Functional ankle instability

NewsBot · Jan 29, 2023

Balance training benefits chronic ankle instability with generalized joint hypermobility: a prospective cohort study
Zong-Chen Hou et al
BMC Musculoskelet Disord. 2023 Jan 27;24(1):71. doi: 10.1186/s12891-023-06179-2.

Background: Balance training is the first choice of treatment for chronic ankle instability (CAI). However, there is a lack of research on the effects of balance training in CAI with generalized joint hypermobility (GJH). This study is to compare the outcomes of balance training in CAI patients with and without GJH.

Methods: Forty CAI patients were assigned into the GJH group (Beighton ≥ 4, 20) and non-GJH group (Beighton < 4, 20) and they received same 3-month supervised balance training. Repeated measure ANOVA and independent t test were used to analyze self-reported questionnaires (Foot and ankle ability measure, FAAM), the number of patients experiencing ankle sprain, isokinetic muscle strength and postural control tests (Star excursion balance test, SEBT and Balance errors system, BES) before training, post-training immediately, and post-training 3 months, respectively.

Results: At baseline, no differences were found between groups with except for GJH group having poorer SEBT in the posteromedial direction (83.6 ± 10.1 vs 92.8 ± 12.3, %) and in the posterolateral direction (84.7 ± 11.7 vs 95.7 ± 8.7, %). Following the balance training, GJH group demonstrated lower re-sprain ratio (immediately after training, 11.1% vs 23.5%, 3 month after training, 16.7% vs 29.4%) than non-GJH group, as well as greater FAAM-S score, plantarflexion strength and dorsiflexion strength at post-training immediately and 3 months, and both groups improved similarly in the FAAM-A score, muscle strength and balance control (SEBT in the posterior-lateral and posterior-medial directions, and BES scores) compared with baseline.

Conclusions: CAI patients with GJH gained equally even better postural stability and muscle strength after the balance training than the non-GJH patients. Balance training could still be an effective treatment for CAI patients with GJH before considering surgery.
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NewsBot · Feb 13, 2023

Functional Effects of Arthroscopic Modified Broström Procedure on Lateral Ankle Instability: A Pilot Study
Shengxuan Cao et al
Foot and Ankle Surgery 11 February 2023

Background
This study aims to assess the mechanical and functional effects of the arthroscopic modified Broström procedure (AMBP) on patients with lateral ankle instability.

Methods
Eight patients with unilateral ankle instability treated with AMBP and eight healthy subjects were recruited. Healthy subjects, preoperative and one-year postoperative patients were assessed using outcome scales and the Star Excursion Balance Test (SEBT) for dynamic postural control. One-dimensional statistical parametric mapping was performed to compare ankle angle and muscle activation curve during stair descent.

Results
The patients with lateral ankle instability showed good clinical outcomes and increased posterior lateral reach during the SEBT after the AMBP (p = 0.046). The medial gastrocnemius activation after initial contact was reduced (p = 0.049), and the peroneal longus activation after initial contact was promoted (p = 0.014).

Conclusion
The AMBP has functional effects of promoting dynamic postural control and peroneal longus activation within one year of follow-up, which can benefit patients with functional ankle instability. However, the medial gastrocnemius activation was unexpectedly reduced post operation.
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NewsBot · Feb 20, 2023

Less impact absorption at the ankle joint is related to the single-leg landing stability deficit in patients with chronic ankle instability
Shinshiro Mineta et al
Journal of Biomechanics 18 February 2023, 111509

