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Functional ankle instability

Discussion in 'Biomechanics, Sports and Foot orthoses' started by NewsBot, Aug 18, 2008.

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  1. NewsBot

    NewsBot The Admin that posts the news.


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    Biomechanics of ankle instability. Part 1: Reaction time to simulated ankle sprain.
    Mitchell A, Dyson R, Hale T, Abraham C.
    Med Sci Sports Exerc. 2008 Aug;40(8):1515-21.
     
  2. NewsBot

    NewsBot The Admin that posts the news.

    Biomechanics of Ankle Instability. Part 2: Postural Sway-Reaction Time Relationship.
    Mitchell A, Dyson R, Hale T, Abraham C.
    Med Sci Sports Exerc. 2008 Aug;40(8):1522-1528.
     
  3. Admin2

    Admin2 Administrator Staff Member

  4. NewsBot

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    Subtalar instability: a biomechanical cadaver study.
    Weindel S, Schmidt R, Rammelt S, Claes L, Campe AV, Rein S.
    Arch Orthop Trauma Surg. 2008 Oct 7. [Epub ahead of print]
     
  5. NewsBot

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    Effect of Foot Orthotics on Single- and Double-Limb Dynamic Balance Tasks in Patients With Chronic Ankle Instability
    Amelia R. Sesma, Carl G. Mattacola, Tim L. Uhl, Arthur J. Nitz, Patrick O. McKeon
    Foot & Ankle Specialist, Vol. 1, No. 6, 390-397 (2008)
     
  6. NewsBot

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    Lateral ankle sprain alters postural control in bipedal stance: Part 2 sensorial and mechanical effects induced by wearing an ankle orthosis.

    Genthon N, Bouvat E, Banihachemi JJ, Bergeau J, Abdellaoui A, Rougier PR.
    Scand J Med Sci Sports. 2009 Apr 20. [Epub ahead of print]
     
  7. NewsBot

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    Effects of Taping and Exercise on Ankle Joint Movement in Subjects With Chronic Ankle Instability: A Preliminary Investigation.
    Delahunt E, O'Driscoll J, Moran K.
    Arch Phys Med Rehabil. 2009 Aug;90(8):1418-1422
     
  8. NewsBot

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    Altered ankle kinematics and shank-rear-foot coupling in those with chronic ankle instability.
    Drewes LK, McKeon PO, Paolini G, Riley P, Kerrigan DC, Ingersoll CD, Hertel J.
    J Sport Rehabil. 2009 Aug;18(3):375-88.
     
  9. NewsBot

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    Modified Evans technique improves plantar pressure distribution in lateral ankle instability.
    Ateşalp S, Demiralp B, Ozkal UB, Uğurlu M, Bozkurt M, Başbozkurt M.
    Eklem Hastalik Cerrahisi. 2009;20(1):41-6.
     
  10. NewsBot

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    The influence of Mulligan ankle taping during balance performance in subjects with unilateral chronic ankle instability.
    Hopper D, Samsson K, Hulenik T, Ng C, Hall T, Robinson K.
    Phys Ther Sport. 2009 Nov;10(4):125-30
     
  11. NewsBot

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    Chronic ankle instability. Which tests to assess the lesions? Which therapeutic options?
    Orthop Traumatol Surg Res. 2010 May 19. [Epub ahead of print]
     
  12. NewsBot

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    Chronic ankle instability: Biomechanics and pathomechanics of ligaments injury and associated lesions.
    Bonnel F, Toullec E, Mabit C, Tourné Y; et la Sofcot.
    Orthop Traumatol Surg Res. 2010 May 19. [Epub ahead of print]
     
  13. NewsBot

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    Chronic ankle instability alters central organization of movement.
    Hass CJ, Bishop MD, Doidge D, Wikstrom EA.
    Am J Sports Med. 2010 Apr;38(4):829-34
     
  14. NewsBot

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    Characteristics of people with recurrent ankle sprains: a systematic review with meta-analysis.
    Hiller CE, Nightingale EJ, Christine Lin CW, Coughlan GF, Caulfield B, Delahunt E.
    Br J Sports Med. 2011 Jan 21. [Epub ahead of print]
     
  15. NewsBot

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    Press Release:
    Foot positioning during walking and running may influence ankle sprains
     
  16. NewsBot

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    A systematic review on the treatment of acute ankle sprain: brace versus other functional treatment types.
    Kemler E, van de Port I, Backx F, van Dijk CN.
    Sports Med. 2011 Mar 1;41(3):185-97.
     
  17. efuller

    efuller MVP

    Is this known, or is there just a correlation? The sentence is implying causation.

    Eric
     
  18. Perthpod

    Perthpod Active Member

    Is there much evidence to support valgus forefoot posting to increase lateral ankle stability?
     
  19. efuller

    efuller MVP

    I've got theories and observations, but no studies. Ankle instability can have multiple causes and I'm not sure that it is well defined. A tendency toward inversion ankle sprains is something different than lax lateral collateral ankle ligaments is different from inhibited or weak peroneal muscles.

