bones during mid-stance and push-off phases. CAI participants appeared to adopt a protective strategy by transferring greater force to the lateral forefoot at the heel-off phase while lowering stress around the talus, which may be associated with pain relief near the ankle. These findings suggest further attention should be placed on internal stress in CAI at the push-off phase with implications for long-term foot adaptation.
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NewsBot · Jun 15, 2025

Comparison of psychological factors between healthy athletes and those suffering from chronic ankle instability
Main Article Content et al
Source

Background: Ankle sprain is the most common traumatic injury among handball players, which usually leads to the development of Chronic Ankle Instability (CAI). There is much evidence regarding the mechanical component about this condition; however, the psychological component has been little studied in previous research. The aim of this study was to compare anxiety, personality traits, depression, and kinesiophobia between young handball players with and without CAI. Methods: Case-control study. A sample of 100 young handball players was recruited and divided into athletes with CAI (case group, n = 50) and healthy athletes (control group, n = 50). Main outcome measures were anxiety, personality traits, depression and kinesiophobia levels, which were assessed by self-reported questionnaires (State-Trait Anxiety Inventory, Eysenck Personality Questionnaire, Beck Depression Inventory-II and Tampa Scale for Kinesiophobia-11). Results: Statistically significant differences were found between groups for anxiety, personality traits, depression and kinesiophobia. Case group showed higher levels of state anxiety (Δ-2.50; p < .05), trait-anxiety (Δ-3.80; p < .05), neuroticism (Δ-0.92; p < .05), depression (Δ-4.10; p < .05), and kinesiophobia (Δ6.82; p < .05) compared to the control group. Conclusions: Young handball players with CAI present significant greater levels of anxiety, neuroticism, depression and kinesiophobia compared to healthy young handball players.
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NewsBot · Jun 18, 2025

Effects of balance training with visual occlusion on postural control in individuals with chronic ankle instability: A systematic review and meta-analysis of randomized controlled trials
Peng Chen et al
PM R. 2025 Jun 17.

Objective: Balance training with visual occlusion positively affects the improvement of proprioception and reduction of visual dependence in individuals with chronic ankle instability (CAI). However, the effect of visual occlusion balance training alone on postural control in individuals with CAI remains controversial. This review conducted a meta-analysis of existing randomized controlled trials (RCTs) to investigate the influence of balance training with visual occlusion on the postural control of individuals with CAI.

Literature survey: PubMed, Embase, The Cochrane Library, Web of Science, EBSCO, China National Knowledge Infrastructure (CNKI), and WanFang database were searched until July 20, 2024. RCTs were eligible if they compared the effects of balance training with visual occlusion with balance training on the postural control of individuals with CAI.

Methodology: The following information from the included articles was extracted: basic study information, interventions, and outcomes. The primary outcomes included Y-balance test (YBT) distance and center of pressure (COP) area, and the secondary outcomes were Cumberland ankle instability tool (CAIT) and Foot and Ankle Ability Measure (FAAM) scores.

Synthesis: Eight RCTs were included in this work. The results show that balance training with visual occlusion significantly improved YBT distance (standardized mean difference [SMD] = 0.40 [95% confidence interval [CI], 0.23-0.57], p < .001) and CAIT scores (mean difference [MD] = 3.03 [95% CI, 1.76-4.29], p < .001) in individuals with CAI compared with balance training alone. However, no significant difference was found between the two groups in terms of the COP area (SMD = 0.18 [95% CI, 0.51-0.86], p = .62) and FAAM scores (MD = 1.79 [95% CI, -0.03 to 3.62], p = .05).

Conclusions: Compared with balance training alone, balance training with visual occlusion may help improve the dynamic postural control ability of individuals with CAI. However, its effect on static postural control ability still needs further study
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NewsBot · Jun 19, 2025

Effectiveness of exercise therapy on chronic ankle instability: a meta-analysis
Chengcheng Zhang et al
Sci Rep. 2025 Apr 5;15(1):11709.

Lateral ankle sprains are one of the most common musculoskeletal injuries. Up to 70% of individuals who sustain lateral ankle sprains develop chronic ankle instability (CAI). Exercise therapy is considered an effective treatment for patients with CAI. This meta-analysis investigated the efficacy of exercise therapy in CAI patients by reviewing 15 randomized controlled trials (RCTs) involving 586 participants. Databases including PubMed, EMBASE, Cochrane Library, and Web of Science were searched from inception to September 13, 2024. The Cochrane Risk of Bias Tool was used to assess study quality. Meta-analysis, sensitivity analysis, and publication bias analysis were conducted using RevMan 5.3.0 and Stata 18.0 software. The Grading of Recommendations, Assessment, Development, and Evaluations (GRADE) approach was applied to evaluate the quality of evidence. Main outcomes were assessed using the Foot and Ankle Ability Measure (FAAM) and the Star Excursion Balance Test (SEBT). The results demonstrated that exercise therapy significantly improved FAAM-S (MD = 7.98, CI: 4.11 to 11.86, p < 0.0001, I² = 30%). Long-term exercise therapy (over 4 weeks) significantly enhanced FAAM-A (MD = 10.95, CI: 6.60 to 15.29, p < 0.00001, I² = 0%) and dynamic balance ability of ankle joint (SBET-A: MD = 4.83, CI: 1.04 to 8.63, p = 0.01, I² = 62%; SEBT-PM: MD = 6.93, CI: 2.37 to 11.48, p = 0.003, I² = 69%; and SEBT-PL: MD = 8.98, CI: 2.66 to 15.29, p = 0.005, I² = 86%). After categorizing by exercise type, the results indicated that strength training was more effective in improving SEBT-PL (MD = 8.15, CI: 6.09 to 10.21, p < 0.00001, I² = 0%), joint mobilization was more effective in improving SEBT-A (MD = 7.65, CI: 4.93 to 10.37, p < 0.00001, I² = 0%), and proprioceptive training was more effective in improving SEBT-PM (MD = 10.46, CI: 5.27 to 15.65, p < 0.0001, I² = 33%). In conclusion, long-term, multifaceted exercise therapy demonstrates superior rehabilitation efficacy for patients with CAI. Personalized treatment plans, informed by SEBT assessment results, should prioritize targeted interventions such as joint mobilization, strength training, or proprioceptive training. This approach holds significant theoretical and practical value for optimizing CAI treatment strategies and enhancing patient outcomes.
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NewsBot · Jun 27, 2025 at 12:20 AM