Single-leg landing (SLL) stability deficits are common dysfunctions after lateral ankle sprain (LAS), and are associated with reinjury and needs to be addressed. SLL stability deficits could be associated with impact absorption ability. Thus, we evaluated these relationships. We recruited 46 patients with chronic ankle instability (CAI) and 64 control patients and measured their kinematics, SLL stability, and impact absorption ability. The SLL stability was evaluated by calculating the anterior-posterior stability index (APSI) and medial-lateral stability index (MLSI). The impact absorption ability was evaluated by calculating the energy absorption (EA). The large negative value of the EA indicated the absorption of a large amount of energy. The Japanese version of identification of functional ankle instability (IdFAI-J) score (P < 0.001), MLSI value (P = 0.004), and sagittal plane ankle EA value (less EA at ankle joint) (P < 0.001) were significantly high in CAI, and sagittal plane knee EA value (more EA at knee joint) (P < 0.041) was significantly low in CAI than in the control group. Multiple regression analysis showed that the APSI was associated with sagittal plane ankle EA (β = 0.275, P = 0.004). The MLSI was associated with sagittal plane ankle EA (β = 0.204, P = 0.034) and the idFAI score (β = 0.234, P = 0.015). The SLL stability impairment after LAS was related to decreased impact absorption ability at the ankle joint.
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NewsBot · Feb 26, 2023

Effect of varied dorsiflexion range of motion on landing biomechanics in chronic ankle instability
Seunguk Han, Hyunwook Lee, S. Jun Son, J. Ty Hopkins
13 February 2023

Background
Limited dorsiflexion range of motion (DFROM) is a risk factor for lateral ankle sprain. However, varied DFROM exists within the chronic ankle instability (CAI) population, and how the variability may influence altered movement patterns during landing is unclear.

Objective
The purpose of this study was to identify different movement strategies during maximal jump landing/cutting among CAI patients classified by varied DFROM.

Methods
One hundred CAI subjects were classified into 3 subgroups based on their DFROM, measured by the weight-bearing lunge test: a Hypo- (≤40°), Normal- (40–50°), and Hyper-DFROM group (≥50°). Participants completed five trials of maximal jump landing/cutting. Lower extremity joint angles and EMG activation of seven muscles were collected from initial contact to toe-off. Functional analyses of variance were used to evaluate between-group differences for these outcome variables.

Results
Hypo-DFROM group (14M, 10F) displayed the reduced ankle dorsiflexion and inversion angles with increased hip flexion angle as a compensatory kinematic chain movement strategy. In addition, motion restrictions of the ankle are associated with altered muscle activation in both distal and proximal muscles during landing/cutting. Normal-DFROM (25M, 30F) and Hyper-DFROM (11M, 10F) groups also have different movement strategies including greater inversion angle and less EMG activation, which could contribute to further ankle injuries.

Conclusions
Our data suggest that limited DFROM negatively affects the ankle joint during demanding movement within the CAI population. These movement patterns in CAI patients with pathomechanical deficits could contribute to further ankle sprains.
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NewsBot · Feb 26, 2023

Effects of Anticipation on Joint Kinematics during Inversion Perturbation in Individuals with Chronic Ankle Instability
Seunguk Han, Hyunwook Lee, Jon Tyson Hopkins
24 February 2023

Although chronic ankle instability (CAI) patients display altered reactive joint kinematics after inversion perturbation, little is known about the effects of anticipation on reactive joint kinematics among CAI, coper, and control groups.

Objective
To assess changes in reactive joint kinematics after different inverted landing situations including planned- and unplanned-condition among groups of CAI, coper, and control.

Methods
Sixty-six volunteers participated (22 per group). Participants completed 3 trials of both planned and unplanned single-leg landing onto an inverted force platform while reactive joint kinematic data were collected from initial-contact to 200ms after initial-contact. Two-way repeated measures ANOVAs were used to examine the differences between condition (planned-, unplanned-conditions) and group (CAI, coper, control).

Results
There were significant group by condition interactions for total ankle displacement in the frontal plane (p<0.01) and maximum ankle inversion velocity (p=0.01). CAI patients displayed increased ankle displacement (p<0.01) and maximum inversion velocity (p<0.01) under the unplanned condition compared to the planned condition. However, copers did not show any differences in ankle displacement and maximum inversion velocity between the two conditions.

