Restrictions in the Ankle Sagittal- and Frontal-Plane Range of Movement during Simulated Walking with Different Types of Orthoses

Frank Thiele,Silvio Lorenzetti,Renate List,Christoph Schwaller,Sebastian Schuhmacher,Stefan Plüss,Joël Rhiner

doi:10.3390/jfmk3020021

Abstract

Different types of orthoses are available to clinicians for non-surgical treatment of acute ankle sprains. The goal of this study was to scientifically compare the movement restrictions in the sagittal and frontal plane during simulated walking between one adaptable semi-rigid brace (OrthoTri-PhaseTM), four non-adaptable semi-rigid braces (OrthoStandardTM, MalleoLocTM, MalleoSprintTM, VACOankleTM), and one rigid cast. Predefined time sequences of rotational moments and axial loading during gait were applied via an ankle joint simulator, with the pneumatic pressure inside the orthoses kept constant to ensure the same condition for different trials and orthoses. The peak ranges of motion (RoMs) in the frontal and sagittal plane during gait were analyzed for statistically significant differences using single-factorial ANOVA with post-hoc Bonferroni analysis. Significant differences in peak plantar-/dorsiflexion and in-/eversion RoM during gait were found between different types of orthoses. In the sagittal plane, the rigid cast most significantly restricted overall RoM followed by the Ortho Tri-PhaseTM in Phase 1 and the Ortho StandardTM. The peak restriction in-/eversion RoM of the VACOankleTM came closest to the rigid cast, with a shift towards inversion. The VACOankleTM allowed for significantly larger dorsiflexion movement compared to all other orthoses. The present results may help clinicians in the decision-making process of finding the optimal orthosis for individual patients.

Highlights

Acute ankle sprains represent 40% of all sports injuries [1], especially associated with stop-and-go activities such as basketball, volleyball, and soccer [2]
Three types of orthoses (i.e., MalleoSprintTM, VACOankleTM, Ortho Tri-PhaseTM in Phase 3) exceeded the zero strain reference of 18◦ dorsiflexion during gait [21], with the highest peak dorsiflexion during gait measured for the VACOankleTM as 37% above the recommended limit
A higher risk of inducing critical stress in the ligaments is given for these orthoses, which may be disadvantageous during the recovery process from severe ankle sprains (Grade II and III), especially in the early stages of healing

Summary

Introduction

Acute ankle sprains represent 40% of all sports injuries [1], especially associated with stop-and-go activities such as basketball, volleyball, and soccer [2]. Thereby, it is likely that the incidence rate of injuries to the ankle ligaments is significantly higher than reported in epidemiological studies because up to 50% of patients are estimated not to seek medical assistance, and remain unregistered [4]. The most common mechanism for lateral ankle ligament injuries is a combination of inversion and adduction of the foot in plantarflexion (i.e., supination trauma) [5]. Isolated injuries to the medial ligament complex seem to occur less frequently compared to injuries to the lateral ligament complex, amounting to 3–4% of all ligament injuries to the ankle joint [9]. There exists evidence suggesting that the incidence rate of medial ligament injuries to the ankle joint might be underestimated [10,11]. Patients will describe an eversion, external rotation, or abduction mechanism [8]

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