    Some studies of sinus tarsi syndrome and lateal ankle instability have demonstrated increased latency to activation of peroneal muscles in response to a sudden inversion movement, and this could explain why they have an increased number of ankle sprains. An increased latency probably would not be helped by a forefoot valgus wedge. On the other hand, peroneal weakness might be helped by a forefoot valgus wedge because there would be increased pronation moment from the ground when there was decreased pronation moment from muscles.

    Eric
     
  20. Perthpod

    Perthpod Active Member

    I guess it would depend on the forefoot plantar pressures too, as to whether it could be approp. treated with ff valgus wedging. An excessively supinated gait ( that predisposes patient to lateral landing and lat ankle sprains) with ++ px under the 5 th would not respond well to extra valgus wedging.
     
  21. efuller

    efuller MVP

    I disagree. A foot with a laterally positioned STJ axis could be considered as a foot with an excessively supinated gait. Whether or not to add a forefoot valgus wedge would be dependent on the eversion range of motion of the forefoot in stance. If the person has a lot of eversion range of motoin available and is "oversupinated" or has a problem like peroneal tendonitis, then adding a forefoot valgus wedge would be quite beneficial. A foot with a laterally deviated STJ axis can have high pressures under lateral forefoot and have a large range of eversion range of motion available. Although a foot with a partially compensated varus will also tend to have high pressure sub 5th met. You can tell the difference between these feet with the Coleman block test or assessing maximum eversion height.

    Eric
     
  22. NewsBot

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    Foot pressure and center of pressure in athletes with ankle instability during lateral shuffling and running gait.
    Huang PY, Lin CF, Kuo LC, Liao JC.
    Scand J Med Sci Sports. 2011 Aug 18.
     
  23. efuller

    efuller MVP

    It would be very interesting to combine this with peroneal EMG recordings. The reason that there may be a more rapid shift of the COP from lateral to medial may be that the peroneals are acting more in the ankle instability group. They might be acting more because this group has a laterally positioned STJ axis.

    Eric
     
  24. NewsBot

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    Functional Ankle Instability and Health-Related Quality of Life
    Arnold, Brent L.; Wright, Cynthia J.; Ross, Scott E.
    Journal of Athletic Training, Volume 47, Number 1, November/December 2011 , pp. 634-641(8)
     
    Last edited: Jan 4, 2012
  25. NewsBot

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    Altered plantar-receptor stimulation impairs postural control in those with chronic ankle instability.
    McKeon PO, Stein AJ, Ingersoll CD, Hertel J.
    J Sport Rehabil. 2012 Feb;21(1):1-6.
     
  26. NewsBot

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    Associated intra-articular ankle pathologies in patients with chronic lateral ankle instability: arthroscopic findings at the time of lateral ankle reconstruction.
    Lee J, Hamilton G, Ford L.
    Foot Ankle Spec. 2011 Oct;4(5):284-9
     
  27. Admin2

    Admin2 Administrator Staff Member

  28. NewsBot

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    Increased in-shoe lateral plantar pressures with chronic ankle instability.
    Schmidt H, Sauer LD, Lee SY, Saliba S, Hertel J.
    Foot Ankle Int. 2011 Nov;32(11):1075-80.
     
  29. NewsBot

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    Orthotic intervention and postural stability in participants with functional ankle instability after an accommodation period.
    Hamlyn C, Docherty CL, Klossner J.
    J Athl Train. 2012;47(2):130-5.
     
  30. NewsBot

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    Discriminating between copers and people with chronic ankle instability.
    Wikstrom EA, Tillman MD, Chmielewski TL, Cauraugh JH, Naugle KE, Borsa PA.
    J Athl Train. 2012;47(2):136-42.
     
  31. WillTrekker

    WillTrekker Member

    You could add a FF Valg Wdg, but that is often TOO late (LMS to Toe-Off Phase of Gait) to "catch" the rearfoot from inverting, rolling, or spraining; in order to prevent the RF from chronically inverting all too easily, especially in the laterally placed STJ-A, place a laterally based wedge of 2, 4, or 6mm, depending on the severity of the instability and the size of the patient.
    "Intrinsic STJ-Instability (STJ-I) is eval'd by putting the STJ thru a ROM, and then one will feel either a smooth arc (normal), little to no motion (suspect coalition, either caritilaginous or ossseous), or as though there is a sharp "dell of the arc of ROM" and the ankle 'gives way laterally' (=STJ-I)...
    Now, this is the rearfoot (ankle) that rolls/inverts/sprains--EVEN when sub 5th MT head is loaded and one places their other index finger sub proximal medial heel!! Yes, in heel contact to rearfoot loading phase of gait, one should [needs] to place a medial wedge in to ALL shoe gear and/or onto their Functional Foot Orthotics.

    Any questions. Do this and your patients will luv you.

    Also, place your patients into a Bioskin Biolok (low profile, ultra-breathable) ankle brace, with the straps reefed up/locked in place while the ankle/rearfoot is dorsiflexed & everted into the position of maximal stability. This is for work, play, exercise, and uneven terrain such as for military et al.

    How do you like it know. The total package. Stability from the ground up and all around the ankle.
     