Conclusions
CAI patients displayed greater changes in ankle joint displacement and maximum ankle inversion velocity occurred after inversion perturbation under unplanned condition compared with copers and controls. Current data suggest that altered reactive joint kinematics under the unanticipated condition in CAI patients may contribute to the condition of CAI after ankle sprains. Clinicians should focus on rehabilitation programs to recover and/or develop feedback control for CAI patients during functional movements under unanticipated condition to prevent further injuries.
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NewsBot · Mar 30, 2023

Systematic review of the methodological quality of patient-reported outcome measure for patients with chronic ankle instability
Pablo Cervera-Garvi et al
Clin Rehabil. 2023 Mar 28

Objetive: Chronic ankle instability is generally associated with ankle sprain. Its consequences can be measured by means of patient-reported outcome measures (PROMs). The aim of this review is to identify the PROMs specifically available for chronic ankle instability and to evaluate their methodological quality and that of the cross-cultural adaptations made.

Data sources: Papers were retrieved from PubMed, Embase, Scopus and Google Scholar databases, with no time limit applied, based on the following inclusion criteria: (1) type of participants: patients with chronic ankle instability, over 18 years of age; (2)type of study: those specifically focused on this pathology, using PROMs specific to chronic ankle instability and published in English; (3) type of outcome: measurement properties based on COSMIN criteria in patient-reported outcomes associated with chronic ankle instability.

Methods: This systematic review, following the COSMIN checklist, was conducted to determine the methodological quality of PROMs specific to foot and ankle pathologies, for patients presenting chronic ankle instability.

Results: Of the 576 studies identified in the initial search, 34 were included in the final analysis of measurement properties. Four - the Ankle Instability Instrument, the Chronic Ankle Instability Scale, the Cumberland Ankle Instability Tool and the Identification of Functional Ankle Instability - were original questionnaires, and the remaining 30 were cross-cultural adaptations.

Conclusion: The Cumberland Ankle Instability Tool and the Identification of Functional Ankle Instability questionnaires can be useful instruments for evaluating chronic ankle instability, both in patients with this condition and also in non-pathological patients.
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NewsBot · Apr 3, 2023

Risk factors for chronic ankle instability after first episode of lateral ankle sprain: A retrospective analysis of 362 cases
Jieyuan Zhang et al
Journal of Sport and Health Science 15 March 2023

Highlights
•Identification of patients with high risk for chronic ankle instability (CAI) is crucial for more effective and efficient treatment of acute lateral ankle sprain (LAS).
•For patients who had at least 1 positive clinical finding in the 10-meter walk test, the anterior drawer test, or the inversion tilt test, magnetic resonance imaging (MRI) scans were helpful in predicting CAI after first-episode LAS.
•Age, body mass index, posterior talofibular injury, large talus bone marrow lesion, and Grade 2 tibiotalar joint effusion were 5 prognostic factors that MRI scanning used to predict CAI after first-episode LAS.
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Background
Chronic ankle instability (CAI) is a common sequela following an acute lateral ankle sprain (LAS). To treat an acute LAS more effectively and efficiently, it is important to identify patients at substantial risk for developing CAI. This study identifies magnetic resonance imaging (MRI) manifestations for predicting CAI development after a first episode of LAS and explores appropriate clinical indications for ordering MRI scans for these patients.

Methods
All patients with a first-episode LAS who received plain radiograph and MRI scanning within the first 2 weeks after LAS from December 1, 2017, to December 1, 2019, were identified. Data were collected using the Cumberland Ankle Instability Tool at final follow-up. Demographic and other related clinical variables, including age, sex, body mass index, and treatment were also recorded. Univariable and multivariable analyses were performed successively to identify risk factors for CAI after first-episode LAS.

