Functional ankle instability

NewsBot · Jul 14, 2024

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

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

Design: Cross-sectional study.

Setting: Controlled laboratory.

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

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

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

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

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

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

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

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

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

Level of evidence: Level 2.

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

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

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

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

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

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

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

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

Design:
Cross-sectional study.

Setting:
Controlled laboratory.

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

Functional Ankle Instability (FAI) is the subject of extensive research in sports and other environments. Given the importance of accurately measuring this latent construct, it is imperative to carry out a careful assessment of the available tools. In this context, the aim of this review was to take an in-depth look at the six most cited measurement tools to assess FAI, with a specific focus on patient-reported outcome measures related to ankle and foot. Four electronic databases (Web of Science, Scopus, Pubmed, and SportDiscus) were searched (up to November 2022) to identify the six most cited questionnaires for assessing FAI. Our analysis showed that the most cited questionnaires are the following: the Lower Extremity Functional Scale (LEFS), the Foot Function Index (FFI), the Foot and Ankle Ability Measure (FAAM), the Foot and Ankle Outcome Score (FAOS), the Olerud and Molander Ankle Score (OMAS), and the Cumberland Ankle Instability Tool (CAIT). Each questionnaire was thoroughly assessed and discussed in three sections: Development, Reliability, and Summaries. In addition, bibliometric data were calculated to analyze the relevance of each questionnaire. Despite variations in terms of validity and reliability, conceptualization, structure, and usefulness, the six questionnaires proved to be robust from a psychometric point of view, being widely supported in the literature. The bibliometric analyses suggested that the FAOS ranks first and the FFI ranks sixth in the weighted average of the impact factors of their original publications.
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NewsBot · Oct 7, 2024 at 1:53 AM

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

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

Share This Page

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