  32. efuller

    efuller MVP

    I would agree that a valgus heel wedge would work sooner than a forefoot wedge in heel to toe gait. I don't understand why a forefoot valgus wedge working later is a problem. The effect of the forefoot wedge would be seen as soon as the forefoot hits the ground. If there is range of motion of the STJ available the forefoot valgus wedge will tend to put the STJ in a more pronated position and this will be accompanied by more internal leg rotation which will move the STJ axis to a more medial position. With the axis and the foot in that position the ground will be less likely to cause the STJ to invert and "roll". So, there is no reason not to use the forefoot valgus wedge if there is STJ range of motion available.


    The "dell of the arc" was something taught to me back in podiatry school. I looked at it a fair amount around that time, but I don't recall correlating that with the complaint of ankle instability in gait. We've had a couple of discussions about what causes the examiner to experience the "sharp" sensation. Having looked at a fair number of cadaver specimens, I haven't seen anything anatomical that could explain that sensation. My explanation is that when you move the STJ when holding the fifth metatarsal the position of the applied force changes more quickly than in feet without the sharp sensation. You also don't get the sharp sensation when you move the STJ when grasping the calcaneus.

    What do you think causes the sharp sensation? Why do you think the sharp sensation would correlate with ankle instability?


    Did you really mean to say medial wedge? In a foot with an extreme laterally positioned axis, the 5th met head may sit medial to the axis and force here will still cause supination. A valgus heel and forefoot wedge can help by decreasing supination moent from the ground by shifting the center of pressure more laterally. If there is range of motion, the valgus (lateral) wedge can move the axis more medial as explained above.

    Of course, as you mentioned you can work use an ankle brace to apply moments to the STJ from something other than changing the location of ground reaction force.

    Eric
     
  33. drsha

    drsha Banned

    This is a very interesting thread that I have monitored until now.

    There seems to be agreement that there is a laterally deviated STJ Axis in play.

    I am not sure if the forefoot position that is being discussed here is equally in agreement. Is it pronated or supinated?

    I read that it is everted but I'm looking more for the sagittal plane component, as I'm not so sure that inversion forefoot moments are the real culprit.

    In addition, there seems to be a greater supinatory moment produced in the UA compared to the its mate with the same injurious force. Perhaps this is indicative of an assymetry of the limbs where the short side is more inverted and therefore is more apt to sprain when challenged with supinatory moments.

    Perhaps a lift on the UA might help or LLD should be considered as culpatory? After all, a 1/2" valgus wedge in the rearfoot with have a 1/4" lift effect.

    Dennis
     
  34. NewsBot

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    Two-week joint mobilization intervention improves self-reported function, range of motion, and dynamic balance in those with chronic ankle instability.
    Hoch MC, Andreatta RD, Mullineaux DR, English RA, Medina McKeon JM, Mattacola CG, McKeon PO.
    J Orthop Res. 2012 May 18. doi: 10.1002/jor.22150.
     
  35. NewsBot

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    Effects of Joint Mobilization on Ankle Dorsiflexion Range of Motion, Dynamic Postural Control and Self-Reported Patient Outcomes in Individuals with Chronic Ankle Instability
    Master of Science in Exercise Science, University of Toledo, College of Health Science and Human Service, 2012.
     
  36. NewsBot

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    In Vivo Kinematics of the Talocrural and Subtalar Joints With Functional Ankle Instability During Weight-Bearing Ankle Internal Rotation: A Pilot Study.
    Kobayashi T, No Y, Yoneta K, Sadakiyo M, Gamada K.
    Foot Ankle Spec. 2013 Feb 25.
     
  37. NewsBot

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    Effects of Chronic Ankle Instability on Energy Dissipation in the Lower Extremity
    Terada, Masafumi; Pfile, Kate R.; Pietrosimone, Brian G.; Gribble, Phillip A.
    Medicine & Science in Sports & Exercise: 8 May 2013
     
  38. NewsBot

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    Aquatic Training for Ankle Instability
    Gioftsidou Asimenia, et al
    Foot Ankle Spec June 27, 2013 1938640013493461
     
  39. NewsBot

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    Selection Criteria for Patients With Chronic Ankle Instability in Controlled Research: A Position Statement of the International Ankle Consortium
    Phillip A. Gribble, Eamonn Delahunt, Chris Bleakley, Brian Caulfield, Carrie L. Docherty, François Fourchet, Daniel Fong, Jay Hertel, Claire Hiller, Thomas W. Kaminski, Patrick O. McKeon, Kathryn M. Refshauge, Philip van der Wees, Bill Vicenzino, Erik A. Wikstrom
    J Orthop Sports Phys Ther 2013;43(8):585-591. doi:10.2519/jospt.2013.0303
     
  40. NewsBot

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    The Effectiveness of Foot Orthotics on Improving Postural Control in Individuals With Chronic Ankle Instability: A Critically Appraised Topic
    Michael L. Gabriner, Brittany A. Braun, Megan N. Houston, and Matthew C. Hoch
    Journal of Sports Rehabilitation (in press)
     
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