Results
A total 131 out of 362 patients with a mean follow-up of 3.0 ± 0.6 years (mean ± SD; 2.0–4.1 years) developed CAI after first-episode LAS. According to multivariable regression, development of CAI after first-episode LAS was associated with 5 prognostic factors: age (odds ratio (OR) = 0.96, 95% confidence interval (CI): 0.93–1.00, p = 0.032); body mass index (OR = 1.09, 95%CI: 1.02–1.17, p = 0.009); posterior talofibular ligament injury (OR = 2.17, 95%CI: 1.05–4.48, p = 0.035); large bone marrow lesion of the talus (OR = 2.69, 95%CI: 1.30–5.58, p = 0.008), and Grade 2 effusion of the tibiotalar joint (OR = 2.61, 95%CI: 1.39–4.89, p = 0.003). When patients had at least 1 positive clinical finding in the 10-meter walk test, anterior drawer test, or inversion tilt test, they had 90.2% sensitivity and 77.4% specificity in terms of detecting at least 1 prognostic factor by MRI.

Conclusion
MRI scanning was valuable in predicting CAI after first-episode LAS for those patients with at least 1 positive clinical finding in the 10-m walk test, anterior drawer test, and inversion tilt test. Further prospective and large-scale studies are necessary for validation.
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NewsBot · Apr 18, 2023

A test battery for evaluation of muscle strength, balance and functional performance in subjects with chronic ankle instability: a cross-sectional study
Sofia Ryman Augustsson, Erik Sjöstedt
BMC Sports Sci Med Rehabil. 2023 Apr 13;15(1):55

Background: Studies investigating ankle condition in subjects with chronic ankle instability (CAI) using an on-the-field test battery are scarce. Understanding which tests that are most challenging for these subjects has the potential to set realistic goals in rehabilitation and return-to-sports criteria. Thus, the primary aim of this study was to investigate CAI subjects regarding strength, balance and functional performance with an easily used test battery that required minimal equipment.

Methods: This study was conducted with a cross-sectional design. A total of 20 CAI subjects, engaged in sports, and 15 healthy subjects serving as a control group, were tested for assessment of strength, balance and functional performance. A test battery was developed accordingly; isometric strength in inversion and eversion, the single leg stance test (SLS), single leg hop for distance (SLHD) and side hop test. The limb symmetry index was calculated to determine whether a side-to-side lower limb difference could be classified as normal or abnormal. The sensitivity of the test battery was also calculated.

Results: The subjects were 20% weaker on the injured side compared with the non-injured side in eversion (p < 0.01) and 16% weaker in inversion (p < 0.01) (Table 2). For the SLS test, the mean score of the injured side was 8 points (67%) higher (more foot lifts) compared to the non-injured side (p < 0.01). The mean distance of the SLHD was 10 cm (9%) shorter for the injured side compare to the non-injured side (p = 0.03). The mean number of side hop was 11 repetitions (29%) fewer for the injured side compare to the non-injured side (p < 0.01). Six of the 20 subjects obtained abnormal LSI values in all five tests whereas none obtained normal values in all tests. The sensitivity of the test battery was 100%.

Conclusion: Deficits in muscle strength, balance and functional performance appear to be present in CAI subjects with the largest impairments in balance and side hop performance, which stresses the need for return to sport criteria for this group of subjects.
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NewsBot · May 1, 2023

Within-session and between-session effects of auditory biofeedback training on center of pressure location during gait in patients with chronic ankle instability
Luke Donovan et al
Physical Therapy in Sport; 29 April 2023

Objectives
To establish preliminary gait training dosage parameters for patients with chronic ankle instability (CAI) by determining the within-session and between-session effects of auditory biofeedback training on center of pressure (COP) location during gait.

Design
Observational Longitudinal.

Setting
Laboratory.

Participants
19 participants with CAI, 8 participants who did not receive auditory biofeedback (NoFeedback group) and 11 participants who did receive auditory biofeedback (AuditoryFeedback group) over an 8-session 2-week intervention.