Arthroscopic Characteristics and Risk Factors for Syndesmosis Widening in Chronic Lateral Ankle Instability: A Cross-sectional Study of 521 Patients
Tong Su, MD, et al
Source

Background:
To report the measured characteristics of inferior tibiofibular syndesmosis (iTFS) widening—a condition involving abnormal separation of the distal tibia and fibula in patients with chronic lateral ankle instability (CLAI)—and to investigate its associated risk factors.
Methods:
Consecutive CLAI patients undergoing arthroscopy and Broström surgery between June 2020 and August 2023 were included. The anterior, middle, and posterior parts of the transverse iTFS space was measured by using the customized probe under arthroscopy to explore the characteristics of iTFS widening. Univariate and multivariate logistic regression analysis were used to analyze the relationship between related factors (gender, age, body mass index [BMI], time after initial injury, sprain recurrence, Beighton score, and intra-articular lesions) and iTFS widening.
Results:
A total of 521 CLAI patients were included. Among those patients, 272 (52.2%) were found with arthroscopic widening at middle syndesmosis ≥3 mm, with 67.3% demonstrating wider posterior interval and narrower anterior interval, 31.3% equivalent posterior and anterior interval, and 1.5% wider anterior interval and narrower posterior interval. According to univariate analysis, female sex (P < .001), Beighton score (P = .001), BMI (P = .008), and osteochondral lesion at lateral talus (P = .040) were significantly associated with the presence of iTFS widening. Multivariate analysis revealed that female sex (P < .001; odds ratio 3.130, 95% CI 2.076-4.720) was an independent risk factor of syndesmotic widening in CLAI patients.
Conclusion:
Among CLAI patients undergoing surgery, 52.2% demonstrated concomitant iTFS widening. Arthroscopic measurements revealed an overall trend of a wider posterior iTFS space and a narrower anterior iTFS space. Female sex was identified as an independent risk factor for arthroscopic iTFS widening in CLAI patients. However, the clinical significance of this widening remains uncertain, as no correlation with patient-reported outcomes or postoperative function was assessed.
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NewsBot · Jun 28, 2025 at 4:00 AM

Investigating Peroneus Muscle Quality in Ankle Stability: A Comparative Analysis between Chronic Ankle Instability Patients and Healthy Controls
Cheryl Shu Ming Chia et al
Physical Therapy in Sport 27 June 2025

Highlights:

• Peroneus muscle qualities are significantly different in patients with chronic ankle instability.
• Increasing peroneal muscle stiffness and decreasing eversion strength of the peroneus muscle are associated with increased postural sway.
• Eversion strength is less important for maintaining postural sway in healthy individuals, but is a significant contributor to ankle stability in patients with CAI.
• Peroneal muscle echogenicity is not associated with balance functions.

Objectives
To compare peroneal muscle quality between individuals with chronic ankle instability (CAI) and healthy controls, and to examine their relationship with ankle stability.
Design
Case-control study.
Setting
Research laboratory.
Methods
Sixty-five participants (35 with unilateral CAI, 30 healthy controls) were assessed. Peroneal muscle size, echogenicity, and passive stiffness were measured using ultrasound imaging and eversion strength was assessed with a hand-held dynamometer. Ankle stability was evaluated using the Y Balance Test (YBT), lateral step-down, and single-leg stance tests.
Results
Compared to controls, individuals with CAI showed significantly lower eversion strength, higher muscle echogenicity, and increased passive stiffness. In the CAI group, greater stiffness and reduced strength were associated with higher centre of pressure displacement during single-leg stance. Higher eversion strength was associated with increased YBT scores across all participants. Echogenicity was not directly associated with stability functions.
Conclusion
Deficits in peroneal muscle quality, involving echogenicity, strength and stiffness, are demonstrated in the CAI population. These factors are associated with impaired instability among CAI individuals. Peroneal muscle echogenicity may not have a direct association with balance functions. Interventions targeting peroneal muscle quality may improve balance and reduce recurrent ankle injury risk in this population.
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Functional ankle instability

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Short foot exercise for functional ankle instability

Functional relevance of the small muscles crossing the ankle joint

Comparison of Functional Ankle Motion Measures

Low-Lying FHL Muscle Belly in Functional Hallux Limitus

Chronic Exertional Compartment Syndrome Caused by Functional Venous Outflow Obstruction

The functional importance of human foot muscles for bipedal locomotion

A narrative review on the tests used in biomechanical functional assessment of the foot and leg

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Functional ankle instability

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Short foot exercise for functional ankle instability

Functional relevance of the small muscles crossing the ankle joint

Comparison of Functional Ankle Motion Measures

Low-Lying FHL Muscle Belly in Functional Hallux Limitus

Chronic Exertional Compartment Syndrome Caused by Functional Venous Outflow Obstruction

The functional importance of human foot muscles for bipedal locomotion

A narrative review on the tests used in biomechanical functional assessment of the foot and leg

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