Main outcome measures
COP location was measured at the start and at each 5-minute interval during treadmill walking across all eight 30-minute training sessions.

Results
The AuditoryFeedback group had significant within-session lateral-to-medial shifts in COP location during only session-1 at the 15-min (45% of stance; peak mean difference = 4.6mm), 20-min (35% and 45%; 4.2mm), and 30-min time intervals (35% and 45%; 4.1mm). Furthermore, the AuditoryFeedback group had significant between-session lateral-to-medial shifts in COP location at session-5 (35–55% of stance; 4.2mm), session-7 (35%–95%; 6.7mm), and session-8 (35%–95%; 7.7mm). The NoFeedback group had no significant changes in COP location within-sessions or between-sessions.

Conclusions
Participants with CAI who received auditory biofeedback during gait needed an average of 15-minutes during session-1 to meaningfully shift their COP location medially and 4-sessions before retaining the adapted gait pattern.
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NewsBot · May 2, 2023

Efficacy of Platelet-Rich Plasma for Chronic Lateral Ankle Instability After Modified Broström-Gould surgery: A Randomized, Single-Blinded, Prospective Controlled Trial
Amir Sabaghzadeh et al
Foot Ankle Orthop. 2023 Apr 26;8(2)

Background: Modified Broström-Gould (MBG) surgery is frequently used for chronic lateral ankle instability (CLAI). However, conventional postoperative management (CPOM) due to prolonged immobilization may have adverse effects on tendons, ligaments, and joints, causing stiffness. This prospective, randomized controlled trial aimed to determine outcomes among patients randomized to receive CPOM plus ultrasonography-guided triple injections of leukocyte-rich platelet-rich plasma (LR-PRP) compared to patients who receive only CPOM after MBG surgery.

Methods: The present study included 40 patients with symptomatic CLAI who were candidates for the MBG surgery. The patients were randomized into 2 groups of 20, the control and PRP groups. In the PRP group, patients were injected with 3 doses of LR-PRP solution using ultrasonographic guidance. In the first injection, 2 mL of LR-PRP was injected near the injury site, and in the second and third injections, 4 mL of LR-PRP was injected in the tibiotalar joint. All patients received a short leg splint for 2 weeks, followed by 4 weeks in a walking boot. The primary outcome measure was the visual analog scale (VAS), and the secondary outcome measures were the American Orthopaedic Foot & Ankle Society (AOFAS) ankle-hindfoot scale and ankle total range of motion (total ROM). The assessment was performed at baseline and 3 and 6 months after surgery.

Results: The mean VAS and AOFAS scores improved significantly in both groups 6 months after surgery (P < .001). However, the PRP group did not significantly improve in VAS or AOFAS scores compared with the control group. No clinically significant difference was observed between the 2 groups regarding the total ROM scores at month 3.

Conclusion: The application of LR-PRP after MBG surgery did not show any superior clinical or functional improvement over CPOM.
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NewsBot · May 10, 2023

Cross-cultural adaptation and validation of the Chinese version of the ankle joint functional assessment tool (AJFAT) questionnaire
Jinfeng Li et al
J Foot Ankle Res. 2023 Apr 26;16(1):22

Background: Ankle joint functional assessment tool (AJFAT) is gradually becoming a popular tool for diagnosing functional ankle instability (FAI). However, due to the lack of standard Chinese versions of AJFAT and reliability and validity tests, the use of AJFAT in the Chinese population is limited. This study aimed to translate and cross-culturally adapt the AJFAT from English into Chinese, and evaluate the reliability and validity of the Chinese version of AJFAT and to investigate its psychometric properties.

Methods: The translation and cross-cultural adaptation of AJFAT was performed according to guidelines for cross-cultural adaptation of self-report measures. 126 participants with a history of ankle sprain completed the AJFAT-C twice within 14 days and completed the Cumberland ankle instability tool (CAIT-C) once. Test-retest reliability, internal consistency, ceiling and floor effects, convergent and structure validity and discriminative ability were investigated.

Results: The test-retest reliability (ICC = 0.91, 95%CI = 0.87-0.94) and internal consistency (Cronbach's alpha = 0.87) of the AJFAT-C were excellent. No ceiling or floor effects were detected. A moderate correlation between the AJFAT-C and the CAIT-C suggested a moderate convergent validity. The AJFAT-C had a two-factor structure: 1. function of the unstable side of the ankle joint (9 items) and 2. symptoms of the unstable side of the ankle (2 items). The ideal cut-off point of the AJFAT-C was calculated as 26 points.

Conclusion: The Chinese version of AJFAT can be considered as a valid and reliable ankle joint function evaluation tool that can be applied in clinical and research work.
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NewsBot · May 11, 2023

Center of Pressure Deviation during Posture Transition in Athletes with Chronic Ankle Instability
Takanori Kikumoto et al
Int J Environ Res Public Health. 2023 Apr 14;20(8):5506

Center of pressure (COP) tracking during posture transition is an ideal scale for determining the recurrence of an ankle injury, thereby preventing chronic ankle instability (CAI). However, the same is difficult to determine because the reduced ability of certain patients (who experienced sprain) to control posture at the ankle joint is masked by the chain of hip and ankle joint motion. Thus, we observed the effects of knee joint immobilization/non-immobilization on postural control strategies during the posture transition task and attempted to evaluate the detailed pathophysiology of CAI. Ten athletes with unilateral CAI were selected. To examine differences in COP trajectories in the CAI side and non-CAI legs, patients stood on both legs for 10 s and one leg for 20 s with/without knee braces. COP acceleration during the transition was significantly higher in the CAI group with a knee brace. The COP transition from the double- to single-leg stance phase was significantly longer in the CAI foot. In the CAI group, the fixation of the knee joint increased COP acceleration during postural deviation. This suggests that there is likely an ankle joint dysfunction in the CAI group that is masked by the hip strategy.
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NewsBot · May 14, 2023

The Effects of Therapeutic Exercise With and Without Mobilization in Participants With Chronic Ankle Instability: A Randomized Controlled Trial
Cameron Bolton et al
J Sport Rehabil. 2020 Apr 23;30(2):206-213

Context: Manual therapy (MT) is reported to increase range of motion (ROM), improve balance, and decrease pain in individuals with chronic ankle instability (CAI). Additional literature is needed to examine the effectiveness of the addition of MT to a therapeutic exercise regimen in individuals with CAI. Objective: To examine the combined effects of thrust joint manipulation (TJM) and exercise on function in participants reporting CAI. Design: Randomized controlled trial. Setting: Research laboratory. Participants: A convenience sample of 30 participants (mean age 23.7 [3.65] y; mean height 169.50 [9.50] cm; mean mass 66.48 [10.64] kg). Intervention: Participants were randomly allocated to the exercise (n = 15) or exercise + TJM group (n = 20) and completed an exercise program. The exercise + TJM group also received MT at the talocrural, proximal, and distal tibiofibular joints in the first 3 sessions. Main Outcome Measures: Self-reported outcomes were recorded at baseline and follow-up using the Foot and Ankle Ability Measure (FAAM), the FAAM-Sport (FAAM-S) subscale, and the Ankle Joint Functional Assessment Tool (AJFAT). The side-hop test, figure-of-8 hop test, 3 directions of the Star Excursion Balance Test, and dorsiflexion ROM were also assessed at baseline and follow-up. Results: Only the exercise + TJM group demonstrated an improvement in weight-bearing dorsiflexion with the knee flexed following treatment (P = .02). For all outcome measures, except ROM, subjects improved significantly at follow-up regardless of group assignment (P ≤ .01). Conclusions: Our data suggest that rehabilitation of patients with CAI is related to improved ROM, function, and self-reported outcomes. This provides evidence that the addition of MT to exercise may enhance improvements in ROM as compared with exercise alone. Additional research is needed to identify optimal parameters to maximize therapeutic benefit.
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NewsBot · May 16, 2023

Risk Factors for the Recurrence of Instability After Lateral Ankle Ligament Repair
Andi Praja Wira Yudha Luthfi, et al
SOurce

Background:
Arthroscopic anterior talofibular ligament (ATFL) repair is widely performed for chronic lateral ankle instability (CLAI). Although many studies have reported excellent outcomes with this procedure, the recurrence of instability remains a common concern. Therefore, this study aimed to analyze the risk factors for the recurrence of instability after arthroscopic repair for CLAI.
Methods:
Fifty-six ankles of 53 patients with a mean age of 31.8 ± 14.7 years were retrospectively reviewed. All patients underwent arthroscopic ATFL repair. If instability remained immediately after ATFL repair, calcaneofibular ligament (CFL) repair was performed. The Ankle Activity Score (AAS) was assessed preoperatively, and clinical outcomes including the Japanese Society for Surgery of the Foot scale, Karlsson-Peterson scores, and the Self-Administered Foot Evaluation Questionnaire (SAFE-Q) were evaluated preoperatively and at the final follow-up. Talar tilt angle (TTA) was assessed preoperatively and 1 year postoperatively. Ankles were divided into 2 groups—nonrecurrence (postoperative TTA, <6 degrees) and recurrence (postoperative TTA, ≥6 degrees)—and clinical outcomes were compared.
Results:
Sixteen ankles showed recurrent instability, whereas 40 did not. AAS, TTA, and social functioning in the SAFE-Q were significantly higher in the recurrence group than those in the nonrecurrence group preoperatively. In addition, the rate of poor ATFL remnant quality and the number of CFLs not repaired despite the preoperative injury diagnosis were significantly higher in the recurrence group than in the nonrecurrence group.
Conclusion:
Arthroscopic repair for ATFL and CFL deficiencies with preoperative high activity, poor remnant quality, and neglected CFL injury can result in the recurrence of instability. Appropriate surgical procedures to prevent the recurrence of instability should be selected for these ankles.
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NewsBot · May 23, 2023

Role of interventions targeting plantar cutaneous receptors in improving postural control in Chronic Ankle Instability: A Systematic Review with Meta-Analysis
Anand Kumar Singh et al
The Foot; 12 May 2023, 102034

Introduction
Chronic ankle instability (CAI) is a disorder that occurs after one or more acute ankle sprains and is characterised by persistent symptoms which include episodes of ‘‘giving way’’ a sensation of instability, recurrent ankle sprains, and functional deficits. Despite of effective treatment strategies a comprehensive approach is needed that can break this continuum of disability and improve the postural control. A systematic review with meta-analysis assessing the effectiveness of interventions targeting plantar cutaneous receptors for improving postural control in individuals with chronic ankle instability.

Methods
The systematic review with meta-analysis was performed following PRISMA guidelines. Outcome measure used to evaluate the improvement in which static postural control was assessed on SLBT (Single limb balance test) and COP (Centre of pressure) whereas dynamic postural control was assessed on SEBT (star excursion balance test) and scores expressed as mean ± SD and random-effects model were performed, and heterogeneity between the studies was calculated using the I2 statistic.

Results
A total of 168 CAI populations were included among the 8 selected studies in the meta-analysis. In which,5 studies using Plantar massage and 3 studies using foot insole were assessed, with moderate to high quality on the Pedro scale (range 4 to 7).For single and six-sessions of plantar massage showed insignificant effect on SLBT COP and for the single session of custom moulded FO showed insignificant effect on SEBT.

Conclusion
The meta-analysis showed non-significant pooled results for plantar massage and foot orthotics on static and dynamic postural control when assessed on postural outcome measures. Further high-quality evidence-based trials would be required to highlight the importance of sensory targeted approaches to treat the postural instability in CAI patients
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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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